? 2/17 AMPS170, +3: 67 Possible Surgery for Ear mass

S

Shorshe’s Mum

Member
Hi all,

Shorshe has been having chronic otitis that has been unresponsive to treatment. After coming to Thailand she recently got diagnosed with a mass. The discharge from her ears doesn't contain a lot of bacteria but inflammatory cells. The vet's advice is to do a CT scan to see the extent of the growth and then operate immediately after. Depending on how large the growth is her entire ear canal might need to come off.

She has since had blood work, cardiac workup and abdominal ultrasound. It seems that vets feel things are fine to operate. I consulted a second vet specialising in internal medicine and she said that while not an emergency, I should considering operating within a month or so unless the mass is rapidly growing in which case it should be operated asap. She also said she would be most concerned about heart and lungs as the induction drug will cause suppression of heart and respiratory rates but added that maintenance on gas anaesthetics is very safe. She has mild asthma (takes seretide evohaler once a day) and the xray showed visible bronchial pattern which teh vets said is consistent with older cats and nothing very unusual. Her ECG, chest xray and heart ultrasound were all normal. The vet doing the ultrasound said one heart valve is weakening and she should have the test every year to check if its deteriorating but also said it shouldn't be a concern for surgeries. Her ALT is still a bit high in the 200s. The ultrasound shows slight enlargement of portal vein although portal blood flow/pressure is within normal range. The internal medicine vet said that this was not a concern for surgeries as there are no overt symptoms. Sh also said ALT might be higher due to diabetes. ( I have not yet recieved all the reports from the vet in soft copies so I haven't uploaded all of them in the sheets).

I definitely feel her ear discharge is increasing in volume. While before cleaning once a day would reduce discharge now I am cleaning 2-3 times a day (with TRIS-EDTA otic solution) and still there are dried crusts in her outer ear.

Additionally, the vet asked me to increase her food intake. Her body condition score is 4 and according to the vey she should have at least 220Kcal per day (she is having maybe about 180-200 now). At her heaviest (long before diagnosis in 2016-17) she was about 6.5kg. She is a larger cat and now weighs about 4.9.

Please let me know what you all think? Has anybody had surgeries on diabetic cats who are 12+ years old? What should I flag with the vets? What questions should I ask?
 
My thoughts are more about how long and how complicated of a surgery is it? What's the vet's experience with doing this kind of procedure? Do you need a veterinary surgeon who specializes in ear, nose, and throat procedures? (If this were a child, you'd be seeing a pediatric ENT surgeon.)
 
I completely agree with what Sienne has said. If this were my cat, I would want to know 1) if there are any other, perhaps less invasive treatment options such as radiation or something else. Not all radiation is deep. My own cat had Strontium 90 radiation performed at a university hospital for squamous cell carcinoma on his nasal planum. This radiation does not go deep but stays localized to an appropriate depth and doesn’t damage surrounding tissue. There is another treatment for cancers (and I am not sure you are dealing with cancer here) called electochemotherapy that keeps the chemo more localized. I am not saying that these things are appropriate treatments in your cat’s case, but only saying that I would investigate every treatment option available even if I had to travel far for the procedure.
2) If surgery is the best option, I would want to know how much experience the vet performing the procedure has in that particular procedure. It sounds pretty extreme (and I do hope that the growth will not be extensive enough to warrant full ear canal removal!) If the vet has never successfully performed this surgery, I would not let them operate on my cat. I would investigate university veterinary hospitals or specialists who are very familiar with this type of surgery. It sounds like you have gone to great lengths already to ensure that Shorshe is healthy enough to have surgery and that is very good. My heart goes out to you. This is incredibly stressful, I know. So the next step is a CT scan (which will already require anesthesia) — this will at least give you some answers. What about her taking oral steroids? If they believe it is an inflammatory condition she may respond well to steroids (although it will raise her blood glucose, you should be able to compensate for that with insulin.) I know steroid is somewhat of a dirty word for a diabetic cat, but there are cats who must be on a steroid for various conditions if there are not better options. Does the ear drop/cleaner you are currently using have a steroid component to it? If so, that will most likely be raising BG already.
 
Thank you all for your advice. I am planning to take her to the small animal veterianry hospital at the Chulalongkorn University next month. In fact the internal med vet I consulted is a senior professor at another University vet school.

So I think they do not want to do two round of anaesthesia: they want to do the CT and based on the result operate. I will upload the images from the digital otoscope here to give you a better idea. The tumour is blocking the lower part of her ear canal so it's not visible how much it extends. And I think the idea is to excise and then biopsy it to find out what is going on with it (as in whether it's the c-word--god I feel so superstitious about this) or not. I am really struggling with the decision: part of me wants to delay the surgery and do more visual inspection to see if its growing rapidly. I just got her back living with me full time after nearly 8 years (she lived with my parents in India after I moved out for my job). What if something goes wrong during the surgey? I just want her to have many many good years.
 
I know you are doing your very best for her. My best wishes for everything. I sincerely hope that the tumor is not very extensive. Your poor baby. I am happy knowing that she has you watching over her. It’s not easy making these decisions either! :bighug:
 
Okay so forgot to attach the images as usual. I am adding them to the spreadsheet (they might be a bit graphic for some?). I just read up in the qualifications of the surgeon. She specialises in endoscopic surgery. I will take a second opinion from the university vet hospital/department--the issue is I cannot choose a surgeon at the university hospital and since it's a teaching hospital they might assign someone junior. But yeah, it is something I need to explore and also need to postpone her surgery , not least because I realoly need to save up for the costs, it's quite quite expensive and insurance has never been available except for accident cover.
 
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