Tuesday, January 31, 2006

Damned if you do, damned if you don't

Veterinarians see a lot of mast cell tumors. Mast cells are full of histamine, the stuff that causes allergic reactions (in small doses) and anaphylactic shock (in large doses). A lot of dogs will get solitary mast cell tumors, and these usually are low grade - unlikely to metastasize and cause problems - and are cured with surgical excision.

Sometimes cats will get multiple mast cell tumors in their skin. There are usually too many to even think about cutting them all out. There is also very little published in the medical literature about treating them.

As luck would have it, I had 2 cats with multiple cutaneous mast cell tumors at the same time. We tried controlling them with cortisone (dexamethasone) but the tumors were growing and were itchy. One orange cat had lumps and bumps all over his head - he looked like he had leprosy. It was time to try chemo.

My boss does a lot of chemotherapy, and after talking to several veterinary oncologists, the consensus was to try CEENU orally followed 2 weeks laterby vinblastine injections.

The orange kitty got his first pill, administered by me in the hospital. The next week he had lots of mast cell symptoms - vomiting, itching - and the tumors continued to grow. The owner did not even see any palliative effect from the chemo pill, and after supportive care didn't help, elected euthanasia. It was a good decision, but I wondered if she would have had a better response if we'd been able to give her the vinblastine, too.

The black kitty got her first pill the day before the orange kitty, and came back last Thursday for vinblastine. We checked her liver and kidney function as well as her blood count; everything was fine so I gave the injection.

On Friday the owner called me and said her cat was a little lethargic and eating less. I assured her that was expected, but to verify that the kitty was indeed eating through the weekend.

On Sunday, the cat crashed and went to the emergency hospital. The doctor there told me she looked like "death warmed over." Her blood count was terrible - she was severely anemic and had NO white blood cells. The chemo can often suppress the bone marrow, and this was happening to her. Despite supportive care, the cat continued to decline and was later euthanized at the emergency hospital.

I feel terrible for this cat and her owner. I feel badly that I gave the injection that caused her ultimate death (although it was the drug and dose recommended by an oncologist). It is tough when we have a disease with no good options for treatment, and sometimes the chance for cure has terrible consequences.


Emily said...

I'm sorry you had two tough cases that ended similarly. Cancer is such a complicated disease. I'm sure you did the best you could for them.

Dad said...

Don't know how you do it. I tear up at 'God save the Queen'.......wouldn't do well at all with treatment decisions and possible nasty consequences. Thanks for sharing the sad story;

Anything nice happen today?

Aunty Norma said...

My heart goes out to you,Jenn...in your proffession (two F's?) there are nice bits and nasty bits..like Life itself really....carry on doing your best,lovey, it's all anyone can do..:o) xxx

paula said...

Jenn - I'm so sorry you had such a tough time, you can only do what you think is best for the animals at the time. If it's any comfort at all I would have no hesitation in you treating my cats, the fact that it bothers you so much proves what a true professional you are.

Leah said...

I am so sorry about the two kitties. Try not to doubt anything you did. You did what you knew to do. I trust your decison with my animals with all my heart. So does Ms. K with the black kitty. I guess I missed the case with the orange kitty. Some kitties respond well and some don't. Maybe both of the kitties where ready to go. Just remember we would love to save them all but can't...but all we can do is try and that is what you did. Thats why I trust you.

Leigh-Ann said...

As an owner, I'd be most concerned about my cat's comfort, and that was your concern as well. You tried conventional methods which didn't work, and really, many owners may have chosen to euthanize at that point without even trying chemo. I think you offered the appropriate treatment advice, and I'm sure the owners were grateful that you were willing to take that extra step for them and their pets.

If either cat was mine, I might take some comfort in knowing that my cat and I had made a medical contribution toward the future. The next time you treat a cat with this condition you'll be armed with more experience and more anecdotal evidence to share with oncologists when you seek treatment advice. This is one of the reasons I've always been supportive when a vet wants to do a necropsy on one of my pets -- I like to think that while my pet didn't make it, someone else's pet might survive in the future because of our experience.

Anonymous said...

Woah, those were some tough cases. Sometimes there's nothing more we can provide for animals with terrible illnesses -but love and comfort. Which, I know you show to every client you see.

Keep doin' what your doin'


Lisa said...

I don't know that I can add any useful comments to what everyone else has expressed so well. I just wanted to say that you are an amazing person. Like your Dad, I don't know how you do it, and do it so well. I mean, sure you're very smart and great with people and animals. But it is your sympathetic heart that puts you over the top and really makes you a great vet. I know you did all you could for these poor cats. And I'm sure all your experiences help you learn more for the next case that comes in. Thank you for hanging in there with the tough ones. Like Bono and his famously stubborn girth.