What to do about Bob the cat (lung cancer diagnosis)
May 5, 2016 5:39 AM   Subscribe

My 11-year-old cat most likely has lung cancer with a poor prognosis. Aside from the heartbreak, I don’t know how to proceed in terms of surgery versus no surgery.

Meet Bob. We adopted him from a local cat shelter about four years ago, after he’d been found wandering the streets as a stray. I honestly can’t imagine this cat as a stray, because he is the most timid cat I’ve ever known.

He is also the sweetest, most lovable cat I’ve ever known. He has not a mean bone in his body, and just wants to be petted and loved. When I am having a crappy day at work, thinking about Bob and looking at pictures of him is seriously what gets me through it.

Which is part of why this year has been so rough. Bob has already had a tough time given his past life as a stray. Then earlier this year, he was diagnosed with hyperthyroidism, and we opted for the radioactive iodine therapy that is supposed to essentially cure it. The therapy unfortunately involved being hospitalized for several days, which Bob did not deal very well with. The radiologist vet even said that he could tell Bob was unhappier than most there due to his fearfulness.

However, he came home (and was overjoyed, shaking and walking around the apartment head-butting everything and meowing excitedly), and we were delighted that we would now have many more years with him.

Then last month he started throwing up repeatedly, not eating, and losing weight. After a couple days of this, we took him to the emergency vet, where he was diagnosed with pancreatitis. After repeatedly taking him back over the course of three days for several hours at a time, he was finally hospitalized overnight for it, and the emergency vet again noted how unhappy he was there.

While diagnosing his pancreatitis, the vet noticed a mass in his lung that a specialist there later told us was 95 percent likely to be lung cancer. The mass is too deep to ultrasound or biopsy. The next step would be to do a CT scan, which the vet said could be done only as a precursor to surgery. She said that if they performed the surgery and the cancer was aggressive, Bob would likely live for another 3-5 months afterwards. If they did the surgery and the cancer was less aggressive, he could live for another 1-2 years.

Without surgery, she said that again, depending on the aggressiveness of the tumor, lifespan could range from less to three and up to 12 months.

We had a home visit vet come out this week to discuss hospice options for Bob. He still seems like he always has, and we’ve just noticed a little shortness of breath sometimes when playing (actually noticed this as long ago as this past winter). Otherwise, he is in seemingly good shape.

The home vet, however, seemed a bit surprised that we were not pursuing the surgery option for him. Maybe that was just my interpretation. She said that the good news is that lung cancer tends to be slow growing in cats, and seemed to think that it might be worth it to extend his life by considering the surgery option.

The reason I’d been leaning away from the surgery is that I figured Bob has already been through so much this year, between the two hospitalizations and multiple emergency vet and regular vet visits. I cannot emphasize how much he hates the vet, and it seems like every time we bring him home from hospitalization he’s just a little more shaky and uncertain. It took several months for him to warm up to us when we adopted him, and I have sometimes thought that maybe he has a version of cat PTSD from his time as a stray. If we were to go through with the surgery and he died three months later, I would never forgive myself.

But presumably, if they were to prepare him for surgery and do a CT scan, they would be able to tell how aggressive the cancer was and then would back off from performing the surgery. Would it be worth it, taking Bob’s mental health into account, for us to go ahead with this? Would an extra year or two of life be worth taking him back to the hospital, and hospitalizing him for 2-3 days following a possible surgery? For what it’s worth, the specialist vet said cats tolerate surgery very well and she was confident that the surgery would not be a major risk for him.

I love Bob so much and am grief-stricken that our time with him is now so limited. I want his remaining time with us to be comfortable and happy. At the same time, I don't want to sentence him to a premature death by failing to take action.

Has anyone else here faced a similar decision with your pet, in terms of an illness with a poor prognosis like this? Any advice or opinions will be gratefully considered.
posted by cat friend to Pets & Animals (14 answers total) 1 user marked this as a favorite
 
We just went through this with a beloved senior rescue pet, and decided not to do surgery. Our pet lived for about a year after diagnosis, and although her health declined at the end, she was affectionate and happy right up until the very end. I can't tell you what to do, but both our vet and my family were very comfortable with that decision, and I personally felt it was the most ethical choice in our specific situation.
posted by instamatic at 5:55 AM on May 5, 2016 [3 favorites]


I am a hugely crazy cat person and have had cats with special needs who required a lot of expensive medical care for extended periods of time - and no way would I put an 11-year-old cat through lung surgery. Trust your gut. You know what's best for Bob.

And I am so sorry you and he are going through this. I had to put my best ever cat down after an extended illness last summer, and knowing his lifespan was limited actually turned out to be a good thing, because I consciously worked really hard to appreciate the cuddly little jerk every day we had together. It's never easy to lose a pet you love, but I'm grateful at least that I knew what was coming and wasn't surprised when the end came.
posted by something something at 5:56 AM on May 5, 2016 [6 favorites]


You poor thing (hugs).

I had a similar situation. My cat died of cancer at 15, and she was my best friend. The vets couldn't operate (it was a cancer of the connective tissue holding her organs) or treat other than to palliate.

If sweet Bob is a fearful cat, I would not continue to bring him in for the remaining treatment. All he knows and wants is comfort with you. You've given him an amazing life off of the streets, you've given him warmth, companionship and love... that's all a cat wants.

This is so hard. No matter what decision you make, it will be really difficult and you may have doubts. Were it me, I would try to make his remaining days as sweet as possible. And if you can have the vet come to the home in the end (when it comes), that would be even better.

I wish I could send you strength and comfort yourself. It's going to be ok.
posted by Dressed to Kill at 5:57 AM on May 5, 2016 [7 favorites]


More specifically: we decided to do the less invasive treatment and care-- so we did X-rays and EKGs and treated her for pneumonia on the vet's suggestion that the lung mass might be that (and that there was very little downside to trying that treatment). We brought her in regularly as her health declined to try new meds to slow the progress and make her more comfortable. But we were clear from the beginning that we didn't want risky and expensive treatments such as surgery. Our pet may have been a bit closer to end of her lifespan as a 12-14 year old large dog with kidney and heart problems, but I think I'd personally do the same for an 11 year old cat. Though if the cat were fearful of the vet (our dog was not), I'd prioritize his mental health over length of life as long as his quality of life didn't suffer because of it. And when quality of life suffered too much, I'd euthanize. That's what we did and it was so hard, but right.
posted by instamatic at 6:02 AM on May 5, 2016


When we were facing this choice with our Staffy, it helped to remember that pets live in the Eternal Now, and that the quality of each day is much more important to them than the total number of days.
posted by Mary Ellen Carter at 6:14 AM on May 5, 2016 [23 favorites]


I am very sorry for what you are going through. (And happy for Bob that he has people who love him.)

A few years ago, my sweet dog, the first I ever loved, was diagnosed with cancer at about 2/3 of the average life span for such a dog. The vet was aggressive in selling us on the idea of chemotherapy etc., and it seemed right to us because we wanted to have more days with her. Turned out to be a horrible decision - vastly decreased her quality of life and increased her life span by very little. Obviously, this anecdote is not a scientific study or a moral/psychological answer to all questions. But I will, from now on, always give love for as many days as there are remaining, rather than trying to increase the number of days remaining through unpleasant medical procedures.
posted by sheldman at 6:33 AM on May 5, 2016 [2 favorites]


I'm so sorry. I'm with others that say, keep Bob happy and comfortable and out of the Vet's office. Even for a human, I think quality of life is more important that quantity. It's more loving to keep Bob a happy boy at home, than extending his life. He already has so many health challenges, and there's not saying that if it's not the cancer, it might be something else.

Starting now, Bob should be totally spoiled and loved on, giving him an exceptional last few months is so much better than squeaking out a year with expensive, scary and painful treatments.

Am I the only one who has to turn the channel when this commercial comes on?

posted by Ruthless Bunny at 7:18 AM on May 5, 2016 [1 favorite]


So last Friday I put my beautiful 18-year-old tortie to sleep because she'd been battling cancer over 6 months. She was a wonderful old lady and my heart is still breaking, but I couldn't face putting her through cancer treatment because it seemed unfair to do it to a cat who wouldn't understand why you're putting them through it. I know this is hard. This is the worst. But are you considering cancer treatment because you're not ready to let go of Bob? Would the stress of treatment on him be worth it?

There is never going to be an easy decision, but you do have to consider quality of life.

My heart goes out to you.
posted by Kitteh at 7:19 AM on May 5, 2016 [1 favorite]


Yes, quality of life over quantity. And when it comes time, euthanasia at home where Bob knows he's safe and loved, is one last gift you can give him. I know it's tough. I'm sorry, this hurts so badly.
posted by WalkerWestridge at 9:50 AM on May 5, 2016


I think your initial decision was a good one, based on what you know about Bob and his reactions to treatment. I think you should stick with what your gut told you.

Our cat developed a terminal condition and we could have chosen to pursue aggressive treatment to MAYBE prolong her life. Our vet was very honest with us and said he didn't recommend it, because it would cause her so much distress that she would have very low quality of life.

It was hard, but we chose to keep her comfortable, spoil her rotten with cuddles and love, and have her put to sleep when the vet felt she would soon not be comfortable anymore. I don't regret our choice.

I'm so sorry you are going through this. It's so very hard.
posted by hurdy gurdy girl at 10:51 AM on May 5, 2016


> The vet was aggressive in selling us on the idea of chemotherapy etc.

This seems to be pretty common, and from their end it's understandable, but it's still using our love for our pets to bludgeon us into doing something that may not be right either for us or for our pets. I agree with hurdy gurdy girl: trust your gut, and try to give Bob the best time you can while he's with you.
posted by languagehat at 10:54 AM on May 5, 2016


I can't answer about which is the right decision, but the fact that you're asking makes me feel confident that whatever you decide will be right. Having had to say goodbye to a few beloved creatures over the years, I can say with absolute certainty that, as heartbreaking as a terminal diagnosis is, having 'goodbye time' is so much better than the times we had sudden calamity. I know it's awful now. I'm not bright-siding you, this sucks so bad. But having the awareness to always linger for a few more cuddles than I might otherwise? I am so grateful for the times we had that.
posted by Fantods at 3:52 PM on May 5, 2016 [1 favorite]


Thank you for your thoughts. I'm sorry to hear so many stories of loved pets that have passed away but am grateful for the perspectives you have shared with me. I think at this point I'm going to just try to make Bob as happy as possible for his remaining time. Extra cuddles, for sure.
posted by cat friend at 4:41 PM on May 5, 2016 [11 favorites]


Just saw your update, and this fellow cat lover has been there and thinks you're doing the right thing for your little guy. Your "prescription" -- giving Bob extra cuddles and attention in a setting where, as WalkerWestridge said, "he knows he's safe and loved" -- is exactly what he needs right now.
posted by virago at 5:47 PM on May 5, 2016 [1 favorite]


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