Cat surgery -- to biopsy or not??

[TooPatient]

Lily is 10 years old and was not spayed as a kitten. She had health issues that made surgery a very bad option for her. About a week and a half ago, she started having some blood/urine issues. I took her to the vet thinking it was a urinary tract infection. They gave her an antibiotic injection and drew a urine sample. It turns out it is not a UTI so the vet says it is a problem with her uterus.

The vet recommended doing a full ovariohysterectomy. Her reasoning sounds good. (has to do with the shape of the uterus and the tendency for infections to get stuck and not fully treated with antibiotics plus a couple of other things she mentioned that make removal sound like it is worth the risk)

DH is still out of work. We can manage the surgery ($200 initial exam, $200+ blood test, $400 surgery) but the vet is recommending sending the uterus (and ovaries?) to a lab for biopsy to make sure there isn't cancer. That would add another $200 on to the procedure. We can do it if we have to, but would rather not spend the money just because.

She is 10 years old with other health issues. If she has cancer (especially in the abdominal area), we will NOT choose to treat as we feel that would be unfair to her. We would keep her as happy and comfortable as possible and make the necessary choice when the time came.

Clearly, I hope she does not have cancer. Hopefully it is all just hypothetical!


That said -- Do we biopsy or not?

Is there any sort of thing they would be looking for that would be easily treatable? Can anyone think of a situation where we would regret not having the biopsy? I asked the vet and she just repeated that the biopsy would let us know that was coming. The vet's assistant talked with me when I took Lily in for the blood draw and said that it was really just because "people usually want to know" so they can prepare.


Surgery is Thursday morning. I have to make a decision by then..... help, please!

The only downside to skipping it that I can think of is that she may have a health issue in the future that would leave us having to do a different test to try to confirm or rule out something we could already have checked for. But then I figure the vet would still do the other test anyway to confirm that it actually was that and not some other thing we could do something about.

 

[movie zombie]

........The only downside to skipping it that I can think of is that she may have a health issue in the future that would leave us having to do a different test to try to confirm or rule out something we could already have checked for. But then I figure the vet would still do the other test anyway to confirm that it actually was that and not some other thing we could do something about.

the other testing may cost even more and even more tests might have to be run to get a final diagnosis.
if you do this now it will rule out a lot or confirm things and give you peace of mind if you decide to not continue with other tests down the road and/or decide to euthanize.
you will know you did all you could do and that your decision is a sound one.
yes, do it.

 

[luvsdmb]

I say do the biopsy, what's another $200. You will probably wonder(and worry) if you don't. I hope everything is okay

 

[Gypsy]

I know that another 200 can be a very big deal.

That said, I would do the biopsy. If it is positive you will know that you have a very limited time with you. It will give you time to spoil her even more than she already is and give you peace when she does pass to know that you made the most of all the time remaining.

If it is negative, you know that she doesn't have cancer. It could be something easily treatable if it isn't cancer. And that would be good to know that too.

 

[TooPatient]

Just Googled some information. I think the infection the dr was talking about when I first took her in is pyometra.

I think that is very likely. She's been having a bloody sort of discharge that does look a lot like the uterus lining. The dr said an infection like that could leave her feeling like she has to urinate all the time so that would account for her going potty where she is sitting.

She perked up within 24 hours of getting antibiotics. The bleeding is almost gone and the discharge is reducing. She is full of energy and very happy again. It has now been 8 days since antibiotics and 11 days of discharge.

Not sure if that helps?


Thanks all who have given advice! That is sort of how I am leaning. I just don't want any regrets and $200 is such a small amount in the long run even if it is a big amount right this minute. That said, I don't think she has cancer so the test wouldn't show anything useful. (unless they check for more than cancer?)


ETA: Sick cats & dogs are so much worse than sick people! At least with people, you can talk to them and get their input. The cats & dogs are relying entirely on us to make the decision...

 

[missy]

I'm so sorry TP. What a difficult situation and I hope it turns out to be nothing terrible and very curable so she can go on and have another happy decade with you guys.

I vote for biopsy and perhaps you can raise some funds with a fundraiser or something if it turns out there is a possibility of successful treatment even if it turns out to be cancer. Just putting that out there because while 10 yo is not young it isn't terribly old either for a house cat.

Sending you lots of good kitty health vibes and big hugs for a happy resolution. Also sending your dh job dust.

 

[TooPatient]

I'm so sorry TP. What a difficult situation and I hope it turns out to be nothing terrible and very curable so she can go on and have another happy decade with you guys.

I vote for biopsy and perhaps you can raise some funds with a fundraiser or something if it turns out there is a possibility of successful treatment even if it turns out to be cancer. Just putting that out there because while 10 yo is not young it isn't terribly old either for a house cat.

Sending you lots of good kitty health vibes and big hugs for a happy resolution. Also sending your dh job dust.

Thanks Missy! I'd love another happy decade with her

We're hoping it is "just" an infection. That is what it seems to be and the vet thinks is most likely. She just wants to biopsy to be safe.

We've had a cat die of cancer before so have talked a lot about this. I know some animals can be treated and go on to have happy and healthy lives (like one of my mother's cats ) but I also know what the treatments look like. If it were a relatively easy treatment we would definitely make sure she got that. We just don't want to cause her huge amounts of suffering if the outcome is not likely to be positive (which in the abdomen it would not be). She has had so many other issues (asthma, collapsed lung, ongoing sinus infections, etc) and gets very sick so easily that it would be very hard on her.

 

[kgizo]

I was in a similar situation a few years back so I sympathize with how difficult it is to make these decisions. I vote no biopsy. As you said, if she has cancer you will not treat it so it will not change the course of her treatment. If you did it and she has cancer, it doesn't rule out other medical issues that might exist so it probably won't save her from future tests. So, the $200 gets you partial knowledge but doesn't impact her quality of life at all. I would save the $200 for now because you may need to put it towards other medical needs in the future where she is more likely to get a benefit (perhaps seeing an IM specialist or getting an ultrasound. I hope she is feeling better soon.

 

[missy]

I'm so sorry TP. What a difficult situation and I hope it turns out to be nothing terrible and very curable so she can go on and have another happy decade with you guys.

I vote for biopsy and perhaps you can raise some funds with a fundraiser or something if it turns out there is a possibility of successful treatment even if it turns out to be cancer. Just putting that out there because while 10 yo is not young it isn't terribly old either for a house cat.

Sending you lots of good kitty health vibes and big hugs for a happy resolution. Also sending your dh job dust.

Thanks Missy! I'd love another happy decade with her

We're hoping it is "just" an infection. That is what it seems to be and the vet thinks is most likely. She just wants to biopsy to be safe.

We've had a cat die of cancer before so have talked a lot about this. I know some animals can be treated and go on to have happy and healthy lives (like one of my mother's cats ) but I also know what the treatments look like. If it were a relatively easy treatment we would definitely make sure she got that. We just don't want to cause her huge amounts of suffering if the outcome is not likely to be positive (which in the abdomen it would not be). She has had so many other issues (asthma, collapsed lung, ongoing sinus infections, etc) and gets very sick so easily that it would be very hard on her.

Hi TooPatient, it sounds like you have it covered and I know you will do what is best for your sweet kitty. It seems most of our cats end up with cancer issues but fortunately (with the exception of our darling Butch) we have managed to extend the quality of their lives for at least a few years. I am hoping it won't come to that for your sweet baby though and that she is absolutely fine save a minor problem that is easily fixed. Tons of kitty dust being sent your way and many many good thoughts for at least another healthy and happy decade with her!!!

 

[isaku5]

What a tough decision, PT! . As a life-long lover of kitties, I can only tell you what I would do and why.

I would spend the money on kitty's tests. If nothing was found, that's good news; however, if it's an aggressive cancer, I would vote to keep her comfortable for as long as you can and following that, euthanize her kindly - by kindly, I mean the vet injects the necessary drugs and she falls asleep in your arms. You hold her until she's passed and then decide what to do with the remains.

We have several kitties interred in our flower garden at the back of our house. Each was buried intact, but definitely dead. My husband isn't usually a 'pet' person, but at each 'service', he has delivered a fitting eulogy for that kitty.

Personally, I have always felt that when I adopt a kitty, I am responsible for its welfare and will do everything I can to keep the fur-baby alive.

Our current handsome lad used a few of his lives several years ago: Just before we were to go to the cottage with family, Sammy stopped eating and drinking. He had the usual tests, but one thing the vet told us was that he might have to be force-fed and watered every four hours if he had the slimmest chance. We did this hoping for a miracle so we could leave him at the vet's for the weekend. The vet gave us an appointment for 10 am on the day we left. I cancelled that appointment and took him to the best animal clinic within 50 miles. For a huge fee, a vet would call us every day with an update. I needed that reassurance; sad but true . The final report was that he was still not eating or drinking, but should go home.

He complained loudly all the way home and he brought expensive drugs with him (which we had to pay for before his release).

Anyway, within a few days of continuing treatment at home, he started to eat and drink on his own!!!!! Miracles do happen and as of today he is a happy, healthy 15 year old kitty.

I'm not saying that everyone should take that route, but for me, it was the right choice.

I realize that I made the choice between having a great weekend with family and trying to save a 13 year old kitty.

Our kids are valuable, but they're old enough to look after themselves. The same is true with the in-laws.

Sammy had to count on our continuing care and our commitment to bring him through. He did and we did and the reward is seeing his bright eyes.

Sorry for the long post.

 

[azstonie]

I vote no biopsy.

Here's why: Data is gathered to make treatment decisions. You stated that you would not treat her for cancer but rather give her comfort care instead. So why would a biopsy matter to you?

A biopsy would only offer you useless information. $200 is a substantial amount of money given the cost of the surgery you have already committed to. If you cat does have cancer, you will have expenses involved in treating her pain and any other problem that arises. Use the $200 to pay for her comfort, not lab work.

 

[Maria D]

I would not have the biopsy done if I didn't plan on treating the (possible) cancer. And, like you, I would not have this cat undergo cancer treatments for the same reasons you gave.

For peace of mind, you could talk to your vet about the concern you stated; would skipping this test have an impact on future treatment/tests unrelated to cancer? Or would more tests have to be done anyway.

Does your vet even know that you wouldn't want cancer treatments? One of my cats died of cancer a few years ago. He was 12 years old when he became ill. Our vet could feel a large tumor in his abdomen, confirmed by an x-ray, and didn't think he could be cured. He did feel the cat might live longer with aggressive treatments and asked us up front if this was the route we wanted to take. After talking about it and deciding we did not, our vet helped us give the care that was right for us and our cat - no further tests if we weren't gong to act on the results. At the time, we could well have afforded all the tests and treatments, but felt that it wasn't fair to our cat to go through all of it. Just throwing that in there because I have had vets in the past that I felt tried to make me feel guilty for not wanting to spend the money. Glad I found the vet we have now.

Good luck with your decision TP, well wishes for your kitty!

 

[ecf8503]

Let me politely butt in here for a minute. I'm a veterinarian, and I worked in cats-only clinics for years.

It seems to me several diagnostic steps were skipped here. You said " They gave her an antibiotic injection and drew a urine sample. It turns out it is not a UTI so the vet says it is a problem with her uterus."

A key here is whether or not there is a persistent discharge or if it is actually inappropriate urination. Did they determine that? Can you tell?

When they drew the urine sample, was it collected via sterile cystocentesis? Was the urine actually cultured on an agar plate? Were x-rays taken to look for the possibility of bladder stones? Often pyometras can be seen on x-rays too. Did they ultrasound her abdomen to look for pyo or cancer?

I personally would like to see a more thorough workup obtained. X-rays. Ultrasound. Urine culture. etc.

Is surgery necessary? Maybe. If it's a pyometra, then yes definitely - that can kill her. Does she have cancer? Who knows - but it bothers me that your vet jumped to this conclusion without ruling out more common things first.

 

[chemgirl]

I honestly wouldn't biopsy in your situation. You wouldn't treat cancer (I probably wouldn't either). The benefit to biopsy in your case would be knowing if it is cancer so you can monitor quality of life and make informed decisions. Useful, but you'll do that anyway right? If your kitty seems off, lethargic, stops eating you can take her back in for further tests.

 

[TooPatient]

Let me politely butt in here for a minute. I'm a veterinarian, and I worked in cats-only clinics for years.

It seems to me several diagnostic steps were skipped here. You said " They gave her an antibiotic injection and drew a urine sample. It turns out it is not a UTI so the vet says it is a problem with her uterus."

A key here is whether or not there is a persistent discharge or if it is actually inappropriate urination. Did they determine that? Can you tell?

When they drew the urine sample, was it collected via sterile cystocentesis? Was the urine actually cultured on an agar plate? Were x-rays taken to look for the possibility of bladder stones? Often pyometras can be seen on x-rays too. Did they ultrasound her abdomen to look for pyo or cancer?

I personally would like to see a more thorough workup obtained. X-rays. Ultrasound. Urine culture. etc.

Is surgery necessary? Maybe. If it's a pyometra, then yes definitely - that can kill her. Does she have cancer? Who knows - but it bothers me that your vet jumped to this conclusion without ruling out more common things first.

Thank you for your post!

I don't remember bladder stones being mentioned much. I think she said something about why she thought they weren't that but I can't remember what her explanation was. There were no x-rays or ultrasounds done.

The urine was collected via needle directly from the bladder. They kept some for initial in house examination and sent the rest to a lab for more in depth testing.

We've also done blood work. Kidney, liver, etc all functioning normally. White blood cell counts are elevated as are the other thing she mentioned (she said consistent with an infection but I don't remember what she called them, maybe titer count?).


I'll keep reading this thread. I am supposed to check her in at 8am (PST).

The vet should be available then for final questions. I will definitely ask her about the bladder stones. I'd hate to have my sweet kitty have a surgery she doesn't actually need and still be sick with something else!

 

[TooPatient]

She is out of surgery and already awake and walking around. We decided to not do the biopsy and I think that was a good decision.
The uterus was apparently rather large (swollen?), visibly infected, and oozing.

Her antibiotic injection is still in her system, but they want her to take additional antibiotics since it was so infected. I'll take her back for another injection when the time comes.

Now... Off to build stairs in front of the dryer so she isn't jumping up/down after surgery.

 

[TooPatient]

The little Houdini!

She got out of her carrier on the way to the vet. Now she managed the soft cone in all of 30 seconds. I've got her in a onesie (spelling????) and she's on her way out of that. Had to sew the neck smaller in the 3month size and she's still working her way out.

Even with us sitting in the room, she is going straight for the stitches as soon as she can get to them.


Gah!!!!


I'm glad she is okay. Just have to get her healed up so she stays okay!

 

[TooPatient]

Got her!

A bit of creative thinking, but she is wrapped up and leaving her stitches alone

Ended up using a non-adhering gauze pad and wrapping her in self-stick bandage like what the vet used on her paw for the IV.


Picture of before surgery and a couple of after. Not sure how well it shows in the pictures, but she is SOOOOo much smaller now:

(Oh -- don't mind the taped up boxes she is standing on. We taped a bunch of empty boxes together to make her stairs up to the dryer so she doesn't hurt herself getting to her favorite place to sit.)

 

[ecf8503]

Glad she is doing well!

 

[junebug17]

Omigosh what a beautiful kitty! Look at that sweet face - I'm so glad she tolerated the surgery ok, I'm sending best wishes for a speedy recovery. I guess she's feeling pretty good if she's insisting on making her way on the dryer! Keep us posted TP!

 

[isaku5]

That kitty is sweetness all in one package .

In her 'before' picture she looks great and with a bandage- just as great.

Best of luck to you both!

 

[Gypsy]

She is out of surgery and already awake and walking around. We decided to not do the biopsy and I think that was a good decision.
The uterus was apparently rather large (swollen?), visibly infected, and oozing.

Her antibiotic injection is still in her system, but they want her to take additional antibiotics since it was so infected. I'll take her back for another injection when the time comes.

Poor baby. She must have been in such pain. What a dramatic before and after. I love the stairs to the dryer. What a great cat mom.
She's got such a pretty face!!

More pics???

Love the bandage solution.

 

[missy]

Oh, so happy your sweet kitty is out of surgery and hopefully doing well. She's such a beautiful girl. Big but gentle (((hugs))) and kisses to her for a speedy and full recovery!

 

[TooPatient]

She is out of surgery and already awake and walking around. We decided to not do the biopsy and I think that was a good decision.
The uterus was apparently rather large (swollen?), visibly infected, and oozing.

Her antibiotic injection is still in her system, but they want her to take additional antibiotics since it was so infected. I'll take her back for another injection when the time comes.

Poor baby. She must have been in such pain. What a dramatic before and after. I love the stairs to the dryer. What a great cat mom.
She's got such a pretty face!!

More pics???

Love the bandage solution.

Thanks!

The vet (or her assistant?) did not like the bandage and tried to get us to remove it and fight with her again using the cone... Yeah.
I let them know that I would only do so if there was some medical reason to be concerned (like rubbing the incision or whatever) because she fought the cone so strongly I am sure she would have torn her stitches if I tried the cone again.
The vet came back personally with a reply that it was fine if that was the only way to get her to leave her incision alone and the only worry is that we be careful to not wrap too tightly.

The stairs were a fun joint effort between me & DH. We gathered up all of the empty boxes from the garage and taped them together. She absolutely LOVES them. Not sure how we're going to be able to take them even when she is healed


More pics soon!

 

[TooPatient]

Oh, so happy your sweet kitty is out of surgery and hopefully doing well. She's such a beautiful girl. Big but gentle (((hugs))) and kisses to her for a speedy and full recovery!

Thanks Missy!

She is really up and active today. We were finally able to unwrap her! She is mostly leaving her incision alone and the vet says a little is okay now that we are past the first few days.

She looks so funny with her shaved tummy and skinny waist! SO much more energy than before!


I am so glad we took her in as early as we did. That infection had to have been growing for some time. My poor sweet kitty had to have been so miserable
The difference between now and a few weeks ago is remarkable!

 

[Gypsy]

Be careful. My MIL's Noel was similar, vet told us after the first few days we could stop being as diligent. Two days later she had licked her stitches so bad she infected them all and then we had to get an industrial cone, that she almost killed herself using (she almost broke her neck when she got caught, panicked and couldn't get free), and us painting iodine Mercurochrome on it twice a day until she was fully healed PLUS antibiotics.

So... I wouldn't listen to them about that. Keep wrapping it. You can't watch her 24 hours a day and she can lick it and infect it faster than you think.

 

[TooPatient]

Be careful. My MIL's Noel was similar, vet told us after the first few days we could stop being as diligent. Two days later she had licked her stitches so bad she infected them all and then we had to get an industrial cone, that she almost killed herself using (she almost broke her neck when she got caught, panicked and couldn't get free), and us painting iodine Mercurochrome on it twice a day until she was fully healed PLUS antibiotics.

So... I wouldn't listen to them about that. Keep wrapping it. You can't watch her 24 hours a day and she can lick it and infect it faster than you think.

Thank you!!!

How long is it prone to infection? She has the dissolving stitches (almost entirely internal -- just a little end where the tie off happened). Is there something I should look for as an indication that we are okay to stop wrapping?

 

[Andelain]

Poor kitty, hope she makes a complete recovery. Little cutie!

 

[lulu]

I vote no biopsy and just watch her carefully.

 

[azstonie]

Glad your sweet kitty is recovering well!!!

It was good to hear from the experienced cat veterinarian, btw, if steps along the way are skipped one should know that.