Midnight

by: Dr. Alexis Gullett from Animal Medical Center

Midnight is a 14-year-old male neutered domestic shorthair cat who originally presented earlier this summer for sneezing blood. Earlier medical history included routine vaccines, as well as a diagnosis of cardiomyopathy (a type of heart disease) with a grade 5/6 heart murmur. (Heart murmurs are graded on a scale of 1 to 6, with 1 being barely heard, and 6 being heard loudly and sometimes even being able to feel it on the outside of the chest.) Up until his visit this summer, he had been doing very well. At his original visit this summer, his owners related that he had been sneezing for about a week, and occasionally dribbling blood from his nose. He was in good spirits, and his physical exam revealed a large "swelling" of his left cheek as well as severe dental disease. Causes at that time were narrowed down to severe infection from the teeth that had abscessed the roots of the teeth, or cancer with some infection of the tumor. It was decided to start by treating the infection and inflammation with a steroid shot and antibiotics, with a recheck exam when finished with his medication.

Midnight came back two months later for a re-evaluation of his breathing and cheek swelling. His owners reported that he did not have much improvement on the medication, and once the medicine was finished, he started to get worse again. At this point he was not eating well, preferring soft food and juice to hard food. He was also still sneezing with some bloody discharge from his nose as well. His heart murmur was still the same, and his lungs were clear. His left cheek was still swollen, but at this point his gums on the left side were swollen as well, with a mass on the gum. Most of this teeth on the upper left side were either very loose or missing altogether. The original swelling of his cheek by this point was quite large, and very firm to hard in spots. It was discussed with the owner that most likely this was due to cancer of some sort, as typically swellings due to infection will resolve with extended courses of antibiotics. Skull radiographs showed osteolytic areas (where the bone has been eaten away) of the upper jaw and actually into the skull proper. This was especially noticeable around the teeth. There was also some ossification (bone formation) of the cheek tissue. This is usually due to an aggressive cancer, and after much debate the owners decided to use pain control to keep Midnight comfortable until they felt he was unable to enjoy his days. He was given another injection of long-acting steroids, and an long-acting injectable antibiotic. As of his last visit, Midnight was doing ok.

Bone cancer can affect many areas of the body, not just the skull. We also see it in the spine, as well as the legs. The most effective way to treat it is through amputation (removal) of the affected limb, as well as radiation and/or chemotherapy depending on the exact cancer. However, as we see in Midnight's case, it may not necessarily be the most comfortable or humane option. While we surely could have referred him to a specialist and removed a large portion of the tumor and followed up with radiation, with his history of a heart murmur, age, and dental status, there was a very good chance that he would have a very hard recovery and actually be in more pain from the treatment than he was with the disease. For this reason we selected palliative care. In humans we call this Hospice.

While we would all love to be able to fix all of our pets problems, we ultimately have to decide what is truly best for them. Many illnesses, including many cancers like Midnight's, can be effectively treated or managed the earlier they are diagnosed, making regular routine visits to the veterinarian even more important than just "getting those shots" every year. Exams and other health screenings, such as blood work and sometimes even x-rays, can uncover illness before our pets actually show symptoms of them, and should be considered a normal part of our pets' yearly health care.