The Hobbit Hole VII - But not yet weary are our feet...

[Fedora]

Hi, Rosie,

I have a good friend who's an experienced vet and I took the liberty of seeing if he had any suggestions on your cat. Of course I only had a little information to give him so this is by no means a diagnosis, and if I knew more specifics he might have more to say, but based on what I was able to tell him here is his reply [and I'm combining the text of a few emails here so please ignore any typos]:
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I would really need to see results to formulate an alternative. But get the thing off of cat food. Too much ash content. Start it on red meats raw and warmed eggs crushed and powdered egg shells...... sunlight as in DIRECT sunlight and the like.

One thing that may help might be lung lobe removal of that lobe only, since there are three lobes per lung. I would suspect that if it goes into trauma to look for labored breathing that could possibly develop into what is call Lung Lobe Torsion.

Adenocarcinomas are tumors of glandular tissue that are malignant (adenomas are tumors of glandular tissue that are benign). When the tumor cells are unrecognizable as a particular type of gland (sweat gland, ceruminous gland, etc) it is a bad sign. The fact that the pathologist thought this lump had already spread is also a bad sign. In general, chemotherapy is not too helpful in adenocarcinomas in cats. Radiation therapy can be palliative (meaning it can slow the spread of the condition and alleviate some of the discomfort that may be present) but it is not usually curative, unless there is newer research on this issue I am unaware of. Catching these tumors very early and doing a very wide surgical excision is the best course of action but that isn't possible at this point and may never have been possible. These tumors can be so malignant that they have spread when you find them, even if they are still very small. Not good news.

I am very sorry...... Let's hope for benign but Chemo in this case is not the right way to go..... neither is Radiotherapy. It maybe autoimmune related and there is hope for the kitten. Fresh meats. Iodine in shrimp
steamed and cooled but near raw. Lobster.. crushed egg shells and lots and lots of support and love....remember it is life and one must take responsibility and care. Remember the Patron Saint of animals :))) Meats such as liver lightly braised and then colled but fed somewhat raw as fish and the like. We must build the immune system. For a kitten to have these problems so young is rare but not unheard of.

Again I don't have the info needed to make a clear descision on findings that are so vague. Here is some reading however:

Feline Mammary Adenocarcinoma (FMGAC)
by Dr. Alice Villalobos
SVMA SUN VALLEY '98

In the U.S.A., comparative statistics between cats and humans show that one in nine women will suffer from breast cancer in contrast to only 25 of 100,000 cats. Over 183,000 surgeries are performed every year on women to fight breast cancer. 43,000 women die every year and one in three have metastatic lesions in the brain at death.

Incidence IN CATS

FMGAC is the third most common tumor in cats after hematopoietic and skin tumors are considered. Cats experience breast cancer risk in a ratio of 50% less rick than dogs. Histopathology finds that 86% of tissues sent from feline mammary gland excisions are malignant adenocarcinomas and less frequently sarcomatous. Intact cats are at greater risk of developing FMGAC at 31.8 of 100,000 cats. OVH cats show less risk at 20.4 of 100,000.

The average age at onset is 10-14 years with a range as young as nine months to 23 years. The mean age is 10-12 years in several studies. Siamese cats may be regarded as being at two times greater risk than other cats. And sadly, the Siamese as a breed alone also develops their FMGAC at a younger age. Next at risk are Domestic Short Hair cats who are intact followed by spayed females. FMGAC very rarely involves male cats.

COMMON MANAGEMENT MISTAKES

It is a definite mistake on the part of any practitioner to take a "wait and see" attitude, postpone a work up or waste precious time on any beloved cat that presents with mammary nodules or cysts. Cats with breast nodules must be automatically considered at a 90% or greater risk for malignancy. Tubular, papillary and solid carcinomas are the most common histologically malignant forms of FMGAC, but most tumors have a combination of tissue types in the same cat. Biopsy reports will vary and some will find the less common types of duct papillomas, sarcomas, mucinous carcinomas adenosquamous carcinomas and adenomas.

ETIOLOGY

The etiology of FMGAC remains multifactorial. Most researchers agree that MGAC causation may originate in the milieu of hormonal influences on pathogenesis. Verification has been found in hormone receptor research work in women and dogs but less so in cats. Cats have lower levels of detectable hormone and this makes research frustrating in this species. A 1971 study suggested that intact dogs and cats had a seven fold increased risk of FMGAC, but other studies did not substantiate this work. Rarely one will see a young, intact female cat with huge mammary masses which are benign. This condition is known as fibroepithelial hyperplasia and should not be mistaken for FMGAC.

IATROGENIC FACTORS

The role of progesterone, testosterone and estrogen have been investigated in cats. Only 10% of FMGAC were found to have estrogen receptors while humans and dogs have a much higher level of positive receptors. It seems that prolonged progesterone levels play an influential part in causation of FMGAC. Megase, ovaban, depoprovera and other progesterone-like drugs were frequently used in cats for miliary dermatitis or behavior problems. Later on these drugs were associated with the development of FMGAC or benign mammary hyperplasia and documented in the '70's by 12 veterinary colleges. Cats that have cystic ovaries and other uterine disorders are more likely to develop breast cancer than healthy queens. History and Symptoms

Unfortunately cats with bumps look and feel fine so many pet owners don't think bad thoughts. One study in 1978 found that most cats may have had their mammary masses noted over five months before visiting the veterinarian. Cats present with locally invasive nodules which may be firm moveable or fixed to the abdominal wall and overlying skin. About 25% have ulcerations and most have micrometastasis into the local lymphatics and near by lymph nodes. Often one can palpate the "beaded chain" appearance of involved lymphatics. Tumors close to the nipples may be expressed yeilding a tan or yellow liquid. Often there is swelling and discomfort and infection and mild fever. Involvement may be more often in the cranial two mammary glands or along the entire right or left chain with over 50% of cases involving more than one gland at presentation. A few cases may be associated with chronic mastitis or mammary cystic disease or uterine disorders.

WORK UP AND STAGING

Remember that this cancer is very aggressive! Consultation should recommend x-rays, a profile, FNA of local nodes if enlarged, U/A and U/S. Direct the client toward a radical surgical excision of both chains one month apart if the cat is a good candidate. Three views of the chest are important to evaluate for pleural effusion and interstitial densities which may be faintly visible. Consultation with a radiologist may help to distinguish the difference between old cat lungs which may show aging changes and inactive inflammatory lesions that mimic the metastatic process. It is fair to tell your client that you feel the x-rays are equivocal yet vote to proceed with surgery. One can wait 7-12 days and take a second set of x-rays to see if the presumed lesions are stable PRIOR to a definitive surgery.

PROGNOSIS IS ALWAYS GUARDED TO POOR

Unfortunately the recurrence rate of FMGAC that were surgically removed runs high (66%) and most afflicted cats are dead within one calender year. If tumors are smaller than 3cm, the cat has a better chance. If the tumor is 2-3cm, the data shows that cats can get a two year median survival. If the mass is 1cm and shows no lymphatic invasion the median survival is 3 years. So it makes sense to educate our pet owning public to jump when they first find lumps and ulcers in cats!

TREATMENT FOR FMGAC

I prefer to coach the client into two radical chain mastectomies one month apart and one year of chemotherapy using mitoxantrone at 5.5mg/M2 every 21-30 days for one year. If the tumor is fixed to the wall, I prefer to use aggressive intraoperative techniques such as chemotherapy implants using carboplatinum and intraoperative radiation therapy. We have cases in which clients come to our service after several recurrences at a local site. The last thing they want is another surgery. Often the previous surgery was not definitive in that it did not remove the body wall which the tumor was in contact with nor was the local draining lymph node removed for histopathology. Radical surgery along with aggressive intraoperative technique can spare further surgery. Follow up intralesional chemotherapy implants are also very workable while systemic mitoxantrone or adriamycin chemotherapy is being administered. Cytoxan given at 10mg/kg divided over 2 days once at 21 days after adriamycin or mitoxantrone is helpful. Cytoxan can also be given at 1/2 of a 25 mg tablet every other day in 7-10 pound cats with safety while they are on the other chemotherapy agents. The seven and ten day nadir for these agents should be marked with a CBC to document the WBC and platelet count. If the cat feels fine and has no leukopenia, the follow up treatments may proceed with no change in dose. Taxol remains too toxic for use in private practice. Gene therapy and TALL-40 (activated WBC's) are still a reaseach mile away from every day use. A 50% short term response has been observed using chemotherapy; however, fmgac remains resistant in its advanced stages. The best results are seen in early cases that get bilateral mastectomies and one year of chemotherapy. An increased client awareness program in your practice and early aggressive case management is the key to successful outcome.

[Scott from the Left Coast]

Go down on the Tribnet to the local section and check the story by Sherman and Hagey titled: Audit hits City's financial oversight. That's the one where my Finance Director trades blows with the State Auditor. That made a mess everywhere today.

[Penny1]

Poor thing! And poor you! I hope you can still get some sleep tonight, and hope she settles down soon!

[Fedora]

Yawn... back from choir... and it's just about bedtime.

Doh! I was just typing you my new story idea but I guess I'll save it, then. What day do you leave for Colorado again?

BTW, last night I found in one of my sf anthologies that I had an early story by Connie Willis called "Fire Watch" with the same characters from Doomsday Book. It was pretty cool!

I guess you're going to bed, so have a good night!

[JenB]

Colorado is Thursday night. Go ahead and send the story - I refuse to go to bed quite yet. I haven't done anything today!

[Fedora]

Colorado is Thursday night. Go ahead and send the story - I refuse to go to bed quite yet. I haven't done anything today!

Okay, I'll type a quick summary. BTW, what's your take on "Fire Watch"?

[Wneighbor]

Knock knock

Anybody home?

[Ramius]

I did find that one. All you need to read is:

This audit, conducted in the shadow of the David Brame scandal, focused on several issues brought to the attention of auditors by whistle-blowers, tipsters or outside investigations.

This is truly related to the Brame case how???

Of course it isn't... but for the Trib, there is no other story. The REAL story if SOME media outlet would just report it, is how the Brame case was completely fouled by the Trib. They completely missed the real story, but successfully used it as a wedge to drive into the city.

A good personal friend is in the TPD. Morale at the PD could NOT be lower. The real crisis has not yet begun to materialize. The TPD pretty much feel like they will never be able to recover from the hatchet job that the Trib has done on their department. When cops start bailing out of the department and nobody wants to work there because of an undeserved rap, maybe that will make the front page? No, I don't suppose it will.

[Ramius]

Who's there?

[JenB]

"Fire Watch", IMO, was a little weak, like some of her earlier stuff, but showed her promise. The basic theme of her writing is in there, but more explicitly than in other places (again, IMO, all of Connie Willis' stories are about people, and how individual people matter more than these great events that are happening around them).

I like the story; it didn't grip me the way Doomsday Book does, or entertain me like Bellwether or To Say Nothing of the Dog (which has a little tiny refrence to Fire Watch in it, just a mention of the main character in passing).

[Wneighbor]

't's only an elf.....

you want me to go away? :-)

[Ramius]

Oh, jeez... I finished reading the rest of the story. That list of "Ten Items" that the 'auditors' found is *really* *really* lame.

They're b*tching about amounts in the thousands, in a budget in the many tens of millions. Yeesh. This is tantamount to calling *me* on the carpet for authorizing a new laptop for one of my staff, out of my three million dollar budget. Yippee Wahhh friggin' whooo.

[Ramius]

Elf who??? :-)

Howdy howdy there... hope your birthingday was satisfactory?

[Fedora]

Huh, interesting take. See, for me it actually gave me a different perspective on Doomsday Book that gave me a deeper apppreciation for the characters and technology and themes there. Also, I like studying WWII so I thought that was interesting in its own right. I guess maybe that just reflects my idiosyncracies as a reader. Anyway, I will try to get ahold of Bellwether and To Say Nothing of the Dog--what are those about?

BTW, you've got mail.

[JenB]

Bellwether is about trends research, sheep, Pied Pipers, smoking nazis, lattes, barbies, and True Love. No time travel.

To Say Nothing of the Dog is comic time travel to the Victorian era. Also the the Blitz and a couple other spots. Lady Schrapnel has decided to restore Coventry Cathedral to its original glory and is making time travellers research it for her, and the hero's job is to find out what happened to the Bishop's Bird Stump, an exquisite example of Victorian art. It also involved time paradoxes, the unravelling of the space-time continuum, Enigma, why Napoleon lost at Waterloo, croquet, jumble sales, literary references, and True Love. Oh, and absent-minded dons, lovestruck Oxford students, boating the Thames, and the cat. To say nothing of the dog.

Sigh... I love that book. I laugh aloud every time I read it.

You've got mail.

[Wneighbor]

Elf with an attitude! :-)

Birthday woulda been better if I still lived back home around all my friends. But, it cheered me greatly to have a call after work from one particular friend. :-)

Made it to work today huh? Uh, not the kind of work that involved hauling gravel I mean. Ya sore today?

[Fedora]

I will check those out. She really does some creative things with time travel! Gives me some story ideas. . .

You've got a reply, with a story attached.

[msdrby]

Oh WN, the quilt is beautiful!

[Scott from the Left Coast]

The City Council had a complete come-apart over it. Of course, they kow-tow to the Trib as well. To my staff (the aforementioned young females), the Trib is like God.

What the hell am I doing here?!

[JenB]

What the hell am I doing here?!

Not a line I ever want to utter.

Fedora, I'm going to bed. I'll get back to you tomorrow evening. Sorry, my head hurts too much to be coherent.