Catch 22

[bmused]

i adopted a 3lb starving stray in October 2009. We took her to the sliding scale clinic here (FACE) to be cleared to bring in the house. We thought she was about 6 months (judging by size) but it turns out she is at least 3 yrs, just petite, and has had kittens.She had "some jaundice". She was neg for feline leukemia, etc, and we left her to be spayed. However, when her presurgical blood work came in, her bilirubin and another item were "off the charts", we were told she likely had pancreatic or liver cancer. (although skeletally thin, she had a hard distended abdomen so we thought she was preggers.) They observed her all day, and stated that with her lab results, they expected her to be vomiting and have diarrhea and be completely listless. and were very surprised that she ate all day long and wasnt acting sick. But that the anesthesia would like kill her, so she could not have surgery.
They recomended an ultrasound to further the diagnosis, but that is beyond our reach financially.  if she cant withstand the anesthesia to be spayed, how could she withstand it for a cancer surgery?  Am I missing something here? My husband wont let me charge $600  at 28% for ultrasound if there is no chance of change in the outcome, and if she cant have anesthesia for surgery...this is a true dilemma,
BTW, Mini is doing well, upto 6 lbs now, no diarrhea/vomiting, starting to play and show some pep. her gums are less yellow and her belly is not so hard as it was in Nov.the only things NOT improving are her scruffy coat and disposition. We had resigned ourselves to just making the remainder of her life comfortable (i know pancreatic cancer is very quick in people) but now i am wondering if that is the right course either.. Since she cant have surgery yet seems to be improving, are there any other therapies she might be able to withstand?

[Arnold L Goldman, D.V.M.]

Hi,

Without a diagnosis therapy is not something that can be intelligently discussed.

There are a multiitude of reasons for a hard abdomen and jaundice. Ultrasound perhaps with fine needle liver aspirate may be helpful, however, expolratory surgery may lead to the diagnosis and suggest a treatment plan. The problem may be correctable at surgery, for example if it were an obstructed bile duct. On the other hand an uncorrectable problem may be revealed andnow the cat will have had a surgery. That's why intermediate steps like ultrasound are valuable...to avoid invasive and costly procedures when possible.

Under the circumstances your plan to offer a comfortable home until and unless pain or suffering occur is reasonable. Should the cat begin to do poorly, you will then have to choose again between workup and perhaps euthanasia. It may also be late for workup as whatever the process is that is occurring, it may have advanced.

In any case, without a specific diagnosis (vcarious cancers, pancreatitis, gall bladder disease, liver disease, other) no specific treatment can be recommended.

Sincerely,

Arnold L. Goldman DVM, MS
MedHelp & PDOC

[bmused]

Thank you, Dr Goldman. I would like to give this little girl the best chance  i can on a fixed income. Your reply implies that exploratory surgery CAN be done!
I was left  believing that there was NO surgical option available when they declined to spay her at the clinic. So i didnt see the sense in going into debt to find out what exactly is wrong IF they cant operate if needed at the end of it, anyway.  

I would guess that she is just too high risk for the sliding scale clinic to do surgery on,and that i need to look for a different vet for Mini-Mouse. We go back there for another bloodtest in March, to see if her values have changed. Those kind people tried to prepare me for the worst (and tried to help her get ultrasound) but in spite of the pessimism, the cat is thriving and getting stronger everyday.

Thanks for taking the time to open this door for Mini and me. I see some light at the end of the tunnel now that might not be an oncomiing train!