Most of us understand the value of a second opinion in human medicine. But I felt guilty and ashamed for not accepting an expert's opinion. Credentials are a big piece of the puzzle. Your usual veterinarian or a radiologist who performs an ultrasound might have the same answers as an oncologist. Or they might not; you have the right to ask about and for the best treatment options for your cat.
In Ellie's case, the radiologist who performed her ultrasound gave advice based on circumstances for dogs (we will cover more about this in a future post, "Cats, dogs, and humans are different.") When you hear your cat has a 5-centimeter mass on her liver, of course, your first question will be "Is this cancer?" The radiologist did her best to answer the question.
Even the specialty surgeon we saw locally wasn't sure what to make of Ellie's mass and suggested we go to the closest veterinary school (two hours away). I don't want to call her out, but she was baffled that Ellie's liver enzymes were completely normal because she thought a mass of that size, benign or not, should affect liver enzymes. Yet, after the biopsy revealed Ellie's mass was cholangiocarcinoma, I researched quite a bit and found that for that particular cancer, liver enzymes may not be affected.
I'm glad I kept going and sought the opinion of a surgical oncologist. The resident who talked through things with me admitted that it was unlikely that all surgical oncologists would agree on how to proceed. What mattered in the end was that I found the team who was confident they could remove her mass, biopsy it, ensure she survived surgery, and live with a better quality of life.
There were other factors involved in my decision: there was no evidence of spread, Ellie was in excellent health for her age, and if the mass were benign, surgery would essentially be a cure. At first, I thought driving Ellie two hours away for a consultation and surgery was a bit crazy. But we managed.
When we went back for Ellie's surgical follow-up, after the biopsy revealed her mass was cancer, I asked about chemotherapy. Cholangiocarcinoma tends to come back elsewhere in the liver roughly 80% of the time. They said they would not do chemotherapy because of the lack of proof of its effectiveness and the chance that it would make Ellie sick and affect her quality of life. They sent us off with an appointment for an ultrasound in three months to recheck Ellie's liver. I stewed over this for three weeks. I wasn't satisfied, but a FACULTY EXPERT said no. Shouldn't she know? Why would I know better?
At three weeks, I got over my guilt enough to ask our veterinarian for a referral to the next closest veterinary school (a three-hour drive each way!). I felt crazy seeking a second opinion and even crazier for driving my cat so far for it! The medical oncology faculty was honest with me. There was a 20% chance chemotherapy would stop cancer growth. I'd already done a lot of research into possible chemotherapy agents and their effects. We agreed to try chemo on the condition that Ellie maintained her quality of life.
She has (we will cover more about this in a future post, "Learn to live one day at a time or treatment to treatment."). Each treatment is contingent on how she tolerates the last treatment and if there is growth.
Currently, Ellie acts more like herself than when she had a 5-centimeter mass growing on her liver. She enjoys chasing the laser pointer and her yarn balls. After her first two treatments, she experienced a few days of loose stools. She's lost much of the fur on her face, the back of her head, and her tail. Her quality of life is good. Right now, she is not showing any signs of giving up (and I watch closely).
I do not know how Ellie's case will end. We know that there are spots on Ellie's liver that developed between her surgery and her first chemotherapy appointment. We don't know if they are cancer; for now, they are not growing. Right? Wrong? There might never be a clear answer. But I feel good about seeking second opinions given Ellie's specific circumstances. I encourage you to trust your instincts, even if one expert doesn't agree, and advocate for your cat's health.
DISCLOSURE:
PLEASE NOTE that we are not veterinarians, nor do veterinarians review our posts. This website is meant to support you and your cat on your cancer journey. Technical or medical advice is beyond the scope of this website. Please ask your veterinarian for advice for your specific circumstances.
Great post, Kat. It's never wrong to get a second opinion, and I'm sure glad you did. Hugs and purrs to you and Ellie (and Latte and The Boy, too)!
ReplyDeleteThis is a great post and should help others make better choices. I agree, always ask the oncologist, they are the specialists. I know human and feline cancer is different, but as you saw from my last post the chemotherapy worked for me. Although the cancer is still there it is now dormant. I had always said I would never have chemotherapy because of the way my mother suffered through it over 40 years ago, but my consultant explained how it had changed since then and they can change or adjust the chemicals, and also as it had spread to my liver it was the only treatment likely to be successful and it was!
ReplyDeleteAs I said earlier, I know human and animal cancer is different, but the basics are there. I wish you and Ellie every success on her journey to better health. Never give up, there were times when I wanted to, but I kept going even though I felt dreadful , but it passes.