Complete Care for Your Aging Cat

by Amy Shojai

  —mimics the signs of a brain tumor, but the symptoms of a

  stroke typical y improve over time. Symptoms due to a brain

  tumor tend to get progressively worse. An inflammatory disease,

  such as encephalitis, can also cause these signs, and

  sometimes a spinal tap or test for antibody levels in the blood

  (titer) wil be checked for specific diseases.

  A general neurological workup may include an MRI—magnetic

  resonance imaging—that shows the veterinarian the inside of the

  brain to determine if it’s structural y abnormal. “It’s pretty

  straightforward now that we have the imaging techniques,” says

  Dr. Klopp.

  Senior Symptoms

  Symptoms of a brain tumor are vague and vary according to what

  part of the brain is affected. Symptoms may grow progressively

  worse, or very suddenly turn bad. Watch for:

  Seizures, by far the most common symptom, which are

  typical of the forebrain

  Any behavior change, often similar to cognitive dysfunction

  symptoms

  Head tilt, weakness, circling, or muscle atrophy on one side

  of the face, typical of tumors of the brain stem.

  Treatment

  Owners of pets diagnosed with brain tumors may opt either for

  pal iative care—keeping the cat comfortable perhaps with anti-

  seizure medication until the end—or treating to get rid of a tumor.

  Surgery, radiation therapy, and chemotherapy from the cancer

  arsenal may be helpful, alone or in combination. Surgery is

  usual y the treatment of choice.

  “I don’t see people who aren’t committed,” says Dr. Klopp.

  “They say, I just want it out. I want to know it’s not growing in my

  cat’s brain.” The nice thing about cat brain tumors is they can be

  treated and after surgery they don’t tend to come back.

  “Frequently they can be considered curable,” says Dr. Klopp.

  “Cats can live for years after having a meningioma.” Because

  most patients are already senior citizens, adding two or more

  years of quality of life is a significant benefit.

  The drawback with surgery is that it can be expensive. “You’re

  talking about a pretty big emotional and financial commitment for

  the owner,” says Dr. Klopp. While radiation or chemotherapy is

  an option, she says she’s not had much luck with chemotherapy

  for brain tumors in pets. “It’s not my first choice,” she says, but

  she wil offer it as adjunct therapy or if clients can’t afford or don’t

  want surgery. “It depends on the client and patient individual y. I’m

  not going to offer brain surgery to every single case that has a

  brain tumor. The goal is to give them back a happy quality of life,

  and if I don’t think I can do safely, I’m not going to offer that.”

  It can be difficult to avoid damaging normal tissue with

  radiation therapy. Yet an innovative method is now available at

  University of Florida’s Evelyn F. and Wil iam L. McKnight Brain

  Institute. The system uses a three-dimensional ultrasound

  guidance system to pinpoint the location of the tumor, and target

  radiation beams precisely, while sparing the surrounding tissue.

  With the new technique, pets can be treated in one high-dose

  treatment, rather than through repeated sessions over a period of

  weeks. Radiation therapy requires anesthetic to keep the pet in

  the proper position, so the single treatment session avoids the

  repeated doses of anesthesia that is a concern in geriatric cats.

  The procedure costs roughly the same as for traditional veterinary

  radiation therapy, but a limited number of animals may be eligible

  for subsidies or free fol ow-care and imaging.

  “So far we’ve done a total of 22 animals, including both cats

  and dogs,” says Nola Lester, BVMS, a clinical instructor in

  radiology with the University of Florida Col ege of Veterinary

  Medicine. “In some cases we’ve seen fantastic results and the

  tumor completely disappears. In others, this is not the case.”

  Bottom Line

  “I’m probably pretty cheap,” says Dr. Klopp, of University of

  Il inois. “The majority of the cost is the after care.”

  · Most of brain tumor surgeries performed by Dr. Klopp, with

  fol ow up care, run about $2,000.

  · Traditional veterinary radiation therapy costs approximately

  $2,200, thought the amount varies in different parts of the country.

  Golden Moments: Fixing Phantom’s Pain

  Phantom, a beautiful blue Persian show cat, had just

  celebrated his eleventh birthday two years ago when his owner

  Judy Miley noticed a problem. “When I showed him in the

  American Cat Fanciers Association (ACFA) he was the third

  best cat in the nation,” says Judy. “You get real y close to your cat

  when you travel with him al the time. He’s just one of the family.”

  So when Phantom suffered a seizure, she was concerned.

  “My vet real y didn’t know what was causing them, and said just

  keep an eye on him.” Medication was an option if the seizures

  became frequent, but Phantom only had one more in October—

  and the five-month interval between the two episodes didn’t cal

  for drugs.

  “Then he started acting odd,” says Judy. “He’d give me very

  low, deep in his chest meows, tel ing me ‘Mom, help me,’ and he

  started hanging his head way down low when he walked, as if he

  had a terrible headache.” Yet another set of X-rays of Phantom’s

  head stil didn’t reveal any problems. The veterinarian knew

  something was wrong but didn’t have the proper equipment to

  find out. Judy, who lives in Lafayette, Indiana, told her vet, “I’l do

  anything to try and find out what’s wrong with him.” Because no

  neurologist was available at the veterinary school at Purdue

  University, right across the river, Phantom was referred to

  neurologist Dr. Lisa Klopp at the University of Il inois.

  In early November, Judy and her husband Fred traveled to the

  school for Phantom’s appointment, and Dr. Klopp gave the cat a

  ful neurological exam. Dr. Klopp stil found nothing, but she

  recognized that Judy and Fred knew Phantom best, and that

  something was surely wrong. “She offered to do an MRI on him to

  see what we’d find,” says Judy. The test would cost $380.

  They left Phantom overnight for the test and drove home.

  The next day, Dr. Klopp cal ed that she had the results, and Judy

  returned to the clinic, this time with her daughter, Denise, for

  moral support. “Denise is an RN, and she loves this cat, too. And

  she knows how I feel about my cats.”

  The MRI—magnetic resonance imaging—clearly showed

  that Phantom had a tumor in his brain. “My daughter and I both

  sat there and cried. It was terrible,” says Judy. The tumor was

  also producing fluid that encompassed three times the space of

  the tumor itself. “It was pressing his brain outward into his skul ,”

  says Judy. Phantom’s tumor, shaped like a cone, was located

  between the two spheres of his brain. The fluid it produced fil ed

  the space between and was splitting the t
wo spheres apart.

  Certain kinds of brain tumors have a better prognosis than

  others, but the MRI didn’t diagnose what type Phantom had. A

  biopsy—analysis of tissue from the tumor—would be required

  and that would require surgery. At the same time, as much of the

  tumor as possible would be removed. “Dr. Klopp said the surgery

  would cost between $2,000 to $3,000.”

  The proposed expense rocked Judy, but she was more

  concerned about potential surgical risk to Phantom because of

  his age. “So we thought hard about it for a short time, but then we

  said yes. Do what you need to do. See if you can help him and

  give him a chance.”

  Phantom stayed overnight, and his surgery was performed the

  next day. Unfortunately, the tumor was in a position that made it

  impossible to remove. Only enough was taken for the biopsy, but

  Dr. Klopp was able to extract al of the fluid and relieve the

  pressure on the cat’s brain. “We had to wait for the biopsy tests

  to come back,” says Judy. It was good news. “It was a

  meningioma. And it was nonmalignant.”

  The whole family was relieved at the news. Phantom stayed in

  the hospital for only three days and was ready to come home. Dr.

  Klopp explained the further treatment options available to

  address the tumor. Radiation treatment was suggested as the

  best option. It would include anesthesia each time to ensure the

  exact same spot was targeted.

  The radiation would run $1,300 to $1,500 on top of the surgery.

  The estimated final bil , including surgery, radiation, medications

  and exams, would be about $5,000. “My husband and I said,

  absolutely. Go ahead. Let’s see if we can stop the growth of that

  tumor and the production of the fluid.”

  Radiation treatments began right after Thanksgiving.

  Phantom stayed at the hospital, undergoing 16 sessions of

  radiation, one for every day of the week—and came home to be

  with Fred and Judy on weekends.

  Being away from home was rough on everyone. Phantom

  didn’t want to eat when he was at the hospital, and he dropped

  from 10 pounds down to 6 ½ pounds during the treatment

  regimen. “Dr. Klopp would bring him turkey and ham, feed him

  baby food and try to get him to eat,” says Judy.

  The final treatment occurred right before Christmas. Before

  Phantom went home, Dr. Klopp did a second MRI to check the

  status of his tumor. It was the same size, but the treatment had

  prevented any return of fluid.

  Judy worried that with al of the invasive treatments, the

  sweet personality she loved about Phantom might somehow

  change. The biggest problem, though, was the food issue.

  “Phantom acted like he was absolutely starving, but he forgot

  what to do and how to take it into his mouth,” she says. But once

  the anesthesia was ful y out of his system, he started eating

  again.

  That was almost eight months ago. “Now he’s back up to

  almost eleven pounds,” says Judy. “He doesn’t hang his head

  anymore, and he runs and plays with my other cats. He’s like he

  was before anything ever happened.” Phantom’s most recent

  MRI, performed at the end of July 2001, showed the tumor in his

  brain had shrunk, and only a tiny, insignificant amount of fluid

  remained.

  At the time of the surgery, Dr. Klopp wouldn’t guess at

  Phantom’s prognosis. After his surgery, and the biopsy, she

  estimated he’d live at least a year or more—but there was no way

  to tel . Now that the radiation treatment has been so successful,

  “She’s not putting any time limit on him at al ,” says Judy. “We’re

  going to do another MRI in the spring to keep an eye on it.”

  Other than the tumor in his brain, which no longer causes him any

  problems whatsoever, Phantom’s health is excel ent. “They find

  nothing wrong with him,” says Judy. “His treatment was worth

  every penny. I’d do it again if I had to, if only to take him out of his

  pain.” After al , at 11 years old and counting, Judy says every

  single day is a gift.

  CANCER

  Feline cancers can strike at any age, and the kind that is often

  associated with feline leukemia virus (FeLV) and feline

  immunodeficiency virus (FIV) tends to strike young to middle-

  aged cats. But cancer mostly strikes older cats, and 80 percent

  of tumors found in cats are malignant. The Veterinary Cancer

  Society says cancer accounts for nearly half of the deaths in cats

  over the age of ten.

  Cats can develop many of the same types of cancers that

  affect people, but some are more common. According to

  veterinary oncologist Carolyn J. Henry, DVM of University of

  Missouri, the most common sites for feline tumors are 1) lymph

  glands, 2) skin and subcutaneous and 3) mammary tissue. The

  most common of the skin and subcutaneous tumors, in

  descending order of frequency, are basal cel tumors, mast cel

  tumors, squamous cel carcinoma, fibrosarcoma, and sebaceous

  hyperplasia and adenomas.

  “Owners of cancer patients are in a state of shock,” says

  Barbara Kitchel , DVM, an oncologist at Michigan State

  University. “It’s the C word, the chemotherapy, the horror, the

  fright.” The good news is that a number of cancers can be easily

  treated, some can be cured, and in al cases, treatment can help

  maintain the cat’s quality of life.

  Nearly 90 percent of lymph gland cancers are caused by FeLV,

  and affect the lymphatic system and blood cel -forming organs

  such as bone marrow and spleen. Skin cancer, the second most

  common types, usual y affects the face and head, often due to

  overexposure to sunlight. Fibrosarcoma is a malignancy of the

  connective tissue of the body, with a wide range of subtypes—

  col ectively referred to as soft tissue sarcomas. Vaccine-

  associated fibrosarcomas are included in this category. Breast

  cancer is also very common in cats, and Siamese are reported to

  have twice as much risk as other breeds. Other common old-cat

  cancers include digestive tract tumors, oral tumors, and bone

  cancer.

  Senior Symptoms

  Signs of cancer vary from type to type depending on what part of

  the body is primarily affected. In general, the Veterinary Cancer

  Society lists ten common signs of cancer:

  Abnormal swel ing that persists or continues to grow

  Sores that do not heal

  Weight loss

  Loss of appetite

  Bleeding or discharge from any body opening

  Offensive odor

  Difficulty eating or swal owing

  Hesitation to exercise or loss of stamina

  Persistent lameness or stiffness

  Difficulty in breathing, urinating or defecating

  The cel s of the body die and are replaced al the time in a

  normal process cal ed mitosis, in which a cel divides into two

  identical cel s. Sometimes the new cel s mutate for unknown

  reasons. Instead of duplicates of the parent cel , abnormal, fast-

  growing cancer cel s take the place of healthy one
s and interfere

  with normal body functions. A breakdown in the immune system

  can al ow tumors to grow either in one isolated place (cal ed

  benign) or proliferate throughout the body (malignant).

  Occasional y certain families of cats show a predispositions for

  cancers, but these show up pretty early in the cat’s life. Cancers

  are more likely to develop as a consequence of a lifetime

  accumulation of injuries or insults, says Dr. Kitchel . “We’re

  seeing the extremely old geriatrics, like the nineteen-year-old

  cats that come in with cancer,” she says. “We tend to see more

  carcinomas in the elderly, maybe because carcinomas appear

  most often in epithelial tissues [such as skin].” Skin, lungs, and

  bladder tissues are more likely to be affected by contact with the

  outside world, so damage from the sun over a lifetime ultimately

  causes old-age cancer.

  There’s added concern with geriatric cats. “When you reach

  that advanced age, you lose a lot of reserve capacity in a variety

  of your organs, like your liver and kidney function,” says Dr.

  Kitchel . “We have to be so careful with what we try to give to very

  geriatric patients when we try to treat them.”

  Encouraging news from researchers at Purdue University

  suggests that the “oldest-old” among pets, similarly to very old

  humans, seldom develop lethal cancers.

  Cats that don’t develop cancer until very old probably have a

  better chance of surviving it because of the same extreme good

  health that has al owed them to live so long. “Just because they’re

  old doesn’t mean they shouldn’t be treated,” says Susan G.

  Wynn, DVM, a certified veterinary acupuncturist in Marietta,

  Georgia.“If you take, for instance, a twelve-year-old cat with

  lymphoma, we’ve had lymphoma cats live another four years or

  longer.”

  Reducing Risk

  Many feline cancers are associated with feline leukemia virus

  (FeLV) and feline immunodeficiency virus (FIV). A number of

  preventative vaccines are available for FeLV, but it has taken

  many years to develop similar protection against feline AIDS.

  Dr. Niels Pederson, DVM, an international authority on these

  viruses at University of California-Davis, and immunologist Janet

  Yamamoto, a professor at University of Florida, first identified FIV