Thursday, March 9, 2023

Bette Davis Develops Nerve Sheath Tumor Rear Along Spine

Bette Davis was seen in January for rear leg lameness, immobility of the tail, and difficulty going to the bathroom. I posted about it at that time. She was treated with antibiotics and prednisolone. By the end of January, she had finished the course and had fully recovered her mobility and ability to go to the bathroom. But two weeks later in February, she developed bathroom issues so was put on prednisolone 1ml once a day. That worked fine until March when March 6 she suddenly showed signs of rear leg lameness again. We had an appointment for Wednesday March 8 by which time she had gotten weaker, had again developed bathroom issues-inability to urinate or defecate fully. This time we opted for an MRI because she could have spinal cord or vertebrae injuries or lymphoma-although her gastro scan did not show signs in her organs of lymphoma (although it can appear elsewhere.) Both respond to prednisolone to reduce inflammation. 

Today, March 9, was the MRI. Unfortunately, she has cancer but one we did not think about-Nerve Sheath Tumor. It is growing along the nerve on the left side of the spine but growing into the right side of her rear limb which is why she is weak in the rear legs but has significant discomfort in the right rear leg. It has also made her numb in the rear end and rectum area, making it difficult to urinate and defecate. 

The solution short term is to increase the prednisolone to 1ml BID for the rest of her life. She cannot increase the amount of the prednisolone even as she might grow weaker and have more difficulties going to the bathroom because then immune suppression issues will develop, leading to other various health issues that are even more serious. 

Radiation is a possibility but expensive: the vet estimated $7-10k. We have been referred to Oncology at the state vet school and might hear from them next week. At the consultation, we will learn more. How will we pay for it? From savings, investment account from which we can borrow without penalty, CareCredit, credit cards. But how often will she need treatment? And we have four others, three of whom are her siblings and the same age with their own issues (Katharine has HCM now.)

There is no surgery possible as far as we know for her tumor.

Diapers and rear leg lameness might also be in the future. There are plenty of cats on social media that do both and seem to live happy lives. BUT with her nerve cancer, pain will be an issue and pain meds will be needed in the future. BUT it is likely not life threatening the vet said and she could live a normal rest of her life existence. But then again, he gave her a year before her life was impacted and that is when people tend to put cats to sleep. 

We prefer not to do that especially after we lost Baby by putting her to sleep without fighting for her life (in 2021 she had been in the ER for a week dying of acute pancreatitis and I failed to bring her home to either try to get her to recover or let her die at home.) I don't want to run the risk of letting Bette go too soon just because taking care of her isn't easy, just because she can't easily move around if she can manage. I must decide how I want things to end for her so that I'm prepared. I was so prepared for Myrna's death in 2015 after six years and nine months of facing the fact. But I was so caught off guard with Cooper (who lived five months after being diagnosed with heart disease) and Baby that I still feel a lot of shame and heartbreak.

Here is one link to one explanation. You can Google for others if interested. 

"...Nerve sheath tumors (NSTs)...are benign or malignant mesenchymal tumors and they originate from periaxonal Schwann cells (schwannoma) and fibroblasts (neurofibroma/neurofibrosarcoma). Due to its mesenchymal origin the terminology for NSTs is diverse and a wide range of names has been used in the literature, e.g., neurinoma, schwannoma, neurofibroma, neuro(fibro)sarcoma, neurilemmoma, neurogenic sarcoma, and neurofibromatosis. Currently the most widely used name is nerve sheath tumor...NSTs may occur in every large or small nerve in the body...grow outside the dura mater (extradural) they may extend along the pathways of the nerve roots into the intervertebral foramen. Once inside the spinal canal they may develop an intradural-extramedullary component or even an intradural-intramedullary component (Figure 1). Clinical signs include severe, unexplained, and intractable pain, thoracic or pelvic limb lameness, monoparesis, ataxia and proprioceptive deficits. Early diagnosis and an aggressive surgical protocol maximize the possibility for complete tumor resection sparing the limb. NSTs have a high rate of recurrence, and the overall prognosis is considered poor..."


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