Sorry you haven't gotten much of a reply here except sympathy from Christine's and mine. I really have little to offer except it seems to me that if you don't do the surgery, she is sure to develop problems with her eye. If you do the surgery you might lose her. Maybe it's worth the risk; only you can decide. Good luck, keep us posted.

PS there is another thread here about removing a cat's eye, older cat. Look for it.

I don't think Meghane has posted for quite some time, maybe busy with her practice.

My own thoughts run to:

If I do nothing, the eye will get much much worse, & my cat will have pain & misery.

If I elect the surgery, she might die under anesthetic.

If she survives the surgery, I'll have her for at least some additional time.

but how much longer will her kidney disease remain manageable, & what are the odds of the heart murmur causing more problems?

At what point am I dragging an elderly animal through medical procedures that are paying diminishing returns (ie, is the extended lifetime worth the pain, stress, & fear caused by the procedures themselves?) for my benefit rather than hers?

Animals don't fear death;

they live in the moment, & if any of the moments are miserable, especially at the age your cat has achieved, I think we have to end their pain, no matter how much pain it causes us.

I'm sorry that I can't give you a definitive answer, & I wish you & your beloved kitty the best.

I am very sorry for what you and your girl are going through. I haven't seen Meg post on this forum for years, I don't think. I'm not a vet, but I have had quite a bit of experience with chronically ill, elderly cats of my own having to go through anesthetic procedures of one type or another. In fact, one of my elderly kidney cats just had his right front leg amputated last Thursday because of a malignant fibrosarcoma on that leg. That same cat was hyperthyroid for 3 yrs before receiving radioactive iodine treatment last November. I also had a kidney cat who was also hyperthyroid have one of his ear pinna amputated due to skin cancer, and he was a year older than your boy at the time. I've also had kidney cats about the same age as your boy undergo extensive dental procedures under anesthesia. All of these geriatrics came out of their procedures just fine with no additional renal damage.

The trick to keeping a chronically ill geriatric feline safe under anesthesia is to make sure the procedure is performed in a surgical clinic that is fully equipped with monitoring equipment (which many private practice clinics are not), and that the procedure is performed by an veterinarian experienced both in the specific procedure AND in operating on chronically ill feline geriatrics. It sounds like you have those bases thoroughly covered. You are running all necessary pre-surgical diagnostics (I don't see why there would be any concern about doing the cardiac ultrasound the day before surgery), and you're having specialists performing those diagnostics and the surgery itself. Just make sure that her blood pressure will be closely monitored throughout the surgery. Also, make sure that they do NOT under ANY circumstances administer Metacam to her before, during, or after surgery. If they are anticipating substantial post-surgical pain, request buprenorphine for pain. If the pain will be mild to moderate, Tramadol would likely be sufficient to handle pain.

The only eye removal I've ever had performed on one of my animals was on a horse. Any post-removal pain she experienced was not even noticeable. So I suspect your cat's discomfort will be limited.

In your situation, I personally would not hesitate to have the eye removed, assuming she is OK'ed for surgery by the cardiologist after the echo. Her kidneys can be kept safe by a competent surgical team using the recommended monitoring equipment.

I wish you and your girl the best possible outcome.

Laurie

My thoughts are with you during this difficult time. My only suggestion, if you have any doubts, is to get a second opinion. I do that by going to a veterinary teaching hospital.

https://www.avma.org/professionaldevelopment/education/accreditation/colleges/pages/colleges-accredited.aspx

I'm sorry you are having to make such a tough decision for your kitty. The only frame of reference I can offer is having a kidney disease/hyperthyroid kitty who we made the very difficult decision to have significant dental surgery done with. I had not wanted to do the procedure earlier because of how frail she was health-wise, but her teeth got to a point where we felt it was necessary to do something. It's that whole risks versus rewards thing. We did not go into it lightly, and I called and asked the vet any question that came into my head, especially in regard to things that needed to be done in advance to keep her safer during her surgery. The vet was great getting back to us with any questions we had.

Did you ask as to whether it would be better to have the echo now versus so close to the surgery? Did you get an answer? If you would feel more comfortable getting the results from the echo and then deciding on how and when to do the surgery, can you do that? I know it is scheduled already, and it sounds like you have wonderful veterinarians, but have they discussed the contingency plan if the results from the echo are not favorable? I say, within reason, ask any question you feel you need the answer to. You may regret it if you don't, but when this is over and your kitty is healing, you won't regret the prep you did. I hope most vets understand the anxiety and stress of putting a beloved pet through this, and will be willing to hear your concerns and answer your questions.

When our cat ended up having her surgery, it was rough- in part because she could not eat well and she was worn out from the surgery. I was glad we did not go into it lightly, but treated it like a surgery for a patient who is compromised. A week or two later when we'd gotten over the rough patches and she was mostly back to normal, we were very glad we did it.

Laurie, I'm so, so sorry about your kitty with the fibrosarcoma. I had a fibrosarcoma kitty years ago and it was a trying time.

Prayers and positive thoughts for all the kitties.

I certainly understand your concerns, and I can not say with certainty that you won't lose her under anesthesia. It is, of course, always a possibility. But if ocular melanoma is as likely as skin melanoma to metastasize (which is something I don't know), that is definitely NOT the way you will want to see your girl's life end. Weigh the risks and benefits, not just for today, but for the next few years. Some cats live into their 20's. I have three who are in their 20's now. One of them is CKD, hyperT, and broke one of her legs at age 19. Another is CKD, hyperParathyroid, and has a mass that is almost certainly malignant in her abdomen. The third is remarkably healthy, though very arthritic. Cats are remarkably stoical and strong. Their will to live is undauntable.

Eye removal surgery is, in my VERY limited experience, a pretty quick procedure that involves minimal disturbance of surrounding structures. I would expect your girl to be under anesthesia for a short period of time and to have minimal post-surgical pain, both of which would substantially reduce risk to her internal organs. Ask the ophthalmologist about this and see if my assumptions are correct. As surgeries go, this one may pose much lower than average risk.

Laurie

I understand what you're going through dealing with the possibility of metastasis. Even though Mew's fibrosarcoma is not typically a metastasizing cancer, it CAN metastasize. His pre-surgical chest x-rays and abdominal ultrasound were clear of gross tumors, but that does not guarantee that there aren't cancer cells still in his system that were too tiny to be visualized on x-ray or ultrasound. These surgeries are calculated risks regarding future malignancies. Like you said, there are no crystal balls ... yet.

Metacam is known to do serious and sometimes fatal damage to the kidneys and liver of some cats. I consider it faaaar too high risk a medication for me to EVER allow used on any of my own cats for any reason. Buprenorphone and Tramadol are narcotic painkillers that are safer for use in kidney cats. A fentanyl patch can also be used for pain, but Mew's surgeon preferred oral bupe or Tramadol because the doses could be adjusted, if necessary. Bupe is considerably stronger in its effect than Tramadol, in my experience using both with my cats. You REALLY need to be very clear with your surgeon about exactly which pain meds will be used on your girl.

Laurie

I didn't realize that there was any such thing as a benign
melanoma, but I sure hope your girl's turns out to be benign. Three weeks seems
like a tremendously long time to wait for a pathology report, though. I'm also
confused about the anesthesia. Why would they say anesthesia for no more than
an hour when the procedure itself is no more than 15 mins? Why would they keep
her anesthetized for potentially an extra 45 mins? These are questions I’d be asking.

Vets use Metacam because, as far as I know, it is the only
anti-inflammatory labeled for any sort of use in cats (bupe, Tramadol, and
fentanyl are exclusively painkillers), though that labeled use does not include
the type of surgery your girl will be having. Still, I don’t permit its use in
my cats. There are far too many reports of serious illness and death associated
or suspected with Metacam. The manufacturer of Metacam also has kidney-related
warnings in its package insert relative to its use in cats. If
the manufacturer is putting these issues in the package insert, I’m certainly
not going to dismiss it. Here’s a link to the package insert. I recommend you
read it in its entirety: http://www.bi-vetmedica.com/content/dam/internet/ah/vetmedica/com_EN/product_files/metacam/Metacam%20cat%20Injectable%20PI.pdf

As far as buprenorphine is concerned, it’s important to note
that ALL drugs come with risks. This is especially true with cats who are, as a
species, drug-sensitive. It’s just another situation where you have to weigh
risks and benefits, and do your due diligence in researching reports of adverse
drug events. Metacam has developed a problematic reputation among many owners
whose cats have suffered adverse effects from its use. As far as I know,
buprenorphine does not have nearly as many reported adverse events associated
with its use in cats. Plumb’s Veterinary
Drug Handbook, the drug reference used by most practicing veterinarians, offers
these precautions relative to bupe’s use, “All opiates should be used with
caution in patients with hypothyroidism, severe renal insufficiency,
adrenocortical insufficiency (Addison’s), and in geriatric or severely
debilitated patients. … Rarely, patients may develop respiratory depression
from buprenorphine; it, therefore, should be used cautiously in patients with
compromised cardiopulmonary function. …”

My animals have been my primary teachers over the decades …
but the Internet comes in mighty handy, too.

Laurie

"There are far too many reports of serious illness and death associated
or suspected with Metacam."

I suspect many if not most of those are due to the fact that vets dont seem to stress how important it is to give metacam after food, it is very dangerous on an empty stomach. My dog had eyelid surgery a couple of years ago and the opthamologist sent her home with metacam (I was very worried too because of the bad reputation it has) and the label did say to be given after food but I think it should have been stressed that it MUST be given after food or it can have deadly effects. my dog was on it for a couple of weeks I think and she was fine with it. It may be very different in cats though?

one of the things I noticed while she was on it is she seemed a bit high, I would catch her sitting around and just staring off in space for ages at nothing at all. If you do go with the metacam, make sure it's never given on an empty stomach. I know of at least one person who lost their dog to metacam because the vet never even told the owner this and kept instructing them to continue and increase the dosage after the dog became ill. I do think it's worth having a good talk to the opthamologist about her pain meds, our opthamologist was fantastic and was always available to answer any questions I had and he was known as the best in my city so even though I was nervous as hell about her surgery, I was confident in his abilities and knowledge and felt I had to trust his judgement, but you have a right to have your fears dealt with before you go ahead with surgery (and even then if you are like me, you'll be pacing back and forth until it's over and you can collect her.)

Dogs are far less drug-sensitive than cats, which is why the
concerns about Metacam are largely centered around the many negative reports of
its effects on cats rather than dogs. It's also why the labeled use for Metacam
in dogs includes both oral and injectable forms, while labeled uses for cats
are for a one-time subQ injection ONLY (though many vets prescribe it in
repeated oral doses despite label warnings against it). BTW, the injectable
form is always administered to cats on an empty stomach, because it is given
pre-surgically when cats are fasted.

Laurie

I don't have any experience with eye surgery in my own animals, and while I generally avoid surgery on my old pets, there is no hard and fast rule. I wouldn't subject a 20 year old cat to time in the pet hospital or surgery under any conditions, but 17 is not so very old by comparison. I wish you and your lovely black kitty all the best, whatever you decide.

I'm not sure I'm correctly understanding what you wrote in your last post, kitcatsinc. Has the ophthalmologist determined whether or not the malignancy has invaded the structures behind the eye? Or is it restricted to the eyeball itself? Or is this something he won't know until after he has removed the eye?

And what is this about glaucoma? I assume this is a completely separate issue from the melanoma. If she doesn't have glaucoma now, is she somehow at increased risk of developing it later because of the melanoma?

I've had cats with Stage 2 and Stage 3 kidney disease live comfortably for YEARS with proper management, so I don't know why you're thinking only in terms of months with your girl. Of course, she may only have months if you don't remove the malignant melanoma and it metastasizes to other parts of her body.

Laurie

I'm understanding the situation a bit better now, but I'm still rather confused about what the surgeon has said about how long it would take the tumor to double in size if not removed. I'm assuming that when he made that comment, he was referring only to the size of the original tumor, and not to the likelihood of metastasis to other parts of her body that I assume could occur at any time and would not be dependent on any specific size of the original tumor. Also, at what size does the surgeon anticipate the tumor starting to cause pain for Lexi? I assume that as the tumor grows and creates more pressure, it will cause her increasing pain.

I've dealt and am dealing with CKD in a number of my elderly cats, and I've dealt and am dealing with various cancers in my cats. Of the two, the cancers have been deadly far more quickly.

Laurie

" labeled uses for cats
are for a one-time subQ injection ONLY"

this is only in the us though, in other countries it is labelled as safe for cats to be used orally and long term (with monitoring). metacam is sold in many countries and the labelled usage isnt the same across the board. IOW, even the manufacturer isnt definitive on some of these things and it's probably about as dangerous as many other pain meds particularly for older animals who may not have perfect health.

From the Metacam package insert I linked above:

"Foreign Experience:
Repeated use in cats has been associated with acute renal failure and death. In studies used for the foreign approval of Metacam 5 mg/mL Solution for Injection in cats, lethargy, vomiting, inappetance,
and transient pain immediately after injection were noted. Diarrhea and fecal occult blood have also
been reported.

Post-Approval Experience (Rev. 2009):
The following adverse reactions are based on post-approval adverse drug event reporting. The categories
are listed in decreasing order of frequency by body system:

Urinary: azotemia, elevated creatinine, elevated phosphorus, renal failure
Gastrointestinal: anorexia, vomiting, diarrhea
Neurologic/Behavioral: lethargy, depression
Hematologic: anemia

Death has been reported as an outcome of the adverse events listed above. Acute renal failure and
death have been associated with the use of meloxicam in cats."

Regardless of how Metacam may be labeled and used in other countries, the above statements in the U.S. packaging certainly does NOT imply that this product is safe for use in cats.

Laurie

""Foreign Experience:
Repeated use in cats has been associated with acute renal failure and
death. In studies used for the foreign approval of Metacam 5 mg/mL
Solution for Injection in cats, lethargy, vomiting, inappetance,
and transient pain immediately after injection were noted. "

If you read my post I spoke of oral use in cats, not injections

"Regardless of how Metacam may be labeled and used in other countries,
the above statements in the U.S. packaging certainly does NOT imply that
this product is safe for use in cats."

so are you saying the US labelling is correct and international labelling is false? who is to say which labelling is right or wrong? it's a grey area at best. im not interested in a debate about it and you obviously have very strong feelings against it and that's fine. you can hold them to the us labelling, but it doesnt detract from the fact that the maker is not definitive on any of this evidenced by the different labelling. It makes no sense that the different labelling in different countries
would mean e.g. that cats in the US are more prone to akf than anywhere else
and US labelling is also not likely to be more or less right or wrong than other
countries - it is what it is and what we make of it I guess. just something to ponder. as I said Im not interested in a debate, i think caution needs to be used with all medications, and especially in older animals no matter what the medication. peace out.

I'm saying that I can see absolutely no corporate logic in shooting themselves in their U.S.-based feet by putting such unequivocal and frightening statements in their package labeling if the information was not true and validated. I can't imagine that even the FDA has the authority to force a company to put blatantly false and financially damaging information in a package insert. So yes, I am saying that the U.S. labeling is correct. I can not comment on international labeling, since I have not yet been able to find a copy of that labeling to review. If you have a link to the international Metacam for Cats label, please post it.

Laurie