“Hi Jo, Can I book Nelson in for a dental please.” Joan’s voice is familiar. She’s a regular and an excellent cat mother.
“Sure. Does Nelson have tartar on his teeth?”
I know her well enough to expect she’s already pulled back Nelson’s lips to check his mouth.
I can see Nelson in my mind’s eye – a big fluffy moggie with broad tabby markings and huge green eyes. Joan and Rob love all 3 of their cats, but Nelson is their pride and joy.
“He’s salivating and a bit off his food which is most unusual for him! He sleeps with us, and his breath stinks!” Joan’s comment makes me smile – not at the state of Nelson’s teeth but at the vision of him sleeping, all fluffed up. He probably uses up a decent chunk of her pillow.
Two days later, our vet nurse and I comment on what a lovely healthy beast he is as he calmly regards us through green sedated eyes. After his intravenous anesthetic, I attempt to insert an endotracheal tube to maintain him on isoflurane anesthetic gas.
It isn’t straightforward to pull his tongue out, and suddenly there’s blood in his mouth.
“Where’s it coming from?” Janelle asks.
“Not sure. Maybe he’s bitten his tongue,” I reply and turn it over to check the underside.
An extensive deep tumor runs along the bottom of Nelson’s tongue. My heart sinks as I check how far back it extends. It disappears into the base where the tongue emerges from his throat. I can see from the way the growth is un-encapsulated that it’s a nasty one. Most likely, it’s spread to the submandibular lymph nodes, which sit a bit further back. We need to check what sort of cells make the mass but it’s doesn’t look good.
The owner of the clinic where I do my surgery is experienced at a range of things, including pathology. Dot inserts a needle to suck cells out of the mass while I expose the tongue’s underside. We put Nelson’s face into a mask to deliver isoflurane to keep him under and wait for Dot to stain up the cells on her slide.
I shake my head in dismay at Janelle.
“How am I going to break this to Joan. It will be the last thing she imagined!”
I leave Janelle with Nelson and peer over Dot’s shoulder while she stares down the microscope.
“A squamous cell carcinoma,” she answers my unasked question.
Unfortunately, as I expected.
I take a deep breath and start to dial Joan’s number. She answers, her voice bright and cheerful.
“How is he?”
“Bad news. I’m sorry.”
There is no reply, so I continue.
“There’s another reason apart from his teeth why Nelson is salivating. He’s got a squamous cell carcinoma cancer under his tongue. We can’t get rid of it without taking his whole tongue out. Even then it’s probably already moved into the nearby lymph nodes.”
“What does all of this mean?” Jean asks. She sounds shocked and distressed.
“It means dentistry is pointless. It would be counterproductive and massively increase the bacteria in Nelson’s mouth. The tumor is already bleeding, and an infection would make it nastier.
I need to gently ask whether she wants to put him down rather than let him wake up from the anesthetic. Jean may want to nurse him at home for a short while. She’s starting to cry.
“I can’t
believe it. Nelson is so healthy. He’s only 5 years old!”
“I know. I’m so sorry. We were just saying how good he looked before we put him under.”
“What can we do?’
“All I can sensibly do is antibiotics and painkillers to keep him as good as possible. He’s probably not got much time left.”
“OK, we’ll come straight in and pick him up.”
I return to the surgery area and use sign language to tell Janelle to let Nelson wake up. But Joan’s husband Rob has come onto the phone. He’s also crying.
“He’s like my son!” says Rob. “If he only has weeks to live, just put him down. I can’t stand to have him miserable. Just put him down. We’ll come out now.”
“OK I say. You are sure?” I ask this because I want them both on the same page and Joan’s last words were, she wanted him home.
“Yes. We’re sure.”
When they arrive, I carry their beautiful cat out, wrapped in a pretty sheet. I show them the mass. Joan is able to look, but Rob is too distressed and turns away.
“Please put his tongue back inside his mouth,” he says.
Quickly, I comply
and wrap Nelson back up. Joan kisses me on the cheek and hugs me tightly before
she follows Rob out of the consulting room.