Visiting Vet: Loving Lily

When surgery is the last resort.

Lily and Priscilla. — MJ Munafo

Florence lived in Woodside Village. When her old cat Lovey died in 2006, her daughter, M.J., took her to the MSPCA to find a new companion. “Mom was very frail, and was losing her sight due to macular degeneration,” M.J. told me. “She and I sat in the cat room for an hour or more. I thought, The first cat who jumps up and sits on her lap, doesn’t scratch but does purr, will be the one. That was Lily. She was (and is) a petite, gorgeous, long-haired (very soft) cat.”

Not long after, Florence fell and broke her hip. When it became clear she would have to “rehab” in Windemere for several months, M.J. knew they couldn’t leave Lily alone all that time. Lily moved to M.J.’s house, joining Kastor, Pollux, and Rosalita, their three other cats at the time. Eventually Florence adopted another a cat to keep her company at Woodside, a calico, longhair, part–Maine Coon named Queen Priscilla, but Lily remained at M.J.’s.

Over the years, Lily developed a heart murmur, but since she was feeling fine, the family opted not to pursue a cardiac workup and to just monitor her. Then, last year, Lily developed a growth deep inside her ear. It looked like a little piece of pink cauliflower peeking out. It didn’t seem to bother her much, and might not have been a big issue … except Lily would scratch. The growth would bleed. Lily would shake her head, and blood would splatter everywhere. Walls. Ceiling. Think Jackson Pollock. Or “Psycho.” Not an easy situation to live with.

I had reservations about anesthetizing Lily to remove the mass, concerned her cardiac disease might increase the risk. In addition, ear masses like these, though often benign, can be difficult to excise completely, frequently growing back. For a few months we managed the situation by treating secondary bacterial infections as needed and, when she had a bleeding episode, packing the ear with “hemostatic sponge” — a product that helps stop hemorrhage. It soon became clear this was not a long-term solution. The mass had grown larger. The bleeding episodes were occurring more often. What to do?

“The most definitive treatment would be total ear-canal ablation,” I told M.J. Abbreviated TECA, total ear-canal ablation, is an aggressive surgery that essentially removes the entire external ear canal. It is most commonly done on dogs suffering from such chronic, severe, painful ear infections that they are actually better off having the canal ablated. Considered a “rescue” surgery, it is usually not recommended until all attempts at medical treatment have failed. Owners have to be prepared for complications, which may include a change in cosmetic appearance, hearing loss, damage to the balance system resulting in loss of equilibrium, and damage to the facial nerve, resulting in facial palsy. These can be temporary or permanent.

Before considering referral for this radical (and pricey) surgery, we decided to determine if the growth was malignant. If this was a nasty cancer, it might change the prognosis and affect our decision on how to proceed. Ear masses like this often grow on a “stalk,” and are very friable — i.e., they break apart easily. We were able to “debulk” the growth without anesthesia by simply scooping underneath and gently pulling. This did not remove the root of the mass, so it was bound to regrow, but gave us enough tissue to send for biopsy. As suspected, it was a ceruminous gland adenoma — a benign tumor that originates from wax glands in the ear lining. The prognosis was great, if it could be completely removed.

I consulted specialists. One suggested laser surgery. A fairly quick procedure, this would be relatively inexpensive, and much less invasive than TECA. It would still require general anesthesia, but not for as long. A cardiac workup first was suggested, but not required. Lily’s owner decided laser was worth a try. The procedure went well. Lily came home, no longer splattering blood all over the house … but two months after the operation, the dramatic bleeding began again. Within five months the mass had regrown to its previous size. TECA was really the only solution.

Lily was almost 13 by this time. She had a significant heart murmur. How long was she likely to live, considering her cardiac disease? Could she even survive more surgery? The board-certified veterinary surgeon strongly advised assessing her heart thoroughly first. The cardiologist diagnosed mild to moderate hypertrophic obstructive cardiomyopathy, prescribed medication, and said he felt that Lily was not too high-risk for the surgery. Two weeks later, Lily had a total ear canal ablation. Surgery went well. She tolerated the anesthesia beautifully. The regrowth was biopsied and still found to be benign, despite having grown back so quickly. Because the entire canal and lining was removed, there should be no chance of the tumor growing again. Long-term antibiotics were prescribed to eliminate risk of postoperative infection. The hardest thing was the three weeks after with an Elizabethan collar, to prevent Lily from scratching while it healed.

I removed the stitches last week. It looks beautiful. Should we have pushed for TECA sooner? I don’t know. It really is considered a “salvage” surgery, a last resort. On the other hand, as surgeons say, “A chance to cut is a chance to cure.” In any case, in the end, things seemed to have worked out as they should.

“Priscilla turned out to be the best cat in the world for Mom, “ M.J. writes me. “She never left her side, sat on the arm of her chair, and slept on the bed. She was lying in her place next to Mom when Mom died in September 2012. A few days after, she came to live with us and Lily. Both of these [cats] were perfect for Mom — so soft, especially when Mom’s sight was gone — and now here we are all together. I love them both, and love that they brought Mom such joy.”