Every time I go to write this post, I pause and consider writing something else instead, something easier. But I can't put this off any longer because I remember how I felt the day I got Flip's diagnosis. I scoured the Internet looking for information and found an abundance of medical theses from veterinary students (and doctors) about the disease and it's incredibly low survival rate.
What was lacking was any sort of human writing about how to get through feline oral squamous cell carcinoma (or SCC, as I'll refer to it from here on out). No stories, no pieces of advice, nothing from real pet owners. Seth did manage to find one blog post written by a real person. It was real and raw and did upset me in the moment but it was great to read nonetheless. Reddit also had a few threads about SCC that helped me understand the disease and what it would soon do to my Flipper.
Here is our story.
Sweet Pea and Flip, a few days before I noticed the visible lump on Flip's chin.
In April, just after Seth's birthday on the 2nd, I noticed a hard bump under my 15 year old tabby's chin. Flip didn't seem too bothered by it but I thought it best to get her checked out. I called the vet and told them about the lump but their sense of urgency wasn't there. All the vets were busy and I think I got in with someone the following week.
Ten or so days later, Flip got a biopsy. A few days after that, the result. SCC.
The vet called to tell me about the diagnosis. She was frank. She said the disease is not survivable and that I could get some strong pain medication to last until the day Flip would die. Or, I could explore treatment options that would at best, give me a few more weeks.
I can't tell you how upset this made me. I personally don't like feeling out of control in any way, shape or form. I'm a perfectionist who is in active recovery, but that's a whole 'nother blog category. In this moment, I felt worse that I had in years.
Flip, day of diagnosis. April 20, 2020.
The next few days were so hard. I continued to do online research and I realized that she wouldn't make it more than 90 days if I was lucky. Without palliative treatment, I knew she'd die right-quick and I wasn't ready for that. So, I pursued treatment options, even though part of me felt selfish for doing so.
April 28th was my appointment with Dr. Arkans at Chicago's MedVet. The call was virtual since we couldn't go see him in person due to Covid. He was able to see Flip's mouth on camera and could see how her jaw looked. By now, she'd developed "pirate mouth" – basically the tumor was on her lower left mandible, along the gum line and below her tongue. The tumor was growing fast so her typical facial expression looked like that of a pirate saying "arrrrrr."
He offered me a treatment option called palliative radiation. The treatment would be 4 weeks long. On the first visit, Flip would be put under anesthesia and the doctor would inspect her mouth. Then, he'd set up a laser of sorts right over her tumor. She'd be blasted with radiation for a bit (I can't remember how long) and then given time to wake up under supervision. I would come pick her up after about 8 hours.
There would be 3 follow up sessions where she'd get the radiation again but these sessions were shorter since the radiologists had the laser all set up and ready. I would usually pick her up between 1-2pm on those days.
In total, the treatment was 4 weeks long. Plus the included doctor visits, the cost was $5,000.
In addition, Flip was on several prescriptions – Oncior (Robenacoxib), which is a tablet for cats that helps with inflammation. She also received Gabapentin 2x per day to help with pain. Towards the end of her journey, the pain medication was upgraded to Buprenorphine, but we'll get to that part later.
I decided to do the palliative radiation treatment.
In my research, I didn't find any blog posts from pet owners about this route. I decided to do it because 1) at the time of diagnosis, I couldn't believe it was real and I wanted to give Flip a chance to beat it (even though only 1% or so of cats ever do) and 2) I wanted more time with her. I took a few days to think about if I wanted to pursue treatment and deep down, I could feel that I did. I do think this was the right path for Flip and I, but I'm not sure I would do it again if this happened to another cat (more later).
So, first week of May, treatment began. Flip is a tough cat. Those who've met her know that it takes a long time for her to trust anyone and if she doesn't trust you, she's fiesty as hell. MedVet techs confirmed her fiesty-ness, as she would bat and hiss at everyone she encountered. Some said her fiery attitude made her a great candidate for treatment. She certainly wasn't soft in any way.
The radiation did end up shrinking her tumor, which was a huge positive for me. By the end of May, treatment was over. The Dr told me to call him if things took a turn for the worst and we scheduled a follow-up for about a month out.
April and May were tough months. It took me that long to accept that she was actually dying from cancer. I spend every day with her (luckily we were in quarantine so I got even more time with her). I talked to her constantly, took tons of pictures of her in hopes of saving every moment. I'd tell her how grateful I was to be her mom. We'd snuggle on the couch at home or I'd bring her to my store. I painted a portrait of her. I cried alone in the shop's bathroom. I texted my good friend who was all too familiar with loss and grief and she gave me incredible advice. So many people came forward on Instagram with their own stories and messages of love and support. Flip got tons of presents in the mail – mostly treats which she gobbled up despite having jaw cancer. I cried at home too, randomly. Seth was always there to listen and give me a hug. I had never, ever felt so lost and hopeless as I did during the month of April 2020. In many ways, that month was worse than her actual death.
During the height of my sadness (and anxiety, since I was aggressively fighting feeling sad at every turn), I decided to get Flip a toy that I could keep after she was gone to remind me of her. I found the toy at 4Legs Pet, just down the street from my own shop. It was an orange starfish. Orange was the color I always thought of for her, so I got it. She used it as a pillow during her illness and I caught her snuggling with it a few times!
The month of June was pretty uneventful as far as Flip's health was concerned. But the Dr warned me that the cancer would come back and that the smaller tumor was only temporary. I continued to bring Flip to the store. I sat outside on the porch with her because she loved that. Every night, she slept on the pillow behind my head. She'd done this for years. We called her my "hat."
The second week in July, Seth pulled me aside. He thought Flip's jaw was looking worse and he asked me to face the music. I had gotten used to me and Flip's routine and I think I had refused to see that indeed, she was getting worse.
I set up another appointment with Dr. Arkans and he confirmed what I'd feared to face. The time was here. The tumor had come back and this time, no treatment would do anything for her. He told me it had certainly gotten more painful so we scheduled her to be put down on July 27th (one week away) and he prescribed her Buprenorphine.
The Buprenorphine definitely gave Flip bursts of energy that I hadn't seen in awhile. They say it's because her pain was eased, so she felt better and more active. This broke my heart of course. We had one week to go.
That week, Seth and I brought Flip to the park several times. I gave her anything she wanted to eat, including hard food and treats. She ate them gleefully, ignoring the fact that she had a tumor in her lower jaw. That week was incredibly sad and anxiety filled because I knew what was to come.
Winnemac Park, July 21, 2020
Last day at the shop, July 25, 2020
The morning of Flip's departure from this earth, I got up at 5am. I had my coffee on the porch with her and watched the sun rise. I gave her an entire bag of treats. At 9am, Seth and I dressed up and brought her to MedVet one final time.
I think she knew we were going there. Cats have such good intuition, somehow she knew. She meowed the entire way to MedVet. Once we got there, they showed us to a small room where I filled out some paperwork and selected Flip's cremation options. I chose to have her cremated alone and her ashes placed in a white, ceramic vessel that looked like a cat. I picked that vessel because it didn't look like death and because Flip meowed when I turned to that page in the catalog.
By now, they'd brought Flip back to me. They told me we could stay all day with her in that room but I felt like I was going to vomit if I waited any longer. I told them to move forward with the injection.
Flip sat on my lap and Dr. Arkans got ready to administer the first of two large injections. The first would relax Flip and the second would be a huge dose of anesthesia that would stop her small heart. Flip hissed and batted at him one last time as he put the first injection in. I told her I loved her as her body went limp. Dr Arkans took her away right after that.
The moment I stood up from that couch, I felt light as a feather. A huge weight had been lifted. I knew she was okay. She wasn't suffering any more.
That day, we took off work and went to the botanic gardens. I read emails from friends and family who knew Flip. All shared memories of her. We had dinner at a nice restaurant. Then, we picked up our three other cats and brought them to my shop where we hung out for a bit. Anything to avoid going home.
The first day at home without Flip was so hard. I didn't think I'd get through but by the end of the week, the pain wasn't so intense. I knew I'd done everything in my power to give her a chance. The treatment gave me more time with her and made her ultimate departure much less painful than if it had been a sudden loss.
That said, I'm not sure I would opt for palliative radiation again. Maybe I would, I'd have to actually be in the situation to know, but I feel like I might forgo it. The reason is because I know I can get through the loss of pet now. Before Flip died, losing my cats was one of my biggest fears. As a pet owner, you know that day will come but being the one to decide when to put your pet down, and dealing with a terrible illness at that – those things showed me an inner strength I didn't know I had. SCC killed my cat, Flip. Radiation helped her and prolonged her time but that's all it did. It didn't save her life. While I have no regrets about doing it and it was absolutely the right decision this time, I know now that I can get through the illness and loss. If it were to happen to Sweet Pea tomorrow, the chances of me doing treatment are far less.
Flip (and the loss of Flip) changed me in a big way, in ways that are still in motion right now. It has been 6 months since I let her go and I feel that her illness and departure has opened me up emotionally. I still struggle with hard feelings like sadness and low self worth, but Flip showed me I can get through them. Her illness made my sadness see the light, I couldn't hide it inside. I cried so much during the three months she was sick. I am stronger because of the whole situation and I learned a lot about myself, Flip, and the human condition in the process.
If you are reading this right now because you've just received the devastating diagnosis of SCC for your pet, just know it will get easier eventually. From one pet owner to another, it will get easier. I promise.
Flip "The Dip" Hawthorne: May 14, 2005 - July 27, 2020
Memorial tattoo of Flip and her (still living) sister, Sweet Pea. January 4, 2021.
If you have any questions about SCC, palliative radiation or the loss of a beloved pet that I haven't covered here, please do not hesitate to contact me via email at firstname.lastname@example.org
Huge thanks to Dr. Arkans, Kelsey, and the compassionate team at MedVet Chicago. You were an invaluable part of Flip's journey. No words can ever express how grateful I am for you.
A book that really helped me during this time: Being Mortal by Atul Gawande.