Diffused iris Melanoma

I have been concerned with a freckle in my cat's eye. It grew quite large but her vet told me not to be concerned that it was age spots. I never felt comfortable with that but did not know there were optical vet specialists or I would have consulted one. Fast forward to a year later and my cat was diagnosed with diffused iris melanoma yesterday. They Vet had me rush to a same day appointment to the specialist who confirmed her fear. then I rushed back to the original vet for chest e xrays and blood work, a small relief they turned out fine. When I went back to the specialist the same day to pay with a check and set up surgery I was told there is nothing open until Thursday which is a week from now, which confused me since they just had me urgently rushing back and forth during rush hour traffic to get everything prepared. My regular vet showed concern about the time and said she could do the surgery on Monday. I am left with so many questions and cannot speak to the specialists I first saw because I cannot get past his front desk staff. I am now confused as to whether I should have the surgery done asap but a regular vet or wait a matter of 3 days for a specialist but I have been told that if the tumor starts to break through the eyeball it will spread quickly. The specialist also have the option to put a silicone ball in the lid before they sew it closed which the regular vet does not do. Finally to make things more confusing, the original reason a took her in on Wednesday was to check her thyroid problem as she has lost almost 3 pounds in a year but wants to eat often, has been a bit mood swingy. I don't think this got addressed unless it would have showed in the blood work. So I guess I have 3 questions.

1. Is it worth waiting a few days to have a specialist do the operation or have it done as soon as possible with her regular vet?

2. Does a silicone ball sewn shut in her eye help or make a difference?

3. If she does have a thyroid problem that did not get addressed how will this affect her under anesthesia?

If someone can provide insight we would be eternally grateful.

Thank you, Angel

Optional Information: 
Type of Cat: stray from mexico but striped and colorful
Cat's Gender: Female
Cat's Age: 14
Cat's Name: Chupie the Chupa Cabre

I wrote a reply to you, but it didn't post for some reason.

1. My Silly had her eye removed by my regular vet. If there had been a specialist available, I probably still would have used my vet. I have been using the same one for almost 20 years and trust her completely.

2. Silly has the empty socket, and it kinda freaked me out at first. Now,  she just seems normal to me. It is more of an esthetic thing than medical to put the silicone ball in.

3. The vet should have addressed the thyroid problem. If you take her in Monday, be sure to talk to the vet about it first. If you go with the specialist, call him Monday and make sure he knows about the problem.

Welcome to the forum, dreamkittykitty!

I'm currently dealing with Iris Melanosis in one of my kitties.

Iris Melanosis occurs fairly frequently and most often it's a benign condition. "Melanosis" is the pigmentation, the spots you are seeing. The only conclusive diagnosis of melanoma is one done by a pathology lab after the eye is removed - make sure you have that done, btw.

There are some signals that would indicate a liklihood of melanoma....if, with specialized tools, an ophthalmologist sees that the pigmentation in the iris is "raised" (a rippled surface like moss, rather than a flat surface) and/or there are floating particles of the pigmentation in the anterior chamber of the eye and/or there is an abnormal eye pressure, then a recommendation to remove the eye is usually made. But, conclusive diagnosis can only done afterwards.

dreamkittykitty said:

I have been told that if the tumor starts to break through the eyeball it will spread quickly.

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Perhaps that was your understanding/interpretation of what you were told..........IF the pigmented cells are cancerous, they do not "break through the eyeball".  IF that pigmentation is cancerous, and, if small "particles" break away and move around in the fluid inside the eye, then it's very likely that those "particles" will exit the eye chamber - because the eye fluid is constantly circulating - and can circulate in the body.

If I were faced with the recommendation to remove the eye, I wouldn't freak out (be overly concerned) with a delay of a few days. That said, I would want it done as soon as possible and, if my Veterinarian was well-experienced, I'd have her do the surgery and not wait for the specialist. Again, have the pathology report done - so you have a definitive diagnosis upon which to base any further treatment decisions (perhaps begin chemotherapy).

To the best of my knowledge, the silicone prosthesis is strictly cosmetic - most kitties simply have the eyelids sewn together and do "just fine".

If I suspected a thyroid issue, I would bring this to my Vet's attention immediately - you should know that "ordinary" bloodwork may NOT be able to diagnose Hyper-T in an older cat - often, further tests are required. You can read this (ignore references to kidney disease - focus on the "extra tests" and the why's: http://www.felinecrf.org/hyperthyroidism.htm#diagnosis

As to "If she does have a thyroid problem that did not get addressed how will this affect her under anesthesia", that's best put to your Vet. If your Vet is comfortable proceeding, then it's your choice.

Here are some links for you

http://www.thecatsite.com/t/149263/official-diagnosis-feline-diffuse-iris-melanoma

http://www.animal-eye-specialists.com/uploads/5/8/0/9/5809340/iris_melanoma.pdf

http://www.peteyedoctor.com/uveal-melanoma-and-melanosis.html

http://www.eyevet.ca/iris_melanoma.html

http://www.thecatsite.com/t/255160/lloyd-has-stomatitis-and-iris-melanosis#post_3314234

Thanks for the input!

  So now after I've been researching and talking to the staff ( very difficult to get a tech at the specialist to talk to me though) The main difference in the operation is the Specialist used propofol (sp?) and the regular vet uses ketamine. The blood work came back ok but she had elevated kidney values. The vet said she thought this was not unusual for a cat her age but before they caught the tumor this is what I noticed and why I brought her in

1. lost 2.5 pounds in a year

2. Behavior change more listless and yet agressive ( attack two dogs and an unsuspecting cat passing by in the past month)

3. Change in her coat and eating habits

4. Tends to drink more water even though i add it to her food in the mornin and evening.

5.  Gets constipated unless I put miralax in her food daily

But with the upset of the tumor the other issues never got addressed.  I guess I am concerned with the Ketamine because it has to be cleared through the kidneys. Does anyone have experience with anethesia and or adviceon this matter?

  Angel and Chupie xo

dreamkittykitty said:

The main difference in the operation is the Specialist used propofol (sp?) and the regular vet uses ketamine.

I guess I am concerned with the Ketamine because it has to be cleared through the kidneys.

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That's a significant difference, in light of those elevated kidney values.

Given this new information, I'd opt to have the specialist remove her eye.

Here is a quote from a very comprehensive article on anesthesia for cats with kidney disease:

A commonly used induction agent is propofol. Ketamine is not recommended because it has to be cleared by the kidneys.

http://www.felinecrf.org/anaesthesia.htm

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That site is reputable and recommended by The American Association of Feline Practitioners - so, the info is reliable and science-based. It is also written for the lay person - I'd urge you to read through the Anesthesia section - you'll see that there are several precautions before/during/after surgery that are "musts" for 'kidney cats'........print them off, take them to the specialist's and ensure they will be carried out.

I would be very cautious if your own Vet (who uses Ketamine) offers to switch to Propofol....there's an anesthesiologist who's online "elsewhere" who I remember once writing 'I'd prefer a Vet who is familiar with Ketamine to a Vet who has no experience with Propofol'.

Do ensure that you highlight to the specialist the documented elevated kidney values and your "gut" feeling about Hyper-T.

hope your cat gets better can you post a pic of it? i'm cerious

my one eye cat when she had her eye removed they sowed her eye lids together she is the one in my profile picture

she did not have what your cat had she was attacked and her eye looked like a small red ball popping out of her head no way to save the eye

So this is what I'm worried about.  If the tumor is Melonoma then can't two hours two weeks or two days make a difference because it doesn't seem to matter how fast the tumor is growing but whether or not it is sluffing off cells into the blood stream.

this disease is enigmatic. We know that an iris tumour freely exfoliates cells into the aqueous fluid of the eye and that the aqueous fluid freely circulates out of the eye and into the bloodstream. This would suggest that a malignancy in the eye would have a high rate of metastasis (spreading) to the body.

Luckily, most cases of iris melanosis do not undergo malignant change to melanoma. In fact, a cat with progressive iris melanosis is more likely to develop glaucoma from infiltration and obstruction of the drainage angle (the area in the eye where the intraocular fluid drains) than he is to develop distant metastasis.

However if clinical observation suggests progression, malignant transformation is a possibility and the risk of metastasis is recognized and the prognosis becomes guarded.

Although opinions vary, the usual approach to cats with iris melanosis is to follow the progress by semi-frequent (2 times per year) re-examination. If glaucoma develops, and the eye is painful, enucleation (removal) of the eye is recommended. If any of the pigmented lesions become raised, velvety or if pupillary distortion is evident this would suggest progression and the risk of malignant transformation.

so then I'm left with weighing the odds of taxing the liver of an already frail cat to the odds of waiting two days and metasisis happening, ugh. Not a happy choice to have to make. chupies mom

Not sure how to do that stuff on the computer yet ; (

I'm so angry with both the vets. Why didn't they say this instead of saying waiting a few days wouldn't matter!

   So, I'm thinking of taking Chupie into her regular vet tomorrow with the intention of a meeting before hand to  address some of these questions you have shed some light on. At least I know this vet is open to a conversation and will listen to what I have to fears about.  She actually called the specialist for me to make sure there was nothing unusual going on that he didn't think she could handle. If I'm not satisfied then I have the option of taking her to the emergency vet hospital for a walk in appointment where they have certified board surgeons on hand to consult with though they actually tend to refer out to the specialist we saw.   Tomorrow is the big day so please send love and good vibes if you remember and  keep getting your kitties eyes checked! 

Thank you for the feed back and support, very helpful, hard to read but a must to know.

ps. Does anyone know of a good renal supplement for kitties?  

dreamkittykitty said:

ps. Does anyone know of a good renal supplement for kitties?  

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Be very careful here.

Treating kidney insufficiency/kidney disease is not successfully accomplished with "magic" herbs/pills/tonics/"supplements"/potions/miracle formulas etc........and, I am not talking down to you here! Kidney disease is not "easy" to manage successfully.......the treatment path is usually a roller coaster ride, metaphorically and in reality, emotionally and practically. As guardians/parents/health managers of our kitties we are often desperate for solutions and so, very vulnerable when the snake oil salespeople wave their banners advertising miracle cures/solutions. And, there are LOTS of snake oil products "out there"...some are swindles, some are dangerous.

The most comprehensive "manual" for understanding/treating feline kidney disease - a "manual" that is recommended by The American Association of Feline Practitioners for its reliability and solid science - will be your best resource as you pursue this 'journey' with your kitty. To guide you through, there's a group of people online who were brought together by the woman who wrote that manual, and you could join that group.

I'll give you a few specific links.......these are for later, once the eye issue is resolved.

• about "supplements" - this entire section: http://www.felinecrf.org/holistic_treatments.htm#cautions
• About Kidney Disease - Overview of what you need to know first: http://www.felinecrf.org/just_diagnosed.htm
• Overview of treatments: http://www.felinecrf.org/treatments.htm
• About this online support group: http://www.felinecrf.org/tanyas_support_group.htm
• The online group's homepage http://pets.groups.yahoo.com/group/tanyas-crf-support/

dreamkittykitty said:

   So, I'm thinking of taking Chupie into her regular vet tomorrow with the intention of a meeting before hand to  address some of these questions you have shed some light on. At least I know this vet is open to a conversation and will listen to what I have to fears about.  She actually called the specialist for me to make sure there was nothing unusual going on that he didn't think she could handle. If I'm not satisfied then I have the option of taking her to the emergency vet hospital for a walk in appointment where they have certified board surgeons on hand to consult with though they actually tend to refer out to the specialist we saw.   Tomorrow is the big day so please send love and good vibes if you remember and  keep getting your kitties eyes checked! 

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that everytihing goes okay.  And a for you and Chupie.

So .......................I went to take Chupes into the vet this morning for her scheduled drop off and they didn't have her down for surgery! I panicked and sat in my car calling other places then finally called the specialty vet again too let them know what was happenin and ask their advice. They then said they could get her in tomorrow morning.  (Which was weird because previously they told me I wouldn't be able to do that even if there was a cancelation.)  Then, of course as fate would have it, the regular vet came out to the car and said she did know she was doing surgery on her today but that she just hadn't the time to put it on the schedule.  I didn't know what to do at that point so I just decided to keep the specialist appointment instead of cancelling another one on them but it 's about 500 $ more!!! and they don't keep her over night. They also don't remove any of the the surrounding tissue like the regular vet was going to do so I'm worried but hopefully they are the specialist and know what they are doing. Her regular vet. was also amazingly sweet and told me that from the conversation she had with the specialty vet doctor that they caught it relatively early and she had no fear about me waiting one more day if I wanted to go to the specialty vet and that she supported me no matter what I chose. That women is amazin and ent above and beyond to help me figure things out!  I ordered her and her staff some chocolate covered strawberries which should arrive tomorrow. I want her to know how much I appreciate what she's done. 

  She also assured me this morning that she absolutely did not think Chupie had a kidney problem from the blood work she saw but that maybe Chupies demeanor was from her eye bothering her and not being able to see.  I hope so. thank you for the feed back and articles I am most definitely still going to read them. What is going on with your baby kitty? Is she ok?  I can't believe I have to wake up at 6 am again and go throgh the stress of taking her one more time. I am glad I get her back the same day though

So .......................I went to take Chupes into the vet this morning for her scheduled drop off and they didn't have her down for surgery! I panicked and sat in my car calling other places then finally called the specialty vet again too let them know what was happenin and ask their advice. They then said they could get her in tomorrow morning.  (Which was weird because previously they told me I wouldn't be able to do that even if there was a cancelation.)  Then, of course as fate would have it, the regular vet came out to the car and said she did know she was doing surgery on her today but that she just hadn't the time to put it on the schedule.  I didn't know what to do at that point so I just decided to keep the specialist appointment instead of cancelling another one on them but it 's about 500 $ more!!! and they don't keep her over night. They also don't remove any of the the surrounding tissue like the regular vet was going to do so I'm worried but hopefully they are the specialist and know what they are doing. Her regular vet. was also amazingly sweet and told me that from the conversation she had with the specialty vet doctor that they caught it relatively early and she had no fear about me waiting one more day if I wanted to go to the specialty vet and that she supported me no matter what I chose. That women is amazin and ent above and beyond to help me figure things out!  I ordered her and her staff some chocolate covered strawberries which should arrive tomorrow. I want her to know how much I appreciate what she's done. 

  She also assured me this morning that she absolutely did not think Chupie had a kidney problem from the blood work she saw but that maybe Chupies demeanor was from her eye bothering her and not being able to see.  I hope so. thank you for the feed back and articles I am most definitely still going to read them. What is going on with your baby kitty? Is she ok?  I can't believe I have to wake up at 6 am again and go throgh the stress of taking her one more time. I am glad I get her back the same day though

Thank you for all the support. I think I need to have my heart checked haha.

Silly had her eye out last year and at this time is her usual loving, pesty self. It takes a month or so, and chupa should be back to her normal self.

Did Silly have her regular vet do it or a specialist? Of course, I have regrets already. I feel like her regular vet cared more so she would have done a better job plus it would have been so much cheaper which I was too stressed too consider. basically 850$ compared to 1400$. I feel so neurotic right now .  I just want the whole thing to be over.

So.......I went to the specialty vet for an enucleation this morning and was caught off gaurd by the fact that they were going to automatically put a prosthetic eye in the void before they sew it up. Does anyone have experience with this? the vet is going to call me before surgery but I don't like the idea of there being a foreign object in her body. Did Silly have this?

  If anyone has input it would be appreciated. thanks Chupie and her mom.

Silly's regular vet did it. A specialist would have meant at least a 250 mile round trip. I paid about $200 for the surgery, re-stitching and a week of boarding when the other ladies wouldn't leave her alone. I LOVE MY VET. She can do delicate work like eye surgery, and yet push a 2,000 pound bull around to give it a shot or bolus (large pill for cattle that has to be put in the throat with what looks like a torture device). She has been my vet for 19 years, and I would trust her to treat ME.

Did she have the prosthetic in it or no? the specialist wants about 1400 not including meds

I would go with the specialist based on the anesthetic. Ketamine is much more dangerous and more and more vets won't use it anymore. Because your cat is 14 ketamine would be very dangerous and from everything I read when I got my 16 year old dogs teeth cleaned it is not recommend in senior pets. I know this must be terrible for you but I do think you made the right decision. Hope everything goes well!