Imiquimod 5% cream and multiple site SCC scabs + some rambling

[SilveredFox]

Ok so I found this entire site from a very frustrating search about anything and everything about a treatment my vet and I are going to try for my Honey kitty.

- Also I am sorry in advance that this is so very long of a post I'm also working out my feelings towards the diagnosis since we only just got the biopsy results a few days ago.

I'll continue working with my vet as closely as I can and I basically have her on speed dial with e-mails but the current issue is most of her best guesses are 'the person who sent the biopsy report suggested this may help' and 'I am not sure because the only clinical trial was so very small we have basically no real data'

I told her that I'd found a forum with a very few people who've had experience in using this for cats and she was very supportive of trying to learn as much as I can because she doesn't really know much either. She's been wonderful and she's doing her best to learn with me but she's been frustrated at the lack of ... anything really. There are so few trials, or even people who've used it and then talked about the results that I feel like we're flying blind here but I'm not giving up on my baby girl yet so learning as much as possible can help me know what questions to pass along for her to research to advise me as we go.

So back when my Honey first came indoors she had a slightly odd wound but there were a lot of things going on and the original advice was to just let it heal. Of course being a cat she kept irritating it and I was going through a lot right then and didn't stay as on top of it as I wish I did. Slightly later she came down with very bad peritonitis and that overrode basically everything. I remember asking about the neck scab since she kept scratching it back open so it couldn't heal right and they didn't have much advice.

I almost lost her from the teeth issues so I unfortunately let myself get distracted just dealing with that, and then letting her recover. They had to take out like 8 teeth at once but she recovered beautifully and I was able to keep her going just long enough that they could do it. (Unfortunately covid and severe winter storms as well as the holidays caused huge delays with their ability to get her in and those few weeks of extra waiting were almost too much. I had to syringe feed her criticare just to get her to make it to that appointment so I know rationally why I didn't focus on her neck, but the guilt as her petparent makes me feel like I should have found more spoons to push for them to do more then.

Fast forward a few months and she finally healed up but there were still concerns about her neck and also her nose. Which I'd tried to talk to a tech at one point and the advice was to just watch it in case it grows.

Check up time and I tried again to see what we could do for her neck so her other vet (I ended up seeing multiple different people so it was also hard to rehash everything all over again to new people and worry that I was forgetting stuff) and she suggested either antibiotics or steroids to try and clear it up.

Some things happened and we didn't go through with the steroids right away. Which might have been a good thing since we didn't know what we were dealing with but they were just trying various things to see if they could help things resolve.

Anyways after a nail clipping session we discovered that she also had a strange scab on one pawpad that had gotten agitated. So I rushed her in worried. Different vet ended up being able to get me in and we started all over from scratch - Antibiotics which helped at first, then she plateaued, and there was a scheduling issue that meant that she didn't get right in for another dose immediately. (My vet actually apologized and said if I had spoken up and said something they could have squeezed her in because it was so time sensitive but I hadn't realized at the time - I just figured that they have the appointments they have you know?) She'd also been more inclined to advise that -It's worrying that it's not healing but she wasn't immediately worried and felt like we had time to try the topical treatments to see if it responded.

So after realizing we were back to square one and being utterly frustrated I asked again about options for figuring out what we were dealing with that were less invasive. I still don't know if there were more options that we could have tried but my vet was worried that scrapings might be too easily contaminated and a good solid biopsy would be for the best.

Funds have been a huge issue in this partly because she was an unplanned cat, but mostly because of the pandemic. When I brought her in I was in a really good financial place, and she was quite honestly a few days from inviting herself inside with or without her shots. I got a huge order right as it was getting cold (and she was literally starting to hound the door and try and sneak in to follow us since she'd decided I was her person by that point) and I just went for it.

Of course being an outdoor cat she has a ton of health issues, and I feel guilty every time I can't manage more but I'm glad at least that I can do what I can and will keep doing every single scrap of care that I can offer and afford. Now that events are happening more I plan to work my butt off through the rest of the summer but I am very very scared it won't be enough.

That's part of why my vet was more inclined to push the imiquimod as a treatment option vs finding an oncologist (if I could even get an open appointment apparently they're horribly booked up right now) but I also want to know all my options. Also because she's got lesions in multiple areas but otherwise seems pretty ok.

Right now I know so little and my main plan has always been that if what she has is untreatable I'll give her palliative care and just keep her happy for as long as we have together.

We only did the biopsy on her neck because I was worried that if it WAS something that wasn't going to be treatable that I didn't cause a bunch of pain that would ruin whatever time she has left. I'm glad I did because it was almost all my energy keeping her from scratching and licking her neck - I'm not entirely sure how I would have kept her from multiple open problem spots all simultaneously.

The biopsy came back that it's papilloma induced SCC. And I kindof blanked a bit as she was explaining some of it. She's going to forward all of the results to me so I can look over them with a clearer head.

I posted in the bowen's disease thread because that's the closest I could see to people having used imiquimod, but I wasn't sure if it having changed to SCC would change things? Or maybe someone has different advice or experiences.

My other worries now: Since she absolutely has/had a papillomavirus at some point how contagious could that be? Could I have unknowingly spread the virus to the kittens? They don't live together, Honey stays downstairs and the kittens live upstairs but I go back and forth between the levels constantly and had tried to introduce them to each other towards the beginning - I can't find anything on how infectious Papillomavirus is between cats other than 'it's infectious' and direct contact. And don't worry it doesn't cross species. Or info about dogs.
Vet had no answers but I did ask her to try and look into it for me.

It's a good thing it never worked out to combine the households so to speak but I'm worried those few nose touches or just me going back and forth might be enough to have to worry about going through all of this again with my other two babies and I've been an absolute wreck.

Honey used to be the neighborhood punching bag so she just absolutely doesn't want to tolerate other cats - eventually I gave up and just keep them in their separate bubbles where they're happier, but I'm so anxious about germs now that I've been second guessing everything all the time. I tried my best to chase off the other cats when they tried picking on her, but I know now that she is a teeny, spayed, former housecat so I'm not surprised the other cats in the neighborhood wanted her out of their territory.

She stayed stubborn until the day I could bring her in - she did NOT want to lose her space, but I remember at least two distinct incidents - one giant tomcat chasing her up and down all the neighborhood yards right around when she first showed up and was still pretty semi-feral, and then one after she felt comfortable here where this calico tried to rush *through* me to get at her and nothing I did would dissuade the other cat. Eventually they both ran off and she showed up 15 minutes later hunkered down right by the house.

I was so happy the day I finally was able to bring her in (after getting her a full checkup and her shots) and was prepared for an absolute monster of a cat who had no idea how to behave indoors because outside she was all over everything, but the second she came in and really remembered what this indoors thing was she just went back to this absolute model housecat. No jumping on furniture - I had to actually reassure her for a month once summer hit and it was open window time to get her to feel comfortable sitting in the window and she'd have all these odd habits like she was worried I'd yell at her for jumping up on stuff.

She's better now and she realized that she could go on the couch because she was determined to come sit on me but it took her 6 months before she even tried (once) to jump on my dad's chair. Really wondering if she'd been dumped or something because that's just so odd behavior for a cat. Especially one who had no problem being on top of everything and anything.

She has learned that she's absolutely allowed do get on stuff if she wants and she'll never be reprimanded for it, and that yes she is a good kitty but it took a long time. And I know that it wasn't something from us since it was a day one thing - and no one in our house ever had or would yell at her for being a cat or doing cat things.

This ended up turning into a let me tell you about my Honey kitty thread and less about the Imiquimod but for sure rambling is helping me right now so thank you for your patience in reading through these tangents.

After so many wrong turns I don't want to make the wrong decision here with her. I know she's old - I knew going into this that she probably had a host of medical problems having been an outdoor stray and with God knows what of a health history. I've already spent thousands and I don't even know what I'm doing - I just know I don't want to make her go through countless surgeries if they might not actually give her a good quality of life, but I do want to give her every gentle second I can because she deserves it.

If pictures will help I can post some of where we're at but I'm not sure how to spoiler things yet and don't want to post lesions without being able to make them opt in.

 

[SilveredFox]

(I distracted myself so thoroughly I forgot the other main bulk of questions) I'm in such a tailspin over all of this.

For people who've had to use the cream or other things your cats can't lick - are there any suggestions for keeping them from being able to lick really tricky locations?

The three areas we're going to be using the cream on are - top of her nose (which I'm VERY worried about because I can't exactly block her toungue from just sweeping up there)

Her neck which after the biopsy I have an ok system involving layers of a stockinette, with vet wrap over that and then a home made jury rigged wide leather collar I velcro-d into place that has so far been decent at stopping her licking.

And her pawpad - which again licking.

I tried to ask my vet about washing it off and she pretty much said since the trial didn't say anything about doing so that I probably shouldn't because we don't know if it'll make the cream less effective. But she's also mentioned that she doesn't know much at all about this particular treatment so both of our guesses are the same right now. Her main worry is making it less effective and being able to wipe it off but she's also acknowledged that it's possible cats ingesting this stuff is what caused the side effects that made some cats liver enzymes be elevated.

So I'm really not sure. I feel like we're both working without much information other than 'it was tried in a tiny sample of 12 cats way back in the early 2000's and that's all we know let's experiment'

 

[vansX2]

(I distracted myself so thoroughly I forgot the other main bulk of questions) I'm in such a tailspin over all of this.

For people who've had to use the cream or other things your cats can't lick - are there any suggestions for keeping them from being able to lick really tricky locations?

The three areas we're going to be using the cream on are - top of her nose (which I'm VERY worried about because I can't exactly block her toungue from just sweeping up there)

Her neck which after the biopsy I have an ok system involving layers of a stockinette, with vet wrap over that and then a home made jury rigged wide leather collar I velcro-d into place that has so far been decent at stopping her licking.

And her pawpad - which again licking.

I tried to ask my vet about washing it off and she pretty much said since the trial didn't say anything about doing so that I probably shouldn't because we don't know if it'll make the cream less effective. But she's also mentioned that she doesn't know much at all about this particular treatment so both of our guesses are the same right now. Her main worry is making it less effective and being able to wipe it off but she's also acknowledged that it's possible cats ingesting this stuff is what caused the side effects that made some cats liver enzymes be elevated.

So I'm really not sure. I feel like we're both working without much information other than 'it was tried in a tiny sample of 12 cats way back in the early 2000's and that's all we know let's experiment'

Didn't the Veterinarian ever suggest that Kitty wear a "Cone" around the head ? That way reopening wounds and licking off medication would stop.

 

[SilveredFox]

The problem is that the wound site is directly where the cone would sit. The biopsy vet actually advised both for and against a soft cone which has been frustrating so I've managed the best I can, and I can try the soft cone again for her foot, but it's a problematic situation.

When we tried the soft cone she freaked a bit and it actually started rubbing her neck raw since the scabs are right where it will sit.

Her discharge info said no cone - but then when I had issues keeping her from her neck and tried to follow up they said try the cone - and then it almost tore her stitches out so we ditched the cone.

I plan to try it again but I'm not 100% sure how she'll tolerate it and I'm still worried about opening up the wounds on her neck if she freaks out with it :/

 

[vansX2]

The problem is that the wound site is directly where the cone would sit. The biopsy vet actually advised both for and against a soft cone which has been frustrating so I've managed the best I can, and I can try the soft cone again for her foot, but it's a problematic situation.

When we tried the soft cone she freaked a bit and it actually started rubbing her neck raw since the scabs are right where it will sit.

Her discharge info said no cone - but then when I had issues keeping her from her neck and tried to follow up they said try the cone - and then it almost tore her stitches out so we ditched the cone.

I plan to try it again but I'm not 100% sure how she'll tolerate it and I'm still worried about opening up the wounds on her neck if she freaks out with it :/

Hopefully someone more experienced on TCS can provide you some better answers.

 

[SilveredFox]

I'm also not sure if I should try and find another vet at this point or just stay with the one I have since she has been trying her best to help through all of this. But it's been a process that's for sure.
Here's the little girl in question - still a little out of sorts from the biopsy but being a good baby girl. And a few weeks later at the check up (I wanted her to have a full blood panel so if the cream does affect anything we know her starting point and aren't just guessing)
I tried a suitical but it was the wrong size (it was a gift from a friend) I tried cutting up some old pants - a lot of things kept rubbing it too raw. Glad the leather finally worked and she's tolerating it too she doesn't actually try and get it off now that she's used to it.

And no worries! Thank you for taking the time to suggest something! I still really appreciate it.

 

[vansX2]

I'm also not sure if I should try and find another vet at this point or just stay with the one I have since she has been trying her best to help through all of this. But it's been a process that's for sure.
Here's the little girl in question - still a little out of sorts from the biopsy but being a good baby girl. And a few weeks later at the check up (I wanted her to have a full blood panel so if the cream does affect anything we know her starting point and aren't just guessing)
I tried a suitical but it was the wrong size (it was a gift from a friend) I tried cutting up some old pants - a lot of things kept rubbing it too raw. Glad the leather finally worked and she's tolerating it too she doesn't actually try and get it off now that she's used to it.

And no worries! Thank you for taking the time to suggest something! I still really appreciate it.


View attachment 417785View attachment 417786

It's unfortunate that you are saddled with these several health concerns. For just trying to give her a more stable life.

 

[SilveredFox]

She's happy and she's active and she's absolutely worth it - even with how expensive it's been and if she only has a few more years that's so much better than she would have had if she was still out on the street so I at least feel good about that. And she's very attached to me - my dad is convinced that she knows that I saved her and I think he's right.

She follows me around the house and has been putting up with all of these treatments and has just been the best most gentle little girl.

I looked into pet insurance but all of these things are counted as pre-existing since she was dealing with them before she came in so no one will cover it.

Even if it's just a few years it's a lot. She showed up while I was dealing with losing my mom to cancer - and that was part of why she didn't come indoors right away - we were dealing with too much to suddenly add a new unknown but my mom was super supportive of me feeding her outside, and when I had the funds to bring her in finally it was maybe a few weeks to a month after we'd lost her?

She helped fill the void. I needed her right then just as much as she needed us, I just don't want ignorance, or lack of asking enough questions to lead to things that could have been simple fixes but I didn't even know to ask you know? So I'm very glad this site exists and while I'll still bug my vet about every little thing, I hope that I'll be able to ask better questions if I hang around here.

In her favorite position - an absolute puddle of a cat on my leg. I have no idea how it's comfortable but it's something she's done for ages.

 

[vansX2]

She's happy and she's active and she's absolutely worth it - even with how expensive it's been and if she only has a few more years that's so much better than she would have had if she was still out on the street so I at least feel good about that. And she's very attached to me - my dad is convinced that she knows that I saved her and I think he's right.

She follows me around the house and has been putting up with all of these treatments and has just been the best most gentle little girl.

I looked into pet insurance but all of these things are counted as pre-existing since she was dealing with them before she came in so no one will cover it.

Even if it's just a few years it's a lot. She showed up while I was dealing with losing my mom to cancer - and that was part of why she didn't come indoors right away - we were dealing with too much to suddenly add a new unknown but my mom was super supportive of me feeding her outside, and when I had the funds to bring her in finally it was maybe a few weeks to a month after we'd lost her?

She helped fill the void. I needed her right then just as much as she needed us, I just don't want ignorance, or lack of asking enough questions to lead to things that could have been simple fixes but I didn't even know to ask you know? So I'm very glad this site exists and while I'll still bug my vet about every little thing, I hope that I'll be able to ask better questions if I hang around here.

In her favorite position - an absolute puddle of a cat on my leg. I have no idea how it's comfortable but it's something she's done for ages. View attachment 417795

Yes Pet Insurers are picky. I've only put one of my boys on a policy so far. The Red/ White in the insight picture. He is the naughtiest of the two. Both of mine have been indoor cats since I bought them as kittens.

 

[SilveredFox]

I'm trying to look into insurance for the little ones but there are so many options, and so many different things to look at. I was also trying to budget out wellness plans to see which if any might help keep them healthy. I want to be as proactive as possible with them.

All of mine are indoors only. They all have some sort of kitty cold (Honey occasionally gets flare ups of sneezes, and Griffon and Shion had gunky eyes from day one at the shelter)

He's a handsome little troublemaker! I'm still weighing the options between just keep saving up or try and get insurance but then what if it doesn't kick in when it's needed - all the money spent on it could go towards emergency funds (which is what I did and pretty much have put all of the emergency funds into this so far) And I have no regrets but I'm terrified of anything else coming up while I'm waiting on my next work chance.

My biggest fear right now is that I'll take a cat who's not really in a lot of pain, and who's managing ok and then by trying this treatment I'll mess up her organs somehow and make the problem a ton worse instead of better.

But my vet seems optimistic about trying it and since it's so widespread she thinks this is the best option with the best quality of life chance. Even if it doesn't work it'll be far less stressful than the sheer number of vet visits Honey would need + recovery time + how much of her nose they'd have to try and remove and she just didn't think it would be worth putting her through all of that - when it's still likely it'll all crop back up soon anyways because of what it is (and because the papilloma virus never really goes away)

So I agree with her there I'm just so nervous about trying this stuff.

 

[vansX2]

I'm trying to look into insurance for the little ones but there are so many options, and so many different things to look at. I was also trying to budget out wellness plans to see which if any might help keep them healthy. I want to be as proactive as possible with them.

All of mine are indoors only. They all have some sort of kitty cold (Honey occasionally gets flare ups of sneezes, and Griffon and Shion had gunky eyes from day one at the shelter)

He's a handsome little troublemaker! I'm still weighing the options between just keep saving up or try and get insurance but then what if it doesn't kick in when it's needed - all the money spent on it could go towards emergency funds (which is what I did and pretty much have put all of the emergency funds into this so far) And I have no regrets but I'm terrified of anything else coming up while I'm waiting on my next work chance.

My biggest fear right now is that I'll take a cat who's not really in a lot of pain, and who's managing ok and then by trying this treatment I'll mess up her organs somehow and make the problem a ton worse instead of better.

But my vet seems optimistic about trying it and since it's so widespread she thinks this is the best option with the best quality of life chance. Even if it doesn't work it'll be far less stressful than the sheer number of vet visits Honey would need + recovery time + how much of her nose they'd have to try and remove and she just didn't think it would be worth putting her through all of that - when it's still likely it'll all crop back up soon anyways because of what it is (and because the papilloma virus never really goes away)

So I agree with her there I'm just so nervous about trying this stuff.

I spent many hours Researching Pet Insurances. I Asked many people here on TCS Whom they would recommend . Doing that extra asking confused me That much more on making a decision on what Pet Insurance to choose. I went with "Pets Best " though to date I haven't needed to use it. I paid $240. For the whole year. I didn't want to be bothered with the monthly payments .

 

[SilveredFox]

I think paying up front will be best and be a lot easier in the long run since I'm seasonal. I do pretty good work in the summer (when I can go to fairs and stuff) but if I need it in the winter I won't have to worry because it'll already be paid!

But there are so very many choices. I'll look into that one and probably when I have the spare spoons ask around here for the best suggestions for mine and then just research research research. And hope I pick the right one.

 

[vansX2]

I think paying up front will be best and be a lot easier in the long run since I'm seasonal. I do pretty good work in the summer (when I can go to fairs and stuff) but if I need it in the winter I won't have to worry because it'll already be paid!

But there are so very many choices. I'll look into that one and probably when I have the spare spoons ask around here for the best suggestions for mine and then just research research research. And hope I pick the right one.

I found a site don't remember the name . It provided the 10 Best Pet Insurance Reviews. I just did a Google search . My Reason for getting Pet insurance Was a friend whom has 3 Maine Coons . One of them A female required tumor removal. The surgery Cost him $5500. He was lucky too have the funds available.

 

[fionasmom]

I am sorry that you are faced with this; I did have a cat with SCC in her mouth, but not Bowen's Disease precisely. As you have found, this is an area where information and experience can be hard to come by because BD is multicentric and much less common than a single lesion. One option is to have your vet consult with a teaching hospital to see if anything else can be suggested. This does not show a lack of trust in your vet, especially in a case like this.

My found younger cats are insured; the two oldest ones are not as any treatment for them would be limited at this point. It is definitely a good idea to research insurance given the high cost of veterinary care.

 

[SilveredFox]

Thank you - and I tried the first dose of the cream. Also called up some possible specialists to try and get in touch with. They're still outrageously expensive but so much less than I expected given what I was walked through.

I found out that they didn't actually get around to uploading the results to her file so that's why they were never forwarded to me.

A different vet is on top of it and hopefully it'll get straightened out but I'd feel so much better if I could read over all of the details myself.

I feel like I waited too long to get the biopsy and then at the day I went to do it I felt rushed to get it done and didn't ask the right questions - Like I didn't want a full punch on her toes done but I DO wish she was able to scrape off some to send off for testing as well. I did try and ask but everyone was so focused on her neck that now I'm realizing that if I pushed harder in that moment we would have had better staging results now.

Maybe they can do a different type of biopsy - either a scraping, or a needle one. Or I need to go somewhere else to get those tests done since I need to know what I'm dealing with and where. I'm working on getting driving but it might be at least 3 more months before I can get myself more mobile and have a chance to actually get her to farther places myself.

I'm way over being a teen but life got in the way and times like this I wish I was able to just help deal with stuff myself instead of asking for help from family and friends.

I'll try to ask about the teaching hospital! We're all trying to learn on the fly and it's overwhelming :/

On the sad plus side we're teaching my entire vet's office about BD and SCC in situ (unless it's already metastasizing or the places we didn't biopsy are already metastasized and we didn't check it)

I feel like I wasted $1K to get part of the answer and I'll have to put her through all of this again just to get some sort of answers.

But I'm glad we're starting to make progress. So long as it's not already too late to keep it managed. Only time will tell but I'll keep updating things here, and I'll keep trying to try.

 

[fionasmom]

U. S. Veterinary Schools | American Association of Feline Practitioners

Try to make a list of all questions that come to mind. Don't worry about what they are; if they are important to you that is all that counts. Make a copy for the vet if you are not seeing her face to face. It is very hard to think on your feet in these situations.

 

[SilveredFox]

Vet got back to me! I didn't get to ask everything since it was very late and I was being very stressed, but she confirmed it's In Situ and she's been talking with an oncologist (oncologist has the neck biopsy and pictures to go on, but is providing as much support as they can as we go)

They had uploaded the wrong image to my file so they're going to send the histopathology report over in the morning, and I'm a stressed wreck. I might need to bring her in for her foot since the scabby lesion on her pawpad is partly ripped open and it seems to be hurting her. Currently the vet advised trying to soak it myself and see if I can get it in better shape but I might see if my regular old vet can see us and help me clean it. I just feel a lot safer having a vet do that and also they can give us some antibiotics in case we need them if her footpad's raw.

I'm still worried that while we have a definite staging for the main neck lesion we don't actually know if the nose has a different stage to it but I'm going to try the imiquimod since that's the best suggestion from my vet so far and we'll just see how it goes.

Going to try and have as many pictures as possible so I don't have to rely on memory for keeping track of her progress.

I'm still really grateful that she's doing so much work to learn what she needs to learn I'm just worried about stuff slipping through the cracks because this is such an unknown issue for even the specialist to be dealing with.

Also my current logic is more eyes = more chances of helping see problem spots. She just saw Honey a few days ago, so if I do need to see someone else soon it might be better to have the other vets familiar with the issue. They've been talking together to try and help me but I know seeing everything in person is a much better way to help figure stuff out than just relying on pictures. I'll see her again when we do more follow up stuff. It's going to be a long few months.

I really don't want to keep having to drag her in because that's really stressful for her but I can't get to her pawpad to even try the treatment so she'll have to go back in for that.

I feel like I'm going to know the entire vet practice at this point x.x (not that that's a bad thing but I hope that I'm making the right choices for her)

I do know that no matter what I'm grateful that the vet I'm seeing now has been so passionate about making sure we're on a good path. And she got me on the path to find out what we were dealing with so I'll be forever grateful for her help with all of this even just for that.

 

[SilveredFox]

She's also been absurdly patient with my trying to understand what types of tests they can do will actually offer, versus the likelihood of just getting scabs but no results, but I feel like an idiot having to re-ask questions.

Pretty sure she already explained all of this to me but I've been so frazzled that she had to go over it all again. This has been a lot, and it's kicked up a lot between the memories of other things, and the worry about not knowing what I'm doing. I'm trying not to be obnoxious since I know they're trying really hard to help us, but it's been a desperately stressful month.