[I’m on vacation for four days! (The first vacation I’ve had in over seven months.) So I’m lobbing you two recycled posts for your amusement (Sunday and Monday). I hope they’re new for you. And please excuse the lack of follow-up on your comments. I promise I’ll get to them when I return. –PK ]

Orange has oral squamous cell carcinoma. This disease is a devastating cancer of the mouth. It will slowly devour his soft tissues and dissolve the bones of his face as it progresses, eventually resulting in his death.

Orange came to see me a few months ago because he wasn’t eating as much as usual. He looked, for all the world, like a perfectly healthy orange tabby with a rough patch of gingivitis on one side of his mouth. Hallelujah, I think to myself, here’s an easy one.

More than likely, it seems to me that Orange’s discomfort can be alleviated with a simple anesthetic procedure: dental X-rays and a cleaning with or without dental extractions, as needed.

Then I get Orange under anesthesia only to uncover the horrible truth: under all that simple gingivitis is a tooth that plucks out of its socket like a loose cork from a bottle. Not a good sign. Drills and other such heavy equipment are de rigueur in dental extractions save for the worst kinds of infections—which this was clearly not.

Because perfectly healthy-looking teeth simply do not pop out when grasped with two fingers (especially without significant bleeding) I took a complete set of dental X-rays to help determine the overall health of his mouth.

To my dismay, I saw what no dentist wants to see on a young, healthy patient (or any patient, for that matter): a dark spot on the X-ray where the bone looks like it’s being gnawed away by wayward mouth-rats. This kind of X-ray change is most often caused by terrible infections or by cancers. Never a good sign.

I then used sharp surgical scissors to cut away some of the gummy, bloodless flesh in this area. After this cleanup (called debridement) and some tissue sample retrieval (a biopsy), Orange woke up and was sent home with some antibiotics and pain relievers.

Three days later we had our answer: squamous cell carcinoma. Orange’s mom (an astute medical professional) was, of course, devastated to learn his diagnosis. SCC is among the most common of oral cancers in pets and humans, alike. It has no known cure.

Although we know some risk factors for these cancers in humans (smoking, tobacco chewing, etc.) we have no idea what predisposes pets to this disease. And as with any cancer, we don’t really understand how or why it happens.

A week ago, several months after the initial biopsy, Orange’s mom decided to take him to the emergency room. He’d had a particularly bad day. He seemed painful and had not been eating well. The ER doc prescribed some pain relievers but urged Orange’s mom to consider euthanasia…immediately.

Indeed, Orange has impressively changed. Far from the sleek housecat of a few months back, Orange has grown thin and his coat has dulled considerably. The most impressive change, however: the lemon-sized lump on the right side of his face. Slowly growing, as if from the inside out, the mass has distorted Orange’s facial features beyond fun-house mirror proportions.

Although, to the average person, the tumor has finally pushed his face into the realm of the grotesque, his mom is unwilling to consider euthanasia just yet. After all, he eats, he purrs, he seeks her out, and maintains all his basic routines. He doesn’t sulk or hide. So why not keep him going?

Why not? That’s why Orange came in today. He’s having another bad day and his mom wants some more pain meds to keep him comfortable when he eats.

One look at Orange and his mom and three things become clear:

1-Orange`s mass is painful and infected.

2-Orange`s mom is not prepared to euthanize him.

3-I can make Orange feel better quickly with antibiotics, steroids, and pain relievers (how much better is hard to know).

Orange goes home after receiving an antibiotic injection and a long-acting injection of steroids along with a trans-dermal pain patch (think nicotine patch with an opiate pain reliever that lasts three days). He’ll be on antibiotics for at least the next two weeks—if he lives that long. His mom says she will euthanize him very soon if he fails to respond sufficiently to this treatment.

Some people think people like Orange’s mom are crazy to keep an animal alive under these conditions. But if there’s one thing I’ve learned as a vet it’s that these situations are among the most complex we face in veterinary medicine. When is the right time to end your loved one’s life? At least Orange has someone that actually thinks hard about the healthcare choices she makes on his behalf. Most of us humans will never have that luxury.