My 15+ year old rescue cat Marcello was always the picture of perfect health. He passed his annual routine checkups with flying colors every year and only needed two dentals in the 12 years he lived with us. No sniffles, no sneezing, no coughing, no viruses, no infections. He could not have been an easier cat to care for. Until he started peeing outside the litter box. That’s when things started to change. That was a year and a half ago. 

Marcello lived with three other rescue cats upstairs on our second floor. He would have been very happy as an only-cat, but unfortunately that was not his destiny as I was in cat rescue, and was actively trapping abandoned cats in our community, bringing them home to foster, medically treat, and socialize, before putting them up for adoption with my cat rescue organization. One by one, there was always a new rescue cat that Marcello had to put up with. He hated the competition for attention and would even punish and bully each cat for stealing affection away from him. He was a one-woman cat and that had to be understood by any new resident cat who came to share his home–those were Marcello’s ground rules and he strictly enforced them.

Marcello himself had been abandoned. Someone who owned him in his early years had left him behind and moved away, leaving him to fend for himself outdoors. Marcello survived, but he had been in his share of cat fights and had the scars and torn ears to prove it. But his real wounds were all on the inside—his trust in people had been deeply injured and his confidence in people shaken to the core. During the first two months of Marcello’s healing with us, he feared being abandoned again. Every time I came to visit him in his room, he completely let his guard down and would wrap, twist and curl his body all around me, then head-butt me over and over again, all with a big orange tail flared out like a bottle brush. But when I would get up to leave, Marcello would attack me like a police dog—and bite my ankles with a vengeance and leave me a bloody mess. That fear of abandonment slowly dissipated over time as he came to trust and realize that he was safe with us. In short order, Marcello became one of the most affectionate, loving cats I have ever come to know. He was a cuddle bug who loved nothing more than being stroked, rubbed, petted, caressed and loved every minute I could give him. 

Fast forward to today. For over a year, Marcello had been peeing on all of our rugs upstairs, as well as peeing outside the litter box, and even pooping on the floor under our desk. He had been to our vet three times during the past year to test him for a possible urinary tract infection (UTI), or bacterial infection or urinary crystals—but every urinary test came back negative. Since we ruled out infection, we assumed then that it was behavioral. So, I went to work trying to reduce his stress and anxiety, and create a safer environment for him. I changed the litter box locations, removed some litter box covers, added more litter boxes, added new toys for enrichment, bought the plug-in pheromone Feliway diffuser and plugged one in every room, and rubbed drops of Rescue Remedy into Marcello’s ears, but none of these changes worked. Marcello already had plenty of hiding places, safe boxes in closets, his own cat beds up on closet shelves, and had 7 feet tall cat trees to climb atop, so he could decompress away from cats and people. I finally reluctantly resorted to trying a couple of anti-anxiety medications, but after two months, even those did not make a difference. To Marcello’s chagrin, I did the only thing I could think of as a last resort—I transitioned him to live in our cottage with three other rescue cats. But he was miserable with his new kitty roommates. This was just too much for Marcello, he quickly grew depressed, anxious, and stressed, and still continued to pee outside the box. Now, he was even peeing on his own cat beds. So once again, I loaded him up and off we went for another doctor checkup, this time I needed to get to the bottom of what was causing this chronic problem. I sensed this was not a behavioral problem after all, but a physical one. Something was wrong with Marcello and I had to find out.

On February 10, 2019, I took Marcello to our veterinarian Four Corners Veterinary Hospital, to run diagnostic tests once again for his inappropriate urination. Increasingly Marcello had been licking his belly and “mowing” his hair, he had also started obsessively licking his prepuce area, causing the dilation of his prepuce that had now become large and raw from his neurotic licking. During his exam, Dr. Becker noticed with great concern how his prepuce had significantly thickened in circumference, and he had a slight but distinguishable blue/black discoloration on part of the prepuce skin. She quickly commented that the discoloration was a possible tumor or cancer. I was stunned. This comment was so out in left field for me. This was not the outcome or diagnosis I anticipated at all, and cancer could not have been further from my mind. I never had a cat with cancer. She sedated Marcello and took several tissue biopsies and needle aspirates from inside the prepuce and sent them to a lab in Davis for diagnosis. While at the vet’s office, Marcello was given a steroid injection to arrest the growth of the tumors and we went home with an anti-inflammatory NSAID medication called Meloxicam to control the inflammation and growth, and to reduce pain. 

The biopsy results came back several days later and revealed the worst possible outcome for Marcello—Malignant Amelanotic Melanoma. This was followed by Neuro-Endocrine Carcinoma or poorly differentiated carcinoma inside his prepuce, which would eventually grow to cause him to be unable to urinate. Both are aggressive cancers that grow and spread rapidly to lymph nodes, lungs, bones, and the liver. Malignant Melanoma is very rare in cats—melanomas in general comprise less than 3 percent of skin tumors with approximately 42-68 percent of those being malignant. And malignant melanomas account for less than 1 percent of oral tumors in cats, according to Tufts University. But unfortunately, in their malignant form, melanomas tend to be very destructive locally, and re-grow after surgical removal and then metastasize or spread to other locations in the body. And unlike in humans, melanomas in cats are highly unlikely to be UV-radiation related. Long-term survival rates are highly unlikely. And once the cancer has metastasized, the cat will likely live only 1-2 more months. I was stunned. It is thought that trauma is suspected as a predisposing factor for malignant melanoma since melanocyte cells divide when they are injured. Most cats and dogs get melanomas on their head, in their eyes, or inside their mouth, or on their lower legs. But Marcello’s melanoma was in an almost unheard-of location, the oncologist said he has never heard of a case like his. I knew I was in trouble. 

At the pathologist’s office, a Fontana Masson stain was done to further support and verify the diagnosis of malignant melanoma for Marcello. The results of his blood and urine test came back perfectly normal and healthy. Everything I read about malignant melanoma in cats said the tumors are very aggressive. I read the prognosis is not good, and the odds of long-term survival are very poor to almost nil. The best treatment  for this cancer is complete surgical removal of the original tumor, but the location of the tumor on Marcello’s prepuce made that impossible since the location is too sensitive and would be too painful when urinating. Radiation therapy was an option that I discussed with my vet, but again given the sensitive location, and taking Marcello to an oncologist so many times for treatment under anesthesia – I couldn’t’ put him through that. I accepted that my Marcello was dying. 

Hoping for the best, I started Marcello on Gabapentin, a pain-killer, every day, along with Meloxicam, a non-steroidal anti-inflammatory every other day. I applied an antibiotic ointment to his prepuce morning and night, which I later switched to Lidocaine to numb any pain or discomfort he was feeling in that sensitive area. In addition, I gave Marcello fluids every other day to keep his urine clear and dilute to avoid pain while urinating. The fear I had, and it turned out to be true, was that his cancer had already spread. 

Our attack had been to slow down the cancer’s progress with first anti-inflammatory Meloxicam, but when that didn’t work, our vet recommended a daily dose of the steroid Prednisolone. What we didn’t know, is that his cancer had already quickly spread to consume Marcello’s lungs. One month after his diagnosis in February, I took Marcello back to the vet to see if I could find out if his cancer had metastasized and by how much. I wanted to know how much time I had left with him, if any. Four weeks later, on March 15th, I took him in for X-rays and we found his lungs were a cob-web of cancer. I suspected something in his lungs because Marcello had started coughing—uncontrollably, followed by long periods of rapid, shallow breathing where he was stiff and still. These episodes really bothered him, he seemed almost ashamed at losing control of his body. This was new territory for him. I could see his cough bothered him because he would slink up onto the bed with his head hanging low after it was over—like he was saying “I’m sorry mama.” I felt so much guilt for not being able to help him or heal him, or even buy him significantly more time—all with less suffering. The main thing for me was I didn’t want him to suffer, or die in agony, and I was tormented about what was best for him because Marcello was stubborn and resilient and would be a trooper till the end if he had to. But I could see that he was getting weaker. He still had a good appetite, loved being petted, and slept well, but he hated the lidocaine I put on his prepuce. Then a week later he started choking on his pills. That’s when I knew I was really in trouble if I could not give him his pills. So I mashed his pills into Gerber’s baby food and syringed them into his mouth, one at a time, but that only lasted a few days. His lungs were having difficulty now with swallowing anything that wasn’t soft. And the cancer under his skin around his prepuce was growing—spreading like wildfire, it was like a monster inside of his body now and hard cartilage-like growths were all around his prepuce. Over time, he become more sensitive to these hard masses, whereas they didn’t bother him before. 

By Friday, a week after the X-rays were taken, I could see there was more pain and discomfort, and less pleasure for him. The scales were tipping—fast. Sunday was fast approaching, the day my vet’s office was closed, which is always a scary day for me. I was worried that Marcello’s lungs might quickly become consumed in fluid, suffocating him, and I wanted to avoid taking him to the emergency hospital—a new place for him. His rate of breathing had increased to double the normal rate round the clock, and he was not getting as much oxygen as he should, so I felt the time had come to let him go. I was struggling so much with this decision, because I have always had cats die of old age, or live so long their organs started to fail—I had never had to let an otherwise healthy cat go. It felt so unfair, so unjust. But I reminded myself he had lived 15-20 long years, and 12 of those years were very comfortable and happy. I thought, what would Marcello want? What would I want if I were him? Or if he were me? Cats live in the present, in the moment—to them, there is no “future” as we know it. They don’t see a future, or long for one, or live for one or think about what they will be missing. Marcello’s life was not going to get better, it was going to get worse—and fast. So, with the help of my wonderful, loving cat friends who rallied for a consultation, and reaching out to a cat communicator, along with my vet—I decided that it was time. I decided to let him go the next day, a day before Sunday. And my trusted, compassionate, skilled veterinarian Dr. Becker was luckily working on Saturday—she saved the last hour for me and Marcello. All for us.

I spent the entire day with Marcello on Saturday, feeding him as much Gerber’s baby food as he would eat, reading my book on the bed with him as he slept pressing his body against my side, giving him endless pets and hugs and kisses as the hours past, and letting him know how very much I loved him. I thanked him for finding us, and for entrusting us with his beautiful soul that so touched our lives. I thanked him for all the affection, head butts, squinted eyes, body presses, nightly purrs, bottle brush tail that flared when he was happy, and the love that he shared with me every day for 12 beautiful years.

I brought Marcello into our vet the last hour they were open. It was quiet in the office. I carried him in a huge, soft, fluffy red blanket that he had come to know and was familiar with. We sat on the sofa in a quiet room with low-light designated for doing euthanasia procedures. Marcello curled up burying his head in my arm pit pressing hard against me, getting as close as he possibly could. I covered his body with my big warm sweater so he could hide in the dark. We sat there for a long time, just being quiet. He never even felt the sedation going in ever so slowly, because he had had fluids every other day so he was used to the poke of the needle in the exact same place and the feeling of the fluids going in. To him it was just another day. Slowly, ever so slowly he fell asleep with the sedative, and he never knew what happened after that moment. He just fell asleep and died in my arms. That’s how I wanted it for him, for him knowing I was there with him, holding him close, and loving him till the very end. 

We will love you forever Marcello, you will never be forgotten, you are in our hearts for as long as we live. We will see you when it is our time to go, when we will join you on the other side, over the rainbow bridge. Bye my loving buddy. 

Credits

 (1)Malignant Melanomas in Cats, Dr. Mike Paul, DVM

The Little Tumor That’s Almost Always Deadly, by Dr. Karen Becker, Healthy Pets

Melanoma Update, Hope Veterinary Specialists