15 y o male cat: IBD or small cell lymphoma, what next?

[dulcemir]

A few months ago, I posted this thread about my best boy cat.
$2,000+ later (ultrasound, new bloodwork, B12 screening), the vet determined he either has IDB or small cell lymphoma of the small intestines. Only an endoscopy would be able to allow us to determine the true diagnosis, but I'm not willing to do this because (1) my cat is old, and I don't want to put him through it, and (2) it costs about $3,000 at my vet.
So, the vet said the walls of his small intestines are thick, indicating that he's no absorbing the little food he's eating. He used to weigh 10.5 lbs at the height of health, but he's a measly 8.5 lbs today.
The doctor prescribed him budesonide for two weeks to see how he's doing. If he isn't improving, he'll up it to prednisolone. He also prescribed Mirataz to get his appetite going and B12 to supplement his low levels.
He started the budesonide yesterday and has been totally listless and sleeping all day. He has eaten about 1/2 a meal since Sunday as well. He puked up that 1/2 a meal this morning.
A week before the vet, he was still puking almost daily, but he was still somewhat playful. He seems to have lost all his playfulness since going to the vet.
Long and short of it is:

• What's next? Is this listlessness normal when starting a budesonide regimen?
• What does success with/positive response to budesonide look like?
• He hasn't responded at the first smear of Mirataz tonight. Shouldn't it act immediately? Does it take longer (a few days) for some cats?
• What has your experience been with a senior cat on similar drugs?

I'm sort of preparing myself for the worst in the next few months, so I guess I'm just wanting to see what's on the horizon for me.

 

[Furballsmom]

Hello - my Poppycat hasn't gone through this, but I wanted to answer and give you all my thoughts and prayers. Hopefully others with experience with these meds and/or the illness will see your post soon and reply

 

[dulcemir]

Hello - my Poppycat hasn't gone through this, but I wanted to answer and give you all my thoughts and prayers. Hopefully others with experience with these meds and/or the illness will see your post soon and reply

Aw, thank you. Last night was rough (mostly for me). My next pet will be a long-lived parrot after this trauma!

 

[betsygee]

Hi there, I’m so sorry you and your baby are going through this. I’ve had some cats who have had IBD/lymphoma. I just lost a beloved kitty in April of this year. He had tumors and inflammation that were too far advanced to do anything about. Very tough.

I’ve also had kitties with IBD who have had some success with budesonide or prednisolone—success meaning keeping the IBD more or less under control for some time. I don’t have any experience with Mirataz.

I ended up giving mine whatever they wanted food-wise. Fancy Feast seemed to be a favorite no matter which cat or what the symptoms were. I always kept baby food on hand as well for them to lick and at least get some nutrients in their system when they wouldn’t eat anything else. If you try that, it needs to be just meat and broth, no added spices or anything. Gerber’s and Beechnut both have that kind of food.

Every cat is so different—I’ve lost a couple after 2-3 months on medications, others have lasted much longer. I hope you can find a combination of food and medications that work for your kitty, and others here may have more specific recommendations for you to try.

 

[jeannem]

((((((((((((((((hugs))))))))))))))))))))))))
j

 

[daftcat75]

He needs to eat. Cats are meant to get moisture from their food, not their water bowl. If he's not eating enough, he runs the risk of dehydration. If the Mirtaz doesn't start working today, I'd take him back to the vet ASAP for subcutaneous fluids to avoid dehydration.

Mirtaz may not be working if he's nauseated. Ask your vet about an anti-nausea prescription like Cerenia (maropitant) or Zofran (ondansetron.)

Please also consider that a feeding tube may be needed to get him eating again. The feeding tube does not prevent or preclude him from eating on his own. But he's probably past that. Not eating starts physiological processes that make the cat nauseated and feel even less like eating. If medication alone is not getting him to eat once more, please consider the feeding tube as a lifesaving measure. You'll mind it far more than he will. The only time my Krista ever cared about her feeding tube was when I fed her too fast or fed her too cold. I got instant feedback on both and learned very quickly. Aside from those, I think she knew I was trying to help her. She would very calmly squish down when I asked her and sit there patiently for her feedings. As a bonus, any medicines you can get compounded as liquids can go down the tube with food. When he's eating again on his own, you can have the tube removed and the insertion site should heal within a week. If you do go this route, you'll want to leave the tube in longer than you think he needs it just in case he reverts back to not eating. It's much easier to leave the tube in and not need it than to take it out too soon and have to put another tube in.

Feeding Tubes For Cats

I don't want to bombard you with IBD and lymphoma information right now. His eating and especially his hydration status are more important right now in the short term. If he doesn't want to eat what he normally eats, go to the pet food store and pick up highly appealing brands like Fancy Feast, Friskies, and Sheba. You might think these are junk food. You might be right. But it's better to eat at McDonald's than to starve at Whole Foods. You need to get him eating again as job one.

 

[dulcemir]

A quick update on my favorite boy: The doc put him on 1mg of budesonide a day, and he's doing really well (fingers crossed). He's eating a ton, pooping normally, and the vomiting stopped completely. I am cautiously optimistic, but the vet said he has to be on budesonide indefinitely. The vet recommended we do bloodwork 4x a year to make sure all the readings are ok. Does anyone have experience with long-term use of this steroid?

 

[cocoanlace]

Great news. Your situation just confirms that a good vet is everything. My cat Yogi passed in 2018 from intestinal lymphoma. Budesonide was never prescribed nor was I even aware of it. For appetite, I got appetite pills which he vomited. Pepcid only induced vomiting. He did get meds for constant diarrhea but they did not work. The struggle was finding food, anything, he was willing to ingest. Weight went from 6 pounds to 4 really quickly. I now have a cat on transdermal Mirataz as needed and it seems to work within the hour. Helps nausea, too. I have a new vet, 1 hour and 15 minute drive away, but worth it to get the latest treatments. I wish I had been offered Mirataz for Yogi. I did not know in 2018 that drugs could be compounded to be given inside the ear. On steroids, my cat Missy got shots for asthma. Eventually it gave her diabetes so we stopped and I went to inhaled meds. Hope your kitty continues to do well.

 

[Furballsmom]

Does anyone have experience with long-term use of this steroid?

I didn't know if you were familiar with this thread, hopefully the poster will see your thread

14-year-old cat throwing up every night after dinner, BUT bloodwork, urinalysis, and X-rays all came back 100% normal

 

[dulcemir]

Great news. Your situation just confirms that a good vet is everything. My cat Yogi passed in 2018 from intestinal lymphoma. Budesonide was never prescribed nor was I even aware of it. For appetite, I got appetite pills which he vomited. Pepcid only induced vomiting. He did get meds for constant diarrhea but they did not work. The struggle was finding food, anything, he was willing to ingest. Weight went from 6 pounds to 4 really quickly. I now have a cat on transdermal Mirataz as needed and it seems to work within the hour. Helps nausea, too. I have a new vet, 1 hour and 15 minute drive away, but worth it to get the latest treatments. I wish I had been offered Mirataz for Yogi. I did not know in 2018 that drugs could be compounded to be given inside the ear. On steroids, my cat Missy got shots for asthma. Eventually it gave her diabetes so we stopped and I went to inhaled meds. Hope your kitty continues to do well.

I'm so sorry about Yogi. Did you learn about it more from doing your own research online through sites like this? I found this community incredibly helpful in giving me insight into what my cat is going through.

You're totally right. My regular vet is wonderful but was not able to figure out what my cat's problem was. He originally prescribed him famotidine and Cerenia, but both those drugs were only masking the symptoms of what he thought he was pancreatitis. He referred me to the vet I'm working with now, who narrowed his vomiting and rapid weight loss to either IBD or SCL after an ultrasound. I didn't want to go through the trauma of doing an endoscopy to determine if it was either diseases, so we agreed to go by an empirical treatment. He wrote me a long email to describe my options to me: either budesonide or prednisolone, telling me that the latter was going to be rougher on my cat's system. Because of that, I decided to go with the budesonide, which I'm very thankful I did. I asked for a prescription for Mirataz along with the budesonide, but I only needed to use it once because kitty's appetite returned a few days after visiting the vet.

I spent about $2,000 on diagnostics with this vet already, and initially I thought it was overkill. But I now realize it's worth it to preserve my cat's quality of life.

 

[daftcat75]

I'm so sorry about Yogi. Did you learn about it more from doing your own research online through sites like this? I found this community incredibly helpful in giving me insight into what my cat is going through.

You're totally right. My regular vet is wonderful but was not able to figure out what my cat's problem was. He originally prescribed him famotidine and Cerenia, but both those drugs were only masking the symptoms of what he thought he was pancreatitis. He referred me to the vet I'm working with now, who narrowed his vomiting and rapid weight loss to either IBD or SCL after an ultrasound. I didn't want to go through the trauma of doing an endoscopy to determine if it was either diseases, so we agreed to go by an empirical treatment. He wrote me a long email to describe my options to me: either budesonide or prednisolone, telling me that the latter was going to be rougher on my cat's system. Because of that, I decided to go with the budesonide, which I'm very thankful I did. I asked for a prescription for Mirataz along with the budesonide, but I only needed to use it once because kitty's appetite returned a few days after visiting the vet.

I spent about $2,000 on diagnostics with this vet already, and initially I thought it was overkill. But I now realize it's worth it to preserve my cat's quality of life.

Quality vet care is worth every penny.

I did the best (I thought) I could do with my Krista. But ultimately, it wasn't enough. I didn't feel like I was getting quality care but didn't feel like I could afford the stress and time of a specialist. Especially after Covid up-ended the way we visit vets now with the drop off or drop off and wait in the parking lot visits.

Do some research on budesonide's long term risks or side effects. Yes, pred is harder. I'm convinced part of the reason Krista was not able to mount a comeback after she finally reached remission was that daily pred dosing made her too weak overall. Find out if it's safe to give budesonide daily for the long-term or if it's better to taper to every other day dosing like pred.

The rule of thumb I received on IBD vs lymphoma is that if he can gain or maintain his weight, it's probably not (yet) lymphoma. That said, a lot of vets now think they are two points of progression of the same disease or that today's IBD can become tomorrow's lymphoma. Empirically, this makes sense that when you have any system that's always on (like the overdriven immune system in IBD), it will eventually breakdown and malfunction (as in lymphoma.) Buy a baby scale and weigh him no more than once a week. If his weight is stable, you can move this to once a month as long as it is stable. If he starts losing weight or continues to lose weight despite eating an adequate or more than adequate amount of calories per day, consider that it may have progressed to lymphoma and discuss chemotherapy with your vet. Chemo in cats is not nearly so miserable as it is in people. Most cats show few and mild side effects, if any at all. Krista was simply a little lethargic on the chemo days. But it didn't affect her appetite and she was usually all better by the next day.

 

[cocoanlace]

I'm so sorry about Yogi. Did you learn about it more from doing your own research online through sites like this? I found this community incredibly helpful in giving me insight.
I didn't want to go through the trauma of doing an endoscopy

I think I first learned about transdermal drugs from the Internal Medicine Specialists my kitty is now seeing. She first prescribed Gabapentin last year and then this year I got Mirataz after exploratory surgery. But I do lots and lots of research. I have a cat with a dysfunctional biliary system that just had a $10,000+ surgery, and last week I discovered the sphincter of oddi, showed the article to my vet, and now we are seeking a drug that may help. Just wanted to say that when Yogi had intestinal lymphoma, we did a biopsy with sedation only using a needle to aspirate cells which were sent to the lab. Results were probable lymphoma and we went with that. Cost was under $500 for all of it. The endoscopy method never came up.