- Joined
- Apr 2, 2019
- Messages
- 1
- Purraise
- 1
[I hope this isn't too long of a post! I've read some of the other accounts of lymphoma similar to this and it seems many posted earlier, so their story is broken up into update posts. I've left in a lot of details, because that's what I was looking for when I was reading other people's accounts.]
Hi everyone. This is my first time posting here. I’m happy to accept advice if anyone has anything to add or has had similar experiences, but I wanted to record my cat’s journey through cancer (so far at least).
When she was first showing symptoms and we weren’t sure what it was, but cancer was brought up as an option (specifically large cell lymphoma, since the thickening was in the stomach) I was desperate to find more information. As many of you probably know, there are hundreds of articles about cancer in cats, but they all deal with the same 5-10 general facts. This site is where I found the most specific information, stories about the experiences others had gone through with the same or similar diagnosis. It was really really great when I felt so scared and helpless and confused.
So, I’m hoping that my account of what happened with my cat will shed a little light for someone else in the same situation some time down the road, and that it will help them the way others’ accounts helped me.
My cat is 12-13, and has all the earmarks of being a Russian Blue, but definitely could be a mix. She’s pretty small, generally, and has been a very healthy cat for all her life, with the exception of one UTI when she was much younger, and a lifelong allergy to...something? We did food trials to see if we could isolate it, but never figured it out. She was just mildly itchy around the ears and face, occasionally forming small scabs, but mostly she was fine. Eventually we put her on some transdermal prednisolone, that got rubbed into her ears.
Things really started in December, probably before although I didn’t know it at the time. I bring the cat in for regular check ups at the vet and, after a recent one, we had been told she was getting a little overweight for her size and that she might be at risk for diabetes later in life if it continued. We’d always free fed her previously, and didn’t have trouble with her weight until she slowed down in her old(er) age. So we started her on a diet, gradually limiting the amount of dry food/wet food we gave her.
Eventually we were down to an amount that should have lead to a healthy weight for her. That’s when she began vomiting. For several weeks she would vomit most mornings. Sometimes before we fed her, sometimes after. If it was before she would vomit just liquid bile. If after, it was her undigested pellets of dry food. I assumed at the time it was her stomach adjusting to going all night without food and getting rumbly in the morning. Or that she was eating too fast to start. She vomited frequently enough to be quite concerning, but just not quite frequently enough to take her in.
At the time I didn’t know it, but some of the vomit probably had traces of blood in it. It looked ever so slightly brown tinged, or pink tinged, I thought, maybe? But I was never sure. All our floors are brown wood and our paper towels are unbleached, so also slightly brown. I just wasn’t sure, and other than the vomiting, she seemed totally fine, so I decided to just keep an eye on it.
Then in December she, for the first time in her life besides the UTI incident (she’s always been such a wonderful cat!) she pooped on a shirt on the bathroom floor. It was very gooey diarrhea, but the most concerning part was that there was clearly some bright red blood in it. I called the vet right away and made an appointment for that day. And of course I googled it while I waited. I learned that sometimes bright red blood can occur in the diarrhea if the cat has had indigestion for a while. I thought ‘oh hey! She’s been vomiting a lot, clearly indigestion.’
So I took her in, they checked her out, did a physical exam, I think I brought in a stool sample? And I believe the took some blood to check for parasites. They didn’t find anything, which I thought made sense. Other than indigestion, she seemed fine. Acting normal as usual. So I took her home, thinking, alright, this is probably indigestion from the diet. I’m just going to feed her like I used to, working her back up to free feeding. I’d rather have her a little chubby than have indigestion all the time.
Everything seemed fine for the next while.
Then on February 8 she had another bloody stool incident. I was less worried at this point because she still seemed fine, I assumed it was still indigestion, (and they had had no answer last time I took her in with only these symptoms) and even the vomiting lessened. It’s hard for me to know whether there was blood in her poops at other times either before or after I took her in, because the litter covered it all up. So I still didn’t take her in at this point. Again, thinking she just had a bit of a rumbly tummy at times now that she was old.
So, things really began in earnest on February 24. She vomited bile around 11 pm that was very pink. It was clearly blood, so we gathered her up in her little carrier box and rushed her to the emergency clinic. And thus our struggles began.
They took her in quickly, luckily not many others came in at the time. So they did an x-ray, and found some suspicious things and showed us on the x-ray. There was something going on in her stomach the vet said (I couldn’t really tell, but I haven’t looked at many x-rays, so I took his word for it), and maybe some suspicious stuff in her intestine, but apparently not what it would look like if she’d eaten something she shouldn’t have (that happened once before, but luckily I saw her do it, so she survived that incident). They also did an ultrasound, which they sent out to an expert to interpret later.
The vet told us it could be a couple of things. The most likely being an ulcer, or cancer, and other than that...some sort of mystery lump. He told us the most likely type of cancer for it to be was lymphoma, specifically the large cell version, since that’s apparently more common in the stomach. He said we could do a more invasive test to get a for-sure diagnosis, OR we could simply treat it like an ulcer for a week or two and cross our fingers and hope she gets better.
I guess the ulcer medication wouldn’t have made anything worse (while prednisolone steroids can make ulcers worse). I didn’t want to put her through extra procedures unnecessarily and I thought, if it IS cancer, one week probably isn’t going to make a huge difference. Plus, it made sense! I thought, surely if she had cancer and it was that bad, she would have other symptoms? But all I had seen was what looked like severe indigestion. So I thought, yeah. Let’s go for it.
So we were sent home with instructions to give her:
Famotidine 10 mg ------- give ½ a tablet every 12 hours (this is a pepcid/antacid)
Mirtazapine 7.5 mg --------Give ¼ of a tablet every 48 hours as needed for appetite stimulant
Carafate/sucralfate 100mg/ml suspension------ Give 1 ml every 6 hours. Give 1-2 hours apart from food or other medications.
And to keep her on a bland diet. They recommended a recheck ultrasound in 2 weeks to re-evaluate. If the spot improved, easy, it was an ulcer. If not, it would require further diagnosis, likely a biopsy.
So that’s what we did. We kept to a crazy schedule the first 5 days giving her the medicine every 6 hours, following the instructions to the letter. I’m very lucky in that I make my own schedule and work from home, so my partner, who is a 9-5er though he has some flexibility, only needed to help me with the actual dosing. The cat does NOT like liquid medicine, and because of the type, we couldn’t even give her treats afterwards. I would wake up 2 hours before the dose was due and take away her food bowl. We’d give her the dose at the appointed time, then I would get up an hour after to give her her food back.
We only gave her the mirtazapine once after the visit to the emergency clinic. She wasn’t that interested in eating after whatever sedation they did while she was there for the exams.
We gave her boiled chicken and chicken baby food (the MOST disgusting thing on the planet, apparently). She did eat, but she was not pleased with these new offerings. I would offer her little plates of it every once in a while, to encourage her to fill up, since every 6 hours we needed to take away her food for 3 of them to give her the medicine. Eventually I saw her eating something from the floor near where her food bowl had been (I was just placing them at her favorite spots around the apartment) and I heard it crunch, so I went over and stopped her.
And I saw that it was a strip of boiled chicken that had fallen out and dried. I thought ah ha! She likes her wet food really soupy and she has her dry food, maybe she doesn’t like chewy things? Maybe she doesn’t understand chicken because it’s not like wet food and not like dry food. I can dehydrate the chicken! So I set the oven to its lowest setting and dried a bunch of the boiled chicken. She actually did seem to like it a bit better! If they got too crunchy I would just add a few drips of water to it so it was more like the consistency of jerky, than boiled chicken. Hopefully that revelation will help someone else too. It's something to try at least.
Anyway, we kept on with the medicine dutifully until we ran out of the carafate/sucralfate. Things went as usual from Feb 25 late at night until Mar 1st when she vomited for the first time in a while. I believe we ran out of carafate/sucralfate on Feb 29. So we called the clinic and got a refill on the carafate/sucralfate as well as a new medication called maropitant/cerenia, which is an anti-vomiting, anti-nausea medicine.
We began giving her the carafate/sucralfate again at 2 ml every 8 hours, doubling the dose over a slightly longer period of time. (we were not pleased about more liquid medicine, nor was the cat. It was an unpleasant experience and we had celebrated giving her the last dose). As well as the maropitant/cerenia. I don’t remember the dose on that, unfortunately. I know at one point we were giving her ½ of the 16 mg tablets and at one point 1/4 (these by the way are used for dogs, technically they aren’t officially approved for use in cats, but are routinely given).
Apparently these pills taste very bad and are very bitter. We haven’t had to pill her before, usually she’d just accept the pill pockets, but she’d figured them out by that point, especially with the bad tasting pills. We kind of botched it the first time we gave her the famotidine/cerenia. I got it into her, but she definitely got a lot of bad taste in her mouth.
She vomited a couple times on March 2, just a very little bit of bile, and one of those incidences was about ten minutes after the bad tasting pill, so we think that may have been the culprit for that moment. Kind of ironic for an anti-nausea pill. But after that we coated the bad tasting famotidine/cerenia in just a thin coat of the pill pockets so she wouldn’t taste it, but so that it was small enough to swallow easily, making sure the pill didn’t touch the outside of the pill pocket.
So we continued on like that for the rest of the 2 weeks, with the cat getting increasingly less enthusiastic about her chicken-only diet. We tried hamburger once, but zero interest in that.
Things continued on well enough, we thought hey, maybe it was just a really bad ulcer and needed a bit more than the initial amount of carafate to heal.
But on March 11 she vomited some of her chicken, and had some blood in her stool. It was concerning, and I believe we had once again run out of carafate on March 10.
March 12 was when I knew it wasn’t an ulcer. That morning she vomited again, and it looked just the same as it had when we had first taken her into the clinic. Bile, but very very pink. Clearly bloody. When I saw it I just knew that whatever it was, however long the prognosis was, this was the end for my cat. It was a really hopeless moment for me. (This was around when I started scouring the internet for information on large cell lymphoma in cats, because they had told me that was the next most likely thing, and I found this site that way)
There were also a few little pine needle bits in there. We have pines everywhere nearby, and I think she was going around trying to find roughage to make her stomach feel better. It’s practically impossible to see the little pine needle pieces on our floor, but I tried my best.
I called the vet because we basically knew she wasn’t in critical condition. She was still acting like her usual self and eating some chicken, begrudgingly. And we had the follow up ultrasound the very next day. I went to get a little more carafate/sucralfate to settle her stomach for the rest of the day, but they said I didn't need to rush her in.
March 13 I took her in to have the ultrasound follow up which was done at our regular vet’s office. The found nothing abnormal except in the stomach. I’ll write that part of the report verbatim below:
“There was a hypoechoic thickened region of the gastric wall. The thickened wall was in the cranial margin of the fundus 10.8 mm wall thickness. 30.7 mm approximate length.”
They called me during the ultrasound to see if I wanted a Fine Needle Aspiration done for cytology. This is the least invasive way to get a sample, plus she was already there and I guess they do them during ultrasounds, so they can see what they’re doing. They insert a very thin needle into the area to try to get a sample. I elected to have them do it. I had read that frequently this particular test can be inconclusive. If they found nothing, we’d have to take that with a grain of salt, depending on how good the sample was, since it could easily be a false negative. However, if they DID find cancerous cells, we would know for sure.
All the vets were very nice about everything. Each dr. we dealt with stat’d the test results so that we could have them sooner, which we really appreciated. This had been going on for so long, we just wanted a solid answer. While we waited for the tests I was again furiously searching for any useful information, like, for example, how large is this section of the stomach by percentage? 1.08 cm thick and 3 cm long? I wanted to know if that was 10% of the stomach or 90%? I didn’t find much useful information. I did find that the stomach wall is only supposed to be .2-.3 cm thick. So that was pretty concerning. And anecdotally a cat’s stomach is maybe roughly the size of a billiard ball? So it seemed like a pretty large proportion.
Unfortunately, you don’t always get what you want. Not surprisingly, the test was essentially inconclusive. I’ll write out the relevant parts verbatim:
“The slides are hemodiluted and otherwise somewhat sparsely cellular. In some areas they contain mildly increased numbers of non-degenerate neutrophils and some small well differentiated lymphocytes. In some areas there is a pink to lightly basophilic mucinous background. No infectious agents or obviously malignant cells are seen and there is no infiltrate by large or abnormal lymphocytes, nor by mast cells or eosinopholis.
Comments:
The slides are somewhat sparsely cellular so should be interpreted with caution. Mild inflammation is contributing at least partially to this patient’s problems. This is rather nonspecific and might occur with walled off infection, necrosis, trauma, response to a foreign body or foreign material or ongoing rather severe irritation for any reason. If biopsy is not planned at this time perhaps the lesion can be monitored and if it enlarges or otherwise changes character then biopsy or complete excision with histopathologic evaluation could help provide additional diagnostic and prognostic information”
So pretty much not useful. I’m still glad we did it, because it’s so non-invasive and if it HAD found cancerous cells we wouldn’t have had to move up to an endoscopic biopsy.
So, I made an appointment for her. I figured, even if the cytology report is correct and it’s not cancer, we still need to know what it is. We can’t just leave the cat vomiting blood perpetually. The appointment wasn’t for another week or so, so we continued to give the cat some maropitant/cerenia and carafate to help her stomach be more comfortable in the meantime. Plus we switched from plain chicken and chicken baby food to a prescription cat food bland diet. Purina Pro Veterinary diets EN gastroenteric was her preference over the two we gave her. She definitely appreciated the change and ate the food with gusto!
We waited and took her in for the endoscopy on March 21. She had lost some weight from not wanting to eat chicken as well as needing to fast before each ultrasound.
So they did the endoscopy. She did great, no problems with the anaesthesia or anything. They showed me the pictures of her esophagus and stomach (I’m not sure if that’s standard, I saw the little thumbnails on the screen and asked to see them, they probably would have shown be later anyway though.)
It was very much a “well, there’s your problem” moment. One half of the picture looked like what you might imagine the inside of a stomach would look like, smooth-ish and pink. The other half looked...not like that at all. They said, here’s the abnormal part. I said yes, that looks very abnormal to me also, and I’ve never even seen a picture of the inside of a stomach before.
The dr. came in after the nurse told me a few things and she walked me through what they had done and how the cat had been throughout. She said they’d send the biopsies to the lab and that she’d stat them so hopefully we’d get them on saturday. I was pretty sure, based on the picture, that I knew what it was, but I asked anyway, if she had any guesses as to what it was. I know doctors and vets don’t like to speculate on things unless they have a good idea of the statistics. Her response was “Oh yeah, no this is definitely cancer. The biopsy at this point is just to figure out what kind”. Also, one of their surgeons had been available to take a quick peak as they were doing the procedure and they confirmed that the area was not operable (which usually isn’t the process for lymphoma anyway, but it was good to have confirmation on that also)
I was actually relieved at that point, to at least finally have an answer for sure. So the test results came back on Saturday March 23 and it was indeed large cell lymphoma in the stomach as well as some small cell lymphoma in the very beginning of the intestines (I recall the word duodenem getting used). They had seen a pale and oddly texture part of the intestines, so they had taken a few biopsies of that area as well.
So. We made an appointment for oncology for the 25th. Meanwhile I was trying to do more research, but without the details, and especially since large cell lymphoma is a bit more rare, there was less info. It was time to do some research on chemotherapy.
My cat hates the vet. She’s always been a bit of a scaredy-cat. She’s a real sweetheart and squirms and tries to get away when grabbed for the vet or for medicine, but she never bites or tries to scratch. Sometimes scratches happen anyway because of her struggles, but she’s never attacked.
I thought, if she has to go into the vet very frequently, it might not be worth it. If we have to give her liquid medicine, like the carafate/sucralfate, frequently, that’s also terrible. Once she realized a pattern in the dosage, she’d start hiding around that time of day. She’d get suspicious if the two of us were up and walking around the living room at the same time, because one of us would grab and hold her while the other administered the medicine.
I thought, that’s no way to live, even if it’s not physical discomfort, I would hate for her to be constantly afraid in her home where she’s supposed to feel safe. And it would break my heart if she didn’t feel safe with us anymore. This cat has always trusted me 100%. She never hides when she feels bad. She comes to me and calls for help. I hate not having a way to help her.
So, March 25 we went to the oncology department. It wasn’t very helpful, to be honest, but only because I had done so much research previously. It sounded like there was no real way to choose a good path without knowing more. It didn’t seem like the cat was either in a really great position or a really poor one. Choosing between the middle of the road choices seem very arbitrary. But they did tell us our options, as well as the cost in our area of the world.
From what I could tell, it seems that for lymphoma in cats, the “stage” doesn’t matter as much as it does in humans. The important factors are apparently the location, the type and whether or not the cat responds well to the chemo...which we can’t know unless we try. So, that’s not very helpful.
Right now, I’m really struggling honestly. This cat is the first pet that was just mine. We had a cat when I was young. My mom had her from before I was born. She was a family pet, but this cat is mine. I got her in high school when my sister left for college. She got me through a lot of tough times. I’ve never had to make decisions like this for a pet before. The old family cat just kind of slowed down until one morning we got up and our parents told us they had put her to sleep. I was very sad, but it’s not the same as making the decision yourself, is it?
I feel like when you ask to get a pet (if you’re young), your parents or other adults will tell “it’s a lot of responsibility” and as a kid, you think, “yes, I’ll have to feed this animal every day, scoop the litter box or take it for walks. Make sure it stays out of trouble”. Nobody tells you about the responsibility you’ll eventually have of possibly having to make life or death decisions about your pet. I know I wasn’t prepared to be in this position, even though, intellectually, I knew the cat would not outlive me.
We were given three options. 1) LCHOP protocol chemotherapy, 2) CCNU which is somewhere in the middle of the road, a less aggressive and different type of chemo I think, and 3) just prednisolone. They said that roughly speaking, 25-30% of animals don’t respond to lchop chemo and it doesn’t help. For 50% it helps to some extent. And for 25% they go into complete remission. For the CCNU protocol. It’s 50% odds of no response, and 50% of the combined groups of partial or complete recession.
My biggest problem at this point is I have to be at a wedding in May across the country. It’s my cousin’s wedding and I’m a bridesmaid, so it would be very very difficult to justify missing it. My partner had planned on coming as well, but we canceled his part of the trip. He’ll be able to stay back and take care of the cat.
But because we still don’t know how the cancer is responding to the chemo, we have no clue what her prognosis is yet. It could be only a month or two, or it could be 6-9 months. That’s a pretty big range! And I’m so, so worried that I’m not going to be there for her. She likes my partner, and likes getting pets and snuggles from him, but he doesn’t know her the way I do. And she doesn’t trust him the way she trusts me.
And even if she does ok through May, I’m attending a graduate program in July, and I just can’t miss it. It’s my dream to go and learn and I worked so hard to get into the program. But it would mean living away from her for a month. I’d be able to visit on the weekends, but like I said, I work from home 90% of the time. She’d only have my partner evenings and nights, and she’d be alone most of the day. I don’t know how I’ll balance those obligations if it comes to it.
And I still just don’t know what’s going to happen. It seems like with cancer you can only play it by ear. Sudden turns for the better or worse are common.
Anyway, like I said right now we’re trying the chemo, so I’ll document how that’s been doing so far (she only had her second dose yesterday, April 1st).
On March 25th (a Monday) she got a shot of Elspar/L-asparaginase, the first chemo drug. We also continued to give her:
Cerenia/maropitant 16mg (the anti-nausea drug) ---- ½ tablet once daily as needed.
Prednisolone 5 mg tablet (switched from her ear transdermal to a pill version) ---- One tablet once a day.
Gabapentin ---- 1 capsule 1 hour prior to vet visits (this is a type of anti-anxiety/sedative that is given to cats who are nervous going to the vet, which my cat definitely is)
Famotidine/Pepcid --- 2.5 mg orally twice daily if vomiting. (I missed this in my initial reading of the vet's instructions, so she didn’t get this until Friday night.)
We discontinued the carafate/sucralfate.
Even though they said give the cerenia/maropitant as needed, but every previous time we stopped (or stopped the carafate) she would vomit the next day. We did try this one last time, not giving her cerenia/maropitant pill on wednesday march 27. She vomited the next day and I figure until something actually changes, we’re just going to keep her on it.
Anyway, side effects for this first chemo drug are supposed to be extremely uncommon. And she did alright for the first few days (besides the one vomit incident because of no cerenia). Then on Friday morning, March 29, she woke me up at 7, as she usually does. She feels safe in the bedroom, since visitors don’t go in there, so I moved a food bowl in there. She also seems to like to eat at night, and does most of her eating then since, I assume, she also feels safe with both of us there, and not moving around.
So I got her food and she ate a pretty average portion for her usual breakfast. Then at 8 am she woke me up again. She was drooling a LOT, which is very unusual for her. Even when we gave her the bitter bad-tasting pill, she never drooled. That morning she would drool and cry for a bit, then it would stop for maybe 20-30 minutes, then it would start up again. This continued from 8am - 2pm, when it seemed to just stop by itself, as suddenly and randomly as it came.
I did call the vet offices, who said to try giving her the pepcid to see if it helped. It didn’t seem to. After the first one she had much shorter, less prolonged episodes of drooling and crying, or sometimes she would just drool a bit. There didn’t seem to be any pattern to when it happened, and it only happened 2-4 more times, each of which was not as bad as that first day. I figured, that was an ok price to pay. She didn’t seem too upset, a few hours a week of being uncomfortable didn’t seem too horrible for the rest of the week feeling fine.
For her next visit on Monday, April 1 (yesterday, as of my writing of this) we gave her the Gabopentin for the first time. It’s an anti-anxiety drug/sedative. I don’t know if a somewhat confused drug trip is better than cognizant terror, but the vets seem to think so. So we gave it a try.
I dropped her off at 8:30 am, having given her the 100 mg capsule of Gabopentin at 7:00, one hour before our departure time of 8:00 am. She definitely seemed calmer. I handed her off. They told me they’d call me when she was done, maybe around early afternoon. They had her finished quite early however, around 10:30 am. Which was great. I went to pick her up, they said she had done great and was much less terrified with the sedative. The chemotherapy drug used was Vincristine.
A common side effect of Gabopentin is apparently some wobbliness, which they warned me about when I got her (they told me I probably shouldn’t leave her alone around countertops. They were right.). They also talked to me about the drooling. That it was likely nausea or a strange reaction to one of the drugs, or possible a pain-nausea pairing in which case we could use buprenex, (a narcotic for cats) to rule out pain as a possible cause.
So I took her home and she was definitely real wobbly, and a bit restless, but this seems par for the course for her reaction to sedatives. I had to keep a close eye on her, she definitely missed a few attempts at jumps, but nothing serious. She did some good eating during this time. It took her a while, but eventually she did settle down by around 3pm. By 5pm she was very very sedated, apparently not uncommon for gabapentin? She seemed exhausted, definitely what I would call lethargic. I wouldn’t call her non-responsive, she would respond and would get up very occassionally and move to different favorite sitting position where she’d go back to sleep for a long time.
She did perk up a little bit by late that night and since she was eating I wasn’t too worried. This morning (April 2) She woke me up at 3:40am with her crying and drooling again. She was restless, used the litter box (or at least attempted it). She did have diarrhea, but that is an expected side effect that the nurses told me about when I picked her up, and there’s a medicine I can give her to help with that.
I gave her buprenex at 3:55, since I figured it was time to find out if that would help. It definitely took effect, based on her pupil dilation, but didn’t seem to have any effect on the rest. Up until around 7:30 or 8 she would cry, drool, and try the litter box (or some combination of these) once every half hour or hour. After around 8 she was pretty lethargic, just exhausted from all the side effects, I suppose.
At 9:30 I did get her to take her pepcid/antacid pill in a pill pocket, but she didn’t eat the other treats, and she’s been CRAZY about them. She runs into the kitchen yelling every time she hears a similar bag crinkle noise to the treat bags. So that was pretty concerning. She started to perk up around 11. At 11:15 she had some water (HUGE relief, since she hadn’t had anything since 4am. And the one good thing this whole time has been that her appetite and drinking have been normal) and she visited the litterbox again. At 12:30 she had some of her food too! And that’s where we’re at.
And right now, I’m asking myself if it’s really worth it. Is the chemo worth it? Would she be suffering the same amount without the chemo because of the cancer? I just don’t know. I’m hoping by next week it will be reasonable to take another look at the tumor and see if it’s grown or shrunk. Because that will at least tell us if the chemo is working at ALL.
So that’s that, for now. I hope this post isn’t too long. I just wanted to be thorough :’) I hope some of this information is helpful to someone else going through this, although I hope nobody else does have to go through this.
Thanks for reading. Feel free to ask questions, I’ll do my best to answer and hopefully I’ll have some updates fairly soon. I don’t think I’ll post very frequently, but maybe around once a week, for chemo updates?
Hi everyone. This is my first time posting here. I’m happy to accept advice if anyone has anything to add or has had similar experiences, but I wanted to record my cat’s journey through cancer (so far at least).
When she was first showing symptoms and we weren’t sure what it was, but cancer was brought up as an option (specifically large cell lymphoma, since the thickening was in the stomach) I was desperate to find more information. As many of you probably know, there are hundreds of articles about cancer in cats, but they all deal with the same 5-10 general facts. This site is where I found the most specific information, stories about the experiences others had gone through with the same or similar diagnosis. It was really really great when I felt so scared and helpless and confused.
So, I’m hoping that my account of what happened with my cat will shed a little light for someone else in the same situation some time down the road, and that it will help them the way others’ accounts helped me.
My cat is 12-13, and has all the earmarks of being a Russian Blue, but definitely could be a mix. She’s pretty small, generally, and has been a very healthy cat for all her life, with the exception of one UTI when she was much younger, and a lifelong allergy to...something? We did food trials to see if we could isolate it, but never figured it out. She was just mildly itchy around the ears and face, occasionally forming small scabs, but mostly she was fine. Eventually we put her on some transdermal prednisolone, that got rubbed into her ears.
Things really started in December, probably before although I didn’t know it at the time. I bring the cat in for regular check ups at the vet and, after a recent one, we had been told she was getting a little overweight for her size and that she might be at risk for diabetes later in life if it continued. We’d always free fed her previously, and didn’t have trouble with her weight until she slowed down in her old(er) age. So we started her on a diet, gradually limiting the amount of dry food/wet food we gave her.
Eventually we were down to an amount that should have lead to a healthy weight for her. That’s when she began vomiting. For several weeks she would vomit most mornings. Sometimes before we fed her, sometimes after. If it was before she would vomit just liquid bile. If after, it was her undigested pellets of dry food. I assumed at the time it was her stomach adjusting to going all night without food and getting rumbly in the morning. Or that she was eating too fast to start. She vomited frequently enough to be quite concerning, but just not quite frequently enough to take her in.
At the time I didn’t know it, but some of the vomit probably had traces of blood in it. It looked ever so slightly brown tinged, or pink tinged, I thought, maybe? But I was never sure. All our floors are brown wood and our paper towels are unbleached, so also slightly brown. I just wasn’t sure, and other than the vomiting, she seemed totally fine, so I decided to just keep an eye on it.
Then in December she, for the first time in her life besides the UTI incident (she’s always been such a wonderful cat!) she pooped on a shirt on the bathroom floor. It was very gooey diarrhea, but the most concerning part was that there was clearly some bright red blood in it. I called the vet right away and made an appointment for that day. And of course I googled it while I waited. I learned that sometimes bright red blood can occur in the diarrhea if the cat has had indigestion for a while. I thought ‘oh hey! She’s been vomiting a lot, clearly indigestion.’
So I took her in, they checked her out, did a physical exam, I think I brought in a stool sample? And I believe the took some blood to check for parasites. They didn’t find anything, which I thought made sense. Other than indigestion, she seemed fine. Acting normal as usual. So I took her home, thinking, alright, this is probably indigestion from the diet. I’m just going to feed her like I used to, working her back up to free feeding. I’d rather have her a little chubby than have indigestion all the time.
Everything seemed fine for the next while.
Then on February 8 she had another bloody stool incident. I was less worried at this point because she still seemed fine, I assumed it was still indigestion, (and they had had no answer last time I took her in with only these symptoms) and even the vomiting lessened. It’s hard for me to know whether there was blood in her poops at other times either before or after I took her in, because the litter covered it all up. So I still didn’t take her in at this point. Again, thinking she just had a bit of a rumbly tummy at times now that she was old.
So, things really began in earnest on February 24. She vomited bile around 11 pm that was very pink. It was clearly blood, so we gathered her up in her little carrier box and rushed her to the emergency clinic. And thus our struggles began.
They took her in quickly, luckily not many others came in at the time. So they did an x-ray, and found some suspicious things and showed us on the x-ray. There was something going on in her stomach the vet said (I couldn’t really tell, but I haven’t looked at many x-rays, so I took his word for it), and maybe some suspicious stuff in her intestine, but apparently not what it would look like if she’d eaten something she shouldn’t have (that happened once before, but luckily I saw her do it, so she survived that incident). They also did an ultrasound, which they sent out to an expert to interpret later.
The vet told us it could be a couple of things. The most likely being an ulcer, or cancer, and other than that...some sort of mystery lump. He told us the most likely type of cancer for it to be was lymphoma, specifically the large cell version, since that’s apparently more common in the stomach. He said we could do a more invasive test to get a for-sure diagnosis, OR we could simply treat it like an ulcer for a week or two and cross our fingers and hope she gets better.
I guess the ulcer medication wouldn’t have made anything worse (while prednisolone steroids can make ulcers worse). I didn’t want to put her through extra procedures unnecessarily and I thought, if it IS cancer, one week probably isn’t going to make a huge difference. Plus, it made sense! I thought, surely if she had cancer and it was that bad, she would have other symptoms? But all I had seen was what looked like severe indigestion. So I thought, yeah. Let’s go for it.
So we were sent home with instructions to give her:
Famotidine 10 mg ------- give ½ a tablet every 12 hours (this is a pepcid/antacid)
Mirtazapine 7.5 mg --------Give ¼ of a tablet every 48 hours as needed for appetite stimulant
Carafate/sucralfate 100mg/ml suspension------ Give 1 ml every 6 hours. Give 1-2 hours apart from food or other medications.
And to keep her on a bland diet. They recommended a recheck ultrasound in 2 weeks to re-evaluate. If the spot improved, easy, it was an ulcer. If not, it would require further diagnosis, likely a biopsy.
So that’s what we did. We kept to a crazy schedule the first 5 days giving her the medicine every 6 hours, following the instructions to the letter. I’m very lucky in that I make my own schedule and work from home, so my partner, who is a 9-5er though he has some flexibility, only needed to help me with the actual dosing. The cat does NOT like liquid medicine, and because of the type, we couldn’t even give her treats afterwards. I would wake up 2 hours before the dose was due and take away her food bowl. We’d give her the dose at the appointed time, then I would get up an hour after to give her her food back.
We only gave her the mirtazapine once after the visit to the emergency clinic. She wasn’t that interested in eating after whatever sedation they did while she was there for the exams.
We gave her boiled chicken and chicken baby food (the MOST disgusting thing on the planet, apparently). She did eat, but she was not pleased with these new offerings. I would offer her little plates of it every once in a while, to encourage her to fill up, since every 6 hours we needed to take away her food for 3 of them to give her the medicine. Eventually I saw her eating something from the floor near where her food bowl had been (I was just placing them at her favorite spots around the apartment) and I heard it crunch, so I went over and stopped her.
And I saw that it was a strip of boiled chicken that had fallen out and dried. I thought ah ha! She likes her wet food really soupy and she has her dry food, maybe she doesn’t like chewy things? Maybe she doesn’t understand chicken because it’s not like wet food and not like dry food. I can dehydrate the chicken! So I set the oven to its lowest setting and dried a bunch of the boiled chicken. She actually did seem to like it a bit better! If they got too crunchy I would just add a few drips of water to it so it was more like the consistency of jerky, than boiled chicken. Hopefully that revelation will help someone else too. It's something to try at least.
Anyway, we kept on with the medicine dutifully until we ran out of the carafate/sucralfate. Things went as usual from Feb 25 late at night until Mar 1st when she vomited for the first time in a while. I believe we ran out of carafate/sucralfate on Feb 29. So we called the clinic and got a refill on the carafate/sucralfate as well as a new medication called maropitant/cerenia, which is an anti-vomiting, anti-nausea medicine.
We began giving her the carafate/sucralfate again at 2 ml every 8 hours, doubling the dose over a slightly longer period of time. (we were not pleased about more liquid medicine, nor was the cat. It was an unpleasant experience and we had celebrated giving her the last dose). As well as the maropitant/cerenia. I don’t remember the dose on that, unfortunately. I know at one point we were giving her ½ of the 16 mg tablets and at one point 1/4 (these by the way are used for dogs, technically they aren’t officially approved for use in cats, but are routinely given).
Apparently these pills taste very bad and are very bitter. We haven’t had to pill her before, usually she’d just accept the pill pockets, but she’d figured them out by that point, especially with the bad tasting pills. We kind of botched it the first time we gave her the famotidine/cerenia. I got it into her, but she definitely got a lot of bad taste in her mouth.
She vomited a couple times on March 2, just a very little bit of bile, and one of those incidences was about ten minutes after the bad tasting pill, so we think that may have been the culprit for that moment. Kind of ironic for an anti-nausea pill. But after that we coated the bad tasting famotidine/cerenia in just a thin coat of the pill pockets so she wouldn’t taste it, but so that it was small enough to swallow easily, making sure the pill didn’t touch the outside of the pill pocket.
So we continued on like that for the rest of the 2 weeks, with the cat getting increasingly less enthusiastic about her chicken-only diet. We tried hamburger once, but zero interest in that.
Things continued on well enough, we thought hey, maybe it was just a really bad ulcer and needed a bit more than the initial amount of carafate to heal.
But on March 11 she vomited some of her chicken, and had some blood in her stool. It was concerning, and I believe we had once again run out of carafate on March 10.
March 12 was when I knew it wasn’t an ulcer. That morning she vomited again, and it looked just the same as it had when we had first taken her into the clinic. Bile, but very very pink. Clearly bloody. When I saw it I just knew that whatever it was, however long the prognosis was, this was the end for my cat. It was a really hopeless moment for me. (This was around when I started scouring the internet for information on large cell lymphoma in cats, because they had told me that was the next most likely thing, and I found this site that way)
There were also a few little pine needle bits in there. We have pines everywhere nearby, and I think she was going around trying to find roughage to make her stomach feel better. It’s practically impossible to see the little pine needle pieces on our floor, but I tried my best.
I called the vet because we basically knew she wasn’t in critical condition. She was still acting like her usual self and eating some chicken, begrudgingly. And we had the follow up ultrasound the very next day. I went to get a little more carafate/sucralfate to settle her stomach for the rest of the day, but they said I didn't need to rush her in.
March 13 I took her in to have the ultrasound follow up which was done at our regular vet’s office. The found nothing abnormal except in the stomach. I’ll write that part of the report verbatim below:
“There was a hypoechoic thickened region of the gastric wall. The thickened wall was in the cranial margin of the fundus 10.8 mm wall thickness. 30.7 mm approximate length.”
They called me during the ultrasound to see if I wanted a Fine Needle Aspiration done for cytology. This is the least invasive way to get a sample, plus she was already there and I guess they do them during ultrasounds, so they can see what they’re doing. They insert a very thin needle into the area to try to get a sample. I elected to have them do it. I had read that frequently this particular test can be inconclusive. If they found nothing, we’d have to take that with a grain of salt, depending on how good the sample was, since it could easily be a false negative. However, if they DID find cancerous cells, we would know for sure.
All the vets were very nice about everything. Each dr. we dealt with stat’d the test results so that we could have them sooner, which we really appreciated. This had been going on for so long, we just wanted a solid answer. While we waited for the tests I was again furiously searching for any useful information, like, for example, how large is this section of the stomach by percentage? 1.08 cm thick and 3 cm long? I wanted to know if that was 10% of the stomach or 90%? I didn’t find much useful information. I did find that the stomach wall is only supposed to be .2-.3 cm thick. So that was pretty concerning. And anecdotally a cat’s stomach is maybe roughly the size of a billiard ball? So it seemed like a pretty large proportion.
Unfortunately, you don’t always get what you want. Not surprisingly, the test was essentially inconclusive. I’ll write out the relevant parts verbatim:
“The slides are hemodiluted and otherwise somewhat sparsely cellular. In some areas they contain mildly increased numbers of non-degenerate neutrophils and some small well differentiated lymphocytes. In some areas there is a pink to lightly basophilic mucinous background. No infectious agents or obviously malignant cells are seen and there is no infiltrate by large or abnormal lymphocytes, nor by mast cells or eosinopholis.
Comments:
The slides are somewhat sparsely cellular so should be interpreted with caution. Mild inflammation is contributing at least partially to this patient’s problems. This is rather nonspecific and might occur with walled off infection, necrosis, trauma, response to a foreign body or foreign material or ongoing rather severe irritation for any reason. If biopsy is not planned at this time perhaps the lesion can be monitored and if it enlarges or otherwise changes character then biopsy or complete excision with histopathologic evaluation could help provide additional diagnostic and prognostic information”
So pretty much not useful. I’m still glad we did it, because it’s so non-invasive and if it HAD found cancerous cells we wouldn’t have had to move up to an endoscopic biopsy.
So, I made an appointment for her. I figured, even if the cytology report is correct and it’s not cancer, we still need to know what it is. We can’t just leave the cat vomiting blood perpetually. The appointment wasn’t for another week or so, so we continued to give the cat some maropitant/cerenia and carafate to help her stomach be more comfortable in the meantime. Plus we switched from plain chicken and chicken baby food to a prescription cat food bland diet. Purina Pro Veterinary diets EN gastroenteric was her preference over the two we gave her. She definitely appreciated the change and ate the food with gusto!
We waited and took her in for the endoscopy on March 21. She had lost some weight from not wanting to eat chicken as well as needing to fast before each ultrasound.
So they did the endoscopy. She did great, no problems with the anaesthesia or anything. They showed me the pictures of her esophagus and stomach (I’m not sure if that’s standard, I saw the little thumbnails on the screen and asked to see them, they probably would have shown be later anyway though.)
It was very much a “well, there’s your problem” moment. One half of the picture looked like what you might imagine the inside of a stomach would look like, smooth-ish and pink. The other half looked...not like that at all. They said, here’s the abnormal part. I said yes, that looks very abnormal to me also, and I’ve never even seen a picture of the inside of a stomach before.
The dr. came in after the nurse told me a few things and she walked me through what they had done and how the cat had been throughout. She said they’d send the biopsies to the lab and that she’d stat them so hopefully we’d get them on saturday. I was pretty sure, based on the picture, that I knew what it was, but I asked anyway, if she had any guesses as to what it was. I know doctors and vets don’t like to speculate on things unless they have a good idea of the statistics. Her response was “Oh yeah, no this is definitely cancer. The biopsy at this point is just to figure out what kind”. Also, one of their surgeons had been available to take a quick peak as they were doing the procedure and they confirmed that the area was not operable (which usually isn’t the process for lymphoma anyway, but it was good to have confirmation on that also)
I was actually relieved at that point, to at least finally have an answer for sure. So the test results came back on Saturday March 23 and it was indeed large cell lymphoma in the stomach as well as some small cell lymphoma in the very beginning of the intestines (I recall the word duodenem getting used). They had seen a pale and oddly texture part of the intestines, so they had taken a few biopsies of that area as well.
So. We made an appointment for oncology for the 25th. Meanwhile I was trying to do more research, but without the details, and especially since large cell lymphoma is a bit more rare, there was less info. It was time to do some research on chemotherapy.
My cat hates the vet. She’s always been a bit of a scaredy-cat. She’s a real sweetheart and squirms and tries to get away when grabbed for the vet or for medicine, but she never bites or tries to scratch. Sometimes scratches happen anyway because of her struggles, but she’s never attacked.
I thought, if she has to go into the vet very frequently, it might not be worth it. If we have to give her liquid medicine, like the carafate/sucralfate, frequently, that’s also terrible. Once she realized a pattern in the dosage, she’d start hiding around that time of day. She’d get suspicious if the two of us were up and walking around the living room at the same time, because one of us would grab and hold her while the other administered the medicine.
I thought, that’s no way to live, even if it’s not physical discomfort, I would hate for her to be constantly afraid in her home where she’s supposed to feel safe. And it would break my heart if she didn’t feel safe with us anymore. This cat has always trusted me 100%. She never hides when she feels bad. She comes to me and calls for help. I hate not having a way to help her.
So, March 25 we went to the oncology department. It wasn’t very helpful, to be honest, but only because I had done so much research previously. It sounded like there was no real way to choose a good path without knowing more. It didn’t seem like the cat was either in a really great position or a really poor one. Choosing between the middle of the road choices seem very arbitrary. But they did tell us our options, as well as the cost in our area of the world.
From what I could tell, it seems that for lymphoma in cats, the “stage” doesn’t matter as much as it does in humans. The important factors are apparently the location, the type and whether or not the cat responds well to the chemo...which we can’t know unless we try. So, that’s not very helpful.
Right now, I’m really struggling honestly. This cat is the first pet that was just mine. We had a cat when I was young. My mom had her from before I was born. She was a family pet, but this cat is mine. I got her in high school when my sister left for college. She got me through a lot of tough times. I’ve never had to make decisions like this for a pet before. The old family cat just kind of slowed down until one morning we got up and our parents told us they had put her to sleep. I was very sad, but it’s not the same as making the decision yourself, is it?
I feel like when you ask to get a pet (if you’re young), your parents or other adults will tell “it’s a lot of responsibility” and as a kid, you think, “yes, I’ll have to feed this animal every day, scoop the litter box or take it for walks. Make sure it stays out of trouble”. Nobody tells you about the responsibility you’ll eventually have of possibly having to make life or death decisions about your pet. I know I wasn’t prepared to be in this position, even though, intellectually, I knew the cat would not outlive me.
We were given three options. 1) LCHOP protocol chemotherapy, 2) CCNU which is somewhere in the middle of the road, a less aggressive and different type of chemo I think, and 3) just prednisolone. They said that roughly speaking, 25-30% of animals don’t respond to lchop chemo and it doesn’t help. For 50% it helps to some extent. And for 25% they go into complete remission. For the CCNU protocol. It’s 50% odds of no response, and 50% of the combined groups of partial or complete recession.
My biggest problem at this point is I have to be at a wedding in May across the country. It’s my cousin’s wedding and I’m a bridesmaid, so it would be very very difficult to justify missing it. My partner had planned on coming as well, but we canceled his part of the trip. He’ll be able to stay back and take care of the cat.
But because we still don’t know how the cancer is responding to the chemo, we have no clue what her prognosis is yet. It could be only a month or two, or it could be 6-9 months. That’s a pretty big range! And I’m so, so worried that I’m not going to be there for her. She likes my partner, and likes getting pets and snuggles from him, but he doesn’t know her the way I do. And she doesn’t trust him the way she trusts me.
And even if she does ok through May, I’m attending a graduate program in July, and I just can’t miss it. It’s my dream to go and learn and I worked so hard to get into the program. But it would mean living away from her for a month. I’d be able to visit on the weekends, but like I said, I work from home 90% of the time. She’d only have my partner evenings and nights, and she’d be alone most of the day. I don’t know how I’ll balance those obligations if it comes to it.
And I still just don’t know what’s going to happen. It seems like with cancer you can only play it by ear. Sudden turns for the better or worse are common.
Anyway, like I said right now we’re trying the chemo, so I’ll document how that’s been doing so far (she only had her second dose yesterday, April 1st).
On March 25th (a Monday) she got a shot of Elspar/L-asparaginase, the first chemo drug. We also continued to give her:
Cerenia/maropitant 16mg (the anti-nausea drug) ---- ½ tablet once daily as needed.
Prednisolone 5 mg tablet (switched from her ear transdermal to a pill version) ---- One tablet once a day.
Gabapentin ---- 1 capsule 1 hour prior to vet visits (this is a type of anti-anxiety/sedative that is given to cats who are nervous going to the vet, which my cat definitely is)
Famotidine/Pepcid --- 2.5 mg orally twice daily if vomiting. (I missed this in my initial reading of the vet's instructions, so she didn’t get this until Friday night.)
We discontinued the carafate/sucralfate.
Even though they said give the cerenia/maropitant as needed, but every previous time we stopped (or stopped the carafate) she would vomit the next day. We did try this one last time, not giving her cerenia/maropitant pill on wednesday march 27. She vomited the next day and I figure until something actually changes, we’re just going to keep her on it.
Anyway, side effects for this first chemo drug are supposed to be extremely uncommon. And she did alright for the first few days (besides the one vomit incident because of no cerenia). Then on Friday morning, March 29, she woke me up at 7, as she usually does. She feels safe in the bedroom, since visitors don’t go in there, so I moved a food bowl in there. She also seems to like to eat at night, and does most of her eating then since, I assume, she also feels safe with both of us there, and not moving around.
So I got her food and she ate a pretty average portion for her usual breakfast. Then at 8 am she woke me up again. She was drooling a LOT, which is very unusual for her. Even when we gave her the bitter bad-tasting pill, she never drooled. That morning she would drool and cry for a bit, then it would stop for maybe 20-30 minutes, then it would start up again. This continued from 8am - 2pm, when it seemed to just stop by itself, as suddenly and randomly as it came.
I did call the vet offices, who said to try giving her the pepcid to see if it helped. It didn’t seem to. After the first one she had much shorter, less prolonged episodes of drooling and crying, or sometimes she would just drool a bit. There didn’t seem to be any pattern to when it happened, and it only happened 2-4 more times, each of which was not as bad as that first day. I figured, that was an ok price to pay. She didn’t seem too upset, a few hours a week of being uncomfortable didn’t seem too horrible for the rest of the week feeling fine.
For her next visit on Monday, April 1 (yesterday, as of my writing of this) we gave her the Gabopentin for the first time. It’s an anti-anxiety drug/sedative. I don’t know if a somewhat confused drug trip is better than cognizant terror, but the vets seem to think so. So we gave it a try.
I dropped her off at 8:30 am, having given her the 100 mg capsule of Gabopentin at 7:00, one hour before our departure time of 8:00 am. She definitely seemed calmer. I handed her off. They told me they’d call me when she was done, maybe around early afternoon. They had her finished quite early however, around 10:30 am. Which was great. I went to pick her up, they said she had done great and was much less terrified with the sedative. The chemotherapy drug used was Vincristine.
A common side effect of Gabopentin is apparently some wobbliness, which they warned me about when I got her (they told me I probably shouldn’t leave her alone around countertops. They were right.). They also talked to me about the drooling. That it was likely nausea or a strange reaction to one of the drugs, or possible a pain-nausea pairing in which case we could use buprenex, (a narcotic for cats) to rule out pain as a possible cause.
So I took her home and she was definitely real wobbly, and a bit restless, but this seems par for the course for her reaction to sedatives. I had to keep a close eye on her, she definitely missed a few attempts at jumps, but nothing serious. She did some good eating during this time. It took her a while, but eventually she did settle down by around 3pm. By 5pm she was very very sedated, apparently not uncommon for gabapentin? She seemed exhausted, definitely what I would call lethargic. I wouldn’t call her non-responsive, she would respond and would get up very occassionally and move to different favorite sitting position where she’d go back to sleep for a long time.
She did perk up a little bit by late that night and since she was eating I wasn’t too worried. This morning (April 2) She woke me up at 3:40am with her crying and drooling again. She was restless, used the litter box (or at least attempted it). She did have diarrhea, but that is an expected side effect that the nurses told me about when I picked her up, and there’s a medicine I can give her to help with that.
I gave her buprenex at 3:55, since I figured it was time to find out if that would help. It definitely took effect, based on her pupil dilation, but didn’t seem to have any effect on the rest. Up until around 7:30 or 8 she would cry, drool, and try the litter box (or some combination of these) once every half hour or hour. After around 8 she was pretty lethargic, just exhausted from all the side effects, I suppose.
At 9:30 I did get her to take her pepcid/antacid pill in a pill pocket, but she didn’t eat the other treats, and she’s been CRAZY about them. She runs into the kitchen yelling every time she hears a similar bag crinkle noise to the treat bags. So that was pretty concerning. She started to perk up around 11. At 11:15 she had some water (HUGE relief, since she hadn’t had anything since 4am. And the one good thing this whole time has been that her appetite and drinking have been normal) and she visited the litterbox again. At 12:30 she had some of her food too! And that’s where we’re at.
And right now, I’m asking myself if it’s really worth it. Is the chemo worth it? Would she be suffering the same amount without the chemo because of the cancer? I just don’t know. I’m hoping by next week it will be reasonable to take another look at the tumor and see if it’s grown or shrunk. Because that will at least tell us if the chemo is working at ALL.
So that’s that, for now. I hope this post isn’t too long. I just wanted to be thorough :’) I hope some of this information is helpful to someone else going through this, although I hope nobody else does have to go through this.
Thanks for reading. Feel free to ask questions, I’ll do my best to answer and hopefully I’ll have some updates fairly soon. I don’t think I’ll post very frequently, but maybe around once a week, for chemo updates?
. I don't have any personal experience with lymphoma in cats (thankfully), but unfortunately there are many people here who do, and probably will be more in the future, so I'm sure your postings will be helpful to them. And perhaps someone here will be able to post things that will be helpful to you as well.
