Cat keeps losing weight after ultrasound, GI Panel, fine needle aspiration which looked OK.

jeanft

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Our 11 year old cat Moumouche started to lose weight two months ago, having diarrhea and some vomiting. He is a bit over 6 pounds now from 9 lbs.
The blood panel was CBC/Chem: WBC 22.92, Lymph 6.60, Monos 3.45, Plt 42, TP 5.3, Glob 2.5.
X-rays, Ultrasound suggested lymphoma or an aspect of chronic untreated triaditis.
The fine needle aspiration was done on the abdominal lymph nodes which were enlarged since it was not possible to do it on the spleen or pancreas (poor coagulation with PT/PTT test) Issue with liver?
The neutrophils suggests a suppurative response in the node and/or the drainage area. The lymphoid population is consistent with hyperplasia.
The blood tests are normal, so that means there is no pancreatic insufficiency or other loss of absorption in the small bowel.
COBALAMIN >1000 290-1,500 pg/mL
FOLATE 14.6 9.7-21.6 ng/mL
TLI Feline 25.3 12-82
He eats pretty well when he finds something that he likes but he is still losing weight, straining with liquid bowels and gas. We are using all the different foods recommended with IBD, he bas been taking Mirataz, Prednisolone for almost three weeks now and we started to give him Jarrow Brand S boulardii + MOS and Now Probiotic 10-25 Billion.
What could we look for next? The vet says it might take take some time for Moumouche to gain weight.
Get 2nd opinion?
Thank you.
 

fionasmom

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You have done a lot of testing....blood work, US, FNA...but you still have a cat who is losing weight and having bowel issues. Rather than just giving it some time, I would look for a veterinary specialist, at least an internist. If you have any referral hospital in your area or if you have access to a teaching hospital, I would try to go to a place like those. Going down the street to the next vet might not get you much further, unless you were just lucky. Remember that all tests are your property and have to be sent to the specialist or copied and given to you to carry. If your vet would consult with a specialist or hospital, that might be another option, but I don't think, from your description, that it sounds as if he is motivated to do that.

My experiences with specialists has been that they get to the root of the problem much more quickly which is good for you and your cat. They might be more expensive, but it is much cheaper in the long run than running from vet to vet or returning to the same one. If your tests/results are very recent, ask that they be viewed first, especially if the specialist immediately wants to do another US.
 
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jeanft

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We did not use our regular vet. This clinic specializes in internal medicine and oncology in Houston and has many followers. Not easy to get a feel of the vet since you drop your pet in the morning, pick it up later on. Phone or emails to get info only.
The GI work was sent to Texas A & M University Veterinary which is one hour away and I see mixed reviews.
When I mentioned early stage lymphoma (weight loss) since no cancerous cells in the lymph nodes, I was told to get another Ultrasound in two weeks. A fecal transplant is an option.
Thank you for answer.
 
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jeanft

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We did not use our regular vet. This clinic specializes in internal medicine and oncology in Houston and has many followers. Not easy to get a feel of the vet since you drop your pet in the morning, pick it up later on. Phone or emails to get info only.
The GI work was sent to Texas A & M University Veterinary which is one hour away and I see mixed reviews.
When I mentioned early stage lymphoma (weight loss) since no cancerous cells in the lymph nodes, I was told to get another Ultrasound in two weeks. A fecal transplant is an option.
Thank you for your answer.
 

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As far as getting him to gain some weight, you may want to try Hills A/D line. It's very appetizing and great for keeping weight on sick patients. It is in a pate form that can easily be watered down for extra fluid as well. Raw or whole goats milk is also a great probiotic which can help with nutrient absorption. Kitten food will also help put some weight on him.

Is he still having diarrhea? I wonder if some subcutaneous or even intravenous fluids would help, as he is bound to be dehydrated if his stools are still soft. What treatment have they given him so far? Any antibiotics or anti-inflammatory?
 
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jeanft

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His stools are really yellow, liquid. Never stopped. He was on Metronidazole for ten days, and Prednisolone and Mirataz for almost three weeks now. The vet said to give him a shot of B12 every two weeks. Will see what happens with the Boulardii stuff.
All the supplements are given with a syringe, adding some liquid to his diet. He became so picky when it comes to food. Something that he really loves will be ignored the following day.
 

silent meowlook

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Hi,
So are they thinking intestinal lymphoma? Did they mention IBD? Has anyone discussed a novel protein source such as venison, rabbit or duck? You would have to feed a prescription diet canned of one of the novel protein sources and nothing else. There is also another diet called HA which is also a prescription canned and is hydrolyzed protein. Whatever diet you and your vet decide on. you have to only feed that with no treats or anything else including pill pockets etc.

I have had decent luck with Visbiome probiotic, but if your vet has advised on one, I would just use that and nothing else.

Do you know if the low platelet count was a lab machine error and or if they did a manual count to confirm?
Is he on anything for nausea like Cerenia? Have they talked to you about Chlorambucil? AKA Leukeran?

Lots of questions, I know.
There are also appetite stimulants such as Mirtazapine that comes in a trans dermal variety you can put on his ear. Of course you have to check with your veterinarian.

Have they done a fecal PCR to rule out bacterial load and things such as toxoplasmosis, Coronavirus (cat variety, not people one)

Sorry just reread your post. Is he still on the prednisolone, mirtazapine, and metronidazole? Are they having you give the metronidazole only after he has food in his belly? It can cause nausea on an empty stomach.

I would be concerned about the low platelet count especially given his delayed PT/PTT.

I am sorry this post is all over the place. I don't have time to fix it so I do apologize.
 
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jeanft

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Thank you for your answer. They are not thinking about intestinal lymphoma. I brought it out since he is losing weight, as an early stage, would not show signs in lymph nodes yet since we could not test the spleen or any other organ. He was on Metronidazole for ten days, and Prednisolone and Mirataz for almost three weeks now. He does not have nausea. He only vomited when I gave him elm yesterday morning. Not fecal test, all the stools are liquid. Leukeran has never been mentioned, it would mean he has lymphoma.
No idea bout the ow platelet count. Have not tried the novel protein stuff yet. Have read mixed reviews about it.
That was the last email with the vet " The blood tests are normal, so that means there is no pancreatic insufficiency or other loss of absorption in the small bowel."
The poor thing is spending a lot of time over his box, throwing liquid stuff like under pressure.
 

fionasmom

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I was thinking about this yesterday and wondered if they suspected lymphoma....so that is off the table, which means you don't need to push for Leukeran. Given that your original question was should you get a second opinion, despite the high level of care that you have provided, I would say that it might be worth it to seek another opinion. You have a regular vet, went to a specialist clinic in Houston, and have interfaced with Texas A&M, possibly trying one more might bring more help. Is the fecal transplant a distinct possibility? I have no experience with them personally, but just wondered.
 

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I'd get a second opinion. Or at least have your vet contact a veterinary school or with other vets for a consult.
 

daftcat75

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It sounds like GI lymphoma to me. The side effects of leukeran/chlorambucil are mild, if any, and the long-term risk is lower than that of prednisilone. I would ask if you could start him on a course of chlorambucil and see how it goes. If it is GI lymphoma, you should see results pretty quickly. The stools will firm up nicely.
 
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jeanft

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A fecal transplant was presented as an option by the vet depending on Moumouche's condition later on. I read a bit about it and it seems to be a hit-or-miss. Some have good results, some don't. Worth trying I guess if needed.
The good news is that the Jarrow Brand S boulardii + MOS and Now Probiotic 10-25 Billion seem to be helping, almost no more trips to his box, no more gas, stools are still liquid though. I am going to bring the Boulardii dose up. I added some slippery elm as well.
His TT4 is 2.3 ug/dL which is fine. Nothing on ultrasound. And no symptoms of a cat with
hyperthyroidism.
We are going to get a second opinion, and need to find out if a lymphoma is present. Not easy since we can't do more biopsies. Nothing in the lymph nodes so far, but it could be an early stage without cancerous cells out of the location I guess. I wonder if the big weight loss could be related to IBD (dehydration) only or lymphoma. As you know, it's not easy sometimes to get an idea even with many tests.
Do B12 and folate numbers go down in case of lymphoma?
Thank you for your comments.
 

fionasmom

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That is great news that there is some improvement in the bowels. B12 deficiencies are linked to GI lymphoma and while I can't dx your cat, this does sound like, or at least presents as, lymphoma. I hope you can find a reliable source for the second opinion.
 

silent meowlook

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Cobalamin. Vit B12 deficiencies can be seen in all types of GI disease. That said, normal levels do not rule out GI lymphoma, or IBD.

GI lymphoma wouldn’t need to be seen to say it’s lymphoma. With ultrasound, they should be able to check the thickness of the intestinal and colon wall. Thickening of those structures can be signs of IBD or LSA intestinal lymphoma. Also IBD can turn into lymphoma due to the chronic inflammation. I am not suggesting your cat has either of those. But what is known is that the WBC is elevated, which means inflammation or infection. Neoplasia causes inflammation. So does allergy.

I know you said you read mixed reviews on a novel protein source. There is no reviews just facts, that some cats have severe food allergy that results in inflammation and severe diarrhea. Think of the lactose intolerant person having alarge vanilla malt with whipped real cream, every day.
 
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jeanft

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"The GI work was sent to Texas A & M University Veterinary which is one hour away and I see mixed reviews". This was a comment related to finding another vet not a different type of diet.
I am not against the idea of using a novel protein source. And for sure, remove chicken and fish that he likes a lot. High protein, no grain food is not enough right now. I will call the vet tomorrow.
Hopefully, he will like rabbit or venison. He enjoys the Merrick rabbit pate but it has chicken in it. Both vets told us to let him eat what he likes now, the goal being to make him gain some weight.
 

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If he has lymphoma, he may not gain weight until that’s in remission. Certainly try a diet change. That’s essential as well. I recommend Rawz for single protein pâtés that are truly single protein and limited ingredient. They will send you samples if you write them. There are also online retailers that will sell Rawz by the can as well as the case making it easier to try individual recipes. Diet will be his best medicine: finding and eliminating his triggers. But if he does have lymphoma, that might not be enough. I would discuss with your vet the risks of trying chemo without a cancer diagnosis vs the risks of waiting for more tests or a more convincing presentation. Relentless weight loss and liquid stools were Krista’s lymphoma symptoms. Both only stopped when we started the chemo. However the remission was partial until I removed the last of her triggers (the fish flakes I was wrapping her nightly pred pill in.)
 
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jeanft

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We drove to a location listed on the KOHA website, the store has been closed for quite some time. We will look for Rawz products.
The next test is another ultrasound in one week. I wonder which differences could be seen one month apart. I have read about vets prescribing Chlorambucil with serious IBD cases. A new diet for sure to start tomorrow.
 
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