Cat Lymphoma and High Liver Enzymes

[lovewilbur]

My cat is currently hospitalized at the vet, in good care. I am posting this because I want to know if anyone else has gone through this with their cat and has any additional insight or thoughts on what is going on:

My 12-year-old cat has been receiving treatment for Small cell GI lymphoma.

He is taking predinolosone, chlorambucil, cerenia and famotidine. He has responded well to his treatment. He gained back the weight he had lost, he is a large framed cat (long) and he went from 12lbs back to 15lbs. He has been eating, drinking, being affectionate and still jumping up on stuff and playing. He did slow down a bit. He got diagnosed after having daily vomiting episodes. After going on his medications, he did not vomit anymore.

The other week we brought him in for one of his regular chlorambucil checkups. The vet said he seemed to be doing so well that she wanted to begin to reduce his medications and keep them as low as needed for maintenance. They did notice his liver ATL value was slightly elevated. They were concerned the predinolosone could be causing that. We reduced the dosage and when we went back to check his ATL again, his number had cut down significantly. The vet had us give him gabapentin for that visit because he is typically stressed at the vet.

A day after that vet appointment...things took a turn. He started having diarrhea and audible gas while he was going. We wondered if he had been stressed out (a storm had passed through too) so we monitored him. He threw up after using the litter box eventually so we decided to take him into ER vet to get checked. Before we went into the ER I had checked his litter box and saw part of a plastic wrapper he had ingested and a leaf, both inside of his stool. At that point, I wasn't sure what issue to really address with the vet...so I mentioned it all. The vet (internal medicine and oncology was involved) did an ultrasound and saw inflammation in his liver and gas built up in his intestines. They thought he might've had a UTI and did a culture (though they never told us if it came back positive or not). He was put on antibiotics. His liver values had also raised back up again.

More time passed and he was doing well again. Back to his old self. His stool continued to be runny but eventually, it became solid again (forgot to mention that before these recent times, he typically struggled more with constipation than diarrhea). Last night he was cuddly on my lap and being playful. Then this morning around 4am diarrhea began again. He went several times, threw up and since the vet told us to bring him back if anything changed...we brought him back to the ER to see internal medicine. They called us a bit ago and they said his liver values were now over 1,000! and he is being kept for the day, doing another ultrasound and the specialist will check him again tomorrow.

I swear his liver thing didn't begin until all these medications were introduced...but maybe it had been lurking? I don't think his ATL had been mentioned before. Anyways, I am wondering if this prognosis sounds awful. The vet had previously said that maybe he has another underlying issue, like an autoimmune thing or something else. They offered to do a biopsy but since he had been doing so well...they thought to begin with a conservative treatment first (until today I'm assuming)

I would appreciate any insight or tips. I know cats hide their illness so well...so maybe I have been somewhat delusional...but he has seemed to be doing so good until just this morning. I can tell he really doesn't feel well when he loafs, doesn't purr, and doesn't move around much....this morning he had more visible signs of discomfort but it wasn't as bad as it had been during previous times he has had diarrhea.

Thank you for your time.

 

[lovewilbur]

Edit: I guess it's ALT instead of ATL

 

[fionasmom]

Your suspicion is that the antibiotics might have had a hand in raising the liver value of ALT? That is possible and if it is the case, ALT is sometimes the first to elevate.

I don't think that you know that you have a terrible prognosis, given that he did well for so long with the GI medications. My Chelsea also has small cell GI lymphoma, so I am familiar with the protocol. It sounds as if you have landed right in the middle of the use of the antibiotics, possible UTI (although I am assuming that they would have called by now if one had been found), possible foreign object issue, and another coincidental condition which may have just appeared. That is not to say that this cannot be resolved though and I would personally go on with trying to see what is at the root of the liver values, providing that your boy is a candidate for whatever needs to be done, as a biopsy.

Liver Disease in Cats | International Cat Care
The article lists some possible causes for the raised enzyme; you cat does not have all of them, maybe none of them, but it might help if you speak to the vet about options.

Please let us know what happens.

 

[lovewilbur]

Update: Today he has still been kept at the hospital. They did an aspiration of his liver and bile (I think that's what she said). They are waiting for the results. His ALT was still high today. The internal medicine vets seem to be a bit confused. He was put on 3 antibiotics at the moment and they wanted to keep him there so they can figure out which antibiotics they don't need (based on the test results). They say he is doing well considering. They said he wasn't eating a lot but he tends to be so finnicky, so I am wondering if he didn't like the food. He also gets really anxious while eating....at home he will stop eating if we MOVE at all while he's licking his bowl. Sometimes we have to freeze and stand nearby for him to eat without stopping. So I am hoping they can figure out how to lower the ALT. They still keep speculating that maybe his disease has progressed since it's been almost a year since diagnosis. I hope not. I try to keep in mind that they aren't an oncologist.

I forgot this but his UTI culture came back negative.

I was even wondering tonight if maybe that leaf he ate was poisonous. Just don't get why he was doing so well and then began having issues right after a really good vet visit.

 

[lovewilbur]

Also, the rest of his bloodwork they took today looked good.

 

[fionasmom]

You are gaining some ground since the other bloodwork looks good. Do you know what the leaf was that he ate, just in case? There are apps that identify plants for you if it becomes really necessary to know and the plant is unfamiliar to you. Will they let you bring his own food from home? I do know what you mean about the skittishness of not eating if anyone even walks around. If they need to syringe feed him, I am sure that they will take that step. Please keep us posted. You are doing everything that should be done for him.

 

[lovewilbur]

Update: We brought him home today (Monday). The photo is from the vet on Sunday when we were allowed to have a visit with him. His ALT (liver) values had climbed to 1700! So the vet suggested putting in the feeding tube. He has tolerated it well so far. We just did our first feedings with him today. He is still not out of the woods. Yesterday, his ALT was 865. We hope it continues to decline. This was a hard decision to make, considering the complexity of his medical case at the moment. I felt like I didn't want to give up yet because he still enjoys a lot of his favorite things and is active. I will continue to assess his quality of life each day. Best case scenario: the feeding tube helps his liver to heal and in a month or two we can have it removed and we will get more time with him. The ER vet said prognosis for lymphoma (small cell) is usually about a year (he's had it for about a year so far) but every day in the feline lymphoma group on Facebook...I see lots of cats with small cell lymphoma around for a couple more years. We don't have a crystal ball and can't predict how things will go....but I'm glad we are able to try something else. If anyone has anymore thoughts, please let me know.

 

[Margot Lane]

Agree w/ Fiona’s Mom on this…you are doing everything you can.

 

[fionasmom]

My Chelsea lasted a year and a half on chlorambucil, actually a little longer as we started with pred alone for a while. She was a semi-feral indoor cat who also has FHS and could turn on a dime once everything was too stimulating for her, so I can't even say that she got all medications as scheduled....close to, but she was not the idea patient. I love how your baby is looking out the window. Please let us know how this goes.

 

[lovewilbur]

Wilbur has tolerated the tube feedings well. We feed him 3 times a day and it takes about an hour. Usually, he falls asleep during the feeding but sometimes he gets a bit squirmy. He has been eating a bit on his own but definitely not as much as he used to. We have been trying new foods to see if we find anything else he likes. We got a different bag of dry food and he seemed more interested in that. We were happy to wake up one morning and see that he had eaten almost all of the amount we had put out. His appetite still varies though and sometimes he doesn't even want his favorite treats. I tried a different brand that makes a similar style treat and he eats that! So maybe he has developed an aversion at times to some of his old foods.

We had a recheck at the vet today and his liver enzymes have improved and he has gained weight.

I still question all the time if we are doing the right thing. I study the "feline lymphoma" group on Facebook and a lot of them were able to get their cat through a bout of illness on top of the lymphoma. I worry all the time that I am extending his suffering though. He is definitely not the same cat. He still likes to get snuggly and visit us, but he has mostly been lethargic. I guess we will see how it goes as we continue the feedings to see if his liver can heal. We go back in 2 weeks to recheck with the vet. He has been grooming himself, has shown interest into "getting into things" (like climbing into the open cupboard to attack paper), he hops up on the table and sleeps with us at night still.

I think he may be struggling with nausea. He is on cerenia currently but I have thought about asking if we could try a different anti-nausea med.

 

[fionasmom]

He looks like such a sweet, brave little patient there. It sounds to me as if you are successfully dealing with all this. Wilbur is showing some very good progress with eating and being his usual self, barring the lethargy, which is to be expected. You are really in the middle of treating him and this is probably a transitionary stage that you need to work through. Objectively speaking, you are having a lot more success with this than some do. He is very lucky to have you caring for him and he is cooperating. He looks so happy to be sitting there with you.

If I had tried a feeding tube with Chelsea, I would have been writing this from the ER.

 

[lovewilbur]

Thank you. You are right, we have made some progress with him. He has seemed a bit more alert yesterday and today, but we try to just let him rest. Very happy he has tolerated the feedings well. We thought it would freak him out, but he usually just relaxes and doesn't notice us using the tube. Sometimes he likes to wriggle away. I need to keep in mind this is going to be a slow recovery. I think I read it can take months. Just want to make sure he is comfy.

 

[lovewilbur]

Great news. His liver enzyme results are now completely normal!!!! As of yesterday. His liver healed!!!! We are keeping the tube in for another month (based on vet's advice) and we are decreasing the amount of tube feed he receives. He started eating more on his own as he felt better. We are also going to get his teeth checked out while he has the tube still....because if he needs a cleaning or something done, then it would be great to have the tube in to help with his appetite.

Although he still has other health issues....this tube literally saved his life!!! If we hadn't had it put in, I don't think he would've had a chance :/ I think we will have more time with him and I have read that it is rare for a cat to get fatty liver again? I hope that is true! We will still take it day by day. He has been acting more like himself, although he has definitely slowed down a bit.

 

[lovewilbur]

This was definitely a stressful time but it was all worth it. My husband and I did the feedings 3 times a day. It would often taken around an hour to do, because Wilbur would sometimes move around. We haven't been able to leave the house too long, lol. But anything for Wilbur! Sometimes he would stretch out on our lap and fall asleep during the feeding. Eventually the stress shifted over to just enjoying the moment with him, giving him his gruel lol. My husband did more of the work because Wilbur tends to favor him and his calmness. I took over the afternoon feedings though.

 

[fionasmom]

This is such good news! Wilbur looks very good in the picture, even with the feeding tube still in place. You both did a great job with him and hopefully he will get back to his old self.

 

[lovewilbur]

Long time since my last post! Wilbur got his feeding tube removed on June 19th 2022. He had a great summer and fall. His energy returned, he was eating well on his own and he was enjoying himself. Felt so grateful and happy to get more good quality time with my guy! Spent a lot of time with him and gave him so much attention <3 Felt so happy to do the things he stopped doing when he was feeling yucky.

Things were GREAT until this past weekend. On Saturday he seemed to not feel well. I noticed the most subtle change in behavior. We brought him to the vet quickly -- this time, turns out it was bile duct/gallstones The vet suspected it was caused by his long term use of steroids for his lymphoma (which is in remission, at the moment). Had a long talk with the vet and oncologist. The vet suggested surgery to clear out the stones. It was a hard decision to make. Hate putting our guy through anything difficult. I asked the vet if they thought we were putting him through too much considering his history. He said he was 60/40 leaning towards surgery being a reasonable choice. He wasn't sure what to suggest it seemed, because the surgery was also exploratory (they didn't know what was fully going on until they did the surgery). He had his surgery on December 21st. His lab work looked better after they cleared out the stones. He is hospitalized in recovery right now. I kept fretting over the choice we made and wondered if we were being selfish. I wish I had asked the vet again. The vet said since we caught his issues early, he was still in pretty good shape compared to the other cats he sees. He was flopping around and being affectionate the morning before his surgery, so he didn't feel too terrible overall. He is not out of the woods yet in terms of recovery but he has made steps in the right direction.

 

[fionasmom]

Thank you for letting us know how things are going. It was good to know that Wilbur had recovered and it sounds as if he has faced this new surgery successfully. Please let us know how he does and have a good holiday with Wilbur.

 

[Margot Lane]

Sorry you are going through this…may I ask, what was the subtle change you noticed in his behavior? (My cat is in remission from small cell lymphoma and has also been on steroids/chemo pills a long time— so, want to recognize any signs that might come up).

Long time since my last post! Wilbur got his feeding tube removed on June 19th 2022. He had a great summer and fall. His energy returned, he was eating well on his own and he was enjoying himself. Felt so grateful and happy to get more good quality time with my guy! Spent a lot of time with him and gave him so much attention <3 Felt so happy to do the things he stopped doing when he was feeling yucky.

Things were GREAT until this past weekend. On Saturday he seemed to not feel well. I noticed the most subtle change in behavior. We brought him to the vet quickly -- this time, turns out it was bile duct/gallstones The vet suspected it was caused by his long term use of steroids for his lymphoma (which is in remission, at the moment). Had a long talk with the vet and oncologist. The vet suggested surgery to clear out the stones. It was a hard decision to make. Hate putting our guy through anything difficult. I asked the vet if they thought we were putting him through too much considering his history. He said he was 60/40 leaning towards surgery being a reasonable choice. He wasn't sure what to suggest it seemed, because the surgery was also exploratory (they didn't know what was fully going on until they did the surgery). He had his surgery on December 21st. His lab work looked better after they cleared out the stones. He is hospitalized in recovery right now. I kept fretting over the choice we made and wondered if we were being selfish. I wish I had asked the vet again. The vet said since we caught his issues early, he was still in pretty good shape compared to the other cats he sees. He was flopping around and being affectionate the morning before his surgery, so he didn't feel too terrible overall. He is not out of the woods yet in terms of recovery but he has made steps in the right direction.

 

[lovewilbur]

Thank you very much.

Sorry you are going through this…may I ask, what was the subtle change you noticed in his behavior? (My cat is in remission from small cell lymphoma and has also been on steroids/chemo pills a long time— so, want to recognize any signs that might come up).

I knew something was up when he laid down in a spot he had never laid down on before. Just had that slight shift into lower energy.

 

[lovewilbur]

It is with a heavy heart that I have to report that we lost Wilbur during the night. His recovery from the surgery had been so slow. Two steps forward, one step back. Things rapidly declined overnight. We immediately left to go be with him but he passed before we made it there to the facility. We spent time with his body in a little room to say goodbye (we also spent special time with him before the surgery in case). The vets said we gave him a fighting chance and that the surgery tended to have a 50/50 outcome. They said it was hard to predict how things would go and that often they had patients that surprised them. I kept hoping for the latter. I think maybe he had a hard time recovering from the anesthesia. His blood pressure was struggling ever since the surgery. I keep questioning if I made the right choices. If I put him through too much. The night before he passed the vet said to give it 24 more hours and then let him go. He just went before that point. It was hard seeing him hooked up to the medical devices and in that state. I think we would've said goodbye to him and not done the surgery....but at the time the oncologist said he was feeling 60/40 on the idea of the surgery and that there was a chance.