Cat with possible GI Lymphoma & IBD

MaxiG

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Looking for any insight on what is going on and if anyone else has experienced this. Will try to keep as short as possible. Beginning: Max is 13 he has always been a puker because normally he ate too fast or if food was stale it would come back up. In December 2018 he started having bright red blood in his poop which then progressed to diarrhea.

I took him to the vet and they did x-rays did not see anything so they suspected IBD. I changed his food at their suggestion and things seemed to get better for a while. He would still throw up every now and then but nothing that was concerning. Fast forward to November 2019 he started having constipation issues and vomiting every day or every other day. I took him back to the vet and they again suspected it was the IBD. We put him on prednisolone and high quality food. He was miralax and on the pred for 3 weeks and did great, no throwing up, no bathroom issues.

When the pred prescription was out (kept doing miralax) we were back to square one with the vomiting. I spoke to the vet and she told me it can take 8 weeks for the new food to really help him so I waited and kept feeding him what she suggested. I tracked every time he was sick, no improvement until March 2020 where we went 10 straight days of no vomiting, then April 2020 hit, and it was every day or every other day again.

We went back to the vet and she put him back on pred. This time pred did not help so we did another food change. I got again the 8 week speech regarding the food helping so I kept him on it. Things got worse and he was now throwing up twice a day, still was on miralax. We went back to the vet to get blood work, all they could tell me was everything looked normal including thyroid other than his white blood cells were elevated and his kidney values a little off but they figured it was from the vomiting or he was in very very very early stages of kidney disease and its something we needed to watch going forward. So we stayed on pred and new food.

One day he could not keep anything down and I made emergency app with a different vet this time because i felt i wasn't getting anywhere. He got the full work up xrays and ultrasounds as well as urinalysis (May 2020). He was severely constipated and his gi tract was extremely inflamed. They gave him sub fluids,shot of pred aka dex and some anti nausea. He was then put on another new food royal canin gastro, prescription diet and higher dose of pred 10mg a day. He did very well for two weeks and then we were back at square one, what changed was we started to lower the pred dose from 10-5mg.

So called the vet back up to 10mg, we then kept having constipation issues so he had emergency enema. We then put him on cisapride for constipation and cerenia for nausea. We kept the 10mg of pred since that seemed to work.They now suspected more gi lymphoma and the only way to know for sure was to do the 2500 surgery to extract a piece of his intestine. I love Max so of course i want to do what I can and at this point i had already spent easily 1500 and i just wasnt sure how he would handle surgery so I did not go this route. Also, because if it was something else they likely would do the same treatment. Now on occasion his vomit would have blood in it which I also told them.

We changed his food again and kept on the high pred but June was a rough month. Not only is he now vomiting every other day or every two days, he has become very picky with food. He refuses to eat the new food and his appetite is very up and down. At this point i feed him whatever he will eat just to make sure he gets something. Though usually only last a day or two and he wont eat that food anymore. So i am constantly switching foods.

He drinks a decent amount of water and is still using the cat box. However he seems nauseous a lot, he does this mouth thing like hes trying to eat peanut butter, or acts like hes trying to cover his food by scratching his paw on the ground. The cerenia can only be given every now and then, I was advised not to give every day because it will cause tremors and such. He still has spunk most days and loves to go outside. Oddly, last week he was so ravenous I couldn't get him enough food, that lasted 3 days and then the next few he was barely eating and hiding, his vomit also started to smell foul which i hadn't noticed prior.

Today 7/1/20 hes somewhere in the middle, he will eat and begs but doesnt eat too much and is very finicky. He still wants to go outside and does not seem in pain or that hes struggling to do anything he wants like up on one of our high stools to look out the window. I am only giving him 1 preds 5mg a day because he hates being pilled and his appetite isn't reliable enough for me to give 2 preds a day and to be frank it doesn't seem to make a difference now whether its 1 or 2 preds a day.

He has also lost a lot of muscle mass and i can feel his spine and hip bones. When this started he was 15.84 pounds he is now 11.8. His weight doesnt seem to be dropping to fast. I feel like the nausea is a big reason for his appetite but im not sure what to do for it. I know its a lot but I appreciate any insight from anyone regarding this.
 

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Hopefully daftcat75 daftcat75 will reply to this as she is much more informed than I am about intestinal lymphoma.

Certainly there is a lot going on with your baby. My Chelsea, who is 10, began to show signs of intestinal lymphoma several months ago. We discussed the three options for dx, vet assured the that the ultrasound would probably not be conclusive which would lead to the next two. In the case of her own personal cat, they did have to go to the final incisional procedure for confirmation. For most of her life, Chelsea, a former feral who is indoor only, has been very hard to handle, possibly not even safe to handle so I balked at having her go through surgery and then not allow me to even approach her to check on her well being, etc. The vet agreed to start her on pred and we did get the one pill a day down with protest with a pill popper. I also realized when I started this that she did seem less resistant than she would have been in the past.

I was encouraged by Krista's mom to approach the vet about simply putting Chelsea on leukeran/chlorambucil to treat what we assume is definitely intestinal lymphoma and I have gone this route. My vet is fairly easy going and will work with clients, so agreed, but you might have to seek one out who would go with that option. Chelsea is responding, certainly no worse.
 

daftcat75

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It sounds like the IBD progressed to GI lymphoma and possibly pancreatitis. If you can find a specialist, I would highly recommend working with an internist rather than a general vet practitioner.

I also wouldn't be changing his pred dose around without speaking with the vet as steroids can have long-term consequences if they are stopped or reduced too sharply.

I would recommend getting him tested for pancreatitis as soon as you can bring him down to the vet. It's a non-standard blood test so your vet may not have ordered it. It's called fPLI or "Spec fPLI". If he has pancreatitis, that needs to be treated first and with the highest priority as that can do lasting damage to his pancreas including diabetes and an inability to digest his food. It's common for poorly controlled IBD to spill over to neighboring organs like the pancreas but also the liver. So if he hasn't had his liver checked recently, add those tests to the pancreatitis test.

If you can't find or afford a specialist, you can ask your vet (or maybe get a second opinion) about starting him on chemotherapy anyway. Cats tolerate chemo a lot better than people. Don't be afraid to try it because of your preconception of how miserable it makes people. Most cats have very mild side effects, if any.

My Krista's IBD was being well-managed through diet alone for a couple of years. Until it wasn't. She started having liquid stools and was losing weight. My vet started her on pred first but that didn't help. I asked for leukeran/chlorambucil (chemotherapy.) But the vet didn't want to prescribe it without a diagnosis. The diagnosis was an invasive biopsy. I went over her head and talked to the owner and founder of the practice. I explained to him that the diagnosis was riskier than the drug given that it would come with a recovery period and any further weight loss was not going to be regained. He agreed with me after talking to me about informed consent aka it may not work. Within two doses of the chemotherapy, she had her first solid stools in months. It's not a cure, but it sure looks like a remission. She's still not regaining weight. But we're still finding inflammatory triggers and working to eliminate them. I'm hopeful that once we've found them all, she'll finally have healthy input, digestion, and output without inflammation and may finally start gaining weight again. Or even if she doesn't, just to be free of all the inflammatory responses would be a huge relief for the both of us.

Every IBD story and treatment is different. This is why I recommend a specialist. You can also read the resources at IBDKitties – Helping Save Lives…One Paw at a Time to understand what's going on and read other IBD stories.
 
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MaxiG

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Hopefully daftcat75 daftcat75 will reply to this as she is much more informed than I am about intestinal lymphoma.

Certainly there is a lot going on with your baby. My Chelsea, who is 10, began to show signs of intestinal lymphoma several months ago. We discussed the three options for dx, vet assured the that the ultrasound would probably not be conclusive which would lead to the next two. In the case of her own personal cat, they did have to go to the final incisional procedure for confirmation. For most of her life, Chelsea, a former feral who is indoor only, has been very hard to handle, possibly not even safe to handle so I balked at having her go through surgery and then not allow me to even approach her to check on her well being, etc. The vet agreed to start her on pred and we did get the one pill a day down with protest with a pill popper. I also realized when I started this that she did seem less resistant than she would have been in the past.

I was encouraged by Krista's mom to approach the vet about simply putting Chelsea on leukeran/chlorambucil to treat what we assume is definitely intestinal lymphoma and I have gone this route. My vet is fairly easy going and will work with clients, so agreed, but you might have to seek one out who would go with that option. Chelsea is responding, certainly no worse.
Is the Leukeran/chlorambucil a pill?
 
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MaxiG

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It sounds like the IBD progressed to GI lymphoma and possibly pancreatitis. If you can find a specialist, I would highly recommend working with an internist rather than a general vet practitioner.

I also wouldn't be changing his pred dose around without speaking with the vet as steroids can have long-term consequences if they are stopped or reduced too sharply.

I would recommend getting him tested for pancreatitis as soon as you can bring him down to the vet. It's a non-standard blood test so your vet may not have ordered it. It's called fPLI or "Spec fPLI". If he has pancreatitis, that needs to be treated first and with the highest priority as that can do lasting damage to his pancreas including diabetes and an inability to digest his food. It's common for poorly controlled IBD to spill over to neighboring organs like the pancreas but also the liver. So if he hasn't had his liver checked recently, add those tests to the pancreatitis test.

If you can't find or afford a specialist, you can ask your vet (or maybe get a second opinion) about starting him on chemotherapy anyway. Cats tolerate chemo a lot better than people. Don't be afraid to try it because of your preconception of how miserable it makes people. Most cats have very mild side effects, if any.

My Krista's IBD was being well-managed through diet alone for a couple of years. Until it wasn't. She started having liquid stools and was losing weight. My vet started her on pred first but that didn't help. I asked for leukeran/chlorambucil (chemotherapy.) But the vet didn't want to prescribe it without a diagnosis. The diagnosis was an invasive biopsy. I went over her head and talked to the owner and founder of the practice. I explained to him that the diagnosis was riskier than the drug given that it would come with a recovery period and any further weight loss was not going to be regained. He agreed with me after talking to me about informed consent aka it may not work. Within two doses of the chemotherapy, she had her first solid stools in months. It's not a cure, but it sure looks like a remission. She's still not regaining weight. But we're still finding inflammatory triggers and working to eliminate them. I'm hopeful that once we've found them all, she'll finally have healthy input, digestion, and output without inflammation and may finally start gaining weight again. Or even if she doesn't, just to be free of all the inflammatory responses would be a huge relief for the both of us.

Every IBD story and treatment is different. This is why I recommend a specialist. You can also read the resources at IBDKitties – Helping Save Lives…One Paw at a Time to understand what's going on and read other IBD stories.
Thank you, i will look into these. They want his pred lowered and the plan was to try and get off it all together but things just get worse when we do.
 

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Is the Leukeran/chlorambucil a pill?
Leukeran, the brand name, is a pill. Chlorambucil, the generic, can be compounded into many different formulas. Krista takes it as an anchovy-flavored oral oil suspension. I had it compounded as concentrated as they make it so I could mix the smallest amount into a little bit of food with a few drops of salmon oil mixed in. The whole "medicine meal" I make for her is about the size of a nickel. When she polishes that plate (and she does!), I follow it with her regular breakfast.
 

daftcat75

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This is where I get it. You'll need a prescription. The price is reasonable and the service is top notch. On this page is both the other forms it can be compounded and the available flavors.
Chlorambucil Oral Oil Suspension
 

daftcat75

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Thank you, i will look into these. They want his pred lowered and the plan was to try and get off it all together but things just get worse when we do.
For GI lymphoma, pred and chlorambucil are generally given together. Then, in some cats, the pred can be reduced or eliminated. Others may need to take some dose of pred the rest of their lives. A specialist should be able to decide which yours falls into based on his history and how he responds to the chlorambucil. I got pred compounded into a transdermal. I give Krista a wet willy in her ear every night. She doesn't like it as much as the fish flake wrapped pill I used to give her. But we learned the hard way that fish flakes are inflammatory for her. Now she's on a daily antibiotic for an ear infection and I strongly suspect the duck flavoring of the oral oil is also inflammatory. So we've got a bacon flavored oil on its way and I will see if I can crush the quarter pill into her food for a few days until it arrives to see if that makes a difference vs. the oral oil she's been taking.

If Max is still eating any dry food, that would be an easy fix. Dry food is inflammatory. Cut that out. Beyond that, I can only recommend Rawz pates because they come in a number of single protein flavors without extra ingredients that can make food trials so difficult. Krista had great success with the turkey flavor for a long time. Now she can only have the rabbit. If that changes, we're screwed.
 
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MaxiG

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For GI lymphoma, pred and chlorambucil are generally given together. Then, in some cats, the pred can be reduced or eliminated. Others may need to take some dose of pred the rest of their lives. A specialist should be able to decide which yours falls into based on his history and how he responds to the chlorambucil. I got pred compounded into a transdermal. I give Krista a wet willy in her ear every night. She doesn't like it as much as the fish flake wrapped pill I used to give her. But we learned the hard way that fish flakes are inflammatory for her. Now she's on a daily antibiotic for an ear infection and I strongly suspect the duck flavoring of the oral oil is also inflammatory. So we've got a bacon flavored oil on its way and I will see if I can crush the quarter pill into her food for a few days until it arrives to see if that makes a difference vs. the oral oil she's been taking.

If Max is still eating any dry food, that would be an easy fix. Dry food is inflammatory. Cut that out. Beyond that, I can only recommend Rawz pates because they come in a number of single protein flavors without extra ingredients that can make food trials so difficult. Krista had great success with the turkey flavor for a long time. Now she can only have the rabbit. If that changes, we're screwed.
He is not on dry food. He was for a little bit, maybe a month and now won’t eat it. Even wet food he tilts his head to the side and eats it weird, almost like it’s a thick consistency but it isn’t . I’ve asked them to check his mouth/teeth because this is new but they said everything looked fine. I will check in to those Rawz plates, may be something he would be willing to eat that wouldn’t upset the IBD. Hope Krista’s ear infection goes away soon!
 

daftcat75

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The Rawz pates are hard to find unless you have an independent pet food store near you that sells them. They only sell the pates to independents. They have other brands that aren't as restrictive. Though they have one reason or another why they won't work with Krista (usually chicken or fish ingredients.) You can write them and request samples. If you find one Max likes, I would bookmark these online resellers and buy from whomever has what you need. I personally like Incredible Pets the best because they are more local to me and ship via USPS. But I've purchased from most of these as the rabbit pate is difficult to find this year.

RAWZ | Where to Buy
 

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There was suspected IBD/lymphoma with my recently passed beloved angel cat...sadly I've been researching more now. I cannot vouch for any of these products but I know I personally wish I would've known about herbal supplements before. I've heard good things about CBD but again, sadly, the night I ordered it she passed.

I'm not sure if I'm making things harder on myself but looking up supplementation when it's too late.
Some interesting articles:

Again, can't speak for any of these myself. It's pretty hard to read mostly glowing reviews of miracle products when you've lost someone, but just wanted to share as I wish I had known.
 

daftcat75

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The trouble with alternative therapies is that you get stubborn that it’s going to work and the cure is just around the corner or with the next product. Meanwhile, that’s time lost to try something that has already been researched and proven to work. I would wait for the sonogram results and discuss your next options with the vet. I hardly think you’ve exhausted them that you should be resorting to alternatives yet.

A word of caution about CBD. It is generally very safe on its own. But it competes with many other prescription drugs for liver enzymes. It can make some drugs last longer or become more powerful if the usual metabolic pathways of drug activation or metabolism in the liver are not available to them because of the CBD. Since he’s already taking prednisilone, adding CBD can be dangerous.
 
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daftcat75

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There was suspected IBD/lymphoma with my recently passed beloved angel cat...sadly I've been researching more now. I cannot vouch for any of these products but I know I personally wish I would've known about herbal supplements before. I've heard good things about CBD but again, sadly, the night I ordered it she passed.
[/URL]

I'm not sure if I'm making things harder on myself but looking up supplementation when it's too late.
Some interesting articles:
[/URL]
[/URL]

Again, can't speak for any of these myself. It's pretty hard to read mostly glowing reviews of miracle products when you've lost someone, but just wanted to share as I wish I had known.
I can speak to the Vitality Science products. They tend to be a kitchen sink’s worth of supplements in each formula. If your cat is sensitive to even one of the ingredients, good luck trying to figure out which one. They helped Krista a couple of summers ago. But now, something in them lights her up. I can’t use any of them with her anymore because they all seem to have the same base basket of ingredients with different guest stars. Something in that ensemble mix only makes matters worse now.
 
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MaxiG

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There was suspected IBD/lymphoma with my recently passed beloved angel cat...sadly I've been researching more now. I cannot vouch for any of these products but I know I personally wish I would've known about herbal supplements before. I've heard good things about CBD but again, sadly, the night I ordered it she passed.
[/URL]

I'm not sure if I'm making things harder on myself but looking up supplementation when it's too late.
Some interesting articles:
[/URL]
[/URL]

Again, can't speak for any of these myself. It's pretty hard to read mostly glowing reviews of miracle products when you've lost someone, but just wanted to share as I wish I had known.
I’m so very sorry for your loss as it is never easy to lose something you love. Thank you for the links. I greatly appreciate them. If you don’t mind me asking how old was your cat, was their behavior different? and did you have her on any medications for the suspected illnesses? I ask because it’s just so up and down with mine. There are weeks I didn’t think he would make it and then weeks he acts completely fine other than vomiting which goes away with the Cerenia.
 
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