Here we go on another rollercoaster- IBD, pancreatitis, Small cell lymphoma

[FeralHearts]

I admit at this point I'm exhausted, frustrated and feel like I'm totally failing these kitties.

Between Charlie, Wl, Mia and BH - I can't catch a break.

Poor BH finally got past the Plasma Cell Pododermatitis, only to get TR and end up at a dentist specialist in Jan / Feb and just when I think after all she's already been through that we're doing okay... WHAM .. her appetite goes to poop, she starts to drop weight and a few other things ... and in off I go with her to her DR. I was really thinking the Doc was going to come back and say I was crazy as it was all very mild - but enough to raise my eyebrow. I have to say she has the best vets ever. I'm totally blessed there - thankfully!

Blood work, Doc says is pretty normal for her but it'd not where it should be IMHO but I'm not a vet. WBC, Lymphocytes, Phosphorus, Calcium all low. NEUTROPHIL has gone up a bit as they are usually low. Urine pro is +2, usually +1 and PH has gone up to 7 from a normal 6. Checked her thyroid - normal range. Low side but normal. These have always been low - but dropped again. Every visit they seem to drop a bit more - but always on the low side. So lower and lower.

So we do an ultrasound next.

Diagnoses from ultrasound:

1. Probable diffuse enteropathy such as inflammatory bowel disease or emerging small cell lymphoma.
2. Urinary debris and probable focal mucosal cyst.
3. Probable chronic pancreatitis

Well ^&*(^,&*^%$!!!! I want to scream "Hasn't she been though enough! Haven't they all!" Then I get my head on and go into research / let's get her healthy mode and I have to tell you I'm feeling overwhelmed and a little underwhelmed at the information or I'm just not getting it.

On the plus the vet doesn't think it's Small cell lymphoma due to her age but at the same time with her immunity issues with pillow foot I have to say that I don't feel confident in her luck. The good news it - if it is - it's early stages and treatable because I caught the changes fast enough. So I guess there is some really good luck there. That's something. :-)

At this point the course of action have been diet change and making sure she is eating. I can get food into her as long as I hold her plate. (Wet food) Dry food she would stuff her face until she fell over but wet food takes some finesse on my part. She is gaining a little weight. Of course I don't want her to gain too much or else I'll be dealing with a MIA (Very over weight working on her.) So I'm doing a balancing act.

At this point we have opted not to biopsy but see what happens with diet. A biopsy will be on the table should it be needed and come to that.

This is what I understand so far and need some one to confirm my brain still is working:

Diet change needed as IBD is much like food sensitives and allergies. Novel proteins. etc.

Pancreatitis is a big issue as that can lead to cancer. Both can really. Managing this requires easy to digest foods and low fat? Also preferable smaller meals more often - yes?

From what I am reading and understanding if I can keep her eating it will help with the nausea and discomfort.

I should be looking for a probiotic too and not FortiFlora because not enough of the right enzymes etc.. She already gets salmon oil in her feedings.

When she comes due for her physical in a couple mouths I will request a B12 and folate test. Anything else I should be looking at there?

Unlike many cats, she is mild symptoms wise, what triggered me to take her in was her disinterest in wet food unless I hand fed it, a bit lethargic - mostly in AM feedings, change of behavior with it, looking nauseated after eating - and dropping some weight. At this stage she is not tossing her cookies and is a bit constipated often rather than loss stools.

I can also tell you her appetite is there -she is HUNGRY, it was the nausea that was making it hard. Hand feeding helped in little bits. She drinks fine as well. I see her on the cams several times night and day getting drinks. Also there is a bit of extra liquid in her we tfood.

What other things can and should I be doing to help her?

Ask me anything.

Below is kitty picture payment of her nekkid belly!

 

[Catmom1234567890]

My kitty was just diagnosed with IBD. She had a hairball obstruction and she's having a second obstruction in 5 days. Vet wants to do another endoscopy. My vet bills are in 5 figuers. My only alternative is put her to sleep.

 

[FeralHearts]

My kitty was just diagnosed with IBD. She had a hairball obstruction and she's having a second obstruction in 5 days. Vet wants to do another endoscopy. My vet bills are in 5 figuers. My only alternative is put her to sleep.

I was reading your thread and my heart broke for you. I didn't post yet as I didn't have anything to add that the others haven't already mentioned. I get the big vet bills. Where I live they aren't cheap either.

IBD can be managed with foods etc. but you know that part. :-). I have another one with it that has been doing pretty good for a number of years once I found something he would eat and got him stable. Wasn't easy and was a lot of trial and error - and hair pulling. My hair.

hmmm thinking about what you said ... I ask this question only because both of my two IBD cats won't let you brush them. The other two kitties can't get enough brushing but the two with IBD.. yikes... let's just say I have a lot of war wounds.

So the question is - does she let you brush her? (I have learned to ask things rather than assume.)

One of mine has really, really fine hair. She doesn't appear to shed much but when I do battle and brush her BOY I get a lot! It's almost shocking. I brush twice a week now as much as I can on them to prevent the hair build up. I also have to force hairball treatment on them and keep their beds as clean as I can from the hair as it's fine. More hair than I thought possible.

 

[Catmom1234567890]

She’s a ragdoll so she long haired. I brush her daily. Any little bit of hair she’s ingesting builds up in the stomach. Her GI motility stopped working it seems. First hair ball obstruction, dr took out 1/2cup of hair. Second obstruction, pending upon endoscopy. She will be completely shaved down after second endoscopy.

If she doesn’t get the hair out, it’s going to be full obstruction as X-ray and ultrasound showed blockage wont pass on its own.

 

[FeralHearts]

C Catmom1234567890 went back to your thread this am. Saw the amount of hair - holy cow batman! That's a lot of hair.

I'm going to re-read your thread and do some research on mobility. Not sure I'm going to be much help though. Although you've made me realize I lucked out on both of mine with IBD in many ways. So sorry for kitty but I'd shave her too. Good call.

 

[Catmom1234567890]

C Catmom1234567890 went back to your thread this am. Saw the amount of hair - holy cow batman! That's a lot of hair.

I'm going to re-read your thread and do some research on mobility. Not sure I'm going to be much help though. Although you've made me realize I lucked out on both of mine with IBD in many ways. So sorry for kitty but I'd shave her too. Good call.

 

[fionasmom]

I certainly understand your frustration and exhaustion, all the while wanting to help your cats maintain their health. In my case, it is the current GSD whose medical history rivals yours. Poor boy is seemingly fine when I walk out of the room, but when I walk back in something is suddenly "different" and we go careening down the freeway to the vet or the ER.

Coincidentally, he does have chronic pancreatitis. The vet even allows me to keep sucralfate, Cerenia, metro, and omeprazole on hand so that I can begin the treatment when I suspect it has recurred. Low fat diet is very important in this. However, I do have to add that some doctors feel that the connection to a low fat diet in cats is not the same as with dogs. For cats, that may not be the issue, but a low residue diet might be preferred. Given that you also have an intestinal issue, you may need to consider novel protein. Small meals and easy to digest foods will help as well although I have found that low fat seems most important. Dog eats a home prepared diet, not raw.

https://www.idexx.com/files/spec-fpl-treatment-for-feline-pancreatitis.pdf
This article discusses in detail the low residue/novel protein angle. Lots of current information about feline pancreatitis.

As for the possible lymphoma, I agree that waiting on the biopsy while you test dietary changes is fine. I am just going to put this out there though. At the suggestion of daftcat75 I approached my vet about starting chlorambucil/Leukeran without doing a biopsy. Chelsea, the cat in question, is not a good candidate for excessive handling, semi feral indoor only. Your vet may or may not be interested in allowing this. Certainly proceeding with the biopsy is at your discretion.

The probiotic Saccharomyces boulardii or s. boulardii is used by many members for their cats.

IBDKitties – Helping Save Lives…One Paw at a Time
This might be of some help

 

[daftcat75]

I admit at this point I'm exhausted, frustrated and feel like I'm totally failing these kitties.

Between Charlie, Wl, Mia and BH - I can't catch a break.

Poor BH finally got past the Plasma Cell Pododermatitis, only to get TR and end up at a dentist specialist in Jan / Feb and just when I think after all she's already been through that we're doing okay... WHAM .. her appetite goes to poop, she starts to drop weight and a few other things ... and in off I go with her to her DR. I was really thinking the Doc was going to come back and say I was crazy as it was all very mild - but enough to raise my eyebrow. I have to say she has the best vets ever. I'm totally blessed there - thankfully!

Blood work, Doc says is pretty normal for her but it'd not where it should be IMHO but I'm not a vet. WBC, Lymphocytes, Phosphorus, Calcium all low. NEUTROPHIL has gone up a bit as they are usually low. Urine pro is +2, usually +1 and PH has gone up to 7 from a normal 6. Checked her thyroid - normal range. Low side but normal. These have always been low - but dropped again. Every visit they seem to drop a bit more - but always on the low side. So lower and lower.

So we do an ultrasound next.

Diagnoses from ultrasound:

1. Probable diffuse enteropathy such as inflammatory bowel disease or emerging small cell lymphoma.
2. Urinary debris and probable focal mucosal cyst.
3. Probable chronic pancreatitis

Well ^&*(^,&*^%$!!!! I want to scream "Hasn't she been though enough! Haven't they all!" Then I get my head on and go into research / let's get her healthy mode and I have to tell you I'm feeling overwhelmed and a little underwhelmed at the information or I'm just not getting it.

On the plus the vet doesn't think it's Small cell lymphoma due to her age but at the same time with her immunity issues with pillow foot I have to say that I don't feel confident in her luck. The good news it - if it is - it's early stages and treatable because I caught the changes fast enough. So I guess there is some really good luck there. That's something. :-)

At this point the course of action have been diet change and making sure she is eating. I can get food into her as long as I hold her plate. (Wet food) Dry food she would stuff her face until she fell over but wet food takes some finesse on my part. She is gaining a little weight. Of course I don't want her to gain too much or else I'll be dealing with a MIA (Very over weight working on her.) So I'm doing a balancing act.

At this point we have opted not to biopsy but see what happens with diet. A biopsy will be on the table should it be needed and come to that.

This is what I understand so far and need some one to confirm my brain still is working:

Diet change needed as IBD is much like food sensitives and allergies. Novel proteins. etc.

Pancreatitis is a big issue as that can lead to cancer. Both can really. Managing this requires easy to digest foods and low fat? Also preferable smaller meals more often - yes?

From what I am reading and understanding if I can keep her eating it will help with the nausea and discomfort.

I should be looking for a probiotic too and not FortiFlora because not enough of the right enzymes etc.. She already gets salmon oil in her feedings.

When she comes due for her physical in a couple mouths I will request a B12 and folate test. Anything else I should be looking at there?

Unlike many cats, she is mild symptoms wise, what triggered me to take her in was her disinterest in wet food unless I hand fed it, a bit lethargic - mostly in AM feedings, change of behavior with it, looking nauseated after eating - and dropping some weight. At this stage she is not tossing her cookies and is a bit constipated often rather than loss stools.

I can also tell you her appetite is there -she is HUNGRY, it was the nausea that was making it hard. Hand feeding helped in little bits. She drinks fine as well. I see her on the cams several times night and day getting drinks. Also there is a bit of extra liquid in her we tfood.

What other things can and should I be doing to help her?

Ask me anything.

Below is kitty picture payment of her nekkid belly!



View attachment 393879

That's an ultrasound belly. I don't think Krista had belly fur the last year of her life. Just when it started growing back, we'd have to go back in for another.

My understanding of pancreatitis is that it is often spillover inflammation from the gut. Cerenia will help (as long as it doesn't suppress her appetite like it does with some cats including Krista.) Cerenia has an additional anti-inflammatory action that somehow targets the pancreas. I don't remember specifics. Maybe you can find it in your research. Low fat isn't necessary for cats with pancreatitis.

Novel protein and limited ingredient can help a lot. Just make sure they are truly limited ingredient and they aren't trading an extra animal protein for pea protein or pea starch, clay, cranberries, or other nonsense I have seen in "limited ingredient diet" foods. Rawz single protein pates is pretty much the gold standard for IBD. Turkey might be different enough. Or rabbit if she's been through all the other proteins. I would also eliminate her dry food, if you can. That will help greatly with removing suspected or potential inflammation triggers. Dry food is low digestibility and very challenging for an inflamed pancreas.

Smaller meals fed more frequently can also help. I was feeding Krista 6 to 10 times a day to keep her calories up even when her portions were tiny.

I think you can skip the biopsy. That she's able to gain weight pretty much rules out lymphoma right now. Save your money and your trouble and pick up a baby scale instead. Weigh her no more than once a week. If her weight is stable, you can weigh her once a month until it's not. When she starts losing weight and isn't able to gain it back again despite eating enough or more than enough calories, that's when to suspect lymphoma. At that point, that weight loss also makes her a poor candidate for a surgical biopsy. If it gets to this point, simply ask your vets to lay out the risks of a surgical biopsy and its recovery period versus prescribing chlorambucil and doing regular testing and monitoring for side effects. I expect your vets will agree with Krista's. The drug is less risk than the diagnosis.

I would start with the Cerenia or ondansetron if BH doesn't eat on Cerenia. Also make the diet changes: no dry, possibly novel protein, simple recipes. I can't recommend Rawz enough despite its cost. I believe managing this through diet will help you avoid steroids (or chemotherapy.)