How long does it take to see improvement with chlorambucil? And how much improvement?

[treeclimber]

My little guy has had GI issues getting gradually worse over the last two years. We did all the special diets and nothing helped. For a while it seemed like his symptoms improved with tylosin, but recently that hasn't helped either. We've also tried several different probiotics, including S. Boullardi. He's also on budesonide.

Our vet has brought up the possibility of chlorambucil before, and I'm finally ready to say yes. She just moved away so we'll be seeing a different vet in the same practice next week, but I'm expecting he'll suggest it too - every other diagnosis/treatment has already been tried. (We can't afford endoscopic biopsy, and given the high false-negative rate it doesn't really sound like it's worth it anyway - our old vet was willing to try chlorambucil just based on symptoms/history.)

How long does it take to tell if chlorambucil is working?

How well does it work if it works? Can anyone share any "before and after" stories for how your cat's symptoms changed/improved with chlorambucil?

Currently he's puking daily, but knock on wood his appetite seems OK and he's having solid stools about 75% of the time. He seems to fluctuate back and forth between periods of puking and periods of bad appetite, but right now we're definitely in the puke part of the cycle.

 

[Binxie]

I have not had to use chlorambucil but I have had a cat with IBS and lymphoma, does the vet suspect lymphoma? There are are number of fecal tests that can be done to help determine what might or might not be causing the GI issues, has he had those and has he had an ultrasound?

 

[treeclimber]

The old vet suspected lymphoma, especially because of his age (11-ish years old) and the fact that it has gotten progressively worse over time. I don't know yet what the new vet will say, but if the old vet hadn't moved away then her next step would likely have been chlorambucil.

He's had the basic fecal test for parasites several times. Since the primary symptoms are all at the other end of the digestive tract, he has not had more advanced fecal testing for specific bacteria. He had an ultrasound that was negative (no intestinal thickening) more than a year ago. He also had bloodwork that showed no signs of pancreatitis, early signs of renal disease, and a B12/folate imbalance that possibly pointed at intestinal absorption issues and has been treated with B12 shots.

All of this has hit my finances pretty hard, and the student loan payment freeze is ending. I have cut costs in many areas in my life to continue to afford his special foods and his meds from a compounding pharmacy, but I've already squeezed out as much money there as I can. I feel like crying that I can't be a better cat-mom and get him all the latest greatest state-of-the-art tests for everything, but I can't. At this point unless a test is likely to be a massive game-changer that leads to a clear answer and a cure, the money has to go into his foods and treatments, and hopefully treating empirically might lead to some answers.

 

[silent meowlook]

Hi. You usually use Chlorambucil in conjunction with Prednisolone, on alternating days. Is he on Cerenia for the nausea? That would be something to talk to your vet about. Also ask about Vit B 12 injections. I would still continue with a limited antigen canned diet. It often takes many different things to get it under control.
It took my cat about a week before I noticed a difference.

 

[treeclimber]

Hi. You usually use Chlorambucil in conjunction with Prednisolone, on alternating days. Is he on Cerenia for the nausea? That would be something to talk to your vet about. Also ask about Vit B 12 injections. I would still continue with a limited antigen canned diet. It often takes many different things to get it under control.
It took my cat about a week before I noticed a difference.

Do you know how common it is to use budesonide (his current steroid) instead of prednisolone? Are they usually similar in effectiveness?

He was on Cerenia for a little while, but got a bizarre side-effect where he drooled like a constantly-dripping faucet. Also tried ondansetron, but it didn't seem to have much effect. He was in a low-appetite phase at the time though, maybe it's worth trying it again while he's in a puke phase.

B12 shots have definitely helped - more energy and interest in the world.

A week? That's encouraging - I was expecting it might be a few months!! What kind of changes did you see after a week?

 

[silent meowlook]

Just general improvement in appetite and more active.
I haven’t had any experience with Budesamide but there are others on here that have.