IBD and possible lymphoma, my cat is crashing

[silent meowlook]

Hi
You did endoscopic biopsies. No real way they could perforate the intestines that way. If you had done full thickness surgical biopsies, then it could happen, but that doesn't happen often. And you have been seeing a specialist, right?

When endoscopic biopsies are done, the cat is put under general anesthesia. They are intubated with an endotracheal tube and placed on gas anesthesia mixed with oxygen. Once the cat is at a good plane of deep anesthesia, then the endoscope is put down the throat and the upper GI tract is visualized on a screen that is linked to the endoscope camera. Once all that is reachable via the mouth, then biopsies are taken. They are taken by putting a long wire with a spring-loaded claw on the end that is controlled by a technician squeezing the handle in order to grab little pieces of the inner lining of the duodenum, after each biopsy is obtained the claw grabber is pulled out and the sample is placed on a flat wooden stick and placed into a jar with formula. Three samples are obtained each from the Duodenum, The Jejunum and the Illiam.

I worked for a large specialty group and spent 9 years working for the internal medicine department. We did several endoscopies a week. In my experience it always took a while, so the patient had to be under anesthesia for a while. Often with suspect IBD, lymphoma, or anything that might make the patient not want to eat, we would place an esophageal feeding tube. This would only add about 2 minutes onto the procedure. The doctor was extremely experienced and was fast and accurate with his tubes. I would never trust any doctor to place a feeding tube that wasn't a specialist with massive experience doing it.

Anyway, the reason for the information above is to explain that I don't think there could be anyway for a perforated gut in your cat. But anesthesia is hard on them and can leave some effects that last longer than would be expected. Stress can also cause things that are lying dormant to wake up.

I am posing a link to a veterinarian information page regarding intestinal biopsies.

How best to obtain intestinal biopsies

Indications for intestinal biopsies can range from chronic vomiting and diarrhea to weight loss and even hypoproteinemia.

www.veterinarypracticenews.com

It won't copy as a link. but if you copy and paste in your search bar it should come up.

I will say that I didn't do any biopsies on my own cat. I just did an abdominal ultrasound with an experienced cat doctor that had better equipment than the specialists and she did massive continuing education on ultrasound. I started my can on Chemo (Chlorambucil) and Prednisolone as well as other medications, based on the thickened intestinal walls and the enlarged lymph nodes in the abdomen. Of course, I could do this because I work for a vet.

My choice was that I was fearful of the stress on her. She was already under weight and not feeling well. She has multiple other issues. Most veterinary literature will disagree with this because there are no biopsy results. But honestly, severe IBD and small cell GI lymphoma are treated very much the same. Of course, I also may regret my decision later on.

Whenever a veterinarian recommends diagnostics, always ask them what information will be gained with the diagnostic, and how the results will affect treatment, sometimes they are following a gold standard that they have been taught, and sometimes they are really needing to know these things because it will alter treatment. Most importantly ask questions and expect answers. I know veterinarians are stressed out right now. But so are people with sick animals. Once you are under the care of a veterinarian, they need to be able to answer questions and still make some time for you, even if you are not there. This may come through their technician, but they still need to help you and be involved especially when you have just had a big procedure done.

Sorry for the massive post on your thread. Just trying to help.

 

[Ocean Planet]

Sorry for the massive post on your thread. Just trying to help.

Don't be sorry! Really appreciate the insight! I'm sure I won't be the only one who does either. I'll give it a read a couple times to take it all in.

Yeah, the doctor who did the procedure is a board certified internal medicine specialist for small animals. So not just a regular doctor or surgeon, etc.

 

[Ocean Planet]

Something else I've noticed yesterday and this morning. His attempts for a stool movement are going up, but they are either the size of a half dollar or just a few drops. As much as he has been eating, I'd think it would be a lot more coming out. Now I"m wondering if he is blocked up. Debating if this is another ER visit (not overnight of course)

Gonna call the primary vet this morning. He isn't peeing as much either. Something is wrong...

 

[silent meowlook]

Oh no. I am sorry. It sounds like another visit is in order.

 

[Peaceandcats]

I am sorry....please let us know how he is doing when you get a chance. I know you are exhausted.

 

[Peaceandcats]

I hope your baby made it through the night. I hope you are okay, too!

 

[Ocean Planet]

Sorry for the lack of updates Friday. Between working and 4 hours of sleeping taking care of him, this is starting to take a toll on my health.

I don't know what is going to happen. I ran him in yesterday because I thought he was blocked up. He goes around meowing when he needs to go to the bathroom. So just wanted to be sure...

They looked at his bladder with ultrasound and took a pee sample. All normal and ok. Nothing enlarged and no crystals. They did a rectal exam and did a full body x-ray. Nothing alarming found in his tract and no fluid seen anywhere (like around the heart/lungs). Temperature was a normal 102.x. His weight was 12.5 last summer. He is 11 pounds now So all in all a good visit in a way.

This was a different doctor at my usual vet. She really had no solutions for his constant bowel movements based on the situation. She offered Metronidazole but I said we tried that. Makes me wonder if we should try again long term.... I don't know. Going to try filling these capsules first with probiotics and see how that goes with the steroid.

It's possible I'll get the results this week if lymphoma is definitely part of this or not. I think it will have been 3 weeks.
I'm still scared and keeping an eye on his quality of life. I don't know if this diarrhea will ever go away. I don't know if trying to go the bathroom 15 times a day with limited results is good quality of life.

He looked like death yesterday morning. He sat in a bread loaf in the middle of the floor and turned his head sideways and laid it on the floor while like that to sleep. It looked like something out of the exorcist. Never seen a cat do that before. But then last night I gave him some transdermol gabapentin and he fell asleep on me for an hour and kind of perked up the rest of the evening. Not playing, but prowling around a lot kind like how he used to be.

I'm still fighting. Besides my day job I've put my life and hobbies on hold to focus on him 1000%. I still feel like I'm failing. Just wish something would work to get him to stop going to the bathroom. That is the only issue right now! (for quality of life). Have a few more combinations of pills to try but he is getting smarter and getting more difficult to take them. I'm still trying...

He is up prowling around this morning eating and drinking. Holding steady right now.

 

[silent meowlook]

It’s tough. I look at my cat and wonder the same sometimes. I would make a list of what he likes to do normally. When he stops doing it for a week put a line through it. When there is nothing left, you know. If you can, call and try to speak to the specialist you saw. His issues are way above regular veterinarians.

 

[Ocean Planet]

It’s tough. I look at my cat and wonder the same sometimes. I would make a list of what he likes to do normally. When he stops doing it for a week put a line through it. When there is nothing left, you know. If you can, call and try to speak to the specialist you saw. His issues are way above regular veterinarians.

Thanks, that is a good idea. Actually, he has a follow-up Monday with internal specialist to get/give updates.

 

[daftcat75]

My last cat Krista had liquid poops for two periods in her life. They both lasted months. One was a summer of clostridium. And the other was when her IBD had progressed to lymphoma. This is why I keep pressing s boulardii. Because it’s hard to know which one it might be (especially if the biopsy is inconclusive. Though Krista never had a biopsy.) S boulardii certainly won’t hurt if it turns out to be lymphoma. It will help some. But its not going to replace chemo. In the meantime, it gives you something to try while you are giving the pred a chance. And given that he did take metro, it’s a good bet he will benefit from SB even if you don’t see it right away. It will take a few days to build a steady state. But you may see improvements sooner than that. It doesn’t colonize in his gut. It will only be effective as long as he takes it. When you stop giving it, it takes a few days to clear it out. It took months (two or three) for Krista to clear the clostridium and get her poops back in order. Did you pick up a can of A/D to try the capsule meds trick? Hopefully he’ll like the taste of SB and/or A/D to make one med in his regimen that much easier to give.

 

[daftcat75]

I’m still not ready to read that thread again. But I recorded Krista’s struggles and triumphs the last eighteen months of her life. I’m sure you can find it searching for Krista. It’s called Krista’s Care. It’s massive. 200 pages. Somewhere around the middle probably around July/August 2019 is when we struggled with clostridium. That was confirmed by a diarrhea PCR. Her lymphoma struggles are probably going to be harder to read because we didn’t find a solution until her last month. Those started in November or December 2019. It was a long struggle of pred and more pred and going over my vet’s head to the owner and founder of the hospital to beg for chemo without putting an unstable cat through an endo procedure. He finally relented and it helped a lot. But not completely. It turned out the fish flakes I was wrapping her nightly pred pill in was keeping the inflammation fires burning. When I finally switched her to transdermal pred, all her poop nonsense finally stopped. So if the SB doesn’t help, and if the chemo drug doesn’t help, look to the food you’re feeding him for possible inflammatory triggers. You can do that now while his pred munchies are still high.

 

[NekoM]

I was just reading through the thread to catch up on everything. Here’s everything I know: Your frenemy right now is water, which along with food passes through the digestive tract into the small intestine which normally absorbs most of the water and nutrients into the body, then whatever is left goes to the large intestine that pulls even more water from any remaining food and exits as poop. In your situation water isn’t being absorbed so anything eaten that’s wet doesn’t have a chance of being absorbed and adds more water into the mix, anything dry absorbs water, but is designed to break down as soon as it interacts with it so doesn’t slow it down. Tasty foods add to the problem as it stimulates the gut into creating more gastric juices. I get the feeling your trying lots of different things to try and stop it which is actually making everything worse. Most vets who understand nutrition always recommend a bland simple diet, so you have to chose one type of food and ride it out until the stomach balances itself out. The one thing that’s pretty universal is dry cooked chicken because it breaks down slowly and doesn’t overstimulate the gut. If I were to offer one piece of advice it would be to simplify everything.
You mentioned you were seeing blood that the Vets didn’t catch where it was coming from? Did anyone mention polyps? They generally hide in small pockets of the intestines and are tricky to find but aren’t particularly dangerous. Hope this helps a little.

 

[Ocean Planet]

I'm going to try the Hills A/D trick tonight with his evening medication. I've been scared because if he hates it, it just cuts down on my options to medicate him. I did receive the smaller blank capsules and will practice with those as well tonight. I don't have the S/B yet. It said a delivery of Monday/Tuesday. A transdermal prednisolone would be a last effort but doctors hesitate with it as they say it's a bit less effective. They'd rather I do the pill or liquid if possible.

Understand on your thread for Krista. (I still can't watch videos of my two cats I lost a couple years ago). I will take a peek later. It's not good to have liquid for months, but it is comforting you were able to get it managed eventually. Gives hope, you know? Thanks for all of your replies daftcat75

 

[Ocean Planet]

I was just reading through the thread to catch up on everything. Here’s everything I know: Your frenemy right now is water, which along with food passes through the digestive tract into the small intestine which normally absorbs most of the water and nutrients into the body, then whatever is left goes to the large intestine that pulls even more water from any remaining food and exits as poop. In your situation water isn’t being absorbed so anything eaten that’s wet doesn’t have a chance of being absorbed and adds more water into the mix, anything dry absorbs water, but is designed to break down as soon as it interacts with it so doesn’t slow it down. Tasty foods add to the problem as it stimulates the gut into creating more gastric juices. I get the feeling your trying lots of different things to try and stop it which is actually making everything worse. Most vets who understand nutrition always recommend a bland simple diet, so you have to chose one type of food and ride it out until the stomach balances itself out. The one thing that’s pretty universal is dry cooked chicken because it breaks down slowly and doesn’t overstimulate the gut. If I were to offer one piece of advice it would be to simplify everything.
You mentioned you were seeing blood that the Vets didn’t catch where it was coming from? Did anyone mention polyps? They generally hide in small pockets of the intestines and are tricky to find but aren’t particularly dangerous. Hope this helps a little.

Thanks Neko. That all does make sense. And I've thought about that a lot lately that I've panicked and that we are just trying anything to get it to stop.

He used to have bright red occasional drops of blood. The doctors say that is the inflammation/IBD talking. When they did the endoscopy, she said hes whole track of what they could view looked great. No polyps/masses/ulcers, etc. Since he has been on the prednisolone I have noticed less occurance of any blood drops, if at all.

 

[Peaceandcats]

I am very glad to hear no polyps or blood! I know you must be exhausted and I just want to say you are the best cat dad. I don't know what will happen, but I know you are giving him the best care on the planet. Who on Earth could have foreseen such complications with a common and routine procedure? Not the vets, and certainly not you.

I completely agree with NekoM that a simple and stable diet is best right now (unless the vet advises otherwise). Even the healthiest of cats are so sensitive to even the slightest dietary changes.

My vet also said the same thing about transdermal meds in general - they are simply not as effective (although certainly better than nothing). She said it is hard to get "precise" dosages into the gel.

 

[daftcat75]

I’ll be the contrarian and say that for something like pred where adherence (often daily dosing) is critical, sometimes the faults of transdermal are worth not wrestling with your cat every night. Not every cat pills as easily as the YouTube videos.

Like with my cat and buprenorphine, better some than none. Shes’s a blessing and will take any capsules I dip in A/D and drop the carpet for her. But buprenorphine can’t be given that way. I tell her twice a day, “I’d put this in a capsule for you if I could.” I know you’re supposed to aim for the cheek pocket. But just getting the syringe pressed against her teeth is victory enough for both of us. I aim back and down and hope for the best. Better some than none. Now she also takes gabapentin. I repack capsules for her into smaller doses. It’s not like we need the bupe. But it’s better to give it and not need it than the other way around. She had a couple extractions this week and we’ll use up the bupe as directed. As best as we can.

Circling back to Krista, I made DIY pill dough with SB and a little food. The SB, being yeast, gets tacky like dough when wet. It helped hold the fish flake in place which is what really brought Krista to eat those. Sadly, those fish flakes were a trigger for her. I called it our devil’s bargain. But in the end, she paid the price.

So if you can pill, more power to you. Hopefully the A/D capsule trick works and you don’t have to pill. But if A/D doesn’t work and you can’t pill, better some than none. Better to take transdermal for all its shortcomings than wrestle with your cat nightly and possibly damage that relationship.

And in any case, many pet meds are dosed out with a fudge factor to account for misses and messes.

 

[Ocean Planet]

So far, the Hills A/D food worked great tonight! I made 3 small piles and kinda wrapped the pred and 2 capsules with some probiotic in it and he took all 3. I thought he was almost going to spit one out as he kept licking his lips but it all went down without a fight.

Whew. Hope it keeps up. Pilling might be just fine with this stuff for whatever he needs.

I don't think he's tried to have a bowel movement in 15 hours. Today has been a better day. He still isn't highly playful and still looks in discomfort at times but it has been better regardless.

 

[silent meowlook]

Hi. You are getting allot of conflicting advice here. Please make sure you check with the specialist before making any changes at all.

Water is never a cats enemy. Cats must stay hydrated. If they are having watery diarrhea, they need more water than ever to make up for the fluid loss.

Many cats have an allergy to chicken. The other common food allergy is fish.

 

[Ocean Planet]

After 2 full weeks of liquid stool, he went to the box this morning and no more liquid. It was one long soft piece with a couple pudding drops at the end, woot!

Could we finally be hitting some kind of stability? Perhaps.

While I'm very happy with this, he still lounges around more often than not. I'm wondering if I will ever have my playful version back of my buddy.... especially if he has to add a chemo pill down the road

Small steps I guess..

 

[Peaceandcats]

I think this is the best news we have heard in days!

Yes, I think your baby will improve and eventually have more energy. He is no doubt still weak and exhausted - the diarrhea alone would have zapped his energy, even without all the other stuff.

Thank you for taking such very good care of him 24/7.