IBD/GI lymphoma vomiting

[myboysolgy]

Hello, I know there are many threads discussing IBD/lymphoma and I've read through them but I have a specific question to those of you who have experience with cats diagnosed with either IBD or GI lymphoma who's cat's main symptom was vomiting. I'll pose my main question here and then explain what I'm going through in more detail below. I'm sorry if I sound confused at any point but that would be because I am! And I feel like I am getting little support from my vet and so feeling a little alone in this very confusing journey.

If your cat had IBD or lymphoma, was there any pattern to their vomiting behavior. Like, how frequent, were they in intense clusters or regularly spread apart, specific time of day, how long you observed the symptoms before diagnosis, did you cat seem very ill during vomiting episodes, or any other observations.

I have a 12 year old boy cat (Solgy) who started having episodes of vomiting about 2 years ago. He would suddenly start throwing up regularly (like multiple times a day or every few hours) and seem in discomfort distress. I would take him to the vet and they were do the usual Subq fluids and anti nausea meds and send him home and he would get better and be fine for a while until the next episode, which were generally spread apart by at least a few months. The vets never really suggested any further exploratory diagnostics to find out what was causing it apart from diet changes because they suspected a food allergy (they did do blood tests which have aways come back fine). The most recent vomiting episode was very severe though (throwing up every half an hour through the whole night and was in a lot of distress until I got him to the vet) but again, after the fluids and meds he was pretty much back to his normal self, but this time we did decide to do an ultrasound. They found thickening of his intestinal wall, suggesting either IBD or lymphoma, and I've been facing the usual dilemma of whether to proceed with a biopsy. His lymph nodes were normal in the ultrasound, and he has not been losing any weight or had a decreased appetite (he is big boy at 17lb). Because I am really scared of the biopsy procedure, for the time being I have decided to proceed with a restricted protein diet 'assuming(hoping!)' that it's IBD and I've also researched and started a fecal transplant treatment which seems to have shown promise in cats with IBD who have a microbial imbalance in their GI tract. Everything was going pretty well and no vomiting at all for a month until yesterday, when he started vomiting at 6pm and pretty much vomited every hour to every couple of hours until 12pm today (so 18 hours). The strange thing about this episode of vomiting however was that in between throwing up he was acting normal, was trying to eat, was drinking, walking about and even purring and cuddling. And after 12pm, without any treatment, he just stopped vomiting and is now back to normal. So, I thought I would love to ask some other people who have experience in this area as to whether in their experience, vomiting related to IBD/lymphoma was an acute and intense thing (like in my case) or more spread out occasional but frequent vomiting. Of course I am assuming this latest episode is related to his condition, but he does go out in the yard and there is always the possibility that he ate something weird.

As a side note, his diet during the past 2 years has chopped and changed a lot as I've been trying to find him something that he likes and that works for his condition. Also he was diabetic twice and went into remission twice after a short course of insulin so is mostly on wet food only but he loves his kibble so I do give him some zero carb kibble from young again (limited ingredient one). The really bad episode of vomiting he had right before we decided to do the ultrasound was preceded by me trying a new food with him. He had eaten this new food for about 2.5 days before the vomiting started (it was only natural pets powerpate pork and rabbit), so again, it's entirely possible that it was food related...but we have no idea. I have been combing through all the ingredients of the foods he might have had issues with and identified one potential culprit which is peas/pea protein.The food we currently is on which is a rabbit formula does not have peas in and he seems to be doing well on it. So I guess what I'm working with here is these possibilities 1)IBD 2)GI lymphoma 3)food allergy causing flare ups: possibly peas. I'm just wondering whether the pattern of his vomiting offers any clues and would love to hear about some of your experiences. Sorry this got so long! And thank you for reading if you got this far.

 

[__caitlin]

As you probably saw, my IBD cat's situation is a bit different as acute vomiting wasn't always the symptom -- although it is now. Here's what my experience has been of it:

As Max's inflammation got worse, vomiting became his main symptom both because:

1. he was unable to keep food down; eating more than a little bit will aggravate his stomach and he's likely to throw it up after a couple hours if he eats too much, and
2. on the other hand, when he goes too long without eating (starting around 5 hours), bile builds up in his stomach, and then he is likely to throw up bile, or throw up his next meal

I also tried Instinct's Limited Ingredient Rabbit diet with the peas -- and he did seem to do worse on it, but by that point it was hard to tell. Ultimately, this cycle got worse and worse (over a couple weeks) and deteriorated to the point that I needed to take him to the vet for steroids. He hasn't officially started his steroid cycle yet (budesonide) -- but from one shot of dexamethasone, the results were instantly better. He's at least been able to keep food down since then and has only thrown up from not eating for too long. The main symptom I'm dealing with now is loss of appetite.

What does his vomiting look like? Is it nausea, throwing up bile/acid, or more food (whether regurgitation or throwing up food after a couple hours)?

If he's not at the point where he's losing weight yet, and is still able to keep food down, I would say give the diet trial a chance! Slippery elm also works well for me -- at least in the immediate aftermath of one dose. So if I sense a bout of nausea coming on and give him a dose of it, he's usually feeling better 45 mins later and I can get him to eat at least one meal. I feel more comfortable personally with slippery elm as opposed to Cerenia, since he is also on thyroid medication, and now steroids, so want to try to be nicer to his liver.

And also -- my cat does love his kibble too, but ultimately I had to take him off of it. I would recommend no kibble at all while you're doing a diet trial if at all possible; there's just too much in there you don't know what it is, and kibble has a reputation of being irritating to IBD cats, so could be compromising the trial.

I would also be extremely interested in your experience with the fecal transplant -- I read a lot into it and was considering trying it for Max myself, but I'm a bit nervous about it (since I don't have any vet that can talk me through it). Please keep us updated!

 

[myboysolgy]

Hi Caitlin, thank you for your reply and I'm sorry to hear your struggles with Max too. It's a rollercoaster and I fully sympathize.

Solgy's vomiting episodes have been a bit varied. In the past I would say they were nausea, he would generally throw up the first time in the night and then it would go on and on. He would look in distress/discomfort and howl and pace when he felt like he needed to throw up, and would generally look quite poorly, and of course would not eat during these episodes. Since he throws up over and over it does end up just being a frothy liquid, quite mucousy sometimes, and after a few throw ups will start to be tinted pink from blood.
Other times he has thrown in the middle of the night or early morning just once and it will just be bile, and in these instances I think it might be an empty stomach making him feel ill.
But this latest episode was a bit strange in that he threw up right after eating dinner so the first vomit was full of food (more like regurgitation) and then he vomited continuously every hour or 2 hours for about 18 hours. Apart from the first vomit all the vomits were frothy liquid, nothing in it, but it did get very red towards the last few times. Since 12pm yesterday he didn't throw up again until 10am today, but it was immediately after eating some grass so I'm not sure whether it was just the grass. He hasn't eaten much this morning but is sleeping looking quite comfortable.

I have been giving him slippery elm but mixed into his food. Which brand do you use? Perhaps I should try giving it to him between meals. I use the liquid one from only natural pet which is 250mg per ml and I've been giving him about 0.5ml x3 a day.

You're probably totally right about the kibble. I know this but I always give into him because he begs and sometimes won't eat the wet food without a sprinkle of kibble. I think I need to be firmer..

I will keep let you know about the fecal transplant, he is about 2.5 weeks into a 30 day course. I did send off a fecal sample for analysis before we started his course and the results came back. They are very interesting but also a little hard to really analyze on your own without some kind of guidance. The overall summary is that Solgy does have quite a severe imbalance and not much microbial diversity in his gut. Since starting the treatment he was doing so well and I was really hopeful, but then this most recent episode happened and now I am back to being very worried. If you are interested in seeing what a fecal analysis looks like from animal biome I can send mine to you. You are right though in that it's hard to find guidance from a vet about it. I mentioned I was thinking of doing it to my vet and she just said she wasn't familiar with it. But my thoughts were that it was worth a try because it's very unlikely to do any harm so there wouldn't be anything to lose (apart from $$ but you can find promotions that bring the cost down) and if anything it can't hurt to boost his microbiome. It is a pill and you can't open it because it has to be protected until it reaches the intestines so that is one consideration, in that you have to be able to pill your cat. I actually coat it in a bit of cat dental toothpaste (chicken flavor which he loves) and it slips right down his throat.

 

[theorangecat]

My cat has either IBD or lymphoma and has the same thickening of intestinal walls. He's recently been diagnosed with heart disease, so a biopsy is out of the picture for him. Until he suddenly lost his appetite a couple of months ago, his one and only symptom for about a year and a half was vomiting once every night (just bile mixed with a bit of fur) in the early hours of the morning. It seemed to come on quite suddenly, and he would always eat treats eagerly a minute or two after he threw up, so the nausea wasn't lingering.

I went to several vets when it started and none of them seemed concerned, just said that it was acid reflux and to give him a snack overnight so his stomach doesn't get too empty. It did help the vomiting somewhat, but ultimately it was just a band-aid over the root cause.

My vet said that one way to get a better idea if it's IBD or lymphoma is to do a course of steroid shots. If it's IBD, the steroid shots will most likely help. If it's lymphoma, they won't. (I personally can't go this route with my cat because of the heart thing.)

My vet also suggested to get my cat on a single protein food, the protein being something the cat has never had before, to see if that helps. Unfortunately, my cat is allergic to poultry, so he's had about every other type of protein out there because that's all he could eat and I don't think there are any novel proteins left. You might want to look into trying a raw food diet for a while if your cat is amenable to that. The raw food I get (Primal Raw) doesn't have any of those fillers like peas that your cat might be reacting to, and it comes in flavors like rabbit and venison that might be new to him.

It sounds like our cats' experiences have been pretty different in regards to vomiting, but I do know how tough it is to be going through this and I hope that you're able to figure things out for Solgy.

 

[fionasmom]

Welcome to The Cat Site! You have probably come across this website, but if you have not, it can be very helpful.

IBDKitties – Helping Save Lives…One Paw at a Time

You are certainly providing very comprehensive care for your cat, and I don't have much to add that will be of help. To answer your primary question, my Chelsea has intestinal lymphoma and vomiting was never even close to a symptom. We mostly saw weight loss and inappetance. She was put on pred and then chlorambucil without doing the biopsy. She was/is semi feral, although indoor only since about 5 weeks old, but difficult to handle and I did not think that we could manage any follow up to surgery. daftcat75 encouraged me to approach the vet about starting chlorambucil without the prerequisite diagnostic. Some will agree and some won't, but mine did.

Resolving dietary issue can be very key to this condition and I would try to get rid of the kibble. Easier said than done with some cats, so don't think that I am criticizing you about this.

As for not having a supportive vet, is there any other vet available, or even a specialist in internal medicine or a cat only vet? You really should not have to struggle with those results on your own.

 

[daftcat75]

The acute nature of his latest vomiting episode makes me think it was more the food than his IBD to blame.

It sounds like you found a potential trigger with the peas/pea protein. Certainly avoid that anyway because it isn't ideal for cats and it most definitely can be an allergen or irritant.

Get rid of the kibble. It's not a diabetic thing as much as there's just too many inappropriate ingredients to know which one might be upsetting his gut. But here's the other thing. You don't want to keep triggering his IBD. If it gets too difficult to treat with diet alone, the vet is going to want to try steroids which is not recommended for diabetic or pre-diabetic cats. So let's try to stay ahead of the IBD and away from the steroids by avoiding kibble. Use timed feeders to feed him more often or allow him to feed overnight or during the day when you can't plate something for him. You can also leave canned food out for hours if he's a grazer. Cats just won't eat it because it's dried out before you have to worry about spoilage.

Get a baby scale as well, and monitor his weight. Weigh him no more than once a week, preferably same place and time each week. As long as he is maintaining or gaining weight, it's most likely not lymphoma.

Finally, you may want to try Rawz pates. They are clean recipes that truly are limited ingredient (no peas) making them excellent for food trials. If he eats the Rawz rabbit pate without any issues, then you can reasonably assume that it was the peas in the other rabbit formula that didn't agree with him. But I also encourage you to try Rawz in turkey because that's easier to find when Rawz becomes harder to find. They are a smaller company who shares their canning with human food companies. They do have occasional shortages. When you find Rawz flavors that work, stock up. Incredible Pets, one of the Rawz online resellers, sells by the can as well as the case. This makes it easier to test a few flavors without a full case commitment.

RAWZ 96% Rabbit Cat Can

 

[Meowmee]

My Wizard had vomiting as the main symptom of his IBD which turned out to be lymphoma. It can attack any part of the digestive tract and in his case us showed thickening in the small bowel I think. Eventually though it spread lower, dvm could tell from exams at the end. Lymphoma is not survivable so you need to consider his age, what stage he is at and quality of life etc. try to spend as much time with him as possible.

His waxed and wained and he had vomiting episodes as well. He had the other health issues so they could have contributed as well. He had all the usual treatments, steroids, anti nausea, different diets etc. He was tested for other possible causes.


You are doing the right thing with trying a different diet, try no dry and a home cooked or raw diet, but a very slow transition. You also need to keep him inside and only on leash walks now. Has he been tested for parasites and other outdoor possibilities?

US is sometimes not so accurate and it also depends on who is interpreting it. The biopsy would be after that usually. We never did a biopsy because W was older and already fiv pos for many years. He also had longterm issues with sedation and kidney disease/ anemia. We just assumed it was lymphoma and treated for that with chlorambucil and steroids. I tired many diets but they made him worse. I wish I had known about my current home cooked recipe that I do for guys now for their touchy tums. I think maybe Wizard could have tolerated that. Knowwhatyoufeed.com is where I found the recipe and buy the supplements to add.

Hugs to you and Solgy It’s a hard decision to make about the various treatments.

 

[daftcat75]

I think it's a bit of a stretch to say that lymphoma is not survivable. Large cell lymphoma, something that presents as a mass rather than diffuse thickening, has a poor prognosis. Small cell lymphoma, assuming you find the dietary triggers and eliminate them, can have a much better prognosis. I had at least 7 good months with Krista with steroids and chemo. I should have had more. But I didn't find and eliminate *all* her triggers until she had lost too much weight to stage a comeback. I do take solace that her last month was spent in remission. It was an unrelated bladder infection that proved too much for her after having her immune system suppressed for so long by steroids and chemo. fionasmom has a cat that's been on chemo for longer and is still with her.

 

[myboysolgy]

Thank you SO much everyone for your super helpful replies and input, and for sharing your experiences. It's been invaluable. I feel like I've made some progress today, at least in my mind, whereas before I felt dizzy from confusion and stress.

It looks to me like the vomiting episodes for my cat are actually due to pancreatitis flares. His ultrasound report did show an enlarged pancreas but the vet did not pick up on this as an explanation of his most worrying symptoms. But I managed to speak to them today and he is going in for a GI panel in 2 days so that we can confirm this, and also see if he needs any supplements.

This doesn't solve his intestinal inflammation, which is still due to IBD or lymphoma. I've been thinking about it more and I still feel uncomfortable with the biopsy option, and this view was perhaps strengthened even further when I learned that one of the treatment options for chemo (chlorambucil) also treats severe IBD. So I am going to ask the vet what the actual difference in treatment approach would be if we did get a definitive diagnosis either way through a biopsy. My cat cannot go on steroids like prednisone because of diabetes.

As I see it now I have maybe 2 options. 1) hope it's IBD and try to treat it with diet and maybe probiotics, then repeat the ultrasound in 6 months time and see if there has been improvement. or 2) start him on Chlorambucil. If I felt I had time I would try option 1 and then depending on the ultrasound results move onto option 2), but I am worried that if he DOES have lymphoma I would have wasted 6 months and potentially made things worse. Very difficult to know what to do. With regard to his vomiting episodes, if it is indeed due to pancreatitis it sounds like there is no treatment other than management of the symptoms when flare ups occur. I am going to prep for being able to give him fluids at home, and make sure I have pain meds and anti nausea meds on hand.

With regards to his diet, I totally agree with those who suggested cutting out kibble for good ( fionasmom daftcat75 )and I am going to hold my ground when he begs. So thank you for the encouragement. I have know this all along of course but give in cause I feel liek it's better than him not eating. But the zero carb kibble for diabetics has a lot of guar gum in it, and that was always a concern of mine.

I have been on the hunt for a good rabbit pate (he seems to like rabbit and will ONLY eat pate, nothing with chunks in) and since the Instinct one has peas in I came across the brand KOHA and have been waiting for them to be back in stock. They have been having a supply issue and have been out of stock for months. Although becoming reliant on a brand with unreliable stock is not great when you have kitties with medical problems. So a HUGE thank you to daftcat75 for your recommendation to try RAWZ. How have I never come across this before in all my research?? I immediately called a few local independent pet stores to see if they carried it and found one close by that did, so rushed out to get some rabbit pate and my cat really likes it!! Ohh fingers crossed he doesn't get fussy as he sometimes does after the initial interest but I am so grateful to you for this.

Once again thank you to ALL who have helped. You are amazing. I'm so glad I posted this question here.

 

[myboysolgy]

PS not that important really but how do I change the yellow badge from kitten to mature? I have clicked all over and can't find how.

 

[Meowmee]

PS not that important really but how do I change the yellow badge from kitten to mature? I have clicked all over and can't find how.

That changes according to the number of posts you do, I have forgotten what numbers get you to the next level.

 

[Meowmee]

Thank you SO much everyone for your super helpful replies and input, and for sharing your experiences. It's been invaluable. I feel like I've made some progress today, at least in my mind, whereas before I felt dizzy from confusion and stress.

It looks to me like the vomiting episodes for my cat are actually due to pancreatitis flares. His ultrasound report did show an enlarged pancreas but the vet did not pick up on this as an explanation of his most worrying symptoms. But I managed to speak to them today and he is going in for a GI panel in 2 days so that we can confirm this, and also see if he needs any supplements.

This doesn't solve his intestinal inflammation, which is still due to IBD or lymphoma. I've been thinking about it more and I still feel uncomfortable with the biopsy option, and this view was perhaps strengthened even further when I learned that one of the treatment options for chemo (chlorambucil) also treats severe IBD. So I am going to ask the vet what the actual difference in treatment approach would be if we did get a definitive diagnosis either way through a biopsy. My cat cannot go on steroids like prednisone because of diabetes.

As I see it now I have maybe 2 options. 1) hope it's IBD and try to treat it with diet and maybe probiotics, then repeat the ultrasound in 6 months time and see if there has been improvement. or 2) start him on Chlorambucil. If I felt I had time I would try option 1 and then depending on the ultrasound results move onto option 2), but I am worried that if he DOES have lymphoma I would have wasted 6 months and potentially made things worse. Very difficult to know what to do. With regard to his vomiting episodes, if it is indeed due to pancreatitis it sounds like there is no treatment other than management of the symptoms when flare ups occur. I am going to prep for being able to give him fluids at home, and make sure I have pain meds and anti nausea meds on hand.

With regards to his diet, I totally agree with those who suggested cutting out kibble for good ( fionasmom daftcat75 )and I am going to hold my ground when he begs. So thank you for the encouragement. I have know this all along of course but give in cause I feel liek it's better than him not eating. But the zero carb kibble for diabetics has a lot of guar gum in it, and that was always a concern of mine.

I have been on the hunt for a good rabbit pate (he seems to like rabbit and will ONLY eat pate, nothing with chunks in) and since the Instinct one has peas in I came across the brand KOHA and have been waiting for them to be back in stock. They have been having a supply issue and have been out of stock for months. Although becoming reliant on a brand with unreliable stock is not great when you have kitties with medical problems. So a HUGE thank you to daftcat75 for your recommendation to try RAWZ. How have I never come across this before in all my research?? I immediately called a few local independent pet stores to see if they carried it and found one close by that did, so rushed out to get some rabbit pate and my cat really likes it!! Ohh fingers crossed he doesn't get fussy as he sometimes does after the initial interest but I am so grateful to you for this.

Once again thank you to ALL who have helped. You are amazing. I'm so glad I posted this question here.

What I said about the survivability of lymphoma is based on, does the kitty survive to the point of being considered cured- such as people are often considered cured at 5 years without relapse with many cancers, and also on reading over the years and asking various dvm etc. I was referring to intestinal lymphoma.

Our Dvm treated as for small cell. Even with small cell intestinal lymphoma, statistics I have been able to find indicate anywhere from 75%, and sometimes higher depending on the study or institution if it is a general article, of scl cats treated with steroids and chlorambucil go into remission, sometimes defined as a “full remission” which is defined as completely asymptomatic, but a large number of those, I think pretty much all, have a relapse and the average survival is about 4-6 months in those cases.

I suspect it is a very rare cat that survives totally, and a rare cat that even makes it to the 17 month median or 2-4 year survival rate sometimes mentioned. I can’t find a study that lists how many cats make or have made it that far or have completely recovered with no relapse and without continued treatment, with no relapse maybe with continued treatment or with a relapse and treatment.

The large cell versions, there are two I have read about, are much more aggressive and even with steroid and various other chemo drug combo treatments do much worse with or without any remission and have a much lower rate of remission. They are usually treated with a combo of a 2-3 different inj chemo drugs and a steroid.
Wizard survived about 4-5 months from the time of treatment with chlorambucil, I would not say he ever had a full remission but he had a big improvement intially with the treatment when he started it. Maybe it was a mini remission where his symptoms such as the vomiting stopped, his appetite improved and he gained some weight and felt a lot better.

 

[daftcat75]

A couple of things. Ask your vet about budesonide. It is considered a more locally acting steroid that doesn’t have the same systemic risks like pred. If you get his symptoms under control with diet, you may not need steroids. If it is lymphoma, it likely won’t take six months for that to become apparent. Even if you don’t monitor his weight, the weight loss from lymphoma is dramatic and relentless. You won’t see improvement from diet alone like IBD. Krista’s weight loss stopped when we started chemo. However I kept wrapping her nightly pred pill in a trigger food—fish flakes—in a misguided attempt to get her to pill herself every night. It worked. But it kept the inflammation fire smoldering in her gut. It wasn’t until I switched her to transdermal and removed the fish flakes that she finally achieved remission. My point is your strategy of trying to manage it like IBD and adding chemo if that doesn’t work is a sound strategy. Discuss this with your vet. But I believe a baby scale and Rawz is a great place to start. Possibly budesonide if diet alone isn’t helping. And possibly adding chlorambucil if weight loss continues or accelerates. Don’t forget B-12 shots. These are very helpful and necessary whether it is IBD or lymphoma. Anti nausea and appetite stimulant drugs can be helpful for getting though pancreatitis flare ups.

 

[Catmom1234567890]

join facebook group called feline lymphoma support group. Wealth of information over there.

 

[Catmom1234567890]

A couple of things. Ask your vet about budesonide. It is considered a more locally acting steroid that doesn’t have the same systemic risks like pred. If you get his symptoms under control with diet, you may not need steroids. If it is lymphoma, it likely won’t take six months for that to become apparent. Even if you don’t monitor his weight, the weight loss from lymphoma is dramatic and relentless. You won’t see improvement from diet alone like IBD. Krista’s weight loss stopped when we started chemo. However I kept wrapping her nightly pred pill in a trigger food—fish flakes—in a misguided attempt to get her to pill herself every night. It worked. But it kept the inflammation fire smoldering in her gut. It wasn’t until I switched her to transdermal and removed the fish flakes that she finally achieved remission. My point is your strategy of trying to manage it like IBD and adding chemo if that doesn’t work is a sound strategy. Discuss this with your vet. But I believe a baby scale and Rawz is a great place to start. Possibly budesonide if diet alone isn’t helping. And possibly adding chlorambucil if weight loss continues or accelerates. Don’t forget B-12 shots. These are very helpful and necessary whether it is IBD or lymphoma. Anti nausea and appetite stimulant drugs can be helpful for getting though pancreatitis flare ups.

I'm saying goodbye to Hills ZD, I tried for a month and despite slowly transitioning, she had explosive diarrhea from it. She's usually constipated due to impaired GI motility. I'm going to try RawZ Duck. My vet is against probiotic except FortiFlora. There is a probiotic highly recommended by many IBD parents called Visbiome and Healthy Gut. Has anyone tried these supplements? I would like to transition to homemade raw with completer eventually.

 

[myboysolgy]

That changes according to the number of posts you do, I have forgotten what numbers get you to the next level.

Ohhh I see haha, I thought it was to show how old the cat you had was!

 

[myboysolgy]

I'm saying goodbye to Hills ZD, I tried for a month and despite slowly transitioning, she had explosive diarrhea from it. She's usually constipated due to impaired GI motility. I'm going to try RawZ Duck. My vet is against probiotic except FortiFlora. There is a probiotic highly recommended by many IBD parents called Visbiome and Healthy Gut. Has anyone tried these supplements? I would like to transition to homemade raw with completer eventually.

Oh god, Hills ZD was the worst for my cat. Explosive diarrhea too. I've never seen my cat run to his litterbox so fast. Poor little guy. He also started scooting on the carpet and his bum was a bit inflammed from it. He never scoots. He must have been so uncomfortable. I only gave it to him for maybe 3 days. (I have since read lots of comments from other cat owners reporting the same thing with ZD). I currently have him on RAWZ rabbit since daftcat75 recommendation and he is loving it. I know I started this thread with suspected IBD/Lymphoma but it seem his cyclic vomiting episodes are actually more likely due to pancreatitis (IBD/lymphoma still a concern but an additional one!). His blood panel showed low B12 and since he got his first shot his appetite has been amazing! He's completely off kibble now and is loving the wet food. Fingers crossed he doesn't go off it again like he has with other foods cause I just ordered a case. With regard to probiotic I still have much research to do, I asked my vet but she didn't seem to think it necessary. I have read a lot a bout how s. boulardii supplements are very effective in gut healing though (the brand often recommended is the Jarrow one) so I have started him on those (had to take a break because of his flare). If you need more pointers about this let me know.

 

[myboysolgy]

A couple of things. Ask your vet about budesonide. It is considered a more locally acting steroid that doesn’t have the same systemic risks like pred. If you get his symptoms under control with diet, you may not need steroids. If it is lymphoma, it likely won’t take six months for that to become apparent. Even if you don’t monitor his weight, the weight loss from lymphoma is dramatic and relentless. You won’t see improvement from diet alone like IBD. Krista’s weight loss stopped when we started chemo. However I kept wrapping her nightly pred pill in a trigger food—fish flakes—in a misguided attempt to get her to pill herself every night. It worked. But it kept the inflammation fire smoldering in her gut. It wasn’t until I switched her to transdermal and removed the fish flakes that she finally achieved remission. My point is your strategy of trying to manage it like IBD and adding chemo if that doesn’t work is a sound strategy. Discuss this with your vet. But I believe a baby scale and Rawz is a great place to start. Possibly budesonide if diet alone isn’t helping. And possibly adding chlorambucil if weight loss continues or accelerates. Don’t forget B-12 shots. These are very helpful and necessary whether it is IBD or lymphoma. Anti nausea and appetite stimulant drugs can be helpful for getting though pancreatitis flare ups.

Thank you so much again for more useful info! His last flare up subsided and he is doing really well right now, with great appetite following a B12 injection. He had a blood panel which showed low B12 and high numbers for his pancreas (5.6. Normal is less than 3.5 but high would be around 10 so it's not crazy high but still higher than normal). I'm reassured to think you think my strategy to manage it like IBD and keep a close eye on things is a sound one. My vet was still pushing for a biopsy today but I'm not convinced yet. She seems to think we can repeat an ultrasound in 2 months so I would rather do that and then decide whether to biopsy, esp since he wasn't been losing any weight. He's 16lb and even during his bad flare last week where he vomited for 3 days, his weight is still the same. I have an appointment with a different vet (Cat specialist) in a couple of weeks so will ask for a second opinion. One of my concerns is that the biopsy isn't going to give a guaranteed result. Whilst false positives (for lymphoma) would be rare it sounds like false negatives can easily occur. It's a lot to put him through for a maybe result. Anyway, I will ask the other vet whether waiting for a couple of months would be risky. I have a biopsy appointment booked in early Dec just in case we do decide to go ahead with it, but I booked it assuming I would most likely cancel.

 

[daftcat75]

I don’t know if the biopsy gives false negatives like the endoscopy or colonoscopy can—the latter two having limitations in both reach and depth of sampling. Biopsy on the other hand is guided by an ultrasound so they know where to take a “hot” sample and see which it really is under the microscope. They can also take a full thickness sample instead of just a layer or two like the other methods. And it’s this full thickness sample that can also make it harder to recover than a -scope sample or a needle aspirate.

My concern with the biopsy is that, besides how hard it can be on a cat, is that a negative for lymphoma today doesn’t preclude him from developing lymphoma down the road. Does the vet expect to re-do the biopsy the next time things go south? I promise you won’t miss the weight loss associated with lymphoma. In the meantime, the IBD management and mitigation strategies—eliminating dry food, food trials, simple recipes in a novel protein, etc and steroids if necessary—are not wasted on lymphoma. If you treat this like IBD and that isn’t enough or things do take a worse turn, you’ll have at least tried a plan A making it much easier to suggest a plan B—adding the chemo drug. The difference between the two treatments is not so much a plan A or plan B as much as a plan A plus plan B. You can empirically deduce when plan A isn’t enough only after you have given it an honest effort.

Thanks for the update. That sounds mostly good. The elevated pancreas number isn’t high but high enough that he can’t be feeling great anyway. Hopefully you have anti-nausea and appetite stimulant drugs on hand to get him through any rough patches. I love a lyric in a new Kacey Musgraves song: “Healing doesn’t happen in a straight line.” It sounds like you’re on the right path though.

 

[myboysolgy]

I don’t know if the biopsy gives false negatives like the endoscopy or colonoscopy can—the latter two having limitations in both reach and depth of sampling. Biopsy on the other hand is guided by an ultrasound so they know where to take a “hot” sample and see which it really is under the microscope. They can also take a full thickness sample instead of just a layer or two like the other methods. And it’s this full thickness sample that can also make it harder to recover than a -scope sample or a needle aspirate.

My concern with the biopsy is that, besides how hard it can be on a cat, is that a negative for lymphoma today doesn’t preclude him from developing lymphoma down the road. Does the vet expect to re-do the biopsy the next time things go south? I promise you won’t miss the weight loss associated with lymphoma. In the meantime, the IBD management and mitigation strategies—eliminating dry food, food trials, simple recipes in a novel protein, etc and steroids if necessary—are not wasted on lymphoma. If you treat this like IBD and that isn’t enough or things do take a worse turn, you’ll have at least tried a plan A making it much easier to suggest a plan B—adding the chemo drug. The difference between the two treatments is not so much a plan A or plan B as much as a plan A plus plan B. You can empirically deduce when plan A isn’t enough only after you have given it an honest effort.

Thanks for the update. That sounds mostly good. The elevated pancreas number isn’t high but high enough that he can’t be feeling great anyway. Hopefully you have anti-nausea and appetite stimulant drugs on hand to get him through any rough patches. I love a lyric in a new Kacey Musgraves song: “Healing doesn’t happen in a straight line.” It sounds like you’re on the right path though.

Thank you once again for your reply. You've been so helpful and supportive and I truly appreciate it.

I think the biopsy we are looking at is the endoscopy one, as far as I understood they wouldn't be able to take a full thickness sample. I might be wrong, but I didn't think we were looking at the surgical (cutting open) option.

You make a very good point re the potential for developing lymphoma at a later time. Since all these conditions seem to be linked it doesn't seem like we can say that that is unlikely. I did ask what would change if the biopsy shows lymphoma, and the answer seems to be to add the chemo drug, which she wouldn't generally do for patients with IBD, although the internist who did the ultrasound did add in the report that preemptive chemo was an option. Thanks to you plan A is very much into effect, he is now on the RAWZ pate only and absolutely no kibble, which is a big change as it's the first time he's not on kibble in his life. I have also added CBD to his regimen to hopefully help with inflammation. It's worth a try.

Yes I feel a bit more relieved now that the GI panel has come back and has confirmed he has problems with his pancreas but that it is not too bad. And yes I have the full arsenal ready to combat the next flare if and when it happens. Anti nausea, pain killer, appetite stimulant, antacid, sucralfate, and also subQ fluids, which I gave him last week when he kept vomiting and he sat there and put up with it, he's such a good boy. I still feel very nervous and anytime I hear anything that sounds like vomiting I tense up, but touch wood he has been absolutely fine since Friday so it's been 4 days since he vomited. Oh and I'll be getting the B12 to do at home too.

Love the lyric, it's very true, and I hope I am on the right path, and you've definitely helped me get on it, so thank you again <3 I hope I can reach out again if I need some more help in the near future.