Ibd/pancreatitis, Possibly Lymphoma...

[kg84]

My 11yo cat has been vomiting persistently and losing weight over the last few months. She has lost 3lbs over the span of about 8 weeks, she is currently down to 10lbs. She's a large cat so she looks like skin and bones at 10lbs.

She recently had an abdominal ultrasound which showed inflammation of the intestines and pancreas, as well as enlarged lymph nodes and enlarged adrenal gland. Right now she is labeled with a diagnosis of IBD and Pancreatitis, but the next step would be a biopsy to either confirm or rule out GI Lymphoma. She had a CBC taken prior to the ultrasound that came back normal... originally we were looking at potential for thyroid issue or diabetes. When blood counts came back all normal we proceeded to the abdominal ultrasound for clues.

I now have to decide how to proceed. I am overwhelmed and honestly, devastated. She is only 11 years old and I really thought I'd have a lot more time with her before something of this magnitude came up.

I spoke with my regular vet when discussing the ultrasound results, but she is not a surgeon, so the surgeon is going to call me tomorrow to discuss more. I was told by my vet that she would need an exploratory surgery to take the needed biopsies, because she has so much inflammation in multiple places and it would be too difficult to biopsy all of those locations via laparoscopy. She said that in my case endoscopy/colonoscopy method is not recommended (she mentioned a "full thickness" biopsy is best? And that these wouldnt reach the lymph nodes). Anyway... The surgery sounds pretty invasive and while I won't totally rule it out until I talk to the surgeon tomorrow, I honestly can't imagine putting her through that. It sounds like she would having her entire abdomen opened up and that sounds painful and like a lot of recovery would be needed.

She has been taking Cerenia for the last 2 weeks while we get all of this sorted out, and it has completely stopped her vomiting. She never has had any problem with her appetite, she can eat constantly... The issue is no matter what she eats, it doesn't seem to put weight on her. I had attributed that to her vomiting, but I haven't noticed any real change in her shape since starting the Cerenia even though the vomiting has stopped. The vet explained that the inflammation in her intestines may be preventing her from absorbing the nutrients from her food.

I have the option to start prednisone to try to get the inflammation under control, but I was told that if we chose the prednisone it may interfere with the effectiveness of chemo, if she were to have lymphoma and we were choosing to treat it.

I guess I'd like to hear from anyone else who has been in my shoes. What I want most for her is quality of life. Right now on the Cerenia she's acting completely normal, now that the vomiting has stopped, but she's very underweight and I am scared she will die of malnutrition even though she is eating.

I'm having a hard time justifying the idea of putting her through a surgery that will cause her a lot of pain when she is already weak. I'm also selfishly worried about the costs. And then I instantly get angry at myself for making a decision to potentially shorten her life over money, or fear of a procedure that she could heal from. Even if she did have lymphoma, I don't know what the outcomes are if treated... We might not even treat it if it wouldn't make a big difference in her lifespan.

The vet did say I could put her on an I-D diet, but that would be up to me. She is one of five cats in the house, and they are all free feeding together, I am not even sure how I'd split up their food without having to keep them physically separated all of the time and I don't want to do that to them. They are all friendly with each other. So then I looked at switching them all over to that diet and then realized there would be no way I could afford it for all five of them. Then I feel guilty about the money thing again.

Thanks for listening, I'd love to hear anyone's thoughts.

 

[mrsgreenjeens]

Well, I'm not really the one who can advise you, as I've never had a cat with IBD. But there are many people here who have cats with IBD, AND many others who have or have had cats with Lymphoma. One thing I can tell you, though, is that a cat with IBD should probably not be eating dry food. Food is one of the key issues with IBD, so you may need to switch at least HER to a different food. It doesn't necessarily have to be a prescription food, but should probably at least be a wet food without a grains or carbs or gums. Usually a limited ingredient food is best. And all I recall about the Pred is that you don't want to start it up before an Ultrasound or biopsy because it can sque (sp?) the results. But I honestly thought Pred was part of the treatment. I know it is for IBD, and believe it is for small cell Lymphoma, and possibly for large call Lymphoma also.

Hopefully some others who've been in your shoes will see your thread and pipe in. If not, use your Vet(s) as a resource, and we can always consider featuring your thread on our home page to get more "air time"

 

[babiesmom5]

Well, I have been down this IBD/Pancreatitis/Lymphoma path now with 5 cats, so can truly empathize. For what it is worth, I will give you my opinions.

The ultrasound was a good first step. So much inflammation in multiple places is problematic. Also worrisome is enlarged lymph nodes, often a sign of lymphoma.

An ultrasound cannot distinguish between IBD and Lymphoma. That takes a biopsy. A "full thickness biopsy" is where they open the cat up surgically and take samples of the mucosal lining in various places where the inflammation is present. Yes, it is invasive, BUT, is the most accurate way of distinguishing between IBD and Lymphoma. This is because it is sometimes hard to differentiate between cancerous and non cancerous cells on the mucosal level alone. Analyzing the cells on the sub-mucosal level tells the tale.

The other way to do a biopsy is endoscopically. The cat is anesthetized and a lighted scope goes down the esophagus into the stomach to beginning of the small intestine taking pictures and cell samples. They can also go up the other end taking pictures/samples of the colon. Results are sent off to a lab and you have results in a week. Cat recovers quickly and goes home next day. An experienced Internal Medicine Vet can often tell the likelihood of Lymphoma vs IBD just by what he/she sees while doing this procedure.

If your cat is already in a weakened state, and your vet can best determine that, I would opt for the endoscopic biopsy if the Vet is experienced. All my cats have been done this way and results were accurate. With one cat like yours with inflammation in multiple places, he had both the endoscopy and colonoscopy done during one (longer) procedure. He recovered very well, came home next day.

Cerenia is a good anti-nausea medication, but it is a "band-aid" and only covers up the problem...being the inflammation and pancreatitis. Yes, the inflammation/thickening in the intestines prevents absorption of nutrients. This is why cat will not put on weight. The cat WILL put on weight once the inflammation subsides. This usually requires a fairly high dose of Prednisolone at first, tapered down to lowest dose to control inflammation in the long term whether it is IBD or Lymphoma.

You don't want to start the Prednisolone until AFTER the biopsy. This is because the Pred will mask any lymphoma making a biopsy at a later point much more difficult. I recommend getting a positive diagnosis so that you know what you are dealing with and can begin the most appropriate treatment.

If it is Lymphoma, there are two types; Large Cell Lymphoma (more aggressive) or more often, Small Cell Lymphoma. SCL is VERY treatable. Statistically 70% of cats respond to treatment putting them into remission and their life expectancy is often 2 years or more. They can and DO live a good quality of life.

With SCL, the standard treatment protocol is the chemo Chlorambucil (Leukeran) which is a pill you give them at home several times a week, PLUS Prednisolone. They tolerate this very well and usually improve and go into remission quickly.

So whether it is IBD or Lymphoma, with proper treatment, your cat can have a good quality of life. This is manageable and there is hope!

I trust this has been helpful and I wish you and your cat all the best going forward!

 

[alzycat]

My wonderful Yoshi, also 11 years old, was just diagnosed with small cell GI lymphoma tonight, so I understand your pain. The vet said that IBD is a possibility, but she is also having issues with her kidneys, indicating that it is a spreading cancer and not IBD. I'm deciding to opt out of chemo; because it is affecting her kidneys, my vet believes it won't have a great effect on the cancer anyway. I also, like most, can't afford it, and I don't want to put her through all that extra stress. She is at the vet overnight on fluids, but tomorrow morning they're going to start her on Prednisolone. I hope this extends her life a bit, I'm not ready to say goodbye yet

I unfortunately don't have a lot of answers for you since I'm just beginning this devastating journey myself, but if you ever need someone to talk to or just want to share experiences, I'm always available

 

[PushPurrCatPaws]

Hello, K kg84 , I am so sorry to hear about what you are going through. I've always appreciated B babiesmom5 's input, as she has had a lot of experience with these topics. I know reading about some of the things that she's been through have helped me to process my own experiences.

Did you hear back from the surgeon today, and/or the vet, so that you could find out a bit more information?

I know each case has its own complications and things to consider, so, although I was in a similar situation as you 3-4 years ago with my last cat, the problems and choices are different for everyone. And I just want to emphasize that even though it's impossible to not feel guilty, we all of us try to do the best for our kitties and whatever you decide to do needs to be something you yourself are comfortable with and can handle, emotionally and financially. Hang in there! The right decision for you will arrive when you get enough information to make a good decision.

Did the vet or surgeon mention doing any types of biopsies via a needle, like fine needle aspiration biopsies or core needle biopsies? With our cat, we did some biopsies along that route, especially of and near her pancreatic ducts, as she had a ton of what the radiologist deemed "sludge" near her left pancreatic duct. We wanted to test that substance to see what was going on. It led us to using some pretty intense antibiotics to try to help what was going on. We also had a choice of doing a full thickness biopsy but, like you, really did not want to put our cat or ourselves through that procedure.

In any case, maybe after today and with your having spoken with the surgeon (or vet again), you can decide whether you want to treat any possible cancer or move more towards treating just the symptoms and getting the inflammation down. With the anti-nausea med seeming to be working, maybe you could also think about that option your vet gave you to start prednisolone to decrease the inflammation... perhaps if that inflammation is decreased she could get more substantive nutrition from her food. With our cat, we were unable to use pred because she also was diabetic... and pred increases the blood glucose. It would have really made handling her diabetes a nightmare. The thing is, the pancreas is tied into insulin production, and honestly, each case can be complicated when you are trying to decide what to do... prednisolone can both help and hinder things, depending on what you are trying to accomplish to make the cat feel better. It takes some close discussions with your vet, surgeon, radiologist, etc., to decide what to do. My heart goes out to you!


Best wishes to you, and thinking about you and your dear kitty. I totally hear you when you say, "What I want most for her is quality of life."

 

[PushPurrCatPaws]

Thinking of you and your cat, K kg84