IBD with possible small cell lymphoma

[bentley2013]

I got the chlorambucil but didn't start it yet, my husband thinks I should wait until we have a definitive diagnosis next week. The vet wants to use pulse therapy where a larger dose is give on day one and then another dose in a week. I see that this isn't the normal protocol used, usually smaller doses given more frequently to start and then every 3 weeks or something. Anyone else doing pulse therapy? Also this vet had him on 10 mg of prednilisone two times per day and I lowered it to 5 mg when people on this forum thought that was outrageous. Maybe this vet is too aggressive so I'm concerned about he pulse therapy protocol. Is there a thread on this site that addresses chlorambucil therapy?

Good news, Bentley pooped again, normal consistency, quite large amount no straining. He did this right after I'd given him his sub Q fluids. I would have not given them if he had just pooped 5 min. earlier. Poor guy, he's such a good boy and he loves his momma. He's sound asleep on my lap right now and I'm feeling hopeful for the first time in a week.

 

[dan32]

You can try the search bar up on top for things like "IBD", "chlorambucil", "small cell", or "lymphoma".  I have been doing this nightly for weeks now getting my night time veterinary degree

  From what I have read, it is often hard to get a definitive culture from a needle biopsy or endoscopy - they really like to get a intestinal slice from a surgery (ugh) and the pred usage sort of destroys the audit trail, if you know what I mean.  That is what they told me, at least.

Probably the biggest miracle is after all the worrying, they are still there.

Why is he getting all of the sub-Q fluids?  You seem to have all of the equipment to give it at home, as if you are prepared.  Does he have CKD as well?  I have at points had CKD kitties, but you can't really stockpile Ringer's for any length of time.

 

[bentley2013]

My vet suggested the sub Q due to his constipation. He received sub Q last week three days in a row when he was not eating well and constipated. The last time they suggested that I take the bag home and give him fluids 3x per week. His kidney values were on the high side of normal too. How long can I use the bag of fluid? I flush the line and use a new needle each time. I'm only down to the 3ml line on the bag and I've had it for 5 days. Does it go bad?

 

[dan32]

As someone who has my own problems with the d--- word, the extra hydration is probably great because you can become very weak quite fast.  I think I was giving my CKD kitty anywhere from 100ml to 150ml 2 or 3 times weekly.  Sometimes, if I remember I decided to give only 50ml more often.  I think a bag contains 1000ml, so you could get 10 times out of it.  I would put the whole bag and line set in the vegetable drawer of the refrigerator, then warm the whole thing up in a kettle of warm water before giving it - testing it on my wrist like a baby's bottle first.  My vet would give me as many needles as I wanted for free, but charge for the line set.  I always stocked up on needles and only changed the line set when I got a new bag.  There are various needle widths as well and the extra fine ones were the ones I eventually liked to use, although it took longer to drip out - they were an easier stick.

You can kind of see how fast they absorb the liquid visually, so not to give too much.  If they start to get barrel chested, there can be a danger of water accumulating in the lungs so ease up.  The kidneys can only eliminate but so much at a time.  Ringer's does give them a lift with the electrolytes, but I have only given it for very ill kitties.  My Kinney had one Ringer's drip when he was in the ER a month ago and it perked him up, but he hasn't had any more since then.

 

[donnajean]

One thing I have noticed is that you have been giving him some red meat like venison and you mentioned steak, I don't know if it was beef or venison.  Some cats have problems with red meat.  I know Patches can't tolerate beef, I've never tried venison because of his intolerance of beef.

I know the RAD cat is chicken or turkey but if you were also feeding some red meat that could have been causing problems.  I know you said that he really likes it, Patches ate the beef well also but it didn't agree with him.

Yes, Beef is actually on the list of Allergens for some cats...Beef,  chicken, Fish, dairy, eggs, grains...

From what I have been reading you should start with one single Protein source, the source should be one that your cat has not tried before (rabbit, lamb, etc)

I did not start with a protein source he never had but I have eliminated all grains, he is on a Limited ingredient food , Nature's Variety Instinct, Turkey.

I believe they have it in the LID in Rabbit, Lamb also..

Some vets theories are that IBD in animals starts from Allergens. So far my cat has tolerated the Turkey meal in NVI LID and I also sprinkle some Freeze dried Pure bites treats (Chicken or turkey) over some of his food.

 

[jcat]

I've been emailing with Lisa from the ibdkitties website, is that who you are referring to?

No, LDG's name is Laurie. If you go to one of her posts, for example in this thread: A milestone Gotcha Day for Lazlo!, you can run your mouse over the little triangle next to her user name and choose "Send PM".

This is where she writes of Lazlo's lymphoma diagnosis.

 

[ldg]

LDG (Laurie) here.

First of all, I'm so sorry about everything you and your kitty are going through.

Lazlo didn't have T-cell lymphoma, and his chemo protocol did not include chlorambucil - that is Leukeran, and it's for small cell. So clearly the vet is expecting a diagnosis of small cell (though I see it may be used to treat B-cell lymphoma. I really don't know anything about the various types of lymphoma beyond the breakdown of large cell and small cell).

If I understood correctly, your cat is under the care of a specialist? And it was the specialist that recommended 10mg of pred 2x a day? Either way, that does sound high for a 12.5 pound cat, but have you discussed lowering the dose with whatever vet prescribed this? There may be a reason for it. There are differences between an anti-inflammatory dose (5mg a day) and an immune-suppressive dose (10mg) a day. 20mg? Clearly immune-suppressive. Maybe "too much?" But without asking, you won't know.

I know you independently lowered the dose, but I would definitely at least ask the vet if the 10mg 2x a day was the intended dose, or if the instructions were printed wrong? You don't need to come off as sounding like you're second guessing by simply saying that you're getting support from other cat parents whose cats had cancer, and everyone commended that the dose seemed high, so you just wanted to understand the difference between a more standard 5mg or 5mg 2x a day vs. the dose recommended to you. :nod:

OK - found an article discussing steroid uses in cats on the DVM360 website. The higher dose could be because the drug is prednisone, not prednisolone: (I know prednisolone is still difficult to get here). http://veterinarymedicine.dvm360.com/vetmed/article/articleDetail.jsp?id=656964&sk=&date=&pageID=2

In cats, the absorption and conversion of prednisone to prednisolone is less efficient, and after the oral administration of prednisone, only about 21% of the drug occurs in the bloodstream as the active form prednisolone. (4) For this reason, prednisone and prednisolone should not be considered bioequivalent in cats, and the active form, prednisolone, should be used preferentially.

...These dose ranges have not been verified scientifically in cats, but it is anecdotally noted that cats often require higher glucocorticoid doses than dogs do in order to achieve equivalent effects. This is supported by a study that showed cats had fewer numbers of glucocorticoid receptors than dogs in the organs that were evaluated (liver and skin). (8) The binding affinity of the feline glucocorticoid receptor also was shown to be less than that of the dog. (8) Consequently, many authors suggest that glucocorticoid doses in cats be doubled to achieve equivalent effects, resulting in anti-inflammatory and immunosuppressive dose ranges of prednisolone extending to 2.2 mg/kg/day and 8.8 mg/kg/day, respectively. (7,9,10) Doses for other glucocorticoids should be adjusted based on the relative potencies shown in Table 1 with the exception of triamcinolone, whose potency may be closer to that of dexamethasone, as noted above.

So 12.5 pounds is 5.7kg. Based on this information, the anti-inflammatory dose of prednisolone is about 12.5mg per day, and the immunosuppressive dose is 50mg.

And if using pred, the active prednisolone reaching the blood stream is just 21%.

So.... :dk:

I really wouldn't alter medication based on online advice. I'd chat to the vet.

Many for you and your boy!

OH! FYI, if he has issues with nausea, many, many people have found Cerenia to help. For Lazlo, his eating issues were better resolved with an anti-nausea med (cerenia) rather than an appetite stimulant. The mirtazipine worked well for him. But it does have adverse side-effects in a number of cats. There is an alternative appetite stimulant, cyproheptadine. This has to be given 2x a day rather than once every three days. You can talk to the vet to see if having them compounded into a topical is a possibility. :rub:

 

[donnajean]

Thank you donnajean: I have the Natures Instinct chicken (raw boost), what is LID? I'm not sure what you are referring to. I have some marshmallow root and some slippery elm in capsules. I can put a small quantity in a #4 gel cap and give it to him if I have to but it takes two of us to give him his flagyl every 12 hours. I don't think it would be any easier to squirt it in as a liquid either. Does it taste bad?

Now I find out that the flagyl can also be compounded into a transdermal gel to put in the ear like I'm doing with the prednilisone. I paid 46.00 for the compounded capsules. I'm going to be sure and ask every time a med. is prescribed about the transdermal availability . It is fantastic.

Bentley really gravitates toward food with fish in it whether its canned or dried now. When was feeding him rad cat chicken, he also had Before Grain chicken dry available all he time. I've tried rabbit, duck, beef, turkey and he doesn't like it. I do remember that he liked the sample of the dry duck and green pea but I think it had grains?

What I purchased was Nature's Variety Instinct Limited ingredient diet...The Dry comes in Turkey, Rabbit or Lamb I think. The cans are the same, limited ingredient diet.

I use a 1/2 capsule  slippery elm (solaray brand) put a little water in it and mix it up...Fill up to 1/2 tsp and give it to him in a syringe...the other half I give in late evening..that is just my amount, you can add more water for constipation or less if they have diarrhea.

You can google and look up slippery elm for cats, marshmallow root is another excellent herb basically used for similiar purposes.

Just make sure it isn't given at same time as medications, wait at least 45 min- one hour.

He isn't thrilled with it but he doesn't fight me over it either, no gagging, foaming at mouth, etc.. it doesn't taste bad, smells a little like maple syrup to me.

I use the LID brand because we think Boo also has a allergy to something, it was either a grain or something that is in alot of commercial cat foods. He hasn't been scratching in the past few days so I am hoping I hit on something here with the limited ingredient food.

I just gave him his b12 injection, one more to go then I am going to talk to vet about at least a monthly injection ...I also just ordered Thorne B-Complex Vet for pets figured it couldn't hurt...B12 helps with appetite and  other things..and I read that animals with IBD sometimes develop low B12 and folate levels..

The slippery elm should work for nausea, coats the stomach and helps with constipation and diarrhea... the only thing they warn about is if your cat has high calcium levels it should not be used frequently...

 

[donnajean]

What I purchased was Nature's Variety Instinct Limited ingredient diet...The Dry comes in Turkey, Rabbit or Lamb I think. The cans are the same, limited ingredient diet.

I use a 1/2 capsule  slippery elm (solaray brand) put a little water in it and mix it up...Fill up to 1/2 tsp and give it to him in a syringe...the other half I give in late evening..that is just my amount, you can add more water for constipation or less if they have diarrhea.

You can google and look up slippery elm for cats, marshmallow root is another excellent herb basically used for similiar purposes.

Just make sure it isn't given at same time as medications, wait at least 45 min- one hour.

He isn't thrilled with it but he doesn't fight me over it either, no gagging, foaming at mouth, etc.. it doesn't taste bad, smells a little like maple syrup to me.

I use the LID brand because we think Boo also has a allergy to something, it was either a grain or something that is in alot of commercial cat foods. He hasn't been scratching in the past few days so I am hoping I hit on something here with the limited ingredient food.

I just gave him his b12 injection, one more to go then I am going to talk to vet about at least a monthly injection ...I also just ordered Thorne B-Complex Vet for pets figured it couldn't hurt...B12 helps with appetite and  other things..and I read that animals with IBD sometimes develop low B12 and folate levels..

The slippery elm should work for nausea, coats the stomach and helps with constipation and diarrhea... the only thing they warn about is if your cat has high calcium levels it should not be used frequently...

Thank you donnajean: I have the Natures Instinct chicken (raw boost), what is LID? I'm not sure what you are referring to. I have some marshmallow root and some slippery elm in capsules. I can put a small quantity in a #4 gel cap and give it to him if I have to but it takes two of us to give him his flagyl every 12 hours. I don't think it would be any easier to squirt it in as a liquid either. Does it taste bad?

Now I find out that the flagyl can also be compounded into a transdermal gel to put in the ear like I'm doing with the prednilisone. I paid 46.00 for the compounded capsules. I'm going to be sure and ask every time a med. is prescribed about the transdermal availability . It is fantastic.

Bentley really gravitates toward food with fish in it whether its canned or dried now. When was feeding him rad cat chicken, he also had Before Grain chicken dry available all he time. I've tried rabbit, duck, beef, turkey and he doesn't like it. I do remember that he liked the sample of the dry duck and green pea but I think it had grains?

What I purchased was Nature's Variety Instinct Limited ingredient diet...The Dry comes in Turkey, Rabbit or Lamb I think. The cans are the same, limited ingredient diet.

I use a 1/2 capsule  slippery elm (solaray brand) put a little water in it and mix it up...Fill up to 1/2 tsp and give it to him in a syringe...the other half I give in late evening..that is just my amount, you can add more water for constipation or less if they have diarrhea.

You can google and look up slippery elm for cats, marshmallow root is another excellent herb basically used for similiar purposes.

Just make sure it isn't given at same time as medications, wait at least 45 min- one hour.

He isn't thrilled with it but he doesn't fight me over it either, no gagging, foaming at mouth, etc.. it doesn't taste bad, smells a little like maple syrup to me.

I use the LID brand because we think Boo also has a allergy to something, it was either a grain or something that is in alot of commercial cat foods. He hasn't been scratching in the past few days so I am hoping I hit on something here with the limited ingredient food.

I just gave him his b12 injection, one more to go then I am going to talk to vet about at least a monthly injection ...I also just ordered Thorne B-Complex Vet for pets figured it couldn't hurt...B12 helps with appetite and  other things..and I read that animals with IBD sometimes develop low B12 and folate levels..

The slippery elm should work for nausea, coats the stomach and helps with constipation and diarrhea... the only thing they warn about is if your cat has high calcium levels it should not be used frequently...

Oh, natural balance has a duck and pea limited ingredient diet...it also comes in cans..

 

[ldg]

LID = Limited Ingredient Diet

...though whatever the problem, if Bentley likes wet food, that is the best for him over dry food. A site written by a vet: http://www.catinfo.org

Of course, when you have a sick kitty, whatever they will eat is what's good for them. But if he likes the Rad Cat, the raw is best for him, as it seems to have agreed with him before. Rad Cat is easily digestible, "limited ingredient," and there just aren't lower carb foods than a raw diet. The lower carb, the better, as it is becoming better understood that carbs feed cancer: http://articles.mercola.com/sites/articles/archive/2013/03/10/ketogenic-diet.aspx

...this happens to work particularly well for cats, because as obligate carnivores, their bodies are designed to thrive on fat and protein, with a very, very, very low carb content.

 

[calypsos mom]

I have been dealing with this IBD issue for years with Calypso. Tried all the usual things. Prednisone, Metrionidazal, acupuncture. All the various alternative meats like duck, pheasant, venison, rabbit, unagi, salmon, brush tail. (All in the form of commercial cat food) Canned. And been using the Orijen 6-Fish dry food. Nothing seems to work and my 12 year old has been in a cycle of flare-up for a couple months. Currently is taking 1cc of metronidazal a day. Still not really effective. 

My a recommendation, I came across this website. www.catnutrition.org. I am giving it a try. Ordered my meat grinder and I am going to begin making my own cat food. I was enlightened by the author,

that all the canned food I was using contained carrageenan, which a known inflammatory in cat food. 

Like you, I had tired raw food frozen patties, but did not really take the time to transition my girl. She turned her nose up and I gave up. Also, again, it was commercially processed.

I really have high hopes for the recipe that is in the www.catnutrition.org site and have been communicating with it's author, getting tips to entice Calypso. I am hoping it works, because she is just getting thinner and thinner with the vomiting and diarrhea. Currently I am feeding her the Orijen 6-Fish and some human grade, canned salmon. Can't wait to get her off the dry food, as I know it is a contributor to diarrhea. And well, the canned salmon is not nutritionally sound. Plus, she is also loosing interest in that.

Maybe check out the website on the raw food diet that I gave you?

Good luck!

 

[bentley2013]

The reason I gave up on raw was because I was throwing away more than I was getting down him. I had to coax him to eat it. I thought it was because he didn't like a certain batch of the Rad Cat, but it was actually because his tummy hurt whenever he ate. Until his tummy is better, he avoids food until he's very hungry and just grits his teeth and bares it. I did get him to eat some a/d, maybe a 1/3 of a can and he has been to the dry Orijean food a few times and taken a few bites as well as eating some venison steak. I'm hoping its enough to keep him going. He hasn't been drinking today though. I gave him 125 ml of fluids yesterday afternoon and am thinking about giving more tonight. I will address his diet if and when he feels better from he chlorambucil.

I'm going to wait until Monday to start the chlorambucil because I need to get cerenia from the vet on Monday so I can ne prepared. I just hope I'm doing the right thing for him. I don't want to make him suffer more. I'm worried about the every two week protocol being to harsh but we have to try something or say goodbye because his quality of life right now is not good.

 

[denice]

Best of luck to you and your kitty.  I think it is a good idea to get the cerenia before starting.  I know you don't want to hear anymore diet advice, that's the way I felt when Patches was very sick, but I would avoid raw while he is on the Leukeran and the Pred.  I know there will be people who disagree and I can't point to any study to back that up, but his immune system isn't going to be at a 100 percent while he is on both.  Cooked meat would be fine and of course anything he will eat will be fine for the time being.

 

[bentley2013]

Does small cell lymphoma usually wax and wane like IBD flares? I just think its interesting that Bentley hasn't gotten progressively worse in the eight months since I noticed he was uncomfortable after eating raw food. In fact he was feeling really good in May and June. There have been times when I was concerned he didn't feel well because he wasn't as active, but then he'd bounce back and be up and running around the next day. Since he wasn't vomiting, no diarrhea, and was eating and maintaining weight, I didn't worry, nor did the vet.

 

[denice]

I don't really know but I think that initially it very well could.  It's actually the same cells in the intestinal walls with both but there are more of them with lymphoma.  I have read that they sometimes use leukeran to treat severe IBD that isn't responsive to steroids alone.  I wonder though if those cases actually fall in that grey area where they're just not really sure which it is.

 

[donnajean]

The reason I gave up on raw was because I was throwing away more than I was getting down him. I had to coax him to eat it. I thought it was because he didn't like a certain batch of the Rad Cat, but it was actually because his tummy hurt whenever he ate. Until his tummy is better, he avoids food until he's very hungry and just grits his teeth and bares it. I did get him to eat some a/d, maybe a 1/3 of a can and he has been to the dry Orijean food a few times and taken a few bites as well as eating some venison steak. I'm hoping its enough to keep him going. He hasn't been drinking today though. I gave him 125 ml of fluids yesterday afternoon and am thinking about giving more tonight. I will address his diet if and when he feels better from he chlorambucil.

I'm going to wait until Monday to start the chlorambucil because I need to get cerenia from the vet on Monday so I can ne prepared. I just hope I'm doing the right thing for him. I don't want to make him suffer more. I'm worried about the every two week protocol being to harsh but we have to try something or say goodbye because his quality of life right now is not good.

Bentley,

After two weeks my Boo threw up this morning undigested food. However, he got into my other cats' (spook) Royal canin S/O for dissolving struvite crystals. This was the food he was on before all this started. I asked two different vets if this food was ok for all three boys and  they all said it was fine... Although it has kept Spook crystal free for over 8 months the down side is this food has corn, wheat gluten, brewers rice, egg product, etc... I have always been against grains and wheat gluten, yuck..

He was doing great with the Nature's Variety limited ingredient turkey meal and the canned..I also give Pure bites freeze dried treats , chicken, grind up some and put over his dried and that entices him to eat more.. he loves the freeze dried treats they come in turkey, chicken and I think shrimp...

Nature's variety Instinct does have a limited ingredient dry and canned in Duck, grain free and so does Natural Balance. Natural Balance has two, Duck & Pea and Chicken & Pea Limited ingredient diet in both dry and canned.

It could be his body is reacting to the food, even though he loves fish..Boo got into the wrong food and I really think that is why he threw up because perhaps of the grains, wheat gluten or something in that Royal Canin S/O .

I have been using the slippery elm with success, at least I think it is helping. My Boo so far has no diarrhea, stools are normal, just don't know from day to day though do we?

Vitality Science has a product called G.I. Distress, please look at it, someone else I believe on this forum has used it for their cat. It soothes, tones and calms the G.I tract, also great for treatment resistant vomiting and diarrhea...

It has 6 ingredients in it, work on reducing inflammation, chamomile for calming ...

Best of luck, I know how nerve racking this can be , we only want the best for our furry family members..

 

[bentley2013]

I picked up a copy of the pathology report.

Pathology: 1. stomach: minimal multifocal lymphoplastic gastritis, with luminal ingesta. 2. mild difusse lymphocytic and lesser plasmacytic enteritis, with moderate to marked increase in intrmucosal lymphocytes occasionally forming aggregates, and moderate luminal ingesta - possible epitheliotropic SLC.

The lesional lymphocytes within the duodenum diffuse lay exhibit strong positive cytoplasmic immunoreactivity to CD3 (pan T cell marker). This stain highlights marked epitheliotropism of these cells, further suggestive of an epitheliotropic T cell lymphoma (small cell). PCR clonality test is pending may be back this week. Pathologist noted that these were excellent biopsies.

A clonality population on PCR clonality would confirm an epitheliotropic SCL, whereas a polyclonal population would be more suggestive of an inflammatory reaction associated with chronic IBD.

Should I wait on the PCR to treat with chlorambucil??????? Just got a b-12 shot and had them run labs to see what pretreatment labs look like.

 

[bentley2013]

I forgot to say that the number 2 biopsy on my last post was from the duodenum.

 

[denice]

I take it there has been no improvement after a week on the steroid.  I can only tell you what I would do which is just an opinion I would go ahead and give the first dose of Leukeran.  

From what I understand the way he has the dosing set up you would have the results of the second staining before he would be due a second dose.  If there were some improvement from the steroid I would wait and see, but with no improvement I would go ahead and start the Leukeran. 

But again I am not a vet so that's just a personal opinion.

 

[bentley2013]

I just gave him the chlorambucil and fluids. I'm terrified, but he wasn't improving and he was trembling tonight indicating he's in pain. I'm so upset. He feels terrible.