Inflammtory Bowel disease or Small cell lymphoma

Pouncecat1

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My cat presented with vomiting a week ago and was quite sickly. My regular vet thought he had a bowel obstruction from a foreign body. I took him in for a second opinion and they think it is either very severe Inflammatory Bowel Disease or Small Cell Lymphoma based on the ultrasound study.

They want me to start him on Reglan (Metoclopramide), Prednisolone, and Chlorambucil (Leukeran). Eventually adding an antibiotic (metronidazole).

So a lot of drugs to start at one time. Ugh. He has been on prednisolone before but never on the other 2 medications. For those of you who have used Reglan and Chlorambucil in cats, please tell me how your cat reacted to the medications? And how long did it take for you to see results? Where do you order your Chlorambucil from? As the vet said I can order it by mail and save some money that way.

What symptoms did your cat present with? And please just give me some encouraging news.

I'm super disappointed this happened to him. He is only 10 years old. My other cats are 16 and 14 yrs old. I had hoped he would live forever. He is my favorite and this just breaks my heart.
 

daftcat75

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It sounds like a pill-and-pray approach. Throw all the drugs at once and hope for the best outcome. I don't like it. You don't like it. Your cat won't like it. Can you seek a third opinion? Preferably from an internal medicine specialist.

I'm not a vet. I'm not a specialist. It's not my cat.

But...

If he's still eating readily, he probably doesn't have nausea. Antiemetics sometimes have appetite suppressing side effects. If his vomiting is not an every meal or every day thing, you might do better to reduce his portion sizes and increase the number of feedings rather than giving him another drug and its basket of side effects.

I'd also ask if you could do a month or two of pred without the Leukeran. The only way to know the difference between small cell lymphoma and IBD is a biopsy. But these are invasive and most patients aren't doing too well at this point to begin with. When guardians skip on the biopsies, many vets prefer to treat it like IBD first. If the patient fails to respond to the IBD treatment, then the vet may recommend leukeran to see if there's a positive response. My concern and your concern is that with each drug comes side effects. The cumulative side effects may be worse than picking one diagnosis and trying one approach at a time.

But there is also more to IBD than just inflammation. You may also have to change the proteins he is eating. If he's eating dry, you should reduce or eliminate that. If he's not eating wet food, then there's the whole task of getting him onboard with wet food. If he's only eating twice a day, he'd have an easier time with smaller meals fed more frequently. There's a lot to IBD management. That's why I recommend an internal medicine specialist and not just a general practice vet.
 
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Pouncecat1

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This was the internal medicine specialist. The X rays were extremely concerning. He has ileus (intestinal partial paralysis) so that is why we added the reglan. It improves intestinal motility. Honestly I was terrified they would tell me he had a huge tumor in his intestines and I would have to put him down. None of these things are good. I don't think we can afford the wait and see approach, I'm afraid. If it is cancer, we need to start treatment sooner rather than later.
 

daftcat75

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That was the specialist. Do you trust him/her? If so, voice your concerns about trying multiple drugs at once and ask if you can try one approach and then the other. It is my understanding that small cell lymphoma is a slow growing cancer. If s/he doesn't think this is a good idea, well, s/he knows far more than I do and has seen your cat. I would defer to the specialist. If you don't trust him/her, then you should probably get another opinion.

If you are concerned this may be cancer, you could have the endoscopy with biopsy performed.

Another question for the specialist is whether the pred dose is a low dose for controlling inflammation or a high dose for suppressing the immune response. There are greater risks associated with immunosuppressing doses and you should discuss this with the doctor.
 

MissClouseau

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Personally my rule of thumb for both pets and humans is that if you hear a life-threatening diagnosis or if they decide to put the patient on serious medicine, definitely get a second and preferably a third opinion. Finances would be a concern of course but you don't have to get the tests re-done but show the test results to other vets.

If possible try to find a vet through the internet who is praised for treating small cell lymphoma and/or IBD.

I hope you get all the good news
 

artiemom

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Omgosh, yes. A ton of medications. It is frightening.

My soul- kitty, Artie, had IBD and the. Went on to develop Megacolon.

I may be way out there with my feelings, but they are based on 2 internal medicine vets. One I highly respected.

I did opt for the biopsy. Artie was around 10 years old, at the time. It was very hard on him.

Regardless of having the biopsy or not, treatment began. He did not have any enlarged lymph nodes; but he did has a persistent ileus.

He began all the drugs you mentioned, except the chemo.

From my understanding, the chemo is started IF the standard IBD treatment is not causing results.

He was also, immediately, started on a novel protein diet. A protein he had never eaten— to ease any possible food sensitivities. And a probiotic was also added to his mix.

Since he was vomiting, anti-nausea Med was also added, Cerenia.

The Reglan was tough for him. It is a very bitter medication, irregardless of what form. Leaves a bitter taste.

He also has daily prednisone.

Trying these drugs are pretty basic. If they do not help then chemo drugs are also given.

I am not a vet, and do not know what they are seeing on the ultrasound, to make them begin the chemo.

I would see if you could call and A’s the vet, you feel most comfortable with, and seems to have the better qualifications, why the chemo. If they are a good fit. And this is so important, they will be happy to answer your questions.

It does take a while to see results. A novel protein diet and a probiotic are standards, along with pred. The reglan is an anti-biotic, in case there is an infection. Also to calm the gut down.

Artie could not tolerate the relain, in any form. So, I gave up giving it to him.

I do not know if this story helps. I hope it do s.

There is a an IBD group on Facebook, private.
And a great website on line. IBD Kitties.
Great information on both.

Good luck. ((( Hugs))).

It is a very frustrating and frightening disease.
 
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Pouncecat1

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I've already got him on a new diet- the Hydrolyzed salmon by Blue Buffalo. We had already tried the hydrolyzed soy diets and they didn't help with his food allergies in the past. Since that is pretty much the only food he has not yet been on, that is what he is getting.

I'm not certain about the Reglan at all. Yesterday he was very miserable looking. All hunched up and just sad. Today he felt slightly better with the prednisolone and first dose of the Chemo drug. I skipped the reglan today and opted for miralax instead.

I feel totally heartbroken and helpless. I just went though this with Isabelle over the summer and had to have her put down. I figured Pounce was only 10 and we would have many many more years together. So this is a terrible sucker punch. He was moving around more today but when I look in his eyes, he does not look happy. He still has a sad look in his face. I don't know if I'm doing the right thing here.

I've already pretty much decided against doing an endoscopy and biopsies. I think that would add unnecessary trauma to an already sick cat. Yes it might tell us what we are dealing with. If he has just IBD, he should improve with medication. If this is small cell lymphoma he should improve with medication. If this is large cell lymphoma- there is no effective treatment other than injectable chemotherapy. Large cell is very very aggressive so I don't know if I would go after aggressive treatments.

I am wondering if it would be worth doing a fecal PCR to look for additional infectious agents and see if that might shed some light. Perhaps he has an infection and cancer. BUT again, maybe not.

I'm going to try to get him through the next 2 weeks. He is eating well but so clearly uncomfortable and unhappy. I keep hoping I will walk in the room and he will jump up to see me like he normally does. Right now, he just wants to rest.

This totally blind sided me. I look at him every single day. I pay more attention to him then the others. I sleep with him in bed every night. I never imagined I could miss the fact that he was getting sick. It seemed like he went from fine one day, to terribly sick the next. And I didn't see it coming. Yes he lost some weight, and I had been thinking I needed to increase his food. But I had no idea he was this bad off. Yes I know cancer has a genetic component, but I keep blaming myself for not seeing the warning signs sooner.

Please keep him in your prayers.
 

FeralHearts

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*hugs* I Hardly know what to say really - but I wrote a novel for you anyway. XOXOX

I'm so sorry you and kitty are going through this. You are definitely added to my good vibes pray list.

Please, please don't blame yourself. I know that is easier said than done. You have to remember - Cats have a way of hiding EVERYTHING often until it's a close call or ...

Most days with mine I feel like I have to be psychic to know what's up.

While I too hate the approach of toss "everything but the kitchen sink" at a problem - I can understand why as I had that happen last summer when one of my ferals was accidentally poisoned by neighbor. They tossed everything at her as no one was sure. Blood scary.

I have a suspicion they are doing that here as there is no clear cut answer without a biospy / endo. IF it's small cell Lympo it has to be gotten to as quickly as they can so they don't want to screw around too much. No doubt they'll ween off some as you progress - is that the idea?

How was his bloodwork? Sometimes that can confirm cancer / lymphoma in a way. It did for one of my doggies. (Though they failed to tell me this - a story for another day.)

Do you have the notes for the doctors. If not - do request and read them over thoroughly. What you really can't sort out - write a list of questions and ask.

You probably already know this but keep him feed, keep him hydrated and watch the poo and pee. (Obviously any side effects they noted as well. and anything else obvious like throwing up still.) Get yourself a spread sheet and start keeping details notes of behavior, physical, food intake, pee and poop - everything. (Or log it here daily so you can come back and get the information when and if you need it.

I haven't used those meds - so I can't comment but hopefully others can.

One of my cats as IBS / IBD suspected along with food allergies. He's responded well to food changes but it took a long time to get him there. (picky eater). X-rays showed inflamed intestines as did the ultrasound. Should the food change have not produced any results I may have opt for the biopsy but only as a last resort as he has HCM and Asthma - so the danger of doing a biopsy would have to have been in a case like what you're facing.

He was constipated, tossed his cookies a few times a week - then he would appear fine and then it would start up again. He also chewed /licked his back legs raw.

XOXOXOXOXXOOX I wish I could be more help but it's a lot outside the scope of what I know. Hopefully something in my post is useful to you.
 

MissClouseau

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This totally blind sided me. I look at him every single day. I pay more attention to him then the others. I sleep with him in bed every night. I never imagined I could miss the fact that he was getting sick. It seemed like he went from fine one day, to terribly sick the next. And I didn't see it coming. Yes he lost some weight, and I had been thinking I needed to increase his food. But I had no idea he was this bad off. Yes I know cancer has a genetic component, but I keep blaming myself for not seeing the warning signs sooner.
Just because you didn't see this coming doesn't mean you missed any symptoms though. Not everything gives out a symptom in earlier stages. Even humans get surprised sometimes when they get diagnosed with something themselves because they were feeling fine or had such a mild symptom... because some things give out the kind of symptoms that are identical to the symptoms of... nothing. Like sometimes they sleep more but no way to be sure if it's because the weather is getting colder, or they stayed up late last night watching a fly, or if they don't feel well.
 

Meowmee

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My cat presented with vomiting a week ago and was quite sickly. My regular vet thought he had a bowel obstruction from a foreign body. I took him in for a second opinion and they think it is either very severe Inflammatory Bowel Disease or Small Cell Lymphoma based on the ultrasound study.

They want me to start him on Reglan (Metoclopramide), Prednisolone, and Chlorambucil (Leukeran). Eventually adding an antibiotic (metronidazole).

So a lot of drugs to start at one time. Ugh. He has been on prednisolone before but never on the other 2 medications. For those of you who have used Reglan and Chlorambucil in cats, please tell me how your cat reacted to the medications? And how long did it take for you to see results? Where do you order your Chlorambucil from? As the vet said I can order it by mail and save some money that way.

What symptoms did your cat present with? And please just give me some encouraging news.

I'm super disappointed this happened to him. He is only 10 years old. My other cats are 16 and 14 yrs old. I had hoped he would live forever. He is my favorite and this just breaks my heart.
My Wizard had upper ibd with vomiting. He was fiv+Eventually it progressed to lymphoma. He was older and had crf and did not do well with sedation or meds so no biopsies etc. We gave him pred and chlorambucil. Also on fluids and epogen. Got epogen at walmart specialty pharm and chlorambucil at diamondback compounding pharm. he did well on it for almost a year then it reversed and he stopped responding. He passed purring in my arms at first at 19-20.

Merlin, a younger cat, now may have ibd, he is on steroids and tylosin. Maybe get another opinion. Good luck.💕
 
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