Intestinal lymphoma paliative care questions

Mashah

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Hello everyone,

I need some advice on how to proceed.

Our 16-year-old male cat, who has been in diabetes remission for over 7 years, was diagnosed this morning with intestinal lymphoma based only on his symptoms and the ultrasound. Because of his age, the biopsy was not scheduled, and the chemo is not an option. We (vets included) opted for trying to do everything to give him quality and care, before the final decision.

I am not disputing the diagnosis. Although there could be some similarities with the IBD. I just don’t know if oral 2,5mg of prednisone will be helpful, given the fact that he has intestinal inflammation and absorption problem.

I’m making a list of the things to ask our vet, and I would really appreciate your insight.

In the past four days (before the diagnosis) he’s been on Tolfedine injections that last for 48h. They have made a world of difference for him! He would eat normally, jump (on the counter no less), ask for attention… But these are injections. I’m not sure that the antibiotics they have been giving him are working, because he must take them orally. So, my first question would be that: shouldn’t we be giving him injections instead of pills?

My second question would be if we could stick with the Tolfedine for a while and give him injections at home (as any human companion of a diabetic cat can confirm, we get pretty skillful with giving subcutaneous injections).

Third question is do we give him food he wants to eat, that gives him diarrhea, or do we try to lessen the burden by giving him food that is good for him and that does not provoke the diarrhea. If he eats chicken, he’s fine, but, for some reason, it just doesn’t smell nice to him anymore. So we’ve been buying all sorts of canned, wet food, that he might like to eat, but more often than not, like with the food intolerances, he gets diarrhea, that we cannot come down with Smectite.

Thank you all in advance for your support. I’m trying to gather as much info as possible, since I am the one who has to make the decisions and needles to say, not being a vet myself, I’m scared I might make the wrong ones.
 

stephanietx

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I am so very sorry you're walking this path. I lost my precious girl to intestinal lymphoma very suddenly in early 2021. She had completely stopped eating and was lethargic. I have no help on treatment or care, but wanted to let you know you're not alone.
 
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Mashah

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I am so very sorry you're walking this path. I lost my precious girl to intestinal lymphoma very suddenly in early 2021. She had completely stopped eating and was lethargic. I have no help on treatment or care, but wanted to let you know you're not alone.
Thank you, thank you so much for your kind words. I am so sorry for your loss.
The symptomes can indeed appear quite suddenly and mimic other conditions.
 

FeebysOwner

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Hi. What injections are you referring to? Tolfedine? This drug, by the way, can cause diarrhea and is generally not used in conjunction with steroids (Pred), because it can amplify the possibility for GI ulceration - although I am sure there are reasons that a vet would choose these two, regardless. There are other meds for inflammation and pain that might work also and not contribute to the diarrhea. You mentioned antibiotics too but didn't specify which one. Many antibiotics can also cause diarrhea.

Knowing Pred can trigger diabetes, you might ask your vet about Budesonide instead. It works on the intestinal tract just as Pred does but doesn't have as much of an effect on diabetes or potential heart issues that can happen with long term use of Pred. Either of these meds should work to reduce intestinal inflammation.

You also mentioned an absorption problem. Has his B-12 level been checked. He may benefit from B-12 injections to help with absorption.

Is the chicken he was eating, human chicken or canned cat food? I suspect the former, which means almost anything in the canned foods you have tried - such as fillers or gums - could be the source of diarrhea. I am not sure how to offer anything in the way of food, as I am not sure you know what is in the canned foods that leads to diarrhea. If you are preparing him homemade chicken, perhaps you could try other proteins and see if they don't pose an issue.

I probably asked more questions that I did anything to give you any answers to yours.
 

silent meowlook

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Hi. My cat has intestinal lymphoma. She is on the following.
Prednisolone 5 mg. Every other night
Chlorambucil 2 mg. Every 2 to 3 days, not on the days with the pred.
Cerenia 6 mg as needed for nausea.
Vitamin B 12 0.5cc SQ once every 2 eeeks.
Lactated Ringers 50 mls. SQ as needed for dehydration.
Diet: Royal Canin novel protein source Rabbit (PR)

My cat has been on this for about 3 years and is doing well.

The injections you are giving your cat are a NSAID. As far as I know, that is not a drug you want to use for a long time. Also, as far as I know, it should never be used with a steroid, including Prednisolone due to it having a strong risk of causing gut ulcerations GI issues including perforated gut when used together. If Prednisolone is used, there should be a washout time in between meds.
I have not heard of NSAIDs beings used in cats for treatment of intestinal lymphoma or IBD.

I am not a vet and this is just my experience. Obviously the only one who should be making decisions for your cat is your vet or another vet who has actually seen and examined your cat.

Diet is very important and a canned novel protein diet would be a wise choice as there are links to this being started by a food allergy.
 
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