Kitty with Ibd losing weight again after a stable year. P

dds35day

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Last year My 17 year old kitty lost a lot of weight rapidly before diagnosed with Ibd and put on budesonide, b12 shots. She became diabetic quickly. Suddenly she has begun losing weight again and I am panicking because she is thin now. Before she went from 16 to 10 pounds. She had been overweight but now can't afford to lose weight. Talking with vet about doing a follow up ultrasound asap she is on 1 mg budesonide which initially stopped the weight loss. would the correct path be to increase the budesonide? What would the next dose be? I have heard about leukeron can be given for refractory ibd.
She is my heart and I am terrified. I would be grateful for your experience.
 

daftcat75

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If she is losing weight despite a normal or more than normal amount of calories, that sounds like lymphoma--especially if she is not having any other butt or gut symptoms typically associated with IBD. Unfortunately, another ultrasound won't tell you the difference between IBD and small cell lymphoma. It might reveal a mass if it is not small cell lymphoma. But it may just as well reveal only intestinal thickening consistent with IBD or small cell lymphoma. A lot of vets are hesitant about prescribing chemotherapy without a cancer diagnosis. What they don't seem to understand is that often the drug is less risk than the diagnosis. What I suggest, which is what I did with Krista's vet, is to have an options talk with the vet. It might look something like this:

1. Do nothing. Nobody wants this. But this is an option.
2. Increase the budesonide. This may or may not address the issue if it has progressed to lymphoma. At the same time, it increases her risks for short-term and long-term side effects of the drug. There's also an opportunity cost. How long do you try this before moving to the next option? How much more weight will be lost?
3. Perform a surgical biopsy on a 17 year old cat with poor body condition. Any recovery period after this procedure, and any weight lost during this recovery period is not coming back until the cause of the weight loss is addressed.
4. Try the leukeran and agree to bring her back for blood testing for the potential side effects. They are rare and generally reversible as opposed to organ damage caused by high doses of steroids for long periods of time.

You might try another ultrasound. But it may not provide any new information. Given the opportunity cost of trying other options while the weight loss continues unabated, I would strongly lean on #4. I would also keep up the B-12 shots until the weight loss stops.

In Krista's case, the weight loss stopped nearly overnight with the chemo. She had no noticeable side effects from it. Maybe she was a little more lazy on dosing days. But she didn't seem nauseated and her appetite wasn't affected. Sadly, she didn't reach a full remission for a long time because I was wrapping her nightly steroid pill halves in fish flakes--a trigger food for her--in an attempt to get her to take her own medicine. It worked because she would take the flake wrapped pill every night. But the flakes kept the lymphoma on a smolder until we were forced to switch to transdermal pred. Once I did, her remission was immediate. And tragically too short. The long-term use of steroids had weakened her to the point that she couldn't fight off a bladder infection.

Give the leukeran a chance and try to keep the steroids use to the minimum needed to control her condition.
 
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cataholic07

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Is her diabetes under control? What is she eating? Its possible the IBD turned into lymphoma if its large cell you will be able to see it on an ultrasound/xray.
 
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dds35day

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Thank you. We are watching to be sure the diabetes is under control. It was a little high and vet thought that might be a cause of weight loss. It has been higher and never caused weight loss. I am very grateful for the information. Question:
-Would you suggest increasing the budesonide immediately while scheduling the ultrasound? How would you increase the 1 mg? One and a quarter? I get it compound to tiny tabs.
It could take a little time to get the ultrasound scheduled.
- should we increase the budesonide and then start the leukeron if that doesn't work.?
I am concerned about the handling of it. She licks everything before she sits down, licksy
If she is losing weight despite a normal or more than normal amount of calories, that sounds like lymphoma--especially if she is not having any other butt or gut symptoms typically associated with IBD. Unfortunately, another ultrasound won't tell you the difference between IBD and small cell lymphoma. It might reveal a mass if it is not small cell lymphoma. But it may just as well reveal only intestinal thickening consistent with IBD or small cell lymphoma. A lot of vets are hesitant about prescribing chemotherapy without a cancer diagnosis. What they don't seem to understand is that often the drug is less risk than the diagnosis. What I suggest, which is what I did with Krista's vet, is to have an options talk with the vet. It might look something like this:

1. Do nothing. Nobody wants this. But this is an option.
2. Increase the budesonide. This may or may not address the issue if it has progressed to lymphoma. At the same time, it increases her risks for short-term and long-term side effects of the drug. There's also an opportunity cost. How long do you try this before moving to the next option? How much more weight will be lost?
3. Perform a surgical biopsy on a 17 year old cat with poor body condition. Any recovery period after this procedure, and any weight lost during this recovery period is not coming back until the cause of the weight loss is addressed.
4. Try the leukeran and agree to bring her back for blood testing for the potential side effects. They are rare and generally reversible as opposed to organ damage caused by high doses of steroids for long periods of time.

You might try another ultrasound. But it may not provide any new information. Given the opportunity cost of trying other options while the weight loss continues unabated, I would strongly lean on #4. I would also keep up the B-12 shots until the weight loss stops.

In Krista's case, the weight loss stopped nearly overnight with the chemo. She had no noticeable side effects from it. Maybe she was a little more lazy on dosing days. But she didn't seem nauseated and her appetite wasn't affected. Sadly, she didn't reach a full remission for a long time because I was wrapping her nightly steroid pill halves in fish flakes--a trigger food for her--in an attempt to get her to take her own medicine. It worked because she would take the flake wrapped pill every night. But the flakes kept the lymphoma on a smolder until we were forced to switch to transdermal pred. Once I did, her remission was immediate. And tragically too short. The long-term use of steroids had weakened her to the point that she couldn't fight off a bladder infection.

Give the leukeran a chance and try to keep the steroids use to the minimum needed to control her condition.
Thank you very much. I am very aware that speed
 
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dds35day

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If she is losing weight despite a normal or more than normal amount of calories, that sounds like lymphoma--especially if she is not having any other butt or gut symptoms typically associated with IBD. Unfortunately, another ultrasound won't tell you the difference between IBD and small cell lymphoma. It might reveal a mass if it is not small cell lymphoma. But it may just as well reveal only intestinal thickening consistent with IBD or small cell lymphoma. A lot of vets are hesitant about prescribing chemotherapy without a cancer diagnosis. What they don't seem to understand is that often the drug is less risk than the diagnosis. What I suggest, which is what I did with Krista's vet, is to have an options talk with the vet. It might look something like this:

1. Do nothing. Nobody wants this. But this is an option.
2. Increase the budesonide. This may or may not address the issue if it has progressed to lymphoma. At the same time, it increases her risks for short-term and long-term side effects of the drug. There's also an opportunity cost. How long do you try this before moving to the next option? How much more weight will be lost?
3. Perform a surgical biopsy on a 17 year old cat with poor body condition. Any recovery period after this procedure, and any weight lost during this recovery period is not coming back until the cause of the weight loss is addressed.
4. Try the leukeran and agree to bring her back for blood testing for the potential side effects. They are rare and generally reversible as opposed to organ damage caused by high doses of steroids for long periods of time.

You might try another ultrasound. But it may not provide any new information. Given the opportunity cost of trying other options while the weight loss continues unabated, I would strongly lean on #4. I would also keep up the B-12 shots until the weight loss stops.

In Krista's case, the weight loss stopped nearly overnight with the chemo. She had no noticeable side effects from it. Maybe she was a little more lazy on dosing days. But she didn't seem nauseated and her appetite wasn't affected. Sadly, she didn't reach a full remission for a long time because I was wrapping her nightly steroid pill halves in fish flakes--a trigger food for her--in an attempt to get her to take her own medicine. It worked because she would take the flake wrapped pill every night. But the flakes kept the lymphoma on a smolder until we were forced to switch to transdermal pred. Once I did, her remission was immediate. And tragically too short. The long-term use of steroids had weakened her to the point that she couldn't fight off a bladder infection.

Give the leukeran a chance and try to keep the steroids use to the minimum needed to control her condition.
Thank you.. given the need to move quickly, would you go directly to you leukeron? I could increase the budesonide while we schedule the ultrasound. How dangerous is it for humans? She licks everything before she plops down, licks my fingers etc. I am concerned about the danger...
I feel like I am back where.i was when she was first diagnosed and I was scared she would starve.
 
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dds35day

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Is her diabetes under control? What is she eating? Its possible the IBD turned into lymphoma if its large cell you will be able to see it on an ultrasound/xray.
Thank you. Double checking the glucose levels. She is on fancy feast classic pate and has done well on it. I know it is not optimal but given her diabetes and just controlled vomiting and diarrhea I am afraid to rock the boat. She is on s broulardi and cerenia. Going back to the vet tomorrow. I hope I am panic and she is ok. She is my best friend.
 

daftcat75

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Thank you.. given the need to move quickly, would you go directly to you leukeron? I could increase the budesonide while we schedule the ultrasound. How dangerous is it for humans? She licks everything before she plops down, licks my fingers etc. I am concerned about the danger...
I feel like I am back where.i was when she was first diagnosed and I was scared she would starve.
I don’t have any experience with budesonide. That would be a conversation to have with your vet. I know with prednisilone, they recommend the cat be off of it for a certain length of time (not sure how long) because it might give false negatives on the ultrasound. This is time lost that you could be treating your cat.

Unless you are immune-compromised (or pregnant), the handling precautions are overblown. In my non-vet opinion. You’ll wear gloves and you will probably get it compounded to a flavored liquid. I recommend the most concentrated dose so that you can give the least total amount of liquid. With Krista, it came out to 0.1 mL. That was small enough that, when combined with the anchovy flavoring from the compounding pharmacy, I could put that small amount and an equally small amount of salmon oil on a plate and she licked it clean. As far as being exposed to the medicine, unless you spill it on yourself (or you don’t wear gloves), your exposure will be diluted through a cat.

As far as your cat’s experience with the chemo, most cats experience mild, if any, side effects. You shouldn’t hesitate to try chemo based on how humans react to it. I never noticed any side effects with Krista except maybe she was a touch sleepier on dosing days. But it didn’t affect her appetite at all.

I would discuss all options with a vet. After all, I’m just an Internet stranger who has only cared for one lymphoma cat. Ask your vet to weigh the pros and cons of potential side effects from increasing budesonide and the time you lose to giving that a chance vs. adding in leukeran now. Especially if she’s not having the usual gut and butt issues that IBD cats have. Personally, (I’m not a vet), I think there’s more risk to increasing the budesonide dose than to trying the leukeran. You could probably increase the budesonide dose after giving leukeran a chance.

With Krista, the improvement from leukeran was nearly overnight. She was having liquid poops that firmed up within a dose or two of the leukeran. The weight loss stopped too.

I can’t tell you the right order to try these things. But I can tell you that the sooner you can stop the weight loss, the better her outcome will look.
 
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dds35day

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Thank you very much. I am very grateful for your help. I have found that the experience of pet parents is on target and extremely helpful. I get so afraid. This gives me a good idea of the best path. Thank you for understanding.
 
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dds35day

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Is her diabetes under control? What is she eating? Its possible the IBD turned into lymphoma if its large cell you will be able to see it on an ultrasound/xray.
Her diabetes is not under great control right now and we are adjusting the insulin. If her diabetes was stable I would ask about starting leukeron. I'm worried because it could take a week or so to stabilize the diabetes. She has never lost weight before when her glucose was a little high. But the vet won't agree I am sure to starting the leukeron with the issue of the diabetes being a cause. Plus I worry about giving her the leukeron. She bites me sometimes when I pill her. Not a big deal but would be bad if she is on leukeron from what I have read. She also regularly licks the area where she is going to curl up before plopping down. And licks my fingers. These things might be dangerous on leukeron, is that true?
Thank you so much. I'm going nuts
 

daftcat75

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You should be discussing this with the vet. It may not be a linear thing where you treat the diabetes first and then the (possible) lymphoma. You may have to treat both at the same time to be successful.

As for the handling of the leukeran itself, the easiest is to get it compounded into a flavored liquid. You can add that to a small amount of food or other enticing treat. For Krista, I got hers compounded into a concentrated (less liquid to give) oral oil suspension with anchovy flavoring. I mixed this with a little salmon oil on a plate I used only for her medicine meals. It took her maybe 30 seconds to lick that clean. Then I fed her a normal meal on her normal plates. I washed up her medicine dish. Then I disposed of the gloves I wore to do all that and sealed them in a plastic baggie. I never touched the medicine directly and she never licked me directly after taking the medicine. She washed it down with a meal first. 😋 Even if she wanted to lick me or the blankets or the laundry later, by that time, the medicine was already diluted by the volume of a cat. It is true that the medicine will be in all her body fluids for about a day. But the dose is diluted by the total volume of her body fluids (her blood, pee, saliva, and poop.) This is not the same risk as if you handled the medicine directly.

Time is of the essence here. Talk with the vet. You should be asking these questions and discussing these concerns with the vet. The more time we spend discussing it here is the more time you lose that you could be treating your cat.
 

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I know this is late in replying, but just looking for something when I came across this. Thought I might be able to alleviate some worries of using Luekeran. I adopted a sweet 10yr old from the shelter, and it took my idiot vet 2yrs (and a new vet hired there) to finally diagnose her with lymphoma cancer. Poor luv.
Anyhow! Once diagnosed, I was told they can typically live for 1-2yrs at that point. 3 is really lucky.
Mine's been on her max dose of 4mg for 5yrs come June and still doing well. She went from throwing up daily to once a week. They put her on Prednisone then Prednisolone (after 3yrs on the previous) till I tried something else. Cbd tincture. I give her 8drops of that 2x daily that is 'Salmon oil' flavored, and she only gets sick maybe once every 2-3months tops now? And the Chlorambucil (Luekeran) doesn't make her sick at all. We started on pills, but after 2yrs of paying $25 a pill (and she was taking 8 a month), her doc finally told me about a company in Jersey that does compounding for a fraction of the price. That is in liquid form and is I think about $60 with shipping for 5months worth.
I've been the only one giving her her chemo drugs all these years, and I to have an autoimmune disease (though not Cancer) and it's never affected me in the least. So no harm to either of us!:) She doesn't throw up anymore, no wet stool, and gets around much better since. And she's now 17. Chemo doesn't seem to affect them (thankfully) the same as it does humans.
Hope your baby's problems work out and you find the right solution.
 
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