Likely Small-cell Lymphoma, Continuing Constipation

[MDad1234]

I hope it is ok that I start another thread given my kitty's change in status. I outlined at length her original symptoms/checkups here.

Biopsy results came back, and while they have not been reviewed by the practice's oncologist (that'll be Monday), two of the vets said that it is almost certainly small-cell lymphoma judging from the intestinal biopsy. Not what I wanted to hear of course, but they seemed upbeat about the prognosis with treatment with prednilosone and an oral chem drug (I forget the name) and even said they've seen better outcomes with this over IBD. I'll start those meds soon, after the oncologist weighs in. Kitty also will have to go in again next week (dreading having to get her in a carrier again).

After some very loose and barely formed stools in the days after returning from the vet last week, she didn't poop for over two days, from Sunday to Tuesday, then had a remarkably normal looking BM Tuesday night. The most normal one she's had in over a month, since her symptoms started. Good color, maybe a little firm (especially the "leading end," which was a bit darker and dry). She has not gone again since, three days now. I had started giving her 1/4 tsp of Miralax twice a day that day and have kept up with that. I doubt she's getting quite that much, as she rarely finishes the entire amount of food I mix it into. But she is eating relatively well compared to how she had been before the internist, about 1.5-2 3oz cans of pate-style Fancy Feast a day, plus whatever she wants of an additional can of "gravy lovers" I put down at bedtime, mostly just to get her some additional liquid, which she loves. And she does eat a good amount of the bits as well. Not a great food, I know, but she likes it, and I've been worried about her eating enough calories, and she didn't like the "healthy" brands I've tried. I should add that she's been eating that amount without mirtazapine (last dose Tuesday), which I hope will continue.

I've read a million thread about constipation, but I was wondering if anyone had any insights as it might related to lymphoma. The biopsies also revealed a potential bacterial infection in her colon; the vet wanted me to provide a stool sample for further analysis, but clearly that's been an issue the past few days. I'll provide one as soon as I can, but she said she would still recommend an antibiotic, which I can get this weekend or Monday. Back before the internist, I had tried pumpkin (she wouldn't touch the food with it in there, and I was afraid it might make things worse), and I had been giving her a smaller dose of Miralax. I'm only feeding her wet food now; I had given some dry food after the internist and the first dose of mirtazapine, since I was worried about her calorie intake AND she actually ate some of it. I was afraid that might've led to the first 2-3 day post-vet period without a BM, since she doesn't seem to be drinking out of her many water bowls, but maybe I should offer it again? I would appreciate any feedback!

 

[mrsgreenjeens]

I don't have any actual experience with small cell lymphoma, but I DO have experience with chronic constipation, and I can tell you that dry food can absolutely cause constipation to come on quickly, so it very well have been the instigating factor. Also, with Miralax, you often have to do a little "adjusting" of the amount, but it works wonders! With our two who've basically had to live on it (kidney cats), I also learned that I could never miss a dose of it or they would end up with constipation issues.

Now, with your girl, it could be that once she starts her meds, whether it be from a possible infection, or simply the inflammation, whatever it causing the issue, her constipation issues may be resolved and you may no longer need the Miralax. It's just hard to know. OR, perhaps she will continue having issues and you may want to try to increase her fiber rather than use Miralax by using something like psylium instead of pumpkin.

Good luck at the Vet on Monday. Keep us posted.

 

[MDad1234]

Thanks! She finally went last night. I sat next to the litter box for about 30 minutes, and in that time she got in and almost immediately back out without ever going into a full squat about 4 times, then on the 5th, she started scratching around and squatted. Two harder nuggets and a larger amount of loose, normal-colored stool (and a little gas). I'm going to see what the next one looks like (hopefully it won't be four days this time!) and if it is also loose, I may adjust down the Miralax.

 

[babiesmom5]

My heart goes out to you with the likely diagnosis of small cell lymphoma for your girl. I too have received this diagnosis for my beloved girl, my soul kitty really. Unfortunately, due to missed diagnosis and misdiagnosis, treatment was delayed until it was too late. ( I have posted previously about this and won't go into detail here). You, fortunately have the opportunity to treat. Consider yourself lucky in this regard. Actually small cell lymphoma is rather slow growing and more treatable than the more aggressive large cell lymphoma. The Vet who eventually diagnosed SCL said she has seen cats often go into remission and some live 3-4 years. So there is definitely hope!

Unlike yours, my girl never had problems with constipation. She did have diarrhea, but only there near the end. Might the constipation be due to dry food and the decreased appetite/consumption of food?

As for "cobble stoning", this is likely due to the raised intestinal villi seen during the biopsy. I saw the pictures of my girls biopsy and it did have a "cobblestone" appearance. In fact, the Vet told me based on that appearance that it was likely small cell Lymphoma which results of the biopsy confirmed. You might want to ask the Oncologist to see the pictures for yourself.

Standard treatment protocol for SCL is Prednisolone plus the chemo drug Chlorambucil (Leukeran). Sadly, I was only able to administer one dose for my girl before she passed away...but her biological sister was diagnosed with a bladder tumor two days later....and she finished out her prescription and is still on it.

Prednisolone is an oval shaped white pill. I administer it with a "Pill Popper" which I got from www.DrsFosterSmith.com. You can probably get them at your vet, but mine charges $8.00 for one and Drs FosterSmith charges $2.00; same thing. The chemo drug is compounded into a capsule. You will need to wear plastic gloves when administering. Again, I use a Pill Popper to administer being extremely careful to get it down the back of the throat without the cat biting into it. I keep a separate "Pill Popper" which I use just for the chemo, so you might want to purchase several. You will need to get very proficient in giving pills. Do you have anyone with you in the house to help you?

The chemo is usually well tolerated; however my cat is sometimes "queezy" in the mornings following the chemo the night before. She doesn't want to eat, or sometimes throws up bile before breakfast. You will want to ask your Vet about anti nausea medication. Mine gets Cerenia on those bad days. Not every time is bad, but some days are. They may want you to continue the Mirtazapine to get the appetite up where it should be. I have to do that every now and then to sustain the appetite when it sloughs off...which leads to constipation. You have to keep the food flowing in and out...when one slows, the other slows. She eats only wet of whatever she wants. She has actually gained weight on the chemo; in fact the Oncologist remarks how good she looks! Looking at her, you would never know she has cancer. It does take persistence and vigilance, but it is manageable.

Good luck at the Oncologist tomorrow. Please keep us posted and know that lots of healing thoughts are with your kitty. My cat says "hang in there...if I can do it at age 16, so can you"!

 

[MDad1234]

Thanks so much for all of this information! The vet spoke to the oncologist yesterday, who would like to do one more test on the biopsy they already have (some sort of stain?) to verify for sure if it is lymphoma or IBD. I'm waiting to hear what the estimate on that would be...it sounds like the treatment would be about the same, but unless it is astronomical, I would of course rather know for sure than not. The vet had also talked about taking kitty into the office tomorrow basically just to get her most current weight for the chemo dosing. I may see if we can get out of that; she was just weighed about 10 days ago, and it will take her two days to get over the visit and get back to her eating/med schedule, so unless it is truly critical...

The vet said yesterday that she would recommend doing a high dose, less often regimen of chlorambucil versus daily/every other day, given my cat's issues with pilling. I think she said 8mg at once instead of 2mg spaced out over days. That makes me a little nervous, but I also know it can only help if she gets the medication inside of her, so it might be worth a try. I'll see what the vet says today.

No more poop since Saturday night, but you're right about the food; I think a slight dip in the amount she ate Sunday/Monday might have something to do with it, but she ate almost a whole can of Fancy Feast last night and did pretty well this morning, so fingers crossed.

 

[foxxycat]

Yes that once every two week dose of chemo is called the "Pulse Dose". It's been noted that it's easier on the cat with less frequent doses-they have meds you can also give to help side symptoms.

I will get into that in the next message...so very sorry your baby has this but you can help ease symptoms!

 

[foxxycat]

If you feel comfortable-they can show you how to do sub fluids at home-when doing chemo-it's been shown to help the cat when they get sub fluids the day before, day after of chemo. This helps hydrate the body and give more fighting chance to purge the toxins out.

You can also ask about: Cerenia and Zofran. This is an anti nausea med that is also given the day before, day of and day after chemo. This helps any nausea and enables eating to continue.

If there's pain they can also give you something for pain-some are pills-some are oral solutions. Most likely you may not have to do this unless the cat is showing signs of pain-meatloafing, not eating, hiding-general lethargic or isolating behavior (hiding under bed for more than a few hours)

On yahoo there's a group: Feline Lymphoma and discussion-this is where I learned this information. There's also a spin off group on facebook- feline intestinal lymphoma-most of those members also on yahoo group.

 

[MDad1234]

Thanks for your replies. I'll ask about the fluids and anti-nausea drugs when I next talk to the vet, which should be before I start the chemo drug later this week.