Lost about 4 lbs in an year/IBD or SCL? (Maybe EPI)

[S&Kdad]

Hello all,

First time posting on this site. My apologies for this long post in advance.
I'm worries sick and I have no one to talk to for advise.

I have 2 cats Sonic and knuckles born Aug 2016. Both are Ragdoll flame points from the same litter.

Sonic has been a big boy (14.5lbs) where as knuckles (11.5lbs) is little small with cute googly eyes.

About a year back my wife got pregnant and we moved in to a new bigger house. Right then both the boys were due for a rabies shot and annual examination. Thier doctor who doesn't work in the clinic any more noticed that sonic weights is same as knuckles (11.5lbs) . She told it is perfectly normal and dismissed it with out any importance. Fast fowarding to few months, i found out that Sonic is peeing on the carpet area next to the litter box and I noticed this has been an ongoing issue for quite some time. I took him to a new clinic next to our new home and they did ultrasound and found his intestine linings are enlarged and prescribed him prednisolone and gave him B12 injection. He was still peeing outside the litter box atleast once a day along with 2x Semi-soft stool. He eats about 4 cats of wellness wet chicken Pete small cans and Churu wet treat every night. But still didn't gain weight. So I took him to his old clinic and had a counseling session with the doctor and came up with a action plan. Added new litter boxes and changed the litter and just like that he stopped peeing outside. Last month I felt sonic was more lighter than usually so i checked his weight and he weighed in 10.2 lbs. Dropped a pound in 1 month. I took him to his old clinin again and they did the x-ray and found the same thing( inflammation GI ) and prescribed prednisolone and some medication to help aid the GI track. Since he started his GI tract aiding meds his poop has become solid and no vomiting. But no weight gains. His current weight is still 10.2 lbs after 2 weeks of using the meds. The doctor has suggested to do a surgery to take samples from his stomach, Intestine and liver for biopsy. The estimated cost for this procedure is ranging from 3k to 4k. It's expensive and not easy financially. but I don't mind spending the money. my biggest worry is that he would be in hospital for 3 days. He is very attached to us and I'm scared if staying away might do something to him.

I didn't get in details about the time line. The above whole scenario is from Aug 2021, till now.

On a side note 2019 knuckles was diagnosed with Inflammatory bowel disorder and the dry food diet is changed and he is doing well with very few vomiting since then.

Is there any other ways they can take biopsy without undergoing such a major surgery. What do you guys think ? Does he have cancer ? If so, given the duration of this whole episode would it be a small cell Lymphoma? I don't want to loose him. I'm worried sick inturn this has taken a toll on me and I have lost weight and I'm very depressed. Any advise/suggestions would be helpful.

Also, I don't have insurance for both my cats. Would it be a good idea to get insurance prior to getting any procedure done ? If so, please suggest so that I can start calling.

Thank you in advance.
Sonic and knuckles dad.

 

[fionasmom]

IBDKitties – Helping Save Lives…One Paw at a Time

This site may be of some help with questions about IBD. You said that Knuckles is doing well with the diet, so that is good news.

Where you are with this is, as I understand it, an ultrasound was done which showed enlarged or thickened intestines. This is what is causing your vet to advice the biopsies. Please don't panic as we absolutely do not know that Sonic has SCL or any other form of cancer; however, I would be less than honest if I did not say that your vet is probably suspecting that.

Some vets will do an FNA; however, my own vet told me that they are often inconclusive, just as the ultrasound while better than xrays can also be inconclusive. This leads to the suggestion of a more invasive biopsy. Endoscopies are also used, but can be less conclusive as well. Your vet is suggesting the most conclusive diagnosis which is the surgical biopsy as opposed to the endoscopic one. So, yes, there are alternatives, but many vets don't find them conclusive enough.

As for insurance....all pet insurances have preexisting condition clauses which would exclude previous treatment or conditions. Some will allow for a pre existing condition if it has not been treated for the last 6 months, or whatever the limit of that policy is. So a UTI which did not recur and was long past would not disqualify a cat from being treated for a future bladder condition.

which pet insurance covers pre existing conditions - Google Search

AKC covers preexisting conditions, but also only does dogs. Even at that, it has stipulations as to what. I would make some calls and do some searches as I certainly don't have the last word on pet insurance, but the IBD and ongoing investigation into Sonic's condition might disqualify you.

A couple of us have convinced out vets (well, really one of us and I followed suit) to treat SCL without the invasive biopsies. It means a huge discussion with your vet, if they would even consider it.

 

[Furballsmom]

Hi
Just to mention, both vet clinics have each other's information/data/test results etc?

 

[S&Kdad]

Yes, the data has been shared with each other.

 

[Furballsmom]

Yes, the data has been shared with each other.

That's good, - I was thinking about expressing my doubts about the original clinic but you mentioned that the vet who didn't find the weight loss remarkable has left.

I'm very depressed.

See if you can find a way, either taking walks in a beautiful park, playing with your new baby, maybe a little weight lifting, something, anything, to lift yourself out of the depression. Number one of course it's not good for you and your family, but your cat is like a little sponge for your emotions and you need to be strong for him

 

[daftcat75]

Sorry to say this but failure to maintain or gain weight despite eating enough or more than enough calories is pointing strongly to SCL more than IBD. There are other conditions that can rob cats of calories like HT and diabetes. Has his B12 been tested? IBD cats are often B12 deficient and this alone could present a failure to gain or maintain weight. Assuming you have ruled these out, I would ask your vet to try chemo since pred alone isn't managing it and he continues to lose weight. I wouldn't put a cat who is losing weight through a surgery because any weight lost from the recovery of the surgery is not coming back until the cause of the weight loss is addressed.

I understand that vets don't like prescribing chemo without a cancer diagnosis. But if the vets did their due diligence ruling everything else out in blood tests and they don't see masses/tumors on the ultrasound, then they are down to: IBD or SCL? The former is treated with steroids. The latter is treated with steroids plus chemo. Ask your vet what are the risks of putting an unstable cat through a surgical biopsy vs what are the risks of giving that same cat chemo without a cancer diagnosis? I would hope your vet would agree that the diagnosis can carry more risk than the drug. And that's what this conversation really comes down to. You tell your vet you are giving informed consent to treat this like cancer and add in chemo even though it hasn't been diagnosed.

Pet insurance won't help you. The time to get insurance was when you didn't need it. Everything that he has seen a vet for in the last year can and will be considered towards pre-existing condition exclusions.

 

[Furballsmom]

Regarding the insurance situation, this might help a little bit, from Forbes and updated Sept 2022.

Pet Insurance For Pre-Existing Conditions

 

[FeebysOwner]

I'll keep this short, as I know there has already been a lot of information thrown your way. It took a PARR assay to be done on the tissue collected from an FNA during an ultrasound to confirm Feeby's SCL. All of this is non-invasive and may only require a mild sedative (mostly due to the abdominal area being shaved for the ultrasound). You could look into this as an alternative to surgery.

The B-12 blood test is worth it, although not cheap, to see if your cat is not absorbing nutrients appropriately. Feeby - despite the fact that she can pretty much maintain her weight - is deficient. So, she has now been placed on B-12 injections, that I have learned to do at home.

 

[S&Kdad]

That's good, - I was thinking about expressing my doubts about the original clinic but you mentioned that the vet who didn't find the weight loss remarkable has left.


See if you can find a way, either taking walks in a beautiful park, playing with your new baby, maybe a little weight lifting, something, anything, to lift yourself out of the depression. Number one of course it's not good for you and your family, but your cat is like a little sponge for your emotions and you need to be strong for him

Thank you so much for your kind words. I'm a typical "over thinker" and my wind keeps wandering to worst case scenarios. I'll try my best. I haven't worked out in a week now. I think today would be a good day to start.

 

[Furballsmom]

I think today would be a good day to start

Good for you!! and you just motivated me to get going as well, so thank you !

 

[S&Kdad]

Sorry to say this but failure to maintain or gain weight despite eating enough or more than enough calories is pointing strongly to SCL more than IBD. There are other conditions that can rob cats of calories like HT and diabetes. Has his B12 been tested? IBD cats are often B12 deficient and this alone could present a failure to gain or maintain weight. Assuming you have ruled these out, I would ask your vet to try chemo since pred alone isn't managing it and he continues to lose weight. I wouldn't put a cat who is losing weight through a surgery because any weight lost from the recovery of the surgery is not coming back until the cause of the weight loss is addressed.

I understand that vets don't like prescribing chemo without a cancer diagnosis. But if the vets did their due diligence ruling everything else out in blood tests and they don't see masses/tumors on the ultrasound, then they are down to: IBD or SCL? The former is treated with steroids. The latter is treated with steroids plus chemo. Ask your vet what are the risks of putting an unstable cat through a surgical biopsy vs what are the risks of giving that same cat chemo without a cancer diagnosis? I would hope your vet would agree that the diagnosis can carry more risk than the drug. And that's what this conversation really comes down to. You tell your vet you are giving informed consent to treat this like cancer and add in chemo even though it hasn't been diagnosed.

Pet insurance won't help you. The time to get insurance was when you didn't need it. Everything that he has seen a vet for in the last year can and will be considered towards pre-existing condition exclusions.

I have taken your advice and I'm in talks with the vet. Thank you so so much ! you made such a logical point of Sonic being weak and might not recover. Also, Sonic is super attached to us and he has separation anxiety. Back in 2019 when we went for a vacation for a week, we dropped him off at my friends home with his own room and he last 2 lbs. I've made up my mind, once sonic gets more than 11.2lbs the would be the appropriate time to get the internal biopsies and go from there. Again, Thank you for the advice.!

 

[S&Kdad]

I'll keep this short, as I know there has already been a lot of information thrown your way. It took a PARR assay to be done on the tissue collected from an FNA during an ultrasound to confirm Feeby's SCL. All of this is non-invasive and may only require a mild sedative (mostly due to the abdominal area being shaved for the ultrasound). You could look into this as an alternative to surgery.

The B-12 blood test is worth it, although not cheap, to see if your cat is not absorbing nutrients appropriately. Feeby - despite the fact that she can pretty much maintain her weight - is deficient. So, she has now been placed on B-12 injections, that I have learned to do at home.

Thanks for the plan. Can you elaborate more on this "t took a PARR assay to be done on the tissue collected from an FNA during an ultrasound to confirm Feeby's SCL"?

 

[daftcat75]

Thanks for the plan. Can you elaborate more on this "t took a PARR assay to be done on the tissue collected from an FNA during an ultrasound to confirm Feeby's SCL"?

I can translate this.

If you want a higher degree of confidence that this may indeed be cancer, you can ask for an ultrasound with a fine needle aspirate (FNA.) A fine needle aspirate is using the ultrasound to guide a very fine needle into an inflamed region of the gut where a small handful of cells can be collected. Those cells can be subjected to a test called a PARR assay (I don't know what this stands for or what it entails.) The PARR assay can confirm the presence of cancerous cells. It can also provide a false negative if the FNA did not take a sample from the correct location or if there is cancer there but not in the sample that was taken. It would be a non-invasive, non-surgical option that could confirm cancer but not necessarily rule it out. The worst Sonic would go through besides the stress of the vet visit itself is a shaved belly and a cold probe on it.

 

[FeebysOwner]

The above information covered it for the most part. In an ultrasound, a fine needle aspiration (FNA) is done on 'suspicious' tissue. The FNA tissue is analyzed to determine what the suspicious tissue might be - sometimes that unto itself can identify cancer, one of which is SCL, small cell lymphoma, which seems to be the most common kind in cats. When the FNA analysis results are inconclusive that same tissue can be further analyzed via the PARR assay.
PCR for Antigen Receptor Rearrangements (PARR) | College of Veterinary Medicine at MSU

Many times, without the extra testing, IBD and/or SCL is assumed based on things like intestinal wall thickening seen in an ultrasound and outward symptoms (diarrhea, vomiting, weight loss for some more common examples) and then steroids - and in many cases, chemo - is recommended for treatment. With either IBD or SCL, B-12 injections are usually also recommended, as many cases of either or both can affect nutritional absorption.

 

[S&Kdad]

Thank you for explaining it @ daftcat75 and FeebysOwner

I did mention my doctor about the PNR procedure. She said it would be difficult since they aren't any abnormalities noticed in Ultrasound or X-Ray apart from GI being inflamed.

 

[S&Kdad]

Hello all,
Based on all of your inputs I wrote an email to Sonic's doctor and she replied back saying that she isn't 100% convinced that Sonic has SCL. She said she won't be going forward with the Chemo. However, She is suggesting to run a full GI panel and also to check TLI to check on pancreatic function and micronutrient absorption including B12.

Does this plan of action looks good ? Is there any other test that I should ask her to run the check on ?
So the TIL test, Sonic needs to be fasted 15 hours. Would the fasting throw the B12 level numbers ?

 

[FeebysOwner]

Those tests are covering a lot of territory. Have they already done CBC and Chemistry panels? If not, you might as well 'throw those in'.

While I hate it, many vets want cats fasted for just about all blood tests of any kind. And I was asked to fast Feeby for 12 hours for her cobalamin (B-12) test, so you should be OK.

 

[daftcat75]

Hello all,
Based on all of your inputs I wrote an email to Sonic's doctor and she replied back saying that she isn't 100% convinced that Sonic has SCL. She said she won't be going forward with the Chemo. However, She is suggesting to run a full GI panel and also to check TLI to check on pancreatic function and micronutrient absorption including B12.

Does this plan of action looks good ? Is there any other test that I should ask her to run the check on ?
So the TIL test, Sonic needs to be fasted 15 hours. Would the fasting throw the B12 level numbers ?

I think Sonic has to be fasted for accurate B12 numbers anyway. TLI is not a bad one to check.

Ask her at what point have we ruled out the other possibilities and want to try chemo?

 

[daftcat75]

I think Sonic has to be fasted for accurate B12 numbers anyway. TLI is not a bad one to check.

Ask her at what point have we ruled out the other possibilities and want to try chemo?

She’s the vet. I’m not. Let her tick off the boxes she needs to rule out other things.

At some point though, maybe she will consider SCL and try chemo. It’s one of those things that if it works (if it is SCL), you should see a response fairly quickly. But if it doesn’t, how long do you give it?

And that’s kind where you’re at with all these tests. Perhaps she’ll find it’s not SCL. But how many more tests will she ask for before she entertains the possibility that it might be SCL after all?

I would feel horrible if it wasn’t SCL and I kept pushing you to ask for chemo. So let her tick off her boxes. But I would also feel horrible if it was SCL and she just doesn’t feel comfortable without a clear diagnosis. This is a conversation to have with her.

 

[S&Kdad]

Thank you all for the pointers. I would definitely bring the above points up and discuss with the Vet. The blood draw is scheduled for this Wednesday (10/19) and she said they would get the results back by next week and she would decide the next course of action based on the report. However, she is showing more favor towards the surgery.

Meanwhile, Vet suggested us to change Sonic's diet to selected protein. At first he refused to eat any of these special diets. Finally started liking the Royal canning's PR and he is 100% on it from past 4 days. Ordered Royal canning's PD as well. He is eating 2 cans per day as apposed to 4 cans of Wellness chicken small cans and eats very little dry food (was never interested in dry food) He has gained 0.3lbs so far. I'm really praying and hoping it's not SCL. If this trend of gaining weight keeps up, gaining 0.2 ~ 0.3lbs in a week is a good sign, right ?? may be it's just my wishful thinking.