Lymphoma/IBD cat and Cerenia not working

[sushinemom]

Hello,
my baby boy (Lancelot, 6yo male) was diagnosed with Large Cell Intestinal Lymphoma ~8 months ago. He finished CHOP 3 weeks ago, after a somewhat turbulent rollercoaster with chemo side effects, but an overall great quality of life.

During his chemo, he's never been completely puke-free. Actually, one of the side effects he experienced was, according to his oncologist, Vincristine-induced paralytic ileus. This caused a sudden drop in his appetite and vomit, which got better (but was not perfectly solved) when we removed Vincristine from his chemo. Generally, his oncologist seems to think that he has both IBD and lymphoma, given that there's not been any sign that the lymphoma is spreading/getting worse, but he still regurgitates from time to time.

(Note: I'm using puke/regurgitate interchangeably, but he always empties his stomach within 1-2 minutes from eating in a tubular form, so it should be the first.)

Anyway, fast forward to now: he's been vomiting again and I'm worried.

The timeline:
- He regurgitated twice the week post last chemo after a 3-weeks vomit-free period.
- A week ago (2 weeks post chemo) we ran out of the food he usually eats, and I tried giving him beef instead (which he hadn't had in a long while). Immediately after, he projectile vomited brownish liquid. This was the first time I've ever seen him projectile vomiting liquid. Usually he just empties his stomach in a tubular form, typical of regurgitation.
- After the projectile vomit, I started giving him Cerenia. After that, once a day, he puked a tiny bit of brown liquid.
- I added Slippery Elm Bark thinking his stomach might be irritated.
- Yesterday, I started feeding him a bland diet of just boiled chicken, hoping that his stomach would be ok with a break. Yesterday he didn't puke, then this morning he got nauseous again and "threw up" a single piece of chicken after retching. It didn't even have liquid around it.

Now I'm worried sick because Cerenia doesn't seem to be helping much. One time, the oncologist said that Cerenia doesn't usually help stopping vomit due to cancer, so that's where my brain is going now. I'd love to think it's just an IBD flare up, but it's hard to find info on how those look like and whether Cerenia should completely stop the vomit then.

We have an appointment tomorrow for an emergency recheck with both an internal medicine doctor and his oncologist, so we'll get some answers hopefully. But if anyone has thought I'd appreciate them. It feels so scary and lonely to see a fur baby go through this.

(Oh, other fun fact: when he was on his previous food I had to follow him around to get him to eat because he was so nauseous and would only eat a bit at a time. Once I switched him to boiled chicken, it's like his nausea disappeared overnight. He keeps trying to open up whatever container I put it in and asking for more and more.)

 

[fionasmom]

Wecome to The Cat Site although I am sorry that the complications that Lancelot is having are what brought you here. Certainly you have been incredibly proactive about his treatment and care. Going to the vets tomorrow is the best thing you can do and, until you speak with them, try not to front load a lot of ideas that are going to make you upset.

The boiled chicken gave him some nourishment and some relief from the vomiting even if he did throw up a smaller amount than he has been.....all of which is good news. The fact that he now feels well enough to try to open the container is really cute and touching and hopefully a good sign. Others with more experience with your specific question may post. Please let us know what you are told at the vet's tomorrow.

daftcat75

 

[daftcat75]

Right up front, my experience is with small cell lymphoma. Anything I may have learned about lymphoma through this experience may or may not be relevant to large cell lymphoma. I'm not an oncologist or a vet or even a tech.

Vomiting and regurgitation should not be used interchangeably because the latter is much easier to solve than the former. It helps to become a connoisseur of cat barf in order to know what kind of treatment to seek.

Kinds of cat barf and how to recognize them:

1. Regurgitation: Often within minutes of eating and contains undigested or partially digested food.
2. Acid barfs: Usually occurs in the afternoon or early morning consisting of white foam and usually not much food
3. Bile barfs: Smelly and yellow. Like your cat just vomited poop. You don't forget one of these.
4. Poop barfs: Occurs directly after pooping and is usually a sign of constipation or straining.
5. "Hairballs": Occurs between meals and has a significant amount of hair and may or may not contain food.
6. IBD barfs: Often occurs 1 to 3 hours after eating and will contain a mix of undigested and partially digested food

Regurgitation is usually a simple fix: smaller portions fed more often. IBD cats are not digesting as well as they used to. Therefore instead of giving them the same two meals a day they ate when they were healthier, split it up over several smaller meals. A good start is taking breakfast and dinner and turning them into two breakfasts and two dinners. You can use timed feeders to cover daytime and overnight meals if you need to.

If regurgitation is too much at once, acid barfs is not enough or rather not often enough. Usually a timed feeder for the daytime and another for overnight can prevent the acid barfs. I recommend buying the clamshell design feeders and deploying them in pairs. They don't fail often (maybe four times over hundreds of uses in my experience with Krista.) But if the price for a failure is an acid barf, it's better to have a backup.

Bile barfs should be an automatic vet visit. Your cat reached real deep to bring this up. Don't try to solve this one yourself. A bile barf can be a sign of a dangerous blockage. It's best to seek emergency room attention rather than waiting and seeing.

Poop barfs are a corner case unless you have a chronically constipated cat. There can be another reason for a poop barf. My poor Krista. I was giving her her nightly pred pill wrapped in a small amount of fish flakes. I called it our devil's bargain because it was something she enjoyed and allowed her to pill herself each night. But it was also a trigger food for her IBD/lymphoma. The vet couldn't say one way or another how problematic this would be. When she started chemo, she went from liquid poops to mostly normal poops again. Well, the first round was always a normal poop. The problem was that the daily dose of an inflammatory trigger meant her remission was partial and there was often a second and even third round of poop getting increasingly softer. At the end of all this poop nonsense, she would barf. Poop barfs can be a sign of constipation. Or in Krista's case, a sign of persistent inflammation. When a surgery and its recovery forced my hand to switch her pred to transdermal and she wasn't taking a trigger food with her nightly pred, her remission was virtually overnight and finally complete. And if it came several months sooner, she might still be with me. It was too little too late for her and a bladder infection the next month would prove too much for her tiny steroids and lymphoma weakened body. I mention this because it's important to figure out IBD triggers and eliminate them completely. Do not rely on medication alone for Lancelot's treatment.

Hairballs are sadly common with IBD cats because of the chronic inflammation and the impaired gut motility. With all that inflammation, the digestive process moves slower than in a healthy cat. This is another reason to break up his meals over several small meals a day.

IBD barfs can be the most difficult to figure out. These are the ones you want to keep track of in a food journal. What did you feed? When did you feed it? When did he barf? Was it one of the other kinds of barf? If you can't chalk it up to something else, it is almost certainly related to either the IBD or the lymphoma. You will want to simplify his diet to make this easier to figure out. All wet food is best. There's just too much nonsense ingredients in dry food to make trigger food investigations possible. Rawz single protein pate foods are the gold standard for figuring this out: simple recipes that are truly limited ingredient and single protein. As I mentioned with Krista's poop barfs, it is not enough to simply medicate away the IBD or lymphoma. Until the triggers are found, remission won't be complete and recovery will be limited.
Where to Buy | RAWZ

If he seems to be eating the bland chicken diet without any issues, that's good news and a great start. You can get a supplement premix powder like EZ Complete or Alnutrin to make boiled chicken into a nutritionally balanced and complete diet.
EZcomplete fur Cats - Chicken Liver - Analysis

 

[daftcat75]

You may also want to sign up to the Feline Lymphoma support group. They are much more knowledgeable about lymphoma than I am.
Felinelymphomasupport groups.io Group

Often IBD develops first and lymphoma is the result of an overactive immune system (from the IBD) eventually going off the rails. Chemo is helpful in treating the cancer he has today. Managing the IBD improves the chances for a lasting remission.
IBDKitties – Helping Save Lives…One Paw at a Time

 

[sushinemom]

Thank you so much to both!

I would say what Lance goes through is most likely regurgitation, though this last week's "regurgitation" gets me worried cause it's very different than usual. There were still small amounts of undigested raw treats we gave him, but it wasn't exactly the same as the food he had just ingested like it was before. It doesn't really seem to enter in any of those you describe, really. I'm attaching a (very gross) picture. This happened immediately after feeding the beef. I really wonder (and hope) that the beef I fed him was just not what his stomach needed and he's being just slow in the recovery.

I wanted to get him on rawz, but he's being extremely picky about what he eats. I feel like chicken might (or not) be a trigger for him, and I'll discuss it with the vets tomorrow. Maybe I can find a novel protein to cook for him for a while to make sure nothing disturbs him. I'll feel better if I can get him in complete "remission" again.

For what is worth we were already feeding him multiple times a day before he developed lymphoma, specifically to avoid him vomiting. I think now i might just go a bit with very very very small bites throughout the day until he recovers. We have a journal but there's not really any pattern, except that it's always immediately after we feed him (within minutes).

I wonder if temporarily increasing prednisolone might help?

Someone suggested that if his stomach is very inflamed he might not be absorbing his medication quite as well. I'll ask the vets tomorrow about maybe giving him injectable cerenia.

 

[daftcat75]

With Krista, her IBD barfs generally happened 1 to 3 hours after eating. I am leaning towards regurgitation as what you are seeing. I ended up feeding Krista six times a day in her final years. Two breakfasts, two dinners, a pair of daytime feeders and a pair of overnight feeders. I guess you could say that was eight meals if you're tallying them up. But the feeders were more like a single meal split across two feeders in case one of the feeders failed to open. I like the clamshell design because it doesn't put a time limit on the portion. It won't rotate uneaten portions back inside the wheel like wheel feeders do.
Amazon.com : PAWISE Automatic Pet Feeder for Dogs and Cats, 1.5 Cup Food Dispenser Feeder with 48-Hour Timer - Single : Kitchen & Dining

Is Lancelot also receiving B-12 shots? If he is not, these are essential for IBD/lymphoma cats precisely because the chronic inflammation and chronic vomiting impairs gut absorption of B-12. But B-12 is so necessary for proper digestion and many other body functions.

Optagest was something that was helpful for Krista. Some cats do better with digestive enzymes. Some don't. I recommend introducing it in far smaller quantities to start. With Krista, she was getting meals of 45 grams to 56 grams in size (approx 1.5 oz to 2 oz) and she would get 1/8 tsp of the Optagest mixed into each meal. Digestive enzymes aren't a miracle cure. But they can be helpful. File them under "might help, probably will not hurt."
https://www.amazon.com/dp/B002YGORPW/?tag=thecatsite

I think the beef was just a shock to his system. If he doesn't normally eat beef (or any other red meat), it wouldn't surprise me if it caused him to barf. I went off chicken almost 20 years ago. I can eat eggs just fine. But if I get chicken in my food when I ordered veg*n or fish, it's either coming back up or ripping right through me. Or both. If you try another protein like turkey or rabbit with Lancelot, I would introduce it slowly over several days to a week. Start with a spoonful. Give it several hours before offering another spoonful. The next day, you could try a bit more (spoon and a half?.) Do this over several days until he's eating a full portion of the new protein or you've determined that the new protein is not treating him right.

 

[sushinemom]

Yeah, it's likely regurgitation, which is what he always had issues with. We've been feeding him 6 meals per day since he was a kitten exactly for this reason. We also switched proteins at the time to get his vomit down. He was doing fine with the occasional flare up, until he started vomiting multiple times a week this past September and was finally diagnosed with lymphoma in January.

We did test his B12 and it turned out he had very elevated levels of it. He's had some shots of it together with acupuncture though, which he's having for vomiting. Didn't seem to make a difference.

His current regimen is:
[Morning]
- Ondensatron 2mg
- Proviable (probiotics)
- Happy Earth (traditional Chinese medicine herb)
[Afternoon]
- Slippery Elm Bark
[Evening]
- Cerenia 4mg
- Ondansetron 2mg
- Prednisolone 5mg
- Happy Earth

He's an 11 pounds cat. He hasn't been losing weight at all during any of this.

Yeah, point taken on the beef. The reason I find this weird is that he's actually never had a problem switching food, and never had to do it gradually. During chemo he would regularly start refusing things, and I'd just swap it out with no issue (the biological sister is the same way). I have to say that the only food he was eating in the last month, however, was a chicken pate that was full of gums and bad stuff. I couldn't switch him off it, but I also would hope that is part of what caused the irritation.

Aaahhh, I wish I could have answers immediately, but I suspect this will take a while even with the vets. They never found anything on his ultrasound, the only way we got him diagnosed was with an endoscopy, and even then it was kind of a miracle (we found a tiny amount of cells that pointed to lymphoma in a sample the vet didn't even want to test further cause it was unlikely to yield results). I've wanted this to be wrong for so long. Sigh.

 

[daftcat75]

Cerenia isn't likely to stop regurgitation and it most likely won't stop an IBD barf either. Because he's already taking ondansetron, he's already getting an anti-nausea medication. Cerenia has been known to cause appetite issues in some cats. Perhaps you can discuss with the vet or specialists about giving him a break off the Cerenia. Does the Happy Earth help? Some cats are sensitive to some herbs. You may also want to do a controlled elimination of that one to see if that might be upsetting his stomach and causing the regurgitation. By controlled elimination, I mean keep everything else constant. If you're also giving him a Cerenia break at the same time, you won't know which is doing what. Another concern of TCVM is that quality control isn't always what it should be. Some TCM supplements have high levels of heavy metals as contaminants or impurities in the manufacturing process.

 

[sushinemom]

Thank you, those are good thing to hear regarding Cerenia not always stopping these issues. He started puking during a break from it, so I started it again.

Regarding whether the Happy Earth is helping, we actually did start a couple weeks ago, right after his first regurgitation after chemo. No telling whether this is causing this particular issue of "new vomit". Herbals can take up to a full month for full effect, so I'm hesitant to stop it now in case it ends up helping. I do trust this TCVM doctor, but I'll discuss it with the regular vet too.

You're right that keeping things constant is important to know what's helping. It just makes it so hard cause I feel like I'm rushing against time and if I don't get this under control immediately it will be too late.

I've also bought Mushroom Immune Gold for him and wanted to start it before the vomiting issue surfaced

 

[cataholic07]

What food are you currently feeding? You want to make sure it is carrageenan/agar agar free wet food only or a balanced raw diet. You will also want a bunch of different ones too because I find if they vomit it up, then they do not want it again for awhile. For felice we had 4-5 different brands on hand always.

 

[sushinemom]

Lancelot had his visit yesterday, and the ultrasound was clear!! They found no masses, nor thickening, nor any enlarged lymph nodes, which make cancer issues "unlikely".

The internist suspects Lance has "poor esophageal motility" rather than/in addition to IBD. According to them, IBD cats usually vomit 20-30 minutes after food rather than within 1-2 minutes as he does. He's now taking 2.5mg of cisapride every 12hr. Since this issue predates the cancer they're considering it within normal parameters (for him).

This is all excellent news, of course. I'm still a bit on edge, given that he's never showed any clinical sign on the ultrasound in the first place, and the only sign was unusual vomiting patterns. If he hadn't "projectile vomited" that one time, which was indeed unusual, I'd be much more relaxed. I so wish I hadn't given him the beef! Telling myself it was that, or alternatively the Chinese medicines we've been giving him, and hoping cisapride clears everything up.

For now, he continues to ravenously eat his boiled chicken. What an incredible difference since we switched him from his previous canned food! I went from following him around to force him to eat to having to hide the chicken in sealed containers to stop him from scarfing it down. For now I'm not changing anything until we're out of the woods (I'll supplement taurine later on if needed), but I'll definitely be looking into novel

I hope once things calm down I can get him to put a little bit of weight (he only lost 0.5 pounds in these 8 months, but I'd rather he gain them back).

Thank you all for the support, I'll keep you posted!! Crossing fingers

 

[daftcat75]

Good news on the ultrasound. No thickening basically rules out IBD. When was the last time his teeth were checked out? Cats barely chew their kibble anyway. But if he’s got dental pain, he may be trying to chew even less or swallow it whole. These whole pieces would fill him up pretty quickly and could explain the regurgitation.

Just a reminder that boiled chicken is not a nutritionally balanced and complete diet. It will need more than a taurine supplement. At the very least, you should be adding a calcium supplement until you can either make this complete or move him to something that is. Without the calcium supplement, the phosphorus in the chicken will need to be balanced with calcium from his bones and teeth. This will become problematic over time.

For a calcium supplement,
Prymal Pets Organic Eggshell Calcium - Natural, Ultra-Pure Egg Shell Mineral Powder Supplement for Cats and Dogs - High Absorption, Helps Support Bone, Joint, Teeth, Heart, Immune Health - 12oz Amazon.com : Prymal Pets Organic Eggshell Calcium - Natural, Ultra-Pure Egg Shell Mineral Powder Supplement for Cats and Dogs - High Absorption, Helps Support Bone, Joint, Teeth, Heart, Immune Health - 12oz : Pet Supplies

1 teaspoon per lbs of meat.

Or there is EZ Complete which can make that boiled chicken nutritionally balanced and complete. Though some kitties might have trouble with the green lipped mussel powder in it. They do offer samples. I recommend you try this.
EZComplete Fur Cats 225g - Makes 12.1 lbs of food

There is also Alnutrin. But you will need to add some chicken liver to the boiled chicken.
A Guide To A Balanced, Homemade Cat Food - Alnutrin Supplements

 

[sushinemom]

No thickening basically rules out IBD.

The weird thing has been that he's had lack of thickening since the very beginning, which was used to exclude IBD/cancer until eventually we checked his stomach and found the walls of it were all inflamed (and found signs of cancer in the biopsies). Whatever he has, he clearly doesn't have the usual presentation of it, which sucks because it makes figuring out whether the cancer is back a lot harder since ultrasound alone was not enough to see anything. Hopefully with large cell lymphoma we'd find masses or enlarged lymph nodes if things were worsening, which we haven't.

Thank you for your advice on the supplements. For now we're not changing anything until we can be sure that the cisapride is working. He retched again this morning (once, didn't vomit) which makes me think the problem isn't solved, but it might be worth waiting another couple days before trying something else.

 

[sushinemom]

He hasn't retched in the past couple days, but I still see him more nauseous than usual. It isn't super overt, and I might be looking at him a bit too closely, but I've seen him hang out at the water bowl a bit more often than I'd like. The good news is that when he does he gets his back up and follows the movement of my hand when I caress him, which is usually a good sign that he's not super nauseous.

I did see him drink a bit more than usual, but that might be cause the chicken is more dry than his usual meals so he needs the additional water intake. His urine output doesn't seem increased.

Anyway, we stopped the Chinese medicine and we'll see if that's what's disturbing him. I also asked the vet if we can run a complete blood panel to check his kidney/liver function. He's had chemo and steroids for over half a year now, and I know they check for everything throughout but I worry.... If something is going on, I want to catch if asap.

I haven't taken his weight recently cause his sister has also been sick and there's only so much bad news and anxiety one can take. He's eating and drinking fine, and he's playful and not hiding, so I don't feel like it's super urgent. Last time we weighed him was a week ago, and he had lost 0.1 pounds but that was after a bout of nausea.

Ugh, i know that the vet said that the ultrasound is showing nothing so it's not the cancer, but I really worry whether that's true or not. I wonder if an x-ray would show more stuff, but also I don't know that i should get him through all these procedures just because I'm a worrier.

 

[Maiaiam]

Hi there--

I hope that your other kitty is feeling better and that Lancelot remains stable!

I found this thread earlier this week while I was digging into the research available regarding large cell lymphoma vs IBD. My darling cat M'eira Bella has had a similar diagnostic and treatment path as Lancelot, and so far she has beaten all of the odds and happily confounded her oncologist, her primary vet and all of the specialists she's seen. She was 10 when she was diagnosed with intestinal IBD and also lymphoblastic lymphoma cells in her stomach lining (via endoscopy biopsy) last October. Her bloodwork has always looked perfectly normal, even during chemo, aside from a recent small elevation in lymphocytes, which indicates some inflammation. M'eira is now almost 11 and a half.

I skip the history that led me to want to go deeper than bloodwork. Her initial ultrasound last August looked pretty much normal, but I knew that something was just not ok with her, so I opted for the endoscopy. After the cancer diagnosis we went through CHOP, but I discontinued after the 12th treatment (in February 2021) because she was so nauseous and having so many side effects. She actually improved markedly after that, but she has needed to remain on Cerenia, Zofran, 10mg prednisolone daily, a small dose of mirtazapine, a tiny bit of metronidazole, plus small doses of buprenorphine and gabapentin (she also has some neuropathy in her hind legs). When I've tried to eliminate or reduce, she will begin to vomit either just acid liquid (foam) or her most recent meals, so we are just holding steady for now. M'eira also has hypertrophic cardiomyopathy, but that has remained totally stable for many years (which also doesn't make sense to her cardiologist).

After her last biopsy I have been giving her a variety of supplements from a company called NHV, and I swear she started to eat more the first day I gave her the initial dose of yucca tincture. If you'd like to know the names of the other, let me know. She has had no diarrhea for months, her appetite is great, she is a fabulous weight, her fur looks much better (she's a medium haired torbie), some of the muscle wasting over her spine has even been reversed.

M'eira has had a total of 5 ultrasounds and two endoscopies. The ultrasounds have never shown anything aside from slight/minor thickening in portions of the stomach lining, so it seems that the cancer is remaining only in her stomach lining and it hasn't worsened, which is very atypical for that type. The second endoscopy biopsy showed what was again typed as large cell lymphoma and based on what the specialist (who I believe is generally excelled and highly skilled) saw in her stomach (irregularities and erosions), M'eira was given days to weeks to live. That was four months ago, and M'eira does not appear to be leaving anytime soon. I call her my miracle kitty.

One of the reasons I am writing now is that your Lancelot had a recent ultrasound that showed "nothing" and your doc concluded that the cancer is gone. Based on my experience with M'eira, that may not actually be true. The only way to really find it is to get another endoscopy and biopsy, which of course is hard on cats' systems and also potentially expensive.

However, there is yet another potential twist to my story. At the bottom of the biopsy reports there were a couple of sentences stating that "further testing to confirm diagnosis" could be conducted for an additional fee. The internal medicine specialist who did the endoscopy didn't mention that to me, I found it myself because I request all test results for everything and then read it all. When I asked about it, she called me up personally, maybe because she thought she had made an error in judgment in not offering me that option. As I result, I have requested more specific testing on the biopsy samples, because I am not completely convinced that M'eira was diagnosed correctly. From what I've read in the literature, IBD and lymphoma cells can look very much alike. I am waiting on the results and I believe that if they are not conclusive, there is even more analysis that can be done.

I guess I am wondering whether Lancelot was diagnosed correctly as well, and wanted to make sure you knew that there are more analyses that can potentially be performed on those biopsy samples. In M'eira's case, the lab keeps tissue samples for an entire year, so they could easily do those tests.

These extra analyses are fairly expensive, like more than an ultrasound costs. I don't want to assume that you are able to continue to pay for more testing. I am fortunate to have amazing pet insurance which pays 90% of all costs with a literally one-time low deductible per condition, which is in part why I am able to do everything I can for my kitties. I am the kind of person who wants to do all that she can, regardless; I'm aware that isn't typical and that many pet parents just don't have the means. I learned the hard way...I didn't have pet insurance with my dearly departed soulmate cat Trillium who at 8 years old, ate lilies (a large quantity!!), survived despite kidney damage, and with lots of support, lived 6.5 more wonderful years, getting subcu fluids from me every day. But that's a story for another time.

I will write again once I receive the results of the initial set of analyses. All I want is to be as certain as possible that M'eira was diagnosed correctly.

 

[Maiaiam]

Excuse the few typos and misspellings, it's been a long day!

 

[fionasmom]

Welcome to The Cat Site! Thank you for taking the time to explain the treatment path that you have chosen for M'eira Bella. Certainly you have spared no effort to help her. I agree with you on pet insurance.....we learn the hard way. I now have it for my three youngest cats and, ironically, one has two serious conditions which I have been able to monitor thanks to the insurance.

NHV is the Canadian company in Vancouver which sells pet supplies?

M'eira had an ultrasound and endoscopy, as I am reading this. So additional testing is only on biopsy tissue and you were able to avoid a surgical biopsy which is usually step three?

Here is hoping that M'eira will continue to be the miracle kitty!

 

[Maiaiam]

Thank you for the welcome and the good wishes for M'eira! It is so comforting to know that this community exists. I imagine that many of us (even those with partners/family/friends) end up feeling alone while caring for ailing kitties, in part because they can't tell us in words what they're thinking and feeling.

Yes, NHV is that Canadian company. They offer stellar customer service and even a free video consult with one of their vets/specialists.

You are correct that M'eira has not had a surgical biopsy. It probably would be useful diagnostically, but given her heart condition and the recovery time needed for that kind of procedure, it feels pretty risky. She is a sturdy girl (a happy 11.5 lbs now!) but that last endoscopy threw her for a loop.

Like sunshinemom, I also wish there were more info available about Cerenia's effectiveness for various types of vomiting. M'eira is currently taking 12mg nightly, which is a lot, and even on that dosage she's had a few breakthrough vomiting episodes. I hypothesize that one was a food rejection and a couple of others might have been that she was overfull after a day of consumption. I wonder if there are Substance P type barfs and also more physical/physiological type barfs, and Cerenia might not work for the latter. Originally she was taking 6mg, which was increased during chemo to 12mg, then she didn't seem to need it at all, but when she started foam vomiting in the mornings I started her back up again. I've tried to reduce to 9mg but I am now so freaked out when she has big vomits that when she last threw up on that dose I upped her back to 12mg. Anecdotally it seems like cats can tolerate Cerenia for quite a while, but since M'eira is now in "bonus time" according to her doctors, we are hanging out in total unknown.

What a journey. I feel so grateful to be able to see her return to being so playful, affectionate and seemingly content given the darkness that cancer diagnoses can bring.

 

[sushinemom]

Sorry for the late reply, I've had a couple of eventful weeks with our other cat also getting sick and once they both got better I took some time off thinking about their health issues to just enjoy them.

Before I reply to the other posts, an update on Lance: we removed the TCVM medication (Happy Earth) and he stopped retching! He still seemed a bit nauseous and hanging around the water bowl, but I've seen him do it less and less these days. We did a full blood/urinalysis panel for him, and the results were very good, with just some mildly elevated BUN but regular SDMA (so likely some dehydration), and a low lymphocyte counts likely due to prednisolone. Anyway, he still loves his chicken, is super hungry, and I'm finally seeing his weight trending up!

Next steps:
1 — We add the eggshells to his diet
2 — We remove the ondansentron
3 — We remove the cerenia

...and hopefully he doesn't begin puking again once all these are gone. My nerves are going to kill me throughout the whole process, but it's what needs to be done.

(Making another post to reply to the new posts in the thread.)

 

[sushinemom]

M Maiaiam thank you so much for writing! It's remarkable how similar the paths of our two kitties have been.

Just highlighting some of the similarities:
- Her bloodwork has always looked perfectly normal, even during chemo
- When I've tried to eliminate or reduce, she will begin to vomit either just acid liquid (foam) or her most recent meals
- The ultrasounds have never shown anything aside from slight/minor thickening in portions of the stomach lining (though Lance's never showed any thickening at all)
- The specialist saw irregularities and erosions in her stomach

I also tend to be skeptical of the "ultrasound showed nothing so he's fine" conclusions. For now, Lance seems to have stopped retching (as I said before) so if everything goes well and he doesn't puke again once we remove all the other medication we can breathe more easily. But if he keeps vomiting, especially in a pattern that's different from the one he had since he was a baby ("regurgitation after food" vs "vomiting after eating/on an empty stomach"), then I might indeed push for another endoscopy. Hopefully it won't come to that.

I've also doubted Lance's diagnosis, and until his PARR test eventually came back positive for lymphoma I was in full denial. Now I'm only in a smaller level of denial: according to the oncologist, we've "caught this the earliest he's ever seen". I hope that means that we did indeed get rid of all the cancer cells, and he simply has some IBD left to contend with. But also I've come to the conclusion that, assuming he was misdiagnosed, then he's going to be with us for a long time and I have nothing to fear. If his diagnosis is correct, I'm glad I get to be more intentional in my enjoyment of him, even if it comes with a lot of heartache.

That said, do you know the name of these additional tests? Lance had immunohistochemistry and PARR testing done on his sample, and according to the oncologist this means "we can conclude with almost certainty that he has last cell lymphoma". I have of course held a lot of hope in that "almost certainly", but as I said I'm still going with the assumption that the diagnosis is correct.

I'd also love to know the names of the supplements. I'm holding off on everything until we get steps 1, 2, 3 above taken care of, but it's good to know for the future.

Thank you so much for writing, it's great to feel less alone in this weird, heartbreaking experience.