Lymphoma/IBD cat and Cerenia not working

[sushinemom]

...so I wrote all this and then he retched again today, after two weeks of nothing. Nothing came out, and we had forgotten to give him the usual Cisapride/Cerenia/Ondansentron combo we give. Hopefully it was the lack of Cisapride that made him not empty his stomach quickly enough.

Aaaaah, the process of removing medications will kill me, I already know.

 

[sushinemom]

We took away the Cerenia yesterday and he puked again tonight. I was hoping it was just a coincidence (or the fact that we had run out of cisapride), but then I woke up this morning and found he had likely puked water mixed with a little bit of fur in the living room. Puking on an empty stomach is 100% not normal for him, and the issue that eventually led him to be diagnosed with cancer.

My heart is sinking. Incidentally, we have a visit for a recheck with the oncologist in a few hours. I'm almost sure they will find nothing, like they found nothing every time we went. I don't know how much I should insist with them that the cancer is back. My mind keeps both telling me that this is it, and finding excuses of other stuff it might be.

I wish this wasn't happening. It's so unfair to such a sweet, young boy.

 

[Maiaiam]

We took away the Cerenia yesterday and he puked again tonight. I was hoping it was just a coincidence (or the fact that we had run out of cisapride), but then I woke up this morning and found he had likely puked water mixed with a little bit of fur in the living room. Puking on an empty stomach is 100% not normal for him, and the issue that eventually led him to be diagnosed with cancer.

My heart is sinking. Incidentally, we have a visit for a recheck with the oncologist in a few hours. I'm almost sure they will find nothing, like they found nothing every time we went. I don't know how much I should insist with them that the cancer is back. My mind keeps both telling me that this is it, and finding excuses of other stuff it might be.

I wish this wasn't happening. It's so unfair to such a sweet, young boy.

So sorry that I haven’t yet replied...I do plan to do so! I can TOTALLY relate to what you’re feeling and am sending good energy for this next visit (which may have already occurred?). My heart is with you. Again, what you're reporting has occurred recently is SO similar to my M'eira.

Depending on how long ago the endoscopy was and how much it would help you to potentially have more info, you might want to consider that again (as you’d mention you might). My girl had her second endoscopy about 6 months after her first one and although it was hard on her, she came through it and the biopsy showed the lymphoblastic lymphoma calls again. Results of the deeper testing on the biopsy recently seems to confirm that diagnosis as well. I think you have already used that additional testing but I’ll check the report and let you know exactly what test(s) they did, and also the names of the NHV supplements.

Gotta get ready to see a full day of clients (I'm a psychologist) but I'll be checking email. Please update after the oncologist appointment. As nerve wracking, unfair and heartbreaking as this is, I'm glad that we have connected so we don't feel as alone in this.

 

[sushinemom]

Thank you so much!! Please take your time in replying, we're all here in the long run hopefully.

The oncologist called us and...... Everything is normal! They checked all the lymphonodes, all his organs, and the thickness of his stomach and intestines and nothing is showing up.

So, long story short, they're not worried. But I still am! They said they could theoretically do another endoscopy, but they don't see a reason to put him through this now. I also asked if they could do x-ray to see if maybe the masses are somewhere else, and they said that nothing makes them think there's other stuff going on with e.g. lungs or heart. I asked about checking his esophagus, and the procedure would likely be similar to the endoscopy. In any case, we have an appointment with the internist in a week, which will be the person place to ask about testing rather than the oncologist.

So, here we are. I'll keep a close eye on his feeding and hope i don't see any more empty-stomach puke. Hopefully the removal of the cisapride together with the cerenia was what made this worse. I'm not holding my breath, I'm honestly anxious and scared and feel not taken seriously enough. I mean, I agree that we don't want to just rush into other tests but..... AARGH!!

 

[sushinemom]

He's dry retched twice on an empty stomach this morning again, so I think it's fair to say he's having symptoms consistent with his condition before chemo.

I don't know what to think. I need to write to the internist and the oncologist with my concerns but it's so emotionally hard. At the very least, a day won't change much so I'll keep it for tomorrow. All that aside, he's keeping down food and doing great.

I want to give him more supplements, but I know I need to hold strong for a little bit more and keep monitoring this. We might switch him to RAWZ rabbit in the meantime since I assume chicken can be an irritant. It shouldn't make a difference, but it can't be bad for him.

 

[daftcat75]

If he's still eating chicken, then absolutely give rabbit a try. I can tell you from experience that remission won't happen or will be incomplete if he continues to eat his trigger foods. Medicine (chemo) can only do so much if you keep throwing a lit match in his gas tank.

 

[Maiaiam]

He's dry retched twice on an empty stomach this morning again, so I think it's fair to say he's having symptoms consistent with his condition before chemo.

I don't know what to think. I need to write to the internist and the oncologist with my concerns but it's so emotionally hard. At the very least, a day won't change much so I'll keep it for tomorrow. All that aside, he's keeping down food and doing great.

I want to give him more supplements, but I know I need to hold strong for a little bit more and keep monitoring this. We might switch him to RAWZ rabbit in the meantime since I assume chicken can be an irritant. It shouldn't make a difference, but it can't be bad for him.

He's dry retched twice on an empty stomach this morning again, so I think it's fair to say he's having symptoms consistent with his condition before chemo.

I don't know what to think. I need to write to the internist and the oncologist with my concerns but it's so emotionally hard. At the very least, a day won't change much so I'll keep it for tomorrow. All that aside, he's keeping down food and doing great.

I want to give him more supplements, but I know I need to hold strong for a little bit more and keep monitoring this. We might switch him to RAWZ rabbit in the meantime since I assume chicken can be an irritant. It shouldn't make a difference, but it can't be bad for him.

Is he still taking the cisapride, Cerenia, prednisolone and ondansetron? Slippery elm? Other meds? Has sucralfate been suggested already? It does sound like he has irritation in his esophagus and/or stomach; sucralfate is similar to slippery elm in that it is potentially soothing; it forms a gel-like "band-aid" on erosions and ulcers for about 6 hours. Challenging part is that ideally it needs to be taken 3 times a day and away from food and meds because it can potentially inhibit absorption. I gave it to M'eira after her last endoscopy because of the erosions found on her stomach lining, and she did ok with it initially, but the last couple of times I tried to give it to her she vomited hours later and that can be a side effect, albeit rare, so I went back to slippery elm.

What did his esophagus look like based on the endoscopy? Did it look totally normal?
Do you chase the pills you give him with water? I read on the IBD website that for some cats, pills can get stuck going down and can irritate the esophageal lining. There's a condition called esophageal stricture that can develop when that happens over time. M'eira takes pills like a champ and hasn't done any retching or regurgitation, but after I read about issues with pills I've been squirting a small amount of water in her mouth each time I pill her. She doesn't seem to mind and I am more certain that she has actually swollowed the pills. I put pretty much all of her meds in tiny capsules (size 4) because they go down easy and hide any aversive taste. Supposedly Cerenia tastes absolutely awful to cats and can cause that crazy foaming reaction.

Yes, it is emotionally exhausting and painful to have to keep up on everything. I hope you're being told by the docs and other folks in your life that your commitment to maximizing Lancelot's quality of life is exceptional.

One of the ways I try to navigate the emotional rollercoaster while remaining vigilant is to pull back occasionally and look at the basics:
appetite, energy level and playfulness, interest in engaging with other cats and with humans (whatever was typical pre-illness), fur condition, grooming behavior, urination/defecation regularity and normalcy, weight maintenance give or take a few ounces (what does Lancelot usually weigh?). That way, when hiccups like vomiting/retching occur, you can stay connected to his overall state of being, which hopefully will feel reassuring. For a long time, whenever M'eira vomited or had low energy, I tended to feel a lot of fear/anxiety because I connected it to the initial shock of the cancer diagnosis and started to catastrophize. Once I realized what was happening with me emotionally, I worked on reminding myself that I was doing the best that I could for her and that of course I don't want to feel unprepared or taken by surprise, but with cats, since they are masters at hiding things no matter how in tune with them you are, being surprised by them in various forms is often part of the package. Also, since they can't tell us anything in words, we often have to rely on hindsight to learn.

Another thing I have made peace with (mostly) is that although I wanted to try to get her off all of the meds because that would reassure me/prove she was in true remission, what matters most is maximizing her quality of life. And if that means M'eira will be taking pred, Cerenia, ondansetron etc for the rest of her life because it helps her feel good, so be it. Of course remission is the most desirable outcome, but we are talking about large cell lymphoma here...from what I've read and been told, any cat that lives longer than 9 months after diagnosis (even with chemo) is moving into outlier status. That said, it's been great to find articles on the web describing miraculous kitties who have lived 4-6 years after large cell lymphoma diagnosis, or who have lived even longer and who have eventually died of other causes.

Lancelot has a lot going for him in that he's young, clearly quite resilient and the cancer was caught incredibly early. Plus he has you caring for him!!
Since M'eira is twice his age and has other conditions, I feel that I need to stay realistic about her potential longevity. Just yesterday she was really low energy, seemed nauseous and somewhat checked out and I thought it could be the beginning of the end, but then at 11pm last night she rallied once again, got hungry and has had a great day today. Go figure.

It's certainly possible that Lancelot is sensitive to the chicken, but if you try another protein and he doesn't like it/rejects it by vomiting etc, then you have to weigh the costs and benefits of giving him what he likes most. From trial and error I figured out that M'eira is intolerant of seafood and especially salmon, which is a big bummer, since fish and especially salmon are in so many foods. I had her on all kinds of fancy/high end grainfree wet and dry foods, but after being told of her reportedly dire state after the second endoscopy, she was really loving a grainfree Purina chicken treat so I transitioned her onto their grainfree "chicken and egg" kibble plus Wellness Core chicken/beef pate and she's done very well with those. She historically seemed to be able tolerate lamb, duck and rabbit. The beef was new for her, but it didn't seem to shock her system at all.

If you don't mind me asking and it's not against the rules to ask, where are you generally located? You seem like you have a really good team of specialists. I live in Portland Oregon.

Here are the supplements I obtained from NHV that seem most relevant for your boy:
Yucca, ES-Clear and Nature's Immuno. I have other ones as well, but use them sparingly and based on my intuition. I do suggest that if you have the time and the bandwidth, chat with an NHV customer rep and/or take advantage of the free video consult. I felt no pressure to purchase anything and I felt validated and supported. My pet insurance (Trupanion) has covered all of the supplements at 90% without question, too.

Will you post pics of Lancelot and his sister (who hopefully is all better now)? I'd love to see them. I'll see if I can post a couple of pics of M'eira.

[I also have another kitty (Shaena), who I took in 10 years ago when she was a feral kitten...so far she's remained in good health. Her daddy who was a super sweet "stray" actually brought her and her momma to my backyard, probably because he knew I would take care of them. He had a really good immune system, let me tend to an abscess that healed well and lived long for a totally outdoor cat, so I'm hoping that Shaena will have a long uncomplicated life.]

 

[Maiaiam]

Here's my sweet, beautiful girl. The shot outside was taken relatively recently and she's conveniently hiding her shaved belly and leg areas

 

[sushinemom]

I'm really sorry for the radio silence: I hadn't noticed that the thread had updated, and then things were too chaotic and I couldn't find the time to write. But I'm back now!

Where we're at: Lance went back to vomiting on an empty stomach almost daily, especially after the switch to RAWZ rabbit, though it's hard to know whether that's a coincidence or not. Right now, he's on daily Cerenia, which seems to be controlling symptoms (though sometimes he burps in a way I don't like). On suggestion of the internist we upped the prednisolone to 7.5 mg, which doesn't seem to have helped too much. We might up it more to 10mg, which to be honest seems more like the dose he should be at given his weight.

His doctors don't seem to think that the cancer is back (because no thickening and no weight loss—his weight actually increased), but they also don't exclude him being out of remission. They said we can do another endoscopy to check what's up. I don't know whether that would help. With that said, we got Lancelot an appointment with another internist and another oncologist, so we'll see what they say. Those are in around 20 days.

One thing we want to try now is switching him to an hypoallergenic diet because a doctor that looked at his folder suggested that his IBD might be more strong than initially considered, and controlling that set aside for the diagnosis of large cell lymphoma. We had tried Z/D in the past, but that had been ineffective. Does anyone know what good hypoallergenic diet might be? I'm exhausted by all the research I've been going through, and would appreciate some info.

Now, for some of the questions:

Has sucralfate been suggested already?

It hasn't! I might ask the internist about it. Right now he's taking prednisolone 7.5mg, Cerenia 8mg, Cisapride 2.5mg 1xDay, and Ondansentron 4mg 2xDay. I took away the slippery elm cause it didn't seem to be having much of an effect. He didn't love having it squirted in his mouth, so there's that. We're right now looking into a very strong probiotic called Visbiome. I also have other supplements, but we need to try one thing at a time. It's so hard to hold back.

Thank you for your list of supplements. I might try them in time.

What did his esophagus look like based on the endoscopy? Did it look totally normal?
Do you chase the pills you give him with water?

I think it was normal, as far as I can tell. We also do chase pills with water after reading about the same information. TBH, I think the problem is indeed in his stomach, not esophagus, no matter what the internist say.

I hope you're being told by the docs and other folks in your life that your commitment to maximizing Lancelot's quality of life is exceptional

Thank you. For how hard it is to get through this and how powerless I feel, I know this is to be true and it is of some consolation.

For a long time, whenever M'eira vomited or had low energy, I tended to feel a lot of fear/anxiety because I connected it to the initial shock of the cancer diagnosis and started to catastrophize. Once I realized what was happening with me emotionally, I worked on reminding myself that I was doing the best that I could for her

This is very true and wise. I've been trying to do the same. I think the fact that all the basics are good is solace, though I fear he might decline unexpectedly. It's so emotionally hard. No matter how this goes, that moment will eventually happen, like it happens to all cats, and it's so scary to imagine. But such is the burden we accept when we choose to care for them, and I very much prefer having this pain to never having met and loved him.

Another thing I have made peace with (mostly) is that although I wanted to try to get her off all of the meds because that would reassure me/prove she was in true remission, what matters most is maximizing her quality of life.

I recognize myself a lot in this. You're very wise

Just yesterday she was really low energy, seemed nauseous and somewhat checked out and I thought it could be the beginning of the end, but then at 11pm last night she rallied once again, got hungry and has had a great day today. Go figure.

I hope she's still doing well. I saw her pictures and she's a true beauty. I will post some pics of Lancelot later. They share the fluff!!

If you don't mind me asking and it's not against the rules to ask, where are you generally located? You seem like you have a really good team of specialists. I live in Portland Oregon.

We're in the San Francisco Bay Area. I don't know that I like my team of specialists to be honest. I trusted them initially, but the present situation seems beyond their expertise. I did find some new, good ones though. Crossing fingers they shed some light!

To be honest, him (and M'eira) are such weird cases as you very well know that I can't blame specialists for being confused. With that said, that also means I will do what it takes to find him the best ones.


By the way, Lancelot's sister is still doing well. We need to give her another ultrasound to check that the thickening went down, but we haven't really had the energy to do so yet. It doesn't seem like it's too urgent though, so another couple weeks won't likely hurt.

 

[sushinemom]

Some pics of Lance and his sister:

 

[tyleete]

My 17yr old was diagnosed with Lymphoma Cancer in the intestines almost 5 1/2yrs ago. For a little over 4yrs she took Prednisone every night to stop her from throwing up. Which used to be a daily thing for her. Last year I was told about cbd, and while skeptic, I did the research. Then asked my vet about it. Her father actually suffers from the same disease my cat does, and said it's (cbd) helped him immensely. So we tried it! After quite some time to get the correct dosage, I had a different cat! Not only was she not throwing up anymore (I mean, it's rare if she gets sick even once a month!), she's not anxious anymore either. We're always taking in sad cases, so have cats ranging in age from 17-2. The babies made her stay in her own room and not want to come out anymore. Now on about 0.12ml twice a day? She comes to hang out with us in the living room most of the day long. She's even started grooming herself once again! Which has always been a problem for her.
Thing you have to watch out for, is not to buy anything but full or broad spectrum. And while many states allow for THC in cbd products nowadays, know that IS the chemical that gives the 'high' feeling. I buy stuff that is THC-free. It helps with a lot of problems. Arthritis, sick stomach, intestinal problems, inflammation, increases appetite, anxiety, etc.
There have been 0 side effects and I can't stop recommending it to those with animals in need. Here's a small guide with a little info that might help. Even mentions for cats with Cancer further down.

CBD for Cats: An In-depth Look at Cannabis and Hemp for Cats

Thinking about using CBD for cats and overwhelmed? We were, too. Here's what you need to know about cannabis and hemp for cats.

www.wildernesscat.com

Hope your baby does better soon.

 

[fionasmom]

The 7 Best Hypoallergenic Cat Foods of 2021

There are a number of these sites recommending hypoallergenic cat food. I don 't have any experience with them personally and hopefully others will respond.

As for sucralfate, it has been very effective for my dog with chronic pancreatitis. The vet allows me to keep it on hand.

Such beautiful babies!

 

[Maiaiam]

Sheesh, I didn't get notice that there had been posts after mine a month ago.

In general M'eira is still generally holding her own, without any vomiting at all. Her weight was stable but has dropped a few ounces this week so I need to keep an eye on that. I haven't given her subcu fluids as often in the last couple of weeks so that might be part of it.

@Sunshinemom, your babies are beautiful!! And I can see the fluff similarities between Lancelot and M'eira for sure. Unfortunately the prednisolone has really thinned M'eira's coat out and I don't think that the fur that's been shaved (belly, legs) will ever grow back. Plus she's a fur puller so she's taken more out on her own. . I also haven't seen her grooming herself in a long time so her coat is kinda clumpy in places, which is typically a negative indicator. She won't let my other kitty groom her so I brush her often, but I would really like to give her a bath! She would likely not go for that, though, and since it's now cold outside (and cooler inside) I'd be concerned she'd get a chill before she is all dry. She already has some intermittent congestion--I hear it when she starts to purr)--so I want to be careful.

I do have some more comments and concerns to share so I'll do that later.

 

[Catmom1234567890]

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.

 

[Catmom1234567890]

Is Happy Earth herbal supplement needed? My IBD kitty was on Yunnan Baiyo when she was actively bleeding. It did stop the bleeding but she also barfed from it. As soon as she she stopped bleeding, we cut the herbal medicine out and barfing stopped. Yunnan Baiyo was some serious stuff, my poor kitty had to swallow humongous sized capsule twice a day and the smell was so strong. I think I would gag too

 

[Maiaiam]

Sheesh, I didn't get notice that there had been posts after mine a month ago.

In general M'eira is still generally holding her own, without any vomiting at all. Her weight was stable but has dropped a few ounces this week so I need to keep an eye on that. I haven't given her subcu fluids as often in the last couple of weeks so that might be part of it.

@Sunshinemom, your babies are beautiful!! And I can see the fluff similarities between Lancelot and M'eira for sure. Unfortunately the prednisolone has really thinned M'eira's coat out and I don't think that the fur that's been shaved (belly, legs) will ever grow back. Plus she's a fur puller so she's taken more out on her own. . I also haven't seen her grooming herself in a long time so her coat is kinda clumpy in places, which is typically a negative indicator. She won't let my other kitty groom her so I brush her often, but I would really like to give her a bath! She would likely not go for that, though, and since it's now cold outside (and cooler inside) I'd be concerned she'd get a chill before she is all dry. She already has some intermittent congestion--I hear it when she starts to purr)--so I want to be careful.

I do have some more comments and concerns to share so I'll do that later.

I’m replying to my own post because I want to keep this thread going if possible. Are folks still getting notifications?

Unfortunately I think my darling M'eira might be on her way out. Her appetite has dropped dramatically in the last week and the muscle wasting seems to have accelerated. Her weight is staying stable but that could be due to the assisted feeding and the subcus. She has not been doing any vomiting and she's still affectionate, mobile and using her litter box just fine. She continues to be receptive to my syringe feeding her wet food and I've upped the frequency of her subcu fluids to at least every other day, so between that and all of the meds, I am trying to make sure she is a comfortable as possible. I am giving her buprenorphine again in case she's not only nauseous but also in pain.

She has started doing this weird thing with her mouth and I'm wondering whether anyone else has seen this with their cats: usually after she's eaten on her own or after I've syringe fed her, she licks her chops a bunch and seems to get one side of her upper lip stuck or her tongue caught on the side of her mouth so she isn't able to close her mouth normally at first. Sometimes she also gags while she is doing this. It's like she doesn't quite know what to do with her tongue. I read about a couple of syndromes that involve these kinds of behaviors but I also read that it could be related to nausea and stomach distress. Any ideas?

I have an ultrasound scheduled for this coming Monday but I'm starting to wonder whether putting her through that is even worth any potential new information for me. She seems to tolerate these kinds of procedures well and I always do better with more data, though. But there's a good chance that as has always been the case, the ultrasound and bloodwork may not show anything.

If she doesn't show any independent interest in food over the next couple of days, it might be time to help her pass on. Sigh. While I write this she is purring on my lap. She is such a sweet girl.

Not a fun way to spend a holiday weekend!