Mystery illness, Possibly Lymphoma, Not Eating

[daftcat75]

In my far less experience than S silent meowlook , general vets don’t often have their own ultrasound equipment. There is a traveling specialist who goes from vet office to vet office performing and interpreting the ultrasounds. These are often drop your cat off in the morning and pick them up in the afternoon visits even though there’s no sedation involved. The specialist just wants all his patients lined up so he can get through the batch of them at once. I dropped Betty off for one of these ultrasounds. Based on the results, I booked her an appointment with an internal medicine specialist. I highly highly recommend this for Danno. It turns out when I brought Betty into the specialist consultation appointment, he remembered her because he was the traveling specialist that performed her ultrasound at my vet. The thing with specialists is they are expensive and they can be hard to get that first consultation appointment (long wait times that often aren’t negotiable by need). But they are so worth it. Because once you are a patient of theirs, you realize that initial consultation was tough to get because they only allocate so many hours a week to those. The rest they may be performing surgeries or procedures or doing traveling ultrasounds. But when Betty needed to see the specialist, it was often easier to get that appointment than the one from her regular vet. Specialists are more involved in your cat’s case because they aren’t also doing spay-neuter, new pet physicals, dental procedures, and all those other things that distract a general vet from getting too involved in any one patient.

If Danno were my cat, I would operate on parallel tracks. Get a general vet involved so that you can have someone for anything the specialist doesn’t specialize in. And book that initial consultation with the specialist. It’s rare that they let you jump the line. But you may explain the situation and see if you can send records over ahead of time for consideration for either a sooner appointment or getting on the cancellation waitlist. If you are looking at a typical two month wait, that’s where the general vet can hopefully help stabilize things until the specialist can take the case. And if you need to, go ahead and take him back to the ER. Although an overnight stay can be expensive, sometimes it’s the way to jump the line and see a specialist in the morning. This is how my last cat Krista (in my avatar) jumped at least a month wait to see a neurologist and get a needed MRI within 24 hours of me taking her into the ER.

To sum up, get a regular vet and a specialist and don’t be afraid to return to the ER if neither can fit you in when you really need them.

 

[RussellsMom]

Thank you, silent meowlook and daftcat75:

First, what does this mean: “Often it is ahi?”

Second - and sorry this is a bit long, but I feel I haven’t been quite clear - the main problem here is that Danno is not my cat and I have limited influence in his care.

I begged my brother to take him to the vet the first day he got sick (sudden anorexia and extreme lethargy) and he wouldn’t do it. That was a Friday and he waited all weekend, even when I gave him a list of all the clinics in our area that are open on the weekends, and with much begging and pleading. On Monday, I called him and asked if he had called Danno’s vet (not open on weekends); he said “No, I thought I’d drive over there and see”-??? He didn’t even have their phone number.

So I myself called Danno’s vet first thing Monday morning, but they coldly brushed me off. Not “I’m so sorry, we don’t have any appointments” but just “We don’t have any appointments”. I spluttered, reexplained Danno’s symptoms, and said, “You don’t have emergency slots to see long-standing clients?” (He’s been going there for 7 years). “No.”

Then I called our closest emergency vet – so many of them have closed in recent years, it’s not easy. They said absolutely come right away. The vet suspected hyperthyroid, gave him a cerenia shot, and sent out some labs. He was still eating just fine, so I wasn’t as worried now that he’d at least been seen.

Labs came back Wednesday, not hyperthyroid, no diabetes, creatinine slightly elevated, but kidney values and liver values otherwise normal. Still eating.

Thursday he stopped eating altogether. Friday, I got my brother to agree to go back to the ER. Saw another doctor who strongly recommended the ultrasound and fine needle biopsy because he suspected possible IBD or lymphoma. He admitted he was not a specialist, but he wasn’t happy with what he saw on the ultrasound. We’re still waiting on the cytology report: it doesn’t help that it’s the weekend and tomorrow is a holiday in the US.

In the meantime, Friday Danno ate like he was starving (post-vet and post-Cerenia shot). Saturday morning my brother said he ate a little bit, but I doubt it. I myself couldn’t get Danno to eat anything all day Saturday, and I generally have a way with cats. Today, Sunday, I was able to feed him with my fingers, but only about a tablespoon or so of pate. He did drink water by himself. My brother told me later this evening that he ate a lot of food, but I don’t believe him. The cat I left around 5 pm was nowhere close to being able to eat a lot of food a few hours later. I could tell my brother didn’t want me coming over and putting food with my finger in his cat’s mouth: I could see that upset him. He doesn’t at all understand that to have any chance of recovery, Danno needs to get food in him.

To make matters worse, I don’t drive, and my husband – my greatest support and who also kindly drives me wherever I need to go – has to leave tomorrow on an emergency trip to care for his father, whose dementia has taken a very serious downturn. I’ve asked that while he’s away I go and stay at my brother’s place. They said OK, but I’m afraid they might change their minds. I can be very pushy about the cat, and they don’t respond well to pushy in that house. So I’m trying to be diplomatic while also insisting on the urgency of Danno’s condition. I don’t want to lose what little influence I have, so that I can at least be there to try to feed Danno myself every few hours.

Without asking, I made an appointment at a cat-only vet for Tuesday, and at our own vet, who we trust to be good, for Wednesday, as a backup. The next step is to convince my brother to go to one of those appointments to get Danno some supportive care while we’re waiting on the cytology from the ultrasound. He seems to think it’s perfectly fine to wait for the report before seeing another doctor. I cannot get through to him that it’s not safe for Danno not to eat for days. My husband and I have offered to pay all expenses.

Please believe me, if Danno were my cat, he would have been at our primary vet Friday a week ago, and at a specialist last Monday. I feel so stuck and helpless.

 

[daftcat75]

Given all this, I hope you’re able to make at least one of those visits you booked. Please ask for cans of Hills A/D and prescriptions for ondansetron and gabapentin. I would still love it if he could see a specialist because you’ll get better support and more knowledge and experience for what could be a complex case. But it may end up that your brother may be more receptive to hearing that suggestion from the vet. If your brother agrees to go to one of those appointments, you might want to call ahead and recommend the doc speak to your brother about a specialist referral.

 

[RussellsMom]

Thank you - that's a great idea about calling ahead to ask the vet to recommend a specialist. I do think my brother would be willing to do that if the diagnosis was lymphoma. Also, we'll call the ER vet first thing in the morning for the prescriptions and A/D.

 

[silent meowlook]

Hi. It was a typo. No idea what I had intended to say.

This is a difficult situation and I am sorry you are in it.

 

[RussellsMom]

iPappy, I just saw your message on page 2 of this thread - thank you so much. I'm the same: when a non-human animal in my care (or near my care in this case) is in trouble, I also put everything on hold to help them. I hadn't quite articulated it to myself before I saw your message, but I also achieve some peace of mind by focusing on their symptoms and how they're acting, and I think that's one of the reasons my situation with Danno is so difficult, because I'm not observing him 24/7, just a few hours here and there. I don't know what's going on the rest of the time and it makes me feel so powerless. I'm happy to hear your IBD cat lived to be 15 - thank you for that!

 

[RussellsMom]

The ER vet called first thing this morning with the biopsy results, which showed lymphoma –he was not more specific and he was very discouraging, which seems to be the way with that vet.

Somehow we were able to schedule immediately with an oncologist about 20 minutes away, and within a few minutes, my brother came by with Danno in the car to pick me up.

Danno had a very brief vitals check in the back room, then was brought back to us in the exam room. The specialist spent over an hour with us, detailing all the available treatment options and answering my 1,001 questions. She strongly recommended starting with COP, and Danno received his first dose today. We’ll have a check-up in a week, and second dose in two weeks.

She never once encouraged not treating him – she alluded to that as a option, but said she firmly believed he wasn’t at that point, nor was he at the point of needing a feeding tube, although she stressed the primary need of getting him to eat more.

She seemed optimistic that the treatments will at the very least help him feel better, but she was also more optimistic than not about at least his short-term chances for remission and improved quality of life.

He also had a tiny amount of sub-Q fluids (I was nervous about it because of his heart murmur, but she seemed OK -?), a shot of ondansetron, and a B12 injection. They gave him the first dose of pred today, too, with tablets for us to give daily at home. I also asked about the pred + heart murmur concerns. She seemed reassuring enough that we went ahead with it. If anyone has had similar concerns/experiences, I would love your input.

We were sent home with transdermal mirtazapine and Hills onc/care wet food.

He looked a frazzled mess when they brought him to us in the waiting room, but when he got home, he headed straight for his food and ate some bites of onc. and a whole little tub of Sheba tuna.

For the past few hours, he’s seemed quite unwell to me – meatloafing, or almost, and tufty (fur spiked up). He hovers over his water bowl, and even dropped his nose in it – luckily I was there to move it away in a flash. He napped for a while in his cat bed and seemed more comfortable, but then he got up to pee (he sniffed at it – I assume he smells the chemo in it), and is now lying flat on the floor near his cat box. He seems drugged to me and/or nauseated?

Is this a normal reaction to chemo? Are we making a good decision with this protocol?

 

[fionasmom]

Given that all of this has just happened, he is probably exhausted. COP is a multi drug approach to a higher grade lymphoma and has has some very good success rates. Some vets consider COP which is a three drug method to be better than CHOP which adds another drug which is harder to take and might not have the expected results. However, he might have some side effects and given that you have been willing, with your brother, to try this protocol in order to help Danno, don't hesitate to stay in touch with the vet if something does not seem right. He has eaten once today, which is good, and you have the mirtazapine to use if food is less appealing to him.

You are making a very good decision to try to help Danno in this way and it is extremely kind of you and husband to pay for this.

 

[RussellsMom]

Thank you, fionasmom. Your message made me feel better.

The oncologist also recommended COP over CHOP for the reason you mentioned. She mentioned lethargy, lack of appetite, and nausea as possible side effects but said they were unlikely. We're to call if he vomits or has diarrhea. If he's panting/breathing fast, we're to bring him in to the ER. The oncology department is attached to a 24-hour ER, but it is 20-30 minutes away. It's our nearest 24-hour ER.

Yes, my brother was totally on board with treating him, and he liked the specialist. The prices frightened him, but I at least got to pay for today's visit.

 

[RussellsMom]

I think we'll be splitting the costs - in fact, he was happy to pay today too, which made me happy.

Danno's been eating and drinking pretty well, which is much better than yesterday. But he keeps shifting around so much like he can't get comfortable. That scares me - anyone have experience with chemo like that? I'm so anxious that I want to rush him to the ER every second. We have bupe, but I'm reluctant to give him more drugs today. Any advice?

I also had the terrifying thought that the cytology might be wrong. I didn't think to ask the oncologist if that was possible. Is that possible? How accurate are fine needle biopsies? What if he only has IBD and we've started him on chemo? Could that make him worse? Is that just me catastrophizing?

 

[FeebysOwner]

I also had the terrifying thought that the cytology might be wrong. I didn't think to ask the oncologist if that was possible. Is that possible? How accurate are fine needle biopsies?

Generally speaking, a cytology won't come back as lymphoma if it is not that. Many fine needle aspirations tend to come back 'inconclusive' if there are not cancer cells actually found in the tissue. I would suggest you ask the vet for a more specific diagnosis (more than just 'lymphoma") and get a copy of the test and results. They are yours for free.

 

[iPappy]

RussellsMom I am so glad Danno is getting the treatment he needs. I agree with the others that he's probably feeling quite exhausted from all of this.
I have very little experience with chemo and cats. But, a few members here have mentioned that their cats get a little restless post chemo. My guess is it's a big day for them and they just feel strange, kind of like how you or I feel strange after getting a medicine we're not used to. If Danno is otherwise quiet, I'm sure a call to the oncologist to question whether this is normal or not would be well received.
When my Tag was diagnosed with cancer via biopsy, I too thought "surely there was a mistake in the lab and this is a false positive", but, all the symptoms were there. Trust me, I know how easy it is for your brain to come up with all sorts of "what if" scenarios.
I hope Danno settles in and has a wonderful nights sleep, and you and yours as well.

 

[RussellsMom]

Thank you both so much. I forgot to add to my longer post that she said it was GI large-cell lymphoma. I have done plenty of reading, including on this forum, about the types of lymphoma, so of course that's not what I wanted to hear. But someone wisely said - probably on cmshap/Willy's thread - that every cat is different, so I'm trying to be hopeful about Danno.

My fearful mind will always find any gap to pour in to. So I'm kicking myself very hard tonight about having missed asking her about possible differential diagnoses.

Danno's continuing to eat pretty well, but does seem exhausted/agitated/uncomfortable. Maybe a little more himself though?

 

[silent meowlook]

Hi. If the biopsy came back as large cell lymphoma, that is what it is. Still, lymphoma responds well to chemotherapy.

What you are describing with the shifting weight is discomfort most likely. Don’t hesitate to use the Buprenorphine. Cancer hurts.

One of the risks with chemotherapy is that it will knock the white blood cells down to low. That is why they will only give it after they do a CBC to make sure there are enough white blood cells.

Don’t hesitate to contact the oncologist for any questions and concerns. That is what they are there for and the support is part of what you pay for.

 

[RussellsMom]

Thank you. Had a long call with the oncologist this afternoon, which was reassuring. They do think his lethargy, spaciness and discomfort is probably from the lymphoma rather than the chemo. Also, maybe my hopeful mind will also find any gap, because they did say that while the cytology, ultrasound and symptoms strongly suggested lymphoma, they couldn't say it was a 100% definitive diagnosis. But that they absolutely thought treating it was 100% the right thing to do. I'm going to try to trust. -???!

They were pleased he's eating. He's been drinking a ton since yesterday - way more than usual - which made me worry about his kidneys, but they tried to reassure me that was a very common reaction to the steroid. They also tried to ease my fears about his heart murmur and the pred.

I stayed at my brother's last night to keep watch on Danno all night, but I've just taken a few hours to myself at home. I'll go back over soon to give Danno his medications. I was so happy to see my own cat, Russell. We asked our cherished cat sitter to visit with him and feed him a couple times a day while I'm caring for Danno - that gives me a little breathing room - but I really wanted to see my little guy!

Thanks again, everyone, for your support. I'm so anxious and it really helps.

 

[fionasmom]

Try to remember that you are doing everything that can be done for Danno.

 

[iPappy]

Steroids will definitely cause increased thirst. If it doesn't settle you could ask them if a dosage adjustment is necessary.

 

[Furballsmom]

you are doing everything that can be done for Danno

exactly

 

[RussellsMom]

Danno ate like a champ today. I didn't give him mirtazapine because of that - is that OK or am I being foolish not medicating as directed?

I also didn't give him the cerenia they prescribed because he doesn't seem to me to have nausea - he's eating OK and hasn't thrown up once since he's been sick. If someone thinks that's wrong, please advise me. I don't want to hurt him - absolutely the opposite - but I don't want to overload him. He's not drooling, lipsmacking, vomiting, or inappetant.

I did give him a 5 mg prednisolone tablet. This is prescribed as the daily at-home part of his treatment. He objected a bit to my pilling, which I didn't mind - he's been so passive recently. After that I fed him, and while he was eating, I thought about saying to my brother that I love to see him eating but I'd really love to see him wash his face after eating, which he hasn't done since he got sick last week. I decided not to say it, because it seemed too bittersweet - and then he washed his face! And actually with fairly normal energy.

Now, a few hours later, he ate even more food (the Hills onc. canned), but he looks so dejected and weak at the moment. I know it's only been one day since he started treatment, but it's hard to see that. The doctor said it could be a week before he starts to respond to treatment. It's Day 2 and his appetite has certainly improved, and he does look up now when someone walks in the room. My brother is so happy. I'm so happy Danno's eating but everything feels so perilous to me.

 

[silent meowlook]

Hi. As long as he is eating I would imagine it would be fine to skip the Mirtazipine. But, of course I am not a vet and have no veterinary degree, so I can only tell you what I would do if he were mine.

I would continue to give the Cerenia due to the chemotherapy. The last thing you want is for him to suddenly have nausea that sets him back with his eating. But of course, you can always check with your vet.
The Cerenia lasts 24 hours. Maybe a little longer. And I wouldn’t hold back on the buprenorphine.