Reducing Prednisolone for SCL - Need Advice

TikkaBeer

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Hi everyone. We are new to the forum, but wanted to post because we feel a little stuck about some contradictory advice we received, and want help deciding between the two.

Just to give a summary our cat’s situation, last summer she started having issues with weight loss, vomiting, and diarrhea. She was diagnosed with IBD or possibly small cell lymphoma. When she got a biopsy, it confirmed that it was likely SCL. After experimenting with different medications to manage her symptoms (mainly vomiting), we now have her on the following regimen:

Prednisolone 5 mg daily
Cerenia 8 mg daily
Chlorambucil 5 mg every two weeks (pulsed dosing)

Recently, our vet specialist, who has been helping us manage our cat’s SCL basically from the first diagnosis, advised that because our cat’s symptoms seem to have stabilized, it’s time to start trying to reduce her Prednisolone. She’s worried about the long term effects of her being on the steroid. We’ve tried reducing the medication levels before, most recently the cerenia, but usually she starts vomiting again. However, the vet believes that a certain amount of vomiting is reasonable, and at the very least wants us to reduce to 2.5mg/5mg alternating every other day.

We posted about this on another forum, and got very different advice. They say that the priority should be getting her into remission. They also believe that the dosage for her for prednisolone isn’t even that high, that she could go up to 1mg/lb (she is about 8.5 lbs). I’ve seen other posts that say the most common side effect of long term steroid use is diabetes, which is easily managed and should go away once the steroid is reduced again. They’ve said similar things about maintaining our cerenia usage after we tried reducing it recently, which we ended up going along with.

Our usual vet also regularly weighs in on the treatment plan, and was the one pushing for us to decrease the cerenia lately. We were still willing to try it, despite advice on the other forum that the original dosage was okay. However, we had to raise it back up again because she started to throw up. So it feels like the prednisolone situation will just be a repeat of this.

Any opinions on whose advice we should follow? How do you usually make a decision when there are differing/opposing opinions? Should we get a second opinion from another vet? We’re also wondering, if we go against the vet, does that mean in the long run we will have to look for a new vet who is less concerned about the steroid use? This topic of reducing the medication comes up every few months.

Picture of Tikka attached.
 

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PushPurrCatPaws

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I would go with trying another vet (or two) for a 2nd (or 3rd) opinion, if a different opinion is what you seek.

The main thing to think about is that a Forum should not replace any vet's advice! Any one of us here, including me, could weigh in on their own experiences with using certain meds on our own cats... but we are not vets, and it is really a vet that knows your cat's "particulars" best who should be part of the decision-making. I think you should keep that in mind as members here pipe in with their various experiences. In the end, what path you take in trying to help your cat's symptoms will be your own.
 

Furballsmom

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In the end, what path you take in trying to help your cat's symptoms will be your own.
Yes, exactly.

How do you usually make a decision when there are differing/opposing opinions?
Hi
I try to read as many valid resources as I can to try and be as informed as possible, but the bottom line is how my cat does.

We’re also wondering, if we go against the vet, does that mean in the long run we will have to look for a new vet who is less concerned about the steroid use?
It depends on what you want, and again, how your cat does.
 

PushPurrCatPaws

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:yeah:

I definitely agree with widening the info sources, and trying to become informed... and that is why this site is so great. But, to me, a vet specialist is a good place to turn, and you are lucky that your cat is already a patient of one! In the end, you need to decide what you would like your short-term and long-term end goals to be, and hopefully make the right decisions for your kitty. Another vet's experience and advice might be helpful!
 

fionasmom

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Welcome to The Cat Site! Your Tikka looks almost identical to my Chelsea who also had SCL. As was stated, we are not vets and can only give our own anecdotal experiences, of which others will probably post. We cannot discuss dosage at all. You are clearly trying to take excellent care of Tikka.

I never took Chelsea off the pred and her vet never reduced it. We never used Cerenia as it was not needed. However, that is only my experience and probably puts me in the "remission" camp, if it is possible to get there, as opposed to the "concern about other issues" camp. Again, not to say that is correct, just one way of looking at it.

I have taken my dog (now passed) and cats to other doctors as needed. It does not bother me to be up front about stating that I want another opinion or to ask for a referral if that is what is needed. A second opinion is no cause for complications unless your current specialist has a massive ego and will take a defensive stance. I have, frankly, never had a vet balk at a request for another opinion. Talking to one other specialist would not be a bad idea. It will give you more information and peace of mind about whatever decision you make for Tikka. Please keep us posted.
 

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I don't know what other forum to which you are referring, but the bottom line is a second 'professional' opinion might be one thing to consider. Then you can weigh all the advice you've been given and make your own determination - because yours is what counts in the long run. IMO, you use your acquired knowledge, and the multitude of advice to make a determination. It is not an 'either or' situation.

As far as I am concerned, a certain level of vomiting is not 'reasonable' unless you can contribute it to hairballs, a 'bad day' here and there, or bad food, etc.

I have gotten numerous vet opinions, some mesh, some do not - there is always a difference of opinion in almost every aspect. I can't even use the 'majority rules' because there is always some little nuance where none of them really agree on anything. In the end I have to decide what is best for Feeby because even though I don't have a vet degree, I do know her best.

I do think you run the chance of having to get another vet if you don't 'toe the line' with your current one. I've lost a few, and maybe will lose more over the course of time. Not good for Feeby at her age and her conditions. So, do your best to try to find the most amenable one and work with them. Sometimes, it isn't about what they recommend as much as it is about how much they are willing to work with you.
 
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artiemom

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My guy was diagnosed this week with SCL, level 2..
I became very confused regarding all the advice and resources I was finding. I have been reading up a storm. I am aware of the forum you are referring to.

I like TCS because, while none of us are Vets, we can discuss things, based on our experiences. What works for one cat, does not work for all.. We are all supportive of each other, and try to help everyone..

In my opinion, I would find an internal med Vet, or an Oncologist-- to see how they feel about things.
I do not know if you would need to find a different Vet. I would get a second opinion.. with a specialist of some sort; and then take it from there. With whom do you feel more comfortable with, and with whom does your 'gut' feel right for you and your baby. I think that is the most important thing.

I, also, so not feel that a certain amount of vomiting is to be expected or to be normal.. Not at all.. Chronic Vomiting was the only symptom my guy has. I was expecting IBD as a biopsy diagnosis.. instead it came back as IBD and SCL..Quite a shock to me and our Internist.

I have been told that my guy's medication dosages are all wrong. That is hard to take. I see a trusted Internist at a well respected large animal hospital.. So you can see why I am going crazy. It may e high, but the way it has been mentioned kind of turns me off of a particular forum. They are not Vets... so... I advise you to take their advice with a grain of salt, a lot of research, and personalized , specialized veterinary advice.

I have come to the conclusion that you have to go with your gut... I am still in the process of researching, and asking questions. My guy started his prednisolone meds, yesterday. Personally, I have questions about the dose; from my own research. I do not appreciate someone telling me right out, that it is wrong and over dosed... They do not know my cat, me, or my Internist.

Please go from the gut.. Get a second opinion and go from there.

Any worthwhile, honest regular Vet; should openly welcome your advocating for your baby's welfare. Do not automatically jump to conclusions or take all suggestions as gospel.

I wish you luck.. I am at the beginning this journey.
My guys Chlorambucil should arrive tomorrow. The Prednisolone seems to be doing a number on him: lethargy, decreased appetite.. just not himself.. not playing, not knowing what he wants..
 

PushPurrCatPaws

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Oh boy, doesn't the word, "nuanced", explain a cat's health and moods! :salam:

My cat is nuanced in that long-term pred use has been good for her particular issue (asthma) but, if it is to be a consideration for any other issue relevant to eating and nausea, using cerenia has never worked for any of my cats. For me, long-term pred use almost requires the cat owner to do things for the cat that improve her chances while using pred: canned food, small meals multiple times a day, lots of daily exercise, giving pred with food & at the same time-frame each day, keeping up with bloodwork and tests several times a year, etc. Having a specialist also helps.
 
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TikkaBeer

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Thanks everyone for your responses! After thinking them all over and going over Tikka’s medication history, I have some additional questions.

Based on everyone’s encouragement, ight now our plan is to ask our current vet for a second opinion. One question we had is, would there be a lot of benefit to asking for an oncologist specifically, or would another internalist be okay? Just since we already know that she has cancer (SCL), and since our current vet is already an internalist.

Also, we’ve seen the advice that if our cat did get diabetes as a result of long term prednisolone, it would be easy to manage and would go away once we reduced the prednisolone again. Does anyone have a source for this? We don’t want to make long term decisions based on incorrect assumptions on our part.

Looking through our history of communication with the vet, it’s full of times when she suggested lowering the dosage, we did, and then she ended up throwing up. So I feel like the current dosage/medication mix might be the minimum needed. I may remind her that we’ve tried lower before and it did not work. If she insists again that a certain amount of vomiting is normal, I think at that point we would seriously look at changing vets.

Finally, we have more testing for Tikka in the beginning of July. We’re wondering if it would make sense to say we’ll wait until after testing to start reducing the pred, or if she’ll want us to get it started soon so we can register any effects in the July test. We only increased the cerenia in mid May, so we wanted to give her a period of consistent medication (and no throwing up) before re-reducing.
 
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TikkaBeer

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As far as I am concerned, a certain level of vomiting is not 'reasonable' unless you can contribute it to hairballs, a 'bad day' here and there, or bad food, etc.
How much throwing up frequency would you consider a “bad day” vs unreasonable? In the past we’ve usually increased medicine after she throws up 2-3 in a week. Maybe it would be a good idea for us to clarify with our vet what she means exactly by an acceptable frequency?
 

artiemom

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I will say this, my guy is getting more complicated.. somehow he developed bronchitis.. I will not hijack this thread.

I do not feel that 2-3 times a week, vomits--are normal, and to be expected.. perhaps, and I mean perhaps, 2-3 times a month, and from fur.

If you cat is not in remission, I would not think of decreasing the Prednisolone dose until, then.

I would focus on what the Oncologist or Internal Medicine doctor advised. Personally, I would not deal with a regular vet for this.. They are great for blood work, or other minor issues; with SCL, you need specialists. You need a "team"-- a trusted team.
I would be very hesitant to decrease the dose of Pred, since you have seen the results of that.. UNTIL you, converse; at least, with your kitty's Oncologist . Tell them your qualms about doing so, and how confused you are. You are seeing an Oncologist, because of his speciality.. Because of this, I would thing, his opinions/treatment plan would be more on point, than that of a regular Vet.
Just my opinion..

I am aware of the forum you have consulted. I have very mixed feelings about them. They do offer a lot of good information in their files.. however, exact dosing and such, is not something I feel can be done over the internet.. and by non-Vets.
Even though there is an 'advisor". I feel they are more into 'prescribing', and information, rather than being a real support group. Too rigid.
I found an off shoot of that group, on Facebook, it seems much more understanding, compassionate, supportive.

Take your questions to the Oncologist or Internal Medicine Vet. I did.. I trust our Internal Medicine Vet; however, I do my own research and ask questions based on that: reasonings for doing X instead of XX? Which is better?
You will be surprised with the answers. If the Vet is honest and forthcoming, you may gain more insight into their capabilities and though process.

I am sorry if I am coming across harsh. It has been a very bad weekend and a bad week for both me and Geoffrey--I am just a bit burnt out.

Love, ((hugs))
 

FeebysOwner

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How much throwing up frequency would you consider a “bad day” vs unreasonable? In the past we’ve usually increased medicine after she throws up 2-3 in a week. Maybe it would be a good idea for us to clarify with our vet what she means exactly by an acceptable frequency?
Consistently throwing up 2-3 in a week seems a bit too much. Yes, good idea to get clarification from your vet! Surely, they cannot consider that an acceptable frequency.
 

BellaBlue82

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I agree, it would be best to obtain a second opinion.

If it helps, my cat Sadie has primary IMHA and will unfortunately will be on prednisolone the remainder of her life. When first diagnosed, she was on 5mg for a while (1year) until she stabilized and remained stabilized for at least 6 months. Our vet had her wean by 1/2 mg every three weeks afterwards, until we found her "minimal" dose. She's about 12 lbs, and does quite well on 1mg a day. We do test her monthly for glucose, as there is a slight risk of diabetes in long term steroid use. But again, it depends on many factors such as if they are overweight, on a high dosage, for how long, etc. She has been on prednisolone for almost 4 years now.
 
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TikkaBeer

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We emailed our vet to clarify, and she confirmed that yes, she does consider vomiting 2-3 times per week within the acceptable range.... On top of that, we agreed to do 5mg/2.5mg on alternating days in the meantime, and four days in, she already threw up for the first time in a month. We are still deciding what our next steps will be. We asked her to recommend another specialist for a second opinion, and are working on scheduling that now.
 
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TikkaBeer

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I agree, it would be best to obtain a second opinion.

If it helps, my cat Sadie has primary IMHA and will unfortunately will be on prednisolone the remainder of her life. When first diagnosed, she was on 5mg for a while (1year) until she stabilized and remained stabilized for at least 6 months. Our vet had her wean by 1/2 mg every three weeks afterwards, until we found her "minimal" dose. She's about 12 lbs, and does quite well on 1mg a day. We do test her monthly for glucose, as there is a slight risk of diabetes in long term steroid use. But again, it depends on many factors such as if they are overweight, on a high dosage, for how long, etc. She has been on prednisolone for almost 4 years now.
How easy is it to do the monthly glucose test? I'm wondering if we can accept the diabetes risk, and just test for it regularly, similar to what is sounds like you are doing.

I saw other threads on this forum that also seemed to indicate that steroid-induced diabetes would be reasonably manageable, and would improve once we weaned her off of the diabetes. However, when we asked our vet this, she said that there is also the risk of us not catching the disease and Tikka experiencing a life-threatening diabetic crisis. Hopefully with the regular testing, this could be avoided. She isn't an overweight cat (especially after having IBD), and we already feed her wet food only, so I'm hoping the diabetes risk would be low anyway. However, she does also have kidney disease, which is also a risk factor with the steroid use.
 

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My experience seems similar to Fiona’s Mom sofar. The minute we tried to reduce -even a teench- we were back to square one quite horribly, w/ lots of diarrhea. My vet says she’s had bad experiences trying to cut back the dosage. Can’t hurt to get a second -or third- opinion from a vet.
 

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BellaBlue82

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How easy is it to do the monthly glucose test? I'm wondering if we can accept the diabetes risk, and just test for it regularly, similar to what is sounds like you are doing.

I saw other threads on this forum that also seemed to indicate that steroid-induced diabetes would be reasonably manageable, and would improve once we weaned her off of the diabetes. However, when we asked our vet this, she said that there is also the risk of us not catching the disease and Tikka experiencing a life-threatening diabetic crisis. Hopefully with the regular testing, this could be avoided. She isn't an overweight cat (especially after having IBD), and we already feed her wet food only, so I'm hoping the diabetes risk would be low anyway. However, she does also have kidney disease, which is also a risk factor with the steroid use.
fionasmom fionasmom shared a great link, my second cat Nico has diabetes and I belong to FDMB for him as well. Since I have a glucometer for Nico, I test Sadie once a month. I'm in the same boat with the weight, she's still average size so I think that helps avoid the risk of diabetes. She eats wet food only as well, mostly since I can only feed Nico wet food lol. We've been going strong almost 4 years now with Sadie's condition being managed well by prednisolone, so it is possible! Sometimes you feel like you're walking a tight rope, but honestly once we had her stabilized and were able to lower her dose some I felt more out of the danger zone with her (both her anemia and the risk of DM.)

You can use a human meter, I do for Nico and Sadie, I have a Relion and it's typically on point number wise. I use 26 gauge lancets and there's a small section of their outside ear that's really easy to get a sample for the meter. There's a few videos on YouTube too if you're a little skittish, but I will say after the first few times it's becomes second nature!

I hope this helps!
 
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