Suspected IBD or Lymphoma... is surgery worth it?

rockitorknockit

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Looking for straight talk from those who know more than me. I love my boy, Oscar, and will pay any cost necessary to keep him as healthy and happy as possible for as long as possible. So, while I'm not sure how to pay for any of this yet, money is not something I'm willing to let influence my decision on this. What I can't determine on my own is if a surgical biopsy would be worth the ordeal for him. Is it even an ordeal?

Background: Oscar is a just turned 14, neutered, orange kitty/mush ball. The most well behaved and sweet cat I have ever known. He was losing weight in very slow increments for months. I took him to several vets insisting something was wrong. He has hyperthyroidism and they kept rechecking this but results have repeatedly come back normal since finding the right medication dosage. Finally a vet did gut blood work and some different findings returned. We immediately started weekly B12 injections and made a switch to prescription I/D hard and wet food. He did a quick course of probiotics as well. His weight seems to have stabilized (he has not lost more in about two months now) but due to intermittent vomiting and chronic soft stools (which have been happening since before the gut tests and have not changed) I opted to go ahead with an internal med consult and ultrasound despite my vet telling me we could wait.

Now: That internal med appt was a little over a week ago. Unexpectedly, the Dr marked him has having a level 4 heart murmur (this is a first/new). Gallbladder and liver normal. What she noted was mineralization in the biliary tract and mild thickening of the small intestinal wall. From here she gave me the option of either throwing steroids at it and hoping there are no complications, or doing a surgical biopsy to determine if this is IBD or small cell lymphoma to treat more confidently. (With them doing an echocardiogram pre-surgery to confirm his heart can handle it.)

I need to know if the possible results of the surgical biopsy are worth putting him through it. As it stands, he acts normal now - he eats, drinks, plays, sleeps, purrs. He's thinner than he's ever been at around 10.3 pounds, but he's otherwise his usual self. I'm terrified of a surgery destroying that and seeing him fall apart for no worthwhile benefit. I hate the thought of putting him through it and him suffering. But if doing it can be okay and the results can truly help us extend his life and comfort, I think it makes sense to in order to treat him properly? I just don't know anything about what to expect from this surgery or what might come next. The specialist did not tell me at all what surgery or recovery could look like, and when I asked what would come after the biopsy, she simply said, "We either treat IBD or you have an oncology consult." I don't want to be selfish in my need to know, I only want to do what is best for his life. Can any anyone help with giving more thorough info and opinions? Experiences? What would you do if this was your cat? If surgical biopsy makes sense, what can we expect/how can we prepare? Oscar is my guardian angel on earth. Thank you for your kind and honest help here, in advance.

Attached is a cheeky photo of Oscar with his favorite toy, a stuffed carrot.
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AbbysMom

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What a beautiful boy! I'm sorry you are going through this. :hugs:

I opted not to get the biopsy. At the time my cat was 14. The vet didn't think it was lymphoma based on the ultrasound and she didn't think not doing the biopsy was wrong. I was thinking I wasn't going to put my 14 year-old through chemotherapy if it was lymphoma so we opted to go the prednisolone route. My husband was in full agreement.

There are plenty on this site that did get the biopsy though with no issues. We just weren't willing to put our old lady through it.

Good luck no matter what you choose. :hugs:
 

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I was in the same situation exactly a week ago. What do his labs say? If lymphocytes are high and others normal-ish, you likely have your answer.

Good luck.
 

__caitlin

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Your situation sounds almost exactly like mine too! My 13-year-old boy was diagnosed earlier in the spring.

Is there a reason the vet won't do a biopsy via endoscopy? That's what my vet did. My cat also showed some thickening of the small intestinal wall in addition to chronic diarrhea and some weight loss. After the ultrasound, I was presented with these options:
  1. Biopsy via endoscopy: this would only allow for a sample of the upper GI tract, but better than nothing; requires anesthesia but cats generally recover well from this

  2. Biopsy via colonoscopy: this is more supplementary, but would help with sampling the lower GI; the vet told me it really depends on each cat's colon shape whether or not she'll be able to get in there and get a sample, but it was worth a try while he was sedated. Unfortunately my vet was not able to get a sample due to my cat's anatomy.

  3. Surgical biopsy: most invasive option, but most accurate. As you can see, I opted NOT to go for this one and went for 1 + 2 instead.
My cat was definitely wiped out after the endoscopy; I was really worried about him, but he did recover and return to his normal self in a couple days. I would ask whether an endoscopy is possible and if not, maybe get a second opinion?
 

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The good news is that small cell lymphoma has a better prognosis than large cell lymphoma if cancer is what you are dealing with. So while it's frustrating to spend all that money on an ultrasound and still not have an answer, the choices remaining are still better than they could have been.

I'm not a vet. I don't even play one on the internet. Take my advice with a grain of salt.

Buy a baby scale and weigh him no more than once a week, preferably the same place and time each week. If he can gain or maintain his weight, it's probably not (yet) lymphoma. Unfortunately cancer loves to show up where there's uncontrolled inflammation. So even if he's clear for lymphoma today, his IBD could progress to lymphoma in the future. That's why I recommend monitoring his weight weekly. Because here's the thing. You could spend all that money not to mention the grief Oscar will go through recovering from that surgery to get a "not cancer" diagnosis today. It can still become cancer further down the road. Rather than putting him through that surgery and the recovery that will come with it, save your money and keep a weekly eye on his weight. I promise you won't miss it if he has lymphoma. The weight loss is dramatic and unrelenting. Krista lost half her weight in just a few months. 😿

There's a diet component to both IBD and lymphoma. I recommend searching for posts made by me to see what I have typed out before about diet recommendations and IBD (or lymphoma.) Tldr; no dry food. Novel protein, truly limited ingredients (not just marketing on the label--peas don't belong in a limited diet food!), preferably Rawz single protein pates. You may also want to consider homemade. Keep a food journal and record all butt and gut incidents to try to map out a pattern back to foods and hopefully pin down problem ingredients in those foods.

For medication, try the pred. Sometimes an IBD kitty needs that steroids punch to calm the inflammation quickly and give the food trials a better chance to succeed. I would recommend working with a specialist here to have a plan for the pred rather than a generic pred and pray approach. That plan should include monitoring and possibly a re-check on the ultrasound (and a tapering off the steroids if the specialist recommends that because steroids can give a rosier picture on the ultrasound than reality.) You also want to discuss with the specialist the possibility of trying chemotherapy without subjecting him to a biopsy. The chemo drug is less risk than the biopsy surgery in my non-professional opinion. It's also much better received than the surgery. My Krista slept a little more on dosing days. Aside from that, I never saw any other side effects from chemo. If the specialist says chemo is an option, don't let your preconceptions of chemo in people cloud that decision. Cats handle chemo much better than people.

But also recognize that medication can only go so far if you are continuing to feed inflammatory trigger foods. You can't put out the inflammatory fires with medicine while still stoking them with food. Medicine will be helpful. But you will still need to look for dietary triggers. The most common changes would be to cross off chicken and fish (the two most popular proteins in cat food and thus probably on his immune system's "💩 list" by now, so to speak.) Rawz makes single protein pates that are truly limited ingredient (no peas!) and thus the gold standard for food trials--even better than any prescription franken-food the vet wants to sell you. I recommend trying either the turkey (because Rawz can sometimes get hard to find and the turkey is easy to find during shortages) or the rabbit (and rabbit with pumpkin) which will almost certainly be a novel protein for him. I recommend feeding both the rabbit and rabbit with pumpkin because during shortages, one will be easier to find than the other (usually the pumpkin variety.)

Even when I think I'm just going to slap out a quick response, here I am several paragraphs later wondering where my lunch hour went. 🤦‍♂️
 
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babiesmom5

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Oscar is a very handsome boy! I am sorry you and he are going through this, but I can relate having been down the IBD/Lymphoma path with five cats.

I would definitely pursue an endoscopy after an abnormal ultrasound, "mild thickening of the small intestine". This would indicate that an endoscopy (where they go down via mouth with lighted scope) vs a colonoscopy (where they go up via the rectum) would be all that is needed. Cats recover within a day or two from this.

With three of my cats, an endoscopy diagnosed IBD. They were successfully managed with Prednisolone, and dietary change.

With one cat, he required an endoscopy plus a colonoscopy (same day) which diagnosed bad IBD. He was successfully managed with Prednisolone and dietary change.

With one cat, the ultrasound revealed "Likely gastritis; possibly IBD, less likely Small Cell Lymphoma".
Vet and I thought an endoscopy was not needed at this time, and decided to treat it as gastritis.
Three months later, this cat was dead...from Small Cell Lymphoma!

I learned a very painful lesson. Always best to know what you are dealing with. This is why I would always opt for an endoscopy/colonscopy following any abnormal ultrasound.

If this is not an option with your current IM vet, I would pursue a second opinion. Don't take chances.
I wish Oscar, and you, all the best!
 
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rockitorknockit

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Thank you all SO much for the replies. I've made so many posts on facebook and reddit, and y'all are the first to actually take time to read and respond. It's so very helpful for me. It's a lot to take in and think about... had a good cry about it last night. It's clear I need to speak to the internal medicine specialist further as well.

I want to compose a thorough response for everyone (because y'all's feedback is so valuable to me), but can't do it at the moment. I felt guilty about not replying yet, so wanted to pop in and say thank you and let everyone know I'll write more later - probably tomorrow morning while I am at work. Please check back? Would love to continue to pick the brains of those of you that have been through this.

Thank you so much, again, truly. An update with some answers/clarification coming soon.
 

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Thank you all SO much for the replies. I've made so many posts on facebook and reddit, and y'all are the first to actually take time to read and respond. It's so very helpful for me.
We really do have the best members here. They will celebrate with you and cry with you. :redheartpump:
 

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Aww so sorry about Oscar, he is beautiful and reminds me of my Merlin who is also a big ginger boy, a rescue from my outdoor kitties, but a tuxedo 😀

I have been through this, with my Wizarduni, sweet soulmate and guardian, he was an all black kitty who I rescued many years ago. He was always sensitive to everything and he was fiv pos when I took him in. He always had a touchy tum- I tried numerous foods and eventually raw and home cooked but it did not help. He had the us, the steroids, meds etc. But he would vomit with most meds, and raw food made him vomit more, I didn’t quite get the knack of doing the home cooked with him and Syb and he did not like either much so I gave up- I wish I had found the website know what you feed at that time. So I would have had some guidance on how to go about making their food myself.
He was diagnosed ibd and then crf. We treated the crf with fluids, b12 shots and epogen as he had anemia as well. Then his ibd symptoms which waxed and wained got worse. Weight loss started, he had always been a very svelte boy, all muscle, no fat, oriental body type.

My dvm specialist at the time who was great treated with prednisilone and chlorambucil as for suspected lymphoma because we knew he was high risk for that. I had opted not to do the biopsy when I first brought him there and then the crf popped up, because of his age and because he had always had a hard time with sedation, dvm agreed both times. He did very well on the steroid/ chemo combination and seemed to be improving, but after a few months he took a turn for the worse and eventually when it was time I let him go. It was so peaceful and he was there for me the whole time, he didn't want to leave really, but of all my kitties his death was the most peaceful and still so hard of course. I think he was at least 21 when he left me, so he had a great life, but I would have kept him with me forever if I could have 😿

I don’t know if the biopsy would’ve made any difference. Maybe it would’ve clarified which lymphoma he had and maybe the treatment could’ve started earlier and he could’ve survived longer, I will never know. I can’t tell you what to do, no one can, I can only tell you what I did and what the result was.

If you think he can go through the procedure and be OK I would probably just do it because then you’ll know for sure probably, ultrasounds really are not very accurate- I’ve had DVM tell me they were sure another of my beloved kitties had a specific form of lymphoma from us- eventually I did in a necropsy on her after her tragic death due to convenia and it turned out it was a totally different cancer, nothing even related to what they had said. I didnt believe them at the time anyway due to what happened with convenia and the fact that she had cancer was not diagnosed before being given a drug that she should not have been given, which should not have happened. There have been other cases where things were not properly diagnosed etc.

You still have to make the decision about how to treat him of course- I wouldn’t worry about the chemo, many cats do very well with that. Wizard actually seem to be feeling a lot better when he was on it. I think they need the combination of the steroid and the chemo.

I would also try altering the diet into either a home raw diet where you pretty much eliminate a lot of things. I feed Merlin and Quinn a home cooked with chicken and chicken liver and supplements added from Knowwhatyoufeed.com

Merlin has IBD as well- he was on steroids for a while, he had terrible diarrhea after I took him in and most likely parasites- I treated all of that for about eight months. Eventually I weaned him off the steroid and I put him on the home-cooked diet Quinn was on. They are pretty much cured now and symptom free. DVM at the time wanted me to do the whole biopsy etc. but I didn’t want to do that after the ultrasound. I just tried the treatment with all of the different meds and the diet. He also had tested positive for C. difficile so there were other things going on.

For Quinn he has not been diagnosed with anything, what happened was he had fleas when he was a kitten and I stupidly allowed them to put flea poison on him after which he was vomiting and runs started etc. but I eventually figured out it was a food sensitivity as well because when he ate Syb’s food he got diarrhea. I figured out that fussie cat and the home cooked was best. He and Merlin still eat only one flavor of fussy cat chicken chicken liver and pumpkin soup when I don’t have time to do the home-cooked. Those are the only foods they can eat except for some scraps of turkey and chicken sometimes.

The main thing is just to spend as much quality time as you can with Oscar and try to do the best you can for him it’s not an easy decision to make. He is older so you have to take it all into consideration.
 
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rockitorknockit

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Hi again, everyone. Thank you, again and forever, for all of the kindness, anecdotes, and information. And I apologize for the length of this response. I just need to get some of this out.

The day we took Oscar for the internal medicine consult and ultrasound was stressful for all involved. I had to fast Oscar overnight (which he HATES, obviously), work in the morning (I work an incredibly stressful job), then load the poor miserable puddle into the cat carrier and into the car, drive an hour to the appointment (endless), then hand him off at the door (absolutely the worst part of it all). And then it was almost $300 more than we had planned for, due to him needing an additional testing. I hate this. I hate ALL of it. And I know it's only going to get worse. I can't stand putting him through things when I can't make him understand why its happening. I pray he feels that I'm just looking after him.

I wanted to share a little more about what my original conversation with the internal medicine specialist was like. It was very short and over the phone, since I was not allowed into the room due to COVID procedures. She basically just quickly told me about the heart murmur, then what she saw on the ultrasound and that she suspected either IBD or a type of small cell lymphoma. She stated she generally prefers not to "waste time" with endoscopic or colonoscopic biopsies for these ultrasound results because they so often do not turn out fruitful/miss true results. Therefore, she recommended going straight to surgical biopsy. She then went on a winding tangent obviously meant to give me emotional permission to turn the surgery down about how many people opt out of this due to his age and cost and that we could do steroids right out of the gate, but then she also said a bunch of reasons why jumping to steroids could be dangerous and scary. It was hard to take it all in on the spot, so my takeaway was: doing steroids bad, doing surgery for true diagnosis first good.

My head was spinning (and still is). I had no idea what to think or ask right in the moment (still barely do, really). You all have said a lot that makes me wonder.

Dreading this, but my plan is to call tomorrow and see if I can get a bit of her time. Here are some questions I was thinking to ask...
- Does she feel she can make an educated guess about what's happening based on what we have so far from imaging and labs? Or would less invasive lab work help with that? So we can avoid surgery, assuming that would be ideal.
- How does she really think he would fare with surgery given his age and current state? What is surgery like? What would recovery be like?
- Would trying a course of treatments without diagnosis be risky enough to make the surgery worth it?
- What sort of prognosis are we talking about here, based on the various things he may have? Could surgery truly extend his life? Would just trying treatments essentially be 6 of one and half a dozen of the other?
- Should we be doing anything else anyway? Can I start giving B12 at home? Should I change his diet? He seems so FINE right now... is my attempt to diagnose or treat going to be the thing that sends him downhill (or is that just anxiety, and he's on the precipice of going downhill anyway)?

I don't know what else to ask. Do y'all have any other suggestions? Anything else I should discuss or mention?

I wish a clear answer and path would make itself known to me. I am hoping her responses will help, in combination with what you all have suggested, to get me to a space where I feel less uncertain about it all. I realize you have all been here and know what I mean. I am an incredibly obsessive and worried person anyway, so this is just eating me alive. Thank God I have a spouse to look after ME while I look after Oscar!

More than anything, you've all made me understand that there's a lot I don't understand. Getting into food allergies and diet things sounds incredibly overwhelming, so I guess I need to start with understanding better how what he's eating could be negatively influencing things. (He is a cat who LOVES food and treats, so this also feels very sad in itself.) I also did not know cats tolerate chemo differently than humans - I definitely envisioned that being a "no way" option because I've known plenty of humans who suffered through it but have never seen a cat take it.

I refuse to let cost dictate my decision, but there is also the stress of that, it should be said. I currently have no idea how I will pay for surgery. I do not even have a credit card with a high enough limit yet.

As it stands, I scheduled the heart test and surgical biopsy for November 19th, to get it on the calendar while I did research about it. I am hoping I can come to a decision I feel reasonably confident in before then, so that if I don't want to do it I can just cancel, but if I do then it's already in the books.

Just writing this has felt so emotionally draining. Thank you if you took the time to read through it all. To lighten the mood a bit, I will share another picture of Oscar... one I took over the weekend. One that very much fits my MOOD right now!
oscarmood.jpg
He is loves this blue bed and sleeps in it most of every day and night. It took him almost a year to suddenly start using it, which is hilarious. There is a blue t-shirt in it because I always swap out shirts I've been wearing so he has one that smells like me close by. There is also paper in front of him because he's OBSESSED with paper, and we had a bunch left over from moving! I give him a fresh piece of packing paper every week or so.
 

__caitlin

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I'm not a huge fan of the way your vet talked to you! At least based on your brief description of it.

It's a hard decision. But if I were you, there's a good chance I would opt against the surgical biopsy and maybe also consider switching to a new vet, if only to get a second opinion. As daftcat said, getting a true biopsy right now would be great, but really doesn't guarantee you anything for the future. For me, I'd rather save painful, invasive, and expensive procedures for when the cat is already doing poorly and the balance of their quality of life vs. the risk of the procedure is more proportionate.

Plus, it looks like there's a lot more you could do still to go the route of testing whether he responds to traditional IBD treatments (a lot of this you'd have to do anyway, even if it was IBD + lymphoma):
  • Would definitely take him off the dry food right away if he can tolerate it; it seems like dry food has a bad reputation for cats with IBD, and I know mine didn't respond well to it. Even though it was technically the same formulation as his wet food, I noticed his GI symptoms worsening as soon as I put him on it -- and if I'd known more and addressed that sooner things could maybe have been better for him.

  • You've been giving the i/d food, but you don't actually know what he might be intolerant to. The i/d food is for general digestive upset -- it will not help if he's allergic/intolerant to something in it. It has tons of chicken in it, for example. (But Rawz is probably the best recommendation per the advice above!)
    • The two sites that get recommended a lot (that really helped me) are IBDKitties – Helping Save Lives…One Paw at a Time + Feline IBD -- not that you have to immediately take all the advice in those sites at once. But it really helped me quickly expand my horizons to understand a) just how much the existing veterinary industrial complex doesn't understand about these conditions, and b) the full breadth of possible strategies folks have been trying for years, and how far I could go if I wanted to (and if my cat was ready for it).
  • Many cats do find steroids helpful in the short term, but of course this does depend on other preexisting conditions. The heart stuff would worry me a bit, as well as anything around the liver. But once again, maybe something that could be worth a second opinion from a vet that isn't so surgery-focused?

  • Also, less related, but my clinic allows for payment plans; maybe you could ask if yours does?
I know it's totally a nightmare -- I'm going through almost this exact thing right now except that my boy has progressed from chronic diarrhea + vomiting to just total loss of appetite + vomiting. :( I would say if Oscar is still doing pretty good, I would want to give the at-home treatments a chance first before putting him through an invasive procedure.
 

__caitlin

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Oh, and I should also add -- you can absolutely give B12 at home via subcutaneous injection; so definitely ask about that! They should be able to give you a prescription.
 

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Thank you all SO much for the replies. I've made so many posts on facebook and reddit, and y'all are the first to actually take time to read and respond. It's so very helpful for me. It's a lot to take in and think about... had a good cry about it last night. It's clear I need to speak to the internal medicine specialist further as well.

I want to compose a thorough response for everyone (because y'all's feedback is so valuable to me), but can't do it at the moment. I felt guilty about not replying yet, so wanted to pop in and say thank you and let everyone know I'll write more later - probably tomorrow morning while I am at work. Please check back? Would love to continue to pick the brains of those of you that have been through this.

Thank you so much, again, truly. An update with some answers/clarification coming soon.
I agree w/ everyone: endoscopy at least lets you know what you are up against. I’m on my 4th chemo pill w/ my dear Zorro & cherishing every moment we have together. Lately he has shown less interest in going outside (probably best: less grass nibbling and hunting). Curling up more often next to me for comfort and hungry all the time due to the pred. (Putting on needed weight). Does not seem to be in pain, and I think you will feel better, knowing you are trying to do all you can. Order your RAWZ now as it seems to take awhile to arrive, at least where I am, and if you live in the middle of nowhere (like me) hunt up traveling vets (they do exist) esp if you are squeamish about giving the B-12 shots yourself. Good luck, and I can see you love each other very much, he is a sweet pea.
 
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rockitorknockit

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Thank you so much, Caitlin and Margot (I hope I am not being presumptuous in assuming those are your human names lol) for replying further to me. I really appreciate the insight you both added. I actually tried to feed Oscar only wet food today, just to see how it went. He was pissed. He gets very antsy about requesting dry food specifically at certain times of day. He has a very funny habit of chewing up paper when I won't feed him what he wants, as if to show me, "SEE, HUMAN? FOOD? GOES IN MOUTH? GIVE ME IT!" I ended up caving since I have not spoken to the vet again anyway, but I do see how we may need to land on wet food only. I also shared the helpful links some of y'all have provided with my wife so she could do some research on diet things for him. My work is so absurdly absorbing, I am so glad she is around to try and get into that side of things for me right now since I simply do not have enough hours in the day.

That said, today I anxiously called the internal medicine office at 7am and requested a call back from the Dr to discuss things. At 2p someone else gave me a call back, but I missed it (by mere moments) due to my ENDLESS work meetings. I have no idea what the role of this person is, but her voicemail was nice... she said the Dr had so many hours to get through before she could call me back that she wanted to try and call me sooner on her behalf and see if she could answer my questions. But, since I did not answer, she recommended I try sending an email.

So, I just sent an email to their office. I tried to keep it as succinct as possible since I have so many complex and also emotionally driven questions. I really appreciate that I could type things out so as to not miss things, and I am hoping this will mean that whoever calls me back again will already be prepared for my state and have anecdotes and information to share. I guess I give them a day or two to call back again now? Meanwhile, I just feel this sinister invisible thing looming over us. I worry that I am somehow doing things to make things worse for Oscar without even knowing it, because I feel stupid and blind and don't know enough about anything.

I'll keep everyone updated...
 

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Trying to eliminate dry food overnight is a pretty tall order. I did that to Krista and I don't know how she accepted that from me. I didn't know any better at the time. It was before I found this site. I took her in for multiple tooth extractions and brought her home to wet food only after a lifetime of dry food. Perhaps the one thing going for me was that I started with grocery store cat food: Fancy Feast or Purina. Popular brands are popular with cats. They would not be on those shelves otherwise. I recommend giving him fewer kibbles and then offer him wet when he gets angry for more food. For better or worse, if he does go on steroids, that should kick up his appetite and make him more amenable to wet food. I recommend timed feeders to cover overnight hours if you don't want a paw in the face, and to cover daytime snacking because steroids will give him the munchies. I like the clamshell design over the wheel. It's more flexible in the schedules you can set and it doesn't enforce any time limits by rotating uneaten food away. Wet food can go in those for hours without needing the included ice packs.
https://www.amazon.com/dp/B07FT93YM2/?tag=thecatsite
 
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Margot Lane

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Thank you so much, Caitlin and Margot (I hope I am not being presumptuous in assuming those are your human names lol) for replying further to me. I really appreciate the insight you both added. I actually tried to feed Oscar only wet food today, just to see how it went. He was pissed. He gets very antsy about requesting dry food specifically at certain times of day. He has a very funny habit of chewing up paper when I won't feed him what he wants, as if to show me, "SEE, HUMAN? FOOD? GOES IN MOUTH? GIVE ME IT!" I ended up caving since I have not spoken to the vet again anyway, but I do see how we may need to land on wet food only. I also shared the helpful links some of y'all have provided with my wife so she could do some research on diet things for him. My work is so absurdly absorbing, I am so glad she is around to try and get into that side of things for me right now since I simply do not have enough hours in the day.

That said, today I anxiously called the internal medicine office at 7am and requested a call back from the Dr to discuss things. At 2p someone else gave me a call back, but I missed it (by mere moments) due to my ENDLESS work meetings. I have no idea what the role of this person is, but her voicemail was nice... she said the Dr had so many hours to get through before she could call me back that she wanted to try and call me sooner on her behalf and see if she could answer my questions. But, since I did not answer, she recommended I try sending an email.

So, I just sent an email to their office. I tried to keep it as succinct as possible since I have so many complex and also emotionally driven questions. I really appreciate that I could type things out so as to not miss things, and I am hoping this will mean that whoever calls me back again will already be prepared for my state and have anecdotes and information to share. I guess I give them a day or two to call back again now? Meanwhile, I just feel this sinister invisible thing looming over us. I worry that I am somehow doing things to make things worse for Oscar without even knowing it, because I feel stupid and blind and don't know enough about anything.

I'll keep everyone updated...
O my I feel as if I WAS you about 4 weeks ago! This CAN all seem overwhelming, and it is important to cry. Cry a lot and shake it out of you as your furbie will need you to be there. And you will be. They will give you plenty of written instruction when the time comes and actually, being able to do something constructive for Oscar will help both of you give you a sense of ritual and purpose that is not at all (I think) a waste of time, though be prepared at least in the US for sticker shock. Perhaps it is the type of canned catfood you are serving, and I here humbly defer to daftcat. I would also suggest you read daftcat’s earlier messages to all about cherishing this time you have with Oscar.Who knows? Maybe you’ll be one of the lucky remission winners on this journey, but whatever the outcome, press pause when your time allows and just hang with Oscar. Also if he is about to go on pred., or has just started, his appetite will increase profoundly, for ANYthing. Mine wakes me up at all hours, yowling for the canned stuff. I’d stock up. Good luck and keep us posted!!
 

Margot Lane

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…I thought I’d add two footnotes. One is that as Zorro eats more, it is making me more well acquainted with the other end. I’ve been told to always wear gloves when at the litter box, not only for sanitary reasons but the chemo pills leave residue in the -er- ‘offing‘ that you don’t want on you either. So be prepared to have lots of disposable gloves …I use the close fitting, non powdered kind, which you also need for the chemo pills. It’s also making me more aware of how much kitty litter is used in the world: would be interested to know what others are trying on an ecological/biodegradable level.
 
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rockitorknockit

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Trying to eliminate dry food overnight is a pretty tall order. I did that to Krista and I don't know how she accepted that from me. I didn't know any better at the time. It was before I found this site. I took her in for multiple tooth extractions and brought her home to wet food only after a lifetime of dry food. Perhaps the one thing going for me was that I started with grocery store cat food: Fancy Feast or Purina. Popular brands are popular with cats. They would not be on those shelves otherwise. I recommend giving him fewer kibbles and then offer him wet when he gets angry for more food. For better or worse, if he does go on steroids, that should kick up his appetite and make him more amenable to wet food. I recommend timed feeders to cover overnight hours if you don't want a paw in the face, and to cover daytime snacking because steroids will give him the munchies. I like the clamshell design over the wheel. It's more flexible in the schedules you can set and it doesn't enforce any time limits by rotating uneaten food away. Wet food can go in those for hours without needing the included ice packs.
https://www.amazon.com/dp/B07FT93YM2/?tag=thecatsite
Oscar loves wet food, and before switching to I/D he barely ever ate dry food! I don't think he would have noticed then if I removed the dry food suddenly one day, when he was always eating the fancy feast savory centers. But he seems to prefer the dry food of the I/D now, so he was pretty annoyed with me for that. You're completely right about not trying to make the change so suddenly, though, and also just sticking to it until he's used to it.
The other issue here is I do have another cat. He is only 2 1/2 and eats totally different food (just regular old dry food), obviously. But now they have this power play thing going where they get pissed at each other when one of them is eating a different food, and they both try to sneakily eat the others' food. It's a constant game of picking up and putting down the right food for the right boy and keeping eyes on them when one is eating. Oscar in particular is also a major grazer, so he wants to be fed about 453123 times a day. The other can go much longer stretches without getting antsy for food. (He's the weird one that is not food-motivated at all.)
Timed feeders sounds like a dream, especially for me, the one that is woken 53987452038945 times a night by Oscar needing a fresher snack (vs my wife who could literally sleep through a nuclear blast). But I wonder what your experience is with those and multiple cats who need different foods?
Which also brings me to what Margot Lane said about the chemo drugs and poop... would be worried about my other cat's exposure to things!
Aaand the questions just keep piling up!
 

Margot Lane

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Earplugs. Shouting “NO!” Loudly works for about five seconds. Just had to feed the Z man at whatever ungodly hour it is or he would have finished ripping up what’s left of the armchair. Make sure you don’t wash the lower portion of the automated feeder as the batteries get wet and then you ARE the ‘automated feeder.’
 
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