The well-known problem of IBD or lymphoma and pancreatitis

[arinlars]

Hello all! This is my first post here.  This is the health story of my 12 year old Mimi, my cat.  I will start with her  symptoms with chronic vomiting which I thought it was because of stress with moving or hairballs and allergies. She started over time having diarrhea some months now but not everyday along with vomiting. The last couple of months she had diarrhea every day and vomiting 3-4 times a week but eats/drink normal and she plays a lot. We went 3 weeks ago to have an ultrasound and it showed thick intestines. We then got recommended to see an internist because he would know what it is or what to do. He told me he must either perform a laparoscopy or surgery or try giving her for 3 weeks prednisolone and she how she responds (meaning if its lymphoma she would be worse). I decided  to start prednisolone  because he said he is not so sure it's a lymphoma and I didn't want to put her in such trouble especially if the vet isn't so sure about her disease. Then we start to lower the dose and see how she is. My other vet said this will mask the symptoms of gi lymphoma but the internist said no. I'm confused and scared at this point a lot more than the begining..  Meanwhile while on prednisolone she is great. Diarrhea stopped after 12 hours and vomiting stopped before the medicine actually because I switched her food to Tiki Cat Puka puka luau. She is still playing  and still eats a lot which makes me feel good.  Now after reading the evil internet, I see cats get worse on prednisolone and they live up to 6 weeks if she has lymphoma.. meaning she only has 3 more weeks if she even has it? I was so sad, endless tears and guilt, why did I not pursue the exploratory surgery 3 weeks ago.. I decided now to put her under exploratory surgery and I am scared of the risks.  I see that she feels sometimes pain she just purrs without a reason and stands like a Sphinx but as soon as I get a toy she flips out, she always want to eat and poops normal. She is stressed and I know that is because its my SO's cat which we introduced each other since August and they don't like each other. I am sharing this story because I want to see how other cat parents that had a similar story deal with this. I am scared because I don't know what to expect. The vets now said ok it's too late with the surgery because she is on prednisolone... she must get off that first and then we can perform that. And of course the risk of the surgery... :'( Thank you for reading

 

[stephenq]

Hi @arinlars   and welcome to TCS.

My cat Simon has the exact same issue.  I will post a bit here now, and again later when I have more time in about 12 hours.

The chances are that you're cat has IBD not lymphoma, that's just playing the odds.  Pred doesn't mask the symptoms of Lymphoma, it treats the inflammation that lymphoma (and IBD) creates in the intestines.  Yes in time its fatal, but cats can live up to a couple of years will well treated lymphoma.

Many people skip the biopsy and just treat because the initial type of treatment (pred) is the same whether its IBD or lymphoma.  If the cat stops responding to Pred, the vets will usually say that this point its probably lymphoma, and they will switch you to Leukeran, the safest and most effective "chemo" for lymphoma, but you may never get to this point.

Its true you can't biopsy while on Pred because the disease is in remission, but its seems radical to stop treatment at this point in order to re-induce the disease so you can perform major surgery in order to find out if its IBD or Lymphoma.  You made a reasonable choice to treat without biopsy, your cat is responding very well, so it would seem like your vets would counsel you to continue. Are they suggesting otherwise?

Prednisilone isn't evil.  It is very well tolerated in cats and is in many ways a miracle drug.  Stop reading the internet, you will always find links saying why something is wrong.  Pred saves lives.

Your cat isn't going to die in 3 weeks.  She is responding to therapy.  If she wasn't responding to the Pred then there would be an issue, but there would still be the leukeran option.

The only option that you don't really have without a biopsy are the stronger chemo drugs that a vet won't prescribe for lymphoma unless there is a positive diagnosis via biopsy, but many people will forgo this treatment anyway because its desperate and probably won't help much.

Your cat is doing really well, discuss with your vets continuing treatment.  The pred is working.  So long as it continues to work that supports a diagnosis of IBD. If it starts failing, that supports a diagnosis of lymphoma.

As to your two cats not getting along, how long have they been together?  You may want to consider separating them and doing a slow re-introduction.  You could post about this in the behavior forum.  Stress doesnt help illness, so there is a medical reason to separate too.

By the way, i chose to biopsy my 14 year old cat, it was severe IBD, not lymphoma.  He is on Pred and doing very well.

 

[rubydoo67]

So sorry to hear you kitty is ill. My cat had lymphoma, which was confirmed via biopsy. She was on Predisone which did help her initially. It helped my kitty feel better and act better for a bit. Nothing wrong with that

She was different than you cat as she never had diarrhea nor chronic vomiting. Maybe your cat does have IBD which is treatable

Even if your cat has lymphoma, small cell is treatable and many cats can live a long time under treatment

Remember, every ct is different and responds differently to treatments and diseases. Keep the faith!

 

[arinlars]

Thank you both for the responses , I feel better now.

Well the cats where introduced on August and since then he other cat just keeps stalking my cat Mimi and he just does nothing else and she slaps him. It's funny but quite sad because she used to be alone and different. Since they are together she just stays usually someone higher and never comes to sleep with me anymore. I have Feliway all over the apartment. It helps but a little. Even when they try to play she just smacks him I the face and runs . Weirdos.

I am going to talk Sunday with the vet again so she can tell me what she thinks about my plan with the biopsy. It's week 4 and she is on half of the pill (5mg) every other day but she is pretty gassy and her little tummy rumbles. I cannot tell if she lost weight she was since 1 yrs old about 7lbs. So she is light. I ordered a baby scale and just wait until it comes.

I try and give her the pill with the pill pocket and knit it to a little ball because she is tricky and spits it out. Sometimes I give her a little meatball made out of cat food. I think maybe the pill pocket made her gassy? I don't know.

 

[denice]

You said she is on 1/2 a pill every other day and it's week 4.  Is the dose being tapered now?  Tapering off the dose could be why some symptoms are returning.   The pred does have to be stopped for several weeks before a biopsy to get the best results.  The biopsy is to look at the inflammatory cells and the pred suppresses inflammation.

I chose not to get a biopsy for my kitty, a lot of us here didn't get one.

http://ibdkitties.net/

http://healthypets.mercola.com/site...11/02/inflammatory-bowel-disease-in-pets.aspx

These are both good resources about feline IBD.

 

[arinlars]

The dose was : 1 st week = 1 pill/day 2nd week = half / day 3rd week until forever = half / 2 days, (every other day)

The internist said if she is ok with the lady one then we should continue with that if not we got back to half / day.

I know those sites they are really helpful! Thank you

Husband suggested the gas is because I gave her fish flakes from cat man do , for treat. She wants the other cat's food (weruva chicken no grain but has carrageenan ) because she got bored of hers , the tiki cat and I sprinkled some fish flakes because I knew she would eat it .

 

[arinlars]

I forgot to mention that the internist suggested the dose should be half/ every other day for indefinite

 

[raintyger]

Hi arinlars,

You might want to consider what happens if she does have lymphoma. On average the lymphoma returns after 6-8 months. There are cats that beat the average, of course. One member here I know has a cat that I believe is around 2 years plus in remission. However, if the treatments will be too stressful or would somehow cause problems, it is something to consider.

 

[goholistic]

My Sebastian was diagnosed with has chronic pancreatitis 10 months ago. At the time, it was thought to be a product of IBD or cancer. I, too, was confronted with the decision to have biopsy. I declined, not only because of Sebastian's fragile state at the time, but also because I read and was told by my vets that sometimes even a biopsy is inconclusive and it can be difficult to differentiate between IBD cells and lymphoma cells. Given that we would treat IBD and lymphoma the same, we moved forward as though it was IBD.

The differentiation of intestinal lymphoma from IBD in live cats is usually based on the histologic evaluation of intestinal biopsy specimens. However, it can be extremely difficult to differentiate these two diseases by histomorphology alone. Whereas B cell lymphomas have a distinct cellular morphology and are recognized fairly easily microscopically, intestinal T cell lymphomas and IBD are both characterized by marked infiltrates of small lymphocytes that cannot be distinguished by histology alone. Unfortunately, primary feline intestinal lymphomas are most commonly of T cell origin.

Source: http://intl-vet.sagepub.com/content/48/1/212.full

 

[stephenq]

Hi @arinlars

I'm not sure why you are tapering the drug so soon (how long exactly has he been on it?).  Normally you would want to establish weight gain and a stable cat before tapering, if one would even want to taper in an otherwise healthy cat.  As several have said, if you're going to do the biopsy then you have to stop the pred entirely for several weeks and allow the disease to return before you can do the biopsy.

Some thoughts on the biopsy.

- Endoscopic while less invasive is also less likely to produce conclusive results.  An Echo can help determine if the inflammation is high enough in the intestines to warrant an endoscopy.

- A surgical biopsy is more invasive, creates as sizable incision, but otherwise healthy cats should come through it well and more or less back to their old selves in about a week. A surgical biopsy also lets them take, more samples in different areas and also look at lymph nodes and the liver.

- The down side to biopsies in general for IBD/Lymphoma is that it is possible that they may not yield conclusive results, even with some extra sensitive testing of the samples. In other words, it is possible to oput your cat through the surgery and get no results that you can trust.

When we had out cat examined by an internist he did an echo and concluded that we should probably do a surgical biopsy which we did and we found advanced IBD, a positive diagnosis.  He was put on Prednisilone, a conservative dose because he has kidney issues, as well as B12 injections, probiotics, and a special diet.  The special diet didn't work for him and we opted to stop that, but he is doing great, gained back all his weight and now about 3 months later we are going to get one of several rechecks and consider tapering the pred, but we may not. He's doing really well with no side effects.

Sorry for typo's in earlier post, was typing in a hurry before work.

Getting a baby scale is a very good idea.

 

[arinlars]

Hello StephenQ,

The internist told me to do this plan that I mentioned and then he said last week before I decided with the surgery to have her on the lowest dose for 6 months or indefinitely, we would see.

I forgot to mention that when we did the ultrasound, her intestines where thickened and an endoscopy would be pointless because it was in the middle of her belly, something the endoscope could not reach.

You all give me many hopes, I start to think that she doesn't need any surgery. Btw she did not loose any weight, she is like this for 12 years. The only thing I am tampering is the food, she got bored of it so I bought the tiki cat food with chicken and egg.

Goholostic I am sorry about your kitty. How is he now?

 

[stephenq]

OK, lowering the dose is fine so long as the symptoms don't return.  Many vets will try and treat IBD with medications without a surgical biopsy if the cat isn't losing weight, and you said your cat isn't losing.  Many cats live their lives with IBD as an inconvenience (diarrhea, vomiting etc) but it is maintained via some combo of special diet, and meds like Tylosin (helps restore proper bacteria in GI tract) and when that doesn't work move on to bigger drugs like Pred.

But note that when there is progressive weight loss, that means the disease has progressed to the point where there is nutritional insufficiency and this is when it goes from inconvenient to dangerous.  And on the lymphoma issue, I suspect you can't really have lymphoma (unless super early stages) without weight loss.  Small cell lymphoma is not a mass type tumor, its an infiltrative disease which means that it changes the nature of the existing GI cells and causes (as a result of inflammation) nutritional insufficiency and in time digestive failure and death if not kept in remission, but I think (and this is an educated guess on my part) that a cat who's weight has been stable for some time with these symptoms is very unlikely to have lymphoma because weight loss is a part of the lymphoma disease.

Vets like to discuss IBD and Sm cell Lymphoma as 2 diseases on a shared continuum - in other words IBD can turn into Lymphoma and sometimes the biopsy isn't clear because the cells under inspection could look like either disease (in some cases).

So what I'm suggesting is that a cat with stable weight is unlikely to have Lymphoma, and I would want vet opinions to the contrary before i opted for a surgical biopsy.

 

[arinlars]

That is a very nice explanation. I will go tomorrow and consult the vet. I trust this one and they are great. I am anxious to get the baby scale and compare. My husband noticed yesterday that she could have gain half a pound. It's not really accurate the comparison because she was always tiny so I don't know for sure. 

The Tylosin sounds great. We tried at the very first with Metronidazole and it did not do anything for her. My guess is the vomiting stopped when I gave her the tiki cat (bland food) other that chicken shreds and broth there was nothing else there. The internist gave her the z/d from hills and she vomited like 12 times in one hour so I stopped. All that was before prednisolone. Now she is ok. Well... I guess time will tell. 

I just sometimes think.. if I was more educated about cats diet like 10 years ago, I would never fed her grain or kibbles. Poor kitty

 

[stephenq]

A scale is super important, if the Pred is working your cat will gain weight very quickly, within 1-2 weeks even if it's a small gain.

You may be past the point where tylosin can help.

Z/d which is a hydrolized protein food seems fairly famous for causing bad diarrhea (or vomiting) in cats although it can work in others. Another choice is a novel protein food like rabbit which hopefully the cat doesn't react to.

Let us know what your vet says ok

 

[arinlars]

Does anyone has alternatives to tiki cat food? Or know if the pill pocket or wellness chicken formula causes diarrhea or aggrevates the ibd?

 

[raintyger]

Soulistic and Fussie Cat are similar brands of food. I know that Tiki Cat and Fussie Cat are low calories, so please make sure she's getting her daily caloric intake. That would be horrible for her to lose and weight and for you not to realize that and think that it was the result of her illness! I'm not sure of the calorie content on Soulistic.

Pill Pockets are made of starch and I believe have sugar in it, so I suppose it can cause digestive distress. Wellness has carrageenan, which is on the suspect list for IBD kitties.

 

[arinlars]

Hm she ate some of the other's cat food (wellness) and she had fairly normal poop but a little soft. 

I did not know that about tiki cat, very interesting. She eats 2 small cans a day although she got bored of that. She wants the other cat's food! I will try soulistic next time I saw this food at the pet store yesterday. Chicken & Pumpkin Dinner - In Gravy seems interesting since pumpkin helps with diarrhea yes? 

I also bought Lotus Turkey to give it a try.

 

[stephenq]

Hi @arinlars

IBD as a disease - it's very nature and essentially it's definition - is an inflammatory GI response to animal protein. In theory any animal protein can cause this reaction but in practice it has been found that many cats don't have this response to a protein that they have never eaten before examples being duck, rabbit, kangaroo (not kidding) and as a result the pet food industry has created a class of foods called "novel protein" foods that contain only a single novel protein that hopefully the cat doesn't respond to.

Most pill pockets contain standard proteins, chicken, beef or fish so this can cause inflammation and diarrhea. At this time the only novel protein pill pocket that I'm aware of is made is for dogs, but vets use this routinely for cats. But there is no real point to doing this unless the cats entire diet (100%) is a novel protein, you're either all in or there is no point.

The problem with novel protein diets is that often times a cat will in time develop a reaction to that protein, and then you have to switch them again....and again...
And there becomes no long term solution, which is where the Meds can really help. But every cat is different and managing IBD is a balancing act for which no single page of instructions (like this thread) will work in every instance. This is a disease that is managed, not cured, and it is managed partly by trial
And error, and by careful measured adjustments to diet and medications.

IBD untreated can in time turn into sm cell lymphoma and preventing that is another goal of treating IBD.

 

[arinlars]

Hello all,

so I went to the vet today and she said that she will consult the internist about the surgery, and if we are going to do it then it's without risks (meaning the anesthesia) and the only risk is the intestine, if it is in a bad condition the heal time will be longer etc. She thinks that is probably ibd because she is doing fine on pred and we should even try to lower the dose (from every 2 days to 3 days) and she how she is managing that. She is worrying though that if we proceed with the surgery that the pred wont work so well after, there are cases that the cats are responding well to pred, do the surgery and then dont respond anymore (even if it is ibd). She said if it is small lymphoma the meds are pred and the chemo stuff.

Hm so now I wait until they consult. I believe my kitty is ok, no episode in 1 month. Maybe I am worrying to much but that's what cat moms do no?

 

[denice]

If I were going to go ahead with the biopsy I would definitely have the kitty completely off a steroid for a few weeks before.  The biopsy results won't be reliable while on a steroid.  That was one of the reason's I didn't get a biopsy.  My kitty was very ill, even had gone into fatty liver and he was put on a steroid as part of treatment.  I didn't want to take him off of the steroid.