The well-known problem of IBD or lymphoma and pancreatitis

[arinlars]

Yes, of course, they told me to wait for the consult and then we start 2 weeks every 3 days and then we stop.

I sorry about your kitty, how is he doing now?

 

[stephenq]

You may want to give more thought on the value of re-inducing your cat's disease so you can perform major surgery to see that it has the disease. I'm not saying don't do it, but it's not a small matter

 

[arinlars]

I know.. I keep thinking it I and I think she just has ibd and she is fine, my heart will break if she gets sick again and I cause it .. I think I will just skip the whole procedure. On the other hand I will never forgive myself if she has something like lymphoma and I could do something about it on time.

She responds to the med, eats well and that's what matters now.

 

[arinlars]

One things I forgot to ask the vet though, is that her poop is so light colored I don't know if this is ok or not :/ anyone knows?

 

[stephenq]

I know.. I keep thinking it I and I think she just has ibd and she is fine, my heart will break if she gets sick again and I cause it .. I think I will just skip the whole procedure. On the other hand I will never forgive myself if she has something like lymphoma and I could do something about it on time.

She responds to the med, eats well and that's what matters now.

Ok ask your vets this "given that my cat hasn't been losing weight, how concerned should I be at this time that her condition is lymphoma and not IBD?" My vets, both my primary and my internal med specialist only became concerned about possible lymphoma when there was weight loss (pre-treatment).

If your vets say the chances are low, then that may give you the confidence to continue as is. In many respects your best opportunity to do a biopsy was before you started the Pred. You made a choice, a very reasonable one that many people make, and perhaps the best thing for your cat right not is to live with that choice, and accept some uncertainty as the price paid.

Note also that the first two types of treatments for IBD and lymphoma are identical: Pred, and if/when that stops working, Leukeran. These two drugs have been known to keep lymphoma patients in remission for up to 2+ years in some instances! and when they both fail the only thing that's left and the only thing you wouldn't be eligible for without a biopsy, are very heavy duty types of chemo which will probably make your cat quite I'll and may do very little for her at that point. Many people choose not to go that route when Pred and Leukeran both fail.

 

[quiet]

I am sorry. I didn't have time to read much. So if I am way off just ignore me.

IBD can turn into lymphoma. It seems that the cancer likes to happen to long term inflamed cells. I worry about it all the time with my cat who has chronic rhinitis.

What would you be doing differently if it was lymphoma?

The biopsy they want to do is it surgical?

I sure wouldn't want to upset things more if kitty is doing better. I don't know that I would want to do the biopsy even if kitty wasn't doing better.

 

[arinlars]

StephenQ, the primary vet said she doesn't think its lymphoma but you can never be sure, but she told me to wait until she consults the internist. My gut and her gut says its ibd. She is just doing fine right now abut sometimes I think the internist is eager about the biopsy because of the money? It costs a lot if he does it but it costs 1/3 if the primary vet does it .. But I made the choice not to do a biopsy before the pred because the vets said we do this trial, meaning we start with pred for 3 weeks and see how she is .. She is be through a lot, we moved 2 times thought the continent and we moved a lot, lots of scary airplane rides and she is a thought little kitty, I wouldn't want to make her feel worse.

@Quiet , If it was lymphoma I would start chemo :/ and the biopsy is exploratory surgery because it's in the middle of the intestines and an endoscopy would not show anything. But she is fine now, eating well, playing, pooping well haha. Well that's what matters pooping well and feeling fine .

 

[rubydoo67]

So sorry about your kitty. My cat did have lymphoma, large cell, and the weight loss was rapid and extreme. She got a little appetitie back while on Prednisone, but never gained any substantial weight back. I believe at the end she had lost about 2lbs over 2-3 weeks, which is an awful lot considering how much she lost prior to diagnosis

On the other hand I will never forgive myself if she has something like lymphoma and I could do something about it on time.

. large cell is terminal. I believe all we can do is palliative care and keep them comfortable. Small cell is treatable and I've read many kitties went on to have long lives. Unfortunately, only a biopsy can tell you

Best wishes for your kitty!

 

[stephenq]

StephenQ, the primary vet said she doesn't think its lymphoma but you can never be sure, but she told me to wait until she consults the internist. My gut and her gut says its ibd. She is just doing fine right now abut sometimes I think the internist is eager about the biopsy because of the money? It costs a lot if he does it but it costs 1/3 if the primary vet does it .. But I made the choice not to do a biopsy before the pred because the vets said we do this trial, meaning we start with pred for 3 weeks and see how she is .. She is be through a lot, we moved 2 times thought the continent and we moved a lot, lots of scary airplane rides and she is a thought little kitty, I wouldn't want to make her feel worse.

@Quiet , If it was lymphoma I would start chemo :/ and the biopsy is exploratory surgery because it's in the middle of the intestines and an endoscopy would not show anything. But she is fine now, eating well, playing, pooping well haha. Well that's what matters pooping well and feeling fine .

Again if your cat never lost weight then I think its probably not lymphoma, and I suggested you put that question to your vet.  And no you can never be sure about anything, but we can make informed and educated decisions, and it is also possible that you could do a full biopsy and have an inconclusive result - i was told this can happen as much as 20% of the time.  So even the biopsy may leave you empty handed.

@Rubydoo67 is correct that you can't obtain a positive diagnosis without a biopsy, but as i mentioned earlier, the treatment for small cell lymphoma and IBD is identical so both diseases can be treated correctly without a true diagnosis.   All you lose without a diagnosis is the ability to add very serious chemo treatments later, past the point where most cats can continue a meaningful life.

 

[quiet]

Hi;

Okay so maybe things have changed in the last four years, but....IBD is diagnosed by exclusion of other diseases, such as lymphoma. It is not that you see IBD cells. You see inflammation and the cells associated with that. You get results that are consistent with IBD and the results will also say "no evidence of neoplasia" then you assume and treat as IBD.

You can take samples anywhere through the GI tract with an endoscope. We would call them DUENDO for short meaning double endoscopy. You start out at the front of the cat and get your samples then you turn the cat around.. I am sorry to be graphic. But there is no area of the GI tract that can not be sampled. It is a very long procedure and I wouldn't want my cat to be under anesthesia for that long. You really need to be 100% comfortable with your vet and their techs and be sure that their monitoring and post op care is state of the art because a debilitated cat can have some serious issues in recovery, if not watched like a hawk.

The other problem with doing biopsy now is that you have started the Prednisolone and you have had good results. If you stop it and then start it again you never have as good a result.

If it was me I would not do the biopsy, endoscopy or surgical. I would continue with the prednisolone and try to find a good diet that will not upset your cats GI tract. (Hills in my opinion is horrible food) but there are people on here  that know allot more about nutrition than I do. Be consistent with the food you use as cats do not need variety and do better without it.

The bottom line is that you have to trust your vet but also research everything on your own. It is great that you saw an internist. I doubt he is going to recommend a procedure that isn't warranted because it is expensive. The ones I have worked for are way to busy to try to get more business.

The ultimate decision is up to you.

One more thing to consider with surgical biopsy. I have always known the cat pancreas to be a very fragile thing. Look at it funny and they get pancreatitis. Just what I have noticed. I don't think there have been any recent studies checking the percent of cats with exploratory surgery that get pancreatitis. So, like I said. Just what I have noticed.

Light colored Bowel movements can be a liver issue. Has the food you have been feeding light colored? Do the Bowel movements seem greasy or slimy? Sorry to be gross.

I know you love your cat very much and I am sure your cat knows it. What ever you decide I do hope your cat does very well. I am very sorry you are both going through this

 

[arinlars]

Hi Quiet,

Thank you for the detailed post. Well I wanted an endoscopy and I know the procedure but not for cats. The internist said an endoscopy should be pointless and he would rupture the bowel if he goes further because the part he wants to see is in the middle of the small intestine. So this plan flies off. Then he said about the surgery or laparoscopy. But I trust my vet more than the internist and the clinic he is in.. I don't know why maybe the reviews on yelp. (Out of 100 the 20 were bad but you know how this goes). And my vet charges me 1/3 for what the specialist charges but at this point I don't really care about the price I just want her to feel happy and live long.

As far as the poop goes, she is eating the tiki cat food with chicken which is shredded white chicken only no grains no other stuff. Maybe that's why? Other than that the poop is pretty normal no slime, they break easy when I scoop, they maybe be a tiny bit softer than normal cat poop. My SO says it's too stinky though. :lol3:

I have to make a decision once the vet calls me back this week. I don't want to risk her to get sicker again but I will not forgive me if she gets worse and it's too late, ah I guess I have to do some more thinking, so far my entire sleep is messed up. I only think of my kitty. We have been through a lot and right and she is like a little human to us.

 

[raintyger]

.. I don't know why maybe the reviews on yelp. (Out of 100 the 20 were bad but you know how this goes). And my vet charges me 1/3 for what the specialist charges but at this point I don't really care about the price I just want her to feel happy and live long.
 

The reviews for my area on Yelp all tend to be good for vets, so I would actually be concerned about 20 bad reviews out of 100. Even the vet office that had fur on the exam table and who tried to convince me that they could get a valid urine test for bacteria if I collected it myself via dropper, they got good reviews.

 

[duckdodgers]

So sorry to hear that you're going through this with your kitty   I recently went through these troubles with my Rat Terrier.  We never did have the diagnosis confirmed, but we think that it was lymphoma.  We opted to not put her through cancer treatment and had her put down.  We switched her diet and had her on prednisone, so she enjoyed her life from about January when the symptoms started to earlier this month when she went downhill pretty quickly.  Odds are that you will have longer than a few weeks with your kitty, more if you decide to pursue treatment for the disease.  Hugs to you!

 

[goholistic]

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

Sebastian is doing great right now. Thank you for asking. 

IBD as a disease - it's very nature and essentially it's definition - is an inflammatory GI response to animal protein.

I don't want to go off topic, but just wanted to state that my understanding of IBD is different. My understanding is that the exact cause is not always known, but can be any combination of diet, bacteria, vaccinations, drugs, toxins, parasites, environmental and lifestyle factors, and an abnormal immune response. I do agree that diet and food allergies play a big part, but respectfully disagree that animal protein is the sole cause. 

@arinlars, everyone has given you great information to mull over. I'll just add that with Sebastian's pancreatitis, another reason I declined a biopsy was because I couldn't imagine how the heck he was going to recover from both a severe flare-up of pancreatitis and surgery at the same time, especially since he was vomiting so frequently. Sending lots of vibes for Mimi... 

 

[stephenq]

 
Sebastian is doing great right now. Thank you for asking. 

I don't want to go off topic, but just wanted to state that my understanding of IBD is different. My understanding is that the exact cause is not always known, but can be any combination of diet, bacteria, vaccinations, drugs, toxins, parasites, environmental and lifestyle factors, and an abnormal immune response. I do agree that diet and food allergies play a big part, but respectfully disagree that animal protein is the sole cause. 

@arinlars, everyone has given you great information to mull over. I'll just add that with Sebastian's pancreatitis, another reason I declined a biopsy was because I couldn't imagine how the heck he was going to recover from both a severe flare-up of pancreatitis and surgery at the same time, especially since he was vomiting so frequently. Sending lots of vibes for Mimi... 

I  totally agree that there are many causes of IBD, and I will backtrack and say that while many of the causes result in animal protein reactions, this is not in every case, IBD really is a inflammation of the intestines due to many causes. I stand corrected, thanks to @GoHolistic

 

[arinlars]

@duckdodgers I am so sorry about your kitty.. What were her symptoms? How old was she?

@GoHolostic thank you and I agree everyone's advices where great and really helpful. I am so glad I found this forum. It helped my sanity too I was going crazy without talking to people who have been through the same. ::rub:

Now I wait for the doctors call to tell me if she approves the surgery or not. Today I found some liquid on the rug with some hair and I thought it was vomit but my SO says it was water from the sink, hm. She is doing fine, just enjoying being a cat etc. eating all day long. I am excite to get the scale tomorrow and I will post if she gained weight or lost.

Btw the vet insisted that she continues on z/d , I start to add a tiny bite to her food because she likes it so much, I still don't trust z/d :/

 

[duckdodgers]

@duckdodgers I am so sorry about your kitty.. What were her symptoms? How old was she?

@GoHolostic thank you and I agree everyone's advices where great and really helpful. I am so glad I found this forum. It helped my sanity too I was going crazy without talking to people who have been through the same. :

Now I wait for the doctors call to tell me if she approves the surgery or not. Today I found some liquid on the rug with some hair and I thought it was vomit but my SO says it was water from the sink, hm. She is doing fine, just enjoying being a cat etc. eating all day long. I am excite to get the scale tomorrow and I will post if she gained weight or lost.

Btw the vet insisted that she continues on z/d , I start to add a tiny bite to her food because she likes it so much, I still don't trust z/d :/

She was actually a dog, an almost 10 year old Rat Terrier specifically.  Around December or January she stopped showing much interest in food, lost quite a bit of weight, and got pretty severe diarrhea.  She used to have pretty bad allergies as a younger dog, and the vet thought that this was manifesting itself as GI issues as an older dog.  We switched her food and she started eating just fine again, and anti-diarrheal medication helped considerably.  We'd still occasionally find some pretty disgusting liquid accidents, to put it bluntly.  She was still behaving normally for the most part- still coming to the barn with me and following the horse, went on a beach trip with us, ratting on the farm, etc.  There was still the lingering thought in the back of our minds that lymphoma was a likely possibility, but aggressive cancer treatment wasn't going to be pursued, so we continued with our lives while monitoring her health and behavior.

At the beginning of this month I came home from school fairly late and fed her, she ate just fine.  I feel bad because I didn't pay too much attention to her (I was in the middle of finals), and around 10.00 that night I realized that her belly was SUPER tight and swollen.  She was behaving perfectly normally, but I was very concerned that she might quite literally explode.  I was at the vet school with her 10 minutes later, and they found that both her albumin and globular protein levels were really, really low.  This was causing fluids to leak into her abdomen, which would eventually back up into her chest cavity if nothing was done about it.  They recommended transferring her to their internal medicine department first thing in the morning.  Since I didn't get the final blood results until 2 in the morning I opted to bring her home and take her to our regular vet first thing under strict instructions to bring her back if her breathing became labored. 

This is what her belly looked like after I got home that evening:

http://i31.photobucket.com/albums/c...D-0DF4-4600-8B20-FFC76BEAF3AA_zpssfq20py8.jpg

Took her in the next morning and she was in there for several days getting stabilized.  $1000 later she was returned to us much skinnier, deflated, and behaving normally.  I guess it's worth mentioning that she was technically my boyfriend's parents' dog, though she's been living with us for the past year.  No way would I have opted to spend that much on an older dog that obviously didn't have an enormous amount of time left with us.  We were giving this dog a large amount of steroids twice a day, as well as more anti diarrheal stuff.  She seemed to be enjoying her time.  She has always had a super high prey drive, and the day back from the vet she was already back to full on attacking the cat toys.  A rather amusing little dog in that regard.

The day she came home, playing like normal:

http://i31.photobucket.com/albums/c...A-B566-4875-B919-287D45FBAFBD_zpsz9sthggr.jpg

About a week later she didn't eat particularly well, and I was out most of the morning with my other terrier at the barn.  I didn't want to push it by taking her out with me.  We came back, I let both dogs out, and about an hour later while I was watching TV she started running up the stairs, which she only does on her own when she intends to poop up there.  I fussed at her, and as I was getting up to let her out she raced into the kitchen and had an awful diarrhea accident on the floor.  Let her out, and the same thing outside.  I cleaned it up, hosed off the spot in the yard, and picked her up.  The skin under her belly was super loose and filled with fluid.  It kind of felt as it would if you filled a grocery store bag with a little bit of water and squished it around.  Off to the vet immediately.

You can't get the full effect here, but it was squishy and watery under the skin:

http://i31.photobucket.com/albums/c...E-EE8F-4804-B951-C1BEA52E615B_zpsirx6g1jz.jpg

http://i31.photobucket.com/albums/c...D-561C-476F-896B-B1A6DBC07B5A_zpsq7delgy0.jpg

We were conveniently able to see the same vet that had treated her the previous week on such short notice.  I explained the symptoms, she tested her protein levels and found that they were super low again.  I mentioned that she hadn't eaten well the night before or that morning, but the vet said that her stomach was full.  Things had basically stopped moving down there.  Vet said that it would likely be 24-48 hours before the fluids built back up and backed up into her chest, causing breathing problems.  They gave her a shot of something in an attempt to get her digestive tract moving again to keep her comfortable, told us to double the amount of steroids we were giving her, and bring her back in to be put down when we felt it was fit.  At this point she said that there was still a slight chance that it was some sort of irritable bowel thing, but if she didn't improve with the increased amounts of steroids then the fluids would cause her to suffer and eventually die. 

After shoving the steroids down her throat I tempted her to eat a little bit of chicken baby food, but she would throw up everything she ate.  We put her cage in our room that night to monitor how she was doing, and I had to change her crate pad at about 4 that morning because of an accident.  I had to again force the pills down, and she seemed to be doing a little better after the steroids.  The fluids under her belly had become quite a bit larger.  I spoke to her mother that day and we decided to have her euthanized that evening.  It was a Friday at this point, and since we were already 24 hours since the vet visit we didn't want her taking a sudden turn for the worst and have to take her to the vet school to be put down.  

It is worth mentioning a few things, though.  When she was a year or so old (I think) the dogs were in the family's backyard when a meter man entered the yard unexpectedly.  My boyfriend's mom heard the dogs barking, and as she went to check it out she saw the man spraying the dog with pepper spray.  The story I've heard is that the guy entered the yard without knocking on the door, has "had a bad experience with dogs" and saw this 8 pound creature barking at him, and completely drenched her in pepper spray.  This caused a number of health problems throughout her life, including intense food allergies.  Perhaps this could have manifested itself as IBD later in life, or have contributed to the cancer.  Either way, the symptoms  spoke for themselves and we managed them as they came. 

The experience was really sad for everyone involved, but so it goes.  We got several active months with her from the time she first started having problems, and another week from when she went downhill.  It's the best that I could ask for, and we  wouldn't have proceeded with any sort of radiation or chemo treatment even if we had made a real diagnosis.  I don't regret that decision.  Sorry for the novel here, but the story seems somewhat relevant to your situation. 

 

[stephenq]

@duckdodgers I am so sorry about your kitty.. What were her symptoms? How old was she?

@GoHolostic thank you and I agree everyone's advices where great and really helpful. I am so glad I found this forum. It helped my sanity too I was going crazy without talking to people who have been through the same. :

Now I wait for the doctors call to tell me if she approves the surgery or not. Today I found some liquid on the rug with some hair and I thought it was vomit but my SO says it was water from the sink, hm. She is doing fine, just enjoying being a cat etc. eating all day long. I am excite to get the scale tomorrow and I will post if she gained weight or lost.

Btw the vet insisted that she continues on z/d , I start to add a tiny bite to her food because she likes it so much, I still don't trust z/d :/

Am I recalling correctly that your cat developed diarrhea after starting Z/D?  And if yes, why is your vet keeping your cat on that?  Did you discuss z/d induced diarrhea with him?

And so you are planning to stop the pred and wait several weeks and then biopsy?  I thought you were moving away from that, perhaps I was wrong.

 

[arinlars]

@duckdodgers I am so sorry about your dog. This is so sad did you ever find the guy who sprayed your dog?


@StephenQ the z/d caused her to throw up 12 times within an hour but the vet said it was probably the prednisolone because it was her first day.. I don't trust z/d so I threw it away. I am moving away more and more from the thought of a biopsy - surgery , but I wait to hear also from the vet she is going to consult with the internist and her team.. Still haven't heard. Everyone is saying that is probably ibd but you never know. As I mentioned before she is fine but her poop is like hard like play doe but not like the other cats , rocky. (I am tired of talking of poop poor kitty)

 

[arinlars]

She is pretty gassy still oh it's horrible the smell