Vomiting Cat, Appetite Loss: No Diagnosis

[sarah c]

Update:

So we saw an interal specialist who gave Taz an ultrasound. The small intestinal wall was a little bit thicker than it should have been, but not conculsive for IBD. All lymph nodes looked normal in size, so IDB is the most likely outcome. So we have to decide between putting our 15 yr old cat with a heart condition under anesthetic to get a better diagnosis, or just treat for IDB. The risk of doing that is that giving him steroids can make lymphoma resistant to all treatments if he does in fact have lymphoma. Right now we are leaning more towards treating IBD and not taking the risk of anesthetic.

 

[babiesmom5]

It is good you got the ultrasound. I can well understand your concerns having had a cat with HCM. She was well controlled with medication, but did need to go under anesthesia a couple of times in her senior years and came through fine. She was under the very capable care of a good Vet cardiologist as well as Internal Medicine Specialist, but of course anesthesia is more risk with an older cat and one with HCM.

The mild thickening of the small intestinal wall does point to IBD, but without cellular analysis, you cannot be sure if it is IBD or Lymphoma. You are right in that the steroid will mask it if it is Lymphoma making a biopsy less reliable down the road. So if you are going to get a biopsy for positive diagnosis, now is the time. I would rely on advice of your Internal Medicine Vet and Cardiologist as far as risk assessment.

A steroid will most likely be needed either way. The cat is usually started on a higher dose to beat back the inflammation. Once the inflammation is under control, the vet can scale back to the lowest dose which keeps it under control. With your cat, the initial dose may not be as high as usual due to the HCM. Other medications may be needed as well.

IBD can and sometimes does morph into Small Cell Lymphoma. The sooner you get the inflammation under control puts the odds in your favor. At least your cat will begin a treatment plan while the thickening is still mild. You are lucky to catch it early!

Please keep us updated as treatment plan goes forward. I am thinking positive!

 

[sarah c]

Thank you very much!
My husband was at the appointment today and it sounded like the vet was very much, "eehh, you guys decide." When I pressed him he said the vet's preference was to do the scope so we know what we're treating while of course acknowledging the risks. This vet is at a different hospital than our cardio so I doubt there will be any co-ordination. You raised a great point about doing the biopsy before beginning treatment. I was naively thinking we could give him steroids for a couple weeks so he can regain some strength if and when we decide to do the biopsy but now I know that's not realistic. He's been eating better that last couple of days, we've been giving him novel proteins which have been sitting well with him. He's also bored of them however so he's not going to go crazy eating them. Anyway, I got some anti nausea meds today so that should help give us a couple days to decide.

 

[babiesmom5]

I totally understand the position you are in right now and the difficult decision facing you. For what it is worth, I will share my experiences.

The severity of the inflammation, or bowel thickening, based solely upon the ultrasound, has no correlation with the probability of Lymphoma.

I had one male cat who, the ultrasound showed extensive thickening, both small intestine as well as colon. He was biopsied endoscopically, both upper as well as lower GI tract. Biopsy showed extensive scarring, even to the point of fibrosis. He was in bad shape. Although he had severe IBD, he had no Lymphoma surprisingly. His case, being unusual, was presented at a major university vet teaching hospital to pathology students.

With another female cat, the ultrasound showed a bit of fluid in the stomach and only slight thickening at the entrance to the small intestine. Vet thought it was "probably gastritis", maybe beginning of IBD, "less likely Lymphoma". Since things did not seem bad at this point (especially in light of the male cat), we did not have her biopsied. The vet, hesitant to start her on a steroid if not warranted, suggested I give her Pepcid at night. So every evening, I crushed up 1/4 Pepcid and put it in her food, which she ate very well...until three months later when she suddenly stopped eating. She was immediately taken to the vet who could not restart eating. She was hospitalized where biopsy showed Small Cell Lymphoma! By this time it was extensive in the small intestine and had eaten through her stomach! Despite a very heroic effort, lengthy hospitalization, tube feeding, all sorts of medications, (and a lot of money spent), I lost her painfully 10 days later.

After this experience, I take nothing for granted. I presume nothing. I will always start with an ultrasound and follow up with an endoscopic biopsy...as I have subsequently with 3 other cats...all of whom fortunately only had IBD. After this fact was confirmed via biopsy, THEN
they were started on steroids and other medications and are being successfully managed.

If I were you, I would consult with your Cardiologist about the risks of anesthesia for your cat. Perhaps you could have your Internal Medicine Vet consult with the Cardiologist and come up with a risk assessment which would help guide you going forward. You are going to need to involve your Cardiologist anyway if/ when a steroid is started.

It is a gamble for sure. My experience has taught me to err on the side of caution.

I am glad your cat is feeling better. Cats with IBD often get "taste fatigue"; it is a hallmark of the disease. Usually with a steroid and anti-nausea meds if needed, you can keep them eating the food they are prescribed, often a novel protein.

I wish you all the best as you weigh your options.