More drama (IBD vs. Lymphoma)

Since the last time her weight was taken (roughly 4-6 weeks ago), Layla has lost approximately another pound. She is now below 7 lbs.

I brought her in to the vet so that we could re-check her ALT levels after being on Denosyl for a while... but my vet said to skip the blood work and take her to a specialist (internal medicine vet) for an ultrasound. He said they will repeat the blood work there as well. He said they might suggest other tests but it'd be up to me if I wanted to do them (not due to cost but due to level of invasiveness.. I am uncomfortable putting Layla under full anesthesia and quite frankly really don't want to put her through the stress of it). Because she has been losing weight and has such a voracious appetite, he wants to rule out lymphoma. He mentioned IBD as the other possibility, due to her lifelong digestive problems and the increase in amount of stool. He said lymphoma and IBD can present very similarly in the early stages, though.

He said if I didn't want to go straight to ultrasounding, we could start her on Prednisone to treat the potential IBD. If she doesn't respond (i.e gain weight), that'd give us a pretty good indication that we're dealing with something more serious. He said he would rather see us just go through with the test, though, and stop playing the guessing game essentially.

I'm so totally lost here because although she has been losing weight, I was not expecting to hear something so drastic.

Her symptoms are as follows:

- increased appetite (to an amazing degree.. so much so that she tries to eat off of people's dinner plates)
- weight loss (definitely the most serious symptom)
- increased stool output (and sometimes mushy... formed, but soft)
- gurgling stomach sounds

She is on Denosyl because of a slightly elevated ALT.

I really can't believe where we're at right now.. the vet hospital is really a depressing place and I can't believe I might be headed back there.. I also can't believe I heard a word as scary as lymphoma as a possible diagnosis for my girl.

Any thoughts are much appreciated.

Hi there, sorry Layla is going through this... an Ultrasound will not help you with this as will not show you the inflamed intestine walls. If you want to rule out lymphoma, the best way IMHO would be to run a CBC and Chem-6/or Chem-12... If your vet thinks there is a chance from there, depending on the calcium and white blood cell #s, then you go into x-ray or ultrasound to see what the lymphoma is affecting.
My cat has had chronic diarrhea for a while, and the first measure we did was to rule out lymphoma - no ultrasound or biopsy was necessary for that.

Hi Carolina,

Can you think of any other reason why he'd want to send me to a specialist, then? He seemed very hung up on getting her ultrasounded... I'm not sure if maybe he just feels he's not the right person to work on her case anymore because of its complexity..

Honestly, I truly believe that my cat is not absorbing nutrients properly from her food. The theme of this whole past year has been food problems for this cat, after her old food had a change in formula and we could no longer use it. She's eating Royal Canin Duck and Green Pea.. I've tried NB and EVO Duck but both either made her throw up or aggravated her skin allergies. I can still very occasionally give her a can of NB without any ill effects.

Everything that I've read about lymphoma indicates that her appetite should be decreasing, not increasing. She is EXTREMELY hungry, to the point of trying to steal food off of the kitchen table, climbing in the sink, etc.

The other course of action was Pred for potential IBD... I *hate* to treat her symptomatically rather than clinically AGAIN, but I just don't know what's best..

Sam

Not sure what you have tested for but has she been tested for thyroid, a full panel not just the T4 normally run, also diabetes, and pancreatic insufficieny. Actually there are many things that can cause these symptoms. An ultrasound as well as full blood work up with thyroid is a good place to start so a better picture of the whole thing is available. It sounds like some kind of malabsorption but why is the question. She is eating so much because she is not getting any nourishment most likely. Does she get enzymes ?

In my opinion going to a specialist is the best route, going the Pred route may make her feel better short term but it may just mask what is going on and give it more time to get worse by not finding out and treating what is actually going on

Good luck

Her thyroid has been tested, and, to the best of my knowledge, it was the full panel. It's one of the first things we checked when she started showing all of this food weirdness.

She does not get enzymes or any supplement - I've asked my vet about enzymes, dietary supplements, probiotics, etc but he never thought they were necessary. Maybe now he will feel otherwise since this weight loss is a relatively new thing.

As much as I would rather not, I think I'm going to go through with taking her to the internal medicine specialist. It probably makes more sense to put her through one big vet visit as opposed to all of these smaller ones where she's getting poked and pricked and nothing is getting done. She won't have to stay overnight and I already said that I will not put her under anesthesia, so I guess I've set my boundaries and this is the route to go.

I just really, really hate going there.. I am a science-minded person but abandoned my plans to be a vet because I get way too emotional over seeing sick animals. And heaven knows, there are plenty of 'em at these big specialist hospitals..

Thank you so much.

Sam

Sam I am sorry to hear your Vet discounted the supplements, so many vets today rely on pharmacueticals rather than thinking outside the box to look for more natural treatments. I have 4 animals, two dogs and two cats, all 4 have special health problems and I can tell you the difference has been supplements. As I told my Vet it would've cost me a lot less to go to Vet school to get all this experience and learning My dogs are on enzymes, if they don't get them we have huge issues, the enzymes help them get the nutrients they need from the food. All 4 of them are on probiotics.

I think going to the specialist is a good idea, don't be surprised if he/she does not believe in supplements, I have found this resistence so often. I have a vet who is trained in both Eastern and Western medicine, thank goodness, we have been able to find alternative ways to treat for most issues and I feel the animals are better off for it. Of course sometimes that is just not possible, but the supplements can help support them even in those situations.

Is there any chance she could have some type of a worm or parasite? I'm asking you because when Lynxx caught a mouse. We noticed he was starving. He was constantly hungry, eating a ton of food, needing to be fed every time we turned around. We took him to the vet. He had some type of worm/parasite. It was like he was the host, everything he ate went to the worm/parasite. He was given pills, and that killed the worm/parasite.

I know your cat has other things going on. But reading what you said about her constantly eating, constantly being hungry, and not gaining weight from all the eating, it just sounded so much like Lynxx when he caught that mouse.

After that every time he caught a mouse he went right to the vet, and was treated just incase.

Just an update to say we are seeing an Internal Medicine doctor tomorrow. Please keep my kitty in your thoughts.

:vi bes:

Good plan for your Layla. I think you should see the specialist. Hope you get an answer.

No definitive answers today... but ultrasound did come back clean. No masses. She's got a whole lot of poop/gas in her colon, but all of her organs look good. The vet said a pancreatic deficiency is a possibility. He did blood work, which we'll get back during the week.

If bloodwork shows a pancreatic problem, she'll need medication. If her pancreas checks out OK, we have to think about endoscopy and biopsy to answer the IBD vs. Lymphoma question, which I'm really not thrilled about. He said general anesthesia wouldn't really be a huge risk, but I still don't want to have to put her through that.

She also does have a pretty loud heart murmur. If she needs to go under anesthesia, we'll need to, at the very least, X-Ray her heart to ensure that it's not enlarged. Ultrasound of her heart is also possible.

I know you said her thyroid panel was normal but wanted to share with you our experience that thyroid disease does not always show up in blood values. Our Sammy had normal blood work but yet had: desperate hunger, weight loss, excessive shading, soft stool and gurgly stomach, greasy coat and a grade 2 hear murmur. Our vet was certain he has hyperthyroidism. Once we started Sammy on Methimazole the weight came back on etc.

Also not all kitties with hyperthyroidism show the same symptoms.

I have had two cats with Lymphoma, and one with suspected IBD. The Lymphoma cats were diagnosed differently, Mabel's was through a blood test, Molly's bloods were normal, but an ultrasound showed a 2-3 inch piece of thickened intestine which 3 different vets have told me indicate Lymphoma rather than IBD - that was nearly 12 months ago though, and she is only on a small dose of steroids. I decided not to do a biopsy with her age, as the treatment would be the same regardless. Buster's bloods showed just mild anaemia, no liver issues, although from what I Read that can be a symptom, and he has shown signs of liver issues in the past. 2 vets said that as he feels bloated internally, there is no point doing an ultrasound as it wont show anything different to what they can feel, and again, I am reluctant to do a biopsy. i have managed to control his diarrhea with diet. Good luck

How old are your cats, booktigger? Are there any specific reasons other than their age that make you reluctant to do a biopsy?

Layla's doing OK tonight.. she's hungry but she's holding out for me to give her wet food instead of dry food. (I wish her whole diet could consist of wet food, but I'm not really sure how well it sits with her if she eats too much of it - I think she has an intolerance to the thickeners.) I've been mixing the two and she's been eating the wet + dry, because I'm really not in a good position to get into a battle over food with her. She HAS to eat.

Molly was 17 when she was diagnosed - I had to fight the vet to do the ultrasound, he thought it was better to not stress her out as she was happy. Buster is 13, so i would be more willing to do it to him, but his seems under control, unless he scavenges. He is going for a check up tomorrow though. I found that with both of them, there are certain foods (both wet and dry) that they can't tolerate - that is how Molly was diagnosed, the food she used to eat started going straight through her, and if I give her too much wet she has issues - she has very little dry these days though, I give her two plates of chicken to supplement her instead.

We finally got the blood work back - her pancreatic function is normal and her Vitamin B12 is extremely low (we're going to set up an appt. for a B12 shot ASAP).

This puts us back to square one. It's got to be some sort of intestinal disease, the doctor said. IBD and Lymphoma are the two most likely diagnoses. A biopsy would likely confirm either.

I haven't yet spoken to my main vet, but I'm just so split as to what to do - do I put her under anesthesia and get a definitive diagnosis? She's 12-13 years old and I originally didn't want to put her under anesthesia at any cost. Do I try treating her symptomatically? I'm worried about doing that because that'll mean more time is going by and that's potentially more time without the nutrients she needs.

So stressful...

Tricky decision - the treatment for Lymphoma is steroids, the initial treatment for IBD is steroids, although that can then be controlled with diet, however IBD is likely to respond better to them, they will eventually stop working on Lymphoma, although it is a year tomorrow since Molly's diagnosis and she is still on a very low dose of steroids. I dont know if low B12 indicates one more than the other.

Originally Posted by booktigger

Tricky decision - the treatment for Lymphoma is steroids, the initial treatment for IBD is steroids, although that can then be controlled with diet, however IBD is likely to respond better to them, they will eventually stop working on Lymphoma, although it is a year tomorrow since Molly's diagnosis and she is still on a very low dose of steroids. I dont know if low B12 indicates one more than the other.

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Low B-12 is very common in IBD actually... In a lot of cats that helps a lot - B12 shots, sometimes that and pred is all it takes (B-12 being the missing link). It is a very good thing you found that in the tests... I don't think you are back on square one... This is a deficiency that can be treated, and if so, the treatment can be quite effective. I have not heard it been related to lymphoma... I would give it a try and see if it works befor going on the Biopsy route - but that is only my opinion though.
Also, did your vet check your kitty for pancreatitis with a PLI test? This is a very specific test - it is not a CBC...

Originally Posted by booktigger

Tricky decision - the treatment for Lymphoma is steroids, the initial treatment for IBD is steroids, although that can then be controlled with diet, however IBD is likely to respond better to them, they will eventually stop working on Lymphoma, although it is a year tomorrow since Molly's diagnosis and she is still on a very low dose of steroids. I dont know if low B12 indicates one more than the other.

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I'm hearing all sorts of different things - my vet said that Small Cell Lymphoma would be treated/managed with pills, Large Cell w/ IV chemo, and IBD with steroids. It is very encouraging, though, to hear that your kitty is doing OK on steroids a year after her lymphoma diagnosis. Are there any other things you're doing for her?

Low B-12 is very common in IBD actually... In a lot of cats that helps a lot - B12 shots, sometimes that and pred is all it takes (B-12 being the missing link). It is a very good thing you found that in the tests... I don't think you are back on square one... This is a deficiency that can be treated, and if so, the treatment can be quite effective. I have not heard it been related to lymphoma... I would give it a try and see if it works befor going on the Biopsy route - but that is only my opinion though.
Also, did your vet check your kitty for pancreatitis with a PLI test? This is a very specific test - it is not a CBC...

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Thanks, Carolina. Layla did have a full "Malabsorption Panel" which included pancreatic functioning. It was more than a CBC, though I can't say for certain what exactly it included. I do think I remember my vet mentioning PLI, though, when discussing the results with me over the phone.

I'm surprised that you say you've never heard B12 deficiency linked to lymphoma - both vets keep saying it's pretty much 50-50 as to what she's got going on.

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I took her to the vet today for her first B12 shot. She will get another next Saturday (I will do it at home). My vet wants me to wait about 10 days to see how she is after a couple of B12 shots. At that point, we will decide whether we want to start Prednisolone or go through with the endoscopy.

He said it'd be about a month before we'd know whether or not the Pred is having any effect - I asked him whether or not we can really afford to wait that long, and he said that whatever she has seems to be slow developing and that she probably wouldn't be significantly worse after that amount of time.

Thank you all so, so much.. I truly cannot even tell you how grateful I am for your advice and help.

I did do some research when my first cat was diagnosed with IL, and there was more of a success rate with Chemo and Pred, and i do know someone who's cat had about 18 months with that, but i have issues with putting cats through chemo - that is a personal choice though, and would depend on your feelings towards doing that, and also how fair it would be on your cat to go down that route - Molly couldnt have coped with it, even if it had been something I would have been happy to do, she is very much a 'her terms only' cat - she loves me, and loves fusses, but still hisses at me on a regular basis for approaching her, and i have had her for 5 years, and can hide for a day after a vet visit.

Molly is on half a steroid tablet a day (she can't quite manage every other day unfortunately), but her only other 'treatment' is 2 plates of chicken a day to keep her strength up (she can't tolerate much dry food anymore), plenty of love and cuddles, plus some treats that she can tolerate and being a bit spoilt in terms of keeping her eating - if she isn't eating much, having a good fuss session makes her want to eat more, and putting the food wherever she is.

I have never been told that it would take that long for steroids to show if they are working, with my first cat we tried for 2 weeks and nothing happened, with Molly, I was told that if the steroid jab worked, she could go on pills for the rest of her life, and they would see her again in a month, and the jab was a 3 day one - her symptoms weren't as bad as Mabels though.