Information on diagnosing overlapping problems - lymphoma vs inflammatory bowel and/or diabeties.

Hi all,

I have a cat who is having problems and because I think we have overlapping problems it is turning out to be difficult to get a handle on. I apologize for this being so long, I know how reading long posts are a pain, but I wanted I properly communicate the history of this thing.

It started a over year ago. We brought a new stray (quasi feral) into the house. We took all the usual precautions. He went to the vets first, tests run, vaccinated and neutered. Then he was kept in his own room for a week and a half before introducing him to the rest of the household. He adjusted well but we now believe he must have had salmonella which was picked up by Rikki. I was told that cats will pick up salmonella from eating birds in our area. It takes a separate test to find and typically, unless the animal is sick the best thing to do is to not treat. Just let it run it's course. Treating it can make it become persistent and essentially impossible to eradicate. This is what we did and both cats tested negative on two subsequent tests.

However, Rikki continued to have diarrhea and he lost a lot of weight. He was a large cat, 21 lbs and he dropped down to 16 lbs. He was also very gassy.  He tested positive for clostridium. I tried to treat, with limited success. He would get better and then it would return. Finally, after months, my vet said if he has clostridium it is probably secondary to something else, like inflammatory bowel disease. Rikki was also low in B-12 and the vet felt that this confirmed the diagnosis. After, floundering around for months more trying to find a food he could and would eat, the vet finally prescribed a hypoallergenic diet. We ended up putting him the Royal Cannin because he would not eat the Hill's version.

His diarrhea settled down and he stopped being gassy. If there was an occasion when I would let him cheat on his food or  if he got into someone elses food the diarrhea would return so I assumed the vet was correct. Months went by and I felt he was not gaining any weight back which concerned me. I expected to see him put some weight back on.

Recently, I noticed that he was continuing to lose weight, but it seemed he was hungry all the time. I had to make sure I fed him earlier in the morning and in the evening because he would get anxious and act out. He is prone to getting into things when he wants attention. I took him back to the vets. She was willing to just put him back on B-12 shots but I insisted on running blood work. I was thinking maybe diabetes or a thyroid problem.

The blood work showed an elevated lymphocyte count. The vet said he had months to live and put him on a high dose of prednisolone and told me to feed him anything he would eat. I question this because I already knew that the diarrhea and gassiness would return. She seemed convinced that the prednisolone would take care of the inflammatory bowel symptoms. There is an excellent veterinary oncologist in town but my vet recommended against going there. She said if I wanted to do an ultra sound there was someone else she would send me to, but she did not feel an ultra sound was necessary. I should expect the prednisolone to fix everything for the short term. She also said that he was probably hungry all the time because his body was unable to properly absorb the nutrition he needs.

He got worse on the prednisolone and a regular diet. His diarrhea flared back up. He was very gassy. He continued to lose weight. He was extremely hungry all the time. I was feeding him 4 to 5 times a day. And I started to have real problems with him peeing on my front door. After, some limited research on leukemia and lymphoma I decided to take him to the oncologist anyway to see if I could be better handle on what I was dealing with.

The oncologist said that while his lymphocytes were elevated, they were nothing compared to what she saw with leukemia. She showed me the pathologist report itself which said that this could be an inflammatory response or emerging leukemia or lymphoma. The oncologist said there was no way of knowing what he had without more information. I scheduled an ultra sound, (for tomorrow). But I have read that it can be very difficult to tell the difference between chronic lymphoma and inflammatory bowel disease on an ultra sound. The oncologist said they usually can see other signs like loss of muscle tissue around the intestines if it is a chronic lymphoma.

At the time of this appointment we repeated his white cell count and the oncologist gave me an RX clay to add to his diet. She said it should help with the diarrhea and help remove toxins from the clostridium. The clay helped a lot with the diarrhea although he remained very gassy. His lymphocytes count came back normal on the second test, which as I understand it suggests this is not leukemia. If he had leukemia his white cell count would have stayed elevated or gone up even with the prednisolone.

Now this is where things get weird. I called my regular vet and confessed what I had done, I was feeling guilty for going behind her back. She then apparently called the oncologist and the next call I get from the oncologist, she was suggesting I wait on the ultra sound. Not liking the feeling that I was caught in between  I changed vets. His peeing on the front door was becoming such a problem that I thought maybe he was going into kidney failure. We ran more blood work and he came back with diabetes.

(I now realize that I had to push and emphasize the fact that he was hungry - arrgh!)

We have cut back the prednisolone (but he is still on it), he is on the RX clay. I have started him back on Flagil (250 mg this time as oppose to the 125 tried before) for the clostridium overgrowth, and I have started to find foods that are low in carbohydrates and he is on 2 units of insulin 2x,s a day.

I see improvement already. His sides are not as drawn it. His diarrhea is gone. He is no longer gassy. He seems happier. But, there is still the concern about the lymphoma. The new vet said that lymphomas in cats don't present with elevated white cell count, but I have learned that it is not uncommon for inflammatory bowel disease to turn into lymphoma with time.  I understand the prednisolone could have caused the diabetes, but is it possible for diabetes to have been missed on the first test?  He was losing weight and asking hungry all the time before we started him on the prednisolone.

Rikki, the big dog. (I apologize for my poor photographic skills)

I have dealt with probable IBD and at one time possible lymphoma in a cat for a number of years and it is frustrating and the diagnostics can get really expensive.  I also went to several different vets.  He had flares with different symptoms than your cat but there were no rhyme or reason to them.  Because of the symptoms each vet hospitalized and checked for a foreign body.  Lot's of x-rays and big bills.  I finally took him to a cats only vet on the other side of town and she diagnosed probable IBD.  At this point he also had fatty liver disease.  She also said it might be lymphoma.  She did the ultrasound and two needle biopsies on his liver and still no definitive answer.  He is a dry kibble addict so I couldn't do much diet wise and he is on a small daily dose of a steroid and has been for 2 1/2 years.  If it were lymphoma the steroid would've quit working by now.  My experience has been that at some point just stop the diagnostics and treat for IBD.  It would be great if you can do this with diet especially with his also having diabetes. 

Thank you for responding and this helps. I mean I am sorry you have had to do battle with IBD but it makes me feel not quite so crazy.  I have had a lymphoma (for real) cat before and she was not hungry like this guy is - she didn't want to eat.  That is the part that doesn't fit. I will do the ultrasound. If it is inconclusive, as I expect, then my plan is to work on managing what we have and monitoring his blood work.

I plan to work hard on the diet part. If we can get the inflammation down then maybe we can get him off the pred. If I can get him off the pred, then maybe I can get the diabetes into remission.

Question --> do cats get fatty liver disease from weight loss? I was reading some other threads and it was mentioned.

I will let you know what the vet says tomorrow.

Fuzzycat

Fatty liver is usually caused by not eating but I would think it could also be caused by an absorption problem.  The cats liver isn't very efficient at using fat.  The body begins trying to use fat at a faster rate than the liver can process it.  The liver gets deposits of fat on it because it can't keep up with what the body is trying to use.

Poor baby - and what a journey it's been.

Fatty liver is a risk especially when an overweight cat stops eating - but given your kitty's appetite, at this point I'd have to say he managed to skip that complicating problem. :cross:

I hope the ultrasound will point you in the direction of IBD, as that's the most treatable thing here. :cross:

I just popped in to tell you about a probiotic that will help your kitty eliminate the clostridium. A TCS member, Carolina, has a kitty with IBD. He was treated with everything, and every diet, yet had diarrhea for 14 months. Finally she decided to switch to a raw diet. Once 100% on raw, his diarrhea stopped. I'm not necessarily suggesting raw for your boy. There are risks with it - and a bacterial infection from meat is one of them. Her kitties got clostridium. She discussed with her vet treatment options, and decided to try a probiotic she's used in Brasil. It stopped the diarrhea overnight. I realize the gas and diarrhea are not a problem now, but as the clostridium overgrowth (especially on the pred) is a risk, you may want to either use it, have it on hand, or use a regular probiotic with multiple strains that includes it. This is discussed at the end of Carolina's thread discussing the use. FYI, we rescued kittens in June that had coccidia. We decided to try this probiotic, and as they had to stay in boarding, it was administered at the vet boarding facility. It cleared up their coccidia. Here's the thread, I hope this helps: http://www.thecatsite.com/t/259985/trouble-in-raw-paradise-clostridium-perfringens-and-my-cats

(FYI, it doesn't matter the strain of clostridium: it works for c. difficile as well. There's a LOT of research on it in humans).

:heart2:

Oh - a P.S. How much does he weigh now? Does he need to gain weight? Wasn't he overweight at 16 pounds? 16 pounds is a big kitty - there are definitely some that are healthy weights at that size. But... ???

I just wanted to add that cats that aren't overweight can get fatty liver.  After 6 years of flares Patches went back and forth between underweight and normal weight.  I asked one of the vets I took him to with a flare about fatty liver because he would quit eating.  She was a cats only vet and she told me it wasn't a concern because he wasn't overweight.  Patches would sometimes come out of a flare on his own and because of what she told me I waited too long with the last big flare that he had and he ended up with fatty liver disease.  I just don't want someone to do what I did and wait too long because they don't think their cat can get it.

Denice, I'm sooo sorry that happened. Far too many vets seem to think this, or just don't take a cat not eating seriously enough. I know that my vet has advised to wait "3 or 4 days" before becoming concerned about a cat not eating. After what I've seen here on TCS over and over again, I just thought to myself, "are you nuts???" but didn't say anything. I don't know why more vets don't take the not-eating thing more seriously than they do. But the collective experience of TCS members is, start assist-feeding your cat after 24-48 hours of not eating the minimum amount of food to support kitty's current weight. :nod:

Rikki is down to 15 lbs. He is a large, tall cat, you can't really tell from the picture. His head looks like he has something exotic like a little Abyssinian or Oriental in him. A previous vet has suggested an  Abyssinian.  I have never measured him, I probably should. His flanks are sunken. His belly has been distended but this has improved over that last week so it is  probably connected to the clostridium overgrowth.  I would be happy if I just knew I could put weight on him.

He has just had the ultrasound done. The vet said his liver looked a little 'bright' and his kidneys are a little enlarged, but she didn't see anything else.  I asked about fatty liver disease and she dismissed it saying that only happens when they stop eating completely. His recent blood showed his kidney function within normal range, but my understanding is you often don't see changes in kidney function in lab work until the kidneys are 3/4 rs gone.

The plan is to send the ultrasound out to be read again, just to be safe and then treat for IBD and monitor. I haven't asked again about getting him off the pred., that maybe in the wait and see category. He is on Flagil and the plan is to continue with that for awhile. He is a problem to pill. I was hoping I could find an antibiotic I could inject, much easier, but no luck.

I like the idea of putting him on digestive enzymes and a good probiotic. I will look at the one mentioned and I will let you know if I need more information but it sounds very promising. I have tried a probiotic that I purchased from the vet before and didn't see any difference, but maybe I didn't stay with it long enough or I need a better probiotic or we didn't have him as well stabilized so it couldn't help. I am a little concerned about a completely raw food diet just because of the pred. etc. but I have read about some foods that are pasteurized - not truly raw, but still a long way from Friskies. I want to make sure I change one thing at a time so we know what is going on and what is causing what. If that makes any sense.

One good thing is that the oncologist and the new vet work well with each other and have been excellent about updating each other on his condition. Also, this new vet seems more receptive about talking about diet. Yeah!

Thank you all for your input, this really helps. You have no idea. It was a leap for me to ignore what my previous vet told me and push for better answers. I can only guess that he would have died from the untreated diabetes and we would have assumed it was lymphoma. Moreover, my husband suffers from an anxiety disorder and the cats help him immensely, but he has difficulty dealing with health issues such as these. It helps me to be able to get the level of feedback I have received each time from this site.  I am very impressed with how professionally run this site is and the general level of expertise of the members.

I think all cats are difficult to pill when it comes to Flagil  because it is very bitter.  It seems to be the antibiotic of choice with digestive problems because of it's anti-inflammatory properties.  My vet cut up the pills and put them in gel caps.  That worked until I didn't get one far enough back in Patches mouth and he worked it open in his mouth.  I am glad nothing showed up on his ultrasound even though it means no definitive diagnoses.

Fuzzycat said:

I like the idea of putting him on digestive enzymes and a good probiotic. I will look at the one mentioned and I will let you know if I need more information but it sounds very promising. I have tried a probiotic that I purchased from the vet before and didn't see any difference, but maybe I didn't stay with it long enough or I need a better probiotic or we didn't have him as well stabilized so it couldn't help. I am a little concerned about a completely raw food diet just because of the pred. etc. but I have read about some foods that are pasteurized - not truly raw, but still a long way from Friskies. I want to make sure I change one thing at a time so we know what is going on and what is causing what. If that makes any sense.

Click to expand...

It makes total sense, and is exactly how you should proceed with an IBD kitty. :nod:

And I hear you loud & clear on the pred vs raw diet. I had the same issue when I wanted to transition my cats. Lazlo was in chemotherapy, and was on 5mg of pred a day (his healthy weight is about 12 pounds). The vet - who was not pro- or anti- raw said that his dose wasn't immuno-suppressive (like Tuxedo's was), but is anti-inflammatory. That said, she was happy when I suggested the commercial raw foods processed with high pressure: they're pathogen-free guaranteed. :nod: Here is more about the process and sterile raw food: http://healthypets.mercola.com/sites/healthypets/archive/2012/10/22/sterile-raw-pet-food.aspx

The brands are Nature's Variety, the Primal poultry lines, and some of Bravo's balanced blends (not sure which ones - you can check the site) are now or will soon be HPP treated. :nod: Also, though expensive to use, the Stella & Chewy's foods are treated with HPP. Their feline line is only freeze dried, but they add taurine to the frozen raw dog food. It has 5% veggies/fruits in it, as does the Nature's Variety (and I think the Bravo Balanced Blends) - but as you say, it's a far cry from any dry food Whiskas or something. :nod:

But I agree - one thing, one step at a time.

For a digestive enzyme, I use the Prozyme Original, and I buy it on Amazon, though I believe it is available in a lot of pet stores. The directions require very little powder to be used, which is great. I've tried a number of them at this point, and the one that is easiest to use and the cats don't even notice is the Prozyme Original (for dogs and cats). Mercola makes one that is "great" from a carnivore perspective - but it requires a lot of powder on the food, and my cats hated it. Does no good if no one will eat it!

And if your kitty does not currently have diarrhea, I would suggest the Nexabiotic 20 strain probiotic, discussed in Carolina's thread for maintenance. It just takes 1/4 pill if there isn't currently an overgrowth. FYI, most pet probiotics are not nearly the same quality as human probiotics: they're also ALL made from "fermentation" product: which is dead cultures. I've tried pet probiotics on my cats, and the most popular one, Fortiflora, gave one of my cats explosive diarrhea. I know many have had success using it to clear up antibiotic-related diarrhea. Not us. My holistic vet recommends human-grade probiotics, and now I see why. :nod:

Another FYI, the S. boulardii is not a typical probiotic in that it is made from yeast: so it can be used in conjunction with antibiotics, and you don't have to worry about when to administer it. You'll see the info when you read the link I provided. If you start with the Nexabiotic (or find a different probiotic that has acidophilus+bifidus and S. boulardii), that needs to be given at least two hours before or after the flagyl (which is an antibiotic). Or you can just wait until the course of antibiotics is done to start the probiotic.

A great resource for you will be http://www.ibdkitties.net

I have an update......

The ultrasound was read by a radiologist and his report is the density in the liver was probably from the diabetes, the enlargement of his  kidneys is consistent with his age and the fact that he is now drinking lots of water thanks to the diabetes and the pred. There is evidence that he has had pancreatitis in the past but not now and there is no sign of lymphoma or anything neo-plastic. The IBD could not be ruled in or out.

He has gone from having leukemia/lymphoma, dead in a few months to something treatable with diet in a matter of a month.

So, what I know is that the clostridium is a problem. I know that when I put him on the Royal Cannin hypoallergenic diet (dry) his stomach stabilized but long term he developed diabetes. I didn't think to ask if the pancreatitis contributed to the diabetes.  I am thinking he does have some level of IBD or food allergy. Last year when he lost so much weight is probably when he had pancreatitis. We had him on 125mg of Flagil for the clostridium and the Flagil probably cured the pancreatitis without our knowing about it. His recent weight loss is due to the diabetes. So my job now is working to find the right diet. I am thinking I will go pasteurized raw food or home made. I also have a kidney kitty and I am thinking (hoping) that I can start with core ingredients and then tailor Rikki's diet one way and Fuzzy's the other.

Again this really helps - really, really!

I am planning on picking up some gel caps today. I love that idea.  I am pretty sure I can grind up the flagil  and put it in the capsules myself. He is a strong head thrasher when I pill him and I don't want to have to resort to a cat bag if I don't have to. I am worried I will turn him into a bad pill-er by putting letting it become a battle. I did break down and buy a plastic pill-er. It  helps.

The probiotic I used before was the Fortiflora. It helps to hear that I am not crazy. I will work on the probiotic this week. The RX clay has definitely stopped the diarrhea but he is still gassy, though not nearly as bad as he was a week ago, probably thanks to the Flagil

Thank you so much, the information really helps.

Fuzzycat

I have an update......

The ultrasound was read by a radiologist and his report is the density in the liver was probably from the diabetes, the enlargement of his  kidneys is consistent with his age and the fact that he is now drinking lots of water thanks to the diabetes and the pred. There is evidence that he has had pancreatitis in the past but not now and there is no sign of lymphoma or anything neo-plastic. The IBD could not be ruled in or out.

He has gone from having leukemia/lymphoma, dead in a few months to something treatable with diet in a matter of a month.

So, what I know is that the clostridium is a problem. I know that when I put him on the Royal Cannin hypoallergenic diet (dry) his stomach stabilized but long term he developed diabetes. I didn't think to ask if the pancreatitis contributed to the diabetes.  I am thinking he does have some level of IBD or food allergy. Last year when he lost so much weight is probably when he had pancreatitis. We had him on 125mg of Flagil for the clostridium and the Flagil probably cured the pancreatitis without our knowing about it. His recent weight loss is due to the diabetes. So my job now is working to find the right diet. I am thinking I will go pasteurized raw food or home made. I also have a kidney kitty and I am thinking (hoping) that I can start with core ingredients and then tailor Rikki's diet one way and Fuzzy's the other.

Again this really helps - really, really!

I am planning on picking up some gel caps today. I love that idea.  I am pretty sure I can grind up the flagil  and put it in the capsules myself. He is a strong head thrasher when I pill him and I don't want to have to resort to a cat bag if I don't have to. I am worried I will turn him into a bad pill-er by putting letting it become a battle. I did break down and buy a plastic pill-er. It  helps.

The probiotic I used before was the Fortiflora. It helps to hear that I am not crazy. I will work on the probiotic this week. The RX clay has definitely stopped the diarrhea but he is still gassy, though not nearly as bad as he was a week ago, probably thanks to the Flagil

Thank you so much, the information really helps.

Fuzzycat

PS -

Sorry about the duplication. I thought it didn't post and I hit the submit button a second time. Oops!

No worries, there is also a multiple post ghost, that sometimes puts up posts like 3-4 times despite hitting the "submit" button just once.

I didn't realize he HAS diabetes. Is he on insulin? The pred can really wreak havoc with their blood sugar levels (my dad was a Type 1 diabetic, so I'm very familiar with the issues).

For diabetes, the raw really will be the best diet for him (which works with his needs as an IBD kitty. :nod: ) There is a website put up by one of the U.S. leading experts on feline diabetes, Dr. Elizabeth Hodgkins: http://www.yourdiabeticcat.com You'll see - the diet recommendations are the same, but the diabetic cat website has great info on how to manage the diabetes.

And we can definitely help tailor a homemade diet (or make suggestion on how to alter a commercial raw food) for your kidney kitty. In fact, there's a commercial raw food already perfect for him, as it is made with eggshell as the source of calcium, which already means it's lower phosphorus than anything with bone. When you're ready, just start a thread in the raw sub-forum, and we'll answer questions and help with links, resources, and experience.