IBD with possible small cell lymphoma

I'm new. I have an 8 year old male cat (Bentley) who has had a declining appetite over the last few months. I just thought he was being picky and I would try all kinds of different canned foods as well as raw. I did get him to eat raw (Rad Cat) for a few months but he eventually refused that and was eating mostly dry and plain chicken breast whenever I cooked it for me. Then I noticed that his dry food wasn't being eaten and he even walked away from the chicken breast. I found a large hair ball with chicken chunks at one end and then he seemed to not want to eat and therefore wasn't pooping. I took him to the vet and she said his colon was full of poop and maybe he was just constipated so she gave him an enema which made him vomit so she didn't put the whole bolus in because she said the fecal matter that came out was normal. We did labs and liver enzymes were normal and BUN and creatinine were on high side is normal. He got a shot of cerenia and fluids and went home. Wouldn't eat normally, was able to coax a little food down him. Back the next day, more fluids and another shot of cerenia and made appt. for an ultrasound the next day. I got him to eat a little dry and some chicken breast, he remained playful? He seemed better but they wanted me to take his food up in case they needed to anesthetize him. He wanted food that morning. After the US, they said that everything looked normal, no thickening of the intestinal wall or inflammation of pancreas or liver, some sludge in gallbladder with calcifications on the duct. They thought actigall might help but i didnt like the possible side effects. She then suggested mirtazapine (big mistake) and Pepcid. I agreed to that and regretted it. The side effects were bad. He was unable to settle down and sleep, just layed with his eyes open and breathing rapidly. He did eat, but not worth it. I took him back in the morning not knowing that he was having side effects, just thought he was getting worse, they referred me right away to a specialist to have an endoscopy and biopsy for IBD. Dr. Franklin wanted to do an enema before the procedure because he commented that Bentley's colon was full of stool ( he never had a BM after the last incomplete enema 4 days prior). I took him home after the procedure, they gave him prednilisone and a dose of cyproheptadine (5 days ago) and poor guy has had watery diarrhea 10 times a day since then. The cyproheptadine made him eat but terribly wobbly, lethargic and not himself. He is on transdermal prednilisone 10mg x2 per day. He ate pretty good yesterday ( back to vet for SQ fluids). This morning, I noticed that he hasn't eaten much so I gave him a few pieces of steak and he was wild about it. 4 hours later, he got up went to his box, had horrible watery diarrhea as usual, jumped out of box and threw up the steak. They want to put him on flagyl but I am not sure because side effects are loss of appetite and vomiting among other nasty stuff. I made an appt. with a holistic vet for a consult today without my kitty because the frequent diarrhea makes it very risky taking him out. The whole diarrhea thing started after the ENEMA! He never had it before in his life. His little bottom is so sore from licking it even though I blot it after he goes. HELP!

Hopefully a mod will split this off into it's own thread.  This brings back memories of everything I went through with Patches.  I don't think the diarrhea is a result of the enema it's probably a side effect of one of the medicines that he has been getting.  An enema was always the beginning of getting Patches through one of these episodes.  

Patches was always given Flagyl when he had an episode.  I know one of the possible side effects is loss of appetite and it's hard to give because it's very bitter.  My vet cut up the pills and put them in gelcaps so Patches didn't taste it.  Flagyl is a go to when there is a large flare like this.  It's kills bad bacteria and has an anti-inflammatory effect.  Pepcid never helped my cat and he was never given an appetite stimulant.  Have you called the vet to tell them what is going on now?    He really needs to be seen even though you don't want to take him out.  He may need to be hospitalized on an IV.  That was done for Patches twice.

He's at a point now where he needs intensive vet care.  I not trying to scare you, I remember what this was like and how scared I was.  There really isn't anything that can be done at home to get him through this.

Just got a call from the vet. Biopsy came back as IBD with possible small cell lymphoma. They would have to do staining for an extra $200 to confirm and then put him on chemo that could suppress bone marrow. I told him to forget it that I wouldn't put him through that, I'd rather he be peacefully euthanized at home. The vet used DSS in the enema, it's a gel and maybe that was so irritating that his system doesn't want anything in there so it immediately gets rid of it. Of course, he might not have lymphoma, but I will never know. I just saw a homeopathic vet and he sent me home with some phytomucil liquid, and some Nux-V (homeopathic sublingual) and an enteric support that I'm supposed to crush and give in a syringe. He also suggested that I stop the transdermal prednilisone, I don't know what to do. I hate giving him things by mouth that taste bad it seems so cruel when he already doesn't feel good. I think it might be easier for him to let him go even though it will kill me. I'm already sleep deprived with worry and doting over him day and night. I'm so upset. I did give him fluids earlier. Don't know if I should try the flagyl at this point, I wanted to avoid it.

I didn't get a biopsy done on Patches, only a needle biopsy done on his liver when he had fatty liver disease.  He had all diagnostics.  The biopsy on his liver came back as inconclusive so I had the same result, it might be lymphoma and it might not be.  There is such a thin line between the two and its hard to tell when it has been crossed.

That was 2 1/2 years ago and he's still here.  He is still on a small dose of a steroid.  I know people in the holistic community don't approve of that and I know what can come from long term use but there is also a quality of life issue.  I think you might feel differently if he hadn't had this reaction.  Patches has always gotten his steroid by mouth and it is a small dose.

I'm not going to bother with all the usual things about diet.  I can tell you know already and are getting vet care.  I can only tell you what my experience was and what I did.

As I said earlier Patches has been on Flagyl each time that he has had a flair.  He hasn't had a serious flair since being on the steroid, only two very mild short ones.

Hello bentley2013,
I understand that finances can be an issue often for many of us. My little love, Kinko, was diagnosed in June with small cell lymphoma. I've racked up two surgeries and a number of ER visits since then for him but I would pay any penny to help him.
If he had IBD it will most likely turn into small cell lymphoma which is the most treatable form.
I urge you to determine what he has because if approached early and aggressively the cancer can be kept at bay for a long time. Consider that chemotherapy - even with the small risk of suppressing bone marrow - could keep him happy and healthy for a few more years. With the new protocols and research many cats are living 4+ years after diagnosis and passing from completely seperate issues.
Please reconsider.

Okay, I've reconsidered. I will have the test because maybe it wont' be lymphoma and I would hate to put him to sleep if it is IBD and only something that flares up and then can be controlled. I've read more and feel more comfortable. If I decide to do the treatment if it is, is it expensive?? He hasn't pooped since 1:30 and it is 9:30....praise God!!! I hope that the stuff I got down him (with a struggle) will help too. I will only be able to do that once a day, not twice because it takes two of us. He didn't eat much today but that may be good. Maybe his gut and colon need a rest. He has fluids on board for support. He is such a trooper, he play chasing a string after his treatment. He has played everyday during this ordeal. I on the other hand am a wreck and have lost 5 ibs that I can't afford to lose but I'm not hungry due to stress. Bless my hubby for putting up with no dinner, no house cleaning, etc. I am truly a headcase. Thank you for caring.

It's all relative I suppose. Kinko's Pepcid is over the counter and 1/4 tablet twice a day. It was $8 for a 60 count bottle so that is 120 days.
The Prednisolone is a 5mg tablet all given in one day but halved for an am and pm pilling. That was about $1 a pill.
The Leukeran is $10 a pill where I bought it but the offered the liquid as $7 and I heard you can get it even cheaper at Costco. The Leukeran is once every 3 days but once he goes into remission it will hopefully end up eventually as once every 3 weeks.
The appetite stimulant Mitazapine was $15 for a months worth.
The SubQ fluids I give him are $10 for the bag/hose/needles and that's 10 treatments. I was really squeamish about giving him fluids but it is so easy.
I've paid about $20 for 6 doses of pain meds - but I hold off on using those till he is constipated.
The neasau meds were $20 for 8 treatments and hook up to the SubQ bag. I haven't used one of those yet.
The Miralax was $6 for a tiny bottle and it will take forever for me to get through it.

So all together for the intial treatments I would say:
Pepcid - $2
Prednisolone - $30
Leukeran - $100
Mitazapine - $15
SubQ - $30
Misc Average - $15
$192/month

Now I will be pricing out the Prednisolone and Leukeran and will be getting those down to a cheaper level.
Your cat could do very well on the chemo and not need anything but the Pepcid, Prednisolone, and Leukeran. Lots of cats are successful. My poor little guy is just not doing well on the chemo and needs some help.

Some people are able to treat IBD with just diet changes. There has been a lot of success with diet changes. My cat has probable IBD and I treated him with mostly diet changes. Here is a good video on IBD: Here is a good video to watch on IBD:



Some cats are effectively treated with a raw or homecooked diet. Here is a thread about a cat who had chronic IBD and did not have his first normal stool until he started raw (http://www.thecatsite.com/t/239771/...lucky-bugsy-and-hope-to-raw-challenges-galore)

We also have had some great success stories with lymphoma see this thread (http://www.thecatsite.com/t/241514/lazlos-tumor-is-in-complete-remission)

I hope the mods can move this to its own thread. 

He has been put on canned and raw before he had this big flare.  I think this is one like Patches and that diet alone isn't going to be enough.  I am glad you have reconsidered.  

I never got a definitive answer on the lymphoma.  It has been controlled for 2 1/2 years with steroids so I don't think his was lymphoma.

I'm so discouraged. Bentley eats small amounts but almost exactly 4 hours later he loses it all out his bottom. He just threw up too, no food but stomach juice and a little hair. I really am a mess, I am one of those people who can't go on with their life as usual when I have a sick animal. Very little sleep, charting every meal, potty trip, anything significant as well as insignificant. The staining of the biopsy won't be back until early next week. I don't really know if we can go on like this. He is not improving on the prednilisone 10mg x2 per day. I might start the flagyl today if I can make it to the compounding pharmacy to pick up the gel caps. I really question in the end if I am just allowing him to suffer when euthinasia would be more humane. I don't want to hang on for my sake. If his quality of life is going to be so diminished then it's cruel because he is such a happy , boisterous, playful cat. He was 14 lbs the end of May with no obvious problems, he was 11 9oz. at the vets two days ago, I know he's lost more since then.We got some of the homeopathic stuff down him last night but it was a struggle and I hate that too!! I rescued him from death when he was 7-8 weeks old in August of 2005. He's had the best possible care, food and life. Is that enough? When is enough, enough?I am now worried about my health too due to lack of sleep and no appetite and that isn't fair to my husband, kids and grandkids. I know I'd have to go through the grieving process, but I think I already am. I just tears me up to see him like this. Does anyone else feel this way?

Everyone has to make their own decision about this.  I went through six years of vet hopping with flares like this just to get a diagnoses of probable IBD.  The stuff is devilish to diagnose and frustrating to treat.  I remember at that time I wasn't working from home and I called in and said that I was sick because I was drug out , tired, obsessed with my cats health.

I would at least start him on the Flagyl, these bad flares can take time to resolve.  The last one Patches had ended up with fatty liver and the vet was trying to figure out whether it was IBD or lymphoma.  What I had decided was that if it was diagnosed as lymphoma I was ready to let go.  But as you have seen on this thread there are people here who have gotten the chemo and gotten several more good years with their cat.

I can only tell you my own experience, what happened for me, and the decisions that I made.

A supplement that I think has really helped my cat with vomiting (http://www.vitalityscience.com/v/AllProducts/Cat-Diarrhea-Vomiting/feline-Diarrhea-Vomiting.asp)

Has anyone had the experience of prednilisone causing severe diarrhea in a cat that never had it before and enema and pred was started? I got the flagyl but he is not eating enough and did vomit today and I'm concerned that the flagyl will cause him to vomit more. Side effects are vomiting and diarrhea, wow, not sure if this is the right thing. I have cyroheptadine for appetite but it really didn't set well with him. He was unable to settle down and looked miserable. I almost feel like taking him off of the pred 10mg x 2 per day. I know I'm not supposed to stop pred suddenly, but he's only had 11 doses of it and I don't think that would be a problem without tapering. I also read that the chemo should be started at the same time as the pred for successful treatment. The Dr. said that was true but only if on the pred for a long time. It will be over a week by the time I get the diagnosis if it is small cell lymphoma.

I have seen it on the list of possible side effects but I didn't have that problem.  He is on a larger dosage than Patches was on.  Patches was taking 5 mg  twice a day while he was sick then he was tapered back to a smaller dosage for maintenance.   It could be the dosage is more than he can tolerate.  I would call the vet before doing anything medication wise.

I know you are afraid of the flagyl because a possible side effect is decreased appetite but it is a good medication for problems in the digestive tract.

Ya, I don't know why the specialist wants him on such a large dose. He is only 11 lbs now. I am using a compounded transdermal gel that I rub in his ear so he doensn't have to be pilled for that and he doesn't mind at all, actually enjoys it. I might drop the dose to 5 mg. because it isn't helping his appetite and my be causing the diarrhea.I'm praying that the A/D food he just ate 1/4 to 1/3 of a can stays down. I gave him approx 1/8 of a cyproheptadine even though the last time he had it (larger dose 1/4 tab) he was very uncomfortable and couldn't relax but it did make him eat. I just don't know anymore what is best for him. I just know he has to eat even if he does poop it out 4 hours later in watery diarrhea. I got the flagyl gel cap down him a couple of hours ago, don't know how long it takes to help if it does. I think I might take him in tomorrow and get another shot of cerenia and a B12 shot. I could give those at home in his fluids because they are sub Q. Didn't give fluids tonight, only last night, hope that is enough.Thank you for keeping in touch with me.

You have my deepest sympathies.  My cat Kinney has probable large cell lymphoma with the anorexia but not diarrhea.  His chemo regimen for large cell is much more intensive and I would have kissed the ground for a dx of small cell with only one chemo that can be given at home.

I was giving cyproheptadine as a topical (instead of as a pill) which was pretty successful, but my pred dosing is in a chicken flavored suspension that I just squirt in - so in my case these two medicines are reversed - cypro, topical / pred, oral.  Kinney only gets 5mg pred per day however, which almost instantly worked wonders for his appetite.   The cypro might be easier as a topical, rather than a pill on an empty stomach - I am not a vet however.

I can certainly identify with the pre-occupation with a sick kitty - I have been going through my thing for a couple of months and have had nightmares until recently.  I think if you can bring the diarrhea under control, you might feel that even small cell lymphoma might be handleable.  Small cell has a simple regimen that I would have killed for.

Best wishes to find your way - Dan

Are you waiting for confirmation on the diagnosis as I am? So sorry, I can completely relate. That is so interesting, I wasn't told that I could get the cyproheptadine in a transdermal gel. I will definitely ask if I need more. I have to be careful with it and halve the normal dose because Bentley is very sensitive to it and can't settle down. He did go 8 hours yesterday without pooing because he didn't eat so nothing to poo. I finally gave him his first dose of flagyl at 6:00 last night and at that time he had gone 4 hrs without pooing. He hasn't had diarrhea or a BM in the last 19 hours! I'm encouraged. He also ate last night 1/2 can a/d and dry food off and on all night after giving the cyproheptadine. It's a trade off cause I know he has to eat. He's being picky this morning though refusing chicken breast but I know he'd eat steak if I offered it to him. I didn't give cyproheptadine again this a.m. I will give him more this afternoon or evening if he doesn't eat much today. I really don't think I can own another animal after this because its bad for my health when they get sick. I've had 7 cats and one dog in my 58 years and I've been a wreak every time I go through an illness or end of life with them. It's a shame because I provide an excellent home for them but my obsessive nature makes me focus on nothing else.

A half can of A/D is very good.  It is high calorie and nutrient dense so he doesn't have to eat as much of it as other foods to get enough calories.  That along with being bland and very digestible is what makes it so good for sick cats.  I would keep giving him that in the form of several small meals.  Kind of like the idea of dry toast and tea for people with an upset stomach only it has protein and vitamins in it.

Do you think there would be any problem dropping to 5 mg pred from 10mg x 2 per day? He was only on the 10 mg. for 5 days. The wholistic vet said that since he hadn't been on it very long I could even stop it abruptly right now because there is only a problem if it has been weeks of use. I didn't do it. I guess I should believe that vet. Everyone thinks that the 10 mg is way too much.

I would ask your vet.  Holistic vets will pretty much always want to stop steroid use and conventional vets are sometimes a little quick to use it.  I think the best way is somewhere in the middle but of course it's hard to find a vet in the middle that blends holistic ideas with conventional medicine.  It seems high to me but I am not a vet or even a vet tech so I don't know about medicines.  Patches was very sick and he was on half that dosage.

Have you asked your vet about dropping the dosage?  Steroids also do stimulate appetite but if the dosage is higher than he can tolerate that effect is lost.