IBD with possible small cell lymphoma

How's it going?

Bentley hasn't eaten very much today. Just a few bites of chicken breast and a few bites of dry off and on. He is refusing the venison that has been his favorite over the last few days. Maybe the chlorambucil I gave him last night is responsible. I did give him some cerenia at 5:00 but so far it isn't helping, not vomiting, just nauseous. I was supposed to give 1/2 of a 16mg pill, but after researching it, I chose to try and divide the 16 mg pill into thirds after seeing that the cat dose is 5mg. not 8 mg. I have found that a # 4 gel cap is wonderful for putting the pieces of pills in that i cut up for him, that way he doesnt taste anything, even the prednilisone oblong tablet fits nicely inside the capsule. Gave transdermal cyproheptadine at 3:40 1/2 dose, just applied the rest of the dose. I'm not sure if the transdermal works as well as the oral, there is some debate about the transdermal prednilisone being fully absorbed and I was advised to give it orally instead by a vet on one of the lymphoma yahoo groups. Do you find the transdermal cyproheptadine to be effective? I am still not very optimistic that he will get better. He's in so many meds it can't be good for him.

I had labs run before starting the chemo. His kidney and liver function was back to normal but his white cell count was high at 23,000 and his hematocrit was a little low. I had them give a b12 shot.

How's Kinney?

Honestly if he is eating so little you really need to supplement with the syringe. If this is a problem putting in  a feeding tube is a really simple procedure and then you do not have to worry. Here is more info (http://catinfo.org/?link=feedingtubes)

It's another $1000.00 dollars that I don't have, already spent over $2,500.00. I will see if he eats more tomorrow. He has been getting enough prior to today. He had a large formed BM today. Document every time he eats, eliminates, etc. I will give more fluids tomorrow too although he has been to his water bowl several times tonight. Doing the best I can.

I had pretty good results with the transdermal cyproheptadine at 9mg per .1ml of lubriderm.  So, when Kinney was getting the cyproheptadine, it was 9mg at a time.  The first time I gave it to him, he started eating 15 minutes later.  I would find that after a couple of days, I could skip a few days as it seemed to build up in his system.  I haven't had to use the cypro for many weeks now - as just his daily prednisone has an appetite stimulating effect that worked instead.

Kinney had his 3rd chemo at the hospital today and for the first time got Cerenia (a pill by the vet) to see if he would be less lethargic after his chemo treatments.  He always seems sleepy for a couple days after his chemo, so I asked if we could try the Cerenia.  So far, I don't think it has made a big difference in his disposition.  He does eat however, even if he sleeps a fair amount. 

I had the Cerenia made up into a suspension, which ended up being a big deal since my usual compounding pharmacy did not have the powdered medicine to make it up.  They had to use another pharmacy which is going to express mail it to me.  Not that I am a vet, but it is my understanding that Cerenia is only used for short durations.  When I get the Cerenia suspension by mail tomorrow, I am only planning on giving it to him for one or two days following his chemo.  Just as a reference point...  since you mentioned you thought Bentley was on a lot of meds.

Probably, the others are right in that if Bentley's eating doesn't pick up - you may have to try getting food into him one way or another.  Eating trumps everything else, I think.  I suppose it would be expected that his appetite would fall off right after he gets his chemo treatments.  In Kinney's case, he eats less for a couple of days right after - then makes up for lost time as the chemo purges from his system.  You might try re-presenting his food a few times - I think the chemo does something to their sense of smell.

You have mentioned the Ringer's drips.  I had to re-read your intro - he is only 8yo.  Pretty young for kidney problems.  Do they think he still needs all of those hydrations?

Maybe you could try some of the things that some cats really like that aren't complete foods.   Some cats love the meat baby foods, I have one that would never turn that down another doesn't care for it.  You want the one without onion in it.  You can also try Fancy Feast, I have heard it called kitty crack.  For the very short term things like baby food are fine.

If it is true that chemo affects the sense of smell things like heating the food a little will make it smell stronger.

Well, he finally ate some chicken breast and some venison last night and this morning. He ate a little tuna last night too. Here is my train of thought, I am into quality of life more than quantity with animals. I won't force feed him but I will spend copious amounts of time hand feeding and offering everything under the sun. We already give him pills which he hates but forgives us. I force fed another cat a few years ago and it was the most awful experience for both of us and I discontinued it after he ended up vomiting anyway. He had to be euthanized due to an autoimmune attack on his liver where he was to sick to recover and he was only 10.

I have decided that if Bentley doesn't start feeling better and eating after the third chlorambucil pill I may have to say goodbye because I cannot watch this. I will not be able to have any more kitties because I don't deal well with this, I make myself physically sick and I can't carry on a normal life due to the grief and worry. I realize this now. I am happy for those of you who carry on. I question whether we ask too much of these precious creatures to carry on for our sake. What would they want is my question? What quality of life? As you can tell, I am losing hope and there is no guarantee even with all of these horrible meds that he will ever feel really well like he used to. Sorry to be so negative, I am just not optimistic right now.

I think some cats are just easier to syringe feed than others.  Patches was like the cat you tried to syringe feed.  I know there is a video floating around on this site that makes it look easy but not all cats react that way.  I am pretty sure that's a ragdoll and they are known for being very relaxed and much more compliant than a lot of cats.  I was actually thankful when the vet put in the feeding tube when he had fatty liver disease because I was spending hours trying to feed Patches and making very little progress.

I also understand being at the end of the line financially.  I have been fortunate that when Patches has had one of his huge vet bills I have had the money to pay it.  There have been times when I would not have had the money.  I think it is good that you are giving the Leukeran some time to work.

Does he get any rest days inbetween the Leukeran dosings?  I am noticing in my case that Kinney picks up eating after a day or two subsequent to his chemo treatments, but then his are a week apart.  When I was looking into small cell, I thought that the Leukeran was given only once every two weeks?  On a daily basis, I don't know how he would every recover from the chemo side effects.

I am not a vet, but when I was looking into this - the protocol mentioned here seemed pretty typical: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3092124/

I also remember specifically that the Leukeran can be made into a suspension that can be easier to administer - probably easier going down as well, especially on an empty stomach.

From others using Leukeran, my understanding is that it was given daily, often with no side effects at all. I don't think it is in any way comparable to the "toxicity" of drugs administered in large cell lymphoma treatments.

He gets the chlorambucil once every two weeks. It's a much larger dose less frequently. I got quite a Bit of chicken breast and venison in him late afternoon and evening. He went to the dry food bowl several times after giving the cerenia and cyproheptadine but only ate a few bites at first. He finally broke down and had about 20 bites, also a little Stella and Chewy freeze dried turkey. I gave him some taurine in a capsule because I don't know if he's getting enough with this unbalanced diet. Vet wanted me to give fluids every other day just to make sure he's hydrated well especially since he tends to be constipated and only poops every other day. So I guess I will do that before bed. Poor guy.

I'm sorry, maybe I am all wet.  I happened upon this thread right here on thecatsite discussing Leukeran and the various people posting were on a lot of different doses..  There did seem to be people saying that the Leukeran killed their kitties appetites. 

http://www.thecatsite.com/t/215863/leukeran-side-effects

Denice said:

I think some cats are just easier to syringe feed than others.  Patches was like the cat you tried to syringe feed.  I know there is a video floating around on this site that makes it look easy but not all cats react that way.  I am pretty sure that's a ragdoll and they are known for being very relaxed and much more compliant than a lot of cats. 

Click to expand...

The cat in the video is in a cat bag which prevents them from trying to escape and that is why it looks easy. Carolina who made the video has stated that her cats would fight her before she got the bag and it has made it much easier to syringe feed and pill. 

I am very pro syringe feeding as it saves cats lives. I really believe it saved my cats life while he was refusing to eat while he was having major GI distress. If he had not gotten that extra nutrition he would have developed hepatic lipidosis and probably worse. It is not the easiest thing but it will get a cat over that hump while they are being treated for whatever disease that is causing them to stop eating. A couple of weeks of discomfort was so worth it for me and my cat who is now very happy and healthy.

I actually wish we had known about syringe feeding before as my sister's cat died of total vet incompetence and one of the many things they did not do was tell us cats develop hepatic lipidosis if they stop eating or even that it was dangerous for a cat to stop eating. He ultimately died because they sedated him without our knowledge but he had lost so much weight over a week of not eating much and us being told he should be fine by the vet. My mother and I now believe if we had known to syringe feed him he would not have gotten so weak and we still cry that we didn't know. I will now never let my cats go more than a day without food and I don't care how difficult it is because I cannot live with that guilt again. I understand everyone's situation is different but I just wanted to share why I think syringe feeding is so important. 

I know the dosage for leukeran is all over the place.  Every website shows a different dosage at different intervals.  Even after remission many vets continue  leukeran on a small dosage.  They seem to be using it in conjunction with the steroid as an anti-inflammatory.  There just doesn't seem to be any standard treatment with it.

Usually when a medication becomes the standard treatment for something which leukeran has become for both confirmed small cell lymphoma and cats in the gray area between IBD and lymphoma there is usually an accepted standard protocol that emerges.  That doesn't seem to be the case with leukeran.  It's like everything else with this stuff, it's like shifting sand.  It's even next to impossible to get a confirmed diagnoses.

I finally gave up on finding anything myself and did six years of vet hopping.  I finally found a really good vet that I trust and I go with what she says.  I know that isn't good because I am responsible for my cat's well being but there just is nothing out there that is a general consensus.  One web site says one thing and another says something completely different.  Then add in that every cat reacts to things differently, what works for one cat makes things worse for another cat.

The problem I had with syringe feeding was not with holding Patches.  That's not a problem because he isn't a large cat and he has the long lanky build, I would just wrap him in a towel and that part was fine.  He would lock up his mouth which would mean I would have to pry his mouth open which often resulted in being bitten.  I certainly don't blame him for that and if the bite was bad enough I have insurance I can go to the doctor and get antibiotics.  That would be followed by him being so stressed out that he would vomit so what little I managed to get into him came back up.

I know cats have to eat to avoid fatty liver, I dealt with it with Patches but there are some cats for whom assisted feeding can only be accomplished with a feeding tube.

Bentley's appetite was bad before starting any medications. That's why I took him to the vet in the first place. The prednilisone is not helping his appetite and the chlorambucil has not helped so far either and I'm not sure if it made it worse. He will eat small amounts of dry Orijean in desperation. He ears a fair amount of chicken breast and venison steak. He is maintaining his weight, so I guess I shouldn't panic. He did eat some a/d in the middle of the night but he had cerenia and 1/8 tab of cyproheptadine. I chose not to give it to him tonight to see how he did on his own. Probably a mistake because he hasn't eaten as well tonight.

I decided to give him the meds so he eats tonight.

You mean the cypro for his appetite?  You say an 1/8 tab of cypro.  How many mg is that?  Kinney was getting 9mg, but it was in a topical.

Yes, the cyproheptadine and cerenia. Approx 5 mg cerenia and 1/8 of a 4mg tablet of cyproheptadine. Regular dose is 1/2 tablet, but he is too sensitive and had a bad reaction at that dose. I give him just enough to get him to eat without making him uncomfortable. I also have the topical, but wasn't sure it was effective. I tried a half dose and didn't notice any benefit transdermally. I am going to give his 10 mg. prednilisone transdermally tonight because I've already pilled him once tonight and I don't want to do it to him again. The pred isn't helping anyway so it probably doesn't matter.

I wonder if there is anything that would make his tummy feel better. I know it causes him pain to eat.