starting higher dose of steroid for lymphoma anything I should look out for?

My cat Chalupa was recently diagnosed with the lg cell intestinal lymphoma. She was just started on 5 mg of prednisolone, 1 pill per day. I also have some buprenex in 0.3 syringes I can give her which I kind of stopped to see how this pred is effecting her. Day 1 on the pill, I gave it to her the morning before I left for work and when I came home she was actually playing and jumping and had eaten a whole can I left for her and then ate another one I gave her that evening. Completely shocking to me she hasn't played in months! Day 2, she was less energetic, but still had a pretty good appetite. Day 3 seems exhausted even less of an appetite, but still eating. Is she maybe on too high a dose? Should I start giving her buprenex again in maybe smaller doses? Is it better to give the pred in two small doses rather than 1? The other thing I've noticed is sneezing and runny nose.

I would only give the Pred the way the vet instructs you but 5mg is a conservative dose.  The Bupe can make her sleepy, and I don't know if Leukeran is used in Lg Cell lymphona but it is used in sm cell and most cats tolerate it well.  Lg cell is worse than Sm cell, so i'm curious why your cat is only on Pred and why a relatively low dose.  The pred itself should not affect her behavior, but the Bupe can.  Does your vet suspect she is in pain?

Oh, I'm so sorry. :rub: This was diagnosed via biopsy? Needle aspirate? Did the vet refer you to an oncologist? Have you discussed chemotherapy for her? Or did you opt for palliative care?

Lazlo had large cell lymphoma. He was put on 5mg of prednisone, once a day. There's no need to give it twice a day, that won't have an impact as it takes up to 36 hours to be eliminated. We were referred to an oncologist, and we opted to pursue chemotherapy. It was a big commitment, both in terms of time and money. And the chance is only 50/50 that the cancer responds to the chemo and goes into remission. And once in remission, the average length of remission is about 9 months. So many opt for palliative care, especially as it can be very stressful for kitty to go through everything required for chemo. Lazlo handled the trips and the treatment quite well, which is why we continued with it. We figured we could at least start, and if it was too much for him, we could always stop. We were fortunate, he is now over 2 years into remission, knock wood. :cross:

The pred doesn't stop the progression of the cancer, but it does make them more comfortable. :heart2: Does the vet think she's in pain? Because the main problems are typically nausea and inappetance. We used an anti-nausea medication (Cerenia) and an appetite stimulant (we used mirtazipine, though this doesn't agree with all cats. It only needs to be given once every three days, versus cyproheptadine, which needs to be given twice a day). He also needed acid suppression, but he had a mass in his stomach with bleeding ulcers.

Vibes for you and Chalupa!

Hello LDG, Thank you so much for your reply, it is very hopeful. I'm confused about this disease because of the 57 day prognosis. Chalupa is 11 years old and I have been trying to figure what's wrong with her since July 2013 when I brought her in for what I thought was every test that could be done at a cat hospital.  They said she's definitely fighting something but we don't know what it is. One month later, I'm at animal ER because I found her  laying in a puddle of drool and she wouldn't move and she had peed and vomited everywhere. They diagnose her with pancreatitis. She was given antibiotics, pain reliever, and appetite stimulant. She starts eating again and seems feeling better. Follow up at a new hospital to address pancreatitis and they disagree with diagnosis and suspect IBD. Approx. One month after that she's extremely sick and just gets worse and I am back and forth at the vet doing even more tests. Finally one night when she was about to die and I'm about to go to another hospital I asked the dr to do an ultrasound and she said that she is not a specialist but she might be able to find something and she did. Chalupa had a rupture in her intestine and had to have emergency surgery next day. Dr suspected lymphoma and said her intestines were all messed up. Dr found nothing but a hole and said she sent a sample from lymph node(I think) and tissue around rupture, results came back trauma/foreign object. Chalupa recovered from surgery and seemed relatively ok for a while but never really got better. 5 months later we get another ultrasound and find a mass, I opted for fine needle aspirate, and had to wait for test results over one agonizing weekend. Last Monday I found out her real diagnonsis, large granular lymphocytic lymphosarcoma.

I am opting for palliative care so far, can't imagine putting her through much more and I'm sure I can't afford chemo when there is a slim chance of making any difference. She's been sick for so long now, I discussed with my vet that if she starts suffering I want to put her to sleep, and wanted to add you may as well put me to sleep too, she's my whole life, the only piece of furniture I own is a cat tree. Since starting the prednisolone on Thursday at 5 mg, she seems renewed, today she's doing better than she has in months, actually eating whole meals at once, walking around, asking to go out side and for food! If there is something else I could do for her I will, if you have any suggestions or ideas I would really appreciate it. Now I'm getting addicted to this trying to keep her alive and well stuff. I will carry on with the 5mg once day like dr says. Sorry for my bad writing and long story.

Thank you again for your time, I really appreciate your post.

Best Wishes to you and especially Lazlo.

By the way how old was Lazlo when he went into remission? How old is Lazlo now and how is he doing? Any recurrent problems? Approximately how much did it cost in the end for chemo to get it into remission?

Hello Thank you Stephen Q for your reply, I will carry on with how the dr. instructed me to give the pred. The Buprenex was given before lymphoma diagnosis because appetite stimulants were not working. I have actually gradually stopped using the buprenex since I starting the pred but not sure if I should give it to her or if she really needs it. She's doing really well now on the prednisolone 5 mg alone, I will find out about this leukeran though. Now I'm all filled with hope and probably shouldn't be. I'm guessing we will need to gradually increase the prednisolone, but I thought it loses it's effectiveness within about 6 weeks. Maybe she has lived a lot longer than expected with untreated lymphoma already. I'm not sure which way this going to go.

Thanks again, wish you the best!

Hi @chalupa

I think its not that the Pred stops working per se, but that the disease just gets ahead of the meds.... I'm glad things are going well at the moment and we are sending you positive vibes! Don't hesitate to contact your vet if there is any change or new concern.  There came a time with my own cat's disease (different illness) when she gave me her cell number and said I could call anytime day or night.  That's when it hit home how serious it was, not to mention my Vet's generosity, and I had to start crying.  Enjoy every minute with her.  And remember, if she's feeling good, then she's having a great day.

Keep us informed.

chalupa said:

Hello LDG, Thank you so much for your reply, it is very hopeful. I'm confused about this disease because of the 57 day prognosis.

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I'm sorry - a 57 day prognosis? I don't understand what this is. When Lazlo was finally diagnosed, he was given about 4 weeks to live without treatment. :heart2:


[quote = chalupa]Chalupa is 11 years old and I have been trying to figure what's wrong with her since July 2013 when I brought her in for what I thought was every test that could be done at a cat hospital.  They said she's definitely fighting something but we don't know what it is. One month later, I'm at animal ER because I found her  laying in a puddle of drool and she wouldn't move and she had peed and vomited everywhere. They diagnose her with pancreatitis. She was given antibiotics, pain reliever, and appetite stimulant. She starts eating again and seems feeling better. Follow up at a new hospital to address pancreatitis and they disagree with diagnosis and suspect IBD. Approx. One month after that she's extremely sick and just gets worse and I am back and forth at the vet doing even more tests. Finally one night when she was about to die and I'm about to go to another hospital I asked the dr to do an ultrasound and she said that she is not a specialist but she might be able to find something and she did. Chalupa had a rupture in her intestine and had to have emergency surgery next day. Dr suspected lymphoma and said her intestines were all messed up. Dr found nothing but a hole and said she sent a sample from lymph node(I think) and tissue around rupture, results came back trauma/foreign object. Chalupa recovered from surgery and seemed relatively ok for a while but never really got better. 5 months later we get another ultrasound and find a mass, I opted for fine needle aspirate, and had to wait for test results over one agonizing weekend. Last Monday I found out her real diagnonsis, large granular lymphocytic lymphosarcoma.[/quote]

It took us a while to get Lazlo's diagnosis, too. We were fortunate in that nothing that dramatic happened. But the symptoms - just vomiting - started in January of 2011. Lazlo was 9. Then he just ... lost weight and didn't act right. A few vet visits for the mystery illness resulted in him not improving - and then he started hiding under one of our chairs. At the next vet visit, they did an x-ray, and that's when the mass in his stomach was discovered.

I am opting for palliative care so far, can't imagine putting her through much more and I'm sure I can't afford chemo when there is a slim chance of making any difference. She's been sick for so long now, I discussed with my vet that if she starts suffering I want to put her to sleep, and wanted to add you may as well put me to sleep too, she's my whole life, the only piece of furniture I own is a cat tree.

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:heart2: :heart2: :heart2: Yeah.... the worst part of loving is the loss that - if everything works as it *should* means we have to experience that. You might find this helpful, actually. :heart2: http://www.thecatsite.com/t/237066/when-the-moment-comes

I hope you won't have to face that for some time. :heart2:

chalupa said:

Since starting the prednisolone on Thursday at 5 mg, she seems renewed, today she's doing better than she has in months, actually eating whole meals at once, walking around, asking to go out side and for food! If there is something else I could do for her I will, if you have any suggestions or ideas I would really appreciate it. Now I'm getting addicted to this trying to keep her alive and well stuff. I will carry on with the 5mg once day like dr says. Sorry for my bad writing and long story.
Thank you again for your time, I really appreciate your post.
Best Wishes to you and especially Lazlo.
By the way how old was Lazlo when he went into remission? How old is Lazlo now and how is he doing? Any recurrent problems? Approximately how much did it cost in the end for chemo to get it into remission?

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Lazlo was 9 when diagnosed at the end of July 2011. He started chemo immediately. It was every week for two months with a one week break after the first four treatments. Then it was a treatment every-other-week until the end of January, 2012. Six months of treatments, basically, 16 treatments. Each was slightly different, the doses tailored to how he felt each time. Sometimes they were delayed depending on whether or not he was anemic. And the last treatment of each 4-treatment cycle was always the hardest on him. His story is here: http://www.thecatsite.com/t/234030/mega-massive-vibes-for-lazlo-urgent (The first few pages are just getting the right diagnosis).

Each treatment visit was around $150, though that last one of each cycle was over $200 (I don't remember the exact numbers). They also wanted ultrasounds at the end of each cycle. That was $325. But after the first two, we decided to stop having them done. We knew we were going the full course at that point, so it just didn't matter what was going on inside - either he would ultimately respond or he wouldn't. So we waited until a month after his last treatment to have that final ultrasound done. Now we get them done every six months.

The only ongoing problem is his appetite. And I don't know if it's because we spoiled him so much that now he's finicky, or if he actually is experiencing nausea at times. I don't see him drooling or lip-licking, though sometimes he does sit in the meatloaf position with his head down, which makes me think he's got some GI discomfort at times. We did keep him on pred (5mg at first) for the first year, then reduced it to 2.5mg, then 2.5mg every-other-day, and now he's not on any meds. I do keep all of them on hand, just in case (Pepcid, cerenia, an appetite stimulant, reglan.... ). But all I give him now when he seems like his tummy upset is slippery elm bark powder mixed in George's aloe vera juice. I did transition him to a raw diet that last month of chemo, as I wanted control over what goes into him, and I wanted him on a really low carb diet. I also give him probiotics to support his immune system and GI health.

chalupa said:

Hello Thank you Stephen Q for your reply, I will carry on with how the dr. instructed me to give the pred. The Buprenex was given before lymphoma diagnosis because appetite stimulants were not working. I have actually gradually stopped using the buprenex since I starting the pred but not sure if I should give it to her or if she really needs it. She's doing really well now on the prednisolone 5 mg alone, I will find out about this leukeran though. Now I'm all filled with hope and probably shouldn't be. I'm guessing we will need to gradually increase the prednisolone, but I thought it loses it's effectiveness within about 6 weeks. Maybe she has lived a lot longer than expected with untreated lymphoma already. I'm not sure which way this going to go.
Thanks again, wish you the best!

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Leukeran (clorambucil) is for treating small cell lymphoma. I don't think it's the right chemo treatment for Chalupa. But it never hurts to ask your vet.

As Chalupa was diagnosed with pancreatitis at one point, the buprenex makes sense if they were thinking it was that. Pancreatitis can be quite painful, and that can be part of the reason they stop eating. But if she doesn't currently have pancreatitis, I'm not sure the buprenex is needed, and it may cause more issues than it helps - as the biggest problem, often, with a GI cancer is nausea and inappetance.

But pred often helps with how they feel! I don't know where that six weeks number came from... pred can remain effective indefinitely. That doesn't mean it will - but it isn't something they become "immune" to. :dk: It's probably a good idea to ask about the other medications, so you have them on hand if necessary (an appetite stimulant, and an anti-nausea medication). I see here over and over again that many vets will prescribe an appetite stimulant without an anti-nausea medication. For Lazlo, the anti-nausea med did more than anything else in helping to get him eating again.

I recently found these forums as my cat was diagnosed via a needle aspiration yesterday. She is 9 and I am so sad. Just wanted to let you know we are going to opt for the predisolone treatment as well. Calling the dr. In the am to confirm our course of action. Wanted to let you know that I can relate and best wishes to you and your kitty

Hi LDG,

Thanks for your super informative reply! I I had to go back and find where I got the 57 day number in my head, my doctor sent me this info  below about Chalupa's diagnosis. It does seem very hopeless, I don't know if Chalupa and Lazlo have the same thing, I'm guessing they do considering you were told he has 4 weeks to live. When I spoke with Dr. about it she did not seem to think chemo would help. I'm starting to have more interest in possible drugs that might help her because of the prednisolone.

from Dr

>Chalupa has been diagnosed with Large Granular Lymphoma.  This is a more aggressive form of lymphosarcoma and unfortunately carries a poor prognosis as it appears insensitive to chemotherapy and readily spreads, affects other body systems.  

In one study, 28 cats were treated.  In 23 of 28 cats, chemotherapy alone was used;  4 of the 28  cats received chemotherapy and surgery, and one cat received chemotherapy and radiation.

Overall efficacy of treatment was a median survival time of 57 days and no complete remissions obtained.  One cat reported living to 5 months.

Chemotherapy options incluside the more popular weekly treatments or the every 3-6 week course of treatment.  However, as previously noted, neither is unfortunately that effective. 
As discussed, it would be reasonable to place Chalupa on 2mls per day of the 3mg/ml prednisolone medication.  As stated, I will place some aside in case you elect to pick it up.
 
Again, I am terribly saddened and sorry for this news.  She is a wonderful cat and I know how much you love her.<

There is a downside to this immune suppressant, she has a cold with a lot of congestion, sneezing, clearing throat, that is not going away and seems getting worse sometimes. Also her inner eyelid is starting to show more again. Do you think I need to get her antibiotics maybe in case she has something she can't fight off? Also should I address her overall health with her doctor and do bloodwork and all that again? At this point it just seems like making her comfortable is all I can really do. Since she is improving in other areas I feel like I should be doing more. She is still eating well, not vomiting, or having diarrhea is this as good as it gets? I'm guessing it's downhill from here. The dr. did mention I could pick up antibiotics to be cautious, would you say this might be a bad idea? Does Lazlo ever come down with a cold?

You were saying Lazlo was anemic. I was worried about that with Chalupa initially when I brought her to the dr. but it all got forgotten once we did the ultrasound. She is obsessed with licking the sidewalk and rusty metal if she can get away with it. I thought she had a lot of signs of anemia along with these strange behaviors. If she is anemic can I do something for her at home?

I'm glad you brought up the food you are giving Lazlo because I have also been giving Chalupa raw food and probiotics but this is recent because without the steroid ?Chalupa wouldn't touch raw food, but on it she prefers it over canned or dry.

I have no idea where I read that pred  may help for up 6 weeks only, I could definitely be wrong, probably am.

Thanks again LDG!

Your Lazlo story is really inspiring and also thank you for that link about loss of a pet. Now I have to go read the whole Lazlo story......

Hi RubyDoo67, Thank you for writing, I'm sorry you are going through this, it's awful. I feel like it's too soon for all this to happen to us. I will try to keep sharing our status and concerns regularly and hope you do too. I would like to know more about your cat if you ever have time to share. We should probably keep in touch. 

How is your kitty?

I hope for the best for you and the Cat!

Hi StephenQ, Thanks for the positive vibes! What illness did your cat have that was very serious?

chalupa said:

 
Hi StephenQ, Thanks for the positive vibes! What illness did your cat have that was very serious?

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My cat has a bad case of IBD (inflammatory bowel disease)  which can turn into small cell lymphoma if untreated or unlucky. SCL (Small Cell L) is an infiltrative disease, there is no tumor mass per se, its the nature of the cells that change.  LCL (large cell) involves a tumor mass.

Here are some articles on Lymphona in cats, and thanks for inquiring about my cat SImon

http://www.ivghospitals.com/service/oncology/feline-lymphoma/

http://www.2ndchance.info/lymphomaCat.htm

Hi StephenQ, Do you have your Simon on meds to control the lymphoma? What are your cats symptoms with IBD?

Hi @chalupa

Simon doesn't have lymphoma just IBD, which can be a precursor to lymphoma.  He is on Prednisilone which is currently controlling his inflamed bowel.  The Pred is not good for kidneys however and he has renal (kidney) insufficiency and we may have to taper the Pred in time and try adding in some Leukeran which isn't hard on kidneys but is a form of chemo that not all cats tolerate, although most do.  Leukeran can also be used for small cell lymphoma, but I am not sure if it can be used in Lg Cell, I think not.  He is also on Vitamin B injectons, diet adjustment and probiotics.

How much pred does Simon take and how long has he been taking it? Just want idea how long for it to effect his kidneys like that. How old is Simon? How old was he when he developed ibd? My cat has always had a history of constipation and vets always said she's fine, wish I knew of this lymphoma could have been prevented.

You probably could not have prevented the lymphoma, I think its mostly bad luck.

Simon is almost 15, he's on 5mg 1x day and has been on it for a little under two months.  Within 2 weeks of starting it he was gaining weight which was great because the major symptom of his IBD was serious weight loss.  With IBD and Small cell intestinal lymphoma the effect is intestines that can't absorb nutrients hence weight loss.  The Pred reduces the inflammation allowing proper nutrient absorption. If it wasn't for his kidneys he might have started at 10mg a day.

He gets a kidney recheck in about a week and will be getting regular rechecks for the rest of his life.  If his kidney values start to go the wrong way we will probably try tapering the pred and as i said before adding the Leukeran.  Leukeran is probably the best tolerated chemo for cats with this condition and as i said it helps with sm cell Lymphoma too, but I don't know about Lg cell.

And when I say well tolerated, i mean 80% of the cats have no bad reaction to it, and 20% have a very bad (vomiting) reaction and can't take the drug, and therapy must stop.

For his kidneys , do you ever try shooting water in his mouth with a syringe or mixing water in wet food? Nowadays I squirt water mixed with pedialyte into her mouth with a feeding syringe. Maybe I should bring her in for bloodwork after this 28 day pred prescription runs out if she still lives, now I'm worried about her kidneys even though there's a million other things going on to worry about. I kind of feel like I shouldn't bother asking my vet, she will probably say you can if you want. When Chalupa was younger she used to have kidney issues but I think the extra water I gave her and the fact I stopped giving her only dry food really helped. What are the B vitamin injections Simon gets for? I hope you don't have to use Leukeran already, but guess you don't have much choice if he can't handle pred. I hope he starts feeling better on his own.

When using a syringe rather for feeding or for water always use the side of the mouth and go slow so it isn't aspirated into the lungs.

I hope I do it right, although when she suddenly fights me who knows. While chalupa was in hospital I asked for them to show how to give pills and force feed. They scheduled a demonstration with one of the vet techs. I was surprised they did that, really appreciated it. I'm still not good at force feeding food, luckily don't have to do that. But we got the pills down somehow it's rarely a problem anymore.