9 year old Cat with major weight loss, lethargic, some eating, vomiting....blood, x-ray, ultrasound

We've taken our 9 year old big cat to the vet 5 times in the last week.  We were gone 5 days for vacation and came back to find him acting needy followed by him hiding a lot, lethargy, and major weight loss.  He's usually around 16 pounds and has dropped to 12 pounds.

First vet thought it was kidneys but the blood test came back totally clear.  A couple days later we took him in for an xray and an FIV test....again, nothing.  This vet told us he suspects it's his bowel or intestines so we could either do a blood test panel focusing on that, or we could do an ultrasound that would look at all of this organs.  We opted for the ultrasound 5 days later, and the doc gave us some drug to give him twice day that should increase his appetite.  He started acting weird, kind of like a zombie, grazed a little bit with food, so we took him in again and they said to stop giving him those pills and we injected water into him to hydrate him.  He immediately acted a bit better, moved around more, gained appetite, begged for food.

The next day we took him to a different vet for an ultrasound.  He also anticipated a bowel or intestine issue (IBD or lymphoma)....the ultrasound took only about 15 minutes and he reviewed all the organs and they all looked fine, no signs of cancer, no inflammation, nothing to suggest IBD or lymphoma.  He said we should just monitor him for the next two weeks and see if he gets better and bring him in if he loses more weight.  Well he looked lethargic again this morning, he vomited clear liquid last night, and he won't eat the food we put in front of him.  He slept in our bed with us again (usually never does this) and won't move around a lot, he usually begs us for food first thing in the morning.  

We don't know what to do.  We have no idea what's bothering him.  I know there's a chance he has IBD or lymphoma and the ultrasound wouldn't have picked it up, but how do we find out?  The vet said the next step is a biopsy through the rectum but we don't want to put him through that and it's very expensive.  

My biggest question is could it be something like an illness or disease?  Maybe he's allergic to something?  In the last couple months we've started letting him play in the hallway of our apartment building (just us and one other neighbor that we know), we got a cleaning lady who has come about 3 or 4 times so far, and maybe a few new plants.  Is it at all possible it's something totally different that IBD or lymphoma or should we assume he has something like that and start treating it right away?

He's only 9 and otherwise been a perfectly healthy cat.  We can't figure out what's going on with him and we're worried and scared.  We love this cat and will spend what we have to in order to save his life it means a good recovering and a few extra years or more.  We just are at a loss for what to do to help him.  Any thoughts are helpful.  Thank you.

CWAT32 said:

 

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I'm so sorry for you and your cat.  I'm presuming there no vomiting or diarrhea?  Has the vet looked into hepatic lipidosis? 

Liver values?

X-rays?

He's not experiencing diarrhea, he's vomited few times in the form of a clear liquid (no food).  He's been eating at times but since the last visit he's not doing anything, going back lethargic and non-eating.

X-Rays came up negative.

Blood test of a wide panel was used and nothing showed up.

We just don't know what he has and we're scared to choose a path to treat him and being wrong.

Is the clear liquid mucousy? What is the volume? About a cup? Any signs of hairballs in the vomit?

Start reading about giving subq fluids. Your cat is dehydrated which explains the lethargy. There is an excellent video on giving subq fluids from dr. Kris on this site. Your vets sound clueless. They should have at least given you cerenia to stop the vomiting for now. That buys you time to figure out what is going on without him deteriorating further.

Do you leave your cat often for 5 days? I ask because this could have been brought on by stress. What do you feed him?

We ended up choosing to put him on the prednizone steroid along with B12 injections and an appetite increaser drug.  

The doctor assured us that if this doesn't work in the next 2-4 weeks then we can test for lymphoma with a biopsy and still treat him and save his life if needed.  A biopsy was $2500 which was a lot for a test that might not give us any results (nothing we've tested for so far has). 

We're confident in this path now.  We were worried before that it could take 6 months to find out if he had lymphoma (through trial and error of treating for IBD), and that it would be too late to treat/save him.  The doctor told us as long as we don't bring him in almost dead and a skeleton we can still treat him if he has lymphoma in a month or two.  He said lymphoma in cats is very curable but chemo is expensive and hard on the cat.

Crossing our fingers and hoping this works.

Have they screened for pancreatitis? This test is usually not included in a normal blood panel.

CWAT32 said:

 
We ended up choosing to put him on the prednizone steroid along with B12 injections and an appetite increaser drug.  

The doctor assured us that if this doesn't work in the next 2-4 weeks then we can test for lymphoma with a biopsy and still treat him and save his life if needed.  A biopsy was $2500 which was a lot for a test that might not give us any results (nothing we've tested for so far has). 

We're confident in this path now.  We were worried before that it could take 6 months to find out if he had lymphoma (through trial and error of treating for IBD), and that it would be too late to treat/save him.  The doctor told us as long as we don't bring him in almost dead and a skeleton we can still treat him if he has lymphoma in a month or two.  He said lymphoma in cats is very curable but chemo is expensive and hard on the cat.

Crossing our fingers and hoping this works.

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There is an error in one piece of the info you were given.  Once you start a steroid you loose the ability to learn anything from a biopsy unless you take him off the steroid and allow enough time to pass for the condition to recur (assuming it went into remission in the first place).  However, if he gains weight on the pred (indicating remission) then he most likely has either IBD or small cell lymphoma and the good news is that the pred is the standard and first treatment for either illness.  The negative is if he doesn't respond to the pred,your next choice is to presume  a diagnosis of lymphoma without biopsy (unless you take him off the pred and wait) and then start the next standard treatment which is Leukeran, a generally well tolerated (but not always) "Chemo" that has good results with Lymphoma.  In other words, its complicated and more so without a biopsy, however the good part is that a positive response to Pred is in itself diagnostic and that is helpful, assuming their is a positive response.

Lastly, cats metabolize Presizone into Prednizilone which causes the cat to make an extra internal metabolic step and for this reason, for cats, its generally better to treat with the latter, not the former.

If it's lymphoma, its better to talk about increasing lifespan and quality of life rather than "cure", there really is no cure.

StephenQ said:

 
There is an error in one piece of the info you were given.  Once you start a steroid you loose the ability to learn anything from a biopsy unless you take him off the steroid and allow enough time to pass for the condition to recur (assuming it went into remission in the first place).  However, if he gains weight on the pred (indicating remission) then he most likely has either IBD or small cell lymphoma and the good news is that the pred is the standard and first treatment for either illness.  The negative is if he doesn't respond to the pred,your next choice is to presume  a diagnosis of lymphoma without biopsy (unless you take him off the pred and wait) and then start the next standard treatment which is Leukeran, a generally well tolerated (but not always) "Chemo" that has good results with Lymphoma.  In other words, its complicated and more so without a biopsy, however the good part is that a positive response to Pred is in itself diagnostic and that is helpful, assuming their is a positive response.

Lastly, cats metabolize Presizone into Prednizilone which causes the cat to make an extra internal metabolic step and for this reason, for cats, its generally better to treat with the latter, not the former.

If it's lymphoma, its better to talk about increasing lifespan and quality of life rather than "cure", there really is no cure.

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Thank you for the information, the way you put it sound more accurrate than how I put it.

My biggest question, based on what the doctor told me:  Is there a difference between Small Cell Lymphoma and Lymphoma?  If he had Lymphoma (not small cell) would it most likely show up in an ultrasound or bloodwork?

I just want to be confident in the decision we made to treat him going forward.  The doctor put it that if he doesn't respond well to the steroids then he could still treat/cure small cell lymphoma with similar treatment.

@CWAT32

There is a big difference between small and large cell. Large would show up most likely as a mass. Small cell is what's called an "infiltrative" disease.  It's not a mass per se, it is changes to the cells and the cellular structure of the intestine. Large cell is rapidly fatal, small cell isn't and your vet is correct that you can still treat it if it doesn't respond to the Pred, the next step is usually Leukeran, but without a biopsy you'd be taking that step without a positive diagnosis.  If there was no swelling of the intestine on ultrasound, that is not helpful towards a diagnosis, and it may mean that its something else entirely.

It usually goes something like this:

- Cat has poop (diarrhea) and/or vomiting issues that don't go away and can't be diagnosed as something else.

- Cat then starts losing weight, and the weight loss can't be halted through diet etc.

- Ultrasound is performed and when there is thickened intestines then we generally know that its either 1) IBD or 2) Sm. Cell Lymphoma.  The cat is loosing weight due to nutrient mal-absorbtion because the thickened intestines aren't absorbing nutrients well or correctly.

- Biopsy usually (but not always) will prove its either 1 or 2 (above).  Then treatment is tailored for the specific illness

or

- Biopsy not performed and Prednisilone is started.  Cat gains weight and then we are confident that its either 1 or 2 and treatment continues.  If treatment starts to fail then you can go to Leukeran as alternative treatment as it is now likely to be lymphoma.  But if weight doesn't gain with Pred, then you can go straight to the Leukeran, but going to Leukeran if the pred doesn't work without thickened intestines may result in treating an illness that isn't there, and is actually something else.

Bottom line, the best result with no biopsy is that your cat gains weight on the pred as you then have a pretty good clue as to what's going on.  Gaining weight on Pred is much more diagnostic than failing to gain weight.

--- By biggest concern here is that the intestines look normal on ultrasound.  I would ask your vet if its possible to have a bad case of IBD or lymphoma while still having normal looking intestines on ultrasound.

I just wanted to give an update that on Monday we decided to put Charlie to sleep.

He had his ups and downs but his days were getting worse more than better.  We still never found out what was actually wrong, we had to hospitalize him saturday night because he was looking very rough and wouldn't eat or drink and kept vomiting once an hour.  The vet hospital told us his Red Blood Cell count had dropped from 29 (the first time we brought him in weeks ago) to 13 and that he was very anemic.  They tried to convince us to do a blood transfusion and then a biopsy with feeding tube but that would've cost us $4000.  We drew the line there and just took him home for the rest of the day to be with him, then took him to our vet and had him put down.

The vet did an autopsy and told us that his pancreas was in real bad shape and he had damage to his liver.  He also had fluids in his chest and abdomen.  The vet said it was most likely a form of cancer (not sure where originated) and/or heart disease.  

This was truly the toughest thing I've ever been through with a pet.  Charlie was barely 9 years old and we tried everything we could without breaking the bank to save him and couldn't.  We're very sad and we miss Charlie a ton, he was not like a typical cat.  He was very vocal, very social, you could pick him up and hold him, he would cuddle us at night and in the morning.  He loved to play and had a ton of personality.  I'll never meet another cat like him, and for him to die this way, this soon, is just absolutely heartbreaking.  We were robbed.

I would never wish this on anyone.

@CWAT32

I'm so very sorry for your loss, it is heart wrenching.  If you wish you may remember him in the crossing the bridge forum.  Again I'm so very sorry for what you've been through and your loss of your companion Charlie.

My heart goes out to you. Take solace that Charlie is not suffering anymore. Think of the good times you had together. I pray the loss/hurt you feel heals quickly.

CWAT32, all of the TCS team would like you to know that we are so very sorry for your loss.

Threads are locked after someone has suffered such a loss, as a sign of respect. As StephenQ mentioned, we invite you to place a tribute at http://www.thecatsite.com/f/19/crossing-the-bridge as an enduring testimony to your friend.

         

RIP lovely Charlie