Lymphoma and Crossing Bridge Question

I have posted a little bit about what my poor Squinchy has been going through the past few months and through several trial and error, wishful thinking on my vets part and mine that this was something easily fixable I finally found myself at the point of getting referred to a Internal Medicine specialist for review of her history along with an ultrasound. The specialist recommended that getting aspirates of the liver would be a good thing and easier than a biopsy and I agreed since my cat is a terror when doing to the doctor and has to be sedated just for regular visits.

I left her with the specialist today and she told me she would call if they found anything in the ultrasound. They called me shortly after leaving asking to do additional x-rays because they saw some abnormalities in the ones my vet sent over, which I of course said yes because I really just wanted an answer, good or bad on what was wrong with her.

A few hours later I get another call that they found a mass in her intestine and some swollen lymph nodes. She was going to try to get some samples and she would call me back with any additional news and/or when it was time to pick her up. Once she told me she found a mass and swollen lymph nodes I instantly thought it was lymphoma. The funny part (not really but any little thing helps) is I am a 7 years Hodgkin’s lymphoma survivor as of next month. But anyway…

I was able to talk to the specialist when I picked up my kitty and she says she believes that it is lymphoma but we will get the confirmation tomorrow when they get the pathology report. She also mentioned that she isn’t a good candidate for chemo because she has to be sedated anytime she goes to the vet and also this would be considered an aggressive form of cancer. She said that we could have a few more months with her, maybe even 6. It’s hard to say. It is in her intestine, liver and lymph nodes.

Basically, we are thinking of quality of life, which for now is good. She recommend starting her on the full dose of Prednisolone ( 5mg), keeping her on the medication for her UTI (only 2 dosages left), appetite stimulant, and keeping her on the ursodial for now but we might either just go with Sam-e or do both. She also said that the Pet tinic can’t hurt so keep giving it to her as long as we don’t stress her out with a lot of medications.

After all of that, here is the hard question, would you allow her to cross the bridge now or wait? I know this is a very personal decision and everyone has a different opinion. I don’t want her to cross the bridge now, I really don’t but I have seen loved ones decline, and go through the pain and suffering and it's very hard. I know it is slightly different since I can stop the pain and suffering for my kitty and nature had to take its course for my father, who I lost to Leukemia 2 and a half years ago. He actually passed away in my living room with my brother and me by his side. I know that is why I have a fear, a real paralyzing fear of watching my baby decline in front of me

Any opinions are appreciated. I don’t want to do anything too soon and regret it but I also don’t want to hang on for to long and not get the peaceful crossing of the bridge she and I deserve.

As you said this is a personal decision.  If it were me I would see how your kitty does with the pred.  A steroid will often give a kitty a little more good quality time because of the anti-inflammatory properties.  The big issue will become getting her to eat.  As long as she will eat enough of anything on her own even human food to sustain herself then I think she still has a good quality of life.

I am so sorry you are going through this.  You will find many people here who have been through this.

@Denice Thank you for your reply and understanding. I have been very shocked at the lack of sympathy I have received from others (it's just a cat and remarks about me coming in late because of a sick cat, its not a child and the real big one was -  I would put her to sleep and not let her suffer anymore - the person said this to me when this all started). I know this board would give me support and the guidance I need.

I am afraid about the eating issue. She was always a cat that would eat light some days and very heavy others but right now she is just always eating light unless we put her on the appetite stimulant. I don't know if that is something she could be on long term or not. Honestly, unless a side effect of the medication would kill her before the cancer I don't see a reason she couldn't get a pill every 72 hours if it keeps her going and somewhat healthy.

She is acting a little weird right now since the sedation is still wearing off but she is moving more and used her scratching post. No eating or drinking but they said it could take a few hours before she might have an appetite.

I am so sorry you are going through this. After Minnie's diagnosis of chylothorax (fluid build up in the chest cavity), we had the following options.
1)keep draining her chest as needed, giving her the supplement Rutin which "mends cells" and helps with fluid until it kicks in
2)put a "port" in her chest for constant drainage while we wait to see if the leak heals
3)surgery to fix the leak.. very invasive thru the chest with no assured fix.
None of the options were a sure fix.

We had her 2nd draining in 10 days... trip to the vet ... sedation... then not eating the best for a couple days after..thus she was losing weight but still played on occastion, and still did her daily routines (and night ones..waking me to knead on my neck and nighttime feeding! #spoiled

Less than a week after the 2nd draining we noticed the abdominal breathing was back, thus more fluid ...she had just perked up from the previous one.
During this time, I hated the pilling her 3x a day... 24/7 watching her breathing and eating habits..which would be a lifetime thing.. I was a wreck for sure... as it just didn't feel "right" for her. I couldn't see putting her thru another draining in hopes that would be "thee one" to not fill back up.... so basically prayed about my decision and her... and felt a total peace that I hadn't had up until then... and we had the service come to the home and it was amazing.. so peaceful and loving. I didn't want her to "get to the point" of any suffering just to prolong "my desire" to have her with me.

@MnM Thank you for sharing your story. I am also sorry for your loss but I am glad you were able to have peace with your decision. I hope my cat will let me know when it is time but I a preparing myself to make the right decision for her. If she starts to be in constant pain and is suffering I will know its time.

I am cautious about having someone come to my house but I am looking into my options around where I live. My vet does it in the office and I didn't ask the specialist how they handle it but I think they might be less clinical than my regular vet. I have time but I like to be prepared instead of having to make decisions on the spot that I could later regret.

My cat was diagnosed with large cell lymphoma in early December(?). She was not a candidate for chemo or surgery. It's been over 8 months. We've basically done very supportive measures only. She's still going strong. She is still very interested in eating and not in pain. Most days she eats. A few days she doesn't due to stomach acid abundance. A bad day can be followed by several good days. It's been day-by-day and always monitoring and assessing. Mainly, though, we've been concentrating on enjoying our remaining time together. When she stops eating for more than a day or two, or crashes ... 

Enjoy your little one while you can.

There is a good article here: http://www.thecatsite.com/a/when-is-it-time-making-the-difficult-decision

@cocheezie Would you mind sharing the supportive measures you do? Is your kitty on any medications or supplements? Is there anything the vet recommends regarding the stomach acid? Also, how do you know if she has too much stomach acid?

Sorry for so many questions but I think we might be in the same boat and I was interested in knowing what you think works for your kitty. I am going to read the article now.

It all started off with severe constipation. The tumour was easily seen on an X-ray, so we probably found out much earlier that most cat owners would. Three vets said "not good" and that there wasn't much we could do.

For constipation, she takes miralax and cisipride. She has 20% kidney function and gets sub-q fluids daily to help flush out the toxins. The tumour has moved her internal organs out of place and she is a candidate for stomach acid. We started off with Pepcid AC which worked for about 6 months then she started tossing stomach acid and not eating. After talking to the vet, we switched to ranitidine (Zantac) which is bitter and she doesn't like it at all. She is anemic so we are giving her a B complex/amino acid/iron tincture twice a day - giving her a larger amount what it says on the bottle instead of B12 shots. The vet said it would work out about the same. Confer with your vet first if you think this is an option for you.

Foodwise: we switched to an all wet food diet. Low carb. The problem is finding out what she will eat. She occasionally goes off a food which leads to researching and spending a lot of time in pet food aisles searching for low phosphorus (kidney). We initially tried mixing in some prescription k/d wet but she won't eat that anymore - or the dry k/d. She will eat small amounts of y/d dry (hyperthyroid/fast heartbeat/leg twitch). Novel proteins like duck, rabbit, turkey help get her re-interested in eating. Probiotics help to keep her healthy.

No pain meds (not in pain), no chemo (not a candidate), no prednisone (mainly because there are so many things wrong with her that we and the vet were concerned that the prednisone would mess with one or more of her issues - we didn't want to mess with the status quo). She is showing few symptoms, only a gradual weight loss and lately more pronounced anemia.

Lots of TLC and love. And trying to figure out what is on her bucket list. Her list is long. Most recently we were able to cross a sunny afternoon spent smelling, and rubbing, and eating, and sleeping in a catnip patch off her list. 

The vet (who is very good) and the staff at the clinic are amazed. I have not had blood work done since May because I'm too scared to see the results.

Every cat is different and every timeline is different, so you should check with your vet about what supportive measures will work for whatever symptoms your cat has and may have.

 My prayers and vibes out to you and your precious kitty during this difficult time!   I had my father's cat sent Across the Bridge and that decision was so tough! I still need to post in Crossing the Bridge but somehow that will make it seem real...  She had been fluctuating in health the past couple of years - she didn't want to play and could only lick the gravy off her canned food, so I knew it was time. I only gave her 2 days of that behavior.  I know that some people think that I should have done more, but my situation is such that I cannot - to do more for one would mean that I would need to stop caring for the others. then I would need to either send them to the kill-shelter (which is full and not accepting cats at this time) or simply stop feeding/neutering/vaccinating or adopt them out on Craigslist (where any news search will let you know is a popular way for cat-torturers to acquire victims) or simply dump them off, of course, I CANNOT do any of those alternatives - it would be more humane to perform blunt-force head trauma (sorry, country girl here, raised 4-H & FFA) and I would never hurt or kill a healthy cat.

You are acting in love and with knowledge of what challenges your kitty is facing!! Your own cancer survival gives you remarkable insight into what experiences your cat is going through, which gives you even better authority in knowing when it's "the time to go".  Please know that your TCS family is here every step of the way!!!

Thank you for your responses and support. It means to world to me when I feel like no one cares and is belittling my feelings that you guys know what it is like to have a sick kitty.

Right now her liver is the only organ showing signs of damage/cancer (high enzymes and biliubin). It's obvious to me that as time goes by other organs might start to have issues or potential blockage in the intestines from the tumor.. She also has blood in her urine (which they think is stress induced since it wasn't there from the beginning) with a slightly elevated WBC and mild anemia. The anemia hasn't changed much and as of now and is considered stable. In fact, her H was 28 which is a lot better than the 23 it was 3 weeks ago. Three steps forward and 2 steps back type of situation.

My cat is also a very finicky eater. She always ate dry food and when this first happened she really liked wet food and barely touched the dry food. Now she has switched to only wanting dry food again. Since I know its cancer we are dealing with I might think about getting her some liver, sardines, tuna, whatever she will eat because I want her to be as happy as can be and not lose anymore weight.

Hi - thanks for sharing your story.   It has encouraged me a bit.    I had an ultrasound on my Sissy Pickles (who looks like your kitty) on Friday and the vet said, small cell lymphoma probably in the upper part of the intestine and then large cell lymphoma mass of 5.4 cm lower.    He is recommending exploratory surgery and pathology as to what type of mass / process is going on.    It could be IBD and not cancer.    I have an appointment tomorrow to see if it is worth removing the large mass and treat the "small cell" part.    It is soo difficult to figure out what to do.   Sissy is on prednisone, appetite stimulants and fluids and is more upbeat and eating a bit more.    She too is anemic.    It seems if you do nothing then large cell kills in 60 days or less.    That is the general message one gets out there.  Your story is very unique.  My Sissy is a small cat 7.8 pounds in April and now 7.4 pounds.   I hate the idea of having her last days on this earth not be pleasant days.    I can't extend her life and have her be miserable just so that I don't have to deal with her being gone.    But then I hate the idea of giving her up when it could be IBD.  

I had noticed some very dry small stools in her box and now on fluids they are more normal - still small as she doesn't each much.    She loves dry food and is a fussy water drinker.   I have a drinkwell and she liked it for a while but now seems to have gone off of it.    She does love cat nip - so I should arrange that soon.   She is 14.5 years old and has had a good life.   She lost her lover boy Skippy to cancer 7 years ago and was despondent for a while but for the most part has had a good life.   Sorry, I am rambling.    Still trying to decide on a plan of action and doing nothing (surgical or chemo - you do a lot) seemed too scary to me.   However, it is nice to read that it worked for you.   Thanks, Sissy's Mom

So sorry your kitty is sick.  My thoughts are with you as you face this choice. I think the article that cocheezie linked you to is excellent. 

I recently made the decision to have my beloved Ra put to sleep.  He was very ill, too.  I read a very similar article as the referenced one, and I decided it was time to let him go.  I didn't want to be selfish and keep him here when he was suffering and it was only going to get worse.  He's at peace now. 

I am so sorry you and your cat are going through this. We had a wonderful cat who went through cancer. Most of his life he had high numbers on his blood tests regarding his liver. He was treated with several medications including Denamarin to treat it. All the medicines made his vomit so we finally stopped treating numbers. He was twelve when he was diagnosed with cancer. It was on the very tip of one of his liver lobes. We stuck our necks out and agreed for the vet to take off the end of the lobe. The cat recovered and had a wonderful quality of life for another year before the cancer came back. When it did, we just made the decision to love and spoil him for whatever time he had. He lived from May until the middle of November before we had to make that decision. He was treated with the prednisolone, and the appetite stimulant. Also he had to be medicated for his thyroid. We gave him whatever he would eat, including some fresh seafood. When his appetite really began to dwindle, the vet prescribed Forti Flora, which is a probiotic, to sprinkle on top of his food. It helped a lot. It was several months before he really started to decline. I took care of him like a baby. When he was tired and ready to go, we knew it and we let him go. During those last months, I spent much time with him on my lap on my back porch. I would take a quilt, my coffee, a good book and stretch out on the sofa on our screened in porch with the cat. We got in some good nap time. I would wake up with him on my chest, just as close as he could get to my face. He had never been much of a lap cat, but I think he knew what was coming. For those months my housework and other things around here suffered, but I had some quality time with this cat. I held him, hugged and kissed him, talked to him, sang to him and tried hard not to cry. I didn't want him to feel my pain. I took many pictures and videos of him. On the last day of his life, I took a video of him. I have only watched it one time. The reason is I wanted to really see if it was time to let him go. By having that video, it was confirmed and I have never regretted any of our decisions. You can see his picture here on my avatar.

I wish you peace as you love you cat in her last days. She will be the one to make the decision and she will let you know when it is time. Then you can turn her lose with no regrets.

It is a personal choice.  I would try measures as long as my baby has quality of life. With our dog she just gave me the look that she was ready.  She no longer enjoyed her favorite things. My co-workers laugh at me because I will take time off to take my kitty to the vet. Granted, I never take time off and have 6 weeks vacation left yet this year. I am sorry about your news