Small Cell Lymphoma vs Inflammatory Bowel Disease: The great debate

Hi everyone! I'm new to this site and I'm a proud kitty mama to two beautiful cats, but unfortunately, the circumstance that brought me to this site is not a good one. 

Be prepared to read, this is a little long (sorry!) I’ll start off with a quick history first. My cat Buddy originally came from my grandmother. She got him from an agency that provides cat companions to senior citizens. I know that he had another family before her, but we were never able to find out how long he was there for. My grandmother had him for two years and I have had him for five years, so age wise we guess he is somewhere between 8-10 years old, but he could be older. Whenever my family visited her we always saw that there was a lot of cat vomit, mainly under the bed where she couldn’t reach to clean. He obviously has a history of GI issues. When my grandmother had to move into assisted living she didn't want Buddy to go back to the agency. My one year old kitty Mila needed a friend and I love cats so in 2009 I offered to take him in. We've been a happy little family ever since.

In the beginning of 2012 Buddy started acting weird. He was running around a lot, being very vocal and just overly hyper. A few days later he started throwing up large amounts of food and when we realized he wasn't keeping any food down and had lost weight we took him to the vet. Ultimately the vet determined that he had Hyperthyroid and was put on medication. A few months later the issue came up again and they suspected he also had Inflammatory Bowel Disease and was put on a low dosage of Prednisolone (which he was weaned off of spring of this year).   Over the past two years we've had to bring him in 4-5 times for the same issues; vomiting and diarrhea. Each time his dosage appeared to be off and his intestines were inflamed, so they'd adjust the dosage, put him on antibiotics for a week and he'd be fine. The issue came up again last month. They said his thyroid levels were higher than they were when he was first diagnosed. They did the usual and we were fine. Prior to this he was eating Royal Canin Pea & Rabbit wet and only small amounts of dry, but after last month I opted for the wet food only to avoid possible intestinal issues. Almost exactly one month later he started having diarrhea, lost weight quickly (nearly half a pound over a course of 3 days) and lost his appetite for the pea & rabbit food. I tried switching him to another rabbit formula, which he ate just fine, but the diarrhea continued. I took him to the vet and they suggested that I go see an internal medicine vet for an abdominal ultrasound. 

This vet stated that "there is mild-moderate diffuse thickening throughout the jejunum, which is predominantly noted in the deeper (muscularis) layer, which unfortunately tends to be correlating with lymphoma more so than inflammatory bowel disease. Because wall architecture is largely retained (with the exception of poor definition at the distal ileum), low grade lymphoma may be present.” She also noted that his hyperthyroid levels are currently within normal range and she thinks that the reason we’ve had to change his dosage so many times is because his inflamed intestines were not allowing the medication to properly absorb into his system.

The vet decided to put him on 1mL of Prednisolone twice daily for 10 days, then once daily for an indefinite period of time. She also wants me to give him B12 injections weekly (then eventually taper to once/month) and 1/4 tab of Pepcid AC to help with stomach upset. She said that in two weeks I can come back to reevaluate his health and if he is feeling better she wants to start him on the chemotherapy drug Leukeran. 

Once she said the words “lymphoma” I kind of blanked out for the rest. I was expecting some kind of severe IBD diagnosis, never once did I ever think it could be cancer. I was in shock. When she was talking to me all I could do was nod my head yes or no because if I opened my mouth I knew I would break down.  She said that she expects that it is lymphoma, but there is no way to know for sure without doing an endoscopy or exploratory surgery, but an endoscopy would not be able to get to where they need to pull the samples from. 

I’ve obviously been in denial and found another vet to take him to for a second opinion a few days later. I had been looking into another clinic recently because I was thinking about getting the I-131 Radioiodine treatment for his hyperthyroid. This clinic sees ONLY cats and I had been researching them for quite some time so I felt this would be a good place to try. This vet got all of the information from my previous vets and agreed that it could be lymphoma. But the thing is that over a course of 5 days between my last visit and this one he had gained nearly all of his weight back and has more formed stools. I had switched him to the Natural Instinct limited ingredient turkey diet and he loved it. The vet seemed very surprised. She said even though the pred/b12 can increase appetite, weight gain this fast is uncommon. I took that as maybe possibly he doesn’t have lymphoma, maybe it’s just a bad flare up of IBD. Right now he’s acting like his normal self too (for the last week he’s spent a lot of time sleeping and uninterested). Now he’s awake a lot more, he sleeps in my bed with me, he stalks birds in the windows, completely normal. But she said based on the information she has from the other vets she’d want to pursue the same course of action with the Leukeran, but said that it would be more ideal to have a full thickness biopsy first. She said that without surgery there is no way to definitely diagnosis the problem. She said the surgery involves taking biopsies from all organs, not just the intestines, to find out how extensive the problem is and that if it is cancer (or something else) they may be able to come up with a more targeted treatment plan. 

This is going to be expensive either way so I’m not factoring the cost in with the decision making process. My grandmother just passed 8 months ago and he is all I have left of her so I will do whatever it takes. I am so devastated and lost and I have no idea what decision is the best one for him.  I obviously don’t want him to suffer, I want him to live as long as possible while still having a good quality of life. If he doesn’t have small cell lymphoma and I choose to do the chemo without the biopsy then couldn’t it do more harm than good? Especially if we treat it thinking it’s lymphoma and it’s something else that needs to be treated differently and by the time we figure it out it will be too late to treat? This vet didn’t rule out the possibility of large cell lymphoma either, which would definitely need surgery. 

Can anyone who has gone through this or know someone who has gone through this share their story with me? Maybe if you could go back and go through it over again you’d make a different choice? Maybe there’s an option that hasn’t been offered to met yet? I’m obviously going to continue doing my own research, but this is all new territory for me so I don’t know where to start. I’ll be following up with my vet in a week (I'm sticking with the one that only sees cats) and she wants me to try and decide by then what route I want to take. 

If you’ve made it this far thank you so much for taking the time to read my story. I haven’t slept much the last few days and it’s currently 2am so I hope that I have conveyed my situation clearly. I greatly appreciate any advice you can offer. 

Emily

Mila is on the left, Buddy is on the right <3

View media item 243153 to TCS!

I'm sorry you're dealing with this problem with Buddy and hope that our members will be able to give you some support and advice. While you're waiting for replies, you might want to take a look at this thread, IBD with possible small cell lymphoma You'll find other threads on lymphoma here

Lots of for Buddy!

@EmilyAnn

My cat developed a similar problem and was seen by my vet and a specialist and both of them and everyone I have talked to on the subject says that you can't accurately diagnose via biopsy while a cat is on Prednisilone as the illness is masked, and that you generally want to biopsy (if you're going to) before you start Pred, or if not, then you have to discontinue the pred for a period of time, and force the cat to be symptomatic again before biopsy.

The initial treatment for IBD/SCL (SCL=Small cell Lymphoma) is basically the same, the lowest effective dose of Pred (plus B12, pepcid, diet change etc).  If the cat gains weight then he is winning at least for now and nothing else is really needed.  Either IBD or SCL can go into remission on Pred, but if its SCL then the duration of the remission is likely to be limited.  Step 2 is Leukeran (which can be used for either IBD or SCL if it is no longer in remission) but it isn't usually given unless the Pred is failing.  If its SCL you can gain considerable remission with Leukeran.

The only thing you can't do without a biopsy are the heavy duty chemo drugs for SCL when the cat is no longer responding to the other treatments, but one can make a strong case that at this point you are pointing your cat through pointless distress and its time to let them go.  My understanding is that the drugs after Leukeran are not pleasant.  Leukeran can be well tolerated by about 80% of cats, but 20% cannot tolerate it.

Also, a biopsy is not going to give an accurate diagnosis in 100% of the cases, my vets said that there was about a 10% (?) chance of no clear diagnosis.

So to some extent, a biopsy is for you, not the cat, for peace of mind, and knowledge, but it doesn't have a great impact on treatment.  We chose to do a biopsy on our cat, and were glad that we did, but his treatment would have been the same regardless.

If diet doesn't work, then all IBD/SCL cats go on Pred. If wait gain, then wait.

If no weight gain, or weight gain fails, then Leukeran.

When you said Buddy is on 1ml Pred, did you mean 1mg instead?   My cat is on 5mg per day, which is considered a low dose.  If you cat isn't gaining weight on 1 or 2mg, then a higher dose would be indicated.

Hi Stephen, thanks for your reply. The vet did tell me that if I choose to do a biopsy he'd have to be off of the pred for 5 days before they'd be able to do it. Out of curiosity, what were the results of the biopsy from your cat show and what was the following treatment?

Regarding the dosage of pred I meant to say that Buddy is on 3mg and is given 1mL orally twice daily for 1 days and then once daily ongoing. That was prescribed by the vet that gave the abdominal ultrasound. The vet I saw for the second opinion was surprised that he was put on such a low dose, but said that if it clears his symptoms then it's fine and if they start to come back we can always increase it. He has gained just shy of 1 lb in a week and a half, has formed stools and is acting completely fine. That first vet said that in two weeks if he is doing better then she wants to put him on the Leukeran, but if he's not symptomatic anymore I wonder if that's  necessary? I would think that if the Pred wasn't doing enough then we'd decide to go that route.

EmilyAnn said:

 
Hi Stephen, thanks for your reply. The vet did tell me that if I choose to do a biopsy he'd have to be off of the pred for 5 days before they'd be able to do it. Out of curiosity, what were the results of the biopsy from your cat show and what was the following treatment?

Regarding the dosage of pred I meant to say that Buddy is on 3mg and is given 1mL orally twice daily for 1 days and then once daily ongoing. That was prescribed by the vet that gave the abdominal ultrasound. The vet I saw for the second opinion was surprised that he was put on such a low dose, but said that if it clears his symptoms then it's fine and if they start to come back we can always increase it. He has gained just shy of 1 lb in a week and a half, has formed stools and is acting completely fine. That first vet said that in two weeks if he is doing better then she wants to put him on the Leukeran, but if he's not symptomatic anymore I wonder if that's  necessary? I would think that if the Pred wasn't doing enough then we'd decide to go that route.

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My cat's biopsy results were for severe IBD, and definitive.  Sometimes the results actually can't be clear.

So your cat is getting 3mg daily?  That is a very low dose but if it works then great. Gaining weight is a WIN so that's great news, it means he is responding.  All my vets (specialists and regular vets) all said that they would only add leukeran if a) he didn't respond (or stops responding) to the Pred or b) if there was a positive diagnosis of small cell L.

My cat has been on Pred for a year and is doing well although he is also dealing with pancreatitis, kidney disease and mild cardiac issues so we're balancing a lot of things.

This is a great article on IBD: http://www.allfelinehospital.com/inflammatory-bowel-disease.pml

I just had the follow up appointment with my vet this afternoon. He's been on the Pred 1/day for the last week and a few days ago started a two week supply of FortiFlora 1/day. He's gained nearly a full pound in less than a month and appears to be doing great so we discussed where we should go from here. I'm still torn between keeping him on the Prednisolone & B12 alone, adding the Leukeran or getting the biopsy. Since he's no longer symptomatic I asked if it was necessary to start Leukeran. She said that it's not, but that if it is SCL then the longer we wait to start the Leukeran the less effective it could be when he does become symptomatic again (especially if the SCL has gotten worse or spread). She said that at her office (which deals only with cats) they rarely use an ultrasound to make a diagnosis of IBD or SCL (mainly because a definitive diagnosis can't be made), so her office usually recommends getting the biopsy. She said there may be a 10%-15% chance of getting non-diagnostic results and then we're back to where we are right now, but said that there's an 85%-90% chance that we'd get a difinitive diagnosis. She feels more comfortable doing biopsies because they can create a targeted treatment plan instead of treating what they are guessing the problem is.  She suggested I contact the internal medicine vet that did the ultrasound and ask what percentage of cats that she diagnosis with SCL via ultrasound positively respond to Leukeran. Ugh this is such a tough decision. My fiancé thinks that if he's doing fine on the Pred then we should just stick with that, but I'm looking at the bigger picture. I would never want to put him through anything unnecessary, but I don't want to look back and wonder if there was something else I could have done. I think there's a big difference between wishing you could have done more and knowing you could have done more. 

When you had the biopsy done for your cat how old was he and was the recovery period difficult or long? Are the pancreatitis, kidney issues and cardiac issues  possible side effects from the Pred? 

EmilyAnn said:

 
I just had the follow up appointment with my vet this afternoon. He's been on the Pred 1/day for the last week and a few days ago started a two week supply of FortiFlora 1/day. He's gained nearly a full pound in less than a month and appears to be doing great so we discussed where we should go from here. I'm still torn between keeping him on the Prednisolone & B12 alone, adding the Leukeran or getting the biopsy. Since he's no longer symptomatic I asked if it was necessary to start Leukeran. She said that it's not, but that if it is SCL then the longer we wait to start the Leukeran the less effective it could be when he does become symptomatic again (especially if the SCL has gotten worse or spread). She said that at her office (which deals only with cats) they rarely use an ultrasound to make a diagnosis of IBD or SCL (mainly because a definitive diagnosis can't be made), so her office usually recommends getting the biopsy. She said there may be a 10%-15% chance of getting non-diagnostic results and then we're back to where we are right now, but said that there's an 85%-90% chance that we'd get a difinitive diagnosis. She feels more comfortable doing biopsies because they can create a targeted treatment plan instead of treating what they are guessing the problem is.  She suggested I contact the internal medicine vet that did the ultrasound and ask what percentage of cats that she diagnosis with SCL via ultrasound positively respond to Leukeran. Ugh this is such a tough decision. My fiancé thinks that if he's doing fine on the Pred then we should just stick with that, but I'm looking at the bigger picture. I would never want to put him through anything unnecessary, but I don't want to look back and wonder if there was something else I could have done. I think there's a big difference between wishing you could have done more and knowing you could have done more. 

When you had the biopsy done for your cat how old was he and was the recovery period difficult or long? Are the pancreatitis, kidney issues and cardiac issues  possible side effects from the Pred? 

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What your vet said is practically identical to what mine told me but mine didn't specifically say the leukeran would be less effective if we waited on that and it was SCL.  What my vet said was that if the Pred is effective (cat gains weight) then whatever disease it is, IBD or SCL that it is in remission and there is no immediate need for Leukeran.  If the pred stopped working then we would need to immediately switch to or add the Leukeran.  We also had an Internal medicine Vet do a consult so my suggestion given this slight difference of opinion on the leukeran issue is to get a second opinion from your internal medicine vet on the efficacy of starting leukeran early vs. later.

The one thing we learned from the ultrasound is that my cat's issue was lower in the intestine, not higher which ruled out the less invasive endoscopic biospy (which is also slightly less diagnostic than a full thickness biopsy).

As to your questions about the biopsy, my cat was 14 at the time and his pre surgery testing suggested he was a good candidate for the surgery (despite minor heart illness and kidney disease) but that they would be careful with the amount of fluids given to guard against the heart issue and watch him very carefully.

He spent the night in the hospital - we used a full service highly regarded major animal hospital for this with a surgeon highly recommended by our primary vet.  We took him home late the following day (after visiting him in the ICU after surgery), and he was on Buprenorphine for several days, about 3 i recall.  Bupe is a really good narcotic pain reliever.  So his first 2-3 days at home he was slow. Slept a lot, walked with care, but part of this was definitely the Bupe.  It took him 2-3 days to have a bowel movement but that's normal.  I'd say after the first week at home he was "tired".  But then he came around and was much better, and with any cat, the actual incision should be healed by 2 weeks after surgery. 

The are always possible side effects with Pred although its generally well tolerated in cats.  It can make kidney or heart disease worse, so we tested his kidney values several times over several weeks and months after starting the pred., and a repeat echocardiogram for his heart.  The other possible side effect from pred is a result of a diminished immune system.  The thing for me is, you treat what's in front of you right now instead of treating or not treating based on a hypothetical future.  So yes, the pred may hurt my cat at some point, but right now its needed and working and so that's what i'm doing.  I'm buying him as much time as i can, in the end there is always something that will get you.

Interestingly, his kidney values improved  after starting the pred.  Possibly (according to my vet) the increased nutrient absorption as a result of the pred had a generally good role in helping his other issues.  For a lot of people I've talked to, and for me, Pred is like a miracle drug (for cats).

Also note, 20% of cat's can't tolerate Leukeran.

I think the hardest thing in front of you (at least it would be for me) is the notion of taking him off the pred in order to have the biopsy. My vets said you really have to flush it out of his system, possibly to the point of putting him back into an active disease process before you can biopsy.  I would also discuss this with the internal med vet.

I'm glad on balance that we did the biospy on our cat, but we hadn't yet started the Pred and doing the biopsy was in large measure because I needed to know, not because it would significantly alter his treatments.  The one option lost to you without a definitive diagnosis is the last resort hard core chemo drugs (if leukeran stops working) and I was confident that we would never put our cat through that.  For us it would be Pred, then Leukeran (id SCL), and when those stopped working then we would let him go.

I think there is consensus that IBD and SCL are connected and that the latter appears when a bad case of IBD isn't caught in time....

I re-read your original post and it seems that your vet is very concerned that it may be SCL.  This may increase your need to do a biopsy.

Long answer to your questions....the good news is your guy is currently responding.  Also, you could add the leukeran even before it was technically needed, that is another option. and if he tolerates it then great.  Hard choices, either way is I believe acceptable, biopsy or not biopsy.    Talk to your internal Med vet.

And please stay in touch.

We are going through something kind of similar, my cat had mast cells in the spleen so we took it out almost 2 weeks ago.  He had some elevated liver levels for 2 months, a slight heart murmur.  He is a 15 year old siamese.  One of the reasons I went through with the surgery is because he didn't quite seem right and the barfing/diahrea.  My guy had a little tumor off the liver as well and fluid was building up so we are hoping things settle down.

He is on the pred but only half a tablet right now once/day because he is still healing.  My gut tells me along with reading around here that initial dosage should be higher for a bit, then taper off.  We are going to try that.

What was very surprising to me is he made it through surgery with no issues.  I was talking to him before surgery and he was telling me he would make it so I went with my gut   Although he was acting run down during his bad days with barfing fits he still had a good appetite overall and was maintaining weight.

He had some slight hard areas in the gut as well.

They actually called us the day of surgery and said he was doing so well we could bring him home!  I couldn't believe it only 3 days of a pain medication.  He was more alert than ever while on them and was trying to jump counters without care, we had to lock him upand sleep with him in a room.  He ate and drank the same day, and had a bowel movement the next day.  He had one partial diahrea since surgery, all the others are solid!  He sure doesn't look like he has been in pain since coming home, he walks with a normal stride.  He even has been sleeping with us at night and visiting during the day with his stomach exposed, seems completely at peace.

Unfortunately the barfing fits seem to happen every 3-4 days.  But he still is getting around better than pre surgery, gained almost a pound.

@StephenQ  The vet I now see said that if I stick with the Pred and symptoms return then he could be less responsive to the Leukeran; I spoke with the vet tech for my internal medicine vet to verify this and she didn't know so she asked the oncologist on staff and they said that it's very possible. I'm thinking that they are saying this because if it is SCL then the Pred is just treating the symptoms while the SCL worsens. I'm sure there's better prognosis for those who start it early vs those that start it late. I don't recall exactly where they said in the intestines it was, but both the internal med vet and my vet said that  there's a high chance of getting non-diagnositic results if I choose an endoscopic approach. My vet also mentioned that there's a laproscopic option. They don't offer it there, but the internal vet does. She said that she's not too familiar with it because most patients don't choose it due to higher risk of complications. Did your vet mention anything about the Pred possibly being less effective since he had the surgery? My vet hasn't, I need to ask her, but I have read that a few times on here. 

@damac  That's for sharing your story with me, I've definitely been concerned about the recovery period after a biopsy.  I'm glad to hear that your little guy is gaining some weight, maybe as time passes the vomiting will become less and less frequent.

@myrnafaye   replying to your comment to me on the other thread. I've been told by others on this site the same thing; that normally cats with SCL lose weight. I'm not sure how old he is, somewhere between 9 and 12 I think. I tried tracking down what agency my grandmother got him from in the hope of getting some information, but haven't had any luck so far and I have no idea if they'd even still have a file on him 7 years later. The week before I initially took him in he had lost interest in his food and was barely eating, therefore he lost weight pretty fast. That being said, he was trying to get to my other cats dry food, so it's not like he  lost his appetite completely. I also quickly switched him to another canned food when I realized he wouldn't touch his own and he ate it right up, but I still took him to the vet because even though he was eating the diarrhea didn't clear up. When I updated my internal vet and my general vet with the information that Buddy began gaining weight and having formed stools within a few days neither of them mentioned anything about just sticking with the Pred and not going on the Leukeran. At his lowest weight on 10/15 he was 6.84 lbs, then on 10/17 we started the new treatments and on 10/20 he was up to 7.52 lbs. As of 2 nights ago he was 7.89 lbs. So the fact that he gained weight so fast while on a very low dose of Pred gives me hope that it's not SCL, but they haven't said anything about it. 

@arinlars  I'm responding to your post from your thread. Most of the questions you asked can be answered in my OP if you have a few minutes to read it. Right my my cat is currently eating Nature Variety Instinct limited ingredient Turkey. This one doesn't have the guar gum, xantham gum or carageenan so that's good, but I'm trying to figure out how to rotate other proteins in so that he doesn't develop any allergies too it. Buddy did have an ultrasound done, but they couldn't determine whether or not it was SCL or IBD from it. The internal vet said in the summary I was given that there is mild-moderate diffuse thickening throughout the jejunum, which is predominantly noted in the deeper (muscularis) later, which tends to be correlating with lymphoma more so than IBD. But then she goes on to say that a definitive diagnosis would require biopsy. This same vet clinic also has an oncologist, I'm wondering if maybe I should make an appointment with her to see if she could offer more advice or get her opinion on his treatment. I don't know what kind of tests she would run that haven't already been ran though :/

@Fuzzycat  this is on response to your comment to me on another thread. I definitely haven't decided on whether or not to get a biopsy, but I know that I need to make a decision either way very soon. An internal medicine vet did an ultrasound on Buddy, not an oncologist. I wonder if that could have made a difference? I was referred to the internal med vet because my original vet suspected that something else could possibly be wrong with him because it had only been one month since his last flare up. They did do some bloodwork to check for pancretitis, but since they didn't have an ultrasound they had to send me elsewhere. The pancreas turned out to be fine. Maybe an oncologist could see something that the internal vet couldn't....

Buddy is on a very low dose of pred (he gets the liquid form 3mg/1mL once/day) and has tolerated a much higher dose in the past so I'm not too worried about possible risks for that at the moment. If I'm reading your post correctly it sounds like your oncologist was able to look at Rikki's bloodwork and see that it most likely not cancer? Did they look at the bloodwork there or was it sent to a pathologist? 

My concern is that both of the vets I have seen want to put Buddy on the Leukeran under the assumption that it's SCL, but the pred and B-12 injections are working, his symptoms are completely gone. He has also been taking FortiFlora once/day, but I was only given a 14 day supply and my last one is tomorrow so I'm not sure if that's something they want me to continue or if it was just a temporary treatment to jumpstart the good bacteria in his tummy. So everything is currently under control and I don't want to start the Leukeran if I don't have to because of the potential bad side effects. You said that you wish you would have started the Leukeran earlier, is that because of the diabetes? Had the prednisone been working and not caused the diabetes do you think you would have stuck with it or would you have started the Leukeran with the pred?

I'm glad that Rikki is doing well on the CD. My other cat Mila went through a high stress period a few years ago which caused her to start urinating on rugs and on my bed. She'd also poo on my comforter and my pillow at least once a week. My roommate at the time went to a rescue with the intent of getting her own kitten, but there was a cat that was going to be put down that week that no one wanted so she took her in instead. Don't get me wrong, that is an amazing thing that she did, but this cat was so, SO unfriendly and I couldn't even walk past her without getting my ankles shredded so we had to keep my cat separate from hers. They would have access to the whole house at different times, but because Mila could smell the other cat's scent it freaked her out. Then shortly after that I got Buddy, which I'm sure didn't help, but they did get along within a few days of each other so I don't think that was a problem. One of the things that helped Mila was this thing that the vet prescribed which resembled a Glade plug-in, but it was filled with pheromones meant to lower stress. I think that you can actually buy them at pet stores now without a prescription, but if that's something you haven't tried and your cat is still stressed out it may be worth looking into. 

Emily Ann, I guess I am in the same situation.  The only diff is that Obi never really lost weight.  And he had a bout of mild pancreatitis.  No one mentioned Leukeran to me.  I think that often they treat with increasing doses of pred, and if pred stops helping, then they go to a chemo agent.  I have Obi on the rabbit diet of Nature's Variety, novel protein, same thinking as your vets.  I chose not to have an ultrasound because if the high likelihood that it would show some thickening but not able to distinguish IBD from SCL.  And, the treatment would be the same.  So:  did I want to know this information if nothing would change?  Not really.  Now, not everyone would feel that way. 

And I have another issue, maybe this is not the place to air it but I am any way.  I do realize that veterinary care is pricey, and that the same procedure(s) in human medicine would cost way more.  Having said that, I feel very bad that as a pet owner, these procedures, and especially the biopsy, is really out of reach for me financially.  It is over $1000.  Maybe closer to $2000, perhaps others  here will comment.  So it puts us in a terrible, gut wrenching dilemma:  do we do this expensive procedure, that we may not be able to afford, or just treat to the best of our abilities?  Again, for me, the answer is that Obi is 15 going to be 16 in December, I believe (I also did not know his exact birth date because he was a shelter kitty); or do I make him as  happy as possible?  I chose the latter and not the former.  I wish veterinarians would attempt to do something about the cost of these procedures - I dont think the answer for most of us is to put it on Master Card, or another special pet credit card, that probably has shy high interest rates.  When I owe $1000 to my health care plan, they work out a payment plan with me or are good as long as I make regular payments.  I wish more vets could do the same, but I also understand that many people would never make good on their debt...sigh.   

EmilyAnn said:

 
@StephenQ  The vet I now see said that if I stick with the Pred and symptoms return then he could be less responsive to the Leukeran; I spoke with the vet tech for my internal medicine vet to verify this and she didn't know so she asked the oncologist on staff and they said that it's very possible. I'm thinking that they are saying this because if it is SCL then the Pred is just treating the symptoms while the SCL worsens. I'm sure there's better prognosis for those who start it early vs those that start it late. I don't recall exactly where they said in the intestines it was, but both the internal med vet and my vet said that  there's a high chance of getting non-diagnositic results if I choose an endoscopic approach. My vet also mentioned that there's a laproscopic option. They don't offer it there, but the internal vet does. She said that she's not too familiar with it because most patients don't choose it due to higher risk of complications. Did your vet mention anything about the Pred possibly being less effective since he had the surgery? My vet hasn't, I need to ask her, but I have read that a few times on here. 

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My vet gave no indication of the pred being less effective after a biopsy, none at all and I have several vets.

I am thinking, if your cat is responding well to the pred, why would a vet recommend a chemo drug?? most cats tolerate pred very well, and it is for inflammation.  Stephen, what do you think of Emily Ann's concern about Leukeran being less effective if administered later, if the cat is doing well on pred?

Hi Emily Ann,Sorry about not responding sooner. As far as bloodwork goes, my vet did send it out. I would have to check but I think it had to do with the ratio of immature white cells and the over all white cell count. Am not sure. I do know it took an extra day or two to run. When we did the ultra sound she read it herself, but she also sent it out for a second opinion. Basically, she said his bloodwork was far below what she saw in cats with full blown cancer and nothing definitive showed on the ultrasound. Part of why I had wished I had moved to the Leukeran sooner is Rikki feels good enough to be playful. I haven't seen that in a long time. He has finally put weight on, though i still think he looks thin. Plus, he had been having problems for a long time. But I waited until I felt I had no other real choice. I had gotten him off insulin, the diarreha resolved but still could not get weight back on him. Initially, when he first started having real problems, my first vet told me not to feed chicken. They didn't seem too concerned. Then after months, when I noticed he seemed hungry all the time and he had lost even more weight I went to them and insisted a full blood work up. I was thinking diabetes or thyroid. At that point they said he would be dead in a year and put him on a high dose of prednisolone. He continued to get worse and I made the switch to a different vet and saw the oncologist. It sounds like you are getting better advice than I did early on. In recent years I have run into some excellent vets and some bad vets. Don't be afraid to get a second opinion. I recommend you research the Leukeran. I read that some cats don't tolerate it well. It can cause problems. I haven't heard anything about pred reducing the effectiveness of the Leukeran. I recommend you double check that one. I do trust my oncologist. I have taken two dogs to her over the years. She has been at it for some 20 years now. This expierence has taught me the importance of diet. We had pulled Rikki off the pred. and started him on insulin. I had to control his diet at that point. My new vet told me about some useful web sites and I learned that it was possible to get diabetes in remission with a raw food diet . At that point I had nothing to lose. I was amazed when I was able to get his diarreha under control with just diet. And now his diabetes is in remission. Oh, and we did several rounds of B-12 shots. I would say they are a must. I see the whole IBD thing in cats like crohns in people. Crohns causes chronic inflation of the intestines which leads to cancer. One of the first drugs used with crohns is prednisone. They now has more advanced medications. The son of a close friend was diagnosed with crohns when he was about 15. He just passed from a super agressive form of colon cancer two weeks ago. He was on something called remacade (sp?). His doctors disagree on the role the remacade had on his cancer. One said it probably masked his symptoms early on, another said it could not have. Medicine is more art than science. Good luck.Fuzzy Cat.

Oh and for whatever reasons the paragraphs disappeared when I hit reply. Sorry. I reading something doesn't have paragraph. I would never do that to another on purpose.

Oh, and yes I would have stuck with the pred if Rikki had not developed diabetes. I had two FIV kitties who also had stomatitis. They were on pred for several years and both tolerated it well. It is possible Rikki was developing diabetes before we put him on pred. But the fact he made such a reversal suggests it was induced by the pred. Same thing can happen in people. I agree with Stephen, treat what is in front of you. But also, listen to what Buddy is telling you. If he is feeling better, then what you are doing is working. Keep me informed.

Again, sorry about all the typos and grammar errors. Working from my phone is a bad idea.