This is not intended as a method of diagnosing or treating your cat, but is a discussion on how to help one see the issues, and help you frame a discussion with your vet about your concerns. Use the discussion here to help you talk to your vet. Comments and corrections welcome :-)
Abbreviations:
IBD: Inflamatory Bowel Disease
SCL: Small Cell Lymphoma
Pred: Prednisilone (not Prednisone)
A very short primer on IBD and SCL:
IBD has various types and causes but in simple terms is an inflamed and damaged portion of the intestines that results in serious cases in the cat's inability to fully absorb nutrients causing weight loss in addition to other GI symptoms including but not limited to either or both diarrhea or vomiting.
SCL is an infiltrative type of cancer, not a mass per se, but a change to the nature of the intestine's cellular structure and that eventually causes digestive failure and death.
These two illnesses are thought to be connected along a continuum, ie. IBD can turn into SCL in time.
Here is my "flow chart" that is for people who do not wish to put their cat through a surgical or endoscopic biopsy either due to cost, or risk to the cat, or both and as a result treatment will be based on assumptions, not on a definitive diagnosis. Note that the treatments for IBD and SCL are essentially the same, so one can act responsibly without doing a biopsy, but some people really want to know what they are dealing with. Note that not all cats can be definitively diagnosed with a biopsy.
1- Cat has GI symptoms that can't be controlled by normal conservative means including special diets.
2- Cat starts to loose weight and standard approaches still don't help.
3- Cat optionally (and hopefully) gets a simple ultrasound of the abdomen, and a thickening of the intestine is noted. IBD is strongly suspected, but SCL can't be ruled out.
4- Biopsy is not performed for whatever reason, either cost or hazard to the cat or both.
5- Cat is started on Pred:
A) Cat gains weight
B) Cat doesn't gain weight
A: Cat gains weight. Disease (IBD or SCL) is in remission. It could be either IBD or SCL, diagnosis unclear, but treatment would be the same, lowest effective dose of Pred. Perhaps in time the cat starts to loose weight again and adjusting the Pred dosage doesn't help. Cat is started on Leukeran the #2 standard treatment and tolerated by about 80% of cats. Hopefully the cat goes back into remission. If not, or if that remission ends there are no more effective treatments available without a definitive diagnosis of SCL by biopsy. Note however that if there had been a definitive diagnosis of SCL, then the only remaining treatments are very serious forms of Chemo that many owners would be reasonably reluctant to put their cat through, end result is the same, cat will reach the end of treatment options.
B: Cat doesn't gain weight. SCL is strongly suspected. Cat goes on Leukeran as above.
Abbreviations:
IBD: Inflamatory Bowel Disease
SCL: Small Cell Lymphoma
Pred: Prednisilone (not Prednisone)
A very short primer on IBD and SCL:
IBD has various types and causes but in simple terms is an inflamed and damaged portion of the intestines that results in serious cases in the cat's inability to fully absorb nutrients causing weight loss in addition to other GI symptoms including but not limited to either or both diarrhea or vomiting.
SCL is an infiltrative type of cancer, not a mass per se, but a change to the nature of the intestine's cellular structure and that eventually causes digestive failure and death.
These two illnesses are thought to be connected along a continuum, ie. IBD can turn into SCL in time.
Here is my "flow chart" that is for people who do not wish to put their cat through a surgical or endoscopic biopsy either due to cost, or risk to the cat, or both and as a result treatment will be based on assumptions, not on a definitive diagnosis. Note that the treatments for IBD and SCL are essentially the same, so one can act responsibly without doing a biopsy, but some people really want to know what they are dealing with. Note that not all cats can be definitively diagnosed with a biopsy.
1- Cat has GI symptoms that can't be controlled by normal conservative means including special diets.
2- Cat starts to loose weight and standard approaches still don't help.
3- Cat optionally (and hopefully) gets a simple ultrasound of the abdomen, and a thickening of the intestine is noted. IBD is strongly suspected, but SCL can't be ruled out.
4- Biopsy is not performed for whatever reason, either cost or hazard to the cat or both.
5- Cat is started on Pred:
A) Cat gains weight
B) Cat doesn't gain weight
A: Cat gains weight. Disease (IBD or SCL) is in remission. It could be either IBD or SCL, diagnosis unclear, but treatment would be the same, lowest effective dose of Pred. Perhaps in time the cat starts to loose weight again and adjusting the Pred dosage doesn't help. Cat is started on Leukeran the #2 standard treatment and tolerated by about 80% of cats. Hopefully the cat goes back into remission. If not, or if that remission ends there are no more effective treatments available without a definitive diagnosis of SCL by biopsy. Note however that if there had been a definitive diagnosis of SCL, then the only remaining treatments are very serious forms of Chemo that many owners would be reasonably reluctant to put their cat through, end result is the same, cat will reach the end of treatment options.
B: Cat doesn't gain weight. SCL is strongly suspected. Cat goes on Leukeran as above.
