Lymphoma is spreading...time to euthanize?

Hello,
I was very touched by an older forum about a sick kitty named Krash and people offered support and advice for his poor owner...now I am distraught. I am hoping for some insight.
My 11 year old orange tiger was diagnosed with small cell intestinal lymphoma a few weeks ago. This was confirmed by a biopsy when a large mass was discovered on an X-ray, and we chose to have him explored surgically. Turned out he had 2 masses, one was removed easily from the small bowel, but the other was embedded in the mesentery, which was non removable. Vet said his condition and biopsy results were favorable, there is no cure for lymphoma, only a goal for remission and management, so he did great after surgery, started on prednisolone, and ate like a champ. No vomiting.
Brought him in because the day after we tapered his prednisone, he started to lose interest in food. A day later he quit eating all together and the next day he quit drinking and started vomiting. And hiding.
Back to the vets, twice, and long story short, they did another X-ray, the remaining tumor was still there, size of a golf ball. And it appears there are 2 more masses. His wbc's are really high.
Vet upped the pred again, gave an injection of cerenia, and went home on zofran pills.
He stopped vomiting but refused to eat or drink. He became lethargic and weak. We dropped him off for supportive care at the vet where they hydrated him with sub q fluids and force fed him cat food slurries with a syringe, which he hated.
They wanted to start him on chlorambucil/leukeran next week. They offered to put in a feeding tube.
My question is: how can he begin chemo when he doesn't even want to eat or drink. And it seems like this lymphoma is aggressive if in less than 2 weeks there are already more masses while he is on prednisone. He is clearly not having a good quality of life. This is a previously friendly, social cat who hangs out with us, is very much a part of our family and now it's like he is feral, hiding, withdrawn. We refuse to let him suffer and starve to death but feel terrible for throwing in the towel on him.
Of course after getting hydrated he perked up, was walking around and actually drank a little water on his own.
We are willing to take this as far as we can, as long as he shows signs of life. But to me, when an animal stops eating, they are telling us they've had enough.
Our vet says they've had cats more sick than Spencer, who turned it around with the chlorambucil and are now 3 and 4 years out. I want to believe in the chemo, but I don't trust cancer at all. We prayed for a miracle but it wasn't enough,
Any thoughts comments from anyone who's had to go through this before would be really appreciated.

Start him on chemo and give him a chance, the sooner the better. My cat is on chemo right now, and when she started she was in horrible shape. She started feeling a bit better within 48 hours of starting. I am not sure about the protocol for gastrointestinal lymphoma, but chemo is tolerated very well by cats (mine has had very few side effects, she sometimes vomits her breakfast the following day but is fine later in the day). Chemo has given me quality time back with my cat. Good Luck!

Regarding the feeding tube, if you opt for trying the chemo, the e-tube is the best route to go.  Then you are not force feeding him and his meds go in the tube and when he does get better and want to eat, he can still eat with an e-tube in place.  Here are two good articles to read -- I like what Dr. Kris says in the first one I am listing, that keeping the cat nourished through a difficult time allows you to see his potential for health. 

Whatever you choose, I know you want quality of life for him and you don't want him to suffer.  Cats CAN come back from being so sick they don't want to eat.

http://www.iwillhelpyourcat.com/blog/2015/3/8/feeding-cats-that-wont-eat-at-all-pina-the-e-tube

http://consciouscat.net/2015/06/08/feeding-tubes-save-lives/

I would not presume to tell you when and if you should euthanize, as this is a very difficult, personal decision. I will share my situation and how I came to my decision, and you can take from it what you wish. My cat had pancreatitis and food allergies (may have been a connection). For two years I fed her hypoallergenic food and gave her prednisolone. She did pretty well, the pain went away, she became her playful self, she stopped throwing up - all was good. But prednisolone can bring on diabetes and in April I started noticing some symptoms. Got her blood work and urine testing and sure enough, she was diabetic. Changed her food, tried to switch her off the pred. (in the hopes she would go into remission) and she started throwing up badly, and lost interest in eating. So we gave up on that, continued the pred. and began with insulin. During all this, I had noticed she had some bouts of obvious pain. My vet thought it was strange, not connected to the diabetes at all and recommended an ultrasound. I knew something was up when I picked her up at the hospital because I was told they had taken a couple of x-rays as well, which they didn't do when she had an ultrasound two years ago. It turned out she had gallstones, dozens of little ones many of which were imbedded in her liver. He wasn't sure how to proceed with this issue, it wasn't something he dealt with much and he recommended a specialist, an internist. The internist saw her and explained that there wasn't anything to be done. She also explained that Bailey could go months without the stones doing anything or causing her any discomfort, or one of them could block a tube and cause a bad flare up of her pancreatitis. It was then that I decided to euthanize. She had already been through a lot, lost a great deal of weight, been in pain, she hated the insulin shots (I don't care how many people told me they don't feel it - she did) and I didn't want to risk putting her through more. She wasn't playing with her toys anymore, so while she still loved to cuddle and she would eat food from my hand, her quality of life was greatly diminished and, as I said, the chances were that she would face more pain in the future. I couldn't do that to her, no matter how much I wanted to continue to have her in my life. People told me it was "brave" to make such a decision and that it must have been such a difficult decision. It was not difficult. It was painful, but I was (and still am) certain it was the only decision to be made. So, to summarize, after exploring all the possibilities and after considering her present and future quality of life, I knew it was time. I don't know if this will help you decide what you should do, but I do hope it helps a little. Wishing you the best in a difficult situation.

MewCatMew said:

 
Start him on chemo and give him a chance, the sooner the better. My cat is on chemo right now, and when she started she was in horrible shape. She started feeling a bit better within 48 hours of starting. I am not sure about the protocol for gastrointestinal lymphoma, but chemo is tolerated very well by cats (mine has had very few side effects, she sometimes vomits her breakfast the following day but is fine later in the day). Chemo has given me quality time back with my cat. Good Luck!

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If your Vet thinks there is a good chance for remission, then I agree with MewCatMew and would at least give it a try.  She is right that chemo for cats is vastly different than for humans.  Most cats tolerate it much better. 

Alex went through many phases of not eating after being diagnosed with renal failure.  She also had periods of not being able to use one of her legs, but she rebounded so many times... No one can tell you what is right or wrong for you, your situation, for your cat or for your finances, but I will tell you that no matter how much pain Alex may or may not have been in, she did not want to die.  She  sucked every bit of life she could get out of her 19 + years. When she decided it was time to die, she just quit eating and drinking.  It was different than the other times when she quit eating.  I can't really say how, but we all knew this was it.  I think animals are like humans in that some of them embrace life to the bitter end, and some are ready to slip away into obscurity.

Thanks, everyone. I'm struggling to decide what is humane vs grasping at straws. He's so weak. I've taken to force feeding him with syringes, mixing critical care canned with water and squirting it in the sides of his mouth. He lets me do this. I am able to get his pills in between squirts. He quit grooming himself and he smells like cat litter and the vet techs perfume! Ugh, I wiped him down with a damp paper towel and I swear he looked grateful. He was trying to drink water but has a hard time holding his head up. He is at least, no longer vomiting. I am focusing on comfort, like a kitty hospice.
Having mixed feelings about chemo. It's a huge expense. Not that you can put a dollar sign on your fur baby, but there is no cure for lymphoma, just a hope for remission and maybe 6 months to 1-2 years.? Quality of life. He's already lost so much weight. I feel like he is suffering. I am scared of a feeding tube, I don't even think I would want that for myself.

Spencer11 said:

Thanks, everyone. I'm struggling to decide what is humane vs grasping at straws. He's so weak. I've taken to force feeding him with syringes, mixing critical care canned with water and squirting it in the sides of his mouth. He lets me do this. I am able to get his pills in between squirts. He quit grooming himself and he smells like cat litter and the vet techs perfume! Ugh, I wiped him down with a damp paper towel and I swear he looked grateful. He was trying to drink water but has a hard time holding his head up. He is at least, no longer vomiting. I am focusing on comfort, like a kitty hospice.
Having mixed feelings about chemo. It's a huge expense. Not that you can put a dollar sign on your fur baby, but there is no cure for lymphoma, just a hope for remission and maybe 6 months to 1-2 years.? Quality of life. He's already lost so much weight. I feel like he is suffering. I am scared of a feeding tube, I don't even think I would want that for myself.

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I totally understand what you are saying here. I have lost two cats to cancer, one liver cancer and one nasal cancer. It is painful.

During their treatments of palliative care, our vet suggested Forti Flora sprinkled over the top of the food and also an appetite stimulant. You might just ask the doctor for an opinion about those two things.

We did not do any biopsies, surgery, or chemo on our cat with the nasal cancer. We just treated her with palliative care and loved her until it was time to let her go. She lived from August to June. When our other cat had the abdominal mass, we did not do any scans or biopsies as the vet said they are not always conclusive. He did exploratory surgery and removed a tumor from the end of the liver lobe. The cat lived a year with wonderful quality of life and was being treated for thyroid issues. The cancer came back and we knew we were not going to put the cat through chemo or anything else. We just loved him until the end.

Nobody can make this decision for you. Follow your heart and know that we are here for you.

I am so sorry, I just put my Hannah to sleep two days ago over the same situation. She was vomiting 2-3 times a night and her appetite kept getting worse. They saw a mass in her stomach on the ultrasound two weeks ago. I tried steroids and a different appetite pill but by the last week she wasn't eating anything and I was force feeding her 3-4 times a day to make it to the next vet appt. MollyBlue mentioned that it was just different than the other times she quit eating and I agree.
I am still struggling with whether I did it too soon, she still enjoyed being petted and looking out the window but was starving to death. I could have kept giving her "just one more day", but the vet said it was just a question of when.

I opted not to try chemo, not even because of the money but because I didn't want to traumatize her with going to the vets once a week for IV treatment.

Everyone told me you'll know when it's time and I think I did, even though it was the hardest thing I've ever done. I took off work the day before and spent the whole day with her, I was happy to have that time.

No one could really help me decide, I was the only one who knew her well enough and I just didn't want to wait until she was in pain or suffering. Best wishes to you and your kitty- this forum helped me tremendously. People who don't have IBD kitties just can't understand what it's like.

My best friend just put her lovely 14-year-old Manx to sleep two days ago also.  She DID try chemo, the oral kind, and he did very well with it for a couple of months, but it didn't stop the tumor, which had started under his tongue.  Finally his kidneys gave out, whether secondary to the chemo or to the tumor spreading we will never know (there were two sites in his abdomen on x-ray when they first started treatment.)  He had a good day just before his last day and she hoped he was turning around, but in the morning it was obvious he was just worn out, weak, collapsing and unwilling to even take the formula she had been syringe feeding him and which he liked.  She was very clear that it was time and had a great vet who did what I consider a perfect thing -- set up a room for her and the cat, turned off the glaring hospitl lights and brought in a table lamp, got a big puffy quilt for him to lie on, and told her to take as much time with him as she needed.  Her vet had a full schedule but kept checking back with her between clients.  When it was time and she was ready, the vet did do a pre-sedation shot in the butt, putting the cat to sleep but not gone, and doing the final shot after he was totally under.  Agin he said she could stay as long as she wanted, and she stayed another hour or so before she felt she could leave him to be cremated.  Her husband of 30 years died 2 years ago, and she said she is going to have all 3 of her cats ashes and her own ashes mixed with his when she goes and have them all scattered around their property.  She said she stayed from 1:30 to 5:00 and went through a whole box of kleenex.   The next day a florist arrived with flowers and a card from her vet.  Is that not awesome?

I think everyone who listens closely to their cat and looks at the possibility of quality of life vs. quantity of life can make a decision they are at peace with when the time comes.  I do not know anybody who has regretted putting their animal to sleep too soon, but I know many people who regret not doing it soon enough.   Personally I tend to do it earlier than  most because of the experiences I had when I was younger and didn't know as much.  There are a couple that I did not put to sleep soon enough and that aches my heart, but it has made me a better cat guardian in the long run. 

thank you for your responses. i have been taking it a day at a time. my cat has quit vomiting so he is keeping his syringe feedings down. he is getting zofran for nausea, prednisone, and every other day gets a mitrazipine for appetite stimulant. last night he perked up a little. he was walking around but his back legs are wobbly. he was staring at his water bowl, i have 4-5 of them around the house so he can hydrate wherever he wants. he tried to drink but was having trouble with tongue and swallowing coordination. he was bobbing his head. and his tuxedo area was soaked so it was running down his front. then he would just lie down and lay his head over his bowl, he seems so thirsty, he is getting water in his syringe feeds. i read on line that head over the water dish usually means renal failure. is it possible the prednisone has put him in renal failure? then as if to answer me, he walked over and peed on the dogs bed. this is a cat who has never in his whole life missed the litter box. i would call the vet now but they are closed. will call or bring him in the morning first thing.
the vet wants to start chlorambucil tomorrow and he's so weak already.
he keeps showing me signs that are not hopeful.
vet will support whatever i decide. she said they have some cats sicker than mine rally on the chemo and they are in remission 3-4 years out.
i wish i could believe that but i feel like my boy is miserable.
I'm sorry to hear how everyone came to the conclusion to decide to euthanize, but at the same time there is some comfort there because i can feel the love in your words and your decisions were made out of love for the cat, not about how bad you feel, or how sad for yourself.

Spencer11 said:

I'm sorry to hear how everyone came to the conclusion to decide to euthanize, but at the same time there is some comfort there because i can feel the love in your words and your decisions were made out of love for the cat, not about how bad you feel, or how sad for yourself.

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So true. One thing that Red Top Rescue wrote also resonates with me is "I do not know anybody who has regretted putting their animal to sleep too soon, but I know many people who regret not doing it soon enough." I found this thought expressed often on the feline diabetes forum I was visiting at the time, and it no doubt helped me when I made my decision. While I really wanted to continue to have Bailey with me, and saying goodbye was incredibly difficult, at least I will never have the regret that I know I would have felt if I had waited until a stone shifted and caused a flare up of her pancreatitis. She was still relatively comfortable and because of my wonderful vet, didn't have any more stressful visits to the clinic or hospital, because he came to my home. I miss her terribly and wish it hadn't gone down the way it did, but at least I know I made the right decision for her given the circumstances. As you have gone online to seek answers and support, you show the same qualities of love for your cat that you are noticing in others, so I am sure you will make the right decision for the circumstances you are in.

I do know people who regret doing it too soon.  I did it when I knew I had to, but not before.  Also, it should not be anybody's decision, not vet or people on a forum.  You have to do what you believe in your heart is right and what you can live with down the road. 

Brand new member, here.  Recent experience w. euthanizing my 15 y.o. kitty. As posted above, as heart wrenching as it is, you'll know when it's time. Quality of life being  the issue.  I know these guys can rebound and we grab at the hope.  Your heart will lead you.  Some of us have found comfort in a belief that there's a Rainbow Bridge for our pets on another level (after life). My heartfelt wishes for you as you struggle with your decision.

Yesterday had a long talk with our vet and we agreed that he's not making progress and that chemo would not be beneficial in his weakened state at this point. Vet told me I have done more for him than he could ever ask someone to do and so I cried all day and then had to go to work. When I got home at 11:45, he was in the kitchen. He came out of hiding. He was watching me in the kitchen, interested. I saw a window and gave him some zofran, then waited 30 min to feed him with syringe. He fought me a little but actually chewed and licked his lips. He wasn't gagging and salivating like when he's nauseated. This morning he was the same and after a feeding he walked to water bowl and drank instead of bobbing his head. I should also say that I rubbed his face with fresh catnip leaves and he started purring. So I used the catnip throughout his feedings. Someone told me that catnip was like kitty marijuana. Maybe it has anti nausea and appetite stimulating properties? Maybe he's just having a good day. I called the vet again to report he rallied a bit. Think we are going to try the oral chemo, vet said to wait a few days, she cautioned that when cats have been really really sick, when they sometimes rally, they crash and burn a few days later. For the first time in a week I feel hope. I'm so thankful! We were going to put him down today after a week of not eating on his own. I realize he could lapse but for now I get to have my boy one more day.

As so many people have said, you will know when it is time and based on what happened today, it isn't yet. No matter what happens next, you will have this day and you clearly are appreciating it. I'm sad for what you are going through but glad you had this day.

Just went into vet for a check up. He's still with us. Living on syringe feedings for Two weeks. If I can keep him hydrated, that seems to control and prevent his nausea. He still doesn't want to eat on his own, though. His CBC is ok with the vet to start Chlorambucil. Calling around to try and find it. It's hard to find and skyrocketed in price. When we start it, wondering how long before it will kick in if its going to work.

It sounds like good news for your kitty. I recently lost a cat to large cell Lymphoma which was originally in his spleen. I know that cats with small lymphoma can live much longer. The very best case scenario for my guy was that he would live about 2 more years from his diagnosis and enjoy a very good quality of life. He did. I would do it all over again if faced with the same situation. I am very happy with how he responded to chemo and to the quality of life he had. After a few bumpy weeks at the beginning, every day after that was a really good day for him. He was active and affectionate just as he was before he got sick I wanted to share my experiences with you. He was on a chemotherapy protocol the whole time, and Chlorambucil was one of the drugs in his rotation. He had once a week chemo, rotating several different drugs, for 9 weeks, then every other week, for over a year (his CBC's were so good) then every 3 weeks for the last several months of his life. It took a little while before I noticed an improvement, but after that it was smooth sailing right up until his very last day. He did have some nausea in the first few weeks and it turned out that his anti-diarhhea drug caused a lot of it. I was able to cut down on that drug, also Zofran can cause constipation so between the diarrhea and Zofran, it balanced out. It got to the point where he only needed Zofran for a few days after a treatment, and sometimes not at all depending on the drug. I did have to force feed him for a short time in the beginning. I just fed him with a syringe, no feeding tube. After that, he regained his appetite, although he would get tired of his food after a few days, so I just kept trying new ones all the time. He was able to maintain a very healthy weight. Best of luck to you and your kitty ! 

Thank you for your story! I would be thrilled with 2 more years. Sounds like you gave your kitty the best chance possible. I've been feeding mine with a syringe also. I'm hoping if the chemo works he will feel like eating on his own. Didn't know zofran causes constipation. I've been giving him 1/4 tsp miralax as needed. He is also vomiting more, gets really nauseated when he's dehydrated. Hoping the chemo doesn't make him more nauseated, everyone says cats tolerate chemo much better than humans. Hoping we see positive results. Was warned about possible side effects.

There's a feline lymphona yahoo group, I recommend. It's for small cell lymphoma, so there are people there in very similar situations to yours.  There is a vet who posts there regularly, and a whole lot of support and information. Sometimes I was intimidated by how technical the discussion could get, but there's no need to be, people just want to help. If you search Yahoo Feline Lymphoma Group , you'll find it. The first round of treatment for my baby was rough because he had always LOVED to eat, and I hated to see him not wanting to eat. It was one of his very favorite activities ! I considered stopping treatment, but I'm really glad I continued. Chlorambucil WAS one of the drugs that made him nauseous, but the diarrhea meds was the biggest culprit. I also gave him water with a syringe every 15 minutes up for about an hour at a time until I was sure i got 4 oz. in him. He also had sub Q fluids with every in office treatment. I figured out the nausea because I gave him his meds in advance of a treatment and he suddenly lost his appetite. When I looked up the drug, nausea was one of the side effects. After that, I only gave him that if he had really bad diarrhea. If it was a little loose, not too frequent, and lasted a day,  I gave him extra water. I also crumbled up treats and sprinkled them on top of his food to get him to eat, poured water from a can of tuna on his food, and sprinkled Forti-Flora on his food to help his appetite. Forti-Flora is a probiotic in a base of animal digest which cats and dogs love. I got it on Amazon for cheap.It smells like Bullion.  The probiotic part of it was basically expired, but the flavor was there. I sprinkled a little on his food and he would eat it. He would also sometimes get B-12 injections at the vet's and those also helped. Some of the people on the Lymphoma group had cats with the small cell variety that were living 6-8 years. Every case is different, but I just wanted to share my experience. I have no regrets and I am so glad that I continued treatment. At one point, he got a a little too fat! The vet was very happy to have tell me that he needed to lose a little weight. You can google any of the meds and find out what side effects they could have. Hang in there! If you do suspect a drug interaction, don't be afraid to ask for a different one. The Chemo protocol is pretty set, but the other drugs all have alternatives. Chlorambucil was one of the only drugs that caused nausea for Foggy. I mentioned it to the vet and he slightly lowered the dose and it was much better after that. I think he changed it from 7mg to 5mg. A lot of people stick to organic or raw diets. I didn't do that, I let him eat whatever he would eat. Sometimes he really liked the cheap stuff like Friskies or Sheba. That was fine with me. Best of luck to you and your kitty !