IBD vs Lymphoma Dianosis - Looking for advice from cat owners who have had this

Hi all,

My beloved 14 year old tri-colored marbel Bengal female (Georgie) has had stomach issues her whole life.  She goes to the litter box fine but has always thrown up 1-2 times a week, sometimes more.  When she was a kitten, I kept taking her to the vet and he said either she was eating too fast, allergic to fish flavored cat food, just nervous - a host a reasons not to take it that seriously. 

Well now I feel like I SHOULD have taken it seriously.  Over the past 24 months, Georgie has gone from 11 pounds to 7.5 pounds despite her incredible appetite.  Last spring the vet tested and her B-12 was practically non-existent so I started giving her shots every week.  He told me then that it could be a sign of either severe IBD or small cell intestinal lymphoma but it would be impossible to know where she was on the continuium without an invasive biopsy procedure.  He said to wait and see how she did on the B-12 shots.

About two weeks ago with no improvement on B-12 I went to a  vet specialty clinic to get her an ultrasound and a full round of testing.  They said the ultrasound showed her  intestine was 'abnormally thickened' but they need exploratory surgery to get a sample and rule out either cancer or IBD.  THe vet does not feel that endocoscopy will give an accurate diagnosis based on where her cancer is located.

Part of me really wants to go forward with the surgery so I know what I am dealing with but I am so afraid to hurt my senior cat and put her through extra pain and suffering.  The other part of me just says start her on prednisone and treat with diet and steroids and avoid the pain of chemo and surgery.  I am just afraid that I will make the wrong choice and regret my decision.  If we are dealing with cancer I don't want to watch her slowly die and vomit and starve herself to death.  

Anyone been through this before and chosen the  holistic route?  Anyone done the exploratory surgery and chemo and had a good outcome?  I need advice from other cat owners!

Purrs to all cats and their families!

Georgie and Kristy in Chicago

washateria said:

 
Purrs to all cats and their families!

Georgie and Kristy in Chicago

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Hi and i'm sorry you're going through this!

I went through this with my cat Simon when he was almost 14.  Same questions.  Surgery, treatments, so much to think about.  First, there is no one objectively correct answer to any of these questions because each cat is different, and each owner is different.

As to question one, the holistic route:  For early stage IBD it often can be managed with special diets, like novel protein diets.  The cat's IBD is essentially an allergy (in a sense) to a known protein like chicken that the cat reacts to.  So you try different proteins to trick the body to accept the food.  This often works in early stage IBD and may work for a while.  In severe cases or cases where its progressed to weight loss etc, while a special diet may help, by itself it is extremely unlikely to change the prognosis.  There really is no holistic treatment to severe IBD/SCL (small cell lymphoma), but there are ways of supporting the cat, B12, Probiotics, diet, Pepcid AC for vomiting, Cerenia for severe nausea, sub Q fluids.

Biopsy or not, a great question.  In some respects the biopsy is more for you than for the cat - in the following way.  The treatment for severe IBD or SCL is essentially the same, so one can avoid the surgery if you don't mind a) the uncertainty of not knowing and b) the loss of certain very serious late stage chemo treatments that frankly most people don't put their cat through (its done in hospitals, on an IV, very expensive and can be dangerous).

Prednisilone is usually drug #1, and if it gets the cat into remission (and we're talking about remission not cure in 100% of cases) the cat starts putting weight back on.  Yay and you can feel good you didn't put the cat through surgery.  So the Pred works, and works for a while, but maybe not forever either because the IBD fights back, or it morphs into SCL, or it was SCL from the beginning.  Now what?  Most vets (but not all) will allow the cat to be put on Leukeran  which is a fairly safe oral low level chemo type drug that is indicated for both severe IBD that isn't responsive to Pred, and to SCL.   I would ask your vet up front, would you be willing to prescribe Leukeran for my cat if he was not responsive to Pred, even though i won't get a biopsy?   If the vet says no, then i'd either a) find a vet who will say yes or b) consider the biopsy.

Some vets like to start Pred and Leukeran at the same time, but might hesitate to do that without a diagnosis via biopsy.  It's one thing to prescribe Leukeran to a cat who's failing on Pred, but its a harder choice to do it without Leukeran being the last option.

As to the surgery, note that it isn't 100% definitive for diagnosis.  And even if you get a neg diagnosis for SCL, the IBD may become SCL later and you're not going to biopsy twice, and you can't biopsy after starting treatment with Pred, and no one wants to take their cat off pred in order to do a biopsy. It is major surgery (all surgery is major), in my case, we did do a biopsy on Simon.  He was home the next day, he was on great pain meds for a few days (Bupeprenorphine) and then it was like he was fine, and didn't seem to notice he had the surgery. 

If the pre-surgery blood work says he's ok for surgery, then (pro surgery) the risks are low, the discomfort manageable, the recovery short, and the answers helpful to you perhaps, and potentially helpful to your cat, and can have some effect on treatments. (Con surgery), it's expensive, while the risks are low, they aren't zero and there can be complications, and in very rare cases serious ones or death, there is some discomfort, and the answers may not be helpful, or even if they are meaningful that doesn't always equate with helpful.

Now i've really confused you?  In many ways its about peace of mind for you, and how much uncertainty you're willing to live with. Do you need to know whether its one or the other? 

What happened in my cat's case?  Surgery went well as I said. Diagnosis was severe IBD, no signs of SCL.  Treated with Prednisolone and he went into remission, weight gain started in a week, and he was in remission for a year, then the pred stopped working, we did various other treatments (he also developed pancreatitis, not uncommon with severe IBD), he had several needle aspirate biopsies of his lymph nodes when ultrasounds showed inflamed nodes, and we eventually got an unusual diagnosis of internal mast cell cancer, he went on s special treatment just for that but it was too late, and we lost him 2 weeks later, and had to euthanize him.

I give this story not to scare you, but to share the notion that every patient is different.  Every story and case will be different.  My and my vet's approach is, try and make the best decisions you can at each stage, and when one step doesn't work anymore, you make the next best decision, until you run out of decisions and have to make the very sad and very last one.

The best decision is not exactly the same as the right decision. There is no objectively right decision.  But you talk to your vets, you look into your heart and your head, and you make what feels is the best for you and your cat, and you go with it.

And tomorrow, go to a store or amazon and buy a baby scale and start a weight log of your cat.  Don't weigh him daily, you'll go crazy, but once or twice a week on the same days so you get accurate trends.  If you weigh on different days you can tell if she's gaining or loosing but its hard to calculate how much the loss or gain is per week.

Stephanie!  

Thank you so much for the excellent post and so much information.  I hate that you and your cat Simon had to experience this and it breaks my heart that any cat and owner has to experience this disease.

I had no idea that the treatments for IBD or for SCL were essentially the same save the IV chemo drugs at the end.  THAT is the kind of information I was looking for to help me make this decision.  

Also knowing that IBD had a disease course that will always transition to SCL - no remission - is helpful information that I did not have before reading your post.  I know we will try and stave this off but IBD is a disease we will have ongoing issues with.

I actualy have an appointment this morning with my primary care vet and I am printing out your post now to have a conversation with him on whether he would be willing to perscribe the chemo drug without a biopsy.  I know my specialist vet said 'absolutely not' but my primary care vet is more likely to consider this option for the pain it would save the cat.

I appreciate your wisdom and insight. - letting us benefit from what you experienced with Simon.

I am so grateful that someone is willing to take the time to help educate me on my options.  I want to do the right thing for Georgie but I just felt like I needed a bit more information.  

Thank you again from the bottom of my heart!

Big PURRS from Chicago,

-Kristy and Georgie

@washateria

Hi again!
Just a slight correction, while IBD isn't curable and can go into remission, it need NOT progress to SCL. The latter may happen or may not but regardless treat the disease in front of you and try not to worry about hypothetical futures.

Also it seems your vet misdiagnosed the IBD for a long time which concerns me as it isn't that hard to diagnose presumptively by ruling out other causes of the GI issues.

Let us know what your vet says

And my name is Stephen not Stephanie, I only say that because there is an advisor here by that name as well.