IBD, pancreatitis or lymphoma? Need help!

I have an 11-year-old indoor girl, Betsy, who was recently diagnosed through bloodwork (PLI) with pancreatitis. She had slowly lost weight over the last 2-3 years, and this summer had reduced appetite and worse diarrhea (she's had diarrhea her entire life). Vet prescribed Cerenia, B12 injections, and Amoxy to treat a C. Perfringens infection. Fast forward 4 weeks, and upon re-check of her PLI level, it was up 7 points (37, from 30).

Last weekend she stopped eating and became dehydrated, prompting an ER visit on Saturday night, vets recommended ultrasound, which we had yesterday (Friday) at internal medicine specialty practice. She improved during the week leading up to yesterday's appointment, and her appetite was back and she was energetic and happy (still receiving Cerenia every 48hrs).

Since returning from ultrasound yesterday, she's had no appetite and has barely touched her food. Has peed twice and passed one semi-solid stool (the most solid she has ever had). During the day today, she's been increasingly lethargic and just laying around. Have been trying to coax her to eat, but she's not interested. Tonight she seems to be visibly nauseous, and was sitting on the floor drooling. I gave her a Cerenia and she has kept it down so far (2hrs), but is still laying around and not eating. No longer drooling.

Specialty vet ultrasound found IBD, pancreatitis (which we knew), plus a mass in her common bile duct (with enlarged gallbladder). Liver enzymes tested normal, so she is not obstructed. Vet said it could be all inflammatory, or could be lymphoma. Recommended either starting steroids, or doing very expensive surgical biopsy. We were instructed to call back Monday morning with decision, or to discuss further.

I'm now very anxious that she may not live till Monday morning - should I be very worried about her current nausea/lack of eating, or should I assume once the Cerenia is in her system, she'll improve and be able to eat a little? I really don't want to traumatize her with another trip to ER... any advice would be appreciated since I am extremely worried about my girl!!

I am sorry that I cannot offer you any advice as I am not a vet and actually just joined to ask my own question.  I wanted to respond just to say that I know how you feel and I know it is terrible, I am very worried I might soon lose my 11 year old boy myself, really not that old for a cat   I have the utmost respect for you to care for your cat to this level, I am a male and constantly have to defend myself... even at work I had to explain that this is like my child.

Beyond that, one thing I can say is that if your cat is not eating you can try to syringe feed her and your vet should have mentioned that.  You can also get a feeding tube put in, which is what i Just did for my cat, it is a little stressful at first but ultimately not a big deal.  Also if she has pancreatitis that is somewhat painful so they should have given her some pain meds, I get a 3 day shot call bupephrine(or close to what I just spelled) that works great.  If she was eating all week until yesterday I wouldn't worry too much about her appetite going back down for a day or two, it might just be from the stress of the ultrasound.  Again though I am concerned your vet didn't mention pain control and assist feeding. 

I wish I could be more helpful, I know how stressful and horrifically depressing this can be.  I wish you the best. 

@Wagster, I saw your post and wanted to reply real quick. I'm so sorry for all that Betsy (and you) are going through. I have a cat with chronic pancreatitis, IBD, and now after 2+ years, possibly small cell lymphoma. I opted out of a biopsy.

Try not to let Betsy go too long without eating. It would put her at risk for developing hepatic lipidosis (fatty liver disease) on top of everything else. Try a variety of stinky foods and toppers to entice her. If that doesn't work, she should be assist-fed. Some people opt for a feeding tube if the anorexia goes on too long and the syringe feedings are too stressful.

I know you said liver enzymes were normal and so not obstructed, but I would still be concerned about this "mass" in the common bile duct. I am not a vet, but it is my understanding that this is not normal and could be a contributing factor. Is it a gallstone, a benign cyst, or a cancerous mass? Unfortunately, with these GI diseases, everything is connected and one thing can lead to another. Inflammation can "travel" so to speak. A bile duct blockage (even partial) can affect like 4-5 major surrounding organs. And this chronic diarrhea you mention is likely related. Ugh, it's so frustrating and upsetting and I totally understand. Betsy has a lot going on. IBD and pancreatitis essentially have the same treatments, although I did incorporate a few pancreas-specific supplements with the help of a holistic vet, and most recently, some supplements to help with loose stools. If a biopsy confirms lymphoma, then you would have to decide on chemo. When deciding on expensive tests, I've always asked myself, "What am I going to do with the results?"

As to helping her to feel better, Cerenia is great, so I am glad Betsy is getting that already. My cat gets sub-q fluids every other day, and they really help with his inflammation and to feel better in general. Also, as the other poster said, pancreatitis in particular can be very painful, so you could as your vet about pain meds. Honestly, all these things going on in their little tummies make them feel absolutely awful. Another discussion you could have with your vet is hospitalization. A constant IV drip (closely monitored) and injectable medications could help her make a turnaround with continuing care at home after she's stabilized.

I hope Betsy pulls through. Sending lots of vibes... 

Thanks to both of you for replying.... this has been the second sleepless night for me in a row. Betsy jumped up on the bed this AM but did not want any of her favorite foods when I offered. I was able to get 3-4ml of wet food "slurry" in her by assist-feeding. Considering how good she felt last week (when eating and on regular Cerenia), I feel like she could make a rapid turnaround if she can just get some food in her system. Will give her a break and feed her a little more in a few hours (going to try and go back to sleep now for a bit). Thanks, again, for your advice and kind words. This is extremely stressful and especially on a weekend with the vet not available until Monday.

My cat is also having a rough night and I had to give her Cerenia because she started throwing up and couldn't stop. She hasn't thrown up since I gave her the Cerenia.
I wanted to say I understand being up all night with your baby. I know you've got a big decision to make but if I were you I'd focus on her the rest of the weekend and what she needs. My vet recommended boiled chicken when my cats have upset stomachs. I hope she starts doing better. If I were you if she doesn't improve call the vet on call instead of taking her straight to the ER. Good luck to both of you. I'll pray for her.

leothelioness30 said:

My cat is also having a rough night and I had to give her Cerenia because she started throwing up and couldn't stop. She hasn't thrown up since I gave her the Cerenia.
I wanted to say I understand being up all night with your baby. I know you've got a big decision to make but if I were you I'd focus on her the rest of the weekend and what she needs. My vet recommended boiled chicken when my cats have upset stomachs. I hope she starts doing better. If I were you if she doesn't improve call the vet on call instead of taking her straight to the ER. Good luck to both of you. I'll pray for her.

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Dear Leo, thank you. Your kind words mean a lot to me. All the best to you and your cat, too.

I am sorry you are going through this, several of us have been through this.  It is both scary and frustrating.  The main thing now is to have a vet you trust, take your kitty in when she needs to go in, and ask lots of questions.  There isn't a one size fits all way to conquer this but most of us find a way to get through a flare then control the symptoms.

Wanted to thank everyone (again) who took time to write over the weekend. I feel very, very lucky that Betsy's appetite came back just enough to where I could get a Cerenia in her... which eventually led to feeling better and more eating! We started Prednisolone yesterday and I am hopeful for the future. This experience scared me so much - I have all of you in my prayers who are dealing with these issues. I know that just as easily, things could have gone the other way for us. Prayers and love to all.