Elderly cat won't eat - possible IBD/lymphoma, not responding well to steroids

Hi, I'm new-ish. Had an account years ago and can't remember the log in. The reason I've come back is that my 18-year-old cat, Mister (the handsome boy in my avatar), stopped eating a month ago. He has been to the vet many times since the problem began and it's not getting better.

Here's some history...

In mid-January, for two meals in a row he threw up a few hours after eating (dinner, then breakfast). We scheduled a vet visit after the second time, and by the time he got seen he had quit eating. When the vet saw him, he got a CBC, BMP, T4, and abdominal x-ray, all of which looked normal. In fact, the vet and the tech were impressed with how good his blood work looked for his age. The vet said his intestines felt thickened, but other than that his physical exam was normal. She gave him dexamethasone (steroid), Cerenia (anti-nausea), and sub-q fluids. He quit throwing up, but his appetite did not come back. The next day he got mirtazapine (appetite stimulant) and another dose of Cerenia, which helped. He started eating again, but small amounts.

He also started sniffling and sneezing, so we took him back in. He got oral Clavamox (antibiotic), which he would not swallow (he has a PhD in avoiding oral medication, even the vet techs have a hard time with him), so we had to take him back in and he got Convenia (long-acing antibiotic shot) and another mirtazapine. None of this helped his appetite. Last week he went back in and got more dexamethasone and Cerenia, and a B12 shot. That helped a little and he ate small amounts here and there over the weekend. Today he went in again and got depo medrol (longer acting steroid) and sub-q fluids. We gave up on the Cerenia because he hasn't thrown up any more at all, even after it wears off (only supposed to late 24 hours). He also had another CBC today which showed mild anemia and elevated monocytes. The vet said this definitely indicates some kind of inflammatory process. She says IBD or lymphoma, and thinks it's getting close to time to "make a decision." meaning euthanasia.

Before the vomiting episode last month, Mister had no apparent symptoms. He was happy and seemed healthy. He ate all his food and had no apparent bowel problems. He shares little boxes with our other cat but there have never been any bloody, runny, or otherwise abnormal stools in the box. He has not had an ultrasound or anything that would require anesthesia. 

Also, the vet has checked his teeth every time he's been to see her. She says he has some bad breath and build-up, but that his teeth look good for his age and she's seen cats with much worse teeth who would at least eat wet food. Which he will not.

He has an appointment with another vet tomorrow for a second opinion. Has anyone here had experience with anything like this? What should I ask the new vet tomorrow? He's lost 1.3 lbs in four weeks. This has all happened very quickly and he was apparently healthy until four weeks ago, which is why I'm sort of doubting the IDB/lymphoma diagnosis.

Could the anemia and elevated monocytes be caused by a combination of not eating and steroids? Could he have an infection or abscess that's causing this cluster of symptoms? Are we grasping at straws?

Maybe look into providing him food that's high in protein another way, say cooked chicken or beef or turkey. I know there are a few threads on here discussing a balanced home made diet. I hope he is getting better  

I actually just posted something very similar to this last week. My 9yo cat has been having issues with appetite, vomiting, and lethargy since June 2015. I've had him seen by two different vets and no one knows what's wrong. They suspect IBD but can't say for sure. The current vet ran a mal-digestion panel on him and it came back that he had low B12 (cobalamin) levels.

If you google this "cobalamin deficiency in cats" you'll find that having depleted levels of B12 can cause poor appetite and lethargy. The B12 levels dip so low because they're not properly digesting the food and as a result can't absorb proper nutrients (which may be caused by IBD). Hence the low cobalamin.

He's had two cobalamin injections in the last two weeks and although he's been eating a bit more he's still having episodes of vomiting and loose stool. The vet wants to do two more injections over the next two weeks, run his blood again, and then do an ultrasound.

Back in the summer/fall of last year the previous vet performed an x-ray and noted that his intestines seemed bloated/thick/inflamed. He chalked it up to gas and sent me home with GI food. Obviously, that solved nothing.

I guess if I could offer any advice from my situation it would be to ask if they tested his cobalmin levels if they haven't already. Also, did they check his TLI levels (pancreas). Low TLI could indicate pancreatic insufficiency and high levels would indicate pancreatitis. Both would cause appetite/vomiting issues.

I really hope some of this helps. I can't seem to get any answers though.

Thank you both for your input. He had two B12 shots two days apart last week, and that seemed to make him feel better. But now he's back to not eating and is extremely weak. Last night he ate some small bits of a Kraft single and some Purina treats, and lapped up some tuna water...and he's drinking. I'll ask the new vet we're seeing today about a mal-digestion panel and TLI levels. Fortunately, he hasn't had any loose stools or any more vomiting.

Hopefully the new vet will be able to tell a little more than the other one.

Good luck getting your kitty fixed up, Henryhenryhippo.

Please let us know how the second opinion goes. I'd be really interested to see what they say. 

Good luck to you and your little old man. So handsome.

Thanks for the well-wishes. Mister Cat is a pretty boy, isn't he? And so sweet.

After reviewing the first vet's records, the new vet agrees with the IBD/lymphoma diagnosis.

He gave Mister a B12 shot and some Adequan for general pain, and gave me some prednisone to take home. This was about three hours ago and Mister still isn't very hungry, even after his scheduled mirtazapine. He drank some tuna "juice" and ate a few tiny bits of turkey cold cut, but isn't interested in anything more. Maybe he does need the Cerenia?

The cerenia might help with appetite but there's obviously something else going on. I'm assuming that they didn't run any extra tests?

Henry had his second b12 injection yesterday and has thrown up 3 times since. He really wants to eat though and looks for food minutes after vomiting.

I'm dead set on talking to the vet tomorrow and demanding a complete blood work be done. I want everything tested. I'm also going to demand the ultrasound. I was just skimming the threads and you wouldn't believe how many people have cats in similar situations. A lot of them do turn out to have IBD or advanced lymphoma. This cannot wait anymore!

I know this stuff is very expensive but if you have the means an ultrasound would be the best thing to do if he doesn't improve. Most vets just have to guess and I think a lot of them are so used to people not wanting to spend money or be inconvenienced that they play things down. We have to be our pets advocates.

Mister is such a gorgeous little man. I really hope he turns around. Maybe the B12 will ignite his appetite in time. We haven't tried corticosteroids yet but everyone says they make your cat eat like a linebacker. Have you tried the prednisone yet or is that for tomorrow?

As I'm reading through this I have to agree about it likely being IBD as well.

Especially with feeling the thickening of his intestinal wall, same as my cat has.

IBD has become ridiculously common anymore, I can't help but wonder just what kind of crap is really going in to our cats via their food, what are they doing to the chicken that is causing chicken to become tied with the other top allergen, corn? 

They always say IBD with possible lymphoma, but take it as treating IBD.

IBD can turn in to lymphoma but in my opinion if he just started all of this a month ago he has a good chance that it is not lymphoma.

Gotta get that tummy settled down and eating again, for obvious reasons, losing weight continuously is no good either.

My husband is cooking up some plain chicken for him right now...hopefully he'll eat some of it. He was pretty excited about chicken the other night, but only ate a little bit.

We tried giving him the pred pill earlier this evening but he spat it out. It's one of those that's supposed to dissolve in the mouth, but we wouldn't hold it in long enough for it to dissolve. Like I said, he's an expert at avoiding oral meds. He had a depo medrol shot yesterday, but it didn't seem to do much.

When the vet felt his tummy today he said it didn't feel hard, tense, or otherwise abnormal, aside from the diffuse thickening.

Hopefully he'll eat some chicken, or the Cerenia tomorrow will help.

IBD/lymphoma is probably becoming more common because our cats are living longer and veterinary medicine is getting better at diagnosing things.

My guy refuses any sort of medication which is why I can never do pills. I love how the vets make it seem so easy. "Oh, here use this nifty plunger to pop it in their mouth. Works like a charm!" Yeah, if you can even mange to pry your cats mouth open let alone get him to swallow it.

How did Mister do today? Any luck with the chicken? Have you tried raw? He sounds picky like Henry. We haven't tried fresh raw yet. I have a feeling he'd refuse. So frustrating when you know the stuff they want isn't best for them.

It's hard to pinpoint what causes what. Sure medicine has advanced but we've also been conditioned to feed our pets crap. Same thing with people. How common is IBS and crohns now? In fact all auto-immune diseases are becoming way too common. I was diagnosed with MS 8 years ago and I thought I was so alone at the time but now it's like you can't throw a rock without hitting someone with MS, or lupus, or RA, or celiacs.. You get the point. It's effing scary and weird but it's even stranger that it's becoming normal in domesticated animals. I think you'd be hard pressed to find a wild animal with auto-immune illness or cancer.

Sorry. Ranting.

As far as chicken containing a similar allergen to corn, well, that is what most chickens are fed.

Hatchytt said:

As far as chicken containing a similar allergen to corn, well, that is what most chickens are fed.

Click to expand...

If you are referring to my comment, I was saying that chicken is now pretty much tied with corn as far as allergens in cats go.

They have always been fed corn, it's the other crap, steroids, antibiotics that concern me.

Unfortunately, all food seems to be getting riskier. Every other week, there's a new food to add to the list of "not safe". But, we gotta eat something.

Do you know what his T4 levels were? Early symptoms of hyperthyroidism can be vomiting and diarrhea mimicking some IBD symptoms. It's also possible for cats to have a 'normal' T4 but actually be hyperthyroid. I'm assuming that his levels were low and not grey zone, but you might double check that, even though it does sound like its probably more likely IBD or lymphoma. 

missmimz said:

 
Do you know what his T4 levels were? Early symptoms of hyperthyroidism can be vomiting and diarrhea mimicking some IBD symptoms. It's also possible for cats to have a 'normal' T4 but actually be hyperthyroid. I'm assuming that his levels were low and not grey zone, but you might double check that, even though it does sound like its probably more likely IBD or lymphoma. 

Click to expand...

His T4 is good. At the very beginning, all of his blood work was really good. He was very mildly anemic and had elevated monocytes earlier this week, though.

He hasn't had any diarrhea, and no vomiting other than the first two vomits that sent us to the vet last month. He had another normal x-ray yesterday, and seemed to feel better yesterday evening. He eats a few bites of food now and then, but he acts very hungry and interested in food. We've tried cooked chicken, meatballs (homemade, garlic free), tuna, treats, dozens of different wet foods...nothing gets more than a few bites and then he gives up because it seems like it's hard for him to chew and swallow.

We're thinking of having a dental cleaning to check for FORL.

I hate seeing him like this but I don't know if he's ready to go or not. I'd feel so awful if we had him PTS without doing everything we could. I also feel awful seeing him starve himself.