Sasha-Heart disease, persistent fluid and possible lymphoma?

Brief History:

• Sasha is 11 and has been with us for 10 years. She always had a heart murmur.
• She had throwup 3 years ago, and she was put on Hills I/D food, and was fine. No other issues.
• Last June (2015) she started having diarrhea. 
• She was diagnosed as hyperthyroid and we started with tabs, then gel, she had some skin side effects which resolved, and after having blood work every 6 weeks for last 6 months to adjust the dose, her thyroid is now in the normal range
• But her diarrhea continues, so before starting pred for possible IBD, due to heart murmur we did an echocardiogram on Feb 4th 2016, and they found she was in congestive heart failure with chest fluid. Pred was ruled out.
• Mid Feb, started 1/4 aetonol to relax heart and 1/2 lasix for chest fluid
• 2 Weeks after lasix, the kidney bloodwork came back normal
• Last Friday Mar 11th I noticed she was breathing hard with 60 breaths per minute, took her to vet for xrays but they ruled out plural effusion
• Did repeat cardio on this Tue Mar 15th to see if she is responding to heart meds. Her left atrium dilation had reduced, her left ventricle is still thickened so we are doubling aetonol to twice a day, waiting for liquid meds. We will measure heart rate again after 2 weeks, it is 230 now, expect it to go down to 160.
• But the cardiologist was extremely concerned that in spite of Lasix she has chest fluid. She had lost a pound in a month, continues diarrhea and sometimes food/bile spitup. The cardiologist mentioned that the fluid is NO longer due to heart, but possibly due to cancer
• My vet recommends starting Luekeran, since she says fluid around chest cannot be just IBD but likely lymphoma.

My question is should I

a) Try probiotics hoping it is IBD?

b) Or still go ahead with pred as she is on Lasix to help with the fluid?

c) Or budesonide, is that effective?

d) Or start chemo? Reading side effects makes me very hesitant.

Is a scan helpful, from what I learnt with Nico, IBD vs lymphoma is not easily distinguished.

My 2 cats (Nico & Sasha)  had NO notable issues except the yearly vet checkup for the last 10 years. Nico has IDB which was easily controlled by 1/2 pred. Just lost Nico 3 weeks ago, within 5 days of kidney diagnosis.

We thought we had Sasha under control with the heart meds, but the lymphoma possibility is completely out of the blue.

It is an understatement to say that I am overwhelmed.

T put a face to the name, Sasha is the pretty black and white girl, next to Nico

I don't have experience with lymphoma BUT it could be detrimental to start chemo without a biopsy-they need to know what kind of cancer or other? before treatment. I wonder if its inflammation rather than lymphoma? The best way to determine what to do=biopsy. Otherwise you will be shooting in the dark about what to do and could have problems down the road.

Probiotics won't hurt her and will be helpful either way.

I have been on the lymphoma site for three years and learned so much from them-yahoo groups lymphoma feline discussion in yahoo groups. (my former angel Flash had bone cancer-so joined trying to get answers) I hope that they can figure out why the fluids are appearing in the chest. This must be so scary! Sasha is a beautiful girl!

foxxycat said:

 
I don't have experience with lymphoma BUT it could be detrimental to start chemo without a biopsy-they need to know what kind of cancer or other? before treatment. I wonder if its inflammation rather than lymphoma? The best way to determine what to do=biopsy. Otherwise you will be shooting in the dark about what to do and could have problems down the road.

Probiotics won't hurt her and will be helpful either way.

I have been on the lymphoma site for three years and learned so much from them-yahoo groups lymphoma feline discussion in yahoo groups. (my former angel Flash had bone cancer-so joined trying to get answers) I hope that they can figure out why the fluids are appearing in the chest. This must be so scary! Sasha is a beautiful girl!

Click to expand...

Thanks. Agreed on chemo, what if she does not have cancer?

I believe biopsy needs anesthesia, and her cardio report says avoid general anesthesia due hypertrophic cardiomyopathy. I will ask my vet. The report says she cannot even tolerate IV fluids.

Yes they have protocols for this. You need a board certified cardiologist or internal medicine vet at the minimum.

Opps scratch that-just reread your first post. On phone. Wont let me edit. I see you already have a cardiologist. Hmmmm. Stumped.

Thank you, yes, the cardio report after 2 full echocardiograms advises against anesthesia as she has severe congestive heart disease.

My vet says Leukeran can help with both cancer and if not cancer, still with IBD.

She is against any steroids as they can cause heart failure.

What would others do in this case? Start Leukeran OR let her be as is and just manage her heart disease and thyroid?

As an update, the vet is recommending Leukeran but she says she does not start many cats on that, so we are seeing an internist on Monday.

I am very hesitant on Luekeran if that means she has to be isolated. Also starting probiotics today

nicosasha said:

As an update, the vet is recommending Leukeran but she says she does not start many cats on that, so we are seeing an internist on Monday.
I am very hesitant on Luekeran if that means she has to be isolated. Also starting probiotics today

Click to expand...

Hey, I am checking in to see how Sasha's appointment with the internist went today? Please update when you can. I am hoping all is well!

Oh no I am so sorry that you have to deal with this so soon after your loss of Nico.  

I am really hoping that everything went well at the internist yesterday. I hope Sasha is doing better.

Hi Mukkia,

Yes it was late in the afternoon and took 3 hrs. She had a scan that showed thickening of intestines and enlarged lymph nodes (something about mesentery  ) indicating lymphoma. The internal medicine specialist said she is not candidate for biopsy or steroids, so we have to start chemo Leukeran 2 mg every 3 days. Waiting for her bloodwork results. Good news is she said Sasha does not have to be isolated. Just need to wear gloves while handling the medication and litter.

We will have to see how she responds in 2 weeks, followup bloodwork, hopefully she will be able to eat and be her normal self with the drug. And her diarrhea and weight loss get under control.

Along with her heart disease and lymphoma, her prognosis is around a year. 

I will sign up on the feline lymphoma yahoo group that @foxxycat mentioned.

Given this on top of Nico's sudden passing I am kind of numb, atleast she is giving me some time unlike him.

Zed Xyzed said:

 
Oh no I am so sorry that you have to deal with this so soon after your loss of Nico.  

Click to expand...

Tell me about it.

As listed in my OP, I have been working with Sasha's symptoms and treatments since June 2015, the thyroid, heart failure and now the lymphoma. And thinking about how she is the younger one but has these host of health issues. Crying over these diagnosis especially the heart in early Feb.  Spending hours with the vet for diagnosis, treatments and followups, her thyroid took 6 months to get right dosage. Spending atleast $300 upto 1K a month on her for the cardiograms, scan, bloodwork, specialists.

AND in the middle of all this...

Nico who had stellar bloodwork as of Sept, and NO other symptoms, just collapsed and passed away within a total of 6 days from start to finish. Now I am not sure what to feel? Sorry for Sasha who has all these diseases and is slowly passing away? Or cry for Nico who was silently dying and is now gone?  Maybe his weight loss that I missed thinking he is the healthy one?

When it rains it pours, my cats are teaching me some life lessons.

Zed Xyzed said:

 
Oh no I am so sorry that you have to deal with this so soon after your loss of Nico.  

Click to expand...

Oh and thank you for your thoughtful concern about Nico, when you see both their stories together, you can imagine why it is so much harder and guilt ridden.

nicosasha said:

Hi Mukkia,

Yes it was late in the afternoon and took 3 hrs. She had a scan that showed thickening of intestines and enlarged lymph nodes (something about mesentery ) indicating lymphoma. The internal medicine specialist said she is not candidate for biopsy or steroids, so we have to start chemo Leukeran 2 mg every 3 days. Waiting for her bloodwork results. Good news is she said Sasha does not have to be isolated. Just need to wear gloves while handling the medication and litter.

We will have to see how she responds in 2 weeks, followup bloodwork, hopefully she will be able to eat and be her normal self with the drug. And her diarrhea and weight loss get under control.
Along with her heart disease and lymphoma, her prognosis is around a year. 

I will sign up on the feline lymphoma yahoo group that @foxxycat mentioned.

Given this on top of Nico's sudden passing I am kind of numb, atleast she is giving me some time unlike him.

Click to expand...

I am so sorry to hear that! I know that this must be hard for you. :-(
I don't know if this helps any, but I found a few sites that talk about IBD and mesenteric lymph nodes. So, maybe there is more hope? Or, maybe at least a second opinion? Either way, the good news is that the Leukeran manages both IBD and lymphoma. I am seriously sending you big (((((((hugs)))))))!

Here is one of the sites I found.
http://www.allfelinehospital.com/inflammatory-bowel-disease.pml

nicosasha said:

Oh and thank you for your thoughtful concern about Nico, when you see both their stories together, you can imagine why it is so much harder and guilt ridden.

Click to expand...

You have done everything you can. I think you are a very good furbaby mom! :-) :-( you have been through a lot.

Mukkia said:

I am so sorry to hear that! I know that this must be hard for you. :-(
I don't know if this helps any, but I found a few sites that talk about IBD and mesenteric lymph nodes. So, maybe there is more hope? Or, maybe at least a second opinion? Either way, the good news is that the Leukeran manages both IBD and lymphoma. I am seriously sending you big (((((((hugs)))))))!

Here is one of the sites I found.
http://www.allfelinehospital.com/inflammatory-bowel-disease.pml

Click to expand...

Hi Mukkia,

They are convinced it is lymphoma since the unresolved fluid around the chest inspite of Lasix (the diuretic)  is usually a symptom of cancer and not IBD. And these are the top specialists in the DC area, the Hope advanced veterinary care. Her heart specialist and her primary vet have the same conclusion as the internist. So essentially three different vets.

Anyways after few years, from what I have heard IBD likely morphs into lymphoma which was a possibility with Nico, though maybe he was on prednisolone for 3+ years for his IBD, so his scan did not show it. 

Yes I am hoping she responds to the Leukeran and improves with no major side effects. Any time my family can get with her is appreciated.

nicosasha said:

Hi Mukkia,
They are convinced it is lymphoma since the unresolved fluid around the chest inspite of Lasix (the diuretic)  is usually a symptom of cancer and not IBD. And these are the top specialists in the DC area, the Hope advanced veterinary care. Her heart specialist and her primary vet have the same conclusion as the internist. So essentially three different vets.

Anyways after few years, from what I have heard IBD likely morphs into lymphoma which was a possibility with Nico, though maybe he was on prednisolone for 3+ years for his IBD, so his scan did not show it. 

Yes I am hoping she responds to the Leukeran and improves with no major side effects. Any time my family can get with her is appreciated.

Click to expand...

Awe, I am so sorry, but I am so glad that they gave you a lot of positive news. Medicine, and a sort of long time. Yes,I didn't think about the fluid. Can they pull some of the fluid out and send it to a lab? I guess that doesn't really make a difference. I am so sorry again. I am just one of those people that always tries to have hope beyond hope. Plus, I am so guilty of not completely trusting veterinarians. However, my situation is completely different than yours. My heart truly goes out to you. I know you are going to join the other group, but will you please continue to update here from time to time?