Biopsy or start chemo? Possible IBD or lymphoma

nessa323

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If you have any experience with a cat with inflammatory bowel disease or lymphoma, I would greatly appreciate your input:
I have had my little best friend Noodles since he was 9 weeks old and now he's almost 11 years old. A few weeks ago he started vomiting and was barely eating. After multiple appointments, bloodwork, an ultrasound, and trials of different diets and medications, the conconclusion was that he most likely had inflammatory bowel disease rather than cancer. He has inflammation of his liver, intestines, and pancreas. Therefore he continued to stay on a venison and pea diet and he was started on Prednisolone, Cerenia, Mirtazapine, a probiotic, and B12 injections. He started doing much better, the vomiting stopped and he started eating a lot more. However last week the inflammation had spread to his eyes so an opthalmologist put him on two types of eye drops (but the Tropicamide drops were discontinued since it was causing him to salivate and stop eating). They won't know yet if he'll go blind or not, but now the opinion of all the doctors is that it could be cancer since the inflammation has spread. I know there's no test that can determine if it's IBD or cancer and that only an endoscopy or biopsy can attempt to diagnose them. Therefore our only options we really have are: 1) Have him go through a surgical biopsy which is not only risky since it's a surgery, but to get good results it would require him to get off of the Prednisolone that's currently stopping his chronic vomiting 2) Start him on Chlorambucil that could help him if he has small cell lymphoma, but wouldn't help him if he has large cell lymphoma and could of course have very bad side effects.
The decision is very difficult, both have risks. I'm going to look into a holistic vet as well to see what options they might have. I was just wondering if anyone had any experience and could share their opinion because it is all so difficult for my husband and I to figure out what is best. Thank you for your help.
 
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nessa323

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M missmimz a few weeks ago when they had run extensive tests I am pretty sure I remember them mentioning that his thyroid was normal. I have definitely been interested in raw feeding, unfortunately though he has been extremely picky with food and since some of his medication weakens his immune system I've heard it could be a little risky putting him on a raw diet right now. However I will definitely check out those links regardless, thank you very much!
 

missmimz

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@missmimz a few weeks ago when they had run extensive tests I am pretty sure I remember them mentioning that his thyroid was normal. I have definitely been interested in raw feeding, unfortunately though he has been extremely picky with food and since some of his medication weakens his immune system I've heard it could be a little risky putting him on a raw diet right now. However I will definitely check out those links regardless, thank you very much!
There are a lot of raw IBD feeders, but you have to decide what is right for your cat. You could try homecooked first, which is what a lot of people do that aren't ready or comfortable with raw. EZcomplete, is a great pre-mix you can use for cooked or raw foods. It was created by two former members here that run the IBD group. They are awesome smart women that do a lot of scientific research about cat nutrition and IBD and really know what they're talking about. Good luck :) 
 

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Hi Nessa - I'm so sorry that Noodles isn't doing well. You and your husband have options and choices - I don't think that there is a right or wrong choice here and I know that makes things even harder because of all the what-ifs.  If I could offer any advice, it would be to skip the surgical biopsy, and that is simply because of my experience and my vet's advice.   

I went through something very similiar with my Kami two years ago.  She was 13 and starting to eat less and less, and vomiting more and more.  Bloodwork seemed fairly normal so we treated it like pancreatitis or IBD.  I would say she see-sawed for a couple of months.  We then decided to do an ultrasound which showed some thickening of the intestine and a questionable lymph node.  The vet felt that it might be lymphoma vs. IBD and I was devastated.  

We talked through the options (for the record, my vet said if it was her cat, she would NOT biopsy).  I was paralyzed by the what-ifs:  my vet didnt want to do chemo without confirmation biopsy and I was sick worrying:  what if I dont do the biopsy and it is lymphoma and I could have prolonged her life?  What if it is simply IBD and I can get things back on track through diet change?  what if it is something else that can be easily dealt with through surgery?  I was desperate for someone to tell me this could be fixed  Needless to say, I couldn't think very straight and it took me a few weeks to decide what to do which was a surgical biopsy.

Well, we did the biopsy and it was inconclusive, so we were no further ahead.  Now I am regretting doing the biopsy as I am sorry that I put Kami through that stress and invasiveness.

Strangely, Kami seemed much better after the biopsy and had a couple of months of eating fairly normally and very little vomiting.  Then she started declining: not eating, vomiting what she did eat, losing weight, low energy.  We went back to the vet and bloodwork indicated lymphoma.  I decided to start steroid treatment only and give Kami lots of love.  Diet be damned, if she would eat it she could have it.  That meant kibble (she'd been off it for years because she had developed diabetes which we reversed through diet), Temptations treats, wet food - anything she wanted.  She was my darling.

love to you and Noodles
 
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nessa323

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@Pipperoo  Thank you so much for taking the time to share your advice and story!  I originally skipped the biopsy because I had concerns about putting him through surgery in his fragile state, and also because the radiologist felt that his ultrasound showed more signs towards IBD than lymphoma.  However I later started to wonder if I had made the wrong decision after he didn't seem to improve as much as the vet thought he would on the Prednisolone.  I started to feel guilty for not doing the biopsy because I wondered if that could have given us a better answer.  However looking back at it now, my husband and I both feel that skipping the biopsy and trying different diets and medications first was the best choice we could have made based on his test results and on the opinion of the radiologist.  Now though, we have considered biopsy again since his inflammation had spread to his eyes and we want to get a more definitive diagnosis so we can try to help him better.  But then again we have been going back and forth with how we felt about it because even though we of course want to try to get a more definite diagnosis, we know that there's always risks with surgery and especially now with him already being on a steroid.  At this point, we want to wait at least a few more days and see how he continues to do on just the Prednisolone alone.  Then we feel like if he stays the same we will keep everything how it is, but if he gets any worse then we'll have to think about trying a chemo pill (Chlorambucil) to see if that helps him.  I have always felt very scared of doing the biopsy, and then I read your story and it made me feel more confident in my choice not to have one done.  I'm so sorry to hear that yours was inconclusive, that's of course all of our worst nightmares.  I feel like his primary vet and the two specialist vets probably want me to do one, and I can't figure out if it's really in his best interest or if it's for them to get money or something.  I was very surprised to learn that your vet actually said she wouldn't biopsy, that makes me feel like I shouldn't feel guilty for not having one done yet.  

Noodles is similar to Kami in that he hasn't eaten dry food in so long, he loved his wet food and the homemade food I'd sometimes make for him and his sister.  However now he only wants to eat dry food for some reason.  I always try putting his wet food out first and he might sniff it or lick it a little, but he prefers his dry food now, so I just feed him that since of course we just want him to eat.  He does eat a fairly decent amount and he hasn't been vomiting, but he has had diarrhea lately (the vet thinks it's due to his recent food switch) but other than that the medicine and eye drops have seemed to help him.  So of course it seems like we should just continue doing what we're doing and not change anything, however we're scared that if it is cancer he will slowly deteriorate and possibly go blind, which is why we're considering the Chlorambucil.  Not only is this very hard for us since we love Noodles so much, but my husband actually had to deal with cancer when he was younger (Hodgkins Lymphoma) and though his chemo helped him, it also caused some side effects.  In the end, though I of course want Noodles to live as long as possible, I mainly just want him to live as comfortably and happily as possible even if it means a slightly short life.  I would hate to prolong his life with tons of experimenting if he just ends up living in pain or dealing with side effects.

Again, thank you so much for sharing Kami's story with me, it has helped more than I can express.  I can tell she had an amazing mom that loved her very much and I'm glad that now she is at least not suffering.  If you ever just need someone to talk to, I'm here.
 

denice

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I have an IBD kitty that has been on Prednisolone for 6 years and I didn't have the biopsy done.  A kitty will have to come off of the steroid for a time before a biopsy is done.  The biopsy is to look at the inflammatory cells which the Prednisolone is suppressing.

This is the first time I had heard of the eyes being involved.  I don't think that is a normal thing to happen with IBD.
 

darkhorse321

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Talk to your vet about pepcid AC. My boy was having issues....at 16, I didn't really delve into testing for lymphoma because at his age, it was just going to be too invasive and for what purpose.(he just missed his 17th birthday by two weeks). We suspected lymphoma or IBD, but he'd dealt with megacolon his whole life.

Pepcid AC saved him from a LOT of vomiting. I gave him a 1/4 tablet morning and night and what a difference! In conjunction with a bit of cerenia, pred, bupe for pain, b-12 and fluids, he had some very comfortable days. In fact, I was able to stop the cerenia after awhile.

There's also a hard food/prescription out there for kitties with IBD---easier on their tummy--perhaps ask your vet about that too?

Also, get a pill cutter: That Pepcid AC is murder to split into quarters. Whoever thought a diamond shaped pill was a good idea obviously never had to break them up! ;)

Wishing your lovely kitty and yourself a Happy New Year!
 

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I can attest to Pepcid AC. my angel Floey did very well on it. no vomiting and increased eating. She was loosing weight and she had tumors inside her after an ultrasound that I put off for a month. The Cerenia Pepcid AC and subfluids were a life saver. She was unable to be pilled so the vet taught me how to administer shots and fluids. She managed to live her last 2 weeks quite comfortably. Had I known sooner about these meds I would have tried it sooner. She had a heart issue so we couldn't do pred. But the Cerenia really helps her nausea.

I have heard some cats do well on Chlorambucil. there is a group on facebook feline intestinal lymphoma that has several knowledgeable people who know all about these different medications. you could ask them what they think. They have other suggestions to try as far as medications. At this point you have nothing to loose. We have several members whose cat had large cell lymphoma who has reached a few years remission. It is scary to start but remember these cats are tough birds. the meds don't affect them like they do us.  

When they do chemo=the plan is= Cerenia, sub fluids, appetite stimulants and pain meds if needed. the two days before chemo is given=fluids are administered as well as Cerenia or Zofran. then the day of chemo fluids administered as well as Cerenia. this helps hydrate them and stave off any side effects. we do the fluids and Cerenia for 2 more days after treatment. hopefully this helps rest your mind that this won't be as bad as we think. I can personally attest to sub fluids being a life saver for a sick cat. It's starting to be a universal method of treatment in illness. The only thing to be cautious is heart issues. most times when they do the ultrasound of the belly ask them to do one of the heart. This helps save issues in the future if they have unknown cardiac issues. Often it's not that expensive since they already are there with the wand so not more than 15 minutes of their time to have piece of mind that the heart is stable.
 
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nessa323

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@Denice  Yeah that's one of my worries with doing a biopsy, I know that he'd have to be tapered off of the Prednisolone slowly and I know that during that time he'll stop eating again and start vomiting again.  I really don't want to take him off Prednisolone in order to attempt to get a diagnosis since there's always a chance the biopsy could come up inconclusive anyway.

I don't think the inflammation of the eyes usually happens with IBD either, so that's why they think it's possibly a form of lymphoma.  The eye issue is the main reason I'm considering the chemo, I don't want the inflammation to continue to spread, or make him go blind.
 
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nessa323

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@darkhorse321  My vet had briefly mentioned Pepcid before.  They said if he continued to vomit we could try it, but since he hasn't been vomiting we didn't want to add another medication to his long list of meds.  I have an appointment next week so I can ask them about it again, as well as the food.  However they've had me try multiple foods that they have approved for him, and he's been so picky that it's been hard to get him to eat much of any of them.  

At this point I really don't think there's any chance we'll do a biopsy, I feel that it's too invasive for his fragile body and I know that there's a chance he could go through it only for the results to be inconclusive anyway.  I don't think I'm willing to take that chance.  

I just recently got a pill cutter and though it's not as accurate as I thought it'd be, it's definitely a lot better than trying to cut them myself!

I'm sorry to hear your baby boy barely missed his 17th birthday, but then again it seems like he lived a great long life and I'm glad to hear he was able to have some very comfortable days.  That is my goal with Noodles, of course I want to prolong his life, but I also want to make sure the remaining time he has left is comfortable and happy!  Happy New Year to you as well, thank you very much for your advice!
 
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nessa323

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@foxxycat  I will definitely ask my vet about Pepcid during our appointment next week.  When we had tried to start tapering Noodles off of his Prednisolone he started to vomit again, so we added Cerenia and it helped to stop the vomiting.

Thank you so much for the information, I will check out the Facebook page.  I do believe cats are very tough little beings, I'm so proud of how strong Noodles has been through this whole experience.  It's too bad I hadn't known about asking them to look at his heart when they did his ultrasound.  I don't think they plan on doing a second ultrasound, but if they do then I will definitely ask them to include the heart next time.  The main reason they are thinking it's lymphoma rather than IBD is because of the inflammation spreading to his eyes.  Next week we have a follow-up appointment with the ophthalmologist, then the next day we see his primary vet again and that's when we'll talk about possibly starting the Chlorambucil.  I really appreciate you taking the time to share this information with me, having others share their experiences has helped so much through all of this!
 
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