Suspected Lymphoma. What to expect?

So, I'm now in month six of battling what I and my vets had thought/hoped was IBD with my sweet kitty Ruby. I'll give more of her history below to give you some context, but basically her primary vet strongly suspicions lymphoma. It can't be confirmed without biopsies that I've decided not to subject her to. I've also decided no chemo if it is cancer. I just kind of wondered what those who have been through this experienced and maybe there are some things I could be doing or watching for to help see if this is a bad IBD/triad flare up she might recover from or not?

This all began in September, after a few weeks of smaller, harder stools she suddenly lost all interest in food and became lethargic. I discovered she'd lost 2 pounds. After not responding to antibiotics or DepoMedrol, her liver enzymes sky rocketed. An ultrasound showed minor thickening of the duodenum, and some liver and pancreatic inflammation (tests were neg for pancreatitis). We did mirtazapine for appetite and B-12 injections for cobalamin deficiency. By Thanksgiving she seemed to be doing well, but then she suddenly developed severe non-regenerative anemia. We started prednisolone 5mg daily, but my vet honestly didn't think she'd make it through the holidays.

But she did and seemed to be improving. She was eating and gaining weight. I switched her to a single protein (turkey) grain-free food. We tapered the pred to every other day, but then it all started back up. I went back to every day on the pred, but she started a cycle of 4-5 good days, followed by 2-3 bad days. A couple weeks ago she started acting confused, sleeping 22+ hours in the same spot without moving and going outside the litter box. We found her anal glands were swollen and expressed them and started clavamox in case there was any infection. New blood work showed folate deficiency, declining hematocrit and elevating liver enzymes again and she was losing weight. We upped her pred to 7.5 mg for a week, but I haven't seen much response and her "off" days are coming at more frequent intervals now.

Although the internist was noncommittal, her primary vet has suspected lymphoma all along based on her blood work and lack of response to any treatment—things that in her experience happen less in IBD kitties than lymphoma kitties. I get excited every time I get her to perk up, but each time it's less perky than the last. It's been a long battle of ups and downs and it's only getting harder. Aside from the home care I've been doing, I'm basically out of treatment options without additional tests that I'm unwilling to do (and the vets aren't advising either). But it's hard to not to feel like I'm giving up on her. I certainly don't want to throw in the towel before she does. At least we still snuggle all the time and she only wants to purr and be curled up with me 24/7, it breaks my heart to have to go to work!

I am so sorry.  You are doing all you can do.  Keep her as comfortable as possible, lots of love and let her eat whatever she will eat.  

I have a bit of information for you. Ive known several cats who responded to chemo. I have also had a cat who we didnt have time to do chemo on her but maybe some of this information can help make your four legged friend be abit more comfortable...

would it be possible for the Internal vet to do an ultrasound and fine needle aspiration guided by the ultrasound? although because steroids are being used it may not be possible to determine cancer without stopping steroids for 14 days but i just wonder if another ultrasound would help.

Has your cat been tested for whats called hemobartenella (sp?) it is a parasite from fleas that can cause anemia and treatment is a round or two of doxyxycline. I would ask about this.

also just because she tested neg for pancreatitis it doesnt mean she doesnt have it. some cats test neg for it but have clear symptoms of it. My girl did. sometimes it does cause infection. and that is usually treated with: pain meds. sub fluids. doxy for infection. cerenia for nausea. pepsid for tummy acid.and appetite stimulants.

Also pancreatisis is very painful. My angel Floey struggled with constipation all her life.she also got a few bouts of pancreatitis. Canned pumpkin and miralax were a staple in her diet. pepcid helped her imensely as well as cerenia and sub fluids. she would perk up after her sub fluids and eat. We chose to do her medications as injections due to less stressful than pilling. Which she would not allow. Even the vets wouldnt be able to.

I am not sure if it is or isn't lymphoma without a biopsy but she definately will feel yucky if she is anemic. What is her white blood cell levels?

Theres a group on yahoo and facebook called feline lymphoma . the facebook one is called feline intestinal lymphoma and there are several people who can walk you through the steps of treatment. I wanted to mention that chemo in cats is nothing like it is in humans. they can help you find an oncologist who would work with your internal vet if you want. they also have a very good vet who answers questions-this is the yahoo group. Dr Jory in Atlanta. He has answered many questuons and has much experience with feline cancer and the chemistry behind treatments.

Depending on what it is we are dealing with there are options to give medications at home vs iv drip. If its small cell they have a med that is taken once every 2 weeks as well as pred. It may be worth just finding out exactly what you are dealing with.

chemo in kitties has a routine of two days before chemo treat with sub fluids cerenia then another two days after. usually this helps the cat not have symptoms as sub fluids hydrate and help flush out the toxins cerenia helps with nausea.

In the meantime I will be sending you prayers and vibes that you can get some answers soon.

For appetite you can feed meat babyfood. gerber and beechnut has four flavors and most cats love it. only make sure no onions or garlic.

Keep us posted. Hoping things get better soon. I do understand how overwhelming this information can be as sometimes we never get a clear diagnosos but instead we aim to treat the symptoms.

I'm so sorry you and Ruby and going through this.  You are both in my thoughts.  

Foxxycat, thanks for your reply. I think I am going to speak to the internal medicine doctor again next week—or sooner if things don't go well—just to see. She did mention a fine needle aspirate when we first went in in October, but I don't know if the pred would affect those results. My regular vet is very attentive and helpful, but she's basically said anything further would require an internist and she's not optimistic. She hasn't meant it in a discouraging way, just doesn't want to give me false hope.

We know we aren't dealing with any parasitic infections, but I do wonder about pancreatitis. It was suspect initially, but her liver was more inflamed (and her liver enzymes now indicate that's probably still the case). I believe her white count was close to normal, or has never indicated any infection. But she does keep flirting with anemia.

As far as feeding, mirtazapine works well if I can get it in her (she also will not be pilled). I usually crush pills up in whipped cream, but if she's off food I do have liquid. Syringing it to her is a nightmare, but sometimes I get it in! She's a fussy eater. She won't eat any kinds of wet foods or baby foods—she won't even eat real meat except for lunchmeat. But lately she throws that back up so I haven't done it in awhile.

I've read the cancer treatments over and over. We've just been through so much. The improvements have been so small and she's nothing like her normal self. I worry that any cancer treatment could just turn into perpetuating this state for years, which I don't want for her. Vet visits are a nightmare for her. They have trouble doing blood draws and her hair starts falling out whenever we go. I can't ask her to make more regular trips there for treatments. I'm torn there. If you'd asked me months ago if I'd do anything to save her life I'd have said yes. But after months of this I'll only say "Yes, if it's not torture for her." I second guess every action I've taken so far, but I suppose that's natural.

I will keep everyone posted. She's been curled up on the sofa for almost 20 hours. Time to see if I can get her medicated for the night.

I am so very sorry for you. I was afraid it was going to go this way. But at least you tried looking at the options. Some cats are good patients..some cats turn into hellcat. Sending you healing vibes...if nothing else you can do sub fluids at home to help keep hydration going.

foxxycat said:

 
I am so very sorry for you. I was afraid it was going to go this way. But at least you tried looking at the options. Some cats are good patients..some cats turn into hellcat. Sending you healing vibes...if nothing else you can do sub fluids at home to help keep hydration going.

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Thanks. She's really sweet mostly, just not one for vet visits and meds. I'm going to talk about getting some of her meds compounded as transdermal gels. Last night I had to syringe her with salmon juice mixed with mirtazapine, cerenia and prednisolone. Usually I don't syringe, but when she's off food I can't crush up pills into anything she'll eat. She went from rag doll to mountain lion in about 20 secs (she's a jaw clenched and head whipper). But at least I got it in her and she's eating again for now.

Fortunately we haven't had to do sub-q fluids. She drinks tons and hydration hasn't been an issue yet, though the pred probably has something to do with that. She likes me to pour water for her directly from a water bottle now. She's spoiled

I talked to the internal medicine vet today, she wants me to increase her prednisolone to 10mg a day (given twice a day in 5 mg doses) for a week and see how we do. She said the next step would be a biopsy to confirm or deny lymphoma, but without that this is about the most we can do. But she did say to get back in touch and see how things are going after a week and we'd go from there. So, we'll do this and I'll just keep her eating and loving the best I can. I can't get any of her meds as transdermal gels, so I guess we'll keep with the syringes until she'll take it with food again.

for pilling I discovered a trick=get some empty gel caps- I think the ones I use are #3. Put the pred and all the others into it- then coat it with butter-get yourself a pill buster or pill popper. This makes life so much easier. You could get a number #2 and #3 size- I know the pred is 5mg each and you would need a bit bigger gelcap to put those in. you may have to break it up and tip the paper to slide the crumbs into the larger half of the empty capsule. I just coat it with butter and pill pop it in her mouth after I syringe a few dabs of water-then after pilling do the same with the water...it makes so much easy and my pumps doesn't let me open her mouth a lot. I just have to pull up on her top of mussle and the mouth opens enough to get the pill popper inside. then follow with water...then treats

Here is one site that explains the sizes: http://www.thrivingpets.com/index.php/gelatin-capsules.html   you can get better prices on Amazon or other discount sites. Thriving pets is a good site but they are pricey for some of the medications but looks like the caps are not unreasonably priced.  but if you want ease of ordering and fast shipping they won't disappoint.

Here is the pill popper I use: http://www.thrivingpets.com/index.php/pet-piller-pill-popper.html

when you put the capsule in it=only butter the larger half of the pill otherwise it slides right out and doesn't stay in. I learned the hard way. The larger end goes outside and that's the butter end-it will be fine. most cats love butter and this just helps it slide down the hatch better. I will try to video tape pilling pumps so I can show you how I do it. The other thing is have the cat up higher so you don't have to bend over. I have this medium tree that is a cat post--I sit her ontop of it and put it up against the corner cabinet-she can't back away and high enough for me to pill her. Avoid slippery counters=they will slide away!

foxxycat said:

 
for pilling I discovered a trick=get some empty gel caps- I think the ones I use are #3. Put the pred and all the others into it- then coat it with butter-get yourself a pill buster or pill popper. This makes life so much easier. You could get a number #2 and #3 size- I know the pred is 5mg each and you would need a bit bigger gelcap to put those in. you may have to break it up and tip the paper to slide the crumbs into the larger half of the empty capsule. I just coat it with butter and pill pop it in her mouth after I syringe a few dabs of water-then after pilling do the same with the water...it makes so much easy and my pumps doesn't let me open her mouth a lot. I just have to pull up on her top of mussle and the mouth opens enough to get the pill popper inside. then follow with water...then treats

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This is a good trick to know, thanks! I have so much trouble getting her mouth to open at all, but lately I've had luck syringing. I've just been crushing her pred, mirtazapine and cerenia up and mixing with a small amount of salmon water. I use an infant syringe with a wide diameter so all I have to do is quickly squirt it in in one shot. Seems to be working for now. It's just impossible to syringe larger volumes of fluids because it ends up all over her face and me! And most of the liquid versions of the oral meds are higher volume.

well the mirtazapine and pred taste HORRIBLE!! doesn't matter if compounded into a liquid-you have to be good at aim and shoot so to speak then follow with something yummy otherwise yuck. these meds can cause foaming at the mouth too because they are horrible..my angel Floey..she used to foam so bad when I just tried to get 1 quarter tablet of Pepcid into her...I ended up getting injection meds for Pepcid. unfortunately injection pred has some risks and pill form works best. Transdermal gels don't work as good as they claim. The particles need to be small enough to pass the blood barrier in the blood vessel in the ear. Some people have had good luck with it. I tried it and the meds didn't work. injection was the only way I could get it in her.

Thank goodness pumps allows me to use the pill popper..I have a method of using my pincher fingers on the upper jaw and tilt head back with other hand-then quickly get the pill popper in her mouth and the capsule goes done the shoot. It's important to wet the mouth before and after administer of meds..

I learned quickly that the liquid mirtazapine tastes nasty, so I switched to the pills. The pred she doesn't mind so much. For months I've been grinding up her pills into ReddiWip and that's worked amazingly well, but when she's nauseous she won't eat it so I have to resort to syringing. The vet did tell me that transdermal won't work for these meds, but the salmon syringe seems to be working effectively. Once I get the technique down so I can be sure I'm not losing any of the dosage in the mixing process, I think I'll be golden. At least until she'll start lapping up her whipped cream again

Today has been a tough one. After upping Ruby's prednisolone to 10 mg a day, she seemed to be doing much better. Eating and pooping regularly, a little more active. Her internal med doctor wanted to start tapering the pred, but I called her regular vet and asked if we could recheck blood work before making any changes. Most values were good, but unfortunately she is severely anemic. Her hematocrit is down to 12. Her white count wasn't elevated. Her bone marrow is simply no longer producing red blood cells. We suspect she has had lymphoma and it has gone into her bones. The prednisolone helped as long as it could, especially in the liver/GI area, but it's not helping now. There's really no treatment recommended so it's looking like we've just got a week or two left together.

Yesterday was our 9th anniversary together, making this all the worse to deal with. So, for now, I'm just keeping her as comfy and stress free as I can. The vet said the end likely wouldn't be painful or traumatic, she most likely just won't wake up some morning. So now I guess I just wait and get as much out of our time left together as I can.

I am so sorry..five years ago lost my little dark choc tortie to bone cancer..same thing..except I couldn't get her to take the pred...The transfusion could buy you time but maybe it's best to let nature take it's course. I am so very sorry. I remember how scared and sad I was in 2012 when Flash had to be sent onward. Just give her all your love, hold her and keep eye open for end of life transitioning. Sometimes death is not pretty. Be  aware that it may be better to help her along sooner rather than later. Things to be on the watch: uncontrollable vomiting, panting, lethargy that is not responding. The oxygen levels are now at a critical level. You may get a week. or a month. Hard to say, the pred is probably holding her stable-which is why she is eating and drinking. The pred def helps stave off the bad effects of cancer.

=if her immune system was attacking the red cells the pred is thought to stop this but sometimes it doesn't work. I am so very sorry for you. Sending you every good thought that maybe ... I can't even put it into words..,. tears in my eyes..eyes leaking..damn allergies.. So very sorry. You did the very best you could...yelling at the universe flailing my arms around at the universe to stop this!    

Yeah, I think honestly at this point the stress of a transfusion would kill her. The vet said no more blood tests or visits because she's too worried the stress will cause a heart attack. I am hoping she goes peacefully and I hope I'm with her when it happens, but if things get critical I will help her on. We kind of feared this from the start but tried like hell to fight it and hoped it was something else. She was severely anemic in November and it we knew then it was non-regenerative, but she rebounded miraculously when we started pred. But if you're dealing with cancer, and we didn't know and still don't for certain, it only works for so long. She's the closest bond I've ever formed with a kitty and to be losing her so soon is beyond brutal. But I took the day off work and I'm gong to spend it and the whole weekend snuggled up with my baby.

Thank you for being with me. It's a pain that's somehow both familiar and unique—everybody has been through it, but nobody can truly share it with you.

Here's a couple pics of my Ruby. The first from the very first year I had her, she was about 9 months old. The second is her today.

My heart goes out to you. She is a lovely lady with what sounds like amazing people by her side. I completely empathize with your pain. I knew I loved my Mak of 9yrs, and that we had a very close bond, but I'll be damned as I wasn't prepared for this world of hurt as his health is suffering. He might as well be my actual child at this point. He has been officially diagnosed with small cell lymphoma, after months of vomiting, a week of an ultrasound, aspiration, and an emergency surgery and as of last week, he now has an e-tube in place to feed him (and make it easier to medicate him). But of course, Mak is an unusual poly-dactyl (6 toes on the back, 5 on the front), so he does nothing the usual or easy way, apparently.

Anyhow, I was reading through your thread looking for some possible new info or insight, and then kept reading because I wanted to make sure I didn't have anything new to add to your journey. There are only two things I would add to this discussion-

One is I was able to get a hold of transdermal gels for mirtzapine and prednisiolone, shipped from Wedgewood Pharmacy out of NJ (I am in Cali). I can post more details if you are still interested in them at this point.

Second is I might recommend you check out Life Gold. I came across it a week or so ago and bought some. I talked it over with my vet and he said it couldn't hurt. It's cheap, it's all herbs, and it has 300+ reviews with almost a five star rating. What tipped me over the edge to buy it was a women struggling with a cat dealing with cancer, at the end of their rope of options, so she figured why not. She also had a science background and discussed the different trials possibly demonstrating efficacy or not.. Her experience sounded like a solid, grounded review with her seeing some optimistic results. Anyhow, check it out here if you're interested.

https://www.petwellbeing.com/produc...0RrtbvMMhv5d5yaU7JGshlPWWIx1ph6PaoaAo6d8P8HAQ

Again, my thoughts, hugs and heart are with you guys. This shit sucks in a very big way and the journey is an enduring one. No matter what, cuddles and purrs are the best, for everyone involved. Much love and many many hugs.

MamaMakAttack said:

Again, my thoughts, hugs and heart are with you guys. This shit sucks in a very big way and the journey is an enduring one. No matter what, cuddles and purrs are the best, for everyone involved. Much love and many many hugs.

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I don't know how I didn't see your post sooner! So sorry to hear about your Mak. Ruby is a polydactyl too, I feel like they have magical powers.

Ruby is still hanging in there. We had quite a few good days last week and into the weekend. We've kind of hit a spot where she's slowing down and not really wanting to eat even with mirtazapine. But she likes ham and ice cream so she's getting as much as she wants! Really, that isn't a whole lot but she's going to get whatever she loves at this point. She eats more if I encourage her to eat food out of my hand.

I did have to switch to a non-clay litter. I discovered her eating kitty litter and it turns out that's a symptom of very severe anemia (apparently they eat small rocks and litter because they crave minerals as they become depleted). Something to keep in mind if you're going through this with your kitty at some point. My vet recommended Lixotinic as a blood-building supplement. I didn't order any because I'm not sure how much time we have left and I don't want it to be filled with traumatic syringing episodes. But it might be something you could look into in the future. I wish it's something that had been recommended much sooner—but I really don't think my vet expected her to still be with us. I'm so proud of her for fighting so hard.

Unfortunately I've come to realize that by the time I was aware there was a problem we were most likely already in stage 4 lymphoma, transitioning in to stage 5 (which is bone marrow involvement). It's been really hard on me not knowing for sure what's going on, but I know it was in her best interest not to do additional tests. Somedays are good and I get so excited I almost forget what's coming, and then some days I just start crying in the middle of the grocery store. It's been the hardest six months of my life so far and I can empathize with you completely on your journey too. I hope it's going well!

Re: crying in the grocery store... exxxxactly. some moments i am at peace with everything and then wooosh im a ball of tears. it's nice to know however though that other people are just as affected by their kitty's health. happy or hard. hugs hugs