Possible Lymphoma

Hello fellow cat lovers, 

I've been reading through some forum posts trying to get some peace of mind about my Lily.  She has been going through cycles of vomiting, diarrhea and not eating for months now. She has also been losing weight (about a pound over a few months). We have been back and forth to the vet and she has had multiple blood tests. The blood tests came back clean each time. However, her symptoms persisted. I'm very convinced that she is suffering from IBD or lymphoma. She is 12 years old (almost 13), so I have a sinking feeling we are dealing with Lymphoma. The vet just gave me an estimate for a final blood panel, ultrasound, and biopsy. After doing research, I'm really uncomfortable with the idea of a biopsy. I'm also not sure I am financially capable to doing a long-term treatment plan if she does have cancer.  The hardest thing has been the periods she only picks at her food...and the fact that despite the symptoms she acts like her normal self (she doesn't sleep more than usual, still runs about and plays -- though she has never been overly playful). 

I'm just looking for anyone to share their experiences with this unpleasantness. I also recently moved to a new State this year so the vet I'm working with is not that familiar to me. At this point, My instinct is telling to get the last blood panel and talk to my vet about options going forward if it is IBD. Medications, diet changes anything that I could do to help. Since I do not want to biopsy I know we cannot really confirm cancer. I have been doing a lot of Internet research about IBD, Lymphoma, raw food diets, etc but I am interested in some more personal anecdotes. Thanks!

It could well  be IBD rather than lymphoma.  I had the same issue about which it is with my cat and  I think everyone else has had the same issue.  I chose not to get an biopsy done, others have had it done.  I chose to go ahead and treat for IBD and that was over 6 years ago and Patches is still here.  I would ask the vet about trying a steroid, my kitty is on Prednisolone.  The thing with a steroid is that you can't go back after starting it and get a biopsy done without taking your cat off the steroid for a period of time.  If it is lymphoma the steroid should help slow the progress and give her more quality time.

Denice said:

 
It could well  be IBD rather than lymphoma.  I had the same issue about which it is with my cat and  I think everyone else has had the same issue.  I chose not to get an autopsy done, others have had it done.  I chose to go ahead and treat for IBD and that was over 6 years ago and Patches is still here.  I would ask the vet about trying a steroid, my kitty is on Prednisolone.  The thing with a steroid is that you can't go back after starting it and get a biopsy done without taking your cat off the steroid for a period of time.  If it is lymphoma the steroid should help slow the progress and give her more quality time.

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I think @Denice meant to  say "Biopsy", not "autopsy".  :-)

chachahowski said:

 
Hello fellow cat lovers, 

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I too had a cat with advanced IBD and he reacted quite well to predisolone and it bought him easily 15 months.  Your cat sounds like an excellent candidate for "Pred" regardless if it is IBD or lymphoma, both are usually treated the same way.  And a biopsy is not required, some people have them done, others chose not to and just treat and either is ok.  If she responds to treatment then you basically have your answer.  B12 injections, Cerenia for vomiting (miracle drug) and diet adjustment can all help.

Thanks @Denise and StephanQ! Lily returns to the vet on Tuesday and we are doing to discuss treatment options. I will make sure to ask about prednisone! I really hope it helps with the vomiting because aside from the gastrointestinal issues she acts like my perfectly normal kitty.

Well Lily got the results of her last blood workup back. It ruled out pancreatitis and any bacterial infections that could be the cause of her symptoms. Meaning we are left facing either IBD or lymphoma. My vet wants to do the ultrasound this week and she keeps bringing up doing a biopsy. I'm really unsure/uncomfortable with the idea of performing surgery on Lily. I keep asking to meet with the vet to discuss options face to face and she keeps sort of pushing it off. I do not feel I am able to make the best decision possible for Lily and for myself. Financially, it has been very frustrating to go through all of these vet visits and tests without getting any answers. 

I just feel at a loss about whether to biopsy or not. My gut tells me not to do it. I know a lot of people on here say that it is okay to decide not to biopsy, however my vet isn't being the most compassionate. She has the attitude that it is my responsibility to do whatever it takes to diagnose/treat Lily even if that is not a realistic possibility for me (financially or emotionally). I also do not want to put Lily through anymore undo discomfort. 

I'm really frustrated and really upset because I feel like I am losing my cat.  

chachahowski said:

 
Well Lily got the results of her last blood workup back. It ruled out pancreatitis and any bacterial infections that could be the cause of her symptoms. Meaning we are left facing either IBD or lymphoma. My vet wants to do the ultrasound this week and she keeps bringing up doing a biopsy. I'm really unsure/uncomfortable with the idea of performing surgery on Lily. I keep asking to meet with the vet to discuss options face to face and she keeps sort of pushing it off. I do not feel I am able to make the best decision possible for Lily and for myself. Financially, it has been very frustrating to go through all of these vet visits and tests without getting any answers. 

I just feel at a loss about whether to biopsy or not. My gut tells me not to do it. I know a lot of people on here say that it is okay to decide not to biopsy, however my vet isn't being the most compassionate. She has the attitude that it is my responsibility to do whatever it takes to diagnose/treat Lily even if that is not a realistic possibility for me (financially or emotionally). I also do not want to put Lily through anymore undo discomfort. 

I'm really frustrated and really upset because I feel like I am losing my cat.  

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Hey there,

I appreciate your concerns and fears, and i want to address them.  When our cat Simon's presumptive diagnosis of IBD went symptomatically from mild to years later, severe (weight loss, bad diarrhea) we met with our vet, as well as an internal medicine specialist, and a surgeon for consultations and not one of them  pressured us to do a surgical biopsy.  What they and every  vet should do, is lay out the pros and cons, the risks and the benefits and then you make an informed and personal decision based on your preferences for your cat  (it's not their cat) because no decision is objectively correct and any vet who says or implies otherwise is practicing bad medicine in my opinion.

Having said that I will lay out some specifics as I have gone down the entire road of IBD from diagnosis to eventual death.

1- IBD is hard to diagnose and when i said our cat's "presumptive" diagnosis what i meant is that vets will make that type of diagnosis based on physical findings in exam, symptoms and the results of treatments.  In other words with a working Dx (diagnosis) of IBD based on symptoms, you can make the diagnosis stronger if you treat the symptoms based on that Dx, if the symptoms get better.

2- IBD or SCL (small cell lymphoma) is treated initially the same way, with prednisolone and if the cat responds to the Tx (Treatment) then you know its either IBD or SCL and that the cat is going into remission which is good (Both IBD and SCL causes thickening of the bowel).  Now if the Pred doesn't work,or stops working, the next drug is Leukeran (chlorambucil) which many vets will prescribe without a biopsy result (because there is really nothing else to do) and a few will not for whatever reason they have.  I would not go to a vet who says they won't use Leukeran without a biopsy if Pred fails to work.  If you've vet (and i would ask) falls into that category then they are effectively forcing you to do a biopsy (see paragraph one) or forcing you to lose a potential future Tx.

3- But biopsy or not, you either need to have one OR  start prednisolone therapy because you will lose your cat if you do nothing, and its going to be a hard, painful experience for your cat if she goes that way without treatment.  It is premature to worry about the financial costs of cancer treatment (and I recall that Leukeran isn't that expensive) because you can get a great result from the prednisolone for almost no money at all.

4- An ultrasound is a fine idea, yes its a bit of money (but 100's not 1000's) but it will show thickening of the bowel which is plenty of evidence to start the Pred (which can and should reduce the inflammation regardless of the cause at least for a period of time).  If you start Pred, you have a cheap treatment that can work for a long time if its IBD, and for at least some time if its SCL, and if that treatment stops working, then you can evaluate the costs of other Tx's, but there is no reason for your cat to have neither Dx work or Tx, at least one is indicated - and a good vet should offer either  a biopsy or Pred therapy.  Responsible veterinary care means offering the best treatments and diagnostic tests the client can afford while never withholding a reasonable treatment when the client cannot afford all the diagnostic work.  Simply put, if the client can't afford the fancy diagnostic work, and/or in your case doesn't want to put their animal through big surgery with recovery etc) then the vet tries what they think the best Tx is, and you see if it works.

So some personal info.  We elected to do a biopsy, we had good pet insurance that covered a lot of it, and the recovery on my 13 year old cat meant a couple of days on good pain meds, and then a few more days of rest and he was fine.  And we learned that he had advanced IBD, not lymphoma (so technically the biopsy wasn't needed).  He was put on Pred, and he had 15 mostly healthy months until the last couple of months when we had trouble controlling his diarrhea, and had to do a fair amount of work to control vomiting and pancreatitis with cerenia, fluids, pepcid, etc, and finally, 2 weeks before we had to let him go, via a needle aspirate of his lympth nbodes, we got a diagnosis for a rare internal mast cell cancer (never was SCL), a diagnosis that came too late.

Our lesson, and its not your lesson, but it was ours, was that all that big medicine, money and surgery was basically for nothing, and a $1 pill of prednisolone kept him happy and healthy for over a year.  Had we not had money/insurance, and had we skipped the surgery, and the imaging, and all that work, he still would have gotten the pred, and he still would have had 15+ precious months with us.   

So all the above is how i would frame your concerns, and fears and can be the basis for a substantial discussion with your vet, or a new vet and/or a second opinion if that was called for.  If on Tuesday my vet refused to see me and my animal to have that consultation, I  guarantee you my NEW vet would be meeting with me on Wednesday.

Thanks for reading.

Stephen

Stephen Q,

THANK YOU. This was literally exactly what I needed to hear right now, so honestly from the bottom of my heart thank you. I'm going to move forward with the ultrasound and maybe the aspiration. However I'm going to hold firm on foregoing the biopsy and ask about starting Pred treatment. If she keeps pushing a biopsy then I will take Lily to another vet for a second opinion. I just don't want her to get any worse at this point and if starting Pred could help alleviate her symptoms so she stops losing weight and has fewer episodes of vomiting and diarhhea that's all I want for her at this point. I really appreciate all of the clarifications you made about treatement and diagnostic options. Thank you, Thank you, Thank you!

Lily & Heather

chachahowski said:

 
Stephen Q,

THANK YOU. This was literally exactly what I needed to hear right now, so honestly from the bottom of my heart thank you. I'm going to move forward with the ultrasound and maybe the aspiration. However I'm going to hold firm on foregoing the biopsy and ask about starting Pred treatment. If she keeps pushing a biopsy then I will take Lily to another vet for a second opinion. I just don't want her to get any worse at this point and if starting Pred could help alleviate her symptoms so she stops losing weight and has fewer episodes of vomiting and diarhhea that's all I want for her at this point. I really appreciate all of the clarifications you made about treatement and diagnostic options. Thank you, Thank you, Thank you!

Lily & Heather

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Sure thing, for those of us who've been down this road, its good to share with others. 

A few clarifications:

- a needle aspiration of the lymph nodes is only done if they are seen as inflamed during an ultrasound, and in most cases they won't be inflamed.

- Declining to biopsy as i said or implied, is reasonable, but make sure you understand that once you start Pred, you can't biopsy later should you change your mind, the pred invalidates the biopsy by masking the results.

Also, the best $30-$50 dollars you can spend right now is buying a baby scale and tracking your cat's weight 1-2 times a week when starting pred therapy.  If she starts gaining, you will probably see it on the scale within a week or so, even if its just a few ounces and that will tell you that the pred is working without having a vet appointment. Should she continue or start losing weight again, you will see it on the scale before you see it with your eyes, giving you options sooner rather than later.  https://www.amazon.com/s/ref=nb_sb_...ield-keywords=baby+scales&tag=&tag=thecatsite

Note that after getting a baseline weight, you technically need 2 weighings to conclude there is gain or loss.  The first of the 2 shows a change (but could be a normal fluctuation) the 2nd gain or loss in a row indicates a trend and that's what you need to see to make a conclusion.  And remember, a cat with severe IBD can and will be losing weight even if they are eating a normal amount of food - the disease interferes with the bowel's ability to absorb nutrients.  This is why its crucial to reduce the inflammation.

Keep us up to date and good luck.

Stephen

• chachahowski,

I am very sorry you too are going through the same my 12yr old cat Nene and I are going. I completely understand all your fears, frustrations and anxiety as we have been experiencing them too in a daily basis since last summer. My thoughts and prayers are with you both and also, my support. 

I started a thread too just yesterday (http://www.thecatsite.com/t/335442/...-steps-to-take-next-we-need-help#post_4225621) and it has been one of the best things I've done in the last few months. The support I've received in just one day has been very reassuring and despite the fact that I am terribly sorry for what you guys are enduring, it was strengthening to see that Nene and I are not alone on our struggle. 

I will update my thread as much as I can and will also stay on top of yours so that we can share what is working best for us and hopefully bring our kitties back to health! 

I wanted to ask you: what kind of diet are you currently feeding Lily? Definitely carry on with all your vet visits and tests but know that nutrition has been crucial to Nene's improvement and although he's still struggling, in the meantime we've managed to reduce his vomiting and his diarrhea A LOT. 

I used to feed him what I thought was a good, balanced and healthy nutrition (I was so wrong!). It was a variety of dry kibble. Since we started having issues I slowly came to understanding the importance of feeding them a high quality diet that would infer the least amount of stress in his digestive system.

Nene is currently on a grain-free canned food diet completely free of poultry (as at first we thought it could be a food allergy). Removing poultry from his diet resulted on a dramatic improvement overnight and since then we've stuck to rabbit, which has proven to be a great option. 

He is currently eating Ziwi Peak rabbit & lamb and he really likes it. I've also been struggling with encouraging him to eat and this formula has been the one he's liked best so far. I'm not saying by any means this is THE BEST food you can feed your kitty. In fact, I am already planning to transition him to a "human grade" formula, but I haven't yet decided on a particular one. I was motivated to improve his diet after reading this article: http://healthypets.mercola.com/site.../2015/11/08/best-to-worst-pet-food-types.aspx I am currently on step 7 and planning to transition to 6. 

* Know that especially with cats that have digestive disorders food changes must be done very slowly. 

Also, you might have read or heard about the catinfo  blog.   I just emailed the vet that writes this blog in order to schedule a consultation. I can't afford it at the moment but as soon as I have the money I'll talk to her and hopefully learn more about how to bring Nene back to health through nutrition and adequate care. 

Thank you for sharing your story.

Love to both of you. 

P.S.: What I keep telling myself: every little thing is gonna be alright. Keep the faith guys! 

Thanks for the responses everyone! 

We just got back from the vet. Lily had her ultrasound today. As expected her intestines did show uniform thickening, but her lymph nodes were not inflamed so the vet did not perform an aspiration. The vet explained that this does not mean that she does not have lymphoma and they only way to know definitively is to do a biopsy. She also explained that IBD can become lymphoma over time (which I already knew thanks to the wealth of information on this site and from the helpful people who have been chatting with me!). I vetoed the biopsy, so we started Lily on Prednisolone. She will be taking 5 mg tablets twice a day for a month and then once a day for the next month. 

@gatinos  to answer your question about diet. Lily's normal food is Blue Buffalo Dry food for Mature Cats (I believe its Chicken). I asked the vet about diet changes and she recommended trying a novel protein like rabbit or venison. I opted to go with rabbit so I am transitioning Lily slowly to Royal Canin dry cat food (rabbit and green pea). I've been doing tons of research so I know not to switch or food abruptly. I'm just going to mix in a little with her regular food and gradually increase the amount over the next couple weeks. 

Lily has never been one to eat wet food. She was my sister's cat before mine and spent her first 6 years eating cheap cat food and not consistently eating the same brands. When I adopted her the vet suggested trying to switch to wet food because she as a bit overweight for her size. Unfortunately, Lily just never wanted to eat the wet stuff. We tried different textures and flavors and she just wasn't into it. 

I'm really hoping the prednisolone makes a difference. Thank you all again! 

chachahowski said:

 
Thanks for the responses everyone! 

We just got back from the vet. Lily had her ultrasound today. As expected her intestines did show uniform thickening, but her lymph nodes were not inflamed so the vet did not perform an aspiration. The vet explained that this does not mean that she does not have lymphoma and they only way to know definitively is to do a biopsy. She also explained that IBD can become lymphoma over time (which I already knew thanks to the wealth of information on this site and from the helpful people who have been chatting with me!). I vetoed the biopsy, so we started Lily on Prednisolone. She will be taking 5 mg tablets twice a day for a month and then once a day for the next month. 

@gatinos  to answer your question about diet. Lily's normal food is Blue Buffalo Dry food for Mature Cats (I believe its Chicken). I asked the vet about diet changes and she recommended trying a novel protein like rabbit or venison. I opted to go with rabbit so I am transitioning Lily slowly to Royal Canin dry cat food (rabbit and green pea). I've been doing tons of research so I know not to switch or food abruptly. I'm just going to mix in a little with her regular food and gradually increase the amount over the next couple weeks. 

Lily has never been one to eat wet food. She was my sister's cat before mine and spent her first 6 years eating cheap cat food and not consistently eating the same brands. When I adopted her the vet suggested trying to switch to wet food because she as a bit overweight for her size. Unfortunately, Lily just never wanted to eat the wet stuff. We tried different textures and flavors and she just wasn't into it. 

I'm really hoping the prednisolone makes a difference. Thank you all again! 

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I'm glad you were able to get her tested and you've started a treatment. Did they have to sedate Lily to do the anesthesia? Were you there with her while they were doing it?

If Lily doesn't like canned food there might still be an option for her: http://www.vitalessentialsraw.com/fd-cat-mini-nibs

I've started feeding my kitties their rabbit treats and they LOVE them. They are crunchy, just like kibble but they have very basic ingredients:

Ingredients:  Finely ground whole rabbit, rabbit heart, rabbit liver, rabbit lungs, rabbit kidney, rabbit trachea, rabbit blood, raw goat's milk, water, herring oil, mixed tocopherols, d-alpha tocopherol

This could be a good way to go for you, since they can either eat it as it is or rehydrated. 

All the best,

Silvia & Nene.

gatinos said:

 
Did they have to sedate Lily to do the anesthesia? 

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Sorry, I meant to say ultrasound, not anesthesia! 

@gatinos No she is always a perfect angel at the vet no sedative was needed for her ultrasound.

She is enjoying the rabbit food we got from the vet so when I eventually make the slow transition to raw food I will put rabbit in the rotation. I am a teacher so I might wait until summer to switch to a raw diet so that I have more time to make the adjustment and get used to the new routine. I know it's more work.

Hello and Welcome to TCS - I really don't have much to add.  You've gotten some great advice.  I just wanted to offer my support to you and your sweet girl Lily.

Wishing you both the best

chachahowski said:

@gatinos No she is always a perfect angel at the vet no sedative was needed for her ultrasound.

She is enjoying the rabbit food we got from the vet so when I eventually make the slow transition to raw food I will put rabbit in the rotation. I am a teacher so I might wait until summer to switch to a raw diet so that I have more time to make the adjustment and get used to the new routine. I know it's more work.

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Another tip you might want to know is this one about raw goat's milk. Nene wasn't eating yesterday and I was desperate to get some calories in him. He loved it and after reading a lot about it, it seems like a great addition to their diet, particularly for kitties with digestive issues. It's also recommended when transitioning to raw food. 

We're going to the vet for some tests tomorrow. Just blood, fecal and urine for now and to get some B12 shots. I'm quite nervous but looking forward to finding a treatment and for him to recover soon.

Silvia & Nene.

How is Lily doing on the new food & Prednisolone? I hope she's feeling much better!

I'm also curious about how Lily is doing! Did you get the scale? I'm tracking little Mephi's progress and though she doesn't seem to be gaining weight on pred, she's not losing any at the moment. She lost a little right at the beginning of treatment but I think/hope it was due to me trying to find a new routine with her.

Sending love to you and Lily 

Sorry I haven't posted in awhile. Thanks for checking in on Lily. She was great while she was on the pred. Now she's off it though and her symptoms already started coming back. She had been off it for about 3 weeks and she has started having some episodes of vomitting and she has started licking her stomach again (so much she gets a bald spot). It's clear to me she is starting to regress. She is still eating, drinking and going to the bathroom normally (no diarrhea). I did get a scale and her weight has been consistent.

What can be done after a cat has taken prednisolone? I know they are not supposed to take a steroid long-term because that can cause health issues in and of itself. I emailed my vet to ask if there were other treatment options going forward but haven't heard back yet. Thanks for your help everyone.