Age 9 F Tabby - Lymphoma For 2 Yrs! - Now Tumor - What To Do?

[MyCatsCNJ]

We have a decision to make and we don't know what to do.

Summary - our cat has had very slow weight loss, vomiting and diarrhea for almost 2 years. down from 15 lbs to 6 lbs over 20 months. Suspect was IBD. Ran a course of steroids for past year with little change. Last week, we did a rework, and the doc palpated a gold ball size lump which appears to be in the intestines. Now we suspect small cell lymphomas that developed into a tumor stage. Latest CBC and Glucose and Thyroid all normal. When I feel her abdomen now with the weight loss it's very hard, and the lump is evident. She appears to have trouble walking just a tiny a bit from the hind legs and she is typically hunched position. Other than that she still wants to eat! Pee's and poops normal, oddy - now that the end is near.

Other Key points
* She continues to want to eat. Can't keep it down.
* Was very alert/active. Defied that she was sick. Thin as a rail.
* This week we suspect tumor growth is causing issue/pain. Appetite there but then walks away.
* Is hiding now just a wee bit more than usual. Not the death hide. Not yet. We know what that is.

We have three options. And I can't make the choice without true experiences/help. I need your honest opinion. Here is what we can do. What would you do and why?
(1) Continue steroids, advance to Lukeran (generic version);
(2A) Oncologist visit, US and fine needle to confirm tumor type, then perhaps....
(2B) Surgery to remove tumor, then back to #1 or similar.
Risk is: death @ operation or post from condition. Not being at side @ death - maybe.
(3) Do nothing, likely will result in euthanasia. Will be @ side @ death.

Cost is of no concern and we have pet insurance to help. Humane and/or best effort is the concern.

More Detail
Symptoms:
* 9 year old female spayed cat was 15lb in Feb 2017.
* Over 20 months (almost 2 years) she has went down to 6 lbs.
* Vomiting and diarrhea only symptoms thru this entire 20 months.
Exams:
* The vet in Feb 2017 thought she had IBD. Suspicion of lymphoma.
* US, Fine Needle Asp, T4, Glucose, CBC etc. All inconclusive.
* We opted out of scope or surgical biopsy.
Treatment - June, 2017 for 3 months:
* Started Prednisolone
....Result:
- Extremely slow weight loss continued, as did vomit, diarrhea.
- All this time she has had a very healthy appetite.
Treatment - Oct, 2017 - for 11 months:
* Switched to Budnesonide and on it every since. In between, used Flagyl AB's for diarrhea.
....Result:
- Flagyl worked really well to manage diarrhea.
- Extremely slow weight loss continued, as did vomit, diarrhea.
- All this time she has had a very healthy appetite.
Treatment - May 2018 - for 1 month:
* Tried Lukeran (generic).
....Result:
- Extremely slow weight loss continued, as did vomit, diarrhea.
- Vomiting seemed to increase.
- All this time she has had a very healthy appetite.
- No change. Stopped it.
Treatment - mid-Sep, 2018 - 2 weeks:
- Doc said switch back to Prednisolone, we did.
- Stopped the Budesonide same time.
- Just started flagyl on our own, to see if any anti-inflammatory effects.

 

[Furballsmom]

Hello. I'm so so sorry you all are going through this.
I'm one who tries very hard to look at it from the cat's perspective, and whether the quality of life is still there.
She's unable to eat, she's lost scads of weight, she's in pain.
I can't bear it when an ill cat wants to eat but can't, either because of a bad tooth that was missed in a checkup (I've been there) or due to something else. It is an awful blow to the nurturing part of me.

Often it is suggested to ask the vet what s/he would do if it was their cat.

You've been down this path before but I'll post this anyway, there is a list towards the bottom of the article that may be useful;

When Is It Time? - Making The Difficult Decision

 

[white shadow]

.
I'm finding it very hard to restrain myself, MyCatsCNJ..........

I'll focus on one point for now, the single issue that, despite your meticulously documented summary, remains unaddressed:

PAIN CONTROL​

Please, without delay, no matter what else you do or plan to do, get her some pain control medication immediately !

Re-read what you wrote up there - it is clear that you know her to be experiencing pain - earlier and currently.

There is simply no excuse for not acting immediately on this.

With this kind of pain, modern/current therapy is a combination of drugs, each targeting different pain receptors/pathways. Here's a visual for you....one drug from each group is used:

I've provided hospice care to one of my cats, and I used Buprenorphine, Metacam and Gabapentin to successfully keep him pain-free and provide a high quality of living for many months.

Here is the very comprehensive piece from which that chart is taken: Focus On Pharmacology | Management of Chronic Pain in Cats

Once that's addressed, I'd be happy to discuss your options.
.

 

[MyCatsCNJ]

Amazing you say that because I never understood why multiple vets (this is cat #3 heading to the bridge now) NEVER suggested this for any of the cats.

We have a last ditch appt with an oncologist late this week but we need to address the pain now.

Other than that, not sure why it is not easy to give a cat intravenous nutrition and water or is this because they are not human and it's not as convenient/easy. That would likely help in her energy and overall well being.

I don't get it.

==========

.
I'm finding it very hard to restrain myself, MyCatsCNJ..........

I'll focus on one point for now, the single issue that, despite your meticulously documented summary, remains unaddressed:

PAIN CONTROL​

Please, without delay, no matter what else you do or plan to do, get her some pain control medication immediately !

Re-read what you wrote up there - it is clear that you know her to be experiencing pain - earlier and currently.

There is simply no excuse for not acting immediately on this.

With this kind of pain, modern/current therapy is a combination of drugs, each targeting different pain receptors/pathways. Here's a visual for you....one drug from each group is used:

View attachment 255164​

I've provided hospice care to one of my cats, and I used Buprenorphine, Metacam and Gabapentin to successfully keep him pain-free and provide a high quality of living for many months.

Here is the very comprehensive piece from which that chart is taken: Focus On Pharmacology | Management of Chronic Pain in Cats

Once that's addressed, I'd be happy to discuss your options.
.

 

[white shadow]

.
I'm so glad you replied!

Vets - it would be a long story about the things - very obvious, priority things - that are overlooked by some Vets. There's absolutely no excuse....but, there are reasons (enough for tomes!).

Nutrition can't be supplied via IV....but, could be with a feeding tube. Now, some of the same issues will apply, so things like nausea and vomiting must still be addressed, but these can be managed easier.

It sounds like you need a consummate cat Vet. If you have the time, see if there's a cat-only clinic nearby, get an emergency appointment with the Vet with the lengthiest time in practice - often, that's the owner(s), and send your health summary (post 1) to them beforehand. Your message: you need a primary care Vet and, 2, you need an urgent consult. You'll have to 'blow through' the reception and refuse an ER referral (some of those folks are fine for emergencies, but, that's not what you need. I think if you can talk to one of these Vets, you'll get in.

Meantime, yes, pain management first - bring/show that article and chart to whomever it is and insist that you are given combination therapy.

If she can't keep anything down and not taking in any food, she'll develop a liver condition - and that is to be avoided at all costs now. I would be using a small syringe to feed her droplets of pureed food (think smoothie) on a very frequent basis. Now, I have the 'luxury' of being home 24/7/365.....is there someone around home who could feed her like that?

OK. I'll stop here. Hope it makes sense.

Thinking of you both.
.

 

[sivyaleah]

I'm assuming you are in New Jersey?
If so, feel free to send me a private message. I have an excellent vet practice that I can recommend. Several of the vets have cats and are well versed in their care. Our older one was just diagnosed with probable intestinal lymphoma of some sort (we opted not to do biopsy as he's quite elderly and not in good health at all from other diseases such as CKD). We have always received fantastic care from all of the vets in the practice.

 

[siamesecat108]

Going through almost the exact same thing with my cat. It’s so sad to watch the progression. Our vet prescribed 4mg every 24 hours of Cerenia for anti-nausea. Worked very well to stop the vomiting. Best of luck to you and your kitty.

 

[MyCatsCNJ]

.
I'm so glad you replied!

Vets - it would be a long story about the things - very obvious, priority things - that are overlooked by some Vets. There's absolutely no excuse....but, there are reasons (enough for tomes!).

Nutrition can't be supplied via IV....but, could be with a feeding tube. Now, some of the same issues will apply, so things like nausea and vomiting must still be addressed, but these can be managed easier.

It sounds like you need a consummate cat Vet. If you have the time, see if there's a cat-only clinic nearby, get an emergency appointment with the Vet with the lengthiest time in practice - often, that's the owner(s), and send your health summary (post 1) to them beforehand. Your message: you need a primary care Vet and, 2, you need an urgent consult. You'll have to 'blow through' the reception and refuse an ER referral (some of those folks are fine for emergencies, but, that's not what you need. I think if you can talk to one of these Vets, you'll get in.

Meantime, yes, pain management first - bring/show that article and chart to whomever it is and insist that you are given combination therapy.

If she can't keep anything down and not taking in any food, she'll develop a liver condition - and that is to be avoided at all costs now. I would be using a small syringe to feed her droplets of pureed food (think smoothie) on a very frequent basis. Now, I have the 'luxury' of being home 24/7/365.....is there someone around home who could feed her like that?

OK. I'll stop here. Hope it makes sense.

Thinking of you both.
.

Yes, running out of options. Major decline. She is suddenly having a hard time just getting to litterbox. It's obvious that she is just weak. Hiding all day. This is way different than before. The vet declined pain meds. Did not explain why. Even if we make it to Friday Oncologist not sure it will be wise to handle her thru a sedated US and fine needle. It seems to me it's either straight to surgery or straight to bridge. If only I could say lets do surgery just the same way we say let's say goodbye, because in reality surgery under anethesia is half death with options whereas euthanasia is no turn back. What concerns me is post-ops, this is where the risk will exist that we wont say goodbye gracefully. It's a tough decision, and it's all about risk and what the reward will/can be.

 

[sivyaleah]

Yes, running out of options. Major decline. She is suddenly having a hard time just getting to litterbox. It's obvious that she is just weak. Hiding all day. This is way different than before. The vet declined pain meds. Did not explain why. Even if we make it to Friday Oncologist not sure it will be wise to handle her thru a sedated US and fine needle. It seems to me it's either straight to surgery or straight to bridge. If only I could say lets do surgery just the same way we say let's say goodbye, because in reality surgery under anethesia is half death with options whereas euthanasia is no turn back. What concerns me is post-ops, this is where the risk will exist that we wont say goodbye gracefully. It's a tough decision, and it's all about risk and what the reward will/can be.

As we are in the same situation, although, haven't gotten to the point of having to consider euthansia, it sounds to me that she is giving you signals; hiding, not eating, etc. I can't for the life of me understand why your vet won't prescribe some kind of pain killers for her at this time. Our vet discussed this with us in advance to make sure we understood our options when Casper got closer to the end as to not have him suffer needlessly. I can only offer my opinion that if she is as compromised as you say she is, that you do the humane thing and allow her the peace she deserves sooner than later. My heart is with you at this difficult time. Making these decisions is difficult and never without some small amount of guilt or second guessing.

 

[white shadow]

.
M MyCatsCNJ - READ POST #6 ABOVE !

Whatever the heck is going on here, YOU MUST ACT NOW.

No drama here - this is wrong on every level.

NO MORE DELAY - PLEASE.
.

 

[MyCatsCNJ]

This is to thank everyone who responded.

Our beloved Sandy passed last night on her own. My children were able to say goodbye to her two days ago with a long iteration of comforting her per my warning the end was near. My wife and I both force fed her drops of water and baby food last night and I comforted her. drops very minimally to help get something in her. She laid on my stomach. As my breath raised my abdomen up and down, she rose seemingly in comfort laid out on my belly with my breath and purred herself away. She never ever allowed this. She was a tough cat. Granted at this time, she was very weak. Then she stumbled away to rest, was all good until this morning.

It's a well known fact that purring potentially releases endorphins as a natural pain reliever in cats. We know it wasn't a happy purr.

We feel that we did everything right. And this was the best outcome for her and us, less more invasiveness that wouldn't have been fair. I was also never a fan of euthanasia. That is just my opinion. Looking back I wonder if the switch to prednisolone from Budnesodine 2 weeks ago was a correct choice, as it may have had induced Addison's disease. The bud worked so well thus far. This is when her decline became more evident, sometime after the switch. I checked the dosages and they were both right in line with what she needed. But she was on the bud for about 10 months, then we suddenly switched as per the vet's direction. He is a good doc.

It's off the crematory, another thing I'm not a fan of but have done it. My thank to you again. You are good people to have offered your notes....

We have a decision to make and we don't know what to do.

Summary - our cat has had very slow weight loss, vomiting and diarrhea for almost 2 years. down from 15 lbs to 6 lbs over 20 months. Suspect was IBD. Ran a course of steroids for past year with little change. Last week, we did a rework, and the doc palpated a gold ball size lump which appears to be in the intestines. Now we suspect small cell lymphomas that developed into a tumor stage. Latest CBC and Glucose and Thyroid all normal. When I feel her abdomen now with the weight loss it's very hard, and the lump is evident. She appears to have trouble walking just a tiny a bit from the hind legs and she is typically hunched position. Other than that she still wants to eat! Pee's and poops normal, oddy - now that the end is near.

Other Key points
* She continues to want to eat. Can't keep it down.
* Was very alert/active. Defied that she was sick. Thin as a rail.
* This week we suspect tumor growth is causing issue/pain. Appetite there but then walks away.
* Is hiding now just a wee bit more than usual. Not the death hide. Not yet. We know what that is.

We have three options. And I can't make the choice without true experiences/help. I need your honest opinion. Here is what we can do. What would you do and why?
(1) Continue steroids, advance to Lukeran (generic version);
(2A) Oncologist visit, US and fine needle to confirm tumor type, then perhaps....
(2B) Surgery to remove tumor, then back to #1 or similar.
Risk is: death @ operation or post from condition. Not being at side @ death - maybe.
(3) Do nothing, likely will result in euthanasia. Will be @ side @ death.

Cost is of no concern and we have pet insurance to help. Humane and/or best effort is the concern.

More Detail
Symptoms:
* 9 year old female spayed cat was 15lb in Feb 2017.
* Over 20 months (almost 2 years) she has went down to 6 lbs.
* Vomiting and diarrhea only symptoms thru this entire 20 months.
Exams:
* The vet in Feb 2017 thought she had IBD. Suspicion of lymphoma.
* US, Fine Needle Asp, T4, Glucose, CBC etc. All inconclusive.
* We opted out of scope or surgical biopsy.
Treatment - June, 2017 for 3 months:
* Started Prednisolone
....Result:
- Extremely slow weight loss continued, as did vomit, diarrhea.
- All this time she has had a very healthy appetite.
Treatment - Oct, 2017 - for 11 months:
* Switched to Budnesonide and on it every since. In between, used Flagyl AB's for diarrhea.
....Result:
- Flagyl worked really well to manage diarrhea.
- Extremely slow weight loss continued, as did vomit, diarrhea.
- All this time she has had a very healthy appetite.
Treatment - May 2018 - for 1 month:
* Tried Lukeran (generic).
....Result:
- Extremely slow weight loss continued, as did vomit, diarrhea.
- Vomiting seemed to increase.
- All this time she has had a very healthy appetite.
- No change. Stopped it.
Treatment - mid-Sep, 2018 - 2 weeks:
- Doc said switch back to Prednisolone, we did.
- Stopped the Budesonide same time.
- Just started flagyl on our own, to see if any anti-inflammatory effects.

 

[sivyaleah]

M MyCatsCNJ I am so very sorry for you and your family. I'm glad to hear you take comfort in feeling you did everything right for your girl.
It's hard for others to give advice in these instances as we all see through different lenses so to speak. In the end, it is your own choice and I respect yours as it is clear your entire family loved her well.
Thank you too for understanding that all of our advice came from a good place based on our own hearts and experience.
I'm sure one of the mods will be in shortly to close this thread; as TCS does when one suffers this loss.
Again, my condolences to all.

 

[betsygee]

So sorry to read this news. We'll close the thread now out of respect for your loss, and we invite you to post a tribute to Sandy in our Crossing the Bridge thread.