Desperate Help IBD/Lymphoma Chemo

[ShiversOwner]

Hello, my 15 year old cat has been sick since beginning of May, it started with severe diarrhea and pancreatitis. Long story short, vet said it was either very severe IBD or more likely GI lymphoma, and he's lost quite a bit of weight. For the past 2 weeks he's been on Prednisolone daily and 2.25mg Chlorambucil once every other day, with occasional subcutaneous fluids, cerenia, metronidazole and mirtazapine appetite stimulant. This combo seemed to work immediately as his stool returned to normal and he started gaining a bit of weight back but a few days ago, he suddenly stopped eating even with the mirtazapine. Since then he's been very lethargic. These symptoms started 12 days after we began giving him Chlorambucil, does anyone know if these are common side effects of the chemo? I read that side effects typically begin 1-2 weeks after medication begins but how long do they last? I can't tell if this is just side effects of medication or if his cancer is getting worse, and at this rate I may have to put him down within a few days. He means so much to me and I'm really trying everything I can to save him, if anyone has some insight it would be greatly appreciated.

 

[tyleete]

It is hard to know, and that seems a lot of medication. Just like with humans, those can interact & too many can make us feel sick.
I've had 2 now with scl gi/ibd & it sucks. Neither had bad side effects from it, but both took it differently. My babies do 4mg once weekly. I used to five it via pill until I was told that the compounded version is a fraction of the price. So we've been doing liquid for years. 1 of my Cancer cats was on prednisolone (2.5mg) every night to stop the vomiting. Until I tried cbd, that was after she'd been taking the pred for 3yrs. After 2 weeks on the cbd twice daily (tiniest amount), I was able to completely and forever take her off the steroids. I think she used to feel bad the night before her chemo, but I started giving the cbd earlier in the day. Since on that regimen, she did well for another almost 2yrs. And you could tell the cbd made her feel so much better, even keeping her weight on. Eventually kidney failure got her, but she lived almost 6yrs after diagnosis.
My other girl had ibd that led to scl gi, because it till 8 YEARS to get under control. All these stupid vet diets and such and extra meds tried. She was diagnosed about 1.5yrs ago and her treatment is a little different.
4mg once weekly of Leukeran
2.5mg prednisolone every 3rd day
1.5mg cbd twice daily
And we've gotten to needing 1/2 pill of Ondasetron daily lately.
If I don't give the pred every 3rd day her ibd forum symptoms would come back. But I think I'm going to test it again since we got need ibd under control with a good/novel protein food. See if she can get off it permanently.
Do you know if the ibd is good related? I have 4 ibd cats and each of theirs is with only one having occasional flare upssince changing their foods. And not to rx crap. I cut out all poultry, fish, and (sadly) gums. Two took a little while to show results, about a month. Other 2 were instant difference.
And mirtazapine is also a problematic med. Many have to give the gel that absorbs into the skin. It's called Mirataz and is outrageously expensive. But you can give that every day unlike mirtazapine and the side effects are fewer. I rarely use that though since cbd does the same thing and more.
That thesebad results started 12 days after giving your baby the chemo sounds more like something else though. I could very well be wrong, but even though it can take a while for the meds to have the desired effects, the side effects are usually within a day or two, no?
I always do my own research and then come back to the vet with my thoughts and info. Even they can't possibly know everything

 

[fionasmom]

IBDKitties – Helping Save Lives…One Paw at a Time
This site has very complete information about IBD, including discussions about the medication.

Chlorambucil | VCA Animal Hospitals
The side effects are listed here.

I would call the vet and have a discussion of everything that is going on and see if anything is dose related or in others ways remediable.

 

[silent meowlook]

Hi. I’m sorry I didn’t read replies.
That is a normal amount of medication for GI lymphoma treatment. I do suggest asking your vet about giving injectable Vitamin B12 weekly for now. Cats with IBD and GI lymphoma are prone to not being able to absorb this through eating. It is a water soluble vitamin, so what he doesn’t need his body will get rid of.

With a cat that has a major illness like this, you have to let the vet know immediately if they stop eating. Often this can be handled with changing some medications or increasing the dose.

Often cats with these issues have a food allergy as well. Often they will or should be put on a novel protein prescription diet. Those are usually rabbit, venison, or duck. You might want to speak to your vet about that. But first he needs to be eating again.

Often cats are not eating because of nausea, so be sure to give the Cerenia. Also cats that aren’t eating can become quickly dehydrated, so giving SQ fluids at home can help.

My cat has GI lymphoma. I give her Prednisolone 5 mg. every other day and Chlorambucil 3 times a week. I do SQ fluids as needed, vitamin B12 injections every week to 4 weeks depending on how she feels, Cerenia and famotadine as needed.
I feed the Royal Canin rabbit diet only. She has been doing well for a couple of years now.

Your vet seems to be doing the right things but you can always get a referral to a specialist if you want to.

There’s a saying in veterinary oncology that if your pet has to have cancer, lymphoma is the one to have since it is so responsive to treatment.

I know it’s overwhelming. Just let your vet know about the lack of appetite today and see what they suggest.

 

[ShiversOwner]

Hi. I’m sorry I didn’t read replies.
That is a normal amount of medication for GI lymphoma treatment. I do suggest asking your vet about giving injectable Vitamin B12 weekly for now. Cats with IBD and GI lymphoma are prone to not being able to absorb this through eating. It is a water soluble vitamin, so what he doesn’t need his body will get rid of.

With a cat that has a major illness like this, you have to let the vet know immediately if they stop eating. Often this can be handled with changing some medications or increasing the dose.

Often cats with these issues have a food allergy as well. Often they will or should be put on a novel protein prescription diet. Those are usually rabbit, venison, or duck. You might want to speak to your vet about that. But first he needs to be eating again.

Often cats are not eating because of nausea, so be sure to give the Cerenia. Also cats that aren’t eating can become quickly dehydrated, so giving SQ fluids at home can help.

My cat has GI lymphoma. I give her Prednisolone 5 mg. every other day and Chlorambucil 3 times a week. I do SQ fluids as needed, vitamin B12 injections every week to 4 weeks depending on how she feels, Cerenia and famotadine as needed.
I feed the Royal Canin rabbit diet only. She has been doing well for a couple of years now.

Your vet seems to be doing the right things but you can always get a referral to a specialist if you want to.

There’s a saying in veterinary oncology that if your pet has to have cancer, lymphoma is the one to have since it is so responsive to treatment.

I know it’s overwhelming. Just let your vet know about the lack of appetite today and see what they suggest.

Yes, we started weekly B12 injections 2 weeks ago, and as for novel food, we've tried so many different kinds of rabbit/duck/venison cans, pouches, treats. Basically anything out there we've tried. He was actually responding very well up until last week and now he's gone off all food. At this point I'm just trying to get anything in him, we've been doing SQ fluids and he does still drink water. Based on his behavior it does seem to be severe nausea but he's on all the meds already, I don't know what else there is to do.

 

[silent meowlook]

There are additional meds for nausea. Ask your vet for odansetron also called Zofran. It can be given as well as the Cerenia.

 

[daftcat75]

Metronidazole can make cats nauseated.

Cerenia can make some cats anorexic/inappetent.

Prednisilone and chlorambucil both can make a cat lethargic.

It’s hard to know which drug(s) or even if it’s the condition itself that might be knocking him over.

(I had started this post earlier and coming back to an interrupted train of thought.)

To the recommendation for CBD, you must be careful with CBD and other prescriptions. It competes for detoxification resources in the liver and can make drugs like prednisilone take longer to metabolize. Unfortunately, even with the Farm Bill, CBD is still considered far too gray an area for most vets to have a professional opinion on it.

Cerenia is an anti-emetic with anti-inflammatory properties. But there's some debate whether it actually helps with nausea. You might ask your vet for a prescription for ondansetron. This can be given with Cerenia or in place of Cerenia if you wanted to see if his appetite hit might be caused by Cerenia.

Can he have chicken? I'm sure it's not ideal. But Hills A/D is a highly appealing food for sick and inappetent cats to get them to eat something. You might start with the pure A/D stuff first. If he likes it, you can try mixing it with his regular food. Of course, if you already know he can't have chicken, then you might have to balance whether it's more important to get him eating again than to avoid a known trigger. It's a terrible choice. I had to make the same with my Krista when she had her remaining teeth removed to get ahead of chronic resorption. She only wanted to eat a forbidden fish flavored food during her recovery. Do I feed her a trigger food or let her starve? Obviously, I couldn't do the latter. But it did make her IBD worse.

 

[ellen m]

Hello, my 15 year old cat has been sick since beginning of May, it started with severe diarrhea and pancreatitis. Long story short, vet said it was either very severe IBD or more likely GI lymphoma, and he's lost quite a bit of weight. For the past 2 weeks he's been on Prednisolone daily and 2.25mg Chlorambucil once every other day, with occasional subcutaneous fluids, cerenia, metronidazole and mirtazapine appetite stimulant. This combo seemed to work immediately as his stool returned to normal and he started gaining a bit of weight back but a few days ago, he suddenly stopped eating even with the mirtazapine. Since then he's been very lethargic. These symptoms started 12 days after we began giving him Chlorambucil, does anyone know if these are common side effects of the chemo? I read that side effects typically begin 1-2 weeks after medication begins but how long do they last? I can't tell if this is just side effects of medication or if his cancer is getting worse, and at this rate I may have to put him down within a few days. He means so much to me and I'm really trying everything I can to save him, if anyone has some insight it would be greatly appreciated.

Yes, it could very definitely be the chlorambucil! Given every other day, which is fast becoming an obsolete protocol, it causes many cats to be so nauseous they stop eating almost entirely. You can fix this by switching to "pulsed dosing", which is giving it every other week in a slightly larger amount each time. Meanwhile get an script for Zofran (generic ondansetron) from your vet and start giving that for the nausea (cerenia is not good for this). I don't know how much your cat weighs and I don't know if we can recommend dosages and frequencies here but you will need to give that med several times a day. I recommend joining the feline small cell lymphoma group on the groups.io site as soon as possible (can we post links here? I won't risk it until I find out - I'm new here) and they can advise you. You can pull him out of this! It's the cure, not the disease! Please con't consider "the end" yet, you are not even close. Get him on the pulsed dosing and get him on Zofran and he will soon be out of the woods.

 

[ellen m]

Yes, we started weekly B12 injections 2 weeks ago, and as for novel food, we've tried so many different kinds of rabbit/duck/venison cans, pouches, treats. Basically anything out there we've tried. He was actually responding very well up until last week and now he's gone off all food. At this point I'm just trying to get anything in him, we've been doing SQ fluids and he does still drink water. Based on his behavior it does seem to be severe nausea but he's on all the meds already, I don't know what else there is to do.

I'm starting to read through the rest of the replies now. Yes, it is nausea, and it is from the Chlorambucil. And the Cerenia is not helpful. It's good for vomiting but not so much nausea. As someone else said, and I mentioned too, he needs Zofran (Ondansetron), and switch to every other week chemo. It works.

 

[daftcat75]

Now that you mention it. Every other day chemo sounds too frequent. With Krista, I was told either every third day or twice a week since every three days is a pain in the butt to track and remember. But yes pulsed dosing (higher dose less often) can also work. Talk to your vet/oncologist about twice a week or every other week.

 

[ellen m]

Now that you mention it. Every other day chemo sounds too frequent. With Krista, I was told either every third day or twice a week since every three days is a pain in the butt to track and remember. But yes pulsed dosing (higher dose less often) can also work. Talk to your vet/oncologist about twice a week or every other week.

I would stay away from every three days or twice a week, they have not been proven effective AFAIK. But pulsed (every other week) has been proven very effective. EOD has also been proven effective but problem is it makes many cats extremely sick.

 

[EmmySpaghetti]

This is such a hard road to have to navigate. We lost out 13 year old back in February to GI Lymphoma after going through and trying to navigate these same problems. I don't have any helpful advice, as we only used the chlorambucil for about two weeks giving it Monday, Wednesday and Friday, mostly because it was abvious that she did not feel good on it, cerenia did nothing for her, and at that point we chose quality over quantity for our poor girl. I think our vet at the time didn't start the heavier treatment in time as they kept telling us it wasn't lymohoma until about the last 2 months... but I am wishing you and your baby the best

 

[silent meowlook]

There is some information below regarding treatment. Chlorambucil given every other day is just as effective as a larger dose given every 2 weeks. The reasoning for the higher dose less frequently is client compliance, not because cats don't get sick from it. If you think about it, why would it make a cat less sick to get 10x the dose of something that is making them sick?

The treatment plan you are on is fine. The fact that your cat isn't doing well is not. I would contact your vet asap and talk to them about what can be added to address the symptoms you are seeing.

Most important, don't ever change what you are doing without discussing it with your veterinarian. Your veterinarian is the one who has examined your cat. They are the only ones that should approve or change any medications and treatments they have your cat on. It is fine to bring up anything that you read or is suggested to the vet, but don't change, discontinue, or add any medication or Neutracutical without discussing it with them first.

Feline lymphoma: diagnosis and treatment

An experienced clinician discusses the road to success when the diagnostic path is unclear.

www.dvm360.com

 

[ellen m]

Hi there,

Of course compliance is a big plus with pulsed! And of course one would consult with their vet before switching to pulsed (or every other week) dosing, because the vet needs to approve and prescribe it. But compliance is no longer the main reason for using pulsed, according to everything I have been reading. It is currently the recommended dosage on several of the lymphoma-specific groups and in the oncology textbook itself, as well as by many reputable researchers. It has been posted in many lymphoma-specific forums that EOD chlorambucil has made many, many cats extremely nauseous, to the point where the vets thought it wasn't working. It did that to mine, and like countless others, the nausea and inappetance ressolved after we switched him to every other week dosing. Every other week dosing is actually a much SMALLER dose (not larger dose) when averaged over the two weeks, which according to papers posted on lymphoma-specific sites, makes it safer for the immune system, cancer risk, and other risks. For example, on EOD my cat was getting 2 mg EOD which is a whopping 14 mg per two weeks. On pulsed he was getting 5 mg over the whole two weeks. In lymphoma-specific forums it is posted very frequently that cats who are sick on EOD, and they and their vets thought it was "the end", completely recover when they switch to pulsed and pull out of it and do fine - IF their vets could be convinced. I've seen these groups point the cat owners to the exact quote in the (modern) textbook, where it says that pulsed is the preferred protocol. Apparently it didn't use to be preferred but it is becoming more and more the protocol of choice. Of course compliance is a big plus, too! It's also much easier! And the nausea meds only need to be given a couple of times a month instead of all the time. I strongly urge ShiversOwner not to give up! Try to join one of the lymphoma groups. You will see all the evidence you need. Best wishes!

 

[fionasmom]

Feline_Smallcell_Lymphoma groups.io Group
Other members have joined this group. Read the introduction, as they have certain requirements for joining.

Use caution with Zofran (ondasetron) and CBD if used concurrently. Studies have been mixed and done with only small numbers of patients. CBD blocks the enzymes that metabolize Zofran and may slow down the body's ability to clear the drug from the system. In other studies, nausea has been alleviated by the use of both, but these studies were not extrapolated to large numbers of patients or all types of cancers.

 

[artiemom]

Feline_Smallcell_Lymphoma groups.io Group
Other members have joined this group. Read the introduction, as they have certain requirements for joining.

Use caution with Zofran (ondasetron) and CBD if used concurrently. Studies have been mixed and done with only small numbers of patients. CBD blocks the enzymes that metabolize Zofran and may slow down the body's ability to clear the drug from the system. In other studies, nausea has been alleviated by the use of both, but these studies were not extrapolated to large numbers of patients or all types of cancers.

I tried jointing the above mentioned group. I found the owner of the site to be hostile, demanding all my cats medical information, and going as far as for me to print up certain articles, which her Vet-guru expounded. These articles insisted that my Vet was out of touch with the current way of thinking--- as per her Guru-Vet. She wanted me to hand the articles to my IMVet; basically telling him he was wrong and that I knew better than him!! No Way.. I found her and the groups philosophies demanding, and down right outrageous. It was not much of a support group, as it was a promotion for her and her
Guru-Vets way of thinking. Even trying to join and being an accepted member was challenging with all the demands... done a certain way, have to submit a certain way, pictures have to be a certain way, etc... not easy for someone who is already stressed out with the lymphoma diagnosis.

My guy has survived an entire year of EOD Chlorambucil... along with Zofran, occasional Mirataz.. and Cerenia when needed.
I will add, my IMVet is a very well respected Vet at Angell Animal Medical Center in Boston. He trusts me completely, with how we are handling my guy.
Trust is a difficult thing to gain, especially with Vets.. We trust each other..

Just a warning to anyone who may be taken in by this group.. Read things with a grain of salt... think before you suggest anything to your Vet... and please never imply to your Vet that they do not know what they are doing, or not up to date with the current practices... To me, a former medical worker, that is an affront to them...

This is just my opinion, from my own experiences..

 

[ellen m]

YMMV. That particular group saved my cat's life (we did have to work hard to convince my vet of the changes suggested) and I actually consider "Vet-guru's" advice to have been a free consultation with a renowned internist. That said, it goes without saying that not all groups are for everyone, and it's unfortunate that you had a bad experience. There's also a Facebook lymphoma group which is not bad, and which you could join, but it's not focused on small cell. Nevertheless, they do seem to be similarly science-based.

Glad your guy has done well. Your kitties are adorable. <3

Ellen

 

[artiemom]

I found the Facebook group, to be excellent. They do have one devoted to Small Cell Lymphoma. The members are very supportive and are all going through different types of therapies. You can learned a lot from them. I met one member who had my own IMVEt as a Vet when her kitty was sick. He was her IMVet for years.

When there is a terminal diagnosis, you want support, along with information. You want to be able to read the pro's and cons of each type of therapy: And be able to talk freely with your Vet about it.. Trust is a difficult thing to obtain.. Do not jeopardize that by outright telling your vet that he is out of date with current treatments.. Read up, and then you can discuss.

I felt the same as S ShiversOwner : overwhelmed, frightened. I read a lot, and immediately joined the FB group. It helped a ton. Much more than this private group, which I found demanding, without much support. Just wanting to promote their way of thinking. I felt it was: "My way or the Highway". You can get some information from them, but take it with a grain of salt.

This is all just my opinion.

 

[ellen m]

I didn't know there was a FB group for small cell lymphoma. Good to know.

 

[ShiversOwner]

Thank you all for your responses and advice. We had planned on putting him to rest on Wednesday but I think we will postpone and attempt the zofran to help get him eating again, and if that works we will start the pulse doses of chlorambucil.