Desperate Help IBD/Lymphoma Chemo

[ellen m]

I'm so glad to hear this! This warms my heart. I know there is hope for him.

In the meantime I would ask your vet about pausing the chloramabucil, merely temporarily, because I believe it is almost certainly the cause of his nausea, as in so many other cases. (You would pause it for about a week anyway before starting pulsed, which hopefully your vet will agree to try.) There is some specific dosing info for zofran on the small cell lymphoma group, based on recent research on how long it stays in the cat's body (about 4 hours), etc. They also have a paper you can give your vet containing all the published references about pulsed dosing. Some vets are reluctant to try it and will think that the nausea is due to the disease etc.

Best of luck and I look forward to hearing how it goes.

Paws crossed for your little guy,

Ellen

 

[artiemom]

I do not know if you have tried the mirataz ear ointment as an appetite stimulant. I found that it works better, and less side effects than the pill form of mirtazapine.

Every cat is different, as people are in response to treatment. What works for one may not be good for another. I suggest you discuss all options with your Vet, IM Vet and/or oncologist.
Personally, we are using an oncologist.

I wish you all the best of luck with your baby’s treatments.

 

[artiemom]

I'm so glad to hear this! This warms my heart. I know there is hope for him.

In the meantime I would ask your vet about pausing the chloramabucil, merely temporarily, because I believe it is almost certainly the cause of his nausea, as in so many other cases. (You would pause it for about a week anyway before starting pulsed, which hopefully your vet will agree to try.) There is some specific dosing info for zofran on the small cell lymphoma group, based on recent research on how long it stays in the cat's body (about 4 hours), etc. They also have a paper you can give your vet containing all the published references about pulsed dosing. Some vets are reluctant to try it and will think that the nausea is due to the disease etc.

Best of luck and I look forward to hearing how it goes.

Paws crossed for your little guy,

Ellen

I feel all the above information is in the form of “prescribing”. Which we are not allowed to do.

S ShiversOwner . Please discuss treatment with your vet. Do not go by medical treatment prescribed or dosing provided by anyone on the internet. It is a precarious situation.

 

[ShiversOwner]

- Update for everyone -
We stopped the chlorambucil on Saturday, Shiver still didn't eat or drink anything aside from the baby food and SQ fluids we forcibly gave him. Yesterday morning he was very lethargic so I made the appointment to put him down today, but then yesterday afternoon he got up and started eating little bits of treats and drinking water voluntarily (even had some small pieces of bacon).

Now this morning, he's back to being extremely lethargic, and we truly have no idea whether to put him down or try to keep him going. The appointment is in 6 hours and if we cancel, we have to do so within the next 4 hours. We just don't know whether what he's dealing with is progression of the lymphoma or severe chlorambucil side effects. On a side note, the diarrhea Shiver had constantly for the first 6 weeks he was sick has subsided, and his stool is back to a normal state.

For those that have experienced something similar and taken their cats off Chlorambucil, how long does it take for the side effects to go away? He's been off it for 5 days now.

 

[artiemom]

I really cannot advise you about removing chlorambucil, as my guy has been on it for an entire year.
Are you giving any steroids? along with mirataz, or mirtazapine? These are the prime meds for SCL, along with Chlorambucil.

Has your baby had any blood tests recently? Shiver could be anemic! This could explain all the lethargy and lack of appetite. All that would be needed is Vit B-12--- through the Vet.. not yourself.
My guy gets checked for anemia, periodically. This would also cause the lethargy and lack of appetite.

Dehydration can do this also..
All in all, I think you need another Vet appointment, for discussion and treatment.

Steroids can make your baby lethargic. It happened with my guy. We took him off of the prednisolone and put him on Zofran. It made a world of difference.
My guy was so lethargic; that, he would just lie there, staring into space. He did eat, but that was due to the mirataz, using every day, at full dose.

Have you joined or looked at the Feline lymphoma sites on Facebook? They can help you much more than I can.. There are also other chemo drugs to try.
Are you working with a regular Vet? or an Internal Medicine Vet or an Oncologist. An Internal Medicine vet is the best to work with. They can take into consideration different conditions and treat them.

I will tell you that, in my readings, and what I have been told by my own IMVet, Chlorambucil does not usually cause any side effects in cats. Cats are very tolerant to it.

I really think that you need to have a serious sit down discussion with your vet. Personally, I would never take any animal suddenly off a medication, without authorization from a Vet..

All I can say, is (((Hugs)))
Please let us know....

 

[daftcat75]

It could be the effects of not eating much that has him lethargic. It could be dehydration too.

Maybe ask the vet for a can of Hills A/D. That stuff if like kitty crack and it’s exactly what they prescribe for sick kitties who aren’t eating. I would see about that first before the final appointment.

 

[ellen m]

It often takes a week or more for chlorambucil toxicity to abate. It took my own cat two weeks. After that we put him on pulsed and he was fine. I can't say that's what's happening with Shivers, but despite the people whose cats here do well on EOD (I'm sure these cats aren't nauseous, don't need nausea meds, etc., while on EOD, and there are definitely some like that) - despite those people, it would not be logical to claim that because their own cats are fine on EOD, every cat should be fine on it and it's just the disease. That's not what happened with my own cat. In his case, it the the cure, not the disease. Again, no guarantees but I would give this longer. Is he on zofran now? We are not supposed to give dosing advice but that's another thing that my own vet got wrong (and I hear through the grapevine that many do - dosing is now much stronger and more frequent than it used to be, based on research). I can give you a link to the most recent research on that drug's PK and published dosage guidelines but I fear someone will complain about "prescribing", and I'm not. Asking your vet won't help if your vet is not up to date. Can we post links to published research? I can safely say that my own cat needed 2 mg every 6 hours until he came out of his chlorambucil toxicity, which took 2 weeks. Give it more time! The eating yesterday was a fantastic sign! He needs two things: adequate zofran and a switch to pulsed.

 

[ellen m]

It often takes a week or more for chlorambucil toxicity to abate. It took my own cat two weeks. After that we put him on pulsed and he was fine. I can't say that's what's happening with Shivers, but despite the people whose cats here do well on EOD (I'm sure these cats aren't nauseous, don't need nausea meds, etc., while on EOD, and there are definitely some like that) - despite those people, it would not be logical to claim that because their own cats are fine on EOD, every cat should be fine on it and it's just the disease. That's not what happened with my own cat. In his case, it the the cure, not the disease. Again, no guarantees but I would give this longer. Is he on zofran now? We are not supposed to give dosing advice but that's another thing that my own vet got wrong (and I hear through the grapevine that many do - dosing is now much stronger and more frequent than it used to be, based on research). I can give you a link to the most recent research on that drug's PK and published dosage guidelines but I fear someone will complain about "prescribing", and I'm not. Asking your vet won't help if your vet is not up to date. Can we post links to published research? I can safely say that my own cat needed 2 mg every 6 hours until he came out of his chlorambucil toxicity, which took 2 weeks. Give it more time! The eating yesterday was a fantastic sign! He needs two things: adequate zofran and a switch to pulsed.

p.s. My cat was one of the lucky ones because his vet wanted to put him on pulsed. I hear about vets of people in various groups who will fight it tooth and nail. Sometimes they get the vet to switch by showing them the quote in the textbook saying that pulsed is better. If you join one of the SSCL groups you will be able to see all of that info.

 

[ellen m]

One more important point is that the timing favors this being the chlorambucil, which often doesn't accumulate enough to show bad side effects until a month or two after starting treatment. It seems shivers started it about a month and a half ago, which fits this picture like a glove. He's also on a larger than normal dosage (standard EOD dosage is 2 mg, you are giving 2.5 because of the compounding, which is legally required to be different, so it's often just increased for legal, not medical reasons), making toxicity even more likely. My vote is it's the chlorambucil and give it longer.

 

[ellen m]

Sorry, that was a typo. You said you're giving 2.25, not 2.5. Still slightly higher than normal.

 

[artiemom]

S ShiversOwner I was wondering whose decision it was to take Shiver off the chlorambucil?
I hope it was not your own decision. This should be monitored by a Vet..

Cats on any type or regimen of chemo, Chlorambucil included, can be nauseous at any time.
The problem is also Cancer. You do not know which is causing the nausea. That is why these kitties are given anti-nausea drugs, to use as needed. Along with a steroid and appetite enhancer.

Sometimes the steroid is causing lethargy. Personally, I find that Cerenia does not help my cat much when he vomits. The nausea and the vomiting was his only symptom of SCL.

I really have to disagree with E ellen m . She seems to be giving so much more than support and advice. Please do not confuse an already frightened member of this forum.

ShiversOwner, I know you are frightened. I know you are so confused. You want the best for your baby.
Please, really talk things over with your Vet.. Ask how much experience he has treating SCL kitties.
Talk things over with him. There are so many things that can be happening to Shiver right now.
it could be dehydration, as daftcat75 and I suggested. It could be the steroid needs to be changed. It could be anemia... all easy fixes.. but to automatically decide, without a Vet's authorization, to suddenly stop a major treatment, is not good.. not at all..

And, are there any Internal Medicine specialists around you? Or even a Vet University Hospital?
I would definitely go there, for a second opinion, before doing anything you cannot undo...

Again, I wish you ((hugs))

 

[ShiversOwner]

Thank you all for your input. Unfortunately, Shiver woke up today very tired and inattentive and refused food/water. We decided to go through with his appointment to put him to rest, which will happen in about 2 hours. I am devastated for my own sake knowing how much I will miss him, but I am happy for him that he will no longer be suffering.

 

[ellen m]

I am so sorry. You did everything you could. He will rest in peace now.

 

[silent meowlook]

I am so sorry for your loss. You tried and he tried. Sometimes everything isn't enough. Sometimes these things happen for no reason at all. Please be kind to yourself and allow time to grieve, as this is such a painful time.

 

[Norachan]

S ShiversOwner I'm so sorry for your loss.

It sounds like you did everything possible to help Shiver. I think eventually we have to make the decision to let them go, knowing that further treatment might buy them a little more time but that their quality of life will deteriorate. I think you did the right thing. Shiver is at peace now and his suffering is over.



When you feel ready it might help to start a thread in Shiver's memory in our Crossing the Bridge forum.

I'll lock this thread now.

Rest in Peace Shiver