Elevated Lymphocytes In 4 Yr Old Cat

[my3sweeties]

My kitty Sophie has always had small soft stool but for the last month she has diarrhea. She otherwise seems normal and is eating, drinking and playing as always. I took her to the vet about 3 weeks ago and she put her on Metronidazole for 1 week. That did not clear up her problem. We tried a couple of the special diet canned foods with no luck. She is now Z/D for the past 5 days and still has runny poops. The vet did a geriatric panel to get a good overall view of her health and found that her lymphocytes were elevated. She said normal range was .9-5 and Sophie was at 6.5. She thinks it's most likely intestinal lymphoma. I am beside myself with worry and panic. She suggested an ultrasound but also said that that was not always conclusive. The other option was a biopsy but depending where they take the biopsy that was not always conclusive either and obviously more invasive. She said she could start Sophie on a round of Prednisolone to see if that would help but that if I give her the Prednisolone I would not be able to do an ultrasound as it would alter the results.

I don't know what to do! I am so worried right now I can't think straight. I've read online that stress can cause lymphocytes to be elevated and also infection can cause them to be elevated as well. I'm hesitant to jump to lymphoma as the cause but I don't know if that's just wishful thinking. She said all her other blood results were normal.

In the time before I brought her to the vet I tried giving Sophie 1 teaspoon of pumpkin daily with her food and that didn't work. I'm a little leery of the special prescription diets because I know they are filled with crap ingredients and also, I've read on this site that Z/D can actually cause diarrhea! Please can someone give me some advice and with normal blood results other than the elevated lymphocytes, do you agree with the intestinal lymphoma diagnosis?
I need to add that around the same time that Sophie's diarrhea started we were fostering a HImalayan cat for a couple of weeks. The foster cat was kept in a seperate room and they did not have contact but obviously Sophie was aware that she was there. Sophie is normally a nervous cat and this just made it worse. Could the stress of having the other cat here (she has since been adopted) elevate her lymphocytes?
I'd appreciate your views I'm just sick with worry!!

 

[babiesmom5]

As someone who lost their "soul kitty" to GI lymphoma, (in my case due to missed diagnosis), I can truly empathize. I urge you to be proactive now.

Your vet is correct in recommending an ultrasound. I would start there. The ultrasound will at least show areas of most concern in the intestinal tract, areas of thickening, enlarged lymph nodes, tumors, enlarged organs and/or other irregularities. The results will suggest what it possibly is as well as what it probably is not. It cannot diagnose lymphoma, but from the ultrasound pictures, an experienced radiologist can at least determine odds of probability.

I will tell you though, do not rely on blood tests. With GI Lymphoma, bloodwork is often normal, sometimes lymphocytes are elevated, but not always.

An ultrasound will show areas of concern which may later be biopsied. For instance, if the ultrasound shows thickening, inflammation in the upper regions of the GI tract, that would suggest an endoscopy of the upper regions. If the ultrasound shows the problem being in the lower end of the GI tract (which in your case well may be based on the diarrhea), then they will scope the lower tract. They may need to scope both.

An endoscopic biopsy is less invasive than a surgical biopsy. With an endoscopic biopsy, the vet goes down the mouth, throat, stomach etc, or up the rectum with a camera and takes samples which are sent off to a lab for analysis. I have had this procedure done on several cats, both upper end and lower end. The cat is under general anesthesia at the time and makes a quick recovery. In each case, I knew definite results within a week.

Your vet is right also about starting Prednisolone before doing a biopsy. This is because steroids can "mask" possible lymphoma in the GI tract. A steroid will decrease inflammation going on in the GI tract, thus compromising an accurate diagnosis. It is getting the "cart before the horse". If you start Pred now, you may never know what you are actually dealing with until it is too late.

If this was my cat, I would not hesitate in pursuing an ultrasound now if for no other reason than to "rule out" GI lymphoma. Start there.

The good news is that if it is small cell lymphoma, it does respond well to chemo. Most cats do go into remission for several years and they can have a good quality of life.

I wish I still had your options.

 

[mrsgreenjeens]

babiesmom5 makes EXCELLENT points here. I would go with her advise, since she has lived through it.

 

[my3sweeties]

I'm so sorry to hear that you lost your fur baby to this horrible disease. I absolutely know what it feels like as I have lost 7 cats to disease over the years and 3 within 5 months of each other...I was devastated.
I will take your advice although there are no vets in the area that do ultrasounds. I'll have to take Sophie on a 30 minute drive to have it done. I'll call on Monday to make an appointment. Her poops are more formed today although still very soft but at least that's encouraging. Hopefully the new food is easier on her and the inflammation is subsiding somewhat.

As someone who lost their "soul kitty" to GI lymphoma, (in my case due to missed diagnosis), I can truly empathize. I urge you to be proactive now.

Your vet is correct in recommending an ultrasound. I would start there. The ultrasound will at least show areas of most concern in the intestinal tract, areas of thickening, enlarged lymph nodes, tumors, enlarged organs and/or other irregularities. The results will suggest what it possibly is as well as what it probably is not. It cannot diagnose lymphoma, but from the ultrasound pictures, an experienced radiologist can at least determine odds of probability.

I will tell you though, do not rely on blood tests. With GI Lymphoma, bloodwork is often normal, sometimes lymphocytes are elevated, but not always.

An ultrasound will show areas of concern which may later be biopsied. For instance, if the ultrasound shows thickening, inflammation in the upper regions of the GI tract, that would suggest an endoscopy of the upper regions. If the ultrasound shows the problem being in the lower end of the GI tract (which in your case well may be based on the diarrhea), then they will scope the lower tract. They may need to scope both.

An endoscopic biopsy is less invasive than a surgical biopsy. With an endoscopic biopsy, the vet goes down the mouth, throat, stomach etc, or up the rectum with a camera and takes samples which are sent off to a lab for analysis. I have had this procedure done on several cats, both upper end and lower end. The cat is under general anesthesia at the time and makes a quick recovery. In each case, I knew definite results within a week.

Your vet is right also about starting Prednisolone before doing a biopsy. This is because steroids can "mask" possible lymphoma in the GI tract. A steroid will decrease inflammation going on in the GI tract, thus compromising an accurate diagnosis. It is getting the "cart before the horse". If you start Pred now, you may never know what you are actually dealing with until it is too late.

If this was my cat, I would not hesitate in pursuing an ultrasound now if for no other reason than to "rule out" GI lymphoma. Start there.

The good news is that if it is small cell lymphoma, it does respond well to chemo. Most cats do go into remission for several years and they can have a good quality of life.

I wish I still had your options.

 

[my3sweeties]

I read on this site that S Boulardii can help with diarrhea so I purchased some and have been giving Sophie for the last 2 days 1 capsule per day split btwn morning and evening meals. Her poop has firmed up and is coming out "formed" but still soft. I'm hoping that her diarrhea issue will be resolved and that this is IBD rather than lymphoma. I've posted her blood values below, can someone give me their opinion. I will do an ultrasound to make sure but in the meantime I would like some input..

Thanks for your help.

 

[mrsgreenjeens]

The only thing of note that I see on this report is that she is also in the beginning stages of kidney disease . What did your Vet say about that? Luckily she's just early stages, so that's very good and nothing really needs to be done except possibly make sure she doesn't eat foods that are overly high in Phosphorus.

Otherwise nothing stands out to me other than what you already know.

S. Boulardi is amazing stuff

 

[my3sweeties]

The vet said that she was in the beginning stages but that she was more concerned with the elevated lymphocytes. Im not even convinced the elevated lymphocytes are due to intestinal lymphoma. I'm not sure what to treat at this time- suspected lymphoma or early stage kidney disease??? Will the tretment for one conflict with the treatment of the other? If the S Boulardii works and the diarrhea stops, does this mean she doesn't have lymphoma?

 

[babiesmom5]

I know you are worried sick and looking for any clues of reassurance. I agree with what mrsgreenjeens said that the IDEXX SDMA is a marker for early kidney disease. This is likely true, but this value may sometimes be raised due to other factors. I had an IBD kitty who, when initially diagnosed, his IDEXX SDMA value was 15(high), but when he was stabilized, this value returned to normal range (12-14) and he never did have any kind of kidney disease. The GI ultrasound which you will get will also reveal any irregularities with the kidneys such as size, shape, enlargement, calcification which may aid in assessing kidney function.

Early stage kidney disease, while concerning, is (in my humble opinion) not the main priority right now. The possibility of intestinal lymphoma IS. Feline Intestinal Lymphoma, untreated, can be fatal within 6 weeks! Both these diseases can be managed together, however, you will need a good Oncologist (if it is Lymphoma) and preferably a good Internal Medicine Vet for the early CKD, if that is what it is.

My "soul kitty" who I lost to GI lymphoma also had diarrhea. It was helped, and stopped, by a good probiotic...however, it did not stop the Lymphoma from progressing. This was just treating symptoms not the disease.

For comparison, I went back on my bloodwork reports from 4 confirmed IBD kitties. None of them had high lymphocytes. Some had higher Eosenophils, some had higher Neutrophils or a mix of those and others, but no elevated lymphocytes. Now when they were biopsied, some plasma cells with lymphocytes were seen on the lamina propria, but there was no cancer. Biopsy just confirmed the IBD.

Your vet is right to be concerned about the high lymphocyte count. You really need to get a positive diagnosis...the sooner the better.

I would get the ultrasound ASAP. Then follow the guidance of the radiologist and your vet after you get the results. Good luck...please keep us posted.

 

[my3sweeties]

Update:
My regular Vet called and I explained the situation to her. She had a look at the emailed blood test results and said that although elevated lymphocytes "could be" lymphoma she would like to wait a couple of weeks and then do another blood test. She said that there are different types of lymphocytes and that an overall elevated number may not necessarily mean they are cancerous. So, she will make a house call in two weeks and take a blood sample. She will also do a physical checkup and if she can, take a urine sample, otherwise I'm to get a sample and then bring it in. She is going to get a pathologist to analyze the lymphocytes to determine is they are cancerous or not. I told her that Sophie has been very stressed lately due to me fostering another kitty for 3 weeks and she said that could be another reason why her lymphocytes were elevated. In the meantime she suggested I keep giving her the S Boulardii and the prednisolone 5 mg per day for 2 weeks. So far, Sophie is still eating normally and drinking. She is playful and seems to be ok except for being a bit nervous. The nervousness started when the foster was here and got worse the 2 times I had to cage her to get her to the vet. Thank God my vet will do a house call. I really regret bringing her to the other vet this last time.... it was close to my home and I thought it would be better for her overall but really, I don't trust them and now I regret it. Hopefully my vet will get a diff diagnosis once the pathologist has a look at the bloods.