Lymphosarcoma or Bacterial Infection?

[whittwhitt]

Okay guys, I’d really appreciate help with this if anyone has been through a similar situation or has any insight into what’s going on with my Tommie:

May 13th: First vet visit for a fever (103F), not eating/drinking, lethargy. He is normally an inside only cat, these symptoms occurred the day after he was let outside. He loves to eat grass, he also ate some chives that we didn’t know were in our yard (poisonous to cats). Found a tick on his tail. Blood panel showed elevated WBCs, neutrophils, monocytes, with low eosinophils. Lymphoblasts were seen on a blood smear and his platelets were clumped. FeLV/FIV negative. Doc thinks he could have lymphosarcoma. Prescribed Doxycycline and he was back to normal after just 2 doses of 0.3cc’s 2x/day; so he was better in a day and back to normal.

Was fine on Doxy for 2 weeks, was fine off Doxy for a week and a half and then the initial symptoms occurred again.

June 17th: Second vet visit for a fever (103F), not eating/drinking, lethargy. Blood panel was fine besides high monocytes, low eosinophils and basophils (pretty normal readings though in that regard). No lymphoblasts seen on blood smear and platelets were normal. Doxycycline was prescribed again. He felt better after just 2 doses again, so in a day.

Was fine on Doxy for 2 weeks, was fine off Doxy for a week and a half and then the initial symptoms occurred again.

July 20th: Third vet visit to a new vet (they were the only ones who could see us on short notice). Did a fecal smear, nothing abnormal. Very high fever of (104.5F). Vet went over all information/blood work and agreed that it was a bit weird for cancer symptoms to occur the day after he went outside… thinks it’s more likely bacterial, but doesn’t completely rule out cancer. No blood test was ran (this vet is really rural, he’s getting a blood panel done this Friday though). Doc prescribed amoxicillin and Orbax/one pill of each once a day.

After just one pill of amoxicillin and Orbax, he’s already eating and drinking again, very slowly though, and is more lively.

He has another vet appointment on Friday at another vet. This is going to be his new main vet, it’s just hard to get an appointment in my area. I’m going to ask them to review all of the above, run another blood panel/smear, do a fecal float.

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Some questions I have for them, or if you guys have more insight then please inform me: Why are antibiotics working if it’s a possible lymphosarcoma? Why did the cancer decide to present itself the day after he went outside/ate grass/was exposed to new bacteria? Could be a coincidence, I know. I believe the initial blood panel/increase in WBCs, clumped platelets, is just a response to eating chives. He was fine during the second panel, no lymphoblasts were seen. If it was lymphosarcoma would lymphoblasts not be consistently seen? Especially if it’s a cancer that is apparently fairly aggressive. I’m going to ask the vet these questions on Friday.

Next possible steps I’ve been suggested are to try steroids or send him in for an abdominal ultrasound to check for intestinal cancer.

 

[fionasmom]

White Blood Cells of Cats - Cat Owners - Merck Veterinary Manual
Lymphocytosis (high lymphocyte count) Causes

I absolutely have no insights into this any more than you do. There appear to be some coincidences at play and further investigation is needed, so you are doing the right thing to pursue this. The two articles above, the second of which is not about cats, do give some credence to the fact that lymphocytes can appear for reasons other than cancer. Statistically, how often is this the case, I have no idea.

Could you have parallel tick/chives/lymphoma going on, possibly? The use of steriods were brought up in your other thread and I still stand by the fact that I would want a little more information before starting them. Ultrasound could be enlightening, sometimes inconclusive, but it seems as if some diagnostics have to be done to get to the bottom of this.

 

[whittwhitt]

White Blood Cells of Cats - Cat Owners - Merck Veterinary Manual
Lymphocytosis (high lymphocyte count) Causes

I absolutely have no insights into this any more than you do. There appear to be some coincidences at play and further investigation is needed, so you are doing the right thing to pursue this. The two articles above, the second of which is not about cats, do give some credence to the fact that lymphocytes can appear for reasons other than cancer. Statistically, how often is this the case, I have no idea.

Could you have parallel tick/chives/lymphoma going on, possibly? The use of steriods were brought up in your other thread and I still stand by the fact that I would want a little more information before starting them. Ultrasound could be enlightening, sometimes inconclusive, but it seems as if some diagnostics have to be done to get to the bottom of this.

He's going back to the vet on Friday and I'm going to at least request another blood panel, blood smear, fecal float, urinalysis, ultrasound if they can do it, and go from there. I seriously feel like the lymphoblast they saw was - somehow - coincidental or misread. I believe the vet said his RBCs looked a little strange too, but from what I've read, eating chives, which can cause anemia, will do that. Everything on the blood panel/smear a month later looked fine, minus the mentioned low/high readings, which aren't abnormal (from what I can tell).

But yeah, the vet that he went to initially jumped to lymphosarcoma immediately. Wasn't bothered by the chives, thought it could possibly be a tick borne illness - but from what they told me, the 2 rounds of Doxy he's had so far should've knocked it out. I was thinking maybe he should have been on a longer dosage? I believe they told me to give him 0.3cc's 2x/day for 2 weeks. Not sure if that's the standard time/dosage. I was thinking maybe a month long dosage would knock it out, but I'm not sure what most vets prescribe.

Things that do point to lymphosarcoma though are his age, gender, lethargy, not eating/drinking, pretty significant weight loss (he's normally 15lbs - was 13lbs in May, 12lbs in June, and now he's just 10.5lbs, poor thing). Hopefully an ultrasound will clear things up further for us, or I was thinking maybe one of the other tests we're doing Friday would shine some light on what type of bacteria we're fighting. I personally feel like that's more plausible just because he's an inside cat and he started going downhill the day after he was let outside. Seems a bit strange for cancer to decide to present itself then, but not completely unlikely.

I'll check out the articles you linked! Thank you!

 

[fionasmom]

Let us know what you find out on Friday. While I hope that everything will come down to the chives or tick, you are in a gray area where you do need to rule out the lymphoma. Make a list of questions for the new vet, especially if you are not allowed in, and even if you are. If you aren't allowed in, send a copy of the questions in with your kitty and ask that they all be addressed. Some vets do seem to jump to a "favorite" dx based on their experience but you have a lot going on here.

 

[whittwhitt]

Let us know what you find out on Friday. While I hope that everything will come down to the chives or tick, you are in a gray area where you do need to rule out the lymphoma. Make a list of questions for the new vet, especially if you are not allowed in, and even if you are. If you aren't allowed in, send a copy of the questions in with your kitty and ask that they all be addressed. Some vets do seem to jump to a "favorite" dx based on their experience but you have a lot going on here.

Will do! Especially if this helps someone else, I've gotten so much help from looking through older threads here. This vet, thankfully, allows you to come inside. I feel so much better going in with them and personally I like to 'see' them check everything out, call me paranoid I guess. I always come in with questions and theories, things are highlighted and defined, ha. The vet we visited yesterday when we were going back and forth about what it could be told me "you sure you don't want to be a vet? Is it too late for you to go back to school?" - the biggest compliment I've received! I'm interested in medicine but more than anything I just care about my baby. I've had my Tom since I was 13.

I'll keep you guys updated. Seriously hope for the best, it's crazy how things can go downhill so fast. I know I've been a wreck ever since he got sick this last time, because it just keeps coming back. Seeing him get better just to get sick again is very tough on both of us.

Edit: Any chance FORLs could present itself like this? I know during his May exam they noted possible FORLs. Maybe some kind of oral infection? I've had them look into his mouth multiple times, for ulcers or foreign bodies, esp when he was outside eating grass that first time, just in case he tried to bite something he shouldn't have. They didn't see anything besides the fact he could use a cleaning. His last teeth cleaning was... maybe 5 years ago? I'll admit I haven't been the best about giving him toothpaste, I could've been better about that.

 

[fionasmom]

FORLS, any advice?

I have not had to face FORLs myself but it is a somewhat common topic on TCS. Try to remain calm, easier said than done, while all of this is sorted out. This is running such a gamut which now includes enough conditions that it seems unlikely, statistically, that he could have them all. Your baby is very lucky that you are so proactive for him.

 

[whittwhitt]

FORLS, any advice?

I have not had to face FORLs myself but it is a somewhat common topic on TCS. Try to remain calm, easier said than done, while all of this is sorted out. This is running such a gamut which now includes enough conditions that it seems unlikely, statistically, that he could have them all. Your baby is very lucky that you are so proactive for him.

So on Friday's vet appointment, because of his significant weight loss, the vet was able to feel a mass. We did an x-ray and he has a large mass on his lower intestine that looks cancerous. Vet said he's 80% sure he has lymphosarcoma given his symptoms over the last few months as well as his age. They told me to stay on the Amoxicillin, 100mg/day, quit the Orbax, gave him a steroid shot (Depo) and prescribed lactacted ringers, 300ml/day where I have to stick a huge needle under his skin - did that for the first time yesterday, well almost couldn't bring myself to do it, but finally did. I was nauseous and shaking for a good hour afterwards. Going to look into further diagnosing and treatment options on Monday when the vets open. Also bought a little non-toxic ink pad to take his paw prints with, I've seen people use their prints for necklaces and such and thought that would be such a lovely thing to have, regardless of the outcome.

Just wanted to update so if anyone else searches for these symptoms hopefully they have an idea of what's going on with their baby. In all honesty, if the first vet I took him to in May thought it was possible lymphosarcoma, I'm not sure why they didn't offer or order an x-ray right then and there, and save Tom and me 2 extra months of trying to figure out what's going on. The only reason I took him to that vet initially was because they have a habit of being able to see you same-day, and then when he got better after just a few doses of Doxy I thought, hey, well I guess they're wrong because he's feeling better/why would an antibiotic make him better if he has cancer.

Side question - any advice for getting him to eat more? I've bought him every brand, every flavor of canned food. I swear I open 5 cans of cat food a day just because he gets slightly excited at the sound and that encourages him to at least smell it. He'll have a few licks and then he's done. Any tips for possibly making raw food he hopefully can't resist?

 

[fionasmom]

How old is Tommie? I am very sorry that you received this news. It was concerning to me that you had a couple of conditions at play and one was masking the other....or complicating a diagnosis.

To answer your questions, I do not feed raw at all to dogs or cats, so don't have any first hand experience with it. Some on TCS recommend foods like Rawz which you might have seen which are not exactly raw but very close to it. You can order raw food from sites like

Darwin's Natural Pet Products - Delivering Raw Pet Food Direct to Your Door | Darwin's Pet Food
Home Page | Hare Today

As for making your own or getting other advice about raw food, you can post specifically in the Cat Nutrition forum. You don't have to repost everything you have here, but can just ask about raw recommendations for a cat like Tommie with newly diagnosed lymphosarcoma who is not eating well.

StackPath

This link includes a very specific recipe

Other options include Gerbers baby food meats, the stage 2 sitters formulas, and any of the toppers, stews, bisques, delectables which are now made by almost every cat food manufacturer. Hartz Delectables is very popular on TCS with a lot of people.

I am sorry that the first vet did not take this more seriously so that you would know what was going on. Sometimes in an older animal facing a serious condition, vets seem to be less proactive or to make an assumption that the condition is not treatable. It is not fair to the owner and pet of course.

As for sub Q fluids, how did Tommie react? Depending on how you feel about transporting Tommie back and forth, most vets will do the sub Q fluids for you, especially for a cat, for a very small fee. My cat vet charges $5 each time. I have done sub Q fluids a lot and currently do them for my dog but there is a level of uneasiness about doing it at first. Did the vet show you specifically what to do?

How to give subcutaneous fluids to your cat | International Cat Care
Subcutaneous Fluid Administration in Cats

These are only a couple of sites of the many that show or discuss sub Q fluid use.

Please let us know how things go for Tommie.

 

[whittwhitt]

How old is Tommie? I am very sorry that you received this news. It was concerning to me that you had a couple of conditions at play and one was masking the other....or complicating a diagnosis.

To answer your questions, I do not feed raw at all to dogs or cats, so don't have any first hand experience with it. Some on TCS recommend foods like Rawz which you might have seen which are not exactly raw but very close to it. You can order raw food from sites like

Darwin's Natural Pet Products - Delivering Raw Pet Food Direct to Your Door | Darwin's Pet Food
Home Page | Hare Today

As for making your own or getting other advice about raw food, you can post specifically in the Cat Nutrition forum. You don't have to repost everything you have here, but can just ask about raw recommendations for a cat like Tommie with newly diagnosed lymphosarcoma who is not eating well.

StackPath

This link includes a very specific recipe

Other options include Gerbers baby food meats, the stage 2 sitters formulas, and any of the toppers, stews, bisques, delectables which are now made by almost every cat food manufacturer. Hartz Delectables is very popular on TCS with a lot of people.

I am sorry that the first vet did not take this more seriously so that you would know what was going on. Sometimes in an older animal facing a serious condition, vets seem to be less proactive or to make an assumption that the condition is not treatable. It is not fair to the owner and pet of course.

As for sub Q fluids, how did Tommie react? Depending on how you feel about transporting Tommie back and forth, most vets will do the sub Q fluids for you, especially for a cat, for a very small fee. My cat vet charges $5 each time. I have done sub Q fluids a lot and currently do them for my dog but there is a level of uneasiness about doing it at first. Did the vet show you specifically what to do?

How to give subcutaneous fluids to your cat | International Cat Care
Subcutaneous Fluid Administration in Cats

These are only a couple of sites of the many that show or discuss sub Q fluid use.

Please let us know how things go for Tommie.

He's 12 this year, my sweet boy. I've tried every single brand and every single flavor of canned food, at different local stores as well. I've tried toppers and treats and soups. I've tried chicken and turkey gerber, still nothing. He's actually started eating a few bites of his regular cat food as of yesterday, which is great to see but I wish he had more interest in canned for hydration. But hey, if he's getting something on his stomach it's better than nothing. I've tried canned numerous times, and he'll take a few licks and then lose interest. I've gotten recommendations to try fried chicken minus the skin, maybe some tuna - so I'm going to pick those up today.

He looked like he felt better, albeit I didn't get the full 300ml dose in him. He took it very well though, I thought the needle would make him uneasy but it seemed like he didn't feel it, which made it easier for me. They showed me how to do it and I watched quite a few videos online too. I'll try again today and shoot for the full 300mls. Any idea if a 16g needle is the standard for subq fluids? Seems a bit large of a gauge to me. I do work in healthcare so I could grab a smaller needle from work tomorrow if needed.

At this point I'm not too sure what to do, I feel like if it is FORLs messing with his mouth and cancer in his intestine, either way if I treat one or the other, I'd have to get him back to good health first and then go forward with treatments. I'm not sure I can afford either one of those issues, which makes me so unbelievably sad and feel like a terrible mom.

 

[fionasmom]

Choosing and Buying Needles

This is more than you probably need to know, but the needle size decreases as the number becomes higher. I use 18 gauge currently on a 100 lb GSD but there is no right or wrong, within reason, if it works for you. 16g is definitely used for veterinary care. The larger the number, the smaller the needle and the slower it all goes.

Keep your vet posted if Tommie really is refusing food. I use fried chicken to bait traps for ferals and it is remarkably successful; of course, once the trap slams, they are too upset to eat so I don't know if it really works on that level or not. Will he boiled chicken, or rotisserie chicken from the market? At a certain point, he has to eat either by syringe feeding or a feeding tube or with an appetite stimulant which would probably be the best thing to try first off before going to anything mechanical.

Did you vet have any recommendations for treatments? For the intestines or the mouth? What do they feel that Tommie is up to having done, if anything? What is proposed might make a difference to what you might try. As for not being able to afford the care, veterinary care is hugely expensive once you reach higher levels or more critical care and you should not feel as if you are not doing enough just because you may not have thousands put aside. While I don't want to be too clinical, you need to know what the possible prognosis is before/when you invest in expensive procedures.

 

[whittwhitt]

Choosing and Buying Needles

This is more than you probably need to know, but the needle size decreases as the number becomes higher. I use 18 gauge currently on a 100 lb GSD but there is no right or wrong, within reason, if it works for you. 16g is definitely used for veterinary care. The larger the number, the smaller the needle and the slower it all goes.

Keep your vet posted if Tommie really is refusing food. I use fried chicken to bait traps for ferals and it is remarkably successful; of course, once the trap slams, they are too upset to eat so I don't know if it really works on that level or not. Will he boiled chicken, or rotisserie chicken from the market? At a certain point, he has to eat either by syringe feeding or a feeding tube or with an appetite stimulant which would probably be the best thing to try first off before going to anything mechanical.

Did you vet have any recommendations for treatments? For the intestines or the mouth? What do they feel that Tommie is up to having done, if anything? What is proposed might make a difference to what you might try. As for not being able to afford the care, veterinary care is hugely expensive once you reach higher levels or more critical care and you should not feel as if you are not doing enough just because you may not have thousands put aside. While I don't want to be too clinical, you need to know what the possible prognosis is before/when you invest in expensive procedures.

I'll grab a smaller needle tomorrow for fluids. I'm going to call the vet in the morning and ask for pain killers, if he does have FORLs then I'm guessing that's another reason why he's not too interested in food - it just once again amazes me that everything is hitting all at once? I've noticed just recently that when he bites his regular food he favors one side... cancer wouldn't cause that. My husband and I have both been syringe feeding him water and pedialyte as well as canned food which I made into soup, just to get something in him.

For treatment - he referred me to a specialist 2 hours away (we're in a small city) for an ultrasound and needle biopsy, and also offered to do an exploratory lap at his office if I wanted for a biopsy. I'll be honest I can't afford the ex lap, also the ultrasound sounds better given I don't believe he would recover very well from surgery anyway. I'm going to call the specialist vet in the morning and get quotes for everything. I believe I can afford the ultrasound and biopsy, it's the continuous treatment and tests I worry about. Also his quality of life of course but I believe I've read they can take chemo pretty well.

 

[whittwhitt]

Here is a copy of his x-ray that shows the probable cancer in his lower intestine

 

[daftcat75]

As I see it, you have three tasks ranked in priority ahead of you if you wanted to make a play at this.

1. Solve the inadequate nutrition problem. Without this, prognosis and quality of life is poor.
2. Understand the nature and scope of the mass. Is it malignant? Has it metastasized?
3. Determine the short-term and long-term treatment courses with eye to prognosis, outcomes, and quality of life; also taking into account the current health status and the risks involved.

1. Inadequate nutrition:
Normally, I would strongly encourage a full dental workup with x-rays and any and all extractions the vet thinks are necessary. Extract them all if he can because that's where FORLs is eventually heading. Proactive extractions can end an awful cycle before it runs its lengthy and miserable course. But most general vets don't have the skill level or the desire to proactively extract healthy teeth. For that, you would likely need a dental specialist. Tommie doesn't have the kind of wait time that these specialists do--they often have two to six month lead times for appointments. And even if you could get him into a specialist's office tomorrow, all the extractions might not fix his appetite depending on what effect the mass is having. Your best short-term play here is a feeding tube. You will finally be able to get enough canned food soup into him to equal as much canned food as he should be eating right now to battle what might come next. Inadequate nutrition will likely rob him more quality (and quantity) of life than surgery or chemo for the mass.

2. Nature and scope of the mass
An ultrasound and some form of biopsy will be necessary here. The ultrasound will help determine if there are changes in the organs or other masses that might indicate proliferation. The mass seen in the x-ray may not be the end of the story. It may only be the piece of the story that was visible on an x-ray. Even if the ultrasound is all clear for other organ involvement, some form of biopsy is necessary to determine whether the mass is malignant (cancerous.) Hopefully a needle aspirate is all that will be needed. If a surgical biopsy is required, the prognosis is poor without the nutrition problem solved. That doesn't even begin the treatment plan for the mass.

3. Treatment plans
If the mass is malignant, it has to be removed. It cannot be treated with chemo alone. Generally a mass large enough to visualize is also large and old enough to have proliferated. It's not often you get a malignant tumor that stays put. That brings us back to the nutrition problem once more. Unless you get adequate nutrition in him, I could not recommend any kind of surgery. It's just compounding problems and complicating recoveries. Depending on the size or nature of the mass, a section of the intestine may also need to be removed. Even with a feeding tube, that will be a difficult recovery for him. You need to discuss with the oncologist the prognosis (mean survival times) and the chances for recurrence. Even if the mass is not malignant, it still may have to be removed depending on its location or effect on digestion. All roads may still point to surgery even if it is not cancerous. But if it doesn't have to be removed, you should ask about quality of life and the risk for it to become malignant later and what kind of monitoring may need to be done.

A feeding tube would buy you more time to understand the nature and scope of the mass and discuss treatment options for the mass. But it would require a time investment on your part. His stomach is only so big, and smaller now since he hasn't been eating as much. If it takes five* syringes of food plus water to equal one can of food, if he can only take one syringe per feeding, and if he needs two cans of food a day, you'll need to schedule 10 feedings for him. *I'm guessing at all of these calculations here because Krista was already eating on her own when she was released from the hospital having had a feeding tube inserted several days before her release. I mostly used it for medicine and insurance in case her appetite reversed again. However, I did follow this kind of feeding protocol to get her through pancreatitis when I could only get her to eat a half an ounce at a time.

On top of all of this, there's the cost issue you mentioned. I'm not a vet and I don't have medical training. But it does look like a surgery is an inevitable piece of the treatment plan. In the medium term, the teeth still need to be dealt with. In the longer term, they likely need to be dealt with by a specialist. ($$$) I have been thinking that he may have an infection, possibly from his teeth, and that could be the reason why he has been responding to doxy. If that's the case, you may not be able to put off his teeth--especially if you're talking about putting him on an immuno-suppressing chemotherapy agent.

You have a lot of balls in the air, a lot of unknowns, and a few complicating factors here. Certainly lots to discuss and consider with your husband and your vet.

 

[daftcat75]

If he wants to eat kibble, I say let him. At this point, it's more important that he eats than what he eats. Sometimes cats with oral pain have figured out which side hurts less and can crunch once or twice before swallowing. Ironically, softer textures can sometimes be more trouble for cats with dental pain.