Questions for cat with suspected GI lymphoma

[misskalamata]

 
Chemo is notoriously slow for small cell.  Small cell is slow-growing and typically takes a month or more to respond at all and 3-6 months to reach full remission. With large cell, you see tumors the size of lemons shrinking overnight to nothing after one dose. That's not how small cell works.

There's no such thing as a chlorambucil trial.

Can you point me to information that supports this? I've been searching and searching online, and I can't seem to find anywhere that says how long it takes for chlorambucil to start working.

While I'm not decided yet, I have discarded the option of continuing pred alone without a biopsy. It's either biopsy and go from there, or forget the biopsy and try chlorambucil.

 

[misskalamata]

 
I forgot to add in about the steroid.

I use a compounded liquid for my guy. I am paying $40 for a bottle of it at the hospital. He seems to take it well. I am giving him 0.5 mg once a day. I could get it compounded at a private compounding pharmacy for a bit less.

I asked the pharmacist there. He said it comes in different strengths, and would cost anywhere from $30-40 a bottle. 

How many doses are in the bottle? I got 15 five mg tablets of prednisolone (a 30 day supply) from the human pharmacy for $140!

 

Thanks for your encouraging posts...

 

[denice]

That is a ridiculous price for prednisolone.  I think you could find something much better than that maybe at an online pharmacy.  I get 60 5 mg tablets for 30 some dollars.  I don't remember the exact price but it was under 40 dollars.   I just get mine from the vet and that is typically a more expensive way of getting medicine.

 

[denice]

I just looked up Prednisolone on 1 800Petmeds and they have it for 25 cents a pill.  They have a slash through a 31 cents a pill price.  I don't know if it's a temporary reduction or not but 31 cents a pill is much cheaper than what you are paying.

 

[kittyluvr222]

Sounds like you are on the right path.

The information about small cell vs. large cell, and chlorambucil vs. the aggressive chemo used for large cell, and how fast each one works, is well known. Any knowledgeable vet oncologist, and hopefully any internist as well, should confirm this for you. I don't have links at the top of my head. Sorry.

 

[artiemom]

Hi MissKalamata, 

The compounded iquid steroid ilasts me for over a month. The spiration date is about 6 weeks from compounding date. I give 0.5mg once a day. It has to be refrigerated. 

I could get the pills, but I think the liquid is ok for now. As long as he does not spit it out. He is good with the pepcid in a capsule, but giving him another pill a bit later in the morning, would put him over the edge..

I get the pednisolone from the Vet Hospital~~~ very expensive place, but I can get whatever flavor I want. They do have a lot of flavor options. More than the small privately wnned compounding pharmacy. They are both the same travel time from me,. The hospital can also FED-EX it to me overnight for an additional $7. I may take advantage of that during the bad weather. Fed-ex is always here in this apartment building. My super takes my packages in for me also. 

It does seem that you are paying an exorbitant  price for the steroids. Are you getting it from your Vet? or from a people pharmacy?

If from a people pharmacy, you are probably paying the full price that they charge health insurance companies. I would ask them about the price. Tell them it is not for a person, it is for a cat. 

I had read, from another forum--opps sorry guys--I like this place better, That Walgreens does have a Pet Pharmacy Card. If there is one near you, maybe look into it. I have no idea if it is still in existence or not; But it is something to look into for cost savings. 

You are being a good parent/guardian of your baby. You are looking at all aspects of his care. Think of him as a whole. Take everything into consideration. I forgot, how old is Oliver? 

Artie was 11 yrs old and in fairly good heath otherwise. He was so miserable after the endoscopic biopsy. I was hating myself for putting him through it. It seemed to cause more inappetence in him. And I did not know that was possible. He just curled up in a ball and slept. He kept looking at me. I could see in his eyes he was in pain. If I had known how hard this was on him, I do not know if I would have put him through it. I was really second guessing myself. He kept looking at me. His eyes were pleading with me to help him. I remember telling myself that I did this to him..He will never go thru it again, even if it is suggested, which I do not think it will be. 

Remember though, IBD can turn into small cell lymphoma. But there will not be a biopsy done at that point. 

You can always treat the symptoms without a biopsy. and add more and more meds to the list. It is the same way with lymphoma. Just the chemo..

My guy started on Steroid, Reglan, Pepcid ~ added Zofran in when he was nauseous on his days away from Reglan. We also tried Mirtazapine (appetite stimulator), but he reacts badly to that..........

So it is a hit or miss situation. 

Once we got his nausea under control, he seemed to become more alert, and responded to treatment very well. Also keeping him away from chicken and feeding him novel proteins helps. 

It is not just steroid and chemo..  You can also add other drugs to the mix. 

Artie was on 5 meds at one point. The poor cat, I was coming at him left and right...

Your Oliver also has seizures, another complication to add to the mix. 

Whatever you decide, I would look at all the data, in writing, before I made my decision. Forgive me, but I thought you had decided against the biopsies. Now you are wavering on it?

Talking to too many people gets too confusing. It is information overload.. I got that. I had to sit back and trust in my gut, my heart and the learned experience of my Vet and the Specialist. 

Yes, perforating a bowel from an endoscopic or colonoscopic  prcedure is possible, but rarely occurs. Just as common as Humans haing colonoscopies. How often do you hear of anyone having a perforated colon from a colonoscopy. If it is done by a trained professional, then I would not worry about that. 

If you were thinking open biopsy, I would have a specialist do that also. I know my Vet would not even attempt that. That is why we have specialists. 

One thing, please remember this...take a break from this forum for a few days.. write things down, pros and cons, and how you feel about this. Think hard. avoid all discussion on line about it. Then make your decision. Once it is made; do not waver from it.. Wait a few days and then announce, if you wish, what it is....

Remember information overload is dangerous to you and your Oliver...

I think this entire matter has pretty much been discussed to death...

I wish you luck and you can always contact me if I can be of any help...

my only experience is from my guy, and that is recent. I am going along with the flow and learning as I go on...I had to learn to trust the judgement of my Vets, and keep an open, educated mind....that is why the doctors are there. 

((hugs))

 

[kittyluvr222]

Just a couple of comments on this:

Liquid pred has to be well-shaken to make sure you give the right amount. That's a small disadavantage of it.

Yes, there is pain after a biopsy, but my cat was on a Fentanyl patch for 2 days and was fine after that. This is normal.

It has not yet been proven - only speculated - that IBD can "turn into" small cell lymphoma. I'm not saying it doesn't. But I would counter any statement that unequivocally says it does.

I'm not sure what the "other drugs in the mix" that are referred to above, but SCL cats commonly get an anti-nausea med like Zofran or Cerenia to counter their (usually mild) nausea from the chemo drug, and cobalamin injections 1-2 times a month if they were low (most are).

Bowel perforation is extremely rare and I hated to even bring it up, but I did because it is part of the fact that endosocopies can require more surgical skill (and diagnostic finesse) than surgical biopsies. I don't think endoscopy has been proven any safer than the surgical procedure, as invasive as the latter is. Many GP vets can, and do, full-thickness surgical biopsies very well. It doesn't require an expert. All you need for that is a good surgeon.

Beyond that, I agree that the OP has all the information that she could possibly need or use, and just needs to sleep on it and make a hopefully educated

 

[kittyluvr222]

...decision. (Somehow that last word got cut off.)

 

[misskalamata]

Forgive me, but I thought you had decided against the biopsies. Now you are wavering on it?

Yes, I joined that Yahoo group and they all told me I should still have a biopsy done. I really don't know what to do. He's been on a low dose of pred for 2-3 weeks. It's helping with the diarrhea, but he hasn't gained significant weight.

Oliver had a seizure last night and another this morning....the first in weeks. It almost seems like a sign...every time I get closer to having the biopsy done, his seizures start up again...as if to say, No, don't do it!

  I agree that the OP has all the information that she could possibly need or use,

No, I don't. If I did have all the info, I wouldn't be sitting here second-guessing myself. I need to know:

1) What is the probability of a 14 year old cat with Oliver's symptoms/test results having lymphoma as opposed to IBD? 60%? 80%? The vets won't give me numbers.

2) What is the probability of Oliver surviving anesthesia? Endoscopic vs surgery? Again, I need numbers, and the vets won't give me a numerical estimate.

3)How long would he have to be off pred before a biopsy, and, in his condition, can he afford to wait that long?

4) What is the probability of Oliver having a bad reaction to chlorambucil?

5) How dangerous is short or long-term use of chlorambucil in an IBD cat? What are the specific side effects, interactions, etc that are a concern? All I'm hearing is "not recommended" or "against our policy," but why specifically? I need specifics!

6) What is the most likely cause of Oliver's seizures, and how will the seizures affect treatment? The only answer I'm getting here is "we don't know." I know, without an MRI we can't know the cause with any certainty. But what is the most likely cause?

(7 - why is this website so slow? It doesn't matter which computer I use, it takes forever to load and often freezes up in the middle of me typing a post)

I appreciate the info on getting cheaper prednisolone. I'll definitely get it from the vet next time.

 

[denice]

I think the reason that the vet's aren't giving you numbers is there aren't any reliable numbers to give. 

It is encouraging that his diarrhea has improved.  As far as anesthesia goes your vet is your best resource, he or she has all the lab results and your kitty's medical history.

I know that StephenQ had a biopsy done which showed severe IBD rather than lymphoma.  Rather than increasing the pred dose, his kitty was on a much larger dose than your kitty they added the Leukeran.  His kitty was one that did have a negative side effect, severe diarrhea and so the Leukeran was discontinued.  I remember someone here a while back had a kitty that had the same reaction to the Leukeran.

Myself and this is personal opinion, since your kitty is on a really small dose of pred I would ask about increasing the dose.  I know my  kitty started on 10 mg a day and then was tapered down after his symptoms resolved. 

That is really all that I can offer.

 

[stephenq]

 
I appreciate the info on getting cheaper prednisolone. I'll definitely get it from the vet next time.

Hi

I'm joining this thread late, apologies.  And to be honest I'm not sure how much I can add but I have reviewed the thread and here are my thoughts.

How old is your cat?

- TCS should be used to support your decisions and give you ideas to think about, but we are not a diagnostic tool nor should we be a substitute for your vets.  I feel you are relying too heavily on the site for decision making.

- And in relation to the above, and while I think you should continue to post here for support, I believe you should specifically stop using this thread to guide you in the decision making process of biopsy/no biopsy, chemo/no chemo.  There is NO objectively correct decision, nor a perfect decision.  What there is, is the best personal decision that you can make knowing what you know for your cat whom no one knows better than you and your vets.  Eventually all treatments fail (I'm speaking more metaphorically than medically), so go with what you feel is best and if that doesn't work, go to the next option.

- I agree with @KittyLuvr222  that Leukeran is not to be done as a trial, its a commitment whether after biopsy or without.

- Your Pred dose is very low.  I've never heard of a cat getting lower than 2.5mg, with most getting 5mg or higher.

- My cat had a surgical biopsy, negative for SCL, when pred later stopped working we went to Leukeran anyway because he was losing weight, severe diarrhea etc, but he did react badly to it and after taking him off it we actually got a different diagnosis of internal mast cell cancer via lymph node aspirate (by needle).

- I feel that you are in this painful place where you want the answer in advance of the decision, and I feel my painful job is to tell you that you won't get it because the answer literally doesn't exist.  What there is are decisions based on imperfect knowledge, putting your chips where you think they will do the most good and then hoping for the best, and adjusting your treatments based on what happens.  No decision is usually worse than a decision.  Answers come after decisions, not before.  There are risks and rewards, you cannot figure them out in advance to the degree that you know you are doing the absolute best, you can only do your personal best.

I feel you are listening to too many voices between us and yahoo groups.  Talk to your vets, talk to yourself.  Look at your cat's quality of life and possible life span.

And lastly, here is how i often make a medical decision when i'm not sure what the long term prospects are:

1) What can i do to help my cat's quality of life right now?

2) What's the worst that can happen with a procedure that carries some risk of mortality?  If the answer is a peaceful death during anesthesia then i feel that's a reasonable risk as the cat won't know or mind, the loss will be mine, and if i'm willing to live with that loss then i will proceed.  If i'm not then i won't.

@Anne for her thoughts.

 

[kittyluvr222]

@StephenQ,

I'm seeing your comment and question to me (asking whether you can quote me on my first post in this thread) but I have no idea how to reply to it. I can't seem to find any "reply" button for the comment itself so I will respond here: of course you can quote me, and you don't need to attribute any of what I said to me. I feel everything I've said in this forum is more or less common knowledge, or should be.

As for your comment above (or below?), and your cat, I agree with everything you say. And with respect to your cat, most cats will have some degree of nausea (a "bad reaction," as you say, unless it was different altogether?) on chlorambucil. This is easily dealt with using anti-nausea meds. Perhaps your cat had a different reaction, but in any case, my feeling is that the reaction, whatever it was, was a blessing in disguise, causing you to re-ultrasound (you didn't say you did, but I assume you did in order to see the mass and its location and to target the needle aspirate) and correctly diagnose your kitty.

 

[Benji & Sammy's Mom]

Can you point me to information that supports this? I've been searching and searching online, and I can't seem to find anywhere that says how long it takes for chlorambucil to start working.

While I'm not decided yet, I have discarded the option of continuing pred alone without a biopsy. It's either biopsy and go from there, or forget the biopsy and try chlorambucil.

There is plenty of literature (1) supporting the use of predniso(lo)ne and chlorambucil for cats with small-cell lymphoma and (2) that chlorambucil tends to take a few weeks to start working. Most of the articles require a subscription to the publishing veterinary journals. I have access to the "subscription" journals because I am getting my Master's from a school with an incredible library. However, I will post what I found in scholarly publications that was available for free later.