S.O.S. - Kinney has anorexia/anemia

[barbb]

I think it is good that you are doing a re-ultrasound to see what is going on there. But I would definitely ask the doctor "if the aspirate is able to be done and is negative, does that mean he is cancer free?" I say this because, in Toby's case, his mass was negative but other tissue that was not any part of the mass was positive. I was ecstatic when the initial results showed no lymphoma in the mass. I hung onto those words. But then the biopsies of other parts of him came in and were positive. Even then I found it hard to believe. I wanted very concise information and it was difficult to obtain, especially as the surgeons and specialists were/are not the best communicators.

While Toby was being treated, one of my other cats Lulu, also showed a large mass near her thymus gland. She too had eaten less and was losing weight. After Toby's situation and the amount of money we spent trying to figure out his issues without cutting him open, to no avail, we decided to just bypass the ultrasound and said just take it out. It turned out to be a tiny cyst that was attached to a large fluid filled sac. They removed it and she was fine, no cancer. We got a big discount on the surgery as a result of the surgery ending up to be so minor. 

The thing that is scary is how sick your cat was before the prednisolone. This med is treating his symptoms only :-(. Prednisolone is a miracle drug in that way, it makes you feel hungry and jumpy and hyper and it takes down the inflammation. That is why steroids are such wonder-drugs for athletes, because they take away the pain and inflammation, help to add bulk, and give you energy. :-(. But they aren't good in the long run bc they weaken tissue walls and have other side effects, including blocking of your immune system. http://www.patient.co.uk/health/oral-steroids  That is why doctors do not usually want to give steroids before treating the cause of x or y illness.

Since Kinney  has already had one ultrasound and they could not diagnose him from that, I am pretty sure that, unless the aspirate can be done and indicates lymphoma, :-( the doctors will tell you they cannot diagnose him further without surgery :-(.  This is what happened to Toby :-(. Maybe you can get somewhere with this experience that we had,

Last but not least, you might want to call the hospital again and ask if you can feed him later in the night (if you are willing to do that) so long as he doesn't eat more than 10 hours before his surgery(?) Sometimes they allow that so long as it is around 10 or 12 hours without food. I don't know how late you stay up, but this is just a thought. He may be pretty vocal given the high dose of steroids he is on and being hungry from it. If not, then just feed him a lot right before midnite! 

 

[dan32]

I left everybody out last night and starved all three of them this morning, then fed the other two once I had Kinney in the carrier.  I will probably never be able to use this approach again.  Kinney is very clever and remembers all former disguises and tricks.  I almost had him in the carrier, then he escaped and I had a h--l of a time getting him back in. 

The ultrasound at VSEC went better than the ER, although the waiting area is the same.  The radiologist was very nice and gave me a consult as I had requested prior to them taking an aspirate.  I asked him while they were at it to do a Packed Corpusle Volume (red blood cell pctg) to see if we were out of the woods with the anemia.

First the good news: PCV now 33%, up from his low of 12% (a limp dishrag) two weeks ago.  No longer anemic..  Secondly, his duodenal ulcerated mass is no longer visible.  Thirdly, they took an aspirate of one of his lymph nodes to be send out for labwork.  BarbB: I asked about false negatives and he said yes that can happen.

Now the not so good news: Liver and spleen mildly enlarged (less than before) as well as mild thickening of intestinal walls, 2-3mm, but less thick than on previous exam.  Marked enlargment of duodenal lymph node, 2-5cm, similar to last exam.  Mild-moderate enlargement of other mesenteric lymph nodes, overall slightly smaller than on the previous exam.  (I had to look up mesenteric - apparently the bag that contains the intestines and is attached to the abdomen).

So they will call in a day or two with the lab results.  The diagnosis section of the ultrasound report still made it sound like lymphoma "these findings remain consistant with lymphoma or other neoplasia, less likely granulomatous or eosinophilic disease" (allergies as far as I can gather)

Feeling glum.

 

[ldg]

I do hope the aspirate will provide an answer. I take it no one has said anything about small cell lymphoma vs large cell? Small cell is much easier to treat.

But that is GREAT news about the anemia! Apparently the ulcer has healed.

 

[barbb]

Dan, I am so sorry to hear about these results :-( because as you said, the information is still consistent with lymphoma, even though he has responded well to the prednisolone. As LDG said, it is really good that his anemia is improved and that his ulcerated mass is not even visible. That should mean he is feeling a lot better, albeit maybe jittery. His well being is worth it and you have done well by your boy for taking him this far to date and carefully weighing what to do, when, and how, especially giving yourself and Kinney time to absorb the shock and in Kinney's case to regain strength. 

The thickening of the intestinal walls is very disturbing IMO and again IMO that is where they should be taking a sample if they cannot find anything in the aspirate :-(.

And as LDG has said, it would be good to ask them about small versus large cell lymphoma as there is a very large difference in treatment, outcomes etc. Small cell is not curable but can be maintained with pills, altho in your case you would want to ask ahead if they have syringe type treatment should it turn out he has that.

I can tell you from my experience, my oncologist did not go immediately to discussing large or small cell lymphoma, he was hung up on B versus T cell lymphoma http://www.leukaemia.com/web/aboutdiseases/lymphomas_btcl.php.

But it sure does seem that in the case of your cat you can maybe (?) take a little personal leap to intestinal lymphoma or alimentary lymphoma, and start asking questions within that realm to be sure your vet does not bypass that info or area in the pathology report as mine did, and you can ask them what is their process as well as determining what first, then next etc. 

Here is info on types of lymphoma as far as location

 http://www.fabcats.org/owners/cancer/lymphoma.html

Here is info on the significance of B or T cell lymphomas, it appears the distinction needs to be made if you are planning on targeting them for destruction via chemo etc. http://lymphoma.about.com/b/2007/08/18/what-are-t-cells-and-b-cells.htm

I realize I am jumping ahead here as far as going into the nitty gritty. :-(,I apologize. I am soooooo sorry that the news is not better for Kinney. I guess part of me is still running that race to help extend kitty life, if not mine, then others who are in need and their parents. 

Here is a really good link (sorry for all these links) with a diagram of types of lymphomas, symptoms, and recommended courses of action for vets. http://www.2ndchance.info/lymphomacat-Gieger2011.pdf

I am stopping here, it's been a long day and one of the kitties (Lilly) was discovered deceased tonite at the adoption center where I volunteer. She was only 7 or 8, and was given up by her old aged caretaker who had brain cancer. It appears she went to sleep this afternoon and died in her sleep. I was meeting in the other room with other mgrs at the shelter, and stupidly I went in there when I heard the news. Just a glimpse of Lilly brought back all the pain of losing Toby. I have always regarded the adoption center as a refuge for both cats and me, somewhere that good is happening, so it was very sad to see reminders that we can only do so much. Lilly was very well taken care of and free-roaming in the center, so she did have happiness. My thoughts are with you and Kinney, facing this much harder labyrinth, and I will do whatever I can to keep helping. 

 

[dan32]

Most of what I posted in post #62 is taken verbatum from the radiologist's report.  I think the lab results from the aspirate is what will identify the type of lymphoma, if that is what he has (small or large).  Since he originally had an ulcerated mass on his duodenum (which is considered to be the start of the small intestine), I am not surprised that he still has a thickening there - a thickening sounds better than an ulcerated mass, huh?

I don't see that much jitteryness with him.  His appetite is good but not frantic now, not the hourly eating sessions he had in the first week when he was trying to make up for lost time.  He seems able to sleep OK.  Doesn't seem "speedy" to me..

In Kinney's favor, he is only 5yo - so young body.  Most of the lymphoma case histories are for cats 2-3 times his age.  All seem to indicate histories of digestive problems - in Kinney's case he would eat lots of kibble, drink a lot of water afterward, then throw up - get turned off to food, wait to restart eating again (sometimes up to a full day) and repeat.  He has done this since he was little.  He has not thrown up at all since I changed him over to grain-free kibble, but I may be just fooling myself there.  I would say he used to throw up at least twice a week.  So maybe all this has been stewing down below all along...

There has never been any diarrea involved which seems to show up in IBD.

I will have to take this on a day-by-day basis.   (which he seems to be doing)

 

[ldg]

Actually, IBD can be frequent vomiting or diarrhea.

http://www.ibdkitties.net

 

[barbb]

Yes, LDG is right, and that is what I was told too, with Toby- he also had no diarrhea but he was vomiting after eating. And Toby too had some prior history of blockage/constipation. We aren't sure what that was about.
It would actually not be the worst thing in the world if Kinney had IBD that may have morphed to lymphoma, as that does happen, but if it does, I think it is small cell lymphoma which is more a long term illness.

The thickening of the intestinal wall was explained to me as a situation where it becomes less resilient and that is not a good thing, and the thickening can be attributed to the mutant cells which in IBD are irregular and may or may not convert at some point to cancer, whereas in large cell lymphoma I believe they are mutant malignant cells. LDG may be able to help me here, to make sure I am stating this correctly.

I hope the lab results do show something, it would be a huge help. In our case Toby had this huge amount of lymphatic tissue and fluid that was negative and it was so frustrating as we were pretty convinced then, that maybe he would be fine with chemo as the lymphatic fluid was not affected. This proved not to be the case :-( as everyone knows. I also agree, similar to LDG's boy Lazlo, yours has a better chance with being a younger age, to respond to aggressive treatment once they find out what you and Kinney are dealing with..

 

[dan32]

Results back: aspirate did not provide an answer.  They couldn't find anything in the sample of the lymph node that they collected.  He indicated that they thought that the pred had knocked out whatever it is thus far.  I am assuming that they are talking about his duodenal lymph node as that was the one that was specifically mentioned in the radiology report?

So again three options: 1) surgically go in and remove the lymph node with the hopes that a bigger sample will give answers, 2) see the oncologist and proceed without knowing what it is, 3) just keep him on pred and see what happens.  I asked how big of a deal the collection of the lymph node (I assume the one they said was enlarged) would be and he said not so big of a surgery, and quoted something like $2500-$3000.  Yet this is the radiologist I am conferring with, so factor that in.

I guess a consult with their "brilliant" oncologist couldn't hurt - but all this vagueness is starting to feel like a pattern. 

I have been reading up on IBD, small and large cell lymphomas.  I read every one of the GI case histories on felinelymphoma.org - the stories are all over the place - but a common thread seems to be a history of digestive upsets.  I found most of the cases are for older animals.  The small cell looks like a pretty easy protocol (pred with chlorambucil).  They can even make the chlorambucil into a suspension and give it at home, from what I was reading.  That seems do-able to me.   It is the large cell that is the big kahuna with the 16 sessions with varying medicines.  I am not sure we are up for all that.

In my heart of hearts, I keep thinking diet changes are about all I have to work with here.  Actually, he is on a higher "dose" of raw than my other two - yet I have not made a convert out of him by any means.    The Nutro Grain-Free kibble seems to agree with him - no vomitting in two weeks which is about a world record.  I would really like to taper him off the pred and see what happens.  It doesn't seem right to treat him for something we can't identify...

 

[barbb]

Hi Dan,

Very frustrating :-(. In Toby's case, he had a mass that was almost blocking his colon, and he even had impacted feces due to the amount of mass. The entire mass was lymphatic fluid and lymphatic tissue and it was negative :-(.

Where they DID find the cancer cells was in the intestinal walls where there was the thickening. I was told that  this is not unusual i.e. not to see cancer in the lymph area but to find it elsewhere. I do think it would be good for you to consult with an oncologist before going any further because you could be removing a lymph node, only to find that it too is negative, and still missing that there may be cancer somewhere. Plus you can ask about the illness itself- how does it happen that the disease presents with lymphatic swelling and yet may NOT be present there, but show up somewhere else?

And finally, the price you were quoted by the radiologist, that is in the ballpark of what we paid for Toby's exploratory surgery where they took samples from various places. He didn't have a huge incision or anything either. You could talk to the oncologist about that too. 

So far you have gone pretty much the same path as us. If there is a thought to opening up your boy, you may as well be sure that this time it is definitive, or as close as they can get to definitive. Plus that will help you decide his treatment. As you say, the small cell is very do-able and worth a shot. 

 

[ldg]

:nod: Small cell is treated at home.

Vibes for you as you navigate your options and make decisions. :heart2:

 

[dan32]

We are going to see VSEC's "brilliant" oncologist tomorrow, Rebecca Risbon.  I am not sure what will happen.

Personally, I would like to taper him off of the prednisone and see what happens, but I will run that by the oncologist first.  I would want somebody to hold my hand while we do this in case it backfires.  Otherwise, we are just in a holding pattern.

From a low of 7.5 pounds, he is up to 9.0 pounds - so his appetite has been good.   No vomiting - poops normal.  Stable patient as far as I can tell.

 

[ldg]

on all fronts! And yes, it will help you enormously to have a specialist guiding you through everything.

...and they may want you to taper him down anyway to be able to do more accurate diagnosis in the future. Pred can make it difficult.

 

[dan32]

Had my appt. with Dr. Risbon today. 

First the dish: While waiting, I was looking at the certificates on the wall and noticed Red Bank Veterinary Oncology alumni.  When the doctor entered, I asked "you wouldn't happen to know Dr. Clifford would you?"  Her response: "I am Mrs. Craig Clifford".  A husband and wife team.  Since Dr. Clifford practices over in Malvern (far NW Philly suburbs) and Dr. Risbon practices in Levittown (NE Philly suburbs), I asked where they live?  Somewhere in the middle in Montgomery County.  So LDG, I am seeing Mrs. Clifford.

I have been doing so much reading of late that I almost have my night time veterinary degree (LOL), so her opening dialogue was extremely predictable.  Based on Kinney's young age and his rather miraculous response to prednisone - they are strongly supposing he has large cell lymphoma and not the more easily treated small cell which occurs more commonly in senior animals, occurs lower in the intestinal tract and does not respond so well to prednisone.  Again, we could try and take him off the pred to see if the symptoms would come back (eek!), so that they could perform a pretty expensive surgery and take intestinal slices for hopefully a better biopsy.  I asked if all of this was just to determine if it was small or large cell lymphoma and she said yes.  So, I remarked that the cost of the possibly inconclusive surgery could pay for chemo treatments.  YES

So there we are with a strong supposition of  large cell lymphoma and the full kahuna of chemo treatments (my fear) - or take him home on the pred.  She said I could take my time to think about it and if I were to decide to go ahead with chemo, that they could schedule him at fairly short notice.  As I was sitting out in the waiting area for my written discharge papers and bill payment - I asked: "Could you do the first of the chemo treatments right now?"  YES

By the time I went over to Dunkin Donuts for a coffee and returned, he was done.  Patient is home and eating normally so far.

So here we go...  Madison protocol without the definitive biopsy.  Wish us luck!

 

[goholistic]

Wow, I can't believe you're seeing Mrs. Clifford! That's great news. It's a small world, huh?

I'm sorry that the doctor's supposition was not the best of news. Say is was small cell lymphoma, will the chemo also help with that? IMO, it seems like you made a good decision to skip the surgery. Admittedly, this is not my area when it comes to cats. At least, not yet. I do have one cat that may have intestinal lymphoma, but it hasn't been confirmed and it could be IBD. Anyway...from what I read, some chemo treatments can cause nausea, and this is where Cerenia is very helpful.

I do wish you and Kinney the best of luck. You've taken this on with such strength and your updates read with unwavering fortitude. I'd be an emotional wreck, even in the typed word.

Four hugs - one for you and each of the boys. 

 

 

 

 

[roxie]

Dan, I just finished reading Kinney's story. I felt myself getting frustrated. I'm sure you've felt like you were going in circles. I hope the chemo solves the problem and he lives a long, healthy, and happy life. Bubba did the eating thing when he came home from the hospital. He ate almost constantly. He's still eating quite a bit but not as much as he did those first few days. Hang in there. I'll definitely be praying for you, Kinney and your other two kitties.

 

[dan32]

Thanks GoHolistic and Roxie for the positive vibes.  So far Kin doesn't seem to have any ill effects from his first session yesterday.  I am going to try and keep the backup medications to a minimum unless required.  No Cerenia, Pepcid, Miralax or Acidophilus.  I do have appetite stimulant around but haven't needed it in weeks.  I have re-introduced nightly catnip again - our version of medical marijuana.

It's hard not to think ahead to all of the visits necessary, but I am trying to use the "God, just get me through this day" method of getting through it.  Maybe I need to take up Buddhism or meditation to try and find peace...  I have been having nightmares nightly since this all started.  You would think my tired brain would have become fatigued by now.

I have a new appreciation for Cancer Moms everywhere.  And there are plenty of others in the waiting room at VSEC.

The protocol is the same three chemos rotated over and over, so I suppose I can assume he does not have a problem with the first one they used (Vin Christy - Chris Christy's brother).

 

[ldg]

Wow - Mrs. Clifford? :lol3: Yes, what a small world! :lol3:

GREAT that the chemo doesn't seem to be bothering him! I expect it helps quite a bit that he's in such good health otherwise. :cross:

I don't know the protocol - clearly different than what Lazlo was on, but Laz did have a "massive mass" in his stomach, so a completely different situation. Does the protocol include Elspar? I see studies on it, but not the full reports...

Continued for Kinney! And for you. :heart2:

 

[dan32]

The protocol is called "Madison Wisconsin (UW25) CHOP Protocol for Feline Lymphoma":. 

It rotates Vincristine, Cyclophosphamide, Vincristine then Adriamycin in that sequence over four times.  It doesn't seem like he has a bad reaction (so far) to the Vin Christy, which is half of what he will be getting, so that is good - I guess.  Also, there is tapering of the pred to EOD in weeks 7 & 8, then discontinue in week 9. 

 

[goholistic]

Dan32, I came across something on the internet:

Incurable to Cancer-Free in One Year: How Nate-the-Cat Survived High Grade Lymphoma

Now, I must say that alternative treatments are all over the place and are highly debatable. I must also say that there are "natural" treatments out there that are highly dangerous to cats, so if you decide to explore holistic options, please do your research. (Not that your brain has any more energy; I know you're emotionally, mentally and physically exhausted!) 

Something that keeps coming up for feline cancer is Essiac, but it might be used for tumors only. It's mentioned on the widely known LittleBigCat website (www.littlebigcat.com/health/cancer-prevention-and-treatment/).

I also found this [old] document written by a veterinarian (PDF): A Holistic Approach for the Treatment of Cancer

It's important to understand what "feeds" the type of cancer that Kinney has. You wouldn't want to make matters worse by giving him something that exacerbates the issue.

There may be some people that write in and say it's all a bunch of rubbish and it's dangerous. Yes, it can be. But as my username suggest, I do believe that there are some holistic treatments can be helpful when used properly and with caution.

 

[ldg]

As someone with a cancer kitty (1.5 years into remission, knock wood) I'm going to jump in here and say interesting info, GoHolistic, thanks!

We work with a holistic vet and used an oncologist for traditional chemo (on her recommendation, because of how far advanced Lazlo's cancer was when diagnosed). One thing is for sure: no antioxidants while on chemo. They reduce its effectiveness.

As to the 2nd link, "A Holistic Approach for the Treatment of Cancer," the article is from 2005, and mentions beta glucans (which are usually agaricus or reishi mushroom extracts). Though the article is cited, there is conflicting information on beta glucans; one study indicates they actually reduce the activity of NK cells. From the FIVtherapy site: "Mushroom supplements such as agaricus enhance production of IL-12, a necessary co-stimulant of CD8+ maturation after activation by IL-2; however, mushroom-derived 1, 3 beta-glucans are generally found to upregulate TNF-α. (A recent study of Reishi surprisingly found inhibition rather than stimulation, and a recent study of agaricus had strange discrepancies in in vivo and ex vivo results.)

From 2009, "The effects of beta glucans on human immune and cancer cells," http://www.ncbi.nlm.nih.gov/pubmed/19515245

So if someone wanted to supplement with an NK cell stimulant, there has been a lot of work done on AHCC (Active Hexose Correlated Compound) - which is a mushroom extract, but primarily comprised of alpha glucans, not beta glucans. There are no studies in animals of safety that I'm aware of, but there is a pet product, American Biosciences NK-9.

From Memorial Sloan-Kettering:

on AHCC http://www.mskcc.org/cancer-care/herb/ahcc
and on Reishi mushrooms http://www.mskcc.org/cancer-care/herb/reishi-mushroom