Small cell GI lymphoma

[spencer11]

Hello,
Our Spencer has small cell GI lymphoma. Had surgery with full thickness biopsy so we know what it is. Initially did well. Then stopped eating. Prednisone ( prednisolone) has now made him diabetic. He's battled nausea, vomiting, and now diabetes. He still won't eat. I have been force feeding with a syringe and he usually keeps it down. We started oral chemotherapy (Chlorambucil ) on Monday. He's had 2 doses so far. He seems ok... Still doesn't want to eat on his own. My question is for those of you who have been through this: when do you think it will kick in if its going to help? Planning to switch to a different steroid once it gets here. He previously loved to eat and I've offered him everything. He completely is turned off by food. Appetite stimulant doesn't help and makes him have tremors. Cerenia injections help stop vomiting but made him so lethargic he could hardly walk. My poor boy! He's a love and I want him to eat on his own!!!
Vet says treatment results vary from cat to cat and can't really guess if and when he will respond. Monday we have a follow up CBC to check his white blood cells. He's also a little anemic.

 

[stephenq]

Hello,
Our Spencer has small cell GI lymphoma. Had surgery with full thickness biopsy so we know what it is. Initially did well. Then stopped eating. Prednisone ( prednisolone) has now made him diabetic. He's battled nausea, vomiting, and now diabetes. He still won't eat. I have been force feeding with a syringe and he usually keeps it down. We started oral chemotherapy (Chlorambucil ) on Monday. He's had 2 doses so far. He seems ok... Still doesn't want to eat on his own. My question is for those of you who have been through this: when do you think it will kick in if its going to help? Planning to switch to a different steroid once it gets here. He previously loved to eat and I've offered him everything. He completely is turned off by food. Appetite stimulant doesn't help and makes him have tremors. Cerenia injections help stop vomiting but made him so lethargic he could hardly walk. My poor boy! He's a love and I want him to eat on his own!!!
Vet says treatment results vary from cat to cat and can't really guess if and when he will respond. Monday we have a follow up CBC to check his white blood cells. He's also a little anemic.

Hi, the Chlorambucil (Leukeran) can take a while to work, weeks.  Dexamethasone is stronger than pred but may make the diabetes worse.  I'm surprised the Cerenia made your cat lethargic, I've never see that.  Did you give the cerenia sub Q after giving fluids first?  Cerenia stings unless you give fluids first.  Zofran is another very effective anti-nausea drug given sub q, works very quickly, doesn;t sting but must be given every 6 hours.

 

[spencer11]

The vet gave the cerenia, but I don't think he got sub q fluids first. I have zofran pills but they don't seem to work. The key with him is keeping him hydrated, and then his nausea seems better. Between the prednisone and the diabetes, he urinates frequently but doesn't drink as much as he should. So I syringe him water as well.
So I should expect to wait several weeks to see if he may go into remission, if it's going to happen?
Our vet wants to change him to Budesonide instead of prednisolone. She said it would be easier on his blood glucose levels.

 

[PushPurrCatPaws]

Hello,
Our Spencer has small cell GI lymphoma. Had surgery with full thickness biopsy so we know what it is. Initially did well. Then stopped eating. Prednisone ( prednisolone) has now made him diabetic. He's battled nausea, vomiting, and now diabetes. He still won't eat. I have been force feeding with a syringe and he usually keeps it down. We started oral chemotherapy (Chlorambucil ) on Monday. He's had 2 doses so far. He seems ok... Still doesn't want to eat on his own. My question is for those of you who have been through this: when do you think it will kick in if its going to help? Planning to switch to a different steroid once it gets here. He previously loved to eat and I've offered him everything. He completely is turned off by food. Appetite stimulant doesn't help and makes him have tremors. Cerenia injections help stop vomiting but made him so lethargic he could hardly walk. My poor boy! He's a love and I want him to eat on his own!!!
Vet says treatment results vary from cat to cat and can't really guess if and when he will respond. Monday we have a follow up CBC to check his white blood cells. He's also a little anemic.

Check with your vet about the use of Anzemet (Dolasetron) injections as an anti-nausea/vomiting aid.

Many people here rave about Cerenia and it being a "wonder drug", but my last cat did not react well to it at all, like yours. Some cats do not. When I tried it with my last cat, it made her extremely zoned out, wobbly & unbalanced when trying to move, and then she was lethargic, & it did not stop her vomiting at all. It did not help her to eat. (And yes, I did give the vet's prescribed dose/ an injection.) I did not appreciate Cerenia's effects in my cat at all, the effects were very scary. So my cat's vet and I discussed this and decided to try Anzemet instead. It works on different neurological pathways (receptors) in the brain. Anzemet worked much better for her, and we used it as a sub-Q shot for her... for many months. It helped her to feel like eating and although it did not help ALL of her vomiting, it helped most of it. Pepcid and anzemet (and her favorite food(s)) worked well with my cat when she was nauseated.

 

[spencer11]

I will ask vet about Pepcid and Anzemet. Yes, I thought he was having a stroke after Cerenia. I checked his eyes and his pupils were equal but he could hardly walk and was dragging one back leg. I almost took him to the emergency vet but his heart rate and breathing were ok, and my husband agreed he just looked drugged out. He was ok in the morning. I would like to avoid that in the future!
I had asked the vet if high doses of steroids cause Gastric irritation like they do in people ( I am a RN) and they said no, that steroids actually treat nausea, stimulate thirst and appetite, and reduce inflammation/pain. Which would be great, except he was clearly nauseated, vomiting, and dehydrated. I know they give people a PPI ( proton pump inhibitor) when they are on steroids after surgery.
Thanks for the info! It's interesting how our problems are similar but kitties respond to different things.

 

[stephenq]

The vet gave the cerenia, but I don't think he got sub q fluids first. I have zofran pills but they don't seem to work. The key with him is keeping him hydrated, and then his nausea seems better. Between the prednisone and the diabetes, he urinates frequently but doesn't drink as much as he should. So I syringe him water as well.
So I should expect to wait several weeks to see if he may go into remission, if it's going to happen?
Our vet wants to change him to Budesonide instead of prednisolone. She said it would be easier on his blood glucose levels.

OK well Budesonide seems like a reasonable switch, and sub q fluids can do great things so maybe he should be getting that regularly at home.  I've only given Zofran sub Q.  And yes if your cat tolerates the Leukeran i think it can be weeks before you see a result but his blood needs to be taken about every 2 weeks to make sure he's otherwise ok.

 

[PushPurrCatPaws]

I will ask vet about Pepcid and Anzemet. Yes, I thought he was having a stroke after Cerenia. I checked his eyes and his pupils were equal but he could hardly walk and was dragging one back leg. I almost took him to the emergency vet but his heart rate and breathing were ok, and my husband agreed he just looked drugged out. He was ok in the morning. I would like to avoid that in the future!
I had asked the vet if high doses of steroids cause Gastric irritation like they do in people ( I am a RN) and they said no, that steroids actually treat nausea, stimulate thirst and appetite, and reduce inflammation/pain. Which would be great, except he was clearly nauseated, vomiting, and dehydrated. I know they give people a PPI ( proton pump inhibitor) when they are on steroids after surgery.
Thanks for the info! It's interesting how our problems are similar but kitties respond to different things.

I could never use pred with my kitty, as she was diabetic. (We lost her a year ago.)

As you say, your kitty got diabetes from pred - many steroids can cause high blood sugar in cats, etc. (hence the stimulation of thirst and appetite). The vet discussed pred with me, but to use for inflammation/pain (my cat later got pancreatitis)... but we could not use it because of the trickiness of diabetes. We didn't use any steroids.

 

[spencer11]

my cats blood sugar is now over 500.  they switched him from prednisone to budesonide.  supposed to target the intestinal area and be less systemic than prednisolone.  They also started him on insulin shots twice a day.  he is weak and sleeps a lot.  still makes it to the litter box.  he will not eat or drink, everything is done with an oral syringe.  hoping the insulin helps him utilize his nutrition better and he stops losing so much weight.

he has been on chlorambucil for 2 weeks.  he seems to be tolerating the chemo, but not the steroids.  the good news is no vomiting for 9 days.  I'm so worried about my kitty!

 

[ruthm]

I'm so sorry to read your kitty has lymophoma, but glad to hear the vomiting has stopped.

   BTW. What insulin are you giving?   My Tiger was diabetic( and at age 17, she was also CKD, IBD and had chronic pancreatitis) but she did very well on Lantus.  If you have any questions about the diabetic aspect, I would highly recommend you sign up and post on the Feline Diabetes Membership Board- the wonderful people there saved both of us with advice and support.

http://www.felinediabetes.com/FDMB/   Sending good vibes for your kitty to feel better!

 

[stephenq]

 
my cats blood sugar is now over 500.  they switched him from prednisone to budesonide.  supposed to target the intestinal area and be less systemic than prednisolone.  They also started him on insulin shots twice a day.  he is weak and sleeps a lot.  still makes it to the litter box.  he will not eat or drink, everything is done with an oral syringe.  hoping the insulin helps him utilize his nutrition better and he stops losing so much weight.

he has been on chlorambucil for 2 weeks.  he seems to be tolerating the chemo, but not the steroids.  the good news is no vomiting for 9 days.  I'm so worried about my kitty!

I feel for you and your cat.  So much to deal with, hopefully the leukeran (chlorambucil) will help a lot.

 

[spencer11]

I'm so sorry to read your kitty has lymophoma, but glad to hear the vomiting has stopped.

   BTW. What insulin are you giving?   My Tiger was diabetic( and at age 17, she was also CKD, IBD and had chronic pancreatitis) but she did very well on Lantus.  If you have any questions about the diabetic aspect, I would highly recommend you sign up and post on the Feline Diabetes Membership Board- the wonderful people there saved both of us with advice and support.
http://www.felinediabetes.com/FDMB/   Sending good vibes for your kitty to feel better!

 

[spencer11]

He is on Pro Zinc insulin U-40. We were told it could take 7-45 days to stabilize his blood sugars but many cats show improvements after 7 days. Hoping the new steroid is easier on him also. Thanks for the good vibes and the diabetic link.

 

[spencer11]

I feel for you and your cat.  So much to deal with, hopefully the leukeran (chlorambucil) will help a lot.

Thank you! Just canceled 2 trips because we don't want to leave him and wouldn't enjoy ourselves anyway knowing he's so sick right now.

 

[stephenq]

Thank you! Just canceled 2 trips because we don't want to leave him and wouldn't enjoy ourselves anyway knowing he's so sick right now.

I'm so sorry and hoping he's feeling better soon!

 

[spencer11]

Had our cat in this morning for a CBC check since he is due for a chemo pill today and also to check his glucose.  Glucose is better, down into the 200's.  WBC's are normal, which they were worried about those dropping on chemotherapy.  However, he is severely anemic.  His red blood cells dropped 7 points.  vet offered a transfusion, which would only last about a week, with the normal life of a red blood cell.  or she mentioned that it may be time to consider euthanizing him.  She wants me to hold his chemo for now.  he is still on steroids.  Vet is isn't sure if the chemo zapped his red blood cells  or the cancer is getting worse.  I feel like since his WBC's are normal, he is tolerating the chemo in that aspect.  IF the cancer is getting worse, and now we stop the chemo, he can't get better!  He seems a little better to me, now that we've helped his glucose problem.  he lost 1/2 pound in spite of me force feeding him.  he's done well with vomiting, hardly any.  seems like the nausea is better.  he's making his way to the litter box.  

was wondering if any chemo kitties out there had this problem and how it was dealt with.  seems like there should be more options.  it made me sad to think that they have to get a kitty to donate, and so some poor other kitty would have to be stuck.  

if we stop the chemo, can we restart when his labs (if his labs) improve?

i will be talking to the vet in a moment, but wanted to see what other people have done to manage this.

thanks.

 

[stephenq]

 
Had our cat in this morning for a CBC check since he is due for a chemo pill today and also to check his glucose.  Glucose is better, down into the 200's.  WBC's are normal, which they were worried about those dropping on chemotherapy.  However, he is severely anemic.  His red blood cells dropped 7 points.  vet offered a transfusion, which would only last about a week, with the normal life of a red blood cell.  or she mentioned that it may be time to consider euthanizing him.  She wants me to hold his chemo for now.  he is still on steroids.  Vet is isn't sure if the chemo zapped his red blood cells  or the cancer is getting worse.  I feel like since his WBC's are normal, he is tolerating the chemo in that aspect.  IF the cancer is getting worse, and now we stop the chemo, he can't get better!  He seems a little better to me, now that we've helped his glucose problem.  he lost 1/2 pound in spite of me force feeding him.  he's done well with vomiting, hardly any.  seems like the nausea is better.  he's making his way to the litter box.  

was wondering if any chemo kitties out there had this problem and how it was dealt with.  seems like there should be more options.  it made me sad to think that they have to get a kitty to donate, and so some poor other kitty would have to be stuck.  

if we stop the chemo, can we restart when his labs (if his labs) improve?

i will be talking to the vet in a moment, but wanted to see what other people have done to manage this.

thanks.

This is a tough call and I would have real heart to hearts with my vet.  It's possible your friend may be running out of time.  Red blood cell suppression is a known side effect of Leukeran.

"Side Effects The main side effect of concern with chlorambucil (Leukeran) is bone marrow suppression. The bone marrow is the body’s source of all blood cells both white cells and red cells. Since the precursors of these cells are rapidly dividing, they are targeted by chlorambucil. When the bone marrow is suppressed, one can develop an anemia (inadequate amount of red blood cells), a drop in white cells (which constitute the bulk of the immune system), or both." From http://www.veterinarypartner.com/Content.plx?A=1328

Talk to your vet.  I'm so sorry.

 

[sulcal]

Sorry to hear about the struggles of your kitty.  My cat had extremely low red-blood cell count at 9, when is should be in the 40s.  We didn't do transfusions because I would have had to drive a very sick cat over 2 1/2 hours away.  Instead, we used Aranesp.  He got one shot a week plus, an iron shot once every three weeks.  This was supposed to go for 8 weeks and then possible continuation for the rest of his life.  By week 6, his count was up to 41 and I stopped the Aranesp.  I know of another cat, who got the blood transfusion and the Aranesp.  Worked for him.  You do have to make sure you get his counts measured often, as if the numbers increase too rapidly, it can cause a blood clot.  Not sure if it will work in your situation but, you could talk to your vet to see if it is a viable alternative.  

 

[spencer11]

Our cat had started to pick up with his anemia after just 4 days of holding off on chemo. Vet was happy. His blood sugars were stabilizing with the new steroids and insulin. His weight had stabilized. Things were looking up. I had canceled 2 trips but since he was better I decided to go out to lunch with a friend. While I was gone he had passed away. He had tried to crawl behind a bookcase and was cold and stiff when I found him. I guess his heart gave out? I'll never know what happened. heartbroken. Thankful for the best cat ever, grateful he's at peace. My heart is heavy. Thanks to those who offered advice.

 

[ruthm]

Oh my goodness, I am so sorry for your loss!  FWIW, I lost my precious girl Tiger to pancreatic cancer, it happens so quickly and there is never enough time with our precious furbabies, my heart goes out to you.  Fly Free Little One and land softly- you were so loved!

You might consider posting in the Crossing the Bridge section of this forum, somehow it is very cathartic to post a tribute for our  beloved babies.

 

[momofmaxwell]

Hi Spencer11.I'm sorry your boy has small cell.But it one of the slowest growing cancers kittties can get.That being said i would like you to join this group.Lymphoma is all they deal with.As for nausea meds like Ondanestron work a lot better.A human drug used for chemo patients.Sometimes the combination of cerenia & it work better.This group has an Internist who volunteers very  pertinent advice on what he'd do etc.He has been a specialist for 27 yrs.He is truly remarkable.You need to make your posting lge bold and Att: Dr.Olsen New Member diagnosi of small cell won't eat..I lost my boy to small cell after a yr post diagnosis.But i did not go the chlorambucil route and have many regrets.Most vets are not doing pulsed dosing although it has been practiced for yrs.Dr.Olsen believes in hitting cancer hard.Also every cat on the lymphoma group is on lysine 500mg twice per day.As their immune systems are compromised.I have seen many cats, being a member there, do better on other chemo drugs but truly asking Dr.Olsen his opinion of what to do next is key.Does your kitty walk up to food,smell & walk away?Have you offerred 50 zillion brands,flavors out there like I did? What are you syringe feeding? I know about syringe feeding as i syringe fed my Boy for 3 months.I used Iams maxCal vet food.330 calories per tuna size can.Hydration is also huge.Please join as i have seen kitties there have an excellent quality of life going over two yrs.Dr.Olsen had one patient who went 7 yrs.Every kitty of course dealing or should i say battling it in different ways.He will help you with the nausea & answer what you need to know.Members there have been around the block dealing with more than one kitty having it in their lifetimes.Are you  on 10mg of pednisolone per day? Or were you? Has your vet recommended budosemide now? Another anti- inflammatory for diabetics.Dr.Olsen will know all about it.The key is getting his attention as it is a high volume group.I believe also he does surgeries on Mondays and may not answer that day.But try.Also any tests,bloodwork etc he will want to see it all.He talks of probiotics & everything under the sun.The man knows cancer like the back of his hand.Pls don't hesitate to join as soon as you can.There is really no time to waste.If you are not getting enough calories into your boy have you considered a feeding tube? An average kitty weighing approx 10lbs eats approx 180 calories per day.i was feeding My Maxwell 400 calories per day with syringing.He weighed 8 lbs.But he tolerated it well.Not all kitties do. Here is the link to the group.Also a link to a feline diabetes group.Hugs Honey during this very trying time I can relate to totally.Food is Life right now...

https://groups.yahoo.com/neo/groups/feline_lymphoma/info    Sorry I don't have the link for the feline diabets group.you can just google feline diabetes group @ yahoo ok? Hugs C