Logan - Bloodwork results

We got a call from Logan's internist. She got the results much faster than she thought. Surprisingly, he does not have pancreatitis. The results indicate there is inflammation/infection in the upper portion of his small intestines. Best case scenario, this is just an infection. Middle of the road would be IBD. Worst case, it's lymphoma. The only way to know for sure is for them to do a biopsy. This can be done in one of two ways. They could do an endoscopy and get a shallow sample to biopsy, but since this would be only a shallow sample, a negative result may not necessarily mean he doesn't have lymphoma. The best way for them to get good samples is to do surgery. This is obviously the most invasive.

Our other option is to just give him the prednisolone and hope it's just inflammation or IBD. If it is lymphoma, though, the prednisolone could make the lymphoma more resistant to chemo.

So, we have a lot do think about. It doesn't seem like there's a good answer no matter what we do. On one hand, I won't to know if has lymphoma, but do I want to put him through all of that and then chemo? There's an 85% chance he'd go into remission, but it would most likely last only 6-12 months.

We did start the prednisolone on Wednesday night and he did seem to feel better on Thursday afternoon. He ate really well last night, too. She said this doesn't mean it's just inflammation/infection, though. I do not know what to do.

 

((( Kelly ))) I wish I could help. I'm glad he's feeling better, though.

 

I'm sorry, I really don't have any advice. Just wanted to say I'm sorry you are dealing with this.

 

((((Kelly))))

I don't have advice to offer, but I know there are people here who have been through this and may be able to help you at least know what questions to ask. I'm glad Logan is feeling better for now.

 

Wow Kelly! I'm so sorry to hear this. I was in the same spot with Latte this time last year. I opted not to do the biopsy for many reasons. One of the main reasons was because treatment for ibd and lymphoma are often the same. Lymphoma will typically include prednisolone, but also leukeran. Ibd is usually treated with just pred, unless severe than sometimes other things are needed. Im a bit confused about how the pred would make the potential lymphoma resistant to chemo? I dont know everything about both diseases, but I had never hear that. It will definately make any further diagnostic tests you may want to pursue difficult. I might reccomend joining both the yahoo ibd AND lymphoma group. THey are super resources and support. It would be a good question to pose there, as now Im very curious about that statement. Not saying your specialist is wrong...just new info for me!

There are some tough calls to be made when faced with either disease, especially regarding more specific diagnosis and treatments. All we can do is the best we can. It sounds like getting on top of it right away, as you are, is going to give Logan the best quality of life no matter what his issues. Good job with that!

Of course you do know the prednisolone will likely raise Logan's BG. Probably didnt need to write that, but wanted to make sure that was clear. Its the reason latte and I are here...pred induced FD. And you see our struggles, BUT...you also see our success (even when I dont :lol. You are not alone on this list. There are others in similar situations. And there are other resources to offer support as well.

Please let me know if you need anything, have questions, or just plain want to vent! Also, let me know if you need the links for the yahoo groups.

(((((((((kelly and Logan)))))))))))

 

btw...are you noticing any difference just in the last 24hrs or so of using the pred? Even the slightest in vomiting/appetite?

 

I also have no advice to offer, but was relieved to see that Logan is feeling better now.
Looking better and eating well always makes me feel better too.

Good luck in whatever you decide.

 

http://pets.groups.yahoo.com/group/feli ... id=6606790
Lymphoma group

http://pets.groups.yahoo.com/group/Feli ... id=6606790
IBD group

You will have to register and get approval for both groups - this could take up to a day or to, just fyi.

 

(((Kelly)))
My civie, Teddy has intestinal lymphoma. He marked the five year anniversary of his diagnosis one month ago. He was diagnosed via endoscopy. At the time, both he and Bear Man were very ill, and I opted to go for the endoscopy with both of them. Even though full thickness biopsy will give a better diagnosis, I was reluctant to put them both through that. Bear, at the time, was the much sicker of the two, and his diagnosis came back as IBD. Teddy was diagnosed with ileal and colonic lymphoma. Now, five years later, Bear is still the sicker of the two cats. He is also diabetic as a result of his steroid treatment (Teddy, however, is not). I put Teddy through three rounds of IV chemo at the beginning. It was a stressful time, but I would have continued. The specialist felt that the treatment was not working, and she refused to continue. I researched my options, and decided to go with a protocol of an oral chemo drug (Leukeran) and Prednisone. I have made some adjustments to the regimen, but he has done well on those two drugs. I recently consulted an oncologist, who says that that is her first choice of treatment for intestinal lymphoma. I never hesitate to recommend chemotherapy to anyone.

I'm not sure what to say about the infection theory, as I have no experience with that. I think that treatment with a steroid, which suppresses the immune system, would make an infection worse. If there is IBD present, it is not uncommon for inflammation to affect a lot of surrounding organs. The other concern is that once you have started treatment with a steroid, your biopsy results not be valid. You may come back with a negative result because the steroid has affected the tissues. You will have to stop the steroid for some period of time (weeks?) before having a biopsy done.

I don't understand the statement that prednisolone will make the lymphoma more resistant to chemo (like Carolyn, not saying it's wrong, but I'm not aware of how that would be). I guess one option, one that I pursued for a period of time with Bear, is to treat with steroids, and see if there is improvement. The downside is that it makes it difficult to get a valid test if you change your mind and want a biopsy, and that if it IS lymphoma, the sooner you know, the better. I recommend that you get a referral to a veterinary oncologist. I know that this is a scary and confusing time for you, and no one wants to hear that their pet may have cancer, but intestinal lymphoma is very treatable.

Please don't hesitate to ask if you have any further questions.

 

No advice, just thinking of you and Logan and this tough time.

 

Thanks for the links, Carolyn. I'll check those out.

We started him on the pred Wednesday night since the appetite stimulant and anti-nausea didn't seem to help his appetite. By Thursday mid-morning, we noticed an improvement in his eating. He got his third dose Thursday night and he ate like a champ - 3 3oz cans of FF Elegant Medleys! We didn't give it to him this morning and he hasn't eaten well all day. He doesn't seem to feel well again. He spent most of the day in the dog's crate.

As of now, I think I'm leaning towards the endoscopy. I hate the idea of putting him through major surgery and I don't want to just give him the pred and hope it's not lymphoma.

Linda, is your civvie still being treated for lymphoma or has he gone into remission? What side effects did you see with the IV chemo and the pred/oral chemo drug?

I don't know what to do about his eating. We started to see improvement in just a couple of doses of pred and now he's back to not wanting to eat. He's due for another dose of appetite stimulant tomorrow morning so maybe that will help a little. If he stops eating, we'l be in trouble.

 

((Kelly)) I am glad that the prednisone seemed to help him and that he seems better...
The rest of your news is....well...let me just say that you are doing the right thing by asking everyone here first.
Then, they will all give you things to research and read up on and slowly, the path will be clear to you....
I am sorry that you had to hear this news which is confusing..the "either, or" parts are so upsetting.
If it was cut and dried it would be easier......right?
Maybe it is just an infection.....and at least it isn't pancreatitis...that is a good thing and that is confirmed. That's good.....

My thoughts are with you as you go through this process of investigating and thinking....you will come up with the
right thing for yourself and Logan when you have explored things....for now, just hug him and give him an extra huggies from
the three of us here....love to you both...

 

Kelly,
My civie is still being treated for lymphoma. He was on a "pulse" Leukeran schedule for a long time, which involved Prednisone every day, and a higher dose of Leukeran given for four days every three weeks. During the Leukeran days, he would have inappetance, vomiting, and itchiness/jumpiness. About six months ago, he seemed to not be doing very well, so the oncologist changed us over to more of a maintence schedule of a lower dose of leukeran every 2nd day, and a change to Prednisolone daily. He recently had some bad bouts of Pancreatitis, so we have changed the steroid from Pred to a Dexasone injection every 3 days. He took a while to adjust, but now seems to be doing OK again. The side effects of Leukeran seem to be mainly inappetance and nausea, and a sort of itchiness/jumpiness. I am giving Teddy Ondansetron to counteract the nausea. I'm not sure we can even say if he has ever been in remission, as his presenting complaint of blood in his stool has never really entirely gone away. He is still here, though, and doing remarkably well given his diagnosis five years ago. While taking Leukeran, he also has to go to the vet every couple of months (was done more frequently at the beginning) for a CBC, to make sure his bone marrow is tolerating the chemo. Another side effect can be anemia.

The IV chemo was harder on him, not so much for the side effects, which also involved mild nausea and inappetance, but because he had to go to the vet and undergo sedation, which was harder on him than the chemo. He had to have a CBC drawn before every treatment. This had to be done every few weeks, so it was hard to fit into my schedule. I kind of attribute our success, however, to the fact that we hit it hard with a few rounds of IV chemo in the beginning. Clearly, this mode of treatment is also pretty expensive. I think that they have developed better treatments now, which is why I would suggest seeing an oncologist if you can find one.

Long term steroid use can also have bad side effects, which Bear has run into during his treatment for IBD. He has been on some high dose injectable steroids, though. If you end up with a diagnosis of IBD, there are alternatives such as the drug Budesonide, which will be easier on the BG. I guess your main concern right now is getting a diagnosis, and then taking it from there. Another argument for early diagnosis is that untreated IBD can evolve into lymphoma. By the way, Leukeran is sometimes also used as a treatment for IBD.

 

Hi Kelly,
Did you give it to him later today/night? Pred should not be stopped cold turkey, they needed to be tapered off it. Im not sure how necessary that is after only two doses. I know in the first week or two Latte didnt get all of her pred everyday because she would spit it out. Might not hurt to call and ER vet and ask what they think. tell them you are leaning toward a biopsy so you might not be interested in giving the pred anymore...but is it safe after 2 doses to just stop? See what they say.


I know whatever you decide will be the right thing for you, Logan, and the rest of the family. You obviously love him so much.

 

I'm happy to hear you got the results back so quickly - I know how hard it can be to wait on those. Do you know what lab result makes the internist believe there is infection/inflammation in the small intestine? Was the eosinophil or basophil count elevated? I'm trying to learn here....Sasha has IBD centered in her small intestine and nothing definitive usually shows on bloodwork with intestinal inflammation (although inflammation shows easily on a u/s). Her eosinophil counts have always been elevated, but that can be tied to many different things (food allergies, environmental allergies, parasites, IBD, etc.). I don't remember, but has a u/s been done on Logan?

If it is IBD and not Lymphoma, we've had great success with Budesonide as an alternative to Pred. It is actually stronger than Pred, but is locally acting on the GI tract and is not supposed to be as systemic as Pred. Sasha has had very few side effects from it - just a great appetite, no more vomiting or nausea, and perfectly formed stool. Her BGs did elevate but were easily controlled insulin adjustments. I honestly couldn't say enough good things about it. For us, it was wonderful. You'll see if you join the IBD Yahoo group - some cats it works well for, and others not as well.

I'm sure the internist told you this, but once you start a steroid you cannot abruptly stop giving it - have to taper down and then off. It can cause an adrenal crisis to stop without tapering.

I pondered what to do to Dx Sasha in the IBD vs. Lymphoma too. If she had been younger and had fewer conditions, I probably would have gotten the endoscopy or exploratory surgery done. At least then you know for certain what is going on. If Sasha hadn't completely recovered (so far) just from the use of Budesonide, I would have considered the endoscopy again. It is a relative easy procedure, and there is a very good chance you will get an answer from it.

Sending lots of positive thoughts and vines to you and Logan.

 

((Kelly)) There's lots of good information here and several people who have had to deal with these same issues. I hope they can help you come to a decision.

 

Carolyn, I went ahead and gave him the pred last night. So, he got it Wed night, Thurs morning and night, and then Friday night. I'm not sure if he had enough for it to need to be tapered off, but we're tapering him off to be safe.

Cassandra, I honestly don't remember which test she said indicated it was in the small intestines. When I speak to her again, I will be sure to ask.

We gave Logan his appetite stimulant this morning and he's eaten ok - better than yesterday. He was out for most of the day, but has spent the last couple of hours in the dog crate.

Every time I think I've decided on something, I change my mind after reading something else. There just doesn't seem to be an ideal path to take here. The options suck!