Wednesday has cancer or IBD. HELP if you have experience!!

It's been months of diarrhea, 2 lb weight loss, a hypo episode that landed her in the hospital for days (because she had so much diarrhea and she wasn't absorbing nutrients) and the potential diagnosis of both of these months ago....

Now, she still has diarrhea, she poops about 4x a day, her BG is decreasing (to 90 for several days without insulin), and she has lost another 1/2 lb.
I took her to a new vet today (I just moved), and they immediately said something seemed wrong with hr intestines upon physical exam.
The vet said it's either cancer or IBD (which is now the 3rd vet to say this), so we are starting her on:

- flagyl (which helped diarrhea before)
- anti-allergen wet food (they were out of dry)

I am not doing a biopsy, I can't afford it at this point (I have 5K in vet bills already), and she is 13 and regardless, I can't afford chemo if she did have cancer.
We will see if this diet change helps, and if so we will try prednisone on Tuesday, or the other one which doesn't increase BG.

Can someone please help, give advice, tell me what symptoms you have had, does food make a difference, etc!!

 

Re: Wednesday has cancer or IBD. HELP if you have experience

I recently posted about how she ate her own feces and is ravenous.

Her thyroid was checked and it is normal.

 

Re: Wednesday has cancer or IBD. HELP if you have experience

If you go the steroid route, Prednisolone is better than Prednisone. Prednisone is harder on the kitty because the liver needs to break it down into prednisolone to use, so starting with the prednisolone to begin with is better. There is a steroid that targets the gut, Budesonide, that one may have less of an affect on BGs, however I haven't used that. Tucker (GA) took prednisolone for his brain tumor, but it did help his IBD.

When Tucker started Prednisolone, his BGs actually went down. Every cat is different, not all will have uncontrollable BGs because of steroids.

You could talk to your vet about adding a pancreatic enzyme. My vet told me it would not harm Tucker to take it, so we didn't have to run tests beforehand to see if he actually needed, but since he was not absorbing nutrients and losing weight, we thought we would try it. For us it was too late, Tucker was already over 18 yrs of age and had been fighting his brain tumor and low potassium for too long, we had only used the enzymes for a couple of days before he passed so I cannot tell you if they would have helped him gain weight or absorb nutrients.

 

Re: Wednesday has cancer or IBD. HELP if you have experience

IBD and intestinal lymphoma can have very similar symptoms (diarrhea, vomiting, hematochezia, inappetance). It's hard to say if it is one or the other without a biopsy (a biopsy could be done via endoscopy if you don't want to do an incision with full thickness biopsies). I assume that the vet found that the intestines felt thick or ropey on physical exam.

There is an oral chemo drug which is very effective in treating intestinal lymphoma. It is also sometimes tried for IBD as well. Ask the vet if he would consider prescribing Leukeran (also known as Chlorambucil). There are different dosing protocols (pulse or maintenance) which you can discuss with the vet. It is is sometimes used alone for IBD, but is virtually always given in combination with a steroid (normally Prednisolone) for lymphoma. The Budesonide which has been mentioned may be helpful with IBD, and may have a lesser systemic effect (it acts locally in the gut), but I would not mess around with that for suspected lymphoma. Injections of B12 (cyanocobalamin) may also be helpful. The Leukeran may cause some transient nausea and inappetance. That can be combatted with a drug such as Ondensetron if required. I would definitely continue with the Flagyl, and you may also want to consider giving Pepcid AC twice daily.

If your kitty responds to this treatment, it can be reasonably presumed that either IBD or lymphoma was the diagnosis. Intestinal lymphoma is one cancer that is quite responsive to treatment, and the Leukeran and Prednisolone are not overly expensive medications.

Once treatment has been started, you can't change your mind and do the biopsies, as the cells will have been affected by the treatment and the results will no longer be reliable.

I had a steroid-induced diabetic kitty with severe IBD who passed away after many years of fighting the disease. I also have a non diabetic cat who has been in remission from intestinal lymphoma for over 6 years, who still takes a steroid (Dex) and Leukeran. If your vet does suspect IBD, and especially if he suspects lymphoma, I would consider a trial of Leukeran with Prednisolone.

Has the CBC been checked recently? Just curious, as you mentioned the coprophagia. Anemia can sometimes manifest with Pica, the eating of non-nutritive substances.

 

Re: Wednesday has cancer or IBD. HELP if you have experience

Thanks for that info.

I am curious if I have to do a biopsy to start cancer treatment? It's hundreds of dollars, which I really just can't afford.
I know some people won't understand, but I also feel like I am not willing to spend hundreds/thousand on cancer treatment when she is 13, she has had a really good life. I already have 5K in vet bills from the diabetes. Plus, I am happy to hear your cat did well, but most cats don't live much longer even after chemo, according to the stats.

I was considering starting her on prednisolone and seeing how she does with that, would this make things way worse if she has cancer an I am giving her just the steroid? The vet didn't mention that.

- A

 

Re: Wednesday has cancer or IBD. HELP if you have experience

Some vets will prescribe Leukeran (Chlorambucil), without a diagnosis and some will not.

 

Re: Wednesday has cancer or IBD. HELP if you have experience

You don't have to have the biopsy to start treatment, as long as your vet is comfortable prescribing the medications. Giving the steroid alone would not make her condition worse. It will likely make her feel more comfortable by reducing the inflammation in the GI tract. If you don't see improvement after a couple of weeks, you might want to consider adding on the Leukeran. I completely understand your thought process. You are the best judge of what is best for both of you. I'm just tossing the options out there for you to think about. I hope that she starts to feel better on the Pred.

 

Re: Wednesday has cancer or IBD. HELP if you have experience

Thank you very much.

The vet said she can't do chemo, so I am unsure what that means (perhaps she isn't an internist, and just a general vet?)....so we will see what will happen when I can get a hold of her on Tuesday.
She did say once she starts the Pred, she can't get chemo, because of a reason I understood but couldn't explain here right now but that an oncologist had told her never to start pred if the cat would maybe need chemo later.
She was discussing a 3 drug cocktail for cancer treatment...not the Leukeran you mentioned. I will ask her about that.

My cat doesn't have hematochezia, or inappetite. She has soft stools, several a day (often minutes after she eats), sometimes watery diarrhea and is hungry ALL THE TIME.
She has lost so much weight, she is 6.3lbs.

 

Re: Wednesday has cancer or IBD. HELP if you have experience

also, not sure if this points in the direction of IBD and not lymphoma....but when she was first diagnosed with diabetes, she had acute pancreatitis, fatty liver and they were asking me a lot about her stools and vomiting, because there is a "triad" of IBD, fatty liver and pancreatitis.
now that she might have IBD, i keep thinking about how she had the other 2 (and still has pancreatitis).

does this make sense? or am i making too many assumptions?

 

Re: Wednesday has cancer or IBD. HELP if you have experience

The IV chemo protocols are somewhat difficult and expensive to apply. I did go through a few rounds of that with my cat before switching over to the Leukeran, and it was a very difficult process. I fully understand not wanting to go that route. A lot of vets don't do the IV treatments in their practices due to issues with staff handling the drugs, the requirement to be very technically proficient at administering it, etc. With Leukeran, the drug should be handled with gloves, and the CBC has to be rechecked periodically to make sure that the bone marrow is not being adversely affected, but it is otherwise quite straightforward to give. Since it is fairly reasonably priced (I believe that you can order it online in the US with a prescription), and quite well tolerated, I think it is worthwhile discussing with the vet.

It is quite common for inflammation in the intestines to spread to surrounding organs. If the pancreas is involved, as you probably know, the condition is pretty painful. You may want to consider giving something for pain (such as Buprenorphine or Tramadol). I'm not very familiar with fatty liver, but I understand that rapid weight loss does put a cat at high risk, as would the pre-existing inflammation in the GI tract. I can't say whether any of this points more or less toward IBD vs lymphoma. I think that in either event, the steroid treatment will go a long way toward reducing the inflammation.

I think that with both IBD/lymphoma and pancreatitis, you are looking at treating symptoms, which means treating not only the inflammation, but also giving pain meds, meds for nausea, appetite stimulants, sub Q fluids, meds for stomach acid, and B12 supplementation, as required in individual cases.

For HL or fatty liver, I understand that it is critical to get food into the cat. It sounds like your cat is eating well, but that there are problems with absorption. I am definitely not experienced with HL, however.

This is all a bit overwhelming, I am sure, but I think that what you are doing now with diet and Flagyl are both good, and that adding in Pred if the vet thinks that it is necessary is a reasonable next step. See how things are going, and then re-evaluate as needed.

 

Re: Wednesday has cancer or IBD. HELP if you have experience

She has chronic pancreatitis and she only had HL (in addition to the pancreatitis) when she was first diagnosed with DM and was in DKA (she could have had it, as your said from losing weight while going into DKA). I doubt she has fatty liver now.
Her DM was diagnosed about 2 years ago, and this diarrhea has only been going on since about Feb.

I will discuss these options with my vet, and I really appreciate you explaining this from your personal experience.

 

Re: Wednesday has cancer or IBD. HELP if you have experience

I am worried that Sampson may have the same problem. I know that it is either a horrible IBD this time or stomach cancer, which the vet's I have visited say that they can't tell for certain unless they put him under the knife and at 17 years of age I won't do that to him.
What kind of food did they give you? And had the budesonide helped at all? I give Sampson Fancy Feast different kinds, turkey, chicken, beef, tuna some with gravy some not. One or some of these may be causing the flare ups I am watching what happens shortly after he eats to eliminate some of the possible causes. I know that this is difficult but hang in there. There may be other options that are cheaper for you. What kind of food have you been feeding her? The bude doesn't seem to be helping my Sammy at all and he is having a horrible day today. Vet gave him some fluids to hydrate him and he looks really ill all afternoon.
Don't feel bad about not having her biopsied. I feel the same way. It's just terrible to watch them waste away. But do know that you are doing everything that you possibly can for your Kitty. Please keep me updated on Wednesday and I will keep you informed on Sampson as well. Let's keep our fingers crossed and pray. The best we can do is keep them comfortable and show them love.

Good Luck!!

 

Re: Wednesday has cancer or IBD. HELP if you have experience

My vet (specialist) has been willing to prescribe Leukeran w/o an official diagnosis ($$ issues here too!), but not the other chemos. Having gone the chemo route with one cat, it's not something I want to repeat anyway, so that has worked for us. Leuk I found cheapest at Walmart, at $4 per pill (given 2x/week).

IBD and cancer are tough, the symptoms are ugly and can be hard to treat. In my experience the steroids have worked best, I think you need to try things and see if they help. You might want to start with the Budesonide as it doesn't raise the BGs and if there's no improvement in a few days, then maybe go to Prednisolone.

If it's small-cell lymphoma (? if I remember right) the Leuk can give them up to maybe 2 years from what I have read. If it's other kinds of cancer, it won't necessarily help as I understand it.

For me, especially with an older cat, it's about controlling the symptoms and keeping them comfortable. If you don't see enough response from the food change, I would go ahead and try whatever meds you can, and see what works. Some cats respond well to a food change, others don't, or need the food change combined with the meds to get things under control.

My civie who right now has IBD and intestinal cancer was doing awful until we got her on Pred, and that has really controlled it for her. She is still going downhill, but has been a trooper for several months now beyond what I had expected based on how sick she was when I got her to the specialist. So really, your kitty may do great once you can get the right food/meds for her.

I would definitely avoid any dry food, diabetic or not. I have found with my IBD kitties they have done much better on canned than dry - before I knew the general evils of dry food, my IBD guy was always on canned b/c that was all he could tolerate.

 

Re: Wednesday has cancer or IBD. HELP if you have experience

Flagyl is one of the meds given in the case of triaditis and it should help with the diarrhea issues so that med sounds promising.

If the Leukeran can be used to treat both IBD and intestinal lymphoma then it seems like a really good option to discuss with your vet. Often if the treatment would be no different if the tests were run for a conclusion one way or the other, then they will start the treatment.

Unfortunately the food you will be feeding will not be diabetic friendly. The best anti-allergen food my vet could find was a rabbit based food and it was 16% for the wet and 39.7% carbs for the dry. Because it is just an assumption we are looking at triaditis because of existing liver and panceas issues, she have no symptoms of IBD, I opted to not do a food change. Since you have clear IBD symptoms you will have to do a food trial and hope for the best on the BGs. It sounds like just getting some nutrients into her is really important right now.

Good luck. Hopefully you can get some of the symptoms cleared up soon so that she is feeling better.

 

Re: Wednesday has cancer or IBD. HELP if you have experience

Oh, getting food into her is NO PROBLEM.
This cat can eat!!! She was pretty ravenous and then I adjusted her insulin from 0.75 to 0.5 and she is much better, and her numbers are great. I haven't given her insulin in days because she has been 100 pre-meal and seems to be regulating herself. Seriously, this girl is a mess! Off insulin, which would normally be great, but now she has another issue.

She can just eat eat eat and still is wasting away. The diarrhea is killing her. Even though it isn't always watery, there is a lot of it, multiple times a day, and clearly she is not digesting her food because it smells my whole house up. Poor girl.

So, I will discuss the med everyone keeps telling me about with this vet, and hopefully she can prescribe it, and knows how to.

Have I mentioned I just started my first job as a doctor for humans? My work week is about 80 hours, so this is just awful.

Thanks again everyone!

 

Re: Wednesday has cancer or IBD. HELP if you have experience

for people who asked:

she eats fancy feast ocean whitefish and tuna. i have been mixing it with dry food (I know, i know, i just felt soooo bad for her!!) to get her to gain weight.
i am not doing that any longer, now she is just on the prescription diet z/d, which is painfully expensive.

 

Re: Wednesday has cancer or IBD. HELP if you have experience

We never had any success with the z/d. Mine who did well with a food change did well on the (formerly IVD) novel protein diet - duck was what worked best for him. They switched him to that at the same time as starting on Pred, and that worked well for him. ECID though. Hope she is feeling better soon!!!!

 

Re: Wednesday has cancer or IBD. HELP if you have experience

who is that food by?

so far she has eaten 2.5 cans of this food (maybe because she is starving, literally and i am not being strict with portions), however, this is not sustainable! that's over 5$ a day!

i know there is no "cheap" option, but i need options to compare, at least.

thanks for any additional info.

 

Re: Wednesday has cancer or IBD. HELP if you have experience

That is a huge accomplishment. Congratulations on starting work in your field, but your workload sounds gruelling.

I know that some people have had a lot of luck with changing diet. I have to avoid any food with wheat gluten in it (most chunky or gravy varieties) for my cat. A lot of cats have food allergies or sensitivities. I think that the idea behind hypoallergenic diets can be (1) a hydrolyzed protein source like z/d or (2) a novel protein source. The novel protein or limited ingredient diets will normally contain a meat protein (e.g. duck, venison, lamb) and a vegetable protein (e.g. rice, pea) which is not normally found in commercial cat foods, and therefore the cat is unlikely to have built up an allergy. Most of these diets are Rx diets (i.e. junky and expensive, though doing the job they advertise). One product that I came across in my local pet food store (I have not tried it yet) is Dick van Patten's Natural Balance Limited Ingredient Diet. Many people here on the board have a lot of success with making their own raw cat food, however it sounds like you may not have the time, nor would I recommend it for a cat taking steroids due to the immune suppression.

ivd diet: http://www.animalhousemagazine.com/innovative_veterinary_diets_for_cats.htm

Another thing that comes to mind reading posts here and on other threads about diarrhea is EPI (Exocrine Pancreatic Insufficiency), which can be marked by weight loss even with ravenous appetite, and loose malodorous stool. It is pretty rare, I think. There is a test for it - the TLI (not to be confused with the PLI for pancreatitis), and a treatment (pancreatic enzymes). In my experience, it is an expensive blood test.

http://www.sniksnak.com/cathealth/epi.html

One other thought: another medication that can help with diarrhea is Tylosin (Tylan). My lymphoma civie takes both Flagyl and Tylosin.

 

Re: Wednesday has cancer or IBD. HELP if you have experience

Yes the duck diet was extremely expensive - I don't recall what brand bought out IVD, maybe Royal Canin?

Interested what someone said about another illness that could be possible - in my experience with IBD, I have not seen ravenous appetite and weight loss. Typically I have seen low appetite due to nausea. I presume the weight loss is from the malabsorption stuff, which I don't know anything about. When my IBD kitties have had the nausea/diarrhea under control, they have eaten fine and the symptoms clear up. When they have had weight loss, it was because they were not eating well.

IBD is a very ECID illness though, so could just be a different angle on it that what I have seen. But it is an interesting idea I think that there could be something else going on. I presume they've already tested for obvious stuff like parasites? There are also some less common bugs that I think can be associated with IBD. If you are inclined to take the route of extensive testing I might be able to dig up some earlier posts on the subject.

The flagyl can work wonders for diarrhea, so maybe you will find that solves things.

 

Re: Wednesday has cancer or IBD. HELP if you have experience

It seems no one has yet mentioned a raw, more natural diet. With no definitive diagnosis of intestinal lymphoma it certainly would not hurt.

There are manufacturers who make supplemented raw food - Nature's Variety has Instinct Medallions which you might be able to find in a specialty pet store. http://www.naturesvariety.com/raw_products_chicken

The online order manufacturer several of us here use is Feline's Pride. https://www.felinespride.com/#/testimonials Scroll down for the testimonial from owner whose cat Cookie also suffered the diarrhea form of IBD. Also catnutrition.org is a good resource about raw diets.

In this day and age we hope we can throw a pill at something and it will fix it. You sound like someone who wants to do whatever you can to help Wednesday. I wanted to make sure you have another option to consider besides pills or more expensive tests.

 

Re: Wednesday has cancer or IBD. HELP if you have experience

Had not seen this before I hit submit. She does not have to make her own, she can look for Nature's Variety Instinct or order from Feline's Pride. Takes all the work out of it, pretty much.

Why not give a cat raw food because of suppressed immune system? Because some people/vets assume raw food is full of bacteria? Because if not handled properly it is more prone to bacteria?

I and others are not convinced raw food is any more prone to bacteria growth than any other type of food. Bacteria can grow in canned food if left out to long. Raw cat food should be handled the same as you handle raw meat for humans, thaw in fridge, wash hands and counters, etc. Feline's Pride comes in 2.5lb tubs which you can thaw, dish out in smaller portions and refreeze without it going bad as long as it's thawed in the fridge each time. Nature's Variety come in feeding portions called "medallions," so they are easiest to feed with possibly lesser bacteria risk.

 

Re: Wednesday has cancer or IBD. HELP if you have experience

I have no bias against feeding a raw diet. I applaud people who do so. I admit that I downplayed my suggestion of a raw diet in my post above, which I should not have done. I know that many people have had huge success with feeding raw.

The only link that I can put my hand on at this moment with regards to using caution when feeding a raw diet to an immune suppressed cat is here: http://www.catinfo.org/?link=makingcatfood#Safety_Issues. Dr. Lisa (this website's acknowledged feline nutrition expert) warns in the section under safety issues:

"However, knowing that the above precautions were no guarantee that I would be feeding a safe diet, I now par boil the chicken/turkey thighs to the point where they are ~25-50% cooked on the outside and 50-75% raw on the inside.

I definitely suggest doing this for any animal that may be immunocompromised due to illness, advanced age, or if they are receiving any immunosuppressive medications, or antacids."


Thanks to Vicky for highlighting the importance of diet, and the possible benefits of a raw diet. While I would not recommend a raw diet alone for the treatment of lymphoma, I know that it can be key to successful treatment of IBD, and may improve QOL for a lymphoma kitty. I would suggest that anyone undertaking the feeding of such a diet read Dr. Lisa's guidelines.

 

Re: Wednesday has cancer or IBD. HELP if you have experience

i've worked a crazy day, so i will absorb all this when i have a chance.

before i read this board today, i purchased chicken and boiled it thoroughly and fed her 1/2 a breast which she enjoyed.

the canned food i purchased have given her the worst diarrhea yet! so, i am stopping that, even if it is anti-allergen, she isn't getting any of it in her.
so sad. she is so skinny, it's awful.

she also has a lot of gas which i feel when i am holding her, her belly is always "growling".
i had read that IBD usually doesn't present with ravenous hunger. however, her diabetes is now a bit more under control (i think i was dosing her too high at 0.75 of lantus, so i went down to 0.5 and i can see a difference). she also only eats 2x a day, with some snacks. i leave a auto feeder out....

maybe i ca see what the vet has to say about pancreatic enzyme supplement.

there is just so much, i don't want to throw too much at her, then you don't know what is doing what...

 

Re: Wednesday has cancer or IBD. HELP if you have experience

I agree on that! Thanks, Linda, for finding that link. I assume she suggests partial cooking to lessen the bacteria risk, which though it might be slight, you and she are correct that it could cause more problems for an immunocompromised kitty due to those reasons she lists if bacteria were present.

 

Re: Wednesday has cancer or IBD. HELP if you have experience

why leave it partially raw on the inside? doesn't that allow an environment where bacteria would be living? i thought cooking it would kill the bacteria?

i don't meat, so i don't know anything about it!

 

Re: Wednesday has cancer or IBD. HELP if you have experience

Well, I'm not really sure, but I assume she still is grinding the meat after she partially cooks it. The bacteria would most likely only be on the outer parts of the meat so cooking the outside would kill it before it had a chance to get to the inside. And leaving the inside raw still maintains the point of feeding raw food, which is to get back to the cat's more natural diet of raw meat.

 

Re: Wednesday has cancer or IBD. HELP if you have experience

started her on presdnisolone today. we will see how she does....

i did not start any of the other medications recommended because i wanted to just take one step at a time and my vet is not that familiar with the anti-neoplastics. so, we will consider those at our next visit in 2 weeks.

i hope she gains weight, so even if the worst is true, she isn't wasting away.

thanks, everyone.

 

Re: Wednesday has cancer or IBD. HELP if you have experience

Paws crossed that she will feel better on the Pred. Please keep us updated on her progress.