In 2012, my Gracie
View attachment 30013View attachment 30013View attachment 30013 showed some very mild intestinal thickening on an ultrasound. She had no symptoms but her semi annual labs indicated her liver values were mildly elevated so my vet had me take her to an internal medicine specialist, who is supposed to be renowned in intestinal issues, for an u/s. I asked him if she could have IBD or lymphoma and he said because she had no clinical signs, that he was certain the int wit all thickening was related to the liver. Her liver values came down but, for some odd reason, every summer, they went up. Clinically, she remained fine with just occasional scarf and barf vomiting. Her intestinal thickness remained the same and so we did this for three years with no changes in her u/s. He assured me that if she had IBD or lymphoma, we'd be seeing clinical signs.
Finally in July, 2015, she started losing weight and her bilirubin went up. He talked me into endoscopy which I wish I had never, ever done. Yes....many cats have no issues with it and many cats have no issues with exploratory surgery. But she did. I had gotten her stable and doing well all around when we did the endoscopy and it was a slow slide downhill after that. Everything changed. I, personally, believe he somehow weakened her intestines in one of the biopsy samples he took but I have no proof.
Her biopsy came back as IBD but the UofA lab always sends all IBD positive samples to UC Davis for PCR and the result of that was small cell lymphoma. I wanted to start her on budesonide, not prednisilone because I felt, even though it is not part of the protocol for SCL, it would be easier on her. But the oncologist and the IM specialist felt the pred and chemo were a better choice.
The pred caused a weakening in her heart (which can be a side effect and all of her previous echoes showed her heart to be totally normal). I think it also contributed to an erosion in the weak spot in her intestines. Ten days after I started the steroid, I lost her to a spontaneous bowel perforation.
What would I do differently? I would not have done the endoscopy. I would have assumed SCL and treated for it with pulse dosing of leukeran (chlorambucil) and budesonide. There is a SCL group in yahoo and the IM vet who often posts there and works with members of that group said, even though there is no research to show that budesonide and leukeran together can treat SCL, for a FD, he would do it. I wish I had done that and taken whatever time I could have had.
Gracie's liver was normal as was her pancreas. It appears that the IM specialist had it backwards....it was the IBD that was affecting her liver values. She would likely still be alive today if I had started treating the IBD with budesonide in 2012. It could have kept the lymphoma at bay for longer although it is generally thought now that with an IBD cat, it's not "if" he or she will progress to SCL, it's "when".
I am not trying to discourage you from doing endoscopy or even exploratory surgery. I just want you to know of the other risks. I'm sure that what happened with Gracie is fairly rare but
@Wendy&Neko treated both her cats, FD Neko and nonFD Theo, in the more conservative manner by not doing endoscopy or exploratory surgery and I think she is glad she went that route.
I do know of some kitties that have gone into remission with SCL for a couple years. The main issue I see without a biopsy is knowing if you are treating large cell lymphoma or SCL. They are entirely different beasts. LCL typically has lymph node involvement which is seen less in SCL. Also, typically with LCL, tumors will be present. However, ECID. LCL has to have a more aggressive chemo treatment and it does not go into remission that I am awww of. The prognosis is not usually too good for LCL (I did have a kitty with LCL and even with chemo, she did not live long).
I would join the FB IBDkitties and also the FB Raw Feeding for IBD Kitties groups. They are both great although I think the latter is much more active and you don't have to be feeding raw to post or learn a lot. You can also get a lot of info from
IBDkitties website.
I would encourage you to go to the yahoo groups and join either the LCL or SCL groups. The members of the LCL group are friendlier and they welcome SCL cat caregivers. But both groups have an amazing amount of info and help and if Dr. Jory posts, there is a lot of good information from him. You could join both so you can access the info from the SCL group but post in the other, if you like.
There are different protocols for the chemo. My neighbor is currently dealing with SCL in her kitty, Sophie. She has been through two long rounds of chemo and they really seemed to zap her I've time. They had issues with appetite; she became more lethargic, and she lost a lot of weight. She did go into a very brief remission after the first round. They have now stopped all chemo and are just doing palliative care. Her appetite has picked up but they know it is short lived.
I hope this helps.
