5/13 Ruby AMPS 83/+3 76/+8 80/PMPS 76/+3 86

[Katherine&Ruby]

Yesterday on The Life of Ruby.

Today has not started well. Ruby ate her +9 snack at 4 AM and then woke me up at her usual shot time to feed her which I took to be a good sign since she hadn't done that in a long while, ate her breakfast of raw turkey and bison with gusto and then threw it all up 5 minutes later. I have been feeding Olive the same food to no ill effect. I gave her an ondansetron and another cyproheptadine and she has only eaten 2 Dr. Elsey's kibbles and nibbled on some Weruva Family Food. She is refusing to eat her raw food that she once enjoyed so much.

@Liz & Minnie What are these "darcines" you speak of so highly? Are they canned sardines in water from TJs? I have one near me and can go to get some if it will get her to eat.

I had a cat who, several years ago, had a laparotomy to biopsy all of his internal GI parts.

Suzanne, I really appreciate you sharing your experience with me. It sounds absolutely harrowing. I am so sorry you had to go through that. The only way I'd agree to do a biopsy is if I could get an endoscopy. There must be doctors in the NYC area that do this for cats.

Thanks everyone for all of your loving support. I am so very worried and it's helpful that you all know how that feels.

 

[tiffmaxee]

I’m sorry Ruby isn’t feeling well. I had a cat that had lymphoma. She was diagnosed by endoscopy. Whether it will give you a firm diagnosis depends on the location of the thickening. My internist did the endoscopy. It might be more difficult to discern with scl. Tiffany had a more aggressive one, intermediate cell.

 

[Suzanne & Darcy]

Yes. The Darcines are the TJs sardines in water and a favorite of Minnie. Thanks to @Butters & Lyla for the recommendation in the first place. Apparently, Butters is a big fan of a little sardine mashed with a little water. @Liz & Minnie does Minnie just eat the whole fish as it comes right out of the can (I mean not that she eats it out of the can... I'm sure you put it in a dish for her! )

 

[Suzanne & Darcy]

And that is so upsetting about Ruby and the not eating after first eating and then vomiting it all back up again.... and she was so keen on it at first (which must have made you smile... for about five minutes). I'm so sorry. I hope she will get back to eating again later today. Do you expect to have your blood results back today? I sure am rooting for Ruby.

 

[Suzanne & Darcy]

Yesterday on The Life of Ruby.

Today has not started well. Ruby ate her +9 snack at 4 AM and then woke me up at her usual shot time to feed her which I took to be a good sign since she hadn't done that in a long while, ate her breakfast of raw turkey and bison with gusto and then threw it all up 5 minutes later. I have been feeding Olive the same food to no ill effect. I gave her an ondansetron and another cyproheptadine and she has only eaten 2 Dr. Elsey's kibbles and nibbled on some Weruva Family Food. She is refusing to eat her raw food that she once enjoyed so much.

@Liz & Minnie What are these "darcines" you speak of so highly? Are they canned sardines in water from TJs? I have one near me and can go to get some if it will get her to eat.

Suzanne, I really appreciate you sharing your experience with me. It sounds absolutely harrowing. I am so sorry you had to go through that. The only way I'd agree to do a biopsy is if I could get an endoscopy. There must be doctors in the NYC area that do this for cats.

Thanks everyone for all of your loving support. I am so very worried and it's helpful that you all know how that feels.

Yes. My last kitty lost in January 2021 to an unrelated cause, had IBD and suspected SCL, but his thickening was in the muscularis layer and they can't get at that with an endoscopy.

 

[Butters & Lyla]

Yes. The Darcines are the TJs sardines in water and a favorite of Minnie. Thanks to @Butters & Lyla for the recommendation in the first place. Apparently, Butters is a big fan of a little sardine mashed with a little water. @Liz & Minnie does Minnie just eat the whole fish as it comes right out of the can (I mean not that she eats it out of the can... I'm sure you put it in a dish for her! )

Butters will literally gobble up absolutely anything if it has a little mashed sardine and/or water from the sardine can. She cannot resist them. I know they are high in P and Butters has CKD, so I only use them in an eating emergency. When I open a can, I mash up the leftovers and freeze them into 5 gram ice cubes. Easy to melt in a little warm water and make a slurry to add to a larger portion of food when needed, and then the rest of the can doesn't go to waste.

We are rooting for Ruby over here. Sending you lots of support, Katherine. I really feel for you.

 

[Katherine&Ruby]

Yes. My last kitty lost in January 2021 to an unrelated cause, had IBD and suspected SCL, but his thickening was in the muscularis layer and they can't get at that with an endoscopy.

Of course that is where Ruby's thickening is. Sigh.

 

[Liz & Minnie]

Yes. The Darcines are the TJs sardines in water and a favorite of Minnie. Thanks to @Butters & Lyla for the recommendation in the first place. Apparently, Butters is a big fan of a little sardine mashed with a little water. @Liz & Minnie does Minnie just eat the whole fish as it comes right out of the can (I mean not that she eats it out of the can... I'm sure you put it in a dish for her! )

Yes, I renamed them darcines in honor of Mr Darcy . Minnie and Sam love them. I mash them up and put them in a dish. Lyla has the best tips!

 

[Katherine&Ruby]

Butters will literally gobble up absolutely anything if it has a little mashed sardine and/or water from the sardine can. She cannot resist them. I know they are high in P and Butters has CKD, so I only use them in an eating emergency. When I open a can, I mash up the leftovers and freeze them into 5 gram ice cubes. Easy to melt in a little warm water and make a slurry to add to a larger portion of food when needed, and then the rest of the can doesn't go to waste.

We are rooting for Ruby over here. Sending you lots of support, Katherine. I really feel for you.

Some raw feeding groups promote using sardines in raw food instead of adding fish oils for omega 3s, but I've always shied away because it's a) fish and b) the phosphorus levels. But desperate times call for desperate measures. If Ruby doesn't eat the sardines, there are some humans in the household who will happily finish the seconds. Thank you for the tip and good wishes, Lyla.

 

[Katherine&Ruby]

Ruby asked for more food so I gave her a few spoons of Weruva mixed with some raw. She ate most of it. She's been really clingy, insisting on sitting next to me or on me looking for pets and comfort, and just made a very low, mournful meow that I've never heard from her before. I hope that it's the cypro making her vocalize and that she is not in pain.

 

[carfurby (GA)]

Sending prayers.

 

[Liz & Minnie]

hope she improves. Enjoy the cuddles at least if you can, better than her hiding under the bed. Glad to hear she ate.

 

[Katherine&Ruby]

hope she improves. Enjoy the cuddles at least if you can, better than her hiding under the bed. Glad to hear she ate.

My bed sits directly on the floor. There are actually very few hiding places in my house for cats so Ruby's favorite place to be is under my bed covers. Right now she is sunning herself on a patch of light on the bed after eating more food this afternoon. Vet still has not called me with her test results.

 

[JaxBenji]

Sending lots of love and prayers to you all Nice to hear Ruby ate a bit this afternoon.

 

[Katherine&Ruby]

Good and bad news. Good news first: her bloodwork looks great. Still waiting for the results to be emailed to me, but all of her kidney values are lower than they were in March, thyroid, liver, everything is good. Bad news: there must be something going on in her gut and vet said basically he thinks she should go on budesonide, but he doesn't want to put her on it until we get an ultrasound pronto because it could be IBD/SCL or it could be something else. Will bring her to AMC tomorrow and hopefully get a board certified radiologist and then passed on to a good internist who I can trust with her care. Thank goodness I've started to work a bit again so I can pay for these vet bills!

 

[Our Dolly Girl (GA)]

Of course that is where Ruby's thickening is. Sigh.

Katherine so sorry about all that’s going on with Ruby. Our Kitty Funny Face had IBD with possible lymphoma. She also had Diabetes, high blood pressure and Hyperglycemia. We chose to nurse her and she had quality of life for 18 months. Our loving prayers for good lab results and Ruby to start eating without vomiting and no pain. I asked Dolly to send out her powerful healing vibes to Ruby, I hope Ruby starts feeling them soon. Hugs and prayers
Just saw your post. Good luck with the internist tomorrow. We will all be praying for something treatable.

 

[Purrberry]

Good luck tomorrow! I hope you can see Dr. Appleman for your IM consult, as my vets say she is amazing and the go-to for the tough cases. We have a virtual visit scheduled with her in June.

 

[Liz & Minnie]

Minnie sends get-well wishes to Ruby! She was also sunning herself by the window, synchronized sunning. My heart goes out to you on the sick-kitty rollercoaster. Hard to focus on the good news with the fear of the unknown looming, I know, but so much better when they actually have a diagnosis and treatment plan. Sounds like you have a bunch of excellent vets on hand, and she has the most enviable spreadsheet. Good luck tomorrow!

 

[Tomlin]

Katherine, I am sorry to read about your situation. Wishing you the best tomorrow and with the eating in the meantime. Prayers for some answers and solutions.

I recently read about a new test called LymphoPro Feline Dx. It was developed by Sr Jorg Steiner (TAMU) & Dr Sina Marcilio (she was at TAMU but I think she is at UC Davis now). It is used when there is an inability to determine IBD vs SCL using clinical signs and histopathology. Given that this can be an issue many times, & previous use of IHC & PARR are not specific for SCL in cats, this appears to be the latest tool.

The following link is a white paper/basic description of the test, why and how it was developed, and is written by Drs Steiner and Marsilio called “Feline Intestinal Small Cell Lymphoma vs Inflammatory Bowel Disease: Wouldn’t You Want to Know?”

https://cdn2.hubspot.net/hubfs/4459353/assets/resources/LymphoPro White Paper.pdf

It does a really nice job explaining it in terms that are understandable.

This is the link for the actual company & test info:
https://cdn2.hubspot.net/hubfs/4459...phoPro Feline Dx Technical Specifications.pdf

I have not had an opportunity to ask any of my IMs about their experience with this test yet, but figured I would pass it along just in case it is a tool AMC uses (you will have the info ahead of time) or in case it is a tool that you decide you want to ask about after reading the info in case it may be of help.

I will keep you both in my thoughts tomorrow.

 

[Katherine&Ruby]

Good luck tomorrow! I hope you can see Dr. Appleman for your IM consult, as my vets say she is amazing and the go-to for the tough cases. We have a virtual visit scheduled with her in June.

Sadly all of the internists at AMC are booked for an entire month, so I will have to bring her through emergency care and then hopefully get an internist. I hear Dr. Palma is also very good there. We shall see.

 

[Sue and Luci]

Sending prayers and well wishes for Ruby! Hugs for you mama

 

[Katherine&Ruby]

Katherine, I am sorry to read about your situation. Wishing you the best tomorrow and with the eating in the meantime. Prayers for some answers and solutions.

I recently read about a new test called LymphoPro Feline Dx. It was developed by Sr Jorg Steiner (TAMU) & Dr Sina Marcilio (she was at TAMU but I think she is at UC Davis now). It is used when there is an inability to determine IBD vs SCL using clinical signs and histopathology. Given that this can be an issue many times, & previous use of IHC & PARR are not specific for SCL in cats, this appears to be the latest tool.

The following link is a white paper/basic description of the test, why and how it was developed, and is written by Drs Steiner and Marsilio called “Feline Intestinal Small Cell Lymphoma vs Inflammatory Bowel Disease: Wouldn’t You Want to Know?”

https://cdn2.hubspot.net/hubfs/4459353/assets/resources/LymphoPro White Paper.pdf

It does a really nice job explaining it in terms that are understandable.

This is the link for the actual company & test info:
https://cdn2.hubspot.net/hubfs/4459353/assets/resources/LymphoPro Feline Dx Technical Specifications.pdf

I have not had an opportunity to ask any of my IMs about their experience with this test yet, but figured I would pass it along just in case it is a tool AMC uses (you will have the info ahead of time) or in case it is a tool that you decide you want to ask about after reading the info in case it may be of help.

I will keep you both in my thoughts tomorrow.

Thank you so much, Amy. I read the papers and, if I am understanding this correctly, it would be a test performed on tissue collected from a traditional biopsy? I don't know what "formalin fixed, paraffin embedded tissue samples" are, but that is what it sounds like to me. I'm really hoping to avoid a biopsy, so @Marje and Gracie pointed me to a blood test that could possibly circumvent the need for a biopsy altogether: https://vdireview.com/feline-gi-lym...ign=VDI+Labs+-+IVC+E-blast+#4+-+February+2021. Curious to know if you had heard of this.

 

[Wendy&Neko]

I'm sorry to hear Ruby isn't feeling well.

I belong to a small cell lymphoma group on line (so does Elise). I am on my third cat with SCL. Sigh! The group has an IM vet post and he is very experienced in small cell. Unfortunately the test that Marje pointed you to is not a valid one. The Lymphopro test, last I saw, was not available yet either.

Neko could not be diagnosed due to her heart condition - both endoscopy and biopsy require anaesthesia, which her heart could not handle. Latest cat was endoscopy, but thickening was where it could be reached. A travelling endoscopy vet came to the clinic. What is your issue with a biopsy? A lot of the cats on the list do well with it. And I think if I could, I rather know what I was dealing with so I could give the correct treatment. Another option I've seen mention is a laparoscopy assisted biopsy, though performed at fewer places, is less invasive. AMC might be big enough to have the skills.

 

[Mel and Cargo]

Sending prayers to you and Ruby.

 

[Katherine&Ruby]

I'm sorry to hear Ruby isn't feeling well.

I belong to a small cell lymphoma group on line (so does Elise). I am on my third cat with SCL. Sigh! The group has an IM vet post and he is very experienced in small cell. Unfortunately the test that Marje pointed you to is not a valid one. The Lymphopro test, last I saw, was not available yet either.

Neko could not be diagnosed due to her heart condition - both endoscopy and biopsy require anaesthesia, which her heart could not handle. Latest cat was endoscopy, but thickening was where it could be reached. A travelling endoscopy vet came to the clinic. What is your issue with a biopsy? A lot of the cats on the list do well with it. And I think if I could, I rather know what I was dealing with so I could give the correct treatment. Another option I've seen mention is a laparoscopy assisted biopsy, though performed at fewer places, is less invasive. AMC might be big enough to have the skills.

Thanks for letting me know about the tests, Wendy. I have heard about the laparoscopy option. I am afraid of what a biopsy would do. I'd have to fully understand what's involved, how the anesthesia would affect her. I am also financially tapped out. Since the beginning of the year, I've spent over $2,500 in vet bills, and tomorrow I will likely cost me at least $1,500, as I'll be going through emergency care. I feel so overwhelmed, but I also love Ruby so much. I don't know.

 

[Suzanne & Darcy]

Oh wow. Just wow. I go away for a few hours and come back to read all this. I'm very relieved that this was not because of worsening kidney disease. Let's just stop there for a minute and be very happy and thankful for that much. Full stop! Then, let's just move on to the next thing. The intestinal diseases are not good, but they are more treatable and offer a better long-term prognosis than CKD. You have more options. You can manage this. I really think that you will find out what is going on and be able to manage Ruby and keep her well for a very long time to come. I know it is very overwhelming right now. But take each day and each step one day at a time. We will all be waiting to hear each step of the way. MAJOR, HUGE, GINORMOUS HUGS!!!

 

[Tomlin]

The Lymphopro test, last I saw, was not available yet either.

It was available directly through New River VDL commercially on a fee-for-service basis as per Steiner’s recent publication(https://pubmed.ncbi.nlm.nih.gov/32100916/).—see under Conflicts of Interest. However, when I just searched for the contact info for the lab, it looks like New River VDL labs has been dissolved this year. That doesn’t mean the test no longer exists. I will reach out and try to find out if another lab is now managing it....maybe even TAMU given that it was developed there. Hopefully they have found someone else to process it & it would be nice if it was at TAMU given that they process the Full GI Panel. One stop shop would be nice !

One step at a time ! I wanted you to have the info just to have it in case you decide or need to go down this path given the complexity and challenge of the diagnosis sometimes. You may not go down this path at all and choose to manage it without additional testing.

I will work on finding out where this particular test went to—which lab/who is managing it now and post the info so that the info is available (if it is available!)

Best-Amy

 

[Katherine&Ruby]

MAJOR, HUGE, GINORMOUS HUGS!!!

I can't tell you how much I appreciate your comments right now Suzanne! Especially coming from YOU, who has been struggling every day to keep it together. I did tell Frank this evening that I felt proud that Ruby's blood work was so good. I think switching to the raw diet helped a lot. Thank you for trying to help me see the positive. I've posted her labs in case someone can see something in them that I can't.

It's been breaking my heart to see her suffer today. Her fur has gotten spiky, and when she wasn't curled up next to me seeking comfort she was lying around listlessly. Not even the birds outside sparked her interest. After some eating this afternoon she wasn't so interested in eating anything this evening. I gave her half of a darcine and she wasn't that impressed. Not even the kibble entices her.

 

[tiffmaxee]

Katherine, I am so sorry to read this but one step at a time. My lymphoma cat had a high white count showing inflammation. Ruby’s labs are so good. I’m hoping this means IBD vs cancer.

 

[Katherine&Ruby]

Katherine, I am so sorry to read this but one step at a time. My lymphoma cat had a high white count showing inflammation. Ruby’s labs are so good. I’m hoping this means IBD vs cancer.

That's good to know, Elise. Thank you. I didn't know that lymphoma would show up in blood work but that makes sense.

 

[tiffmaxee]

That's good to know, Elise. Thank you. I didn't know that lymphoma would show up in blood work but that makes sense.

It can’t be diagnosed by blood tests but a high white count is one sign of possible cancer if there isn’t an infection. It is raised due to inflammation.

 

[Katherine&Ruby]

It can’t be diagnosed by blood tests but a high white count is one sign of possible cancer if there isn’t an infection. It is raised due to inflammation.

Wouldn't there be inflammation with IBD as well?

 

[Wendy&Neko]

I didn't know that lymphoma would show up in blood work but that makes sense.

Not necessarily - current SCL cat only had an SDMA at the high end, rest of the numbers were good before diagnosis. White cell count was low end of normal. SDMA is now perfectly normal, go figure. Oh, and she has food allergies, so some IBD as well, which made diagnosis more fun.

@Tomlin - What I had heard about the test is what you found out, company no longer around so test no longer available. Would be great to know if someone else is now offering it. We see a lot of kitties here too with the IBD/SCL question.