Feline IBD or Lymphoma

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Carol Kolthoff

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Last Thursday, Max, age 10, was playing with us. Then suddenly stopped and just laid down. Weird.
The next morning he did not wake us for breakfast. Even weirder. He did not eat much all day. And eyes looked dilated.

I got him to his regular vet on Friday . After a ton of labs, all is pretty good, but she was concerned about IBD or small cell lymphoma!!

So an ultrasound was done over the weekend in the ER Animal Hospital. They did see some thickening in the small intestine wall (reactive hyperplasia?). Max was totally freaked out when he got home. He was very fearful. His eyes huge and he was hiding!

So the vet thinks a endoscopy/biopsy of the GI tract would be prudent to get the proper diagnosis. It is a general anesthesia. Otherwise, if I decided not to go that route, we can treat it for IBD. (steroids)

I am extremely worried that he is so nervous the endoscopy would be more harm than good. He has not eaten all day. He is not the same Max!

He is on Serenia for nausea,
Mirataz for appetite
Gabbapentin for pain.

Can I get your advice? I am broken hearted! I have to let the vet know very soon.

Thank you
 
Hi Carol, so sorry that your Max is going through something nasty…

He already gets gaba, do you give him some before vet visits? It usually helps them a lot in dealing with stress.

Does he have some other signs of illness? Typically, both IBD and SCL present with appetite variation, diarrhea, and vomiting among others.
Of course, sometimes there are no signs at all.

Small cell lymphoma is one of the "easy" cancers to treat, and most cats suffering from it end up dying from some other cause after years of treatment, so it definitely wouldn't be the end!
Treatment for both is similar (for SCL you add chlorambucil to prednisolone), and it might make more sense to start first treating IBD. It could give you some time to reflect and decide how to proceed further.
Why does your vet want you to rush with biopsy, is Max having other symptoms? Could it be that she suspects something else? Sorry, I know that you don't need more stress than you already have, I just don't understand why you have to rapidly decide. Plus, all the studies that I've read about the topic state that yes, we do need more studies to understand the why and the how, but ultimately, differentiating between both might not alter a single patient's disease course.

Here some articles in case you want to read about it:
https://www.sciencedirect.com/science/article/abs/pii/S0195561620301091?via=ihub
http://vetfolio-vetstreet.s3.amazon...40005056ad4734/file/PV2013_Al-Ghazlat1_CE.pdf
https://www.dvm360.com/view/treating-ibd-and-lymphoma-without-a-biopsy
https://www.vin.com/apputil/content...&catId=124678&id=8896816&ind=130&objTypeID=17
 
Thank you Daphne and Aida,

She thought if we start the steroid, they won't be able to do a endoscopy later for some reason. But this came on suddenly. No appetite issues ever and he weighs 15 lbs! He eats.
He was playing and stopped. Now he wont eat. I am very scared.
 
Daphne and Aida said:
Treatment for both is similar (for SCL you add chlorambucil to prednisolone),
Click to expand...
I beg to differ. I've had three cats with SCL now, the last one also has IBD. She's been in remission from SCL for 6 years now and only taking pred for her IBD. Not all IBD kitties need a steroid but those that do may need it for life. SCL kitties generally take a steroid for just the first while, until the chlorambucil has had time to take effect, maybe 6-12 months? Remission can happen in 6 months or less on the proper chlorambucil protocol. And the chlorambucil may be stopped after a year or two.

With a diabetic kitty, you might look at budesonide for a steroid (if needed) instead of prednisolone, as it often does not impact blood sugars. Neko was on budesonide and it had no impact on her numbers, though it does for a small percent of cats. Neko did not have a proper diagnosis (endoscopy or biopsy surgery) because her heart condition would not allow anaesthesia.

Current SCL kitty had an endoscopy to take a sample for diagnosis. However, endoscopy can only reach certain parts of the bowels, the top part or bottom part if done like a colonscopy. If thickening is in the middle, duodenum, or there are thickened deeper layers not reachable by endoscopy, then surgery is required.

You may ask why it's good to know if you are dealing with IBD or SCL, the answer is that the treatments are different though there is some overlap. Some IBD kitties can be treated with a change to a novel protein and a good probiotic like visbiome. Some IBD cats (like mine) do need a steroid though it's dose might be tapered down. You also don't want to give chlorambucil unless needed as it's a carcinogen. But if kitty has SCL, it needs chlorambucil to go into remission. A kitty treated for IBD that has SCL, will not survive nearly as long.
Carol Kolthoff said:
She thought if we start the steroid, they won't be able to do a endoscopy later for some reason.
Click to expand...
Absolutely correct, now is not the time to start the steroid. If you start a steroid before surgery, it could mask the disease.

One thing I strongly recommend is ondansetron for an anti nausea drug. Cerenia is fine for reducing vomiting, but not as good at nausea control.
 
Carol Kolthoff said:
Last Thursday, Max, age 10, was playing with us. Then suddenly stopped and just laid down. Weird.
The next morning he did not wake us for breakfast. Even weirder. He did not eat much all day. And eyes looked dilated.

I got him to his regular vet on Friday . After a ton of labs, all is pretty good, but she was concerned about IBD or small cell lymphoma!!

So an ultrasound was done over the weekend in the ER Animal Hospital. They did see some thickening in the small intestine wall (reactive hyperplasia?). Max was totally freaked out when he got home. He was very fearful. His eyes huge and he was hiding!

So the vet thinks a endoscopy/biopsy of the GI tract would be prudent to get the proper diagnosis. It is a general anesthesia. Otherwise, if I decided not to go that route, we can treat it for IBD. (steroids)

I am extremely worried that he is so nervous the endoscopy would be more harm than good. He has not eaten all day. He is not the same Max!

He is on Serenia for nausea,
Mirataz for appetite
Gabbapentin for pain.

Can I get your advice? I am broken hearted! I have to let the vet know very soon.

Thank you
Click to expand...
My one cat has IBD. She was diagnosed 5 years ago. Vomiting blood and bloody diarrhea were her symptoms. US showed the same thing as yours. I opted for colonoscopy and endoscopy, and it was IBD. She’s been on steroids for 5 years and is now 16, going to turn 17 in November god willing. No issues with the procedure, but I did have them do an echo on her prior to her going under anesthesia just in case. Ir was KT not fun and she wasn't eating well and was definitely fearful when it was all happening, especially when we had to give her steroids twice a day, but since has improved and is back to her normal self. She now takes her medication in food.
 
Good point about the Group.io groups. There is also one for feline small cell lymphoma, but they want you to have a proper diagnosis first.

How is Max doing today?
 
Thank you all that replied! Here is an update on “Miracle Max”!

Yesterday, He got the prednisone at 3:30 pm and ate some chopped lean ham at 6:30. ( it is his fav. Food)
Then he ate little bits throughout the might. This morning, he is eating small snacks and he looks brighter and alert. He is resting a lot, but certainly a much healthier cat.

I thought he was done-for. I am so happy we decided NOT to do the endoscopy. I don't think he would have survived the procedure.

I guess he will stay on the prednisone for a while?
And then can they do biopsies a while after? My friend is a vet and she mentioned surgical biopsies being more accurate. Do you know if this is a better option?

Again, thank you all for sharing your knowledge.
I will keep you posted on “Miracle Max!”
 
Carol,
So glad he's better!
So you made up your mind, good! I think that, if you want to proceed with a biopsy, he should be taken off the steroid for a while.
Did you see Wendy's post, where she says that budesonide is a better steroid choice for diabetic kitties? Maybe you can ask your vet if it would be possible to change for that one?
If your friend is a vet, I'm sure she knows better than me, a part-time student!!!
As Wendy said in her post, surgical biopsy would allow to check the entirety of the intestinal tract, whereas endoscopy can only take samples from some portions of it.

Why do you think that he wouldn't survive the procedure? Because of his stress, or does he have other issues? (heart, kidneys etc)
 
Endoscopy is a relatively easier procedure on the cat than surgical biopsy, if it can reach the affected area. If there are no issues with anaesthesia, the other side effect might be temporary irritation from the endoscopy tube. Best to be done by an endoscopy specialist.

Surgical biopsies will be more accurate, depending where the thickening is in the bowels. Surgery can reach everywhere. Some places endoscopes cannot reach. If your vet friend has seen the ultrasound report, she should be able to say which is best.

I'm hoping Max is getting prednisolone, not prednisone? If it's going to be a long term drug for him, you can get it compounded into a chew treat. Though as I said above, budesonide is a better option for diabetics if giving long term.

Carol Kolthoff said:
I guess he will stay on the prednisone for a while?
And then can they do biopsies a while after?
Click to expand...
He would have to be off of prednisolone (hoping it's that) for at least a few weeks before they could do any biopsy, whether via endoscopy or surgical.
 
Hi Group, (Daphne and Wendy)

It is Wednesday night, and it looks like Max is on the mend. He has been eating little bits all day and seems to have more life in him. On Monday, as I mentioned he came back from the Vet hospital, terrified and depleted. I have no idea what happened and it is a reputable facility. But when he came home, it looked like he would not make it through the week! Tomorrow, I will ask the vet about Ondansetrol for nausea. And thank you for the referral to the Feline IBD group. Luckily Max does not have diabetes. Our other cat, Oreo did, which is why I consulted with this group. You all are so knowledgeable and got me through some tough times with feline diabetes.

I will keep you posted on Max's condition.

Virtual Hugs to all!

Carol









Wendy&Neko said:
I beg to differ. I've had three cats with SCL now, the last one also has IBD. She's been in remission from SCL for 6 years now and only taking pred for her IBD. Not all IBD kitties need a steroid but those that do may need it for life. SCL kitties generally take a steroid for just the first while, until the chlorambucil has had time to take effect, maybe 6-12 months? Remission can happen in 6 months or less on the proper chlorambucil protocol. And the chlorambucil may be stopped after a year or two.

With a diabetic kitty, you might look at budesonide for a steroid (if needed) instead of prednisolone, as it often does not impact blood sugars. Neko was on budesonide and it had no impact on her numbers, though it does for a small percent of cats. Neko did not have a proper diagnosis (endoscopy or biopsy surgery) because her heart condition would not allow anaesthesia.

Current SCL kitty had an endoscopy to take a sample for diagnosis. However, endoscopy can only reach certain parts of the bowels, the top part or bottom part if done like a colonscopy. If thickening is in the middle, duodenum, or there are thickened deeper layers not reachable by endoscopy, then surgery is required.

You may ask why it's good to know if you are dealing with IBD or SCL, the answer is that the treatments are different though there is some overlap. Some IBD kitties can be treated with a change to a novel protein and a good probiotic like visbiome. Some IBD cats (like mine) do need a steroid though it's dose might be tapered down. You also don't want to give chlorambucil unless needed as it's a carcinogen. But if kitty has SCL, it needs chlorambucil to go into remission. A kitty treated for IBD that has SCL, will not survive nearly as long.

Absolutely correct, now is not the time to start the steroid. If you start a steroid before surgery, it could mask the disease.

One thing I strongly recommend is ondansetron for an anti nausea drug. Cerenia is fine for reducing vomiting, but not as good at nausea control.
Click to expand...
 
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