7/14 Ruby AMPS 265/+3 253/+6 228/+9 214/PMPS 205/+2 170 vet update

Katherine&Ruby

Katherine&Ruby

Member Since 2020
Yesterday on Driving Miss Ruby. :cat:

Ruby's doing well. Still managing her possible UTI with D-Mannose. She likes the sweet taste and is eating well. Some of the lower numbers we saw yesterday I am hoping are an indication she is feeling better. Pee does not smell so bad anymore.

Today I reduced Ruby's dose of pred back to 5 mgs as per the vet, so I hope that will mean lower overall BGs. Will be monitoring closely.

With my job we are allowed one day a week of working from home for the summer and Wednesdays are my day. I'll be here until I have to go in for an in person meeting later this afternoon. So I get to be home with the kitties for most of the day. Yay.

Healing thoughts for all of the sick kitties and hugs to everyone. Have a good day! :bighug::bighug::bighug:
 
Good morning Katherine!

Yay for working from home! Fingers crossed the reduced pred brings Ruby closer to her normal low numbers that you've worked so hard for. :cool:
 
I'm glad you get to work from home one day a week. I'm sure the kitties will be happy. I'm glad Ruby is eating the D-Mannose and it seems to be helping. Sending prayers. :bighug::bighug:
 
That's great news Katherine being able to be home on Wednesdays
Yay for eating well, I'm happy that the D-Mannose seems to be helping.
I'm sure the kitties love having you home today ♥:bighug::bighug::bighug:
 
Spoke with Ruby's oncologist again today, who called with preliminary results from the urinalysis and bloodwork.

They found no white blood cells in the urinalysis, which does not mean she does not have an infection, as the steroid can suppress expression of inflammation. We will wait on the urine culture results to see what bacteria might be lingering in there, if any.

Her BUN is 35 and her creatinine 1.5, which is GREAT! It means all of the things I've done with Ruby's diet is working and her CKD is well controlled.

Finally, I asked the doctor to elaborate on her decision not to start chlorambucil. She said that we will do another ultrasound in 5 months and see where we are at. She also said that if we have a persistent UTI, that she will take Ruby off the pred and give her chlorambucil to avoid any further kidney damage. She then said that she has had many cats under her care who have lived many happy and healthy years. There is no guarantee, according to her, that giving a cat chlorambucil will cause remission of the lymphoma, and not cause another, more aggressive cancer to form like LCL or mast cell. Even though there was a time when doctors threw chlorambucil at every SCL cat, she said there is "no evidence" that giving a cat chlorambucil is better than not. Having a cat on chemo means more trips to the vet for monthly check ups and more stress for the cat. She told me this all in a very straightforward and no nonsense way.

Onwards and upwards.
 
PerfumedCatMom said:
Spoke with Ruby's oncologist again today, who called with preliminary results from the urinalysis and bloodwork.

They found no white blood cells in the urinalysis, which does not mean she does not have an infection, as the steroid can suppress expression of inflammation. We will wait on the urine culture results to see what bacteria might be lingering in there, if any.

Her BUN is 35 and her creatinine 1.5, which is GREAT! It means all of the things I've done with Ruby's diet is working and her CKD is well controlled.

Finally, I asked the doctor to elaborate on her decision not to start chlorambucil. She said that we will do another ultrasound in 5 months and see where we are at. She also said that if we have a persistent UTI, that she will take Ruby off the pred and give her chlorambucil to avoid any further kidney damage. She then said that she has had many cats under her care who have lived many happy and healthy years. There is no guarantee, according to her, that giving a cat chlorambucil will cause remission of the lymphoma, and not cause another, more aggressive cancer to form like LCL or mast cell. Even though there was a time when doctors threw chlorambucil at every SCL cat, she said there is "no evidence" that giving a cat chlorambucil is better than not. Having a cat on chemo means more trips to the vet for monthly check ups and more stress for the cat. She told me this all in a very straightforward and no nonsense way.

Onwards and upwards.
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Sending hugs to all and thanks for the update. You, Ruby, Olive and Frank are important to us. :bighug::bighug::bighug::bighug::bighug:
 
Nice that you had a day to enjoy the kitties at home today.

PerfumedCatMom said:
Even though there was a time when doctors threw chlorambucil at every SCL cat, she said there is "no evidence" that giving a cat chlorambucil is better than not. Having a cat on chemo means more trips to the vet for monthly check ups and more stress for the cat. She told me this all in a very straightforward and no nonsense way.
Click to expand...
I would love to see any evidence that prednisolone alone is better or as good. Most literature I've been reading says 70-90% chance of remission with chlorambucil. Here is one example post from Cornell. It does mention pred alone as an option if chlorambucil cannot be given, pred can give a remission of 2-4 months vs much longer with chlorambucil. Frankly, on my third SCL kitty, I would LOVE it if there was another option that gave as good an outcomes. I am serious when I say I'd love to see any literature on alternatives if your vet has it.

My two other SCL kitties have not had to visit the vet that often. It is more often initially, but now I'm on a every six month visit schedule.
 
Wendy&Neko said:
Nice that you had a day to enjoy the kitties at home today.


I would love to see any evidence that prednisolone alone is better or as good. Most literature I've been reading says 70-90% chance of remission with chlorambucil. Here is one example post from Cornell. It does mention pred alone as an option if chlorambucil cannot be given, pred can give a remission of 2-4 months vs much longer with chlorambucil. Frankly, on my third SCL kitty, I would LOVE it if there was another option that gave as good an outcomes. I am serious when I say I'd love to see any literature on alternatives if your vet has it.

My two other SCL kitties have not had to visit the vet that often. It is more often initially, but now I'm on a every six month visit schedule.
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Thank you, Wendy. I hear what you are saying and it makes so much sense to me and I am SO worried, but I'm also finding it hard to push. I wouldn't expect a generalist to know all about feline diabetes, but I do hope the one thing an experienced, published, and awarded oncologist understands well is cancer. We will see how this goes for the next few weeks and revisit the conversation again.
 
Wishing you the best and I wanted to clarify a very important point Re: the Cornell post in hopes that it may make you feel at least a little less worried :bighug:

Wendy&Neko said:
Here is one example post from Cornell. It does mention pred alone as an option if chlorambucil cannot be given, pred can give a remission of 2-4 months vs much longer with chlorambucil.
Click to expand...

I want to point out & clarify that both of these points from the Cornell article are pertaining to Lymphoma outside the gastrointestinal system Vs Gastrointestinal lymphoma

Pertaining to Gastrointestinal Lymphoma, specifically small cell lymphoma, they do mention combination therapy with Prednisolone and Chlorambucil and it’s success rates in treating SCL, but the information/points Re: the 2-4 months of remission with Pred alone vs chlorambucil is in reference to the treatment of lymphomas outside the GI Tract which tends to be more aggressive vs SCL.

The information is obviously changing and will continue to change as they learn more about GI enteropathies in cats.The GI thought leaders, such as Dr Marsilio out of UC Davis
(Co-developer of the new Feline LymphoPro Dx test), are practicing in a similar way as Ruby’s oncologist so it’s good to know that the thought leaders across GI & Oncology are on the same page with current recommendations:). As per Dr Marsilio’s most recent publication: “In the author’s experience, many cats with SCL lymphoma initially respond to treatment with steroids as well. In cases of refractory IBD or SCL, chlorambucil can be added to the treatment regime.” (https://pubmed.ncbi.nlm.nih.gov/33187624/)

I highly recommend this publication as it contains very detailed information pertaining to the history of diagnosis & research of GI enteropathies as well as the current diagnostic approaches, including the limitations of both the diagnosis and current understanding of the pathologies. For example, there are more than likely various types of SCL vs “just” SCL which would most likely explain why outcomes with treatment may vary—one cat does well with a med or combo while another doesn’t.

Marsilio made this important note at the end of her paper:

“From therapeutic and prognostic points of view, differentiation currently might not alter either approach or outcome. Many questions remain
unanswered, however, such as whether there are different forms of SCL (epitheliotropic vs lamina propria, mucosal vs transmural location within the small intestine, lymph node involvement, and so forth) and whether those need to be approached differently.”

As always, it takes time for the latest information, changes to treatment protocols/algorithms to get out there to the rest of the vets, so it is not surprising that the latest info coming out of AMC or UC Davis seems contrary to how things were done in the past or even with how some may still be treating SCL today.

The great news is you have access to a thought leader and will be able to share the latest info—an opportunity to learn, gain new insights into the current treatment perspectives & why they are changing:) ! Stay strong and keep the faith:bighug:!
 
Tomlin said:
Wishing you the best and I wanted to clarify a very important point Re: the Cornell post in hopes that it may make you feel at least a little less

I want to point out & clarify that both of these points from the Cornell article are pertaining to Lymphoma outside the gastrointestinal system Vs Gastrointestinal lymphoma

Pertaining to Gastrointestinal Lymphoma, specifically small cell lymphoma, they do mention combination therapy with Prednisolone and Chlorambucil and it’s success rates in treating SCL, but the information/points Re: the 2-4 months of remission with Pred alone vs chlorambucil is in reference to the treatment of lymphomas outside the GI Tract which tends to be more aggressive vs SCL.

The information is obviously changing and will continue to change as they learn more about GI enteropathies in cats.The GI thought leaders, such as Dr Marsilio out of UC Davis
(Co-developer of the new Feline LymphoPro Dx test), are practicing in a similar way as Ruby’s oncologist so it’s good to know that the thought leaders across GI & Oncology are on the same page with current recommendations:). As per Dr Marsilio’s most recent publication: “In the author’s experience, many cats with SCL lymphoma initially respond to treatment with steroids as well. In cases of refractory IBD or SCL, chlorambucil can be added to the treatment regime.” (https://pubmed.ncbi.nlm.nih.gov/33187624/)

I highly recommend this publication as it contains very detailed information pertaining to the history of diagnosis & research of GI enteropathies as well as the current diagnostic approaches, including the limitations of both the diagnosis and current understanding of the pathologies. For example, there are more than likely various types of SCL vs “just” SCL which would most likely explain why outcomes with treatment may vary—one cat does well with a med or combo while another doesn’t.

Marsilio made this important note at the end of her paper:

“From therapeutic and prognostic points of view, differentiation currently might not alter either approach or outcome. Many questions remain
unanswered, however, such as whether there are different forms of SCL (epitheliotropic vs lamina propria, mucosal vs transmural location within the small intestine, lymph node involvement, and so forth) and whether those need to be approached differently.”

As always, it takes time for the latest information, changes to treatment protocols/algorithms to get out there to the rest of the vets, so it is not surprising that the latest info coming out of AMC or UC Davis seems contrary to how things were done in the past or even with how some may still be treating SCL today.

The great news is you have access to a thought leader and will be able to share the latest info—an opportunity to learn, gain new insights into the current treatment perspectives & why they are changing:) ! Stay strong and keep the faith:bighug:!
Click to expand...

I think this is a very interesting discussion. In Ruby’s case, however, I am wondering how this vet knows what kind of SCL she has, and hence, what the appropriate treatment is. I am referring to the “types” of SCL referred to in the article.
 
Suzanne & Darcy said:
In Ruby’s case, however, I am wondering how this vet knows what kind of SCL she has, and hence, what the appropriate treatment is. I am referring to the “types” of SCL referred to in the article.
Click to expand...

This is an evolving area & the very reason for the ongoing studies, changes to treatment approaches & one day (future) some further differentiation of types of SCL. As per Marsilio, the evolution of the understanding of the GI enteropathies, specifically GI lymphomas didn’t really occur until the late 1990s...not that long ago. The first studies to differentiate between LCL and SCL didn’t occur until 2005-2009.

So, the point being, not that Rubys oncologist would necessarily be able to make a specific differentiation of a type of SCL at this point in time that is driving the decision, but that the science, research & clinical experience up to this point has in fact advanced the understanding of SCL enough to know that there is a need for adjustment to treatment approaches that existed. Again, it is an evolving area of study so my expectation is that there will continue to be changes as they advance the understanding further.
 
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