? Non-Diabetic GI issue

[AlphaCat]

I have questions.
My Juan is 13 this year. He was diagnosed hyperthyroid last year. We got him the radio-iodine cure in November. (Confirmed by blood work through February.)
After the cure he gained 1/2 pound in the first month. But then he began losing weight again. He has no more weight to lose. He’s a tall and long cat and weighed in at 8 lbs tonight. In March I brought up his weight loss to the vet. They said, let’s wait and watch. In April, they did more blood testing. Everything normal.
The vet felt a lymph node was unusual, and noted Juan was full of gas with his tummy making noticeable noises. I’ve started rubbing his tummy because this has become an every day thing lately. They gave him a shot of antibiotics as a just in case. In May we had an Ultrasound done. It showed Enteropathy. The vet guesses it’s one of these 4 options, or a combo of them:
IBD
GI Lymphoma
Reactive Lymph Hyperplasia
Pancreatitis

To diagnose better they recommend a biopsy. I got the estimate and it’s $2,000.00.

I’m having a difficult time with this. I feel like why do I want to spend 2G’s to hear them tell me my cat is dying? Can someone make better sense of that?

The doc said (before finding out the cost) if we didn’t go through with the biopsy Juan should be switched to Purina EN food, and they can start him on steroids- which would help 3 out of 4 of the possible diagnosis.

I’ve been feeding Juan Fancy Feast Seafood medley in gravy just to try and put some weight on him. (Before that was a prescription food for struvite crytals due to his history of those.)

Last week he was eating really good. I was able to get a pound on him. He was up to 9lbs. Then the ultrasound, and he just keeps dropping weight. He’s losing .2 lbs every day right now. Tonight he was 8 lbs.

It seems the doctor has an action plan to move forward without exact diagnosis, and if it’s lymphoma they mentioned he’d need chemo, which I don’t know that we could put him through. but I don’t know when/how to say goodbye. He just can’t keep losing weight. Is he in pain?
Other than his increased appetite he’s not really behaving differently. (Except he comes for belly rubs now for his noisy belly.)

I guess I should get him on prednisone and see if that helps. If it does, maybe I can stop catastrophising?

Anyone been here? Did you get the biopsy? Did your cat live much longer after they began losing weight? Was your cat in pain?

 

[Larry and Kitties]

What organs would be biopsied?
What do the feces look like and what is their consistency?
If IBD or small cell intestinal lymphoma then there is the oral chemo drug chlorambucil.
Some vets will not prescribe chlorambucil w/o definite diagnosis while some will if ultrasound shows thickening of the small intestines.

 

[AlphaCat]

What organs would be biopsied?

I assume intestines. The quote shows exploratory abdominal surgery, punch biopsy, and 5 biopsy sites (unspecified).

What do the feces look like and what is their consistency?

They are normal size, frequency, and consistency. (Soft tootsie rolls.) I have taken in a sample for parasite testing, came back normal.

If IBD or small cell intestinal lymphoma then there is the oral chemo drug chlorambucil.
Some vets will not prescribe chlorambucil w/o definite diagnosis while some will if ultrasound shows thickening of the small intestines.

Yes, I think it was implied by my vet that the biopsy is needed for accurate diagnosis and chemo. Without biopsy they will treat for IBD.

I guess my big conundrum is that I don’t know that I want to put him through chemo. I’ve personally had low dose chemo and was miserable. It just means a lot of pain with no guarantee of working or improving the outcome. It does guarantee a lot of stress, (more vet visits, poking and prodding), and potential pain, and certainly the expense is great as just the diagnosis equals surgery and $2,000.00. That’s not including meds, monitoring and future vet visits, + all the other stuff needed to make a loved cat comfortable while going through chemo.
And if we aren’t considering chemo as an option, then why would we put him through this surgery?

I guess I posted here to see if anyone else has been in this position, done the biopsy and had a favorable outcome with chemo. Because it doesn’t feel worth it in effort, pain and cost at this moment.

i don’t aim to sound callous. I love my Juan. Price isn’t the main factor. We’ve already spent 2 grand on him this year alone - but that was for a treatment which has a 90-something percent cure rate and 3 days of inconvenience- not miserable pain.

*If we decide not to biopsy, then our plan is to treat with steroids for hopefully improvement, and do our best by him until he tells us he’s had enough. I’m not entirely sure when that is, because as it is he feels like he’s starving to death. (Even though he eats.) I’m sure my vet will help on that decision though.

 

[AlphaCat]

Here’s my poor Juan eating while at only 8 lbs.

 

[Larry and Kitties]

I guess I posted here to see if anyone else has been in this position, done the biopsy and had a favorable outcome with chemo. Because it doesn’t feel worth it in effort, pain and cost at this moment.

i don’t aim to sound callous. I love my Juan. Price isn’t the main factor. We’ve already spent 2 grand on him this year alone - but that was for a treatment which has a 90-something percent cure rate and 3 days of inconvenience- not miserable pain.

Years ago my Mario stopped eating and was lethargic. He was just recovering from being an untreated diabetic when I adopted hem. He was in poor shape. Took to ER and authorized bloodwork and ultrasound. US indicated a blocked bile duct and maybe other abnormalities too, I do not remember. I authorized surgery. During the surgery they also took 4 or 5 biopsies which I was not aware that I authorized them. The bile duct problem was corrected. When biopsy results came back they showed small cell intestinal lymphoma. Saw oncologist who recommended chlorambucil but not also prednisolone because he was diabetic. The dose was 2mg M-W-F. Like you suggested he was miserable at that frequency That oncologist left/retired and say another one that changed to mplused dose which is a higher dose of chlorambucil but only every two weeks. He then did so much better and lived a good life for two more years.

It is up to you and your situation what you want to do. I have other cats with tumors which I decided not to treat.

 

[AlphaCat]

Years ago my Mario stopped eating and was lethargic. He was just recovering from being an untreated diabetic when I adopted hem. He was in poor shape. Took to ER and authorized bloodwork and ultrasound. US indicated a blocked bile duct and maybe other abnormalities too, I do not remember. I authorized surgery. During the surgery they also took 4 or 5 biopsies which I was not aware that I authorized them. The bile duct problem was corrected. When biopsy results came back they showed small cell intestinal lymphoma. Saw oncologist who recommended chlorambucil but not also prednisolone because he was diabetic. The dose was 2mg M-W-F. Like you suggested he was miserable at that frequency That oncologist left/retired and say another one that changed to mplused dose which is a higher dose of chlorambucil but only every two weeks. He then did so much better and lived a good life for two more years.

It is up to you and your situation what you want to do. I have other cats with tumors which I decided not to treat.

Thank you for sharing your Mario’s story. I’m glad he got a good 2 years with you!

Juan has stopped eating in the last 24 hours. What I have been able to get in him (The gravy from canned food) he vomits up after 6 hours. I’ll be phoning my vet as soon as they open this morning.
My heart hurts.