Possible IBD or Lymphoma

[PamJV]

I'm waiting for biopsy results for Ricky. He's been diabetic since 2016. I wonder if any here have had experience treating a diabetic cat for IBD or Lymphoma? The vet had instructed me to start Prednisolone last week while we wait for the results. She indicated this would likely be just temporary until we get the diagnosis.

It's been very difficult to get Ricky to eat. I started giving him Ondansetron for nausea 3x a day and at first that got him to eat great, but then after 3 days he stopped. I wonder if the Prednisolone has hurt his stomach?

Ricky has a Libre device for BG monitoring. In to the 2nd week with Prednisolone and his BG is now over 500 even though he's hardly eating. When it's that high I give him 5 u of insulin but the BG only comes down by the evening. Once it dropped down to 60 then shot up. My main worry is that he's not eating well and each day is worse. I feel like I should just stop the Prednisolone to see if he feels better without it. By the time we get a diagnosis I think he would have to be prescribed something other than Prednisolone.

Pam

 

[Bandit's Mom]

Tagging

@Wendy&Neko
@tiffmaxee
@PerfumedCatMom

 

[Katherine&Ruby]

Hi Pam,

I'm so sorry to hear that Ricky's not feeling well. My Ruby was recently diagnosed with SCL after an endoscopic biopsy and we also started prednisolone last week. I would add Cerenia to the ondansetron if you can get it from your vet. The two can be given safely together and they can work synergistically. I found that helped Ruby a lot when she wasn't eating and the ondansetron alone wasn't cutting it. Cerenia can be given in a dose of 1mg/lb once a day. I gave it to Ruby in the morning with her first dose of ondansetron and got her to eat well. The prednisolone can be irritating to the stomach so it should always be given with food, which is really hard when he's not eating. Any chance you can wrap the pill in a pill pocket, small piece of meat or cream cheese?

See what the biopsy report says, and perhaps if it's IBD you can switch to budesonide, which will have less of an effect on glucose levels.

If you want some help managing his doses, you should set up a new spreadsheet for 2021 and upload the Libre data so we can see what's going on.

I was you just a few weeks ago and really sympathize. Hang in there.

 

[tiffmaxee]

Katherine gave you good advice. Some cats get an appetite from prednisolone but my lymphoma kitty didn’t. The drop to 60 followed by high numbers is a bounce. That’s normal when a cat’s bg falls quickly or goes down to a number they aren’t used to. Please set a a 2021 spreadsheet so we can help with the insulin. Just put in the last couple of weeks of numbers.

 

[PamJV]

Hi Pam,

I'm so sorry to hear that Ricky's not feeling well. My Ruby was recently diagnosed with SCL after an endoscopic biopsy and we also started prednisolone last week. I would add Cerenia to the ondansetron if you can get it from your vet. The two can be given safely together and they can work synergistically. I found that helped Ruby a lot when she wasn't eating and the ondansetron alone wasn't cutting it. Cerenia can be given in a dose of 1mg/lb once a day. I gave it to Ruby in the morning with her first dose of ondansetron and got her to eat well. The prednisolone can be irritating to the stomach so it should always be given with food, which is really hard when he's not eating. Any chance you can wrap the pill in a pill pocket, small piece of meat or cream cheese?

See what the biopsy report says, and perhaps if it's IBD you can switch to budesonide, which will have less of an effect on glucose levels.

If you want some help managing his doses, you should set up a new spreadsheet for 2021 and upload the Libre data so we can see what's going on.

I was you just a few weeks ago and really sympathize. Hang in there.

The vet said they lost the sample from the intestine. The lab reported results from the stomach biopsy but said there was no intestine sample and she doesn't know what happened. I could have it redone, but that's a lot to put him through when he's not eating. I don't know what to do. What about treating with Chlorambucil and no Pred? I've also heard about Budesonide, although my vet thinks that's not effective. My vet kept telling me Pred does not need to be taken with Food ! This is very confusing.
Pam

 

[Katherine&Ruby]

The vet said they lost the sample from the intestine. The lab reported results from the stomach biopsy but said there was no intestine sample and she doesn't know what happened. I could have it redone, but that's a lot to put him through when he's not eating. I don't know what to do. What about treating with Chlorambucil and no Pred? I've also heard about Budesonide, although my vet thinks that's not effective. My vet kept telling me Pred does not need to be taken with Food ! This is very confusing.
Pam

Oh my goodness! I'm so sorry to hear about the lost sample! Hopefully it will turn up and everything will be fine.

 

[tiffmaxee]

The problem I see with a lost sample is you ain’t know f it’s a different type of lymphoma or other cancer.taking prednisolone will make diagnosis difficult if needed later.

 

[Larry and Kitties]

What about treating with Chlorambucil and no Pred?

That is how my Mario was treated for SCIL. The oncologist did not want to also use prednisolone. He was DX's via full thickness biopsies (cut open). He did good for two years.

 

[Wendy&Neko]

My Neko was put on budesonide (and chlorambucil) instead of prednisolone, because her heart could not stand prednisolone. The follow on ultrasound showed it had reduced the thickness of her bowels by 1/3, so budesonide definitely was working for her. And the bonus was that it didn't impact her blood sugars.

It takes a while for the chlorambucil to start fully working. The pred or the bude helps fill the gap.

 

[PamJV]

Oh my goodness! I'm so sorry to hear about the lost sample! Hopefully it will turn up and everything will be fine.

The biopsy samples were taken about two weeks ago, (June 4th) and they don't keep samples at the vet office. They won't be turning up. The vet only said she was going to question the tech who packaged everything to ask what could have happened. She said we could redo the endoscopy at a discounted price. I'm wondering why should I have to pay for a re-do at all?

 

[PamJV]

The problem I see with a lost sample is you ain’t know f it’s a different type of lymphoma or other cancer.taking prednisolone will make diagnosis difficult if needed later.

That's was my concern too, but the vet said it wouldn't hinder the diagnosis of another endoscopy. Ricky had been seeing an internist at Blue Pearl for a year prior to this. The reason I took him there was I was concerned that he might be resistant to his insulin and also he would urinate outside his box a lot. His weight had dropped a bit too. They had done a lot of tests of all sorts and at one time did an ultrasound and only said there was some slight thickening on the intestine. They didn't think a biopsy was needed then. I finally started with a new local vet because it was just too stressful to keep making the long drive to the internist just to have Libres placed. Then Ricky started urinating quite a lot outside his box and was not eating well so that's when this local vet did the Endoscopy. When I say he urinated outside the box....I mean he'd pee on the dog's bed, my pillow, a chair, against the wall in the bedroom. It was quite annoying, it wasn't like just a little right next to the box. Seemed like all this stopped when he started prednisone.

I thought Prednisone was making him look worse. Yesterday morning he wouldn't eat at all....but after getting Ondansetron he did eat well in the afternoon. I decided to wean him off of prednisone, and was going with the idea of trying chlorabumcil again. But my husband thinks we need to have an endoscopy/biopsy done to make sure what it is first. Also he thinks we shouldn't have to pay for a re-do since the lost sample wasn't our fault. I wonder if the treatment would be the same whether he has IBD or Lymphoma? If the treatment would be the same then the biopsy wouldn't matter as much. But of course it would be good to know. And what about side effects of Chlorambucil?

Pam

 

[PamJV]

That is how my Mario was treated for SCIL. The oncologist did not want to also use prednisolone. He was DX's via full thickness biopsies (cut open). He did good for two years.

Are there side effects with Chlorambucil ?

 

[PamJV]

My Neko was put on budesonide (and chlorambucil) instead of prednisolone, because her heart could not stand prednisolone. The follow on ultrasound showed it had reduced the thickness of her bowels by 1/3, so budesonide definitely was working for her. And the bonus was that it didn't impact her blood sugars.

It takes a while for the chlorambucil to start fully working. The pred or the bude helps fill the gap.

Were there any side effects to chlorambucil or budesonide? I read that chlorambucil can affect the bone marrow.

 

[tiffmaxee]

You should not have to pay for another endoscopy since they lost the sample. I would want to know what it is for the best chance at remission. Prayers your way.

 

[Wendy&Neko]

I wonder if the treatment would be the same whether he has IBD or Lymphoma?

IBD is typically treated with a novel protein diet and probiotics. Sometimes a steroid is needed. Lymphoma treatment consists of chlorambucil and usually a steroid to start. So yes, they are different. If you paid for endoscopy results, and don't have them, the vet owes them to you. So you should get a resample done for free.

Are there side effects with Chlorambucil ?

There is usually some nausea associated with it in the beginning, and the ondansetron helps with that, as does a good chlorambucil dosing protocol. There are no side effects from budesonide.

 

[Dyana]

My Neko was put on budesonide (and chlorambucil) instead of prednisolone, because her heart could not stand prednisolone.

Wendy, it says in her signature that Ricky was diagnosed with HCM. Would having HCM be a reason to use budesonide instead of the predniso lone?

I agree that the endoscopy should be no charge to you since they lost the sample.

 

[Wendy&Neko]

Would having HCM be a reason to use budesonide instead of the predniso lone?

I can't answer that, but the vet might be able to. Neko had more than HCM wrong with her heart when her vet said she couldn't take prednisoline.

 

[PamJV]

I can't answer that, but the vet might be able to. Neko had more than HCM wrong with her heart when her vet said she couldn't take prednisoline.

I've been grabbing at straws, and yesterday when Ricky wouldn't eat and looked worse I assumed it was the pred. Later in the day when I wasn't there I saw via cameras that he had eaten a good amount. So that could mean the Ondansetron took effect. I have felt I should just wean him off of Pred to be safe. The vet here seems to think Chlorambucil would be fine to try even if he only has IBD. She said it's used in severe cases. But how do we know if he has a severe case? I am going to find out if they can re-do the biopsy for free....it should only be the intestine as the stomach result did come back.

 

[Larry and Kitties]

Are there side effects with Chlorambucil ?

Yes, it tended to make Mario nauseous and lethargic. At that time ondansetron was not in common use. Originally he was on Mon-Wed-Friday dosing and then changed to pulsed dosing which is a larger dose every two weeks. He did better w/pulsed dosing. Chlorambucil can be used for severe IBD. https://www.dvm360.com/view/update-...ease-and-intestinal-lymphoma-cats-proceedings

 

[PamJV]

Yes, it tended to make Mario nauseous and lethargic. At that time ondansetron was not in common use. Originally he was on Mon-Wed-Friday dosing and then changed to pulsed dosing which is a larger dose every two weeks. He did better w/pulsed dosing. Chlorambucil can be used for severe IBD. https://www.dvm360.com/view/update-...ease-and-intestinal-lymphoma-cats-proceedings

Larry, I just read an article on Chlorambucil and it said that common side effects could be nausea, vomiting, diarrhea, and loss of appetite. If it did all that then he'd be worse off than he is now. Also one thing scares me. The article says that one must take care to keep other pets away from the urine and stool clumps from the cat on Chlorambucil. It says to scoop the box frequently. I have 4 cats and 5 boxes and I scoop frequently when I am home. But what about when I am not home? And Ricky is urinating a lot so it's hard to prevent that another cat never gets in the box when one of his clumps is there. Unfortunately Ricky also urinates outside the box....sometimes on the dog's bed, on the carpet, on a chair, etc. We hope this problem abates of course. How dangerous is this drug?

 

[PamJV]

IBD is typically treated with a novel protein diet and probiotics. Sometimes a steroid is needed. Lymphoma treatment consists of chlorambucil and usually a steroid to start. So yes, they are different. If you paid for endoscopy results, and don't have them, the vet owes them to you. So you should get a resample done for free.

There is usually some nausea associated with it in the beginning, and the ondansetron helps with that, as does a good chlorambucil dosing protocol. There are no side effects from budesonide.

Wendy, Would Budesonide have similar side effects as Pred with increased thirst and urination?

Pam

 

[Larry and Kitties]

Larry, I just read an article on Chlorambucil and it said that common side effects could be nausea, vomiting, diarrhea, and loss of appetite. If it did all that then he'd be worse off than he is now.

Yes, a lot of cats experience those side effects. That is one reason why the pulse dosing of one every two weeks vice a lower dose three times a week is a lot better. With the pulse dosing the cat may experience those side effect only one or two days after the dose vice almost all the time. Ondansetron reduces/eliminates some of the side effects. I really noted it when my Marios went to pulse dose and at the time was not yet commonly used.

Also one thing scares me. The article says that one must take care to keep other pets away from the urine and stool clumps from the cat on Chlorambucil. It says to scoop the box frequently. I have 4 cats and 5 boxes and I scoop frequently when I am home. But what about when I am not home? And Ricky is urinating a lot so it's hard to prevent that another cat never gets in the box when one of his clumps is there. Unfortunately Ricky also urinates outside the box....sometimes on the dog's bed, on the carpet, on a chair, etc. We hope this problem abates of course. How dangerous is this drug?

I would be a litter concerned if you had a cat who ate litter and kittens who do eat litter frequently. Regarding you own healy just take precause when administering it and I wouod use a dedicated pill power and get capsules and never a liquid. Just wash up after scooping littler. I you are pregnant or trying to get pregnant I would talk to you doctor.

 

[Wendy&Neko]

Wendy, Would Budesonide have similar side effects as Pred with increased thirst and urination?

Not that I noticed with Neko, but she had a lot of other things going on at the time, such as worsening kidney disease. She was also well regulated so not peeing that much more than my non diabetic cat. She did occasionally have some nausea (going to the every two week dosing really helped her too), and some nauseous cats hang out by the water bowl. Budesonide didn't cause that. The other benefit of the every two weeks dosing of chlorambucil is not having to worry about the litter boxes as often. It's just the 24 hours after you give it that you need to be vigilant.

 

[PamJV]

Yes, a lot of cats experience those side effects. That is one reason why the pulse dosing of one every two weeks vice a lower dose three times a week is a lot better. With the pulse dosing the cat may experience those side effect only one or two days after the dose vice almost all the time. Ondansetron reduces/eliminates some of the side effects. I really noted it when my Marios went to pulse dose and at the time was not yet commonly used.

I would be a litter concerned if you had a cat who ate litter and kittens who do eat litter frequently. Regarding you own healy just take precause when administering it and I wouod use a dedicated pill power and get capsules and never a liquid. Just wash up after scooping littler. I you are pregnant or trying to get pregnant I would talk to you doctor.

Larry, I have a 6 lb Yorkie that does eat litter off the floor. She got in to that habit because at one time I was using corn based litter and litter scatter was like food to her. Now even though I've switched to clay litter she still will lick those granules off the floor ! What about when Ricky urinates on the dog's bed, or on the carpet ?

 

[Larry and Kitties]

What about when Ricky urinates on the dog's bed, or on the carpet ?

Just wash the bed separately and use a vacuum carpet washer and carefully dispose of the wash water. That wouod not concern me and di not concern be with the two cats I had that were on Chlorambucil .

 

[PamJV]

Just wash the bed separately and use a vacuum carpet washer and carefully dispose of the wash water. That wouod not concern me and di not concern be with the two cats I had that were on Chlorambucil .

Larry, It still does concern me because for example, some times Ricky urinates on the dog's bed and I won't notice and the dog will still keep lying on the bed. The urine does not have a noticeable smell, so it's not quickly detected. It is a constant battle watching out for when and where he's planning to urinate inappropriately. Ricky has been switched to Budesonide, and I still haven't tried Chlorambucil. The thing is on the 1mg of Budesonide his BG has been remaining in the over 450 range....often it's over 500. I'm using a Libre so I don't get the exact number when it's over 500. I wonder if it might be good to try Ricky on just .5mg of Budesonide? I will be asking the vet this when she returns from her vacation. It's possible the Budesonide is raising his BG the same as Prednisolone did.

Pam