Update: Went to Intermal Med Specialist. Questions

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Sara and Buttercup

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So I finally drove the 6 hours and went to an internal med specilist in seattle yesterday. can't go into whole thing now but just wanted to post part of it with some questions tonight. background about this is in other previous post of mine if you can find them. basically, she has chronic diarrhea, brown pee (pee yellow yesterday) and was slightly anemic (HCT ok yesterday). cat is lying on bed wiped out. hope trip didn't hurt her. vet said that would be ok. but she is eating and drinking and everything, just seems tired. anyway, here is her report on needle aspirate and some questions.

My cat with chronic diarrhea got this lab work result from an enlarged
abdominal lymph node:

"Cyotlogic Evaluation:
Monotonous population of small to intermediate sized lymphocytes, rare
blasts, rare mitosis, and few neutrophils.
Conclusion: differential diagnoses include atypical lymphoid hyperplasia
and small cell lymphoma. Histopathology is needed to confirm and
immunohistochemical stains may also be necessary."

My internal medicine specialist said that this basically means that she
could have small cell lymphoma or severe IBD?
Any similar diagnoses or experiences? thoughts about this?

My cat's doctor recommended trying budesonide first and seeing how she did
on that. If that didn't work, she recommended starting Luekaran. She
said that only a biopsy could give definitive results but that the
treatment would be the same. Steroid and Lukeran.

I have questions about this.
1) Is the chemo used for small cell lymphoma always Lukeran? or are
others used.
2) She recommended starting with the budesonide and not doing lukeran if
she did well on it. I said what if she does well on it (no diarrhea i guess she means) but
still has cancer which is my understanding is still a possibilty. she
said it would be good enough to just be on the budesonide. I don't
understand this. What would be treating the cancer then? I know that
bude. isn't a cancer fighter like pred is and since she is diabetic we
don't want her on pred.

Lastly, and this is my most pressing thing right nowand have tried to
figure out many times before... what form of budesonide is best to use esp
if you are concerned with increase in blood sugar. don't want it to be
absorbed systemically. so "beaded", enteric coated, pill, i am really
confused about this and my internal med vet said didn't really matter but
i have heard that it does, mostly online, from people who say it matters
in what form it is in to be absorbed in the GI tract and not the stomach.
most people say "beaded" is best but "beaded" is not actually a real
pharmaceutical term. Have talked to many pharmacists and they say they
don't know what that means. and if it is the best form, why? i have also
heard that the capsules that have tiny beads in them (entocort/budesonide)
are much stronger than a powdered pill compounded at a pharmacy. very
confused.

also really interested in people who have or had cats with small cell
lymphoma, how it was diagnosed and what treatments were used and with what
success.

it's even more confusing because she may not have small cell lymphoma, just bad ibd. and i still haven't even tried a good dose of probiotics yet because i can't get that info from a vet other than fortiflora which doesn't seem to agree with her. i want to try full dose of probiotics before starting the steroid but not sure what one. are there any in pill form that i could use? she's easy to pill. thx.

Please help!!!! thanks.
 
cleo has small cell lymphoma.

basically we haven't seen any especially groundbreaking lymphoma research recently. most of the protocols have been around since 2001 if not earlier.

you could biopsy to see if it's lymphoma but the results aren't always definitive.
but as jess would say, if you just treat thinking you'll be catching any lymphoma you may be treating for the wrong type of lymphoma as may have happened with her cat earl. really depends on what your cat and you can tolerate in terms of procedures and costs, tho.

leukeran is considered the gold standard (leukeran + pred) in treating small cell lymphoma. the good news about small cell is that it tends to be slow growing. based on remission rates leukeran is the preferred choice. some cats don't tolerate it well, so they go to other protocols, or it stops working as well so they have to switch, but it's usually the starting chemo of choice for small cell lymphoma kitties.

frankly, if it does turn out to be lymphoma, remember the phrase "Cancer trumps diabetes." so even tho prednisolone can raise blood sugar levels, it's still a critical component of lymphoma treatment. you just counter it by playing around with when you give it, or increasing the dose of insulin, or both. for example, some cats' BGs are steadier if the pred is given half in the morning and half at night. cleo, deciding to be different, has lower numbers if i only give it once a day in the early morning hours. so we went up in lantus from 0.75u BID to 1.5u BID (1.75u BID at one point), and her numbers are not as tightly regulated as they were before cancer, but i still have my kitty one year after lymphoma diagnosis and 3 years after diabetes diagnosis. in her case, she had a badly enlarged spleen and in taking it out we found the cancer in the mesentery. exploratory procedures and even pathology on the removed spleen didn't definitively turn up cancer anywhere else tho we are treating this as multicentric lymphoma (suspicious nodes but not enuf lymphocytes elsewhere to be called lymphoma definitively).

my cat harry was on liquid compounded budesonide for a while for chronic horrible diarrhea/IBD. but eventually we switched to a tiny dose of prednisolone daily and add metronidazole (flagyl) occasionally if his poo needs hardening. so far his BG only went up 20 points and is still a nondiabetic number. cats differ, tho, so you'll have to find out what works for your own cat.

hope some of my own experience here has been helpful.
 
Sara and Buttercup said:
and i still haven't even tried a good dose of probiotics yet because i can't get that info from a vet other than fortiflora which doesn't seem to agree with her. i want to try full dose of probiotics before starting the steroid but not sure what one. are there any in pill form that i could use?
Click to expand...

Acidophilis is a probiotic that you can get at a pharmacy or grocery and is usually in pill form. I also have used Culturelle on cats, but that's a capsule that you open and sprinkle on food. Also at pharmacies/groceries.

((((Sara and Buttercup))))
 
Both my Bailey and Mitten or on budesonide. It is the beaded. I used to get it from a local compounding pharmacy but with two cats on it I bough some 3 mg capsules fro a Canadian pharmacy and put the proper dose in gelcaps. It has minimum if any effect on BGs.
 
thank you. what do you mean by beaded. is it called entocort? isn't is supposed to stonger than the powdered form of budesonide? it comes in 3 mg pills and then you divide up the little beads at home?
 
My only input here is that if prednisolone is needed than yes you have to give it and then just treat the diabetes. Sometimes you just HAVE to give the pred as THAT treatment is necessary. Our Boris is on prednisolone and interestingly enough at first it did seem to affect his blood sugars but lately it doesn't even seem to touch them and in fact we seem to be weaning his insulin doses down. Remember - every cat is different!

I'm sorry I can't help you with your other questions but wish you luck with your kitty.
 
I'm not much help (or any at all, really) but my Felv cat, Mickey, was on Leukeran for quite a long time (I'm thinking about a year?) before he finally succumbed to whatever it was that was going on.

We didn't know if it was lymphoma or IBD (he didn't have diarrhea but the vet told me that some cats can still have IBD w/o actually having diarrhea...some become more constipated?) We were told that the treatment for both was the same, so we went with the Leukeran. He tolerated it fine, no side effects that I could point to as specifically from the Leukeran.

Very expensive drug, though. We went through Wal-greens and paid $20 for their drug discount card that works for pets. It knocked about $50 off of each prescription refill.
 
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