Looking for advice on caring for my cat with small cell lymphoma
February 19, 2017 9:08 PM   Subscribe

My twelve year-old cat has been diagnosed with small cell lymphoma of the small intestine. I am looking for advice on how best to care for her, what treatments options to consider, and what questions I should be asking the vet.

My twelve year-old cat has been diagnosed with small cell lymphoma of the small intestine. She's had digestive issues and weight loss for over a year, getting better for a while and then worse again. She saw a veterinary oncologist three weeks ago. Vet prescribed 10 mg of Prednisolone daily, which I was told is the first line of treatment.

She has been tolerating the Prednisolone fairly well--the most noticeable effect was a curbing of her ravenous appetite (she has lost a lot of weight over the past year because her intestines aren't absorbing nutrients properly) and some diarrhea.

We were back at the vet yesterday and it turns out she has lost half a pound in the past three weeks (7.4 lbs to 6.8 lbs -- when she was healthier she was about 8 lbs). The vet said this is due to the lymphoma and it is time to begin the second line of treatment, oral chemotherapy (Chlorambucial (Leukeran) 1.8 mg every other day).

If you've been down this road before I'd like to hear how you approached treating your cat, things you would have done differently looking back, treatments that were helpful, treatments that seemed to do more harm than good, were any over the counter supplement like this helpful (yes, I will check with the vet before giving any supplements), and so on

I've decided to try treating the lymphoma because everything I've read and been told by different veterinarians is that small cell lymphoma in cats is very treatable, they tolerate the chemotherapy well, and that cats with it usually die of a different disease.
posted by fozzie_bear to Pets & Animals (7 answers total) 2 users marked this as a favorite
 
I lost my cat Pumpkin to intestinal lymphoma almost 2 years ago. I've been through the whole thing. It is very hard, and often expensive. We did have a great oncologist, which was vital. She was board certified and had been a researcher before she started her practice here, and her husband and partner in the practice had also been a researcher.

There are some cats who do respond very well to treatment, and occasionally live for years with long term chemo and pred. Leukeran is annoying to handle, but if it works it seldom causes problems. It is true that cats are generally not bothered by the chemo drugs the way humans are, due to dosing and biology. Pumpkin usually felt better after his treatments (iv meds at the vet), while the meds were working. One of the drugs made him a bit more tired for a few days, but he didn't feel worse. Usually is not the best word to use for any kind of optimistic prognosis, as it gives false hope in my opinion. Because the cell size determination is highly subjective to the pathologist who did the exam, there are no guarantees. It all depends on how well the cancer responds to treatment, so please prepare yourself for the worst.

Decide now what your priorities are, and how much of your resources you can realistically devote to this. Pumpkin had indeterminate/large cell and we caught it very early because I knew that there was something wrong with my cat and insisted on tests. My regular vet had a radiologist specializing in ultrasound that got a lucky biopsy. Then we had the oncologist in town, and at that time we could afford the treatments. Very aggressive treatment. We bought him about 9 good months. Strong emphasis on GOOD. This page was helpful in helping us to make decisions about our approach to his treatment and when to stop. As was this. It was important to me that I have no second thoughts or regrets, and more important that he not suffer* for my sake.

Supplements are generally not worth it. The only thing in that vein that might be genuinely useful is Forti-flora, to make food super attractive and help in digestion.

There are medications that can be given to stimulate appetite, if the pred isn't enough (pred often makes them ravenous, and also can make them diabetic). Mirtazapine is the usual medication for that these days. But sometimes the problem is nausea, for which Cerenia (injection or oral) or Zofran are the best options. Reglan is not very effective in cats. If you have trouble pilling your cat, there are compounded treats and other options available. Hell, anything we had to give at home for Pumpkin had to be either transdermal gel or injection because we could not pill him. I am not a fan of putting medicine in regular foods, because it can cause food aversions which are the last thing you need in this situation.

Right now getting your cat to eat is the first step. Do whatever it takes. Fancy Feast classic pate is surprisingly high quality (grain and veg protein free), and cats often love it. If necessary, you can get some high calorie prescription food from the vet. I found a non-prescription food that is almost as caloric and much better quality, I'll dig the info later if you want it. Try having your cat lick it off your fingers or a spoon. But whatever you can get your cat to eat. Anything. Yogurt. Pure meat baby food is good. Also high quality deli meats. The onc vet was known to share her lunch sandwich with the patients.

More info about the disease and treatment, by a good vet, here. I know the site itself is a bit unpolished, but the source is good. Unfortunately, because Yahoo group, the other best resource I found was the feline lymphoma Yahoo group. There was the occasional crackpot, people with terrible ideas about appropriate food for cats (cats are not and can never be vegans), or pushing natural remedies that range from ineffective to dangerous, but they were otherwise extremely helpful.

If you have any questions at all, or would just like to talk, please PM me.

Be with your cat and make good memories now. It is never time wasted to be together, however long you have.

*Every vet or vet tech I spoke with, as well as many people who have gone through something like this, say that what they either regret or hate to see is when a person holds on too long. I don't recall a professional objecting to letting go to a declining terminally ill pet early, but most have had to watch a person holding on too long too many times.
posted by monopas at 1:32 AM on February 20, 2017 [7 favorites]


I think oldercatbailard has had it for ... 2 years? She's nearly 15.

If you've been down this road before I'd like to hear how you approached treating your cat,

Pillpockets. And then the followup treats.

Also, it really helps to use a spreadsheet-sourced paper checklist for her pilling - I keep it on the fridge.

Supplements are generally not worth it. The only thing in that vein that might be genuinely useful is Forti-flora, to make food super attractive and help in digestion.

Ditto. It's helped my cat's diarrhea. Also these days she eliminates mostly on bakingsheet pans lined with sheaves of newsprint - packing paper.

were any over the counter supplement like this helpful

Supplements are just unregulated medications. I strongly suggest to simply do what the vet says.

Right now getting your cat to eat is the first step.

My cat is on wellness grain-free chicken wet food, but yeah, I'd try 3-4 random high quality wet foods from the store along with the high calorie prescription food.
posted by sebastienbailard at 1:44 AM on February 20, 2017 [1 favorite]


We found that we could save quite a bit of money by ordering Chlorambucil through a compounding pharmacy. Also, if your cat is hard to pill, you may be able to inject some of the medications under the scruff, which sounds intimidating, but the cat doesn't really feel it. I wish I could give you good answers to your questions about treatment, but our cat had other medical issues, so I'm sure our experiences were quite different than what yours will be. I think so much depends on the specific cat, too, and how easy they are to give medications, how stressed they are at the vet, etc.
posted by amarynth at 4:27 AM on February 20, 2017


I wanted to add that, on our vet's blood-test-based recommendation, we are giving oldercatbailard vitamin-B12 injections 0.25 mL once a month [need to do this month's shot...].
posted by heatherlogan at 5:59 AM on February 20, 2017 [1 favorite]


My cat got diagnosed with this last summer. I was super freaked out by what I found on the internet, but it has actually turned out to so far be not that bad.

The vet bills for the initial diagnosis were expensive, but he's now on Chlorambucil (one pill every 3 days) and prednisone (daily). The cost per month for these two is probably around $100, and our vet has not yet required us to go back in. I was freaked out because the internet made it sound like the meds would cost hundreds of dollars a month plus extensive vet visits, and I'm so relieved that isn't the case.

The first few weeks, he didn't want to eat much, and we were really freaked out about that. The food that worked best for my cat was actually baby food, Gerber baby chicken or turkey that's basically just ground up meat. This does not have all of the vitamins that cats need to be healthy but when he needed to get calories, I felt OK giving him some of that.

Eventually, after maybe 6 weeks or so of the medication, he started eating normally again. He regained the weight. He went from throwing up daily to rarely.

Giving the cat medicine is a pain in the ass. We've finally kind of figured it out but if it hadn't been the two of us it would have been really hard. We use a pill popper to get him to swallow the pill. He would not take the pill from pill pockets. We had our cat sitter show us how she gives him pills (sticks them far down his throat) and I decided the pill popper would be easiest for this. You are supposed to wear gloves when handling the chemo pills, which is a real pain if the pills get spit out because they will stick to your gloves and make them that much harder to deliver.

The liquid prednisone is also gross. Vets will often give you cherry-flavored prednisone (I guess because it's the same as kid's medicine?), which you can imagine cats hate. We get ours compounded to be liver flavored and it goes down much more easily. Also getting the syringe closer to the back of his mouth makes that easier. It is MUCH easier to deliver with two people. I guess you've probably got that routine down but for anyone reading this question in the future, see if you can get a compounding animal pharmacy to get you liver flavored.

I know that this will only work for so long before he gets sick again, but I'm incredibly grateful that we decided to treat him because these extra months have been a wonderful gift. He has responded really well to the treatment and he was suffering quite a bit before we started, so it's absolutely worth treating if you can afford to. Best of luck to your feline friend!
posted by ch1x0r at 6:57 AM on February 20, 2017 [2 favorites]


Our boy Clem (about to turn 11) is a little ahead of you. He stopped eating in October and the biopsy surgery found small cell lymphoma. We did the feeding tube for about 3 weeks, and he started on chemo pills 3x week soon after that, as well as the steroids which we are reducing the dosage on and he will be off them soon. He lost 4 pounds (18.5 > 14.5) and only eats wet food now, so feeding is a struggle. He threw up some, especially during the night when stomach was empty, but hasn't in a while. He is doing extremely well on the chemo. He is more active and happy and doesn't seem sick, in fact he seems perfectly healthy. He is able to jump higher than he has in years. Because of the chemo his fur isn't growing back from the surgery but that is the only side effect we see. Possible he will lose wiskers but hasn't yet. He is used to the pills as well (as he was on other pills earlier) so he easily tolerates taking them. We are told he can live a year or two. If you'd like to message me you can. He is on twitter and Instagram so I can give his address over message as well if you'd like to follow him. Good luck.
posted by ridogi at 8:33 PM on February 20, 2017


Thank you all for taking the time to share your experiences and advice -- you've given me plenty to think about. Also, seems like a good place to recommend Figo, the pet insurance I bought for both my cats. I was very lucky to buy it before she got sick ($35/month premium, $500 annual deductible, 90% reimbursement). I HIGHLY recommend it if you can afford it.
posted by fozzie_bear at 8:12 PM on February 21, 2017


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