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Dr. Gary
Dr. Gary, Cat Veterinarian
Category: Cat
Satisfied Customers: 19654
Experience:  DVM, Emergency Veterinarian; BS (Physiology) Michigan State Univ
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My cat is 10 years old. For many months, he has lost

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My cat is 10 years old. For many months, he has lost a lot of weight to the point that I can feel his protruding bones whenever I pet him. IF he drinks water it is VERY very minimal so I've been giving him Cat Milk. He eats some hard food but basically swallows it so eating is an issue. His appetite ahs increased beyond belief to the point where he begs for food. Took him to the vet. He has gum disease but unrelated to what is making him lose so much weight. Did all the blood, urine, stool tests and kidney, liver, etc are all functioning normal. Finally, we did an ultrasound. It showed no mass (whew!) but did show a portion of his small intestine "thickened" and lymph node (as the vet said-was slightly reactive, meaning not greatly enlarged but not normal size either. IBS? Lymphoma? Do we do surgery to find out exactly what it is? or just blindly treat him with prednisone. Most likely lymphoma...your thoughts?


Drew :

Hello, thanks for your question today! I am Dr. Drew, and I am a licensed veterinarian. I'll be happy to help you in any way I can.

Drew :

An increased appetite, with weight loss, is most likely to point to Hyperthyroidism, which you did not mention ruling out based on prior bloodwork.

Drew :

I'd want to run some blood tests to check thyroid levels before starting treatment with steroids that might not be of any benefit.

Drew :

Most patients with IBS or IBD or Lymphoma will NOT have a ravenous appetite as you describe.

Customer: replied 3 years ago.


hello?


 

Customer: replied 3 years ago.


I was working and couldn't respond timely. hello?


 

Customer: replied 3 years ago.
Relist: Other.
I was working and the chat was ended. I paid already so it should've been left open not ended less than 20 minutes.
Hello Ragini, I am sorry that the chat was closed, but I am here to help you in any way I can! Please let me know what additional information I can provide.
Customer: replied 3 years ago.


they ruled out thyroid, diabetes.


 

If the thyroid level was checked and found to be normal, then I suppose we'd have to consider intestinal disease as a possibility. I'd also want to be sure that a urinalysis was run, to check for loss of protein (a condition known as protein-losing nephropathy). This could be present even if the kidney levels in the bloodwork were 100% normal. Protein-losing nephropathy could certainly cause significant weight loss.

Intestinal biopsy is the "gold standard" for identifying the presence of inflammatory bowel disease and/or lymphoma, but as you mentioned, a steroid trial is often the option that is chosen instead.
Customer: replied 3 years ago.


All of that was already checked. No sign of intestinal disease but there are for lymphoma.

OK it sounds like a thorough work-up has been done, then.

If finances permit, I'd suggest a surgical biopsy of the intestines, in hopes of identifying what the problem may be.
Customer: replied 3 years ago.

when they do surgery and say biopsy, how do you know it's meant for intestinal and not lymph node?

Both types of tissue should be sampled at the time of surgery.
Customer: replied 3 years ago.

interesting because the vet said they would do a biopsy but didn't mention that 2 would be needed.

It's always a good idea to take samples of several sections of intestines, as well as lymph nodes, in cases where the diagnosis is unknown or unusual.
Customer: replied 3 years ago.


so when she goes in, isn't the exposure going to affect what is going on and spread like wildfire?

There is always a risk that the stress of surgery and anesthesia may cause a worsening of the underlying condition -- this risk must be weighed against the benefits that might be gained by having a concrete diagnosis in hand.

If there's little chance of making a diagnosis, OR, the diagnosis won't change the treatment options (in other words, you would not be interested in chemotherapy if Lymphoma is found), then it might just be safer to do a steroid trial instead of surgery.
Customer: replied 3 years ago.

in this case the stress wouldn't be much so surgery may not worsen things. Over all though....if this is lymphoma and we already know that it is SLIGHTLY "reactive" bigger than normal....from the ultrasounds, seems may not be so far along then opening him up to get the biopsy chances low for it to really stress him out where he would be declining. Right now he is normal....playful, behaving okay etc...my fear is if we do surgery that all of that will change and he will start declining.

Is it a possibility, yes, it is. Elderly cats can be sensitive to the stresses of surgery and anesthesia. At 10 years old, though, he could have lots of years ahead of him, so I'd still proceed, if he were my cat.
Customer: replied 3 years ago.


proceed, meaning proceed with the surgery?

Yes, that is what I meant. Given his relatively young age, I'd want to try to make a diagnosis, if possible, to give the best chances of long term survival.
Customer: replied 3 years ago.


After all of the info I gave you...I originally was conflicted with whether to not do surgery and just treat him with prednisone OR do surgery and find out what's wrong...you feel it would be best to do the surgery. Prednisone would only do so much so it may not be the best route so better to do the surgery right?

Yes, that is correct. Prednisone has anti inflammatory and immune suppressive effects, and may be helpful, but may not be the best option for treatment.

Surgery in order to obtain biopsies will allow for making the determination of whether or not prednisone is the BEST treatment.
Customer: replied 3 years ago.


AWESOME. That's what I've been really conflicted about. Now, I have to discuss with my vet about getting more tissue samples and biopsies correct? What would you do....get tissue samples in like 3 areas of the "thickened" part and biopsy of the lymph node?

Samples should be obtained from:

Duodenum
Jejunum
Ileum

since these are the 3 sections of intestine involved with nutrient absorption from food that is ingested.

A sample of lymph node in the mesentery (the tissue that surrounds the intestine) is a wise idea as well.
Customer: replied 3 years ago.


are they all considered biopsies? she would have to get 4 biopsies?

YES.
Customer: replied 3 years ago.


Perfect. Thanks! Am I allowed to ask you questions after I go home and discuss things with my husband? or is this it?

You can return anytime for followup. :)
Customer: replied 3 years ago.


Ok. Great! How do I do that? log in?

I cannot offer information about the functions of the website, I can only provide veterinary information. If you have questions about the website I will have to direct you to customer service.
Customer: replied 3 years ago.

ok. then let me ask more questions now. would chemo harm him like it does people?

Chemotherapy carries risks to cats just like it does to humans, typically it can cause nausea, lethargy, and bone marrow suppression leading to low blood counts. Some cats do very well, and have none of these side effects.
Customer: replied 3 years ago.


My vet said that it doesn't. That with cats that's not the case.

That's incorrect. Chemotherapy kills cells. Ideally, it just kills cancer cells, but in the real world that's not how it works.
Customer: replied 3 years ago.


well, she said it's not as intensive as it is with people. It REALLY takes a toll on us but not as much with cats.

Yes, that is true.
Customer: replied 3 years ago.


but if he goes through nausea and vomits etc I wouldn't want him to go through all of that pain either

I need to step away from the computer, is there anything else I can answer for you at this point?
Customer: replied 3 years ago.


I just asked:


 


but if he goes through nausea and vomits etc I wouldn't want him to go through all of that pain either

I don't see what you are asking there; that looks like a statement about your thoughts, not a question.
Customer: replied 3 years ago.


what are the chances of him going through such pain as nausea and vomiting?

With any chemotherapy patient I'd say the chances are around 30-40%.
Customer: replied 3 years ago.


ok. great. thanks! Have a nice day!

You're very welcome. Let me know if there's anything else I can do to help :)
Customer: replied 3 years ago.

I'm sure there would be but once I get home, I won't be allowed to continue because the chat would be ended. Thank you for all of your help :-)

As I explained earlier, you can continue where we left off later. I cannot explain the procedure, but if you would like, I can contact customer service so they can walk you through it.
Customer: replied 3 years ago.


yes, that would be very nice of you.

 

HELLO?

Your issue has been brought to the attention of customer service, as requested.
Customer: replied 3 years ago.

Great! And now that you responded and I am replying from home I can continue asking you questions. I talked to my husband...question is if I go the route with giving him prednisone, how long after can I consider surgery as an option? Also, I've been told that if I decide to just give him prednisone then doing surgery later would not be good because the body has already been changing his insides reacting to the meds. What do you think?

if you go the prednisone route, you've basically decided that's all you're ever going to do. Chemotherapy will be much less effective after prednisone has already been used. The choice to go the prednisone route is a serious choice, because there's really no turning back.
Customer: replied 3 years ago.

But I was under the impression that even with chemo, he would be given prednisone any way....

Yes, WITH other drugs. Prednisone when given alone, changes the cancer cells and makes them resistant to other drugs.
Customer: replied 3 years ago.

Ohhhhh....I didn't know that! So what if he takes prednisone and lukeran and no surgery...then? Is surgery a good option later?

If you're going to consider chemo, surgery needs to be done first to obtain biopsies.

There is no reason to start chemotherapy if cancer has not been confirmed by surgical biopsy.
Customer: replied 3 years ago.

That didn't answer my question regarding prednisone and other drugs at the same time. You said prednisone alone can alter cancer cells but what if lukeran is given too? You said prednisone with other drugs would resist other drugs.

Hello,

I’m Camille, and I’m moderator for this topic. It seems the professional has left this conversation. This happens occasionally, and it's usually because the professional thinks that someone else might be a better match for your question. I've been working hard to find a new professional to assist you right away, but sometimes finding the right professional can take a little longer than expected.

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Thank you,

Camille

Customer: replied 3 years ago.


no, it hasn't been answered. I have the records for my cat if it would help to send them. Let me know how.

Hello,

Thank you, XXXXX XXXXX continue to look for a professional to assist you. Since the professionals log in at different times, it is very difficult to predict when one will come on with your particular area of expertise. I will also foward this to customer service for assistance with your request to send records, they will respond to you via email
Best,

Camille

Customer: replied 3 years ago.


ok. I will wait then.

Customer: replied 3 years ago.

These are ALL the records on my cat from the vet. Please review it and all of the questions and responses in this string.


 


download file


 


Anxiously waiting for a response.


 


 

Customer: replied 3 years ago.

I am worried if I'm making the right decision of doing the surgery. After reading all of this I hope you can give me a better idea of his condition and explain it to me in layman terms.


 


Thank you

Hello, I'm Dr Gary. I've been practicing veterinary medicine since 2007. I look forward to helping with your questions/ concerns.

It looks like Dr Drew has given you some solid information regarding how to proceed.

Personally, I would go the surgery route as well to confirm the diagnosis of Lymphoma. If this ends up being non-cancerous and IBD (inflammatory bowel disease) then the prognosis is quite different.

If you don't elect to go to surgery and get the diagnosis, then I would just start Prednisone. Leukeran is an oral chemotherapy drug. It can actually be used in Lymphoma and IBD. The big reason to get the samples is to determine if it's one of those or something else. With Lymphoma, you can either do injectable chemotherapy or oral chemotherapy (ie Leukeran). With IBD, you usually start with just Pred and then add Leukeran later if needed.

Customer: replied 3 years ago.

Thank you, XXXXX XXXXX and basically confirmed everything that my vet and Dr. Drew said. However, I'm a little concerned of how Chemo would affect him if it turns out to be lymphoma AND would I have to give him prescription food or continue with the food I've been giving him. I really don't want him to suffer and fear that the surgery is going to take a toll on him and drain him...will he be suffering if I go this route? If so, like how much?

Chemo in cats is not anything like chemo on people. We use low dosages and less frequent administration. You have to think about it differently. In people, our goal is to cure cancer. In cats, the goal is to have a good quality of life and longer life. They typically feel better going through chemo than they did before it was started. That is our goal when using chemo in animals. Put the cancer into a remission state for as long as we can.

The surgery will have some recovery, but it's usually a fairly short recovery. Most cats are up and around within 12-24 hours and home within 24-48 hours. It's not too bad.

I wouldn't change his diet. I'd just feed him whatever he'll eat.
Dr. Gary, Cat Veterinarian
Category: Cat
Satisfied Customers: 19654
Experience: DVM, Emergency Veterinarian; BS (Physiology) Michigan State Univ
Dr. Gary and other Cat Specialists are ready to help you
Customer: replied 3 years ago.

THANK YOU!!! Please let DR.DREW know that I'm very thankful for his responses. I think I may have annoyed him so he left my conversation :-( But, he should get an excellent just like I gave you :-)

You can rate one of his as well so that he gets credit for all his hard work.

Customer: replied 3 years ago.

Great! Thanks! I feel more secure knowing 3 vets gave the same advice! I feel so good right now...doubts gone all thanks to you and Dr.Drew. Can't thank you enough :-)

You're very welcome. Happy to help.