Large cell lymphoma in my cat

[Dr. Jeff]

Lisa, I'm super sorry to hear about more challenges and worry about Punk's health.

.At what point is not going to the bathroom alarming?

Great question! My answer is based on decreases in BEAM. I''ve know cats over the years that may not defecate for 1-2 weeks and still seemed fine. BTW-all of these cats responded to homeopathic care along with the same recommendations we are sharing in this thread.

2. I read an AI post that said giving Ursodiol with a biliary obstruction can be dangerous - is this actually true?

Not to my knowledge. It is a natural bile acid which is meant to thin the bile.

https://go.drugbank.com/drugs/DB01586

3. At what point since it's the weekend, do I take him to the ER.

A sudden drop in BEAM or whenever you're worried enough to bring him.

he still purrs, still enjoys catnip, and just this morning ate. He is lying next to me instead of the closet...we had a great brush with his tail flicking around....he still has some life in him.

Yes! Perhaps try focusing on those things and doubling them (the more time he spends purring and in a state of happiness, the faster his challenges will gradually resolve.

Is he just shutting down? What can this mean?

Many of these symptoms can be related to severe constipation/obstipation. However, it does not sound like that's currently a problem based on the recent vet findings.

Has Punk been receiving SQ fluids either at the vet or at home?

If you do not already have a trained vet classical homeopath on your vet care team, now might be a good time to find one.

Has Punk seen an open-minded internist like Dr. Forman at CUVS in Stamford?

Marnin Forman | Cornell University Veterinary Specialists | Stamford, CT

www.cuvs.org

 

[LisaArk]

Hi Dr. Jeff,

Thanks so much for your response.

So, this is the second time, that as soon as I wrote on the forum, there was litter box action. This time it was not as productive as the last time - he was indeed, constipated and I had to help him pull it out. It was fairly dry and hard, but he saved himself a trip to the ER tonight...I swear he understands English - I told him if he didn't poop, tonight was ER night. . Dr. Seo had told me it was soft, but it was not soft at all.

Regarding BEAM - the bar is lower than it used to be. I'm happy if he eats or drinks. He's pretty sedentary - he can often eat from a prone position, not standing. It's hard to know if he's uncomfortable because he's so constipated, in pain from stones, the cancer, being anemic, or some combination. But he still gives me winky eyes and purrs and accepts affection and still seems happy to be here. There are times when he's alone for a very long time, and worry about that, but I have to work...

Dr. Seo gave me fluids with B12, but because he's very anemic, he doesn't want me to do sub Q too much.
Seems like this is all quite the balancing act.

I will most certainly check out Dr. Foreman, I'm new to this area, so I'm just getting the lay of the land here. Regarding a homeopath, I had consulted one virtually twice, but I'd like to find another one. There seem to be two in my area, and you, Dr. Jeff are one of them. I have no idea if you accept patients or not....we are quite close to one another.

So, I guess I'm going to go back to to a little Miralax and continue the Magnesium Citrate to soften his stool up and Reglan as well as the Ursodiol...

Thanks very much!

 

[LisaArk]

@Dr. Christina @Dr. Jean Hofve @Dr. Jeff
It is now Wed., Thanksgiving eve and hardly any litter box action...I did make an appointment with Dr. Marnin Forman, but the earliest we could see him is Dec. 16.

Amazingly his BEAM is better than it was yesterday, he's more alert, more social and ate well tonight. Yesterday, he mostly had chicken broth.

This is the the wrap up after my visit last week to Dr. Seo -
P: Owner Discussion: Speculated that Punkin's symptoms may be related to gallstones causing pain and discomfort, potentially leading to episodes of weakness and agitation. Explained the function of the gallbladder and the impact of gallstones on bile secretion and digestion. Discussed the potential relationship between gallstones, digestive imbalances, and Punkin's symptoms, including constipation or diarrhea. Mentioned that the liver tumor and gallstones could be affecting overall digestion and bowel movements. Diagnostics: Ultrasound recheck:Liver: hepatic echogenicity is moderately increased. The hepatic echotexture is moderately coarse. The previously seen hypoechoic hepatic mass effects are still seen (some of mass measures up to 3 x 4cm). The previously seen hyperechoic stones in the intrahepatic bile ducts are still seen. Gall bladder: GB wall remains mildy thick with echogenic debris (both floating and gravity-related). The GB is still bilobed. There is still severe severe dilation in both cystic and common bile ducts with multiple hyperechoic gall stone in the bile ducts. Spleen - the previous tumor effect seen as hypoechoic protruding effect (measures about1 x 1cm) Lymph node - there is hypoechoic lymphadenopathy noted near the liver (0.6 x 0.9cm)Duodenum/pancreas area - noticeable echogenic fat surrounding the duodenum/pancreas are seen. Smith Ridge Veterinary Center 600 Oakridge Commons Plaza South Salem, NY(914) 533-606611/27/2024 Information for Punkin Page 2 of 3 The rest of the organ system look fine. Treatment:Hepar comp 1 vial IM inj Methylcobalamine 1g IM inj Additional Instructions: Explained that Punkin's condition is complex due to the presence of both liver tumors and gallstones, making treatment complicated and difficult. We may need to adjust the supplements depending on how P responds. O to continue the current treatment till the next recheck/communication.


It's very hard to get Dr. Seo to get back to me .. and so, I do have questions - I have sub Q fluids here. Considering the above, and the issue is likely a stone in his bile duct, I imagine wouldn't hurt, only help? Dr. Seo asked us to do it once a week because he's anemic.

Is giving a cat an enema dangerous at all? Not for me to do it, but a vet? Dr. Seo seemed to avoid this each time I brought Punk in, but at some point, Punk is going to explode. The whole issue of using supplements to remove toxins seems like an exercise in futility if he's not defecating -- and potentially more dangerous if the toxins are re-circulating in the body or gathering in his intestines.

It seems these stones are the more immediate danger than his cancer. I don't know if the Ursodiol will work, and if so, how long it would take. In the meantime, his BEAM is too good to call it a day and I'm just trying to sort out how to keep him comfortable.

It seems some of my posts didn't make it to the forum for some reason, is it because I forgot to do this @name thing? I'm a techo moron...

Thanks and Happy Thanksgiving!

 

[Dr. Jean Hofve]

Happy Belated Thanksgiving!

If you want the vets to get directly notified that you posted, yes I think you have to do the @. I don't always see things if they're not in my notifications.

You can give Vaseline for the constipation (search for my many previous posts on it!). But it seems like sometimes he's eating better than others. The constipation may be sort of waxing and waning, that is, when he doesn't eat much, there's not much poop buliding up. Then again there can be a sort of "cork" effect, with something like you helped pull out of him the other day.

Enemas are totally fine, and not all that hard to give. Unless Punk is a real fighter, I've never even had to sedate a cat for an enema. That's far preferable to manual removal of feces under sedation, what we lovingly refer to as a "dig out." Not fun for anyone, but can be the end result of long-standing constipation.

I think what Dr. Seo felt in the abdomen probably was reasonably soft, but you can't palpate what's up in the pelvic inlet that's the first to come out--and what you saw.

Let us know how he's doing! I will specifically look for your posts in case you forget the @ which I do all the time!

 

[Dr. Jeff]

Amazingly his BEAM is better than it was yesterday,

Excellent!

I imagine wouldn't hurt, only help?

Yes, fluids at home would be perfect.

 

[LisaArk]

Happy Belated Thanksgiving!

If you want the vets to get directly notified that you posted, yes I think you have to do the @. I don't always see things if they're not in my notifications.

You can give Vaseline for the constipation (search for my many previous posts on it!). But it seems like sometimes he's eating better than others. The constipation may be sort of waxing and waning, that is, when he doesn't eat much, there's not much poop buliding up. Then again there can be a sort of "cork" effect, with something like you helped pull out of him the other day.

Enemas are totally fine, and not all that hard to give. Unless Punk is a real fighter, I've never even had to sedate a cat for an enema. That's far preferable to manual removal of feces under sedation, what we lovingly refer to as a "dig out." Not fun for anyone, but can be the end result of long-standing constipation.

I think what Dr. Seo felt in the abdomen probably was reasonably soft, but you can't palpate what's up in the pelvic inlet that's the first to come out--and what you saw.

Let us know how he's doing! I will specifically look for your posts in case you forget the @ which I do all the time!

@Dr. Jeff, @Dr. Christina
@Dr. Jean Hofve, thanks for getting back.
You wrote, The constipation may be sort of waxing and waning, that is, when he doesn't eat much, there's not much poop buliding up. Then again there can be a sort of "cork" effect, with something like you helped pull out of him the other day.

It sure seems likely that there is already an accumulation from the many days of not going to the bathroom. But the good news is that he has gone to the bathroom now, two days in a row. In fact, I need to cut back on Magnesium citrate and Miralax because today it was really liquid coming out...a far cry from pulling stuff out of him.

I made some bone broth for him because sometimes he seems to want just liquid - is that likely because he instinctively knows he's constipated? (in cat thought)

His BEAM is better last couple of days - more social, more energized, more pep in his step...

Regarding Ursodiol, the instructions read to increase if there is no digestive upset. I can't sort out if his diarrhea is from the Miralax/Mag Citrate or the Ursodiol? What's a layperson to do??
I guess I reduce the Mag Citrate/Miralax to see if there is a difference? Have a "controlled" experiment?

Thanks!

 

[Dr. Jean Hofve]

Hey, so glad to hear that The Punkmeister is feeling better!

Can you palpate his belly yourself to feel what is in there? It's unlikely that poop would sit from days ago if he has been pushing it out pretty well.

UNLESS.... The one caveat is that sometimes there's a big "cork" and only liquid can get around it. (It happened to me one time and it was NOT fun!) Don't want that! So I'd still be inclined to give a big ol' wad of vaseline just to make sure any large chunks *can* get out if they're stuck behind the pelvic inlet.

I'd also stop with the Magnesium, it's too easy to overdose it over time. Miralax is fine, but maybe give smaller doses at intervals, so if you need to stop there isn't a higher dose from earlier "hanging around." Does that make sense?

I haven't used Ursodiol myself so I can't advise you on that one. Maybe give your regular vet a call on Monday.

As long as his BEAM is good, and improving, and he's a happy guy--nothing to panic about! I'll try to check in here some time tomorrow so let us know what's going on.

 

[Dr. Jeff]

t the good news is that he has gone to the bathroom now, two days in a row

Yay!!

 

[LisaArk]

Hey, so glad to hear that The Punkmeister is feeling better!

Can you palpate his belly yourself to feel what is in there? It's unlikely that poop would sit from days ago if he has been pushing it out pretty well.

UNLESS.... The one caveat is that sometimes there's a big "cork" and only liquid can get around it. (It happened to me one time and it was NOT fun!) Don't want that! So I'd still be inclined to give a big ol' wad of vaseline just to make sure any large chunks *can* get out if they're stuck behind the pelvic inlet.

I'd also stop with the Magnesium, it's too easy to overdose it over time. Miralax is fine, but maybe give smaller doses at intervals, so if you need to stop there isn't a higher dose from earlier "hanging around." Does that make sense?

I haven't used Ursodiol myself so I can't advise you on that one. Maybe give your regular vet a call on Monday.

As long as his BEAM is good, and improving, and he's a happy guy--nothing to panic about! I'll try to check in here some time tomorrow so let us know what's going on.

 

[LisaArk]

Ha, Punkmeister - sometimes I call him that too. So yesterday no magnesium, just a little Miralax. Today, hardly anything in the box, just a little, soft, but somewhat formed, cigar butt shape #2. He has had pure liquid coming out and not sure if it's due to a big "cork" or simply too much magmesium and miralx. Either way, it's better than nothing coming out. And even though he hasn't eaten tons in the last couple of days, he has in the previous weeks.

I have palpated his stomach and I'm not sure what I'm looking for...please elucidate! Until a couple of weeks ago, I never did that, so I don't really have a frame of reference. Regarding the vaseline..I'll have to search what you mean on the forum as well as what a pelvic inlet is. (Just on a break now from teaching) I'm assuming you mean to put it up there myself? That sounds like a fun project for tonight...for all concerned. And then YOU get to hear all about it.

Occasionally, and it happened today, while he was lying next to me I could hear his stomach gurgling...does this mean his stomach is upset, just like a human? I didn't give him any supplements today so I don't make matters worse.

Unfortunately, calling my vet doesn't necessarily mean I'll hear back...it's a very imperfect system they have going there.

Ok thanks so much!

 

[Dr. Jean Hofve]

Oh goodness no, you give vaseline by mouth, just smush a wad of it in the corner of his mouth so he has to swallow it.

If he was constipated you would feel a giant firm to hard log up near his backbone, oriented front to back. At the back end there is bone (pelvic inlet) so you can't feel any further along the way to the back end. But you would definitely feel something big and gnarly.

If everything is softish, then he is fine!

Gurgling is normal, no worries.

 

[LisaArk]

Oh goodness no, you give vaseline by mouth, just smush a wad of it in the corner of his mouth so he has to swallow it.

If he was constipated you would feel a giant firm to hard log up near his backbone, oriented front to back. At the back end there is bone (pelvic inlet) so you can't feel any further along the way to the back end. But you would definitely feel something big and gnarly.

If everything is softish, then he is fine!

Gurgling is normal, no worries.

Hi @Dr Jean Hofve, ha ha ha, Thank goodness! I was sure waiting for my husband to come home for what I thought was going to be quite the adventure. Trying to understand where to palpate. You're indicated sort of under his backbone/spine. But aren't his intestines more under him, in the stomach area? I want to understand just where to palpate. So far, I've palpated everywhere! His stomach seems full, but again, I don't really have a frame of reference and don't know what I'm doing...
Mostly I'm glad for Punk and ME, that I don't have to do anything too invasive. I do have lactulose here, he just threw up from it when I tried it last summer and frankly, it seems pretty disgusting.
Thanks!

 

[Dr. Jean Hofve]

Glad I caught you before you engaged in a very entertaining wrestling match!

So, you want to feel the tummy between the ribs and the hind legs. If he's thin enough or you have long fingers, get your hand under his belly and put your thumb on one side and fingers on the other and gently push in, a sort of pinching motion though of course not pinching hard. Or put one hand on either side. It should all feel relatively soft and mushy in there. It's mostly intestines, but the colon runs straight back from under the ribs to the pelvis more or less along the backbone. If there's a lot of hard poop there it will be obvious. Really!

Here's a little video, they are checking the cat for pregnancy but the motion is the same.

 

[Dr. Jean Hofve]

To illustrate, the colon is the pale tube running from the liver (dark brown thing) to the butt. So your hand will be more or less between the hind legs, and you're feeling upwards. Hope this helps!

 

[Dr. Jean Hofve]

Or maybe that's the spleen. Weird picture, lol! But it's the dark brown thing with intestines behind it!

 

[LisaArk]

@Dr. Jean Hofve thanks very much - this video was very helpful. He is distended in this very place that the video shows, although I feel nothing hard, just full. It's just not leaving him. Dr. Seo thinks there is a stone in the bile duct which is potentially blocking the bile.
Do you think digestive enzymes could help? (I'm a musician, so I don't really know what I'm talking about...) What about an enema, just to clear him out. I fear that all I'm giving him to clear toxins is not leaving him and I hope I'm not doing more harm than good.

 

[Dr. Jean Hofve]

Full is okay, as long as it's not hard. Give more vaseline to help it get out. Inert, safe, will "grease the skids" so to speak. (You may also be feeling bladder which is balloon shaped and not a concern). Bile duct is way the front end, up under the liver and stomach, nothing to do with poop at the point we are worried about constipation. Give him time, lots of fluids. He's doing good! You're doing good!! Let's make sure the major functions are there, then we worry about the bile. Do fill out the form because Standard Process makes excellent products for bile and gall bladder detox. It's in my signature below.

 

[LisaArk]

@Dr. Christina @Dr. Jean Hofve @Dr. Jeff
Update: so the fullness in Punk's belly is fluid. I had a sneaking suspicion it was since i felt no lumpy anything... The vet said he also has fluid in his lungs. I think we are nearing the end. One vet years ago prescribed lasix, I think? He was going to drain the fluid out, but Punk was squirmy, and Dr. Seo didn't have the time to do a blood test to see if he could withstand a sedative. Apparently, the fluid is near the heart and Dr. Seo was afraid to do while Punk was awake. He basically said he felt he had just a couple of weeks and that he'd begin to have trouble breathing.

The thing is, this boy is still eating, he's also drinking tons of broth - why could that be? Like it's going out of style. He still purrs. But, he can't really get off and on the bed himself anymore, and when I lifted him this morning I felt the the pressure of my hands holding him, made him cough..

He still is social, and purrs and eats, but is less active, as I mentioned and it getting weak. Should I wait until I perceive he has trouble breathing? While he still has some quality of life seems soon, but don't want to wait too long. What are your thoughts about this.

And can anyone recommend an in home euthanasia? There is a Lap of Love in Fairfield County, which is where I am. Any recommendations for in home people?

Pretty sad stuff ....thanks for all your help.

 

[Dr. Jean Hofve]

Oh no, I'm so sorry to hear that! Gosh he did so well for so long. What a trooper!

Even though he is full of fluid, he could still be thirsty because that fluid isn't in his bloodstream. The thirst mechanisms would still operate as usual. Probably he is a bit dehydrated from losing so much fluid from the blood.

Having trouble breathing is scary, so you don't want it to get to that point.

It's great than he is still eating and drinking, but those are not the only criteria for quality of life. Purring is usually good, but it is also self-comforting, and sometimes it is a sign of distress. Unfortunately it can be pretty hard to tell the difference.

If he's unable to move around much on his own, and pressure makes him cough, those are not good signs.

My own philosophy is that I'd rather euthanize a day too soon than a day too late.

My cat Puzzle was a good example. She didn't care whether she stayed or went--she told me so, and she told my animal communicator the same. She was very sweet. She was willing to stay if I needed her to. But I let her go when the number of bad days started to equal the number of good days. We knew it wasn't going to get better, and I didn't want to regret waiting. (BTW, it might sound crazy, and perhaps I am... but she has since come to me and showed me how much fun she's having on the other side... she's very pleased with the ability to fly!)

Cats are not as attached to their bodies as we are, and they don't have the same emotional "stuff" about death. In my experience, they're fine with leaving a body that isn't working so well. They aren't really going that far... I think it's more like changing forms than any kind of "ending."

This might be a great time to talk with an animal communicator, and get some clarity between you and Punk about what's coming and what the options are.

Bless you for taking such good care of that boy! I know he loves you!

 

[LisaArk]

@Dr. Christina @Dr. Jean Hofve @Dr. Jeff
Thanks Dr. Hofve, for your response.
@Dr. Jeff, since you're in the area I am, is there any person or service that you would recommend that does in home euthanasia? When i google, Lap of Love of Fairfield County is what comes up. Thanks in advance.