Long Term Steroid Use with Probable, but Unconfirmed, Lymphoma - Cat Forum : Cat Discussion Forums
 
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post #1 of 6 (permalink) Old 02-20-2017, 02:39 PM Thread Starter
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Long Term Steroid Use with Probable, but Unconfirmed, Lymphoma

Hello all! It's been nearly eight years since I posted, and Munchie and I are back with a much more serious dilemma.

In the middle of November 2016, my cat Munchie (10 years old, female) had a two day bout with constant black, tarry, liquid diarrhea . This was accompanied by vomiting (she has always been a big vomiter, but this was her first bout with diarrhea). She was still hungry and eating until we took her food away, about 24 hours after symptoms started. She was still acting normal in other ways - cuddly, purring, a little playful at times.

I initially suspected she had ingested something toxic to her. Although we do a good job cleaning up, she is a constant scavenger, and will often start chomping things she knows she shouldn't simply to let us know that she's hungry (books, paper, dust, anything she can find). She had started a new behavior a few weeks earlier where she would do this even when she had food still in her bowl, which was slightly concerning me. I had also treated her about a week beforehand with Advantage II after finding some flea dust (we had a terrible infestation a few years ago, and a few pop up every once in a while - it was the first time I had given her flea treatment in about two years).

The only other real symptom leading up to all of this is that probably for about a year beforehand, she was significantly less playful than she had been. But it's not like she would never play. And she'd still get the "crazies" once in a while, running around like a nut. I figured, and still figure, she was just going on 10 and the same mice doing the same tricks just aren't that interesting anymore.

So anyway, the diarrhea started in the evening of November 15th. On the evening of November 16th I called the vet who told me to come in in the morning to have them look at her. We took her food away from her this evening of November 16th as well. She vomited a time or two more this evening of the 16th, till finally there was just foam in her vomit and then she stopped vomiting. She continued with the diarhhea until after we went to sleep - at which point her system was empty I suppose.

The morning of the 17th she was still acting normal, begging for food, cuddling up into a ball on my lap and purring. I took her to the vet, and they did an x-ray, which showed an abnormality which they thought may be a tumor. They referred me to University of Pennsylvania Vet ER for an ultrasound. The ultrasound found a mass about 40mm x 20mm on her small intestine. It also showed either swollen lymph nodes or possible metastasizing. They also did a blood test, which had no significant findings. She was slightly dehydrated, as one would expect after such a day or two.

The vet at Penn said that it was probably lymphoma. He was very clear that every case is its own individual case - but he gave us the options of either chemotherapy, which would possibly extend Munchie's life for around six months, or simply treating the symptoms with a steroid, prednisolone, which would possibly give Munchie another two months of quality life.

It was a heartbreaking day - but we decided to treat the symptoms with steroids. 1.5 ML of Prednisolone every 12 hours, dosage of 15mg/5ml. Reading about other people's experiences with chemotherapy and the ups and downs and hopes and false hopes made me feel okay about the decision.

The vet also said that while they would have to confirm the diagnose of cancer IF we had chosen to do chemotherapy, that this was not necessary with the treatment by steroids alone. It would have been a fairly expensive procedure using an ultrasound guided needle, and he said there was no real reason to do it unless we planned to treat a confirmed cancer with chemotherapy. So the probable diagnosis was never confirmed 100%.

So anyway, we got home and she was ravenously hungry after going about 24 hours without food. I was afraid of feeding her too much too fast because of the two days with diarrhea - and she was in a sort of hunter mode that I have never seen before and was really cute. But she was a little eating machine, I gave her a little at a time. She even ate a small chicken cutlet, and she's not normally interested in people food.

It's been over three months now, prednisolone twice a day, and things are very stable. Which is great, and every day she's still healthy I just count as a blessing. I stopped limiting her food, because I figured if eating makes her happy, let her eat all she wants. She went up from 12 pounds to 13 pounds, where she has stayed steady for the past 3 months. She went a whole month without throwing up, for maybe the first time ever. She's thrown up a few times in the past two months - but it's always after doing something dumb, like beating me to a piece of string and eating it. Or taking a big bite out of the mail.

One positive side effects of the steroid has been: she started over-grooming when she was four, and had a completely bald stomach as well as patchy legs. Her fur is coming back in. While her vet had previously said it was due to anxiety, it makes me wonder if the over-grooming was linked to something physical. Either allergies or perhaps this tumor that has been in her abdomen for who knows how long.

We saw her primary vet again the other week in order to get another prescription for prednisolone to last another three months. He suggested a follow up back at UPENN Animal Hospital next time, as he's obviously not an oncologist, and the best he could offer is that it's very slow moving. He couldn't feel any mass, as no other vet could, but they do say it's hard sometimes with bigger cats to be able to feel them.

Just wanted to share my experiences and see what other people think. I've spent the past three months trying not to give myself any false hope about what the future holds for Munchie, and just enjoying the time that we have together. I was okay with the initial decision - but it's getting harder to know whether I'm doing the right thing - whether the mass should be further examined to find out if it actually is cancerous and if there's something better we can do that would have a long lasting affect- not just extending her life by a few months through chemotherapy.

And I'm also wondering that if this was not the correct diagnosis, is it possible that this prednisolone is doing her harm? And how long does it take to start doing damage?


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post #2 of 6 (permalink) Old 02-20-2017, 04:53 PM
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IME, torties are tough! Since she's gained weight, not vomiting as much, stopped overgrooming, cuddling, purring, eating and enjoying her life on the steroid medication, she seems to be doing well on that, and I would continue with it and let your senior sweetie girl be. I have not had experience with use of long term steroid use, so can't comment on that. All the best! Good luck!

"There are no ordinary cats.";"Time spent with a cat is never wasted."~ Colette
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post #3 of 6 (permalink) Old 02-24-2017, 04:19 PM
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Long term steroid use can possibly lead to Cushing's Disease, which claimed one of our cats, but if it gives her a good quality of life in the meantime, then you'll have a few more years with her at least. It sounds as though your cat may have some kind of allergic skin condition, if the treatment has stopped the overgrooming.
We got Taffy when she was 12 and she'd already been on prednisolone for a couple of years in her previous home. Whenever the vet tried to reduce the dose, she'd get a nasty skin condition, so we'd go back to it. (You can never just suddenly stop steroid treatment, it has to be gradually tapered off.)
She was unusually athletic and active for a cat of that age (possibly because of the 'roids!), and remained so until she was almost 14, when she suddenly stopped playing and slowed down quite a bit, all within a few weeks. Six months later we woke up to find her struggling to breath and ended up euthanizing her that day as the vet said there was nothing that could be done.
So, the steroids probably shortened her life a bit, but while they worked they gave her a fantastic quality of life. I can still remember her bolting up tree trunks just for the sheer fun of it while out being walked. We were happy to have given her two more years of love and affection after her previous person went into a nursing home.
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post #4 of 6 (permalink) Old 02-26-2017, 01:56 PM
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Since it sounds like she's healthy and doing well, personally I would just stay the course and keep doing what you're doing. Long-term steroid treatments can indeed have some negative effects, but in your cat's case I would see that as less important than a good quality of life right now. I think you're doing the right thing by living in the moment with her.

I had to make a similar decision regarding Maisie. Bloodwork indicated a malignancy but the vet could not locate it via noninvasive testing. We discussed various options but the bottom line was that the vet did not feel that chemotherapy would add enough longevity to make it worth the loss of quality of life, and with that being the case, he didn't feel that it would be worthwhile to pursue aggressive testing either. We decided that ultimately the best thing for Maisie was just to wait and see how things go. (For the record, it's the same decision I would have made regarding my own health if I'd been given the same prognosis.)

I know it's hard not to have answers and to feel like you're not doing everything humanly possible for your cat, but unfortunately sometimes the best decision is just to make them as comfortable as possible in the short-term and leave it up to nature in the long-term.


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post #5 of 6 (permalink) Old 04-17-2017, 12:07 PM Thread Starter
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Thanks for the advice, I did read it all at the time.

Munchie's been in a slow decline the past month. Took her in to be looked at today and she's in liver failure. Possibly because the lymphoma spread to the liver. Or for whatever other reason. She's eaten very little over the past week. But today will be her last day. She's ready. 5 months to the day we went to the ER and they gave us 2-3 months. And it was mostly a really great 5 months that we all made the most out of.
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post #6 of 6 (permalink) Old 04-19-2017, 04:07 AM
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I'm sorry to hear that. You took very good care of her but sometimes there's just nothing more that can be done besides letting them go. Wishing you peace and comfort!


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