A question for Krista Magnifico:

Hello! Hoping to get some advice on recommended next steps for my cat, Sammie, who is being evaluated for IBD vs. small cell lymphoma.

Sammie is 17 years old and is overall quite healthy! Throughout the time I’ve had her, she’s had a history of vomiting a ~once per week or two (sometimes more frequently). Vomit is usually clear, foamy. No other GI issues or health issues otherwise. She is active and energetic, and has not had any health issues until ~1 month ago when I noticed she stopped eating as much as she previously did. She stopped eating her dry food altogether, and seemed to become quite picky with her wet food. I initially thought her teeth may be bothering her because of the avoidance of dry food, so I brought her to the vet.

Vet found that she had lost a couple of pounds, unintentionally. Based on presenting symptoms, vet thought she might have a GI pathology so ordered an abdominal U/S:

Ultrasound, Abdominal Study Outcome:
Kidneys: overall normal size but mild reduction in detail and small mineral foci. Trace pylectasia noted w/out ureteral disension.
GI: Avg SI thickness normal. Mild corrugation is noted in some regions and some ileus (luminal fluid distension up to 4 mm w/ reduced
peristalsis) noted w/out obstruction. No discrete abnormalities appreciated throughout the small intestines.
Caudal abdominal nodes are prominent to mildly enlarged and rounded w/ smooth texture. One irregular cystic structure noted near right
kidney. The mesentery around the ileus segments is mildly hyperechoic.
A:
Intestines most consistent w/ enteritis
Nodes: r/o reactive vs other
Cystic strucure: r/o benign mesenteric vs inflamed node
Kidneys have evidence of chronic disease.

Here are her prior labs:
PRIOR LABS:

7/15/24: Wt loss 0.28 lb; PCV: 40/7.6; Chem18: BUN 41, creat 1.7, K+ 4.3, phos 4.2
U/A: USG 1.019, pH 6.0, rare wbc/rbc; no bact/cryst; cobalamin: 437; folate: 11.2

2/13/24: Wt loss 0.8 lb; CBCcomp: hct 44, diff wnl (clots in sample; rec. resubmit)
Chem25: BUN 40, creat 1.3; T4: 2.8; SDMA <10
U/A: USG 1.025, pH 6.0, rare wbc, no rbc/bact/cryst, rare fine gran casts.

1/19/23: Wt loss 0.4 lb; CBC: (hct 40, diff wnl); Chem25: (BUN 32, creat 1.3)
T4: 1.8; U/A: USG 1.051, pH 6.5, 1+ prot, rare wbc, no rbc/bact/cryst

11/19/21: CBC: (hct 46, diff wnl); Chem: (BUN 34, creat 1.5); T4. 1.9; DGGR lipase 9
U/A: USG 1.053, pH 7.5, rare amorph. crystals, no wbc, no rbc

6/17/22 Wt loss 0.16 (as desired); USG 1.040; SDMA: 11

Most recent A&P:
A:
1) Intestines most consistent w/ enteritis (IBD vs SCLSA); ileus likely cause of decreased appetite.
2) Nodes: r/o reactive vs other
3) Cystic strucure: r/o benign mesenteric vs inflamed node
4) Kidneys have evidence of chronic disease ; in keeping w/ previous lab findings.
P:
1) Rx: metoclopramide 5 mg: 1/4 tab po every 8-12 hrs.
2) Continue vit B12 as Rxed.
3) picked up Mirataz but hasn't started it yet. Rec. give. metoclopramide for 2-3 days and then if not improved appt, start Mirataz.
4) to consider presumptive pred tx vs ex-lap for biopsies.

Sammie is seeming to eat better with the metoclopramide.

My question:
Is pusuing an ex-lap for biopsy recommended vs. empiric tx for IBD with steroids vs. empiric tx for SCL with steroids + chlorambucil.

Thank you!!!

I have a very special and painful case I need help with, I have tried several different veterinarians with no diagnosis or prognosis so far. It may be a long shot, but I was hoping you could help me shine a light on this.

In April I found an extremely skinny stray cat and took him in. I first thought he was malnourished from lack of food for being in the streets, but 4 months in his case keeps unfolding.

He is likely older than 15 years old, but he’s a happy cat with a lot of energy and mobility. He weighs 3kg but he’s a big cat, you can feel every single bone in his spine, although you can’t see them that easily because he has long hair. He’s completely affectionate, loves to be pet, and asks very politely for attention and food all the time.

All we know about his past is he is neutered, he had some teeth surgically removed and he tested negative for FIV and FeLV.

He had a huge appetite when I first took him in, he would eat 100g of food in one meal and ask for more right after. He would sometimes ‘cough’, it sounded like he was choking on some kind of fluid, it doesn’t happen in sequences, but it happens almost every day until today.

He always drank LOTS of water and produced a lot of urine as well. His feces at the beginning were really solid with some mucus.

After a month, he continued to eat plenty and hadn’t gained any weight, that’s when he started to throw up. It started happening a few days a week, usually after spending several hours without eating he would throw up a clear frothy fluid with no content, and then it progressed to twice every day regardless of when he had eaten.

We suspected it could be diabetes or hyperthyroidism, but the labwork didn’t confirm either, it showed regular kidney function with small liver function alterations.

We then introduced prednisolone (2,5mg/day) and changed his diet from a mix of natural home-cooked protein, hypercaloric wet food, protein supplements, and dry food to exclusively Royal Canin Hypoallergenic while waiting for Royal Canin Gastrointestinal Hydrolyzed Protein to arrive in Brazil, keeping Omega 3 (fish oil) 500mg/a day in his diet.

Vomits went away for a while. He kept drinking lots of water and peeing a lot, but his feces got softer (not liquid).

He had periods where he lost his appetite, which we treated with mirtazapine, he reacted after 6 days.

We performed an ultrasound and discovered that basically all his internal organs were compromised. He has severe alterations everywhere. Still, the best specialists I could find couldn’t tell me what was causing it and offer a course of treatment that didn’t involve opening him up to collect tissues for a biopsy.

I personally think it is absurd that a doctor could look at this frail elderly cat who obviously can’t resist anesthesia without serious risks and say that surgery is the only way to go, all to find out for sure if we’re dealing with a lymphoma or an infection. I’m looking for someone to advise me on the most effective course of action. Of course, I aim to reverse his condition, but I understand that given his age and how advanced it is, it might not be an option.

He is currently at 3kg, eating exclusively Royal Canin Gastrointestinal Hydrolyzed Protein with fish oil, and taking prednisolone every day for a month now. His appetite is healthy, he still drinks a lot, pees a lot, and poops regularly but softer. He eats an average of 5 small meals.
Vomits are back down to a few times a week, usually early in the morning before his first meal, and always a clear liquid. He goes and eats right after throwing up so I get the impression he is not nauseous.
He doesn’t seem to be in pain overall.
He’s not gaining any weight regardless of all my efforts.

That is why I’m giving this a shot and trying to get your attention. I hope you have more resources and knowledge that could help me figure out appropriate next steps to give this little guy the best fighting chances I can.

On this link you’ll find a translation of his bloodwork and ultrasound. I had chat GPT translate it for me so forgive me if there are errors.
Link: https://docs.google.com/document/d/1yqcen-TYzyvfBYU-J4t1tCHola1E2otDGDa1H7V032Y

I appreciate any support you can lend me, his name is Valentim which means brave and strong, and I want him to win this fight.

Hello. I am hoping Dr. Magnifico sees this message as she treated Samantha yesterday (Friday) for me.
She has found a quiet hiding place and I am able to pet her although she is not thrilled….turns her head. I have not seen her eat but I cannot rule it out because she may come out when we are asleep.
Do you think she could be in any pain? If not okay but if you do I have a syringe of 5 ml buprenorphine that was for Dexter but he did not need
It. I did not want to do anything without asking you. If you think it would help could I give her the med?

Another question. One if my other cats was diagnosed with probable lymphoma. I mentioned on Wednesday (I think it was Wednesday) that she had been sneezing from time to time but it was recommended that we hold off because we were already dealing with something major unless it got worse. She is doing it more frequently and seems to effect her purring. There is a good chance I may bring her in tomorrow to see you.

Thanks
Sandy

If you are reading this I want you to know that I truly appreciate you helping us out at the last minute yesterday because of my stupidity.

My 8 year old Belgian Malinois had surgery to remove her salivary gland on June 11, 2019. It was quite an extensive surgery because her salivary gland had ruptured and there were a lot of stones present. I was giving her a bath yesterday feeling in the area where the surgery was and I can feel what I believe is her lymph node or something firm on the side of where the surgery was. Below are pictures of what I am seeing. Could this be lymphoma starting (I lost a dog to that in December) or is it from the surgery. I am so worried! No ER’s where I am at so waiting till tomorrow to take her back in but for now I would like to know ideas on this.

Does anyone have experience with chemo drugs used for feline intestinal lymphoma, small cell type? I’m anticipating having to decide next week to pursue a course of chemo -or not- for my Oak. Oak is now 11 years old, rescued by me as a kitten from a shelter, but never adopted out due to the eosinophilic granuloma that became apparent when he was about 4 months age. He is such a sweet kitty, I call him my ‘circus cat’ because I can train him to do almost anything. Sadly, I’m now training him to happily take gel capsules so we’ll be ready if the time comes. I would appreciate any insight you have on how well your cat(s) tolerate chemo (if you can include the name of the drug, that’s a bonus!). Thank you so much, judy

Last Christmas our kitty snacked on our live Christmas tree. We found the needles in her stool. This also coincided with her being diagnosed with lymphoma. She is amazingly still with us, although life seems to be a series of ups and downs. As she has has digestive issues from lymphoma I certainly don’t want to cause any further irritation this holiday season. We are debating putting up an artificial vs real tree, however I wonder if ingesting the artificial matter (ie plastic) could be more iritating than organic matter. Thoughts?
If we had a room to simply close the tree in to we would, however we have an open floor plan….and if we didn’t have children we would skip the tree altogether!

Question for Dr. Krista; sorry, complicated question(?)

First, to review for benefit of others reading this question:

Patient: Cookie
Rottweiler, spayed female, 2 years old

Presented with lethargy, anorexia, vomiting and diarrhea (threw up only twice and one time diarrhea, then taken to vet, given antiemetics and antibiotics; diagnosed with pancreatitis; getting better since – this was Monday)

During exam foreign material found in stool (grain and corn; we think she got into the horse feed) painful cranial abdomen, low and large bowel diarrhea, enlarged submandibular nodes – this part worries me because these were temporarily enlarged not long ago; resolved quickly, though)

As I’m reviewing the blood results, there are things I could understand as being consistent with digestive distress/pancreatitis but some which are concerning me, namely the globulin and lymphocyte levels, even though they are not extremely low but low nonetheless.

Beside the cPL which is clear in its meaning, the free T4 is low – I assume this is what is meant by not testing for hypothyroidism in ill animals, because the thyroid hormones would be low with any disease process? Is that correct?

I would figure that the ALT/unhappy liver enzymes would also be consistent with such insult to the body, is that correct? And I imagine same would apply to bilirubin in a situation of digestive upset?

The values that concern me are the globulin and the lymphocytes, particularly together with the "easily aggravated" sub mandibular lymph nodes in the mix, particularly as it seems that lymphopenia would be present with both CPV and lymphoma … ? I’d assume that a) Cookie was recently vaccinated for CPV and is improving too rapidly to think CPV? Lymphoma has been on my afraid mind since the first time they were found enlarged.

It also says, though, that lymphopenia could be a result of underactive glands (the source doesn’t say which ones) so would that perhaps have to do with the lowered thyroid function during the digestive distress?

Didn’t find much on low globulins, other than immunodeficiency types of situations, which doesn’t seem to apply. What is the "life-span" of a globulin, and if short, would the low globulins have to do with the unhappy liver?

Can you, please confirm about the free T4 and talk to me about the globulin and more importantly the lymphocytes?

Blood results attached.