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Splenic mastocytosis in a cat

Species: Cat
Breed: siamese
Age: More than 15 ye
I was told for cats with splenic mastocytosis, the treatment of choice is splenectomy. This is the approach the oncologist I just saw for my 15 year old male siamese cat. They also told me to give him 1/4 of a pepcid ac per day.

I feel the 2 vets before this specialist have wasted allot of time considering its been 2 months since I first brought the cat in scared because he started having multiple violent barfing fits every few days and one day he curled up in the laundry hamper almost all day without eating/drinking much.

The first vet did bloodwork and mentioned things about the liver and put him in denamarin and 10 days of antibiotics, and he got diahrea the next day and it hasn't gone away in the 2 months since!

We tried the vets food, some pills for hairballs and fortiflora as desperation for a month and it had no impact so we stopped.

The barfing cycles continue every few days. He can either dry heave and spit out a little liquid or barf his feeding from the previous hour. What a bad day hits he barfs multiple times, seems to eat a little less and doesn't move around as much.

Although his weight is still steady at 8 pounds through all this and overall since the first vet visit he hasn't crashed again, and still sleeps with people at night, he gets around fine and jumps the counters, etc. His appetite is always pretty strong, most of the time he eats right after barfing.

What I am wondering is if at face value taking out the spleen should be step 1 to extend his life?

If I don't do surgery and treat symptoms how long can he live? Taking care of him is very hard right now with the diahrea, I believe they said he has some agitation in his tract. Unless we can get rid of this and the barfing I don't like the idea even though he doesn't seem to be in pain.

Also as far as surgery I am wondering if there is a textbook treatment with drugs for a certain period of time before taking out the spleen to block the histamenes? for some reason they weren't clear on how to prep for surgery and how long.

Also I'm wondering if its possible to make a deal with a vet since money is limited, to do whatever prep medicine wise is needed, then do the surgery and let him recover enough before going home, without all the labs and extra cost? I would put a plan into place to put him to sleep if something goes bad during operation or initial recovery. Then once home I could proceed with medicines. I feel terrible for attempting this but it seems like a better shot than letting him suffer treating symptoms.

Online vet, Dr. Marie

Dr. Marie replied:

Oh, this is a really tough situation. The decisions that you have to make are not easy.

Splenic mastocytosis is not very common. What is happening is that there are tumors in the spleen that are producing extra mast cells. Mast cells contain histamine and can cause many side effects including an upset stomach.

As you know, the best treatment for splenic mastocytosis is to remove the spleen. But, this is not always an easy task. Cats that have this condition can have trouble clotting their blood and the surgery can be very risky. The other factor is that this surgery will likely be quite expensive. At 15 years of age, I would be really hesitant to do this surgery.

*If* your cat survived the surgery and the surgeon was able to fully remove the cancer, then, if the spleen is the only part of the body affected, the average survival time for cats after this surgery is 3.5 years. However, in a 15 year old cat, this might possibly be a little unrealistic.

The other complicating factor is that it is hard to know whether the cancer is contained in the spleen or whether it also is affecting the intestines. This would have to be determined by taking samples during surgery and then waiting several days for the results. If mastocytosis has spread to the intestines then the survival rate is very low. The fact that your cat has significant gastrointestinal symptoms makes me worried that this could indeed be the case.

So, if this were my patient, with the information that you have given me, I would give you these options:

1. Do surgery right away. The cost will be high. There is a significant chance that he will not survive the surgery and there is also a chance that we will find on surgery that the cancer is also affecting the intestines in which case, things may not improve much. But, there is also a chance that we could cure this problem.

2. Try to manage with medication. It is really impossible to say how long this would work for. It could be perhaps a year, but it could be much much shorter.

To me, #2 makes much more sense. I know it is hard but because there are so many variables associated with surgery as well as risk, I don't think that this would be a wise decision.

Some cats with this condition do well with steroids. Another drug that sometimes helps control the histamine release is cyproheptadine. Some vets will also try benadryl to help with the histamine issues and possibly even pepcid to help with stomach upset. These are all options you can discuss with your vet. There are chemotherapy protocols that can be used in some cases, if surgery is not an option, but this would likely require a referral to a veterinary oncologist and would be quite pricey.

What I usually do in cases like this is have my clients set some guidelines for themselves in terms of what they and the cat can tolerate before they start discussing euthanasia. If the symptoms get worse gradually then it's hard to one day say that enough is enough and it is time to stop the suffering. So, if your cat continues to get worse, or is losing weight and not eating then you may need to talk to your vet about whether this is an option that should be considered.

I wish I could give more hopeful advice. I'm not saying that a cure is impossible, but in my opinion the odds are a little stacked against you.

Dr. Marie.

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Disclaimer: Although Dr. Marie is a qualified veterinarian, the information found on this site is not meant to replace the advice of your own veterinarian. and Dr. Marie do not accept any responsibility for any loss, damage, injury, death, or disease which may arise from reliance on information contained on this site. Do not use information found on this site for diagnosing or treating your pet. Anything you read here is for information only.

Customer reply:

I appreciate the perspective. After calling around I am curious if there is some kind of code of conduct or liability issues when it comes to surgery as far as requiring all of this labwork?

I am actually baffled that 2 highly rated local vets will not listen to me and are not willing to work with me and just try the surgery with a couple days of recovery at their facility and see what happens to keep my cost down, with a clear plan to not resuscitate, and always having the option to put him to sleep?

I understand them informing each step of the way but there is risk involved with everything, they are a business at the end of the day and thats what I want to do.

I have seen enough in the waiting room of these vets the last weeks to know that they are a business first, I'm not sure the pets comfort is their first priority.

Online vet, Dr. Marie

Dr. Marie replied:

I understand your frustrations, but let me share with you my perspective. If you were a patient in my clinic and I had to advise you on this situation, here is what I would be thinking:

Surgery is risky. There is no way that I would do surgery on a 15 year old cat with cancer without doing a full panel of bloodwork and also xrays to determine if there is obvious spread of cancer to the lungs or other signs that would make me decide against surgery. The bloodwork is not just to say whether or not the cat would survive surgery, but it helps me know which medications to use. For example, if I am seeing kidney issues on the bloodwork then I know I need to adjust my anesthetic protocol to use drugs that are easier on the kidneys. And I know that I need to be careful with giving enough intravenous fluids to support the kidneys but not too much as to overload them. I also know that I need to keep a close eye on the blood pressure.

Now, one could say, "Well, I don't want all that monitoring...if the cat dies, he dies." But it's not that simple. Let's say I didn't monitor the blood pressure and it ends up dipping during surgery. This can cause serious kidney problems. I wouldn't know this until several days after the surgery though (assuming that he survived surgery). So, when he presents back to me with vomiting and a lack of appetite and looking really unwell, what do I do now? We'll need to do more tests and we'll likely need intensive hospitalization. And those cost money. And I know that my actions of taking a low cost cut rate road to surgery, have made this cat very ill.

The next issue is the cost of the surgery. Many people are shocked to find out that if I do surgery on an animal and the animal dies during the surgery, the cost is not that much lower than for an animal that survives. I've still had to place a catheter, administer a preanesthetic, administer an induction drug, place the cat on an anesthetic machine, prep for surgery, open up my autoclaved surgical packs and spend a good amount of time doing surgery. And, if the cat starts to not do well, it's not like he suddenly dies under anesthetic. No...rather, we would notice things happening and we would say, "OK, let's try increasing the IV fluids", or "Let's give this drug and see if that helps...." At the same time, I've paid my staff to concentrate on this case and I haven't seen any other patients. So, if, after all that, your cat does not make it, there is still going to be a fairly substantial bill.

Now, this next part is tough, but history tells me that the vast majority of time, if an animal dies under anesthetic and I have not already collected some type of payment, I'm not likely to get paid for this. I can't tell you how many people feel justified in not paying a bill because an animal has died.

You could argue that I should be doing this out of the kindness of my heart because I want to help animals. But, the reality is that many times a day I see animals that need help and owners can't afford it. If I treated all of them and didn't charge (or gave big discounts) I would go out of business.

This topic is one that is near to me, which is why I wrote this article: Why are Vets so Expensive.

I know that every vet hates the fact that finances play such a big role in our decision making process with clients.

I hope what I have written hasn't upset you too much. It's just that it's not as simple as "let's try the surgery and see what happens."

So, if you were my client, and you fully understood that surgery was a big risk, and you were willing to go ahead with the tests and pay for surgery even if it is not successful, then I would consider doing this. But, from what you have told me I would likely still be advising against it because of the poor odds. If you did go ahead, I would also be making you sign multiple waivers explaining that you understood the risks.

I know it is really hard to see your little one not doing well. I wish there was an easier solution.

Dr. Marie

Customer reply:

You have been awesome and it all makes sense. I know you don't know my cats history from afar but I was just curious at face value if its age alone that would deter you from taking his spleen out to start or would you determine that by labs like the oncologist was saying? Perhaps its a good sign they didn't see other masses in other parts of the body that made them say no way to surgery?

I should say the cat already has had bloodwork and ultrasound and they sent those samples to a lab. And that is where we are at with taking out the spleen as a first step, which I guess doesn't mean its a terrible cancer or that it has to spread, etc.? They made it sound like at face value this could extend a semi normal life for him and that biopsy of some samples after surgery might reveal a cancer that some try with chemotherapy.

I totally get the cost thing and our vet is trying to make a deal with us for a quote to basically get him back at home which is reasonable. I totally understand that he could die during the operation or come down with something else later but i figured one day at a time.

They made it sound like its an hour surgery that a cat can bounce back from and extend his life with perhaps helping with symptoms.

Online vet, Dr. Marie

Dr. Marie replied:

I'm glad that my advice has been helpful. I had feared I had been a little too direct.

I think that age plays a big factor in this decision. In my mind, a 15 year old cat is quite an ederly cat and this makes surgery more risky than in a young healthy cat. The other potential issue is that there are other symptoms of sickness with the vomiting and diarrhea. In a young cat with no signs of sickness I would be much more excited about doing surgery.

Still, if your vet *is* recommending surgery, they wouldn't do this if they're not comfortable. It really is a tough call!

Customer reply:

Just curious is there a certain date I won't be able to reply anymore? I just wanted to share our outcome either way.

I am looking at my cat who still hasn't lost weight and eats and after being told of all the potential risks strictly my gut is telling me to go ahead with the surgery. We are waiting word any moment to get him in today or tomorrow.

I appreciate your feedback. I understand a vet is in a hard spot with grieving clients. Each vet I have seen has so much information that is above our heads, it seems they are robots.

What has been interesting is after I acknolwedged this with everybody I have seen thus far and asked them what their gut or experience tells them, they have offered no advice nor taken the position as if it was there pet.

The only thing I can assume is they are afraid of being sued or giving people hope in case something bad happens.

Online vet, Dr. Marie

Dr. Marie replied:

You can keep coming back. I haven't implemented a cut off date yet as most people don't abuse the system. :) I would like to hear of the outcome of this story for sure.

I hope everything works out for the best,
Dr. Marie

Customer reply:

He had surgery this morning and made it through with flying colors I am told and he was groggy and awake when they just called. They will give me an update in the evening and have him hooked up to an iv, etc.

He ate well the few days prior to surgery. He did have a barfing fit at 1 am and they had us fast him overnight. He was alert and ready to bug us early this morning sniffing out food. He was stuck at 8 pounds for a couple months.

I think they were going to biopsy a couple things but she said she didn't find major hardning or any growths in the intestines, etc. They took the splene out and a growth near the liver. She didn't say it was deeply attached but that there was some discolor on the liver.

So reading the internet scares me with all of these potential issues.

Right now they say it may take some time for the cat to eat and that its the next hurdle and healing.

Just curious if you might be able to shed light on what the major hurdles are for me in the near future?

Could he go into shock or get a life threatning infection, or are his odds better since he went into and through surgery without a trauma to the spleen, etc.?

thanks so much for any info. its wierd because i felt like i made the right decision and this call was good, but im stressed out now thinking about the next hurdle in the short term.

by the way i don't want to take advantage of the system, what should i pay as a bonus?

Online vet, Dr. Marie

Dr. Marie replied:

No need to worry about a bonus. I don't really run this site for the money - just for the chance to help out where I can. I need to charge something for the questions to limit the number that I get otherwise I'd be spending my entire day answering them. :)

So glad to hear that surgery went well. And also it is great news that there was nothing obvious in the intestines. It's hard to say whether the liver growth is something to worry about or not. I'm assuming they are biopsying it and should have some answers soon.

It's hard to say for sure what the next hurdles are. Sometimes with spleen surgeries, post op bleeding in the abdomen can be a concern. But, at this point the next steps involved keeping him supported while he recovers from surgery.

It sounds like he is in good hands and I would trust the advice that your vets give you.

Dr. Marie.

Customer reply:

Tomorrow my cat goes in for a 2 week post op checkup. He still seems in better spirits than before surgery and hasn't had any discomfort or complications that I can see. Would love your input on the following.

1. we experimented with denamarin this week since he has been off it before surgery. within 2 days he had diahrea and it stunk terrible. i feel stupid but its clear to me the diahrea was caused by this since he has gone almost a couple weeks without since surgery. he had some elevated liver levels still so the vet said we could try it. should i dump it and go with milk thistle?

2. weight fluctuates depending on the time of day but as of now he seems to be up a half a pound from the day his spleen was taken out. overall weight is the same as it was during the first vet visits a couple months ago but now he has no spleen so i guess that is good :)

a week ago at the post surgery checkup we talked about the barfing because he did have a fit one day the first week. vet said he was healing still but we could try low dose of prednisolone 2.5mg/day which he has taken fine.

he is 7.5 pounds right now, do you think its worth a try to ramp up his dose to 5mg/day suggested for a bit and then taper him down after seeing if he will put on more weight, perhaps settle down with vomiting?

i have no idea how quick this drug builds up in their system but he had another barfing fit a couple days after the last. BUT as of this message he has gone a record 5 days since the last barf. maybe coincidence or maybe the drug?

3. we have been on a routine giving him 1/4 pepcid ac day which is no big deal. we are also giving him 1/4 benadryl twice/day. is the benadryl just something we gave before surgery and after during healing in case his spleen spilled out with the histamines or is that going to be a long term treatment for mast cell stuff spreading?

4. is it possible that the mast cell in his spleen was putting stress on his guts and liver and that it could be related to the fluid around his liver and elevated numbers? if so the steroid is supposed to help him settle down and maybe the liver can heal? they didnt say his liver had anything but was discolored one a side with fluid and arent talking about a treatment for it.

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Dr. MarieDr. Marie is a veterinarian who practices in a busy animal hospital in Ottawa, Ontario. She created Ask A Vet Question as a resource for good, accurate veterinary advice online. Dr. Marie treats dogs, cats, hamsters, guinea pigs, and rats. She has been a vet since 1999.

Is an online vet visit just as good as a trip to your veterinarian? No! But, many times, asking an online veterinarian a question can help save you money. While Dr. Marie can't officially diagnose your pet or prescribe medications, she can often advise you on whether a vet visit is necessary. You can also ask Dr. Marie for a second opinion on your pet's condition.