Intestinal Lymphoma vs IBD

Dozy Mare

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My TB mare (12yo) had been gradually losing weight up to Christmas, she'd been a bit fussy with her food which was unusual for her as she had what we thought to be an allergy/grass glands (vet thought so too) so we just put it down to that. Then all of a sudden, in the space of 3-4 days at the start of this month, she just lost all of her muscle condition. She was never fat but she genuinely wouldn't have scored on a body score, it was awful. Bloods were taken and showed low protein/albumin levels which suggested her gut isn't absorbing food properly. We scanned her, scoped her and took some biopsies of her gut, all of which were normal bar one which showed some cells that make them suspicious of lymphoma but not enough to be definitive (as you can guess we're tearing our hair out now). The scan showed some thickening although this may just be scar tissue. We've put her on steroids and she seems to have improved a little - her appetite is huge which is a nice sign (she must be getting 5kg+ of feed each day split over several meals). She's really happy in herself and thinks life is wonderful as she's getting lots of cuddles, feed any time anyone comes near her and she's just doing very short, steady hacks (to keep her sane as she's prone to going up without). Over the last few days she's been struggling a little with her feeds. This may just be because she's full to bursting but today though I noticed she's not eating her hay. The quality is very good and it's really unusual for her as this is all she's been consistently eating all the way through. I'm just worried that she's going to take a step back when we seem to be making some sort of progress.

I was wondering if anyone had any experience with intestinal lymphoma or inflammatory/infiltrative bowel disease? Lymphoma is not really treatable and we've prepared ourselves for the worst (although it'll never be enough) but it's just awful not knowing. I guess I just want to know if it is lymphoma how long we've got (it's the one question I dared not ask the vet and there's so little info out there)?
 
Stomach cancer is just so awful certainly in people so i guess it must be the same in animals, how sad for you and her, i hope you find the right answers, thinking of you both.
 
Thanks putasocinit. I'm just glad she's happy in herself, she has no concept of anything being wrong which, for me, is the main thing.

SusieT that's correct but with the low protein levels in her blood healing will be slower alongside some of the other risks. Part of the problem is that they'd have to pull some of her gut out to do it which would cause trauma plus they'd want to do it under sedation which she fights to the bitter end. She absolutely will not be sleepy and all of a sudden comes round in typical TB style before almost dropping off again. I wouldn't put kicking someone mid-procedure past her. Treatments for lymphoma and IBD are both steroids so realistically a definitive diagnosis is of little use apart from the peace of mind (this still depends on whether or not the steroids keep having a positive effect on the symptoms of IBD) or for the insurance. Unfortunately, it just has to be a waiting game for now.
 
I'd want to re-biopsy the suspicious area again before I go doing an operation. I'm unsure as to what would be gained by having an operation because to see if it is lymphoma, you'd need to look at the cells making up the suspicious tissue, not just looking at the suspicious tissue itself, so in my mind, an explorative laparotomy would just be a roundabout way of getting a sample, which could be done via an endoscope.

Has the vet discussed this with you, or are they proposing a bowel resection, where they would remove some of the intestine?

Either way, it must he difficult dealing with it on a day to day basis, and I hope everything turns out as well as it can for you!
 
That would be absolutely ideal but unfortunately is not realistic as the problem lies in the small intestine which means we have 15-20m to play with. The scope was at its absolute limit and we have no accurate way of knowing exactly where the original biopsies were taken especially since they were so small.

All that's been proposed is an explorative laparoscopy and the steroid treatment we are currently using. I don't think a resection is an option here due to the nature of the cancer. Because it is in the lymphatic system it spreads around the body very quickly.

I'm sure you can see my dilemma as we've got our hands almost completely tied. It's a horrible situation and I'm no good at waiting at the best of times! Thank you for your help though.
 
Ahh that makes complete sense. If it was large bowel it would be a bit easier to deal with with the scope.

Wish you and your mare the best of luck with it, fingers crossed the steroids have an effect!

Also, have you spoken to your vet about the question you asked in the original post? I understand it's a difficult one to broach, but I suppose a professional opinion could go some way towards easing your concerns.
 
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Thank you for your help and concern. I really wish your suggestion was viable! Genuinely got quite excited about it before I thought it through. She's definitely improved, her appetite had been up and she's put on a little condition but it will be a long slow recovery if we can get her there. Her appetite does seem to be slowing though and she can be fussy with getting the steroids into her - we've tried her with treats, apple, carrots, banana (she thinks we're poisoning her), juice...all sorts as well as her normal feeds! Horses, eh?

I haven't spoken to the vet as I haven't seen her and it's not a subject for a telephone conversation I don't think but it's definitely on the books for her next visit. She'll be coming back for some more bloods in a couple of weeks (we review them every fortnight/3 weeks).
 
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