Question for those who have dealt with Liver Disease or Pancreatitis

Hi all-

Recently, Raphael got sick...he dropped a lot of weight, all but stopped eating, was vomitting and was just very, very lethargic. We took him into the vet, had a CBC, urinalysis, fluids, x-rays...the whole shebang. The only thing out of the ordinary were a slightly inflamed pancreas and liver enzyme levels that were also slightly off. We got him to eat on his own again almost right away, he was prescribed denamarin and metronidazole and seemed to perk right up.

Except that on Friday his appetite started to get lower and yesterday he was very, very lethargic. No dehydration or vomiting this time, though! Yesterday he only ate a pinch in the morning, so I had to give him Friskies (turkey and giblets) + baby food, because that typically gets him to eat, and I can mix in his food again gradually. He's eating that again, and he wolfed down a full two heaping tablespoons of that about an hour ago like he hadn't seen food in 8 years. He's taken his meds relatively well..I've gotten the denamarin in him every time and I THINK I'm getting the flagyl in him, but he seems to pretty much drool most of it out.

My question is this: I'm worried about him because he seemed tobe doing so much better, and then he crashed. Any ideas of what could be causing this? Do I need to take him back in for more tests? The CBC and X-Rays were about a week ago, I believe. Either 1 or 2 weeks ago. He was doing great until Friday, and he seemed to relapse, but not completely.

Ideas?

I think the success you had was only a temporary fix - the underlying cause needs to be determined.

I think I'd be asking for X-ray/ultrasound.

If it were I, and if I were in the "windy city", I'd insist on a referral to a specialist at the University College of Vet Medecine.

You may want to touch base with kittymonsters
http://www.thecatsite.com/forums/sho...d.php?t=171959

A couple of other points...

You need to be very ware of his food intake as well. Cats who are not getting sufficient nutrients (at least half of their daily caloric needs) run the risk of developing another, potentially fatal liver disease, hepatic lipidosis. In the absence of nutrient, the liver draws on body fat...trouble is (and, only in cats) the liver "bites off more than it can chew", so-to-speak, and the liver itself turns to fat. Sometimes, assist-feeding is required if a cat won't eat.

I know that diet is also critical in cases such as this...kittymonsters has been preparing Stomper's meals for some time now...

Well, I guess they were already suspecting that? Or something?

He ate really well all week, and it looks like he just crashed again in the past few days. I got him to eat 1/3 of a can of crap food tonight, but it's all he's eating. And I tried to give him more just now and he refused.

This cat is semi-feral. I can hardly get the pills in him, even so, I have to have my husband wrestle him to the ground, wrap him in the bathroom rug, scruff him and then I basically have to rip his mouth open. So force-feeding him would be nearly impossible. I'm thinking a feeding tube is going to be his only nearly-impossible-incredibly-stressful option, but at the same time, he ate on his own for a full week, and had a very good appetite.

Could we just be having another episode of the same thing? Do I need to take him back in and have him retested? Even though the last CBC was a week ago?

This is not a cat who tolerated a great deal of medical intervention, and I can't really afford a mutil-thousand dollar vet bill at this point. We've already dropped $600, just to find out that his liver enzymes were a little off.

He has been X-rayed, and it was 100% normal.

The B-vitamin injection seemed to really perk him up. Is that a fluke or normal? I know I could potentially do those at home, and I think I'd like to if it'll help.

b vitamins are great for energy and metabolism

I have been going through this with my kitty stomper. Cats usually get a sub clinical form of pancreatitis, often associated with IBD.

For stomper his seems to have been triggered by gallstone/gallbladder sludge. He went through repeated bouts of anorexia and or vomiting for many months. Even with prednisone he was having bouts every couple of weeks.

Read up on feline triaditis. You can search gallstones here and Stompers thread will come up.

Have the doctors given you cyproheptadine to help with his appetite? This works great to keep them eating, if they are not vomiting.

They also tried pepcid to keep the acid down, but I don't think that did anything to stop him from being nausous.

The metronidozole also comes in a pill form which may be easier than the liquid. Exspecially using Greenies salmon pill pockets. A little trick I have learned.

Stomper has been stable and doing extremely well ( knock on wood) since his gallbladder removal surgery. This seems to have been his trigger for the pancreatitis.

For the definitive dx of pancreatitis you need a fPLI test which is very expensive, I paid $100 for the first test, and $160 for the second one at the specialty vet. I must warn you, Stomper's treatment over the last three months has cost over $5000.

The vets are going to want you to feed a limited ingredient veterinary diet. I have found though that Stomper does better on his homemade grain free food.

Stomper had elevated ALP and AST liver enzymes as well. No hepatic lipidosos but I am a bit fanatical about making sure the cats eat. I had a kitty die of HL. Since his surgery his liver enzymes have gone back to normal.

please feel free to PM me if you have any specific questions. Lots of and for you and Raphael

km - it's a relief that you're on board!!!

ionessrampant - my own sense, from what you described, is that this is not an "episodic" thing. What caught my eye was the weight loss, inappetence, vomiting...

Pancreatitis "comes in all shapes and sizes"...symptoms can be from "sub-clinical" to mild to severe...so, IF that's what's going on, perhaps it's a mild "form"/state.

I have to tell you, the images you triggered of you and your husband wrestling with this semi-ferral were priceless. Better you guys than me!

Now, you mentioned his aversion to medical treatment. I've found that, the more pleasureable I can make health "stuff" the easier for all, this time and for future times. Treats and syringes of tuna juice for post-pilling work wonders....

Tests...I'd probably have the liver enzyme values done, and discuss with the Vet about having the fPLI test. It's the only accurate to rule in/out Pancreatitis.

I really, really don't have $5000 to spend. Please don't think I'm a bad person, but we keep a little over $1,500 for vet emergencies, and he's now eaten through $700 of that. I need to spend the rest of the money as wisely as possible, while keeping in mind that I have 2 other cats.

This is not a cat that would tolerate a large amount of invasive care. He is semi-feral, and he can barely take a pill without hurting himself and others. I realize that I can have him gassed-down, and for the first round of tests, I did. But it's not something that I've been told I can do over and over and over and over again safely, especially rapid-fire like this.

I took him in this morning for an in-clinic little diagnostics test, and his liver levels are improving, though they are still not great. He was not really eating, and he STILL isn't really eating. They gave him fluids, a B-Complex injection and prescribed him prednisone for the IBD/Pancreatitis, which I don't know why he didn't have it before. We're going to continue that and the denamarin for now.

I'm just really concerned about his appetite. He gained back weight, and then he lost nearly all of it again. The vet didn't prescribe anything to stimulate his appetite...should I call back and ask? Admittedly, if I had to choose between a pill and syringe feeding him, I'd take the pill.

Like I said, I can't afford hugely expensive diagnostic tests to tell me that I can't do anything to help him anyway...the vet felt that with the improved liver levels, the treatment is helping these symtoms level out and get stabilized. At this point, they believe it is a severe IBD flare-up, pancreatitis and some form of liver disease. We are going to go ahead and treat those symptoms and suspected causes.

You are going in the right direction. The big expense for me was the gallstone surgery and 3 ultrasounds. If no gallstones showed up on X-ray and they looked really closely for them, you can put off the ultrasound for now. US will run 200-350$

Please call and ask the vet for some cyproheptadine pills to help stimulate his appetite. These work wonders for Stomper. They usually have you give 1/2 of a 4mg tablet twice a day. Stomper only needs 1/4 a tablet otherwise he becomes a non-stop eating machine.

When their liver values are bad it makes them feel punky so they don't want to eat. The less they eat the less they want to eat and it is a catch 22.

The Denamarin really helps, IMO.

Has the vet talked to you about food type? This will probably make the most difference in the long term.

If Raphael doesn't have gallstones then meds and food will be his treatment for life.

I don't have any advice but you had asked why the vet didn't give an appetite stimulant. When Riley was sick last month and stopped eating, my vet didn't want to give steroids because of possible side effects among other reasons. I was able to successfully syringe feed him though and get him past the worst of it. With yours being semi-feral this may not be possible.

Just a side note, cyproheptatine isn't a steroid. It is actually used in people with anorexia as an appetite stimulant as well. It is also used for cats with CRF that are not eating well.

I don't think it is commonly used for HL for some reason, but I do know it is used in IBD, pancreatitis and cholangiohepatitis to help the cat eat and prevent HL from developing.

It is at least worth asking about. The vet might have a very specific reason for not using it, or might not have suggested it thinking you would not be able to get it down Raphael. Using the pill pockets helps greatly even when they don't want anything else to eat.

Ok, correction: I went in and got to talk the vet myself today, and looked at the levels myself. He doesn't have HL. He just has elevated enzymes. He's too skinny naturally to be a high risk for HL, and even so, he was basically eating, albeit irregularly, before. He has been given denamarin, and in 2 weeks, they brought the liver levels down, but not down enough. We are continuing with the denamarin.

As far as that X-Rays...there was SLIGHT/boderline inflammation of the bowel and pancreas. He has been given prednisone for this. Everything else was totally normal.

So, we are on pred and denamarin. No special diet, though he is on an all-wet, grain-free and pretty limited ingredient for something you can buy at the store.

The vet said he probably didn't need to be on fluids long term, same with the B vitamins, and honestly, I believe I'll have to disagree. He gets a little dehydrated whenever he goes on these hunger strikes, and I know how to do Sub-Q fluids, and I wish I just had the supplies so I could do it at home. And skip the obnoxious vet. When does my vet get back from his trip abroad again?!?!?!

This vet wanted me to do all these fancy diagnostics, when he's "almost positive" the problem is just liver function and the slight inflammation of his pancreas and bowel. I'll say it again: this cat can barely handle an X-Ray, and it was seriously a huge 72-hour production number for this cat to get a dental. I can barely pill him, get him in a carrier and let's not even talk about the digestive pyrotechnics that happen when I try to put him in a car. I really, really have to be careful about managing both our finances and Raphael's stress level, especially when his little body isn't functioning well.

I went through something similar with one of my cats. He had episodes like this over a period of about 18 months and stayed at the vets twice on an IV for dehydration. Three vets and $2,000 later they never really figured out for sure what it was but thought it was episodes of pancreatitis. He has for the most part come out of it. Every few months he will be sick for a day or two including not eating but it isn't nearly as bad and he comes out of it on his own. I know it is frustrating, I was at the point where I was considering euthanasia because I couldn't continue with the large vet bills and no resolution.

Originally Posted by Denice

I went through something similar with one of my cats. He had episodes like this over a period of about 18 months and stayed at the vets twice on an IV for dehydration. Three vets and $2,000 later they never really figured out for sure what it was but thought it was episodes of pancreatitis. He has for the most part come out of it. Every few months he will be sick for a day or two including not eating but it isn't nearly as bad and he comes out of it on his own. I know it is frustrating, I was at the point where I was considering euthanasia because I couldn't continue with the large vet bills and no resolution.

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And honestly, that's what I've heard...that it's nearly impossible for them to really zero in on issues of the liver/pancreas, even with fancy diagnostic testing. I just told the vet to put him on the maximum "blanket" supportive care for those systems and we'd see what happened. I must admit...his poor appetite is soooooo scary, because he gets dehydrated by the third day of poor eating and then he's just a little heap on the floor, poor thing.

I'm going to call tomorrow about getting something to stimulate his appetite. I'm really hoping the pred and latest round of fluids and vitamins perk him up.

He is acting much more "himself" today after fluids, and ate about 1/2-3/4 of a can of food today...he usually eats 1 to 1 1/3 in a normal, healthy day. So, at least he's over half of his daily nutrients.

UPDATE:

Got Raphael in with my regular vet (THANK GOD!) and he very strongly believes it's triaditis, which will be manageable with medication. The pred and denamarin have helped ENORMOUSLY, however, he suggested trying amoxocillian and/or actigall in the future.

Apparently, the X-Ray was somewhat flawed, and my vet wants to do another one, just to be really, really sure that there's no lymphoma, but he doesn't think there is. His enzyme levels were not THAT off, other than his alk. phos. which is almost back down to normal thanks to half a course of denamarin. Lymphoma responds to pred in cats, so he just wants to quadruple check. He was not happy with the other vet's work either.

We will likely do another X-Ray and a biopsy when the meds are finished and we have a better idea of what's responding to what. If it's triaditis, we'll treat it. If it's lymphoma, which it hopefully is not, we'll do supportive care and keep Raphie comfortable

Originally Posted by lionessrampant

UPDATE:

Got Raphael in with my regular vet (THANK GOD!) and he very strongly believes it's triaditis, which will be manageable with medication. The pred and denamarin have helped ENORMOUSLY, however, he suggested trying amoxocillian and/or actigall in the future.

Apparently, the X-Ray was somewhat flawed, and my vet wants to do another one, just to be really, really sure that there's no lymphoma, but he doesn't think there is. His enzyme levels were not THAT off, other than his alk. phos. which is almost back down to normal thanks to half a course of denamarin. Lymphoma responds to pred in cats, so he just wants to quadruple check. He was not happy with the other vet's work either.

We will likely do another X-Ray and a biopsy when the meds are finished and we have a better idea of what's responding to what. If it's triaditis, we'll treat it. If it's lymphoma, which it hopefully is not, we'll do supportive care and keep Raphie comfortable

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YEAH!!!!!! I have been thinking of you two. This is great news. ( well as great of news at triaditis can be ) The meds work great though and you have him on a great diet already. I am so glad you got in touch with your regular vet.

I have supplies at home for Zoe's CRF, so I did do fluid and cypro and pred when a flare up started. Of course this is only because I was working with my regular vet who knew me and Stomper well. After the first couple of episodes we learned it was best for Stomper if I had everything at home and just called in to ok things. e.

Once you and Raphie and your vet get in sync this will be much more easy to control.

great big giant for you. I am SO happy things are going so well.

Originally Posted by kittymonsters

YEAH!!!!!! I have been thinking of you two. This is great news. ( well as great of news at triaditis can be

) The meds work great though and you have him on a great diet already. I am so glad you got in touch with your regular vet.

I have supplies at home for Zoe's CRF, so I did do fluid and cypro and pred when a flare up started. Of course this is only because I was working with my regular vet who knew me and Stomper well. After the first couple of episodes we learned it was best for Stomper if I had everything at home and just called in to ok things. e.

Once you and Raphie and your vet get in sync this will be much more easy to control.

great big giant

for you. I am SO happy things are going so well.

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Yeah, my vet was saying that cats in liver failure or with advanced cancer/lymphoma usually don't respond quite this well to the denamarin, but lymphoma symptoms are potentially helped by pred, so he just wants to be sure. I guess his Alk. Phos. was up near 305, and now it's down below 100, with the normal range being 60-100. I could be wrong on the EXACT numbers, because I'm just remembering...the other levels are hoovering around normal now as well, and he was saying that it's promising that we're dealing with something manageable like triaditis, so we're going to work on that diagnosis until we can get a biopsy and x-ray in. We'll probably do that right after the holidays, since he has 3 weeks left on the denamarin (a 6 week course in total) and 4 weeks left on this course of pred. I also want some time to put money aside for these procedures.

Since his first X-ray appeared normal other than a little bowel inflammation and his kidney-related levels and glucose were completely normal, and have BEEN completely normal, that further leads my vet to believe it's triaditis.

But, he's acting 100% normal and his appetite is BETTER than it's been in months, so I'm hopeful that it IS, in fact, triaditis since it's responding to these meds. He's had IBD-like flare-ups in the past, but not to this extent. This is probably something that's been going on/building up for a while.

Ok, so I got the skinny on why we're doing what we're doing...

The first course of meds was metronidazole and denamarin (which is basically a compound of samE and milk thistle), and that was to address the bacterial aspect of the liver problem, which the original vet suspected was some form of hepatitis, and they always apparently start them on anti-biotics when this is the case.

Once the anti-biotics were finished, and any bacterial problems were caught, he is on pred to supress his immune system and bring his bowel and pancreas into working order, which immunospuppressive agents such as pred are the best possible way to do this. However, it's not great for his liver, so he continues to be on denamarin.

When he's done with the pred, we'll check his liver levels, glucose, and kidney function again, and it's highly likely we'll even do a biopsy and addition X-Ray at this point. It's likely that his liver levels will still be a little wacky from the pred, so at that point, it's a possibility he'll go on something a little more heavy-duty for it, such as ActiGall Rx.

How is Raphael doing? I hope he is well on the road to recovery.