Sick cat in liver treatment

danjoan

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Hi - I was hoping to gain some information. Anything at all would be acceptable, really. This story may get a little TL;DR, I'm sorry!

My 11 year old cat, Pepper, has been sick a little over seven weeks. During the period of May 27th until June 6th, I was out of town, leaving her in the care of my mother. Over the course of my vacation, I was receiving updates on how she was doing/what she was doing, which all seemed perfectly normal. Only thing that wasn't normal was the fact she 'wasn't eating that good.' Now, our first thoughts was that the cat was stressed and missing me. My father had just recently moved into the home after being absent for about a half a year, but she didn't get sick/stressed when he left... then again, my mother and I are her primary caregivers so it seemed plausible. Anyways, my mother told me she wasn't eating dry food very well, if at all, and that she was putting two types of wet food in her bowl which was picked at very sparcely. When I arrived back home the night of June 6th, Pepper seemed like the cat I left for a little over a week, pretty much. She missed me so much she actually slept with me a few nights. The next morning, I came down with a cold and was in bed from Mon-Thurs. I was not monitoring how my cat was eating and my mother passed it off as "her just being picky" until it was too late - she wasn't eating at all. This prompted my mother to tell me to do some research. Admittingly, I was unaware of most illnesses older cats can get, which was completely my fault. Pepper's regular vet wasn't in on that Friday, so we went to another vet. That Friday, Pepper had blood work and urine samples taken. Her bilirubin was high but she was not jaundiced. There was no indication of a hyperthyroid or diabetes or any of that. The vet was actually a bit perplexed as to why she stopped eating in the first place, but was not very helpful with us in determining what could be done. She sent Pepper home that evening telling us "get her to eat whatever you can." Time kept passing into the weekend and we were told we could try syringe feeding, so we bought Hills A/D from the vet for about.. two weeks. Sometime after that weekend, or perhaps even during it, Pepper became jaundiced, whereas she wasn't when she went to the vet. Every day the vet would suggest something new... which could have been told to us in the beginning. The last time we spoke to this vet, she suggested milk thistle. Well, we put that in her food for weeks, but it seems like to no avail. Or it didn't help quite enough.

Fast forward to now. It's been seven weeks this Friday since she went to the vet. After Hills A/D became a bit too expensive on the regular, we switched over to Fancy Feast. Fancy Feast had higher levels of protein, of which we were sure would be better for her. She's been taking it rather well, and I'm convinced the yellow in her skin is decreasing. She's definitely not a deep yellow, but she's still a very sick cat. There have been days where she has picked up and ate on her own! Well, one day in particular - she ate a little bit out of the can and even tried some dry food. She only did it one day and ever since then it's rare to get her to eat something on her own. A treat, maybe. Licks the gravy off the top of the food, maybe. But never genuinely eating on her own. Is it normal for cats with HL to have ups and downs like this? She shows an interest when she knows you have food, but she puts her nose to it and walks away. She does not vomit every day, something that cats with Hepatic Lipidosis are supposed to do. That's not to say that she doesn't vomit - in fact, she just did it earlier, but I'll get to that in a minute. She definitely was vomiting more in the beginning of all this. She might vomit once or twice a week now.

Notable things going on with her:

-Not drinking water (she was in the beginning, a few days after the vet visit but not on her own now). We have been giving her water in the food, to get it in the syringe of course, and giving her regular water also through a syringe daily.
-Not eating. She has tried a few things off and on, a pinch of tuna for instance.
-She seems to be urinating quite a bit. It's hard to tell how much but when she's not laying around, she frequents the bathroom. When she went to the vet, her urine was orange, but it doesn't appear to be as orange anymore. It's hard to tell from the cat litter, but it's not orange-orange anymore, definitely.
-She is constipated. If she spends too long straining to get something out, she will, after leaving the box, throw up her food. That's not to say she hasn't been getting hardly anything out though. In the beginning, she was barely getting anything out at all. But when she does get some out now, it seems pretty normal in length and size. I can't comment on if the color is off, however.
-Her breathing is a bit heavy. This started.. well, a couple weeks ago. I don't think she had it in the very beginning. I read that a cat might have a bit of heavy breathing as a result of the jaundice; I could be wrong. When I pick her up to prepare her for her feeding, she starts breathing heavier since she's nervous. It seems like an off and on thing in terms of how heavy she is breathing. Her voice seems a bit cracky as does her purr.
-As I said earlier, she is jaundiced but it seems to be getting lighter now. She's not extremely yellow but she is not a desired pink either. Her nose is dry.
-She has not been grooming herself outside of cleaning her paws a bit. Before she vomited earlier, she was having trouble with the constipation issues and after she got something out, she tried to lick her behind but stopped herself. I know at least this much that when a cat is trying to lick down there specifically, there might be something bothering her there. Is it worrisome when a cat strains, does nothing, jumps out of the box, a few minutes later repeats the process, and then eventually does something?
-She lays on the bathroom floor or behind a particular couch a lot. Doesn't want to look outside too much or lay in the sun (something she probably needs to do for the jaundice but it's... not to her liking). When she goes outside, she does attempt to eat grass.
-Her head seems a bit warm at times.
-She seems a bit bloated, but seems to be picking up some weight that she lost.
-She has good and bad days. I wasn't awake to witness it, but my mom claims she jumped up on my mom's bed at a fast-paced run only to stand up on her back legs trying to catch something in the window. And yeah, she sporadically tries to eat on her own but only to not show interest the next day. She started 'love-biting' again the other day, too, which seemed to be an improvement but hasn't done it again since.

That's all I can remember off the top of my head. The only thing my mother and I have to go on is the hope that she only has Hepatic Lipidosis and that the jaundice combined with the illness is causing all these other symptoms. She's a pretty strong cat, so I have faith in her, but the clock is ticking and I'm constantly worried. It's my responsibility to take care of her, and when I can't do that to the fullest extent, I feel heartbroken. I feel bad that I left her that week and a half and wasn't able to catch this problem in time. Regardless, I will keep feeding her daily and see if her condition improves within the next week. If she has HL, which is still the most likely candidate, then giving up now would be senseless. But... if by next Friday she's still not eating on her own, can this be considered something other than HL? (I read typical feeding time would be 6-8 weeks..) Is it normal for cats with HL to have up and down days? Is this a slow yet steady improvement on her way to eating again?

Finally, is it imperative that she get to her regular vet immediately and what can they do for her? Stupid question, I know, but the least they could do is take blood and urine samples again and I don't know what good that would do us in terms of finding out the extent of her condition. It'd be like repeating steps A and B again, but is that for the best with this condition? It's been seven weeks, so things could have changed, but forking out another $250 for that bit of information when something else could be done better wouldn't be good. I'm answering my own question here, but only a vet can tell me what to do indepth; I'm just trying to get some possibilities. The vet we took her to that Friday never looked at her teeth, so I've been wondering if she might have a tooth problem. And can her condition take a turn for the worst at any moment, with these symptoms? I've read many things on each particular symptom but not when they're in correlation with liver disease.

If you managed to read this far, I take my kitty ears off to you. Any comments would be appreciated - any at all. I understand the circumstances and am getting ahold of the vet for her opinions here shortly.

~ This is my furry sister; she means the world to me: http://i26.tinypic.com/2upwsiu.jpg ~
 

katkisses

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Whoaaaaaaaaaa!

I just got chills, hun I am going through the EXACT same thing! He IS jaundiced, not eating much at all, not drinking at all, I am force feeding l/d and a/d, giving fluids every day, ect ect ect.

I am going to PM you after this, I am soooo curious now. Maybe my cat isn't "just sick' maye something caused it! Food? Litter? UGH.

My Bear got sick on April 17th and has been sick since then, the vet it totally puzzled and his best guess is FIP. Cats don't usually live this long with FIP though... It's usually just weeks. Bear has had an Ultrasound, it showed that his liver is enlarged and he has pancreatis. Cause is unknown. Vet's other guesses were Cholangiohepatits and a severe GI tract infection. Ask your vet about those.

Bear is on: Milk Thistle, Pred, Amoxicillion, Metro, Ursodiol (ask your vet for this!), Famotidine, and gets 100 units of SubQ fluids daily. I give the fluids myself, it is not that hard. It seems overwheling at first, but it only take me 2 mins a day to give Bear fluids. They REALLY help him, he perks up right after he gets them.

I have been trying everything, and getting creative too:
~Raise her bowls, it may help with nausea.
~Try differnt flavor and differnt brands of food, fish, chicken, beef, ect.
~Try human foods, Bear ate a whole bunch of Baked chicken for a few days.
~Try human tuna in water, and baby food (NO garlic or onion in the ingredients list).
~Try treats, Bear would only eat Tempataions for weeks. Now he will not touch them. ~If she isn't on a nausea med, ask to try one. High Bilirubin makes them nauseas.
~If you can afford it, try an ultrasound. It didn't help us any, but it ruled out cancer/tumors
~When you check her color, hold her in a sunny window. Natural light seems to show the yellowness better, under artificial light I can't even tell that Bear is yellow.
~Put her back on Milk Thistle, it wont fix her, but it may help prevent further liver damage.
~The orange pee is from her Bilirubin being high. (Yes, I ask the vet ALL of these questions LOL!)
~Constipation may be from the food, possibly because she isn't getting enough fluids. Bear didn't poop for a while when this started, now he is regular. No idea why either. Push this issue with your vet, it sounds pretty bad.
~The heavy breathing bothers me. Did the vet check her lungs/abdomin for fluid? Could it be from an enlarged liver pushing on her lungs? Could be the hot weather too.
~That is WONDERFUL that the jaundice is fading, that means her Bilirubin is going down.
~Bear hardly cleans himself either. He sometimes washes his face/paws after a feeding, but nothing more than that. No idea why, he isn't depressed at all.
~They can feel like crap with liver issues (pain from an enlarged liver, nausea, weak from not eating, dehydration, ect)
~Do not stress her at all, stress can make it worse.... whatever IT is...
~Bear's sides seem... slightly more dense too. I think it is from an enlarged liver.
~Bear has his ups and downs too. He went for weeks without touching food (I am force feeding too) now he has been eating a little dry each day. It is a roller coaster to say the least...



Hang in there, you are NOT alone in this.





What meds is she on?


I am so sorry, this sucks SO bad. If we JUST knew what it was doing this......


I have some awesome websites about this type of thing I will PM you.


I hate that you are going through this, it is horrible.
 

farleyv

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Ok, the only thing I am going to say is get her to another vet asap. Was there ever a diagnosis of HL or is that just what the vet thinks.

Too many issues here with your kitty and, frankly, a vet who IMO is not going full out for her.

Please, get to the regular vet.....today.
 

otto

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I agree that a second opinion is imperative. Gather all your records and find a vet who specializes in feline internal medicine if possible.

Welcome to TCS, and please keep us updated on Pepper! Is she still on the milk thistle?
 

mizmelzy

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Soo sorry that you are going through this with your cat. I know it's not easy at all. I am sending lots of healing for your kitty. I hope you can find a vet that can help you diagnose the issue.

Sending lots of
to you both!
 
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danjoan

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Pepper has an appt set for 9:15 AM in the morning with her regular vet with the records from seven weeks ago being sent over fax tonight. If her condition worsens to that of an emergency overnight, we'll have to pay a fee but overnight response can be set up so that's at least comforting. After I posted this morning, Pepper love bit me multiple times, rubbed her teeth against surfaces, purred for a good while, and even plopped over happily once. But, deep down, I could see that she was really hurting. I mean, she was breathing a bit heavy and the purring was probably straining her so I tried to distance myself from her. Oh, and her stomach was making... rather loud noises at one point. I'm trying not to think the worst but could she have gotten CRF right at the time of the liver failure but this was covered up? Wouldn't blood and urine tests show signs of more than just the bilirubin being off if she had CRF though?

Earlier, she tried to use the bathroom and didn't get anything out so she went back and laid down, not trying again like she did last time. There was never a diagnosis of HL but it was definitely suspected since the only thing showing up at the time was a liver problem. Cholanglohepatitis was also suggested and I was told to "look it up". Nothing else...

Pepper is not on milk thistle as we ran out recently. When we bought the first bottle, there was only one bottle left in the store. It was at a GNC about 20 miles from here and the only GNC that was carrying it. I'll call here soon to see if that GNC still has that one bottle left. I don't know of any other supplement stores around.

@KatKisses: I'll write down all those supplements/meds and show them to the vet in the morning, thank you! Pepper is not on any meds at this moment. She was on an antibiotic for the first week after seeing the other vet, though. In response to your brackets:

-She won't take anything out of a bowl. She barely takes anything out of a can.
~We have been trying different types of food. As of right now, she has many different flavors of Fancy Feast at her disposal. It's hard to find the seafood kind.
~She does try human foods! Probably not a good thing to be pumping into her already damaged liver, but hell, we tried. She ate a little bit of white meat chicken (baked) and she nibbles at tuna. Won't eat cheese, something she usually likes. Also won't eat fish or hamburger. I'm afraid to try too many other things.
~Tried human tuna, yep. She nibbles at it but seems to take it willingly, just not as happily as she used to. Baby food.. haven't tried that. I'm thinking it might be a waste since she won't even eat things she loves, but I could be wrong.
~She has taken a few treats! I bought two different kinds recently. She started out liking them but then started turning them down more.
~We'll see what can be done in the morning or what can be suggested as far as an ultrasound goes.
~ I will do that! The lighting in the house doesn't change too much and I've been checking her in the same spots and in different spots and I'm noticing some changes.
~Will do. Or try to. It's been a bit hard to find here.
~Haha, that's one of the only helpful things the vet said to us when she took the urine sample. We were able to narrow it down relatively easy cause of the pee.
~Hmm you may be right about that. She wasn't using the bathroom in the beginning shortly after she stopped eating but there for a while she was picking up relatively fast. I mean as in she's been using the bathroom steadily and regularly and yet now... she seems to be struggling more. We've been on Fancy Feast for a little while now so I don't think that's it. Unless it's the fact it's so thinned down causing problems.
~She wasn't breathing heavy when the vet saw her, which is why I'm worried. It only started after a couple weeks. It could be one of the two things you said. I highly doubt it's the weather but that probably attributes to why she's laying on cold surfaces and near AC.
~I can only hope it's fading.
I want to say the jaundice is causing these symptoms but that's not looking too likely.
~Yep, same as Bear.

~Yeah she does seem really lethargic. She perks up but it's hard to say.
~Stress is something I'm worrying about, yeah. I'm afraid to leave the house for long periods of time even. I know for sure though, that she will be stressed when it's time to take her to the vet. She hates going to the vet. It's liable to make her condition seem worse than normal even.
~I think so, too. She is built like a pear almost.
~Definitely a roller coaster.
But we have to stay strong for Bear's and Pepper's sakes!
 

mews2much

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Some of what you describe she is doing sounds like CRF but it would have shown up in her blood tests.
There are many other things your cat could have.
I have a very sick cat with CRF that now has Anemia.
Do you know what the BUN,Crea and Phos are on your cat?

 

katkisses

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Has her urine pH been checked? Maybe she isn't constipated, but has crystals.

Walmart, CVS, and other Rx stores sell Milk Thistle. At least I know my Walmart & CVS sell it, the only thing is that the MT at walmart is 1000 untils.

That is crazy that your vet doesn't have her on meds! I doubt that this is something that will just go away on its own. Bear gets noticeably worse if I run out of Ursodiol/Famotidine. I still think she needs fluids too.

Try different types of bowls, ceramic, glass, big, little, stainless steal, whatever you have on hand. Try small saucers too. I know Bear is like that too since being sick, he prefers certain bowls. Most of my cat bowls are small glass/ceramic bowls intended for humans that I bought cheap at yard sales. They look like some of the bowls in pet stores, some look nicer lol. I get some of them for 5-10 cents!

I try not to worry too much about what Bear eats, if he will eat it - he gets it. He actually ate hamburger for a couple days until he lost intrest, I cooked in on a George Foreman grill and most of the grease went in the drip pan. He didn't even like hamburger when he was healthy lol. I keep getting different flavors of cat food from my family members who have cats, I just ask if I can have a small zip bag for him to try. He rotates what he likes, he may like 9 Lives dry (sorta) right now, but tomorrow he may make a face at it. Today, I gave him a boiled egg white, he seemed interested but just licked at it. I mixed some wet with it and he picked at it, but he didn't eat much - if at all. You just have to keep trying, if she turns her nose up at something today, that doesn't mean she won't change her mind tomorrow. Bear changes his mind ALL of the time. He was eating Iams for a while, decided he rather have Friskes, then went back to Iams.

I deff recommend trying Whiskas Temptaions Treats, if you haven't. Bear has been eating them the whole time he has been sick, until reccently. Also the fish flake treats, they look paper-y but the smell so fishy that Bear likes those, even though he won't touch tuna right now. I sprinkle them over his dry, hoping he will eat more dry.

I would stay far away from the vet who is currently treating her, yes the vets are not sure what exactly is going on, but he should be making guesses and trying something. Bear would have died if my vet didn't put him on meds, I am sure of it.

When you get the bloodwork back, ask the vet for a copy. Like I said in the pm, CRF would show up in the Bloodwork, but your vet doesn't sound very competent...

I forgot to add eariler, regarding the fluids/bloodwork: if she is a little dehydrated, it can make her bloodwork levels higher... think of it like concentrated juice mix, when you add water it gets bland-er. Ask the new vet to check for dehydration, she may or may not need SubQ fluids.

You might need to write your questions down lol, I always do or I forget.


Many more
 

otto

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Thinking of Pepper this morning at the vet.
Pepper
 
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danjoan

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Aww, thank you otto!


Pepper's trip to the vet today covered a lot. I love her regular vet so much. We did a run down on everything and with the previous tests, and chronic renal failure is out. We're basically narrowing it down to a liver problem, with the liver/jaundice issues causing the fever, the heavy breathing (due to the enlarged liver, it's causing pressure on the lungs abit), etc etc. Pepper is going to be on fluids for a while and she's now on an antibiotic called Cephalexin. Pepper... is not going to do good on fluids, let me tell you. It was a complete nightmare to get the needle in her even for the vets. She was wild and completely terrified. She uhh... urinated everywhere too. My mother and I were going to try to do this at home thinking she might take it better from us but we're not professionals and if she's acting like this with professionals I... just don't know. The needles we have are a bit wide but that's probably a safety measure just in case a cat jerks and could break a needle into the skin. The vet has offered to do fluids for her twice a day but they're not open on Sundays so that would leave us rather at a loss. Still, I'm going to read on giving cats fluids and look at the link you gave me, Kat, here at some point. Dunno if it'll be reassuring or not as I'm slightly intimidated by the fluid thing, haha...

As for levels of things, I want to say the vet said her ALT was 130 something at the time of the blood work testing.. but I can't confirm that. A lot was being said that I kind of forgot to remind the vet to get the copies of the tests. I guess it's not much of a concern at the moment since the bloodwork was from a while ago and only liver levels were off.

Well that's about as much as can be said right now. No sure way of knowing whatever caused the liver problem but I suppose it might've just... happened from getting less food at some point and stress combined or whatnot. The vet said it's likely if she doesn't improve within the next few weeks with the fluids and the meds and the food, that she might not make it out of this. I'm very hopeful though as Pepper is a very strong kitty. :] Thanks for all the thoughts from everyone!
 

mews2much

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Your cat could have FLD from not eating or it could be some other liver problem.
I use a 18G needle when I give my CRF cat fluids and she just sits there and lets me do it.
Sorry your cat went wild.
Can you get a cat bag and try the fluids at home?
I did have another CRF cat that went crazy if you tried to give her fluids years ago.
What size is the needle?
Good Luck with your cat.

 
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danjoan

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Don't really know the size but I see 18 x 1A on the side of the needle cap so I guess it's about the same size as yours.

Cat bag..? Are you talking about the fluid bag?
 

mews2much

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It sounds like your needle is a 18G also.
They are big so the fluids can get through them.
I am talking about a bag you put the cat in so she can not move.
Some of the vets use them to get blood and do fluids.
How much fluid is your cat getting?
 
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danjoan

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200 ML a day, I believe. Twice daily. I was not told about a cat bag, just that she could be wrapped up in a towel when we were administering the needle. It's looking like we probably won't be able to do it by ourselves with how fiesty she is. She definitely has a lot of pep left in her...
 
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danjoan

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It's 0.9% Sodium Chloride for dehydration. I don't know if that makes any difference or not but I don't think the vet would administrate it if it were going to do any harm... One bag should last her 5 days, the vet also said. This feline CRF website lists a cat that took 200 ML a day: http://www.felinecrf.org/fluid_therapy.htm

Course Pepper doesn't have CRF, but it's at least reassuring to know another vet has administered that much before. She'll probably decrease the amount once Pepper shows signs of feeling better but I don't know.
 

mews2much

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I thought your vet was doing 400ML a day.
200 Ml is ok.
It goes by the weight of the cat also.
My CRF cat is very sick right now and may not last much longer which I dread.
How is your cat today?
 
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danjoan

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Oh, sorry. I probably worded that wrong. I meant 200 ML a day, with that total being split up in half and given daily. 100 ML at a time and all.

I am sorry to hear that about your kitty.
S/He's surely put up a good fight and has fulfilled her/his purpose in your life. I hope that they will not be in pain when it's time for her/him to leave.


Pepper is doing okay. After the vet visit this morning, she's been laying around and had a bowel movement and then shortly after vomited a little something up but she just had a great feeding and is resting now. Going to go to the vet a little later for her second dose of fluids~
 

mews2much

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My cat is 18.5 years old and we found out she had CRF in Oct 2008 when we went to the Er vet.
We also found out she had high bp then.
She has meds for that also.
Is the vet giving your cats anything for the throwing up?

 
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danjoan

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No, the vet didn't give Pepper meds for the vomiting. Her vomiting is very sparce at best so I'm not sure if the vet didn't think it was necessary or if she's just starting out with the current medication or whatnot. The last time Pepper vomited was on Friday night after the first day of the fluid treatment.

As far as an update on Pepper, she has been taking the fluids daily except for on Sunday [vet was out; vet's been offering to do the treatments for free and it's easy and fast] and has been showing signs of recovery. Her nose is PINK and not a really light yellowish-pink anymore. I mean it's her normal nose again! Sometimes it's dry like it has been, other times it's cold and wet. She still has a fever every now and then as felt by her hot ears and the nose being hot/dry but she is continuing on the antibiotics so we're hoping to fix that too. Pepper has been doing some things like her old self. She looked out the window with interest, licked herself a bit, and has been eating a few treats daily. Sometimes she'll just keep on taking the treats if you give her more. Other times, she'll take a few and stop of her own accord.

Other things don't seem so good. Before we took her to the vet, she was love biting and purring, etc, but she has not been doing that... or trying. Seems she doesn't want to purr; it might be a bit of a strain. The problem we're looking at now is her heavy breathing. :/ It seems to be persistent and she stuck out her tongue a bit while sleeping. It's more heavy than it is rapid at rest (aka without stress). The vet hasn't suggested too much about that saying that it's probably still from the enlarged liver. I mean, it /has/ been going on a pretty long time. My mom and I are doing all we can and since she's showing improvements we're pretty much elated, but there's more to be done... like getting her to eat/drink again on her own. The vet has pretty much given her only a few weeks on the fluids saying that if she doesn't improve within this time that there's probably not much hope and since she has improved some... well... we're staying positive.
 
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