Feline Hepatic Lipidosis Home Treatment ADVICE NEEDED!! - Diagnosed Saturday 11/3/12

Hi all!

I decided to join The Cat Site because I would love some personal advice for my 9-year-old cat, Howard (he's the smiley guy in my picture) and without your site, I would have never known I could treat this on my own. So first off, thank you from the bottom of my heart. You've given me hope, and you've given a very well-deserving kitty cat who means the world to me a new shot at life. Here's the rundown that's led us up to today:

I moved home with my parents about 4 years ago between moving from one apartment to another, and I brought Howard with me. He's always been an anxious cat and a huge Momma's boy, but the moving was always hard on him, so I decided not to bring him with me to my new apartment because I didn't know how long I would be there, it was in the same town as my parents so I could visit him often, and if I got in a place that was more permanent, I would move him in with me at that time. He's done well at my parents' house, and I'm finally in a more permanent place, so I moved him in with me, my boyfriend, and our 4-year-old son, along with our 4-year-old cat we rescued a year ago, Max.

Things went well at first, but Howard was losing some weight (I thought this was good because he used to be overweight, but I'd never heard of FHL... ugh I wish I'd known then what I do now...) but what concerned me more is he was over-grooming and ended up injuring himself on his belly about a month ago. He was given preventative antibiotics by our vet, we brought him home, and he was doing well besides the decreased appetite. Over time he stopped eating completely so I got some pheromone sprays, catnip, and new toys to make him more comfortable because I believe (even to this day) it was the stress from a new home with new people and a new cat that made him go anorexic in the first place. All of this time he's spent at our house, from the first visit to the vet, he has been in our bedroom with the door shut because he loves sleeping with me at night on my pillow. Sometimes he shows interest in coming out, and I let him roam around the house if he wants, but he usually doesn't make it that far out of our room before wanting to go back to his 'safe place'. Definitely not a prisoner in there, and I always check on him and play with him until he lets me know playtime's over by going under the bed to the kitty bed I have for him under there.

Anyway, on Saturday I was shocked to see his skin near his ears, his gums, and whites of his eyes were all yellow. We took him to the emergency vet who said what vets say to most people facing FHL, "hospitalize him or have him euthanized" (I'm paraphrasing). Thanks to YOUR SITE I found a third option, treating him at home! I've been doing force-feedings since Sunday, and I started doing sub-q fluid infusions after our normal vet trained me on these right away Monday morning. For the first force-feedings, I was doing 1/2oz every 2 hours of Blue Wilderness canned food, about 1 teaspoon of GNC Ultra Mega High Calorie Booster Premium Formula Gel, and water to make it runny for a syringe. His vet gave me CliniCare and Royal Canin Recovery RS, so now I'm using those with a little of the GNC Calorie Booster Gel, 1/2oz every 2 hours. I give him 100cc sub-q fluids every morning as well, and his urine output is good, at about 3-4 voids per day. He also had a little poopy on Monday night, but that's been it for bowel movements.

My question is, I've heard about SAMe, L-Carnitine, and other supplements... are these needed? Also, his weight on Saturday at the emergency vet was down to 8.6lbs, and his weight on Monday was already 9.2lbs! How many oz should I be feeding him per day? I've included his abnormal lab results from Saturday as well... his TBIL was really high and rather concerning.

I started a blog for him at http://howard.stompingrounds.us which has more detail than I've left here, I just didn't want to overwhelm anyone who may otherwise have advice for us. Thank you SO MUCH for helping us. My spirits are fairly high we can do this, but at times it's extremely overwhelming and I breakdown. I want my baby Howard to make it through this so badly. I'll do anything, my only limit is money, so I can't have him hospitalized.

Here were his abnormal labs from Saturday:

ALT 379 (normal 12-130)

ALKP 262 (normal 14-111)

TBIL 12.3 (normal 0-0.9)

Thanks again!

Jessica and baby Howard <3

Also, the emergency vet put him on an appetite stimulant, which I don't think has kicked-in yet, or it's not working. It is Mirtazapine 15mg, I give him 1/4 tablet every 12 hours. Does this medication usually work?

I don't know if cats with fatty liver reliably respond to an appetite stimulant? It might be worth trying another one. We used mirtazipine for Lazlo when he was undergoing chemotherapy, and it really helped him - and it was apparent right away (as within 1/2 an hour of giving it to him) that it was helping. Though that dosage sounds off to me - it's possible the vet is using it off label. But it's meant to be given 1/4 tablet every 3 days. This is one of the reasons vets will choose mirtazipine over other appetite stimulants, it's long-acting.

I have no experience with fatty liver - but found this on L-carnitine. I have no idea what the dosage for a cat would be. Perhaps your vet could look into it? http://www.livestrong.com/article/539608-l-carnitine-for-fatty-liver/

Right now, as you now know, food is his most important "medicine." What he should be given is the amount his body needs daily as if he were at his normal weight. When I had to assist feed Lazlo, I gave him his 5 ounces daily, divided into three meals (though more frequent but smaller meals is probably better for a kitty with HL).

I'm so glad you found TCS and learned about this disease - and didn't listen to your vet! (BTW, are there other vet options in the area? :dk: You might want to consider a more ... optimistic - informed - vet. :rub: ).

Many vibes for you and Howard! :heart2:

P.S. He's a beautiful guy - love his smile!

A really good food for this is Hills A/D.  It is prescription food so it's only available from a vet and is on the pricey side.  About two years ago I had a cat with this.  The vet put in a feeding tube which I found easier than force feeding but it can be done with force feeding.  She also put him on an antibiotic along with prednisolone.  He is still with me and has been healthy since.  Patches ALT reading got up over 1200 and he survived.

Thanks, LDG, for the information regarding Mirtazipine! I don't think it's really working to increase his appetite at all, but that's all the emergency vet really said we could do at home, sit and wait for that to kick in (she said it could take 3 days, but it's been 4 days now and nothing). So sorry you had a cat go through a battle with cancer! That must have been really hard.

As far as the L-cartinine goes, it sounds like that's to help his liver enzyme levels return to normal, which I've seen many kitties with FHL on the forum here with those levels way higher than Howard's. Maybe we can just do it without that supplement, since his are high, but not WAY high.

And lastly, getting a new vet... it may be an option. I have hope for our regular vet because we've been going to her since the 90's, and she was willing to train me to do sub-q fluids at home. It was the emergency vet at the emergency pet hospital that was so "all or nothing" about the illness. What a joke, I left that place completely heartbroken, but our regular vet has been very helpful so far. The only thing I haven't really gotten from her is an exact amount of food I should have as a target to feed him every day, so I'm just feeding him 1/2oz every 2 hours, up to 7 times/day, and hoping to increase it to 1oz 5-6 times/day.

Denise, I've heard mixed things about the Hills A/D, mainly that it doesn't contain very much protein. I've heard cats with FHL need diets high in protein, but it worked for your kitty and I'm very willing to try anything. We're going to the vet on Friday for a checkup so maybe I'll ask her about it then. She gave me some CliniCare and Royal Canin Recovery RS canned food, so those are what I'm using in his feedings now. He already has more energy and strength when he's awake, but he's been sleeping so often with his body trying to repair itself! Poor baby.

Oh I didn't understand that was the e-vet. Yes - call your vet and ask about the appetite stimulant. Especially if it doesn't seem to be working, I'd be a little concerned about that dose.... :cross: It has different effects in different cats - it makes some cats really loopy. It made Lazlo a little hyper - and some kitties, I think it makes them sleep. I know his body needs that downtime right now to repair, but I'd be wondering if the mirtazipine is making him sleepier than he otherwise would be. :dk:

If he's not complaining about being syringe fed, I'd just keep up with it, though the feeding tube does make it REALLY easy for kitties that stress over this. :nod: We didn't need to go this route with Lazlo (who is going strong, BTW! He finished chemo in January, and it did send the "massive tumor" in his stomach into complete remission. Now it's just a matter of how long he'll stay in remission. :cross: ), but the vet said that even really sick kitties can usually manage the surgery - they only need to use a really short-acting anesthetic, it only takes a few minutes, and it only requires about a 1/4" incision. :nod:

The 1/2 ounce every 2 hours sounds good - but you might want to bump the number of times you feed him so he's getting 5 or so ounces of food if he normally eats a 5.5 ounce can daily.

Also, as you'll probably have to assist feed him for some time, you might want to consider ordering some syringes. If you're using the ones the vet gave you with those rubber stoppers, they suck, and get "sticky" really quickly. These are the ones recommended to me by TCS member Carolina, and they work GREAT.
Just cut the tips off so they're long enough and wide enough. Really easy to clean!

The overgrooming of the belly may be his way of telling you where he is hurting. Has the Vet ruled out underlying causes of the FHL? That MUST be treated as well.

You are doing a great job of taking care of him. Needless to say food is key at this point. Hill's a/d, while not the best quality, is usually loved by cats. I would not worry about quality of food at this point - anything he will eat is good.  Try heating the food up or offering 2nd Food Baby Food. A feeding tube may be helpful if he is refusing food. FHL can be successfully treated!

Good luck

It's been years since I had a cat with HL, but I still remember feeding him every 4 hours religiously for FOUR months (via a stomach tube)!  Not all cats need to be force fed for that long, but some obviously do.  And one word of advice...once he does start eating on his own does not mean you can stop assist feeding.   Nosirree!  You will need to help him along for quite some time, because he probably will not consume nearly enough calories to survive, let alone gain back what he has lost.  He may just pick at food for quite some time.  But it will be worth it the trouble, believe me

As to how much to feed each time, I agree with LDG that it really depends on how much he was eating before.  And I would think that the Royal Canin Recovery is a good food to be giving him. 

for you and Howard.  (love his picture btw (

Thanks so much for all of the replies! I'll give him his mirtazapine tonight, but tomorrow morning I'll put in another call with his regular vet to see if we should stop that. I just don't want to be giving him medication that isn't working when his system is already strained enough. Glad to hear Lazlo is in remission! Let's all hope he stays that way and has many many happy years of love left in him! (I can't find that cute fingers crossed emoticon you used, but mine are crossed for you!)

As far as the injury to his tummy, I hadn't thought that maybe his tummy was hurting him. I'll have to ask the regular vet about it tomorrow and maybe do some checking on it at our appointment on Friday. Great tip, much appreciated!! 

Thanks for the advice on how much to feed him as well. I think I'll try to bump a couple of the feedings to a full ounce and see if he can handle that in one sitting. He did dry heave this morning right after I gave him the mirtazapine... that darn mirtazapine!! Haha

I'll talk to the vet about costs for a feeding tube as well... not sure if I can afford it, or how Howard will enjoy having a tube hanging out around his neck, but I've definitely considered it already as he's regaining some strength and how he's giving me the cold shoulder after feedings. It's definitely stressful, unlike the fluids which he was PURRING through this morning. Such a funny kitty

And syringes. Yes I need those syringes! I heard Petsmart carried them, but apparently my Petsmart doesn't. I bought some of a different brand from the dog isle, one works okay but the other has no suction past 1/4oz. None. Quite worthless, but the one does get the job done and it is tapered, but the end isn't quite as small as I would like. And thanks for linking it from Amazon, I happen to have a giftcard to Amazon right on my desk!

As far as how he's doing, he pooped again today, about twice as much as Monday's smallish one and more "normal" looking. I was super happy about that! He's been a little less sleepy today, probably because he got a longer break between feedings last night to get really good uninterrupted sleep. His personality is coming back here and there, so he does seem worlds different than he did on Saturday, we're just not in the clear until he starts eating on his own as much as he did before all this. Thanks so much for all the advice! I think I covered all the questions, I'm pretty tired so forgive me if I missed one. I feel like I have a newborn baby in the house again with all these feedings and schedules and everything haha

girljeans said:

As far as how he's doing, he pooped again today, about twice as much as Monday's smallish one and more "normal" looking. I was super happy about that!

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Only a great mom gets happy about poops!! I can relate!!!!

Last night Howard had a bout of diarrhea and didn't make it to the litter box. Is this normal right now, to have a bout of diarrhea, or should I be concerned? Today has been really hard so far... spent the whole morning crying because I feel so helpless. I know Howard's shown signs of improvement and that he still probably has a ways to go before he starts eating on his own. It's just the thought of 'what if he doesn't start eating on his own' that's scary. We don't have a lot of money to do diagnostics as to why he stopped eating in the first place. Really hopeful that it was just stress.

I was able to get the 2nd syringe to fill up to 3/8oz, so for his 2nd feeding today I gave him 7/8oz. I'll check on him soon to see if he's kept it down, and if so we'll probably do larger feedings from now on. I need some positive vibes right now really badly. This is just so hard 

girljeans said:

Last night Howard had a bout of diarrhea and didn't make it to the litter box. Is this normal right now, to have a bout of diarrhea, or should I be concerned?

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Is he currently getting antibiotics or was he given any at the vet? How many doses of Mirtazapine has he had?

Sugarcatmom said:

Is he currently getting antibiotics or was he given any at the vet? How many doses of Mirtazapine has he had?

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No, there's no antibiotics in his system right now. He had a shot of antibiotics about a month ago that was long-lasting (2 weeks) but that's been a month ago now. He's had 9 doses of mirtazapine so far. I didn't give it to him this morning because he's getting such a high dose (7.5mg/day) and it hasn't started working yet. I want to see if he acts differently after skipping a dose.

gooned said:

Has the Vet ruled out underlying causes of the FHL? That MUST be treated as well.

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I cannot emphasize this enough. In fact, FHL is usually a secondary reaction to an underlying cause. Be sure to ask on Friday.

Hun - have you seen or talked to your regular vet since you were at the e-vet? I know you said she trained you to do the sub-q fluids at home, but I don't remember if that's since you've been to the e-vet. She's seen his bloodwork? Have you discussed it with her?

Have you continued feeding him the same food via syringe? Or have you switched foods? Wondering if a food switch might be the culprit. :dk:


Hang in there hun!!! He needs you right now. :heart2: :rub:

girljeans said:

He's had 9 doses of mirtazapine so far. I didn't give it to him this morning because he's getting such a high dose (7.5mg/day) and it hasn't started working yet. I want to see if he acts differently after skipping a dose.

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Personally, (although of course you should discuss this with your vet), I would say that after 9 doses with no effect on Howard's appetite, it's pretty clear that it isn't working and there is no point in giving more. I'm also rather surprised at how high that dose is (standard is 1/4 of a 15mg pill every 3 days), considering his liver is compromised. From Veterinary Partner: http://www.veterinarypartner.com/Content.plx?P=A&A=2552

Concerns and Cautions

Patients with liver or kidney disease should receive a reduced dose of mirtazapine or a reduction in the dosing schedule as discussed above.

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Sugarcatmom said:

Personally, (although of course you should discuss this with your vet), I would say that after 9 doses with no effect on Howard's appetite, it's pretty clear that it isn't working and there is no point in giving more. I'm also rather surprised at how high that dose is (standard is 1/4 of a 15mg pill every 3 days), considering his liver is compromised. From Veterinary Partner: http://www.veterinarypartner.com/Content.plx?P=A&A=2552

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Thanks so much for the information, I was thinking the exact same thing! I'll definitely discuss it with his vet tomorrow, and I'm not going to give him the dose tonight either. I just don't feel right about doing it.

And yes, LDG, she's seen his bloodwork. I saw her the Monday after the Saturday I went to the e-vet (Saturday was the first day I noticed his jaundice, and having gone through nursing school, I knew it was an emergent situation). On the e-vet's notes, her suspicions for the anorexia are, in order of likelihood, 1 - stress, 2 - metabolic diseases, 3 - IBD, 4 - neoplasia, 5 - viral diseases such as FeLV/FIV, 6 - mouth pain/tooth problems. Howard has been exposed to my parents' indoor/outdoor cat, Tigger, who was tested a couple years ago for FIV and came back negative. That's not to say he couldn't have contracted it since then, but Tigger certainly shows no symptoms. Max (our other cat) was tested last year when we rescued him and was negative, and he's never been around any other animals and is strictly indoors only, as is Howard, even when Howard was at my parents' house.

The thing about Howard is, he's always been an anxious cat, always a hider, and I am the only human being who he's ever truly warmed up to and actually enjoyed being held by. When I got him, I was in an abusive relationship, and my boyfriend thought it was hilarious to basically tease or hurt Howard until Howard would get really angry. I've never seen a kitten get so frustrated and angry (all out growling, hissing so hard he'd choke on his tongue, already having the "death glare" of a full-grown cat), but anytime I tried to stop him from hurting Howard, I'd get the wrath instead. When Howard was about 5 months old, I left the loser boyfriend, but I don't think Howard ever trusted anyone else ever again. He trusted me because I never ever did those things, and I always tried to protect him from those things happening. We were bonded through those few months, and that bond is still very strong. So even though I moved Howard to where I was, he didn't get to know Dan much at my parents' house, and he doesn't know Max, and Lucas' unpredictable hyperactive behavior makes him scared. My parents are happy they're down to 1 cat and will not take Howard back. So I'm doing my best to make him feel comfortable here. I almost wish I never would have tried to move him, but my parents, despite that I'm 28 now, always make snide remarks about how they're taking care of my cat for me. I feel bad for initially leaving him there, but I didn't want to move him around and stress him out, because each time he's moved with me, he goes through such a stressful transition. I wanted to spare him of that, even though it meant I'd be missing him like crazy.

Anyway this has gotten a little off track and personal, but I just feel like Howard is really susceptible to stress because of those first few months of his life. He is comforted by me, it's just everything else that's so new to him. I feel like the worst mommy to Howard after how much stress my choices have brought to him.

On another note, he did throw up today after the 4th feeding that was 7/8oz. He also had another bout of diarrhea. So I think I'll probably do a schedule of 1/2oz, 7/8oz, 7/8oz, 1/2oz, 7/8oz, 7/8oz. That will get him 5oz/day, and hopefully doing just 1/2oz for the middle feeding will give his tummy enough time to digest before the next two larger feedings. Also, I ordered those four paw syringes and a cat bag with rush shipping, so they'll be here tomorrow already. I feel more hopeful than I did earlier today. I guess I'm just excited to hear the vet's advice and see how Howard's doing. I want some answers!

I just realized I did my math wrong. With that feeding schedule, he'll get 4.5oz/day. Maybe that will be okay for tomorrow, and we'll figure out how to get an extra 1/2-1oz on Saturday. If he should be getting as much as before he came down with FHL, then it should be at least 5oz. Is that a good rule of thumb?

Hi hun, sorry you are going through this.... I know others are helping you already, and I see you are doing a great job with feeding him! Keep it up and he should start getting better soon.
About the diarrhea - I suspect that Royal Canin Recovery food is probably as rich as Hills A/D.... And possibly the culprit for the diarrhea. For HL kitties, you start feeding A/D by diluting the food in the first few days to prevent tummy upsets, as the food IS rich. I am not sure of the guidelines for Recovery RS, but I think it might be a possibility.
Ask your vet if you can give him a probiotic. The vet might want to sell you Fortiflora.... I am not really a fan of it because of the ingredients - it is EXCELLENT to make a kitty eat on its own, as it is irresistible (when he gets a little better), but it is a weak probiotic, with some nasty (IMHO) ingredients, and very $$$$.
You can buy a good one on Amazon or your natural food store for much cheaper and of much higher quality. Just look for an Acidophilus and Bifidus probiotic, (with live bacteria is better) and you will be good to go. The probiotic will keep her intestinal tract good shape and control the diarrhea.
Just ask the vet, as you want to know it is ok to give her - I am pretty sure it is, but you want to confirm that.

Good luck to you and your baby