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

Well we just got back from the vet, there's some good news and not-so-good news. We did get the Fortiflora, just to help his digestive system and to perhaps perk his appetite as well. Overall the vet said he looked better as far as disposition and energy levels. He weighed 9lbs even, which is less than Monday (9.2lbs), but he had 2 bouts of diarrhea and vomited once yesterday, plus he had a semi-formed stool this morning, so he's had a lot of output. We are also decreasing the mirtazapine to 1/4 pill every 3 days. She is almost positive the cause of his anorexia is stress because he's otherwise had nothing show up on his labs, and he's always been healthy for his annual exams aside from his weight. I had her recheck his labs, and this is where it's really good and not-so-good.

ALT - 180, down from 379 on Saturday - this is GREAT news! She said when the liver begins to heal, the ALT goes down first.

ALKP - 278, up from 262 - She said this is more of the "chronic" enzyme, or the one that takes longer to go down. It went up a little bit, but she thinks it will level off soon and start dropping as well.

TBIL - you should probably sit down - 18.0 - up from 12.3 ... This really worries me, and she said it is pretty darn high, but as long as he's pooping and acting healthier it should go down. She said TBIL can sometimes spike before it gets better and that we can recheck it next week if I want to, which I am certain I will!

She also said a feeding tube would be in the $200-300 range, but I'm using that as a last resort. We've gotten a fairly decent rhythm down with the feedings and I want to see if the new syringes and cat bag make it even more manageable. If he starts fighting the feedings to a point where I can't get enough in him, we will do a feeding tube. So she had lots of good information for us, answered all my questions, and I'm really grateful that she seems so interested in how Howard is progressing through this. Howard is actually downstairs right now, albeit behind the couch, but at least he's out of his room! It makes me happy that his curiosity has come back enough for him to overcome his fears of being out of his safezone. So overall - good update, and I feel much better today as well. Just keep swimming!

Ok - I'm going out on a limb here, because reading your update I felt a big !!!!!!!!!!!!!!!!!!!!! Yes, some of the numbers are concerning, but given the information from the vet, it sounds like it's part of the healing process. :heart2: :cross:

The Fortiflora may or may not help. One of my kitties had explosive diarrhea, and the fortiflora made it worse. So just a head's up on that. I hope it helps, but if he has more issues with diarrhea, just bear in mind you may need a different probiotic. :rub:

He's SO adorable! And it's great that he feels well enough to be out of his comfort zone!

Keep up the great work momma! I'm sure the cat bag and new syringes will help. Have you seen Carolina's video on syringe feeding with the bag? If not, I'll find it for you.

OK, I went and got the link anyway.

http://www.thecatsite.com/t/227858/syringe-feeding-lucky-video-if-your-cat-is-not-eating

Is the video this one?



I do his pretty much the same way except he's facing me on my lap and more upright. I can't seem to get a good angle if he's facing away from me, and I can really see where the food goes in that position. I did get the cat bag and syringes and they're working great! I think the cat bag makes him feel a little less restrained than the towel burrito method did, because he can still move his paws around which also give me hints as to if I'm giving him too much. I give him much smaller amounts in each swallow than Carolina does, because I'm too scared to make him aspirate! Maybe if i try to do it a little quicker like she does, it'll take less time and therefore less stress. The new syringes are a godsend! They hold their suction and don't drip randomly like my old ones did, lol!

I haven't mixed the Fortiflora in his food yet, but I'll try that for his feeding coming up in a few minutes. It'll be his 1/2oz smaller feeding, so far he's had 2 1/2oz's in 3 feedings and kept it all down! Yay! So after another 2 1/2oz that he'll get in small portions over 3 more feedings today, we'll be at 5oz! Our target! Woo hoo!

He got to see my mom today who came to pick up my son to give me a break (Lucas is a rambunctious 4-year-old... if any of you have kids, you understand lol!) and he let her pet him. I hope seeing her was comforting for him, since he lived with her for a while. This morning I was going to start his fluids and feedings at 8:30, but when I went up there he was purring for me and so I changed the scheduled 'feeding' into a scheduled 'lovins' and I think I'm going to do this every morning from now on. He's always happiest first thing in the morning, so I'm going to let him keep his happy mornings and just love on him. It makes me feel super happy to get all those purrs from him too, and really gave me a happy outlook on today. So every morning we'll have a new ritual where there's no medical anything, I don't get to pull back his ear or his gums to see his coloring or anything like that. Just love and cuddles, and he gets a break after the love and cuddles before I do anything, so he doesn't learn to anticipate medical stuff always follows cuddles. 

Thanks so much for all of the advice! I sooooooo appreciate it immensely! <3

Yes, that's the video!
The catbag is a huge helper IMHO..... It just makes it so much easier, as it leaves both your hands free to do the job - I think that's the biggest advantage.
I think as you get used to the feedings and a bit more confident, you will get more comfortable with bigger amounts per swallows - it all depends on what your cat can take - follow your kitty's lead.
It is important to have a rhythm so the kitty doesn't get bored and start to fight the meal. That's why you see me doing it rather quicky. Keep a firm hand.... Feed, wait for the kitty to swallow and breathe, then feed again. keep going without taking too long in between feedings.
Have all your syringes prepared prior to start feeding so you don't have to stop in the middle....
Once you get the hang of it, it becomes easy......
A huge thing also is to not be stressed before you start the feeding. If you are, go out, take deep breaths, meditate..... come back once you are calm and confident. It will make a world of difference!!
Good luck hun, you are doing GREAT!!

girljeans said:

This morning I was going to start his fluids and feedings at 8:30, but when I went up there he was purring for me and so I changed the scheduled 'feeding' into a scheduled 'lovins' and I think I'm going to do this every morning from now on. He's always happiest first thing in the morning, so I'm going to let him keep his happy mornings and just love on him. It makes me feel super happy to get all those purrs from him too, and really gave me a happy outlook on today. So every morning we'll have a new ritual where there's no medical anything, I don't get to pull back his ear or his gums to see his coloring or anything like that. Just love and cuddles, and he gets a break after the love and cuddles before I do anything, so he doesn't learn to anticipate medical stuff always follows cuddles. 

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I think is this is an absolutely fabulous, wonderful idea! :heart2: :rub:

LDG said:

I think is this is an absolutely fabulous, wonderful idea!

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Right?? I don't know why I didn't think of this right away! It's odd to "schedule" cuddle time, but that way I can dedicate a half hour or more to just loving on him. This morning I was in there for an hour just petting and loving on him, and it was a good hour between that and his sub-q fluids and feeding. He gets lovins at night, too, but isn't as happy because the feedings are fresh in his mind and he's unsure if I'm just going to make him eat again. I wish Dan was better with the feedings so I could just be in charge of the love and make Dan do all the un-fun stuff! lol! But in all seriousness, I think he's starting to realize that it's a necessary evil because of the way he's cooperating more during the feedings. He doesn't have to like them, he just has to let me do them. I hope his appetite comes back soon!!

So we’re dwindling in the feedings… this won’t be that great of an update.   Yesterday Howard only got 4 ounces total because he stepped in his own pee in the litter box, then proceeded to lay on that foot without bothering to clean himself. His face/neck have been difficult to clean after each feeding with just a washcloth so with a dirty face/neck/belly/foot, we gave him a bath. He was so stressed about the whole ordeal and wouldn’t even try to lick himself dry, so we had to towel dry him as nicely and as best as we could, which made him more stressed. I know food is the most important treatment for FHL, but I couldn’t bring myself to do his last feeding after all of that. He needed some TLC and stress-free time.

Fast forward to today, we had plans this evening (my extended family is in town which is never a quick visit, but thankfully for Howard's schedule tonight is the only night we planned to spend with them) so I got 3 ounces in him before we left the house, with plans to do 2 more feedings tonight to get to our 5 ounces. Well I opened a can of food for him and he licked the lid and the food a few times on his own (yay!) but then immediately vomited (dangit!) and was turned off to trying any more of it. I left it in his room to see if he’ll get re-interested in it in a little bit. We’re only at 3 ounces so far today and it’s nearing 11pm here. I would like to get at least 1 more ounce in him but he threw up after voluntarily taking maybe 10 licks of cat food juice. I’ll still be up for another hour or so, so maybe I’ll just give his tummy some time to settle and try a feeding shortly before bed. The only thing reassuring is that I went into this knowing there would be good days and bad days, and this just happens to be one of the bad ones. Should I try to feed him anyway or should I just let him be? His food is diluted... maybe it's the Fortiflora? It's been almost 6 hours since his last feeding so I don't really know why he threw up. :/ Is it because he had an empty stomach? He always has kept down his first feeding of the day... I just don't understand why he threw up this time.

Have you tried plain baby food? Gerber 2nd Food Chicken with Gravy. It's not ideal but I've seen very sick cats eat it. If you try it, skip the FortiFlora and any other supplements the first time. 

Good luck

I haven't yet, but I'm going to the grocery store today so I'll pick some up. It was really exciting that he was interested in food. He didn't touch anymore of it though after this, and I didn't give him anymore feedings either. So he had good TLC last night and this morning, and I'm about to do his fluids and his first feeding. I'll update on how that goes. I know there's medications for nausea, do any of them work with FHL? If he vomits again today, I'll be talking to his vet about that tomorrow.

Years ago I had a kitty w/ HL and at the time was told that his own option for survival was for me to drive him 8 hours in the car from where we lived in BC, Canada, across the border to a Vet Hospital in Washington State, for insertion of feeding tube (apparently nobody local to me could do it) and that without it his prognosis was very very grim.   Long story short, I took him home and fed him round the clock, syringe-fed A/D in frequent small amounts, regular subQ fluids, I also gave him meds for nausea.

As he improved, which was in about 3 weeks!.....I found it was like he "forgot" how to eat on his own.  It was recommended that canned Fancy Feast was one to try as even ill kitties like this one...particularly the seafood flavors, and be sure to always warm up a little in the microwave......slightly warmed canned food is always more palatable to a kitty (just test first to ensure it's not too hot!!!).   He would sniff the food but didn't seem to know to lick it up?  It was very strange as this had always been a cat that lived for food!   I had to put a little of the food on my finger and onto him mouth, or a little in his mouth.....and over time this worked...because sometimes he's seem very interestsed when I put down a plate of food but it was like he didn't know what to do with it.

i have an old girl with kidney disease and I syringe feed her once a day to supplement what she eats on her own.   To make it easier for both of us, I have a large cushy dog pillow that I'll kneel down on and put her between my legs.   I'll wrap a towl around her (sort of like a "cape") and use a clothespin to secure it.  

I find that this type of syringe for feeding works the best of all I've tried.   It's generally used in humans after dental extractions to flush out the area where tooth removed.   I will cut MOST of the curved tip off, leaving about 1/8th to 1/4 of an inch of the tip remaining.   I have about 6 syringes and I get them all filled before we sit down (just use one plunger).  I just mix her Rx reduce protein canned food in a glass bowl with a little water, warm up slightly......make it so that I can easily spoon it into the barrel of the syringes but not TOO watery.

http://www.dhphomedelivery.com/productcart/pc/catalog/NeedlesSyringes-12cc_412_curved_tip-800.jpg

My Vet clinic keeps these syringes and I think all dental offices have them so you could always ask your dentist office for a few, I'm sure they'd have no problem even if you offered to pay a few dollars for them.   Could maybe also order them online?

Any food your syringe feed should always be slightly warmed first.......as cold food (even room temp) can be a real 'shock' to the tummy and can increase them throwing up.   I even find this with my old kidney girl.  

If the appetite stimulant isn't working, I'd stop it as there's no sense putting drugs in the body that aren't working.

Not sure if it's still available but back then we used the appetite stimulant Cyproheptadine (aka Periactin) and it worked well.   Each cat is different.   I had an old kidney girl 2 years ago who tried them all and this one was the only one that worked.   It's a human medication, actually an antihistamine but has been used in cats for years as side effect is appetite stimulation.   I always found that giving the smallest dose necessary was best.   If I recall correctly it comes in a 4mg tablet.   I started off trying 1/8th of a tablet but generallly never had to give more than 1/4 of a tablet (though Vets often prescribe more).    In some of my cats over the years, it would take effect in 30-45 minutes...but I did have one cat who didn't have the appetite increase until about 2-3 hours after.......so each cat is different.   I would definitely ask your Vet about whether you can get some and try this.  

Sometimes lack of appetite is due to  mild nausea........has your Vet ever tried a shot of Cerenia?   I remember years ago when my cat had HL, I gave him something daily for this.......Reglan? Maxeran?  Can't recall now for sure what it was (I remember giving is by subq injection, whatever it was?).

Sometimes those pouches of cat food with the gravy are tempting to a sick kitty, particularly the gravy..................so buy a few of them (Whiskas makes them in the pouches, cheap at Walmart).....and try putting some of the gravy on top of whatever canned food (seriously, try Fancy Feast seafood pate types).......even if kitty only licks the gravy, that's great......as that will get them started on eventually eating the food, too!

Reglan is probably what you are thinking of for the nausea.  That's what our Vet had us give our old CRF guy when he was nauseated and the Pepcid AC wasn't cutting it.  1/8ht of a Reglan 3 times a day.  Luckily, DH takes it, so we already had it on hand.  But I don't know how it reacts with the liver, so it might not be appropriate for HL kitties. 

It's odd, but seems to happen frequently, that HL kitties will vomit when they try to eat on their own, yet if fed through a feeding tube, can normally keep it down.  I don't understand it, but it happens. 

Sure hope Howard is feeling better today

Yes, it might not be a bad idea to chat with the vet about an anti-nausea med. There are other options: the pepcid a/c is sold OTC as famotidine. 10mg is the usual amount for an adult cat. It has to be given at least one hour before or two hours after a meal to be effective for 24 hours. As mrsgreenjeens suggested, reglan is another one, it's prescription. When Lazlo was really nauseous because of chemotherapy, we used Cerenia off-label. I prefer cerenia to reglan, because it's just 1/4 pill given once a day - and can probably be crushed and mixed into his food, so would reduce the stress of having to pill him with another med. But give the vet a ring, and see what the suggest. :nod:

I'm sorry you had a good news/bad news kind of day. Let's focus on the fact that he was willing to lick some of the cat food juice! You'll get the nausea worked out. :rub:

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the_food_lady said:

As he improved, which was in about 3 weeks!.....I found it was like he "forgot" how to eat on his own.

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This!! It sounds like Howard. He's doing a lot of licking, and not so much wanting to get solids in his mouth, but he was so ravenously licking the Fancy Feast that he ended up "accidentally" eating some. I've been feeling like he's forgotten how to eat since before the diagnosis, but I thought it was silly. He'd lost his rhythm with lapping water and it reminded me of when he was a kitten and he was just switching from bottle to bowl. I'll ask his vet about it later this week, and the anti-nausea medications if he starts vomiting again. Overall, today is looking soooo great and I hope it's just continued improvement from here on out!!! So proud of him I could cry!   Haha! I just bought 1 can of baby food and 1 can of fancy feast, so I'm going to stop at the store and get a case of FF and a few more cans of baby food. Once his appetite seems fully returned, I'm going to be feeding both cats canned Blue Wilderness food, and maybe venture into a raw diet in the future. I do NOT want to go through this again!! Please keep your fingers crossed for us and keep the vibes comin'! I think they're working!!! 

Also, I forgot to mention that his output has been really good! He had a #2 this morning that looked completely normal, it wasn't "black" or runny or anything.  He is still quite yellow, but it can take a while for that bilirubin to flush through his system. As long as he has an appetite and is acting more playful (he woke me up from a nap earlier today, because he was downstairs and saw my hair peaking around the corner of the couch and started playing with it), I'm happy. He's happy, he's getting back to his old self, and I'm stoked. I love him so much!!! 

GO MOMMA and GO HOWARD!

Wow - what absolutely wonderful news!!!

I'm glad to hear of his progress. Did I miss something or did the Vet tell you his FHL was most likely caused by stress?

gooned said:

I'm glad to hear of his progress. Did I miss something or did the Vet tell you his FHL was most likely caused by stress?

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The emergency vet said it was her #1 suspicion, and his regular vet said she was highly suspicious it was just stress as well, due to moving in a new home and otherwise having a very healthy record. He does have a reaction to rabies vaccinations so we have to give him benadryl before each vaccination, but otherwise he doesn't have anything wrong with him. He has those black spots on his nose/gums that many orange cats get, too.

The fact that his appetite seems to be coming back as he's decided to venture out of his room more frequently tells me that it almost certainly was stress. He's suddenly acting like "Hey, this is my house too", and his appetite is coming back. I'll still get his labs checked again later this week or maybe next week if he has a good week. The other thing is, I stopped using the CliniCare and the Royal Canin for his feedings and went back to the Blue Wilderness for all 5 ounces yesterday. I think those were too much for his tummy and that's what was causing the nausea/vomiting. And look how he is today! Not saying that the vet doesn't know her stuff, but that all cats are different and you have to take their cues to heart. I asked her about the tummy licking to the point of injury maybe being him trying to ease pain in his tummy, but she said cats who overgroom often overgroom their tummy. *shrug* Still a very good point though, and something I could have missed. If he goes downhill again or his appetite stops again, we'll do some testing to see if it could be something with his internal organs.

I'm just so glad we're having a good day! I know the battle isn't over yet, but it's hard not to get really giddy about your loved one doing so well!! 

OK. You can brag about his poop again!

gooned said:

OK. You can brag about his poop again!

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LOL   You know I will!!   All of his poops have been slowly turning into "normal" poops, today's being super normal! I don't know if it's the Fortiflora (which I'm still giving him, I mixed it in all his feedings yesterday and today) or what, but I'm not going to change what I'm feeding him because I think   we've found the magic mixture with just Blue Wilderness canned food, some of the GNC High-Calorie Supplement, Fortiflora, and water. Not saying that's what all cat parents should use for their HL kitty, but that's what's working for Howard!