Older Cat With Liver Disease

I'm trying to decide if I should get an ultrasound examination for my cat, Clyde, who has some form of liver disease.

Clyde was born in April 1997, so he's about 16.5 years old now.

Almost a year ago he had elevated liver enzymes on a senior blood panel.  Everything else was okay, including thyroid, blood cell counts, etc.  Just the liver seems to have problems.

Since then I've had a total of three blood panels and the liver enzymes (especially ALT) have been higher every time.  Supposed to be up to about 76 (don't know the units, might be mmol/L???) and he was at around 500 the first time, then 700+ eight months ago, and now 1400+ just recently.  Again, most other values are considered acceptable or borderline, so only the liver enzymes are severely elevated.

He has also had a couple of x-rays, which were not remarkable.  The liver looks normal on x-ray.

He has been on 2.5mg/day of prednisolone for about 10 months.

Now the vet is encouraging me to get an ultrasound of the liver.  It's about $600.  If I believed he could be cured, I would do it without hesitation, but in a cat of this age, I am very skeptical that the vet will be able to do anything, even if the problem is diagnosed.  Or, even worse, the ultrasound may show nothing unusual and would then be a waste of money.

Clyde's behavior is fairly normal.  He is active, playful, eats (not a lot, but he eats fairly consistently), and uses his litter box fairly regularly.  The only way I would realize something is wrong is because of the blood test, and he has lost some weight.  So his quality of life is okay at this point.

I'm really not sure what to do.  I'm kind of thinking I should just keep him happy and see how he does.  Clearly his liver is a serious problem, but all the information I can find suggest that it's unlikely anything truly  meaningful can be done about it.  It could be managed, and that's a big maybe, but doubtful it can be cured.

What would you do?

(By the way, this isn't really about the money for me.  I could spend the $600 and it wouldn't really affect my life one way or the other, but at the same time I don't want to waste money if it's unlikely to help him.  The procedure is also unpleasant for the cat, and I believe they have to shave him.  I'd rather spare him the trauma if it's not useful in this situation.)

Thank you for your comments....

Hi and welcome to TCS. Sorry to hear your kitty has liver issues. So it sounds  like your vet is not sure what is causing the elevated liver enzymes and wants to do an ultrasound? I guess the question for your vet is what will an ultrasound tell him and how will that affect treatment?

Is prednisolone the only treatment that has been tried so far? What about exploring an infectious cause in which case antibiotics may be helpful.

I find this article very informative on liver disease. http://www.cat-world.com.au/liver-disease-in-cats

vball91 said:

 
Hi and welcome to TCS. Sorry to hear your kitty has liver issues. So it sounds  like your vet is not sure what is causing the elevated liver enzymes and wants to do an ultrasound? I guess the question for your vet is what will an ultrasound tell him and how will that affect treatment?

Is prednisolone the only treatment that has been tried so far? What about exploring an infectious cause in which case antibiotics may be helpful.

I find this article very informative on liver disease. http://www.cat-world.com.au/liver-disease-in-cats

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Thank you for the reply.

The vet says an infectious cause is unlikely because the white blood cell count (and maybe other things) do not suggest any infection.  Before prescribing prednisolone, she mentioned that it suppresses the immune system and would make him worse if he had an infection, but since it seemed he doesn't, it would be okay to try.  (The lack of signs of infection were noted BEFORE he was on prednisolone, and didn't really change after he was on it either).

I'll have a look at the link you provided and see if it helps me to make a decision.

Hi mdmaroon and welcome to TCS !

First off, if the best that this Veterinarian can do is to do bloodwork, take radiographs and prescribe a low-dose steroid.........while watching the liver values rise, then, I'll suggest to you that this is NOT a Vet to whom  I would entrust the care of my cat.

Please don't tell me that this is a feline 'specialist', a cat-only Veterinarian......because, this sounds like a general-practice Vet who is 'lost' when it comes to dealing with anything out-of-the-ordinary involving felines.

Most of us here have quickly realized that all Vets are not created equal, and that the very best care is to be had at a cat-only clinic.

You should also know that there are great risks in treating cats long-term with steroids - especially, senior cats.

I'd really urge you to seek out a competent feline-only Veterinarian asap.......and, to get your cat started on a well-recognized liver supplement - Denamarin:  Denamarin for Cats

As well, I wouldn't consider his age an impediment....and, remember, livers regenerate, unlike other organs.

(As you can see from the referenced article, a careful, methodical diagnostic process is needed, with ultrasound being part,.....I wouldn't let the current practitioner go any further, however...........get yourself a proper diagnosis!)

The vet did have me try Zentonil Advanced, which seems to be similar to the product mentioned above, Denamarin.  That was quite some time ago, but he was on it for a few weeks and his liver enzyme values continued to rise while using this.  The pills are quite large and it was a real struggle to get him to take them.  They cannot be crushed as they are only effective if they pass through the stomach undigested, and are designed to do that if they go in whole.  Since they didn't seem to be effective, and due to the difficulty in administering these pills, I stopped doing it.

The vets opinion is that he likely has some form of liver cancer.  Nothing shows up on x-ray, so it would have to be a diffuse form, distributed throughout the liver.  If that's the case, Zentonil or Denamarin wouldn't be expected to help very much.

So the question becomes, could ultrasound detect this sort of cancer, and even if found, can anything be done?  I'm hesitant to put him through tests to diagnose something for which there is little hope of a good outcome.

What about a liver biopsy?  The vet didn't really mention this as an option, but I guess I could ask.  Is it acceptable practice to just do a biopsy and not bother with ultrasound at all?

Hi there, 

My cats are young and thankfully have clean blood work, but I have a geriatric maltipoo who is 17 and also has elevated liver values. I agree that it is strange that your vet is giving your cat steroids. My dog is on a supplement called hepato support which has milk thistle and I just started her on Sam-e and it is called Denosyl for pets. Both of these supplements are also used for cats. i order mine online because they are a fraction of what the vet charges, here is info on the Denosyl (http://www.entirelypets.com/densd4forsma.html). 

I ended up doing a bile acid test with my dog which was $400 and imo a total waste of money because it told us absolutely nothing. I have decided against doing an ultrasound because from my understanding it will also probably not tell us much either. I found a more trustworthy vet and he told me it would be a waste of money to do an ultrasound  and that elevated liver values are very common in older dogs at least. He said as long as she is going to the bathroom and eating not to worry too much and just keep monitoring her values. She gets really bothered by all the poking and prodding and was super sick after the bile acid test so I have decided to just leave her be and give her supplements and will retest her in a few months. Some people may disagree but she is very old for a dog and I just want to make her last years happy. I also want to save money for actual treatments and not waste money on endless tests which never really tell you what is wrong (again I have had bad experiences spending thousands on testing which never ever tells me anything and others may have different opinions).

The ultrasound i do not believe can definitively diagnose cancer so I think you would have to get a biopsy too. If my dog was younger I would probably do all these tests but at this point I am not sure she would survive things like chemo and I just want to make her quality of life good right now. I actually know quite a few people who did chemo with their elderly  dogs and it made their dogs sick and all of them died soon after so I do not want to go through that. Cats do seem to have better chances with chemo than dogs though and there are lots of success stories on here. 

One of my girls had a tumor in the liver that only the ultrasound exam could find.  X-rays could not detect it.

So not doing an ultrasound would have been a terrible mistake because we would have never found out why the liver enzymes kept going up and up.

Ultrasound can also see a lot of other problems in that area that don't show up on X-rays.  It's one of the most important diagnostic tools our vets have.

I would also like to address this

(By the way, this isn't really about the money for me.  I could spend the $600 and it wouldn't really affect my life one way or the other, but at the same time I don't want to waste money if it's unlikely to help him.  The procedure is also unpleasant for the cat, and I believe they have to shave him.  I'd rather spare him the trauma if it's not useful in this situation.)

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Over the years my cats have had a number of ultrasounds for one reason or another.  I was with them every time because our vet and the board certified specialist who does these exams actually encourage owners to be with their pets. So I can assure anyone who has doubts that the exam is neither unpleasant nor traumatic for the animal.  It is a totally noninvasive, totally painless procedure, including the shaving, even if a cat or dog has to have a chest and abdominal ultrasound at the same time.

Hi Franksmom,

Yes, I think I'm kind of leaning to your way of thinking.  When it comes to elderly animals, especially when they have exceeded the average lifespan for their breed, diagnostic tests just end up confirming that there's nothing you can do.

Clyde is a very nice cat, and I wish I could keep him alive for many more years, but I don't think it's a realistic goal, regardless of how much money I sink into tests.

The vet's main reason for prescribing prednisolone was to help keep some weight on him.  She felt that he was getting dangerously thin, and prednisolone has the side-effect of causing hunger, and weight gain.  Since being on the prednisolone, his weight has only dropped 200g, down to 3.73kg.

Remember Steve Jobs?  He was a billionaire, and all the money in the world couldn't save him from cancer.  This makes me even less hopeful that doing an ultrasound will accomplish anything.

I'm still thinking about it though.  It's hard not to.

Violet said:

 
One of my girls had a tumor in the liver that only the ultrasound exam could find.  X-rays could not detect it.

So not doing an ultrasound would have been a terrible mistake because we would have never found out why the liver enzymes kept going up and up.

Ultrasound can also see a lot of other problems in that area that don't show up on X-rays.  It's one of the most important diagnostic tools our vets have.

I would also like to address this

Over the years my cats have had a number of ultrasounds for one reason or another.  I was with them every time because our vet and the board certified specialist who does these exams actually encourage owners to be with their pets. So I can assure anyone who has doubts that the exam is neither unpleasant nor traumatic for the animal.  It is a totally noninvasive, totally painless procedure, including the shaving, even if a cat or dog has to have a chest and abdominal ultrasound at the same time.

Click to expand...

Well I guess that gives me some hope that an ultrasound could find something.  However, was there any benefit to detecting this tumor?  Was the vet able to remove it and prolong the cats life because you did an ultrasound, or was it simply a matter of finding out what was wrong, and then having to accept an unpleasant outcome?

mdmaroon said:

 
Hi Franksmom,

Yes, I think I'm kind of leaning to your way of thinking.  When it comes to elderly animals, especially when they have exceeded the average lifespan for their breed, diagnostic tests just end up confirming that there's nothing you can do.

Click to expand...

Yes this is where I am right now. In my case even if the ultrasound showed there was something wrong with her liver the vet said she would be on the same medications. No one has mentioned cancer but god forbid if she did have it I frankly would rather not know because of all the elderly dogs who have done badly on chemo and died. Like I said though cats do seem to do better on chemo and here is one story about a geriatric cat who got chemo and lived three more years (http://www.floppycats.com/rags-lymphoma.html)

Well I guess that gives me some hope that an ultrasound could find something.  However, was there any benefit to detecting this tumor?  Was the vet able to remove it and prolong the cats life because you did an ultrasound, or was it simply a matter of finding out what was wrong, and then having to accept an unpleasant outcome?

Click to expand...

The benefit was that we knew what was wrong and didn't try to treat blindly with all kinds of things just to do something.  Because of its location it couldn't be treated with surgery.

The results of the original ultrasound and a follow up ultrasound a few months later showed it was not a fast growing cancer and that gave me peace of mind.  

When our cat died eventually more than a year later, it was from totally unrelated causes.

All I can say, when it comes to the ultrasounds, I have no regrets

Although I did already try the Zentonil Advanced, which didn't seem to help, I'm thinking of trying a milk-thistle extract type medication again.

The Zentonil pills were huge, and very difficult to administer, and MUST be administered whole (can be broken in half, but not crushed...even half is big).  I am good at pilling as I do it every day with the prednisolone.

What I'm thinking of trying is a milk-thistle supplement made for people.  Jamieson Milk Thistle extract.

Here's what's in it:

Milk Thistle (30:1) extract 150 mg (Silybum marianum seed), equivalent to 4,500 mg of raw herb.

Excipients: Dicalcium Phosphate, Cellulose, Vegetable Stearic Acid, Calcium Silicate, Vegetable Magnesium Stearate, Water-Soluble Cellulose, Silica, Polyethylene Glycol.

I've googled all the ingredients and can find nothing to suggest that any of them should be harmful to a cat.  Could this be worth a try?  It's cheap, and the pills are smaller, so I think he would tolerate them better.

I wanted to comment even though I don't have this situation, but I see a lot of my own thinking in your comments.  My oldest cat is 12 - hopefully a few years from serious health problems.  But she had stubborn, stubborn upper respiratory infections the first year of her life, which meant administering lots  of antibiotics among other things. Boo, unfortunately, is a TERRIBLE patient, just awful.  The worst.  So bad that only a minority of vets and vet techs that have dealt with her can handle her.  Just to get a syringe full of meds into her mouth 2x a day was an epic battle - and most of the time I was never sure if I got the whole dose in her.  She can tell INSTANTLY that something is up and its time for medication.  Total drama queen with howling, screeching, a blur of fur and claws.  I cannot wrap a "kitty burrito" fast enough to contain this cat - even the "Feral Suits" used by shelters were useless, as I simply could not wrestle her into them.  She also tends towards obsessive behavior - a cat like her would NEVER give up trying to get a cone, bandage, etc..OFF.   Can't even begin to imagine what she'd do with a feeding tube. Why, just today she had a "bad butt day" with a poop that just would not "detach".  Just the act of wiping her butt for 3 seconds has her screeching and freaking! Three seconds!

AND, she's prone to really severe side effects from medications.  Thus a double-whammy of trouble should she develop a typical old-age disease requiring lots of medicating.  Age gets all of us eventually, and SOMETHING is eventually going to get her.

Thus - like you, we've weighed how most treatment regimens (drugs and the stress of administering them) would diminish her quality of life and bring daily stress into it ON TOP of illness.  What a crappy combo - illness + stress.  I am not talking about the one time things like ultrasounds, but the medications, possible diet changes the cat won't get on board with, begging them to eat.  It can seem to snowball - you start with one drug, then have to give another to counteract the effects of the first one!

Its one thing to wrestle with a young, resilient cat, but seems cruel to put an older, frail cat through that kind of stress on a regular basis.  I would be concerned that despite all of the modern medical stuff being thrown at her, the stress itself would take a few months off her life.

We have decided we'd rather have Boo around LESS if it means she's HAPPIER.  I don't see the benefit of an extra six months, a year, if that time includes twice a day freak out sessions. Quality is what we are going for, not quantity.

It sounds to me like you know what to do - the only question you have to resolve (like us) is: is it important that you KNOW what the specific illness is?  We have not decided that ourselves - will cross that road when we get there.

But I get what you are saying - it seems that the older the animal, the more epic the treatments have to be, with little guarantee that the cat comes out ahead with better health.

Good luck and I hope my rambling at least let you know I get your situation and others share your concerns.

I am sorry I haven't seen this thread until now. I am going to share Muffin's history with the same issue as you cat. He was found as a stray almost 14 years ago and became our pet. When his first blood work was done, his liver enzymes were high. I tried him on Denamarin for several months. Long story short, he started vomiting after almost every meal. It did bring down the liver numbers. At the time he had no symptoms of any illness. We decided to quit the Denamarin because we felt like we were treating the numbers and not the cat.

Last year in May the vet found an abdominal mass at his regular yearly vet check so he did some X-rays. A tumor was there and the vet didn't know where for sure as the x-ray didn't show that. He explained our options and they were feed him whatever it took to keep him eating and love him for whatever time was left, do a CT scan which he said was not always definitive, or do surgery. He explained that we would really need to say goodbye to Muffin before surgery because it could be a situation where nothing could be done. After several days of thinking and praying, my husband came in one day and said he wanted Muffin to have the surgery because it would be his best chance, Because we live in such a rural area, we were going to have to drive several hundred miles for the scan. Muffin had surgery, was cut from his upper chest to almost his groin. The tumor was on the tip end of one of his liver lobes and was totally removed. He was stitched up on the inside and closed with staples on the outside in order to get him out from under the anesthesia twenty minutes sooner. He recovered well and had a good year of life. The tumor was a primary liver cancer, which meant it started on the liver. In May of this year, the vet told us the tumor is back. We opted not to do anything else surgery wise because of his age. We are loving his and taking one day at the time. So we never did a CT scan as our vet told us they are not always definitive and the possibility was we might not learn what we wanted to.
Not everyone agreed with our decision, but in Muffin's case it clearly was the right one. You are in a tough spot and I am sorry you and your cat are going through this. Hold your fur baby, love him and tell him every day how special he is. Hugs and prayers going your way.:nod:

mdmaroon said:

Although I did already try the Zentonil Advanced, which didn't seem to help, I'm thinking of trying a milk-thistle extract type medication again.

The Zentonil pills were huge, and very difficult to administer, and MUST be administered whole (can be broken in half, but not crushed...even half is big).  I am good at pilling as I do it every day with the prednisolone.

What I'm thinking of trying is a milk-thistle supplement made for people.  Jamieson Milk Thistle extract.

Here's what's in it:

Milk Thistle (30:1) extract 150 mg (Silybum marianum seed), equivalent to 4,500 mg of raw herb.


Excipients: Dicalcium Phosphate, Cellulose, Vegetable Stearic Acid, Calcium Silicate, Vegetable Magnesium Stearate, Water-Soluble Cellulose, Silica, Polyethylene Glycol.

I've googled all the ingredients and can find nothing to suggest that any of them should be harmful to a cat.  Could this be worth a try?  It's cheap, and the pills are smaller, so I think he would tolerate them better.

Click to expand...

I would really recommend Hepato support it is vet formulated and at least in my dog I have noticed a difference (http://www.amazon.com/gp/product/B005ODH646/?tag=&tag=thecatsite).

The other thing I wanted to recommend doing anything to get your cat to eat. For my dog I give her anything she wants I feed her lots of treats and hand feed her dog food. She was losing weight but now is no longer.

I have an 85 year old grandfather and he is the same way and has become really picky and only wants to eat certain things. I think it is part of getting old.

mdmaroon said:

 
Although I did already try the Zentonil Advanced, which didn't seem to help, I'm thinking of trying a milk-thistle extract type medication again.

The Zentonil pills were huge, and very difficult to administer, and MUST be administered whole (can be broken in half, but not crushed...even half is big).  I am good at pilling as I do it every day with the prednisolone.

What I'm thinking of trying is a milk-thistle supplement made for people.  Jamieson Milk Thistle extract.

Here's what's in it:

Milk Thistle (30:1) extract 150 mg (Silybum marianum seed), equivalent to 4,500 mg of raw herb.

Excipients: Dicalcium Phosphate, Cellulose, Vegetable Stearic Acid, Calcium Silicate, Vegetable Magnesium Stearate, Water-Soluble Cellulose, Silica, Polyethylene Glycol.

I've googled all the ingredients and can find nothing to suggest that any of them should be harmful to a cat.  Could this be worth a try?  It's cheap, and the pills are smaller, so I think he would tolerate them better.

Click to expand...

I feel like the duck in the Aflac commercials........who is not being heard.

DENAMARIN is the supplement of choice for felines...............

DENAMARIN contains both MILK THISTLE AND SAMe................ (Denosyl LACKS SAMe)

mdmaroon - do you live near a Veterinary College?  http://www.aavmc.org/Member-Institutions.aspx

White Shadow said:

 
I feel like the duck in the Aflac commercials........who is not being heard.

DENAMARIN is the supplement of choice for felines...............

DENAMARIN contains both MILK THISTLE AND SAMe................ (Denosyl LACKS SAMe)

mdmaroon - do you live near a Veterinary College?  http://www.aavmc.org/Member-Institutions.aspx

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I am not sure where you are getting your information because Denosyl isthe vet formulation of SAMe (

http://www.nutramaxlabs.com/dog/dog-liver-health/denosyl-for-dogs). Denamarin has added  silybin which is Milk Thistle. Both supplements are good and the denamarin is a good all in one pill.  My dog does well on hepato support for milk thistle and it is also a vet formulated supplement and I like it because it has added B vitamins (http://www.drugs.com/vet/hepato-support.html).

The OP already mentioned that a very similar formulation called zentonil was used and did not help (http://www.drugs.com/vet/zentonil-advanced-200-can.html). Though it may be worth a shot to try another brand. 

Franksmom said:

 
I am not sure where you are getting your information because Denosyl is the vet formulation of SAMe

Denamarin has added  silybin which is Milk Thistle.......... the denamarin is a good all in one pill. 

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Franksmom - YES, thank you for the correction.

My error - it's the Milk Thistle extract that's missing from the Denosyl.

Back to my point: DENAMARIN is the all-in-one, THE supplement of choice for cats.........which was NOT prescribed at the outset.

White Shadow said:

 
I feel like the duck in the Aflac commercials........who is not being heard.

DENAMARIN is the supplement of choice for felines...............

DENAMARIN contains both MILK THISTLE AND SAMe................ (Denosyl LACKS SAMe)

mdmaroon - do you live near a Veterinary College?  http://www.aavmc.org/Member-Institutions.aspx

Click to expand...

Sorry, I wasn't ignoring you, it's just that I'm in Canada and Denamarin might not be available.  I can ask my vet if that is an option.

However, Zentonil Advanced ALSO contains SAMe and Silybin, just like Denamarin.  It's pretty much the same, as far as I can tell.

I will ask the vet if Denamarin is available in Canada.  Thanks.

I'm kind of leaning towards doing the ultrasound now.  The only thing is, if they find something that can be treated by surgery, then I have to decide if I want to put him through that.  I think that's what I'm really afraid of with the ultrasound...finding out that surgery will be required, and then that might ruin what quality of life he has left, or maybe he won't even survive it.

Given the choice of a risky surgery, where they may just end up recommending euthanizing him on the operating table, or just letting him enjoy his remaining days kind of makes me afraid to do the ultrasound.

So, I've decide to go ahead and do the ultrasound. Appointment is on Tuesday.

I'll let y'all know what they find...