Relapse? Fighting against fatty liver disease.

We took our cat Sabbath (13 years old) to the vet on 4/30 when we realized she had stopped eating and had started to lose a significant amount of weight. We also noticed she was spending more time sleeping and was not as social as she normally would be. She was also throwing up what looked to be foam and bile as she had not eaten to throw up any food yet she was still nauseated and throwing up.

They did an exam on her, blood work and also a urinalysis etc. 

The blood work showed her pancreasis and liver levels to be very high. The urine showed a UTI.

We were given an antibiotic in liquid form for the uti and pancreas, marin liver supplements, antacid crushed and mixed in tuna flavoring and a/d critical care wet food to give to her. 

The vet told us feeding her and getting the antibiotic and supplements were the most important part. That the antacid was there if she was continuing to throw up foam and it did not stress her too much to give it to her. Needless to say the antacid ended up being a waste of money as we only gave it to her once. Giving her the other meds was hell as the marin would cause her to foam terribly at the mouth. The antibiotic was good when she kept it down which she did keep down most times.

She finished the meds and we started to be successful with syringe feedings and she even started to eat on her own. On her own being when we would set the plate down in front of her she would nibble a little and try to eat it. She was still nauseated and not eating enough so I called the vet. I asked if she had fatty liver disease and she said no but that her levels were high and it was leading towards it. That we brought her in before it got to that point. She prescribed antinausea and apetite stimulant meds. These are in pill form cut in 1/4 so she always tastes them and foams terribly when we give them to her. Depsite the struggle of giving the meds to her it was like a miracle happened. She was eating off the plate when it was given to her and she started to eat more of what was on her plate. The most I have seen her eat since she got sick. It got to a point we no longer had to stress her with the nausea and apetite stimulant pills and she continued to do well. Then out of nowhere she started to "gag" when we would put the food near her and would walk away from the plate like she did before we took her in. Before we knew it she was not eating again. We have since had to start giving her the nausea and apetite stimulant meds but they don't seem to phase her this time around. She now wants nothing to do with food and when we go anywhere near her with food she immediately gets up and hides from us. We are now forced to syringe feedings again. 

I don't understand the sudden change. She was doing so good and gave us so much hope and now we are back to square one. She has not thrown up any of the syringe feedings like in the beginning but I don't want to force her to eat when she was doing so good eating on her own.

Is this a sign that the cat is too far gone at this point? Is her refusing food altogether even when she is not nauseated/vomiting a sign of something else? 

I am at such a loss right now. My husband and I don't have money to keep bringing her back to the vet. They said they could do ultrasounds and xrays on her if she didn't get better. We actually used grocery money to bring her in the first time. The part that bothers me the most is why the sudden change from wanting to eat to not wanting to eat at all. Especially since she started to eat on her own at one point. Even at first when she was really sick she would smell the food and you could tell it made her nauseated so sthat was why she would not eat it. Now it's like the minute her plate comes near her she wants nothing to do with it and gets up and walks away. She even sees me coming with it and goes to hide. 

Other things I have noticed about Sabbath is that her ears look like the fur on them is thinning. I also noticed that from time to time her ears feel warm. She has not been cleaning herself like she normally does. She does drink water and I have seen her pee in the litter box. However we have 2 cats so I am not sure if the BM's in the liter box are from her. Also she is still thin. I have not noticed a significant change in her weight even with the force feedings and her eating on her own when she did.

I am thinking on calling the vet today but I know they will just tell me to bring her in for even more tests. Any suggestions on what I should ask them or tell them. Anyone else have this yo yo effect with the same diagnosis. Is she at the point of no return? I don't want her to suffer if she is dieing either.

Sorry I forgot to mention. Before all this.. Sabbath and Ichabod were only on dry food diet. Sabbath refuses to have anything to do with the dry even during the times she started to eat on her own. She was only eating the wet critical care from the vet. Which is a shock to me as she never wants to touch wet food. 

The up and down is a part of a lot of the chronic digestive illnesses.  My kitty has IBD and he also went through a bout of fatty liver.  He would be fine one day and the next day be like your kitty is.  He would vomit blood tinged bile.  I would leave for work, he would be fine and I would come home to the blood stained bile on the carpet.  It sounds like you don't have a lot of money for testing, an ultrasound would be good if you can swing it.  I would ask the vet for a round of prednisolone.  If this is an inflammation issue the pred will clear it up and you will know what you are dealing with.

The wet food is better for kitties anyway.  The A/D isn't good long term but now it's the best food for him.  You will need to syringe feed if he's not eating on his own.  There are some natural things that can be done to control inflammation but now while he is critically ill I would try the steroid.

That's just it we have been syringe feeding her. Then she suddenly seemed to be getting better. Was wanting the food in front of her and lapping it up and keeping it all down. 

Now out of nowhere she is back to square one and we are back to syringe feedings. I actually find it a tad worse because she has no interest in food at all. Atleast before she seemed to be interested but was just to nauseated to eat it on her own. 

I thought maybe it was the food itself. That maybe she just is sick of the critical care food and offered her different types of food. I even made her chicken and put tuna juice on it etc. Nothing. She just walks away from me and trys to hide so I don't offer it to her again. 

So far she has not thrown up the syringe feedings we recently have been giving her. I almost wonder if I will have to bring her in and have them put her on a iv type feeding. The vet did mention that. But she also mentioned keeping her for days and the bill being outrageous. Not that I don't care enough about her to do it.. it's more less the money is not there to do it.

So sorry to hear about your kitty. I agree that an ultrasound would be a great start, if you can swing it.. Your kitty sounds exactly like what I just went through with my cat. She had large cell lymphoma, which we knew from an ultra sound and biopsy. When she started the medication, her eating really picked up but eventually her disease surpassed her medication and she refused to eat. She lost a great deal of weight which in turn made for very poor health. Typical of the cancer type/lack of nutrition, her fur became very rough looking and unkept too. I found this was very typical too

I'm not sure what is going on with your kitty but nutrition is of the utmost importance. Again, if you can swing the ultra sound that would be great . It's not cheap and that's for sure!

My kitty did appetite stimulants too but they only helped for awhile

Here's hoping for the best for your kitty!

When you found out she had lymphoma did she get a special treatment route at that point? I am just curious if this shows up on an ultrasound if there is anything they can do for her. I assume this would not show up then on the blood work she already had.

There are chemo options but I wouldn't jump to the conclusion that it's lymphoma.  IBD was the route cause of fatty liver and cholangiohepatitis in my kitty, that inflammation can spread to the liver and pancreas.  The feeding is the necessary treatment for the fatty liver.  The antibiotics are needed for the pancreas and is a very good precaution because of the weakened state of the liver while it is inflamed.  Neither addresses the inflammation which could well be at the route of his issues.  That is why he may get better and then relapse, that is the nature of these inflammatory issues.

I know diagnostics are very expensive.  At the very least I would ask about trying a round of a steroid.  Prednisolone is the steroid most often given but there have been supply issues with it for awhile.

Oh I see what you are saying. You are saying if there is something else wrong with her other then the liver and pancreas issues that caused all of this to happen it could cause her to relapse. I didn't really even think of that. I just keep thinking of what they diagnosed based on the blood work

So an ultrasound would show up IBD issues or inflammation issues like you talk about? There still is no rhyme or reason as to why she stopped eating in the first place so this could all make a lot more sense as to why she is yo yoing. My husband and I immediately thought it was either digestive or her teeth. But the vet doesn't seem to think its her teeth. Maybe it is digestive. The first thing we thought was digestive so when she stopped eating we tried different foods and by that point I think it was too late as she would not eat anything.

I'm so sorry your going through this with Sabbath. 

Fatty liver, from what I've read, is usually secondary to some other condition that caused the cat to stop eating in the first place. You've got a double whammy - the fatty liver itself and also the other "thing" yet to be determined.

Nausea and vomiting can be a sign of many different conditions. For my Sebastian, his frequent vomiting and fussiness with food ended up as chronic pancreatitis. Many kitties with pancreatitis, IBD, and other GI diseases are high risk for fatty liver disease simply because they don't feel well and stop eating. When Sebastian is nauseous and/or in pain, he will sniff the food, walk away, and go to one of his "sick spots" to lay down. And, yes, things can change literally overnight, or in my experience, even within a few hours.

Pancreatitis might be something else worth testing for. It's a special blood test from Idexx called spec fPL, which has to be sent out to Texas A&M. An ultrasound, as others have said, is also helpful. It will show inflammation and thickened areas of the GI tract.

As for the meds...Sebastian gets a lot of things, and I wouldn't be able to pill him as frequently as I do if it wasn't for empty gel caps. I just stuff everything into an empty gel cap, close it, and coat it with organic coconut oil. He doesn't taste a thing. I bought # 3 gel caps from Amazon from the "Empty Caps Company."

Well her pancreas levels were high on her original blood test so makes me wonder if this is a good indication and the vet did say it could be why the liver has started to increase in levels too. The vet gave us the antibiotic Clavamox (liquid) that we gave to her for about a week. It was suppose to help with the pancreas and UTI that she got. The following week is when we started to see a change in her for the better but by the end of that same week we are back to square one with her again and starting a new week off badly. I feel bad if we are force feeding her a/d critical care and her insides are inflamed or her pancreases can not handle this food!!??  There has to be some other root cause to all of this. I am going to have to find a way to get her back in for some more testing. The vet mentioned xrays and ultrasound. Does anyone know what exactly would show up on an xray? It sounds to me that the ultrasound is the most important if we can only afford one or the other.

She has always been a finicky picky eater. Before she was sick she would join her sister in the kitchen any time I would have wet food and meow for some. Then I would give them each some and she would smell the wet food, snub her nose at it and walk away. That is why we ended up going with the dry food until now. I never understood why she would never even try the wet food after she smelled it. Now she has no choice as she won't touch the dry and we have to syringe feed her. I feel aweful when I do it. I will feel even worse if it's causing her to have more digestive issues.

I would skip the x-rays and have just the ultrasound if you can swing it.  I know I hated doing the syringe feeding as well but it is necessary.

When you found out she had lymphoma did she get a special treatment route at that point? I am just curious if this shows up on an ultrasound if there is anything they can do for her. I assume this would not show up then on the blood work she already had.

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I originally thought she had eaten a string, plant or something. She was notorious for that! Got an X-ray which showed a possible stomach mass. We then got an ultra sound with a biopsy. Turns out it was thickening of the stomach and large cell lymphoma. They have to take a sample to test for it. There are treatments available, depending upon the type. Prior to this, I noticed her sleeping in not normal places. She never was a huge eater so that didn't catch my attention but the fact she lost weight stirred me too. She also.was throwing up yellow bile. She wasn't too much of a puker before but if she did, it was always fur balls, not food or bile. That was startling too

I certainly don't mean to imply this is what is happening with your cat, but I from my reading it seems these symptoms are indicative of this, or IBD or something internal. Your vet can certainly find out through more testing.

My cat was started on Predisone and an appetite stimulant which helped a lot with her eating for a while.

I've read Nausea can also make cats not want to eat

Maybe you can do an ultrasound? Figuring out what is wrong is half the battle!

Best wishes for your kitty!

nicolefrank117 said:

 
I feel bad if we are force feeding her a/d critical care and her insides are inflamed or her pancreases can not handle this food!!??  There has to be some other root cause to all of this.

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That's just the thing. When Sebastian's pancreas is inflamed, this IS the cause of him not wanting to eat. Now the exact cause of pancreatitis itself is unknown at this point, but there are many varying theories amongst the literature.

nicolefrank117 said:

 
I am going to have to find a way to get her back in for some more testing. The vet mentioned xrays and ultrasound. Does anyone know what exactly would show up on an xray? It sounds to me that the ultrasound is the most important if we can only afford one or the other.

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http://felinedocs.com/dr-diana-lafer/ultrasound-or-radiographs-x-rays-–-what’s-the-difference/

Yah we have been giving her nausea and apetite stimulants and at first they were like a miracle! She started to eat on her own off her plate and ate more then she has ever eaten since she has gotten sick. We gave them to her again now that she has gotten to this point and its as if it does not phase her. She has not gagged or thrown up any of the syringe feedings so that is a plus compared to when she started off. 

Is there special diet for IBD, pancreatitis and the other conditions you guys have mentioned. 

I hope this a/d critical care is not doing more harm then good for her. It's the first wet food she has ever even considered trying. 

One thing we noticed with her too before she started to eat on her own was we would have to put some on our finger and give her a little. Then she would sniff it on the plate and eat on her own. Or we would have to pile the food up tall for her and she would eat off the top. When it would get down too low she would stop and we would have to pile it up high and she would eat again. We also at some times would have to stir the food with our finger and then she would eat it. All sorts of odd things while trying to convince her to eat. Once she started to eat on her own that sort of interesting behavior lessoned. We have tried to start up with this fun rituals again to get her to eat this time around but she won't even sit down anywhere near the plate. She will totally turn her body away and bury her face in a blanket or get up and walk away from it.

GoHolistic said:

 
That's just the thing. When Sebastian's pancreas is inflamed, this IS the cause of him not wanting to eat. Now the exact cause of pancreatitis itself is unknown at this point, but there are many varying theories amongst the literature.

http://felinedocs.com/dr-diana-lafer/ultrasound-or-radiographs-x-rays-–-what’s-the-difference/

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What is it that you do currently when Sebastian gets to that inflamed point and does not want to eat? Is he on a special diet that helps with the inflamation ?

What do you do in this case? Say Sebastian has one of her flare ups and does not want to eat?

nicolefrank117 said:

 
What do you do in this case? Say Sebastian has one of her flare ups and does not want to eat?

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Supportive care, mostly, and syringe-feeding if necessary. There's no magic trick, unfortunately. His flare-ups are inflammation, and only time and supportive care can bring it back down. The vet might order me to increase some of his current meds, such as the anti-emetic and antacid, as well as doing the sub-q fluids at home every day (instead of the usual every two days). We basically continue doing what we're doing, but maybe increase a few things. The things he does not get on a regular basis that we might add during a flare are an antibiotic, pain medicine, and an appetite stimulant. Pancreatitis is very painful. He is on a daily steroid (prednisolone) for inflammation, but increasing that is a last resort.

If the cat feels bad enough, sometimes the anti-nausea and appetite stimulants won't help. Sebastian's first pancreatitis attack was the worst. I brought him home after four days of being hospitalized, and he still wouldn't eat on his own, even with the anti-nausea and appetite stimulant. At best, he maybe took a few bites and would walk away. I had to syringe-feed him for I think almost two weeks to supplement what he wasn't eating on his own. He was a good boy about it. I would talk to him gently and sweetly throughout the feedings and not apply too much force when handling him. I would reward him afterwards with very high-pitched verbal praise and brushing, since he loves to be brushed. He never went very far and never hated me for it. I would do the feedings in a different room than where he would normally eat, and I would also use a different food than what I would normally put down for him.

By the way, Sebastian had many, many tests of all sorts done, but mainly the spec fPL and ultrasound(s) confirmed his diagnosis.

I really appreciate all of this added information. I have a message in to our vet. I am at work right now but I pray when I get home Sabbath is doing even the slightest better. I am going to stop on my way home and pick up some baby food (chicken flavored) and see if I can get her to try it. Right now the only thing she will try on her own when she will eat is this a/d critical care. Which is what I also have been syringe feeding her. I tried to offer her other foods and she refuses them. I wish she could just talk and tell me what is wrong  the thing that also confuses me is she is starting to act more like herself .. she was no longer hiding. was actually jumping up onto the couch to lay with me. Then when she is by me she has head butted me, rolled over on her side and rubbed her face on the couch etc. She was not doing any of these things weeks ago. She also drinks water on her own so I know that is better then some people are experiencing with their cats. I really am just insanely depressed because it's all I think about and it's actually caused me to get sick myself. I feel so helpless for her.

nicolefrank117 said:

 
I really appreciate all of this added information. I have a message in to our vet. I am at work right now but I pray when I get home Sabbath is doing even the slightest better. I am going to stop on my way home and pick up some baby food (chicken flavored) and see if I can get her to try it. Right now the only thing she will try on her own when she will eat is this a/d critical care. Which is what I also have been syringe feeding her. I tried to offer her other foods and she refuses them. I wish she could just talk and tell me what is wrong  the thing that also confuses me is she is starting to act more like herself .. she was no longer hiding. was actually jumping up onto the couch to lay with me. Then when she is by me she has head butted me, rolled over on her side and rubbed her face on the couch etc. She was not doing any of these things weeks ago. She also drinks water on her own so I know that is better then some people are experiencing with their cats. I really am just insanely depressed because it's all I think about and it's actually caused me to get sick myself. I feel so helpless for her.

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I'm sure you know this, but just make sure the baby food doesn't have onions or garlic added. What did Sabbath enjoy eating prior to all of this? Whatever that was, perhaps offer that for her to eat on her own while syringe-feeding the A/D?    I know exactly what you mean. When Sebastian started to feel better, he was up and about, moving around, getting in my lap, etc., but when I offered food...nope...not interested. It was very frustrating. A lot of food was thrown away.

I got sick, too, when Sebastian was ill. I lost like 15 pounds that I couldn't afford to lose. Hang in there.    Try not to think about it too much (easier said than done). I had to put myself in "robot mode" with everything and just do it and get it over with. And then I felt a little relief afterwards when the syringe-feeding was over and I knew he got some food in him. Baby steps. If she's starting to act more like herself, that is a good sign. When you are feeding her, you're giving her the nutrition she needs. 

Let us know how the convo goes with the vet. Sending lots of vibes for Sabbath. 

Yes I did read about the onions and garlic on another website but I appreciate the added reminder!!!

Honestly I am not sure that she "enjoyed" the dry food she was on. I stopped giving it to them when I realized she stopped eating and was throwing up more often. I switched to a grain free dry food and wet foods hoping she would try them and start to feel better. She refused everything from her old dry food to all of the new food and still does. For the past couple of weeks the only thing we could get in her or get her to try has been this a/d critical care stuff Makes me worried that once she is better if it will be hard to get her off of it.