Relapse? Fighting against fatty liver disease.

nicolefrank117 said:

 
Sorry got another question. I remember my vet mentioning before about keeping Sabby overnight and putting her on ivy nutrients or fluids if she got worse. Did anyone have success with this? I know it cost more but if it will help her I am willing to do the Care Credit and do it if people have had success with it!

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Sebastian was hospitalized during his first pancreatitis attack for four days. They had him on an IV and were giving him daily meds via injection or in the fluid line since he wasn't keeping anything down. Fluids are really important for pancreatitis. He had a couple other overnights in the succeeding months when he had flares, but it was just one night. Overnight stays are not cheap, but sometimes the continuous IV can make a big difference. The vets monitor the flow and adjust....can't be too much, too fast. (Sebastian still gets fluids every other day at home.)

Was 4/30 the last time Sabbath has blood work? Not that you want to think about spending more money, but blood work is usually run periodically when there are liver issues to keep tabs on the numbers. What does your vet suggest?

Denice said:

 
I don't know what your kitty is being given but to be honest none of it worked for Patches either.  I think how effective those meds are depends on the kitty.  Patches was never given cerenia for nausea though, a lot of people here have had success with that.

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Cerenia really helps with Sebastian's nausea.

Denice said:

 
I don't know what your kitty is being given but to be honest none of it worked for Patches either.  I think how effective those meds are depends on the kitty.  Patches was never given cerenia for nausea though, a lot of people here have had success with that.

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First Sabbath was on Clavamox, Marin and an antacid. When that was said and done she was then given Cerenia for nausea and an appetite stimulant (not sure which one as I am at work). They worked miracles at first. Then she was even eating on her own with out either of them. Then the relapse and she stopped eating and started the gagging. We tried the nausea and stimulant again when we saw this happening and it doesn't seem to phase her. She did gag before but she has kept all her food down still. When this all first started she was throwing up everything.. when her stomach was empty she was throwing up foam and bile.

GoHolistic said:

 
Sebastian was hospitalized during his first pancreatitis attack for four days. They had him on an IV and were giving him daily meds via injection or in the fluid line since he wasn't keeping anything down. Fluids are really important for pancreatitis. He had a couple other overnights in the succeeding months when he had flares, but it was just one night. Overnight stays are not cheap, but sometimes the continuous IV can make a big difference. The vets monitor the flow and adjust....can't be too much, too fast. (Sebastian still gets fluids every other day at home.)

Was 4/30 the last time Sabbath has blood work? Not that you want to think about spending more money, but blood work is usually run periodically when there are liver issues to keep tabs on the numbers. What does your vet suggest?

Cerenia really helps with Sebastian's nausea.

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Yah I am definitely going to bring her back in. If there is even the slightest chance that the fluids will help her then I am letting them keep her over night to see if it helps her. Did you notice when you brought your baby home after the fluids that their appetite started to come back? 4/30 was the last time she was in. I have been in contact with the vet via phone since then giving her updates. That is how I was able to get the appetite and nausea meds. She did tell me though that this was the last of the nausea meds she wanted to prescribe (2nd script) and that if she was worse or not getting better to bring her back in for more tests. So I guess that really is the next step for her. 

I am wondering too if Sabby does have IBD if this a/d critical care food is upsetting her stomach more

The A/D is mainly pork which is a novel protein for most kitties so I doubt that it's causing issues but anything is possible.  I think the vet wanted to be careful with the cerenia because it depletes a chemical in the brain.  Most kitties who are on it long term take it for a few days then a short break and then take it again.  The break is to give the chemical a chance to build back up in the brain.

It's hard to tell if it's IBD or something else.  For diagnostics my priorities would be the ultrasound, the new blood test for B vitamin absorption, and the definitive blood test for pancreatitis.  

Denice said:

 
The A/D is mainly pork which is a novel protein for most kitties so I doubt that it's causing issues but anything is possible.  I think the vet wanted to be careful with the cerenia because it depletes a chemical in the brain.  Most kitties who are on it long term take it for a few days then a short break and then take it again.  The break is to give the chemical a chance to build back up in the brain.

It's hard to tell if it's IBD or something else.  For diagnostics my priorities would be the ultrasound, the new blood test for B vitamin absorption, and the definitive blood test for pancreatitis.  

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What makes me nervous is the corn flour.

Talked to the vet.. bringing her in tonight. Gonna do the xray, ultrasound and blood work. Once we get the results if her levels are higher or worse or she seems like she needs to have the fluids/iv then they are going to keep her over night. Wish me luck!

Good luck! Let us know how it goes!

Sending LOTS of vibes...     

nicolefrank117 said:

 
First Sabbath was on Clavamox, Marin and an antacid....

...she was then given Cerenia for nausea and an appetite stimulant ....They worked miracles at first....

Then she was even eating on her own with out either of them.    [I will add: also without antacid treatment]

Then...she stopped eating and started the gagging.

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So, first the antacid.......followed by its replacement with the anti-nausea med.....she returns to eating on her own, all meds withdrawn....something then happens....and she stops eating again.  WHAT IF the "something" that happened was that she became constipated, bloated, stopped eating and the stomach acid redeveloped ?  REMEMBER......in that quoted scenario, antacid was ONLY used "once" (for one period). The anti-nausea med alone will NOT eliminate/deal with stomach acid.

I would have them begin an antacid regimen for her now (i.e. speak with the Vet, point out that it was the missing link when she stopped eating and request that they give it a try - it won't hurt in any case).

Oh and, another of the clues that suggested this post was the story about piling up her food....when the pile was high, she ate...when it lowered, she withdrew. One of the well-known tips to help a cat who may be/is nauseous is to raise the food dish: http://www.felinecrf.org/nausea_vomiting_stomach_acid.htm#raising_bowls

Just one other tidbit....once she's firmly back to eating on her own, you want to changeover to another wet food. With her fixation on the a/d and, if she were here, I would expect a lengthy process of very slowly adding a tiny amount of the new food into the a/d and increasing that amount in tiny increments over time until, eventually I would be feeding 100% new.

To summarize a long-winded post

• constipation could be cause/contributor, so stool output & quality needs to be assessed - treatment may be needed (see below)
• antacids need to be added in and the results evaluated

Just as a final insert, MiraLAX would be my choice of laxative, if one were needed, and I'm mentioning it because Vets are only slowly hearing about it (most prescribe Lactulose...horrid stuff, that !) More here: http://www.felineconstipation.org/prevention.html#OsmoticLaxativesPrevent    (some cats are prone to chronic constipation...perhaps because of a lifetime of dry food...one of mine is such and, after two years of an all-wet diet which includes extra pumpkin, still needs daily MiraLAX dosing)

@White Shadow  thank you so much for taking the time to type all that out. I really appreciate it. The added information makes a lot of sense. I am going to bring some of this up to the vet when I get my check in call tomorrow.

Needless to say I am a wreck. Had to leave Sabbath at the vet hospital. Blood work shows that everything has elevated and gotten worse. Today when we got home we noticed her skin has yellowed and is jaundice

The xrays and ultrasound were pretty positive. No cancer or tumors. The only thing that really showed up was that she was a little constipated. The vet feels this is secondary. But I do see some of @White Shadow

points that I plan to bring up. She does believe that it is quite possible that due to some of the things Sabbath was doing prior to being sick (throwing up her food on a more regular basis etc) that IBD could be a factor as @Denice  suggested. Pancreatitis is still considered a part of the issue as well. She told me how the three can go hand in hand.  

They are keeping Sabbath tonight and tomorrow night. She will be given a catheter, iv and nutrient fluids and be monitored with feedings. She told us at her current state she highly recommended them keeping her. They plan to also do something for the constipation. She said the fluids alone could help with that but if they don't see any improvement they will get a stool softner and possible enema to get things moving. 

If things are not improving with her eating by Friday we have to make a decision to sign the ok for them to  do surgery to put in a feeding tube.  I absolutely hate thinking about this but at the same time there is a better chance of us getting all the food and medications she needs in to her to get her better before the disease continues to get worse and kill her. 

She told me that there is a 50/50 chance this all will work. Some cats pull through and are great and others not so well. But it's worth trying to see if she can pull through this. 

Driving away from the vet was the hardest thing ever. I know she has to be so scared. To leave her there like that. I know I won't be getting any sleep tonight. I already have a kink in my neck and feel insanely sick to my stomach from all of this. 

My kitty had a feeding tube when he had fatty liver.  I really think it made the feedings easier and less stressful both for Patches and me.  I think we kind of balk at the idea because of the way they are used in people.  In people they are used for someone who is at the end with a neurological or muscle type disease or someone in a vegetative state.  For kitties it can be a very effective part of treatment for something like fatty liver.

Denice said:

 
My kitty had a feeding tube when he had fatty liver.  I really think it made the feedings easier and less stressful both for Patches and me.  I think we kind of balk at the idea because of the way they are used in people.  In people they are used for someone who is at the end with a neurological or muscle type disease or someone in a vegetative state.  For kitties it can be a very effective part of treatment for something like fatty liver.

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Thank you. These kind words do make me feel better about things. If it comes to her needing this we will do it. We got approved for the Care Credit. Just hopefully we can pay it all back. Atleast after all is said and done I can say we did everything we possibly could. 

I'm so sorry that Sabbath's numbers are worse.    Do you know what kind of feeding tube they would use? Not that that matters in the general scheme of things, but it's one of the things I asked when we were considering a feeding tube for Sebastian.

  

I actually am not sure. I guess I didn't think to ask. I was more concerned about asking if she was so bad off that a feeding tube would be a waste of time. Like it if was worth trying. That is when she told me it was a 50/50 chance. Before they do the surgery they are going to consult with us etc. So when they do I will have to ask. She did tell me it goes like through her neck into her esophagus and into her stomach.

I called and checked on her earlier. 

She is about the same but she is stable. Nothing to be alarmed about. She is curled up in the blankets of her cage. She still has not went to the bathroom and still refuses to eat on her own. They are leaving dry and wet food in with her incase she wants to try to eat. They syringe fed her last night and this morning. She said when they take her out this next time to feed her and stuff they are going to give her something to try to get her to go to the bathroom. They were waiting it out hoping she would go on her own. She is up front away from the noisier areas and she said she is where she can check on her more frequently. I guess she is in the area with with “sicker” animals that need more care and more of a watchful eye on them. She said she is not panting or doing anything alarming. Her blanket is not in the cage with her because when they clean the cage they might take it and throw it in the wash and give it to another animal. So it’s in her crate but that is next to her cage. I miss her so much. My poor sweetie.

I just opened up a fortune cookie and it said "time is the wisest counselor"

I know she is really sick now but she can get through this.  They didn't see any growths on the ultrasound and that is a big deal.  My kitty was also refusing to eat and was not going to the bathroom as well.  Actually that's what he would do when his IBD would flare, I just didn't know that it was IBD.  

Poor Sabbath. I don't have much to add right now, except virtual hugs and lots of vibes. It sounds like she's in really good hands.

Denice said:

 
I know she is really sick now but she can get through this.  They didn't see any growths on the ultrasound and that is a big deal.  My kitty was also refusing to eat and was not going to the bathroom as well.  Actually that's what he would do when his IBD would flare, I just didn't know that it was IBD.  

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Now that your cat has survived everything and is doing better how do you keep the IBD under control? What do you do if your baby gets a flare up and does not want to eat so it does not end up with the fatty liver or pancreatitis again? 

I am hoping she pulls through this and I can do all that I can to try to not let it happen again. 

I am already leaning towards no more dry food. Right now the only dry food in the house is what is left of their Grain Free Blue Buffalo Basics that I bought when I noticed Sabbath stopped eating the Science Diet food that was possibly making her sick. I already got them started on the wet food .. right now its the Grain Free Adult Healthy Choice pate. Ichabod is eating both but I am measuring things out now. Sabbath before taking her in would not try any of it. I will try again when she is better. I was considering getting the Wellness Chicken wet ood. I heard it actually has more calories then the a/d critical care and was going to ask the Vet it that would be ok even for her tube feedings. I noticed the a/d critical care has corn flour in it. If she has IBD wouldn't that make it worse? Atleast the Wellness food is grain free. 

I know right now the focus is getting her to survive this and then later get her back to a normal routine but I am so scared if she does survive all this of her getting this again. I have no clue where to start to make sure she continues to eat once she is ok. I can already see myself freaking out if one day she doesn't want to eat after she is better.

Patches stays on a very low dose of steroid.  There are other ways through diet and probiotics that may very well work.  I have been afraid to try them because Patches would get so sick with flares.  Right now just get her through this and well again, then think about long term.  

The important thing with preventing fatty liver is that the kitty takes in enough calories to avoid the cycle.  A kitty, especially one with a history like this shouldn't go much more than 24 hours without eating even it means syringe feeding.  Right now anything that she will eat is fine.

Nicole, here is some straight, solid information about feeding tubes - many people have found the article reassuring: Feeding Tubes for Cats  -  Lisa Pierson  DVM

I'll say a few things....remember, I'm at a distance...I'm not caught up in the emotions inherent to what's happening on the ground.

I will sound critical......NOT of you in any way....just of the picture I'm watching.

(I'll also preface with this: Ten years ago, I was in a similar position, overwhelmed with information, an emotional wreck......and, completely, utterly on my own.  If only I had had someone with me to see and hear things clearly, ask questions, point out incongruities...and on and on....I know our outcome would have been different.)

Only for your benefit then, here's what your understanding was last night:

 They are keeping Sabbath tonight and tomorrow night. She will be given a catheter, iv and nutrient fluids and be monitored with feedings. She told us at her current state she highly recommended them keeping her. They plan to also do something for the constipation. She said the fluids alone could help with that but if they don't see any improvement they will get a stool softner and possible enema to get things moving.

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But, Nicole.......this is all that was done (as of four hours ago):

 They syringe fed her last night and this morning. She said when they take her out this next time to feed her and stuff they are going to give her something to try to get her to go to the bathroom. They were waiting it out hoping she would go on her own.

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Where's the promised IV......into which they could have added the antacid (and, which they said could help with constipation - nothing truer, btw)......but, they're "hoping" she will eat and defecate on her own...???

Two feedings with one pending.....for a cat with HL who should be fed small amounts every two hours...???

So, why the rush to have her admitted last night? She might as well have been at home with you !  You could have added the stool softener to the a/d yourself (provided the existing stool is in the intestine, not the rectum...did she tell you where she saw/felt the stool?)

And, just as a matter of service and caring for the cat, they can give her her blanket and put an index card sign on the kennel "PATIENT'S BLANKET" - simple solution. We know those sorts of little comforts go a long way toward reducing cats' stress....(I leave a little cat bed with my cats for in-hospital stays.)

I trust that you understand the "why" of my post....my hope is that it may be useful. I'll also not have a lot of extra time later on tonight, though I'll try to check back.

I had called her earlier in the day way before I posted the update on her. They were giving her the feedings like they were suppose to. Sorry this was more of a summary of things. I didn't mean to confuse anyone. Last night when we got to the vet they did another exam on her, more blood work to compare to last time, xrays, ultrasound, and then also re weighed her. 

She is getting meds through the iv as well as nutrients and getting her hydrated.

She was not constipated to a point that it alarmed the vet. It actually looked to her like it was secondary and being caused by her being dehydrated. She did not feel it was bad enough to have caused all the issues she was having. The xrays and the ultrasounds didnt show any blockages or tumors etc. Everything as far as BM was at the end of things ready to come out. There was nothing backed up into her stomach etc. That is why she was hoping that once she was more hydrated from the fluids/ivshe might go naturally on her own. Especially since we had the pooping accident at home that we think was her since it was outside the litter box. But they were going to do something to get things moving if she did not go on her own. They put some dry and wet food in with her in case she decided to want to eat on her own but they are still syringe feeding her and have her on the iv etc. 

The reason for the hospitalization is because her levels went up, she has lost more weight and now her skin is yellow (jaundice). She is not getting better she is getting worse. We are hoping keeping her there and getting her hydrated again will help give her a boost she needs to get back to where she was the other week when she was getting better. Talking to people on here it sounds as though that really was worth doing as it seems to have helped many other cats on here. The other thing is we work full time and I feel that it is best to put in her in safe hands that can give her even more feedings then I am able to at home. Especially since apparently what I was doing must not have been enough if she only got worse. Which makes me feel rather lousy. I look at it as if she is getting worse and they can give her proper care all day long even when I am not around during the day then that is what she needs to get better then I am ok with that. 

Numerous people at random have told my husband and I that a feeding tube seems harsh and that we should just put her to sleep. We had to explain to a lot of people the importance of her eating and this disease. It's amazing how many people are not aware of how this disease is and how it kills cats. Honestly I have had my cats for going on 13 years now and I had no idea until all this had happened which is really scary. I am disappointed that I learned it the hard way. 

For those of you who have tube fed your cats... how long was your cat tube fed before they got better and the tube was removed? How was your cat when you first brought them home with the tube and after they removed it later on?

My kitty had a feeding tube for a month but it varies.  The tube will stay in until she is eating well on her own again.  The vet kept him at the clinic until he was worked up to full feedings with no issues which took about 3 days.  Not all vets do that.  He was getting the A/D through the feeding tube.  The A/D was diluted half and half with water and he got 60 ml four times a day.

I had a lot of people who thought it was harsh and I should have had him put to sleep.  He actually tolerated the feeding tube very well and that is the norm for kitties.