Fatty Liver and Finding the Underlying Cause

Hi.  This is my first time posting here.  I am completely at the end of my rope when it comes to my cats.  I can give a little bit of what has been happening this year.

I have three cats in total.  Two have been together for almost 7 years now and the other I brought home about 2 1/2 years ago.  The newest one lives out in my garage as she's still mostly feral, but she is a completely sweet little girl.  She is kept inside because she is deaf.  The other two I have had since they were kittens.  My oldest, William, is 10 years old and the younger girl is around 7.  They are both DSH orange tabbies.

Back in January, Little Girl was diagnosed with histoplasmosis.  We have no idea how she got it because she is only indoors.  She almost died before we figured out that anything was wrong.  She lost half of her body weight, would projectile vomit up to five times a day, but she was constantly hungry for food.  She would beat everyone out of the kitchen just for the chance to eat.  After about 8 months of treatment, she is hale and happy again.  We find out next month if she can come off her medication and everyone was going to be happy and celebrate.

In June, William was diagnosed with a Grade III heart murmur.  He's otherwise health and has no external symptoms.  He went to a cardiologist three weeks ago and was given a borderline normal diagnosis with possible thickening of his heart.  He is suppose to go back in 6 months for a definitive diagnosis of whether he has HCM.  All seemed well and normal and good until last week.

William started acting off.  The spark that made him my lovable man was gone.  He was listless.  He wasn't eating as much.  Then...he just stopping moving at all.  He would stay in the same spot for hours at a time which was incredibly unlike him.  He ran a very low grade fever that reached around 104.5 but has since been down around 102.5 to 103.0.  He lost about 2.5 lbs since the last time he was weighed at the cardiologist.  Because of my busy schedule, I had my father take him to the vet on Friday.  That morning, when I checked his gums, I noticed the first signs of jaundice.

By the time he got to the vet, he was most definitely jaundiced.  His gums are a pale yellow, his nose alternates between yellow and pink, his ears are yellow and the pads of his feet are turning yellow.  We suspect fatty liver because his bilirubin was elevated, but we don't know what caused it.  Because of Little Girl, the vet immediately drew blood for a histoplasmosis test.  We won't know the results till the end of next week.  He came home on Saturday, but he won't eat.  He seemed better and was walking around the house like normal.  They gave him B12, a SubQ of fluids, and put him on an appetite stimulant and a pill to support his liver function.

I feel like I've been put through the wringer.  My emotions are all over the place.  I cry a lot because I feel so helpless for him.  I am so afraid that I'm going to lose my boy.  I keep kicking myself for not going to the vet with him and asking the important questions.  I look at his symptoms and I fear that he has FIP.  The vet told my father that everything she saw in the blood work indicated something that could be fixed.  I can deal with histoplasmosis.  I've been dealing with it for months with Little Girl.  The involvement with his liver just scares me.  The vet just said that the best thing for him is to eat, so I've been force feeding him and giving him treats.

I just don't know what to do.  Has anyone else out there ever gone through this?

The Fatty liver was caused by not eating, the diagnoses that needs to be made is why he quit eating.  http://www.petmd.com/cat/conditions/digestive/c_ct_hepatic_lipidosis   Your vet is right, getting enough calories in is the only thing that will stop the vicious cycle that is fatty liver disease.  IBD is often a cause of aneroxia but it normally does not cause a fever, even a low grade one.  If nothing else shows up I would ask about the better test for pancreatitis.  There is a test done at the vet's office then there is one that is sent to Texas A&M.  The one that is sent out is the better of the two tests.  Often a vet will do both because of the immediate result with the less sensitive test.

The fever is what has me worried about FIP.  His test results sounded normal though.  Nothing elevated in his white cells.  Nothing elevated in his red.  Bilirubin was up, of course.

Today, when I came home from work, he was curled up on the bed.  He ate a handful of treats but now he's just loafing there.  He seems a little grumpy and he feels warm again.

I know this isn't an issue with thyroid.  He was tested for that three weeks ago and the levels came back fine.  As far as pancreatitis, his body temp is elevated not low and he has only vomited once this week because of car sickness.  I can ask about the possibilities, but it doesn't seem to match.

FIP is really rare in older cats, it's something that usually happens in kittens or young cats.  It sounds like you are a lot like me, we tend to go to the worst possible illness and worry about that.  I think the chances of this being FIP is very very small.  Kitties with Pancreatitis don't always have vomiting.  Was his white cell count up?  

This is my problem...I wasn't at the vet appointment.  My dad said that the white was just barely elevated and the red was in the normal range.  Our vet said that everything pointed towards something that could be treated.  These past few days has been extremely nerve wracking for me.  Looking at websites about what "might" be wrong definitely isn't helping.

My guy is curled up on the bed right now.  It's apparent that he's not feeling well.  My only silver lining is that I have to go to a family event out of state and he will be at the vet for a week starting on Tuesday.  I wouldn't be surprised if I had to take him in tomorrow.  I've been keeping a log of his food intake.  It's laughable at best but I'm doing my best to help him.  

I was really shocked with how bad his jaundice had gotten between the time I saw him that morning to the time that he came home yesterday.  It's not like mustard yellow or anything, but it's still a startling shade of pale yellow.

Hi there .. There are different reasons for jaundice including infection and a buildup up of toxins in the system. A high bilirubin level is an indication of jaundice but not necessarily fatty liver, so too is the high fever. Given that your other kitty developed histoplasmosis which is a fungal infection, its possible that this could be what William is now dealing with as well. Symptoms of this infection include lack of appetite, loss of weight and fever.

If your vet is suggesting that this condition can be treated successfully, chances are that he/she suspects an infection as well. Once the blood tests are back, treatment can begin. For now, getting some food into William is the goal. Below are a couple of additional links, one regarding Histoplasmosis that will provide you with a bit of additional information.

http://www.petmd.com/cat/conditions/digestive/c_ct_histoplasmosis

http://www.petmd.com/cat/conditions/digestive/c_ct_jaundice

Lots of positive vibes for you and your furbabies

Thanks.  I let him see if he wants to eat before I pull out the syringe and the blender.  He's so mad at me, but I know it's for his own good.  He is feeling warm again tonight.  I almost wish that the vet had kept him there, but their philosophy is that they recover better when they are home in familiar surroundings.

I pulled the exact discharge report.  This is what it says.

Procedures performed:

Physical

Metabolic profile (elevated liver tests)

CBC

UA

Histoplasma antigen test

SubQ

Vit B-12

Oral Medication

Diagnosis:

Liver disease, etiology open

Anemia, non-responding, mild

Thrombocytopenia (low platelets)

Medication:

Mirtazapine - Every other day

Denamarin - One Tablet Daily

Eat as much as cat wishes

I would agree with your vet. Better to have him at home than a strange place when he is feeling badly. Plus, depending on arrangements at your particular clinic, sometimes there is someone looking in on cats overnight, sometimes not.

You can try some different foods that he doesn't usually eat such as tuna, fancy feast or those shredded foods with gravy, even meat-based baby food. Anything that you can think of that he would like. 

The report suggests that your vet suspects problems with the liver, but the cause is unknown. The denmarin will help to support and improve liver function. It contains a derivative of milk thistle apparently which is a natural herb that humans take for liver issue. A very sensible approach I think. Hopefully it can help in William's case as well. 

I've tried all sorts of foods.  He usually licks at the gravy and then he's done.  He ate some tuna for me yesterday and then he will eat some treats.  I cannot stop crying for my boy.  I want so badly to help him get back to being himself, but I just feel like I'm losing him.

I know it must be heartbreaking and overwhelming in finding yourself dealing with a second sick kitty, but please try and stay positive. Tears are natural and healing, but thinking the worst is not going to help William. The not eating can be a scary thing, but try not to let this get the better of you. Keep working at it and if need be contact your vet if you have any concerns or are in need of some guidance and support. 

 

I will take anything I can get at this point.  I realized that my thermometer was out of batteries, so I ran downtown to get another one.  In the mean time, I wrapped an ice pack in a towel and took it to his new nesting spot.  He feels so warm to the touch.  His ears are warm, his face is warm.  He seems to like the cool feeling under his body.  When I got home, I took his temp.  I was shocked that is was 102.5.  Surely that can't be right.  He let me take it again and it was 102.9.  I will take that small blessing!  He's been up over 103 for the past few days.

Yes, the temp is definitely moving in the right direction. 102.5 is the high end of normal Blessings!

His little nose is really dry.  I have given him water mixed in with his food all day today, but I know he probably needs another SubQ from the vet.  Is there anything I can do to help him with that?

You can use a dropper to give him water or Pedialyte (unflavored of course). Be careful so he doesn't get any in his lungs.

Make sure he's getting at least 150 calories a day. I don't know what your vet has you giving him but make it adds up to that.

Since we are at the very beginning of this, I don't have a calorie guide line for him.  The vet simply said that anything at this point is good.  I estimate that we are about 100 - 120 calories for today.  I'm going to try some baby food just before bed.  We had some luck with beef baby food in a syringe last night.

Also, should I be concerned that he wants to stay in one spot?  He was up and roaming around yesterday, but it was also his first day home from the vet.  Today, he was up and around this morning, but now he just wants to stay in his makeshift bed that he made out of my comforter.  Is this kind of inactivity something to be concerned with?

Update:  William was acting a little off when it was getting close to bedtime.  I decide to let him be while I was getting some things done.  I went to check on him just now and found the spot where he had been lying was covered in large amounts of liquid vomit.  He had moved spots and looks like he's feeling better.  The strange thing was in the middle of the vomit was a thing about the size of a pea.  When I picked it up, it was a little solid and almost looked like a pill capsule.  On closer inspection, it's a foreign object.  None of his pills have the kind of coating that I found and he took his liver pill this morning around 8am.  It's a pale blue, has the consistency of a soft plastic.  I have NO IDEA what this thing is!

Has he passed any stool since all this started?  You said he hasn't vomited, usually with an obstruction from a foreign object they will vomit everything usually an hour or so after eating.  I would definitely call the vet in the morning about this.  Vomiting kind of goes with a lot of these digestive issues but a possible foreign body is something different.

I know he pooed at the vet.  I cannot tell if he has while he's been home.  He shares a litter box with Little Girl and I work through most of the day so I don't know who is going where and when.  Whatever he just threw up, he is feeling a million times better.  He's up and active now.  He's grooming at the moment and being social.  Still no interest in food.  This thing was round and when I squeezed it, a small amount of vomit was expelled from the inside.  Like it said, it's about the size of a pea and looks like it's a blue plastic.  I picked it up because everything else was liquid and pale brown.  It looked like a bit of mold sitting in the middle of all that throw up.  It's most definitely not his pills.  I went a checked just in case and his pills have no covering on the outside of them.

He had a projectile vomit in the car on the way home from the vet yesterday.  Before that, he has only ever thrown up hairballs or lumps of undigested food, but that was all before he got sick.  

Surely a foreign body like that can't cause jaundice.

If he is still acting ill you should take him to an emergency vet as these guys can go down hill really fast. Do you think he was acting more lethargic after the vet, before the vet or the same? is he using the litter box? Is he drinking any water on his own?

The thing is with cats, once they don't want to eat and go into hepatic lipidosis you often need to have a feeding tube placed because it causes a cat so much stress to syringe them food and there is no way you can get enough food into a cat that way. With a tube it takes about 10 minutes three times a day and you get all the calories into him he needs. Don't syringe feed him after he has vomited.

He may need to be on IV fluids if he is this ill and vomiting. How is his breathing? A yellow cat is a sick cat and honestly it sounds like he needs to have an ultrasound with a specialist to determine what is going on with his liver, and bile duct etc. He could have bile duct obstruction or cholangeohepatitis or many other things going on. An experienced board certified specialist will be able to help you with all that.