Fatty Liver and Finding the Underlying Cause

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quiet

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See if you can find anything around the house that looks like what he threw up. Also make sure you don't have any potpourri or essential oils around the house. Think of anything different that could have gotten into. He is indoor only right?
 

quiet

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Sorry for the multiple posts I just keep thinking of things. About you not being at the vet visit: You can call your vet and have them e-mail the blood results to you. You can also speak to the vet and ask them what is going on. It is a really good idea with an ill cat (or dog) to get a copy of the medical records and blood work so that if you do have to take him to the ER at night you have all his records right there with you.
 
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weemomma

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He's acting better right now then he has acted all day.  He's acting more like his normal self.  I guess the feeding we did at around 6 upset his stomach.  Once he got everything out, he's feeling better.  He has been feeling better since he came home from the vet.  He's been grooming now for about the past 30 minutes.  He hasn't done that in a long time.  He's just not interested in food.  His breathing is fine.  He's not labored in any way.  He has been purring a lot, but I know cats do that both out of affection and when they don't feel good.  Right now he's bright eyed and responding to me just fine.  He won't play, but I figured if I was as sick as he is right now, I wouldn't want to play either.  His jaundice looks fine too.  He hasn't gotten any more yellow then he was this morning.  I do not know that he has drank on his own today.  I do not know that he has used the bathroom today.  I work most of the day and when I came home, he was already in his hiding spots.  He shares a litter box with his sister so I do not know who is doing what, where or when.

There is nothing in the house that he has access to like potpourri or oils.  The thing that I found in his vomit doesn't look like anything I have in the house.  He is an indoor only cat, does not go outside at all.  He was treated with SubQ liquids at the vet.  He does not have an IV at home.  We are supporting his liver with medication, but it's only been two days.  We are waiting to see the outcome of a test before we proceed.  I was suppose to call tomorrow with an update on his eating any way.  I am pushing hard for a feeding tube, but the vet says that is the last thing to think about right now.  He has a heart condition and she wants to make sure that we figure him out before we go into a surgical procedure.  
 

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If you do decide to go ahead with a feeding tube and further diagnostics I strongly urge you to get a referral to a specialist in internal medicine. Where I worked the vet could place an E- tube in less than 5 minutes, so very minimal anesthesia time. Just sedation. But with an underlying heart condition it should be monitored with the type of monitors and staff that are at specialty hospitals or university hospital. Things can go horribly wrong with E-tubes and vets that don't place them all the time. So it isn't to be taken lightly that is for sure.

Well, I hope he continues to improve.

Another thing is to always monitor closely after any fluids including sub q as they can get volume overload more quickly than a cat with normal heart function. Sounds like he is doing better and I hope it continues. Best of luck with him. 
 

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Good morning ...

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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!
The small blue thing that William vomited could be some med that he was given at the vet clinic. When I look back at the report you posted, it does indicate oral medication was administered. I would call the clinic and speak with your vet or someone and let them know about this blue thing to see if they can confirm whether this is what was given.
 
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.
I don't think the blue thing has anything to do with the jaundice. Jaundice is the result of a buildup of bilirubin caused by either some obstruction in the bile duct (gallstones) or an infection of some kind. It could be that between what he has received in the way of meds at the clinic, and what he is getting for meds at home, that there is an interaction and something isn't being well tolerated. I would also let your vet know about the vomiting, so they can make a determination as to what needs to happen next if anything. 

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He's acting better right now then he has acted all day.  He's acting more like his normal self.  I guess the feeding we did at around 6 upset his stomach.  Once he got everything out, he's feeling better.  He has been feeling better since he came home from the vet.  He's been grooming now for about the past 30 minutes.  He hasn't done that in a long time.  He's just not interested in food.  His breathing is fine.  He's not labored in any way.  He has been purring a lot, but I know cats do that both out of affection and when they don't feel good.  Right now he's bright eyed and responding to me just fine.  He won't play, but I figured if I was as sick as he is right now, I wouldn't want to play either.  His jaundice looks fine too.  He hasn't gotten any more yellow then he was this morning.  I do not know that he has drank on his own today.  I do not know that he has used the bathroom today.  I work most of the day and when I came home, he was already in his hiding spots.  He shares a litter box with his sister so I do not know who is doing what, where or when.

There is nothing in the house that he has access to like potpourri or oils.  The thing that I found in his vomit doesn't look like anything I have in the house.  He is an indoor only cat, does not go outside at all.  He was treated with SubQ liquids at the vet.  He does not have an IV at home.  We are supporting his liver with medication, but it's only been two days.  We are waiting to see the outcome of a test before we proceed.  I was suppose to call tomorrow with an update on his eating any way.  I am pushing hard for a feeding tube, but the vet says that is the last thing to think about right now.  He has a heart condition and she wants to make sure that we figure him out before we go into a surgical procedure.  
Glad to hear that he is feeling much better. The grooming and being social are very good signs. I would agree that you have to be very careful with the syringe feeding. If it is not going well, I wouldn't continue doing it, but let your vet know as soon as possible, and discuss other options.

Hope things go better with the food now that he has gotten whatever it was out of his system, and that you will hear back about the blood results soon.
 
 
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weemomma

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If you do decide to go ahead with a feeding tube and further diagnostics I strongly urge you to get a referral to a specialist in internal medicine. Where I worked the vet could place an E- tube in less than 5 minutes, so very minimal anesthesia time. Just sedation. But with an underlying heart condition it should be monitored with the type of monitors and staff that are at specialty hospitals or university hospital. Things can go horribly wrong with E-tubes and vets that don't place them all the time. So it isn't to be taken lightly that is for sure.

Well, I hope he continues to improve.

Another thing is to always monitor closely after any fluids including sub q as they can get volume overload more quickly than a cat with normal heart function. Sounds like he is doing better and I hope it continues. Best of luck with him. 
I really do trust his vet with his life.  I do get frustrated sometimes that it just feels like they think this is just a cat, but I know that they care about all of my animals.  They are a cat specialized hospital too.  I think he is in the best place that he could be right now.  If it does come down to a feeding tube, I will see if I can't take him to the university hospital just down the street.  That is where he saw his cardiologist.  I know everyone has his best interests in mind, but it's just really hard because he's my baby.  He is the special one out of all of my cats.  It's really hard to see him down when he hasn't been sick a day in his life.
 
Good morning ...

Quote:

The small blue thing that William vomited could be some med that he was given at the vet clinic. When I look back at the report you posted, it does indicate oral medication was administered. I would call the clinic and speak with your vet or someone and let them know about this blue thing to see if they can confirm whether this is what was given.

I don't think the blue thing has anything to do with the jaundice. Jaundice is the result of a buildup of bilirubin caused by either some obstruction in the bile duct (gallstones) or an infection of some kind. It could be that between what he has received in the way of meds at the clinic, and what he is getting for meds at home, that there is an interaction and something isn't being well tolerated. I would also let your vet know about the vomiting, so they can make a determination as to what needs to happen next if anything. 

Quote:

Glad to hear that he is feeling much better. The grooming and being social are very good signs. I would agree that you have to be very careful with the syringe feeding. If it is not going well, I wouldn't continue doing it, but let your vet know as soon as possible, and discuss other options.

Hope things go better with the food now that he has gotten whatever it was out of his system, and that you will hear back about the blood results soon.
 
I called his vet this morning and relayed what he had done last night.  I believe the oral medications that were given to him were the liver pill and the appetite stimulant.  The blue thing remains a mystery this morning.

He is feeling better this morning.  To me, his color looks a little bit better, but I'm trying really hard to not get my hopes up.  He is still jaundice and yellow, but when I look at him, it doesn't seem as yellow as yesterday.  He was up and about this morning, still moving a little gingerly.  He jumped up in bed with me, followed me around the house, but still not interested in eating or drinking.  His head was held high, his tale up.  He seems to be better then where he was last night.  When I gave him his pill, he drooled and stressed out.  Now, he's back in his little makeshift bed resting.  My problem is I can't just leave food out for him because his sister will come behind and eat it all.  I gave him a small pinch of dry food and a tablespoon of wet food and a cup of water and when I came back, she was chowing down and he was nowhere to be found.

I'm having a real dilemma today about whether to force food on him.  He didn't do well with it last night, but I know he needs to eat.  Tomorrow he will go to the vet for a week to stay.  I know that they don't want to tube him without know what caused the fatty liver, but I really want to go with that option.  After all that I've read about fatty liver and its treatments, I think that will be the best for all of us. 
 

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I had a feeding tube put in when Patches had fatty liver but there isn't anything magical about the feeding tube.  It's getting enough calories in that turns this around.  The feeding tube makes the feedings easier but the tube itself doesn't do anything.   It may be the anesthetic they want to avoid.   If it is fatty liver it will be awhile before he wants to eat again and he will start with just nibbling a little bit of food here and there.
 
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He just ate about three treats for me.  We might try some warmed baby food here in a little bit.  He doesn't seem interested in drinking either and that's what worries me.  No one seems too concerned about the situation, but of course I just have the worst in the back of my head.  I wish I could tell if he has used the litter box too.  I just changed the litter and usually that entices them both to come running, but I think that they are both hiding at the moment.
 
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weemomma

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I did have a question about something that I had seen on another site.  Will Nutrical help him at all at this point?  I went to Petco yesterday to get the feeding syringe and I almost picked some up, but I talked myself out of it at the last moment.  Anyone had any experience with that product?
 

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I know people here have used it.  It is a way to get calories in a small amount of something that kitty eats.  When Patches was on a feeding tube I gave him a food called A/D from Hills.  It's a prescription food that is only available from a vet, that will probably be what they will give him while he is at the Vet's.  The Royal Canin equivalent is called Recovery.  Which one your vet uses will probably depend on which line of prescription foods they carry.
 

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Hi weemomma .. The nutrical sounds like a very good idea. Actually anything at all that can help to provide nutrition should be given.

The lack of drinking may have to do with the sub-Q fluids William has received. He will likely receive more fluids once he goes into the clinic, so I wouldn't be too concerned about this, but you may want to mention this when you go in so they know what he has been taking in, in the last 24 hours.

Keep trying with the baby food, treats, bits of shredded chicken, cream cheese. Just be careful with foods that may contain onions, garlic and this includes the baby food, as these items can be upsetting to cats. As William will be at the clinic tomorrow, they will have techniques for getting him to eat, and additional forms of nutrition as Denice mentioned.

Lots of vibes for William in the next few days .. Hang in there and try not to stress ...
 
 
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I just talked to his vet and we are going to put in a nasal tube tomorrow and see if that helps him any.  She said that the reality is that he is going to need the feeding tube, but she wants to try all of the options first.  The appetite stimulant has obviously not worked.  He just drooled when I gave it to him.  She wants to treat the fatty liver even if we don't know what caused it just yet because the bottom line is, the fatty liver will kill him if left untreated.  If it's histo, we can treat that when the test comes back.  Anything else will have to be determined with a liver biopsy and she's not prepared to do that just yet.  

In a way, I'm happy that there is a course of action.  In another really big way, I am so incredibly sad.  I just want to shake him and tell him that if he would just eat, this would all be better.  I know that he's a cat though and just doesn't understand.  My heart just breaks because I'm going to be 1000 miles away from him for a week.  Rationally, I know that if something were to happen to him, I couldn't stop it anyway.  I've told him that if things get to be too much, we had a good 10 years together and it's okay to be tired and need to rest.  I just don't want to lose my boy...
 

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Fatty liver is a vicious cycle.  He is nauseated so he doesn't want to eat but not eating is feeding into the cycle of fatty liver.  I know it is frustrating.  I did the same thing thinking why won't you just eat.  My vet started treating the fatty liver while continuing with the diagnostics to figure out what caused the anorexia.
 

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I just talked to his vet and we are going to put in a nasal tube tomorrow and see if that helps him any.  She said that the reality is that he is going to need the feeding tube, but she wants to try all of the options first.  The appetite stimulant has obviously not worked.  He just drooled when I gave it to him.  She wants to treat the fatty liver even if we don't know what caused it just yet because the bottom line is, the fatty liver will kill him if left untreated.  If it's histo, we can treat that when the test comes back.  Anything else will have to be determined with a liver biopsy and she's not prepared to do that just yet.  

In a way, I'm happy that there is a course of action.  In another really big way, I am so incredibly sad.  I just want to shake him and tell him that if he would just eat, this would all be better.  I know that he's a cat though and just doesn't understand.  My heart just breaks because I'm going to be 1000 miles away from him for a week.  Rationally, I know that if something were to happen to him, I couldn't stop it anyway.  I've told him that if things get to be too much, we had a good 10 years together and it's okay to be tired and need to rest.  I just don't want to lose my boy...
Your vet sounds very sensible!
Trying the non-invasive things first is good. Force feeding and tubes are not natural. If you can get kitties to eat naturally, it is so much better for them. If he does need the feeding tube, then he will be somewhere that they can monitor how things go with this.

I understand your fears and sadness .. This is all so sudden and nothing is certain at this point. Being away from him may seem scary at first, but actually it may be the best thing for you, and him at this point. It will give you some time to yourself, to put your mind on other things and collect your thoughts. Just from what you have told me, it sounds like William is in good hands, and will be in the best place.

Keep your chin up ..
 
 
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I opened up my second bedroom today and the cats have been lounging in there nonstop today.  Little Girl has been lounging with William on the bed.  He hasn't felt much like moving again today.  I don't think he's gone to the bathroom at all.  I'm trying my hardest not to worry about him and pester him since he's going to the vet tomorrow.  His body temp is normal, but his nose and ears feel so hot.  I've been napping off and on since about 2 because I did not sleep well at all last night.  

Should I be more aggressive with him?  Should I be forcing him to eat and drink?  Trying to tempt him to the litter box?  I have no idea what I need to be doing right now for him.
 

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He NEEDS calories. That's the only way to clear his liver. So, yes, forcing food is the only way until he has a tube put in. If he's naseated, try giving him a very small amount frequently. Like maybe one dropper/syringe full (if it's not a very big syringe) every 15 minutes. But he just absolutely needs to get some food in his system.

Nutrical, Pediasure/Ensure (vanilla only), baby cat formula, whole goat's milk---all are good ways to boost caloric intake without overloading his stomach. But do try to get at least one jar or meat baby food into him every day, plus something else to boost the calorie count to 150.
 
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I have no idea to gauge if I've gotten 150 calories in him.  How many calories are in typical cat food?  I've been giving him baby food today, but I don't want him over full like he was last night.
 
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Also, he has no interest in water.  Is this normal for fatty liver cats?
 

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This sums it up pretty well but does not go into the full complexity of the disease.

From Cornell University Feline Health Education

Feline Hepatic Lipidosis (FHL): The most common acute liver disorder causing severe jaundice in the cat that is potentially lethal without judicious supportive care. FHL is a syndrome initiated by several days of inappetence. Thus, many primary disease processes initiate FHL and must be concurrently managed during FHL diagnosis and treatment. After vitamin K treatment to reduce risk of bleeding, placement of an esophageal feeding tube is needed to allow owner feeding and treatments that support feline metabolic needs during FHL recovery. We have come a long way in managing this common feline syndrome over the last 20 years and now most affected cats can recover. Early diagnosis improves chance of recovery and involves routine laboratory tests, ultrasonographic abdominal imaging, and fine needle aspiration of the liver.on:
 
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