Hepatic lipidosis, lymphoma ? Looking for advice

elle688

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Hi everyone-

I'm new here, and desperately seeking some advice.

In June, I decided I was going to buy my beloved Meekers (12 years, 10 lbs) some healthier dry food. He had been eating an organic dry food (available to him all day), and getting wet food in the morning (he loves his Friskies). I added some Prescription Diet Joint Care into his organic dry food, but I soon noticed he refused to eat it. I now feel very guilty that I allowed this to continue, because he would only pick at his dry food, and eventually stopped eating it. I started feeding him Friskies 2-3 times per day.

I began to notice some weight loss, and eventually realized he needed to see a vet (again, I feel very guilty that I waited so long - little Meekers is my baby, and I would never intentionally do anything so careless). I brought him to the vet, where he underwent an X-ray and blood test. The X-ray showed that his liver was quite enlarged, and his enzymes elevated. I brought him home with Zentonil (liver supplements), appetite stimulant (Mirtazapine) and antibiotic (Metronidazole). He would soon vomit after administering the Zentonil, and the Mirtazapine side effects made him behave quite strangely. Within 1-week of administering all of these medications, I brought him back to the vet and hospitalized him because he seemed quite lethargic (he was likely somewhat dehydrated at this point). He was hospitalized at the vet, where they gave him Ampicillin (antibiotic), Cerenia (anti-nausea) and rehydrated him via IV.

He had been scheduled the following day for feeding tube placement and liver biopsy. However, a blood coagulation test suggested his coagulation time was slightly elevated (1.8 and then 2.0 sec, when it should have been 1.2 - his other coagulation level was normal). I decided not to go through with it, but had him hospitalized for 6 days. I then had an abdominal ultrasound taken, which displayed an enlarged liver, and 'reactive' but not necessarily enlarged lymph nodes. I hoped this suggested that his immune system was working to fight off something instead of the early stages of lymphoma.

I took him home that night, and it has been quite a rollercoaster ever since. I brought him home with Clavamox (antibiotic, for 10 days), Famotidine (antacid, for 10 days), and Cyproheptadine (appetite stimulant). The appetite stimulant made him very drowsy, so I stopped giving it to him because he can't really go feed from his bowl if he passed out asleep all of the time. I started force feeding him 30ml a/d Urgent Care 7 times/day (about every 2-hours). He vomited quite a bit, which I think was the Clavamox because I put him on Cerenia (which helped, thankfully), and then he wasn't nauseous or vomiting as soon as the Clavamox were finished. I had brought him back in, hoping to do a fine needle aspirate of the liver + feeding tube insertion, but his slightly elevated coagulation time was still 1.8-2.0 sec, and I decided it would be selfish to put him through a potentially life-threatening procedure (however minimal) in case he hemorrhaged. I wasn't sure whether it was a good sign that his coagulation level hadn't gotten worse since the first time it was measured.

He has great days, and what look like not-so-great days (or is this how he always was?). He started waking me up with head-butts and kisses in the morning to feed him again. That typically only happens in the morning because then I have to start force feeding him in order to ensure that he is maintaining/gaining and not losing weight (he is currently around 7 lbs, which has stabilized). I am extremely lucky that he is so complacent -he used to just lie there, I imagine due to lack of energy - but now he sits up, fights only a little, but otherwise takes it like a champ. He has had a lot of diarrhea since the start of the week, but as of Tuesday I purchased some FortiFlora and have been adding it to his a/d Urgent Care - his stools actually have a shape now (I didn't think I could ever get so excited about poop).

I guess my question (now that you know Meeker's long history) - has anyone gone through the liver aspiration with a slightly elevated blood coagulation time ? Is there any advice or something I can be doing better for him ? I am still utterly terrified  that he has lymphoma, and that I am making his limited time here a living hell by force feeding him every 2 hours. But, if it were lymphoma, would I be seeing his behaviour improve/starting to beg me for food/eat on his own) ? His not-so-great days are basically him just sleeping on the couch, seems to have low energy, but my boyfriend says this is what he always did during the day (and I guess he is right, I'm just so worried with the very fine line between lethargy and sleepiness). Could it be that he is on the road to recovery and that his behaviour is suggestive that his liver is on its way to functioning normally ?

I am so sorry that this message is so long, I just wanted to give all of the information in order for everyone to fully understand his situation. Thank you in advance for you time, help, and any suggestions.

Lindsay
 

denice

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Hepatic Lipidosis has a long recovery  time.  The liver has to use up  the fat deposits and that takes time.  Getting enough calories in is the only 'cure', that stops the body from sending more of it's fat reserves to the liver.  My kitty had this almost 7 years ago.  He had the ultrasound, needle aspirate of the liver and feeding tube put in.  The vet didn't say anything about abnormal coagulation times though.  The feeding tube made the feedings easier but it's getting enough food in on a daily basis that cures the hepatic lipidosis.

His results from the needle biopsy were inconclusive as far as cancer goes.  It just showed that he had hepatic lipidosis and cholangiohepatiis which is just a fancy name for an inflamed liver.  We went with treating for IBD and he has been on a steroid since.  Your kitty's diarrhea was probably caused by the  antibiotic. 
 

mrsgreenjeens

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My cat had Hepatic Lipidosis probably 20 years ago, and I honestly don't think they ever even discussed needle biopsy back them.  He was diagnosed because his ears and gums turned so yellow.  No ultra sound was needed.   He also got a feeding tube installed.  Long time recovery for him....4 months with the feeding tube, but remember, this was a long time ago, and things have greatly improved now.

You didn't say, but is Meekers taking anything NOW to help heal his liver.  You mentioned he was getting sick with you gave him the Zentonil.  Have you tried it again?  How about anything else.  There are several things that help with the liver...Sam E, Milk Thistle, Denamarin (which contains both of the previous items), Ursodiol), vitamin E, and others.  Some of these things you could mix with the A/D and syringe feed him so you wouldn't even have to worry about pilling him.  I would definitely ask my Vet about the use of some supplements if you aren't.  The can advise you as to just how much to use, etc. 

Also, when a cat IS recovering, I think is is natural that they aren't going to be as energetic as normal, for that very reason...they are in recovery mode.  That takes a lot of "internal energy".  Their bodies, just like our, know what to do, and that is to take it easy to allow time for recovery. 

Why is your Vet even kicking around the thought of Lymphoma?  And Lymphoma of the LIVER?  Why else biopsy the liver?  Cancer's of the liver in cats are very rare from what I've read.
 
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elle688

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Thank you for the reply :)

Meekers isn't taking anything now for his liver, but you bring up an excellent suggestion. Perhaps now that he is improving (behaviourally, at least), I will discuss putting him back on the Zentonil. I'll also look into your other suggestions (I see that Denamarin contains both SAMe and silybin just as Denamarin, so perhaps staying on the Zentonil is the best idea). You're also very correct that he is in recovery, perhaps I need to be less analytic in terms of his behaviour - I'm having a bit of a hard time with this because I have been so worried.

The first doctor I brought him to largely emphasized his age - an older, geriatric cat, lymphoma typically develops around his age, being 12 according to her. He wasn't overweight (he had a belly, but nothing major). She actually told me that she would say her diagnosis was 50% hepatic lipidosis, 50% lymphoma. I was heartbroken. I have since switched doctors at that clinic, but neither one of them can say what is wrong with him without the fine needle aspirate. I had decided against it, because there was risk of hemorrhaging given his coagulation times, and I know that I cannot afford to treat him with chemotherapy (it was estimated at $5000 per year, and I am a low income PhD student) and I was told the prognosis was not good. I figured that he is being treated for everything treatable right now, therefore knowing what is wrong with him is not worth putting his life at risk with the aspiration if I could not treat lymphoma anyway. I would say it has made this even more difficult, because I don't know how much time I have left with him and I feel guilty about his current way of life. I'm just trying to stay hopeful.

If I can ask, how long did it take for your kitty to start gaining weight, and how much food intake was s/he getting daily ? I understand this was quite long ago, so I understand if you can't remember :) Is it normal that Meekers has vomited a couple of times in the past 4 days ? Thanks again for taking the time to read, and for offering some information about your experience :)
 
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elle688

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Thank you for the reply - that was exactly my thought in terms of his diarrhea. The probiotics seem to be helping now, so I will continue to use them over the course of the month. I'm following the vet's suggestion in terms of caloric intake with the a/d Urgent Care, he has vomited a couple of times since Thursday (not sure if this is normal or a bad sign). I am considering putting him back on the Famotidine (antacid) to see if it helps.

Did your cat eventually eat on his own normally ? I'm just wondering how long I should be maintaining him on 7 x 30ml per day, and when I can start gradually decreasing the amount of the force feedings - perhaps once he reaches closer to his normal weight ? 
 

mrsgreenjeens

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Yes, some cats get Lymphoma, but it's kind of rare, and unless you didn't give us the whole story, I just don't really see many symptoms of it.  You didn't list vomiting and/or diarrhea before Meekers starts the meds, and those are fairly common symptoms of Lymphoma, along with the loss of appetite.  When they did the Ultra Sound, was there a mass anywhere...anything other than an enlarged liver?  Enlarged liver can be explained by HL, as can the coagulation level, at least per this article:  http://www.peteducation.com/article.cfm?c=1+2135&aid=217.  BUT, said article does say you can only definitely diagnose HL with a needle biopsy, and I have NEVER heard that before, and believe me, I've seen many, many cases of it here on TCS...don't recall anyone ever saying they had a needle biopsy for it. 

Back to the issue at hand though.  If it were Lymphoma, there are different kinds...small cell and large cell.  One of our members had cats with both kinds, and the treatment was vastly different.  One cat went thru a long drawn out chemo therapy and lived for several years afterwards.  The other cat was put on a steroid and a very small dose of something else...and she's still around meowing happily.  So...I wouldn't put it off  automatically assuming you can't the worst.

I'm just suspect that the Vet can't diagnose HL.

HL in itself is a deadly condition.  I'll be frank, some cats do not make it.  It takes lots of time and energy, and is best served with a feeding tube.  If you can get some Vitamin K into Meekers, maybe you can get his coagulation under control, then you can go ahead and get the needle biopsy to find out if it is indeed HL.  If it IS, then I would get an E-tube installed for his feedings.  Then you can do all his meds right into the rube too.

Yes, it's normal for some vomiting to occur.  Sometimes it's as simple as the food going in too fast, or too much at one time.  Or it being too cold.  Or it just not sitting well in their tummies.  And, yes, I would continue with the Famotudine. 

At any time he may eat on his own, but you should continue the force feedings until you are certain he is eating enough calories to maintain his normal weight.  Usually it takes at least a month of force feedings, if not longer.  As I recall, we fed Bashful two 30 ml syringes every 4 hours for 4 months.  But he was a HUGE cat...not fat, just huge.  we have a picture of my husband holding him, and he's probably at least 3 feet long from head to tail.  I think he weighed over 20 lbs. 
 
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elle688

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Hmm I don't think I've left anything out, so I'm hoping you're right that his symptoms don't necessarily fit with lymphoma. This year, he vomited once in April and perhaps another time but I can't remember if it was before or when the inappetence began (he tends to vomit once at the beginning of a season, like a hairball), and he wasn't experiencing diarrhea. He didn't vomit nor have diarrhea when he was hospitalized either, but he was receiving Cerenia IV there, and he hadn't been on antibiotics for all that long (I've since put him on FortiFlora, and his diarrhea has improved).

There were no masses in the ultrasound - but lymphoma wouldn't necessarily present with a tumour, right ? That's good to hear about the lymphoma outcome, the first doctor I had seen was not entirely optimistic about prognosis if that were to be diagnosed. I would say that Meekers has improved since I have brought him home, likely because I am aggressively force feeding - I am somewhat hesitant about the feeding tube still because of the coagulation level, but at the same time it is becoming increasingly difficult to stay home with him all day to feed given I have to get back to school at some point.

He has been force fed by me at home (when he was hospitalized he wasn't receiving the full 210 ml of a/d Urgent Care per day) since Sept 14. We have had some hiccups (nausea, vomiting, etc) where he wasn't always reaching 210 ml per day, but I would say he has been getting that amount consistently for a week and a half. Though he isn't losing weight anymore (he had been consistently while hospitalized), he isn't gaining either. Should this be concerning ? I had read that a/d Urgent Care should result in quick weight gain given its high caloric content..

Now that his behaviour is somewhat normal, I'm also reconsidering putting him on the appetite stimulant - Mirtazapine or Cyproheptadine (I currently have both). Did you ever use an appetite stimulant with Bashful ? Wow, 20 lbs - what a big kitty !! 
 

mrsgreenjeens

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Well...everything I'm reading about Lymphoma is that it's actually a tumor, so I would think it would show up on an ultra sound...usually as some form of a mass.  However, that doesn't mean it's necessarily to.  You can't always believe everything you read on the internet


A/D isn't really that high calorie.  Here are other foods out there that have higher calorie content.  However, it is highly nutritious, and is very good for sick cats.  Plus it is one of the best foods out there for syringe feeding.   I don't know how many calories Meekers used to eat, but if he's being force fed the same amount as he used to eat, then he won't actually gain weight.  He needs to eat MORE calories in order to gain weight.  Maybe you could add in some Nutri-Cal or more A/D to get him to start gaining?  I would call the Vet and ask what you could do since he's now maintaining, but not gaining.  Perhaps instead of thinning the A/D with water, you could thin it with that canned or carton kititen replacement milk, or even goat's milk (NOT cow's milk though)  or add in a raw egg yolk.  That's got lots of nutrition and extra calories. 

We never used an appetite stimulant with Bashful, not sure they even had them way back then
 
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