Liver problems

I posted a few months ago but I thought I would create a new thread as things have changed and I'm hoping there's someone out there who's been through a similar situation or who can offer some advice.
Sorry in advance for the long post!

My 7 year old tortishell (Boo) had some major anxiety issues from day one, I adopted her and believe there were problems at her prior home (I got her at 3 months old). The biggest issue was the inappropriate urinating. We had run some tests at the vet and ruled out medical problems - it was clearly behavioural. This past October it became much more frequent as a new cat was brought into our home and my sister and her husband had temporarily moved in. I always said my last resort was going to be some sort of anxiety medication and I finally was at my wits end. I brought her to the vet and we decided to give meds ago and she was prescribed Clomicalm.
Come November my boyfriend and I purchased our first house and moved in December 1st. With Boo being on the medication it had completely eliminated her peeing on our bed, clothing etc - it was amazing but it was also making her a bit "zombie" like so I decided to start tapering her off. Within about a week or so of moving in she started acting funny. I'd wake up to find her just sitting in her litter box, I started getting worried and turned to dr Google which told me one of two things - illness or anxiety. I summed it up to her anxiety. Shortly after I noticed she was licking her lips a ton and then her appetite started to decrease a lot.
I got her to the vet, they ran a full blood panel and they said she needed to stay a few days as they figured it was fatty liver.
After being here for 3 or 4 nights her high levels weren't dropping drastically enough for them to continue assuming it was that. We decided to do some X-rays and also give her some medication for a possible infection as well as a liver support. She had an ultra sound done as well about a month ago, that came back completely clear with no concerns. I'm working with two different vets at the same clinic and we all have been left wondering if this is a result of the anti anxiety medication.
Fast forward to now. Her liver levels have dropped a ton and she's still getting her daily liver support. Her ALT level at the beginning of all of this was crazy high sitting at 1,500 accompanying other high levels (I don't know what, I've lost track). She's been having blood work done every 3-4 weeks with a steady drop, until today.
3 weeks ago the ALT level was 225 and today it came back at 232.
I'm feeling incredibly disappointed, I'm not sure what to think. I've been given a few different scenarios.

1) this could be Boo's "norm". We don't have these levels to compare to from before she was sick.

2) she's plateaued. Her liver could have been so severely insulted that it won't ever go back to a "normal" level

3) there's still a chance of a tumour that isn't being picked up on by ultrasound. Full exploratory biopsy would be the only real way to find out.

The vet doesn't want to do the full biopsy at this point as Boo's behaviour is better than ever. She's got a great appetite, lots of energy and ever since moving her anxiety has gone down tremendously.
We're going to try her on a different liver support soon, which if I heard correctly has a couple of other nutrients in them.

If you've made it through my novel, I'm wondering if anyone has any experience with a cat who has "above normal" liver levels naturally?
If you haven't, any advice is appreciated. It's been a pretty awful few months as I was sure on a few occasions I was going to lose her. There's been some "ups" lately, but I'm feeling pretty discouraged today.

Fatty Liver disease often does do permanent damage to the liver and this could very well be her normal.  It isn't horribly high.  Normal is 100 or less and given how high ALT levels can go with something like Fatty Liver Disease this is very close to normal.  My kitty that had Fatty Liver now has normal enzyme readings but the vet treats him as though he has some liver damage.  He hasn't had any vaccinations since before the Fatty Liver.  He also got a different antibiotic after having teeth extracted then my other kitty did because of the assumption that there is liver damage.

I would probably ask the vet about giving some kind of liver support supplement like Denamarin or Milk Thistle.

Denice said:

Fatty Liver disease often does do permanent damage to the liver and this could very well be her normal.  It isn't horribly high.  Normal is 100 or less and given how high ALT levels can go with something like Fatty Liver Disease this is very close to normal.  My kitty that had Fatty Liver now has normal enzyme readings but the vet treats him as though he has some liver damage.  He hasn't had any vaccinations since before the Fatty Liver.  He also got a different antibiotic after having teeth extracted then my other kitty did because of the assumption that there is liver damage.

I would probably ask the vet about giving some kind of liver support supplement like Denamarin or Milk Thistle.

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Thanks for the response, Denice.

After the initial 4 days stay at the vet, they no longer thought it was Fatty Liver as her numbers weren't dropping as fast as they should've with whatever medication she was receiving. But who knows.

She's been on Zentonil Advanced (100mg) since this started, but I will inquire about Denamarin. The vet did mention on the phone yesterday that there's another liver supplement she wanted to try, it's a bit cheaper and also has a couple of other nutrients in it that this current one doesn't - I wonder if it's Denamarin.

I'm just trying to stay calm at this point, I finally started to relax about this whole situation and I'm scared it all sparking up again and we have no real answers.

Hi. I'm so sorry you are going through this with you baby. It is so hard not knowing exactly what is going on inside them. I just wish they could talk.

I'm going through something similar as my cat was just diagnosed with fatty liver yestetday. I cannot figure out how to post a new thread so hoping someone on here might be able to answer a small question. You noted that your cats ALT was upwards of 1500 originally. Do you know what the ranges would be fore all the liver enzymes? And how bad the ALT at 450 is? That's what my cats came back at.

Good luck with your fur baby! Sending healing thoughts!

My cats ALT went over a 1000 before it started dropping.  I honestly don't remember any of the other numbers, it was over 6 years ago.  The main number the vet kept an eye on was the ALT so that is the one I remember.

It took a long time for Patches ALT to start dropping.  It actually continued to rise even after he started eating again well on his own.  I think it took at least 3 weeks if not a month for his ALT to start dropping.   Patches Fatty Liver was confirmed with a needle biopsy.  I don't think it is at all unusual for it to take awhile for that number to start dropping because that was true for Patches.

Thanks, Denise. Did you treat by assist feeding or the feeding tube?

I had the feeding tube put in.  There is nothing magical about a feeding tube though, it is getting enough calories in every day that leads to recovery.  The feeding tube just makes it easier and I believe less stressful.

Yes, I've been contemplating the feeding tube. I opted not to get it originally because she appeared to be so weak, I was afraid to put her through a surgery. She seems to be dealing with me force feeding her quite well, although, she definitely doesn't like it and will hide briefly afterwards but always comes back out. She eats a couple of treats on her own sometimes. I'm able to get between 3/4 and 1 whole can, plus high calorie booster and goats milk into her, which I assume is about the amount of calories she would require with a feeding tube.