Hepatic Lipidosis w/ Encephalopathy - Need advice!

I'm glad I found this forum!

My smallest female, Pretty Girl, had been acting strange since going in to the vet for her yearly exam and rabies shot. When she seemed to have lost most of her appetite, I wasn't overly worried. She's a small cat, not even 9 pounds, and though she was looking thin, she wasn't looking that thin. I figured she had stressed herself out (she always has been a bit neurotic) and that the rabies shot had knocked her appetite out. Three weeks after the vet visit, she stopped moving and was dehydrated. She was at the vet the next day. I was concerned, but not worried. Stupid me.

She was jaundiced, and severly dehydrated. The vet was having a hard time judging just how bad she was due to the fact she was hiding it so well. Her liver was enlarged, and she was depressed, lethargic, and pretty well out of it. She had lost 2 pounds in three weeks.

She was hospitalized imediately and put on an IV. Physically she was responding well, but she still wasn't really there mentally. FeLV and FIV tests came back negative. Her blood work showed only abnormal liver enzymes; everything else was normal. They did a liver biopsy (by needle) and sent it out to a specialist. The only thing that was there was hepatic lipidosis. The vet was surprised, because she's so small. That was the last possibility on his list.

On Wednesday they started to (finally!) force feed her once they had the diagnosis of hepatic lipidosis. On Thursday, she tanked again. They called me to come in immediately, because they thought she was going to die. Her liver wasn't processing the ammonia out of her system, and she developed hepatic encephalopathy. She also had a potassium depletion. By that night, she was on the verge of slipping into a coma, and the vet told me later she had only had a 13% chance of pulling through. We went to bed Thursday thinking that we would be getting the call in the morning.

Friday morning comes, and the vet tells me she's up and moving around the cage! She hadn't vomited once in the time she had been there, so he was okay with sending her home in the evening; he wanted to keep her on an IV as long as he could. I was stunned.

We brought her home, and she was really happy to be home. She can use the litterbox, but she's not eating or drinking on her own. I had asked the vet about subQ fluids over the weekend, and he didn't seem to think they were necessary. She's on Denosyl, Tumil-K (Potassium Gluconate), Metronidazole, Lactulose (for the encepalopathy), and baytril. She's also to get 12 cc's of Hills k/d (low protein to keep the ammonia levels down) mixed with water force fed by syringe three times a day. (If anyone can help me out with how to force feed her, I'd be grateful! I've done it with kittens, but she's fighting like crazy.)

He seems to think that as long as she's tolerating being force fed, that she doesn't need a feeding tube. I really want to pressure him on that, because I can't force feed her by myself, but I don't know if the tube would be easier on her. Money is not an object.

He's also dodging the question of how much brain damage she has. She's working her paws (something she has never done), head pressing, tongue is out, she rocks, and she'll suddenly sit down and zone out. I can understand why he won't give me a direct answer, but I would like an idea of what to expect.

He also said that she's probably not suffering. He said that she's like an alzhiemer's patient who is sick, but can't realize it.

He honestly cannot tell me if she'll make it through the weekend. I personally think he sent her home because he couldn't do anything else for her. He flat out said that she had gotten as much fluid through the IV as she could. The only hope was that she'd get better once she was comfortable and calm at home. I'm just trying to figure out when to give her meds to her, spaced apart so she doesn't get sick, and still manage to get to work.

If anyone can offer some advice, first hand experiance, anything, we'd be grateful. The entire house has been off since she's been sick.

Honestly, I'd get her to a specialist and get a second opinion asap. I'd want to know why she's on an antibiotic, and why she's on flagyl (Metronidazole).

When I was assist feeding my cat who was not eating at all (though did not have hepatic lipidosis) I certainly was advised to feed a lot more than a total of 36 cc's of food, let alone diluted food, per day. I am not a vet or vet tech, and certainly not there with test results in hand, but I as an owner, would not be comfortable that this would be sufficient fluid or food intake over the weekend.

Can you get your vet to discuss this a bit more with you - why not set you up to do sub-q fluids over the weekend? For help in assist feeding there is a great yahoogroups list on assist feeding. It is called Feline-Assisted-Feeding and you can find it via a search on yahoogroups.com, it is a superb group re just the issue of how to assist feed, and may well also be able to discuss amounts to feed.

Please let us know how things go, I wish you and your kitty all the best,

I've unfortunately had a lot of experience with force-feeding, and 36cc of food a day is no where near enough. Just a couple of months ago, I lost Bob to a non-specific liver disease, so am somewhat familiar with the problem. First, the fact that Pretty Girl isn't drinking means she must get those fluids somewhere else; I can't believe your vet said she didn't need IVs anymore. Second, you must get more food into her. I was giving Bob as much in 1 sitting as Pretty Girl is getting in a day! If all else fails, wrap Pretty Girl in a large towel with only her head sticking out to feed her. She will be SO mad, but she'll get over it. If you think a feeding tube would be easier on her, get it inserted as quickly as you can.
Liver disease isn't something you can take a "wait & see" attitude with.
http://www.sniksnak.com/cathealth/liver.html will give you some info on liver disease.
I don't think I can stress strongly enough just how serious a condition this is.
You have to treat liver disease very aggressively.
Good luck.

Like Libby, I too am used to force feeding. I read your initial post with a lot of alarm. I would right now, find a feline specialist in your area, or if that is not possible, find a second vet. Your cat is dangerously ill, and if you let your mindset be- I can't force-feed her, she will die. Sorry to be so direct, but she has a lot of things against her. Right now, you are in her corner, and you need to fight for her. Ask the new vet to show you how to administer sub cu's. They really are not that hard after you do it a few times, it comes naturally.

I would also listen to Pat and Libby. Both ladies have been there and done this several times. FHL can be defeated, but you have to attack hard and aggressively. But that is not the only issue you face with Pretty Girl which is why you should be seeking another vet, a feline specialist or a vet university to help you


http://www.thecatsite.com/Health/85/...Lipidosis.html

I have no experience with this, but just wanted to wish you all the best, I do hope you cna find a vet who is willing to treat this more aggressively.

I strongly agree with the advice you've been given by Hissy, Pat & Alix, and Libby.

You need a new vet ASAP. Dehydration especially is very dangerous and Pretty Girl's liver is already compromised from lack of food.

I've been assist-feeding (not force feeding) my cat who has liver disease for about 6 months. I didn't think at first I could do it either - the website Pat & Alix mentioned helped tremendously. www.assistfeed.com

Please let us know how Pretty Girl is doing - best of luck to you both.

I should rephrase that - I CAN feed her, but she's not LETTING me. She's drooling so much that it slides out of her mouth without her swallowing it. My mother has been able to get food and water into her without her fighting too much. We're going to do as much as we can, and come 8:30 am Monday, she's back to the vets for another IV and a feeding tube. They moment I go near her, she starts drooling uncontrollably, probably because she's associated me with nail trimmings, baths, medicine, vet trips, etc. She's my mother's cat, and I just take care of all the important things. I think with a feeding tube it'll be easier on all of us, because then my mother can leave her care to me. (It's killing my mother having to force anything onto Pretty Girl. Up til now she's never even pilled a cat, and she's having to do force feedings and medicating 8 times a day.)

Unfortunately, he is the best vet in the area. I've compared notes with a few other ladies who have been through this and he's treating it far more aggressively then their vets did for their cats.

There is a specialist, but he's two hours away. The emergency clinic is over an hour away, and they're the only one's open right now. She wouldn't make the trip. She barely made it the three minutes home without freaking out. They also say they don't have her record which the vet assured me they faxed over. So they'd have to rerun every test, which isn't going to tell them anything because it took a specialist to tell us that she only had hepatic lipidosis. They told me over the phone that they wouldn't be able to do anything based on what I tell them the vet told me. They'd need to test everything themselves. She's a 9 pound cat, fatty liver is the furthest thing from everyone's mind.

The metronidazole is because the vet thinks that there is some sort of underlying problem that they can't find. She's not stable enough to do an exploratory to see the liver and take a larger biopsy. The baytril is to keep her IV sites from getting infected since she tore all of them out on her own. She's also very weak, and I have six other cats with a possible herpes virus. I think antibiotics are a good idea.

We're going to push as much fluids and as much food as she'll take over the weekend and see what happens. The problem is that the vet is pretty sure with how severe her neuralogical problems are, somewhere around 70 to 80 percent of her liver could have failed. She seems to be doing better today - her neuralogical symptoms seem to have diminished.

What was bad was that the only symptom she had given us was the lethargy. She never vomited, she never had diarreah. She's always been so nervous that she eats by herself in the middle of the night when all the other cats are asleep with me. I've also never witnessed her using the litterbox in the year that we've had her.

The excessive drooling is a symptom of the fatty liver disease, not just the fact the Pretty Girl is upset. I mentioned my Bob earlier--he also drooled uncontrollably when he was sick. Cats with liver disease become incredibly nauseated; my vet recommended 1/4 of a Pepcid tablet 2x daily.

I strongly urge you to ask the vet to show you how to give your kitty IVs at home. She must be kept hydrated, and once you get the hang of it, it's actually pretty easy to do.

How are you & your Mom trying to feed Pretty Girl? If you use a "people syringe" the job goes much easier. You can pick them up at a drug store--try to get one about as big as your index finger that has a long tip on it. Cut off about 1/2 of the tip to get a bigger opening. Remove the plunger & pack the food into the barrel. I bought several of these so that I could have 3 or 4 ready each time I fed Bob. Some went on my lap, most went into him. The best way to try to beat this disease is to feed, feed, feed! It will take time, tho; the forced-feedings may have to continue, without fail, for up to 2 months. If the feeding tube would make this easier, please get it inserted ASAP.

Like hissy said, your cat is dangerously ill; fatty liver disease is, quite literally,
a life or death situation. You have to commit to nursing care 100% or your cat has no chance what-so-ever. I genuinely wish you the best of luck with this situation. Having been thru it so recently myself, I know what an awful situation you're faced with.