Please Help! Sick Older Cat

Hello,

My 14 year old Sweetheart of a guy Lenny has been diagnosed with Liver disease about a month ago. I am loosing it here, along with my wife, as Lenny has been on Fluids for the past 10 days, along with Beytryl, Prednisone and Pepcid. On top of this , he also has Hype Thyroid disease, for which he was given Methimazole. Lenny is impossible to pill, so we found this great pharmacy in AZ that made a transdermal of the Methimazole and the Ciproheptaiden for his apaetite. He seemed like he was getting better last week, and then he started vomiting. First food, then liquid (presumably Bile). So we took him back to the vet who suggested we stop the Transdermal stuff, and stop feeding him wet food (he was eating his dry food ). That was two days ago and we have not seen him eat the dry food, except for a few pieces. He is continually looing for us to feed him wet food, but the vet thinks that may hve caused his vomiting. His brothers Vinnie and Jimi) are depressed and don't know what to do, since Lenny is the Alpha cat and is now either sluggish, not cuddling witht them and hides under the bed sometimes. Honestly, he seems like he still has some life left in him, so I don't think he is ready to go yet. After a somewhat disheartening experience with a prominent "Specialist" vet in San Francisco (who drained my bank account and does not know how to effectively communicate with their clients) I finally found the best vet hospital I have ever been to. So I called today t osee if they had 24 hour care, and they don't. They said I could bring him in and they would hook him up to the Vac machine and give him fluids and meds, but nobody will be there to monitor him.

I am severly depressed, my wife is feeling the same way and we just don't know what to do. I'm just wondering if I should be looking for some alternative therapy for him, as he seems to still have some life left in him. Before this problem, the only other problem he had was slight case of Pancreatitis in December. Otherwise he has been a fat, happy, very talkative, dear cat sincve we adopted him at age 6 at the North Beach festival. I am willing to spend more on him(i'm already close to broke), but I have to figure out what's best for him. Do I take him to the regular vet and leave him unsuprovised overnight - or do I just try to work out a payment plan with another emergency hospital in San Mateo and leave him there for a few days?. Please email me any suggestions and post here as well. Thank You

Howie- Your post brought tears to my eyes- what a great dad you are to Lenny! Much of what you describe is familiar to me - my 17 year old girl also has liver disease (for a few years now) so I empathize with what you're feeling.

As your vet may have explained, there are many types of liver disease. Do they know which specific one Lenny has? Some conditions can be cured, most are treatable. One very important thing to keep in mind - the liver is the only organ in the body which can regenerate itself, provided there are still some healthy cells left. It's an amazing organ. Remembering this fact has gotten me through more tough times than I care to recall.

My preference would be to find a fairly large animal hospital with board certified internists, which provides 24 hour care. I'd be very reluctant to leave Lenny alone all night.

Vomiting is a pretty typical side effect of liver disease, unfortunately. My girl is also on Pepcid which helped quite a bit. Lenny is on lots of meds right now, so it's possible that they're not agreeing with him, and could be the cause of the vomiting. Antibiotics are tough on the digestive system, and often cause vomiting, diarrhea, or both, which in turn leads to inappetance. Speak with your vet about trying a different antibiotic that might be easier on Lenny's system.

It's good that Lenny's being given fluids, that's important. He also needs to eat. Since Lenny wants wet food, (which I personally feel is preferable to dry but you have to do whatever works) I would give it to him. I'm not a vet, but my own feeling is that with all the meds Lenny's on, the chances are greater that it's one of them or the combination of them that's making him sick, not the food. If the food never made him sick before, why would it bother him now? Just make sure it's high quality food - no by-products, nothing artificial. Colors and preservatives are just more junk that his already compromised liver has to process out. If he's not eating enough on his own, assist feed him. He's already got liver disease, you don't want to run the risk of hepatic lipidosis which is a serious condition of the liver caused by lack of eating or not eating enough. I've been assist feeding my girl for several months - it made a world of difference. This site will help you: www.assistfeed.com Keep in mind that small, frequent meals are easier for the liver to handle. Consider adding a digestive enzyme to his food, like Prozyme, to help his body utilize the nutrients from the food.

Ask the vet to give you injectable B vitamin complex - very good for liver patients and it will sometimes help spark appetite. My cat also gets fluids, and I inject 1cc into the venoset port once per week, per my vet.

You said that Lenny had a bout of pancreatitis - maybe that's a chronic problem which could also be causing him to feel lousy. It can be difficult to diagnose - hopefully it was just the one time.

There are very beneficial supplements that you can use with Lenny. One is Denosyl, which was suggested by my vet. It's a human supplement, Sam-e, which you may have heard of. Denosyl is made specifically for cats and dogs. My kitty gets one per day - it has to be taken on an empty stomach. I get it through entirelypets.com, about $30 cheaper than what my animal hospital gets for it. Ask you vet about Denosyl, and also another product made by the same company called Marin. Marin contains silymarin (from milk thistle) which is very good for the liver. What's especially good about Marin is that the silymarin is combined with phosphatidycholine, which helps the body absorb the silymarin. My only reservation with this product is that is uses a very low dose of silymarin. I use a much higher dose with my cat.

How long has Lenny been on pred? When was his last bloodwork? Does it seem that the pred has been effective in decreasing the liver enzymes? My cat was only on pred a short while - ironically it seemed to spike her enzymes very high- ALT was over 1100! All the vets swore the pred wouldn't have done that, but I discontinued it (weaning her off - you never stop pred abruptly) and the enzymes went down, though never back to normal levels.

Once you get Lenny stabilized, speak with your vet about I-131 for his thyroid. It's radio-iodine therapy, and it's amazing. One of my cats had this therapy a few months ago and I'm extremely happy with the results. It's not cheap (is there anything vets do that is? LOL) but it's safe, non-invasive and targets only the thyroid gland, leaving other organs unaffected. The downside is that Lenny will have to stay at the vet's at least several days (mine had to spend 4) - the length of time varies depending on where you live. The good news is that his thyroid will be back to normal and you won't have to worry about giving him meds for that.

I know this is an extremely long post - I hope some of it will help. Try to be cheerful around Lenny - he needs you to be strong for him and reassuring.
Hang in there - all the best to you, your wife, and your sweet boy Lenny.

Hi KT,

I really want to thank you for your reply to my posting. Yes, it was long, but thorough, and I really appreciate you taking the time to respond. I agree with that you have to say, and I am taking him in to the vet tomorrow and will most likely leave him there.

Givng him the fluids at night seems to perk him up a bit, but I have to say that I don't really see any improvement with the omition of the Transderaml Thyroid/Apetite medicine, so I am assuming that it was not the cause of the vomiting. I just got home and Lenny was very hungry, so I boiled some chicken and he ate most of it! I still don't understand why he suddenly shy's away from his dry food though. We also got this Natural food from a speciality pet store that he seemed to like as well. I am just hoping that he does not wake me up all night vomiting. In regards to the 24 hour care, my friend who used to be a vet tech believes that the it would just add more stress on him at this point in time. She believes that being in a quiet hospital on the Vac machine with fluids and B Vitamins will defenitly help, so I am giving it a shot. I will write back to this board tomorrow when I get back from the vet. I defenitly feel better tonight, as does my wife, and we were able to eat tonight as well. Lenny's brother's Vinnie and Jimi are still a bit perplexed, but we are trying to play with them as much as possible to keep them happy. Thanks again and I'll keep you updated

I think KTLynn's post was superb, and have nothing to add except a big "I agree" re letting him eat wet food if that's all he'll eat as no eating - no cat, and that sure isn't the goal.

Please keep us posted, I wish your kitty all the best. Oldsters have a special place in my heart and our home.

Well Lenny is now spending his second night at the vet's office. He is not vomiting an apparently ate some wet food last night, but he is not eating today On top of all of that, he now has a high fever, but it subsided a bit when I ran home from work to visit him this evening. They are going to do an ultrasound on him, as they are unsure what is causing his fever, etc. He still has very high liver values (Hepatitis) but some of the levels have gone down. The only reason I did not break down completely at the vet, was because I spent my lunch hour staring out at SF Bay, balling my eyes out. I did make it back to work for 2 hours though before the vet called and asked me to visit. While visitng him this evening helped me out a bit, our home has a void in it without Lenny. His brothers Vinnie and Jimi are looking for him everywhere and are talking up a storm. I am literally willing to take out a loan to pay for his care, but the vet said that the ultrasound will hopefully shed some light on what is causing his problems. He looked so sad in the cage tonight, and even when I picked him up he seemed limp. His beautiful eyes were still shining, but he seems "out of it." I just really hope that they can find out what is wrong with him and put him on a treatment plan. I don't think he wants to leave us yet... I just hope that me and my wife can get through this difficult time. I don't meen to whine here but these past few months of my life have been an emotional rollercoaster. Lenny is the one who cheers me up and gives me strength. Thank you all for your prayers and thoughts and please write me back if you have any questions or suggestions.

Thank

Howie

Howie-
Thanks for posting again to let us know what's been happening. I've been thinking about Lenny a lot the last couple of days.

I'm sorry your little guy is still having a rough time. It's very good that he's stopped vomiting and has eaten a little. I can understand that with a temp though, he wouldn't necessarily feel up to eating now. Sounds like his body is fighting some sort of infection with the elevated temperature. Nerves can cause a higher than normal temp as well.

My girl also had an ultrasound done with a biopsy. Are they doing that for Lenny? It's a good idea to do it since you don't want to have to put him through an ultrasound twice, if you can avoid it. The ultrasound itself is not invasive or painful, but you know how nervous our poor cats get whenever the vet needs to do any testing. A biopsy would help pinpoint what the specific liver problem is. It's done with a very fine needle during the ultrasound. The biopsy is minimally invasive and takes only tiny samples of the liver tissue from several areas of the liver. Lenny would have to stay one more night if they do the biopsy. Ideally, you want a board-certified internist doing this procedure.

Howie, the fact that some of the liver values have started to come down is good news, even though they're still not at normal levels. It's a step in the right direction, and is another good sign along with Lenny's eating a bit more and not vomiting.

I'm not surprised that Lenny seems "out of it" - he's still not feeling well, and he's at the vet's. Most cats aren't happy about having to stay at the hospital and get out of sorts just by being in a strange place.

This has been so emotionally draining for you and your wife - Lenny's brothers feel it too. All of us who've been through serious illnesses with our beloved kitties know those feelings all too well.

Sending all good thoughts and prayers to your boy to stay strong.

Thanks K.


He did have an Ultrasound done today but no biopsy, as I believe he had one back in December when he had the Pancreatits. The vet told me a ton of information (in medical terminology that was a litle above me), anyway she said that it appears that he may have Pancreatitis again, and he is in pain/discomfort. So they have him on another antibiotic on top of Beytryl that has helped. His fever is mostly gone and he was purring and doing his famous "flop" in the cage. Unfortunately they have him in a small cage during the day when they are busy, so he was flopping in his little cardboard litterbox
We are going to take the financial hit and have him stay with these wonderful Vetrinarians for a few more days so they can monitor him. They are all board certified and the hospital has won a lot of awards for service.

They said he ate some dry food today and they are encouraged by that and think he will eat more in the next day or so. Me and my wife are feeling a lot better today! I am just hoping that he will continue to improve and not have setbacks. I am going to run down there tomorrow night after work to see him again. I really do appreciate your postings :-) I really miss having Lenny in our apartment and can't wait till he is back at home with his ma,pa, Jimmi and Vinny.

Howie - So glad you posted the latest update on Lenny!

I'm sorry he's apparently suffering another bout of pancreatitis, but at least you have an answer. Are there any pain meds that they can give Lenny since this can be a painful condition? Buprenex is one of the newer pain meds you could ask about. His body will heal faster if it doesn't have to deal with pain.

It's so great to hear that his fever's almost gone and he's starting to do his normal "Lenny things" again! It's important as well that you're satisfied with the care he's getting and have confidence in his vets.

Are you bringing any favorite foods from home to Lenny that may help get him eating more? Fresh roasted chicken usually does the trick for my little guys.

With liver disease and pancreatitis, the symptoms can wax and wane. It doesn't necessarily mean the condition is worsening - it just tends to flare up sometimes. This *could* happen - it may not. If it does, Lenny will get through it with the excellent vet care and dedicated, loving family he is so very fortunate to have.

Please keep posting updates - looking forward to the one about Lenny's homecoming!

I agree...and yes, Bupronex is wonderful (so think the two cats of mine who've had it)

Lenny is finally coming home tomorrow !! The vet said he has been improving and now weighs 10.4 pounds !!! I will have to continue his fluids and meds for at least another week or two, but luuckily most of them are administered through his fluids line. I also have the transdermal ( a lifesaver) for his Thyroid.

I am so happy and I will hopefully be able to sleep better tomorrow. His brothers are eagerly awaiting his return as well.Here is a link to some photos of Lenny along with his brother's Vinnie and Jimi !.

http://photos.yahoo.com/[email protected]

That is wonderful news to hear!

I've been following this thread, but haven't posted as I have no advice to offer. It's wonderful news that Lenny is doing so much better and coming home. He's adorable, as are his brothers.

Lenny finally came ome yesterday after 6 days in the hospital. On the drive up the coast back to S.F., Lenny seemed happy, alert and eager to get home. He talked a bit in the car and we talked back t ohim of course.

When we got home, he immediatly wanted some wet food, sow e gave him some Tuna. He only ate a little bit becuase his brother Jimi decided he wanted some. Ten minutes later, Jim and Lenny were curled up together, cleaning each other !! My wife and I were so happy to see this , as they have not been together like that for about 3 weeks. All was good and Lenny was out in the apartment and not hiding. About 2 hours later, Lenny puked up his food, and then some liquid and went under the bed for 3 hours. We finally got him out at about 9:00 PM for his Fluids and meds. The only oral med is Clavamox which was very difficult to get into him. He did get some but not the whole 1 cc last night. He slept way under the bed last night and did not come out as far as e know. About an hour ago, he came out a little and puked up some more liquid, but no solid food. He is now still under the bed and I am worried.

His diagnossis is the following: Cholangitis/Cholangiohepatitis, along with a possible bout of Pancreatitis, and some inflimation of the Gall Bladder.

While at the hospital on an IV and the same meds I am giving him now (Pepcid, Prednisone, Beytral, and Urisodol) he did not puke once. He has been eating well since Tuesday and making regular bowel movements, etc. I was feeling releaved yesterday and so happy that he is home, but I am now concerned that he is hiding (they took the Fentynal patch off before he came home). I am going t ocall the vet today, but I just thought that from what they told me that he was on the road to recovery. I just hope he does not continue to hide and puke. I plan on spending the whole day at home observing him today. They told me to feed him whatever he wants as well. If anyone has any thoughts on this please let me know. I am now feeling down and worried again for my Lenny. He is such a great presence in our life and we just hope he pulls-through.

Thanks

I spoke with my Vet today and she said to hold-off on the Ursidial transdermal and to also not give him the Clavamox. She is a bit perplexed (as am I) as to why he did not puke in the hospital at all, and did puke last night (food) and this morning (liquid/bile?). The only other change being at home is that they took the pain patch off of him (Fentynal) before he came home. She said to wait another day and see how he looks. I may have to bring him in to get the patch put back on. (urghh-- it cost's $60.00) I have already accumulated $1780.00 worth of bills for him I am so upset becuase I really thought that by leaving him in there for 6 days that he would be on the road to recovery. I don't know how much more I can take, and I can't afford much more..... He has been sleeping inside the middle of our 6 foot cat post, which he only started doing when he got sick. I am giving him as much love and "good vides" as possible. My Ragdoll "Vinnie" has been running around the apartment yelling all day too. I think he was abit suprised to see Lenny yesterday, and may he is worried like me.

Howie, I was so pleased to read your post from Friday about Lenny returning home and it was great to see his pictures (he and his brothers are three good looking guys - Vinnie looks very much like my boy). It was disappointing though to see in your next couple of posts that since being home, Lenny isn't feeling well again.

My cat also has cholangiohepatitis, the non-bacterial kind, so antibiotics aren't effective for that. She too takes ursodiol. At one time my vet suspected that my girl might also have pancreatitis, but as you know, it's tough to diagnose. Fortunately (fingers crossed) it has seemed less likely that my kitty has pancreatitis. She has enough to deal with - she has kidney problems as well as the liver disease.

Liver disease, pancreatitis, antibiotics - all of these things either alone or together can cause vomiting. Most antibiotics, Clavamox included, should be taken with food or they can cause vomiting. If you gave them to Lenny on an empty stomach, it could be the reason he got sick at that point. When my cat took Clavamox recently it upset her system so much that even taking it with food she still vomited. She continued to feel lousy for a week after they were discontinued since antibiotics stay in the system a while. I can understand why your vet advised discontinuing the Clavamox, but I'm not sure why she wanted you to stop the ursodiol. Do you know the specific numbers of Lenny's liver values? In the meantime, try to get Lenny to eat bland foods, like plain chicken or turkey since it will be easier for him to digest.

I'm unfamiliar with the pain patch they gave Lenny. How long is it effective?
Is there any way you can just pick up the patch and apply it yourself to save Lenny another trip to the vet? If not, can they give you another pain med, like Buprenex, that you can administer at home? (It's a liquid in an oral syringe - usually a very small amount that's easy to give).

If your vet hasn't already done so, he/she needs to give you as much information about pancreatitis as possible so you know what to expect. From what I've read, what Lenny's going through is not unusual, unfortunately. Vomiting and of course, the diminished appetite that results from it are common. Some of the advice I read about was to give IV fluids (as opposed to subQ fluids - ask your vet her opinion about this), pain meds, and meds to control vomiting. Pancreatitis in cats is more often an ongoing condition, so flare-ups tend to keep occuring.

You might want to do a search in this forum for members who have had experience dealing with pancreatitis, and/or start a new thread about it.

I know it's very troubling and disappointing to you that Lenny still isn't feeling well. I've learned with my girl that sometimes it takes trial and error to figure out what might be causing the problem. Most of the time I know it's just the nature of the $#@% disease, either the liver or the kidney problems.

Keeping good thoughts going for Lenny that he'll soon get through this latest episode.

KTLynn,

Thanks for your response. It's nice to know other people have experienced similar issues with their cats and can understand what I'm going through.

In regards to the pain patch, it called Fentynyl and it is a very strong Morphene (synthetic) patch that takes 24 hrs usually to be in full-effect, and then only lasts for 72-96 hours. The vet said that if he still looks like he is in discomfort and is lethargic, then I need to bring him down there to get it put back on since it's a controlled substance. I am reluctant to bring him back so soon since he was there for 6 days and about 5 other visits in the past three months. So, I think I will ask my vet about the liquid med you mention as an alternative. The only problem is, is that Lenny is very stubborn and difficult to administer meds to. Given his reduced interest in food, and the fact that he is smart and can pick up on any meds in his foods (or so it seems lately), I don't know if he would take it in his food.

I will however do my best to do anything to try to make him more comfortable. How do you know when your cat is in pain, or just pissed off? I am a worry-wort when it comes to my cats. My Ragdoll Vinnie needs his teeth cleaned and I can't afford it right now due to lenny's vet bills. Anyway, I am going to get the Liver values when i speak with the vet tomorrow and I will post them. Maybe I just need to give him some more time and hope that he continues to eat more and more without vomiting.It's now 11:00 PST and he has not vvomited since the little bit of liquid this morning. Also, yesterday when he vomited it was about 3 hours after he got home and prior to us trying to give him the Clavamox, which is why it was so weird for him to do that considering he did not vomit at the hospital.

Thanks again, and I am sending good vibes to you and your kitty

Howie-

Regarding the pain med I told you about, Buprenex: you don't need to give it with food, which is one of the great things about it. Unlike my boy, my two girls are tough to give liquid meds to, but the dose is so small you can do it quickly. It's still a two person operation, though, (at least in my house, LOL) - one to hold the unwilling patient, one to squirt in the meds. Buprenex isn't as long lasting as the Fentynyl - it needs to be given every 8 hours, but since you can avoid bringing Lenny back to the vet by using this rather than the patch, it could be well worth it.

Cats hide pain far too well - it can be really difficult to determine. A slight vibration that can be felt when put your hand on your cat's side can be one indication of discomfort or pain. Take a look at this webpage which discusses the question of determining pain:
http://www.vetinfo.com/catpain.html#...in%20in%20cats
Scroll down and you'll see several titles under the heading "Pain in Cats". Click on "Assessing Pain in Cats"

How much has Lenny been eating? I don't want to give you more to worry about, but if he's only getting a teaspoon here and there a few times during the day, it's not enough. Small amounts of food at a time are ok, but it has to add up at the end of the day to what Lenny would normally eat. If he hasn't been eating enough on his own, start to assist feed him. For most cats assist feeding will only be a temporary situation - many times it will "jump start" them into eating on their own again.

Ask your vet if any of the meds Lenny is currently on could be causing the vomiting as a side effect (in addition to the Clavamox). If the vomiting doesn't continue to decrease, inquire about meds to help control it. I'm still curious why your vet discontinued the ursodiol.

I'm very glad that as of your last post, Lenny had only vomited a small amount for the day - a good sign.

Thanks so much for your kind thoughts for me and my little girl - we're keeping the good vibes going for you and handsome Lenny too!

Hi KtLynn and everyone else who has been following this thread,

I am sorry I have not been on the site all week. Just a bit busy around here lately.

Last Monday, 2 days after Lenny came home, he finally came out of his shell and began to act normal. At 5 am he woke me up (rather his brother Vinnie did) to feed him some dry food. Lenny came out from under the table, talking up a storm and then proceeded to eat and eat and eat. He is now about 11 lbs (I'm estimating) an he is looking much much better. He is not longer in need of fluids and the only he is getting are the Prednisone, along with the Ursidial (trans-dermal) and the Thyroid/Cypro trans-deramal).

We did go away the other day overnight and had a friend come over and hang with our dudes. She said he was out and about but a bit slow. When we came home Lenny did vomit a bit of liquid. However, it was not nearly as much as he did before his hospitalization. He is eating well, begging us at dinner like a dog, and acting much more like himself. He still will not play with toys, nor is he running around the apartment like he used to do, but I am confident that he is on his way to an even greater recovery.

I am going to speak with the Vet tomorrow to inquire about weather or not I really need to give him the Clavamox (remember, Lenny is really hard to give meds to in his mouth). The only other issue he has right now is that he is sneezing a hell of a lot, and I am wondering if maybe the Clavamox would help in that matter.

I will write back tomorrow after i speak with the vet. I am so relieved that he is on his way back. Even going away for one night was hard for us , given his 1 week stay at the hospital. Thanks again everyone for your good thoughts and prayers.

-Howie & Lenny

i have no advice to offer either...but this thread made me cry so i just had to respond and say my heart goes out to you and lenny!! i think i would have a beakdown if i lost my little fiona as well. good luck to you and lenny...he looks so cute in his pics, especially the one with his other two buddies! i will be sending my prayers...

Hi Howie -
What terrific news (picture a smilie here doing cartwheels, LOL)!!! In less than a week, Lenny has improved tremendously. So happy for you all!

Since my little girl also takes ursodiol, I asked my vet about the ursodiol transdermal Lenny gets. She wasn't aware that ursodiol came in that form. Do you know if this is fairly new? I get ursodiol in capsules and mix the contents into my cat's food. Where is the patch applied and how often does it need to be re-applied? My vet thought there might be a problem with the body heat of the cat possibly affecting the meds in the patch.

I wonder if Lenny picked up a bug while at the hospital and that accounts for his sneezing. Since the Clavamox may have caused his digestive upset, maybe you could try another antibiotic, like Antirobe, which is supposed to be well tolerated. You may just want to see if he can fight this off first, without more meds, since his system is first getting back to normal.

Thanks so much for the update - way to go Lenny!