Relapse? Fighting against fatty liver disease.

[nicolefrank117]

Sabbath did really well yesterday when we brought her home. She ate numerous times on her own. At one point I couldn't put the plate down fast enough. She's never done that before even when she was healthy. She must've been very hungry between all the vomiting and then getting those meds in to control it. But its a good sign that she still wants to eat. She also was roaming a little more around the house but of course Ichabod is still hissing at her so she tends to go back into the bedroom. I also found her at one point cleaning her little face with her paws. It was like she was back to where she was before all this happened. 

Around 4am I got up to use the washroom and she was laying by the side of the bed and I noticed she ate a decent amount through out the night. 

Around 5:15am we were awaken by sounds of her vomiting. She threw up 3 times but they were smaller amounts then she has been throwing up. The only thing is she didn't have any stool in her litter box. So that concerns me. 

We dropped her off at the vet this morning at 6:30am. The doctors get in around 8:30am so I left a very descriptive note for her letting her know how Sabbath has been doing since we brought her home yesterday. 

Not sure how much more of this we can do. Our Care Credit is almost at it's end. and we don't have any more funds available. If this doesn't work today then we will be at a loss on what to do. 

 

[denice]

Lack of motility can be part of the disease, I know it is for Patches.  When he would have a flare he would have the nausea and constipation.  When he had his first flare he was only 18 months old so the vet thought it was a foreign object.  He was hospitalized with a lot of x-rays which showed gas patterns that didn't change over time.  

When Patches was very sick, including the Fatty Liver, he was started on a higher dose of the Pred.  He was on 10 mg a day for probably 3 months and then dropped to 5 mg as a maintenance dose.  The thickening of the walls of the digestive tract is what causes the motility issues.  The pred takes down that inflammation.  There is also a medication called cisapride that increases motility.  I would rather not use it at least long term but that would be another possibility.

 

[nicolefrank117]

 
Lack of motility can be part of the disease, I know it is for Patches.  When he would have a flare he would have the nausea and constipation.  When he had his first flare he was only 18 months old so the vet thought it was a foreign object.  He was hospitalized with a lot of x-rays which showed gas patterns that didn't change over time.  

When Patches was very sick, including the Fatty Liver, he was started on a higher dose of the Pred.  He was on 10 mg a day for probably 3 months and then dropped to 5 mg as a maintenance dose.  The thickening of the walls of the digestive tract is what causes the motility issues.  The pred takes down that inflammation.  There is also a medication called cisapride that increases motility.  I would rather not use it at least long term but that would be another possibility.

That would make a lot of sense as to what keeps happening with her. Might explain why she was doing so well once they put her on some of the meds for the inflammation. She is still on all of them but these last couple of days she has either gone without due to the vomitting or the vet has given her what she needed while she was there.

I just realized that what they have been giving her yesterday and today is another name for reglan. That makes me nervous. That was a medication they offered me for my motility issues and once I read the side effects for humans I refused to take it. It was actually black listed for humans. I don't see any black listings for animals though. Maybe it works a little differently on them. It seemed to help her out greatly yesterday. I am wondering if the early morning vomitting was because the medication had worn off. The only odd thing I noticed about her when she came home yesterday was she seemed a little figity. She would be laying around and then need to get up and walk around and then she would lay down again. In a little while later she would do it again. So I kept an eye on her and the rest of the day and eventually she laid down and was all good. I was not sure if this was the medication or if she was just making sure she really was home since she spent so long at the vet. 

Do you think it would be safe to attempt trying a raw diet on her right now? Do you think she might hold that down better then the store bought processed foods? I am feeding her the good stuff.. no grains, gluten etc. All for sensitive bellies and low ingredients. If anything I could try to the Instinct Raw Bits and see if she will even try them. I remember when I was attempting to try to force her to eat (before the tube) that I offered her some pieces of cooked shredded chicken and she ate it. It was cooked though. Was thinking on asking the vet about it. 

What do you feed your cats again? She will only eat the Natural Choice Chunky Chicken Pate. I have wasted so much money trying to find wet food she will eat. She snubs her nose at all of them. I have even put some on my finger to get her to taste it and no go. She smells the Natural Choice Chunky Chicken pate and immediately will eat it. She still is eating her grain free Blue Buffalo Dry Food without any issues there. I tried to get her to try Instinct CHicken with the freeze dried bits in it and she wouldn't bother with it. She wouldn't bother with their wet food either.

 

[denice]

Most kitties here seem to get prescribed Cerenia for vomiting but with motility issues the Reglan could be a better choice.  The Reglan stimulates muscle contractions in the upper digestive system so there is more efficient emptying of the stomach along with working on the part of the brain that recognizes nausea.  The Reglan is also supposed to help with acid reflux.  The Cerenia only works in the brain.

I would continue giving the food that she will readily eat for now.

 

[nicolefrank117]

 
Most kitties here seem to get prescribed Cerenia for vomiting but with motility issues the Reglan could be a better choice.  The Reglan stimulates muscle contractions in the upper digestive system so there is more efficient emptying of the stomach along with working on the part of the brain that recognizes nausea.  The Reglan is also supposed to help with acid reflux.  The Cerenia only works in the brain.

I would continue giving the food that she will readily eat for now.

Yah she was on cerenia already. That was the one she was on when we first got her eating again. Then she relapsed and it didn't seem to work anymore. 

The reglan is being used exactly for the reasons you described. I am just going to keep a watchful on her while she is on it. Atleast she is at the vet all day today being monitored.

My concern is how long does she have to be on it for and if we will eventually be able to give it through the tube with the rest of her meds. While she is at the vet she is getting an injection of it since she is having the vomiting issues. We can't keep bringing her back everyday. Just don't have the money for it.

 

[micknsnicks2mom]

 
Sabbath still seemed to be a little reserved yesterday. Ever since the vet visit on Tuesday she has been a little reserved and a little less social. Doesn't help that it's been raining and storming on and off and that tends to scare the both of them.  I also think Ichabod is a little intimidating and on edge as well which is making Sabbath nervous. I sprayed the areas Ichabod lays in alot with Sentry Calming Spray and this morning when she was near Sabbath she did not hiss at her. This is the first time she hasn't so I was very happy to see this. Now hopefully it will stay this way, However Friday we have to take Sabbath back in for her 1 week check up. I think I might need to buy stock in this stuff ha ha.

Besides being a little less social she is still attempting to eat in the middle of the night in her little hideaway in the closet. 

When I got home from work yesterday I checked and she had eaten a portion of the wet food I had left out for her. I went off to make her syringes and when I came back into the room she was finishing off what was left of the wet food.The good thing is she is going to the plate and eating it on her own. I am not having to shove food in her face to try to get her to eat it. It is starting to feel like somewhat of a miracle every time she does that. 

We went to Pet Smart to get the calming spray and while we were there I picked up some Blue Buffalo Treats in Chicken and Duck. All grain and junk free. Figured maybe I could get her to eat try them. When I offered them to her at first she didn't seem very interested. But when she saw me breaking them up into tiny pieces she began to nibble at them. When she tasted them she went crazy ha ha. Gobbling up what was left in front of her and sniffing for more. I thought well this is getting her to eat something so I broke up some more. As I was breaking them up I wasn't fast enough for her. She started to sniff my fingers and get them from me as I was breaking them up. Since these treats are not bad for them I gave her more then I normally would treats to get her eating something by mouth but stopped so I would not over do it.

Later in the evening I brought her downstairs. Seeing she was still being less social and I think Ichabod's hissing has started to intimidate her I picked her up and put her downstairs on the couch by us. I knew before we knew it we would be going to bed and then she would be locked in there all night. I wanted her to get out of the room some and enjoy the rest of the house for a little bit. She started to rub her head on me and the couch and roll around a little. Not sure if the calming spray was helping or if she was just happy she was ok to be down there (Ichabod was upstairs). Either way I fell asleep on the couch and my alarm on my phone woke me up cause it was time for her 3rd tube fed meal/late night feeding. I looked around and she wasn't there. That's because she had took it upon herself to go into the kitchen and eat some of the kibble that was out. All on her own again! 

This morning I woke up and half the wet food was gone again. The kibble was still there but she did eat the wet on her own during the night. I left to go make her syringes and came back to her finishing off the plate of wet. I have only been giving her like a spoonful so if she doesn't eat it we don't waste a bunch of food. I gave her a minute before doing her feeding since she just ate. She sat perfectly for me this morning and purred the whole time during the feeding tube meal.

Things have really been going well and the signs of improvement have been everywhere. Fingers crossed that we see some results on her blood work at her 1 week check up tomorrow! 

this may already have been suggested or tried, but have you tried gently rubbing ichabod with a towel and then gently rubbing that same towel on sabbath? exchanging scents.

my snick would always hiss at her litter mate brother, mickey, after he or they both had been to the vet's. the scent exchanging with a towel fixed that problem for us. i gently rubbed the towel on them both before one/both went to the vet's, then rubbed the cat(s) who had the vet appointment with the towel right when they got back home.

 

[denice]

If the vomiting is mainly in the morning it could be excess stomach acid.  The Famotidine  is an antacid and is the active ingredient in Pepcid.  I am not sure what dosage she is on but I know with the over the counter 10 mg Pepcid I would give 1/2 tablet in the evening, I have seen kitties here getting a full tablet (10mg) a day.  

 

[nicolefrank117]

 
this may already have been suggested or tried, but have you tried gently rubbing ichabod with a towel and then gently rubbing that same towel on sabbath? exchanging scents.

my snick would always hiss at her litter mate brother, mickey, after he or they both had been to the vet's. the scent exchanging with a towel fixed that problem for us. i gently rubbed the towel on them both before one/both went to the vet's, then rubbed the cat(s) who had the vet appointment with the towel right when they got back home.

I need to try this for sure. Sabbath is there today all day long. So maybe I can get Ichabod rubbed down in the towel before we bring her home.

 

[nicolefrank117]

 
If the vomiting is mainly in the morning it could be excess stomach acid.  The Famotidine  is an antacid and is the active ingredient in Pepcid.  I am not sure what dosage she is on but I know with the over the counter 10 mg Pepcid I would give 1/2 tablet in the evening, I have seen kitties here getting a full tablet (10mg) a day.  

It has happened at other times of the day though.

 

[nicolefrank117]

Called to check on her since I have not heard anything from the vet today.

The vet was busy so the vet tech gave me a summary...

- she had another vomiting episode today

- they gave her more of the medication 

- since the medication she has eaten on her own and has kept it all down

- did another xray and it looked good

- they are going to give her another treatment of medication at 3pm and see how she does

The vet is suppose to call me around 5pm with an update. I hope she does as that is when I get off work and I was hoping to pick her up. The vet tech made it sound like that depended on how she takes to the 3pm treatment. Thats great and all but I can't keep leaving her there for over nights or all day treatments so I am getting very nervous about all this. To me it's like unless she has this medication she is going to continue throwing up. That to me is not good.

 

[denice]

This is sounding more and more like IBD and the types of flares that Patches would have.  I went through six years of vet hopping, hospitalizations with supportive treatments and a couple of E.R. visits before it was diagnosed.  The vet clinic that I took him too was my last try because I couldn't continue with the financial bleeding without  some kind of resolution.  I had put off going too long which is why he had fatty liver.  

I think what you are seeing is the ups and downs that go with the flares.  I noticed that they have her on 5 mg Prednisolone daily, Patches was on 10 when he was very sick.  He was tapered down to 5 once he had been stable for quite some time, I want to say 3 months but I am not sure.  I would ask the vet about the steroid dosage when you talk to her.  Many vets are very conservative when it comes to steroids which is understandable but sometimes they can be too conservative.

 

[nicolefrank117]

Is the increased amount of steroid the only thing that helps the flare ups? I do remember my vet saying she wanted her to be on the steroid dose she is on now and then actually decrease it and get her off of it.

 

[micknsnicks2mom]

 
I need to try this for sure. Sabbath is there today all day long. So maybe I can get Ichabod rubbed down in the towel before we bring her home.

i think it would be worth trying. vet smells can upset many cats, so i can understand that ichabod might react the way he does when sabbath smells like the vet's -- even though it's not poor sabbath's fault she has vet smell on her. i'd look for ichabod's reaction (to sabbath with the vet smell on her, after gently rubbing her with the ichabod-scented towel) to be less hissy/growly than it has been, and the hissing/growling might also stop sooner than it has before. if you get that reaction from the scent exchange using the towel, i'd call that positive results.

be sure to get ichabod's cheek areas rubbed onto the towel too.

if it works/helps, maybe next time you could lay the towel somewhere that ichabod likes to nap or relax, so he'll get the towel scented for you on his own -- or at least help to get the towel scented for you.

 

[nicolefrank117]

Update on Sabbath.. 

Brought her home tonight. 

No food through the tube. Only meds. She is to continue eating by mouth,

We are to now add the metoclopramide (reglan) to her daily meds which is what they have been giving her along with her other meds.

Her xrays are showing only the bubbles of gas in the colon and no longer all in her stomach and intestines. The vet said this is a good sign as that is where it should be showing up. It also means the meds are working. She said that if she throws up a little to not be alarmed as it may take a little time to get everything working as it should. She said if she stops eating then we should be concerned. The fact that she is eating and wanting to eat by mouth on her own especially after throwing up is a positive sign.

So now we are doing...

In the AM...

Metronidazole

Ursodiol

Prednisolone

Vitamin K

Famotidine

Denamarin

Metoclopramide

12 hour later meds..,

Metronidazole

Prednisolone

Famotidine

Metoclopramide

The one thing we did notice with the Metoclopramide is that since she has been home she has been very lively. She is antsy so to say. She lays down and then gets up and walks around. Then she lays down and then starts roaming around again. So we are keeping a good eye on her. The vet said this is a side effect of the med and not to worry too much about it but if she does anything out of the ordinary or alarming to call them.

 

[cocheezie]

Hoping everything works out for Sabbath.

 

[denice]

Hopefully this will take care of things.  Given how Reglan works it seems like it would help.  So much of this with the chronic digestive issues is trial and error, it would be nice if there was a one size fits all way of dealing with them.

 

[nicolefrank117]

Thank you everyone for your advice, support and everything through this. You guys really are helping me cope and give me direction I would not have on my own. 

Last night she did not vomit. However she did not eat any of the wet food I left out for her. She attempted to nibble some on dry last night. The vet did say they feed her and she ate anything they offered her. Maybe with the meds making her fidgity she was just a little on edge from being at the vet all day. 

This morning I tube syringed all her meds with water etc. I made it a point to start off with her antacid. Then gave her the rest very slowly. I did my best to constantly check that there were no air bubbles. She did a little burp type thing during so I stopped and let her chill for a little bit as my goal is to not have her vomit up all these meds. Especially since the reglan is now in there as well.  After a little time passed I gave her the rest and of course cleared the tube with water. No more leaking! So they did definitely change the top of the tube as they said they did and I was not crazy that something was wrong with it.  By the time we left for work it had been an hour and she had not vomited. She went and laid down on our bed (so hopefully she still hasn't vomited ha ha). She did not attempt to eat on her own this morning that I am aware of. She did get adventurous last night and went all the way downstairs and drank from the water fountain and nibbled on some kibble. We decided to leave our bedroom door open last night since she was so antsy and we didn't want her to feel cooped up. Our room can also get warm and we didn't want to contribute in any way to her getting uncomfortable and vomiting. Her food is stashed away in the closet and Ichabod has not discovered it because she keeps distancing herself from her. So we were not too worried about her getting into it over night. When I woke up it didn't look like she touched the wet food. She may have eaten some of the kibble. If she adventured downstairs to the food dish by the water fountain then she may have eaten some of that again. Hard to tell with that one as we leave it out all day right now to just have something out for her at all times. Ichabod eats from it as well (which is why we limit her wet food). Once she is better this won't be the case. They will be on set scheduled feedings. They are already starting to get a feel of that since Sabbath had to eat at certain times with her tube. 

I am hoping that during the day once her meds settle that she does eat some more. I am hoping the junk  food they give her at the vet didn't make her snub nosed towards the good stuff she has been eating at home. If she doesn't eat then I will start to become concerned. She did have a nice sized soft stool in her litter box this morning. That is a very good sign that things are passing the way they should be. I did not wake up to any vomit anywhere in the house so that means she had the BM without throwing up. Fingers crossed this works. I just pray the side effects from the meds don't cause her any issues. She was so up and down last night with the sitting down and getting up my husband and I had to keep an eye on her because she would jump up and down off the couch and the bed. We have to watch cause of the tube we want it not to come detached or cause issues with the stoma etc

 

[nicolefrank117]

Sabbath ate while we were gone at work today.. she also used the litter box and she did not vomit all day!!

Just gave her evening meds. Keeping an eye on her so she hopefully keeps it down. She has been sleeping since I tubed them. 

Gonna give her a little time before offering her more wet food. In the mean time dry food is sitting out if she decides she wants to eat. I am just too nervous of offering her something too soon and she pukes up all the meds. Fingers crossed. 

 

[denice]

Sounds like things might be back on track.

 

[nicolefrank117]

I am trying sooooo hard not to get my hopes up that things are back on the up but it does seem promising atleast as of now. 

She did not vomit all evening!

She is still eating on her own!

She is still using the litter box!  

I was even able to mix the Natural Choice Chunky Chicken wet food (the only one she will eat) in with some Blue Buffalo Basics Limited Ingredient Turkey and Potato (which I prefer for her to eat as I think it would be better on her tummy and is the same line as her dry food) and she ate it. At first she was hesitate but later in the evening when we were sleeping she ate all of what I left out for her. I mixed that again this morning and noticed she nibbled a little on it sometime between when I did her morning meds in the tube until right before I left for work. So within about an hour of her morning meds. I am hoping to gradually reduce the chicken out of it and hopefully get her eating the turkey since it's a less aggravating protein on her belly. I have been mixing the exact same thing for Ichabod as well as I don't want her to develop anything down the road. 

So as of an hour a go when we left for work she had not vomited. Fingers crossed it will be the same when we get home from work later today. 

I really think this reglan is helping her.