Ursodiol or gallbladder removal?

[Musiaka]

An ultrasound we did today showed that Musiaka has stones in his gallbladder. His liver is a bit larger than it should be (liver enzymes came back normal).
The vet thinks it's what's causing Musiaka's chronic vomiting.
She suggested we either try Ursodeoxycholic acid (like Ursodiol) to dissolve the stones or remove the gallbladder completely. The removal of the gallbladder sounds scary and we would need to find a good specialist in another city. But there are great risks involved with Ursodiol as well. The vet said it might result in a blockage and that we would have to monitor Musiaka's gallbladder by doing an ultrasound every two weeks. That also sounds scary and risky! A stuck gallbladder stone would definitely hurt as hell. The vet said to look out for lethargy, green vomit and diarrhea.
I would maybe risk it with the medicine, but a removal of a stuck stone would require going to another city and I don't have a car - what if it happens so sudden and I wont be able to get Musiaka help in time?

Do we have other options? Or which should we opt for - Ursodiol or gallbladder removal?

 

[Musiaka]

Also, we're supposed to take Ursodiol (here it's called Ursofalk) and SAM for the liver. Sharing Musiaka's blood results:

 

[Musiaka]

Any insights?

 

[fionasmom]

Wow....what a place to be! I have not treated gall bladder specifically in any animal I have owned and so have no direct experience with ursodiol.

I would ask about side effects of the medication; aside from the fact that it might cause a blockage (or might not work and thereby cause the blockage?) and the frequent ultrasounds, are there other side effects such as nausea, diarrhea, vomiting, etc.

Is Musiaka a good candidate for surgery? There is an excellent chance that she will come through okay and recover?

I would want the experienced specialist to perform the surgery, as you said. The possibility of transporting a cat with a gall stone to an ER is something to consider. You would need a plan in place for that if you choose the meds, just in case. If this happened on the weekend, night time, is there a place you could get her to?

I don't know if there are other options or some brand new drug. Googling reliable websites have brought up ursodiol only.

With humans, there are a couple more surgical procedures using scopes or catheters for those who are high risk for surgery. I don't know if anyone does that for animals. Laser and ultrasound are sometimes used to smash gallstones; again, I don't know if that is available for animals.

I have often leaned toward surgery if it would resolve an issue once and for all for my animals and for family members. But that is just my opinion and you know everything about Musiaka so you have to make the most informed decision that you can.

 

[Musiaka]

Wow....what a place to be! I have not treated gall bladder specifically in any animal I have owned and so have no direct experience with ursodiol.

I would ask about side effects of the medication; aside from the fact that it might cause a blockage (or might not work and thereby cause the blockage?) and the frequent ultrasounds, are there other side effects such as nausea, diarrhea, vomiting, etc.

Is Musiaka a good candidate for surgery? There is an excellent chance that she will come through okay and recover?

I would want the experienced specialist to perform the surgery, as you said. The possibility of transporting a cat with a gall stone to an ER is something to consider. You would need a plan in place for that if you choose the meds, just in case. If this happened on the weekend, night time, is there a place you could get her to?

I don't know if there are other options or some brand new drug. Googling reliable websites have brought up ursodiol only.

With humans, there are a couple more surgical procedures using scopes or catheters for those who are high risk for surgery. I don't know if anyone does that for animals. Laser and ultrasound are sometimes used to smash gallstones; again, I don't know if that is available for animals.

I have often leaned toward surgery if it would resolve an issue once and for all for my animals and for family members. But that is just my opinion and you know everything about Musiaka so you have to make the most informed decision that you can.

There are possible side effects as you say - nausea, vomiting etc. But it can be managed by giving the med with food.
I will call the vet and clarify if Musiaka will need to be taken to the ER if a stone gets stuck because she didn't mention that on her own. She only said to look out for green vomit, lethargy etc, discontinue the med and call them asap. If he does need to be taken to the ER then it's tricky... Then we have to quickly find a way to get to another city and an emergency surgery will cost so much more than a scheduled one.
The vet said Musiaka is a good candidate for the surgery... so I don't know. Don't know what to do.
I've seen posters who had used Ursodiol and would so much appreciate their insight...

 

[MissClouseau]

Ursodeoxycholic acid is very commonly used for cats. I gave mine too for 3 months and it wasn't even a certain gallstones diagnosis back then but it was more like "just in case gallstones are what causing the trouble."

Did you get a picture or CD of the ultrasound? If it's at all possible, I would get an opinion from a internist (specialist) and then maybe also from a well-experienced surgeon. I understand there may not be one in your area but some vets agree on consultation from far away. I know surgeries that only remove the stone and not the whole gallbladder. Maybe Musiaka is not a good candidate for that but worth to ask a specialist. But they would probably need to see the size of the stone and the location.

 

[Musiaka]

Ursodeoxycholic acid is very commonly used for cats. I gave mine too for 3 months and it wasn't even a certain gallstones diagnosis back then but it was more like "just in case gallstones are what causing the trouble."

Did you get a picture or CD of the ultrasound? If it's at all possible, I would get an opinion from a internist (specialist) and then maybe also from a well-experienced surgeon. I understand there may not be one in your area but some vets agree on consultation from far away. I know surgeries that only remove the stone and not the whole gallbladder. Maybe Musiaka is not a good candidate for that but worth to ask a specialist. But they would probably need to see the size of the stone and the location.

Ok, so maybe it's not that dangerous of a medication? I also read that it's precribed to treat fatty liver. Did your cat notice any side effects?
The vet has saved some pictures from the ultrasound so I'm sure she would give them to me in case I wanted to consult a specialist. There were bumps on the gallbladder walls and multiple stones. She said it's not worth getting surgery to just remove the stones.
I don't get how the vet back in Sweden didn't mention anything about Musiaka's gallbladder 2 years ago... or maybe he did and I didn't understand (my Swedish is good, but I didn't always know the medical terms). In any case he didn't prescribe Ursodiol back then which he should have done. Current vet said there's no way Musiaka didn't have stones 2 years ago

 

[MissClouseau]

Ok, so maybe it's not that dangerous of a medication? I also read that it's precribed to treat fatty liver. Did you cat notice any side effects?

I haven't heard of any serious side effect of the medicine. It's used for all kinds of inflammatory liver issues and gallstones. It's not for certain if it helps all of them as there is not enough data. My cat didn't have any side effects at all. Based on your description it sounds like your vet isn't worried about the medicine itself but worried if the stones "fell" in a big size, that might cause blockage. I don't know how likely it is, this is also a question for a specialist. However, if there are too many stones and/or their size is big, ursodeoxycholic acid might take too much time to work. It can get misleading to give an example from different cases as the stone size, general condition of the cat, etc all matter but, typically from what I saw, if a stone is too big, they remove the stone surgically.

There were bumps on the gallbladder walls and multiple stones. She said it's not worth getting surgery to just remove the stones.

I don't know how good your vet is but personally I would find a surgeon expert for this.

Removal of gallbladder is called cholecystectomy by the way. You can find some info about it here too: Cholecystectomy in Cats - Conditions Treated, Procedure, Efficacy, Recovery, Cost, Considerations, Prevention

If there is no expert in your area, you can maybe try local forums to find a vet who is well-experienced with gallstones and/or this kind of surgery. Or you can ask a specialist through social media/email if they would recommend anyone for this kind of problem in your area.

 

[daftcat75]

Krista was on ursodiol for a bit. To be honest, it was during that period where she had so much other stuff going on (elevated liver enzymes, pancreatitis flare-up, ear infection with ruptured eardrum, broken tooth and two dental surgeries) that she ended up with a feeding tube to make it all easier and less stress on the both of us. The ursodiol, being a liquid, went right down the tube with a little food. I don't know that she ever tasted the stuff. I don't know that I did either. I used to taste her liquid medicines to know what I was forcing on her. As far as side effects? I can't answer that either. Urso wasn't her only prescription going down the tube. I don't know if Krista's concern was ever a stone as much as what they were calling "sludge". The urso did its job though. Maybe you can ask your vet about a urso first strategy with a plan to recheck and decide if surgery is necessary in a certain period of time (3 weeks? or however long he expects to see an improvement from the ursodiol.) Based on the recheck, he could decide whether to continue with the urso- or recommend surgery. In any case, there's likely going to be some hoops to jump through to get that surgery even if that's the course you choose today. You'll likely need to consult with the surgeon first including a transfer of records and films (x-rays/ultrasounds.) Some of these specialists have very long waiting periods to get that consultation appointment. The procedure appointments are generally scheduled fairly quickly after a consultation though. I would pursue ursodiol first while calling around to surgeons. It just may work out that by the time you would be able to schedule a surgery, the ursodiol would have had enough time to dissolve the stones making the surgery unnecessary.

 

[Musiaka]

Krista was on ursodiol for a bit. To be honest, it was during that period where she had so much other stuff going on (elevated liver enzymes, pancreatitis flare-up, ear infection with ruptured eardrum, broken tooth and two dental surgeries) that she ended up with a feeding tube to make it all easier and less stress on the both of us. The ursodiol, being a liquid, went right down the tube with a little food. I don't know that she ever tasted the stuff. I don't know that I did either. I used to taste her liquid medicines to know what I was forcing on her. As far as side effects? I can't answer that either. Urso wasn't her only prescription going down the tube. I don't know if Krista's concern was ever a stone as much as what they were calling "sludge". The urso did its job though. Maybe you can ask your vet about a urso first strategy with a plan to recheck and decide if surgery is necessary in a certain period of time (3 weeks? or however long he expects to see an improvement from the ursodiol.) Based on the recheck, he could decide whether to continue with the urso- or recommend surgery. In any case, there's likely going to be some hoops to jump through to get that surgery even if that's the course you choose today. You'll likely need to consult with the surgeon first including a transfer of records and films (x-rays/ultrasounds.) Some of these specialists have very long waiting periods to get that consultation appointment. The procedure appointments are generally scheduled fairly quickly after a consultation though. I would pursue ursodiol first while calling around to surgeons. It just may work out that by the time you would be able to schedule a surgery, the ursodiol would have had enough time to dissolve the stones making the surgery unnecessary.

Oh yes, now I remember that the vet mentioned something about sludge. That it will clear out the sludge but then there's a risk that a stone will try to go through and get stuck.
That is what I am afraid of because I'm going by how it can go for humans - if a stone gets stuck we usually need to be hospitalized and get a surgery asap and the pain is one of the worst ones in the world.
What I'm trying to figure out is if it's the same with cats. We live in a small city and there are no vet clinics opened at night for example. I didn't get a clear answer from the vet about it, she only said what to watch out for and when to discontinue the med and to call them. But I'm thinking if a stone gets stuck, it's not gonna help to just discontinue the med, then Musiaka will be in grave dangerous, won't he?
If I put Musiaka on Ursodiol, we will be doing an ultrasound every 14 days for the first month and then once monthly. That's the plan so far (if I get the courage to start with the medication...). I have urso in a capsule form, the vet said it's ok to open the capsule up, split the contents into parts and then mix them with a treat.

About the surgery - I doubt there is waiting time... These types of surgeries cost half of the average salary in this country, not many go through with them.

 

[Musiaka]

I haven't heard of any serious side effect of the medicine. It's used for all kinds of inflammatory liver issues and gallstones. It's not for certain if it helps all of them as there is not enough data. My cat didn't have any side effects at all. Based on your description it sounds like your vet isn't worried about the medicine itself but worried if the stones "fell" in a big size, that might cause blockage. I don't know how likely it is, this is also a question for a specialist. However, if there are too many stones and/or their size is big, ursodeoxycholic acid might take too much time to work. It can get misleading to give an example from different cases as the stone size, general condition of the cat, etc all matter but, typically from what I saw, if a stone is too big, they remove the stone surgically.


I don't know how good your vet is but personally I would find a surgeon expert for this.

Removal of gallbladder is called cholecystectomy by the way. You can find some info about it here too: Cholecystectomy in Cats - Conditions Treated, Procedure, Efficacy, Recovery, Cost, Considerations, Prevention

If there is no expert in your area, you can maybe try local forums to find a vet who is well-experienced with gallstones and/or this kind of surgery. Or you can ask a specialist through social media/email if they would recommend anyone for this kind of problem in your area.

I think I have found a clinic that specializes in these tyoes of surgeries, will try to send in a picture of Musiaka's gallbladder. Maybe they can also give a better answer about the risk of a stone getting stuck while on urso.
Also, thanks for the link!

 

[fionasmom]

Tell the vet you have to know if a bile duct obstruction is possible in the same way that it is for people.

 

[daftcat75]

I could be wrong. But I think not starting the med is higher risk than starting it. I'm no doctor. But I would put your treatment risks at highest to lowest: doing nothing > the surgery > the ursodiol. If it were my cat, I'd start the meds while you're researching or deciding on the surgery.

 

[Musiaka]

I talked to the vet. She has confirmed that bile duct blockage is possible and would need immediate hospitalization and surgery as Musiaka's life would be in danger in such a case. Not only is it in another city, but also an unplanned, urgent surgery like that would cost 2-3 times more than a planned one. If it's a medication that might put Musiaka's life in danger, I will not take it. The vet said she isn't very keen on being responsible for a situation like that and even offered to return the money for Ursodiol. She said we could just stay on SAMe and slowly switch to a monoprotein diet, gave advice on how to get Musiaka to eat the food he doesn't want to eat.
I think we will do that for now, manage his symptoms and also plan for the gallbladder removal surgery... She didn't say Musiaka's life is in any immediate danger right now

 

[fionasmom]

Please keep us posted as you work your way through this. At least you have a game plan and something to work toward.

 

[Musiaka]

Please keep us posted as you work your way through this. At least you have a game plan and something to work toward.

Yes, I feel a bit less in the dark knowing exactly how things are with Musiaka's organs. Gallbladder stones, enlarged liver and some thickening in the stomach's upper walls. No thickening in his intestines. I'm a bit comforted by the fact that his blood results were good despite all this.

One thing that puzzles me though, is that the vet recommended to skip cerenia while trying to manage Musiaka's symptoms with SAMe and food. I understand her reasoning, she wants to see if those things help and cerenia might give a false impression that they do, but I'm thinking...more vomiting = more inflammation, so isn't it better to administer Cerenia once in a while at least? One dose usually last for quite a while until Musiaka vomits again

 

[fionasmom]

I have a dog who takes Cerenia once in a while, so I see your point, but I think that you should clarify this with the vet as she monitors Musiaka's condition. Tell her your concerns about inflammation and increased vomiting if it leads to that.