Alfie, 12, Elevated Liver Enzymes. All advice gratefully received.

sebbyz1969

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Hi to you all - I thank you in advance for sharing your wealth of knowledge. I have had cates my entire life and this is the first time I've encountered liver problems in my beautiful boy Alfie.

Details. Domestic Short Hair.

Alfie has always been slender by nature, but had weight loss in May, resulting blood tests showing elevations as seen in the attached files. To summarize elevated levels:
May 30th, 2023
PHOS: 3.0 mg/dL LOW (3.0 mg/dL)
CA: 11.8 mg/dL HIGH (reference range 7.8 -11.3)
Glob 6.0 g/dL HIGH (reference range 2.8 - 5.1)
ALT 409 U/L HIGH (reference range 12-130)
ALKP 246 U/L HIGH (reference range 14-111)

June 13th. 2023 after 2 weeks on Denamarin, and Clavamox.
PHOS: 2.8 mg/dL LOW (3.0 mg/dL)
CA: 11.4 mg/dL HIGH (reference range 7.8 -11.3)
Glob 5.8 g/dL HIGH (reference range 2.8 - 5.1)
ALT 347 U/L HIGH (reference range 12-130)
ALKP 155 U/L HIGH (reference range 14-111)

July 12th. 2023 after Denamarin and Clavamox were stopped due to stress caused by administering meds *values went up without Denamarin, down with it.
PHOS: 3.7 mg/dL Normal range (3.0 mg/dL)
CA: 11.2 mg/dL Normal Range (reference range 7.8 -11.3)
Glob 5.9 g/dL HIGH (reference range 2.8 - 5.1)
ALT 399 U/L HIGH (reference range 12-130)
ALKP 211 U/L HIGH (reference range 14-111)

All other values are in the normal range.

Urinalysis not completed due to empty bladder
Fecal not completed
Free T4 and was in normal range - waiting on actual results from the vet.

Alfie had an ultrasound on July 17th, 2023, results were not provided until 8.5.23

The ultrasound results are overwhelming and I can't quite figure out how to interpret them; even the vet said there is a lot to process and nothing conclusive.

They would like to do a biopsy, but as they already said his liver was very vascular, I am very concerned about him bleeding out and inconclusive results which has happened so many times with my cat (promises of a diagnosis that didn't arrive).
The vet said it could be liver disease, liver cancer, lymphoma, or none of those. No masses were detected but lots of inflammation. Spleen normal.

The good stuff:
He has been back on Denamarin and we've added in daily b12.
He was 7.5 lbs and weighed in at 8.2 lbs yesterday. He isn't a big eater but has been eating enough to put on some weight.
He's bright in himself and playful.
Poop is normal
Pee is a normal amount

The not-so-good stuff:
He didn't eat well today though he seems hungry and keeps checking for food which when offered he is walking away from.
He threw up 4 times today, which is new:
2 clear liquid vomits in quick succession with cat hair (not a hairball) but not any food.
The 3rd time he threw up, he had eaten a decent amount of food, but then he regurgitated it within 2 minutes and there was grass in it.
4th time he ate grass and threw the grass up shortly thereafter, no food as he hadn't eaten
*He ate a little this evening and has kept it down
He is stretching a lot, like his little tummy might be hurting?

I spoke with the vet today and she wants me to give Cerenia pills and start Mirataz transdermal, both seem reasonable to support Alfie, but I read that Cerenia is not always advised with liver issues as it makes the liver work harder.

The vet doesn't seem overly concerned, which seems odd? But that may be because today is the first day of vomiting.

Would love all advice about the next steps. I've attached his bloodwork and the ultrasound results and I would be so grateful for all of your suggestions.

Food wise, the vet gave us the i/d prescription diet, but we are also giving some for struvites. Really he just wants to eat Meow Mix which is crap, and we were able to switch all of our cats over to wet food until recently and it has definitely helped Alfie put on some weight I would say, despite my serious reservation about any dry food.

What food suggestions do you have to keep him eating?

I have found that those on a forum usually have the best advice due to living these experiences and I thank you so much for your time.
 

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Furballsmom

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Hi, from what I recall with my angel Poppycat and his triaditus, we used the denamarin and fluids, but after he made it through that we went with milk thistle. I got a very clean product without any extra ingredients, in order to maintain his liver function as best as possible.

Can you find a cat-only veterinarian? And/or an internal med specialist? We didn't, but it isn't a bad idea unless you can find a cat-only vet who's seen a number of cats with these liver, pancreas, kidney and thyroid issues, which unfortunately seem to come in combination fairly frequently from what I'm reading.

About food, a non prescription brand with a lot of varieties I'd suggest is Weruva, for now or later. They put a lot of effort into making food that helps people with cats that have compromised digestive systems, such as uber low phosphorus food, as low as possible iodine content, low sodium etc. Dry food that I used was Halo and Blue.

Not that this is an option for everyone, and maybe your cat won't take you down this path but I ended up hand feeding him (a tongue depressor, suggested by my vet, works well) on a several times daily schedule for about a year or more. Bless that cat's heart but he was finicky to start with, he wanted his fancy feast which after the triaditus he didn't get as often, in the form of their kitten food but otherwise he was getting Royal Canin mother and baby cat et al, and I was going to do everything in my power even with all that his digestive system was dealing with to avoid skinny old cat syndrome. He was 17.5 years old :rbheart:

For the most part, we made that goal of mine. The reason I'm mentioning all this is that although every cat is different, my little warrior's troubles started with elevated liver numbers.

As you are, keep an eye on his weight. It sounds like you're keeping a log, which is the best way to keep track of what's happening with him. Don't leave eating up to him, especially if he seems interested but also of course if not.

If you have to, mix Meow Mix with other food 💞🙏 . He's got to eat, and to keep it down.

Any Good Tips To Get Your Cats To Eat? Share Them Here!
 
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sebbyz1969

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Hi, from what I recall with my angel Poppycat and his triaditus, we used the denamarin and fluids, but after he made it through that we went with milk thistle. I got a very clean product without any extra ingredients, in order to maintain his liver function as best as possible.

Can you find a cat-only veterinarian? And/or an internal med specialist? We didn't, but it isn't a bad idea unless you can find a cat-only vet who's seen a number of cats with these liver, pancreas, kidney, and thyroid issues, which unfortunately seem to come in combination fairly frequently from what I'm reading.

About food, a non prescription brand with a lot of varieties I'd suggest is Weruva, for now or later. They put a lot of effort into making food that helps people with cats that have compromised digestive systems, such as uber low phosphorus food, as low as possible iodine content, low sodium etc. Dry food that I used was Halo and Blue.

Not that this is an option for everyone, and maybe your cat won't take you down this path but I ended up hand feeding him (a tongue depressor, suggested by my vet, works well) on a several times daily schedule for about a year or more. Bless that cat's heart but he was finicky to start with, he wanted his fancy feast which after the triaditus he didn't get as often, in the form of their kitten food but otherwise he was getting Royal Canin mother and baby cat et al, and I was going to do everything in my power even with all that his digestive system was dealing with to avoid skinny old cat syndrome. He was 17.5 years old :rbheart:

For the most part, we made that goal of mine. The reason I'm mentioning all this is that although every cat is different, my little warrior's troubles started with elevated liver numbers.

As you are, keep an eye on his weight. It sounds like you're keeping a log, which is the best way to keep track of what's happening with him. Don't leave eating up to him, especially if he seems interested but also of course if not.

If you have to, mix Meow Mix with other food 💞🙏 . He's got to eat, and to keep it down.

Any Good Tips To Get Your Cats To Eat? Share Them Here!

Thank you so much! I may have a dozen other questions for you - including - did you biopsy? Did the results help you? I am so scared about the option to do so. We put my darling Boots through a myriad of tests and were none the wiser after they were all done so we ended up treating him symptomatically with the best guess.

I will look for a specialist to see what we can discover - they'll likely push for a biopsy, but we can discuss.

I found this food which says all the right things, but I'm sceptical as it's dry food. PRO PLAN® VETERINARY DIETS HP Hepatic Dry Cat Food

Thank you for mentioning triaditus - I googled it and that seems to hit a nerve with the possibilities offered - thank you more than words can say!
 

Furballsmom

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did you biopsy
I double checked with my partner just in case my memory wasn't clear, and no, we did not.

That dry food might be good to have on hand, either as a backup or to supplement for more calories. I'm like you, canned food is better but kibble can be useful.
 
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sebbyz1969

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I double checked with my partner just in case my memory wasn't clear, and no, we did not.

That dry food might be good to have on hand, either as a backup or to supplement for more calories. I'm like you, canned food is better but kibble can be useful.

I was wondering, when you said that your lovely Poppycat didn't get Fancy Feast very often, but had 'Royal Canin mother and baby cat et al', was that because Fancy Feast is bad for triaditus, and the Roayl Canin is high calorie?

Thank you!
 
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sebbyz1969

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Also, do you remember which milk thistle you used? Alfie is easier to pill than to use liquid with.
 

Furballsmom

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because Fancy Feast is bad for triaditus, and the Roayl Canin is high calorie?
Yes and yes :heartshape:

It is my personal opinion, supported to a degree by menadione's Material Safety Data Sheet (at least it was at the time in 2019 and earlier, but I noticed since then they've changed the data) that synthetic vitamin K can cause liver issues, which is the ingredient Purina uses in all their foods. Looking at it from the perspective of a cat like Poppy who ate FF and Friskies multiple times daily over his entire long lifespan, and considering it isn't water soluble so it isn't eliminated in urine, as soon as I got the report of elevated liver numbers prior to 2019 I went on a lengthy hunt to get him to eat other brands. He and I finally came to a compromise, and I was eventually able to get him to eat a couple of other brands.

With the triaditus, he wasn't eating as well, (didn't like his supplements) and with the handfeeding it was a little challenging some days to get enough calories in him, so that's where the RC came in plus the consistency of the pate was easy to feed.

The Milk Thistle I used was a powder that I mixed into his food - https://www.chewy.com/herbsmith-herbal-blends-milk-thistle/dp/112381
 
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sebbyz1969

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Thank you so much! Alfie had a great day yesterday and has been eating pretty well since his rough 'throw up day'.

Weight stable at 8lbs. Playful and eating without any intervention.

I have an acupuncture appointment for him on Tuesday with a favorite vet who uses modern and homeopathic treatment. I'll take all my results with me and have his bloodwork redone.
 
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sebbyz1969

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Hello again!

Alfie has lost an ounce - not a huge amount in the scheme of things, but of course, it has me panicking. I will say that he is playing, resting comfortably, and eating without prompting.

I have an acupuncture appointment for him tomorrow so we'll run bloodwork again and see how he's going.

I have gabapentin so he won't be so frightened - any thoughts on giving that to him? Is the stress relief worth the extra burden on his liver?

Thank you!
 

Furballsmom

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This is one of those challenging things, because if he's very stressed the adrenaline also is a load on the various organs. Will you have a chance to discuss the pros and cons with your vet? How badly stressed out does he get?
 
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sebbyz1969

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Thanks so much for your continuing kindness, Furballsmom Furballsmom - I am so grateful.

We have had an at-home vet previously, which made everything easier, but she has recently stopped this part of her practice.

He is highly stressed I would say, but has been once a month since May, so perhaps a little less so that the first carrier to vet visit.

I called the vet to ask for some advice so she will call me in the morning.
 

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I have gabapentin.....Is the stress relief worth the extra burden on his liver?

S sebbyz1969 - there's no "challenge" anywhere here for Alfie. Nor is there any trade-off involved....gabapentin is cleared by the kidneys, so there's no liver involvement.

Could you put together a shortish, narrative-style history (medical/social) of this little guy? That would make for a more complete, fuller understanding than what we have.
 
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sebbyz1969

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S sebbyz1969 - there's no "challenge" anywhere here for Alfie. Nor is there any trade-off involved....gabapentin is cleared by the kidneys, so there's no liver involvement.

Could you put together a shortish, narrative-style history (medical/social) of this little guy? That would make for a more complete, fuller understanding than what we have.
Yes, Absolutely! :)

Alfie is about 12 years old and was found as one of 3 kittens. Mum had been caught by TNR and neighbors had left kittens to fend for themselves when they were not yet weaned. There's a long story, but all 3 ended up with me! The only thing better than 1 kitten is more kittens; Alfie, Violet, and Boots, all DSH tabbies! We lost Boots to FIV-related lymphoma in November 2021 (devastated). Alfie and Violet are FIV negative.

Habitat:
Indoor 85% of the time. We have a fenced yard with a 'Cat Fence' so my cats can have time outside but cannot leave the yard and other animals cannot get in unless they fall overhanging trees (two squirrels, one racoon in 10+ years)

I have read that overheating can begin elevated liver concerns, but I'm reading everything and have no idea of its validity.

I am sequestering them during the hottest parts of the day, although they are mostly staying in without the need for interference.

No fleas, but I am wondering about parasites....the vet mentioned Flukes and I have panacur which I will begin after tomorrows's vet visit.

Food:
Up until recently, all my cats were eating Friskies wet food.
Introduction of prescription dry due to Alfie being picky and bloodwork results.

Health history:
Alfie's health has always been good up until now. Perfect bloodwork in January 2022.

He has always been slender and 'slinky', walks slow, playful, timid, kind, sweet as sugar. Never the alpha in the room.

In May we noticed weight loss although Alfie was regularly visiting the food plate, pooping and peeing, not hiding, no throwing up, no diarrhea.

A vet visit revealed elevated liver values, and some other high and low results, but the vet found that the liver was most significant.

We started Alfie on a long course of Clavamox for suspected infection, some prescription diet, and Denamarin for his liver.

The bloodwork retesting on June 13th showed some reduced values for Alfie's liver. Administering the medication had been difficult for my spouse and the doctor suggested we stop the Denamarin and see.

July's bloodwork showed the liver values went back up without the Denamarin and the ultrasound revealed all sorts of things going on, inflammation, suggesting possible triaditus, IBD, lots of other possible causes but nothing concrete.
there has been no vomiting since last Thursday after Alfie ate grass.

Weight was 7.5lbs and seems stable now at about 8lbs (7.95lbs yesterday)

Alfie is drinking water, and playing, ate great yesterday, and ate a little today, but not as much as yesterday so I'm on edge. Dinner time soon, so I'm hoping!

We have a motion detector camera so I can peek without bothering him. And I work from home in the room my cats eat and use litter trays (not close together) so I am seeing almost everything that is going on like a mad cat stalker.
 
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sebbyz1969

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Oh, should add, that I am administering the Denamarin now ( I was not home previously) and Alfie is tolerating my nightly interruptions without too much upset.
 

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My kitty recently had stopped eating and after bloodwork found his liver enzymes high, he was actually diagnosed with pancreatitis. The vet (both of them) seemed to think that the high liver enzymes were due to the stress of not feeling well and a trip to the vet. Did the vet perform the test to check for pancreatitis? It's a special test that's not in routine bloodwork. Pancreatitis can be caused by stress and it causes inflammation in the whole gastro tract.
 
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sebbyz1969

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My kitty recently had stopped eating and after bloodwork found his liver enzymes high, he was actually diagnosed with pancreatitis. The vet (both of them) seemed to think that the high liver enzymes were due to the stress of not feeling well and a trip to the vet. Did the vet perform the test to check for pancreatitis? It's a special test that's not in routine bloodwork. Pancreatitis can be caused by stress and it causes inflammation in the whole gastro tract.
Thank you so much! How is your kitty now?
Pancreatitis has been mentioned and not ruled in or out yet. I'll ask about the special test tomorrow - thank you so much for mentioning it! :)
 
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sebbyz1969

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I am so sorry for the delayed reply. I had to reschedule the vet visit for today at 3pm; I am going to give Alfie some gabapentin to calm him some for the appointment. Poor little guy.
The good news is that he is eating and playing and the last weigh-in was 8lbs 2 oz

Thank you so much for your kindness and for checking in!
 
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