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

[stephanietx]

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!

He is much better. He is still on meds, but he's eating great and has finally started feeling more like himself. My vet told us that if the pancreas isn't happy, the rest of the GI system isn't happy. My guy never threw up, but he got very picky at eating, had increased nausea, drank a lot of water (not diabetic and glucose levels were perfect), and had diarrhea.

 

[sebbyz1969]

HI all, I am so sorry for the delayed response. I have been working 70 hours a week and had not found a moment to return as I have no new blood test results to add yet.

The vet visit last week was inconclusive. The vet said that the pancreatitis test has to be done after fasting for 12 hours so we couldn't do it at that visit.

The vet wanted to complete in-house tests of the liver, but given that the ultrasound results revealed a number of issues, I asked for a full blood panel which was sent out last Wednesday, and have not come back yet, which seems odd. I'm waiting on a call from the vet.

Panacur for 5 days is complete. That was not fun for anyone - least of all my darling Alfie, but I hope if Flukes are involved that those are gone or at least going.

Fecal sample was negative for everything, although, I confess, I don't know what they tested for.

Alfie was not so hungry today, but is maintaining at about 8lbs, give or take 2 ounces. His ribs feel better, and he feels more substantial which is good. And he is just such a love. Playing and happy. Not hiding. He seems a little frail sometimes, but I am assured by my family that I am simply mad.

 

[Furballsmom]

I am assured by my family that I am simply mad.

Whichever the case, (and you very likely are not) hopefully the frailness resolves

 

[sebbyz1969]

Hello! I finally got the blood results today. Levels are lower than previously, but still high.

Vet advised us to just monitor and keep on with the Demamarin unless we decide to biopsy, but with weight stable and levels dropping,, I'm torn. There must be something going on, and the Denamarin is supporting his liver a bit, would love your thoughts. Thank you!

 

[Furballsmom]

This doesn't help you particularly, but every cat is different. Your boy is stable for the moment with dropping levels, so you might want to consider going with your vets' suggestion, for now.

 

[fionasmom]

I agree that is your best option. You have reached a point where the next step is another procedure...or not at this time. Your vet is not trying to back you into a corner with a biopsy, so I would do what they suggest and monitor.

 

[sebbyz1969]

Thank you so much for responding. I think I am struggling with the decision to do more because I have made many mistakes with all my cats when there have been options to pursue; always picking what I thought was best and not always being right. I've always done all the tests without question, but I think I am particularly worried about a liver biopsy as I've read about possible bleedouts with the procedure, while understanding it may be the only way to know more than I know now.

Currently, my next step is acupuncture and advice from my most trusted vet, but as Alfie is so completely terrified, I'm also hesitating to put him through that.

Alfie are grass twice today and threw it up once. Strangely, he is heavier today than yesterday but he didn't eat breakfast, but had a snack at 11am that he has kept down.

I used Cerenia and Mirataz(topical) on our beloved Boots, a different cat who we lost to lymphoma , so I am nervous to start it as he never came off of it once we started and developed cachexia (likely lymphoma related rather than medication?)

Does anyone have experience with temporary usage of either or both medications?

Thank you again for all of your kindness and time.

 

[silent meowlook]

Hi. It is fine to use both of mirtazapine and Cerenia together. It is what your specialist recommended at the bottom of the ultrasound report. He said to use it even if no vomiting.

I would think that if he needs to be seen again, it would be best if he was seen by a board-certified internal medicine veterinarian. With liver biopsy, it can be done as an ultrasound guided fine needle aspiration. But that is something that only a specialist should be doing. I have seen a few dozen of them done but never saw any bleeding. I was working for a specialist then. We also kept them in the hospital at least the day and most of the time overnight to make sure they were okay. Overnight they were monitored closely for any signs of trouble. A regular vet wouldn't have the staff to do that.

It is also better, for next time, to have the specialist do the ultrasound. That way they can look at anything they might have a question with instead of being limited to pictures. Allot of vets do send their ultrasounds to specialists to review because of lack of the specialist to be available and other reasons. It is an acceptable way to do things. It is just with a complicated case like your cat it might be better to have the specialist hands on.

Your cat Alfie is absolutely adorable.

 

[sebbyz1969]

Thank you so much S silent meowlook , I so appreciate your kindness and advice. I'll start looking for a specialist today.

 

[sebbyz1969]

If anyone has any Internal Medicine Specialist Referrals for Orlando, FL, I would really appreciate them!

 

[fionasmom]

Find a Veterinary Specialist
ACVIM Home

Search Results


From the American College of Veterinary Internal Medicine. The last link is specifically for Orlando, but I recommend that you search specifically in your area as there may be others. Other options are included as well.

 

[sebbyz1969]

Thank you so very much! fionasmom

 

[sebbyz1969]

Hi all, I just wanted to check in with an update.

The good stuff
Alfie's weight is stable, put on a little weight even, he knows that if he stands on the scale I bought he gets a treat so that is adorable.
No yellowing of skin, eyes, or gums
Not hiding
Eating well (mirtazapine assisted)
Cuddly
Sleeping comfortably
One vomit of grass in 2 weeks, no other vomit

Not so good stuff:
Drinking switches from a lot to not a lot at all, but he's peeing a good amount when he goes.
A little constipated, gave Miralax
I bought a water fountain, but he doesn't care for it (yet), although one of my other cats 'discovered' it today so I'm thrilled.

I feel like he's a patient at the moment and not a cat - I know that probably sounds silly, as of course, he is ill, but I am not seeing much that makes me think he's happy at all or that the medicine is making him feel better. We just started this journey and I am in it for the long haul, but I am hoping to find something that makes him feel....better.

My current vet who does acupuncture and modern medicine said that we can't try steroids for inflammation if we are going to biopsy as it will negate the results; which I had heard before.

I guess I'm just feeling sad for him and I so appreciate this lovely site where others just get it. Thank you so much.

Currently on:
Acupuncture once a week (I swear by it for cat arthritis, my cats had it before me, jury still out for Liver, Triaditis or whatever little Alfie has)!
Mirtazapine 1.88mg (approx) once every other day - makes him eat and meow a little
Cerenia as needed every 24 hours - this seems to make him a little depressed
Denamarin 1 every 24 hours
B12 chewable
Miralax as needed

Pending:
Urisodol, error at the vet delayed filling at the compounding pharmacy
The vet wanted to know why he wasn't already on it from his previous vet beginning in May.

Specialist appointment, next Friday.

They gave him fluids last week which made his fur look better (off and on it looks 'stary').

I was reading that lactated ringers is not a good choice for liver issues so I need to read more about that.

Thanks in advance for any thoughts you would be willing to share.

 

[Furballsmom]

am hoping to find something that makes him feel....better.

I don't know about the sub-q fluids and liver issues, our vet had us give our angel Poppycat fluids during his triaditus.

 

[silent meowlook]

Table 6

A review of fluid therapy.

www.aaha.org

The above should answer your questions about lactated ringers in cats with liver disease. The quick answer is that it is fine to use.

 

[sebbyz1969]

Thank you so much for taking the time to share your thoughts with me. I have been reading so much about the drugs Alfie should be taking, side effects, and biopsies.It's overwhelming and I know that the people here on this forum know more than the vets because they live the trials.

Today Alfie had a shaking episode after some Miralax, which I am wondering might have caused a painful tummy. He pooped a little after the shaking and then the shaking stopped but I've seen it before in other cats and it always freaks me out as it has to be pain related I would think.

It just occurred to me an hour ago that I could try pumpkin! I can't find anything that tells me not to give it with any of the suspected issues that Alfie may have. Now I just need some luck getting him to eat it when he's not feeling so great.

If he won't eat it, I think I might syringe a little after I pill him tonight, even a little bit has to be better than none?

 

[silent meowlook]

With my cat what helps for constipation is Sub Q fluids. Some cats have relief from the Miralax and some do not do well on it.

Unfortunately there is still much information that is not known about IBD and intestinal
lymphoma. There are some that think it has a link to a food allergy. I have to wonder if the miralax could trigger that in some cats. But, like I said, some cats do well on it.

If you read too much into the medications and side effects you will make yourself crazy. Best to find a vet you trust and follow their advice.

You do know that the biopsies may not give you the answers you are looking for. With my cat, I chose not to do the biopsies and treat as lymphoma due to the results of the ultrasound, which yielded thickening of the intestinal mucosa and enlarged lymph nodes with a space occupying mass. Your vet is right, that if you give Prednisolone, you can’t do the biopsy afterwards.

The meds you are using sound pretty much standard, sans the pred. With the vitamin B12 it is often given as an injection due to poor oral absorption in a cat with a compromised gut. l

 

[sebbyz1969]

Thank you so much! I am so grateful for all of your advice and words of wisdom.

 

[sebbyz1969]

A long overdue update. It's been a little crazy, so the good stuff first.

We saw the specialists; an intern, and a resident took care of him and the radiologist happened to be on-site that day>
I don't have the full report yet, but they said the ultrasound showed nothing that was on the first report. No inflammation of note for any organs, no sludge in the gallbladder. I asked how that was possible as we had not even started with the ursodial as the vet didn't ask the compound pharmacy for the correct tabs so I had been waiting on them.

They said, that the first report was not read by a radiologist but by a specialist. They said they felt there was more credence in the new ultrasound as the radiologist had been right there viewing it.

His calcium levels are high, and they believe he has Idiopathic Hypercalcemia (not good) but ruled out cancer - his malignancy panel was 0

His gastro panel ruled out pancreatitis

Not so good
Liver values are a little higher than they have been, waiting on exact numbers. Continuing with Denamarin for now.
Vets think it could still be an infection and I discovered that the first round of clavamox was not completed in full.
New meds, marbofloxacin, on its way, not yet started.
B12 levels were good, so I am to continue with the oral

Alfie's weight is between 126 and 130 ounces most days, he has been eating well without mirtazapine but will add it back in if he drops below 126oz.

No vomiting for a few days, occasionally with grass. A little constipation, switched to Miralax as I almost aspirated my darling boy on Lactulose. Petrifying!

Would love your thoughts! Thank you!

 

[fionasmom]

Glad to hear that there has been some good news and we appreciate the update. I have used Miralax daily for a cat who had a constipation episode and it has been very reliable. I dissolve it in the Hartz Delectables Stews, which are very liquid, and she eats it as a snack.