Atipical Hepatic Lipidosis

[Antonio65]

Never heard of puffing on food, though Sometimes cats do scratch around the dish as if they want to dig it,. Some say this means "I don't like it" , some say this means "I will eat it later".
Hopefully he will eat more during the day

It seems you live in Europe... Some details in your posts make me think of this

 

[denice]

The liver enzyme numbers are always off with hepatic lipidosis so I do not think he was into that yet. Hepatic Lipidosis is almost always secondary to something, it is caused by not eating. A cat's liver is not efficient at breaking down fat. If a cat's eating goes down enough then they start breaking down fat faster then the liver can metabolize it and they develop fat pockets on their liver. Hepatic lipidosis is treated by getting enough calories in to stop the process so the fat deposits can be metabolized. Treating the original cause of not eating is also necessary.

Your cat's history sounds very much like Patch's history. He would have spells where he would quit eating and vomit clear liquid, as it went on he began having blood in the liquid that he was vomiting. He would be fine for awhile, sometimes months and then he would have another flare. His digestive system would actually completely freeze. He was hospitalized with his first flare when he was only 18 months old and they also thought a foreign object. They didn't have an ultrasound machine so they took daily xrays looking for gas pattern changes and there were none which suggested a foreign object. He finally came out of it on his own.

He had a flare that did go into hepatic lipidosis but he had the wonky liver enzyme numbers, the root cause though was not eating. I went to a new vet who did have an ultrasound machine and there were signs of inflammation in his intestines. He was treated for IBD with a steroid for 8 years with no more flares.

 

[ConfusedOwner]

Antonio65 He used to scratch around the bowl. It meant "I'm full, I will bury this and come back to it later ". I wouldn't be surprised if he developed a new similar habit or if he always had it we just did not notice.

denice our vets seem to think it can be hepatic lipidosis without having liver enzymes off. I also read some studies where they were off only in about 70% of the cases. As far as I understand the only way to know for sure is liver biopsy or liquid aspiration.

They seem to think the root cause could be either stress - from loosing the other cat recently - maybe combined with the bad tooth or the hairball from his stomach.

Doesn't IBD always come with very loose stool? His stool always fine. If anything, he might have had very short constipation periods over the time.

 

[Antonio65]

[
Doesn't IBD always come with very loose stool? His stool always fine. If anything, he might have had very short constipation periods over the time.

IBD can give diarrhea or vomit, depending on which tract(s) of the GI is(are) affected.
My cat has an IBD of the upper tract, and she has vomits early in the mornig, not always, though.

 

[ConfusedOwner]

His nose blowing around food got worse. He even does it when we put a finger with food few cm away from him. And if we put some wet food in his mouth he starts licking his mouth and nose blowing simultaneously. We got him licking some boiled chicken with a lot of parmesan on top. Tried raw too, but no success.

We think it is something smell related now. But we may never know what it is.

I spoke with the vet over the phone updating him, and he said he feels putting the tube back in is not necessary as long as Silvester is getting even a few pieces in by himself. I guess that's the end of hepatic lipidosis diagnosis. He said we should do nothing for few days, see how Silvester handles that. Not try to force feed him, just tempt him. Maybe just try to clear the air ways with some home inhalations.

I feel we're letting him go. The food he's taking in is simply not enough. It is just a matter of time before something starts failing, and it seems highly unlikely he starts getting more food in on his own.

I honestly don't know what we could do. After all, our main priority is that the boy does not suffer. That's why we wanted to know what he has in the first place, to put a stop to it if it turned out to be something for which treatment would involve too much stress or discomfort for him. We don't want a long life for him as much as we want a happy life, and after all he's been through maybe letting go at this point is the right thing to do. It breaks my heart, but it is what it is.

If he doesn't get better and we don't figure out what was wrong, I'll probably won't come back with an update. It would be too difficult. I'm just saying this because I saw way too many threads where owners did not update and I felt bad not knowing what finally happened.

I'll keep watching for your replies, maybe one of you will come with an ideea to get us out of this mess. Meantime, fingers crossed for some serious twist of fate!

 

[Mamanyt1953]

You can syringe feed him. Since you already have pate style food, mix with water into a slurry, draw into an oral medicine syringe (or eyedropper in a pinch), put the tip between his cheek and gum, and slowly inject the food. Since he did so well with the tube, it may not stress him at all.

We think it is something smell related now.

I think you may well be right. Almost everything you've said keeps coming back to that. I don't know where in the world you are, but if there are any universities with vet schools that you can reasonably get to, they always have cutting-edge equipment and front-line procedures. Also, international airports can be a resource for specialists. You would want to contact the Customs people who have to deal with animals and quarantine all the time.

 

[Mamanyt1953]

OH...you can PM me at any time, for anything regarding his health, if that would be less stressful for you! I may not know the answer, but I'll try to find it. I'm here almost every day except Sunday (USA...don't know which side of the International Date Line you may be on!)

 

[Sallysoo]

I feel you. Understand fully it is very important for Kitty to eat enough and importantly on its own too. It is okay if u hv to let him go and painful for you to update us. You kn you will hv our full support. I will pray for miracle to happen on him so he can hv many more years to be with you physically and to give back lots of love. For me I love my kitty v much and would be in great heart aching to see him going thr such stress, in pain and suffering, I will and hv to help him cross the rainbow peacefully. No regrets if that is the best way as we all will leave one day just a matter of time. Cry freely if u need to. We will always keep our each of our special fur babies we had ever care for in our hearts, thoughts and dreams.

 

[Antonio65]

His nose blowing around food got worse. He even does it when we put a finger with food few cm away from him. And if we put some wet food in his mouth he starts licking his mouth and nose blowing simultaneously.

That is strange indeed!
So even the vet can't find an answer to this issue?
The advice of Mamanyt1953 is good. Go to a vet university if you are able to, and ask a professor.
Also forcing him with a syringe and tube food is an excellent idea. I fed my Lola with a syringe for months and this helped a lot!!! I swear!

I feel we're letting him go. The food he's taking in is simply not enough. It is just a matter of time before something starts failing, and it seems highly unlikely he starts getting more food in on his own.

I would not give up on my cat if I don't know what my cat is suffering from. I could accept it if I know what he/she has, but not otherwise.
I use to fight till the end, it's not in my attitude to give up without trying everything! I would not forgive myself.

Keep fighting!

 

[ConfusedOwner]

When I said maybe it's the right thing to give him up, I did not mean we're not going to try anything. Just that we're only going to try things which are not very stressful on him.

Syringe feeding is out of the question for us, as well as performing additional investigations which imply anesthesia or even vet visits without a rather clear possible outcome. We don't want him to be scared of us while he is in his home safe space. Let's not forget this entire thing might be stress related, after all. It's already bad enough that he's going in hiding very fast when on of us gets dressed to get out.

But this doesn't mean we'll not try to have him eat. We have started using the nebulizer(he looks like Rudolph now with his pink nose, I hope that is normal). We're petting him a lot and regularly presenting food to him. We have scheduled him for a CT on Tuesday, but we're not yet sure we're going to go through with that.

It's been almost 3 days since the tube is out. We don't know if he drinks any water. He's peeing once or twice a day, but we never saw him drink. He doesn't seem dehydrated though. He also pooped a small poop, but at the time he probably had some tube food left in.

He barely eats. Yesterday, when he was home alone, he vomited about 8 pieces of undigested food(the only vomit with the tube out, so far) So we know he goes to eat by himself, but the quantity he gets is so insignificant that we only realized he ate when we saw the vomit.

With us here, he never had more than 2-3 pieces or more than 3-4 licks a meal. 3-4 times a day. One notable exception when he licked pate of my finger for about 30 seconds. I was petting him on the place we used to tube feed him - he was just sleeping there when I initiated the petting. Funny thing, I was trying acupressure while petting him. Never believed in that stuff, and it didn't work after that either. But there's no effort to insist in certain places during petting, so why not?

Otherwise, you couldn't tell he's not eating if you just looked at him. He's walking around with us, sleeps with us, enjoying petting sessions, quite a lot initiated by him.

We got around 10 types of treats today, he licked 3 times from something with chicken liver and ate half of something with dried herb. We're going to keep trying to stimulate him with anything we can think of and we'll continue the nebulizer(we just started that one today) and we'll see how it goes.

 

[ConfusedOwner]

Can't figure out how to edit. Not medically relevant, but he also found a rubber ball and played with it for about 10 minutes. Goes to show how normal he behaves except for refusing to actually eat.

 

[Mamanyt1953]

If he is playing, then he hasn't given up, and that's half the fight right there. Sorry that syringing would be too stressful for him, although you might try it just once, since he tolerated the tube feedings well while it was there. Don't push it, just...offer it. Worth a shot if you keep it very low-key.

And keep us posted, as you have been doing. I, for one, am invested in Silvester now.

 

[foxden]

Have you offered KMR (kitten milk replacement) or goat's milk? Either of these can provide a lot of calories and nutrients in small portions.
Some members have fed these when their cats are having trouble eating.

 

[ConfusedOwner]

Actually no. Somehow we didn't try either of that. But I'll get out and try to get some today, if I can find some. We did try Greek yogurt though (the fat kind) without success.

Seems he eats a bit more. Got quite a lot of treats yesterday(maybe 8, over the entire day) and 12-15 dry pieces together with some pate licks. Don't know if the nebulizer had something to do with it, and we're afraid to try it again because the pink nose looks more like a irritation that like normal. Sent a pic to the vet and waiting for them to get back to us.

He also pooped again, he seems constipated because it dropped after he went out of the litter box and some was stuck in his anus. We don't think laxatives are safe right now, we'll keep monitoring and reevaluate.

 

[Antonio65]

Syringe feeding is out of the question for us, as well as performing additional investigations which imply anesthesia or even vet visits without a rather clear possible outcome. We don't want him to be scared of us while he is in his home safe space.

This depends on kitty's attitude. If he isn't very manageable the he could be scaried, but some kitties are happy to be syringe fed.
Mine would purr as well while I was feeding her...

He's peeing once or twice a day, but we never saw him drink. He doesn't seem dehydrated though.

Weigh the water bowl once a day (or everytime you give him new fresh water) and you'll have the measure of how much water he's drinking.
My cat drinks 30-50 ml of water a day, plus the moisture of her wet food. And pees twice or three times a day.

 

[ConfusedOwner]

Update: no significant changes. Not at all interested in cat milk. Got 4 licks of raw yolk and backed off. Drinks, pees. Probably less than normal. Less activity, to be expected given he's not getting more than 20% of what he should.

Talked to the vet, he said we can still call this progress. Which is true, but at this rate I might actually start to get phisically and mentally sick myself.

We decided together with him that CT doesn't really make sense. Best case scenario we find some foreign body in the nose area, but that gets extremely unlikely as he sleeps without noises in the past few days, soon after tube got out. Anything else is probably untreatable anyway. And, worst case maybe, the chances are quite high we would see absolutely nothing.

Right now there's no plan. We'll get him back to the vet in a few days for a check-up, we might know more after that.

 

[Mamanyt1953]

Try the goat's milk. Raw is always best, but in a pinch, you can make do with the canned stuff. Here in the South, they shelve it with the baking supplies at the grocery store.

 

[ConfusedOwner]

Goat yogurt was no good. We could not find milk.

Update: he is eating slightly more, almost unnoticeable. He had a 33hrs interval between the last two times he peed, although he is drinking water. He's now 48hrs since last poop. He also has been hiding a lot more in the last 2 days. And he acts hungry: following us when we get to the kitchen and leading us to the food bowl. Sometimes going to the bowls, smelling them all, not taking anything. Other times going straight to some bowl, fresh woken up, eating 3-10 kibbles, then stopping. Still getting in some treats. On wet food he's only licking the gravy, with a lot of appetite, but only for about 20-30 seconds. Then he stops.

We went to the vet few hours ago. They performed blood work and xray and weighted him. He lost 400g in the last 7 days, down to 5.25kg. The x-ray showed nothing. The blood work showed "as if he's a 2 year old healthy cat".

At this point they have no medical hint to follow. After surgery, endoscopy, several xrays, several ultrasounds and blood work, the boy looks physically a few years younger than he is. We're starting him on mirtazapine tomorrow hoping that this will boil down to a psichologycal problem.

Our greatest fear comes from the fact that all the threads describing lack of appetite without other symptoms end up being lymphoma. (that is, all the threads on which follow up is posted)

 

[Mamanyt1953]

I am so sorry you and your baby are still going through this. I'm a bit at a loss now, but am keeping a candle lit for you both!

 

[laura mae]

It sounds like you are offering him some kibble. While it isn't something a lot of folks would offer long term, if the wet food is making him nauseous, the kibble might be what to offer most. My cat Jeffery was pretty ill and stopped eating for a couple of different reasons. Spent 4 days in the kitty hospital and had to be syringe fed. He's recovering from some sort of stuffy nose virus thing. But he was also snorting, like a reverse sneeze when lowering his head to the food dish. Much to my dismay, the vet fed him Hills I/D for cats with digestive upset--just in case his reaction was about an upset tummy. Well he loves that stuff. When he wouldn't eat the wet food, he ate that.

Eons ago I had a cat that developed hepatic lipidosis after the landlord SPRAYED the house which was divided into apartments for bugs. Hazel didn't eat for 3 days and developed the disorder. It took her 2 months to recover. Her feeding tube was surgically implanted directly into her stomach and I syringed Hills A/D that I mixed in the blender several times a day. It took a very long time. That tube started irritating her and it was removed. The vets suggested Meow Mix because at the time it was also referred to as "kitty crack." And that got her appetite back. Anyway, I think the commonality between Meow Mix and the Hills I/D might be the animal digest that they coat the kibble with.

I suggest these as something that might get your cat to eat a bit more.