Need some support/input as like all pet owners in this situation I'm a complete wreck and exhausted.
Before I go into details, to sum it up, I'm struggling with the decision regarding my 13-yo cat to put in a feeding tube versus forcing feeding for another few days to help resolve Hepatic Lipidosis considering there's a high likelihood there's a serious underlying cause that I would elect to have my pet put down if it requires further and/or ongoing costly treatments. Diabetes and Hyperthyroidism have been confidently ruled out via tests.
Theo started eating noticeably less about 3 weeks ago (about half) until about 10 days ago he was eating little to nothing and I knew something was wrong. Took him to the vet 8 days ago. He had a pretty high fever, peaked at 105, was of course dehydrated. All the viruses you can easily test for came back neg. Kidney's good. Two 17-panel bloodwork tests one week apart didn't look bad. Had Glucose in his urine when we did a later urinalysis but second bloodwork confirmed no diabetes but he was borderline anemic since last blood test. He's a 13-yo male single indoor cat but we do use Rover for someone to come in while on vacation which coincidentally the cat sitter last visited about 11 days before he wasn't eating well. (Could they have brought something in all the tests missed?) No upper respiratory symptoms like sneeze, running eyes, etc.
The course of treatment to this point is Mirataz for appetite (made no difference so far), Gabapentin in case he has pancreatitis and is in pain, and we just added Cerenia which I should have protested and demanded Odansetron as he's not had any issue with vomiting this whole time (except once after a force feed) but could be nauseated. (The vet is young, in her 30's but I think she's competent.)
The fever broke 2 days ago and for the first he drank a little water on his own and just a couple of dry food chunks. Got him SQ fluids yesterday. I've been force feeding him with a 2 teaspoon syringe. Shooting for 180 calories (he's 9.5 pounds) but if I can hit at least 100 calories at least I'll know I'll be slowing the degree of wasting. Sometimes I try to also give him a teaspoon or two of unsalted bone broth for additional hydration and few calories. He tolerates the force feeding but after one 10cc syringe (2 teaspoons) he's pretty much done with me. So trying to see if he can tolerate it once every 2 hours 16-18 hours a day.
I've read a lot about what possibly could be going on. All along I was pretty convinced it had to be Acute Pancreatitis but after digging deeper, low temp is like 5 times more common than a fever for Pancreatitis. This is the key stat: In 90% of cases Hepatic Lipidosis is a secondary condition to a primary illness. The most common being diabetes, hyperthyroidism, pancreatitis and unfortunately cancer. I am confident based on test results we have ruled out the first two. It it's pancreatitis, the initial treatment was the same you would do for pancreatitis. If it's cancer I'd just have him euthanized right away. In addition about $1,000 is what I consider to be the reasonable max to spend on a later-middle aged cat for diagnosis and initial treatment (fluids, antibiotics, bloodwork, appetite/nausea/pain meds) and I've just about hit that point. If it was my human child, money would be no object. I did spend close to $2,000 on him 3 years ago to diagnose and have a bladder stone removed but in that case he was younger and more importantly we knew exactly what we were dealing with and what the prognosis would be. There was absolutely no guesswork involved.
So we are essentially on about day 10 since he was eating or drinking very little if nothing and had a fever. And although he has shown signs of progress two days ago, today he has not shown any signs of improvement. Once again drank a tiny bit of water on his own. Got off the bed when you shook the treat bag but didn't eat the treats and was able to jump back on the bed, barely. His energy is understandably very low not meeting his calorie requirements and he's also probably a little sedated from the 0.5ml of Gabapentin and daily Mirataz I'm guessing.
The key to resolving Hepatic Lipidosis is getting enough calories in them which is why a feeding tube is recommended. If it's caused by Pancreatitis, he may have a chance of full recovery if we can reverse the Lipidosis. And I could live with the chance he'd have another bout of Pancreatitis but I'd probably just put him down at that point. I don't really see the point in proceeding with an Ultrasound, as that is really a tool that if it uncovers anything the other diagnostics were not able to, it's very likely it will be something serious like cancer, requiring further expensive treatments.
The literature states force-feeding can be "contradictory" for Hepatic Lipidosis as it can create an aversion to eating. I would think if any cat recovered they aren't going to be so scared from being force fed for a couple weeks that they won't go back to eating their normal food?!? Feeding him Hills A/D in this case) which is far different than his normal Solstice Tuna+Skipjack in gravy. So really what I'm struggling with right now on this Saturday is if come Monday, he's basically not improved do I opt for the feeding tube? My gut is telling me, since I'm adverse to further expensive treatments, if he's not getting better at all with the force feeding for 5-7 days, then all roads would probably lead to Euthansia anyway and the feeding tube isn't going to be a difference as far as the ultimate outcome. On the other hand, would an esphogeal feeding tube not be a ton more money (a ton be > $500 in my case) and provide a significant higher chance he can recover and it ended up being acute pancreatitis and not cancer. My gut is telling me if I can't see even very small inremental signs of improvement with the force feeding the tube and and ultrasound is not worth it.
In general you would think if the fever went away and he started to touch his water bowl, things HAVE to keep gradually getting better as long as I keep force feeding him? If not, then it's the end of the road or would end up being the end of the road pretty soon anyway. Not knowing for sure what you are dealing with is just brutal emotionally and on the pocketbook!
Before I go into details, to sum it up, I'm struggling with the decision regarding my 13-yo cat to put in a feeding tube versus forcing feeding for another few days to help resolve Hepatic Lipidosis considering there's a high likelihood there's a serious underlying cause that I would elect to have my pet put down if it requires further and/or ongoing costly treatments. Diabetes and Hyperthyroidism have been confidently ruled out via tests.
Theo started eating noticeably less about 3 weeks ago (about half) until about 10 days ago he was eating little to nothing and I knew something was wrong. Took him to the vet 8 days ago. He had a pretty high fever, peaked at 105, was of course dehydrated. All the viruses you can easily test for came back neg. Kidney's good. Two 17-panel bloodwork tests one week apart didn't look bad. Had Glucose in his urine when we did a later urinalysis but second bloodwork confirmed no diabetes but he was borderline anemic since last blood test. He's a 13-yo male single indoor cat but we do use Rover for someone to come in while on vacation which coincidentally the cat sitter last visited about 11 days before he wasn't eating well. (Could they have brought something in all the tests missed?) No upper respiratory symptoms like sneeze, running eyes, etc.
The course of treatment to this point is Mirataz for appetite (made no difference so far), Gabapentin in case he has pancreatitis and is in pain, and we just added Cerenia which I should have protested and demanded Odansetron as he's not had any issue with vomiting this whole time (except once after a force feed) but could be nauseated. (The vet is young, in her 30's but I think she's competent.)
The fever broke 2 days ago and for the first he drank a little water on his own and just a couple of dry food chunks. Got him SQ fluids yesterday. I've been force feeding him with a 2 teaspoon syringe. Shooting for 180 calories (he's 9.5 pounds) but if I can hit at least 100 calories at least I'll know I'll be slowing the degree of wasting. Sometimes I try to also give him a teaspoon or two of unsalted bone broth for additional hydration and few calories. He tolerates the force feeding but after one 10cc syringe (2 teaspoons) he's pretty much done with me. So trying to see if he can tolerate it once every 2 hours 16-18 hours a day.
I've read a lot about what possibly could be going on. All along I was pretty convinced it had to be Acute Pancreatitis but after digging deeper, low temp is like 5 times more common than a fever for Pancreatitis. This is the key stat: In 90% of cases Hepatic Lipidosis is a secondary condition to a primary illness. The most common being diabetes, hyperthyroidism, pancreatitis and unfortunately cancer. I am confident based on test results we have ruled out the first two. It it's pancreatitis, the initial treatment was the same you would do for pancreatitis. If it's cancer I'd just have him euthanized right away. In addition about $1,000 is what I consider to be the reasonable max to spend on a later-middle aged cat for diagnosis and initial treatment (fluids, antibiotics, bloodwork, appetite/nausea/pain meds) and I've just about hit that point. If it was my human child, money would be no object. I did spend close to $2,000 on him 3 years ago to diagnose and have a bladder stone removed but in that case he was younger and more importantly we knew exactly what we were dealing with and what the prognosis would be. There was absolutely no guesswork involved.
So we are essentially on about day 10 since he was eating or drinking very little if nothing and had a fever. And although he has shown signs of progress two days ago, today he has not shown any signs of improvement. Once again drank a tiny bit of water on his own. Got off the bed when you shook the treat bag but didn't eat the treats and was able to jump back on the bed, barely. His energy is understandably very low not meeting his calorie requirements and he's also probably a little sedated from the 0.5ml of Gabapentin and daily Mirataz I'm guessing.
The key to resolving Hepatic Lipidosis is getting enough calories in them which is why a feeding tube is recommended. If it's caused by Pancreatitis, he may have a chance of full recovery if we can reverse the Lipidosis. And I could live with the chance he'd have another bout of Pancreatitis but I'd probably just put him down at that point. I don't really see the point in proceeding with an Ultrasound, as that is really a tool that if it uncovers anything the other diagnostics were not able to, it's very likely it will be something serious like cancer, requiring further expensive treatments.
The literature states force-feeding can be "contradictory" for Hepatic Lipidosis as it can create an aversion to eating. I would think if any cat recovered they aren't going to be so scared from being force fed for a couple weeks that they won't go back to eating their normal food?!? Feeding him Hills A/D in this case) which is far different than his normal Solstice Tuna+Skipjack in gravy. So really what I'm struggling with right now on this Saturday is if come Monday, he's basically not improved do I opt for the feeding tube? My gut is telling me, since I'm adverse to further expensive treatments, if he's not getting better at all with the force feeding for 5-7 days, then all roads would probably lead to Euthansia anyway and the feeding tube isn't going to be a difference as far as the ultimate outcome. On the other hand, would an esphogeal feeding tube not be a ton more money (a ton be > $500 in my case) and provide a significant higher chance he can recover and it ended up being acute pancreatitis and not cancer. My gut is telling me if I can't see even very small inremental signs of improvement with the force feeding the tube and and ultrasound is not worth it.
In general you would think if the fever went away and he started to touch his water bowl, things HAVE to keep gradually getting better as long as I keep force feeding him? If not, then it's the end of the road or would end up being the end of the road pretty soon anyway. Not knowing for sure what you are dealing with is just brutal emotionally and on the pocketbook!
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