End of life care: Liver disease and fluid in the lungs?

[Dexy]

This has been an awful week after seeing two different vets. after being in the hospital for weeks having surgery I returned home and my cat had no interest in food. My dad was taking care of him and noticed about 5 days before I came home he didn’t want to eat any dry food and just certain wet food.

i took him to the vet and his liver levels were crazy high. They did an X-ray and he had some fluid in his lungs as well.
They suggested syringe feeding recovery food, some sub fluid, nausea med and appetite meds. We also sent a sample of the king fluid away for testing but no results yet.

he was letting me force feed him for a couple days but since we came home from the vet he’s being deteriorating. We gave him som gabapentin and although it made him a bit groggy he felt better. I decided he was fighting too much with the force feeding and we should put a tube in. I had to go to a different cat clinic to do the procedure and they wanted to do another x ray to check on the fluid in the lungs.

there was more fluid and they decided not to do the tube. There was also evidence of the liver swollen, spleen swollen, biliary mucocoele obstruction (these were his highest levels in his blood work, normal bilirubin is up to 5.2 he has 111).

I initially wanted to treat the suspected fatty liver disease, but now there are a host of problems and the vet suggested I consider euthanasia.
I took my poor boy home and promised if I were to ever put him down it would be at home in his bed looking out into the backyard he loves.
He really got me through my health issues and has been in my life for 11 years through so much. He really is the coolest and most lovable dude so this breaks my heart.

does anyone have any experience with liver issues and fluid in the lungs?

I want to give him a peaceful end, he is currently still giving me cuddles all night although I know he’s in pain so I don’t want to prolong it to a point where he’s suffering. What pain medicine have people used for end of care life? He doesn’t deserve to be in pain or fear he is too much of a good boy.

 

[Mamanyt1953]

Have you found a vet yet who will come to your home? Not all do. It is time to start looking, and when you find them, ask that vet about pain meds that might give him a bit more good time. Vets who euthanize at home are, often, more open to some palliative care. My heart with yours. I know it is breaking.

 

[Dexy]

Hi yes I have contacted a hospice who will come to the house. The two different vets have given me medication. One is gabapentin and the other buprenorphine. He’s taken gaba before and it seems to help but does make him sleepy.
Oddly enough he looks great today, and less yellow which is weird. He’s also being very affectionate, just sleepy still. I think the sub fluid made the Pleural effusion worse. Glad he’s feeling better for a bit at least this is so sad as he’s a great little guy

 

[cat nap]

...He really got me through my health issues and has been in my life for 11 years through so much. He really is the coolest and most lovable dude so this breaks my heart.

does anyone have any experience with liver issues and fluid in the lungs?

I want to give him a peaceful end, he is currently still giving me cuddles all night although I know he’s in pain so I don’t want to prolong it to a point where he’s suffering. What pain medicine have people used for end of care life? He doesn’t deserve to be in pain or fear he is too much of a good boy.

Hi yes I have contacted a hospice who will come to the house. The two different vets have given me medication. One is gabapentin and the other buprenorphine. He’s taken gaba before and it seems to help but does make him sleepy.
Oddly enough he looks great today, and less yellow which is weird. He’s also being very affectionate, just sleepy still. I think the sub fluid made the Pleural effusion worse. Glad he’s feeling better for a bit at least this is so sad as he’s a great little guy

Hi D Dexy ...I am so sorry that you and your 11 year old cat are having to go through this difficult time, right now.
Can you tell us his name?
Will be sending you major Health, Strength, and Peace vibes at this difficult time.

(I have not had any experience with liver issues in cats, but with the fluid in the lungs...one of my previous rainbow cats did develop FIP...but she was much younger than your guy, and sadly passed from it.)

(The buprenorphine I did use, with another rainbow CKD cat, which did help him, right near the end, except that it also caused his one eye pupil to dilate, while the other did not. It sort of freaked me out, at the time.
I then decided to only give a much smaller dose, which was in a liquid syringe and given into the side of the cheek. I cannot recall how much, though, now. It helped him to sleep more comfortably, but again, this was in the last week of his life.)

It was hard, since like you said, you want to do everything to make our cats comfortable, and hope that somehow things will turn around, but at the same time you also know that you need to make the tough decisions, to not allow these beautiful animal companions of ours to suffer.

Like you mention, sometimes our cats tend to rally when they are feeling at their worst.
I don't think they actually ever give up, until their bodies do.
We know that they never live as long as us, but that does not make it any easier.

Will be sending you all Thoughts of Strength and Health, in the times ahead.

 

[Mamanyt1953]

Oh, good. I'm glad you have someone lined up. That is certainly what I want for my girl, when the time comes.

I'm lighting a candle for you AND your baby!

 

[Dexy]

Thank you so much for all the kind words. He miraculously has been eating on his own the past two days a lot. I’m not going to hold on to hope but I am happy that he’s comfortable right now.
His name is Dexter and he’s a very good boy.

He’s really tired but that’s him recovering.

 

[Mamanyt1953]

WHAT A SWEETIE! Wishing him many more good days! Cats can amaze us, sometimes

 

[cat nap]

Thank you so much for all the kind words. He miraculously has been eating on his own the past two days a lot. I’m not going to hold on to hope but I am happy that he’s comfortable right now.
His name is Dexter and he’s a very good boy.

He’s really tired but that’s him recovering.

Dexter is indeed a handsome boy!

Way to go Dexter. Keep eating on your own.
Sending more Thoughts of Health and Strength to Dexter and you.

WHAT A SWEETIE! Wishing him many more good days! Cats can amaze us, sometimes

....So true.
Our cats teach us so many things, too,...about being strong, taking each day as it comes, living in the moments, how to deal with difficulty, etc.
Cats truly do amaze.

 

[Dexy]

Well this is day 3 of eating on his own and he’s still going strong eating even more today. I can’t believe it. He’s very affectionate too. If he continues on this track the vet suggested bringing him in next week for a chest and abdomen ultrasound just to see for sure what’s going on. The X-ray May have been misread from the cat clinic that was going to put in the feeding tube, as the previous X-ray read by the radiologist did not suggest some of the same things. Who knows.
Im cautious for optimism, I’m giving him a low dose of gabapentin as he’s in discomfort a bit without it and this definitely seems to help. No real breathing issues either yet. At the very least I’m getting some super cuddly days with him, he doesn’t want to give up just yet.

 

[cat nap]

Well this is day 3 of eating on his own and he’s still going strong eating even more today. I can’t believe it. He’s very affectionate too. If he continues on this track the vet suggested bringing him in next week for a chest and abdomen ultrasound just to see for sure what’s going on. The X-ray May have been misread from the cat clinic that was going to put in the feeding tube, as the previous X-ray read by the radiologist did not suggest some of the same things. Who knows.
Im cautious for optimism, I’m giving him a low dose of gabapentin as he’s in discomfort a bit without it and this definitely seems to help. No real breathing issues either yet. At the very least I’m getting some super cuddly days with him, he doesn’t want to give up just yet.

Way to go Dexter!
I wanted to post some extra information last night, and I had wrote it all out...but because I was not sure what was going on with your Dexter...I didn't want to stress you, or give you more things to think about.

My worry was the fluid on Dexter's lungs, and if it caused him any breathing issues, then most of the things I wrote would not have helped.
I wondered if the Vets, first or second,....gave you any differential diagnosis...on what they thought Dexter might have?

If they thought heart congestion...causing fluid build up...then lasix could be given.
If tumours, then I'm not sure if prednisolone could be given.
If FIP...then also not sure what meds could help.
Liver issues can be overcome, sometimes, depending on what is causing them....with either antibiotics, pred, liver meds and supplements, too.

Is there any way you can email the Vets, and get his reports, and bloodwork?
These actually belong to you, since you paid for them.
And if you ask them that you want to keep them for your own records, then they should send them to you.
(I'm just curious if they did a full blood panel on Dexter, with proBnp for heart, SDMA for kidneys, and what the actual liver values and references values are.)

If this is too much work, to post them, then I understand, since none of us here are actual vets, so we couldn't read the values as complete anyway, and couldn't really offer the advice that a Vet would.

I just really wondered what both Vets told you what they think that Dexter has?

Anyhow, D Dexy ...I will still be sending extra Mega Health vibes...coming your way...for Dexter and you.
Give your boy some extra scritches from all of us, here.

 

[cat nap]

Okay, I'm just going to post what I wrote last night, but only because if you do go next week to the Vet again, then asking about certain liver medications or supplements may help.

What is really difficult to decide, though, is that because Dexter is eating on his own...you actually don't know how to decide if introducing anything new, into his food, would make his taste for his food change?
You actually don't want to do anything that would alter his tastes, ..and want to do everything for him to continue to eat regularly.

------------------------------------------------------------------------
I don't know if it could help, but on J Jenny22 's thread, she did mention giving her cat prednisolone, milk thistle, and early on her cat was given ursodiol, too. (ursodiol is given if there are blockages in the bile ducts, I think)

Another member there, MissClouseau , also mentioned Denamarin...which I think contains milk thistle and SamE together.

(my previous rainbow cat Sparky, was given SamE, when he had some bile duct blockages. But he was also given antibiotics, as well. So we really didn't know which helped more, at the time.)
Milk Thistle - A Wonder Herb? | Little Big Cat
Denamarin vs. Milk Thistle: 2022 Comparison and Key Differences
Ursodiol | VCA Animal Hospitals

With Dexter though, the problem of fluid buildup...or pleural effusion is worrying...especially if it affects his breathing...so I'm not really sure how well prednisolone would help, or if a Vet would be okay with giving it, to counter any inflammation happening within his body.
I really wish they did have something to make the fluid go away, for your Dexter. The only thing that comes to mind would be lasix.

Perhaps your two previous Vets were thinking heart failure? due to the fluid build-up? and not fip.
Tumours? but that would be seen on an x-ray, I would think.

Whatever Dexter has, though, I also hope that you get more quality days with him.
---------------------------------------------------

So I wrote that last night, but just wanted to say, D Dexy ....just go by what you're seeing from your Dexter, and go with what you think is best.
I am just going to continue to send Thoughts of Health and Strength your way.

 

[Dexy]

Thank you for the advice

so I do have some zentonil but like you mentioned he is eating on his own and I’m very cautious to give him anything that may stop it. I think if he’s still eating well after today I may give him some tomorrow. alternatively I do have a natural milk thistle product I could give him as well. Just feeling out the day.

the vets are not really sure what’s going on. At first they think fatty liver because of the history of me being away and he Is VERY attached to me and emotional kitty. The fluid in the lungs was mild to moderate amount and they did test it.
He is on cerenia which helps with the nausea I’m sure he is feeling, and I’m giving him small amounts of gaba which is making him so comfortable but not completely sedated.
His is not struggling with breathing, it’s been consistent the past several days at around 21 breaths per minute.

with the obstruction his primary vet said when they drained the fluid with the ultrasound guided needle she manouvered around a bit with the machine and didn’t see anything to suggest a biliary obstruction. I think for peace of mind I’m going to book the ultrasound anyway, even to just get a better idea of what kind of pain he can be in or The potential of knowing exactly what’s happening.
He’s 11 years old so they think FIP is unlikely.
I have no idea if this could be related but when I left for my surgery first week of January I did have Covid. I know it’s not related to fip but just something I thought of.
It could possibly be heart related, and then the ecg ultrasound would hopefully identify that.
If it was just fatty liver disease I think he could beat it, there are just two major issues to consider the lungs and the liver right now. Poor guy.
He is currently cuddled up in a blanket sleeping peacefully.

i have also attached his initial blood work.
Thank you for caring.

 

[di and bob]

As long as he is eating, there is hope. It may be temporary, but you never know, miracles DO happen. One of my cats was diagnosed with Leukemia, and is still going strong almost three years later! I give him DMG to build up his immune system. He was SO sick, they said he only had days to live. He was just skin and bones. i got some Delectable Lickables in the stew flavors and he took a few licks a day, it was all that kept him alive. I keep it around now in case he gets sick again, and give their meds in it each morning. Stress and not eating is horrible on cats and could have very well contributed to his fatty liver. I'll pray for your sweet boy, as long as he eats a tiny bit and seems to be getting stronger, there is hope!

 

[cat nap]

Thank you for the advice

so I do have some zentonil but like you mentioned he is eating on his own and I’m very cautious to give him anything that may stop it. I think if he’s still eating well after today I may give him some tomorrow. alternatively I do have a natural milk thistle product I could give him as well. Just feeling out the day.

Sure, that totally makes sense.
I would do exactly what you are doing, too.
Taking it day by day is the best.
It's so hard for us to know, what to give our cats, to not cause any food aversion, or any upset stomachs, or taste.

(Zentonil was actually what my former Vet had given to me, too, when my rainbow cat Sparky needed it. One vet, at the time, thought it wouldn't work, but the female Vet thought it would...and I think it did, but my young 1 year old cat was also on antibiotics, too, and did got over that flare up of bile obstruction and jaundice. The female Vet told me afterwards, that she really didn't know what actually caused the jaundice and bile buildup.) (Honestly I didn't even notice the jaundice, but the female Vet did, when I had brought him in for his yearly vaccinations. He didn't stop eating or anything, at that time.)

the vets are not really sure what’s going on. At first they think fatty liver because of the history of me being away and he Is VERY attached to me and emotional kitty. The fluid in the lungs was mild to moderate amount and they did test it.
He is on cerenia which helps with the nausea I’m sure he is feeling, and I’m giving him small amounts of gaba which is making him so comfortable but not completely sedated.
His is not struggling with breathing, it’s been consistent the past several days at around 21 breaths per minute.

with the obstruction his primary vet said when they drained the fluid with the ultrasound guided needle she manouvered around a bit with the machine and didn’t see anything to suggest a biliary obstruction. I think for peace of mind I’m going to book the ultrasound anyway, even to just get a better idea of what kind of pain he can be in or The potential of knowing exactly what’s happening.
He’s 11 years old so they think FIP is unlikely.

You mentioned before that they tested the fluid...but did you get the results back, at all?
What type of fluid?
what type of cells in the fluid?

D Dexy ...you're actually way better than me....knowing about the normal breaths per minute...and how to count them and all.
(I would have to probably watch a ton of youtube videos to understand it all.)

He’s 11 years old so they think FIP is unlikely.
I have no idea if this could be related but when I left for my surgery first week of January I did have Covid. I know it’s not related to fip but just something I thought of.
It could possibly be heart related, and then the ecg ultrasound would hopefully identify that.
If it was just fatty liver disease I think he could beat it, there are just two major issues to consider the lungs and the liver right now. Poor guy.
He is currently cuddled up in a blanket sleeping peacefully.

Ohh, I'm so glad that you were able to get over Covid.

And actually I think you may be onto something, with that relation of having covid and potentially your cat becoming sick, too.
I remember thinking that too, but only because it seemed like there were many threads and cases online, that I read,...where the vets didn't know what was going on, but the cats were sick, but then recovered, too. It just seemed so strange, and a lot of 'not knowing why the cats were getting sick'...just out of the blue.

Yet I don't think there are any tests that vets can do to prove it, though. Initially I remember reading some articles about it, early on with covid and owner's dogs or cats becoming sick, but nothing recently....so I think it would be more prevalent, if there were an easier connection...meaning I think that more of our animals would be getting sick, with all the variants going around. It doesn't seem like that is happening at all.
Plus, so many cats have regular corona viruses, and they don't actually mutate into anything else.

Since fip is related to corona viruses, but so are other mild cases of feline upper respiratory infections, and it's only if the corona virus mutates does a certain cat develop fip. They don't really know what causes certain cats to get to the mutated stage, either.

But I'm glad that they don't think that the fluid...is fip related..in Dexter's case. That's a relief.

i have also attached his initial blood work.
Thank you for caring.

You are so welcome, dexy.
Thank you for posting it.

Dexter's bloodwork is not really that bad...if I compare it to J Jenny22 's cat Lulu...over in the other thread.
It's like you said before,...yes...his Total Bilirubin is quite high at 111.2 (norm 0.0-5.2)...but his GGT is not that off at 7...(norm 0-6).
.
You did mention in the other thread that Dexter had bilirubin crystals in his urine, too.
So I'm not sure why the excess bilirubin is spilling over into his urine, except that perhaps the 'recycling of the bilirubin' within his system is not working properly.
Not really sure how the bilirubin crystals would affect how he gets rid of toxins from his body.
I'm hoping that he can get rid of any excess through drinking water, and flushing, urinating it out.
SDMA is at 15 (norm is 0-14)...so really not that high...but not sure how sensitive the SDMA test is. (I have to read up on that test later.)

You're right about the ALT, AST, and ALP being high...but then again...Lulu...had even higher values...so there is hope.
Especially since Dexter is eating.

The Creatine Kinase...being at 1290...(norm is 64-440)...is, like you said, very high.
But this value is different than Creatinine.
I read that Creatine Kinase is affected if a cat is very stressed and fearful...and that is precisely what you mentioned in the original post...in Lulu's thread (Jenny22).
So...I'm not really sure...but perhaps being that Dexter was so fearful at the Vets, that this number can be different...if bloodwork were taken at home setting.

That's where it also gets hard for you...since if Dexter gets fear aggression going to the Vets...how can you ask the Vets to interpret the results of the bloodwork, and his urine analysis, hydration state, stress levels, or even blood pressure, hypertension...while he is at the Vet clinic..and stressed.

I so wish that mobile vets were much cheaper...since it might help if they came by...and took blood.
(but I read online that someone mentioned that he got an estimate of $175 but then it turned into $745...and I was thinking, "what??"
I wish I could remember where I read it, though. It was either in the comment section, of some website article, or reddit, or somewhere else.)
Maybe if you call around and ask about Mobile Vet prices, and what they can actually do at home...then you could at least get a better idea of costs...for bloodwork, and urine.

With your idea of doing the ultrasound, it does sound good, ...I would just ask the Vet...ahead of time...if the ultrasound would help with an actual diagnosis....and treatment plan...or if waiting and doing another blood panel would help...and also when to do it...since it all depends on 'how NOT to stress your Dexter'...too.

Still sending you major Health vibes...for Dexter and you.
Also, like di and bob mentioned...as long as Dexter is eating...there's hope.
Will be sending prayers, along with di and bob's, too.

 

[Dexy]

So I got the results sent to me from the cytology, it does mention fip, but the vet seems to think it’s heart related. I have his ultrasound booked for Friday. They mentioned that going to specialist to have the heart ultrasound done would be better for heart problems but it is far more expensive. I’m going to do the one at his vet, they will do the abdomen and heart and if there is a problem Identified with the heart I can go from there and decided if a specialist should happen. I mostly want to know how bad what’s going on is so I can help if he is terminal to make things better for him or if there another direction of treatment. He becomes very scared an aggressive and I think the specialist hospital would be detrimental to him. Again my main concern is making him happy and comfortable.

I attached the cytology and I urine test from when we did his blood.

I really appreciate all the advice and thoughts. He still eating like a champ, and no breathing issues but he’s not comfortable so keeping him on the Cerenia and gaba.

 

[cat nap]

So I got the results sent to me from the cytology, it does mention fip, but the vet seems to think it’s heart related. I have his ultrasound booked for Friday. They mentioned that going to specialist to have the heart ultrasound done would be better for heart problems but it is far more expensive. I’m going to do the one at his vet, they will do the abdomen and heart and if there is a problem Identified with the heart I can go from there and decided if a specialist should happen. I mostly want to know how bad what’s going on is so I can help if he is terminal to make things better for him or if there another direction of treatment. He becomes very scared an aggressive and I think the specialist hospital would be detrimental to him. Again my main concern is making him happy and comfortable.

Oh, good you got the results.
It's so interesting.
In the Report it says:....
----------------------------
Pathologist Report:
...No evidence of an infectious agent or neoplasia in this sample

And in the Comments:
Differentials to consider include cardiac insufficiency, neoplasia, cardiomyopathy, FIP, vascular disease (eg. Thromboemboli), organ torsion or inflammation.
Is there evidence of a mass lesion?
Is there evidence of cardiac disease?
The neutrophils may be present due to irritation of the fluid or underlying low grade inflammation.
--------------------------------
I really like that it says 'no evidence of neoplasia in this sample'.
I guess they don't entirely rule it out, since in the comments...it asks if other 'mass lesions' are seen...but hey, it sounds good that it wasn't in that sample, anyhow.

So yes, I can see why the Vet would now want to rule out cardiac problems.
Could you maybe ask her...if running a 'proBNP'...on some bloodwork...would indicate cardiac problems.??

(My previous rainbow cat Spotty, had a heart murmur detected when he was 14 years old. The Vet ran a full blood panel, and also that proBNP number,.. and told me that it would indicate if the numbers were rising, from baseline to later tests, then in all likelihood he did have cardiac problems.)

(When his numbers did go higher, I was sent to a cardiologist, which like you said are super expensive. It was around $740 CAD, in 2014,...so I can imagine that the prices would be much higher now. The cardiologist ran a heart ultrasound, heart echo, or whatever she called it...and it showed that Spotty had early HCM, but did not have to go on any medication, at the time. His heart muscle on left side was either stiffer or somehow affected, (I would have to go and see if I still have the paperwork, to explain it better.)

(Anyhow, my Spotty also had CKD, and was eating the Hill's K/D diet, so the cardiologist said that the diet was okay for him, but to come back six months later, or maybe it was a year later, cannot recall,...and repeat the heart ultrasound. Unfortunately, the CKD, kidney disease, caused him to decline about 1.5 years after the diagnosis. He rapidly declined when he was 15.5 years old.
It was hard, because for CKD, you're supposed to give sub-q fluids and hydration, but for HCM...you're not supposed to have too much fluid around the heart. Both diseases called for opposite treatments. So we basically just treated the CKD with prescription diet.)

If your Vet can do the heart and abdominal ultrasound, plus maybe ultrasound the kidneys, then I would go for that, too.
Hoping that it is not too expensive.
Or if they have someone who comes by the clinic, and does them, at a lower cost, then that would be good, also.

I attached the cytology and I urine test from when we did his blood.

Thanks so much for posting this, also.
I'll have to look up some terms, especially dealing with the urine crystals, and urinalysis...but it's very helpful for us all, since anyone else who reads this thread, may find it useful...and learn from it, too.

Also, sometimes, people come across it, and may have more ideas to add.

I really appreciate all the advice and thoughts. He still eating like a champ, and no breathing issues but he’s not comfortable so keeping him on the Cerenia and gaba.

You're very welcome, I only wish I knew more, but I find exchanging ideas very useful, and helpful, too.
I appreciate you for posting about Dexter, and all the info.

So, so glad that Dexter is eating like a champ, still.
Maybe it was just missing you and stress, or
Maybe it's really ...what the comments said...."low grade inflammation"...and Dexter is fighting it off, himself.
I'm going to be voting for it to be the most easiest thing...that just goes away.
Thanks again, Dexy, and Sending you more Thoughts of Health and Strength for your Dexter and you.

 

[Jenny22]

I skimmed over the thread - so I apologize if I missed anything. But I wanted to make a few points

First, here is a site that I came across one night when when my face was glued to the web looking for answers on what could be causing my cat's high GGT/bilirubin:

Disorders of the Liver and Gallbladder in Cats - Cat Owners - Merck Veterinary Manual

Learn about the veterinary topic of Disorders of the Liver and Gallbladder in Cats. Find specific details on this topic and related topics from the Merck Vet Manual.

www.merckvetmanual.com

.

Also, there is a Facebook group called Cats with Multiple Medical Conditions (kidneys, heart, IBD, liver and more). You can post your cat's symptoms and see if anyone else has had a similar situation with the fluid in the lungs. This group was very helpful and I received dozens of responses of people who told me their cats pulled through.


I agree with cat nap; every vet that I spoke to said as long as the cat is eating, that is a very good sign no matter how bad the cat looks. And Lulu looked so bad that I consistently questioned if I was allowing her to suffer by giving her the chance to bounce back - it was just so difficult to tell if she was going to make it or get worse. And Lulu only nibbled a few times over the course of 2 weeks - she was not eating every day or more than a tablespoon of food on her own. Apparently eating anything at all was still a very good sign I was told. From what I read, if your cat is eating all his calories on his own, you're in very good shape in terms of the fatty liver. If he's not, make sure you are syringing the rest!

In my case, we think the prednisolone is what eventually helped Lulu get over the hump because there was clearly unresolved inflammation going on. Her new vet thinks it could have been triaditis while the ER had it down as cholangiohepatitis that caused her to originally stop eating. On week 2-3 of aggressive nutrition and with the bloodwork getting worse in some areas, I suspected the high GGT and bilirubin levels had to be an obstruction. Her vets agreed it was something bigger going on. But she bounced back quickly on as soon as I introduce pred as a part of palliative care to make her comfortable. So now I think the bloodwork continued to rise not due to an obstruction but due to inflammation which perhaps mimicked an obstruction in her bile ducts. This explains why the GGT and bilirubin kept going up and why she responded so well to steroids. But this is very particular to my cat and Lulu did not have any fluid in her lungs. And the end of the day, I opted out of further diagnostics (biopsy and aspiration) so I don't really know what caused her to stop eating and to become so sick or slow to respond to the fatty liver treatment. It was 3 long weeks before I even had a glimmer of hope. By week 4, I felt we could actually beat this. My theories on what happened with Lulu bounce back and forth between dental issues and an infection in the mouth that became systemic to her eating some of the dog's fresh pet (intolerant proteins) which flared her IBD and subsequently neighboring organs (triaditis). The most important thing however, was to keep getting the calories in her to reverse the fatty liver. I do think milk thistle helped but you should just check with your vet if what you have is ok to give and the dose. But you do absolutely have to make sure that your cat is getting ALL of the required calories for his pre-fatty liver bodyweight.

Also, there came a point where I felt like scaling back on meds also helped (not that you should do this without your vet's consent). And I did not like the idea of an appetite stimulant. It made Lulu anxious and sick. To be honest, a cat with fatty liver is not going to really eat as they are nauseous so what is the point of an appetite stimulant anyway. Anti-nausea meds are more important I think. And I was syringe feeding her anyway. The only food she took to eventually eating on her own was CN Critical Nutrition prescription - you can check with your vet to see if they have it and see if her appetite eventually perks up with it as my cat is very picky. But it was a rollercoaster. Some days she ate no more than a tablespoon of food. Other days she refused all food. Nothing was linear about her improvements on a day to day basis and somehow eating even that small amount was a very good sign to the vets. So, I think you have a pretty good shot with your boy.

I also was unwittingly spreading Covid at the same time Lulu was developing whatever caused her to stop eating. We both became very sick at the same exact time with symptoms. But I think it was coincidence - at the very least maybe it just made it more difficult for her immune system to fight whatever was going on. But I don't think it is why she got sick.

For what it's worth, and aside from the high creatinine kinase level, your cat's bloodwork was very similar to mine. My cat is also very very skittish and does not do well at vets (especially ERs). But as far as going to vets in general, she did eventually become more comfortable in the car driving as she had so many appointments. Keeping my hand in the crate to pet her as I drove kept her calm. She stayed on the front seat. As for the ER, I avoid those places like the plague if I can. An ultrasound will probably be helpful but I would minimize stress as much as possible if your cat is anything like mine. You can reach out to local pet rescues or put a post up on your local Facebook town page to see if there are vet techs that can help with meds or subQ fluids if you need it. It helped me to have someone like that stop by and give me their opinion on how she looked vs other cats they have dealt with. Pet rescues see senior cats with fatty liver and multiple comorbidities bounce back all the time. Hearing those stories firsthand kept my mind in healthy place as did the support of this forum.

Thinking of you and Dexter.

 

[Dexy]

Just an update, Dexter decreased eating again. Maybe half a can. I’m going to try and force feed with a syringe in the morning but not sure he will take it. Also it makes him so depressed and I’m worried it is causing him more pain or discomfort. He shows interest in food but just can’t eat it when he goes to try. Even treats arent working.

I will have to make a choice on his quality of life if his appetite doesn’t bounce back over the next day or two. I really have tried everything I could. Wish I knew exactly what was wrong with him. i got optimistic when he started eating on his own again.

the gabapentin seems to be making him comfortable at least. The beupenorohine kept him awake all night and I don’t want him to go through that although it did relieve his pain, did not help with eating though.

the cerenia doesn’t seem to work and might make him feel worse so I may stop that tomorrow.

maybe I can try some cbd to help with nausea or pain.

I never gave him the zentonil as I was worried it may make him feel worse, any experience with this at all?

I gave him a b12 shot yesterday but that didn’t seem to help.

thank you for all the advice

 

[cat nap]

Just an update, Dexter decreased eating again. Maybe half a can. I’m going to try and force feed with a syringe in the morning but not sure he will take it. Also it makes him so depressed and I’m worried it is causing him more pain or discomfort. He shows interest in food but just can’t eat it when he goes to try. Even treats arent working.

I will have to make a choice on his quality of life if his appetite doesn’t bounce back over the next day or two. I really have tried everything I could. Wish I knew exactly what was wrong with him. i got optimistic when he started eating on his own again.

I got optimistic too, when your Dexter started to eat on his own again.
I was so hoping that he turned a corner, and that he was only suffering from some 'low grade inflammation' type thing.

I wonder if the fluid in his chest cavity is back, and that is making him feel uncomfortable again?
If you could get a Vet to drain the fluid, once again, then he may feel better...but that would probably be temporary...since we don't really know the reason the fluid was forming to begin with.
(I remember other members mentioning this, in older threads,...but it would only buy them some extra time...until they knew more.)
Not sure if mobile Vets who could come to your home, could do this procedure.

It's so difficult with our cats as they get older and develop diseases, since our regular Vets then need to do more testing...in a logical way...to Rule Out...any of the big things first...and then to be able to treat the existing symptoms, too.
It's hard for the Vets to also know how to treat our cats...without doing further diagnostics.
They would only be guessing, and potentially not using the right treatments,...if they didn't have all the diagnostic procedures and labs in front of them.

the gabapentin seems to be making him comfortable at least. The beupenorohine kept him awake all night and I don’t want him to go through that although it did relieve his pain, did not help with eating though.

the cerenia doesn’t seem to work and might make him feel worse so I may stop that tomorrow.

(I also found that the buprenorphine was way too strong for my previous CKD cat. His one pupil got dilated, and like you said, he began to move around and could not settle down. Even at a small amount, it was very strong, but he was very sick.)

Since the gaba is working I would skip the bupe for now.
This online website mentions that the bupe "might increase pressure in the biliary tract"...and since Dexter does have jaundice...then I think it may cause him more pain than not.

Check with your Vet just to be sure, but I would skip the bupe for now,...since the gaba is helping.
Pain Control In Dogs & Cats – Burrard Animal Hospital
"All the opiates should be used with caution in patients with hyperthyroidism, severe renal insufficiency, Addison’s and in severely debilitated pets. Buprenorphine might increase pressure in the biliary tract, so it should be used very carefully in patients with jaundice."

maybe I can try some cbd to help with nausea or pain.

I never gave him the zentonil as I was worried it may make him feel worse, any experience with this at all?

I gave him a b12 shot yesterday but that didn’t seem to help.

thank you for all the advice

Definitely try the zentonil.
At this point, I would try it for sure.

(with my previous rainbow, fiv+ and felv+ cat, the zentonil did help him to get over the jaundice and whatever bile obstruction he had. But he was also on antibiotics, too.)

Is it the advanced one...with milk thistle, too?
Zentonil Advanced 200 (Canada) for Animal Use - Drugs.com
or the other one that does not contain milk thistle?
S-Adenosyl-Methionine (SAMe)
Either way, try it...since if Dexter is getting worse...then it may help.

I've never tried cbd in my cats, so wouldn't know.
My worry would be on how cbd affects the Liver.
For this, too, I would ask the Vet,...since they may know if it would make things worse or better.

Continuing to send Loads of Health vibes for your Dexter and you.

 

[Jenny22]

What exactly did your vet say in terms of a diagnosis? I'm not a vet so take this with a grain of salt, but I thought Dexter's bloodwork looked like fatty liver? If this is also what your vets are saying, then you NEED to force feed. Either that or get a feeding tube. That is the treatment to reverse fatty liver - aggressive nutrition. Have your vets not told you this? I'm a little thrown that they are not more actively pushing you to get the calories in as the number one form of treatment here.

The reason cats will not eat on their own or as much with fatty liver is because they are nauseous. The liver disease leads to nausea, then the cat eats less which affects the liver more which makes the cat more nauseous. It's an endless cycle that does not get better by doing nothing. So step 1 is getting Dexter on an anti-nausea med that agrees with him. My Lulu does not do well on cerenia, either. It either caused her to still vomit when her fatty liver was at its worst, or it makes her unable to vomit which was even more difficult to watch. She just looks sick on it. I tried to add ondansetron with the cerenia as per the advice of others with nauseous cats (which vets put up a fight to give me) and then I just tried ondansetron alone. Ondansetron (Zofran) is what worked for Lulu. When she is not this sick and I suspect nausea, I usually just give slippery elm which is an herb - it wouldn't work for fatty liver nausea, though.

I had to advocate for my cat because I found that most of the vets I was dealing with were either not preparing me with the best way to treat this at home or they were resisting allowing me to try other avenues before putting her down. For me, bringing my cat back to the ER for further diagnostics was out of the question so they were reluctant to work with me - this was not just because of money but more so because I had to draw a line in terms of my pet's quality of life. The ERs stress her out so much that she almost cannot bounce back from them. At that point, I was more willing to put her down in my home then bring her back to that.

As per being difficult to syringe - I found the Gerber baby food (meat & gravy) to be the easiest and most palatable. Not only did it come out of the syringe effortlessly but Lulu did not fight me on it. She fought me on everything else. I actually really like the small syringes because they are more gentle and less intimidating. But they take forever to get the calories in with. I syringe very quickly into the side of the mouth while she is resting (never from the front or down the throat - do a little to the side so the cat swallows it back on her own). I walk towards her from behind, put my hands on her jaw from above and quickly squirt the baby food into the side of her mouth. I may put a dollop on my finger for the next syringe to see if she would eat on her own. This actually worked for us - if she would lick off my fingers, then I would basically hand feed her the rest. But I usually had to syringe at last the first ml and in the beginning I had to syringe all of it as she really wouldn't eat anything - not even treats.

As for your cat's quality of life. I absolutely feel your pain. I went through the same exact emotions with my cat just a few weeks ago. It is so difficult to watch and as per my other thread, I constantly debated her quality of life. I had euthanasia scheduled 3 times. In fact, if I was able to get back the first appointment that I pushed back, Lulu wouldn't be here right now. The thing with fatty liver is that the cat feels downright awful. They are nauseous, uncomfortable, probably in pain if the primary reason was similar to my cat's. The treatment is hard for the owner as it is for the cat because it does feel like having them suffer through it is not worth - it feels like you are making them worse. I get choked up even thinking about how stressful it was. I lost 10 lbs in 1 weeks from not eating. But if you are basing your decision to put your cat down because they are not eating DUE to fatty liver, I would seriously try to force feed or get the feeding tube before making that decision. Because it is 90% reversible and the cat will not start eating on their own at this point - they need your help to get them over that hump and to help them help their liver regenerate. They are going to look terrible while you force feed them but they will only get better if you do. If you're basing your decision on Dexter's appetite level, he will not get better by doing nothing. My cat's numbers were way worse than Dexter's, and she bounced back. But again, you need to speak with your vets on if there is something more going on. For Lulu there was, and she still bounced back.

I have no experience with zentonil - but from what I read it supports the liver. Dexter probably needs some form of liver support. If you want to try something more natural, as your vet about milk thistle. But the primary treatment is still going to be the same here - treat the nausea, then aggressive nutrition. And definitely speak to your vet on confirming what exactly you're dealing with and if it is just fatty liver cause that may change the treatment or your decision on euthanasia. For Lulu, it turns out she had either triaditis or cholangiohepatitis, so adding prednisolone is what finally helped her recover. She's actually still in recovery - she gets blood work done today to see if her levels are finally normal again. Are you doing follow up blood work to check in on your cat since you haven't had more diagnostics?