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

[Jenny22]

I never knew you were using the 1ml syringes.
I always thought they were the 3ml...or the 10 ml.
Wow. Now I kind of understand even more...about how hard and difficult...and time consuming...it had to take you...to get all those calories into your Lulu.

Yah, it was the 1ml syringes that worked the best. Eventually, when I had to give VeraFlox as the antibiotic, the box came with it's own syringe. This turned out to be the syringe I use for everything now! It literally NEVER gets stuck. It looks like it could be a 4ml syringe, but the numbers stop at 2 (I guess for the VeraFlox dosage). You would probably never be able to syringe canned food in these small ones - honestly, I think baby food is the only thing that will effortlessly move out of it.

I never tried the oil method but I probably should have with some MCT that I have - that would have worked, It is the rubber part that eventually expands I guess or gets too much moisture in between the stopper? It just starts getting stuck between rinsing and moisture and whatever other reasons, I don't know.

Also, I don't spoon the food into the syringe - I place the syringe into the jar of baby food and just suck in the amount I want to give. Sure the outside gets a little messy but this is the easiest way to do it, and it's quick. I guess I would also have to think about contaminating the jar but I'm expecting to give an entire jar that day so I don't think it matters.

As for the temptation treats, I think they are just about 2 calories a treat? Lulu can eat 20 in a sitting. That's about 40 calories right there. I know they are not good for her, but they were a godsend in getting extra calories in her while making her a tiny bit happier.

 

[Jenny22]

Just catching up on some of the recent posts; I know you will be able to make the right decision on your Dexter. If it gives you any hope or calms you, I will say that the cuddling and the purring I didn't see in my cat until maybe week 2.5 - 3 of treatment. The loaf position that you described is what my cat was in for at least 2 weeks straight and periodically for weeks after that - I mean just gut wrenching. I will also say that it usually gets worse before it gets better. Another cat person who went through this told me the same thing. Lulu was really not that bad until I took her to the ER and yet another - 1-2 days of not getting calories in her were wasted. After coming out of the ER she got worse and worse (ALT went from 850ish to 1300ish). It wasn't until another week after that of sticking with the treatment and all my doubts that her bloodwork started to improve (albeit not enough and with other bigger red flags again pointing to bigger issues just like you have with Dexter).

One of the reasons that fatty liver was so unbelievably difficult to push through for me (not sure if this the case for everyone) is because improvement is NOT linear. It was such an emotional rollercoaster that at times I think I was ready to put her down because I couldn't personally cope with the constant doubting based on observation. It sounds like you are there now. I feel really bad about that but I had her quality of life in mind as I am sure you do as well. One day she started to nibble and eat and I thought we were through the toughest part. The next three days, her appetite waned again. One day she perked up to me bringing a new toy home. The next three days she showed zero interest. This just went on and on and on until I finally accepted the "reality" and realized that there was something bigger that was preventing her from fully recovering. I got confirmation from her vets as well and so I made the decision - off to schedule euthanasia again. BUT then I woke up to her eating the most she had eaten in a month. That's when I knew, she was dictating whether she planned to fight this or not as it seems Dexter wants to also call the shots.

If I were you, I would continue to force feed until you definitively decide that you are moving forward with palliative care or euthanasia. Until then, it doesn't benefit you to not force feed as giving them up is the same thing as allowing your cat's health to decline.

If your cat is experiencing inflammation as mine definitely was, then addressing that inflammation will significantly impact how he is feeling. Maybe you can discuss with your vet some appropriate anti-inflammatory meds or supplements?

As for Dexter being stressed, I used bach remedies just the other day for a 1.5 hour car ride to a board certified dentist for Lulu. I was amazed at how much it calmed her for the entire trip! Definitely check with your vet to make sure it's not something that interacts with medication or that it impacts the liver. But it is super easy to administer - I would just smear a dab of the flower essence oil on her ear.

You're doing the best you can. Sometimes we need that reminder from others because we think we are torturing our cats. Your Dexter is fighting - he is showing you he is fighting. You will know when or if it's time to let him go. In the meantime be proud for being the dedicated and loving owner that he is lucky to have and that is willing to go to such lengths to help him.

 

[cat nap]

Thinking of Dexter and you today, D Dexy .
Hoping that the news is not all terrible, but realistically my mind just jumps to 'worst case scenarios'.
(It's weird that I mention to try and stay positive, but I cannot take my own advice, at times.)

Then I realize, whatever Dexter has, it's already here.
But I'm still Hoping for the Best...since whatever he does have, you'll still know how to deal with it, because you've been dealing with it for a long while.

 

[Dexy]

Thank you for your words. The poor guy got hit hard with the sedation yesterday so he’s slowly recovering and a bit drowsy today. I’m amazed how he’s endured all these tests although I know how hard it is on him stress wise.

the vet has to wait for the ultrasound report which sadly will be till after the weekend I’m guessing. She did say there was still fluid in his lungs but his breathing seemed fine.

i really hope I can get some sort of answers. I fear they may say he needs to go to the specialist but I don’t know if his spirit can take anymore of that. I guess we wait and see.

as of now he is sitting on the couch with me looking out the window like he always used to like to do so I’m happy about that. He hasn’t been himself for over 2 weeks now so it’s been hard to watch. I’m still getting the odd cuddle though (used to be several times a day before)

 

[Dexy]

Just wanted to update on Dex,

so his heart ultrasound came back all clear (so not sure about the fluid around the lungs it’s clearly connected to the other issues). His ultrasound shows his liver swollen, part of his intestine and a swollen lymph node. Possibly lymphoma or they think maybe triaditis as the swollen lymphnode could possibly be connected to that. No obstruction of the gallbladder like previously thought but he has some fluid in his stomach as well and he’s inflamed.

the vet gave some antibiotics and a steroid (predislone) as a Hail Mary.

I only tried the steroid first as I’m afraid to over drug him, and it’s been a week and it has helped a lot. He’s more social and getting stronger. I syringe feed him but he’s also eating on his own a bit too. Even had dry food for the first time in a month yesterday. I’m only giving him this and Zentonil for his liver health and he’s so much more comfortable it’s much easier to see. I stopped the gabapentin as the steroids make him feel much better than the gaba did.

im hesitant to add in the antibiotics now as he seems to be doing well. I know there is a good chance he can take a turn but im just happy he’s comfortable and doesn’t look like he’s in pain. It’s his 11th birthday on Sunday so I’m happy he may get to see it.

I attached the ultrasound any input would be greatly appreciated.

 

[cat nap]

Just wanted to update on Dex,

so his heart ultrasound came back all clear (so not sure about the fluid around the lungs it’s clearly connected to the other issues). His ultrasound shows his liver swollen, part of his intestine and a swollen lymph node. Possibly lymphoma or they think maybe triaditis as the swollen lymphnode could possibly be connected to that. No obstruction of the gallbladder like previously thought but he has some fluid in his stomach as well and he’s inflamed.

the vet gave some antibiotics and a steroid (predislone) as a Hail Mary.

I only tried the steroid first as I’m afraid to over drug him, and it’s been a week and it has helped a lot. He’s more social and getting stronger. I syringe feed him but he’s also eating on his own a bit too. Even had dry food for the first time in a month yesterday. I’m only giving him this and Zentonil for his liver health and he’s so much more comfortable it’s much easier to see. I stopped the gabapentin as the steroids make him feel much better than the gaba did.

im hesitant to add in the antibiotics now as he seems to be doing well. I know there is a good chance he can take a turn but im just happy he’s comfortable and doesn’t look like he’s in pain. It’s his 11th birthday on Sunday so I’m happy he may get to see it.

I attached the ultrasound any input would be greatly appreciated.

Thanks so much D Dexy ...for this update on your Dexter.
I was thinking about Dexter and you, over the weekend, but was a bit afraid to ask for an update.
I'm over the moon, right now, in hearing that Dexter is doing much better, and that the ultrasound results are not that bad.

I really don't know what to say about the above ultrasound results.
You've already done a FNA...and so I'm not sure why they would even recommend another one on the fluid?
(unless the person reading the ultrasound findings, didn't have those FNA results in front of them?)

(I'm not really sure what the procedure is,...when our Vets send off for ultrasound analysis.
Do our Vets share all the findings they have,...with the other dvm's...who are only writing up what they specifically see in the ultrasound,...and then make recommendations on what to do further,...in terms of testing,...based on those ultrasound findings.

Yet, at the same time, I would want the person who is reading the ultrasound findings to 'keep an open mind", and look at all the possibilities, too,...so as not to be overly influenced with the prior findings, either.
I would much prefer my own Vet to reach their own conclusions, but then again, having other dvm's professional opinions, in front of my Vet, are also helpful, too.)

(my problem, is that the Vets that I liked, have all moved away to other practices, so I have to start over, with establishing who I think is good at running tests, diagnosing, and explaining things.)

(though, I have to say I'm so thankful that you did not listen to that other dvm, who recommended euthanasia after doing x-rays, and not placing that feeding tube. I'm so confused in who we are supposed to believe and which dvm's are supposed to give us useful advice. Why such a huge degree of difference of opinion from Vet to Vet?)
I think I'm beginning to question everything, which is not always that great. Rrrrr.

I'm so glad that the prednisolone is helping your Dexter to feel better.

As for the antibiotic,...again I'm not sure what I would do either.
I understand not over drugging him, or altering any taste buds he may have, NOT wanting him to go off of any food that he is now eating,...but also at the same time...I suspect that your Vet may think that Dexter could have some sort of bacterial infection going on...so giving the antibiotics would also help him...to get rid of any bacterial infection that may be causing him swelling or inflammation, too.?

Which antibiotic is it?
and how long do you have to give it for?
(does it come in different forms, like compounded flavoured meds?)

What I might consider doing is another blood test...in the future,...and specifically asking for that 'Spec fPLI'...add-on, to rule out the pancreas.*
(Since Dex does not like going to the Vet, then maybe you can phone around and ask how much the mobile vets would charge for an in-home blood draw. It might be way too expensive, but at least you would know and have options. Your own Vet sounds excellent, though. Maybe ask them, if they do home visits, too. It never hurts to ask.)

I would also ask the Vet, if the treatment for triaditis is any different than what you are doing now, in using the prednisolone plus antibiotic...or only the pred alone is sufficient.
And if lymphoma, then is adding the antibiotic useful at all.
I guess what you are asking the Vet is...for an educated professional treatment, or Plan...which it sounds like they have already done.

Honestly, it's so hard to know what the best thing for your Dexter is, right now, since you've seen him begin to eat on his own.
Right now, it sounds like he is doing well, and improving, so I understand that you don't want to do anything to upset that forward momentum.
(I wish I could be more help, but I'm not at all sure what would be the best to do in this case, either.)

You have really good observational skills, and instincts when it comes to your Dexter,...so definitely keep Trusting your own observations and instincts, too.
You know your Dexter the best.
Dexter eating on his own, even a little bit,...is a good sign.
Hoping that he eats more and more...and gets stronger as the week goes by.

Also Hoping that whatever Dexter has, that the prednisolone and zentonil, help him to clear out any inflammation in his body, and help his liver to heal.
It's just strange that the bilirubin was so high, to begin with, but no actual white cells, or cells that would show infection were high, in his initial bloodwork.

Still Sending Dexter and you all Thoughts of Healing and Strength.

*(edited to add...in next post)

 

[cat nap]

Edit to add:
I just noticed that you already did have a 'Spec fPL"....test done on the blood chemistry...back in the Cytology report...in your post #15...so I'm not really sure how doing another one, would help, a month later?
Dexter's range was normal back then...being 0.7 (norm 0.0-3.5)

Shouldn't that have Ruled Out...anything having to do with the pancreas??
It did say, "Serum Spec fPL concentration is in the normal range. It is unlikely that the cat has pancreatitis. Investigate for any other diseases that could cause observed clinical signs."

(Will have to read more up on Triaditis in cats, and see if anything comes up with fluid and inflammation, too.)
(Also, specifically how bilirubin is recycled, affected or increased with certain diseases.)

I'm still going to be praying that it's an infection, or something that just goes away,...with your Dexter getting stronger.

 

[Dexy]

Thank you so much for all your help and thoughts, not sure what the heck he has. I’m thinking lymphoma? But maybe it is an infection. Fingers crossed.

 

[cat nap]

Thank you so much for all your help and thoughts, not sure what the heck he has. I’m thinking lymphoma? But maybe it is an infection. Fingers crossed.

Toes, fingers and all paws will be crossed here, too.
Rooting for your Dexter to continue eating on his own, too.
Dry, wet, whatever he likes. Come on Dex...you can do it!
Birthday tuna special...orr...baby food special...on Sunday, for you big guy.

 

[Dexy]

Well he made it to his birthday and the steroids seem to have made him more like himself. He enjoyed suntanning today, hope this keeps up its nice to see him so comfortable.

On a side note because I’m feeding him the recovery diet and not his usually urinary s/o, is there anything I can put in his food to prevent urinary crystals? I’m worried because he’s not getting his normal diet to prevent it.

also I started giving him Nutrical that has helped give him the extra calories and vitamins.

 

[cat nap]

Well he made it to his birthday and the steroids seem to have made him more like himself. He enjoyed suntanning today, hope this keeps up its nice to see him so comfortable.

On a side note because I’m feeding him the recovery diet and not his usually urinary s/o, is there anything I can put in his food to prevent urinary crystals? I’m worried because he’s not getting his normal diet to prevent it.

also I started giving him Nutrical that has helped give him the extra calories and vitamins.

View attachment 414292

What a handsome guy!
Happy Birthday Dexter, best wishes from the fur gang over here, two cats and a dog...(though the dog would probably eat your birthday treat...so we won't tell him.)

"On a side note because I’m feeding him the recovery diet and not his usually urinary s/o, is there anything I can put in his food to prevent urinary crystals? I’m worried because he’s not getting his normal diet to prevent it."

That's a great question. I actually would create another thread to specifically ask about this.

I can't remember what type of crystals or sediment, does Dexter have?
Were they bilirubin crystals?
Struvite crystals?
or calcium Oxalate crystals?
I think it's important to know which ones...since different kinds...would have to be dissolved differently.
For this it would be best to ask the Vet. They have to know of different supplements to give, to help dissolve the crystals.

Since I do recall that certain crystals need to have them dissolved by 'changing the PH of the urine'...in a cat.

Check the ingredients in Dexter's urinary food...since that will most likely give you an indication of what type of 'additive', 'supplement' or 'ingredient'...you can possibly look for as a supplement.

If it's struvite stones, I don't remember if it's specifically methionine? which does this.
I would definitely ask your Vet...just to be sure.

If you also do a "Search" in the upper right hand corner...then a number of threads may also pop up...and give you some ideas.

Does Dexter still enjoy eating his urinary food?
or does he enjoy his recovery food better?

(I would ask your Vet if you could place out some of his urinary food, in tiny portions, at certain times of the day...on a separate plate?
And then at other times of the day...if you can place out the recovery food?
Maybe if using tiny portions of the urinary food, but NOT mixing them,...it would be okay to try?)

Although, knowing cats, they would probably walk away from anything which they are supposed to eat...unless food toppers or 'animal digest' cat food enticers are used.
Getting them to eat 'healthy stuff' is just so hard.

 

[cat nap]

Well he made it to his birthday and the steroids seem to have made him more like himself. He enjoyed suntanning today, hope this keeps up its nice to see him so comfortable.

On a side note because I’m feeding him the recovery diet and not his usually urinary s/o, is there anything I can put in his food to prevent urinary crystals? I’m worried because he’s not getting his normal diet to prevent it.

also I started giving him Nutrical that has helped give him the extra calories and vitamins.

View attachment 414292

Hi D Dexy ...how's your Dexter doing?
Would love to hear an update, if you can.

 

[Dexy]

Hi, he is still doing ok actually. He’s sick but he hasn’t gotten worse in terms of his comfort or demeanor. His blood work came back with some more issues as is sdma was high now. His ultrasound showed one of his lung lobes had collapsed but his effusion has lessened and there are no ascites in his belly.
We are doing a round of antibiotics to see if maybe it’s by some chance bacterial. We are trying everything for him.
I will say he is still an absolute sweetheart so as long as he’s not in a lot pain I’m happy. He runs around trying to catch squirrels in the backyard which is awesome.
I feel so bad for him but he doesn’t want to give up.

 

[IndyJones]

Many people can live a perfectly normal life with only one lung so I don't see why a cat would be different. Exercise might be more difficult for him now but it sounds like he's enjoying life and happy.

 

[Dexy]

Thank you, ya his breathing hasn’t changed and he isn’t struggling. He also runs in the back yard but no indication of breathing issues so that is comforting at least

 

[cat nap]

Hi, he is still doing ok actually. He’s sick but he hasn’t gotten worse in terms of his comfort or demeanor. His blood work came back with some more issues as is sdma was high now. His ultrasound showed one of his lung lobes had collapsed but his effusion has lessened and there are no ascites in his belly.
We are doing a round of antibiotics to see if maybe it’s by some chance bacterial. We are trying everything for him.
I will say he is still an absolute sweetheart so as long as he’s not in a lot pain I’m happy. He runs around trying to catch squirrels in the backyard which is awesome.
I feel so bad for him but he doesn’t want to give up.

Thank you D Dexy , for such a quick update.
Dexter sounds good.
Sure the lung issue is not the greatest, but like IndyJones mentioned...hopefully the issues with his lung lobes will not stop him from enjoying life.

Trying to chase squirrels, in the backyard,...Wow.
That really is awesome. ...and Fun.
Making sure that his Territory is not invaded by pesky squirrels.

It does not sound like your Dexter even cares what the Vets have to say.

Sending you Continued Vibes of Healing for your Dexter.

 

[Dexy]

Thank you he’s just the best He’s a little fighter for sure.
I attached his recent blood work if anyone has any advice.

 

[Dexy]

 

[cat nap]

Thank you he’s just the best He’s a little fighter for sure.
I attached his recent blood work if anyone has any advice.

Thank you so much for posting Dexter's photo, too.
His eyes look bright.
He looks attentive and engaged with whatever he is watching.
Head up, strong.

If it was not for his blood work mentioning icterus, I would not even be aware of it.

With Blood Work,..the only thing I do, (as a layperson), is run through the results...and look items up.
And also compare this Blood work to previous ones...so to see if a pattern emerges, and what directions certain samples go.

(This website may help a little with understanding blood work...but it has so, so much, information...that my eyes tend to 'bug out' and my brain goes into overload...so I only end up taking in a small understanding of it...and reading it on occasion. (usually I forget about the things I've read, the highs and lows don't get remembered either, and so, I turn elsewhere to read some more.)
Laboratory Results Table Of Contents - Ron Hines' Vetspace - 2nd Chance - The Animal Health Website

Blood work is really just a 'snap-shot'...of that particular day,...and at that 'particular time'...so it is useful, to see changes over time...and for our Vets to have as much diagnostic information available to them...so they can give our cats the best treatment, that their expertise and experience, training, tells them.

It's sounds like you have a real good Vet.
So by trying out the antibiotics, and seeing the response from your Dexter,...I'm sure that the Vet thinks that this could knock out any bacterial causes for the lung lobe/liver issues.
I'm really liking your Vet. She or he sounds very good.

Are you still having to give any Supplements to Dexter?
anything for his Liver values?

Is Dexter eating better?
Any special food given for his health issues?

Sending you More Mega Health Vibes for your Dexter.
Hoping that the antibiotics knock out any bad bacteria.

 

[Dexy]

Sorry for the late reply, I had to stop the Zentonil because he would throw it up combined with the antibiotic. He just finished 10 days of the antibiotic and it made him lose his appetite so I’m going to stop it and start giving him the Zentonil. He has been on prednisolone the past 6 weeks and it has done wonders for him so keeping him on that. I have a phone call with the vet tomorrow to discuss putting him on urisidol. She is wonderful and hasn’t given up on him. Although I know he is very sick and all I really want to make sure is that he is comfortable.