hepatic lipidosis & hospice scheduled tomorrow - is it time to stop force feeding or is there hope still??

Jenny22

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Over the course of 2 weeks and despite telling my primary vet that my cat was eating less, she unfortunately developed hepatic lipidosis. I even urged him earlier last week to please prescribe anti-nausea medication to get her to eat, but he didn't want to overload her kidneys. I feel as though he wasn't taking my concerns seriously. After requesting bloodwork, he finally realized what I feared...her liver enzymes were through the roof and she possibly had an infection. The cause of hepatic lipidosis is uncertain as she has mild early stage CKD and IBD that I have been able to manage through diet. I wound up taking her to the ER that night and then she was transferred to another location for the internist and had an ultrasound and fluids. That was last weekend. I felt the whole experience made everything worse as they usually do - she's so fragile and easily stressed by vets. She became jaundiced while there and they did not feed her at all even after the ultrasound. They wanted to put the feeding tube in but it more than tripled the hospital estimate and I couldn't afford it. The ultrasound showed that she had an inflamed gall bladder and bile ducts...no obvious signs of cancer. Bloodwork showed ALT of 882 at the time and also signs of infection plus her gall bladder enzymes were also off the chart. I took her home and began syringe feeding her but she just looked miserable and nauseous the whole time. I fought with the ER to please prescribe ondansetron to help with the nausea as cerenia was preventing her from vomiting but did not help with the nausea. They wanted me to bring her back in for reevaluation and that's where I had to draw a line. This cat has already been through so much in the last few months not to mention I was financially tapped out at this point. Not knowing the extent of her dental/mouth pain I don't know if I want to keep syringe feeding her. She just looks so uncomfortable every time I feed her and I don't know why. And if she gets better, then I have to address the dental stuff (and her heart to be safe beforehand). I did eventually get ondansetron and it did help. I don't know why they would not have given it sooner or why they didn't give any other vitamins or support to me to do this at home. I honestly felt as though I have been completely without the support of both her primary vet and the ER vets in the best way I could do this at home given that I was unable to afford the feeding tube. I just didn't feel like they gave the best medications or any supplemental vitamins to help with her liver...

As a last ditch effort, I bought a bunch of kitty crack foods, and she immediately started eating the fancy feast. She even ate the fancy feast hard treats (she never eats anything hard anymore). Of course, now she is back to her meatloaf stance.

Hospice is coming tomorrow morning at 11:00am to put her down. I change my mind every hour on if this is the right decision or not. I don't know. She's clearly very uncomfortable but I don't know if I'm supposed to push through that and keep feeding her. At one point does one stop and say "this is making her worse"? For the most part, she's usually in a meatloaf position. But she does have moments where she looks more relaxed. Do I need to stop looking for the silver lining in all of this and be more realistic?

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catmom2wires

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I am in the same situation with my Felix. Going to the vet in 15 minutes. I am pretty sure it is time…

Better to let them go a week too soon than one minute too late. We are making the decisions out of love, and love will not let us down.

Hugs.
 
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Jenny22

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I'm so sorry to hear about your baby! Same symptoms? Assisted feeding?
 

catmom2wires

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No, not exactly the same. Physical decline with no obvious cause.

Best wishes to you and your beautiful girl.
 
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Jenny22

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I'm so sorry about Felix. My heart breaks for you right now. Thanks for responding.
 

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As a last ditch effort, I bought a bunch of kitty crack foods, and she immediately started eating the fancy feast. She even ate the fancy feast hard treats (she never eats anything hard anymore). Of course, now she is back to her meatloaf stance.

Hospice is coming tomorrow morning at 11:00am to put her down. I change my mind every hour on if this is the right decision or not. I don't know. She's clearly very uncomfortable but I don't know if I'm supposed to push through that and keep feeding her. At one point does one stop and say "this is making her worse"? For the most part, she's usually in a meatloaf position. But she does have moments where she looks more relaxed. Do I need to stop looking for the silver lining in all of this and be more realistic?
J Jenny22 ...I'm so sorry that both you and your beautiful cat,...have to be going through all this difficult time surrounding her health.
I don't think there is ever an easy way to go through it...since we never want these beautiful and precious cat companions of ours to suffer...but at the same time...we want, wish and pray for miracles to happen...or something to happen to make this all turn around. :frown:

Sadly, I guess we do have to be strong, and help to alleviate our cat's suffering.
She does look to be in pain in certain photos, and yet in others...like you said...she looks more relaxed.
The jaundice looks very bad, though.

(a special cat I had back before 2014, also had jaundice...plus fiv+ and felv+,...and he did get better when my Vet had noticed the jaundice...but he was given antibiotics and samE and milk thistle (zentonil...I think it was called)....however when he got another infection some two years later...I also had to choose to euthanize him...but it wasn't really much of a choice...since he was in such a bad state.)

I totally feel for you, and your cat. :alright:
You didn't mention her name, or maybe I just missed it.
But anyhow...I will be sending you all thoughts of Strength, Peace and Love...for you and your beautiful cat. :vibes::vibes::caticon: :grouphug::hugs::grouphug2:
 
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Jenny22

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How are you doing? Please know that we are thinking about you and your baby during this hard time.
Hi! I think better? I don't want to jinx myself and I am not holding my breath. But....I was ready to let her go this morning and in a last ditch effort to get her to eat, went to the store picked up some fancy feast and temptation treats. I mean, this whole time she would go to her food bowl and want to eat but turn away from it. When I opened up the temptation treats, she perked up, leaped onto the couch, and ran to me begging for them. I couldn't believe it. Then I opened a can of fancy feast and she immediately started eating it. When her primary finally got back to me, he told me to hold off on the hospice visit and so I postponed it for Thursday in case her health does decline. But last night -- she didn't even look like a sick cat anymore?? I gave her a little bit of prednisolone even though they didn't want me to because of her heart (but what would it matter if she was getting put down anyway), and I wonder if that actually made her more comfortable. This morning she also looked great! But I think I syringe fed her too much 20 minutes ago and she looked uncomfortable afterwards. I'll give her a break and then get back to it. She's had about 100 calories so far for the day. I think I read somewhere that 200 calories is ideal. I've been giving her plain gerber ham baby food as it's been easy to syringe and she's been tolerating it. I would imagine the protein quality would be good if it's for a baby.
 
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Jenny22

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J Jenny22 ...I'm so sorry that both you and your beautiful cat,...have to be going through all this difficult time surrounding her health.
I don't think there is ever an easy way to go through it...since we never want these beautiful and precious cat companions of ours to suffer...but at the same time...we want, wish and pray for miracles to happen...or something to happen to make this all turn around. :frown:

Sadly, I guess we do have to be strong, and help to alleviate our cat's suffering.
She does look to be in pain in certain photos, and yet in others...like you said...she looks more relaxed.
The jaundice looks very bad, though.

(a special cat I had back before 2014, also had jaundice...plus fiv+ and felv+,...and he did get better when my Vet had noticed the jaundice...but he was given antibiotics and samE and milk thistle (zentonil...I think it was called)....however when he got another infection some two years later...I also had to choose to euthanize him...but it wasn't really much of a choice...since he was in such a bad state.)

I totally feel for you, and your cat. :alright:
You didn't mention her name, or maybe I just missed it.
But anyhow...I will be sending you all thoughts of Strength, Peace and Love...for you and your beautiful cat. :vibes::vibes::caticon: :grouphug::hugs::grouphug2:
Her name is Lulu :) I asked her primary on if I should keep the hospice appointment or I should continue treatment. Because she started eating a little bit, he told me to hold off. I asked him for a plan of action in increasing my success at home, but he didn't want to prescribe anything else as felt it was a bad idea to pile on the meds. She's clearly not well, but she no longer looks miserably in pain. Now, she just looks uncomfortable or relaxed. Getting calories in her seems to be helping so far, or at least I hope so. Hospice was rescheduled for Thursday in the case that she gets worse.
 

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Her name is Lulu :) I asked her primary on if I should keep the hospice appointment or I should continue treatment. Because she started eating a little bit, he told me to hold off. I asked him for a plan of action in increasing my success at home, but he didn't want to prescribe anything else as felt it was a bad idea to pile on the meds. She's clearly not well, but she no longer looks miserably in pain. Now, she just looks uncomfortable or relaxed. Getting calories in her seems to be helping so far, or at least I hope so. Hospice was rescheduled for Thursday in the case that she gets worse.
That is great J Jenny22 :)
Lulu eating anything at this time, is great. :clap2:
I hope that thursday's appt. gets cancelled too.
Will be saying many prayers for Lulu. :vibes::vibes::caticon: and sending Healthy Vibes.
Come on Lulu...please get stronger. :touched:
Everyone, here, reading this, cares,...and sending you Strength. :grouphug: :hugs: :grouphug2: :greenpaw::bluepaw:
 

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I would have done the same thing; if she is suddenly eating let her continue on and hope that she might be turning a corner. She may not get back to a baseline health level, but she may be comfortable and happy with care and support.
 

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I have seen cats with worse liver enzymes that made complete recovery. Liver is great at healing. If the issue was gallbladder, she can even live without a gallbladder (after her liver heals enough for a surgery. If that ever is necessary.)

If it becomes necessary she can also get a feeding tube instead of syringe-feeding.

And for the records, my own cat had a ALT of 800 in April without even any obvious symptoms. She still has issues with her liver-gallbladder-bile ducts and the cause is unknown. Liver issues are very common among cats and the reason is not always obvious but is still managable.
 
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Jenny22

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Thank you so much MissClouseau! Everyday is a rollercoaster, you know. Is she making progress? Am I letting her needlessly suffer? She looks great right now (please don't let me jinx myself here). She was eating some commercial raw rabbit I put out for her last night which made me so happy. Overall, she must have gotten over 200 calories in her yesterday (I fed her about 140 calories, plus she ate maybe 70 on her own plus treats). She's walking around more actively and doesn't seem to be in distress. My focus now is that she hasn't had a bowel movement in maybe 9 days....which is expected since she didn't eat for maybe 4-5 of those days. And I've seen her go 7 days without a bowel movement before. But she's been going in and out of the litter box a lot so I think she wants to go. I'm afraid to give her anything as I don't know what will interact with her drugs or what her electrolytes are like. She hasn't had any supportive vitamins or fluids during this time.
 

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Thank you so much MissClouseau! Everyday is a rollercoaster, you know. Is she making progress? Am I letting her needlessly suffer? She looks great right now (please don't let me jinx myself here). She was eating some commercial raw rabbit I put out for her last night which made me so happy. Overall, she must have gotten over 200 calories in her yesterday (I fed her about 140 calories, plus she ate maybe 70 on her own plus treats). She's walking around more actively and doesn't seem to be in distress. My focus now is that she hasn't had a bowel movement in maybe 9 days....which is expected since she didn't eat for maybe 4-5 of those days. And I've seen her go 7 days without a bowel movement before. But she's been going in and out of the litter box a lot so I think she wants to go. I'm afraid to give her anything as I don't know what will interact with her drugs or what her electrolytes are like. She hasn't had any supportive vitamins or fluids during this time.
If things get worse, consider hospitalizing her instead of putting down.

As for the bowel movements and in case she doesn’t eat enough on her own, I highly suggest keeping Fortiflora at home.
 
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Jenny22

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I was wrong about the bowel movements - I think it's been 7-8 days actually. I made a telemedicine mobile vet appointment tonight. Her hospice is still scheduled for tomorrow. There are two reasons I do not want to hospitalize her. One is that I am completely out of money at this point. The second reason is that Lulu has had a bunch of medical issues which landed her in the ER over the last 4 months. Some I should not have taken her but I had no support from primary vets so I felt I had to be safe than sorry. I regretted it immensely as the ER visits made her sicker just from stress. I don't think I could put her through a trip back to the ER. Where I am, they are overly booked and flooded. So, the stress factor would be through the roof, they would keep her longer than necessary, and they wouldn't let me see her. She's not going to survive another ER visit. I think she would prefer I let her go before I bring her back. It's such a tough place to be in. I wish I had better options and that I was able to find her a primary that worked with us to keep her healthy. With covid, it became impossible to get good care with vets being understaffed. We never built up a relationship pre-covid because she did not have any health issues. Everything happened at the worst time. Here are some updates and comparison that I was writing up for the mobile vet.
 

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MissClouseau

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There are several different medicine for liver and gallbladder like Denamarin, ursodiol, maybe supplements like milk thistle. You need at least one to support the liver. And antibiotics for jaundice. If they prescribed none, you can absolutely call them back and ask why they didn’t. If they have left the treatment halfway, it’s on them and you don’t have to pay again for a proper prescription.

I’m not in the USA but if you are I heard about Care Credit.
What is CareCredit? | CareCredit
 
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Jenny22

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The ER gave me only cerenia, miratz, and antibiotics. I called her vet on Monday and asked about ursodiol but he keeps pulling the same old line of not wanting to overload her system. He seems to not like "stacking pills" as he said. I don't either, but I think she needs it??? He said a sick cat will only feel worse if you keep adding medications. And then he had to rush off the phone. He's incredibly hard to get in touch with and super rushed everytime I speak to him. In a sense, I want to scream...if I am considering putting her down, why would you not try anything at that point?? I feel very overwhelmed tackling this all on my own without the help of her vet. :( I did get approved for care credit but it would not be enough to cover her back in the ER. I don't want to bring her back there at all either - she wouldn't improve there unless I fork over $3500+ which is what they were quoting me for the feeding tube and overnight stay. If I opted for diagnostics it would have been $5000. I had already spent $1600 at the ER plus another $1600 in the transfer where the Internal medicine was. I was only approved for $1000 in care credit. I agree, I feel like I have been left to help her fight this halfway. But maybe the mobile vet will prescribe some for me today. Can I ask you after everything I have told you -- why is it do you think I should not consider hospice? I ask because I am getting pressure from my family and it is making me doubt my decisions. So many others told me about their issues with hepatic lipidosis and to stick it out. But others have said I need to consider her quality of life and have made me question if I am not doing that. Lulu is sleeping all day, just about. She no longer looks like she is in pain, but she does not look like she is well - I still see that as suffering so it's breaking my heart prolonging it.
 

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J Jenny22 ...The third photo looks better than the second one.
More similar to the first photo.
So I hope that you get better help from the mobile Vet...and see what they say. :bluepaw:
...I agree, I feel like I have been left to help her fight this halfway. But maybe the mobile vet will prescribe some for me today. Can I ask you after everything I have told you -- why is it do you think I should not consider hospice? I ask because I am getting pressure from my family and it is making me doubt my decisions. So many others told me about their issues with hepatic lipidosis and to stick it out. But others have said I need to consider her quality of life and have made me question if I am not doing that. Lulu is sleeping all day, just about. She no longer looks like she is in pain, but she does not look like she is well - I still see that as suffering so it's breaking my heart prolonging it.
Just know, that you are still an amazing cat guardian, and that whatever you decide to do...please have no regrets. :hugs:

Your Lulu knows that you have tried everything possible to get her well again.
The things you have already done,...just shows the abundant Love you have for her....and Lulu knows that. :alright:

ER Vet places are extremely expensive...either because of all the latest equipment, staff around the clock, or whatever else they deem their prices to be. (I wish that there was some regulatory body that set prices...but that never seems to be the case.)

Also, know that you doing hospice care...is amazing...since it is very emotionally difficult, and turns to physically draining, to watch and feed a sick animal.
Constantly questioning ourselves about our choices for our loved furry companions is also so difficult...since we cannot ever tell how much pain they are really in.
If Lulu is still eating, ..then I would continue.
But if she looks to be not moving, hardly getting up, not being able to get to her litter box, or drinking on her own,...then it might be time. I guess only you can decide, since you see her there, and we don't.

Go by what you are seeing,...and after talking with the mobile Vet. :alright: :grouphug::hugs: :vibes::vibes::caticon:
 
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