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

[Jenny22]

Thank you, I tallied up the numbers and she is right on the line. No breathing issues (I would have put her down immediately if there were). As for pain, she is no longer in that arched painful meatloaf stance. Yes, she is eating, but no not enough. She does let me syringe feed her and then she will actually even lick the syringe and start to eat out of the jar. She has no problem walking around and if I pull her skin back she does not appear to be dehydrated. HOWEVER, she shows no interest in anything at the moment. Would not play with toys ever since I took her to the ER, is not showing much interest to her favorite brush, and doesn't even perk up when I open the door. I'm not sure she is going to pull through this but I have a mobile vet appointment in 15 minutes and am going to run by her. Plus hospice is still set up for tomorrow as of right now. I would say that her quality of life is not good right now. But the point was to get her liver to recover and then she would feel better so it is expected she would feel terrible. And her appetite and pain management has improved, but her interest has waned and she is more lethargic. What she has is curable, but I don't have the medical background to navigate this or know if she is making progress. What does progress even look like for hepatic lipidosis? The decision to put her down would not be because she has a terminal illness, but more so because I am unsure if she has the strength to fight this and I can't let her suffer needlessly.

 

[Jenny22]

Thank you so much..... really.... The hospice is for euthanasia. So she is not really getting hospice care, just the option to be euthanized here in my house with me. Yes still eating, but no not nearly enough. She no longer looks like she is in constant pain, but she does look very depressed and lethargic. She hardly gets up. I feel like she is actually more active at night as I catch her eating from her bowl while I am sleeping. But the most worrisome is that she shows no interest in anything.

Thank you for your support. I will see what the mobile vet says and if they can help.

 

[cat nap]

Thank you so much..... really.... The hospice is for euthanasia. So she is not really getting hospice care, just the option to be euthanized here in my house with me. Yes still eating, but no not nearly enough. She no longer looks like she is in constant pain, but she does look very depressed and lethargic. She hardly gets up. I feel like she is actually more active at night as I catch her eating from her bowl while I am sleeping. But the most worrisome is that she shows no interest in anything.

Thank you for your support. I will see what the mobile vet says and if they can help.

I think the depressed and lethargic is due to the liver/bile/gallbladder or jaundice problems...but still a good sign that she is eating on her own at night. I thought she was only being syringe fed.
The no interest could also be because she is just too tired, and feeling sick...and has to conserve all her reserve energy to trying to get well or even just surviving.
If she is not hiding from you...and trying to sleep in hiding spots...plus still eating...then I'm not thinking it's time, yet.
Hopefully the mobile Vet can give you better answers...on how long...or what hepatic lipidosis recovery looks like.

 

[Jenny22]

I think the depressed and lethargic is due to the liver/bile/gallbladder or jaundice problems...but still a good sign that she is eating on her own at night. I thought she was only being syringe fed.
The no interest could also be because she is just too tired, and feeling sick...and has to conserve all her reserve energy to trying to get well or even just surviving.
If she is not hiding from you...and trying to sleep in hiding spots...plus still eating...then I'm not thinking it's time, yet.
Hopefully the mobile Vet can give you better answers...on how long...or what hepatic lipidosis recovery looks like.

yessss...... that's what I had hoped her primary would do - tell me what to look for and guide me. and all those things you said, I agree - which is why at times I am thinking "no, I'm not letting her suffer. She just feels bad so of course she looks sick. But I have to give her time to pull out". I think other people getting in my head is making it difficult to make my own unbiased decisions.

 

[Jenny22]

The mobile vet is finally going to give her fluids, liver support, and vitamins. Finally....someone who is going to help me. She also said hold off on euthanizing if the cat if she is eating on her own. I pushed back hospice to Saturday. If Lulu does not show significant progress before then, then I've decided it is time to let her go. The mobile vet told me it takes 3 days for the jaundice to start to clear up. So, now I feel like I have a concrete marker to follow since Lulu just started eating at full caloric capacity.

 

[suzeanna]

So glad to see your kitty feeling a bit better. Puree treats like Nulo and Churu, although not nutritionally complete, could help with the hydration and getting her to poop.

 

[cat nap]

The mobile vet is finally going to give her fluids, liver support, and vitamins. Finally....someone who is going to help me. She also said hold off on euthanizing if the cat if she is eating on her own. I pushed back hospice to Saturday. If Lulu does not show significant progress before then, then I've decided it is time to let her go. The mobile vet told me it takes 3 days for the jaundice to start to clear up. So, now I feel like I have a concrete marker to follow since Lulu just started eating at full caloric capacity.

Oh, Wow...that is Fantastic news.
I'm so glad that you thought of calling a mobile Vet...I would never have thought of that.
I will totally be Hoping and sending Health Vibes...that these next few days continue to go well.

Edit to add: PS. ...your Plan is a good one.

So glad to see your kitty feeling a bit better. Puree treats like Nulo and Churu, although not nutritionally complete, could help with the hydration and getting her to poop.

That totally makes sense...about the Puree treats.

I was going to also suggest those Lickable treats...or whatever contained more water, too.

Not sure if something like puree pumpkin with water,...or the 1/4 to 1/2 teaspoon miralax, or plain metamucil,... would help with any constipation. Not sure if adding this type of fiber would help...or not.
(darn...I should have asked you to ask the mobile vet...before...but only thought of it now.)

Hopefully, by giving her fluids...this will help Lulu feel better...and flush out more bile build up.
I think you will notice a difference right away...with giving her fluids.

 

[fionasmom]

That is a good course of action and I hope that you do see improvement.

 

[Jenny22]

So, Lulu's appointment is tomorrow and I am relieved about that. But I'm looking at her ears, and I swear they are getting MORE yellow! Why would they get more yellow if I am filling her with calories? . She had 230 calories of food yesterday and today so far she had about 170 calories. Was it bad for me to give her the Gerber Baby Food Ham? She was eating the raw rabbit at night but she won't eat on her own during the day. I may syringe her some baby food and then she starts to lick it off the syringe and eat some of it on her own. <sigh>. Tomorrow cannot come soon enough. I have a feeling I won't be postponing the next hospice appointment.

 

[cat nap]

So, Lulu's appointment is tomorrow and I am relieved about that. But I'm looking at her ears, and I swear they are getting MORE yellow! Why would they get more yellow if I am filling her with calories? . She had 230 calories of food yesterday and today so far she had about 170 calories. Was it bad for me to give her the Gerber Baby Food Ham? She was eating the raw rabbit at night but she won't eat on her own during the day. I may syringe her some baby food and then she starts to lick it off the syringe and eat some of it on her own. <sigh>. Tomorrow cannot come soon enough. I have a feeling I won't be postponing the next hospice appointment.

Do you mean her mobile vet appointment?

Not sure exactly why they would be getting more yellow.
But maybe because there is a blockage, or inflammation in the bile ducts..so that the bile spills over into the blood.
It's supposed to go down with digestion...but I'm not sure...what happens when the liver cannot filter it.
Jaundice in Cats - Symptoms, Causes, Diagnosis, Treatment, Recovery, Management, Cost
Fatty Liver – IBDKitties

No, I don't think it was bad for you to give Lulu the Gerber Baby food.
Whatever you can get her to eat...at this stage...is not a bad thing.

If you can mush up some wet cat food...in a zip lock bag...or plastic bag...adding a little warm water....and place it on a flat plate...and see if she eats that...then it might add more nutrients...and hydration.
Crumble up some treats...on top...and maybe she will eat it...on her own, too.

 

[MissClouseau]

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.

Liver issues are usually secondary. It's usually like the actual problem is with the gallbladder/bile ducts, or somewhere else and liver gets affected from that. As you know hepatic lipidosis can be the result of not eating alone. Liver makes a recovery most of the time with the right treatment. A lot of gallbladder issues are fixable too, although sometimes takes a long time, or even surgery. But the most important thing is to control hepatic lipidosis because if it gets worse, then nothing can be done for the other issues.

But others have said I need to consider her quality of life and have made me question if I am not doing that.

Quality of Life Scale is for the the times when the cat is terminally ill - that list we all often share originally made for cancer patients. So it's for the times when the cat is terminally ill and her condition is at a point of not improving enough. It's not for the times when a cat is only ill. Like, a cat can be ill, very ill, extremely ill... and get better with treatment. There ARE treatments for most liver and gallbladder problems. Of course they will feel bad most of the day when they are very ill/extremely ill but it's temporary.

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.

It will take at least weeks, maybe months her to make a full recovery from hepatic lipidosis. My own cat has had some mysterious liver problem for years now. The first week of 2019 she was hospitalized with mild jaundice and mild hepatic lipidosis. She used a supplement for over a year, and another medicine for the first 3 months. The first 6 months after she was discharged from the clinic she had less energy than her normal times. Also her gallbladder/liver were still sensitive. I even had/have to handfeed her wet food because she can't handle the air she swallows, she already gets gassy after meals.

I know finances can be a major problem. No judgment there. Maybe there are other options like a cheaper clinic, a payment plan offered from a clinic, or GoFundMe page.

 

[Jenny22]

Liver issues are usually secondary. It's usually like the actual problem is with the gallbladder/bile ducts, or somewhere else and liver gets affected from that. As you know hepatic lipidosis can be the result of not eating alone. Liver makes a recovery most of the time with the right treatment. A lot of gallbladder issues are fixable too, although sometimes takes a long time, or even surgery. But the most important thing is to control hepatic lipidosis because if it gets worse, then nothing can be done for the other issues.



Quality of Life Scale is for the the times when the cat is terminally ill - that list we all often share originally made for cancer patients. So it's for the times when the cat is terminally ill and her condition is at a point of not improving enough. It's not for the times when a cat is only ill. Like, a cat can be ill, very ill, extremely ill... and get better with treatment. There ARE treatments for most liver and gallbladder problems. Of course they will feel bad most of the day when they are very ill/extremely ill but it's temporary.


It will take at least weeks, maybe months her to make a full recovery from hepatic lipidosis. My own cat has had some mysterious liver problem for years now. The first week of 2019 she was hospitalized with mild jaundice and mild hepatic lipidosis. She used a supplement for over a year, and another medicine for the first 3 months. The first 6 months after she was discharged from the clinic she had less energy than her normal times. Also her gallbladder/liver were still sensitive. I even had/have to handfeed her wet food because she can't handle the air she swallows, she already gets gassy after meals.

I know finances can be a major problem. No judgment there. Maybe there are other options like a cheaper clinic, a payment plan offered from a clinic, or GoFundMe page.

I am starting to think that there is an obstruction....maybe gallstones? Tonight Lulu did not eat... when I went to bed she was even avoiding me. Just now I woke up to her vomiting despite being on cerenia and ondansetron. Of course she looks to be in discomfort. And now she is resting on me and purring surprisingly. I tried one syringe of baby food right now and she made an awful groaning noise and turned her head away. And of course now is far from me on her perch. It is true I don't have the funds to take her back to the ER, but in all honesty, she would not want me to. I know my cat and she would rather be laid to rest than go back there. The ERs are filled beyond capacity here. Vets are understaffed. The stress and trauma would be unsurmountable to her. In fact, her condition took a turn for the worst when I took her to the ER. I immensely regret that decision. And I do think that what is going on here needs more than aggressive nutrition. So I guess the ER would have also be necessary? She is getting more yellow despite getting enough calories in her. And she is looking worse and back to looking in pain. In my heart, I don't think she wants to fight this.... Lulu has been through so much in the last 4 months, in and out of ERs for IBD and other issues. And with the shortage of vets due to covid, we had to constantly try new vets or make unnecessary ER appointments. It was all too much for her that when this happened, I was only willing to go as far as some easier diagnostics and fluids. But surgery is out of the question and bringing her back is not what she would want. It really isn't just about money. There are a few hours left until the morning, but I'm not expecting to see a sign that she wants to keep fighting.

Her mobile vet tomorrow was going to give her fluids and liver support, vitamins, etc. But she's looking worse and worse at this point. I'm not sure if it is necessary to do that to her. Plus, I'd have to drive her and she's already in discomfort. In addition, Lulu has a heart murmur that I was going to get checked out right before this happened. So I don't know if she would even be able to handle anesthesia for surgery. The reason for the appointment is so I could take her to a dental specialist for her stomatitis. She already has IBD and CKD. So, there is so much to address and more trauma for her if she came out of this ok. I honestly don't think I can put her through anything else.... I would not be able to forgive myself if her last moments were in a place like that, either.

Thank you so much for all of your optimism and your strength. And for all of your kind words and your stories. While I feel guilty that I let her go this many days without improvement, at least I know that I tried everything in my capacity. Had her jaundice not worsened along with her level of discomfort, I would have syringe fed her as long as she would have allowed me. I would have given everything to her. My heart is so broken seeing the way this week has unfolded...

 

[MissClouseau]

I am starting to think that there is an obstruction....maybe gallstones? Tonight Lulu did not eat... when I went to bed she was even avoiding me. Just now I woke up to her vomiting despite being on cerenia and ondansetron. Of course she looks to be in discomfort. And now she is resting on me and purring surprisingly. I tried one syringe of baby food right now and she made an awful groaning noise and turned her head away. And of course now is far from me on her perch. It is true I don't have the funds to take her back to the ER, but in all honesty, she would not want me to. I know my cat and she would rather be laid to rest than go back there. The ERs are filled beyond capacity here. Vets are understaffed. The stress and trauma would be unsurmountable to her. In fact, her condition took a turn for the worst when I took her to the ER. I immensely regret that decision. And I do think that what is going on here needs more than aggressive nutrition. So I guess the ER would have also be necessary? She is getting more yellow despite getting enough calories in her. And she is looking worse and back to looking in pain. In my heart, I don't think she wants to fight this.... Lulu has been through so much in the last 4 months, in and out of ERs for IBD and other issues. And with the shortage of vets due to covid, we had to constantly try new vets or make unnecessary ER appointments. It was all too much for her that when this happened, I was only willing to go as far as some easier diagnostics and fluids. But surgery is out of the question and bringing her back is not what she would want. It really isn't just about money. There are a few hours left until the morning, but I'm not expecting to see a sign that she wants to keep fighting.

Her mobile vet tomorrow was going to give her fluids and liver support, vitamins, etc. But she's looking worse and worse at this point. I'm not sure if it is necessary to do that to her. Plus, I'd have to drive her and she's already in discomfort. In addition, Lulu has a heart murmur that I was going to get checked out right before this happened. So I don't know if she would even be able to handle anesthesia for surgery. The reason for the appointment is so I could take her to a dental specialist for her stomatitis. She already has IBD and CKD. So, there is so much to address and more trauma for her if she came out of this ok. I honestly don't think I can put her through anything else.... I would not be able to forgive myself if her last moments were in a place like that, either.

Thank you so much for all of your optimism and your strength. And for all of your kind words and your stories. While I feel guilty that I let her go this many days without improvement, at least I know that I tried everything in my capacity. Had her jaundice not worsened along with her level of discomfort, I would have syringe fed her as long as she would have allowed me. I would have given everything to her. My heart is so broken seeing the way this week has unfolded...

I’m so sorry you both are going through this :-( CKD and IBD surely makes everything more challenging

May I ask how old is Lulu and what was the bilirubin level the last time the vet checked?

 

[Jenny22]

I’m so sorry you both are going through this :-( CKD and IBD surely makes everything more challenging

May I ask how old is Lulu and what was the bilirubin level the last time the vet checked?

So, now I hear her eating??? She still has not had a bowel movement in over a week.... omg, the emotional rollercoaster is going to kill me before this thing gets her... Lulu is 14 years old. She had ZERO issues (other than chronic vomiting which I addressed by switching her to raw rabbit about 1-2 years ago). When that specific commercial raw brand discontinued their line, all hell broke loose. So about 4 months ago, I had to resort back to other foods and tried chicken and it was a grave mistake. The IBD was diagnosed and she just had one cascading issue after another after that. So that was basically the last 4 months of her poor little life. Hence, I am reluctant to put her through anything else. The bloodwork attached is from Wednesday at her primary (I realize I don't have the bloodwork from the ER the next day but I know the values worsened and they started mentioning gallbladder after that). At this point, I don't even think she had jaundice. It developed by the time I got to the ER the next night.

 

[Jenny22]

Here are the last ER notes (Internal Medicine) from 12/31

. I think updated numbers are on there.

 

[MissClouseau]

GGT is gallbladder. That seems to be normal. Her liver enzymes are high but I have seen higher. We have seen ALT of 1000 on TCS, and higher bilirubin that made recovery.

I didn’t realize she was 14! She looks much younger.

With cats with liver issues they get nausea and abdomen pain over things like excessive gas. Maybe the rollercoaster you see is about that.

 

[Jenny22]

GGT is gallbladder. That seems to be normal. Her liver enzymes are high but I have seen higher. We have seen ALT of 1000 on TCS, and higher bilirubin that made recovery.

I didn’t realize she was 14! She looks much younger.

With cats with liver issues they get nausea and abdomen pain over things like excessive gas. Maybe the rollercoaster you see is about that.

Not sure if you saw it, but in the second report her GGT was 18. Yes, Lulu always had the softest fur as if she was still a kitten and such a young precious face. I never thought she looked her age, either.

Based on the blood work, what do you think? Despite getting 230 calories in her yesterday, she turned more yellow today. What could have caused that? I was thinking gallstones maybe. I had leftover prednisolone and started giving her a small dose to see if it helped (the ER didn't prescribe it because of her heart). But at this point, it is life or death. I wish we had her on pred from the beginning. Maybe we could have see an improvement from the inflammation.

She barely touched her food right now.... so, I think she is still nauseous. She got in about 170 calories all day, as I had hoped she would eat another 50 at night like she did the night before.

 

[Jenny22]

 

[MissClouseau]

Not sure if you saw it, but in the second report her GGT was 18. Yes, Lulu always had the softest fur as if she was still a kitten and such a young precious face. I never thought she looked her age, either.

Based on the blood work, what do you think? Despite getting 230 calories in her yesterday, she turned more yellow today. What could have caused that? I was thinking gallstones maybe. I had leftover prednisolone and started giving her a small dose to see if it helped (the ER didn't prescribe it because of her heart). But at this point, it is life or death. I wish we had her on pred from the beginning. Maybe we could have see an improvement from the inflammation.

She barely touched her food right now.... so, I think she is still nauseous. She got in about 170 calories all day, as I had hoped she would eat another 50 at night like she did the night before.

ICYMI, all of these might affect the liver


I know from my cat going through liver problems that apparently it’s sometimes difficult to pinpoint what exactly the problem is. If she has gallstones they might see it on ultrasound.

My own cat git diagnosed with Cholangiohepatitis last year at the check-up. We’ve been monitoring her enzymes since. I was told sometimes it’s even just the body causing self inflammation and that triggers a domino effect on the other organs. IBD alone might be a trigger for your girl. Or an infection. Or something else.

 

[Jenny22]

ICYMI, all of these might affect the liver
View attachment 406755

I know from my cat going through liver problems that apparently it’s sometimes difficult to pinpoint what exactly the problem is. If she has gallstones they might see it on ultrasound.

My own cat git diagnosed with Cholangiohepatitis last year at the check-up. We’ve been monitoring her enzymes since. I was told sometimes it’s even just the body causing self inflammation and that triggers a domino effect on the other organs. IBD alone might be a trigger for your girl. Or an infection. Or something else.

If you were in my shoes, would you keep the mobile vet visit where she would get liver support, vitamins, and fluids? Or would that be a wasted visit if she's stopped eating already and has lost complete interest in anything?