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

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Jenny22

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Oh I see! Those are Churu. I linked to a different brand, Nulo.
oh...I thought they were the same! Just went to the petstore and didn't see them. Tried fancy feast again - a few licks and she was done. New bag of temptation treats. She kind of got excited and ate about 5 and then done. Exchanged the raw rabbit 3 times now because of freezer burn! Unfortunately, all the bags at the stores have freezer burn and she will seldom eat them at that point. So, no success there. :(

She is now hiding under the blanket. It snowed last night so not sure if she is cold or feels very unwell. :(
 

cat nap

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Only 2 of the Nulo purees (similar to Churu) have chicken -- https://www.chewy.com/nulo-freestyle-perfect-puree-variety/dp/291685
Oh I see! Those are Churu. I linked to a different brand, Nulo.
I'm so glad that you, both,... suzeanna suzeanna and J Jenny22 ...made me aware of how dumb I've been with reading labels. :cringe:

If you both didn't point out that ingredients like 'chicken'...actually exist in packages that say .."with tuna"..."with tuna and shrimp"(Delectible Squeeze ups)...and even in 'Whiskas seafood selections pate wet cat food'...there is...'whitefish and tuna dinner'...containing chicken.:eek2:..and savoury salmon dinner...contains chicken, too. :gaah:

(my cats do not have a problem with chicken...they just hate the taste of beef...but omg....why do companies make the packages so misleading. Holy, if you both didn't point this out...I would have totally been oblivious. Thank you both...for this info. :))
oh...I thought they were the same! Just went to the petstore and didn't see them. Tried fancy feast again - a few licks and she was done. New bag of temptation treats. She kind of got excited and ate about 5 and then done. Exchanged the raw rabbit 3 times now because of freezer burn! Unfortunately, all the bags at the stores have freezer burn and she will seldom eat them at that point. So, no success there. :(

She is now hiding under the blanket. It snowed last night so not sure if she is cold or feels very unwell. :(
This below thread talks about a "liver shake" recipe for sick cats.
Not sure how it would affect the liver...and best to ask the Vet...but I will post it here:
"liver Shake" Recipe For Inappetant Cats

The same member who posted the above...also posted these links...but I cannot actually find that particular thread.
Just in case it comes in handy for the future:
Financial Aid for Pets
No Money For Vet Care? How To Find Help And Save Your Cat’s Life – TheCatSite Articles
(shout out of thanks...to LTS3 LTS3 ...for the info.)

Not sure if all the links work, and which State you live in...but hope it helps.
 
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Lulu's updated bloodwork came in. We knew it was going to be much worse than before as her first round of bloodwork was before we knew she was this sick. After the ER, she got significantly worse. And since I don't have bloodwork from her worst to compare to now, I don't realistically know if she's better? Anyway, the new updated bloodwork is before I was given vitamins for her, ursodiol, subQ fluids, & milk thistle. So, she might be better NOW than she was when this was taken. But none the less, the numbers are awful and I am going through this feeling of anxiety if I am doing the right thing by trying to nurse her back. 12/28/21 is when we took the first bloodwork. 12/31 is when she wound up at Internal Medicine in the ER. 1/6/21, is when we took the second bloodwork and she was just starting to get back up to 200 calories over 24 hours. Now that it is 1/8/21, and she has had all of this other support, I don't know if she is better or worse. I think maybe I should request more bloodwork for tomorrow or Monday and then I will know that nothing I am doing is working???

My heart is just so crushed right now.... (Lulu is 14...not sure why her age keeps showing up incorrectly on all these reports)
 
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catmom2wires

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Her liver is not good for sure. I just cannot envision that some fluids and vitamins could have changed those stats too much.

Cats do not get the concept of “you will have a painful/difficult recovery and then you will return to a somewhat normal life.” They simply know that they feel bad, don’t want to eat, etc, and they are so hard-wired that they will not give up no matter what. The “here and now” is all that matters to them. It is up to us as their carers to decide how much we expect them to endure. I always try to put myself in their place. Would I want to feel nauseous or in pain or be so weak I was falling down for days/weeks on end, even if there was a remote chance I might (but probably won’t) be a little better eventually?

Quality over quantity…always!

Good luck with your decisions. Lulu sounds like a very good girl.
 
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I want to let her go, but I think that's because this has been equally hard on me and I don't think I have the strength to keep fighting for her. And gosh, that makes me feel so bad like I am giving up on her. I would not put her through this for another week. I wanted to trust the mobile vet and try the supportive care she provided since we didn't have that before to help us. So, Lulu never stood a chance before if you ask me. I think I am going to cook a duck tonight. If lulu does not eat it....then I am going to make a decision for her soon. She already has IBD and CKD. And I had to address a heart murmur and stomatitis before all this happened. Maybe the vets are realistically expecting too much of her. :(
 

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Well, I have some thoughts. First, I support your decisions. You know Lulu better than anyone, and you are her trusted guardian.

Second, YOU matter. You can be tired, broke, sick, and those all weigh in your decision and are valid. We all are adults and know by now that life is not fair, so as long as the decisions are made with love and concern, they are good decisions.

Thirdly, I have some thoughts about the mobile vet. Is she someone you have an established relationship with, and know how she operates? If not, I think she may have been one who will pull out all the stops, whether or not they necessarily should be. The fact that she ran a thyroid test, in the face of known overwhelming liver dysfunction, is a tiny red flag. When my last two kitties died, the vet made it clear that he would not run the thyroid test unless everything else came back good. It is a specialized, expensive test, so he saves that for last. Indeed, on both Brillo and Felix, the problems were found with the CBC, and we never checked the thyroid. Also, the fact that she seemed SO positive that you could pull Lulu through this was a bit shocking to me. Lulu is a senior girl, and even minor things can easily become major in oldies. I wasn’t sure the vet was considering that. Forgive me if I am off base on any of this.

I hope Lulu dives into the duck! If not, I hope your next decisions bring you peace, because from what I have seen, you are doing everything out of and with love for your precious girl.

Hugs to you both.
 

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It's never easy. One of my cats went into liver failure and I had to let them go. It wasn't fair to keep them alive in that condition and it broke my heart. But we have to do right by them not what is easy or best for us.

Trust yourself if your inner voice says you should let her go then listen.
 
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Well, I have some thoughts. First, I support your decisions. You know Lulu better than anyone, and you are her trusted guardian.

Second, YOU matter. You can be tired, broke, sick, and those all weigh in your decision and are valid. We all are adults and know by now that life is not fair, so as long as the decisions are made with love and concern, they are good decisions.

Thirdly, I have some thoughts about the mobile vet. Is she someone you have an established relationship with, and know how she operates? If not, I think she may have been one who will pull out all the stops, whether or not they necessarily should be. The fact that she ran a thyroid test, in the face of known overwhelming liver dysfunction, is a tiny red flag. When my last two kitties died, the vet made it clear that he would not run the thyroid test unless everything else came back good. It is a specialized, expensive test, so he saves that for last. Indeed, on both Brillo and Felix, the problems were found with the CBC, and we never checked the thyroid. Also, the fact that she seemed SO positive that you could pull Lulu through this was a bit shocking to me. Lulu is a senior girl, and even minor things can easily become major in oldies. I wasn’t sure the vet was considering that. Forgive me if I am off base on any of this.

I hope Lulu dives into the duck! If not, I hope your next decisions bring you peace, because from what I have seen, you are doing everything out of and with love for your precious girl.

Hugs to you both.
It's interesting that you pointed out the thyroid test. I just had that done last week, so right - why would she run it again? I do not have a relationship with this vet.... But I am in other Facebook groups where just about every single person that has gone through this with their cat (also with multiple health issues) is telling me to hold on as their cats were maybe even worse and came out of it. It's hard for me to fathom as even if Lulu stands a chance to recover from this, if it is going to take a month of her feeling bad - then I do not think it is worth it for her. She's been through so much already. I am surprised that others were able to stick this out for so long...I am making myself sick and using up all my vacation and sick days battling this beside her... Thank you for your kinds words, right now. I don't have any support and I am carrying this burden alone; it is so taxing. really... I don't know what I would do without this forum.
 
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It's never easy. One of my cats went into liver failure and I had to let them go. It wasn't fair to keep them alive in that condition and it broke my heart. But we have to do right by them not what is easy or best for us.

Trust yourself if your inner voice says you should let her go then listen.
I think I have a very good instinct on what to do in most situations. With my last dog, I knew it was time even when I didn't. With Lulu, I ask myself if I should let her go. I calm my thoughts and try to feel the answer as I always do. But I don't feel like she's asking me to let her go. I actually feel like I'm giving up on her. It's really odd. I don't feel like she's necessarily fighting either. I don't understand this feeling of duality that I have with her and it is causing me so much mental turmoil. It would be so much easier if I really felt like she had given up. But I don't feel that way. The only thing that is clear is that her quality of life is not good. What cat wants to feel bad all day long.... And that's what she looks like...lethargic, no desire to play, iffy about food and mostly not eating, uncomfortable. I desperately wanted her to feel better...to pull her out of THIS even if it meant putting her down for something else. I wish it didn't have to be this gray area where I feel like a horrible person if I try to fight this or a horrible person if I stop fighting.
 

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I'm jumping in here late in the conversation but I did want to mention something that I went thru with my cat near the end of his life. My boy had CKD, and with that, nausea was a common symptom. Fluids were the biggest thing that kept him feeling well, but the other was that cats who have nausea, tend to associate how they feel with the smell of their food. So you could present them with something and they'll perk up and eat it (or some of it anyway), but because they were feeling nauseous they then associate the smell of that meal to why they feel sick and will not want to eat it the next meal. What I did to help my kitty to keep eating was to offer something that smelled completely different for every single meal so that the association of "this smell"="sick" didn't happen. It helped quite a bit. With Lulu's IBD and allergy issues, this may be difficult to find enough different foods for a rotation, but I thought...any little bit helps I guess...
 

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Think of it logicly if you can.
If she's suffering with no end in sight no chance of recovery and continuing to decline and not eat and stuff then it may be best for her and you to let her go.

You wouldn't be giving up at all you would be ending a battle that will end in a very bad way no matter what you do.

I personally believe it's best to send them to the bridge early than late as I don't want them to suffer endlessly.

It's ok to disagree with me. I'm simply sharing my thoughts. I am here to give what support I can no matter the decision made.

It's really hard when the fur kids are sick and we fur parents need all the non judgemental support we can get.
 

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It is a hard decision, it always is. I had a cat survive Hepatic Lipidosis. It is always caused by something else and that something else is really what is important in deciding whether to let go or give the supportive treatment to get them through it. Patches was 7 1/2 and his was caused by undiagnosed IBD. Got him through the Hepatic Lipidosis, got the IBD under control and he lived another 8 years. He didn't have CKD and was younger. The things to look at is quality of life, will treatment be successful and where will she be at if she gets through the Hepatic Lipidosis.
 
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I don't want to jinx myself, but she may have turned a corner! Of course I don't know for sure, but I suspected what caused the hepatic lipidosis was a combination of me watering down her food (as I noticed she was showing less of an appetite to the thicker purees) and her teeth/mouth issues. I think even by watering down her food, I was unwittingly lowering her calories and she was already eating less. I wanted to address her teeth, but her vet wanted to wait 3 months to address the kidneys, first. Now, I realize he was just avoiding treating anything. In those 3 months, I strongly believe her mouth became worse and now I know it is stomatitis from reviewing her ER reports from her primary medical history. Her primary never told me it was stomatitis.

Anyway, last night I chose to stop syringe feeding her as I am tired and exhausted and getting pressure from my family that I am doing the wrong thing here. And I just don't think I can put her through this for another week. But I also don't feel like she is telling me she wants to go; that's what makes this so hard. I don't get that she's given up. That's why I feel like I'm the one who has given up. Anyway, I gave her prednisolone for her mouth, not expecting much and blended some duck with water and put in on a flat plate, then went to bed.

When I woke up this morning, she ate ALL of it! And her body language looked better overall. I think that's why she looks as though she wasn't getting better! It's her mouth! I do realize that if she pulls out of this, I need to take her to the dental specialist ASAP. And I'm going to try one of those applications for the funds to do a full mouth extraction as so many people told me it vastly improves their quality of life - from what I read it is the way to go in managing stomatitis. I 100% believe that if I fix this one issue, she will be fine. With the IBD, I managed it perfectly with diet. In fact her internal medicine doctor told me he didn't think it was IBD because she was food responsive; so he thought it was food allergies, primarily chicken. As for CKD, that was also managed by keeping her on a low phosphorous diet and it was very early stage so I wasn't too worried about that either.

Of course, I don't know what damage will be done, even to her kidneys, if she comes out of this. But she actually looks pretty good this morning and I have to believe it's from the prednisolone. No, I don't think it just stimulated her appetite. I think it just helped her feel better and she doesn't look miserable, now...just lethargic. I can deal with lethargic. I can keep nursing her with lethargic. What I couldn't do was see her clearly in discomfort as that was no way to live.

Anyway, crossing my fingers. I had already pushed hospice back to Tuesday. So, if the prednisolone is working, then I feel 2-3 more days will show a significant recovery. My goal moving forward is to see how much she will eat on her own.
 

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It is great that she ate and looks better. Pred can do that, and vets often prescribe that to let the pet have a good day or two while decisions are being made. Just be aware that it does take a toll on the kidneys and liver. I think that is where the vet mentioned “stacking meds.” You can’t do one thing without affecting another.

What do you think the chances are a vet will do a major oral surgery with a failing liver and anemia, along with renal issues? I think you may need to prepare yourself for that answer.

Keep doing what you feel is needed to help Lulu. Go with your gut as always.

C
 

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1/6/21, is when we took the second bloodwork and she was just starting to get back up to 200 calories over 24 hours. Now that it is 1/8/21, and she has had all of this other support, I don't know if she is better or worse. I think maybe I should request more bloodwork for tomorrow or Monday and then I will know that nothing I am doing is working???
I can't really speak to the CBC portion of the tests, but from what I know the liver numbers are going to take longer than just a few days to improve. So, doing new testing in another day would seem a bit premature, IMO. I'd ask the vet what would a be realistic date for re-check based on all the new treatments she just received.
So, if the prednisolone is working, then I feel 2-3 more days will show a significant recovery. My goal moving forward is to see how much she will eat on her own.
I don't know if you can count on a 'significant' recovery in just a couple more days. The biggest indicator for you that she is experiencing some improvement within the next few days is her eating more and at least to start off with eating some of it on her own.

Of course, you need to do what you believe to be the right thing - but the effects from hepatic lipidosis are not going to go away in just a matter of days. I hope you see some continued improvements over the coming days.
 
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Jenny22

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It is great that she ate and looks better. Pred can do that, and vets often prescribe that to let the pet have a good day or two while decisions are being made. Just be aware that it does take a toll on the kidneys and liver. I think that is where the vet mentioned “stacking meds.” You can’t do one thing without affecting another.

What do you think the chances are a vet will do a major oral surgery with a failing liver and anemia, along with renal issues? I think you may need to prepare yourself for that answer.

Keep doing what you feel is needed to help Lulu. Go with your gut as always.

C
I didn't realize that regarding the surgery... I assumed fighting hepatic lipidosis meant her liver would regenerate.... :( And anemia I also assumed would go away.

As for the CKD, it is early stage and I've had others tell me their cats had full extraction with CKD no problem. They actually didn't understand why my vet was putting off addressing her teeth due to CKD.

Ok, you've got me realistically thinking here... I took her off of the cerenia as I honestly think it makes her sick. I did keep her on the ondansetron, however. And I took her off of mirataz as it either was making her act weird on a regular dose or doing nothing on a small dose. So, I've in a sense swapped some meds instead of stacked. He did say I could do that. I was told I could probably stop the antibiotic but after the recent bloodwork, the mobile vet told me to keep her on it. So, that's disappointing. So right now, it's milk thistle, ursodiol, ondansetron, and veraflox. And then I added the prednisolone but just a small dose.

Do you think I should get follow up bloodwork in a few days? And if her numbers further declined, that would make the answer easy to put her down?
 
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Jenny22

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I can't really speak to the CBC portion of the tests, but from what I know the liver numbers are going to take longer than just a few days to improve. So, doing new testing in another day would seem a bit premature, IMO. I'd ask the vet what would a be realistic date for re-check based on all the new treatments she just received.

I don't know if you can count on a 'significant' recovery in just a couple more days. The biggest indicator for you that she is experiencing some improvement within the next few days is her eating more and at least to start off with eating some of it on her own.

Of course, you need to what you believe to be the right thing - but the effects from hepatic lipidosis are not going to go away in just a matter of days. I hope you see some continued improvements over the coming days.
By significant recovery, I mean that I just don't want to see her in pain. If she is lethargic, I think I can work with that. If she is suffering, I honestly don't want to put her through a month of feeling uncomfortable. I get that it would take a while for her to be normal, again. But the bigger question is how long does she have to feel THIS bad for to get to that point. And that is really how I've been trying to evaluate the reality of the situation and her quality of life.

I abhor infinite indefinites. Just not knowing how long this will take is soul crushing. How long should it take for a cat to eat on their own without anymore help and to seem somewhat normal? I know every cat is different. But do you think we are talking many weeks more? I was thinking that she would be eating most of her calories on her now, seeing how much she ate last night. It was the most I had seen her eat since this all started.

Regardless, I still have the hospice set up for Tuesday and I am still gauging what is best here. Here is how Lulu looks most of the day. Much more comfortable than last week, but still sleeping quite a bit.
IMG_5928.jpg
 

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I took her off of the cerenia as I honestly think it makes her sick. I did keep her on the ondansetron, however. And I took her off of mirataz as it either was making her act weird on a regular dose or doing nothing on a small dose.
Ask the groups you have joined about an alternative to cerenia. I know I read about it in some of the forums I have joined but am having trouble finding it. Most of the forum members do use a combination of ondansetron and an anti-nausea med. I don't know how long you've been using Mirataz (sorry, I didn't go back and look), but the ointment can build up in the ears causing new doses to be less effective. So, wiping her ears with something as simple as unscented hypo-allergenic wipes can clean up the residue. Normal dosage is 1.5" length of ointment daily - way too much for many cats, and most likely too much until their system adapts. Tbh, it is an experimenting game to find the right dose for your cat. If you are dosing her with the regular amount daily, what happens if you cut the dose in half instead? Maybe 3/4 of a dose? Etc.
How long should it take for a cat to eat on their own without any more help and to seem somewhat normal? I know every cat is different. But do you think we are talking many weeks more? I was thinking that she would be eating most of her calories on her now, seeing how much she ate last night. It was the most I had seen her eat since this all started.
As you said, every cat is different, but I would imagine that a very slow recovery over many weeks is the more likely scenario. If the treatment works for her, then you should start to see small, tiny changes in her and any of them that are positive also mean that the associated discomfort should be reducing concurrently.

I don't see where the vet prescribed a mild pain med - is there a reason for not doing so? Also, these FB groups you are communicating with, are there members who have experience with hepatic lipidosis? I am sure they can give you some clues about the duration of time it takes for improvement from their own personal experience.
 
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Jenny22

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Ask the groups you have joined about an alternative to cerenia. I know I read about it in some of the forums I have joined but am having trouble finding it. Most of the forum members do use a combination of ondansetron and an anti-nausea med. I don't know how long you've been using Mirataz (sorry, I didn't go back and look), but the ointment can build up in the ears causing new doses to be less effective. So, wiping her ears with something as simple as unscented hypo-allergenic wipes can clean up the residue. Normal dosage is 1.5" length of ointment daily - way too much for many cats, and most likely too much until their system adapts. Tbh, it is an experimenting game to find the right dose for your cat. If you are dosing her with the regular amount daily, what happens if you cut the dose in half instead? Maybe 3/4 of a dose? Etc.

As you said, every cat is different, but I would imagine that a very slow recovery over many weeks is the more likely scenario. If the treatment works for her, then you should start to see small, tiny changes in her and any of them that are positive also mean that the associated discomfort should be reducing concurrently.

I don't see where the vet prescribed a mild pain med - is there a reason for not doing so? Also, these FB groups you are communicating with, are there members who have experience with hepatic lipidosis? I am sure they can give you some clues about the duration of time it takes for improvement from their own personal experience.
I have a cerenia alternative here, but I don't think it's necessary. The cerenia was actually making her vomit. On ondansetron alone for nausea, I have not seen her vomit (crossing my fingers). I would rather not add another med to the mix if she is holding her food down. And Mirataz is the ointment, 1.5 inches. She paced and yowled for 2 hours trying to vomit and unable to the first night. It was so hard to watch. I brought the dose all the way down to 0.5 inches. But again, if prednisolone helps with appetite, why stack another med.

Lulu had just gotten buprenorphine for her teeth when we realized she had hepatic lipidosis. Her primary told me to take her off it as soon as we found out. Out of desperation, I did give her a dose one night to see if it would alleviate her pain, but it just made her look more uncomfortable. The prednisolone, on the other hand, is the only thing that I noticed has made her feel more comfortable. I gather from its anti-inflammatory capabilities. I do give her some slippery elm, as well. And I have CBD but since it is a natural blood thinner, I'm not sure it is good to give to her right now. Plus, honestly...CBD never seemed to really help her before.

I have spoken to DOZENS of people on multiple facebook groups, read reddit forums, read thecatsite forums, read scientific articles, etc. You name it. The consensus from the Facebook groups is to stick it out as most of the members who went through this were able to beat it (also with cats having multiple medical issues IBD, CKD, pancreatitis, etc.), a lot of them through assisted feeding as well. For one in particular, she said that her cat ate poached pork on his own after a week and that's when she knew the worst was behind her. I've seen others say a few weeks and I've read posts where people were in this for a month. A month of THIS is unacceptable for my cat. But if she looks like she's not in pain and is eating on her own, I have no problem giving her some meds and subQ fluids to help her along the way. But if we're talking about assisted feeding and keeping her alive with little progress for weeks, I just don't think that's fair to her. That's pretty much where I am at.

At the end of the day, my quality of life would drastically improve if I were to put my baby down. And I think that thought makes me so sick to my stomach, that I wind up wanting to try harder for her. I really wish this was more cut and dry as it was for my dog when he had cancer. My parents are watching my dog right now as I go through this. He was diagnosed with lyme disease at the same time and I haven't seen him in 2 weeks. :(
 
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