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

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So, after leaving the ER, she was pretty immobile, crouching, etc. and hiding. She's kind of been in the bedroom sleeping all day instead of out near me which makes me sad. But she mostly looks tired. I completely feel for you and the dental issues with your cat. I had no idea with Lulu. I was only told she had mild gingivitis about a year ago and that was it. I regret not addressing her teeth then. But I also feel the vet was incompetent and probably under diagnosed the severity of what was going on with her teeth. She had been on a homecooked and raw diet for a year, so I don't know how her teeth went from mild gingivitis to feline tooth resorption and stomatitis.
Not sure how teeth can go that bad,...within a year, either.
My guess would be that the resorption, is not really seen, visually, ..since it's below the gumline...and only an x-ray would show it.

(It doesn't really help, knowing this after the fact. (and why us laypeople...have to research and learn these things...when some vet doctors...who are educated in their field...and who are getting paid to examine and treat our animals...are not being thorough.)

My problem...is the ones I really like...and find to be excellent...often leave the Vet clinic, after a year or two.
They either join other clinics further away, or open their own clinics...also far away.

(With me, though, I blame myself, too,...since I also noticed bad breath...from my rainbow cat Spotty, ..but chucked it up to being his wet cat food. I should have remembered to mention this to the Vet...and I also had missed a six month scheduled appt...so really I had dropped the ball, there, too. I find it's so important to keep up with the appt's for senior cats and dogs. Things move quickly, at their age. Sadly sometimes our Lives get in the way...of things...and we forget to reschedule...and prices of Vet procedures also seem a lot higher than before.)

Lulu has definitely made progress,...from the time when she left the ER. :)
Wonder if it's more to do with what the mobile Vet gave her,...since last friday...or all the things that you have given her.
Probably a combination of both. :cool2:

(With Pred, as a kid, I was on it for a muscle inflammatory disease.
It definitely takes away inflammation, and does make a human extremely hungry.
I needed to take some type of 'milk of magnesia' type of liquid, to coat the esophagus and stomach, and I think there may have been some type of pepcid meds...but it was over 40 years ago...so really cannot recall.)

Unfortunately with Lulu...I did read that pepcid AC can be toxic to the liver.
So again,...you are so limited...with what you can give her, to not cause any further liver damage.
I did read online, that corticosteroids can change the Liver values...to increase them..so maybe just keep that in mind, when seeing the bloodwork. :bluepaw:

When you first posted her bloodwork, I was a bit shocked that the ALT was off the charts.(that would have been from the mobile vet's)
But if Lulu...was acting better than when she had come from the ER...then those high numbers...are not really indicative...at what you are seeing ...in better improvements with Lulu.
That's why I think you have to 'look at the cat's actions, too'...and not just the numbers.
Though numbers help us all...in making decisions...like you mentioned before.
What I am angry about is that I was discharged without any real guidance or instruction on how to treat this at home...no real liver support or helpful meds or fluids. And then I'm even more angry that her primary who was responsible for us even being in this situation made no attempt to check on us and didn't offer any advice or additional support either on how to treat this aggressively at home. In fact, when I asked for ondansetron which the ER refused to give her, her primary called me yelling at me because he was frustrated that my pharmacy hung up on me and then proceeded to tell me that he wasn't spending any more time on this and that I could drive the two hours back and forth to get my prescription from his office the next day. She vomited that night without the meds...I honestly felt so abandoned and overwhelmed. Thank goodness for sites like this. ❤❤❤
That ER place discharging you without any instructions, liver support meds, foods, supplements, or fluids...just sounds wrong.
Even just instructions of where you can purchase the supplements or fluids...would have been the decent thing to do.

And no, it should not be so difficult to easily fax in a prescription to your closest pharmacy. Or have the pharmacy be able to call up the Vet..for the prescription, too. In this day and age,...having to run around it just wasting time.
I'm so glad that you found this new mobile vet.
She sounds to be way more supportive, and professional than that primary one.
My dog was diagnosed with Lyme disease. He is on meds. I don't know how early we caught it or if he was suffering from any longterm effects. I haven't seen him so I hope he's ok. I pushed for the blood test - I just knew intuitively that he had Lyme. I don't know why. But I knew and I am so glad I listened to my gut. My last dog went undiagnosed for 8 months at least and I strongly believe that is what caused his cancer and his organ failure.
I hope your dog is okay, too.:greenpaw:
Wow, so it was you who had to push and ask for the blood test.
Really glad that you saw the signs, and went with your gut instincts, too.

(Here, we give the dog topical Revolution...which covers only one type of tick.
I know that one of the vets, last year told me, that it does not cover the other two types.
So maybe I'll have to research, again, just to see which ones are dominant in this area.)
Thanks for that info, Jen.
The mobile vet does do bloodwork, by the way. I think I am going to retest Lulu on Friday.
I think retesting either this Friday, sounds good....or even next friday.
Hopefully the 'in house' blood work would cover the liver values.

I know that the mobile Vet said "1-2 weeks to see improvements"...so even if you wait until the next friday...that would be okay, too.
Hoping that your Lulu just continues to eat. :crossfingers::crossfingers::crossfingers: :vibes::vibes::caticon:
 

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After she eats, she is back into this meatloaf pose. Do you think that is inflammation? Is that normal with hepatic lipidosis? This is part of the problem in getting her to recover; I feel food makes her feel ill right afterwards no matter what I give her.
"meatloaf position after meals" is usual for gallbladder-bile duct problems and sometimes happen even when there is a mild issue with gallbladder/bile duct. For my cat, it helps to handfeed her wet meals. She swallows less air and at least gets less gassy. They might also wake up with nausea and puke early in the morning, or want to eat to decrease nausea.

Also, is there a reason to not try hepatic dry food? I know you said Lulu never had interest in dry food and that IBD might make things tricky but dry food is typically more calorie dense. My cat eats ProPlan's. That has the simplest formula I know which might make it less risky to try.

PRO PLAN VET HP Hepatic Dry Cat Food | Purina
 
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Not sure how teeth can go that bad,...within a year, either.
My guess would be that the resorption, is not really seen, visually, ..since it's below the gumline...and only an x-ray would show it.

(It doesn't really help, knowing this after the fact. (and why us laypeople...have to research and learn these things...when some vet doctors...who are educated in their field...and who are getting paid to examine and treat our animals...are not being thorough.)

My problem...is the ones I really like...and find to be excellent...often leave the Vet clinic, after a year or two.
They either join other clinics further away, or open their own clinics...also far away.

(With me, though, I blame myself, too,...since I also noticed bad breath...from my rainbow cat Spotty, ..but chucked it up to being his wet cat food. I should have remembered to mention this to the Vet...and I also had missed a six month scheduled appt...so really I had dropped the ball, there, too. I find it's so important to keep up with the appt's for senior cats and dogs. Things move quickly, at their age. Sadly sometimes our Lives get in the way...of things...and we forget to reschedule...and prices of Vet procedures also seem a lot higher than before.)

Lulu has definitely made progress,...from the time when she left the ER. :)
Wonder if it's more to do with what the mobile Vet gave her,...since last friday...or all the things that you have given her.
Probably a combination of both. :cool2:

(With Pred, as a kid, I was on it for a muscle inflammatory disease.
It definitely takes away inflammation, and does make a human extremely hungry.
I needed to take some type of 'milk of magnesia' type of liquid, to coat the esophagus and stomach, and I think there may have been some type of pepcid meds...but it was over 40 years ago...so really cannot recall.)

Unfortunately with Lulu...I did read that pepcid AC can be toxic to the liver.
So again,...you are so limited...with what you can give her, to not cause any further liver damage.
I did read online, that corticosteroids can change the Liver values...to increase them..so maybe just keep that in mind, when seeing the bloodwork. :bluepaw:

When you first posted her bloodwork, I was a bit shocked that the ALT was off the charts.(that would have been from the mobile vet's)
But if Lulu...was acting better than when she had come from the ER...then those high numbers...are not really indicative...at what you are seeing ...in better improvements with Lulu.
That's why I think you have to 'look at the cat's actions, too'...and not just the numbers.
Though numbers help us all...in making decisions...like you mentioned before.

That ER place discharging you without any instructions, liver support meds, foods, supplements, or fluids...just sounds wrong.
Even just instructions of where you can purchase the supplements or fluids...would have been the decent thing to do.

And no, it should not be so difficult to easily fax in a prescription to your closest pharmacy. Or have the pharmacy be able to call up the Vet..for the prescription, too. In this day and age,...having to run around it just wasting time.
I'm so glad that you found this new mobile vet.
She sounds to be way more supportive, and professional than that primary one.

I hope your dog is okay, too.:greenpaw:
Wow, so it was you who had to push and ask for the blood test.
Really glad that you saw the signs, and went with your gut instincts, too.

(Here, we give the dog topical Revolution...which covers only one type of tick.
I know that one of the vets, last year told me, that it does not cover the other two types.
So maybe I'll have to research, again, just to see which ones are dominant in this area.)
Thanks for that info, Jen.

I think retesting either this Friday, sounds good....or even next friday.
Hopefully the 'in house' blood work would cover the liver values.

I know that the mobile Vet said "1-2 weeks to see improvements"...so even if you wait until the next friday...that would be okay, too.
Hoping that your Lulu just continues to eat. :crossfingers::crossfingers::crossfingers: :vibes::vibes::caticon:
Thank you so much for your support. ❤The ER gave minimal instructions, I should say. They were so busy, it took 3 hours to get my cat AFTER she was already discharged. And some tech who had no answers quickly dumped on back on me. The instructions I was given were vague about how much she should eat when I kept asking for a caloric number because she is fed homecooked meat. They just said 1/4 of a can 2-3 times a day (they didn't even say what type of canned food or how many oz of a can). And they gave cerenia and appetite stimulant and antibiotic. That was pretty much all she got...nothing for the liver or bile ducts, no fluids, etc.
 
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Jenny22

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"meatloaf position after meals" is usual for gallbladder-bile duct problems and sometimes happen even when there is a mild issue with gallbladder/bile duct. For my cat, it helps to handfeed her wet meals. She swallows less air and at least gets less gassy. They might also wake up with nausea and puke early in the morning, or want to eat to decrease nausea.

Also, is there a reason to not try hepatic dry food? I know you said Lulu never had interest in dry food and that IBD might make things tricky but dry food is typically more calorie dense. My cat eats ProPlan's. That has the simplest formula I know which might make it less risky to try.

PRO PLAN VET HP Hepatic Dry Cat Food | Purina
This was soooooooooooo helpful! I could not find this information anywhere! So, for a few months before the hepatic lipidosis, my cat was having morning acid vomits. She was also having those vomits if she didn't eat for 4-6 hours. So, I was unable to be gone from my house for longer periods of times and even showed up to holidays late as a result. Since I fed her homecooked meals, I had to put them down periodically throughout the day; I didn't want her to get sick from not eating or eating anything spoiled. She had to eat small meals spread throughout the day - about 3-4 and maybe a 5th one overnight to prevent vomiting. Do you think she could have had a gallbladder issue before this whole hepatic episode?? I thought it was IBD and acid reflux related.

Also, I was cooking her a lot of pork (normally I would alternate with rabbit as a leaner meat). But she was over the rabbit and the pork was more accessible and cheaper to come by. I wonder if the fat content was too high. I was mixing tenderloin or chops with ground meat for an event amount of fat. I was conscious of the fat percentage, but I never really knew what that should be as google had all sorts of conflicting answers. But I also think I accidentally added too much egg yolk for motility. Do you think these foods could have caused an issue with the gallbladder unbeknownst to me this whole time? I read the cholesterol in yolk was bad for the gallbladder. :( Another person I spoke to on Facebook is also dealing with these morning acid pukes and they are also feeding their cat pork.

Lulu does not eat kibble...never did. The only kibble I ever saw her eat would be my dog's kibble in the kibble of the night. I never understood why she would do that. But she also has dental/mouth issues so it's difficult for her to try and eat anything hard.

Right now, she is eating the CN canned food on its own. So, that has been the best thing to happen all week. Praying it is not fleeting.
 

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...So, for a few months before the hepatic lipidosis, my cat was having morning acid vomits. She was also having those vomits if she didn't eat for 4-6 hours. So, I was unable to be gone from my house for longer periods of times and even showed up to holidays late as a result. Since I fed her homecooked meals, I had to put them down periodically throughout the day; I didn't want her to get sick from not eating or eating anything spoiled. She had to eat small meals spread throughout the day - about 3-4 and maybe a 5th one overnight to prevent vomiting. Do you think she could have had a gallbladder issue before this whole hepatic episode?? I thought it was IBD and acid reflux related.
Not sure if Lulu had gallbladder issues before the hepatic lipidosis...since the primary vet's Bloodwork...only showed
a GGT of 5 ...then ER was 18....then mobile vet was...17 (normal range 0-6).
Cholesterol went from 333..to 342...then...405 (91-305 range)

(I would have thought that the ggt would have been higher to begin with, if she had gallbladder issues before the hepatic lipidosis.
But then, again,...something did cause her to stop eating...so perhaps it's possible that she was not feeling well from gallbladder pain, and went off her food,...even though they didn't detect it...in the bloodwork at first.
(not sure. gallbladder issues in humans is strange, too. Since I had sludgy gallstones, or bile, and only when it hit a critical point where it caused a blockage, were the gallstones seen. Then removal of gallbladder happened...but I'm not too sure if it's common practice, here, that they remove the gallbladder in cats.)

Have you ever considered using a 'timed feeder' for Lulu.
https://www.amazon.com/dp/B07FT93YM2/?tag=thecatsite
(shout out of thanks to @ daftcat75...for recommending this one,...in a thread from last year.)

He mentioned using those for his rainbow cat Krista.
He had two out...so that if one failed, then the other was a backup.
It's here in this thread: read post #269...from @ daftcat75...
Musiaka's journey with IBD and liver issues
Also read Post #264...for extremely informative advice...of keeping a food journal.

There are also different types of timed feeders, that @ LTS3 had written about...that contained spaces for "ice packs"...so that you could put down cat food, and not worry about it getting spoiled.
(I can't find that particular post...but if you search online, and read the reviews...they may help.)
Also, I was cooking her a lot of pork (normally I would alternate with rabbit as a leaner meat). But she was over the rabbit and the pork was more accessible and cheaper to come by. I wonder if the fat content was too high. I was mixing tenderloin or chops with ground meat for an event amount of fat. I was conscious of the fat percentage, but I never really knew what that should be as google had all sorts of conflicting answers. But I also think I accidentally added too much egg yolk for motility. Do you think these foods could have caused an issue with the gallbladder unbeknownst to me this whole time? I read the cholesterol in yolk was bad for the gallbladder. :( Another person I spoke to on Facebook is also dealing with these morning acid pukes and they are also feeding their cat pork.
Do you use some sort of online website, or online cat food/calorie calculator,...to figure out all those fat percentages...and such?
Something like this Site:
BalanceIT.com

(Not sure about the added egg yolks, and gallbladder link,...or the high cholesterol content.)
Lulu does not eat kibble...never did. The only kibble I ever saw her eat would be my dog's kibble in the kibble of the night. I never understood why she would do that. But she also has dental/mouth issues so it's difficult for her to try and eat anything hard.
She might be hungry at night,...or else some flavour and smell is attracting her to it.
I would try those automated timed feeders for her, then.

(Strangely, enough, my cats do not chew their dry food,...they just tend to swallow it.
I do hear them crunch it at times...but while watching them closely...it looks more like just lick, crunch, swallow.
They also just like to lap up their wet food with tongues.)
They do like to graze at night.

But from reading a lot, it does seem that wet cat food is the best for kidney issues.
I think that a lot of the trouble we see, is also age related, too.
As with people,...our animals age...and health problems usually show up.
Right now, she is eating the CN canned food on its own. So, that has been the best thing to happen all week. Praying it is not fleeting.
"Right now, she is eating the CN canned food on its own."
:yess::banana1::woo::jive:

I'll be praying, too.
Come on Lulu...you can do this.:goodluck:
 
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Jenny22

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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:

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:

Thank you so much. I am so heartbroken over all of this. And yes, I'm tired...I'm so drained and tired in every way. I am rerunning bloodwork for Lulu tomorrow. $230. I'm running out of room on my care credit card, but I need to know if the last 2 weeks of treatment were in vain (or the last week at least as that's when we added all the other supplements like liver support & fluids, plus 200 calories/day). She is moving. She drinks water, uses the litterbox, has bowel movements, jumps on furniture, gained over a lb since the ER, eats a tiny bit every now and then but not often, and no longer looks like she is in constant pain (thank goodness). For the most part she never stopped drinking water or using the litterbox and and as soon as she was less in pain, she was moving around more. She even has more energy and started fighting me on both subQ fluids and syringe feeding which I took as a good sign? But I feel like it's not enough...I feel like the improvements she made were so subtle in the last 2 weeks even though she actually looks like a normal cat to the outsider. On the flip side and what's more worrisome to me is that I feel like she keeps getting more and more yellow, she's very lethargic, and continues to show ZERO interest in anything - laser lights, mouse and bird toys on a string, doesn't perk up when I come up. She just kind of IS..... But her color getting worse week to week has got to mean something is progressing, right?

Her primary actually called to check in last night and when I told him her kidney levels were now elevated, he said that was a bad sign. He said elevated kidney levels is not typical of fatty liver which makes him think something bigger could be going on. If the new bloodwork shows that she is continuing to deteriorate, then I have to assume that this isn't just fatty liver we are dealing with and I am going to reconsider hospice. I just don't feel like her improvements are significant enough to warrant continuing to put her through this...I don't want to wait until she is barely holding on. One thing is clear - her quality of life is very poor at the moment and has been for the last 2-3 weeks. Last night, her primary told me he put a cat to sleep that he couldn't believe was still alive...that cats are amazingly resilient creatures but that doesn't mean we should take advantage of that fact...which is in agreement with how I feel. I don't want to wait until she's completely given up and won't move. I don't want it to get to that point... Is that me giving up? I feel so conflicted.

Just now I picked up more prescription CN canned food as she actually wants to eat it! She took a few licks (honestly didn't even make a dent). And she's back to her uncomfortable loaf position....even thought I heard her moan :(. Just gave her some prednisolone to see if it is inflammation related. I have buprenorphine here but I gave it once to her and she looked uncomfortable on it so I'm reluctant to give it to her again.
 
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Jenny22

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Not sure if Lulu had gallbladder issues before the hepatic lipidosis...since the primary vet's Bloodwork...only showed
a GGT of 5 ...then ER was 18....then mobile vet was...17 (normal range 0-6).
Cholesterol went from 333..to 342...then...405 (91-305 range)

(I would have thought that the ggt would have been higher to begin with, if she had gallbladder issues before the hepatic lipidosis.
But then, again,...something did cause her to stop eating...so perhaps it's possible that she was not feeling well from gallbladder pain, and went off her food,...even though they didn't detect it...in the bloodwork at first.
(not sure. gallbladder issues in humans is strange, too. Since I had sludgy gallstones, or bile, and only when it hit a critical point where it caused a blockage, were the gallstones seen. Then removal of gallbladder happened...but I'm not too sure if it's common practice, here, that they remove the gallbladder in cats.)

Have you ever considered using a 'timed feeder' for Lulu.
https://www.amazon.com/dp/B07FT93YM2/?tag=thecatsite
(shout out of thanks to @ daftcat75...for recommending this one,...in a thread from last year.)

He mentioned using those for his rainbow cat Krista.
He had two out...so that if one failed, then the other was a backup.
It's here in this thread: read post #269...from @ daftcat75...
Musiaka's journey with IBD and liver issues
Also read Post #264...for extremely informative advice...of keeping a food journal.

There are also different types of timed feeders, that @ LTS3 had written about...that contained spaces for "ice packs"...so that you could put down cat food, and not worry about it getting spoiled.
(I can't find that particular post...but if you search online, and read the reviews...they may help.)

Do you use some sort of online website, or online cat food/calorie calculator,...to figure out all those fat percentages...and such?
Something like this Site:
BalanceIT.com

(Not sure about the added egg yolks, and gallbladder link,...or the high cholesterol content.)

She might be hungry at night,...or else some flavour and smell is attracting her to it.
I would try those automated timed feeders for her, then.

(Strangely, enough, my cats do not chew their dry food,...they just tend to swallow it.
I do hear them crunch it at times...but while watching them closely...it looks more like just lick, crunch, swallow.
They also just like to lap up their wet food with tongues.)
They do like to graze at night.

But from reading a lot, it does seem that wet cat food is the best for kidney issues.
I think that a lot of the trouble we see, is also age related, too.
As with people,...our animals age...and health problems usually show up.

"Right now, she is eating the CN canned food on its own."
:yess::banana1::woo::jive:

I'll be praying, too.
Come on Lulu...you can do this.:goodluck:
I never did the timed feeder because I thought it was only for dry food which she did not eat.

I was following the guidance of a Facebook group to feed her. I was using Alnutrin as the meal completer and there were directions on there. The Facebook group was very adamant about following AAFCO standards so I felt comfortable following their advice. For Alnutrin and for kidney disease to keep the phosphorous levels low, I used 6 lbs boneless ground meat and mixed with 3oz of liver along with 40 grams of Alnutrin with eggshell (to compensate calcium not received from bone). Typically this is a raw recipe, but I would cook the meat and add the Alnutrin which can be done. I would then add a lot of water and puree the meat (both for her teeth and to add extra water for early CKD). I would freeze the meat in 2oz containers in my freezer and let them thaw before each meal. So I gave her 8-10oz a day of food mixture but because I added a lot of water, I'm thinking it was closer to 2-6oz of actual meat. I regret getting lazy about measuring before adding water. But making food for her was really over complicating my life and I was getting overwhelmed managing her IBD through diet (and now CKD as well). If she liked the commercial raw brands, I would have given those to her. But she was just so damn picky all the time. Honestly, for years and year and years she was a picky eater. It was always a problem with her. And once she is done with something, she's basically done and you have to start all over with something else if you can even find that something else.

I remember taking her in as a stray kitten...I worked in a restaurant at the time and ordered her a fresh cooked salmon filet. She had ZERO interest in it... was crazy. I don't think she ever liked salmon. And then at 6 years old, she got out of the house and took off (courtesy of my careless ex boyfriend). For 7 nights from dusk till dawn, I searched for her. No amount of food could catch her. Eventually on the 7th night, I had built a fort with her perch and a have-a-heart trap with roasted chicken and then set up night vision cameras. We finally caught her. She was sooooo skinny. I think about that now - how on earth did she not wind up with fatty liver then? She was such a skittish cat and I really don't think she ate for almost a week!! She was never obese so it's difficult to understand how she wound up with it now, either. :( She was so overstimulated when she got out that she did't trust her surroundings, even me when I would spot her in the yard at 4am. She would run away from me. When I finally caught her, I'll never forget.....there was this look of relief in her face. She slept in my arms like she was finally at peace for almost a whole day. It was so unbelievably precious.
 

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Do you think she could have had a gallbladder issue before this whole hepatic episode??
I think it’s possible she had a problem with her gallbladder or bile ducts. We found out my cat had ALT 800 at check up. An internist’s guess was she had something wrong with her gallbladder/bile ducts which was damaging her liver. They said if it wasn’t for the check-up I could have missed it all. Sometimes there is no significant symptom until pancreas is affected from liver-gallbladder and at that stage the cat is anorexic and that causes hepatic lipidosis.
 
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Jenny22

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I think it’s possible she had a problem with her gallbladder or bile ducts. We found out my cat had ALT 800 at check up. An internist’s guess was she had something wrong with her gallbladder/bile ducts which was damaging her liver. They said if it wasn’t for the check-up I could have missed it all. Sometimes there is no significant symptom until pancreas is affected from liver-gallbladder and at that stage the cat is anorexic and that causes hepatic lipidosis.
When I requested bloodwork as Lulu had already stopped eating (she was trying to but clearly she was nauseous), that's when her ALT was also around 800 (850?). She barely ate in 1-2 days at this point. Waiting for the results, taking her to the ER, and then the stress of the ER and them keeping her for another 24 hours without feeding her ....by the time I took her home, she had not eaten for 5 days. I wonder if the results would have been different if I avoided the ER and started force feeding her then. I feel like the ER was a death sentence. :(. Of course, if there is something bigger going on, then it wouldn't have mattered and I would be blaming myself for not taking her to the ER. Tomorrow's bloodwork cannot come soon enough.
 

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When I requested bloodwork as Lulu had already stopped eating (she was trying to but clearly she was nauseous), that's when her ALT was also around 800 (850?). She barely ate in 1-2 days at this point. Waiting for the results, taking her to the ER, and then the stress of the ER and them keeping her for another 24 hours without feeding her ....by the time I took her home, she had not eaten for 5 days. I wonder if the results would have been different if I avoided the ER and started force feeding her then. I feel like the ER was a death sentence. :(. Of course, if there is something bigger going on, then it wouldn't have mattered and I would be blaming myself for not taking her to the ER. Tomorrow's bloodwork cannot come soon enough.
Knowing my own cat had very high liver enzymes but she was almost totally asymptomatic, I always suggest everyone to intervene if their cat doesn't eat more than a day and take them to the vet for tests to check the liver and start to feed the cat by day 3 regardless. In a normal cat, not eating for a day or two typically isn't enough to develop hepatic lipidosis. But if the cat already had issues with her gallbladder-liver, then things are just more sensitive you know. There is even non-anorexic hepatic lipidosis. Maybe your kitty also had a milder version of it.

That said, you're being harsh on yourself. We only get to see the result of our choices. Impossible to know what would happen if you did things differently. Maybe somehow she was going to get too stressed that day and get even worse. Taking care of a pet is constantly taking decisions about them. At times on things we don't fully understand, like their health. Not easy! You're trying to do your best.
 
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Knowing my own cat had very high liver enzymes but she was almost totally asymptomatic, I always suggest everyone to intervene if their cat doesn't eat more than a day and take them to the vet for tests to check the liver and start to feed the cat by day 3 regardless. In a normal cat, not eating for a day or two typically isn't enough to develop hepatic lipidosis. But if the cat already had issues with her gallbladder-liver, then things are just more sensitive you know. There is even non-anorexic hepatic lipidosis. Maybe your kitty also had a milder version of it.

That said, you're being harsh on yourself. We only get to see the result of our choices. Impossible to know what would happen if you did things differently. Maybe somehow she was going to get too stressed that day and get even worse. Taking care of a pet is constantly taking decisions about them. At times on things we don't fully understand, like their health. Not easy! You're trying to do your best.
I want to say that Lulu was pretty asymptomatic at the time that her ALT was over 800. In fact the only symptom was that she just wasn't really eating. She will still playing at this point and did not seem to be in too much discomfort. When she was, I really thought the problem was her teeth - it may have been still. That bloodwork was taken on a Wednesday and it wasn't until Thursday night that she started to become jaundiced. Between Thursday and Friday transferring from one ER to the Internal Medicine ER is when she severely declined. Lulu was eating probably half of her normal calories for 1-2 weeks leading up to this point. I knew about liver failure in cats that did not eat for a few days. But I was unaware that even eating less would lead to hepatic lipidosis. I just thought as long as they were eating, they would be fine. That was sheer ignorance on my part and I'm not sure why I never picked that up with my senior cat while I learned quite a lot this past year going from a healthy cat to lots of cascading issues. I did become overwhelmed this year trying to stay on top of new health issues and how to properly manage them.

Anyway, of course I don't know why she started eating less - that's the mystery. But there are a few things that could have contributed. One is that I do think she was having dental pain. Another is that for the month of November there was loud construction on the floor above me for the new tenant to move in. And in the first week of December, the landlord just finished gutting and renovating my bathroom. Lulu was clearly stressed by the renovations for about a month straight. But I imagine there wouldn't be a lag for when she started eating less unless I was completely unaware at the time. Then of course, there is the idea that something internally was going on - IBD flare, gallbladder, I don't know. I do think I added too much yolk to her homecooked meals. I'm not blaming myself or anyone else as much now that we are weeks into this. I'm trying to stay optimistic or find peace in whatever decision I make in the coming weeks.

And yes, I know I'm very harsh on myself. I try not to be. But my last dog had Lyme disease undetected for 8 months (I had this gut feeling that I should take him to the vet as he was drinking a lot of water but then he stopped so I let it go as I was struggling financially). I think the Lyme disease wreaked havoc untreated for too long and he wound up with cancer and organ failure. But I brushed off his symptoms for old age and a whiny dog. It took a long time to forgive myself when I realized he was trying to tell me something was wrong. I only had 2 weeks with him when I found out it was metastatic lung cancer and that dog was my heart and soul...like my old yeller. ❤ So, now I find myself trying to not repeat those situations. To be aware as much as possible. To listen to my pets. And to advocate for them. When I miss a detail, I guess I feel like I failed. I get it - I need to be kinder to myself. And I'm trying. And you're right - I am doing my best. I can honestly say that I am looking back and doing more than I think most people in my shoes would do; so that brings me peace.

Lulu is yellow for sure. But she actually looks pretty good in other ways. I'll post her updated bloodwork when I get it. I cannot be more grateful for this forum. I had no support in my personal life to get through this and it was making me sick carrying the burden alone. Thank you all so much for being that support I needed and to get me to a place where I feel some stability and can function at work and outside of taking care of Lulu. Last night, she curled up in my arms under the blanket so I could spoon her like she always used to. ❤❤❤
 
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Updated bloodwork for Lulu plus comparisons and notes. I had hoped for a clearer picture here, but it seems like where she has improved in one area, another she has regressed. I really don't know what to make of her bloodwork. The mobile vet simply said to continue treatment. Does this look like there is a bigger issue going on other than fatty liver that may have been missed on the ultrasound?

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Updated bloodwork for Lulu plus comparisons and notes. I had hoped for a clearer picture here, but it seems like where she has improved in one area, another she has regressed. I really don't know what to make of her bloodwork. The mobile vet simply said to continue treatment. Does this look like there is a bigger issue going on other than fatty liver that may have been missed on the ultrasound?

View attachment 407979
Her jaundice has risen significantly. ALT shows liver damage, it's normal for that to elevate too when there is jaundice. Bloodwork shows there is a problem with liver but it cannot show the reason. The next step is usually ultrasound. If there is tumor somewhere or gallstones ultrasound show it, then you get a "this can't be cured unless the tumor is removed" (and she may not be suitable for a surgery with her current liver enzymes and jaundice.) However for other liver problems, as far as I know the treatment/medicine is pretty similar.

I don't know what else to say other than discuss the situation with the vet. Maybe they'll recommend another treatment.
 
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Her jaundice has risen significantly. ALT shows liver damage, it's normal for that to elevate too when there is jaundice. Bloodwork shows there is a problem with liver but it cannot show the reason. The next step is usually ultrasound. If there is tumor somewhere or gallstones ultrasound show it, then you get a "this can't be cured unless the tumor is removed" (and she may not be suitable for a surgery with her current liver enzymes and jaundice.) However for other liver problems, as far as I know the treatment/medicine is pretty similar.

I don't know what else to say other than discuss the situation with the vet. Maybe they'll recommend another treatment.
Yes, I've discussed this with her vets. I called the ER Internal Medicine vet and she reviewed the bloodwork saying they'd want to remove the gallbladder to see what's going on and that procedure would be risky for Lulu. She recommends considering euthanasia. She says I did everything I could and no amount of money or diagnostics probably would have made a difference a couple weeks earlier. Her primary vet suggested taking her off of meds and seeing if she bounces back before rushing to put her down as sometimes it's the meds that really make an animal feel worse. The mobile vet was basically telling me to continue treating her which I have a problem with. Her GGT just came back increased as 24. Her GGT and Bilirubin are the levels that continue to increase. Her ALT actually got better from last week but it's the bilirubin that worries me.

So, I cried last night and decided to focus on palliative care. And Lulu, again she does this when I'm ready to put her down....she ate over 200 calories on her own last night while I was sleeping! She slept in my arms and near me. She greeted me this morning and continued to eat on her own. She walked around effortlessly. She looked normal!! <sigh>. I know it could be just a good day but it always feel like she is trying to tell me she's not ready because she does these 180s when I make a decision to call hospice. I am still focusing on how to keep her comfortable as if these are her last days. Maybe a miracle will happen. But my focus has now shifted towards palliative care and most likely euthanasia.

She already had an ultrasound in the beginning - but I don't think putting her through anymore diagnostics is to her benefit at this point. Surgery would also be out of the question. I will continue to shower her with love and wait for a sign from her on when it's time to go.
 

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Yes, I've discussed this with her vets. I called the ER Internal Medicine vet and she reviewed the bloodwork saying they'd want to remove the gallbladder to see what's going on and that procedure would be risky for Lulu. She recommends considering euthanasia. She says I did everything I could and no amount of money or diagnostics probably would have made a difference a couple weeks earlier. Her primary vet suggested taking her off of meds and seeing if she bounces back before rushing to put her down as sometimes it's the meds that really make an animal feel worse. The mobile vet was basically telling me to continue treating her which I have a problem with. Her GGT just came back increased as 24. Her GGT and Bilirubin are the levels that continue to increase. Her ALT actually got better from last week but it's the bilirubin that worries me.
Jenny, when I looked over the blood results, I only noticed her WBC and Creatinine went up...which I took as Lulu still has an infection going on somewhere...but not sure about what higher Creatinine means.
The Idexx SDMA actually came down, in numbers...so that was surprising.

I didn't see the new GGT numbers...so I must have missed them, and that increase does look higher...compared with 5-18-17-24 number progression.
But wouldn't that just mean that Lulu might still be having gallbladder issues...or a gallbladder flare up?
Were you thinking that it's something worse, going on? like lymphoma?

Her Liver values are actually coming down, like you mentioned, ...which means that the treatment that the mobile Vet has given her...is actually working.
Aren't the Bilirubin levels...going up...just an indicator that the 'recycling system' of a cat's bilirubin...is not working correctly,...and more bilirubin is being spilled into the bloodstream...than can be taken up by the cat's body?
(I'm not sure...since I haven't really looked into how the bilirubin system works...in a cat)

I'm actually terribly shocked that the Internal Medicine Vet is now recommending euthanasia...at this particular time??
Why didn't they recommend it before they did all those expensive diagnostic tests...or when Lulu was under their care?
I really have no faith in them...since how they treated Lulu...at discharge from ER was awful.

I also don't really give much weight to what your primary Vet has to say either. Although, him not rushing to euthanasia, and at least offering a somewhat alternative...is semi okay. Still, I wish that he had done all those ER diagnostics...so that you would have had more money in reserves.

The only Vet, that I would believe at this point is the mobile Vet,...since whatever they gave Lulu is actually working ...and bringing the numbers down...although very, very slowly,...and I guess from reading about hepatic lipidosis, ...that seems to be in line with what others have said, that the illness takes a very long time to reverse.
After one week's treatment, from the mobile Vet, seeing that Lulu's liver values have come down, is somewhat reassuring...and even though, I didn't expect them to come down after a week, the treatment does appear to be working.

Can I ask you, why you have a problem in treating Lulu...as per the mobile Vet's directions?
If it's cost,...than that is entirely understandable,..and if it's time spent doing more blood tests plus cost,...or giving meds, B12 shots,..fluids, this is also understandable.
If you continue on and just give the prednisolone, would that be too costly?
Or just treat Lulu with the meds already given,...and when they run out, keep her only on the liver supplements?
I don't know, just wondering if treating her with food, pred, and or liver supplements would be okay.
So, I cried last night and decided to focus on palliative care. And Lulu, again she does this when I'm ready to put her down....she ate over 200 calories on her own last night while I was sleeping! She slept in my arms and near me. She greeted me this morning and continued to eat on her own. She walked around effortlessly. She looked normal!! <sigh>. I know it could be just a good day but it always feel like she is trying to tell me she's not ready because she does these 180s when I make a decision to call hospice. I am still focusing on how to keep her comfortable as if these are her last days. Maybe a miracle will happen. But my focus has now shifted towards palliative care and most likely euthanasia.

She already had an ultrasound in the beginning - but I don't think putting her through anymore diagnostics is to her benefit at this point. Surgery would also be out of the question. I will continue to shower her with love and wait for a sign from her on when it's time to go.
Maybe that is the best thing...to just shower her with love,...and wait until she tells you when it's time to go.
Not to make yourself worry about any more tests, at all.
:alright::hugs::hugs::grouphug::grouphug::vibes::vibes::caticon:
 
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Jenny, when I looked over the blood results, I only noticed her WBC and Creatinine went up...which I took as Lulu still has an infection going on somewhere...but not sure about what higher Creatinine means.
The Idexx SDMA actually came down, in numbers...so that was surprising.

I didn't see the new GGT numbers...so I must have missed them, and that increase does look higher...compared with 5-18-17-24 number progression.
But wouldn't that just mean that Lulu might still be having gallbladder issues...or a gallbladder flare up?
Were you thinking that it's something worse, going on? like lymphoma?

Her Liver values are actually coming down, like you mentioned, ...which means that the treatment that the mobile Vet has given her...is actually working.
Aren't the Bilirubin levels...going up...just an indicator that the 'recycling system' of a cat's bilirubin...is not working correctly,...and more bilirubin is being spilled into the bloodstream...than can be taken up by the cat's body?
(I'm not sure...since I haven't really looked into how the bilirubin system works...in a cat)

I'm actually terribly shocked that the Internal Medicine Vet is now recommending euthanasia...at this particular time??
Why didn't they recommend it before they did all those expensive diagnostic tests...or when Lulu was under their care?
I really have no faith in them...since how they treated Lulu...at discharge from ER was awful.

I also don't really give much weight to what your primary Vet has to say either. Although, him not rushing to euthanasia, and at least offering a somewhat alternative...is semi okay. Still, I wish that he had done all those ER diagnostics...so that you would have had more money in reserves.

The only Vet, that I would believe at this point is the mobile Vet,...since whatever they gave Lulu is actually working ...and bringing the numbers down...although very, very slowly,...and I guess from reading about hepatic lipidosis, ...that seems to be in line with what others have said, that the illness takes a very long time to reverse.
After one week's treatment, from the mobile Vet, seeing that Lulu's liver values have come down, is somewhat reassuring...and even though, I didn't expect them to come down after a week, the treatment does appear to be working.

Can I ask you, why you have a problem in treating Lulu...as per the mobile Vet's directions?
If it's cost,...than that is entirely understandable,..and if it's time spent doing more blood tests plus cost,...or giving meds, B12 shots,..fluids, this is also understandable.
If you continue on and just give the prednisolone, would that be too costly?
Or just treat Lulu with the meds already given,...and when they run out, keep her only on the liver supplements?
I don't know, just wondering if treating her with food, pred, and or liver supplements would be okay.

Maybe that is the best thing...to just shower her with love,...and wait until she tells you when it's time to go.
Not to make yourself worry about any more tests, at all.
:alright::hugs::hugs::grouphug::grouphug::vibes::vibes::caticon:

So the primary vet thinks the WBC going from high to normal back to high could just be stress related. I passed this onto the mobile vet and she says that could be but there is usually a trend you can see when it is stress and she didn't have the report in front of her. She's going to get back to me on that. Lulu has been on antibiotics for 2 weeks orally and she also had the convenia injection that would have lasted 2 weeks. Intuitively, I just feel like it's time to stop giving her antibiotics. I hope that is not a decision I regret but the primary also suggested it. With IBD, I always think oral antibiotics can do more harm than good in upsetting the gut flora and the immune system. The primary thinks se might do better if scale back the meds.

Surprisingly, I realized that her breath doesn't smell as bad as it did the last few months. It doesn't smell at all now. Could that be from the antibiotics??? It was really bad the last couple of months....So, now I'm wondering did she have an abscess or some bacteria in her mouth this whole time?? Did that travel down to her intestines and actually be the cause of all of this now leading up to her eating less which then resulted in the fatty liver? The reason I dismissed this is because the primary kept saying to me when he first checked her teeth that bad breath is a symptom of tooth resorption even though she didn't have bad breath at the time. When she developed halitosis over the next month or two, I assumed it was the dental disease progressing but he wanted me to wait to address it and to focus on her kidneys first. You see - I'm still racking my brain here! But the fact that she went from terrible breath without addressing the dental issues to no bad breath makes me think that this could have started with a bacterial infection from her mouth and resulted in inflammation of her organs? I mean I eventually realized that her mouth was bothering her leading up to her not eating as much but I really am starting to think that the inflammation in her gut was also brewing unbeknownst to me and related to to the teeth this whole time! Anyway, I digress...

I was also surprised to see the SDMA number go down but the creatine go up since they are both kidney related. I don't really understand what that means, either to be honest. We suspected early kidney disease even though her numbers were stage 2 at best by the IDEXX standards. Why the creatinine is rising I am unsure but it has concerned all of the vets.

You did not see the GGT numbers because they were not ready, yet. So on the report I attached, I did not have access to that very last result - not sure why it was sent on a different day. Because the GGT and the bilirubin have consistently risen, I am worried there is an obstruction or who knows maybe even cancer that was not detected by the ultrasound. Something is causing an "obstruction" Lulu has been on the ursodiol for a week, so that number should have improved if it was merely bile sludge as the mobile vet is convinced. She actually still thinks it is bile sludge and that it will take time to clear. The only comforting factor here is that I think prednisolone helped her. Since prednisolone is used for inflammation, that makes me think maybe it is just inflammation and not actually an obstruction like gallstones that are worsening those numbers. And as per my paragraph above, maybe the inflammation is related to bacteria that traveled from her teeth? Even if the antibiotics worked, I wonder if residual inflammation is just a result of the trauma that was developing internally. I'm not a vet, so I really don't know.

Yes, I think the mobile vet's treatment is working....to a degree. And I was thrilled to see some of those liver enzymes go down. But the ursodiol should have made a difference with the GGT and bilirubin numbers. So, I am concerned that what is going on here might be out of the mobile vet's capability in reversing. I'm really worried it could be cancer or like I said, an obstruction that would warrant surgery which is just not an option for her for so many reasons. This is why I am not keen on continuing to aggressively treat her. If it is merely bile sludge, then it will clear on its own as the mobile vet thinks with a little support. Maybe prednisolone is the answer to getting the sludge to move as it would decrease inflammation in those pathways? I know optimism is usually a good thing, but I just felt it was a red flag that this vet wasn't even considering the possibility that we could be dealing with a bigger issue. I don't want to indefinitely treat my cat for something that turns out not to be just "fatty liver" but terminal as the IM vet suspects and I've caused her to needlessly suffer in the process.

The ER vet did not mention euthanasia even when I brought it up the first go round at the ER. She sounded shocked I asked as I had no idea what I was dealing with or how serious it was. She said she would always try to treat a cat before putting them down and so that gave me hope at the time that Lulu had a shot here. But this was a different IM vet that I spoke to yesterday. Lulu must have seen a few different ones while she was there and I got a hold of whoever was on the shift yesterday. I think the reason why this IM vet is pointing towards considering euthanasia is because I was adamant that I would not put Lulu through anymore diagnostics or testing or even surgery (other than bloodwork) to figure out what is causing the elevated GGT or bilirubin. Even if I had the money, sending her back to the ER for these diagnostics would have been a death sentence for her and what for? To confirm the worst case scenario? She said that she would have hoped that I would see a more significant recovery by now and so these numbers are worrying just as is Lulu's behavior or subtle improvements. She didn't recommended I put Lulu down right away but it was more along the lines of palliative care with the belief that Lulu had something bigger going on and was not going to improve.

So now....on the flip side....Of course when I again get it in my head that I am going to schedule euthanasia, it's almost like my cat fights back! She ate like 200 calories on her own last night!! She ate more this morning and has gone to the food bowl a few times today to eat. Even when I syringe her some baby food, I only have to syringe 1-3 ml and then she licks the rest up on her own. Her body language looks much healthier, too. Don't get me wrong, she still has moments of looking uncomfortable and shows zero interest in playing. But, there are other good signs like grooming, and gaining weight, and more energy, and eating on her own. I haven't even had to give her an anti-nausea pill in 2 days (knock on wood). She even greeted me this morning and last night she slept with me as if nothing was wrong. So, while crossing my fingers that this is not just a good day and maybe she has turned a corner, I also know that I need to remain realistic that there is still something going on and she may continue to get worse.

My game plan is palliative care for now. Make her comfortable. Give her love. Do not rush to put her down; give her a chance unless I think she is in pain. I will not let her suffer. But as long as she is showing signs that she is fighting and is comfortable with the help of meds, I will follow her behavior and maybe run one more blood test to stay realistic. I am very worried about the GGT and bilirubin numbers, honestly. But she does look better?? If those numbers continue to rise, well I don't know what to think... But they say treat the cat, not the numbers...right?

I might also be feeling pressure. I got into a small tiff with someone on social media that implied I was not taking my cat's quality of life into consideration. 🙄 So absurd... it is literally ALL I have been doing from the beginning.
 
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Surprisingly, I realized that her breath doesn't smell as bad as it did the last few months. It doesn't smell at all now. Could that be from the antibiotics??? It was really bad the last couple of months....So, now I'm wondering did she have an abscess or some bacteria in her mouth this whole time?? Did that travel down to her intestines and actually be the cause of all of this now leading up to her eating less which then resulted in the fatty liver? The reason I dismissed this is because the primary kept saying to me when he first checked her teeth that bad breath is a symptom of tooth resorption even though she didn't have bad breath at the time. When she developed halitosis over the next month or two, I assumed it was the dental disease progressing but he wanted me to wait to address it and to focus on her kidneys first. You see - I'm still racking my brain here! But the fact that she went from terrible breath without addressing the dental issues to no bad breath makes me think that this could have started with a bacterial infection from her mouth and resulted in inflammation of her organs? I mean I eventually realized that her mouth was bothering her leading up to her not eating as much but I really am starting to think that the inflammation in her gut was also brewing unbeknownst to me and related to to the teeth this whole time! Anyway, I digress...
I honestly do think that a lot of damage to other organs, is actually caused by dental issues (in my 15.5 year old rainbow cat, he did have bad breath, heart murmur, and then diagnosed with CKD after the teeth extractions..at the age of 14)...so it makes a lot of sense, what you are saying about the mouth bacteria possibly causing inflammation in Lulu's other organs.
Yet, it is also possible that her IBD, inflammation in her intestines was a separate issue, related to sensitivities or allergies to certain ingredients in food, too.
Plus, Lulu could have developed gallbladder and liver issues, from either bacteria, like you are thinking, food causes, or even just flare ups with blockages, over time, from the sludge forming,...and not being adequately filtered or flushed out.

I think when a cat is older, especially a senior, then any number of 'perfect storms'...so to speak, can converge,...to cause so many different issues.
All we can really do is concentrate on those that we can treat.
Also, hoping that our cats respond to treatment.
I was also surprised to see the SDMA number go down but the creatine go up since they are both kidney related. I don't really understand what that means, either to be honest. We suspected early kidney disease even though her numbers were stage 2 at best by the IDEXX standards. Why the creatinine is rising I am unsure but it has concerned all of the vets.

You did not see the GGT numbers because they were not ready, yet. So on the report I attached, I did not have access to that very last result - not sure why it was sent on a different day. Because the GGT and the bilirubin have consistently risen, I am worried there is an obstruction or who knows maybe even cancer that was not detected by the ultrasound. Something is causing an "obstruction" Lulu has been on the ursodiol for a week, so that number should have improved if it was merely bile sludge as the mobile vet is convinced. She actually still thinks it is bile sludge and that it will take time to clear. The only comforting factor here is that I think prednisolone helped her. Since prednisolone is used for inflammation, that makes me think maybe it is just inflammation and not actually an obstruction like gallstones that are worsening those numbers. And as per my paragraph above, maybe the inflammation is related to bacteria that traveled from her teeth? Even if the antibiotics worked, I wonder if residual inflammation is just a result of the trauma that was developing internally. I'm not a vet, so I really don't know.
Even if you are not a vet, you really do think logically, and are able to absorb so much of this information, and explain it well.
Not to mention your observations, and further questions are also very logical.
Yes, I think the mobile vet's treatment is working....to a degree. And I was thrilled to see some of those liver enzymes go down. But the ursodiol should have made a difference with the GGT and bilirubin numbers. So, I am concerned that what is going on here might be out of the mobile vet's capability in reversing. I'm really worried it could be cancer or like I said, an obstruction that would warrant surgery which is just not an option for her for so many reasons. This is why I am not keen on continuing to aggressively treat her. If it is merely bile sludge, then it will clear on its own as the mobile vet thinks with a little support. Maybe prednisolone is the answer to getting the sludge to move as it would decrease inflammation in those pathways? I know optimism is usually a good thing, but I just felt it was a red flag that this vet wasn't even considering the possibility that we could be dealing with a bigger issue.
Oh, okay. It's because of the issue that the mobile vet, is not considering that it might be something like cancer, instead of the bile sludge causing the obstruction.
I don't want to indefinitely treat my cat for something that turns out not to be just "fatty liver" but terminal as the IM vet suspects and I've caused her to needlessly suffer in the process.
Ahh, okay. I get it now.
Your fear is that you are causing Lulu to suffer, by prolonging her life with treatment,...for this 'fatty liver,'...but she may have a terminal condition...which was not easily diagnosed...on the previous ultrasound.
You are basing that on what the IM vet suspects.
The ER vet did not mention euthanasia even when I brought it up the first go round at the ER. She sounded shocked I asked as I had no idea what I was dealing with or how serious it was. She said she would always try to treat a cat before putting them down and so that gave me hope at the time that Lulu had a shot here. But this was a different IM vet that I spoke to yesterday. Lulu must have seen a few different ones while she was there and I got a hold of whoever was on the shift yesterday. I think the reason why this IM vet is pointing towards considering euthanasia is because I was adamant that I would not put Lulu through anymore diagnostics or testing or even surgery (other than bloodwork) to figure out what is causing the elevated GGT or bilirubin. Even if I had the money, sending her back to the ER for these diagnostics would have been a death sentence for her and what for? To confirm the worst case scenario? She said that she would have hoped that I would see a more significant recovery by now and so these numbers are worrying just as is Lulu's behavior or subtle improvements. She didn't recommended I put Lulu down right away but it was more along the lines of palliative care with the belief that Lulu had something bigger going on and was not going to improve.
I don't know, I think it's the whole 'consider euthanasia'..."if you're not going to do anymore diagnostics with us"..approach...that I find to be terrible...coming form the IM vet.
Yes, you definitely have to prepare yourself for eventual euthanasia...
and because they are vets, ...they may be helping you prepare for this outcome...but it's still good that she didn't recommend putting Lulu down, right away.
Sorry, about that. I entirely misunderstood.
So now....on the flip side....Lulu ate like 200 calories on her own last night!! She ate more this morning and has gone to the food bowl a few times today to eat. Her body language looks much healthier. She even greeted me this morning and last night she slept with me. So, while crossing my fingers that this is not just a good day, I am going to remain realistic that there is still something going on and she may continue to get work. But I will give her the most love and care I can to be comfortable and will not rush to put her down. As long as she looks "good" I will give her a chance to recover. I already got into a small tiff with someone on Facebook that implied I was not taking my cat's quality of life into consideration. 🙄
Jenny, I think you are a very realistic and caring cat guardian.
So don't let some random person, on facebook, make you think otherwise.
(even if that person is part of some hepatic lipidosis group)

You've always mentioned your Lulu's quality of life, and how she acts, looks, and where you will draw the line, once her quality of life is no longer there.
I would do exactly what you are doing, and take it day by day. :hugs: :grouphug: :hugs:

(One of my old Vets, in the past, told me,...that I would know, if my cat's time has come, if he completely stops eating, cannot make it to the water bowl, or litter box, and starts to hide. If he does not move about, and has more terrible days than good ones.)

That person, whoever they may be,...is not in your shoes, does not see what you see.
Only you can make that decision, and I know, just from all that you wrote in this thread, that when you do see those signs that Lulu has had enough, that you will say goodbye to her.
It does not sound like that time, is right now, either.

Hoping your Lulu has another good night, continues to eat on her own, and greets you whenever she wants.
Okay, maybe not when you are actually sleeping...since yeah...you need your sleep, too. :bluepaw:
(I mean not waking you by meowing, :blush:...sleeping with you is good.:thumbsup:)
Have a good night. :greenpaw:
 
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Jenny22

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I honestly do think that a lot of damage to other organs, is actually caused by dental issues (in my 15.5 year old rainbow cat, he did have bad breath, heart murmur, and then diagnosed with CKD after the teeth extractions..at the age of 14)...so it makes a lot of sense, what you are saying about the mouth bacteria possibly causing inflammation in Lulu's other organs.
Yet, it is also possible that her IBD, inflammation in her intestines was a separate issue, related to sensitivities or allergies to certain ingredients in food, too.
Plus, Lulu could have developed gallbladder and liver issues, from either bacteria, like you are thinking, food causes, or even just flare ups with blockages, over time, from the sludge forming,...and not being adequately filtered or flushed out.

I think when a cat is older, especially a senior, then any number of 'perfect storms'...so to speak, can converge,...to cause so many different issues.
All we can really do is concentrate on those that we can treat.
Also, hoping that our cats respond to treatment.

Even if you are not a vet, you really do think logically, and are able to absorb so much of this information, and explain it well.
Not to mention your observations, and further questions are also very logical.

Oh, okay. It's because of the issue that the mobile vet, is not considering that it might be something like cancer, instead of the bile sludge causing the obstruction.

Ahh, okay. I get it now.
Your fear is that you are causing Lulu to suffer, by prolonging her life with treatment,...for this 'fatty liver,'...but she may have a terminal condition...which was not easily diagnosed...on the previous ultrasound.
You are basing that on what the IM vet suspects.

I don't know, I think it's the whole 'consider euthanasia'..."if you're not going to do anymore diagnostics with us"..approach...that I find to be terrible...coming form the IM vet.
Yes, you definitely have to prepare yourself for eventual euthanasia...
and because they are vets, ...they may be helping you prepare for this outcome...but it's still good that she didn't recommend putting Lulu down, right away.
Sorry, about that. I entirely misunderstood.

Jenny, I think you are a very realistic and caring cat guardian.
So don't let some random person, on facebook, make you think otherwise.
(even if that person is part of some hepatic lipidosis group)

You've always mentioned your Lulu's quality of life, and how she acts, looks, and where you will draw the line, once her quality of life is no longer there.
I would do exactly what you are doing, and take it day by day. :hugs: :grouphug: :hugs:

(One of my old Vets, in the past, told me,...that I would know, if my cat's time has come, if he completely stops eating, cannot make it to the water bowl, or litter box, and starts to hide. If he does not move about, and has more terrible days than good ones.)

That person, whoever they may be,...is not in your shoes, does not see what you see.
Only you can make that decision, and I know, just from all that you wrote in this thread, that when you do see those signs that Lulu has had enough, that you will say goodbye to her.
It does not sound like that time, is right now, either.

Hoping your Lulu has another good night, continues to eat on her own, and greets you whenever she wants.
Okay, maybe not when you are actually sleeping...since yeah...you need your sleep, too. :bluepaw:
(I mean not waking you by meowing, :blush:...sleeping with you is good.:thumbsup:)
Have a good night. :greenpaw:
Thank you so much for all of your kind words. ❤❤❤ I will keep you all updated. And no matter which way this goes, hopefully my thread will be helpful for someone else.
 

all4mom2

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Having read this loooong thread (you're lucky to have gotten so much feedback -- I've hardly gotten any), I'll chime in to say palliative care is definitely the way to go with a 14-year-old cat. I see so many people bankrupt and exhaust themselves and torment their senior pets with vet visits, overnight stays, tests, and procedures, and in the end it always ends the same way, as they can't live forever. Keep him happy, safe, and loved at home for however many days he has left. An HONEST vet would give you the same advice...
 
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Jenny22

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Having read this loooong thread (you're lucky to have gotten so much feedback -- I've hardly gotten any), I'll chime in to say palliative care is definitely the way to go with a 14-year-old cat. I see so many people bankrupt and exhaust themselves and torment their senior pets with vet visits, overnight stays, tests, and procedures, and in the end it always ends the same way, as they can't live forever. Keep him happy, safe, and loved at home for however many days he has left. An HONEST vet would give you the same advice...
I feel lucky, as well. When Lulu was immediately sick I took her to the ER, but I took her out of that place as quickly as I possibly could and vowed not to bring her back under any circumstances. I slept in the parking lot when she stayed overnight; I had no choice as she needed the ultrasound to see what was going on and the Internal Medicine vet did not arrive until the next morning (I had taken her to the ER at night). I also said no to biopsies or surgeries of any means. I know where to draw the line with her.

Lulu turned a corner the other day. She almost looks normal...very close to it and eating on her own now. I know to take it with a grain of salt unless this becomes her norm. I'm thinking I would get one more round of bloodwork next week to evaluate the GGT and bilirubin ONLY if she continues to look good - and that would allow me to stay realistic on if she is actually going to make a full recovery or not.

Yes, she is 14. No, I would not try to extend her life if this clearly felt like the end. Her getting sick with a treatable condition has been very confusing on what the right decisions are to be made. It was never black and white and the grey area was so subjective to vets, myself, and others I reached out to me support. Of course, there is the matter that lead to the liver fatty but I am inkling of what that was. To me, I think if it's going to take months for her to recover, then I am not willing to put her through that even if it is reversible. And by months, I mean her clearly feeling uncomfortable for that length of time not just a little off or lethargic. I also draw the line at surgery. If she needs surgery to recover, that is when I know it's time. If she is recovering on her own, then I know I need a plan of action to improve her quality of life after this mess (as I know her dental disease was a big issue here).

In the interim, I only know she is not ready to go yet. And despite her mobile vet remaining optimistic and relieved that I did not put her down as I thought I was going to sooner, I am still approaching this situation with palliative care and a focus on making her comfortable. I've scaled back on some meds and given her space. She's either going to continue to get better as she has been all week or she is going to get worse. And in the case that she gets worse or the bloodwork shows no improvement with the gallbladder and bilirubin, then I think it's safe to say that her quality of life is diminishing the longer this goes on.
 
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