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

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Hi Jenny, I was wondering if those 'urine dipsticks'...that some members have used for their diabetic cats, would help at all in Lulu's situation:
Would catching her urine, free flow, and then using a syringe to place drops on the 'urine stick pads'...which change colour, indicating bilirubin, or 'urobilinogen'....being present...help at all.
It's probably not accurate enough, since it is subjective,...due to colour changes...but it does seem a lot less expensive.
Just a thought, ..as I have never actually tried to use them myself.
Checkup Pet Wellness Urinalysis Testing Kit Urine Testing for Dogs & Cats, 50 strips - Chewy.com
I also wonder how accurate they are.

I read about them on this website...but I'm having a hard time absorbing and understanding all the differences between conjugated and unconjugated bilirubin, so really not sure.
Bilirubin – eClinpath
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.
On another note, I was just wondering...if you were to go back,...just a month and a bit...and compare how Lulu was looking and acting,...then,...and now?
Is she showing major improvements?
From your above update,...it does sound like she has.
Because if she did have cancer, then I doubt that she would be improving at all...so I'd scratch that cause off the list.
 
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Jenny22

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Hi Jenny, I was wondering if those 'urine dipsticks'...that some members have used for their diabetic cats, would help at all in Lulu's situation:
Would catching her urine, free flow, and then using a syringe to place drops on the 'urine stick pads'...which change colour, indicating bilirubin, or 'urobilinogen'....being present...help at all.
It's probably not accurate enough, since it is subjective,...due to colour changes...but it does seem a lot less expensive.
Just a thought, ..as I have never actually tried to use them myself.
Checkup Pet Wellness Urinalysis Testing Kit Urine Testing for Dogs & Cats, 50 strips - Chewy.com
I also wonder how accurate they are.

I read about them on this website...but I'm having a hard time absorbing and understanding all the differences between conjugated and unconjugated bilirubin, so really not sure.
Bilirubin – eClinpath

On another note, I was just wondering...if you were to go back,...just a month and a bit...and compare how Lulu was looking and acting,...then,...and now?
Is she showing major improvements?
From your above update,...it does sound like she has.
Because if she did have cancer, then I doubt that she would be improving at all...so I'd scratch that cause off the list.
OKAY....so this is going to be long...sorry. 😬

I actually have one of those free catch urine kits. I got it off of Amazon I think but not sure it tests bilirubin. She would need to urinate in the litterbox with whatever non absorb litter it comes with. I haven't tried it because I was unsure she would use it. She's finicky. She once peed on a blanket of mine because I changed her litterbox to one that had a hood. She eventually got used to it, but I could not believe she did that. So many years ago... Anyway, the mobile vet told me I could use those even to just catch the urine and then give to her in the past. But to use the kit it comes with, I'm unsure. I'll double check. By the way, all her bilirubin levels were elevated so I don't know what they all mean but I don't think it matters if they are all climbing, right?

I will say this - and also funny you mention her urine. I read that with jaundice the urine is usually orange in color. I haven't actually noticed it to be that dark or that shade. I use World's Best Kitty Litter for her which is a pale yellow due to being corn based. But her urine did get darker. Like a more saturated deep yellow when scooping up clumps. Just today, I noticed that the clumps are shifting back to a paler color so that the litter actually looks the same color dry as wet. I'm not sure if this is a good sign. Could it be? On a side note, I noticed that Lulu's urine was darker weeks ago...maybe over a month ago - I thought this was a good sign since her urine looking clear was a bad sign for kidney disease. I thought her urine having a color to it meant her kidneys were maybe functioning better. Now, I get a little worried and am starting to overthink if she had something going on with her bile ducts for longer than I thought and before the fatty liver set in?? I don't know. Again, could be overthinking this. She went 3 months without bloodwork, so all of this had to have developed in that time span in which I can at least say the halitosis did develop and her more frequent acid pukes also developed. So, I don't really know...

To answer your question, the timeline goes as follows:

- October...her bloodwork was fine with possible early kidney disease (stage 2 at best because her urine was clear and her creatinine slightly raised). Other than that, all normal though I should go back and double check to be honest

- November - December... I always gave Lulu small frequent meals as it curbed her vomiting but I was noticing that the time in between meals needed to be shorter or she would have what I suspected was acid reflux (having them more and more often in the morning). Sometimes, they were somewhat projectile. I also noticed that her breath really started to stink. But other than this, everything else was normal. Oh - one thing I am still confused about is that she started to walked and step MORE CAREFULLY. I tried to tell her vet this as it was odd behavior but he brushed it off just like the inappetence. She's still doing it - could it be from muscle weakness? I at one point thought it was her eyesight.. She didn't show these signs when playing. When playing, she was running and jumping and not the least bit careful though she didn't always react to the toy. The walking... It was just went she was walking towards me, and she would ever so gently and carefully test the blanket with her paw as she stepped on it. Almost like she needed to make sure it was there? I can't find any information online what this is a behavior.

- December 9th - 16th?? The bathroom renovation finally finished a week earlier and I know it was stressing her out. But I did start to notice that she was eating less. I would give her 2oz homemade meals in intervals...About 3-4 of them a day. I started giving an extra in the middle of the night to curb her morning vomits. Instead of eating 4, she was eating only 2-3 a day around this time period. She also seemed more lethargic I thought.

- December 16th - 27th... Lulu's eating became less and less until she pretty much stopped completely by the 27th. Again, I thought this was her teeth and frantically called her vet asking for pain meds. She was still playing, but she did look like she was in pain - she wouldn't let me touch her mouth so I assume it was only dental at the time. At one point, I saw her drooling before she started vomiting and her stomach was spazzing pretty significantly to get it out. I never saw her drool before. So this is one of the reasons I start to suspect she is experiencing severe nausea and not just dental pain.

- December 27th - 29th... I am watching her stance carefully and beginning to think she is not just having dental pain but also nauseous as per the last paragraph. The churu treats from the vet didn't work and made her sicker. I demanded bloodwork for a further evaluation. Overall, Lulu is still playing and looks ok. She's just not eating and seems nauseous from time to time. She really did not look sick at this point. All of the other instances I mentioned above were very fleeting and not often minus the bad breath. That was pretty constant.

- December 30th - 31st... I get the bloodwork results and Lulu's ALT is over 800 along with other elevated enzymes. But she still looks pretty good and is playing and climbing on me. I take her to the first ER where we noticed she has become jaundiced. I am then told to drive an hour away to another ER where they keep her overnight until the Internal Medicine vet arrives the next morning. I don't get her back until 10pm that night because they are so understaffed. By the time I get her back, she's a different cat completely. Mind you, she has barely eaten in 5 days at this point (not including her appetite becoming and less and less the two weeks leading up to this week).

- January 1st - 6th...First days of syringe feeding and getting Lulu back up to 200 calories a day . Lulu looks MISERABLE. First couple of nights she paced like she wanted to vomit but couldn't. She is actually vomiting through the anti nausea meds from time to time. She's very jaundice at this point and continues to become more jaundice as the week goes on. She looks as though she is in constant pain. 24/7 sitting in a hunched position with squinted eyes. Does not play at all. Shows no interest in anything. Does not eat. Does not even really react to me. She's clearly weak and has lost weight. It was gut wrenching. There were fleeting moments where she showed some interest in food but I still could not get her to eat on her own. I was unable to get my hospice appointment back or else she would have already been put down as I honestly could not bear to see her go another week like this. So, I went to the mobile vet instead who believes she's not that bad and does bloodwork which we know is going to be worse cause she is a DIFFERENT cat since leaving the ER vs her before ER bloodwork. Plus, she's much more yellow. I had one surprising day here where I opened a can of fancy feast for the first time in years and she came running for it. But after a few licks, she was over it. Temptation treats she also hadn't had in years. And so I opened a bag and she looked like a crazy cat on crack chasing me and jumping on the couch for some. But again, this behavior was fleeting.

- January 7th - 14th... Lulu is clearly still uncomfortable, but I feel like she is in less pain. She seems to be walking around more. She is showing more interest to food, but it's very hot and cold whether she will eat on her own that day. But I'm not noticing the same 24/7 hunched position with some groaning and squinted eyes. Now, the arch of her back is a little lower, her eyes are a little more open, and sometimes she looks completely relaxed in her form. She is very very lethargic, however - maybe even more so than the week before. And I have switched her from cerenia & ondansetron to just ondansetron as I really did not like how the cerenia was affecting her. She continues to become more yellow despite showing improvements in other areas. She went from looking like constant pain to looking constantly uncomfortable or nauseous. This is also the week where she has had liver support and fluids and vitamins, etc. We run new bloodwork to see if there are any improvements.

- January 15th - 18th... The blood test results are both great and devastating to me at least. The mobile vet shows concerns but really strongly believes my cat is going to pull through this. Her liver enzymes are going down! Great! Her WBC has fluctuated which her primary thinks is due to stress. Her creatine is up which is concerning to all vets. But the most concerning is her GGT and her bilirubin continue to climb. And so this would explain why she continued to get yellow even though she was showing improvements. Again, I am worried that she wasn't showing significant enough improvements, that she was still clearly suffering, and that there was something bigger going on which is what the Internal Medicine vet at the ER also thinks. She says she does not believe the cat is in pain but she is probably very uncomfortable and without knowing for sure if there is a bigger issue here and unable to put her through surgery that palliative care was a good next step. The mobile vet thinks it's just sludge and it needs time to clear. Me, personally? I can't let me cat needlessly suffer... she's still not eating on her own. She has become averse to just about any canned food, protein, raw food I could think of. To be honest, I was giving up again and decided to stop aggressively treating her. This night I didn't try to syringe feed her 200 calories. I left it at 100 and went to bed stroking her face that I loved her and that I was sorry I couldn't fix this - tomorrow I would call hospice back.

- January 19th to 21st (Today)... I wake up to find out that Lulu ate almost 200 calories on her own last night!! She had about 50 calories in CN canned food I left in her bowl. She ate like another 100-150 calories in temptation treats I left out. And she slept in my arms and beside me all night in a super comfortable form. That day, she continued to eat and graze as she did when she was healthy. I only had to syringe feed her about 3ml of baby food, and she would eat the rest on her own. I couldn't believe it! Her body language was better, her energy was better, she continued to gain weight, she was now eating on her own, I was waking up to her sleeping next to me like she always used to instead of wanting to be alone. And I was able to stop any sort of anti-nausea meds. She was not vomiting at all. The one thing I changed here- I added Prednisolone! So on prednisolone by itself, both her appetite was stimulated, and her nausea seemed to have dissipated. Over the next couple of days, she continued to eat on her own and her body language improved. I still would syringe some food just to get her appetite going, but she would then finish the portion without a syringe.I did stop the fluids since she was now getting enough energy to fight me. She was no longer on any pills as she was also fighting me on that. She still looks VERY lethargic. But I see her in a more comfortable form and relaxed, head up, eyes open watching me, more energy. She still will not play and shows zero interest in anything. And I don't see a difference in her jaundice. Also, she does have moments where she does look uncomfortable still. Today, she ate less than the day before, she seemed very uncomfortable, maybe nauseous for most of the day. And she has been hiding underneath the blanket every now and then. I don't know if that's because I brought my dog back home and he's clumsy and big and not her favorite. If she's cold... or if she's having a bad day.

I know this was a super long response. But to answer your question - she is MUCH better than when I brought her home from the ER 3 weeks ago. But she is still MUCH worse from right before I brought her to the ER a day earlier. And though the ultrasound did not detect cancer, I feel like it can't be ruled out because prednisolone can kill cancer cells as per her primary vet. And I know it is used heavily for lymphoma. So, there is a possibility that her improvement in behavior is almost placebo in that it really is cancer and the prednisolone is making her more comfortable and hungry. I just don't know. I'm hoping that the inflammation in her gall bladder and bile ducts is being calmed down by the prednisolone and allowing the bile sludge to move. That's what I hope is the problem. If someone were to say that the treatment for fatty liver was a linear progression, then that would make it so much easier to know if she was getting better or worse. But it is so darn up and down...

For now, I continue to treat this as a palliative care case and to see if she continues to get better or if she starts to show signs that she is worse. And of course, in terms of her quality of life - I can't let her be this uncomfortable for weeks. We are 3 weeks in and she has improved...definitely. But really, is it enough?? Did she improve enough for me to warrant letting her continue to go through this before I decide enough is enough. Yes, she's eating and drinking and using the litterbox and mobile. But she's also lethargic and shows no interest in anything and at times clearly still uncomfortable though not nearly as often anymore. At one point does one say that it's time as she is senior cat with co-morbidities and issues that would need to be addressed even if she is pulling through. I have been in such a limbo for too long...putting my cat down when she is improving feels like I am prematurely giving up. But allowing her to stay alive because she has shown improvements also feels like a sin in the case that she was never going to make a full recovery. I was hoping to run one more blood test to really evaluate if this is placebo or if all of her numbers are finally going down.
 

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My feeling is that by the time kitties get to be 14 or more, something is always going wrong; they're coming to the end of their natural lifespans. We can spend every minute of every day and every last penny we earn (and even go deeply into debt) trying to test, measure, monitor, screen, correct, and obsess over every problem they have, but there will always be something else or the threat of something else going wrong with them...

Unfortunately, most vets today seem to encourage this -- for obvious reasons.

I think at some point all we can do is try to give them the most pain-free, stress-free rest-of-their-lives that we can. We don't always do that right (I know *I* don't), but we can try.
 

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If someone were to say that the treatment for fatty liver was a linear progression, then that would make it so much easier to know if she was getting better or worse. But it is so darn up and down...
I am just not exactly sure that linear progression is necessarily 'the norm'. I scrolled through this thread looking for @mrsgreenjeans to have responded, and if she did, I somehow missed it. I know she has dealt with a cat with hepatic lipidosis, and if I recall correctly it took at least 4 months to get to a better place with her cat. Perhaps she can at least let you know more about her situation. I know I have read similar stories, and if I remember any of their names, I will let you know.
 

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I know this was a super long response. But to answer your question - she is MUCH better than when I brought her home from the ER 3 weeks ago. But she is still MUCH worse from right before I brought her to the ER a day earlier. And though the ultrasound did not detect cancer, I feel like it can't be ruled out because prednisolone can kill cancer cells as per her primary vet. And I know it is used heavily for lymphoma. So, there is a possibility that her improvement in behavior is almost placebo in that it really is cancer and the prednisolone is making her more comfortable and hungry. I just don't know. I'm hoping that the inflammation in her gall bladder and bile ducts is being calmed down by the prednisolone and allowing the bile sludge to move. That's what I hope is the problem. If someone were to say that the treatment for fatty liver was a linear progression, then that would make it so much easier to know if she was getting better or worse. But it is so darn up and down...
Yes, it definitely seems like its up and down. :frown:
Much like FeebysOwner has mentioned, in the post above, it's not a linear progression at all....when it comes to healing.

Take a look at the chart...posted in this website:
The chart is at the bottom of the page,...and shows the way that certain liver values actually go up, and then down, with healing during the 13 days. (specifically ALP, GGT, and Total Bilirubin)
GGT – eClinpath
Indicators of cholestasis – eClinpath

(It does not make your decisions any easier, since like you said, this disease's treatment is not linear at all. The only thing it may help deciding, is when to choose to do further bloodwork, or not do it,...since it does not seem there are any patterns in the ups and downs...on the bloodwork. Maybe the mobile Vet would know about this...and guide you to not have to do any unnecessary bloodwork.)

Tell her that you have very limited funds, and cannot afford doing them all. Only the ones that would help you the most...in making any further decisions.
For now, I continue to treat this as a palliative care case and to see if she continues to get better or if she starts to show signs that she is worse. And of course, in terms of her quality of life - I can't let her be this uncomfortable for weeks. We are 3 weeks in and she has improved...definitely. But really, is it enough?? Did she improve enough for me to warrant letting her continue to go through this before I decide enough is enough. Yes, she's eating and drinking and using the litterbox and mobile. But she's also lethargic and shows no interest in anything and at times clearly still uncomfortable though not nearly as often anymore. At one point does one say that it's time as she is senior cat with co-morbidities and issues that would need to be addressed even if she is pulling through. I have been in such a limbo for too long...putting my cat down when she is improving feels like I am prematurely giving up. But allowing her to stay alive because she has shown improvements also feels like a sin in the case that she was never going to make a full recovery. I was hoping to run one more blood test to really evaluate if this is placebo or if all of her numbers are finally going down.
Whatever you decide to do, J Jenny22 ...just know we will support you, no matter what. :hugs::grouphug::hugs:

It's harder for you, since one day Lulu is eating well, and then the next she may not feel the greatest, then she bounces up again.
By the way, all her bilirubin levels were elevated so I don't know what they all mean but I don't think it matters if they are all climbing, right?
I think with the different bilirubin levels, it matters more to the vets, since they use those different values in determining causation, and progression.
Bilirubin – eClinpath
 

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I scrolled through this thread looking for @mrsgreenjeans to have responded, and if she did, I somehow missed it. I know she has dealt with a cat with hepatic lipidosis, and if I recall correctly it took at least 4 months to get to a better place with her cat. Perhaps she can at least let you know more about her situation.
And to no surprise to me - I managed to screw up mrsgreenjeens mrsgreenjeens name, so my previous post did not elicit her attention.
 
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Jenny22

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Yes, it definitely seems like its up and down. :frown:
Much like FeebysOwner has mentioned, in the post above, it's not a linear progression at all....when it comes to healing.

Take a look at the chart...posted in this website:
The chart is at the bottom of the page,...and shows the way that certain liver values actually go up, and then down, with healing during the 13 days. (specifically ALP, GGT, and Total Bilirubin)
GGT – eClinpath
Indicators of cholestasis – eClinpath

(It does not make your decisions any easier, since like you said, this disease's treatment is not linear at all. The only thing it may help deciding, is when to choose to do further bloodwork, or not do it,...since it does not seem there are any patterns in the ups and downs...on the bloodwork. Maybe the mobile Vet would know about this...and guide you to not have to do any unnecessary bloodwork.)

Tell her that you have very limited funds, and cannot afford doing them all. Only the ones that would help you the most...in making any further decisions.

Whatever you decide to do, J Jenny22 ...just know we will support you, no matter what. :hugs::grouphug::hugs:

It's harder for you, since one day Lulu is eating well, and then the next she may not feel the greatest, then she bounces up again.

I think with the different bilirubin levels, it matters more to the vets, since they use those different values in determining causation, and progression.
Bilirubin – eClinpath
Thank you ❤ Lulu's liver enzymes went up and then started coming down. So that is good. But it seems something is still blocking her gall bladder or bile ducts based on the GGT and bilirubin numbers escalating from a week ago (hoping it's just inflammation since prednisolone seemed to help). I like going off of these specific numbers because if these levels go down, then I know she is on the road to a full recovery as far as I can see and in terms of the HL. If they continue to elevate, then I feel it is safe to say that something else is going on. I said this last time before the last bloodwork but she turned a corner and her behavior continued to improve even when those numbers were escalated so I didn't want to make a decision to let her go just yet. I felt I should give her a chance.

I reached out to the town Facebook page to see if someone could help with the subQ fluids because she really has improved overall! And I know they will make her feel better. This person has been working with a rescue for years and has seen hepatic lipidosis so many times, and all of them in senior cats she says. When she saw Lulu, she was surprised by how good she looks and how much energy she had. It seems everyone that sees Lulu actually thinks she looks very healthy and good for a cat with HL and is surprised I have considered euthanasia (while of course I get passed judgements from others). Maybe I'm a little dramatic because I see that she's not the same and that just hurts me deeply to know she's not feeling her best. But her coat is soft, she continues to gain weight, she eats, she drinks, she uses the litterbox, she walks around, she has a lot of energy and fights now, and just looks more comfortable in general. She's just sooooo lethargic, probably nauseous...

I've already decided as long as she continues to improve and looks comfortable, I'm not going to put her down. Unless I think she is suffering, had enough or is telling me she's had enough, or her blood results continue to show that something else is going on that is just not improving, I will commit to keeping her comfortable.

I'll come back and update this group with more information when I have it.
 

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I'm late to this thread, and I do have experience with Fatty Liver, but my experience is quite old, probably 25 years ago. But I will give you my thoughts if you're interested.

As someone already mentioned, the Pred should definitely make her feel better, but it can definitely cause heart issues, so just be prepared, in case. But my thinking on that is, why NOT use it if it makes her feel better, even if it might possibly shorten her lifespan. After all, if she doesn't feel better, the other option doesn't give her any life at all, right :frown:.

Now, on what she is eating, most of her calories are coming from Temptation treats? That part worries me a little bit. Is she still vomiting? You did say you think she is nauseated. I think it might be from those treats, particularly if she does have IBD or food sensitivities. Is there any way you can cut back on those and increase her nutritionally complete food? If she isn't getting nutritionally complete food, I can certainly see why she is still pretty lethargic. Have you tried feeding her reconstituted freeze dried raw food vs frozen raw? There might be some other flavors to try :dunno:? You can crumble it up so it's almost like pate although I'm not sure you could get it through a syringe for force feeding. Stella and Chewy has rabbit, if you wanted to try it again.

Honestly, I don't think adding extra water has been something you did wrong. Many of us here on TCS add extra water to our cats' food. Having had three kidney cats in the past, I now add extra water to every single meal for my "now" cats to keep them plenty hydrated. Our Vet approves of that.

As to stopping the Ursodial, I'm not sure I would do that because the liver CAN heal, but it doesn't do it overnight. It takes time, and the Ursodial can help. If nothing else, use Sam-E or Milk Thistle (or both) instead.

Lastly (I think), my motto is to treat the cat, not what the bloodwork says. With our kidney cats, we rarely had their blood drawn because we could tell how they were feeling by how they acted. If something unusual happened, then we would talk to their Vet and possibly them in. With our Fatty Liver cat, same thing as I recall. And he was definitely on a feeding tube for FOUR LONG MONTHS! We fed him every four hours. I can't remember how long it took him to quit being yellow, but I do recall he didn't even start eating on his own for a very long time.

Bottom line, I would continue with some of the meds, (liver supplements and Pred and anti-emetics if needed), feed more nutritious food even if it means force feeding, and sit back and try to relax a bit. Let some time pass. See if you can get someone to help you give her sub-qs (I think I read you were looking into help with that) and watch Lulu for clues as to what she wants to do. One or two bad days, even in a row doesn't mean it's the end. But you know her and she will let you know when she's had enough :hugs:
 
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Jenny22

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Now, on what she is eating, most of her calories are coming from Temptation treats? That part worries me a little bit. Is she still vomiting? You did say you think she is nauseated. I think it might be from those treats, particularly if she does have IBD or food sensitivities. Is there any way you can cut back on those and increase her nutritionally complete food? If she isn't getting nutritionally complete food, I can certainly see why she is still pretty lethargic. Have you tried feeding her reconstituted freeze dried raw food vs frozen raw? There might be some other flavors to try :dunno:? You can crumble it up so it's almost like pate although I'm not sure you could get it through a syringe for force feeding. Stella and Chewy has rabbit, if you wanted to try it again.
It took me 7 pages and 3 weeks to realize how to respond to parts of replies. 😂

For only a day or two, the majority of her calories came from temptation treats. And I let her have it as both palliative care and just to make sure she was getting her calories in in the case that she turned a corner. But the bulk of her calories have really come from Gerber Baby Food (ham) which I started adding a meal completer (alnutrin) with all the appropriate nutrients to along with extra taurine. I've also since added back her Antinol meds which is really just concentrated omegas and green lipped mussels. The other bulk of her calories have come from the CN canned food. I won't syringe it because it's the only thing she will eat on her own and I can't risk her becoming averse to eating it. Also, the canned foods have been difficult for me to move through a syringe and I'm afraid of aspiration. With her IBD, she honestly couldn't tolerate canned food before so there's also that little tidbit where I am afraid to add too many uncertain variables right now that will cause more inflammation. But I can say that about half of her calories are coming from Gerber Baby Ham with nutrients added back in while the other half is coming from CN canned that she eats on her own. Also, she is getting a vitamin tonic in a syringe once a day that her vet prescribed to me - I think that was supposed to help with the anemia as it has lots of vitamins including iron. And sometimes she may get a dollop or two of Nutri-Cal if I need to cover her meds in something. I have tried freeze dried which she never liked and commercial raw which she used to love but only one specific line which has since been discontinued (all of her cascading health issues 5 months ago started when the line was discontinued actually - way before the hepatic lipidosis set in). Getting her issues under control took me a while to figure and I was home cooking her meals since she was not adjusting well to the homemade raw. But I have tried all of your suggestions... :(

Lulu has not vomited in over a week, actually. And this is either with or without ondansetron. I started giving the ondansetron again because I felt like she was nauseous. She looks so much better since I have given it to her. Before I was giving 1/2 a pill every 8 hours. She became too strong and started resisting the pills. So I stopped as I just wanted her to be comfortable. She started looking great without the need for anti-nausea meds at all! And then just as quickly as she started looking great, she also started eating less and lip smacking. I added a full pill just once a day and that actually seems to do the trick. It keeps her from being nauseous and back to eating more but it's not overtly making her miserable by trying to pill her every 8 hours.

As to stopping the Ursodial, I'm not sure I would do that because the liver CAN heal, but it doesn't do it overnight. It takes time, and the Ursodial can help. If nothing else, use Sam-E or Milk Thistle (or both) instead.

So, Lulu is already on milk thistle. The ursodiol is supposed to help the bile sludge break down according to her vet 🤷and as per the blood results, it seemed to have not been working after a week of meds. That's really my biggest concern. If it were working, her bilirubin wouldn't continue to increase week over week as would her GGT - I assume? So if it really is an obstruction of some sort or bile sludge that is the obstruction, adding the ursodiol should have lowered those numbers. Her continuing to get more and more yellow even after adding it on made sense once we saw the bloodwork because her liver enzymes were declining at this point so she should not have continued to become more jaundiced. BUT she is doing much much better so I have this feeling that if I ran bloodwork again that the numbers would finally all be declining including her bilirubin & GGT. I can't be certain but I feel like the yellow is also the tiniest bit lighter. I added the ursodiol back in once I saw her turn a corner. I felt like I owed it to her to continue to support her. After all, she really does not look that bad anymore. Clearly, she's still sick and not feeling great. But it's not like it was 3 weeks ago where all I wanted to do was put her out of her misery. She just looked so uncomfortable and in pain. :( As I said in my post, I had 100% decided to put her down on week 1 as I could not drag her through that for another week. But I couldn't get her hospice appointment back and then she turned a corner and continued to improve and that's really why she is still here. Plus the mobile vet that day convinced me to give her time and not put her down. It just wasn't super linear. But, she is on it now. Lulu is very easy to syringe meds. She doesn't like them, but she doesn't resist them. I don't need to move her to a special room or restrain her. She lets me do it wherever she is laying and so why not if it can only make her feel better and it's not stressful for her. So, she continues to be on ursodiol. :)

Lastly (I think), my motto is to treat the cat, not what the bloodwork says. With our kidney cats, we rarely had their blood drawn because we could tell how they were feeling by how they acted. If something unusual happened, then we would talk to their Vet and possibly them in. With our Fatty Liver cat, same thing as I recall. And he was definitely on a feeding tube for FOUR LONG MONTHS! We fed him every four hours. I can't remember how long it took him to quit being yellow, but I do recall he didn't even start eating on his own for a very long time.
I have heard that before. I do follow Tanya's page for kidney cats. :) I think the reason it was difficult to remind myself of this is because I could not afford nor wanted to put Lulu through any invasive procedures or more diagnostics. So, part of me was gambling on the ultrasound being correct and her not having a underlying terminal issue that would have preceded the hepatic lipidosis as the primary reason for her liver enzymes being elevated and why she was eating less in the first place. My biggest fear was that I could be causing her to needlessly suffer through an issue that may never get better because there was something bigger going on underneath it the entire time. And the only way I could really gauge that was through bloodwork. As to me, week over week I never really felt like she was making significant enough improvements to warrant putting her through anymore treatment. But just as I decided in my head that I was letting her go, she would turn a huge corner as if she wanted to fight. Week 3 is when she turned the biggest corner and why I actually have faith that she might pull through and will continue to do what I can to keep her comfortable. I don't want to jinx this because I don't know if it is the prednisolone hiding a bigger issue that really is still there. But in her current state, she does not look like she's suffering as she did before and I don't feel the need to rush to hospice again like I did multiple days for the prior weeks before.

Interestingly, Lulu showed an interest in food and would sometimes surprise me and eat a little bit even during week 1 when she was at her worst. Throughout the weeks, she never stopped drinking or using the litterbox and eating on her own was always there but in small bits, unpredictable, and fleeting. Week 3 is when she began eating on her own like a normal routine again....but still picking and not getting enough calories on her own. When I wake up, she is sleeping on me like she always used to. Her food bowl is empty which means she picked on her CN food all night till it was gone (usual eating behavior). And then she wakes up with me and goes straight to her food bowl to eat some more. So, I'm finding her eating the most in the middle of the night and first thing in the morning. Throughout the day, she also picks but I just don't think it's enough calories on her own which is why I still give her the baby food. She hasn't actually eaten many or any temptation treats the last few days.

When you say 4 months with a feeding tube - how did YOU survive that???!! Do you remember how bad your cat was? How yellow was she? Was caused her to going into HL? Do you remember her liver enzymes at her worst? How old was she? Sorry, I have so many questions...

Bottom line, I would continue with some of the meds, (liver supplements and Pred and anti-emetics if needed), feed more nutritious food even if it means force feeding, and sit back and try to relax a bit. Let some time pass. See if you can get someone to help you give her sub-qs (I think I read you were looking into help with that) and watch Lulu for clues as to what she wants to do. One or two bad days, even in a row doesn't mean it's the end. But you know her and she will let you know when she's had enough :hugs:

Thank you so much for sharing your story and for giving me your support. I do have her only on the meds you suggested. :) Milk thistle, vitamins, prednisolone, and only ondansetron if she looks like she needs it. Over the weeks I cut out the antibiotic as she had been on it for a while, the cerenia which I felt made her sicker, and mirataz as the appetite stimulant which I also did not like for her. I'm genuinely glad I scaled back on her meds. And I did find someone to help me with the subQ! She has worked for rescues and administered subQ fluids for 20+ years I think. She was a godsend and is going to come to my house 2x a week but I am playing that by ear as doing the subQ with a stranger in her home seemed stressful so if she does not get used to it in one or two more session, I may stop it completely. It's very important for me to keep her stress levels down as much as possible. I have to say that Lulu hasn't had any bad "days" in almost a week, now. Though she still has bad moments, particularly at night she may look uncomfortable and groan sometimes. And then of course my head goes right back to "I need to put her down; she's in pain! fire! fire!"....you know, just sheer panic. I'm so bad at this. It's not that I am inpatient as much as I am just so utterly intolerant to see my pets suffer at all. I find it personally difficult to cope with the anxiety that it gives me. I can say though, that this week is the first week where I really felt like I could sit back and relax and pick up my life and focus on my job, etc. Before I was so riddled with anxiety that I lost 10 lbs in a week the very first week she was sick. I don't want to jinx myself, but everyday she honestly looks more and more like she is going to pull through. ❤❤❤
 

mrsgreenjeens

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It took me 7 pages and 3 weeks to realize how to respond to parts of replies. 😂



INTERESTING! I still don't know how to do that :p



When you say 4 months with a feeding tube - how did YOU survive that???!! Do you remember how bad your cat was? How yellow was she? Was caused her to going into HL? Do you remember her liver enzymes at her worst? How old was she? Sorry, I have so many questions...
I survived all that time because it's what we do...whatever is necessary for our furkids. Plus hubby and I split the duties. He worked nights and I worked days, so that was helpful. And I do remember this happened over Christmas and New Years, so there were some holidays in there, also helpful for catching up on sleep :lol:. Our cat was pretty bad, that's why we went with the feeding tube, AND, those were the days before the E-tubes, so his tube went directly into his stomach, what a pain that was as he kept trying to pull it out. Now they install them into the esophagus so the cats can't grab them with their teeth. Soooo much easier. Anyway, I digress. He was extremely yellow. He was a white cat with black spots, and looked bright yellow to me in his ears and his gums and even the outer edges of his eyes. I would call him neon yellow. We never knew what caused it, and back then we were too ignorant to even ask to see his labs, so I have no idea what his liver enzymes were. (and hubby was a nurse...how stupid is that????) OH, and I think he was also about 13 or 14 at the time.

I'm so glad LuLu seems to be feeling better. Keep an out on her breath though, as I'm sure you are doing. If it starts getting bad again, I would put her back on antibiotics.
 
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Jenny22

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I survived all that time because it's what we do...whatever is necessary for our furkids. Plus hubby and I split the duties. He worked nights and I worked days, so that was helpful. And I do remember this happened over Christmas and New Years, so there were some holidays in there, also helpful for catching up on sleep :lol:. Our cat was pretty bad, that's why we went with the feeding tube, AND, those were the days before the E-tubes, so his tube went directly into his stomach, what a pain that was as he kept trying to pull it out. Now they install them into the esophagus so the cats can't grab them with their teeth. Soooo much easier. Anyway, I digress. He was extremely yellow. He was a white cat with black spots, and looked bright yellow to me in his ears and his gums and even the outer edges of his eyes. I would call him neon yellow. We never knew what caused it, and back then we were too ignorant to even ask to see his labs, so I have no idea what his liver enzymes were. (and hubby was a nurse...how stupid is that????) OH, and I think he was also about 13 or 14 at the time.

I'm so glad LuLu seems to be feeling better. Keep an out on her breath though, as I'm sure you are doing. If it starts getting bad again, I would put her back on antibiotics.
Thanks so much for sharing all of that! Lulu continues to improve behavior wise - overall she is clearly much better than at her worst. However, for about 20min every night & around the same time, she looks like she is very much uncomfortable and in pain as she keeps moving and groaning. You can see it in her face, as well. I'm not 100% sure but this might be when the prednisolone is wearing off. So, I give her another dose and within an hour or two, she is up and about. That is worrisome to me that after 4 weeks she is still experiencing inflammation, but I just don't know enough about this stuff. Maybe that's normal. 🤷

I thought for sure this week her urine was getting lighter! and I even thought her eyes & skin were getting lighter. But just as quickly, I started noticed her urine begin to take on that deep yellow again and her jaundice just looks so bad today. Yes, neon yellow on her skin...all yellow in her ears. And like a dark dirty yellow in her eyes. Luckily, I still have that rescue lady helping with subQ fluids 2x a week and she patched me into a great vet and got me the rescue discount....which I couldn't be more grateful that she would do that for me. So, Lulu has an appointment set up on Thursday and again I will run it by the new vet to help me monitor her progress, quality of life, bloodwork, etc. It's been 2 weeks since Lulu's last blood panel. This vet works with the rescues and with hepatic lipidosis often. I'm still in touch with the mobile vet but since she no longer services my area and her house calls are too expensive, I didn't have anyone to pick up where she left off until I found this lady. Plus, it's 5 minutes from me so not a stressful drive for Lulu. ❤

Will update soon. And maybe when this is all over and if Lulu does pull through as she seems to be doing 🤞I will put a timeline together for others that can use it as reference on what can be expected week to week.
 
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The new bloodwork has come back! Since the mobile vet no longer services my area and her last primary was too far to take Lulu to while sick, I had to go to a new vet locally that a rescue center recommended. We discussed palliative care over the phone since her last bloodwork was concerning despite treatment. As mentioned here, I had already decided no more invasive tests or diagnostics, no more ERs, no more situations that would be too stressful or hard on her. I just wanted her to be comfortable. In fact, she was unsure why I wanted to rerun bloodwork with palliative care. But I explained to her that I needed to know if that bilirubin was still rising and if it was, then I would feel more comfortable knowing I made the right choice and could be at peace and focus on just making her more comfortable.

So, the bloodwork came back and the vet called me to understand what the heck I did as Lulu's numbers have improved significantly! Not to say we are in the clear yet but she seems optimistic, now. Not only did her liver enzymes improve, but also the bilirubin and kidney values.

Of course, they are still high - but at its highest her ALT was around 1200 and is now down to it's lowest at 405 since I first took her to the ER. Her AST is normal now at 90 whereas it was 418 a couple of weeks ago. Her ALP is still high but also coming back down.

I believe her GGT is down too? If that is the same thing as GGTP. So it went from 5->18->17->24 previously. On this test it is at a 22. but I am not sure the ranges are the same.

Her WBC is also down but still high.

Her creatinine went from a 3.2 down to a 2.

And her bilirubin finally went down!! From 16.2 all the way down to 4.4.

Her cholesterol did go up - whatever that means as I can rule out the egg yolk theory since she hasn't had any of that in a month.

I have to go back through this forum to remember the changes and when they took place. But the biggest change that both the vet and I believe is the prednisolone I added as a last ditch effort to make her comfortable. Because of this, the vet thinks her issues really stemmed from a very very bad IBD flare. Other things I think made a difference is that I scaled back on meds in general. I had already been slowly cutting out meds that I thought made her worse. I also continued the milk thistle so that may have helped even though we could not see an improvement after 1 week on it. And lastly, I did eventually cut out the ursodiol as I realized it was causing Lulu severe abdominal distress at night. The vet says this is common and she sees it often with her patients. Lulu did not have ursodiol for 3 days before this test. I read that in rare cases, it can make jaundice worse. I also read a lot of conflicting information about it online that made it difficult to know if it was a good med to keep her on. The vet wants me to rerun bloodwork in 2 weeks. So, we'll know by then if keeping Lulu on pred while also taking her off ursodiol is still trending towards recovery. Lastly, she has been getting IV fluids at home. So, lots of variables but I really truly think what made the most significant difference was a combination of scaling back on meds, adding prednisolone, and getting enough calories in her.



Screen Shot 2022-01-28 at 12.34.28 PM.png
 

MissClouseau

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Of course, they are still high - but at its highest her ALT was around 1200 and is now down to it's lowest at 405 since I first took her to the ER
That’s such a major improvement! To give you an idea, my cat’s ALT was 800 in April and with supplements and all it went down to 400s in only like August.

Her creatinine went from a 3.2 down to a 2.
2 is even considered normal!

I hope she continues to improve. I’m rooting for you two:goodluck:
 

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This is all very encouraging!

As far as GGTP vs GGT - I believe they are the same thing - Gamma-glutamyl transpeptidase. The range looks to be 1 - 10 on the above report. What was the range on the previous lab report?

Regarding cholesterol - It can be part of the overall indicators of liver issues, but I think Prednisolone can elevate this enzyme. Ask the vet to see if I am correct.
 
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Jenny22

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This is all very encouraging!

As far as GGTP vs GGT - I believe they are the same thing - Gamma-glutamyl transpeptidase. The range looks to be 1 - 10 on the above report. What was the range on the previous lab report?

Regarding cholesterol - It can be part of the overall indicators of liver issues, but I think Prednisolone can elevate this enzyme. Ask the vet to see if I am correct.

I believe the range was 0-6 on the previous tests. She was actually at a 5 the very first test right when she started to becoming jaundiced.

Her vet just told me to maybe not give her egg yolk because of the cholesterol. But Lulu has been on prescription canned this whole time anyway. She has a follow up tomorrow so I can ask. The vet noticed her thyroid level was a little elevated so she thinks that's something we're going to have to address down the line. I really want to transition her to home cooked again (I'd love to do raw but it was too difficult to transition her before and I'm petrified of winding up with another internal crisis because of her IBD).

All in all, Lulu looks pretty great and even played with me for the first time in weeks a few days ago! It was fleeting but she's getting there. Of course as soon as she looked her best, I woke up to her finding a piece of chicken that fell out of my plate the night before (I thought I got all the pieces but this one must have fallen under the couch). She was nibbling at it and of course I panicked that it would set another IBD flare in motion. I gave her some pred & ondansetron just in case. She's fine I think but it may have flared her up a little bit as she isn't as lively as before. I have no idea if she only got a nibble or was eating it for an hour. Again, could be coincidence.

She's still yellow, still sleeps a lot, but she really does not look like she's in any pain or discomfort except for her mouth at times. She's clearly not fully recovered and it really does look like the fatty liver hit her hard. She just seems so.....aged to me now?? I might ask her vet if she can sedate her or give her pain relief to take a look. I think the left side is really bothering her...maybe a bad tooth? She loves the crunchy temptation treats but needs to move them to the right side of her mouth to chew them or else she spits them out. So, I'm wondering if it's just a bad tooth and not stomatitis. I read prednisolone helps with stomatitis so I hoped that would be good enough for pain. She also sleeps beside me every single night. Sometimes, she lets me rub her belly. She eats ALL her calories on her own and then some. :) I actually have to get her to cut back a bit because she's eating so much now (probably from the pred). Even her urine has lightened up back to it's previous color and her urine output as gone back to her pre-fatty liver output.

We take bloodwork in another week from now (2 weeks apart). I hate the idea of running her through it again if she's clearly getting better, but I think we should since she's on the prednisolone.
 
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Jenny22

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I might have to create a thread for this, but does anyone else have a cat that "excessively swallows"? I guess it could also be lip smacking but I know it's not nausea. She was doing it a lot before the fatty liver started and still does. She does it when I rub her chin which feels so fragile for some time now. She does it right after she yawns (and she yawns a lot lately for some reason). She does it after she drinks water and then she does it for no reason at all. She'll walk up to me, sit in front of me like she wants something, and then there goes that swallowing/lip smacking - I think she even does it when she's hungry. So again, I really don't think it's nausea. Someone mentioned acidity in the mouth or lack of being the problem? Either way, she does it a lot and I don't know what it means. I suspected it was related to dental issues or stomatitis. But I added the video to a stomatitis group and no one else recognized it. :(

I can't upload videos here. So not sure how to really show. Can you upload gifs to this forum? I'm going to send a video to her vet, tomorrow.

. It is similar to how this cat looks after having some catnip. She doesn't do it for long periods of time, she just does it a lot throughout the day.
 

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...I suspected it was related to dental issues or stomatitis. But I added the video to a stomatitis group and no one else recognized it. :(
I would have thought it was connected to dental issues, too.
(My previous rainbow cat, Spotty, had bad breath...and would drool, too.)
Does Lulu drool at all?

Will she let you open her mouth, from the sides,...and take some photos, of her gum lines, and teeth?
Or just let you pull back her side lips...and see the gums?
Are they very red?

Does it look anything like these website photos?
http://www.kingwestvets.com/cat-cavities/
I can't upload videos here. So not sure how to really show. Can you upload gifs to this forum? I'm going to send a video to her vet, tomorrow.
Yes, gifs have been uploaded before.
mp4's are allowed, too,...but usually they are extremely short...25MB limit...I think.

Most members upload their videos to sites like youtube, or gify,...and then use the 'drop down 'media button''....(it's the 'three dots' beside the smiley face in upper ribbon.)...to insert/embed their videos into their posts.

Hoping that this helps explain it better:
How To Upload And Add Videos To Your Posts – TheCatSite Articles
and How to Embed videos:
Embed videos

***Sending the video to your vet sounds really good. :thumbsup:
 

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Hi, Jenny, I just read through this entire thread, and I have recently gone through much of what you are going through. My darling Fritz, 10 years old, was diagnosed with diabetes last July. I home tested, collected urine in a ladle, and tested for ketones, in addition to giving twice daily insulin injections. My life for the past six months has been entirely devoted to Fritz. In October, Fritz began vomiting and although he ate every day, he was diagnosed as having DKA and hepatic lipidosis. He was hospitalized and was released with the recommendation to euthanize him. His electrolytes were completely out of whack, although his bloodwork was fairly normal. I was warned about Refeeding Syndrome and the horrible fate that awaited my boy. I called his vet re euthanizing him and she said let’s wait and you can bring him in on Thursday and we can do his bloodwork and see where he stands. Fritz was so happy to be home, ate like a champ, and when he went to the vet five days after being released to be euthanized, his bloodwork was perfect, as were his electrolytes. I had the same situation as you re the Emergency hospital. It took four hours to get him checked in, although when he was released, it was mercifully quick. The feeling I had from the two emergency vets, was that they simply gave up on him. He came home with his beautiful fur shaved from having an ultrasound under sedation, at which time they also did a biopsy of his pancreas. The histology report was inconclusive. $6,000 later and no feeding tube, told that there was a growth on his pancreas only to okay the biopsy and get no definitive results. I swore he would never go back to that hospital. He had diarrhea the first week and I gave him BM Toneup drops from Petwellbeing. He was also taking milk thistle daily and, of course, his insulin. That boy fought like a tiger for his life and so did I. Being Fritz’s caregiver became my life. I am a member of the Feline Diabetes Board and their advice was invaluable. A month after leaving the hospital, he was diagnosed as hyperthyroid. So we did the entire Mirataz/compounded thyroid meds put on his ears, etc. He did great, he gained back the weight he had lost, and for 3 1/2 months, we had the blessing of more time together. Fritz had never been sick, always completely healthy. He was so cooperative during the entire time, letting me test his blood glucose, patiently having meds put in his inner ears or in his mouth.. We would have many good days and then a bad one. He was given Cerenia and was put on Pepcid AC as needed. The last week of his life, he began to go downhill. He was at the vet 3 times in 6 days, not eating, given fluids and B12, now diagnosed with pancreatitis as well. I was able to syringe feed him and get extra calories into him using Six Fish treats and Churu. At the end, he would even turn away from Churu, which he dearly loved. A DKA kitty has to eat one and a half times what he was eating before. Most of the time, we were able to achieve that. But the last four days, he turned away from all food most of the day and would eat at night. On Sunday, he had ketones in his urine again. He still played with his favorite toy, he was still extremely cuddly and affectionate, he drank water and went to the litterbox. He refused all food. But I told him that he had fought so valiantly when I begged him to stay with me and I released him from that. I told him it was his turn, his decision and I had promised to never let him suffer, and that I would follow his lead. And so he showed me. I gave him Buprinex that last weekend because I refused to let him be in pain. On Monday, Jan. 24, I took him to the vet, they did more bloodwork and I was finally able to go inside the vet’s office. On paper, he looked fine, but when you looked at him, you knew. He had lost over a pound from Thursday to Monday. The time had come to show him how very much I loved him, my vet said that he was going into DKA again, would probably not come out of it again, and if we didn’t help him, he would probably pass on his own. And so I made the decision to free him of all pain, knowing that I would be carrying that burden from then on. I was ferociously protective of him and would have done anything to save him, but his vet was fully convinced that he had pancreatic cancer. My baby’s death was so blessedly peaceful. I had time to spend with him, talking to him, loving him, kissing his precious face and little knothead, and then he was given a pre-shot, went sound asleep, and never knew when the other shot entered his little body and stopped his huge heart. My vet thanked me for being so brave, but it wasn’t bravery, it was unconditional love. We were so bonded, he was my soulmate, I was devastated. I was crying, my vet was crying, we were hugging. It was awful. I had to take his empty carrier out, burst into tears, and have not had one day since that I haven’t cried, longed for him, and missed him terribly. BUT I would do it again in a heartbeat. Take his pain onto myself and release his beautiful spirit from his failing little body. That is what love is; that is what love does. I have been sleep-deprived since he was released from the hospital, I lived according to his schedule, there were times I was so exhausted that I thought I would feel relief when the end finally came. I was wrong. However, I can say without doubt that I did everything in my power to prolong his life as long as it was apparent that he still wanted that life. This past Tuesday, he was to have had a consultation with an internal medicine specialist. He had been gone a week by then. I have his lovely urn, and two canvas portraits of him arrived today. You do the best you can do and then some, and when the time comes, please realize that you gave Lulu the greatest gift of all, you set her free. I know that Fritz’s spirit still exists, in a lovely place where there are never goodbyes. You cannot devote that much time, effort, and love and not have it hurt you to the core when the war is over. But you can know that you did right by your best friend, your constant companion, your little love. I weigh 100 pounds because of the stress of it all, lost 20 pounds in two months. Please take care of yourself. I was so focused on Fritzi that I neglected myself. You are doing everything humanly possible for Lulu, and I pray that she lives many more happy, healthy years. I am with you all the way, I would not have put Fritz through another hospitalization, they gave up on him. Two things to add: Fritz fully recovered in five days from DKA and hepatic lipidosis, sort of a miracle, so there is no set time for recovery; and second, his supplements arrived too late, but I had ordered Power Probiotics, Lypozyme enzymes, Happy Paws CBD, and Gastro ULC, which is a super effective natural form of Pepcid AC with none of the side effects, Those products are available on the Ask Ariel website. You and Lulu will be in my prayers. I fully understand what you are going through, every aspect of it. I was fortunate enough to have great pet insurance or I would have had to let my baby go far sooner. Stay strong, follow her lead, and pay close attention to weight loss. This, too, shall pass. I thank God every day for the gift of an additional 3 1/2 months with my love. And I too, believe that far better a day too soon than a moment too late.
 

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