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

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mrsgreenjeens

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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.
Dental problems can cause excessive swallowing, so I'm guessing since you are seeing signs of mouth pain, that's probably it.
 
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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?
I think it still is dental, to be honest. Lulu never drools even when she's nauseous. I only ever saw her drool once right before she had a violent puke and a few days before she was diagnosed with the fatty liver. So, I think it was nausea from whatever was going on with her liver.

I can only open her mouth enough to drop a pill in and even that is difficult. I can't open her mouth fully or long enough to see. But I can move her lips up to see some of her teeth in the front and they do look like tooth resorption. Her last vet said she already lost 2 teeth and he says she has stomatitis. So, I know she has dental issues. I just don't know if that's what's causing the lip smacking. Her gums are inflamed, too but not as red as the photos in the link you sent me.
 
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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.

Thank you so much for sharing your story. I am so very sorry for what you went through. With Lulu, I truly was going to put her down and a lot of reason was because she has so much going on to make her fight through this. Now that she's recovering, I do wonder how much time it is really buying me with her. It gives me a little bit of anxiety to think if it's not this, something else is going to just pop up soon afterwards. It's like everything started going wrong all at once. But like you said, it gives me the chance to spend each day with her as if it's her last, stay positive and avoid thinking of what will be next, give her as much love as I can, and to improve her quality of life as much as I can. Cats are so fragile as they age and I know there is only so much I can do. All I can do is love love love her as I know you did so well with your cat. It made me cry reading your story because I could feel just how much love you had for your baby.

I was actually never told anything about refeeding syndrome. The ER released us with very simple directions that said feed 1/4 can of cat food 3 times a day....which by the way, sounds like it would have been too many calories. I tried to ask them to give me a caloric breakdown because lulu didn't eat canned at the time. But they didn't. Didn't even tell me what size of a can or that I was supposed to slowly build her calories up over the next few days. I really felt so lost and overwhelmed. Hepatic Lipidosis is gut wrenching to go through. I am so sorry that you had to experience that. I read your story twice, actually. It made me cry a second time, too. I knew my cat was suffering but I did not get that look from her that she was ready. That's what made it so difficult for me and caused me so much anxiety. I just didn't feel like it was time. I'm usually very good about feeling these things and for her I could not feel anything. I kind of feel as though I would schedule euthanasia sometimes because I was the one that couldn't bare to see her suffer anymore, and then overnight each time she would turn a huge corner as if she was fighting to live.

Thank you again for sharing your story. I may come back to it a few times as a reminder of the time I have with Lulu and when that time comes to an end. ❤❤❤
 
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Dental problems can cause excessive swallowing, so I'm guessing since you are seeing signs of mouth pain, that's probably it.

I think you are right. Today I move my finger across her jaw until I gently touched the spot that I suspect is causing her problems. She turned her face away and then began to lip smack and swallow. The vet thinks Lulu looks great but is not ready to address any teeth related issues until she makes a full recovery. And since narcotics are probably bad for her liver, we won't be able to give her those either unless she stops eating.

So as of right now and as long as she is eating, there is nothing I can do. I hope the prednisolone at least helps with inflammation.
 

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I think it still is dental, to be honest. Lulu never drools even when she's nauseous. I only ever saw her drool once right before she had a violent puke and a few days before she was diagnosed with the fatty liver. So, I think it was nausea from whatever was going on with her liver.

I can only open her mouth enough to drop a pill in and even that is difficult. I can't open her mouth fully or long enough to see. But I can move her lips up to see some of her teeth in the front and they do look like tooth resorption. Her last vet said she already lost 2 teeth and he says she has stomatitis. So, I know she has dental issues. I just don't know if that's what's causing the lip smacking. Her gums are inflamed, too but not as red as the photos in the link you sent me.
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....
Jenny, what medications is Lulu presently on?

With the stomatitis, that the last vet diagnosed...did he say that you could 'spray'...or use 'any type of gel on her teeth', and gums?

(I know one of the other members, had posted something similar to this in their post,...but would have to go back and see what it was)
(With my rainbow cat...I did try to use some sort of 'foam spray'...from Petsmart, and then also some sort of 'spray or rinse'...but it was in between the time, that I had to take Spotty to the cardiologist for a heart echo, and before the actual teeth extractions,...and of course Spotty didn't have digestive issues.)

With your Lulu...I wouldn't know if any type of 'gel, rinse, enzymatic toothpaste, or spray'...would cause her more digestive issues...and affect the way things taste.
I do wish they had something, though, that would at least help,...in the meantime, to lessen the inflammation against her teeth.
And yeah, my guess would have been that the prednisolone would do this.
I do remember that your mobile vet mentioned that antibiotics would help this condition, too.

These two websites might be better at explaining Stomatitis in cats.
I know that you already know this stuff...but I just post these websites...in case anyone else is reading this thread...and also to maybe stimulate other ideas.
stomatitis
Stomatitis in Cats: Causes, Symptoms and Treatment - Cat-World
 
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Jenny, what medications is Lulu presently on?

With the stomatitis, that the last vet diagnosed...did he say that you could 'spray'...or use 'any type of gel on her teeth', and gums?

(I know one of the other members, had posted something similar to this in their post,...but would have to go back and see what it was)
(With my rainbow cat...I did try to use some sort of 'foam spray'...from Petsmart, and then also some sort of 'spray or rinse'...but it was in between the time, that I had to take Spotty to the cardiologist for a heart echo, and before the actual teeth extractions,...and of course Spotty didn't have digestive issues.)

With your Lulu...I wouldn't know if any type of 'gel, rinse, enzymatic toothpaste, or spray'...would cause her more digestive issues...and affect the way things taste.
I do wish they had something, though, that would at least help,...in the meantime, to lessen the inflammation against her teeth.
And yeah, my guess would have been that the prednisolone would do this.
I do remember that your mobile vet mentioned that antibiotics would help this condition, too.

These two websites might be better at explaining Stomatitis in cats.
I know that you already know this stuff...but I just post these websites...in case anyone else is reading this thread...and also to maybe stimulate other ideas.
stomatitis
Stomatitis in Cats: Causes, Symptoms and Treatment - Cat-World
Lulu is on milk thistle, pet tinic, and prednisolone. That's it for now.

I think there are two parts to not treating what's going on. The first being that we don't actually know because she won't let us look in her mouth. I honestly feel they would need to sedate her to get a good look and that's probably not a good idea while she is still jaundice and dealing with fatty liver. The second part is that even giving her anything for pain could impact the liver. So, the vet wants to focus on getting her to fully recovery before addressing her teeth. And I guess while she is still eating, she's doing fine. They said if it gets to a point where she is not eating, then they would discuss what can be given to her if pain is the source of her not eating.

Also, I don't really know if it is stomatitis - her last primary wrote it down in the records but never told me about it. He only said feline tooth resorption. And he seemed extra hesitant with her as it was. So, I'm not entirely sure he was ever right on that diagnosis. This is why I had her scheduled to see a board certified dentist - which I've since had to cancel because of the fatty liver. I am leaning more towards a toothache because her source of pain seems to be very localized to a spot I can practically touch with my finger, and as long as she doesn't chew on that side of the mouth, she seems fine. But with the lip smacking and her chin seems fragile (not sure how else to describe that), I hope it's not something worse like cancer. I mean, of course I don't actually know if there are ulcers in her mouth or down her throat. All I can say for now is that she is doing better and better each day and I plan wholeheartedly to address any discomfort in her immediately afterwards to give her the best quality of life. If I didn't know my cat as well as I do, I'd have no idea she had any dental issues or pain in her mouth at all. So, I hope that's a sign that it is manageable in the meantime and until she makes a full recovery.

No gels or sprays were mentioned to me. But I can bring it up to the vet during Lulu's bloodwork next week and see if it can be helpful for tooth pain as well and not impact the liver.

It's all very weird. Her teeth issues were one of the reasons I eventually decided I was going to put her down. Fighting fatty liver is hard enough and I thought about the road ahead of her to really get any other issues under control and it was both financially out of my budget and felt like I would be putting her through too much. But then she kept turning a corner each time I had hospice scheduled as if she wanted to fight. And of course, you don't put down a cat that's recovering. Just have to take it one day at a time without overloading her too much. Maybe the vet will agree on the gel. :)
 

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Lulu is on milk thistle, pet tinic, and prednisolone. That's it for now.
Thanks for this Jen, this is good to know.
I think there are two parts to not treating what's going on. The first being that we don't actually know because she won't let us look in her mouth. I honestly feel they would need to sedate her to get a good look and that's probably not a good idea while she is still jaundice and dealing with fatty liver. The second part is that even giving her anything for pain could impact the liver. So, the vet wants to focus on getting her to fully recovery before addressing her teeth. And I guess while she is still eating, she's doing fine. They said if it gets to a point where she is not eating, then they would discuss what can be given to her if pain is the source of her not eating.
I totally agree with this.
It makes the most sense not to introduce anything that would interfere with, or delay, Lulu's recovery.
This Vet sounds really good.
No gels or sprays were mentioned to me. But I can bring it up to the vet during Lulu's bloodwork next week and see if it can be helpful for tooth pain as well and not impact the liver.
Yeah, that's like my biggest concern, too,...Not introducing anything that will impact the liver...in a negative way.

These are some of the things you can ask the Vet about, next week:
Specifically if this one type of gel, called 'Oratene Veterinarian Antiseptic Oral Gel'...would at all be recommended over the 'chlorhexidine rinses or gels'...
and how each would impact the Liver?

This is the page I came across it:
Managing Feline Stomatitis
But you have to take note...that it's actually confusing which one to buy...since the labels are so similar...and the ingredients are different. Some of the reviewers mentioned this.

One said that they needed the Antiseptic type oral gel...but just got the new type of oral gel...and then there was also a maintenance gel...that most said didn't do much. Ugghhh...it was all so confusing...So definitely read the ingredient lists, the reviews,...and ask the Vet.
Amazon.com : oratene antiseptic oral gel
ORATENE Enzymatic Brushless Oral Care Dog & Cat Dental Gel, 1-oz tube - Chewy.com

(One reviewer mentioned, that one of their cats had many issues where their cat could not undergo anesthesia so no dental could be performed, therefore s/he used the gel. But didn't say, which other issues their cat had...and if it were liver related.)

And of course, you know since I like informative websites...then I'll insert some more, here, if you don't mind:
Gingivitis And Stomatitis In Cats | VCA Animal Hospitals
This one has an excellent video, where the dental Vet explains things well:
Resorptive Lesions - Animal Wellness Center of Bonita
 
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Thanks for this Jen, this is good to know.

I totally agree with this.
It makes the most sense not to introduce anything that would interfere with, or delay, Lulu's recovery.
This Vet sounds really good.

Yeah, that's like my biggest concern, too,...Not introducing anything that will impact the liver...in a negative way.

These are some of the things you can ask the Vet about, next week:
Specifically if this one type of gel, called 'Oratene Veterinarian Antiseptic Oral Gel'...would at all be recommended over the 'chlorhexidine rinses or gels'...
and how each would impact the Liver?

This is the page I came across it:
Managing Feline Stomatitis
But you have to take note...that it's actually confusing which one to buy...since the labels are so similar...and the ingredients are different. Some of the reviewers mentioned this.

One said that they needed the Antiseptic type oral gel...but just got the new type of oral gel...and then there was also a maintenance gel...that most said didn't do much. Ugghhh...it was all so confusing...So definitely read the ingredient lists, the reviews,...and ask the Vet.
Amazon.com : oratene antiseptic oral gel
ORATENE Enzymatic Brushless Oral Care Dog & Cat Dental Gel, 1-oz tube - Chewy.com

(One reviewer mentioned, that one of their cats had many issues where their cat could not undergo anesthesia so no dental could be performed, therefore s/he used the gel. But didn't say, which other issues their cat had...and if it were liver related.)

And of course, you know since I like informative websites...then I'll insert some more, here, if you don't mind:
Gingivitis And Stomatitis In Cats | VCA Animal Hospitals
This one has an excellent video, where the dental Vet explains things well:
Resorptive Lesions - Animal Wellness Center of Bonita

I'm going to look into all of this. Thank you so much for sharing! I'll update the group soon with Lulu's next test results if interested. I put a timeline together for my vet and will share it here for others dealing with hepatic lipidosis once she's fully recovered. And crossing my fingers that we don't run into anymore hiccups before then.
 

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I'm going to look into all of this. Thank you so much for sharing! I'll update the group soon with Lulu's next test results if interested. I put a timeline together for my vet and will share it here for others dealing with hepatic lipidosis once she's fully recovered. And crossing my fingers that we don't run into anymore hiccups before then.
It will be great if you can share. More info is always useful to keep it here for current and future cases!
 

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Hi my poor kitty wasnt eating very much the past week. I had to have emergency surgery and had to leave him for a month. My dad was living at my house and looking after him and I guess after awhile the stress of not having me around he began to stop eating dry food and only wet, and picky at that. Since I have been back for 5 days its been even less I have been forcing the wet food down. I took him to the vet (he had to be sedated as he has sever fear aggression) and they did blood, urine and xray. The anti nausea meds allowed him to eat on his own a bit tonight but not what he needs to have. I am considering giving him the feeding tube but in case this isnt survivable would that be cruel? I just want him to comfortable he means the world to me.

His liver levels are quite high and he has jaundice. They found no blockages in his x ray but some fluid in the left lung where they took a sample (which was yellow and they suspect from the high bilirubin

He is 11.

ALT 604
AST 361
ALP 354

Bilirubin 111
Creatine 1290

He has bilirubin crystals in his urine.

My question is does anyone know of a cat that has come back from those levels? If I give him a feeding tube will he be uncomfortable or should I just try to let him live out his days in peace. He is such a lovely cat and I just want him to feel loved and comfortable. The vet visit scared him but before that he has been so cuddly and typically his self other than the not eating. I just want to give him every chance.

Thank you for your help
 

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Hi my poor kitty wasnt eating very much the past week. I had to have emergency surgery and had to leave him for a month. My dad was living at my house and looking after him and I guess after awhile the stress of not having me around he began to stop eating dry food and only wet, and picky at that. Since I have been back for 5 days its been even less I have been forcing the wet food down. I took him to the vet (he had to be sedated as he has sever fear aggression) and they did blood, urine and xray. The anti nausea meds allowed him to eat on his own a bit tonight but not what he needs to have. I am considering giving him the feeding tube but in case this isnt survivable would that be cruel? I just want him to comfortable he means the world to me.

His liver levels are quite high and he has jaundice. They found no blockages in his x ray but some fluid in the left lung where they took a sample (which was yellow and they suspect from the high bilirubin

He is 11.

ALT 604
AST 361
ALP 354

Bilirubin 111
Creatine 1290

He has bilirubin crystals in his urine.

My question is does anyone know of a cat that has come back from those levels? If I give him a feeding tube will he be uncomfortable or should I just try to let him live out his days in peace. He is such a lovely cat and I just want him to feel loved and comfortable. The vet visit scared him but before that he has been so cuddly and typically his self other than the not eating. I just want to give him every chance.

Thank you for your help
Your best bet to to discuss this with your Vet. Ask them what they would do if it were THEIR cat. Tell them you want the honest truth, no sugar coating.

Bloodwork is pretty hard for lay people (which we are here on this forum) to really get a grip on because certain values go together. For instance, the creatinine is sky high, but we usually see it with BUN, and also a BUN/Creatinine Ratio, which isn't there. And those particular values are related to kidneys, which you didn't mention your Vet mentioning. Plus depending on what lab runs the bloodwork, they also assign normal values, so we don't know what those are compared to your figures.

It appears there are some liver issues here though. What did your Vet say about them, and what are they doing about them? Any supplements or medications given yet, aside from the nausea med? With the fatty liver which it sounds like he has, there is usually an underlying condition which causes it, but as you stated it could have simply been the circumstances of you being away that caused him to stop eating (stress), and once Fatty Liver starts, drastic measures have to be taken, like either force feeding or a feeding tube which just makes force feeding much easier. Personally, I'd go the feeding tube route has I've done both and the feeding tube was just so easy, especially if you are giving meds too.

As far as whether to give it to a cat who has something incurable, to me it really depends on what that is. By no means would I ever intentionally let a cat suffer like letting them starve to death, so if a feeding tube meant they could live on happily for a long time, I would do that. But if it meant they could live for a week or two, I probably wouldn't go that route and would keep a close eye out for any signs of discomfort then make "the call" :frown:. Again, this is hard to say not knowing the diagnosis. Hope this makes sense
 
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Jenny22

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Hi my poor kitty wasnt eating very much the past week. I had to have emergency surgery and had to leave him for a month. My dad was living at my house and looking after him and I guess after awhile the stress of not having me around he began to stop eating dry food and only wet, and picky at that. Since I have been back for 5 days its been even less I have been forcing the wet food down. I took him to the vet (he had to be sedated as he has sever fear aggression) and they did blood, urine and xray. The anti nausea meds allowed him to eat on his own a bit tonight but not what he needs to have. I am considering giving him the feeding tube but in case this isnt survivable would that be cruel? I just want him to comfortable he means the world to me.

His liver levels are quite high and he has jaundice. They found no blockages in his x ray but some fluid in the left lung where they took a sample (which was yellow and they suspect from the high bilirubin

He is 11.

ALT 604
AST 361
ALP 354

Bilirubin 111
Creatine 1290

He has bilirubin crystals in his urine.

My question is does anyone know of a cat that has come back from those levels? If I give him a feeding tube will he be uncomfortable or should I just try to let him live out his days in peace. He is such a lovely cat and I just want him to feel loved and comfortable. The vet visit scared him but before that he has been so cuddly and typically his self other than the not eating. I just want to give him every chance.

Thank you for your help
I am sorry for what you are going through. As I am still going through this process and it is fresh for me, I absolutely sympathize with you. Just as Mrsgreenjeens said, it is best to discuss with your vet. I don't know exactly what is going on with your cat, but I agree that your cat could have fatty liver based on the liver enzymes and your story of how your cat had been eating significantly less for a while. Fatty liver will make your cat very nauseous and not want to eat. If this is the case, my cat was much higher at about 1200 ALT at her worst during fatty liver and is making a fully recovery (knock on wood). But I cannot comment on those kidney levels you mentioned and I don't believe her bilirubin levels were that high. She was VERY yellow, though. Lulu's levels went up to stage 3 CKD at its worse but have since dropped back down. She is 14. And if it's any consolation, there came a point when the vets also suggested that she had much bigger issues going on and did not think she would make it - she pulled through. You do need to narrow down the primary reason of why she stopped eating, resulting in fatty liver. If you think it was just stress, then you have less to worry about. For me, we're starting to think my cat had triaditis (the ER thought cholangiohepatitis also). I refused to put my cat through any further diagnostics, so the main goal was just to treat the fatty liver until I added steroids on a whim and that turned everything around. Your cat may need specific treatment in addition to feeding her in addressing the primary issue if it turns out to not be from stress. It took 3 weeks before I could see enough of a difference that led me to believe my cat would survive. But I did set up euthanasia three different times. On the morning of, Lulu would surprise me by starting to eat a little or showing improvements in behavior and that's the only reason why she's still here. That's how I moved forward with deciding whether or not to fight for her or to let her go not knowing if she could survive whatever was happening.

As for the feeding tube. From everything that I have read and people I have spoken to, the feeding tube is a very easy procedure to both put in and take out. It is not unethical for the cat. It's also easier on your cat and prevents food aversion. From first hand experience, syringe feeding/force feeding is not for the faint of heart. I opted out of the feeding tube thinking it was unethical and also not being able to afford the cost. My cat had been through so much already and I was afraid to put her under. But her primary said the procedure is super quick and urged me to do it. I now know why so many people and vets highly recommend the feeding tube. Unless you are able to force feed (which is not easy) your cat 24/7 around the clock for weeks at a time, the feeding tube is going to save you and your cat sooooooo much stress. There is also the issue of aspiration if you do not syringe properly.

I actually think it might be less cruel to do the feeding tube if your vet is unsure your cat will make it. Syringe feeding meds and food can be really stressful for your cat. It was as first for mine. I could only syringe baby food and I had to do about 1-3ml at a time. This took me literally 24 hours to get 200 calories into her. And meds were also a nightmare. But fatty liver is reversible, so I would at least try. Did your vets run an ultrasound or do any other diagnostics?
 
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Jenny22

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Just an update on Lulu's status. We've been running bloodwork every 2-3 weeks now to stay on top of her progress. It's expensive but reassuring to see her levels continue to improve. She continues to do well except for having a "bad day" every now and then which I think is due to her dental/mouth pain. On those days, she seems to eat less but she still looks great considering. I have antibiotics and narcotics that I was told I could give if she stops eating. I've used the pain killer once maybe. I'm holding off on the antibiotic unless she clearly needs it - we don't want to upset her gut/IBD/appetite. So far she is hanging in there but I am itching to address whatever is going on with her mouth.

As of 2/11, here are her most recent numbers. :) She runs another test on 3/3 and I hope that is the last one as I am beyond broke from this entire experience. Even trying to transition her back to a healthy diet is breaking my bank. :( But I LOVE seeing her look so much better and cuddling in my arms at night. ❤

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Hi my poor kitty wasnt eating very much the past week. I had to have emergency surgery and had to leave him for a month. My dad was living at my house and looking after him and I guess after awhile the stress of not having me around he began to stop eating dry food and only wet, and picky at that. Since I have been back for 5 days its been even less I have been forcing the wet food down. I took him to the vet (he had to be sedated as he has sever fear aggression) and they did blood, urine and xray. The anti nausea meds allowed him to eat on his own a bit tonight but not what he needs to have. I am considering giving him the feeding tube but in case this isnt survivable would that be cruel? I just want him to comfortable he means the world to me.

His liver levels are quite high and he has jaundice. They found no blockages in his x ray but some fluid in the left lung where they took a sample (which was yellow and they suspect from the high bilirubin

He is 11.

ALT 604
AST 361
ALP 354

Bilirubin 111
Creatine 1290

He has bilirubin crystals in his urine.

My question is does anyone know of a cat that has come back from those levels? If I give him a feeding tube will he be uncomfortable or should I just try to let him live out his days in peace. He is such a lovely cat and I just want him to feel loved and comfortable. The vet visit scared him but before that he has been so cuddly and typically his self other than the not eating. I just want to give him every chance.

Thank you for your help
My kitty had a feeding tube and it didn't seem to bother him and he did recover. The main number that the vet was following was the ALT and it got up to 1300 at its peak and he recovered.
 

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Just an update on Lulu's status. We've been running bloodwork every 2-3 weeks now to stay on top of her progress. It's expensive but reassuring to see her levels continue to improve. She continues to do well except for having a "bad day" every now and then which I think is due to her dental/mouth pain. On those days, she seems to eat less but she still looks great considering. I have antibiotics and narcotics that I was told I could give if she stops eating. I've used the pain killer once maybe. I'm holding off on the antibiotic unless she clearly needs it - we don't want to upset her gut/IBD/appetite. So far she is hanging in there but I am itching to address whatever is going on with her mouth.

As of 2/11, here are her most recent numbers. :) She runs another test on 3/3 and I hope that is the last one as I am beyond broke from this entire experience. Even trying to transition her back to a healthy diet is breaking my bank. :( But I LOVE seeing her look so much better and cuddling in my arms at night. ❤

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Hi Jen,
Can I ask you a few questions that have been kind of bugging me for awhile...having to do with Lulu's time in the ER?
(I wanted to wait and ask them,...after you've gotten the latest blood-work results...but then I'm thinking I may forget.)

Basically, I just wanted to know, what this term "ATH" meant?
It was posted in post #35...under the ER report...where it says Plan:
-------------------------
Plan:
ATH
IVF @ 14ml/HR
Unasyn 80mg IV q 8
NPO
Monitor RR/RE
----------------------------
1)..What does "ATH" mean?
(I tried looking up a whole bunch of Vet abbreviations, and still have no idea?)

2)...Also, more importantly...why would the ER Vet...write down NPO..(nil per os...meaning "nothing by mouth")...for a cat who is anorexic???

I'm pretty sure that there must be a logical reason for doing this.

Perhaps it has to do with the IV meds that were given...the Unasyn?
Did they suspect a 'bacterial infection' of some sort, so the unasyn was given.
I know that you mentioned 'bacterial infection' before, in this thread.

or...maybe to do with allowing the Liver to rest?
or...were they worried about vomiting, or some such thing?
or...would food cause more inflammation?

I don't know, so I was just wondering if the Vet had verbally told you her Plan, and why she with-held food?

I know that the Vets had their reasons,...but I was just curious about this part.

3)...Final question is.. I noticed that Lulu's...Cholesterol"...levels were still a bit high..so will you need to 'adjust her food' or what she has been eating...or is this more to do...with the Fatty Liver, still?

You don't have to rush and answer these questions.
Just whenever you have the time to.
Hoping that your Lulu is behaving herself, and still doing well. :)
Still sending your Lulu, plenty of Health thoughts and Health wishes.:bluepaw: :vibes::vibes::caticon:
 
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Jenny22

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Hi Jen,
Can I ask you a few questions that have been kind of bugging me for awhile...having to do with Lulu's time in the ER?
(I wanted to wait and ask them,...after you've gotten the latest blood-work results...but then I'm thinking I may forget.)

Basically, I just wanted to know, what this term "ATH" meant?
It was posted in post #35...under the ER report...where it says Plan:
-------------------------
Plan:
ATH
IVF @ 14ml/HR
Unasyn 80mg IV q 8
NPO
Monitor RR/RE
----------------------------
1)..What does "ATH" mean?
(I tried looking up a whole bunch of Vet abbreviations, and still have no idea?)

2)...Also, more importantly...why would the ER Vet...write down NPO..(nil per os...meaning "nothing by mouth")...for a cat who is anorexic???

I'm pretty sure that there must be a logical reason for doing this.

Perhaps it has to do with the IV meds that were given...the Unasyn?
Did they suspect a 'bacterial infection' of some sort, so the unasyn was given.
I know that you mentioned 'bacterial infection' before, in this thread.

or...maybe to do with allowing the Liver to rest?
or...were they worried about vomiting, or some such thing?
or...would food cause more inflammation?

I don't know, so I was just wondering if the Vet had verbally told you her Plan, and why she with-held food?

I know that the Vets had their reasons,...but I was just curious about this part.

3)...Final question is.. I noticed that Lulu's...Cholesterol"...levels were still a bit high..so will you need to 'adjust her food' or what she has been eating...or is this more to do...with the Fatty Liver, still?

You don't have to rush and answer these questions.
Just whenever you have the time to.
Hoping that your Lulu is behaving herself, and still doing well. :)
Still sending your Lulu, plenty of Health thoughts and Health wishes.:bluepaw: :vibes::vibes::caticon:
Ask away :) As devastating as all of this has been for me, it is just as fascinating. I have medical issues, myself. Western medicine failed me and at some point I had to do all of my own research to understand what was happening in my body. I used my own health timeline, my bloodwork, diary of symptoms vs diet and stress, research research research, etc. Today, 4 years after my first emergency surgery I am still fighting with doctors to run the appropriate tests and finally got proof of what I've been saying about my body for years. My gynecologist cannot get over my situation; she was in the operating room and saw how bad the disease was in me when they opened me up. I refused any sort of long term medication and educated and advocated for myself and my health for the most successful form of treatment. Today, I am symptom free of this disease and she is beside herself on how that is even possible with just how bad I was and that I never went on meds. In April I was diagnosed with premature ovarian failure, and again I educated myself, took more tests, made decisions based on bloodwork and gene mutations, and 3 months later I am fertile again. My AMH has doubled twice in 6 months. Anyway, the point is that as much as I don't trust both western doctors (and now vets), I find the bloodwork and all of the data that I can gather on my own invaluable in helping me make the right decisions for my own cat. The research is out there. I am happy to answer what I know in the hopes that it helps someone else.

ATH - I think this means "at the hospital"? Because it is mentioned right before transfer to the IM. I had to switch ER hospitals that same night as the first one did not have an IM. And the IM was not in the building for about 7hours so they held Lulu in the hospital. It was about 24 hours of my driving from one hospital to the other, sleeping in my car, etc. It was a terrible draining night - and I wound up with covid symptoms that same night. When it rains, it pours, eh...

NPO - If this means to withhold food, then there are two reasons why they did that. One is that Lulu was at the ER for almost a whole day before the IM could suggest further diagnostics suggest as a FNA and biopsy. Because she would need to be sedated, she wasn't allowed to eat. The second reason is if I agreed to the feeding tube, again it would require sedation so she was not allowed to have food in her stomach. This much I get - what aggravated me as that I declined all these procedures and they still didn't try to get food in her between the hours that I declined and the hours I was allowed to pick her. Essentially, they consciously allowed her fatty liver to progress within that time period. With aggressive nutrition being an emergency treatment, I was so let down by the ER. Taking her was a waste of money and a huge mistake. The only thing is did for me was give somewhat of a safe answer that this probably isn't cancer even though it couldn't be ruled out - and that made me more comfortable in treating the fatty liver rather than needlessly letting her suffer with something that was terminal anyway. But I don't think she would have gotten as bad as she did had I not taken her to the ER - I immensely regret that decision.

Unasyn - I didn't look this one up - but Lulu was suspected of having an infection from the start based on her bloodwork by her primary, the ER, and the IM.

Cholesterol - I am surprised to see Lulu's Cholesterol not come down by now. I can't say for sure, but I now know I was adding way too much egg yolk to her home cooked meals for motility. I really struggled to get her bowel movements normal through a home cooked diet which resulted in constipation. The egg yolk helped to move things along. I often wonder if that is what caused the high cholesterol. But she hasn't had any egg in over 2 months now and the cholesterol was still high on her last test. I did have one more round of bloodwork and will post it here as soon as I get the results in my email. Maybe the CN critical nutrition is not great for cholesterol? It is only supposed to be temporary and she's been on it for over a month - maybe two?

I found a highly recommended nutritionist in Australia that helps patients all over the world (I am in the US). She's very familiar with cats with comorbidities like Lulu. I was going to go through her this time for a meal plan as it's really too much of a headache to try to figure out what works for my cat and the stress of making sure all the appropriate vitamins are there.

Unfortunately, I do have some bad news... I kept pushing to address Lulu's teeth now that she was recovering but her primary said we had to focus on the fatty liver. No one could sedate her to take a look at her mouth while her liver enzymes were still elevated. Unfortunately, I noticed a lump on her bottom left jaw about 3 weeks ago. The primary vet also confirmed it but again said we could not address it. At her follow up this week, it had noticeable grown. She suspected an oral tumor. I took her to a board certified dentist the following morning and he also confirmed he believes is to be small cell carcinoma (SCC). They can't rule out an infection and I couldn't afford further diagnostics. It was gut wrenching to have to leave "empty handed" but I also felt relief as they wanted to hold her there and I didn't want to put her through all of this all over again. This poor cat fought so hard to fight fatty liver to succumb to SCC. They said it's aggressive which means I'll probably lose her within the next 1-2 months. She is currently on clindamycin as a last ditch effort to see if it is an infection. But she is so fragile at this point that I am worried about the side effects of the clindamycin or that it could accelerate the cancer.

On a plus note, the dental specialist said she looked so healthy and strong that you could not tell this cat had any of the illnesses that she has been diagnosed with. That was comforting to me. For all the things I feel guilty about when it comes to my pets, that made me feel like I must have done something right - that I really did exhaust all efforts. If I had to do it all again, this time I would better advocate for my pets instead of trusting vets because I was too afraid to burn bridges or overstep my boundaries as a pet owner with zero education in veterinary practices. But at the end of the day, just like my own body, I knew my cat better than the vets ever could have with all their education. I should have pushed harder to assess her issues instead of waiting. Said no to waiting on addressing her teeth. Asserted myself when the vet did not believe me that she was eating less. Demanded anti-nausea meds when I was refused, demanded liver support when she was going through fatty liver, etc. So many lessons learned.
 
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Jenny22

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I am very sorry that you may be facing SCC after all that both of you have been through.
Thank you. I feel sorry for her that she has to go through this. 😔 Just seems so unfair for her. But who knows - maybe she hasn't used up all her lives yet. The clindamycin seems to make her feel ill so I won't keep her on it long. At the end of the day, it was worth it to get her out of fatty liver because she looks so much better and I'm sure feels better. At least the cancer is localized rather than making her feel ill systemically the way fatty liver did.
 

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Unfortunately, I do have some bad news... I kept pushing to address Lulu's teeth now that she was recovering but her primary said we had to focus on the fatty liver. No one could sedate her to take a look at her mouth while her liver enzymes were still elevated. Unfortunately, I noticed a lump on her bottom left jaw about 3 weeks ago. The primary vet also confirmed it but again said we could not address it. At her follow up this week, it had noticeable grown. She suspected an oral tumor. I took her to a board certified dentist the following morning and he also confirmed he believes is to be small cell carcinoma (SCC). They can't rule out an infection and I couldn't afford further diagnostics. It was gut wrenching to have to leave "empty handed" but I also felt relief as they wanted to hold her there and I didn't want to put her through all of this all over again. This poor cat fought so hard to fight fatty liver to succumb to SCC. They said it's aggressive which means I'll probably lose her within the next 1-2 months. She is currently on clindamycin as a last ditch effort to see if it is an infection. But she is so fragile at this point that I am worried about the side effects of the clindamycin or that it could accelerate the cancer.
I'm so crushed by this added news about your Lulu. :frown:
It makes me so angry, and sad, and thinking it's just not fair. :disappointed:

For Lulu to have beaten Fatty Liver, with the intensive care that you gave her for over four weeks, with two of the weeks being really bad, made me hope that you were going to have another year or two, with your girl cat.

I know Lulu is 14 years old, but I still figured that you'd have another year or two left...if Lulu managed to get over the Fatty Liver.

(and the scientific studies and scientific surveys, or whatever they were called, where they mentioned the actual percentages of cats that actually do recover from Fatty Liver was quite low, according to those scientific papers, when they talked about syringe assisted feeding versus e-tube feeding. You and your Lulu smashed those odds, and percentages, and showed me, that I should never just look at percentages and numbers, since individual cases are all that matters.

The things you did for your Lulu, in getting her here, getting her another extra two months, since looking back, she may have been euthanized in early january, but she made it this far. She told you she was not ready, and did those 180 degree turns, whenever you decided that it was time. Lulu showed you that she was not ready to go, just yet. And also your own words, and thoughts, showed that you were always conflicted in these decisions, as opposed to the other animals that you had, where the answers were more clear cut.

Your cat Lulu, taught me that I will not just ever look at percentages and numbers, as I did in the past, when making tough decisions.
I'm rather going to try and look at the whole situation, and get some extra opinions, and research, too,...so as not to rely on just average cases.

Your Lulu and you, cannot be placed in the average category, since Lulu and you beat the Fatty Liver.

I hate (insert swear word) cancer.
It seems to never show up on regular blood tests, and seems to be found when tumours are already large, and showing.
On a plus note, the dental specialist said she looked so healthy and strong that you could not tell this cat had any of the illnesses that she has been diagnosed with. That was comforting to me. For all the things I feel guilty about when it comes to my pets, that made me feel like I must have done something right - that I really did exhaust all efforts. If I had to do it all again, this time I would better advocate for my pets instead of trusting vets because I was too afraid to burn bridges or overstep my boundaries as a pet owner with zero education in veterinary practices. But at the end of the day, just like my own body, I knew my cat better than the vets ever could have with all their education. I should have pushed harder to assess her issues instead of waiting. Said no to waiting on addressing her teeth. Asserted myself when the vet did not believe me that she was eating less. Demanded anti-nausea meds when I was refused, demanded liver support when she was going through fatty liver, etc. So many lessons learned.
You did plenty right, J Jenny22 . :alright: :hugs:
I hope you don't feel guilty about any decisions made, or any of the things that were done. :hugs::grouphug::hugs:

I do understand it, though,...since I do the exact same thing to myself...in that 'double guessing'...'looking back, and thinking about what I would do differently'...getting sad about the 'why didn't I notice things sooner, or why didn't I take them into the regular vet sooner'...type of thinking.

Yeah, we do learn so many lessons...and that's a good thing,...if we can accept the lesson, 'that we still did okay, at the time,...for what we had known...at the time'.
Also, not to be too hard on ourselves...either...since our animals are getting older, and health issues are bound to come up.:bluepaw:

(I don't know any older person, or older animal,...that didn't develop some issues.
Sometimes it's just been a 'luck of the draw' kind of thing that 'one health issue' was caught in time, while looking for another one.

I guess doctors and vets...always do the 'rule-out'...of the big, obvious things first...and then like you had mentioned earlier in your post...unless we actually advocate for ourselves, and do some extra research...then it seems like things get missed.)
Thank you. I feel sorry for her that she has to go through this. 😔Just seems so unfair for her. But who knows - maybe she hasn't used up all her lives yet. The clindamycin seems to make her feel ill so I won't keep her on it long. At the end of the day, it was worth it to get her out of fatty liver because she looks so much better and I'm sure feels better. At least the cancer is localized rather than making her feel ill systemically the way fatty liver did.
You seem so much more Positive than me,...in thinking...and in Accepting,...because the line of "...maybe she hasn't used up all her lives yet."...is so, so true. :agree:
This line just made me smile and laugh a bit...because you are so right.! :)

Lulu has NOT used up all her nine lives.
She IS still here, and it's not like she is dying tomorrow.
So you still get to enjoy being with her, and she enjoys being with you...for a while longer. :touched:

(one of the other members, here, di and bob di and bob ...had mentioned that one of their cats was diagnosed with leukemia, years ago, and had not even been given a long time to live, yet he outlived all the predictions that the vets had made.
I did read that she gave her cat some DMG immune supplement Life gold for cats with cancer, but have not done any research into these products.
Is Lifegold A Legitimate Supplement?

So who knows...what will happen...with this potential tumour.

I'll still be hoping for your Lulu to be feeling okay...and that she will let you know when it's time.
She has until this point, in time,...so I figure Lulu will let you know,...in the future, too.:caticon:

***Can you still be giving Lulu...prednisolone...in case it could help shrink any tumours, or inflammation?
I know you said, that her jaw felt fragile,...so not really sure about this?

(Would love to see another photo of your girl Lulu, too. But only if you have the time.
Heck, even if it's just a kitten photo, or older photo,...just anything really, to offset all the bad news going around.)
Take care, Jenny, and hoping that you and Lulu, and your dog...do have a good week. :greenpaw: :hugs::grouphug: :catrub:
 
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di and bob

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My boy IS still going strong after given 'days' to live with a leukemia diagnosis. We even dug his grave. Assuming his brother and mama also have it I have given all three DMG and Lifegold. I never tested them because it wouldn't matter. I would never separate them. There ARE still miracles out there!
 
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