Hepatic Lipidosis/Mouth Ulceration/Syringe-Feeding

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spiderplant

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Our youngest(1 year old) is having a horrible time.  At this point, I've gotten about 75% of a can of Hill's AD into him from around 8:30pm to 2:45am.  We're going to feed him once more before our late bedtime.  He went to a vet appointment on Friday and the vet believed he was having a herpes flareup with a secondary bacterial infection.  He had been a bit lethargic but, after a night of being isolated from his brothers, he had mucous dripping from his nose.  The vet thought he'd be fine and sent us home with Zeniquin(he's had 2 doses).  Today, around 6:30pm, we brought him in for an emergency visit because he was still refusing food and had signs of jaundice.  He wasn't dehydrated but the vet went ahead and gave him subcutaneous fluids.  She also pried his mouth open and discovered a horrible ulceration(with pus) on his tongue.  It was awful.. I can't imagine the pain he's in.  When we got home and I popped open the first AD can and he actually ate a little on his own.  I have since had to syringe feed him.  I've gotten most of the can into him as well as a few supplements(carnitine, a multi vitamin mix with arginine/taurine, a mushroom complex, milk thistle, and DMG).  He seems to be in good spirits.

The vet told us she believed he was in the "3%" who would not make it.

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I have every supplement imaginable here and various types of food.  Any suggestions would be greatly appreciated.  He's taking the AD well and hasn't had any diarrhea or anything of that nature.  I realize this is a critical time and calories are everything.  Any advice is appreciated.  He had a rough start in life, is extremely shy with strangers, but relaxed and purred in my arms when I held him at the shelter.  His brothers love him and so do his parents..
 

denice

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I am so sorry and he is a handsome cat.  I assume you're giving him L-lysine.  I haven't dealt with herpes but that seems to be pretty standard.  I have had a cat with hepatic lipodosis and my cat had a feeding tube put in.  I don't know about anesthetic with all the upper respiratory stuff,  You are getting enough food in him with the syringe especially since you are using the A/D but that must be really painful for him.

I'm sorry I don't really have any suggestions but don't give up on him.  He's young and cats have amazing recovery abilities.
 

mservant

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Hi, I'm so sorry your little 1 year old is having such a hard time and your vet is worried about him.  I too have a young cat (2 1/2) with FHV 1 and had awful problems with his mouth from about 6 months age .  I know how terrible I felt when I got him to the vet and they found he had an infected sore on his tongue, at the angle of his jaw, and tonsillitis in addition to gingivitis.  I still have awful feelings of guilt that I didn't spot it sooner and how much pain he must have been in.  He was a poorly little cat at that point but thankfully responded well to the antibiotics and a strict long term oral routine.  The FHV was diagnosed when he had repeated runny eyes after his mouth had settled down a bit.  If you saw him just now you would never know he has had any health problems at all (unless you look at his tongue as it's scarred).

Please be careful if thinking of trying the L Lysine as there are concerns about using where there is any liver or kidney damage present.  It is more for blocking and reducing the regularity /severity of virus outbreaks so perhaps not be something to rush in to just now but wait to see how the vet feels things are going over the next day or two.  If using and the vet doesn't know check it out with them.

If the antibiotics take effect quickly you may find your boy starts to eat again quite quickly as long as his food is nice and soft. Mouse certainly did.  I think as long as it's nice smelly stuff they like they will start to eat again as long as they're not too congested as well as having the sore mouth.  If not, keep up with the syringe feeding.  I give Mouse water to drink from a syringe too as he enjoys doing this and it helps to keep his water take up even when he's stressed and maybe not wanting to drink from his bowl.

Will be thinking of you and hoping you have better news when you next speak with the vet.
 
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goholistic

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Aw...poor baby! Tongue ulcers are very painful. My Boo has had them twice with this herpes virus. You didn't really say how long the cat wasn't eating before you started to assist feed. Did they apply a Fentanyl pain patch or anything for the pain? (I'm not sure how this affects any liver issues.) DMG is a good immune-booster. I also use this during their flares, in addition to the l-lysine.
 
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spiderplant

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The vet we saw for the emergency visit did not do much at all. No bloodwork was performed. He was only given fluids. When I brought him in to see his regular vet he did not look in his mouth, said he'd seen "a lot worse"(as far as the herpes flareup), determined he had a secondary bacterial infection, and sent us home with an antibiotic. I also requested an FeLV test at that time, even though he's been tested before. It came back negative. I had thought he might have looked a little jaundice at that time but his vet obviously did not. It wasn't until we saw the other vet that she noted it.

He didn't eat much Thursday and I isolated him Thursday night(it appeared he hadn't eaten the plate I made of his favorite foods). When I got him out of the room Friday he looked pretty bad(he wasn't experiencing ocular/nasal discharge beforehand, I think the stress of being away from his brothers(we put up a screen door) pushed him over the edge. I did notice diarrhea in the litter box as well(the reason I had isolated him). His appetite really began to slack off after I made the appointment on Tuesday. I'm not sure exactly how much he was eating because we feed everyone together, throughout the day.

He's currently holding down the AD I've been syringe-feeding him; no diarrhea or vomiting. I wasn't given any instructions as to how much to feed and I've found a lot of conflicting information. I'm currently aiming for one can. I've offered him various foods(tripe, chicken, Fancy Feast, the AD), he gets excited about them and looks as though he's about to eat them, but then stops. The ulceration is on the very far right side of his tongue so I syringe-feed on the left side, btw.

At this point, I'm leaning towards bringing him to another vet for bloodwork(to determine what his liver values actually are) and so on but I don't know if he can handle the stress.  I would -at least- like to pick up pain meds, if they're safe for his liver.  There are no 24 hour clinics here so hospitalizing him is not an option, btw.  This is something I've never dealt with before, obviously.

I forgot to mention, I've backed off on the lysine.  I decided on DMG, NAC, milk thistle, and the multivitamin(Life Extension Cat Mix) for now.  He's tolerating everything very well.
 

goholistic

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Yeh, it sounds like he wants to eat, but the ulcer is just too painful. Hopefully his mouth will start healing up soon!  
  Keep up with the syringe feeding.

The Fentanyl patch really helped my Boo with pain when he had his ulcer, but the vet wanted me to bring him in for it. They shaved an area on his ribcage and applied the patch. It releases the pain medication slowly and is good for three days, so you wouldn't be bothering his mouth with oral medication. It did make him a little loopy and he staggered a little...but it was better than pain! If you have to bring your cat in for this, then you might as well get the full CBC while you're in there. If his numbers look good, you might be able to add l-lysine back into your supplement mix.
 

stephanietx

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If the sore on his tongue was so severe, it was no wonder he didn't want to eat!  Poor little guy.  Did the vet give you any kind of pain medication?  If not, then you might ask for something, but be sure it's not Metacam, as that can cause a whole other set of problems.  I have given my cat Zenequin previously and it worked well.  Switching to a grain-free diet, if you're not already feeding one will help as will Lysine.  For the ulcers, many find that pure Evening Primrose Oil (500mg once a day) is helpful.  However, getting him healthy first is the priority.  Try warming the food up a bit to help entice him to eat.  Don't get it too warm as it'll irritate his tongue more.  At this point in time, I don't know that you need to be too concerned with his liver values as he wasn't without food for too long.  Lastly, the Zenequin might possibly be causing the diarrhea.

What are these and what are they for? 
DMG, NAC, milk thistle
 

denice

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One can of the A/D a day will be enough.  It is calorie and nutrient dense.  If he does have hepatic lipodisis it may be a while before he eats on his own, it's the nature of the illness.  The behavior of acting interested in food and then walking away is what most cats do when they are nauseated.

If he's jaundiced I would want to get his liver numbers so you know where you're at.  There is a supplement called Denamarin that combines milk thistle with SamE that really helped bring down Patches liver enzyme numbers.
 
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spiderplant

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"It did make him a little loopy and he staggered a little...but it was better than pain! If you have to bring your cat in for this, then you might as well get the full CBC while you're in there. If his numbers look good, you might be able to add l-lysine back into your supplement mix."
At this point, without knowing his liver values, it seems like stopping his pain is the best thing I can do for him. The syringe-feeding is going okay but it's stressful for him. I want him to be able to eat on his own again.

"Did the vet give you any kind of pain medication? "
Nope, nothing. :( I've had a very hard time finding a vet out here and there aren't a lot of options. Our regular vet would prescribe something if I asked for it. I'll look into the best, safest option.

"I have given my cat Zenequin previously and it worked well."
I'm always hesistant to use antibiotics on my guys but I can tell it's helping(he had his third dose today). The smell(I have a very sensitive sense of smell) he had the day I took him out of his room(Friday) screamed "bacterial infection" and, after seeing the side of his tongue, he definitely needs this. The vet seemed to believe he hasn't had it for very long. I would guess it hasn't been infected for long but it might have started with an irritation days ago?

"Switching to a grain-free diet, if you're not already feeding one will help as will Lysine."
He's been on grain-free canned, commercial raw, and homemade cooked since we adopted him in December. My current plan for him and one of my other boys, is to do a more limited ingredient diet with lamb(Rad Cat, Instinct) and see if they improve. That's once he's recovered, of course. He's always had a great appetite for any raw food. He's the sweetest, most gentle cat but he growls when he eats his favorite foods.

"For the ulcers, many find that pure Evening Primrose Oil (500mg once a day) is helpful. "
I currently don't have straight Evening Primrose Oil but I do have Udo's Oil(it contains it) and krill oil. I can order EPO and have it here within a couple of days, though.

"Try warming the food up a bit to help entice him to eat. "
I've been warming the AD everytime we feed him. We also cooked chicken today, just to make a more appetite-stimulating environment for him, if that makes sense. After my last posting, he ate a tiny bit of mashed chicken on his own. I keep heating chicken, AD, and Fancy Feast and offering it prior to syringe-feeding him but he, understandably, can't eat it on his own right now. :/

"DMG, NAC, milk thistle"
I give DMG(Feline Immune, Vetriscience, liquid) to my 15 year old daily for his respiratory issues; it's a good immune booster and I read it's helpful for liver issues. The NAC(N-Acetyl-Cysteine) is recommended for liver problems(I've known many people with various liver diseases who benefitted from it) and my 15 year old takes it as it thins out mucous/protects the lungs. The milk thistle is for cleansing his liver/regenerating liver cells. I was in the supplement industry for several years so I can think of a great deal of supplements for "liver support" but I'm trying to keep it simple for him. He's tolerating everything very well so far but yeah, it would be wonderful to have a holistic vet right now.

"If he's jaundiced I would want to get his liver numbers so you know where you're at. There is a supplement called Denamarin that combines milk thistle with SamE that really helped bring down Patches liver enzyme numbers."
I really wish I pushed the vet to do bloodwork but it never happened and she seemed to be in a hurry to get out of there. :/ I've been out here a little over a year and yeah.. it's a completely different veterinary experience than what I'm used to. SAM-E is wonderful for liver problems and I imagine it would help with his mood a bit as well. I'll check out the Denamarin.

We're going to do a couple more feedings tonight and then make a few phone calls tomorrow. At this point, I lean strongly towards bringing him in for a third opinion/bloodwork/etc.
 

tracy826

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I nursed four shelter kittens through pretty serious calicivirus and the shelter vet prescribes sucralfate. The tablets are dissolved in water and given by syrings to coat the tongue just before feeding. It really soothes the pain and helps them eat. It's nearly miraculous in getting nutrition into them. Please ask your vet about it or ask him/her to look into it.
 

sarah ann

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Does he have hepatic lipidosis or are they concerned he will develop it?

http://www.michvet.com/library/medicine_hepatic_lipidosis.asp

If he does have hepatic lipidosis he needs to be hospitalized as they can stabilize him.  I would put him strictly on canned food. Right now he absolutely needs to have all his vitamins and minerals. With a sick cat the bacteria in raw food can make them worse.  Do not feed raw to a sick cat!   If you are healthy you can handle exposure to bacteria, but not if your immunocompromised.

You need to aim for a minimum of 210 calories a day or more.  I would aim higher than that- 250 calories.

I would get bloodwork done next. ASAP. Bloodwork will really help you get an idea on how he is doing.
 

peaches08

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With commercial raw, there is much less concern about bacteria due to how it is processed.
 
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spiderplant

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Our sweet baby, Atlas, is no longer with us.  It was FIP.  Thank you for the advice offered.  We miss him terribly.

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denice

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I am so sorry.  FIP is such a cruel disease and there is nothing that can be done for it.
 

goholistic

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I'm so deeply sorry about Atlas. 
  I was not expecting this at all. FIP is horrible and can take so many forms. Just know that Atlas is no longer suffering. Rest in peace, little man. 
 

mservant

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Thank you for letting us know. I am so sorry you have lost Atlas, he looks beautiful in your posts, and I so hoped he would pull through.  He was lucky to have his furever home with you and that you did everything to give him a full and loving, comfortable life. He is free of pain now and will want you to take good care of yourself. 
  
 
 

blueyedgirl5946

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Oh behalf of The Cat Site Moderating Team, we are truly sorry for your pain and your loss. You might wish to post a memorial thread to Atlas in our Crossing the Bridge Forum. When you do that our members can offer their support and condolences there. I am going to close this thread now.
 
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