Hepatic Lipidosis - success without feeding tube?! Freaking out.

[FrothOnTheDaydream]

Sangria has hepatic lipidosis. It's my fault. She was on Flagyl, and it made her stop eating. She would eat a bit, but I guess not enough. She saw a general vet and an internal medicine specialist. They prescribed:

- Hills a/d emergency food
- subq fluids (LSR)
- clavamox
- Mirtazapine

Her liver values were terrible, and she was starting to turn yellow. Luckily, there is no vomiting and she is still alert and playful. I've been giving 80ml subq fluid every 12 hours. The clavamox is 62.5mg every two hours and the mirtazapine is 1.88mg every 24 hours.

I'm freaking out because although she is VERY easy to syringe feed (AND I add nutri-cal to the a/d emergency food), I read online that syringe feeding doesn't work for hepatic lipidosis and that she needs a feeding tube. The specialist did not recommend a feeding tube and didn't even mention it. I started the aggressive feeding yesterday and she is STILL yellow today.

I feel like I can't breathe. I didn't sleep. I can't stop crying for longer than thirty minutes.

Is it not possible to bring her back from this without a feeding tube? We are seeing her specialist again (4 hours away) on Wednesday. Will she survive until then if she is alert and playful!?

 

[mrsgreenjeens]

It IS possible to save her doing syringe feeding vs a feeding tube. Many people opt for the feeding tube because they find it is easier. Since your girl is ok with the syringe feeding,go for it!

She will be yellow for some time still. Jaundice takes a while to build up, and it also takes some time to go away. Could be weeks. And the same with her blood work. Some times the numbers actually get worse as they are healing. I can't explain why, but it has happened.

It sounds as if your girl is doing great since she is alert and playful. Many cats with HL don't have the energy to do much of anything except sleep. Keep up the good work

 

[FrothOnTheDaydream]

It IS possible to save her doing syringe feeding vs a feeding tube. Many people opt for the feeding tube because they find it is easier. Since your girl is ok with the syringe feeding,go for it!

She will be yellow for some time still. Jaundice takes a while to build up, and it also takes some time to go away. Could be weeks. And the same with her blood work. Some times the numbers actually get worse as they are healing. I can't explain why, but it has happened.

It sounds as if your girl is doing great since she is alert and playful. Many cats with HL don't have the energy to do much of anything except sleep. Keep up the good work

I don't think you know how much it means to me to hear "keep up the good work". I feel powerless in this situation, and that makes me feel like I'm doing the right thing. My brother doesn't understand why I'd put so much effort into a cat and keeps telling me to put her down. But she's so bright eyed and playful that I can't!

I'm also happy to hear that the jaundice at this point is normal. It's scary to look at. I woke up this morning and thought jaundice means the end and that her liver has failed.

I mix her a/d urgent calorie food with a bit of nutri-cal paste and a teaspoon of KMR kitten formula powder to up the nutritional content and calories. We've done 90ml today so far! I'm also lucky that she isn't vomiting or having diarrhea. She took a few bites of cat food that I bought. Vet told me that even if I have to feed her junkier food, it's ok.

 

[mrsgreenjeens]

Don't listen to your brother . He has no idea what he's talking about in this situation. Many cats with H/L do not make it, but many DO, and your cat sounds like she is doing well, especially since she is not vomiting AND is even taking a few bites already. That is absolutely fantastic! Take it from me. When my cat had H/L, he didn't even try to eat for weeks, and every time he did he threw up. That was years ago though, and we weren't giving him any other medications that I can recall, nor were we giving him sub-q fluids. I'm sure that is making a difference?

Are you also giving your girl any liver supplements like milk thistle or Sam-E along with her meds? The nutri-cal and KMR are good additives. 90 mls already sounds super!!!!!!!

 

[FrothOnTheDaydream]

Don't listen to your brother . He has no idea what he's talking about in this situation. Many cats with H/L do not make it, but many DO, and your cat sounds like she is doing well, especially since she is not vomiting AND is even taking a few bites already. That is absolutely fantastic! Take it from me. When my cat had H/L, he didn't even try to eat for weeks, and every time he did he threw up. That was years ago though, and we weren't giving him any other medications that I can recall, nor were we giving him sub-q fluids. I'm sure that is making a difference?

Are you also giving your girl any liver supplements like milk thistle or Sam-E along with her meds? The nutri-cal and KMR are good additives. 90 mls already sounds super!!!!!!!

We haven't given milk thistle or Sam-E! Is Sam-E prescription only?

I really, really hope she pulls through. Is there a timeline for when she will be "out of the woods" so to speak? As in, if she survives a week is she likely to pull through? Not sure if that makes sense. I didn't sleep last night LOL.

Also, calorie intake for an 8lb cat is like 180 calories per day. That seems low. Should we be aiming for higher?

 

[mrsgreenjeens]

I hope she pulls through too . I can't really give you a timeline, but from what you say, I already feel hopeful. What did your Vet say?

Both Milk Thistle and Sam-E can be purchased over the counter. You might call your Vet and ask about using a liver supplement and why they didn't suggest their use? Their ARE prescription ones also, so there may be a reason they didn't prescribe them.

I think the 180 cals per day seems reasonable. Did your Vet discuss this with you? I'm guessing they are the ones who said to try to get 180 cals into her.

 

[FrothOnTheDaydream]

I hope she pulls through too . I can't really give you a timeline, but from what you say, I already feel hopeful. What did your Vet say?

Both Milk Thistle and Sam-E can be purchased over the counter. You might call your Vet and ask about using a liver supplement and why they didn't suggest their use? Their ARE prescription ones also, so there may be a reason they didn't prescribe them.

I think the 180 cals per day seems reasonable. Did your Vet discuss this with you? I'm guessing they are the ones who said to try to get 180 cals into her.

I looked up Sam-E, and I think it might interact with the mirtazapine since it's technically an anti-depressant (also appetite stimulant). Perhaps that's why my specialist didn't bring it up. Either way, I'll ask him about it on Wednesday. Yes 180 was calculated based on her current weight versus where we want her to be. Poor thing went from 8lbs to 7lbs

 

[silent meowlook]

Hi.
Syringe feeding will work provided you can get enough in and without aspiration. You should be feeding one can of the A/D a day. Was an ultrasound done to determine that it is in fact Hepatic Lipidosis? And to rule out pancreatitis. I am sure they tested for that.

Keep the feedings on a routine schedule. Don't ever fight with the cat regarding feeding. Make sur the food is room temperature or slightly warmer. Think mouse temp. If the vet didn't recommend a feeding tube, there may be a reason. It does require anesthesia, although brief. If your cat is easy to syringe feed, most cats aren't, that may be why. If you are syringe feeding, you may not need the Mirtazapine.

Did they give you anything for nausea like Cerenia? if not, I would ask for that.

Always give your cat the option to eat on their own should they want to. So, offer a tiny amount of the AD on a plate before syringing. Aim for a can a day divided into 4 or more feedings. If you get the Cerenia, give it an hour before the first feeding. Also ask about Forti Flora probiotic. While it isn't the best probiotic, it does have a flavor enhancer in it that attracts some cats. Another product that has a flavor attractant on it is Temptation treats. You don't want to use much of them but if you crush them into a powder and sprinkle on the food, sometimes it works to get them to eat. Not much though because the stuff is absolute crap. What are the antibiotics for?

 

[silent meowlook]

Why was she originally on the Flagyl? Are you sure that is what made her stop eating?

 

[FrothOnTheDaydream]

Why was she originally on the Flagyl? Are you sure that is what made her stop eating?

She was on it for loose stool (chronic). Her appetite was fine until she went on it. The thought is that it caused inappetance which is a side effect.

 

[Furballsmom]

Hi, something that might help is if you have a bathroom scale, you can weigh her and be better able to see how things are going.

 

[FrothOnTheDaydream]

Hi, something that might help is if you have a bathroom scale, you can weigh her and be better able to see how things are going.

Why didn't I think of this!? Would two days since diagnosis be too soon to check? I'm not sure how quickly cats gain weight, but she lost weight rather quickly when this all started.

 

[FrothOnTheDaydream]

Hi.
Syringe feeding will work provided you can get enough in and without aspiration. You should be feeding one can of the A/D a day. Was an ultrasound done to determine that it is in fact Hepatic Lipidosis? And to rule out pancreatitis. I am sure they tested for that.

Keep the feedings on a routine schedule. Don't ever fight with the cat regarding feeding. Make sur the food is room temperature or slightly warmer. Think mouse temp. If the vet didn't recommend a feeding tube, there may be a reason. It does require anesthesia, although brief. If your cat is easy to syringe feed, most cats aren't, that may be why. If you are syringe feeding, you may not need the Mirtazapine.

Did they give you anything for nausea like Cerenia? if not, I would ask for that.

Always give your cat the option to eat on their own should they want to. So, offer a tiny amount of the AD on a plate before syringing. Aim for a can a day divided into 4 or more feedings. If you get the Cerenia, give it an hour before the first feeding. Also ask about Forti Flora probiotic. While it isn't the best probiotic, it does have a flavor enhancer in it that attracts some cats. Another product that has a flavor attractant on it is Temptation treats. You don't want to use much of them but if you crush them into a powder and sprinkle on the food, sometimes it works to get them to eat. Not much though because the stuff is absolute crap. What are the antibiotics for?

I'm very lucky that she doesn't struggle or freak out. She does make sounds like she's really annoyed towards the end, but she's otherwise accepting of it. I'm giving her approximately 250 calories per day at this point. Last night, after only two days of syringe feeding, she ate a BIG handful of treats (temptations) and 4-5 bites of dry food. This is around midnight after she had already gotten all her syringe feedings. I do have Forti Flora. I haven't tried it yet! Can't hurt to try.

The specialist gave us mirtazapine. It's an appetite stimulant but he said it can double as an anti-nausea pill. Luckily, she doesn't have vomiting.

I'm keeping her in my room until she's well. Last night she woke me up at 3am with her toy mouse. I gave in and played with her LOL.

I hate to say it, but a lot of what the specialist said in terms of specifics is muddy to me because I was HIGHLY emotional when all of this was going down. He said something about prescribing them in case the hepatic lipidosis was actually caused by pancreatitis which just happened to develop during the course of Flagyl treatment. He also said something about wanting to be sure there's no infection. I'm not sure in what order he said things, and I'm probably mixing it up.

Her first ultrasound in December did show chronic inactive pancreatitis. So, maybe it got activated again?

Thank you so much for your help! Sorry I wrote a book.

 

[Furballsmom]

Would two days since diagnosis be too soon to check?

No, I actually think it is just right, --you need a benchmark point to start from

 

[FrothOnTheDaydream]

No, I actually think it is just right, --you need a benchmark point to start from

Thank you!! She had dropped from 7.8lbs to 7.0lbs when she was weighed two days ago. Should I wait until morning to weigh her and see if she has gained a couple of ounces?

 

[Furballsmom]

Should I wait until morning to weigh her and see if she has gained a couple of ounces?

Maybe, since she needs enough time to absorb the nutrients and turn that into actual weight

 

[BellaBlue82]

Hi there, I also have a kitty with liver issues right now. And I am syringe feeding as well, he does perfectly fine with it! We put his "bib" on and he eats it all up at each feeding.
And I agree, liver issues are tough. Casper is on Denosyl (SAM-e by Nitramax) and milk thistle, so far we're still waiting for his jaundice to go away. It's only been one week. I think there is a combo of these two (SAM-e and milk thistle) called Denamarin made my the same company. But Casper couldn't handle both together from the sample we got from the vet, so we purchased them to administer separately. These are all OTC and can be purchased through Chewy or most pet stores. He will also be starting Renal K+ gel today for his potassium.
I do know SAM-e shouldn't be taken within 2 hours prior to eating or 1 hour after eating. The same goes for other medications since it can cause stomach upset. Casper could not handle mirtazipine (interaction with his liver) so we are administering ondansetron for nausea instead with liquid pepcid.
We have a vet check up today and will discuss adding Ursodiol which is a prescription supplement. It has a different role, but is used in severe liver damage cases. While Casper's numbers aren't astronomical, they are impacting his RBC, potassium and kidney values. Sadly, they are all tied together like a chain effect. But he's still going strong! Just sleeping a lot, which is necessary for his recovery.

I hope this helps, there's many options surprisingly for Liver function that are beneficial!