High Liver enzymes, change in appetite- need advice

perez.samantham

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Hello everyone!
Advice is very much appreciated!
So my 13 year old cat Calvin has been loosing weight. We lost my 17 year old cat in March, so I started weighing him. He has lost over half a pound. Otherwise- he is acting fine. He throws up 2-3 time a week: sometimes it catfood, sometimes its hairballs, sometimes its bile. I was giving him 1/4 can of wet food at a time (same with my 1.5 year old cat) and if there was food left uneaten, it would stay their- so I was wondering if maybe the puking could be a result of eating spoiled food? (I have since then started lifting the food after 10 minutes and refrigerating it.
So I decided to take him into the vet last Thursday.
His kidneys are fine, glucose level are fine, thyroid is fine.
Liver enzymes were high: at 160. They said normal is under 120, and chronic liver failure is over 200.
They sent him home with a liver supplement and we did an IV drip and they made an appointment for one month out.
I gave him the supplement Thursday and Friday and Saturday, but Sunday morning he threw up. My husband thinks he ate old food.
I fed him lunch (not knowing he had puked earlier) and he ate it with enthusiasm, but then puked about 30 minutes later.
He did the same with Dinner. I did not give him his liver supplement Sunday, Monday, Tuesday.
Monday Morning he asked for food, so I fed him half of his normal amount, and he threw it up.
I called the vet, and they were crazy busy. I ended up talking to a total of three vets, none of them gave me any real guesses other then they want to do a bunch of tests that may not tell us anything.
So Monday I decided that maybe this was all because of food? So I made him bland boiled chicken and rice, and I got him to eat about a spoon full!
A few hours later, I had more success! The third time I tried to feed him, he didn't want any, but seemed interested in my other cats food, so I gave him a spoonful, and he ate it, and he kept it down! We repeated this process about 3 more times. He had only eaten about 2/3rds of his normal daily intake, if not less. My husband was about to feed him before bed last night (4am) and Calvin puked a small amount of bile (to me this says he is hungry and didn't eat? he is a picky eater sometimes and will refuse to eat certain flavors of food knowing ill give in and give him another can) but my husband chose not to feed him...
I got up at 8am, and fed him his normal amount. He was pleased, and ate it all.
He then sat with me on the couch for several hours, until around noon I realized he hadn't meowed for more food like he normally does (normally I start getting meows around 11am) So i decided to feed them. Calvin has no interest in food. I tried giving him treats (which he has never refused in 13 years) and he has no interest.

So now I am worried again.
Monday I thought he was dying, Yesterday he was on the mend, and today he is acting sick again.
He still gets up and walks around occasionally, he is currently sunbathing, looking mighty comfortable actually- but he has no interest in food.

Maybe his tummy is still small from being upset for a few days and he is full from breakfast still? (fed him at 8am, now its almost 5pm...)
Or maybe its the wet food I am giving him?
Also- he has access to dry food constantly. I haven't seen him eat any, but it is there if he wanted it.

Also- I can't really tell, but he might be jaundice- his ears and gums look a little bit yellow to me. But he is a white cat with pale and pink gums, and he has always had a bit of a yellow tint to him... so I can't tell if I am just being over dramatic or if he really is yellow.
For that reason I ended up giving him his liver supplement at 2pm (Denamerin Advanced- they said to give on an empty stomach) and he kept that down. But now I still can't get him to eat.

The vets here are swamped- I have an appointment made for Saturday, but that is 3 days away.

The vets want to do a Bile-acid blood test. If its positive, then his liver is failing, nothing I can do. If it is negative, we don't know what's wrong and I wasted a bunch of money.
They also want to do an endoscopy to look for tumors. If there are tumor, nothing I can do. If there are no tumors, they can look for other issues, but its literally exploratory at this point.
They could also biopsy the stomach to see if he has gastrointestinal disease- the test is very expensive, then needs to be analyzed by a specialist which is also expensive.

I am hoping the liver supplements will help. But I also know that if his liver is already acting funny, that putting pressure on it by him not eating, could cause liver failure.

Does anyone know what an enzyme level of 160 really means? If his liver is failing, how long does he have? Is he in pain?
How long without eating until I should be really worried?
Any information, or advice would be greatly appreciated!!!
Thank you in advance!
 

daftcat75

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There’s a lot to unpack there.

First, barfing in cats is sadly common but never normal. Not even hairballs. Ingested hair should pass through and be pooped out. When it’s coughed up, that’s usually the first signs of a developing gut motility issue.

Throwing up bile would can also be pointing to the same. His gut or stomach isn’t moving like it should. So he’s bringing it up.

I’m assuming the liver number is ALT. 160 isn’t high. 200 isn’t even high. But it does warrant attention. My Krista was hospitalized when her ALT came back at 1400. She spent ten days on IV fluids and that brought her down to the 160’s. ALT can go high when there is inflammation elsewhere. In her case, she was having both dental issues and an IBD/pancreatitis flare-up. When the problem teeth were removed and her gut was given rest via IV fluids, the liver numbers slowly came down.

My guess is that he has IBD, possibly GI lymphoma, and maybe pancreatitis. Rather than spending money on exploratory surgery or endoscopy, I would start with an ultrasound first.

In the meantime, I recommend feeding him smaller meals more often. If you feed him 2 oz twice a day, I recommend trying 1 oz, 4 times a day. This smaller amount gives his slower gut a chance to digest it and push it through.

My other recommendation, without a diagnosis to confirm IBD, is a change in proteins. If he normally gets chicken and fish, see if he’ll eat beef, lamb, venison, or rabbit. Or ask your vet about a hydrolyzed diet. Hydrolyzed means the protein is processed so it doesn’t look like a chicken protein to the body anymore. When doing food trials, you have to pick a food and give it as much as 13 weeks. You also have to be diligent that you’re not leaking the very foods you are trying to avoid in his dry food, treats, or secondary ingredients in his food. Often times a so-called novel protein food still has the very proteins you are trying to avoid further down the ingredients list.

Ask about IBD. Ask for an ultrasound. Elevated liver enzymes aren’t a death sentence. But they also often aren’t conclusive and you have to find the underlying reason why they are elevated.
 

daftcat75

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Also, wet food can be left out for several hours. It takes a lot longer than that for canned food to spoil. Cats also have a highly acidic stomach to combat spoilage. Raw food however spoils much faster and should never be left out more than an hour.
 

daftcat75

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One more thing. Dry food can be inflammatory. If he likes wet food, that’s half the battle. See if you can add more wet food and reduce or eliminate his dry food.
 

BlackCatOp

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Agree with above.

Also remember that liver enzymes do not evaluate liver function. For liver function, you would need a bile acids - however if they are jaundice there is no point in running a bile acids as it will come back elevated.

There is what is called “pseudo liver function tests” on the chemistry- Albumin, glucose, cholesterol and BUN will all be decreased and Bilirubin will be increased. These can help evaluate liver function as there are produced/cleared by the liver.

As far as vomiting- the list is end list.

Hope you kitty feels better soon!
 

MissClouseau

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Does he still groom himself? Are you doing anything for hairballs? Sometimes they can't pass the hairballs over a problem. Sometimes they can't pass the hair because there is too much hair and/or not enough hydration. Either way it sounds like he needs extra help during this time so even if hairballs aren't the cause of the current problem(s), it could make it worse. Try brushing at least once a day. If he gets stressed out by the brush you can try petting him with a bit damp hair so the hair will stick to your palms.

Liver problems are usually treatable but they are usually a secondary problem and the main cause should be found to treat both. It gets dangerous if they don't eat longer than 24 hours, risking fatty liver disease.

Did they check his gallbladder? Gallstones for example is rare in cats but might also cause liver issues. Really, quite a few different things might cause liver problems. That's why they do and will keep asking for more tests if they don't find a reason.

Did they check for worms?
 

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I would not spend money on all the tests, and definitely no surgery. He might not recover from it.

Ask for anti-nausea meds (they work great), an appetite stimulant, and an antacid. I agree it may be pancreatitis or GI issues, but if he’ll stop throwing up and begin eating, over time, he should improve unless something else is going on. If he has inflammation or infection he may need an anti-inflammatory or even an antibiotic. I would try meds before lots of expensive tests.

I have a cat who was acting similarly recently, and I thought she was going to die. We got her on nausea meds, fluids, an appetite stimulant, and an antibiotic, and after not eating for 5 days, she began slowly to eat, and over two weeks, returned to her normal self. Blood tests indicated kidney function issues initially, but she’s 100% now. While she was not eating, I syringed unflavored pedialyte into her along with Gerber turkey baby food. It definitely helped.

Have you considered calling a different vet who may have more time to see your cat? You can have his test results sent over, and a second opinion never hurts. Also, did the vet run a urine test?
 

mrsgreenjeens

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When you talk about the liver enzymes being 160, it's important to know WHICH ones. There are actually more than one liver enzyme, as alluded to above. Here is a great article regarding the liver which may be helpful to you: Elevated Liver Enzymes In Cats – Should You Be Worried?

I will tell you that I had a cat whose ALT used to get up into the 400s on and off, and we could tell because she would start vomiting bile and lose her appetite. Every time this happened, she would get an antibiotic treatment and her numbers would go down and she'd start eating again. This happened several times. We never knew why, and she was already 14 years old or so with chronic kidney disease, so we opted not to get invasive testing done.

I think if I were you, as suggested above, I would think about calling another Vet. You could get the records from your existing Vet to perhaps save a little, although they might want to get further bloodwork. But honestly, I'm a little surprised that they didn't automatically put him on antibiotics or at least discuss it with you and discuss all the other things discussed above as possibilities of what might be happening (unless they did and you just didn't mention it)

Whatever you do, you MUST get food into him. If that means you need to syringe feed him, so be it. Many cats who refuse to eat end up getting an E-tube, which makes things SO MUCH EASIER for everyone involved, including the cat! We had a different cat with Hepatic Lipidosis who was on a feeding tube and that made such a difference. These new E-Tubes are (if you'll pardon the pun) the Cat's Meow.
 
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perez.samantham

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Thank you guys so much for the advice!
I ended up calling the vet again today, and we came up with a game plan.
We are starting with a GI Diet. He started today and seems to be doing well!
meh didn’t eat much, but he ate, and kept it all down! And now he is asking for more! (I have to give him his liver supplement soon so I am waiting to feed him more)
I have another vet appt in a week, if he is still vomiting or the jaundice hasn’t decreased (it’s already better today) if he isn’t better we will start him on steroid and antibiotics.
And that doesn’t work, then I’ll do an ultrasound.
I really appreciate all the advice guys! I will continue checking for more advice, and I will try to keep you all updated!
 

daftcat75

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I think you have to do the ultrasound before you start him on steroids or you have to taper him off the steroids before you can do an ultrasound. The steroids can give a rosier picture of what's going on than what's really going on. Other than that, your game plan sounds good. Discuss this with your vet next week before you start him on steroids.
 

mrsgreenjeens

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I think you have to do the ultrasound before you start him on steroids or you have to taper him off the steroids before you can do an ultrasound. The steroids can give a rosier picture of what's going on than what's really going on. Other than that, your game plan sounds good. Discuss this with your vet next week before you start him on steroids.
Yes, that's what I've heard also
 
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perez.samantham

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So he isn’t showing interest in the new food.
he really wasn’t interested in food most of the day. He would eat a bite or two and be done.
I ended up feeding my other cat his normal food, and Calvin ended I eating almost an 1/8 of a can of wet food. I also watched him drink water!
Not nearly enough food, but an improvement.

Any advice on transitioning him to the new food?
 
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perez.samantham

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So this morning same thing:
No interest in the GI food at all. He was however interested in the old food. Took a few bites, drank some water, and is done.
He is showing interest in food, but then doesn’t eat. I think he is nauseated, so I called and left a message for the vet to see about prescribing an anti nausea medication or possibly an antibiotic in case of an infection. She is in surgery so I likely won’t hear from her until tonight.
But his activity level is slightly better. He is purring again, asking for live, jumping on the couch: but he still spends 90% of his time sleeping. But he is a 13 year old cat... so I don’t know how much is normal lol.
he is still slightly jaundice too.
 

mrsgreenjeens

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To transition to the new food, usually you would mix a little of the new food in with his old food. This may or may not work since he isn't really eating much at all. But it's worth a shot. Otherwise you might try using toppers, which could be tuna juice, crushed old kibble that he likes, crushed treats that he likes, crushed anything that he likes, sprinkled on top.

I'm not surprised the jaundice isn't going away, because until he eats WELL, it probably won't. That's because the liver needs to heal from whatever is wrong, and it needs food and fluids, plus may need antibiotics as mentioned earlier (and hopefully your Vet will prescribe some if they think it's a possible infection) and it also take time for the Danemarin to work. it's usually a 30 day course, I believe.

Hope your Vet gets back with you early enough today for you to get some anti-emetics and whatever else is appropriate to get your little guy on the road to recovery.

:vibes::vibes::vibes:
 
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perez.samantham

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So the vet ended up giving us an anti nausea med yesterday- thank goodness!
He started eating and drinking again!
he is only at about 20% of what he should be eating, but he is back to acting normal for the most part.
So after he ate last night, we immediately saw him perk up. This morning- I got my normal kitty greeting! I was so excited! I fed his a mix of the GI food and his old food, and he immediately switched plates with his brother and he ate the friskies while my other cat ate the GI friskies mix lol. Now Calvin is acting like his tummy is upset again. Not nearly as bad as before, but he’s sleeping- and his eyes just tell me he’s not feeling as great as before he ate.
So I am fairly convinced this is all food related.
going to do some research on ways to incorporate the GI food...
Does anyone know what type of food he needs? I’m not a huge fan of what I was prescribed - it’s Hill’s Digestive Care I/d wet food. I am not a fan of the ingredient list...
They wanted me to buy gastrointestinal response dry food, but it was going to take too long to ship here. Also wasn’t a fan of that food.
When the main ingredients include ground- cornmeal, I don’t like it.
I really like Nulo brand cat food- the limited ingredient food... and the prescription food is EXPENSIVE. I’m wondering if I can find something better...Does he need high or low protein, fat, carbs? Could I maybe switch him to like a duck or rabbit based food? - my other cat dealt with allergies as a kitten, so he had lamb and rabbit for about 6 months. That food was even less expensive then the prescription food... his jaundice has greatly improved today. He isn’t nearly as yellow, and his nose has pink in it again, and doesn’t look so dry.
last night he jumped on the couch for love, purred, leaned into the petting. So he is on the anti nausea meds for a total of 4 days, and the liver supplements-
Oh I need advice on that... yesterday- the first pill I tried to give him: he has learned to push the pill to the side with his teeth and he chews it trying to spit it out. The second time I tried he bit his younger trying to stop me 😭 I about died inside. We bought a pill shooter thing... but I didn’t try it yet... any advice?
I’m hoping now that he has an appetite again I can get him to eat the pills in some cheese.
last night that is how I got him to eat the anti nausea meds- it’s tiny tiny and I got Calvin interested in a small bite of cheddar cheese.
I noticed a difference within an hour.
hopefully cheese will work for the bigger supplement pill now that he has an appetite again 😁
 
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