Liver Disease, Cholestasis Cat

[Chaz Galloway]

Hello everyone,
My 11 year old cat Chaz has been seeing a specialist for problems related to his liver for quite a few months now with no progress, and I am desperate for any information that could help. The problem started 6 months ago when I noticed he had lost some weight (approximately 3 pounds) in the span of a year. Since I was not dieting him I thought this was odd and took him into the vet for an overall check. Other than the loss of weight, he had no other symptoms of a sick cat. The vet ran bloodwork and determined his ALT and ALKP were slightly elevated. She recommended I see a specialist to have an ultrasound on his liver to determine the problem. The ultrasound showed some inflammation of the liver, gallbladder, and spleen with some sludge in the bile duct. She felt that this could be from bacterial cholangitis and prescribed antibiotics (metronidazole and orbax) to try. On the follow-up a few weeks later, his levels were still consistently increasing, but at this stage, all of his liver enzymes were elevated- ALT, AST, ALP and GGT. By this point, I decided to go see a different specialist with more experience an hour away from our house to get more definitive answers. It took a few months to get in with the new specialist, but by the time we did, his liver enzymes were slowly but surely continuing to increase. She performed an ultrasound guided fine needle cytology on all of his affected organs and said the only thing she could confidently say from the results were that he did not have lymphoma. Good news, but still not a lot of information for all of the time and money spent on this journey
Since the antibiotics alone didn't seem to be helping much, and the metronidazole was making his stomach hurt, she advised to stop that antibiotic but added a daily steroid (prednisolone) to the mix. She requested a follow up bloodwork panel in 7 days, as well as a special digestive enzyme blood panel to rule out IBD. I just got the results back from the panel and still his levels are persistently rising as well as some other measurements! Not only are his levels even higher, he now has elevated bilirubin and decreased red blood cells & platelets. The digestive enzyme panel was all perfectly normal. It goes without saying that I am frustrated, exhausted, and emotionally drained!!!! Because of the results, the specialist is pushing a surgical biopsy just to get a definitive diagnosis. Not only am I hesitant because we have no real results from all of this expensive and stressful testing, but also because Chaz has a heart murmur and anesthesia is a huge risk. Not to mention further damage that could result to his liver from having to process the anesthesia. But I also want to do everything I can to help him get better. Does anyone else have any experience with liver problems in a cat? What worked or didnt work? My cat is eating and otherwise acts like his usual self. Some days he sleeps a little more than I would like, but hes also on a steroid..
Please, please help

 

[Furballsmom]

Hi

Every cat is different, so what my angel Poppycat had back in 2019 may have been somewhat different (although the term used was triaditis I'm not sure it was quite that fullblown) but I'm really concerned here that your boy isn't getting denamarin, milk thistle or something of that nature to provide support and benefits to the liver.

Are these vets cat-only?

This may have some info in case you haven't seen it yet;

Cholangitis/Cholangiohepatitis Syndrome in Cats | VCA Animal Hospital.

 

[Chaz Galloway]

Hi

Every cat is different, so what my angel Poppycat had back in 2019 may have been somewhat different (although the term used was triaditis I'm not sure it was quite that fullblown) but I'm really concerned here that your boy isn't getting denamarin, milk thistle or something of that nature to provide support and benefits to the liver.

Are these vets cat-only?

This may have some info in case you haven't seen it yet;

Cholangitis/Cholangiohepatitis Syndrome in Cats | VCA Animal Hospital.

Thank you for replying so quickly. The vet specialist I switched to is not cat only. There is a cat only clinic about 50 minutes away from my house but they are not accepting new patients right now. Unfortunately, there are not very many veterinarian specialists in the middle Tennessee area and they are always reminding me that there is a vet shortage. I do have Denamarin that I ordered myself after reading a few articles online. Im struggling with administering a pill to him, but if it may help then Im willing to try harder.

 

[Furballsmom]

I just saw that Chewy has compounded liquid denamarin, but you may want to research milk thistle as well.

 

[Chaz Galloway]

I just saw that Chewy has compounded liquid denamarin, but you may want to research milk thistle as well.

That would be a lifesaver! I'm seeing it says milk thistle/sAMe supplement in the liquid form on chewy. Is that what you're referring to?

 

[fionasmom]

Pilling Cats: Must-know Tips For Hiding Pills – TheCatSite Articles
Getting Cat To Take Pills... Post Tips Here.

 

[Furballsmom]

Hmmm, I didn't double check the other members post, but I'm thinking that's what was being referred to.

 

[Chaz Galloway]

Just wanted to update on my cats liver situation in the chance it may help someone else who decided to go perusing the internet for answers like they tell you not to do I see you.

Currently, my cat is at Blue Pearl emergency hospital staying the night while they check over his heart and give him another ultrasound to prepare him for a surgical liver biopsy in the morning. This is the first time I've come home to an empty house without my cat and ouch.. I don't like this feeling. Since a scheduled appointment for surgery would have taken 4 weeks, the vet said taking him through the emergency department was the quickest way for him to get a biopsy done. Not the most financially feasible way, but time is not on our side for my sweet little boy. On the ultrasound, the specialist noted some chronic fibrotic changes to the liver and looked unlikely to be fatty liver pockets. Since hes still eating on his own, they are advising against placing a feeding tube, but that may change depending on what they see when they look at his liver. Fingers crossed all goes well with his biopsy tomorrow. I probably wont sleep much tonight worrying about how scared he must be in his kennel at the ER I hope he knows I hate this feeling as much as he does.

 

[Furballsmom]

 

[fionasmom]

Please let us know what happens. I know it is so hard to wait and worry through all of this.

 

[LelaCat]

That's me...scouring the internet for any answers...and I found this!

I am so sorry you and your kitty aregoging through this. Wishing you and your kitty the best.

My cat is a little older at 17 and is having this exact course of problems. Weight loss, vomiting, elevated liver enzymes, elevated creatinine, gallbladder sludge. Ultrasound showed inflammation of the intestines and liver. Vet specialist wanted to do upper endoscopy with biopsy and surgical liver biopsy, but she we felt she was too fragile and the vet admitted anesthesia would be more risky for her small size(5.5lbs). Tried Ursodiol, steroid and antibiotics with no improvement. Switched to novel protein diet due to vomiting and this has improved. She is on Royal Canin P/D Duck food now...possibly allergic to chicken, but not proven. She has been vomiting less partially digested food since we switched but she isn't gaining weight. After this steroid break, she had an ultrasound guided FNA of the liver which did not show any definite cancer or other definitive problem...just inflammation. Vet said FNA cannot rule out lymphoma and this could be a false negative. She said we could do the previously mentioned surgical biopsies or start oral steroid. We decided to do steroid again bc previously we had trouble administering it due to the amount prescribed and the medicinal taste. Also with her vomiting prior to the food switch, we had a hard time getting it in consistently with food. Vet prescribed nausea meds and a compounded flavored oral steroid. She did really well taking that nightly with food. Follow up labs 2 weeks ago showed most liver enzymes decreased with the exception of the ALT(now over 2000)...it went up again. Vet is assuming this is lymphoma and said since we weren't keen on doing the biopsies, we could start Chlorambucil(oral chemo) and recheck in 3-4 weeks. We started her on the Chlorambucil this past Sunday and she has done well so far. She's only getting 0.1mL(10mg/mL) every 72 hours. Next dose is tomorrow morning. We have another follow up on Feb 8th to recheck labs again. We are monitoring her closely and hoping we are doing the right thing for her.

 

[Chaz Galloway]

Chaz is at home resting comfortably in bed for the first time in three days. The surgeon said he did really well with the biopsy surgery, anesthesia, and being in the emergency setting for such a long time. I was extremely worried about anesthesia considering he has unclassified cardiomyopathy along with whatever this liver thing is. They also placed a feeding tube in case he doesnt feel like eating, and for all of the medications I have to give him. I could have bought a new car with the amount i've spent on vet visits over this last month I understand people not being able to afford this kind of care, just for a diagnosis alone. Hopefully we get some answers within the next week on what this is and I will keep yall updated! I know how stressful and expensive this journey is, and from my experience, the veterinary field doesn't have a lot of answers when it comes to liver issues in cats.

 

[Furballsmom]

Thank you for an amazing update!

 

[LelaCat]

So happy to hear everything went well and Chaz is resting comfortably. Thank you so much for sharing!

 

[Chaz Galloway]

That's me...scouring the internet for any answers...and I found this!

I am so sorry you and your kitty aregoging through this. Wishing you and your kitty the best.

My cat is a little older at 17 and is having this exact course of problems. Weight loss, vomiting, elevated liver enzymes, elevated creatinine, gallbladder sludge. Ultrasound showed inflammation of the intestines and liver. Vet specialist wanted to do upper endoscopy with biopsy and surgical liver biopsy, but she we felt she was too fragile and the vet admitted anesthesia would be more risky for her small size(5.5lbs). Tried Ursodiol, steroid and antibiotics with no improvement. Switched to novel protein diet due to vomiting and this has improved. She is on Royal Canin P/D Duck food now...possibly allergic to chicken, but not proven. She has been vomiting less partially digested food since we switched but she isn't gaining weight. After this steroid break, she had an ultrasound guided FNA of the liver which did not show any definite cancer or other definitive problem...just inflammation. Vet said FNA cannot rule out lymphoma and this could be a false negative. She said we could do the previously mentioned surgical biopsies or start oral steroid. We decided to do steroid again bc previously we had trouble administering it due to the amount prescribed and the medicinal taste. Also with her vomiting prior to the food switch, we had a hard time getting it in consistently with food. Vet prescribed nausea meds and a compounded flavored oral steroid. She did really well taking that nightly with food. Follow up labs 2 weeks ago showed most liver enzymes decreased with the exception of the ALT(now over 2000)...it went up again. Vet is assuming this is lymphoma and said since we weren't keen on doing the biopsies, we could start Chlorambucil(oral chemo) and recheck in 3-4 weeks. We started her on the Chlorambucil this past Sunday and she has done well so far. She's only getting 0.1mL(10mg/mL) every 72 hours. Next dose is tomorrow morning. We have another follow up on Feb 8th to recheck labs again. We are monitoring her closely and hoping we are doing the right thing for her.

Im so sorry you're having the same troubles. It is very distressing because the symptoms never seem to improve no matter what you give them. I've been dealing with this for 6 months and am completely spent. Have you had IBD ruled out? In my cats case, he did not have the correlation with IBD so we are solely focusing on the liver. But in many cats with liver issues, IBD is highly suspected if they are vomiting. They have a blood test you can do to help rule out IBD that tests for pancreatic enzymes, small & large intestine absorption. This may help you distinguish between lymphoma without undergoing anesthesia. I'll keep updating on my case in hopes it helps others make informed decisions about their cats. Feel free to ask questions, this site has helped me with my cats journey so far.

 

[LelaCat]

Thank you so much. Yes, this has been extremely difficult for us as well. Lela has always been extremely healthy until the weight loss started. We have been dealing with this about 6 months as well. The vet said the biopsy would rule out IBD, but she never mentioned bloodwork to check for IBD. I will ask about this at our follow up appt on Feb 8th.

I think 2 appointments ago she mentioned her course of treatment thoughts... biopsies and treating this as an immune related inflammation like IBD. Lela seems to have all the signs of IBD except diarrhea. She has always had more trouble with constipation although some sites say if the large inestine is involved, it could still be IBD. I've read that Chlorambucil is used to treat IBD also..just different doses for IBD and lymphoma. I honestly don't know how Lela's dose compares, but it seems on the low to mid end. She has been eating well actually despite my worries about the chemo making her not want to eat. We are giving the antinausea meds twice a day now, so that probably helps a lot. I've also added b12 to her nightly prescription duck food pate, gravy, steroid, miralax mixture to help nutrient absorption as well. Hoping this medicine will decrease the inflammation and help her start absorbing nutrition better.

 

[Chaz Galloway]

It sounds like you're on the right track. I had another cat that had IBD and he did not have diarrhea either, only constipation and vomiting. All of the internal medicine vets seem to think Chaz's liver is also being caused by some sort of chronic inflammatory response. The biopsy is rough on them, no matter what the vets say. I did this as a last resort because he went downhill so quickly over the last few days. He is very weak right now and im watching him all hours of the day. Many people on the site have mentioned milk thistle/SAMe or denamarin to supplement the liver. I ordered some on amazon but my cat would not take denamarin in the pill form no matter what I did. They have a generic version in a liquid form on chewy with a vets approval, which i'll be trying as soon as possible. It is thought to help the liver regenerate before severe fibrosis takes over.

 

[LelaCat]

Good to hear first hand that cats can have IBD with constipation and no diarrhea. Gives me hope that Lelas condition will improve with this treatment.

Sending good vibes and healing strength to sweet Chaz.

Lela won't take pills either. I've had to do all liquids and mix it with a small amount of wet food or puree treat. If she doesn't eat that then I give it manually with a syringe.

Thank you for the info on liver support. I'm adding it to my list of questions for our next vet check up and will do some reading on it before then.

 

[Chaz Galloway]

Hey all you cool cats & kittens,

Just wanted to update everyone on Chaz since his liver biopsy last week. He's doing slightly better today, but every day feels like a rollercoaster. Some days he's very interested in food, eating on his own- then the next day he turns his nose up to everything I offer him and looks lethargic. I'm never quite sure what is an emergency symptom and what is just part of his unknown liver condition.

On another note, I know many people on the cat site have said the feeding tube was less stressful for them, but I have to say I feel the opposite. It's been VERY stressful for me. I worry about it getting infected, pushing the food too fast, giving him too much fluids, not flushing with enough fluids. On top of that, I spend every waking minute counting his calories, monitoring him with this long tube hanging out of his neck.. AHHHHH! I'm also getting discrepancies in the amount of calories he should be eating every day. The surgeon said 150 but the internal specialist says 260 calories/day for a 14 pound cat.. big difference between the two.

I also wanted to say that this liver biopsy has been extremely difficult for Chaz- more than I was led to believe it would be by the internal specialists and surgeon. I dont mean to say this to discourage people from doing all the tests recommended by their vet, I just wish they were a little more candid with me about how big of a surgery this was going to be & what the recovery time looked like. I'm sure this all depends on the cat, their age, and the underlying illness, but his recovery has been slow and painful. I completely understand those of you who are on the fence about an invasive liver biopsy, especially if you have an older cat with health problems. I'm hopeful he turns a corner here soon, but in the meantime i'll be busy mixing up cat food slurry to put in his feeding tube.

 

[fionasmom]

Thank you for posting an update; it is very helpful to members who might be faced with the same problem. We all are pulling for Chaz. I have found with vets and surgeons, even the very competent ones, that they often underestimate the difficulty of a procedure on a pet. Maybe they do so many that they lose focus on that part of their work.