Liver Disease, Cholestasis Cat

[LelaCat]

Not like small circles, but pacing around the house. I forgot to add earlier that her liver labs came down more...was 944 now in 500s. Her sodium and potassium were low, but the vet didn't say anything about it needing intervention. Still waiting for her to call so I can ask specifically. I didn't think about it at the time whe. She was going over all the bloodwork, etc.

 

[Chaz Galloway]

Not like small circles, but pacing around the house. I forgot to add earlier that her liver labs came down more...was 944 now in 500s. Her sodium and potassium were low, but the vet didn't say anything about it needing intervention. Still waiting for her to call so I can ask specifically. I didn't think about it at the time whe. She was going over all the bloodwork, etc.

Wow thats great news they came down!! A slight dip in sodium and potassium could just be from an excess of fluids and that should balance itself out as she pees over the next few days, but good call requesting a call from the specialist just to be sure. Things can get so complicated when there are multiple health concerns going on. I still think fluids were a good choice (I know it may not feel like it right now) to help bring her liver levels down. Thats what I would have done too if it makes you feel any better. I really cant think of a scenario where it would do more harm. Does she seem slightly improved since she first came home?

Weird question, but did they happen to clean her ears? Cats can get vestibular disease from water getting in the ear and it makes them look like theyre drunk. It happened to me once after Chaz had his ears cleaned at the vets office.

 

[LelaCat]

Thank you for the reassurance. I'm feeling super stressed. I sure hope she improves over the next few days. She does seem slightly better than when she first came home. She isn't walking wobbly but still seems oddly spaced out at times. She will sit by her water bowl and her head will drift down until it nearly touches the water surface. She will sometimes have a slight tremor, like a little minute swaying back and forth when sitting like a turkey.

I'm not aware of any ear cleaning, but she has been getting the Mirtazapine transdermal ointment on the ear pinna. She hadn't had any issues with it before the fluids though.

 

[Chaz Galloway]

I reached out to a family friend of mine who is a veterinarian and asked if fluids could cause these symptoms and he said yes!- especially one with kidney problems. He mentioned sodium and potassium being very sensitive markers when giving fluids to a cat with CKD so that would raise an alarm bell it may just be the fluids. He said if she is eating, going to the bathroom, and not having a hard time breathing then all should be okay until you can speak to the vet. If it does not seem to go away, there are things that can be done, such as replacing potassium and sodium in the diet or giving a lasix medication if theres too much fluid. Here are some signs of overhydration in a cat that I found online.

Overhydration may manifest as wet mucous membranes, increased skin elasticity (heavy or gelatinous), shivering, nausea, vomiting, restlessness, serous nasal discharge, weight gain, chemosis, tachypnea, cough, dyspnea, pulmonary crackles and edema, pleural effusion, ascites, diarrhea, or subcutaneous edema

Sorry for so many replies, I hope this helps. I know how stressful these things can be when you're only trying to help.

 

[LelaCat]

Thank you so, so much. I really appreciate your genuine concern and helpfulness!!

She ate a little earlier and is using the bathroom normally. I feel like she's getting a little better as time passes but she has been more restless during the day and a little better at night, for whatever reason. She ate some treats this afternoon and a little of her kibble food earlier this evening. She is drinking water here and there, not as much as before but probably bc she's more hydrated now. Waiting for her to eat her soft food with medicines, but sometimes she eats it pretty late at night. Yes, super stressful waiting this out.

The vet office called earlier to tell me the vet had a family emergency and won't be able to call today, so your vet friend's advice is immensely appreciated. They told me to take her to the ER if she's still wobbly. I tried to explain that she wasn't wobbly like before but she's definitely off from her status prior to the fluids. Plus, the ER doesn't know her at all nor what exactly they did for the IV fluids this week. I told them I'd take her if she had the drunk, wobble walk again. Hoping one of the 2 vets she is seeing calls tomorrow and that she just pulls through to a more comfortable state like before.

 

[Chaz Galloway]

Keep me updated how everything goes and her status as of today!

Chaz has an appointment on Monday to recheck blood levels from the chlorambucil and if they are good, hopefully we can remove this feeding tube I cant wait to get this thing out so we can both have our freedom back and I don't have to constantly clean and maintain it. But I have to say that I am glad they gave him one. If anyone is on the fence about tube feeding like I was, it has helped him gain back nearly 3 pounds that he lost and has been extremely helpful when giving your cat 4+ medications every day. I did have to push the vet to give me antibiotics over the course of this week because I started to notice an increase in yellowish discharge and crusting at the port site. The vet really didnt want to give him antibiotics, but I pushed because as a nurse, I know the dangers of infection while on chemotherapy. After just two doses, I noticed a 90% improvement with the discharge changing from yellow to white in color. I can tell hes feeling so much better and not scratching at it as much too. Sometimes you have to really push them and advocate for your cat if you feel something isnt right.

As for the chlorambucil, he definitely seems a bit lethargic and eats less on the days I give it to him. But he has handled this medication surprisingly well. He has never vomited or had diarrhea, which is a common side effect. I do believe the feeding tube helped immensely with maintaining daily calorie intake on days he didn't feel like eating.

 

[LelaCat]

So happy to hear Chaz is doing so well! Keeping my finger crossed for excellent lab results and continued improvements! And kudos to you for sticking up for your Kitty's wellness and insisting on those antibiotics. I feel like the vets see our pets as a decision tree or flowchart without actually seeing them as a cherished loved one like we do. It's really hard to know when to trust what they say and when to insist on something different. It makes everything more stressful.

Lela's local vet called this morning. She said the sodium was only 2 points high and the potassium was just 2.5 points low, so she didn't think this was related to her current state. She suggested bringing her in to check her blood pressure to see if that is causing her symptoms. I worry that it may appear falsely elevated bc she gets so anxious at the vet but I guess we'll see. I wish I could accurately check it at home.

She is getting a little better though. She ate really well last night and has eaten this morning also. She still doesn't seem as comfortable as she was prior to the IV fluids. She still seems spacey sometimes and just off. My husband and I are so upset. We feel like we set her really far back and made everything worse. Hoping she improves to where she was before.

 

[Chaz Galloway]

hows your baby doing? Any new updates?

 

[Furballsmom]

it has helped him gain back nearly 3 pounds that he lost

The things we do for them. As much as you hated doing it and worried about doing it incorrectly, he gained weight, which is bringing tears to my eyes as I'm writing this (I had to increase the handfeeding for my Poppycat to four times daily during his last months, not because he couldn't eat but he wouldn't eat his hyper-T food and also didn't want to take his supplements no way no how, and with all that he had going wrong, I absolutely didn't want him to end up with that Skinny Old Cat syndrome--even so, we came close a couple times. However, this doesn't even begin to compare to your hospice care of every three hours and working at night, not least because a popsicle stick loaded with a bit of food which was a method suggested by my vet, is a lot less complicated to work with than a feeding tube. Wow. I know that people feed 'round the clock for orphaned kittens, but you're incredible, and..., just..., wow.).

Wondering if you or anyone else has any experience with cats and IV fluids?

Hi - my angel Poppycat had only gotten subcutaneous fluids, so unfortunately I can't give a good comparison of reactions. Do you have housecall vets in your area who could come to the house, which might be less upsetting for her?

 

[LelaCat]

I took her in this morning for her blood pressure check. Lela was very bright and alert at the appt. They checked her BP 3 times and the systolic ranged from 156-170. The vet said she spoke to the specialist vet yesterday and they said they wouldn't treat her BP unless it was over 180. She also said BP measurement is not that reliable in cats. I think Lela was nervous, as usual at the vet. She slept a lot after the appt and only had some wobble steps when walking around after some hard naps.

Super late last night/early this a.m., I found a powdered aluminum hydroxide powder on Amazon that has no flavor and decided to order it. I showed pictures and info to the vet and she said I could use that instead of the mint flavored gel they sold me Thursday. I still got an oral prescription from her today also in case I have to give it to Lela manually. I mixed up her soft food with all the medicines a little bit ago but she hasn't eaten it yet.

The vet also said she wanted to prepare us that she thinks Lela is close to the end. I already know this, but it was still very upsetting to hear. I know the day will come but I wasn't thinking it would be soon. I told her she wasn't this bad before the fluids and we felt responsible for her decline. She tried to reassure me that it wasn't our fault, more likely advancement of her anemia and kidney disease. She said Lela is stable for the moment. We will just do our best to keep her comfortable as long as we can.

 

[Chaz Galloway]

I'm so sorry, I cant imagine how difficult it must be for you to hear those words.

I absolutely agree with your vet, I do not believe fluids would have advanced anything or caused damage. Hang in there!! Her body could just be taking longer to adjust, I'm still hopeful for you!!!!!

 

[Chaz Galloway]

Well, I just came back from Chazzy's 2 week checkup appointment and it was disappointing. His liver enzymes have not improved, in fact, they tripled since starting the chlorambucil. His ALT went from 400 two weeks ago to a whopping 1400 today. The vet said to continue it for another week and retest, but if it does not start coming down then we have nothing left to try for him. I feel defeated, disappointed, frustrated, and so so sad. I really thought he was doing great.

 

[LelaCat]

I am so, so sorry about Chaz's appointment. It is so difficult when their affect is not matching the labs. You are doing everything you can for him.


Did the vet mention anything about altering the medication dosages? Or changing to cyclosporine or another immune modulating drug?

 

[BellaBlue82]

Hugs to both of you. I'm so sorry you are going through this, and I just went through it with Casper. You are both doing everything you can for them.

 

[Chaz Galloway]

I am so, so sorry about Chaz's appointment. It is so difficult when their affect is not matching the labs. You are doing everything you can for him.


Did the vet mention anything about altering the medication dosages? Or changing to cyclosporine or another immune modulating drug?

No she didnt. I brought up methotrexate as well because I read that some cats who do not respond to chlorambucil will respond to methotrexate. She seems like she is not as knowledgeable about these kinds of autoimmune diseases in cats and I may seek a second opinion from another vet. I'm also hesitant to continue on the chlorambucil for another week since his liver values sky rocketed on it. Before todays bloodwork, his ALT was slowly progressing but never this much. His value would always trend upward maybe by 50-100 points every month but nothing has ever been close to 1400 like it was today. Perhaps the chlorambucil is hepatotoxic for him? I know that is a rare side effect, but its not impossible. She didn't seem to think it was the chlorambucil but my gut is telling me that it is.

Did you stop the chlorambucil at two weeks or did it need to be tapered off like a steroid?

 

[LelaCat]

Go with your gut. And the second opinion sounds like a good idea. There are multiple medications that can treat these diseases. There has to be another avenue to pursue.

We stopped cold turkey, no taper. Our vet recommended 2x per week after that but we decided not to give it anymore bc it was too hard on her.

Do you think the high dose steroids could also contribute to the elevation? Or was he on that before the Chlorambucil without any problems?

 

[Chaz Galloway]

Go with your gut. And the second opinion sounds like a good idea. There are multiple medications that can treat these diseases. There has to be another avenue to pursue.

We stopped cold turkey, no taper. Our vet recommended 2x per week after that but we decided not to give it anymore bc it was too hard on her.

Do you think the high dose steroids could also contribute to the elevation? Or was he on that before the Chlorambucil without any problems?

I dont believe its the pred because hes been on that for about two months now, and only just started the chlorambucil two weeks ago. The steroid alone helped him to eat more, but it didn't help bring down his liver levels. They slowly kept rising, which is why we added the chlorambucil. However, his ALT has never been higher than 400, except for today where it was 1400. That just seems like a huge jump and not typical for his disease process so far. I'm very suspicious.

 

[LelaCat]

Gotcha.

You have a lot of medical knowledge...so trust your judgment. If it wasn't increasing that much without the Chlorambucil, you could at least take a break from it and recheck labs to see how the liver values are affected. I read there are some latent effects even after stopping, so you may want to check labs further out than 1 week. Double check that though...the only info I can find now is related to humans.

 

[fionasmom]

I apologize if I missed it or misunderstood about the specialist, but wondered if you have any access to an oncologist specifically.

 

[Chaz Galloway]

I apologize if I missed it or misunderstood about the specialist, but wondered if you have any access to an oncologist specifically.

Sorry just now seeing this! I have not reached out to an oncologist.. yet.. but it did cross my mind. My cat has been really unwell since stopping the chlorambucil. I was hoping he would start to feel better but it doesnt seem like hes turning a corner. He's very lethargic, uninterested in things he used to love, and doesn't have a great appetite.