Liver Disease, Cholestasis Cat

fionasmom

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There is some good news at least with the lower levels of ALT and bilirubin and the weight gain!

I often call the drug companies if I have questions.
 
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Chaz Galloway

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Honestly, he's not doing great. He continues to lose weight on this medication regardless of how much time has passed with him on it. He lost all of the weight he gained back on the feeding tube and then some. Initially, the Atopica brought his levels down slightly, but the next week they went right back up. Getting the medication in him is a nightmare- yes I've tried all the tricks. I even hired a professional to come to my house and help us with medication techniques to try to make this easier for everyone involved. It took the vet tech 4 attempts to give him a capsule and she didnt even get the whole pill in on the last try before I said it was enough. I've tried using gelatin capsules to disguise the taste of the Atopica. but pilling this cat is nearly impossible & traumatic for everyone. Even with my husbands help restraining him he finds a way to violently thrash his head and spit out the pill.

We've lost faith in vets at this point. We've spent thousands on getting him care and treatments only to be perpetually let down every time. Nobody really knows how to help him and hes fed up with constant medication. Sorry this is such a downer of a response, but it is what it is.
 

KittenAppliance

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I'm really sorry to hear this, poor guy. My own kitty has been trudging through empirical treatment to address her liver problems... We've been through antibiotics and prednisolone without her responding, and one of the next options our vet has put on the table is atopica. In our situation, we dont really have answers as to what is causing her illness (she's has 2 ultrasounds and liver aspirates, but neither showed anything except for mild diffuse inflammation of her liver... but her ALT has continued to rise). A surgical biopsy is financially not feasible for us, and I'd also be really worried to put her through it as she is 14 years old and quite a small girl...we are lucky so far that her eating has improved with mirtazapine, though it is still not what it used to be. The worst is pilling her...she's gotten increasingly more upset about being pilled over the past couple of months. It's really heartbreaking work, and it's hard when you repeatedly go through it and then at the next blood draw, learn that it wasn't even helpful for your baby.

Honestly, he's not doing great. He continues to lose weight on this medication regardless of how much time has passed with him on it. He lost all of the weight he gained back on the feeding tube and then some. Initially, the Atopica brought his levels down slightly, but the next week they went right back up. Getting the medication in him is a nightmare- yes I've tried all the tricks. I even hired a professional to come to my house and help us with medication techniques to try to make this easier for everyone involved. It took the vet tech 4 attempts to give him a capsule and she didnt even get the whole pill in on the last try before I said it was enough. I've tried using gelatin capsules to disguise the taste of the Atopica. but pilling this cat is nearly impossible & traumatic for everyone. Even with my husbands help restraining him he finds a way to violently thrash his head and spit out the pill.

We've lost faith in vets at this point. We've spent thousands on getting him care and treatments only to be perpetually let down every time. Nobody really knows how to help him and hes fed up with constant medication. Sorry this is such a downer of a response, but it is what it is.
 
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Chaz Galloway

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I'm really sorry to hear this, poor guy. My own kitty has been trudging through empirical treatment to address her liver problems... We've been through antibiotics and prednisolone without her responding, and one of the next options our vet has put on the table is atopica. In our situation, we dont really have answers as to what is causing her illness (she's has 2 ultrasounds and liver aspirates, but neither showed anything except for mild diffuse inflammation of her liver... but her ALT has continued to rise). A surgical biopsy is financially not feasible for us, and I'd also be really worried to put her through it as she is 14 years old and quite a small girl...we are lucky so far that her eating has improved with mirtazapine, though it is still not what it used to be. The worst is pilling her...she's gotten increasingly more upset about being pilled over the past couple of months. It's really heartbreaking work, and it's hard when you repeatedly go through it and then at the next blood draw, learn that it wasn't even helpful for your baby.
I really feel for you and anyone that has to go through this with their cat. They were never able to identify the cause in my cat either. We put ours through the biopsy and every test they recommended to help figure it out, and every time it just came back as liver inflammation. Such a vague term.. its extremely frustrating to hear they dont really know what causes it or exactly how to treat after spending thousands. If I had to do it all over again I would not have put mine through the surgical biopsy. It was very very hard on him and the first few days out of surgery were touch and go. We have tried prednisolone, chlorambucil, ursodiol, milk thistle, denamarin, and currently atopica with no luck. Some cats do respond to chlorambucil, but it made my cats liver values spike into the 1000s and we had to stop. I'm taking him to another specialist this week about 2 hours away for yet another try.

And YES the pilling... dont even get me started LOL. When did your liver journey start and what are your cats liver values if you dont mind me asking. I can look back at Chaz's latest and see if there is a similar trend.
 

KittenAppliance

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Our liver journey started in mid February. Our cat has dealt with constipation issues in the past, and we started to see signs of it again and it wasnt responding to the usual doses of lactulose... so when we brought her in to the vet, something more serious wasn't even really on our radar. Sh had recently been getting pickier than usual about food, which I wondered if it could have been causing the constipation to flare up since we were changing up her food... i was worried that she maybe had a tooth problem that was causing the food pickiness. Turned out, her teeth were excellent, but she had lost a fair amount of weight which had the vet concerned. Her senior blood panel came back a few days later with ALT 320, AST 159, ALP 273. Her billirubin was slightly elevated at .7. Her lymphocytes were slightly elevated at 10.55. Our regular vet said she was concerned about cancer...

At the point we brought her to the vet initially, there had been no change in behavior really except pickyness about food and recent straining to poop. She still asked for food and played and was snuggly and her usual self.

The vet did some xrays and said that nothing was showing up on them...except that she was constipated. We went to a specialist and had an ultrasound and repeat bloodwork about a month later (it was tough getting an appointment). The bloodwork showed that it was mostly the same except her billirubin level was getting a bit higher. We started her on mirtazapine and cerenia to help her with eating. Weve continued the mirtazapine throughout this whole ordeal pretty consistently as needed.

Her ultrasound showed some diffuse inflammation in the liver but no masses, the bile duct looked normal, gall bladder normal, no sludge. They took aspirates, and the cells looked completely normal.

We started her on an antibiotic, tho the vet managed our expectations because she said that infection usually shows some impact on the gall bladder/bile duct, and that seemed normal in her results.

2 weeks later, the bloodwork showed her billirubin had gone down to normal, but her alt, ast, alp, were all slightly higher.

We continued the antibiotics for 2 more weeks, but her bloodwork didnt really change again on it, so the vet started her on prednisolone. She REALLY has been fighting against the prednisolone... and after 2 weeks of it, her ALT has shot up to over 900

The doctor suggested a few other possible directions to go in lieu of a biopsy... atopica is one of them. She also mentioned a hydrolyzed protein food on the off chance that it is somehow related to IBD...but our cat's pickiness with food has really skyrocketed and she doesnt eat any one food. She eats like 3 different foods throughout the day, (but not without rejecting 3 or more first). And it's not the same 3 foods every day. We've managed to get her weight back up with a lot of daily effort and trial and error and with mirtazapine, but it continues to be a daily struggle. The vet has also mentioned the possibility of chemo, on the chance that it is lymphoma. But everything remains guesswork and her symptoms are still vague and dont really fit any particular thing. So the options just carry risk to her health without even knowing what is actually wrong.
 
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Chaz Galloway

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Our liver journey started in mid February. Our cat has dealt with constipation issues in the past, and we started to see signs of it again and it wasnt responding to the usual doses of lactulose... so when we brought her in to the vet, something more serious wasn't even really on our radar. Sh had recently been getting pickier than usual about food, which I wondered if it could have been causing the constipation to flare up since we were changing up her food... i was worried that she maybe had a tooth problem that was causing the food pickiness. Turned out, her teeth were excellent, but she had lost a fair amount of weight which had the vet concerned. Her senior blood panel came back a few days later with ALT 320, AST 159, ALP 273. Her billirubin was slightly elevated at .7. Her lymphocytes were slightly elevated at 10.55. Our regular vet said she was concerned about cancer...

At the point we brought her to the vet initially, there had been no change in behavior really except pickyness about food and recent straining to poop. She still asked for food and played and was snuggly and her usual self.

The vet did some xrays and said that nothing was showing up on them...except that she was constipated. We went to a specialist and had an ultrasound and repeat bloodwork about a month later (it was tough getting an appointment). The bloodwork showed that it was mostly the same except her billirubin level was getting a bit higher. We started her on mirtazapine and cerenia to help her with eating. Weve continued the mirtazapine throughout this whole ordeal pretty consistently as needed.

Her ultrasound showed some diffuse inflammation in the liver but no masses, the bile duct looked normal, gall bladder normal, no sludge. They took aspirates, and the cells looked completely normal.

We started her on an antibiotic, tho the vet managed our expectations because she said that infection usually shows some impact on the gall bladder/bile duct, and that seemed normal in her results.

2 weeks later, the bloodwork showed her billirubin had gone down to normal, but her alt, ast, alp, were all slightly higher.

We continued the antibiotics for 2 more weeks, but her bloodwork didnt really change again on it, so the vet started her on prednisolone. She REALLY has been fighting against the prednisolone... and after 2 weeks of it, her ALT has shot up to over 900

The doctor suggested a few other possible directions to go in lieu of a biopsy... atopica is one of them. She also mentioned a hydrolyzed protein food on the off chance that it is somehow related to IBD...but our cat's pickiness with food has really skyrocketed and she doesnt eat any one food. She eats like 3 different foods throughout the day, (but not without rejecting 3 or more first). And it's not the same 3 foods every day. We've managed to get her weight back up with a lot of daily effort and trial and error and with mirtazapine, but it continues to be a daily struggle. The vet has also mentioned the possibility of chemo, on the chance that it is lymphoma. But everything remains guesswork and her symptoms are still vague and dont really fit any particular thing. So the options just carry risk to her health without even knowing what is actually wrong.
Wow, this sounds eerily similar to my cats symptoms, levels, and experiences so far! I also felt like my cat didnt fit the liver disease mold. He is extremely picky with food. It's a constant battle finding a food he will eat that day- whether its a completely different brand or not we have to switch it up constantly. He also has constipation issues and often strains when he poops. The only time he ever vomits is if he has been straining to poop. When he does poop, it looks normal just in small amounts. We did a pancreas enzyme test to rule out IBD (its simply a fasted blood test) and his results came back negative. Our surgical biopsy came back that it was lymphocytic cholangiohepatitis, basically just liver inflammation. The bacterial tests all came back negative, so we stopped the antibiotics from then on out with them saying it was unlikely to be bacterial and more autoimmune inflammation. They recommended we pay another 500 for additional lymphoma test to completely rule out cancer and it was also negative.

The only other vet owner I found that had these similar symptoms was a woman at my vet specialists office. She had a middle aged female cat with the same symptoms. They put her cat on chlorambucil and tapered down her prednisolone. After a few months her cat was considered to be in remission. I don't think the atopica is a bad option to try, but keep in mind it may add to her eating issues. We had to start him on a very low dose, much lower than the vet prescribed initially because he completely stopped eating at the recommended dosage. Just use your best judgment and if you feel like shes eating less than normal skip a day and start again the next until you can work up to the prescribed dose. If that doesn't work then chlorambucil might be a good second option. I'll try to keep you updated with our visit and any other information that might be helpful to you. If you have any questions please feel free to ask!
 

BellaBlue82

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I'm so sorry to hear about those of you that are going through this. 😢. Casper was 18 when he was diagnosed with liver failure.... We did not wish to put him through a biopsy at that age. We never really found out what exactly caused it, the vet suspected initially he had cholangiohepatitis because of his constant constipation issues. He joined his brothers over the rainbow bridge just about a month after his initial diagnosis, he just declined so quickly and his values got worse even with all the various medications we tried.
Sending you all hugs, I know how difficult it is trying to take care of your babies when they're not well and that feeling in your heart when you feel like it's not getting better. ❤❤❤
 

Anca

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Hi all

I just wanted to say thank you for this thread, as this is exactly what I am currently going through with my cat. It all started with being extremely picky over food, then eating less of anything, then trowing up white foam or clear liquid. At the end of June I started to look more into it, she was about 3.5kg then. Her ALT and ALP were not that high in the beginning, being 313 and 141 at the time of her first blood tests. We did 3 days of iv's to rehydrate + anti emetic + liver protector. At the ultrasound the first vet saw some weird stuff so she recommended a CT. We did the CT and it turned with a suspicion of lymphoma. That as that but after the CT anesthesya my cat did not want to wake up for 5 hours, she should have done that after 20 minutes max at that level of anesthesya given for a CT. We took her to the EE and they woke her up and stabilized her during the night. Most probably during the 3 days of IVs her rose from 300 to probably around 500 and her liver was not getting the substance out anymore.

After checking her out from ER, I let her to rest a day and took her to another clinic, she was already yellow so here went another 2 days of IVs and then home again, being stabilized, she ate at the clinic so we would hope she will now continue at home since she was not yellow anymore. They did not redo the blood work then since they did the ultrasound and it showed the liver being inflamed and all the stomach around it. I gave them the CT and they ruled out cancer based in the ultrasound (a biopsy or endoscopy was anyway out of the question after the CT experience). After the IVs the yellowness disappeared. She did seem to eat relatively better for the first 4 days then the vomiting started and the nausea, which reduced her appetite.

Back again, 2nd round of IVs after a week as we thought those two days were not enough and we did not check her levels to make sure she was indeed ok to let go. Here we go again , rehydration, Prednisone and whatever else they gave her 3 days then 2 days under supervision. Given royal canin gastro wet and dry while at the clinic. Took her in with ALT 260 and ALKP 611, so very high again. After 5 days took her out with 179 and 255 so a significant change. Cancer was cleared out again, IBD as well, she had no inflammation again, according to them she was ok and just needed to eat. Got a mirataz cream and started applying it from that that day on.

Got her out on Saturday, got her in again this Friday, with the same pattern. The moment I got her in the house she refused the royal canin gastro although she ate the same thing there, in a cage 5 days in a row. Turned her tail on me the moment I put that in the bowl and went to eat the other royal variety I had in for the other cat. Ok, fine with me as long as you eat. However, the latter repeated itself, every day more pickier, especially on the royal canin variety. Day 4 or 5, puking started, I got another type of food to try and do the exclusion diet, she did like and seem to eat those better but the puking did not stop, but rather intensified at two times per day at least. She would just lay, sleep and all of the sudden she felt nausea and went and puked. After three days of this she already started to get yellow again so here she is in the clinic again, with 264/455 again. Apparently at around 400 her jaundice is starting so no wonder she was very yellow at 600 the first time I brought her in. Probably had around 500 when I did the CT thus the trip to the emergency room

She has lost 1kg in one month since we started this, so now she is really thin and weak and not sure what we are going to do after this session. It looks her liver has an increase in toxicity before she even gets a chance to get her appetite back with mirataz. The treatment period for the ointment is 2 weeks but her liver is making her nauseous and sick in 4-5 days and then she does not want to eat anything. So we are also on a loop like the previous cases did.

After I check her out this time, I think I will ask for another opinion for a last time, whether there is anything we can give her at home to try and keep her liver in better levels while we strive to make her eat, to somehow keep her levels under control. There is a place here where they do biopsies under inhalation anesthesya but I don't really want to put her through another traumatic experience as she is very weak and really don't trust any advice that she would resist another anesthesya. Like you all mentioned here, it seems like vets seems to undermine the adverse effects and do not warn you properly enough. For example, both peritol and mirataz, which I gave her for appetite stimulation made her drowsy and confused and caused lack of equilibrium. When I told this to the vet he said that is really weird as all the cases he saw were of being agitated and hyper stimulated. Although drowsiness was a clearly written side efect on both these drugs. Whatever, as long as she easts she can be a bit confused. But then her liver starting to act again and here we are.

So now I am waiting for this vet's final advice and if he says he has nothing much to add, I will just go and ask for the 2nd opinion on meds at home and if those do not work well... It is what it is, I do want her with me, I love her very much, she is 14 and I am 34 so she has been with me for almost half of my conscious life, so I am heartbroken since this Friday, especially when I got hope back two times already (when she woke after the CT and when cancer was ruled out - if that was even correct). But I don't think I can torture her more with IVs and visits every few days just to discover more, try more, keep her in a constant state of drowsiness, needles and stress and then end up with her dying anyway, but after much more stress. I am still trying to work out the pain that the next week might be my last with her, unless maybe some home meds work or someone has a sudden brilliant idea that actually saves her for real and not for just for several days... not really managing it well but from your posts here I can see that this sort lymphoma/liver disease path can be a really long and painful one, both for her and for me.

However, I do feel a bit calmer now reading all these posts and feel less in the dark now, this sort of condition puzzles doctors around the world and they do their best with what they can.

Much respect for all of you that put your lives on hold and invest fortunes to try and make your old friends feel better. You do your best and you never know when you do right or wrong, I have the same frustration going in my head for over 3 weeks now, all these thoughts that I could have done better, that some steps could have been skipped, that I constantly get my hopes up and put them down again. It's a tough ride when this happens.
 

fionasmom

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Thank you for posting your story; I am sorry that you are facing this with your cat. My experience has been that liver conditions are extremely hard to treat and manage. The same is true of humans with liver disease.

I do want to assure you that you have done over and above for your cat. Not allowing certain procedures like a biopsy or endoscopy does not mean that you are not doing everything that you can. Any pet owner has to weigh the value of putting a cat or dog through extensive testing which itself might take a toll or which might even result in a negative outcome. Vets will outline for you everything that can be done, but it does not mean that you should do it all.

Asking for another opinion is an excellent idea. Take records of everything that you have already done and ask about palliative care and how much can be done to keep her comfortable.

Liver toxicity does lead to inappetence, nausea, and a change in the taste of food. The dog I mentioned several pages ago became extremely lethargic and confused, which can result from the liver itself in addition to medications. We even tried Anipryl (dog cognitive decline medication which I am not at all suggesting for your cat) to see if it would help a little bit, but it did not.

Please remember that you can post here any time that you need to.
 

KittenAppliance

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Hi all

I just wanted to say thank you for this thread, as this is exactly what I am currently going through with my cat. It all started with being extremely picky over food, then eating less of anything, then trowing up white foam or clear liquid. At the end of June I started to look more into it, she was about 3.5kg then. Her ALT and ALP were not that high in the beginning, being 313 and 141 at the time of her first blood tests. We did 3 days of iv's to rehydrate + anti emetic + liver protector. At the ultrasound the first vet saw some weird stuff so she recommended a CT. We did the CT and it turned with a suspicion of lymphoma. That as that but after the CT anesthesya my cat did not want to wake up for 5 hours, she should have done that after 20 minutes max at that level of anesthesya given for a CT. We took her to the EE and they woke her up and stabilized her during the night. Most probably during the 3 days of IVs her rose from 300 to probably around 500 and her liver was not getting the substance out anymore.

After checking her out from ER, I let her to rest a day and took her to another clinic, she was already yellow so here went another 2 days of IVs and then home again, being stabilized, she ate at the clinic so we would hope she will now continue at home since she was not yellow anymore. They did not redo the blood work then since they did the ultrasound and it showed the liver being inflamed and all the stomach around it. I gave them the CT and they ruled out cancer based in the ultrasound (a biopsy or endoscopy was anyway out of the question after the CT experience). After the IVs the yellowness disappeared. She did seem to eat relatively better for the first 4 days then the vomiting started and the nausea, which reduced her appetite.

Back again, 2nd round of IVs after a week as we thought those two days were not enough and we did not check her levels to make sure she was indeed ok to let go. Here we go again , rehydration, Prednisone and whatever else they gave her 3 days then 2 days under supervision. Given royal canin gastro wet and dry while at the clinic. Took her in with ALT 260 and ALKP 611, so very high again. After 5 days took her out with 179 and 255 so a significant change. Cancer was cleared out again, IBD as well, she had no inflammation again, according to them she was ok and just needed to eat. Got a mirataz cream and started applying it from that that day on.

Got her out on Saturday, got her in again this Friday, with the same pattern. The moment I got her in the house she refused the royal canin gastro although she ate the same thing there, in a cage 5 days in a row. Turned her tail on me the moment I put that in the bowl and went to eat the other royal variety I had in for the other cat. Ok, fine with me as long as you eat. However, the latter repeated itself, every day more pickier, especially on the royal canin variety. Day 4 or 5, puking started, I got another type of food to try and do the exclusion diet, she did like and seem to eat those better but the puking did not stop, but rather intensified at two times per day at least. She would just lay, sleep and all of the sudden she felt nausea and went and puked. After three days of this she already started to get yellow again so here she is in the clinic again, with 264/455 again. Apparently at around 400 her jaundice is starting so no wonder she was very yellow at 600 the first time I brought her in. Probably had around 500 when I did the CT thus the trip to the emergency room

She has lost 1kg in one month since we started this, so now she is really thin and weak and not sure what we are going to do after this session. It looks her liver has an increase in toxicity before she even gets a chance to get her appetite back with mirataz. The treatment period for the ointment is 2 weeks but her liver is making her nauseous and sick in 4-5 days and then she does not want to eat anything. So we are also on a loop like the previous cases did.

After I check her out this time, I think I will ask for another opinion for a last time, whether there is anything we can give her at home to try and keep her liver in better levels while we strive to make her eat, to somehow keep her levels under control. There is a place here where they do biopsies under inhalation anesthesya but I don't really want to put her through another traumatic experience as she is very weak and really don't trust any advice that she would resist another anesthesya. Like you all mentioned here, it seems like vets seems to undermine the adverse effects and do not warn you properly enough. For example, both peritol and mirataz, which I gave her for appetite stimulation made her drowsy and confused and caused lack of equilibrium. When I told this to the vet he said that is really weird as all the cases he saw were of being agitated and hyper stimulated. Although drowsiness was a clearly written side efect on both these drugs. Whatever, as long as she easts she can be a bit confused. But then her liver starting to act again and here we are.

So now I am waiting for this vet's final advice and if he says he has nothing much to add, I will just go and ask for the 2nd opinion on meds at home and if those do not work well... It is what it is, I do want her with me, I love her very much, she is 14 and I am 34 so she has been with me for almost half of my conscious life, so I am heartbroken since this Friday, especially when I got hope back two times already (when she woke after the CT and when cancer was ruled out - if that was even correct). But I don't think I can torture her more with IVs and visits every few days just to discover more, try more, keep her in a constant state of drowsiness, needles and stress and then end up with her dying anyway, but after much more stress. I am still trying to work out the pain that the next week might be my last with her, unless maybe some home meds work or someone has a sudden brilliant idea that actually saves her for real and not for just for several days... not really managing it well but from your posts here I can see that this sort lymphoma/liver disease path can be a really long and painful one, both for her and for me.

However, I do feel a bit calmer now reading all these posts and feel less in the dark now, this sort of condition puzzles doctors around the world and they do their best with what they can.

Much respect for all of you that put your lives on hold and invest fortunes to try and make your old friends feel better. You do your best and you never know when you do right or wrong, I have the same frustration going in my head for over 3 weeks now, all these thoughts that I could have done better, that some steps could have been skipped, that I constantly get my hopes up and put them down again. It's a tough ride when this happens.
You might want to try the oral mirtazapine instead of the mirataz ointment.... my cat really hates the ointment and seems really lethargic and hides for a few hours after I put it on her ear. She can smell it as soon as i open the ointment and runs and hides and puts her ears back. Of course, she also hates being given pills but honestly she perks right up within an hour after the oral pill. Cats all have such different responses to different things, it could be worth trying out the oral mirtazapine.
 

KittenAppliance

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Hi all

I just wanted to say thank you for this thread, as this is exactly what I am currently going through with my cat. It all started with being extremely picky over food, then eating less of anything, then trowing up white foam or clear liquid. At the end of June I started to look more into it, she was about 3.5kg then. Her ALT and ALP were not that high in the beginning, being 313 and 141 at the time of her first blood tests. We did 3 days of iv's to rehydrate + anti emetic + liver protector. At the ultrasound the first vet saw some weird stuff so she recommended a CT. We did the CT and it turned with a suspicion of lymphoma. That as that but after the CT anesthesya my cat did not want to wake up for 5 hours, she should have done that after 20 minutes max at that level of anesthesya given for a CT. We took her to the EE and they woke her up and stabilized her during the night. Most probably during the 3 days of IVs her rose from 300 to probably around 500 and her liver was not getting the substance out anymore.

After checking her out from ER, I let her to rest a day and took her to another clinic, she was already yellow so here went another 2 days of IVs and then home again, being stabilized, she ate at the clinic so we would hope she will now continue at home since she was not yellow anymore. They did not redo the blood work then since they did the ultrasound and it showed the liver being inflamed and all the stomach around it. I gave them the CT and they ruled out cancer based in the ultrasound (a biopsy or endoscopy was anyway out of the question after the CT experience). After the IVs the yellowness disappeared. She did seem to eat relatively better for the first 4 days then the vomiting started and the nausea, which reduced her appetite.

Back again, 2nd round of IVs after a week as we thought those two days were not enough and we did not check her levels to make sure she was indeed ok to let go. Here we go again , rehydration, Prednisone and whatever else they gave her 3 days then 2 days under supervision. Given royal canin gastro wet and dry while at the clinic. Took her in with ALT 260 and ALKP 611, so very high again. After 5 days took her out with 179 and 255 so a significant change. Cancer was cleared out again, IBD as well, she had no inflammation again, according to them she was ok and just needed to eat. Got a mirataz cream and started applying it from that that day on.

Got her out on Saturday, got her in again this Friday, with the same pattern. The moment I got her in the house she refused the royal canin gastro although she ate the same thing there, in a cage 5 days in a row. Turned her tail on me the moment I put that in the bowl and went to eat the other royal variety I had in for the other cat. Ok, fine with me as long as you eat. However, the latter repeated itself, every day more pickier, especially on the royal canin variety. Day 4 or 5, puking started, I got another type of food to try and do the exclusion diet, she did like and seem to eat those better but the puking did not stop, but rather intensified at two times per day at least. She would just lay, sleep and all of the sudden she felt nausea and went and puked. After three days of this she already started to get yellow again so here she is in the clinic again, with 264/455 again. Apparently at around 400 her jaundice is starting so no wonder she was very yellow at 600 the first time I brought her in. Probably had around 500 when I did the CT thus the trip to the emergency room

She has lost 1kg in one month since we started this, so now she is really thin and weak and not sure what we are going to do after this session. It looks her liver has an increase in toxicity before she even gets a chance to get her appetite back with mirataz. The treatment period for the ointment is 2 weeks but her liver is making her nauseous and sick in 4-5 days and then she does not want to eat anything. So we are also on a loop like the previous cases did.

After I check her out this time, I think I will ask for another opinion for a last time, whether there is anything we can give her at home to try and keep her liver in better levels while we strive to make her eat, to somehow keep her levels under control. There is a place here where they do biopsies under inhalation anesthesya but I don't really want to put her through another traumatic experience as she is very weak and really don't trust any advice that she would resist another anesthesya. Like you all mentioned here, it seems like vets seems to undermine the adverse effects and do not warn you properly enough. For example, both peritol and mirataz, which I gave her for appetite stimulation made her drowsy and confused and caused lack of equilibrium. When I told this to the vet he said that is really weird as all the cases he saw were of being agitated and hyper stimulated. Although drowsiness was a clearly written side efect on both these drugs. Whatever, as long as she easts she can be a bit confused. But then her liver starting to act again and here we are.

So now I am waiting for this vet's final advice and if he says he has nothing much to add, I will just go and ask for the 2nd opinion on meds at home and if those do not work well... It is what it is, I do want her with me, I love her very much, she is 14 and I am 34 so she has been with me for almost half of my conscious life, so I am heartbroken since this Friday, especially when I got hope back two times already (when she woke after the CT and when cancer was ruled out - if that was even correct). But I don't think I can torture her more with IVs and visits every few days just to discover more, try more, keep her in a constant state of drowsiness, needles and stress and then end up with her dying anyway, but after much more stress. I am still trying to work out the pain that the next week might be my last with her, unless maybe some home meds work or someone has a sudden brilliant idea that actually saves her for real and not for just for several days... not really managing it well but from your posts here I can see that this sort lymphoma/liver disease path can be a really long and painful one, both for her and for me.

However, I do feel a bit calmer now reading all these posts and feel less in the dark now, this sort of condition puzzles doctors around the world and they do their best with what they can.

Much respect for all of you that put your lives on hold and invest fortunes to try and make your old friends feel better. You do your best and you never know when you do right or wrong, I have the same frustration going in my head for over 3 weeks now, all these thoughts that I could have done better, that some steps could have been skipped, that I constantly get my hopes up and put them down again. It's a tough ride when this happens.
We have basically stopped working on how to solve the liver problem and have just been trying to manage her appetite, since we had no luck with guess work with treatments, or with imagine and fine needle biopsy. We have been giving her denamarin and mirtazapine, and we have been lucky enough that she has been doing pretty okay with this. She continues to be picky with eating and feeding her can really be a whole ordeal, but she did gain her weight back between the mirtazapine and a lot of open cans of a variety of wet foods and a variety of kibbles for her to choose from when she starts rejecting a recent favorite. She hasnt gotten any worse in terms of how she seems to feel, or with any of her symptoms (one symptom actually improved randomly---she had developed a ton of dandruff for a while, but that has resolved for no apparent reason). It's all been a huge mystery and it continues to be stressful not knowing how much longer she'll continue to be doing pretty well, since we know we haven't actually cured the problem.
 
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Chaz Galloway

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Hi all

I just wanted to say thank you for this thread, as this is exactly what I am currently going through with my cat. It all started with being extremely picky over food, then eating less of anything, then trowing up white foam or clear liquid. At the end of June I started to look more into it, she was about 3.5kg then. Her ALT and ALP were not that high in the beginning, being 313 and 141 at the time of her first blood tests. We did 3 days of iv's to rehydrate + anti emetic + liver protector. At the ultrasound the first vet saw some weird stuff so she recommended a CT. We did the CT and it turned with a suspicion of lymphoma. That as that but after the CT anesthesya my cat did not want to wake up for 5 hours, she should have done that after 20 minutes max at that level of anesthesya given for a CT. We took her to the EE and they woke her up and stabilized her during the night. Most probably during the 3 days of IVs her rose from 300 to probably around 500 and her liver was not getting the substance out anymore.

After checking her out from ER, I let her to rest a day and took her to another clinic, she was already yellow so here went another 2 days of IVs and then home again, being stabilized, she ate at the clinic so we would hope she will now continue at home since she was not yellow anymore. They did not redo the blood work then since they did the ultrasound and it showed the liver being inflamed and all the stomach around it. I gave them the CT and they ruled out cancer based in the ultrasound (a biopsy or endoscopy was anyway out of the question after the CT experience). After the IVs the yellowness disappeared. She did seem to eat relatively better for the first 4 days then the vomiting started and the nausea, which reduced her appetite.

Back again, 2nd round of IVs after a week as we thought those two days were not enough and we did not check her levels to make sure she was indeed ok to let go. Here we go again , rehydration, Prednisone and whatever else they gave her 3 days then 2 days under supervision. Given royal canin gastro wet and dry while at the clinic. Took her in with ALT 260 and ALKP 611, so very high again. After 5 days took her out with 179 and 255 so a significant change. Cancer was cleared out again, IBD as well, she had no inflammation again, according to them she was ok and just needed to eat. Got a mirataz cream and started applying it from that that day on.

Got her out on Saturday, got her in again this Friday, with the same pattern. The moment I got her in the house she refused the royal canin gastro although she ate the same thing there, in a cage 5 days in a row. Turned her tail on me the moment I put that in the bowl and went to eat the other royal variety I had in for the other cat. Ok, fine with me as long as you eat. However, the latter repeated itself, every day more pickier, especially on the royal canin variety. Day 4 or 5, puking started, I got another type of food to try and do the exclusion diet, she did like and seem to eat those better but the puking did not stop, but rather intensified at two times per day at least. She would just lay, sleep and all of the sudden she felt nausea and went and puked. After three days of this she already started to get yellow again so here she is in the clinic again, with 264/455 again. Apparently at around 400 her jaundice is starting so no wonder she was very yellow at 600 the first time I brought her in. Probably had around 500 when I did the CT thus the trip to the emergency room

She has lost 1kg in one month since we started this, so now she is really thin and weak and not sure what we are going to do after this session. It looks her liver has an increase in toxicity before she even gets a chance to get her appetite back with mirataz. The treatment period for the ointment is 2 weeks but her liver is making her nauseous and sick in 4-5 days and then she does not want to eat anything. So we are also on a loop like the previous cases did.

After I check her out this time, I think I will ask for another opinion for a last time, whether there is anything we can give her at home to try and keep her liver in better levels while we strive to make her eat, to somehow keep her levels under control. There is a place here where they do biopsies under inhalation anesthesya but I don't really want to put her through another traumatic experience as she is very weak and really don't trust any advice that she would resist another anesthesya. Like you all mentioned here, it seems like vets seems to undermine the adverse effects and do not warn you properly enough. For example, both peritol and mirataz, which I gave her for appetite stimulation made her drowsy and confused and caused lack of equilibrium. When I told this to the vet he said that is really weird as all the cases he saw were of being agitated and hyper stimulated. Although drowsiness was a clearly written side efect on both these drugs. Whatever, as long as she easts she can be a bit confused. But then her liver starting to act again and here we are.

So now I am waiting for this vet's final advice and if he says he has nothing much to add, I will just go and ask for the 2nd opinion on meds at home and if those do not work well... It is what it is, I do want her with me, I love her very much, she is 14 and I am 34 so she has been with me for almost half of my conscious life, so I am heartbroken since this Friday, especially when I got hope back two times already (when she woke after the CT and when cancer was ruled out - if that was even correct). But I don't think I can torture her more with IVs and visits every few days just to discover more, try more, keep her in a constant state of drowsiness, needles and stress and then end up with her dying anyway, but after much more stress. I am still trying to work out the pain that the next week might be my last with her, unless maybe some home meds work or someone has a sudden brilliant idea that actually saves her for real and not for just for several days... not really managing it well but from your posts here I can see that this sort lymphoma/liver disease path can be a really long and painful one, both for her and for me.

However, I do feel a bit calmer now reading all these posts and feel less in the dark now, this sort of condition puzzles doctors around the world and they do their best with what they can.

Much respect for all of you that put your lives on hold and invest fortunes to try and make your old friends feel better. You do your best and you never know when you do right or wrong, I have the same frustration going in my head for over 3 weeks now, all these thoughts that I could have done better, that some steps could have been skipped, that I constantly get my hopes up and put them down again. It's a tough ride when this happens.
Just wanted to reply and update as well since it has been awhile. I agree with kitten appliance for treatment. We exhausted most treatments because they simply didnt work for my cat or made him worse. Im sure the medication sensitivity has to do with the liver already being impaired. Currently, my cat is on leflunomide and prednisolone. He is always a little bit yellow. This has become his new normal. I do not try to get his liver levels down, I simply try to give him the best life I can. Sometimes that means giving him subQ fluids at home and sometimes that means cooking him chicken if thats all he will eat for dinner. He sleeps a lot more than he did but other than that he acts pretty normal.

My cat is a lot larger than most cats at about 13 pounds and he did struggle with the biopsy they did. I do not regret doing the biopsy but it was very hard on him. It took him a full week to not look like he was on deaths door after the biopsy. In my case, it did not give us any life changing information it simply said liver inflammation. If I had to do it over again with smaller cat, I would not do a surgical biopsy. The anesthesia on an already compromised liver was difficult for him. I respect everything youve done and support any decision you choose. We all understand and we are here for you.
 

BellaBlue82

Sadie rules, Julian drools, my boys rule heaven ❤
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I send thoughts and hugs to all of you. I agree, liver issues are by far the worst medical issue I've dealt with in all my years of owning cats. We do everything we can for our babies, and I'm so glad to read these updates of kitties at least maintaining their lifestyle.
It really does come down to what you know and feel in your heart. I knew when Casper went through this that there was not much we could do based on his age (18) and how hard this hit him. Of course we still tried everything we could, but after two weeks of seeing him no want to eat at all we made the best decision we could for him.
All of these beautiful furry kids know how much we truly love them, and I know they are not only thankful for how hard we try to take care of them but also love us more in return. ❤
 
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