Liver Disease, Cholestasis Cat

[Chaz Galloway]

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.

How is Lela doing? Any luck with some good old rest & recovery at home?

 

[fionasmom]

I don't know if you have anything like convenient access to an oncologist, but it might be worth a try if you do.

 

[LelaCat]

Lela isn't doing that well. I'm still hoping she will improve some, but her condition seems to be worsening. She isn't wanting to eat as much or as regularly as before, even with the appetite stimulant and nausea meds. She still likes to lay on her window sill and rotate nap areas and she is eating a bit throughout the day, just not as consistently as before the fluids. I am going to try some different food flavors, but its hard bc of her chicken allergy. So many foods have chicken products even if they arent chicken flavored. We are keeping her comfortable and making sure she feels loved with lots of family hugs and sofa cuddles. My husband and I are so, so extremely sad. She's been our sweet babycat for 17 years.

 

[Chaz Galloway]

Lela isn't doing that well. I'm still hoping she will improve some, but her condition seems to be worsening. She isn't wanting to eat as much or as regularly as before, even with the appetite stimulant and nausea meds. She still likes to lay on her window sill and rotate nap areas and she is eating a bit throughout the day, just not as consistently as before the fluids. I am going to try some different food flavors, but its hard bc of her chicken allergy. So many foods have chicken products even if they arent chicken flavored. We are keeping her comfortable and making sure she feels loved with lots of family hugs and sofa cuddles. My husband and I are so, so extremely sad. She's been our sweet babycat for 17 years.

I am truly sorry you're going through this! Was really hoping she would come around.
Honestly, I understand and have been in a pretty bad place lately. Chaz also seems to be worsening, not wanting to eat on his own and crouching down like his stomach hurts. I hate to say this, but he also looks slightly more yellow than he was last week. All I want to do is help him, but I feel like I've failed miserably. He's been off the chlorambucil for about a week and a half with no improvement. We get more blood taken on Monday to see if his liver has improved since stopping the chemo, but I am not expecting it to. No matter how old they get, always be your baby.

 

[fionasmom]

You have not failed anyone. You are trying your hardest to help Chaz and when things don't seem to go wonderfully we always think that there is something else that could have been or could be done.

 

[LelaCat]

I am truly sorry you're going through this! Was really hoping she would come around.
Honestly, I understand and have been in a pretty bad place lately. Chaz also seems to be worsening, not wanting to eat on his own and crouching down like his stomach hurts. I hate to say this, but he also looks slightly more yellow than he was last week. All I want to do is help him, but I feel like I've failed miserably. He's been off the chlorambucil for about a week and a half with no improvement. We get more blood taken on Monday to see if his liver has improved since stopping the chemo, but I am not expecting it to. No matter how old they get, always be your baby.

My heart hurts for both of our kitties. I understand how you feel. It is awful beyond words. I wonder if my husband and I made/are making the right decisions and if there is anything else we could do better. I feel so sad for Lela even though death is a natural part of life. It is so hard to see her decline.

We have had a rough weekend. Yesterday she was in and out of the litter box whining, sometimes howling. I checked her rear end and she had a piece of large caliber, firm stool that she could not pass. I tried luke warm water soaked cotton balls to help loosen it, but it wasn't helping. There was a little bleeding also. We messaged the online vet through Just Answer and she said it would be best to take her to urgent care. When I was about to leave, my husband found a piece of stool in a cardboard box she lies to sit in. I wasn't sure if that was the piece that was stuck but took her in anyway in case there was more stool further up. She also hadn't eaten much the night before despite using the appetite stimulant. The urgent vet said there may be more stool, thought he could feel more and suggested an enema and also fluids to help her hydrate. He also prescribed an oral appetite stimulant. I had reservations about the fluids, so we did the enema yesterday, but I had to take her back in today for sub q fluids. She drank so much water yesterday evening and last night that I could tell she really needed it. The vet today also prescribed some gabapentin for pain. We gave her 1 dose at 2:00 and around 4 she was very unsteady on her feet, staggering and falling over if I didn't help her walk. They told me she may be drowsy, but never mentioned these side effects. I did see online that those things can happen with this medication. She does seem more comfortable but I wonder if this medication is too much for her. The unsteady, staggering is pretty bad. We'll call the local vet in the morning for an appointment. We will probably have to do sub q fluids at home and also follow up on the Gabapentin dose or another alternative medication.

 

[Chaz Galloway]

My heart hurts for both of our kitties. I understand how you feel. It is awful beyond words. I wonder if my husband and I made/are making the right decisions and if there is anything else we could do better. I feel so sad for Lela even though death is a natural part of life. It is so hard to see her decline.

We have had a rough weekend. Yesterday she was in and out of the litter box whining, sometimes howling. I checked her rear end and she had a piece of large caliber, firm stool that she could not pass. I tried luke warm water soaked cotton balls to help loosen it, but it wasn't helping. There was a little bleeding also. We messaged the online vet through Just Answer and she said it would be best to take her to urgent care. When I was about to leave, my husband found a piece of stool in a cardboard box she lies to sit in. I wasn't sure if that was the piece that was stuck but took her in anyway in case there was more stool further up. She also hadn't eaten much the night before despite using the appetite stimulant. The urgent vet said there may be more stool, thought he could feel more and suggested an enema and also fluids to help her hydrate. He also prescribed an oral appetite stimulant. I had reservations about the fluids, so we did the enema yesterday, but I had to take her back in today for sub q fluids. She drank so much water yesterday evening and last night that I could tell she really needed it. The vet today also prescribed some gabapentin for pain. We gave her 1 dose at 2:00 and around 4 she was very unsteady on her feet, staggering and falling over if I didn't help her walk. They told me she may be drowsy, but never mentioned these side effects. I did see online that those things can happen with this medication. She does seem more comfortable but I wonder if this medication is too much for her. The unsteady, staggering is pretty bad. We'll call the local vet in the morning for an appointment. We will probably have to do sub q fluids at home and also follow up on the Gabapentin dose or another alternative medication.

Gosh we just cant get a break! Thats so stressful when they're crying in pain at the litter box. Did they send you home with any laxatives to prevent getting another enema? A medication called purge has worked wonders for an IBD kitty I had to soften hard stool. As I'm sure you can tell, the enema is pretty hard on them. But absolutely necessary in your case. Poor sweet baby.
Chaz takes gabapentin for vet visits because hes a very large cat and I cannot get him in the carrier by myself without a fight, but it has never caused him to stagger. Do you know the dosage they said to give and how often? Chaz takes 50 mg and it does take a full 2 hours for it to kick in. The bottle says one hour, but no ma'am I've made that mistake before and it does not kick in for 2+ hours. I know that it is metabolized in the liver and excreted through the kidneys so it could be that it stays in her body longer because of her kidney issues. If thats the case, I might be hesitant to give it to her everyday unless you feel she's in pain. I was always told by the vet that gaba is one of the safest meds for cats with liver or kidney problems but you never know how a cat will react to a new medication.

 

[LelaCat]

They did not send any laxative meds home. They did give more instructions for the Miralax. Although, she has to eat the mixture I make for that to work. She ate it tonight, thank goodness.

They prescribed Gabapentin 50mg/mL--0.25mL, so that would be 12.5mg, if I did the math right. She only weighs 4.1 lbs(1.86kg) now. I found a chart online that recommends 5mg per kg for chronic pain, so that would be 9.3mg dosage. So maybe the dose is just a little too high. And they said I could give it to her up to 3x per day/ every 8 hrs! That seems like way too much. We're not so patiently waiting for this dose to wear off so we can see how she does. It did help her get some restful naps and she did eat a decent amount though.

Keeping you and Chaz in my thoughts for your appointment tomorrow.

 

[Chaz Galloway]

Just back from the blood draw and his ALT has come down from 1472 last Monday to 585 today. I know thats still not a good number, but I am thrilled that it came back down. This confirms my suspicion that the chlorambucil was hepatotoxic for him. His ALP also came down slightly, but his bilirubin was up to 1.3. He did seem slightly more yellow to me as I mentioned in my last post. Really, we are back in the same position we were three weeks ago

BUT I am happy to see that it did come down and not remain in the 1000s. Now, I am just waiting to hear back from the specialists on the treatment plan going forward. I also believe it may continue to decrease over the next week or two since the chemo has a lingering effect.

 

[fionasmom]

That is great news about Chaz's numbers coming down so much! Hopefully a successful treatment plan can be determined to help him.

With poor little Lela, it is absolutely true that any impairment of the liver or kidneys will affect the processing and elimination of a medication like gabapentin or anything in the same class. Definitely discuss the dose with the vet even though it sounds as if it helped her.

 

[LelaCat]

Awesome news!! So happy to hear! I know there is still more to figure out, but at least his liver enzymes are coming down.

Lela is doing a little better as the Gabapentin wears off. She is still stumbling sometimes, but it is waaay better than yesterday.

 

[Chaz Galloway]

Wanted to update on Chaz's journey. After talking to the specialist, she wants to try him on Atopica cyclosporine medication. It won't start to take effect for two weeks once he starts, so we will recheck bloodwork at that time. Seeing that he reacted poorly to the chlorambucil, theres a chance he may respond poorly to this medication as well. There were some changes to other values on his bloodwork this time that concern me. His platelets were low and his globulin was high. Even though his red blood cell count isn't considered low, its trending down and just a few points away from being low. The vets don't seem phased by this, but of course I'm worried that this is an indication that his disease is progressing. Clinically, hes not doing very well. He sleeps most of the day, looks more yellow and wants to eat less on his own every day.

 

[fionasmom]

I hope that the new medications helps. Please let us know how things go.

 

[Chaz Galloway]

I have not started the Atopica yet because Chaz decided it was time for the feeding tube to come out. The vet really wanted it to stay in due to all of his medications, but he kept scratching at it every day underneath his kitty collar until the hole in his neck became so large that food he was eating by mouth started coming out of the hole!! It was very alarming to discover. They recommended we take it out since it had been in for two months and it was clearly bothering him. I am a little relieved its out because of the constant complications from being in so long- infections, loose stitches, irritation. But I'm worried that he wont get the calories he needs and I'm having a VERY hard time getting 6 medications in him every day, especially the prednisolone. He does not swallow the liquid meds, he spits out all the medication no matter how long I hold his head. My vet warned me that the atopica has a terrible taste as well so I need to figure something out before I start that because what I'm doing is simply not working. It's making him not want to eat food and the last thing I need is a food aversion.

Has anyone had any luck with transdermal prednisolone? I've read mixed reviews of it not working as well as the oral formulation, but I'll take transdermal of anything I can get.

 

[fionasmom]

Pill pockets without grains or chicken?
Injectable prednisolone
daftcat75

Search Results for Query: transdermal prednisolone
General posts on TCS that mention transdermal pred

 

[daftcat75]

It’s a little late now that the tube is out. But there is a company and product called Kitty Kollar that is specifically designed to keep the tube site clean and safe from cat claws without requiring a cone. The stoma closes up quickly. But if you need that extra protection, you could use a makeup round or a gauze square to protect the site and the Kitty Kollar to keep it fixed in place while keeping his claws away from it.

Does he have dietary restrictions? If chicken is okay, I recommend asking your vet for a can or two of Hills A/D and trying this method for medicating. This is how I give my Betty five capsules in the morning and four at night. She always shows up for meds and purrs the whole way through. I call A/D her cake frosting. I take a small smear of what’s left after I’ve given her all her meds and put it into her food. That gets at least a few more bites of food in her stomach while we’re waiting for those meds to kick in.

There may be some truth to transdermal absorption being less efficient than gut absorption—especially if you aren’t washing old doses off between applications. But some pred is better than none. If transdermal is how you can ensure he remains in compliance with a medication that compliance is very important, then that’s better than skipping doses or having doses come back up. Pred is a strong drug anyway. I don’t know that the difference between absorptions is going to mean he will get a sub-therapeutic dose.

But if he can have A/D, I highly recommend trying that method first. I spend about fifteen minutes each Saturday or Sunday morning cutting up Betty’s pills and packing them into capsules for the week. It’s such a small price for not having to wrestle her or for her to not have to taste her meds. It also means once a week I have an inventory of her meds and if any need refills. I don’t get caught running out anymore.

 

[Chaz Galloway]

It’s a little late now that the tube is out. But there is a company and product called Kitty Kollar that is specifically designed to keep the tube site clean and safe from cat claws without requiring a cone. The stoma closes up quickly. But if you need that extra protection, you could use a makeup round or a gauze square to protect the site and the Kitty Kollar to keep it fixed in place while keeping his claws away from it.

Does he have dietary restrictions? If chicken is okay, I recommend asking your vet for a can or two of Hills A/D and trying this method for medicating. This is how I give my Betty five capsules in the morning and four at night. She always shows up for meds and purrs the whole way through. I call A/D her cake frosting. I take a small smear of what’s left after I’ve given her all her meds and put it into her food. That gets at least a few more bites of food in her stomach while we’re waiting for those meds to kick in.

There may be some truth to transdermal absorption being less efficient than gut absorption—especially if you aren’t washing old doses off between applications. But some pred is better than none. If transdermal is how you can ensure he remains in compliance with a medication that compliance is very important, then that’s better than skipping doses or having doses come back up. Pred is a strong drug anyway. I don’t know that the difference between absorptions is going to mean he will get a sub-therapeutic dose.

But if he can have A/D, I highly recommend trying that method first. I spend about fifteen minutes each Saturday or Sunday morning cutting up Betty’s pills and packing them into capsules for the week. It’s such a small price for not having to wrestle her or for her to not have to taste her meds. It also means once a week I have an inventory of her meds and if any need refills. I don’t get caught running out anymore.

Thank you so much! Any tips and tricks to make medication easier are greatly appreciated!! He did have the Kitty Kollar, unfortunately he found ways to get around it just enough to scratch at his tube site I do have a script and some leftover cans of the A/D food, so I can give that a try.

 

[Chaz Galloway]

Chaz has been on atopica now for nearly a week. It's been AWFUL getting medications in him by mouth. He refuses any tips or tricks I've found online about eating meds in his food, he salivates at the sight of an empty syringe before I even get close to him, and pilling is completely impossible as he will not swallow the pill. Sometimes, if i'm able to get it in his mouth, he will hold the pill for several minutes and then spit it out. Completely exhausting and frustrating trying to medicate this cat. He hates the taste of A/D and refuses treats. If he smells or tastes anything in food he will not eat that food again.

I am starting to become very concerned he's not handling the atopica very well either, which is heartbreaking since he could not handle the chlorambucil. I think he is just very sensitive to medications. He's become wobbly on this med, sleeps all day, has eye discharge, and an abundance of dandruff he's never had before. I have a vet appointment scheduled this Thursday and I'm going to push to get some bloodwork done early since these symptoms don't feel right.

 

[fionasmom]

Search Results for Query: atopica

I don't know if any of the search results from TCS re: Atopica will help.

None of this will help, but I have cats who hate A/D and have reacted to pills in the same way that Chaz is. It just makes everything that much harder. You are doing the right thing to get back to the vet about this.

 

[Chaz Galloway]

Hey everyone!
Chaz had his vet follow up yesterday, and even though hes a little more wobbly, some of his liver levels went down slightly. His ALT went from 585 down to 419 yesterday, and his bilirubin went from 1.3 down to 1.0. He looks noticeably less yellow, but I'm still worried about his lack of coordination while taking this. I couldn't find much about cats becoming ataxic while on Atopica since it apparently only happens to about 2% of cats.. go figure! I don't want to stop giving it to him since it's the only thing he's responded to and basically our last shot at treatment, but I also cant have him falling all over the place. I'm going to reach out to the drug company today and try to find out if this is a true adverse reaction or if its okay for a little while longer.

He also gained 4 ounces without the feeding tube!