Liver Inflammation - Milk Thistle, How Much??

[Teri122]

I know there have been some people on here whose cats have had liver disorders, I am specifically treating cholangiohepatitis, pancreatitis. Tabitha was diagnosed a month ago, but her liver enzymes were elevated the month before that when my vet pretty much was resigned to diagnosing her with a liver tumor. Subsequently the ultrasound and FNA diagnosed the cholangiohepatitis. Her enzymes are very elevated, ALT was over 1000, ALP 500 or so. This did come on quickly because she was constipated in Sept and her enzymes then were all normal when we checked her labs then. (The first elevation was seen 2 months later). She was put on Metronidazole and Prednisolone twice a day, and Baytril. After 3 weeks she started balking at the Baytril. Tabitha is a feral I have cared for for 10 years outside before I brought her inside last Feb. She is very content, even happy inside with her buddy who was also brought in, but I can not touch her. Which makes giving medication a bit difficult, obviously. She has to take everything on her own. I was to start Denamarin, but after the first dose, and two after that she seemed "off". She started running from me when I would get near her after she took it. She ate it fine, but just then seemed freaked out by me, which did not happen with all the other meds she gets. Plus it has to be given on an empty stomach and with work, and giving her small frequent meals, that was difficult. So I stopped the Denamarin and started on Milk Thistle Seed Powder which just mixes in her food and she seems to like it. But I am having trouble finding a real dose to give her. I called the company (Herbal Vet) and they couldn't help me. The bottle says a dose is 1/8 tsp, and to give 2-3 times a day. Not clear if that is 1/8tsp 2-3 times a day, or spread out over all meals. 1/8 tsp = 250mg. And I figure that is maintenance, not to treat such off the chart liver studies. I have read that cats should get 10mg/lb. She is 7lbs, but again that is probably maintenance, not treatment.
Does anyone have any experience using milk thistle, I would love to hear success stories!! This is so stressful because it isn't like I can GIVE her meds to treat what ails her, she must TAKE the meds. And getting her to the vet is a very stressful sneak and grab episode so I only reserve that for when absolutely necessary because quite frankly it sucks. Sorry for being so long. Just got writing, and... ya know.
Thank you if anyone has ideas.

 

[FeebysOwner]

Hi. So sorry about your little girl. I have no experience, but recall a few other members that might have some input.

daftcat75 , B babiesmom5 , Antonio65 , @denice ????

 

[1 bruce 1]

I gave milk thistle to a dog and the results blew me (and the vet) away.
If the company can't help on dosage questions (which seems...really weird) could you call your vet, explain the situation and ask them what they recommend?

 

[daftcat75]

Everything I’ve read says milk thistle takes time to work. My Krista still isn’t eating like she used to. So anything that gets in the way of her eating, I can’t really afford right now. She’s not crazy about the milk thistle powder. I don’t think she dislikes it but she will eat around it if she can. My current theory on liver disease and it’s only my guess and not a well-researched position (yet) is that liver inflammation rarely happens on its own. It’s usually carry over from somewhere else. In Krista’s case it was dental disease and IBD. In yours, it’s pancreatitis. What I don’t see in your post is enough prescriptions to treat the pancreatitis? Where’s the anti nausea, anti emetic, pain relief, and appetite stimulants? What are you feeding Tabitha and how is her appetite? Pancreatitis can be particularly nasty and I am thinking that would take precedence over liver enzymes. Ask your vet about ursodiol as well. That can help with liver disease. IV fluids can help too but it took several days and that’s not cheap.

 

[daftcat75]

I think the milk thistle can help long term in a supporting role. But I don’t think it’s strong enough medicine to treat acute inflammation.

 

[blueyedgirl5946]

Ask you vet about Denamarin. My cat was treated with it for awhile and it did help.

 

[furmonster mom]

I had a cat with cholangeohepatitis due to a nasty bacterial infection. So we had to fight that off with antibiotics while also supporting the liver.
We also had to deal with occasional inflammation with Prednisolone.

Marin/Denamarin = silymarin = milk thistle. The only thing about Marin/Denemarin is the name branding and dosage.

AFAIK there is no toxic level to milk thistle, though overdosing can basically become a waste. Getting a reasonable dosage is based on weight. Figure that the typical human dose is based on average of 150 lbs. Break it down from there. When I used it, I consulted with my vet and she helped me figure the breakdown. Milk thistle is very bitter, so I found it easier to give in small capsules.

Denosyl is another branded supplement for liver support. It is s-adenosyl, which is also SAM-e. Again, the human supplement can be used, but needs to be broken down to small dosage.

We also had to put him on Ursodiol. I was not able to find a comparable supplement for that.

I gave supplements twice a day with meals.

I will say that we seemed to see the most improvement with a high dose of milk thistle. We backed the dosage off once the numbers came down, but still kept it in the regimen for support.

 

[babiesmom5]

I am not a vet, but daftcat75 is correct in stating that liver inflammation usually does not happen on its own.
I think what you may be dealing with is a "Feline Triaditis Syndrome" which describes the concurrent condition of cholangitis, pancreatitis and IBD.

There is a common outflow track for the feline pancreas and bile duct as they approach the major duodenal papilla. The anatomical close proximity makes it likely that there is spillover/involvement with pancreas, bowels and liver.

What I am trying to say here is you can't just treat liver in isolation. The cat also has pancreatitis and likely also bowel involvement.

As others here have stated, I would be concerned about cat's hydration status. Is the cat getting any pain medications? Anti-nausea/vomiting meds? Any appetite stimulants? These will all significantly affect the outcome of cholangiohepatitis.

I think a multi-faceted approach is needed here.

To answer your specific question, the usual dose of milk thistle/silimarin is 2-5 mg q 24 hrs.

Other supplements that may be helpful with liver function are Ursodiol usually given 5-15 mg/kg. q 24 hrs.; SAM-e usually given 90 mg/cat q 24 hrs; Vitamin E usually given 50 IU q 24 hrs.

Note: these are usual dosages, but only your vet is qualified to prescribe exact dosages.

I would highly advise (if you are not already) your cat be under the care of a good Internal Medicine vet.

With liver enzymes this high, and other organs involved, I would not just rely on supplements.
And milk thistle does take time to reach a therapeutic dose, so I would speak with your vet first.

I wish you and Tabitha all the best!

 

[blueyedgirl5946]

I read you post again and saw that you had already tried the Denamarin. Sorry I missed that to begin with. It has been a long time ago, but I seem to remember my vet said it was hard to get the right dosage just giving Milk Thistle. I do hope you can find something here that helps your cat. Good luck.

 

[1 bruce 1]

filler for deleted post.

blah bling blah.

Here's some antlers.

 

[Antonio65]

What others said is correct.
You have to find the reason why the liver enzymes are so high, in my case the real reason had never been assessed.
I used to give my cat pills similar to Denosyl, and I was told to strictly follow the directions, an overdosage would have bee quite toxic. I talked to the doctor of the manufacturing brand, he said that on overdosage could alter the methabolism and bring some issues, like high or low (can't remember) blood pressure.
Ursodiol (or similar) is also very good.

Others said it right, it can take weeks for the therapy to show some effects.

 

[Teri122]

Thanks for all the replies. To address some questions. Tabitha did have a FNA - fine needle aspirate, for diagnosis. So cholangiohepatitis is the diagnosis we got from that, that is what is causing the elevated enzymes. She occasionally gets a cerenia, zofran, ciproheptadine, gabapentin .But it has been a month since the diagnosis and starting the antibiotics and pred. I don't think she has pain, and overall her appetite is good, I just give those occasional meds to keep problems at bay. I am hoping the metronidazole and pred are helping with the main issue and things are starting to resolve in her system, and the milk thistle is to try to lower her enzymes and help regenerate her liver. I would say she doesn't need fluids because she drinks pretty much, and only gets wet food, plus I can't give her fluids anyway, I can not touch her. I was considering ursodiol, even asked the vet for a script, but adding another pill is not really what I want to do. It is stressful enough getting her to take 4-5 pills a day, sometimes she does on the first try, sometimes it takes 3-4 tries of hiding the pills in various things for her to eat them. Frustrating her before meals is not good for either of us. Basically right now she gets 5 small meals a day, 2 with miralax in them, 3 with as much milk thistle as she will allow .

 

[daftcat75]

Ursodiol can be compounded into a liquid which means they can add a flavor to it. I’m not sure if the flavor is enough to mask the taste though. But it is just a small amount and only needs to be given once a day. Ask the vet again about ursodiol. I think it would be of more help in the short-term than the milk thistle.

 

[Teri122]

My vet nixed the Ursodiol over Denamarin because her ALT is what was most critically elevated and Ursodiol is more for elevated ALP. Since milk thistle can be given with food and was not another pill I chose that for her hoping it does the trick to help with regeneration. This is the first time I have had a cat that I can not get any med I want in them, so it is really stressful to have to pick what is the best thing to do for her. I am wondering if I should try to restart the Baytril again, but then starting and stopping antibiotics is not good either...
Someone above had said that milk thistle dosage is 2-5mg, but the powder we have comes in 250mg/ 1/8th tsp. And the drops (as a backup but she really doesn't seem to like the taste of them) is something like 10mg/drop.
Sorry, I am just throwing my thoughts around really...

 

[daftcat75]

My vet nixed the Ursodiol over Denamarin because her ALT is what was most critically elevated and Ursodiol is more for elevated ALP. Since milk thistle can be given with food and was not another pill I chose that for her hoping it does the trick to help with regeneration. This is the first time I have had a cat that I can not get any med I want in them, so it is really stressful to have to pick what is the best thing to do for her. I am wondering if I should try to restart the Baytril again, but then starting and stopping antibiotics is not good either...
Someone above had said that milk thistle dosage is 2-5mg, but the powder we have comes in 250mg/ 1/8th tsp. And the drops (as a backup but she really doesn't seem to like the taste of them) is something like 10mg/drop.
Sorry, I am just throwing my thoughts around really...

Herbsmith has a page on milk thistle powder vs milk thistle extract. You could just leap ahead to Silymarin Math to see how to convert a powder dose to an extract dose. I think you'd actually have to give a bit larger than 1/8 tsp to as much as 1/4 tsp to compare with Denamarin.

Milk Thistle

 

[Teri122]

Thank you. I will look that up . She is getting at least 1/4 tsp since I am putting it in most her meals so I feel better. Appreciate the referral.
This is Tabitha in her heated thinking cup, and with her best bud OliverChuck .

 

[Polly Bushings]

I am not a vet, but daftcat75 is correct in stating that liver inflammation usually does not happen on its own.
I think what you may be dealing with is a "Feline Triaditis Syndrome" which describes the concurrent condition of cholangitis, pancreatitis and IBD.

There is a common outflow track for the feline pancreas and bile duct as they approach the major duodenal papilla. The anatomical close proximity makes it likely that there is spillover/involvement with pancreas, bowels and liver.

What I am trying to say here is you can't just treat liver in isolation. The cat also has pancreatitis and likely also bowel involvement.

As others here have stated, I would be concerned about cat's hydration status. Is the cat getting any pain medications? Anti-nausea/vomiting meds? Any appetite stimulants? These will all significantly affect the outcome of cholangiohepatitis.

I think a multi-faceted approach is needed here.

To answer your specific question, the usual dose of milk thistle/silimarin is 2-5 mg q 24 hrs.

Other supplements that may be helpful with liver function are Ursodiol usually given 5-15 mg/kg. q 24 hrs.; SAM-e usually given 90 mg/cat q 24 hrs; Vitamin E usually given 50 IU q 24 hrs.

Note: these are usual dosages, but only your vet is qualified to prescribe exact dosages.

I would highly advise (if you are not already) your cat be under the care of a good Internal Medicine vet.

With liver enzymes this high, and other organs involved, I would not just rely on supplements.
And milk thistle does take time to reach a therapeutic dose, so I would speak with your vet first.

I wish you and Tabitha all the best!

 

[Polly Bushings]

my three mongrel cats are on canned and raw food (frozen beef). All have hard stools. Linda, the abyssinian, has abnormal liver counts. the vet put her on maropitant citrate (nausia), miralax, 1 gm flagyl n clavimox. different than treatments listed here. i think I should give her milk thistle and acidolphilus....but will consult with my vet. they are in tite with John Hopkins research on Cats.

 

[white shadow]

.
Teri122 - I just came across a note I had made about the time of your last post above, and then misplaced!

Should you be interested, there are (at least) two specialized online communities that focus on Pancreatitis:

• Cats With Pancreatitis - FB
• Feline Pancreatitis Support - Yahoo Groups

From my experience, the Yahoo Groups are the very best sources of info, advice and support for people dealing with specific feline diseases/conditions. This one has been active for ~12 years and has had 1500+ members and their cats. I can't speak to the FB groups, though.
.

 

[Teri122]

Thank you White Shadow. I may look into the FB page. Actually I have had a lot of experience with pancreatitis, but never (well, almost never) the liver issues. My Seamus often had bouts of pancreatitis, and that is generally the first thing my vet considers when any of my cats are under the weather with no apparent cause. I know all you can do for that is basically keep them comfortable until it resolves. My cat Montana had acute liver failure after his neuter surgery at a TNR clinic. He had a reaction to the sedation and his temp shot up to 107 degrees. The Doc gave him valium and packed him in ice. He survived, no brain damage, but a few weeks later I noticed he was not eating when he would come by for dinner, and had gotten skinny. Anyway, that was relatively easy to treat.
Tabitha's cholangiohepatitis is a different story. We are on day 47 of her pred and metronidazole, and 27 of the milk thistle. I would love to know what her liver enzymes are currently, I would have to think they are down because she is doing so well. Actually I might start a threat to see if anyone can help with what to expect at this point. I am hoping we can maintain her on just the milk thistle alone in another month maybe, but if I ask the vet they will probably want labwork done and I would rather not have to take her in since she is a feral and it is super traumatic getting her in a carrier.
Anyway, sorry for the run on.
Thank you again!