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Liver Problems After Methimazole - Still Not Eating

Discussion in 'Cat Health' started by twotabbies, Nov 8, 2018.

  1. twotabbies

    twotabbies Thread Starter TCS Member Young Cat

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    Sep 4, 2014
    Hi cat friends,

    Here I am again--when I'm at my wit's end and not sure what to do I'm glad I can come here for support, if nothing else.

    Our 15 year-old tabby Princess (P) has a host of problems:
    • HCM (hypertrophic cardiomyopathy) diagnosed in Feb
    • Medications to treat: Enalapril/enoxaparin sodium by injection
    Most recent diagnosis: Hyperthyroid (diag. 10/6) which we initially treated w/ methimazole. The methimazole robbed her of her appetite so after 2 weeks we discontinued w/ intention to have her receive radioactive iodine therapy.

    She has been off methimazole since 10/24/18 and has not regained her desire to eat. She seems hungry/interested in food but turns it down 9/10 times. Have tried multiple brands, dry, wet, expensive, cheap, healthy, junky, baby food, tuna, whole 9. Sometimes she eats a little but we've been "keeping her alive" with syringe feeding Hills a/d recovery occasionally as tolerated (per vet).

    She has rec'd x-rays and an abdominal ultrasound (last week). Ultrasound showed "mildly" inflamed liver/pancreas. Bloodwork showed elevated liver levels and high calcium. Vet has recommended
    -needle aspiration biopsy to check for cancer $300 at minimum
    -$500 test to inquire about the cause of ^ calcium levels

    She is currently taking her heart meds plus:
    • mirtazapine for appetite stimulation (1 tablet/3 days)
    • Cerenia for anti-nausea (1 tablet/day but we're almost out--EXPENSIVE; $30 for 4 pills)
    • Received a long-acting antibiotic on 10/31.

    More importantly: NEITHER ARE WORKING and Cerenia makes her drool. I'm afraid with her liver what she really needs is a corticosteroid and an anti-inflammatory. I'm also wondering about giving her Denamarin to help w/ liver function.

    She is eating small bits here/there and I understand she's nauseous--our regular vet has told us no more they can do and we are exclusively seeing a referral vet. We asked the vet about installing a feeding tube (she had one 4 yrs ago when she had hepatic lipidosis) but they won't do it since they want to know the "root cause" of her inappetence. It's also somewhat risky to put her under for that due to her heart and complications from anesthesia. It's so frustrating bc we know she needs to eat in order to get well. The loss of appetite and changes for the worse happened when she was given the methimazole. I've been reading up about methimazole hepatic toxicity in cats (and humans!) and apparently it can happen; methimazole is hard on the liver. The vet doesn't seem to acknowledge the connection between the methimazole and her current liver condition (as yet diagnosed only as "mild to moderate inflammation of liver and pancreas") and wants to run all these tests.

    We spend $300/month on her heart meds and around $500/every 6 months for her echocardiogram checkups. We're in the hole $1400 from last week's vet visits. Of course, we don't want her to suffer and are not nearly ready to let her go. She is my heart and soul. Husband and I can't fathom our home/life without her. I am just at my wits end. She does seem "sick" but she is still ok with litter box, drinks water, can jump up/down on the bed/couch, still friendly and cuddly but does want to sulk for a fair amount of time.

    What to do?
     
    Last edited: Nov 8, 2018

  2. Furballsmom

    Furballsmom TCS Member Top Cat

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    I'm so sorry!!
    If they haven't clarified, can you ask them what they see as possible causes of the inappetance, how long they intend to wait, and what they plan to do about it when they think they know?
    If you don't like what you hear, can you contact a university veterinary medical department?
     
    twotabbies purraised this.

  3. 1 bruce 1

    1 bruce 1 TCS Member Top Cat

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    Maybe a second opinion.
    Wanting to find the root cause is a good thing, but this girl needs to eat and not be sick while she does.
    My first thought was Denamarin as well.
     
    Furballsmom purraised this.

  4. Antonio65

    Antonio65 TCS Member Top Cat

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    My cat was diagnosed with hyperthyroid in September 2016 and was put on methimazole, which I was against, because I wanted her treated with radio-iodine.

    To cut this long story short, my cat was on methimazole for about 10 months before I was able to have her treated with I-131 in August 2017.
    The thyroid issue was solved, but her liver started showing some problems. We tried everything, several ultrasound scans, several blood tests, she was visited by specalistic vets and so on.
    She eventually died 3 months ago from what it seems it was hepatic failure.

    I'm definitely positive that the methimazole was at the root of all her troubles, but all the vets do not agree.
    I had also joined a Yahoo! Group for HT cats, and I have to say I received much more support and info from them than from all vets, and I asked them the same question and they said that there's no medical evidence that the methimazole can cause liver issues, though I had read that on some occasions (maybe rare) it can indeed.
    Probably my cat and yours are one of those rare patients who show these problems.

    You need to do something now, before your cat gets HL and goes downhill from there.
    Denosyl, Denamarin or everything that can be of support for her liver must be given. Force feed her, it's the only way to save her.

    Best of luck!
     
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  5. blueyedgirl5946

    blueyedgirl5946 TCS Member Veteran

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    Sometimes a probiotic sprinkled over the food helps to get them eating. Ask your vet about Forti Flora.
     
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  6. twotabbies

    twotabbies Thread Starter TCS Member Young Cat

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    Sep 4, 2014
    Thank you so, so much for this. I am incredibly sorry about the loss of your fur baby. It's comforting to know that someone else was possibly impacted negatively by methimazole, although your cat was on it for much, much longer than mine. Princess was only taking it for about 2 weeks and the damage was already done.

    We are sending her to emergency today to ask about a feeding tube. Syringe feeding is becoming more and more difficult and as we know from her bout with HL, the treatment for liver conditions involves intensive nutrition and feeding for cats who are inappetent. Please wish us luck. If we can get her eating on her own we can pursue the i-131.
     
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  7. foxxycat

    foxxycat TCS Member Top Cat

    I am so sorry your kitty is not feeling well.

    There's a webpage that deals with kidney disease but there's a page that explains the different medications to help with nausea.

    Tanya's Comprehensive Guide to Feline Chronic Kidney Disease - Appetite Loss, Nausea and Vomiting

    If you scroll down about 1/3 of the way there's diff treatment options for nausea. She lists the different medications that you can try. Some cats don't respond to Cerenia. Some had better luck with Zofran. There's one more listed there but can't remember the name of it. I wonder if there's anything on that page that could give some clues to what's going on?

    Also they have injection form of Cerenia and wonder if that would work better? Also Cerenia is very bitter, have you been putting it in an empty capsule? I use a pill popper to give my cat Pumpkin face her pills and butter on end of pill...the trick is to keep them from tasting the pill!

    I don't have any experience with the heart issue but wanted to share this link that could help Princess!

    Keep us posted!
     

  8. twotabbies

    twotabbies Thread Starter TCS Member Young Cat

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    Sep 4, 2014
    Thanks foxxy cat and all who have responded. Princess is heading to emergency with my husband now and I'll be joining them shortly.

    Let me know of any questions I should ask--possible diagnoses, etc. Lord knows they will want to run more tests even though she was just there last week. My heart hurts with her being put through all of this but we want to save her, if we can.
     
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  9. foxxycat

    foxxycat TCS Member Top Cat

    I would ask about subfluids, and a different anti nausea medication. And with the heart issue they would have to be careful with steroids. What about an appetite stimulant? That could be done after proper anti nausea medication. Zofran. Pepcid AC, they can try different types and have them do an injection instead of a pill. That would bypass the stomach issues.

    I'm so sorry about everything!
     

  10. Antonio65

    Antonio65 TCS Member Top Cat

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    Ask for testing bilirubine (all of them), and pancreas as well.
    Bilirubine started raising in my cat long before we could notice she was getting jaundice.
    I'm sure that if knew that earlier, things would have been much different!

    Best of luck, I'll be thinking of you and Princess!
     
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  11. twotabbies

    twotabbies Thread Starter TCS Member Young Cat

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    Sep 4, 2014
    UPDATE on Princess:

    Still at emergency vet. Her elevated calcium is a concern for cancer. The dreaded C word. Will be doing needle aspirate to find out more. Will provide more details.

    Can you imagine - heart disease, hyperthyroid, and cancer - all found and coming up in a year?
     

  12. Furballsmom

    Furballsmom TCS Member Top Cat

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    :vibes::grouphug: :crossfingers: :hugs: :redheartpump::redheartpump:
     
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  13. Antonio65

    Antonio65 TCS Member Top Cat

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    Where does the vet think Princess might have a cancer?
    I mean where will the vet do the needle aspirate?
    I'm sorry, but do not give up, Princess needs you now more than ever
     
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  14. twotabbies

    twotabbies Thread Starter TCS Member Young Cat

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    Sep 4, 2014
    Thank you for the good vibes, you guys.

    We are home from the emergency vet and doing well so far. After consulting with an internist a feeding tube was placed last night and that went very successfully according to her doctor she saw yesterday. We have done 2 feedings via tube today. Last night she was groggy from sedatives and still tired today but she was able to jump on the bed this morning to spoon with me as she always does.

    Aspirates of the liver, pancreas, and spleen all came back with ZERO signs of cancer! Sending a malignancy panel to be sure. At first the Dr was saying she would be surprised if it wasn’t cancer. Barring any unusual results from the panels she finally conceded it seems like a reaction to the methimazole! As was our hypothesis all along.

    She’s getting a steroid in the form of prednisolone along with Cerenia, mirtazapine, and denosyl.

    We were so annoyed bc the hospital didn’t give her enoxaparin for her heart! Lots of missed communications.

    Continue positive thoughts, you all are so kind
     
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  15. Furballsmom

    Furballsmom TCS Member Top Cat

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    :vibes: :cheerleader: :hangin:cheering you on, and hang in there!!

    Thank you so much for the update!!
     
    Antonio65 purraised this.

  16. Antonio65

    Antonio65 TCS Member Top Cat

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    I'm crying for the joy!
    What a wonderful news that Princess hasn't cancer!!!
    Now, I would really like to know what vets think about methimazole and liver toxicity.

    Could I ask you the dosage of methimazole you are/were giving to Princess?
     

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