I've decided that I want to keep a diary for Mika's recovery and treatment of her liver and gallbladder issues (cholangiohepatitis). Since I am a first time cat owner and first time pet owner, I was told that I can put it here if I wanted advice or support for Mika as well. I really appreciate and value the knowledge of this community so I want all the help I can get when it comes to this. Any and all help and knowledge is useful here! For those that don't know Mika's story: Spoiler Mika's issues began a few weeks after I found her on the street. She literally walked up to me out of the bushes, meowed and rubbed herself on me. It was instant love and I scooped her up and brought her home. I took her to a local shelter where they checked her out. She was healthy from the initial exam, weighing in at 7.5 lbs. She had no flea or any other issues but they did find a microchip. The vet there called the original family who said they didn't want her anymore (I suspect Mika was abandoned out on that street). At this point, all seemed well until right before finals ended (I'm a college student), she stopped eating. I knew nothing about cats issues with not eating and I was told by people who had owned cat their whole life that it was probably the stress from packing up for the summer to go back to my parent's place. After getting to my parent's house, Mika ate little to nothing. Finally, after a week of no eating, I took her into a vet where I was told that her liver values were through the roof, she was jaundiced, her gallbladder was all out of wack and incredibly inflamed and enlarged. We immediately started her on Ursodiol, Cerenia, and Verflox to get the bile flowing, help with any nausea, and combat any infection that could have been causing this. Mika's appetite didn't come back and we failed miserably with medicating her (she's bad about it and I was very new to it). After another week of force feeding (miserably) and with Mika declining more, I was given an appetite stimulant (Entyce) which did nothing. I had noticed that Mika was gagging anytime food was presented to her and asked for a stronger anti-nausea medication to which I was told, "We don't have anything stronger. Her liver is probably failing, take her to an emergency vet". Of course, I did. The emergency vet basically said, "There is anything I can do for her, take her to A&M." So we did. Mika was immediately admitted to A&M with her bilirubin at 9 and they confirmed that she was having some really bad liver issues. They recommended a liver and gallbladder aspirate to better understand what kind of infection was causing Mika's issues. In the hospital she began eating immediately and having normal bowel movements. The aspirate found gallbladder sludge. The cells of the liver and gallbladder were looked at and found nothing other than inflammation (which was obvious just by looking at the organs). It was speculated, though, that based off all the values, the way her liver and gallbladder looked, and with the aspirate that Mika had probably been suffering from this for a very long time (another reason I believe her original owners dumped her). They cultured their findings from the gallbladder (the sludge) and the liver which resulted in nothing growing. No bacteria. No fungus. Nothing. Mika was sent home after 3 days since she was eating well for them and her values had dropped. Her bilirubin was at 6.9 and her liver values had dropped (I don't know the original values, never saw the results) GGT 43, ALT 740, and ALP 472. Same medications as before, just told to keep it up. We went back 3 days later for a follow up. Mika's levels all skyrocketed. Bili 10.5, ALT 675 (I was told that while this value dropped, it didn't mean anything because her others had risen by so much), ALP 588 and GGT 47. They did another ultrasound to make sure Mika didn't have a blockage somewhere and came back saying the gallbladder sludge was acting like an obstruction on its own. They upped her ursodiol (and made it liquid), kept her on the veraflox, added denamarin (a liver protectant), noted that she had a UTI and prescribed Clavamox for that, and also added praziquantel which is an anti-parasitic in case this was liver flukes. I finally got good at giving Mika medicine and we used that technique to force feed her. I was told that any calories were better than none but when I called to update the vet at A&M about her starting to eat a little on her own more, she was concerned that she wasn't getting enough calories. Mika was supposed to be getting 160 daily for her recommended weight of 8 lbs. She was averaging 90-100 then which I was proud of considering how difficult it was to get her to eat on her own and to force feed her. The vet wanted to put in a feeding tube but wasn't sure Mika was strong enough to handle it (I also didn't have the money to afford it after her hospital stay and her very expensive recheck 3 days later). I continued to force feed her, giving her every food she would eat, trying my best to get her as close to 160 daily as we could. We had a vet visit to get the clavamox where the vet told us her numbers looked better and some were close to normal which we accredited to the denamarin, her bilirubin was still high at 12 (UM???) but this vet (the original vet I had taken Mika to when she got sick before A&M) really thought she would continue to trend downward. We went back after the clavamox was finished and he told us her numbers had gone up a little but not much (Come to find out recently by "a little" he meant ALT and ALP were in the 900s!!) but that her bilirubin was at 7 which was a good sign. He believed the "little" increase might have been because her UTI didn't clear up so we did another round of Clavamox. Eventually we got to a good point. Mika was eating her 160 calories all on her own. She started looking better, acting better and her jaundice seemed to be getting better. I brought Mika to a vet near my apartment up at school to get established before the school year started. Mika had some really itchy ears from an untreated yeast infection (which was diagnosed by the first vet but was put aside because of her other issues) but was acting really well. Her weight had dropped again which the vet said could be the difference of a bowel movement in her colon (it was a small drop from 5.75 to 5.68) and that we could look into steroids to make sure there wasn't inflammation that was causing her to not get all the nutrients she needed. IBD was brought up as something that could cause a cat to not gain weight. She commented on how pretty and soft Mika's coat was and how she was obviously fighting and trying hard to get better. She told me it was really impressive I got Mika eating on her own and acting this healthy without a feeding tube. We did blood work since it had been 3 weeks since her last check and I was fairly positive it would look much better. The results came back with some good news. ALT 453, AST 138 (normal is 100; I don't know levels for this before as it wasn't on any tests that I have or were shown before), GGT 28 (normal is around 10) and ALP 240. Her bilirubin was still at 7 but the vet said that she felt confident that she was obviously doing better. We just needed to worry about her weight now. She called A&M for their advise on the steroids and why they didn't prescribe them before. The vet at A&M was surprised to hear Mika was doing good (I was told they expected to her have died already which the vet there did tell me would happen if I didn't do a feeding tube) but believed that if she wasn't gaining weight and her numbers still being high that they recommended a liver biopsy (open surgery) so they could check for liver abnormalities. I asked if that meant cancer and my vet relayed to me that no, they wanted to check for "congenital or autoimmune abnormalities" in the liver and biliary system. She told me that the biopsy with the open surgery part made sense because she had seen it herself where aspirates of the liver weren't done in the area with abnormal cells and they came back totally normal. However, she didn't recommend it yet because the biopsy could tell us nothing or it could tell us just to keep her on the medication she's been on. The steroids were the route she was recommending and we could just go ahead and do the B-12 shots with it. I am back at my parents house now and Mika has started exhibiting symptoms of another UTI. Small pees, drinking water more often but she doesn't seem to be going to the litter box more. One of her symptoms before was yellow pee, bright yellow pee. That has returned too as it was gone for a while (almost 3 weeks). I am nervous. Mika has been throwing up for the past few nights/mornings. It seems to be her wet food rather than the dry kibble she has been eating. None of the wet foods have a common protein in that may be making her sick, either. She is still eating well but has been favoring her wet food less now that she has kibble she likes. I've been feeding her 1/4th a cup of kibble and Mika has been eating about 1/2 can of 5.5 oz wet foods from Halo. It's been hard to calculate her exact calorie intake but so far she hasn't slipped too much. She's still getting 160 or close to daily (lowest was 152). Her appetite for wet food is definitely going down. With her peeing yellow, I went and got new ursodiol from the first vet that saw her. I was worried that her liquid ursodiol wasn't working because it had been left out (my fault, for sure) for some time. The vet by my school assured me it should be fine but I would rather be safe than sorry. I had a huge upset with the first vets to see Mika and have decided I will NEVER be taking Mika back there again. The receptionist told me I could get her ursodiol no problem but when I showed up the vet insisted I do an examination plus blood work before I could get her ursodiol. I told them no, we weren't changing the dosage just the formula from liquid to pill. I didn't have the money to do a vet check, blood work and get the ursodiol either because of an issue with my bank. I told them that clearly the receptionist wasn't told I needed all of that otherwise she would have told me over the phone when I asked (she even had the bottle at the front ready for me when I walked in). I got lots of nasty looks and when the vet gave up they tried to UPCHARGE me for the ursodiol. I told them I was told a different number and a vet tech there confirmed I was told the right amount originally which is what I paid. I have called the vet up by my school and waiting for her to return my call. Mika still has a very full feeling belly despite throwing up. I'm wondering if that could be over eating? But I have been trying to weigh her regularly (not as accurate as it could be because it's me on a scale then me plus Mika on the scale and subtracting the difference). Yesterday her weight was 6.2 lbs. Today it's 5.2 lbs. I'm sick to my stomach. Mika is still acting okay. She's cuddling, she's climbing around and she's asking for pets. She wanted to go outside earlier but it's too hot right now. I will update once I get a call back from my vet.