Mitzi has fatty liver, what to expect?

[PushPurrCatPaws]

I’ve been reading through this thread (and one other thread of yours), and want to send along my wishes that I hope your kitty improves and starts to feel better!

I am not a vet and can only speak from my own experience with my current and previous cats, but my first thought regarding your story was, did the vet explain why the need for antibiotics in your kitty’s case? Does
your kitty have a bacterial infection? The reason I ask is many antibiotics can cause nausea and upset stomach during the time-frame that they are being administered. This could make your kitty feel like not being very active and could be a reason for any lethargy you might be seeing. It can take a day or two for this nausea to show up, and it looks like you’ve been given antibiotics for 14 days. So, I would just double check with the vet on clear reasons why this was prescribed.

I agree with others on abovementioned advice regarding fatty liver disease — many small meals and often,etc.

I also agree that one OTC option for upset tummy or apparent nausea might be to try Pepcid AC (make sure it is that form of pepcid: “Pepcid AC”) and you can first run that by the vet and ask the vet for specific dosing. Normally, the cat would only get a small portion of the 10 mg pill and it is not for me to say what dose your vet might recommend. But it works well, when given on an empty stomach (an hour before food or a few hours after food). My cat usually perks up about 40 minutes after her 1/4 tab of pepcid ac, and she eats a lot better. It is a temporary measure only for her, not given to her more than 1-3 days.

I know what it’s like, to miss an old vet, one you’ve had for your pets for years! It is hard.

 

[Maggsy]

Thanks, my vet said that she'd ring me yesterday to check on Mitzi's progress but alas, call never came so I now have to wait until Monday when I'll ring her myself
Yay! Mitzi did a normal poop overnight, first one since last Monday (she didn't poop at vets)
I wonder if the bit of air fried chicken breast, coated in a little olive oil helped, or maybe it was a coincidence but I'm very much relieved right now,
she's eating whatever I give her and I haven't given another mirtazapine yet, tried playing with her wand chaser but she's not interested atm, maybe it's too soon ...
I'll buy some Pepcid AC and SEB today to have on hand in future and I've ordered hairball paste too but I won't use any of these until I get the all clear from the vet..
I thank you all for your comments and advice, makes me feel not so alone

 

[FeebysOwner]

We can't be 'with' you, but on this site, you are never alone.

 

[Maggsy]

I went to clinic, my vet not in today but I got copy of bw and lab results, vet assistant could tell me reason for antibiotic but said maybe because of suspected pancreatitus ?

 

[Maggsy]

hope I've done this right LOL,

 

[Maggsy]

So, vet didn't gat back yo me so I rang and left messages a couple of times this week, she finally got back to me today, conversation didn't go well,
I told her that Mitzi is extremely lethargic and seems unwell even tho' she's eating okay, she just lays on my bed, doesn't want to move and seems stiff legged when she does walk, she seems constipated and has only pooped once in past 3 days, poop resembled rabbit pellets ...
Vet said that since she's not vomiting and is eating that she's not nauseated or in pain and she recommended another vet at the same practice if I wasn't happy with her treatment...
ended up with me being very upset and alluding that she has less empathy than a brick ...

I found another vet locally and will get more bloodwork in 2 weeks to see if Denamarin has changed anything,
Meanwhile first vet rang me back and said that I could pick up A cerenia tablet at the counter ($17for one pill ?) if i wanted it

 

[FeebysOwner]

I'm sorry - I didn't see your Friday post until just now.

I think you are right to find another vet, as it doesn't sound like this one is very good at communicating and it would appear that if you ask questions they must be taking that as some sort of affront. Get all of Mitzi's records/test results to share with the new vet. They are yours for free, you just have to ask for them. It is just too bad that is two weeks away. Perhaps, you should consider talking with another vet in their practice, just to reiterate your concern about Mitzi's lethargy. Maybe they can explain better to you what that is about. Also, ask about the pooping issue.

Mitzi is older, so being sedentary could be impacting her being stiff legged, especially if she has any arthritis.

Cerenia is for nausea and/or vomiting, so I am not sure since Mitzi is eating what value that has.

The fact that she is eating is good, but I don't know if some of the lethargy could be due to any of the meds she is on - it is possible.

ALT is the main value that is high, and that can relate to liver/biliary issues. But stands to reason that would likely be high from fatty liver disease.

 

[Maggsy]

thanks, the above diagnostics and notes are all that I have, maybe I'm being paranoid but Mitzi seemed better before she went in to vet for treatment, her only symptom was that she wasn't eating, I feel (maybe wrong) that the 200mg of antibiotics a a day for the week has contributed to her lethargy, I started her on Denamarin yesterday and am monitoring her closely, if only she'd do a decent poop, I'd be immensely relieved ( probably more so than she) lol

I did apologise when she rang me back, said that I was frustrated as I'd been given no follow up plan and no idea how to proceed or when to get her blood work checked again etc
I mentioned Ursodiol to her but she said it wasn't needed, seemed more interested in pushing RC Satiety products for her weight!

 

[FeebysOwner]

Some antibiotics might cause some lethargy, sleepiness. They can also cause some stomach discomfort too, but if Mitzi is eating, it doesn't seem like they are. But, I'd still think it might be worth it to ask one of the other vets if they would talk to you about it.

It might be OK to give her a bit of Miralax, but I'd ask one of the vets about that too, just in case. It does sound like she is getting constipated. Most folks start out with 1/8 tsp, mixed with some food once or twice a day, and wait to see if it makes any difference before giving any larger dose.

 

[Maggsy]

I believe we have Osmolax here which is same thing, I'll check and make sure I keep it handy for future use, I've just given her another strip of the malt paste, she laps it up willingly, hopefully it will take effect soon or i's back in the carrier bag for her

 

[FeralHearts]

Maggsy Sorry I'm late to the thread and I'm so glad to see you are getting such wonderful help here. I'm really sorry you are having to go through this with your baby.

I believe that she's been the only thing that's kept me going, if anything happens to her I reckon I'll just give up, what to do!!!

Firstly - never give up - never surrender. *HUGS* She wouldn't want that for you.

Denmarin is a liver supplement. You may want to ask your vet about this.

This for sure.

thanks, I'm reading thru' posts of others who have cats with similar problems and hoping that my Mitzi hasn't progressed too far along with this disease...

Each cat is different, and each situation unique. What you didn't know about in Bravehearts issues was she had another vet last year who was nowhere near as dillegant as her new one. I have little doubt in my mind that they failed her last year and that she probably was at the start of what ultimately transpired. It was either missed, brushed off because they thought I was being over cautious after what happened to her sisters (Mia, who passed), or I got her in right at the start of it and there wasn't enough evidence to support what I felt - so they decided she was fine.

In other words - don't lose hope.

One day at a time. One moment at a time. Cats are pretty good at doing that and we need to take a page from their book. Step, by little step.

I mentioned Denamarin but she said that there's no call for it at this stage,

I've ordered Denamarin

Good. My reaction to what your vet said was pretty close to a bad word that started with an F ...followed by the words..."your vet". Not a normal reaction I would have - but as you can imagine I'm a bit sensitive right now so my tongue is a bit loose. *yikes* and I personally had a bad reaction to hearing a vet say that. Sorry.

It has a wide margin for being safe. Just like anything else - don't go nuts. Use the proper amounts. (And ask questions about it to the new vet as well.... I'm not a vet.) I can only tell you what I've learned as a layman. So don't take what I say as gospel.

I feel that unless I'd mentioned Denamarin, she may not have mentioned it,

This is often the case. May times here I've been given things to ask about to the vet and it always shocked me to find out later that it should have been in their wheelhouse of knowledge. They are human though.

Even with the amazing vet I have now.. I have other sick cats, one will some issues that could benefit from Denamarin (Zentonil - same thing). When I mentioned giving that to him too, she said absolutely yes - and he has been on it since I learned about it with Braveheart. He's doing well with it. I wondered why we didn't think of it beforehand for him as well.)

This is so hard, vet said not to give Mitzi treats and to make sure that she eats every 4 hrs but the only way I can get her to take the antibiotics is to crush them (2 pills Amoxyclav 50, twice a day) mix them with a bit of a treat and flaked chicken breast and hand feed her, it's just too difficult trying to force dry pills down her throat, she just spits them out, I've got a pill popper but it greatly offends her and I don't want her any more stressed at this stage

she ate some chicken last night as well as a third of a can of pro plan beef& carrots ...
today she's had a tblsp of chicken and maybe same of Hills 11+ dry food,

Be relaxed to when you give these things. Remember they can feed off our energy. Breath in. Breath out. Breath in. Breath out.

If you can wait until she's resting you might be able to use the pill popper to quickly sneak it in before she knows what's up. That's what I do with my Charlie as he's a nightmare for a lot of things. Sneak attacks work great.

I'm so happy to read she's eating a bit. How is her drinking?

I'm also worried about possibly forcing water into her the wrong way and making her choke,
I'm such a coward, lol

LOL you aren't a coward. I know that fear. It's real. Take it all slow.

Hi. If she is lethargic, I would look for another vet. Preferably a cat only hospital if there is one near you.

Lethargy in a cat is concerning. But I think this vet won’t be much help.

You can ask the vet that your cats records and bloodwork be sent to you.

This too.

Having the full records, SOAP notes and test copies are valuable. Read them over well. Vets make mistakes, we make mistakes and sometimes they forget to tell you things, but have written them down - sometimes things get lost in translation / communication.

We can't be 'with' you, but on this site, you are never alone.

No. Never alone. . this place is a treasure of support and smarts.

has only pooped once in past 3 days, poop resembled rabbit pellets ...

I know people have said miralax, I use that on mine too... I'd also want to add a suggestion - but talk to a better vet first... Lactulose.

There is a downside here with that med though.

1. She needs to drink, mind you even on Miralax etc she needs to drink. (Drinking for constipation - just like people but especially with those meds)
2. It can impact potassium levels so those would have to be watched.

On the plus it helps the liver and helps with any ammonia build up in the blood if her liver is acting up.

ended up with me being very upset and alluding that she has less empathy than a brick ...

Good for you!!! (Though sorry you were upset) Sometimes people need a good smack to remind them to be a better human.

In fairness to the vet - they could be overworked. We have a shortage her of docs and even shorter for really good ones.

That being said... whatever the reason is for them being this way... I would third that a new vet is in order.

I found another vet locally and will get more bloodwork in 2 weeks to see if Denamarin has changed anything,
Meanwhile first vet rang me back and said that I could pick up A cerenia tablet at the counter ($17for one pill ?) if i wanted it

Yes, that stuff is expensive. Use it with care as it is processed through the liver but if she needs it, she needs it. I used that with BH as well.

------

I think you are doing exceptionally well here with the circumstances.

Be sure to breath, eat and drink water. Caretaking can exhaust you and remember you won't be any good to her if you get run down as well.

Slow, steady. One foot in front of the other.

You are doing an amazing job. I hope you know that.

I know how scary it is. Let the fear guide, and motivate you... don't let it take over. It's a friend when you harness it. It's an enemy if you let it make you panic.

Whenever you are overwhelmed. Sit. Take a few sips of water - and breathe slowly and deeply. One step in front of the other.

 

[stephanietx]

Sorry I'm late to the party. I've had 2 kitties with pancreatitis, one also had IBD. I cannot speak to fatty liver as I have no experience with that.

First, the most important thing is that she needs to eat. You can try plain meat baby food, no onions, garlic or binders. You can also boil some chicken add in some broth and puree it like baby food. Feed her what she will eat at this point. My vet says that if the pancreas isn't happy, nothing in the body will be happy, and that's what you're seeing.

Second, definitely seek the advise of another vet sooner rather than later. You could possibly ask for a consultation and take in the latest bloodwork and sit and talk with the vet to see what he/she would recommend that you've not already tried.

Here's a good article about pancreatitis and suggested treatment (US based) Pancreatitis in Cats

The most effective treatment for pancreatitis is steroids (prednisolone or budesonide), anti-nausea and anti-emetic. My kitty was on steroid, Zofran (Ondansetron), Fomatadine (plain Pepcid, not Pepcid AC), Cerenia as needed, baby gas drops (Simethicone), and we did B12 injections. He also suffered from diarrhea, so we gave him slipper elm bark syrup. (US measurements) Bring 1/2 Cup water to a roiling boil. Remove from heat and add 1 teaspoon of Slippery Elm Bark powder. Whisk until it's the consistency of a raw egg yolk. You can add 1/8 teaspoon to wet food twice a day. You can also syringe it into the side of the mouth or mix with baby food. Store in the fridge to up 7 days. You can purchase slippery elm bark at a health food store/apothecary. It's also available through the Amazon Australia website. https://amzn.asia/d/hDMDWMO

To give pills, try a pill wrap or pill masker. It's like a flavored treat and you wrap it around the pill. It's different than a pill pocket, but you could try those. Our kitties love cheese, so we also hide pills in cheese. Here's what we use. https://amzn.asia/d/bT20OGd

Ask the vet about B12 injections. That really helped my two.

Lastly, know that this is a very frustrating diagnosis to walk through. I really hate pancreatitis and IBD. It's a rollercoaster of emotions and good days/bad days. Be patient with yourself and with your kitty. Remember to breathe and love on your baby. It's also okay to cry because it can become overwhelming, especially when you don't think your kitty is improving or when they improve, but have a setback. Keep coming here and posting updates, asking questions, and getting support.

 

[stephanietx]

One other thing I wanted to mention is Mitzi's poop. Small pellets is usually a sign of hard stools or constipation. Some meds can cause that. If you think it's the medication, then you can try adding plain canned pureed pumpkin (no spices added) to wet food to help soften stools and keep things moving. Also, adding water to wet food will help.

 

[Maggsy]

Thanks to you all for your concern and advice, I'm taking it all on board,
I think the paste is working as she did a somewhat normal poop this am, YAY!
I've ordered milk thistle drops, they'll be here on Sunday, is it okay to give these while she's on Denamarin or should I wait,
I asked the vet and she said that while it may not do any good, it will do no harm
Why is everything so darned expensive!
Bless you all and thanks again

I think most of my problem is not knowing what it is, I have no idea what I'm dealing with and my resources are dwindling, I will do all in my power to keep her going but feel like I'm up against some invisible foe

 

[FeebysOwner]

I am glad Mitzi may be 'turning the corner' with her stool issues! I can't answer the question about using milk thistle and Denamarin together. They do have an overlapping ingredient - silybin. But, not sure that is a big issue, tbh. Here is an article about both, until others who have experience with this see your post and can respond.
Denamarin vs. Milk Thistle: 2024 Comparison and Key Differences (pawster.com)

 

[F+V]

No cat hospitals or specialists here, in fact most animal treatments need scripts and many which I see on Amazon.com can't be shipped here, it's very frustrating,
Xmas holidays will be here soon and I'm dreading another incident as local vets are mostly closed/limited hrs and the only emergency clinic is miles away, I'll ask for bw/records so that they can see her history if I do need to take her in
(I'm just afraid that this may happen again)
She ate 1/2 a can of FF this morning and a tbsp of dry, I feed her every 4/5 hrs

I really miss my old vet, known him for 35yrs and I trusted him with my pets, he retired and the old practice changed to a mini supermarket for animal accessories/feed etc, I know that all vets must be qualified but the new ppl didn't seem to have the same caring attitude ( maybe I'm just biased) anyhow, I moved away so not close now

I'm sorry that Mitzi is lethargic....
If you are in the greater sydney area or brisbane/sunshine coast area I can recommend a few vets... or is there a university that has a veterinary hospital attached to it, like the Uni of Sydney in your region? Regardless, you've already found another vet, so let's hope they are better than the previous one.

Denamarin and other supplements can also be purchased on Pets Megastore - Discount Medical Supplies for Pets
Denamarin and milk thistle can be given together, but because Denamarin already contains silybin - a component of milk thistle, you might want to monitor the dosage of milk thistle to avoid giving an excessive amount. It's probably safer to stick with Denamarin until you can get sound advice from a vet who knows the supplements or someone on here.

I found vets in Australia often prescribe antibiotics even when there's no confirmed presence of infections... the diarrhea is likely a side effect of Clavulox. Are you still giving famotidine (pepcid) and cerenia (maropitant)?

SAA in bloodwork is a biomarker for inflammation and tissue damage, so the next time you can ask for that to be included.

 

[Maggsy]

I'm sorry that Mitzi is lethargic....
If you are in the greater sydney area or brisbane/sunshine coast area I can recommend a few vets... or is there a university that has a veterinary hospital attached to it, like the Uni of Sydney in your region? Regardless, you've already found another vet, so let's hope they are better than the previous one.

Denamarin and other supplements can also be purchased on Pets Megastore - Discount Medical Supplies for Pets
Denamarin and milk thistle can be given together, but because Denamarin already contains silybin - a component of milk thistle, you might want to monitor the dosage of milk thistle to avoid giving an excessive amount. It's probably safer to stick with Denamarin until you can get sound advice from a vet who knows the supplements or someone on here.

I found vets in Australia often prescribe antibiotics even when there's no confirmed presence of infections... the diarrhea is likely a side effect of Clavulox. Are you still giving famotidine (pepcid) and cerenia (maropitant)?

SAA in bloodwork is a biomarker for inflammation and tissue damage, so the next time you can ask for that to be included.

Thanks F+V, I'm in Adelaide and thanks also for link to Pet Megastore, that is the cheapest I've ever seen for Denamarin, my recent purchase was a bargain from Petchemist.au @ $67, this is $10 cheaper so I just ordered another month supply, not sure how long she needs to take it but I'm guessing it will be at least a couple of months, the milk thistle is a back up if I need it, rather have it on hand and not need it than be without ...
I also bought Forti flora to add to her food, she doesn't seem to mind it ...
She hasn't had diarrhea, she was constipated but went this am so I'm hoping she's turned a corner, also seems a bit brighter today, actually came looking for me for her brekky, fingers crossed.
I'll be taking her for check up in the coming weeks ( unless anything untoward happens) so just taking it day by day for now

She hasn't had any cerenia, vet said she didn't need it and antibiotic was given 'just in case' there was infection which they couldn't see,

 

[FeralHearts]

I think the paste is working as she did a somewhat normal poop this am, YAY!

I bet you've never been so happy to see a cat poop in your life! I know - I feel the same way when one of mine is having issues and then there is poop and I run around like a happy crazy person.

Why is everything so darned expensive!

I know how you feel. *hugs*

I think most of my problem is not knowing what it is, I have no idea what I'm dealing with and my resources are dwindling, I will do all in my power to keep her going but feel like I'm up against some invisible foe

*hugs* I know this one too. It's especially hard when the enemy has no name but illness. Stay the course - you are doing well.

I found vets in Australia often prescribe antibiotics even when there's no confirmed presence of infections... the diarrhea is likely a side effect of Clavulox. Are you still giving famotidine (pepcid) and cerenia (maropitant)?

I can kind of answer that. They did that both with Mia and Braveheart. They started them before the Culture and sensitivity came back.Sometimes it's to get ahead of it just-in-case, especially if they are unsure. Mia's leg for example was hot hot hot and they were sure there was an infection. They started her on antibiotics - there was no infection. With Braveheart, since no one could definitely tell they did the same and they kept her on it. There was a reason - I've honestly forgotten. I'll ask when WL goes for her check up on Monday.

For pancreatitis - that is one of the go-tos for that illness.

She hasn't had diarrhea, she was constipated but went this am so I'm hoping she's turned a corner, also seems a bit brighter today, actually came looking for me for her brekky, fingers crossed.

YAY!!!!!!!! I'm glad she seems brighter today. Slow and steady. You have a lot going on and a lot of information flying at you too. Take some time out for yourself to recharge as well.

I'll be taking her for check up in the coming weeks ( unless anything untoward happens) so just taking it day by day for now

Nothing untoward will happen. We aren't giving the universe any ideas.

Exactly - day by day. Step by step. I imagine you feel quite overwhelmed right now as well as worried.
Sit.Water.Breath... and eat and sleep.

You already know to love on kitty... don't forget you as well. XO

 

[Maggsy]

I am glad Mitzi may be 'turning the corner' with her stool issues! I can't answer the question about using milk thistle and Denamarin together. They do have an overlapping ingredient - silybin. But, not sure that is a big issue, tbh. Here is an article about both, until others who have experience with this see your post and can respond.
Denamarin vs. Milk Thistle: 2024 Comparison and Key Differences (pawster.com)

Thanks, the milk thistle is back up in case I need it, that must be a US site as we don't need script for denamarin here and price I'm assuming is $US? wish it were that cheap here,
Mitz seems a tad more alert today, will be her 3rd dose today

 

[F+V]

Thanks F+V, I'm in Adelaide and thanks also for link to Pet Megastore, that is the cheapest I've ever seen for Denamarin, my recent purchase was a bargain from Petchemist.au @ $67, this is $10 cheaper so I just ordered another month supply, not sure how long she needs to take it but I'm guessing it will be at least a couple of months, the milk thistle is a back up if I need it, rather have it on hand and not need it than be without ...
I also bought Forti flora to add to her food, she doesn't seem to mind it ...
She hasn't had diarrhea, she was constipated but went this am so I'm hoping she's turned a corner, also seems a bit brighter today, actually came looking for me for her brekky, fingers crossed.
I'll be taking her for check up in the coming weeks ( unless anything untoward happens) so just taking it day by day for now

She hasn't had any cerenia, vet said she didn't need it and antibiotic was given 'just in case' there was infection which they couldn't see,

I can't answer how long she needs to be on it, but it's safe for the long-term use. My boy had gastroenteritis in late July and I still don't know how that happened, and his ALT and SAA were elevated at 133 IU/L and at 23.3 mcg/mL, respectively. They dropped to 91 and 3 a month later, and even though ALT of 91 is still higher than the reference range of 22 to 84 his vet said it was fine. It was not fine by me, because he always had ALT of around 64, so I started giving him and his sister Denamarin and they've been taking it for a month now. Will do another bloodwork in a few weeks as well.

I'm not sure if it's close to you but there is Uni of Adelaide veterinary hospital Roseworthy Veterinary Hospital for when you need a specialist.

As for probiotics, Forti Flora doesn't really do much, but if it entices Mitzi to eat food, why not.
You need multi-strain probiotics, ideally ones that are known to be effective in cats such as pediococcus acidilactici, lactobacillus gasseri, saccharomyces boulardii, lactobacillus reuteri, and there may be others.

Fingers crossed indeed! Hope you won't have to worry about taking her to the vet over the weekend.