My kitty has hepatic lipidosis...

[-Cory-]

Hi everyone. This is my first post on this site, which is such a shame because it looks like a place I would enjoy posting on in other circumstances. My 6 year old kitty, Pudge, has been diagnosed with HL and I suppose I am just looking for some insight as to what others have experienced during recovery. I'll lay out a brief timeline of events below.

Day 1 (Monday): Noticed Pudge quit eating. I had been gone over the weekend, so it's possible she quit Saturday or Sunday and I was not aware.
Day 2 (Tuesday): Pudge still refused to eat. I got her in to see her primary vet. He took x-rays, did some bloodwork, and gave her fluids with B12. Bloodwork only showed elevated WBC and he prescribed an antibiotic to fight a minor infection.
Day 4 (Thursday): Pudge still not eating. Called vet again and he gave her a Cerenia shot and I began syringe feeding her.
Day 5 (Friday): Pudge still not eating. Vet recommended I take her to emergency clinic. She was admitted and they did more bloodwork, including a pancreatitis test and an ultrasound. Nothing out of the ordinary and liver still looked fine. It was noted that she had a wound on her back, possibly from a fight with my other cat. They gave her fluids, B12, an antibiotic, nausea meds, and an appetite stimulant. After the diagnostics, they recommended I transfer her to another emergency clinic near a larger city that had an internal medicine specialist on staff that might be able to help us more.
Day 6 (Saturday): Pudge was moved to 2nd emergency clinic. They checked her bloodwork and continued the medication protocol from the 1st emergency clinic. Liver still seemed fine according to blood work.
Day 7 (Sunday): Pudge started eating for them and they suggested I take her home and see how she does. This happened before I could have the consult with the internist.
Day 8 (Monday again): Pudge did not eat for me, other than some treats and a few bites of canned chicken.
Day 9 (Tuesday again): Pudge showed the same eating habits as the previous day. I was starting to get very concerned about HL at this point and took her back to the 1st emergency clinic. They gave me A/D food and some cerenia and mirtazapine to take home, but said I need to go see the internist.
Day 10 (Wednesday): I took Pudge back to the 2nd emergency clinic. They checked her blood and she had an ultrasound performed by the internist. No indication of pancreatitis, lymphoma, or IBD. Her liver was showing up bright on the ultrasound and her levels were elevated in the bloodwork. Decision was made to have an esophageal feeding tube put in.
Day 11 (yesterday): Started first day of tube feeding. Pudge seemed in reasonably good spirits. Tube feeding went well and she had no issues with it. 25 ml of half A/D and half water, 4 times over the course of the day.
Day 12 (today): Pudge is much more lethargic today. She also appears to have some diarrhea and a respiratory infection. 40 ml of the slurry, 4 times today.

Tomorrow and Sunday will be 50 ml, 4 times a day. Monday will be the final build up to 105 ml, 3 times a day until she gets better. I have some oral cerenia and mirtazapine left from the vet and they instructed me to crush it and give it to her in her feeding tube. I might ask about switching to zofran.

So. I am so worried. The last 12 days have been so stressful and overwhelming. I am struggling emotionally because she seems a little worse today, although I am trying to stay logical in that I'm sure she feels terrible and the respiratory infection is not helping matters. I know I stressed her out some too because I had to wash her off in the sink. I think she had an accident while she was sleeping today and I didn't want her to continue sleeping with feces all over herself. I guess I'm just looking for some reassurance. Can anyone provide some of their own experiences with this? I'm really trying to feel hopeful here, but the last few days have been so overwhelming. She does not appear to be jaundiced, which I'm taking as a good sign. Her liver seemed fine on Day 7 and was not on Day 10, so I'm hoping we started treatment quick enough before things got too bad. Yesterday she showed some interest in food, which I took as a positive. Today, not so much but she seems to be feeling a little worse today. The emergency vet told me to follow up with my primary vet as soon as I can, which will be on Tuesday. I'm really hoping she improves a little in the next few days. I don't want to drag her back to one of the emergency clinics because that would be so stressful to her and the stress won't help her.

I've got a few questions that I'm hoping people might be able to answer.

1. Are there any liver supplements I should talk to my primary vet about? I don't know what her level of experience with HL is and I want to be the best advocate for my kitty that I can be.
2. I know diarrhea can be a symptom of HL (although it's also possible she's struggling because of the antibiotics). How long did the diarrhea take to resolve? I will clean it up for her willingly, but I am definitely looking forward to not having to.
3. Did your kitties experience some daily ups and downs? I know we're really early into the treatment, but it's hard not to feel discouraged when she seems so much more lethargic than she was yesterday. I know she's probably coming down from all the stress (a minor surgical procedure, being sick in general, going to the vet about 5 times in the last two weeks, getting checked in for an overnight stay at the emergency clinic on two separate occasions, etc.) and that lethargy is probably to be expected with this condition. I have also read that they can get a little worse before they start to get better.
4. Any advice beyond "stay the course"? I've read a few other threads on this forum about this condition and that is the most common thing. Just keep feeding her and being patient. Anything else I can do to help her?

I appreciate anyone who reads and responds, even if it's just with encouragement rather than actual advice.

 

[daftcat75]

Good work on the feeding tube. That will definitely help as most cats will resist syringe feedings by mouth making it very difficult to get enough calories into them. If you haven't already, I suggest looking into a Kitty Kollar to make the stoma site cleanings/wound dressing a lot easier.

Kitty Kollar - Special Hugs for special kitties & kanines

I don't have any experience with HL. Sorry.

My Krista did have a liver infection/inflammation. But she recovered quite quickly with a very expensive hospital stay on IV fluids.

Let's see if I can answer some of those...

1. Liver supplements take a number of weeks to "kick in". Denimarin is the one vets will recommend. But it's a horse pill and can't be broken up. Milk thistle is another liver support supplement. I know this comes in a powder so you can likely mix that into her food slurry. Apparently, you can also get it in a liquid. But I would ask your vet about this before adding it to her protocol.
2. The diarrhea is almost certainly a combination of the antibiotics and having her stomach/gut empty for a number of days. You can try sacchromyces boulardii for stabilizing her gut. But it's not likely to fully clear up until she's done with the antibiotics. The Jarrow brand of s. boulardii is the gold standard as it has MOS, a pre-biotic. You can also ask your vet about Proviable, a vet-strength probiotic. But probiotics may not work as long as you're giving antibiotics.
3. Krista didn't have HL. Despite getting a feeding tube inserted, by the time she came home, she was eating by mouth again. I kept the tube in for insurance (didn't want to repeat that procedure if she stopped eating) and medicine. She yanked it out herself after a month. Sorta. She went in to have it adjusted because a suture came loose. The vet had the tube in her hand and a needle in the other hand and Krista yanked away leaving the vet holding the tube minus the cat. I wish I saw that. But she was no worse for the wear and I wasn't going to put her through another intubation when she was eating by mouth just fine.
4. I know one of the staff/moderators on this site has experience with HL. I believe she had said it can take a number of weeks to get back to good.

Cats are tough. I have confidence that Pudge is in good hands and will pull through. But do keep an open dialogue with your vet. You may even suggest a medication holiday to see if the meds cocktail is making her lethargic. But that also could be the infection or the HL itself. It is confusing, frustrating, and worrying when your cat is on so many meds, she's not feeling well, and she can't tell you what she's feeling.

One suggestion I have which you should run past your vet first (don't change the course solely on the advice of an internet stranger!), some cats are anorexic (lose their appetite) on Cerenia. Yeah. Crazy! A drug that's supposed to help with nausea can suppress their appetite rendering it moot. Since you now have control over when she eats and how much, ask your vet if you can try a cerenia break to see if her appetite returns. Though her appetite may also be suppressed by the antibiotic. You may also ask about Zofran. I don't have experience or input on Zofran other than it is an alternative to Cerenia.

If the diarrhea doesn't clear up soon, ask your vet if she should come back in for fluids since diarrhea is dehydrating.

 

[eva21513]

I can't answer really any of your questions, but I do have some thoughts.
First of all, in the event that Pudge has another accident, you might think about getting some cat wipes - there's lots of brands and varieties (you'd probably be best served by one intended for grooming), and they're available at Petco, Petsmart, etc. That way you can avoid the stress of the sink-bath.
What antibiotic did they give her? Many, maybe even most/all antibiotics, cause lethargy and diarrhea. My Millie just had a course of Convenia and her personality changed so much during that time that I honestly feared I was going to lose her. She went from playing 2+ hours per day, following me around the house, chatting to me all day even when resting, even with a URI and fever!, to just laying in one or two spots. Truly. All day, aside from eating maybe 1/4th of her normal amount. She completely stopped purring and grooming herself too - again, things she had still been doing even while sick. Antibiotics can really take a lot out of our babies.
With regard to diarrhea, you might ask either your vet, or the on-call vet, or the emergency vet, or the on-call at the emergency vet, whether you can give Pudge some probiotics. I wound up giving Millie Dr. Mercola probiotics to help with the antibiotic-induced diarrhea. You can get them from Chewy or Amazon if you can't find them locally. I had to wait for those to arrive, so in the interim, I found that lots of owners of cats with IBD use Florastor, which is a human probiotic. I just opened up the capsule and measured out a cat-appropriate amount, and mixed with Millie's food. You just don't want to give the capsule, no matter what. Obviously ask one of the vets you've seen recently for their advice about the probiotics, though, just in case. Don't feel bad about leaving a message for the on-call - you've spent PLENTY of money there lately and, regardless, they want to help you and Pudge! And certainly ask about switching to Zofran. Millie does not do well on Cerenia - it's totally 'a thing.'
Little things that might help:
- Play some cat music for her! (And for yourself.. it's actually really soothing, and she'll notice that you feel more relaxed, even if she's too tired and overwhelmed to respond.)
- Get a humidifier going for her respiratory infection - it really helps so much. Also see if you can get her to sit in a steamy bathroom with you for 5-10 minutes twice a day.
Big, big hugs to you and scritches to Pudge. You're doing so great and I know she appreciates and loves and adores you and she is so lucky to have you for an owner!

 

[daftcat75]

Forgot to post the link to the s. boulardii:
https://www.amazon.com/dp/B07NW49TC7/?tag=thecatsite

And a discussion of how it works, how much to give, and how often:
https://www.foodfurlife.com/my-cat-has-diarrhea---what-do-i-do.html#/

Here's a link to the Proviable:
Nutramax Proviable - Free shipping | Chewy

Your vet probably also has this or can recommend which one to order.

 

[daftcat75]

I second the suggestion for cat music. Or rather Music For Cats. Cat researched. Cat approved. You can find it on all the major music streaming services (Apple, Spotify, Amazon, probably Google Play too.)
Home | Music for Cats | David Teie

 

[sstrat23]

I have some insight having personally dealt with HL with one of my exes cats, TJ.
First thing is consistency is absolutely key here. You will not see too much improvement until a full week, week and a half of feeding. Even then, she won’t be 100%. Keep in mind she’ll be lethargic during this process because she doesn’t have a lot of energy. Combo of the food slurry and rest is exactly what she needs. I fully understand being concerned and wanting her back to normal as you feel for her state, but this will take time. TJ definitely had ups and downs. One day he’d be interested, the other he’d sleep away the day and not move around especially in that first 2 weeks.
TJ had experienced a bout of diarrhea that was caused by the antibiotics and his body readjusting to a new food and getting adequate amounts again which lasted about 3-4 days, so I would research symptoms and consult with your vet regarding the anti-biotic. You can call them and they will let you know whether you need to come in. Good news is the slurry will keep her mostly hydrated. TJ did not drink a whole lot during the process. Keep in mind, if you are concerned with hydration you can also feed her water through the tube- but don’t over do it.

I definitely would not add anything to supplement. Her liver still processes those supplements and I would not add any stress to her liver unless your doctor suggests it.
My best advice is to stay calm as the cat can sense your mood and anxiousness. Reassure her and be patient during the feed process. I developed a very strong bond with TJ during this time as I was the one that did all of the feedings as my ex was too scared she’d hurt him. So about a week or so you should see some energy levels return and in TJ’s case it was a battle to keep him to stay still! But calming music, talk to her, and reassure her. Keep her environment stress free.
I can say the road to recovery can take a bit. I think TJ had his tube in for 1.5 months. The doctor told me it depended and sometimes they’ve seen even longer paths of having the tube in upwards to 3-months as the cat would still not eat on their own, but was recovering still. They kept it in even when he began to eat his kibble just to be sure he didn’t have a relapse.

I know this is just another stay the course post, but they are right. Trust in the process and understand you are going to judge progress by weeks, not days.



Wishing for a quick recovery!!

 

[-Cory-]

Thank you for everyone who has posted. I don't have a humidifier, but I do have a clothes steamer. I put that on when I gave her the last feeding of the day and she is definitely less wheezy. I'll probably start doing it every feeding until the URI has cleared up. Got some feliway refills as well and have been streaming some cat music for her and she does seem more relaxed, even if she is still just sleeping. Also, THANK YOU for telling me about pet wipes. I didn't know these were a thing. She's not 100% clean, but definitely better. I feel like I'm walking the line between trying to provide the absolute best care, but also not pester her too much so she can rest.

Thank you to everyone who has responded so far. The last 12 days has been so difficult. Lots of anxiety and ugly crying. I'll try to update periodically (and possibly participate on other parts of this site).

 

[-Cory-]

Update on Pudge. She does seem a little better today. Definitely still weak and lethargic, but she did get up when I came in her room and seemed happy to see me. That didn't happen at all yesterday, even if she did lay backdown and go to sleep pretty quickly. She is still having some diarrhea, but made it to the litter box in the night. Those two things in and of themselves have definitely improved my outlook this morning. She was also willing to eat a couple of cat treats.

 

[di and bob]

Go to Walmart, Target, or a dollar General and get some Hartz Delectable Lickables in the stew, in the treat section. I don't know what they have but when my cats stop eating completely, they still manage to lick up some of this. It's worth a try. the liver is one organ that can heal itself over time, so hang in there and pray. There are still miracles out there you know! I'll pray for your little girl too.....

 

[-Cory-]

Got another question. We just got through the third feeding of day 3 and she vomited it up as soon as we finished. I warmed the food and I don't think I was going too fast. Is this an expected part of the process? My discharge instructions say to skip the next feeding if she vomits and that makes me so anxious since the best way to fix this is food.

 

[sstrat23]

Couple of things could be the issue.
She does have anti-nausea medication, correct?

With TJ I gave him 5ml every 3-5 minutes. Upped it to about 10ml every 3-5 when he began to get higher amounts.

He did vomit a couple of times. Feed her slowly and watch her mouth. If she starts smacking her lips or licking a lot, then stop. If it persists I would call your vet.

So a single feeding could last 20-30 minutes. That was described to me by my hospitals vet. So if your feeding a are much quicker slow down. If you think she may have vomited due to rushing the feed, go ahead and try again on her next scheduled feeding. If it happens again, call your doctor. Also make sure the slurry isn’t too thin. Could be too much water making her feel overly full and it’s much easier to come up.

 

[Mamanyt1953]

. I don't have a humidifier, but I do have a clothes steamer.

Re the steaming for snuffly noses...a few minutes in the bathroom with you, shower running on hot, will do the trick as well. Works a treat on cats, dogs, rats and humans! Would probably work as well on snuffly horses, but I don't have a bathroom that big!

This is doable. Hekitty had HP many years ago following pancreatitis, when I didn't know diddly about HP. I'd have intervened much sooner, had I been aware! However, after a couple of fraught weeks, she was back to normal, and never had a problem with either the pancreatitis or HP again.

 

[-Cory-]

It could have been too fast then. My discharge instructions said 10-15 minutes, but I think that was too fast for her. I gave the vet a call and they said to try slowing it way down and see how she does and to call them back if she still has problems in the morning. We just ran out of the anti-nausea meds. They gave me 3 days worth of the anti-nausea with instructions to transfer maintenance to my primary vet as soon as I can. I have an appointment with them on Tuesday, but I pretty much have to rely on the emergency clinic until then.

I appreciate the encouragement. I'm sure things will even out, but this felt like a huge setback.

 

[sstrat23]

I understand. And sometimes they prescribed more for the anti-nausea. I had 5-days to cover the initial week. Your vet may prescribed just a bit more, but the reason they don’t do a lot is sometimes it keeps their appetite down and discourages eating on their own. Of course she is being fed via tube. I’m sure she’ll be fine. Spread it out to 20-30 minutes- more if needed. I timed feedings on a Netflix or tv show. If she begins licking her slips stop- give it 5 minutes and then continue and feel her out.

I understand the anxiousness, but I feel like you are doing everything you should and that’s what she needs. Give lots of encouragement and love and I’m sure she’ll come out of this stronger than ever and she’ll appreciate you so much.

Do not look at it as a set-back. It’s a learning lesson and you are feeling our her current limitations and finding where she is comfortable.

Give us plenty of updates and we’ll try and get you through this tough time. Nothing you are experiencing is far off what I experienced TJ.

 

[sstrat23]

Lordy. Wrote this on my phone and discovered multiple typos. Apologies, but nonetheless keep at it! Consistency is key here.

 

[-Cory-]

Thank you, sstrat. After some time, I'm feeling a lot more philosophical about it. This one failed feeding isn't make or break and I learned something. She also decided to come out of the spare room tonight. I've been keeping her shut in there (with frequent visits from me) to keep her separate from my other one for now. She has generally wanted to stay in there and sleep. Tonight she came out and got in her cat tree for a little while and fell asleep in her normal chair in the living room. That feels good.

 

[sstrat23]

Signs of usual behavior is always a good thing. Keep us posted! I’m confident you’ll both get through this just fine.

 

[-Cory-]

Update on Pudge. We ran out of the cerenia on Friday night. I called the vet this morning and they got me a Zofran prescription after I explained that the only time she voluntarily ate was on the Zofran they gave her last Sunday. She did vomit some when I tried to give her the Zofran and I noticed some of the water was coming back through the tube, although I think she got most of the medication. The vet asked we come back to verify that the tube was still in the right spot. Good news is, the tube was fine. They think it was a combo of not being on any nausea meds since Friday and me not heating up the food quite enough. They also injected a little more cerenia while she was there and fed her through the tube with no problems. I got her back home and she clearly feels SO MUCH better. She actually ate a few bites of kibble on her own. I think maybe the Zofran is what we needed, or the Zofran/cerenia combo. I'll keep an eye on her until my primary appointment on Tuesday and I should have a better idea if the Zofran alone is good or if the combo is better. I know those meds perform similar, but separate, functions.

Just realized I haven't posted a pic of her. This is her from back in October. She's kind of a ham.

 

[di and bob]

I'm so happy she feels better. What a beautiful little girl!

 

[-Cory-]

Update for this morning. She definitely still seems to be feeling better, although when I checked on her this morning I found she did vomit at some point in the night. It would have been well after her last feeding, which was around 8:00. I checked on her at 12:30 before I went to bed and she had not vomited at that point. I can't tell how much of it I think she lost vs kept. This tells me that her nausea is probably not under control yet. I feel like if it had been an issue in my methodology, she would have vomited during or shortly after the feeding. Frustrating, but I feel like this is probably a typical bump in the road for this kind of recovery. I'm going to proceed with feeding her as planned today, but keep be very vigilant for any signs of nausea. Her primary vet visit is tomorrow and maybe with consistent care from the right person we can dial in on what works for her.