Pippen's Liver

[furmonster mom]

*sigh* where to start....

sorry, this may be lengthy...

7 years ago, Pippen was on death's door because of some severe liver issues.  Short story:  His bile was flowing backwards, scarring up the liver and, on top of that, there was a really nasty bacteria taking advantage of the situation.  So his liver was basically being attacked on two fronts.  Of course we didn't find all this out until we were able to do a biopsy for a sample, so he also had a surgery to recover from.... Eventually, he did "recover", though he's been on liver support supplements ever since.

And here we go again....

Almost 2 weeks ago, we took Pip in because he was just not acting himself... off his appetite, sleeping by himself, y'know, just feeling "punk".  So the vet took some blood samples, and lo & behold his ALTs and ALPHOS had taken a dramatic jump, and he had a UTI.  So, we scheduled a laparoscopic biopsy to get a liver sample.

When we went in for the surgery, the vet took a blood pcv, where they discovered that his coagulant levels were a bit low.  So they gave him a vit. K shot, and we proceeded with the surgery.  The vet was apparently surprised at what she saw... his liver looked exactly as damaged as it had been 7 years ago.  Oy vey!   So, they got a sample, and we put Pip on antibiotics in anticipation of the nasty bacteria we expected to see again.

Sample came back... no bacteria.  But there was extensive scarring, inflammation, cellular desiccation and necrosis.  And all this IN SPITE of the fact that he's been on liver support (Marin, Adenosyl, Ursodiol) for the last 7 years!  Argh!

So, we go on a low dose of Prednisolone to try and chill down the immune system a bit and bring the inflammation down.

Skip ahead another week.

We go in for follow up.  Take some blood.  PCV count is very very low (16).  ***?  There is absolutely no reason, with a raw diet, for him to be anemic.  None.  Vet postulates that he may have a gallbladder blockage, which would explain a lot. 

So, she keeps him for a few more tests: blood cbc, ultrasound, and x-ray.

CBC comes back looking fine, even the ALTs are dropping (in spite of the surgery & stress).

Ultrasound shows everything looking normal.  There is no internal bleeding.

X-ray shows no blockages.

Basically, his immune system has gone haywire.  It is going to war, berserker style, on his liver and blood cells.

So, we are amping up the Pred, in the hopes of shutting down the immune system and giving it a "re-set".

This brings me (finally) to my conundrum.

Suppressed immune system & the raw diet.... waddo I do?

What do folks recommend for kitties with suppressed immune systems?

I've never really given probiotics, but I did stop at Petco and got these http://www.petco.com/product/120828/Nutri-Vet-Probiotics-Capsules-for-Dogs.aspx .  I know it's for dogs, but it was the only one on the shelves that listed actual bacteria in the formula.  I remember there was a conversation about various probiotics... but my brain is not cooperating and I'm not finding it.  Halp!

 

[vball91]

So sorry that you and Pip are going through this difficult time. My question would be what is the daily dosage of prednisolone? The dosage determines how much the immune system is compromised. I do know that other kitties on pred are fed raw. I also know of at least one kitty on chemo who was fed raw. I think a lot of it has to do with your comfort level and the risks vs. rewards of raw food. Not really a very definite answer, sorry.

For the probiotics, I would recommend the Nexabiotic 20 strain. It contains acidophilus & bifidus with their known benefits and also S. Boulardii for clostridium strains.

 

[ldg]

First of all, I'm so sorry! :heart2: Poor Pippen. :rub:

What's his dose of pred? Because 5mg (if he's 8 pounds or more) is an anti-inflammatory dose, but not technically an immune-supressive dose. 10mg would be an immune-suppressive dose.

Lazlo was on 5mg of pred for months... a year? following completion of his chemo. We did drop it to 2.5mg a day, but he's never had any raw food related issues (knock wood), not even while on chemo.

Of course, I have used a probiotic since two weeks or so before even starting raw. I clicked on the link: that probiotic only has 1 billion active CFU. I would (based on the recommendation of my holistic vet) switch probiotics so you can substantially up that dose. Most probiotics don't survive the trip through the gut, so it's better to start out with a higher dose. We were using 10 billion CFU of an acidophilus+bifidus human supplement (again, my vet recommends human supplements, because you can find higher quality; and most pet probiotics are made from fermentation product (dead cultures), though these have shown to be of benefit), but we recently switched because of two experiences with nasty bacteria (none in our kitties). But a TCS member found that a specific probiotic, S. boulardii, can TREAT clostridium strains; we had two rescue kittens where S. boulardii resolved their coccidia. Both of these (clostridium and coccidia) were treated only with the probiotics and without antibiotics.

FYI, L. acidophilus and Bifidobacterium have shown effectiveness against E. coli and Salmonella.

So this is the probiotic we're using, because it has acidophilus, bifidus, S. boulardii, and others.
The human dose recommendation is two capsules daily for a total of 30 billion CFU, of which S. boulardii is about 5 billion. S. boulardii is a yeast-based probiotic; it does not "populate" the gut the way traditional probiotics do, so it must be given 2x a day.

I don't know when you need to give Pippen the antibiotics, but the probiotic needs to be given at least 2 hours before or after the administration of the probiotics - but because of the acidophilus and other strains in it. Antibiotics do not kill S. boulardii.

Anyway, for an adult cat, when not treating clostridium or coccida, but using as a maintenance probiotic, the dose would be either 1/4 capsule 2x a day (for total 7.5 billion CFU) or 1/2 a capsule 2x a day (for total 15 billion CFU). How much is "right"? There's no real answer to that. I decided to use 1/2 a capsule daily.

 

[furmonster mom]

Ahh... Nexabiotic-20.  Thank you.  That's exactly what I was trying to remember.

I'm thinking of this as not only a support against the antibiotics he's on right now, but also to hopefully cover some of the work that the immune system would normally manage.  Also, I'm hoping that it will help with nutrient absorption to combat the anemia.  Waddya think? are my expectations too high?

For the first week, when we were just trying to calm the immune system down, the Pred was 1/2 a pill per day (2.5 mg).  Now we are on 2 pills (10 mg) once a day.  He is still getting the Marin, Adenosyl, and Ursodiol.  The goal is to "re-set" the immune system, then decrease again and maintain at 2.5 mg of Pred a day.

I'm just a bit stressed at this point.  Since we really don't know the cause of it this time around.  I'm racking my brains, trying to figure out what the heck could have set things off after 7 years.  

  It feels like we're just throwing spaghetti against the wall.  If it doesn't work...

 

[peaches08]

I don't have any advice, just wanted to send many good vibes your way!

 

[mrsgreenjeens]

I don't have any advice, just wanted to send many good vibes your way!

me too

 

[ldg]

Furmonster mom, are they sure the anemia is not due to any internal bleeding?

And I'm a little confused. He's anemic, and ... what's low? His platelets? Or proteins (coagulant factors) in his blood plasma? And there's no gall bladder blockage, correct?

When Lazlo was anemic, the holistic vet recommend a supplement, Yunnan Baiyao:
If there is no internal bleeding, do not give the "emergency tea pill" in the middle of the package. The dose is 1 pill every 2 days for three days, then 1 pill every 3rd day for three days. I assume you'll be checking back in on his PCV by then.

You can also feed him digestive enzymes. They work together with the probiotics to improve nutrient absorption. If he has ulcers, don't use them.

And you can feed him some extra liver, preferably beef if he likes it and you know he keeps it down. You can use the freeze dried treats.

 

[furmonster mom]

Initially, his coagulant levels (dunno the exact terminology) were low.  So he got a shot of vit. K before the surgery, and they sent us home with some as well.

They've actually checked for internal bleeding twice now, because the bruising from the surgery was really freaky bad, so I brought him in the day after.  They also gave us some Yunnan Baiyao at that time.

Hmmm... maybe a timeline would be better:

First visit:  Bloodwork shows high ALT/ALPOS & UTI.  Scheduled biopsy.

Second visit:  Biopsy day.  Bloodwork shows low coagulant levels.  Shot of vit. K.  Sent home with vit. K, Marin, Clindamycin, & Torb.

Third visit:  Day after Biopsy.  Freaked out over extensive bruising.  Checked for internal bleeding.  Quick bloodwork shows levels dropped 2 points.  Sent home with Yunnan Baiyao

Fourth visit:  Biopsy results.  No bacteria (but the anitbiotics still needed for UTI).  Extensive scarring, inflammation, dessication, and necrosis (worse than 7 years ago).  Sent home with Prednisolone with instructions for low dosage (2.5 mg/day).

Fifth visit:  Week after Biopsy.  Bloodwork (pvc) shows red blood cell count extremely low.  Theory that he may have blockage in gallbladder.  Checked for internal bleeding.  CBC, ultrasound, and x-rays clear gallbladder and bleeding.  Sent home with instructions for higher dose of Pred (10 mg/day) to suppress immune system.

That's pretty much the nitty gritty.

OH

On top of all this....

Babee (the dog) broke one of her front teeth.  So now we have a dental issue on our hands. 

 

[ldg]

Oh my goodness! to you and to Babee!

Well, as they prescribed the Yunnan Baiyao before, if it's not something you're doing now, perhaps ask the vet? Or just order it and use it the way we were told to in order to help Lazlo's anemia.

The probiotics will definitely not hurt, and may help on a number of fronts, especially on that dose of pred.

I am just so sorry to hear about Pippen's liver. What a mystery.

 

[katluver4life]

I don't have any advice, just wanted to send many good vibes your way!

Me too!! So sorry your going through this.

 

 

[mschauer]

This brings me (finally) to my conundrum.

Suppressed immune system & the raw diet.... waddo I do?

What do folks recommend for kitties with suppressed immune systems?

I've never really given probiotics, but I did stop at Petco and got these http://www.petco.com/product/120828/Nutri-Vet-Probiotics-Capsules-for-Dogs.aspx .  I know it's for dogs, but it was the only one on the shelves that listed actual bacteria in the formula.  I remember there was a conversation about various probiotics... but my brain is not cooperating and I'm not finding it.  Halp!

I believe this is the probiotic Laruie has been recommending:

Nexabiotic

Is your vet generally supportive of a raw diet? If so, has she expressed any concern about him eating a raw diet with his problems?

You could consider a home-cooked diet if you aren't comfortable with giving him a raw diet at this point.