got an email from my vet and he said go ahead and give pred so i did..2.5 mg tonite after dinner.
Hes just not feeling good. lethargic. still.
i know hes a bit anemic and my vet suggested hormone therapy if it doesnt improve.his k was ok last time, still a bit low i think.
so i hope this will help him. i found all this out on a routine blood for teeth cleaning and then the cholangiohep came..so i see his teeth are still bothering when he eats..he chews funny..only wet food. before the sickness he ate dry also, no problem. i read the pred will help with his gums, they are swollen also.my vet said he is not a candidate for cleaning right now.
he comes out in sun in day but in night is under my bed. at least in nyc he sat on couch with me so i dont know whats up.
his blood work is next monday to see how the tbilli is and liver..i will do cbc also for the anemia..
any advice would love some. thanks
Cat liver issues
Re: Cat liver issues
What exactly is your vet referring to when he mentions hormone therapy? Please be specific. I doubt this treatment would be necessary, let alone appropriate for the condition. But, if you can tell me what the vet is referring to, ....
Why are Benny's gums inflammed, and is there anything else going on with his oral health? Diseased teeth? Gingivitis? Stomatitis? If he is having oral pain, perhaps a short course of veterinary prescribed pain medication could help, but vet has to choose one most appropriate to use when prednisone is used. The pred may be all that is necessary, but if there is truly a diseased tooth or oral abcess or ulcers, then pain meds should be approached (low dose). Oral pain in cats will prevent them from eating sufficiently.
When you say the biopsy showed no infection, did the vet do a culture and sensitivity test on the sample? Did they feel there may be intestinal bacteria? I ask, because many times in these cases, there is in fact bacteria or an overgrowth of bacteria going on and at least amoxicillin and/or clavamox should be discussed. Sometimes, when there is bacterial overgrowth, antibiotics like amoxicillin may be necessary for a few weeks. I realize I advised you to ask the vet to take a break from his previous antibiotics, but he was on Baytril, and without a culture and sensitivity to at least rule out other bacteria in other locations, this treatment might be getting overlooked. Please just ask him about this.
If this is Benny's first episode with a liver problem, it's quite possible this was an acute episode at first, which could then lead to a chronic state. The acute phase requires very agressive treatment (with several of the meds I've previously mentioned), and sometimes it requires lengthy treatment (especially if there is bacteria, and also if there is a bile duct obstruction, gall bladder problems or biliary tract disease). If certain meds are stopped too soon, the condition can wax and wane and not truly resolve as it should in a timely manner. Right now, you've only got him on ursodial and denamarin with the new addition of prednisone. He may also need sub-q fluids (ask the vet), antibiotics, possibly an oral vitamin solution (prescribed by your vet, but probably wait for next labs to determine for certain), and possibly low-dose oral pain medications if vet feels he has abdominal pain, bacterial infection, or diseased teeth. Please remember, pain can cause the "tiredness" and lethargy. As can bacterial infection. Even though a bacterial infection may not have shown up previously, it's always possible a secondary bacterial infection could develop.
When was Benny's temperature last checked?
Is he still eating Fancy Feast, and is he keeping it down? (not vomiting). Remember, he could be dehydrated (which can also cause lethargy), so remember to ask the vet about potential sub-q fluid therapy.
Why are Benny's gums inflammed, and is there anything else going on with his oral health? Diseased teeth? Gingivitis? Stomatitis? If he is having oral pain, perhaps a short course of veterinary prescribed pain medication could help, but vet has to choose one most appropriate to use when prednisone is used. The pred may be all that is necessary, but if there is truly a diseased tooth or oral abcess or ulcers, then pain meds should be approached (low dose). Oral pain in cats will prevent them from eating sufficiently.
When you say the biopsy showed no infection, did the vet do a culture and sensitivity test on the sample? Did they feel there may be intestinal bacteria? I ask, because many times in these cases, there is in fact bacteria or an overgrowth of bacteria going on and at least amoxicillin and/or clavamox should be discussed. Sometimes, when there is bacterial overgrowth, antibiotics like amoxicillin may be necessary for a few weeks. I realize I advised you to ask the vet to take a break from his previous antibiotics, but he was on Baytril, and without a culture and sensitivity to at least rule out other bacteria in other locations, this treatment might be getting overlooked. Please just ask him about this.
If this is Benny's first episode with a liver problem, it's quite possible this was an acute episode at first, which could then lead to a chronic state. The acute phase requires very agressive treatment (with several of the meds I've previously mentioned), and sometimes it requires lengthy treatment (especially if there is bacteria, and also if there is a bile duct obstruction, gall bladder problems or biliary tract disease). If certain meds are stopped too soon, the condition can wax and wane and not truly resolve as it should in a timely manner. Right now, you've only got him on ursodial and denamarin with the new addition of prednisone. He may also need sub-q fluids (ask the vet), antibiotics, possibly an oral vitamin solution (prescribed by your vet, but probably wait for next labs to determine for certain), and possibly low-dose oral pain medications if vet feels he has abdominal pain, bacterial infection, or diseased teeth. Please remember, pain can cause the "tiredness" and lethargy. As can bacterial infection. Even though a bacterial infection may not have shown up previously, it's always possible a secondary bacterial infection could develop.
When was Benny's temperature last checked?
Is he still eating Fancy Feast, and is he keeping it down? (not vomiting). Remember, he could be dehydrated (which can also cause lethargy), so remember to ask the vet about potential sub-q fluid therapy.
..........Traci
-
christymexico
- Posts: 97
- Joined: Mon Feb 27, 2012 1:21 am
- Location: mexico
Re: Cat liver issues
he only mentioned hormone therapy if anemia is not resolved did not go into specifics yet.
His oral health is bad. tht is the reason i did blood work in august before a cleaning and the liver enzyme was high. his teeth are in bad shape and in need of cleaning gums are red and plaque gingivitis is++
the two needle biospy specimans. there are dense aggregates of lymphocytes and plasma cells in the portal tract refion associated wih portal fibrosis and bile ductular proliferation. brging fibrosis is also seen. lesssr number of neutrophils are soon. the inflamatory reaction and fibrosis encroaches on the limiting plate with degeneration of the adjacent hepatocyes. microorganisns are not seen
severe chronic activ lymphoplasmatic cholangiohep is diagnosis.
he has never had liver problems and since last night has eaten alot and driken more water. he has been out of house more and walked in garden since I gave first dose of pred.
Throughout this all he has never vomited . I overfed him my first force feed and he threw that up.
i will ask about secondary infection by email to vet
we are alone without vet care here in mexico
the dr comes next monday for blood work to be sent to mexico city by air.
His oral health is bad. tht is the reason i did blood work in august before a cleaning and the liver enzyme was high. his teeth are in bad shape and in need of cleaning gums are red and plaque gingivitis is++
the two needle biospy specimans. there are dense aggregates of lymphocytes and plasma cells in the portal tract refion associated wih portal fibrosis and bile ductular proliferation. brging fibrosis is also seen. lesssr number of neutrophils are soon. the inflamatory reaction and fibrosis encroaches on the limiting plate with degeneration of the adjacent hepatocyes. microorganisns are not seen
severe chronic activ lymphoplasmatic cholangiohep is diagnosis.
he has never had liver problems and since last night has eaten alot and driken more water. he has been out of house more and walked in garden since I gave first dose of pred.
Throughout this all he has never vomited . I overfed him my first force feed and he threw that up.
i will ask about secondary infection by email to vet
we are alone without vet care here in mexico
the dr comes next monday for blood work to be sent to mexico city by air.
Re: Cat liver issues
The biopsy report comments suggest non-suppurative cholangiohepatitis, as opposed to suppurative (the latter is generally more serious). This means you might have to expect this to be a chronic condition, that may require long-term therapy or even life-time therapy (like very low doses of pred, perhaps some breaks in between), and frequent followup lab work to monitor it.
You'll also want to stay ahead of potential IBD and/or pancreatitis because these often occur hand in hand with cholangiohepatitis (especially chronic cases). For example, the pancreas may become inflammed during an episode and will demand agressive treatment to prevent a serious worsening condition (remember that when multiple organs are involved like liver, pancreas, intestines, gall bladder, that it makes it more serious and prompt agressive treatment is necessary).
Likewise, hepatic lipidosis is always a concern when there is severe dehydration, anorexia, and/or combined with a pancreatic episode. IBD is sometimes a precursor in some cats with cholangiohepatitis, so each time you get a followup exam, always pay attention to liver and pancreatic enzymes. And don't forget the gall bladder function, since it is so closely related to the liver and pancreas.
I still strongly feel you should be giving sub-q fluid therapy at home, so please discuss that in full with your vet. It may not be necessary to use antibiotics at this point, the biopsy didn't suggest there was bacterial infection, but this didn't involve an intestinal biopsy, so it should still at least be discussed.
When Benny starts feeling better and eating more sufficiently, it might be wise to attempt to transition him to a hypoallergenic diet (example, Hill's Rx Z/D), particularly if the vet feels IBD may enter the picture.
Be prepared this condition can take some time to show improvement and recovery (but it may still remain chronic, which means it may wax and wane, or once recovered, Benny could have more episodes in the future, so familiarize yourself with the most common symptoms). The lethargy can take some time to resolve since the liver and biliary system are working overtime to regenerate. So, proper medications and fluid therapy can help alleviate some of those symptoms. Fluid therapy can oftentimes perk up a cat considerably because in almost every type of liver disease, dehydration is usually always present.
Hang in there, keep your vet updated, and keep a log of Benny's medications and the times the vet reduces, ceases or changes them or the doses. A log helps you keep track of how the medications are affecting recovery, which meds seem to provide improvement, how Benny is responding and in which time frames etc. Also keep notes of his appetite, amounts of food taken in, his overall attitude and activity level, etc. You should expect to get frequent followups with bloodwork for possibly a few more weeks, or, at least until Benny has shown marked improvement and most of the med doses have been decreased or ceased (except the pred).
Please keep us updated, I know this is a trying time and it will take some patience, keep an eagle eye on Benny and update your vet as he requests.
You'll also want to stay ahead of potential IBD and/or pancreatitis because these often occur hand in hand with cholangiohepatitis (especially chronic cases). For example, the pancreas may become inflammed during an episode and will demand agressive treatment to prevent a serious worsening condition (remember that when multiple organs are involved like liver, pancreas, intestines, gall bladder, that it makes it more serious and prompt agressive treatment is necessary).
Likewise, hepatic lipidosis is always a concern when there is severe dehydration, anorexia, and/or combined with a pancreatic episode. IBD is sometimes a precursor in some cats with cholangiohepatitis, so each time you get a followup exam, always pay attention to liver and pancreatic enzymes. And don't forget the gall bladder function, since it is so closely related to the liver and pancreas.
I still strongly feel you should be giving sub-q fluid therapy at home, so please discuss that in full with your vet. It may not be necessary to use antibiotics at this point, the biopsy didn't suggest there was bacterial infection, but this didn't involve an intestinal biopsy, so it should still at least be discussed.
When Benny starts feeling better and eating more sufficiently, it might be wise to attempt to transition him to a hypoallergenic diet (example, Hill's Rx Z/D), particularly if the vet feels IBD may enter the picture.
Be prepared this condition can take some time to show improvement and recovery (but it may still remain chronic, which means it may wax and wane, or once recovered, Benny could have more episodes in the future, so familiarize yourself with the most common symptoms). The lethargy can take some time to resolve since the liver and biliary system are working overtime to regenerate. So, proper medications and fluid therapy can help alleviate some of those symptoms. Fluid therapy can oftentimes perk up a cat considerably because in almost every type of liver disease, dehydration is usually always present.
Hang in there, keep your vet updated, and keep a log of Benny's medications and the times the vet reduces, ceases or changes them or the doses. A log helps you keep track of how the medications are affecting recovery, which meds seem to provide improvement, how Benny is responding and in which time frames etc. Also keep notes of his appetite, amounts of food taken in, his overall attitude and activity level, etc. You should expect to get frequent followups with bloodwork for possibly a few more weeks, or, at least until Benny has shown marked improvement and most of the med doses have been decreased or ceased (except the pred).
Please keep us updated, I know this is a trying time and it will take some patience, keep an eagle eye on Benny and update your vet as he requests.
..........Traci
-
christymexico
- Posts: 97
- Joined: Mon Feb 27, 2012 1:21 am
- Location: mexico
Re: Cat liver issues
i will mention it today. We are on day 2 of pred and he is eating much better and coming out more..a tiny bit more himself. i had tried the w/z in nyc and bought one of eah kind of single protien foods in pet store and he had no part of it
I can get the Z here in mexico but only the dry in a bag or the hairball formula in a bag
nothng wet here except obesity and urinary or a/d
i will ask about the fluids,how will i tell he is dehydrated?
also, what are the signs /symptoms of pacreas problems?
lastly, what is a specific gall bladder test?
i have to ask for all directly in mexico
thanks again
hes just not himself:/ and i know it will take time i just feel for him..i watch him like a hawk and am constantly checking his eyes ears and gums..i now he hates me lol..but hes so sweet and such a trooper. i just hope he feels better soon, maybe sub q will help
I can get the Z here in mexico but only the dry in a bag or the hairball formula in a bag
nothng wet here except obesity and urinary or a/d
i will ask about the fluids,how will i tell he is dehydrated?
also, what are the signs /symptoms of pacreas problems?
lastly, what is a specific gall bladder test?
i have to ask for all directly in mexico
thanks again
hes just not himself:/ and i know it will take time i just feel for him..i watch him like a hawk and am constantly checking his eyes ears and gums..i now he hates me lol..but hes so sweet and such a trooper. i just hope he feels better soon, maybe sub q will help
Re: Cat liver issues
Tests: bilirubin, ALT, ALP, ammonia, bile acids and other liver enzymes.
Signs of pancreatitis: anorexia. very painful abdomen, hunched over stance (sternal position indicates pain), nausea, vomiting, diarrhea, low OR high temperature, dehydration, lethargy, depresssion, jaundice, weight loss. Not all cats will have all the symptoms, but any of these are what to watch for and get prompt vet attention. In some cats, they will have an acute episode that could develop into a chronic condition. Some cats are asymptomatic until presentation and the vet finds one or more of the symptoms on exam and tests. The fPLI is the most sensitive test for this, needs to be sent to an outside lab.
How to determine dehydration: http://www.cathelp-online.com/emergency/vitals.php
Signs of pancreatitis: anorexia. very painful abdomen, hunched over stance (sternal position indicates pain), nausea, vomiting, diarrhea, low OR high temperature, dehydration, lethargy, depresssion, jaundice, weight loss. Not all cats will have all the symptoms, but any of these are what to watch for and get prompt vet attention. In some cats, they will have an acute episode that could develop into a chronic condition. Some cats are asymptomatic until presentation and the vet finds one or more of the symptoms on exam and tests. The fPLI is the most sensitive test for this, needs to be sent to an outside lab.
How to determine dehydration: http://www.cathelp-online.com/emergency/vitals.php
..........Traci
-
christymexico
- Posts: 97
- Joined: Mon Feb 27, 2012 1:21 am
- Location: mexico
Re: Cat liver issues
great thanks.
the pred has him eating and drinking so much
all his signs from the page show him well hydrated.
his gums are super moist and pink
and skin seems ok to snap.
will ask for the tests thanks so much
he just is gonna take some time to get back i think..i hope ..he perked up looking at bird outside so thats cool, hes more fussy backtalking and taking less crap from his baby sister cat of 8 months so thats all good..
take care and thank you again
c and benny
the pred has him eating and drinking so much
all his signs from the page show him well hydrated.
his gums are super moist and pink
and skin seems ok to snap.
will ask for the tests thanks so much
he just is gonna take some time to get back i think..i hope ..he perked up looking at bird outside so thats cool, hes more fussy backtalking and taking less crap from his baby sister cat of 8 months so thats all good..
take care and thank you again
c and benny
-
christymexico
- Posts: 97
- Joined: Mon Feb 27, 2012 1:21 am
- Location: mexico
Re: Cat liver issues
benny is doing great. energy appetite..pink gums and skin
monday dr does bloods.
the pred gave him diarrhea but i am hesitant to give him metronidzle because he is just so happy.
if it continues tomorrow I will have to.
hes doing so well..hope the blood results will agree.
christy
monday dr does bloods.
the pred gave him diarrhea but i am hesitant to give him metronidzle because he is just so happy.
if it continues tomorrow I will have to.
hes doing so well..hope the blood results will agree.
christy
Re: Cat liver issues
To my knowlege, pred doesn't cause diarrhea, best to discuss that with your vet. Could be the change in food or something else.
..........Traci
-
christymexico
- Posts: 97
- Joined: Mon Feb 27, 2012 1:21 am
- Location: mexico
Re: Cat liver issues
UREA
mmol/L
11.00
4.1-10.8
ELEVADO
CREATININAmol/L
136
<175
COLESTEROL
mmol/L
5.54
1.81-3.88
ELEVADO
BILIRRUBINA T.mol/L
53.00
<6.84
ELEVADO
BIL. CONJUGADAmol/L
27.60
<5.8
ELEVADO
BIL. NO CONJ.mol/L
25.40
<1
ELEVADO
ALT
U/L
226
<72
ELEVADO
AST
U/L
134
<61
ELEVADO
FOSFATASA A.
U/L
79
<107
TRIGLICERIDOS
mmol/L
0.83
0.57 - 1.14
CK
U/L
230
<277
PROTEÍNAS T.
g/L
88.0
59.6-80.8
ELEVADO
ALBÚMINA
g/L
31.0
26-39
GLOBULINAS
g/L
57.0
29-47
ELEVADO
RELACIÓN A/G
calculado
0.5
0.58-1.16
DISMINUIDO
CALCIO
mmol/L
2.14
2.05-2.76
FÓSFORO I.
mmol/L
2.82
0.96-1.96
ELEVADO
POTASIO
mmol/L
11.00
4.1-10.8
ELEVADO
CREATININAmol/L
136
<175
COLESTEROL
mmol/L
5.54
1.81-3.88
ELEVADO
BILIRRUBINA T.mol/L
53.00
<6.84
ELEVADO
BIL. CONJUGADAmol/L
27.60
<5.8
ELEVADO
BIL. NO CONJ.mol/L
25.40
<1
ELEVADO
ALT
U/L
226
<72
ELEVADO
AST
U/L
134
<61
ELEVADO
FOSFATASA A.
U/L
79
<107
TRIGLICERIDOS
mmol/L
0.83
0.57 - 1.14
CK
U/L
230
<277
PROTEÍNAS T.
g/L
88.0
59.6-80.8
ELEVADO
ALBÚMINA
g/L
31.0
26-39
GLOBULINAS
g/L
57.0
29-47
ELEVADO
RELACIÓN A/G
calculado
0.5
0.58-1.16
DISMINUIDO
CALCIO
mmol/L
2.14
2.05-2.76
FÓSFORO I.
mmol/L
2.82
0.96-1.96
ELEVADO
POTASIO