mysterious cat illness

[toxin101]

i adopted a cat almost 4 months ago. she was approximately 1 yr of age, had just finished weaning a litter of kittens and was subsequently spayed. when i got her she was skin and bones - i was told by the rescue group this was because she had just been a mom (my vet gave me a look of disbelief when i told her that's what i'd been told). she was eating about 2x the normal cat food amount (i allow my cats to free feed) and put on only a small amount of weight. then she slowly started eating less and less until she would not eat on her own and became even more underweight and dehydrated. i took her to the vet because she had a high fever and wouldn't eat and lost her usually spunky personality. she was giving a shot of penicillin, ketoprofen and sub-Q fluids and send home with oral calvamox and ketoprofen. still not eating, i began to force-feed her with high-calorie food. her blood work came back pretty normal (CBC, biochemistry, FIV, FIP and FeLV) except for the high bilirubin, high toxic neutrophils, high amylase and low albumin & globins levels/ratio. i was told the bilirubin was high due to hepatic lipidosis from not eating (hence the force feeding), the toxic neutrophils means inflammation/infection (hence the antibiotics) and not to worry about the rest (i guess the values weren't that far from normal). it's been a couple of weeks now and no sign of improvement, though she did put on some weight from the force feeding. she has just finished a 2nd course of antibiotics (baytril) and is on appetite stimulants (i forget the name). though she's eating more, she's not eating much and has lost some of th weight put on while i was force feeding her.

her signs/symptoms are few and very broad and generic, as would be seen with any sick cat - lethargy, depression, anorexia. no gastrointestinal upsets (normal litter box habits and no vomiting). no apparent pain. she plays very little, if at all. she only eats treats (thank goodness "treats" in my house means hill's t/d diet) and occasionally cooked chicken breast. she sneezes occasionally, combined with slight congestion and "nose crusties" - which she even developped briefly while on the baytril. her fur usually looks dry and flaky, but that improved with the force feeding and always improves if given omega-3 fatty acid supplements.

the next test my vet has suggested is an ultrasound, but all she said she expected to see was the fatty liver (this was about 3 weeks ago). she also suggested a virologist, but acknowledged that not all viruses can be detected.

do you have any other suggestions for either illnesses or tests? could it be cancer? allergies? i can't stand to see the cat have almost no quality of life for no apparent reason.

thanks in advance for all your help.

[Tina B and crew]

well...if it's hepatic lipidosis it needs to be treated aggressively with high calorie nutrition until the liver values come down to normal levels. I know when our Gizmo had HL we had an ultrasound and biopsy done ASAP so the vet would know what course of action to take. He ruled out cancer, bacterial infection and possible liver flukes (from eating lizards)....we opted to have the PEG tube surgically inserted so we could tube feed him. The vet gave us a feeding schedule and goals to gradually increase the amount of food he received each day. It took 3 months but we finally got Gizmo back to his normal healthy self.

I would question why your vet hasn't looked at this more aggressively. How much food is your cat getting daily? If it isn't enough then the HL will continue to progress. It sounds like your kitty has some other problems on top of the HL. I can't give you many other answers, but I think I'd get a second opinion...I'd definitely want a biopsy and ultrasound of the liver ASAP if it were me. Hopefully Traci can give you some better advice.

[Traci]

The most important thing is finding the cause of the original problem....which could be anything from a viral to parasitic infection to any primary disease. Due to the young age of your kitty, I would not suspect cancer at all, but would advise to test bile acids to help rule out liver shunting (which could be going overlooked or mistaken for hepatic lipdosis). When testing bile acids, also opt to test ammonia levels in the blood. I would also retest pancreatic enzymes to determine if there is an infection or pancreatic episode going undetected (which closely relates to liver function, both liver and pancreatic enzyme testing should be done thoroughly)

Your kitty probably has multiple secondary infections, but again, the cause needs to be ruled out. When your vet tested for FELV/FIV/FIP, did she actually send a serology out to an outside lab for results? If not, get that done immediately, and include testing for hemobart and toxoplasmosis, plus fungal disease.

As for the upper respiratory infection, this could be secondary to something else, but could also be a viral-related problem (i.e., chalmydia, calicivirus, rhinotracheitis.....what is kitty's vaccination history?). Your vet CAN test for these type virals using exudate from eyes, nose, oral secretions or esophageal fluid. The serology sent out could help rule out other virals, infectious causes, fungal disease, blood-borne parasites (using ELISA"s or specific IFA's).

Was an x-ray ever done? Was a fecal analysis done to rule out parasites, salmonella, toxo, bacterial causes?

I agree with Tina, see another vet immediately, preferrably a feline-only vet, and don't wait another minute, something is going undiagnosed here, and since there has been virtually no improvement with current treatment, this is probably indicative of a disease process going undetected. Please read the following two posts for more information on possibilities, including testing options, run them by a NEW vet...

http://www.cathelp-online.com/phpBB2/vi ... php?t=2059

http://www.cathelp-online.com/phpBB2/vi ... php?t=2114

[toxin101]

thank you both for your comments and suggestions. i am going to become a thorn in the side of my vet and print out what you've said and see what the vet says. the 2 other posts referred to me were great reading - it's unfortunate that someone else had to deal with such a sick cat, but it let me know that i'm not alone in dealing with a difficult-to-diagnose cat. i spoke with the vet this morning and we decided i should start syringe-feeding again (at least 1-2x/day, since she is eating on her own), but i have to take my other cat to the vet next week for his annual shots (he's not sick at all in anyway and he's lived with her for 4 months now) and will tag her along for a quick visit and consultation. it's not like she's dying before my eyes or getting any worse, she's just not getting any better.

[Traci]

The concern here, according to your posts, is that you don't have the time to afford to wait. If a liver condition is present, time is of the essense to treat promptly and agressively. Please don't wait a week for a second opinion....whenever there is no response to medications, no response to any treatment approach taken, this should be a red flag to you that something is amiss, something is going undetected. This is why the need for additional diagnostics are necessary...to get to the cause of the problem instead of simply treating the symptoms as they occur (and worsen...in liver disease, the liver can fast deteriorate in a matter of mere days, to the point where it can be impossible to regenerate or recover). You need to know WHAT is causing all of these symptoms, rule OUT potential causes, and treat this effectively and promptly.

You said she continues to lose weight, and is still not eating sufficiently. Even if this WAS properly diagnosed as hepatic lipidosis, your current vet is NOT doing enough (hepatic lipidosis needs to be treated promptly, and agressively)....she needs to confirm the diagnosis however appropriate (with a needle biopsy or ultrasound or ultrasound-guided biopsy, test bile acids, recheck other liver enzymes, etc), and she needs to get your kitty immediately started on an appropriate feeding schedule with proper diet and include appropriate fluid support. Saying it or suspecting it does not confirm it, and it may be an entirely different health condition altogether, the differentials need to be ruled out immediately in order to form a correct treatment approach.

Please don't wait on this...either discuss your concerns immediately with your vet and demand a detailed treatment plan approach or see a new vet altogether....ASAP.

[toxin101]

thank you for your help and concern. she is doing better with the additional feeding. i am concerned that there is no firm diagnosis, however i also know that i do not have an unlimited supply of cash. i know how upset and worried i was when my last set of kittens had undiagnosed diarrhea, and how much money it cost me then to have all the stool sample tests and medications for both of them, still to have the cause undiagnosed - the kittens outgrew the condition (which is what the vet suspected they would do).

i know it's my own problem that i feel guilty and "bad" for not doing everything possible for this cat, based on what you advise, but i also know that there's no way i can possibly pay for everything and still be able to afford to keep myself and the cats housed and fed. you're probably thinking by now that i don't deserve to have pets, but i'm not doing anything less for these cats than i would do for myself if i were sick - actually, i already do more for them than i do for myself! i applaud those who are in a great financial situation and can afford to go the extra mile for their pets, or those who are willing to sacrifice things for themselves for the sake of their pets. to have all those tests done that you are recommending would cost me thousands of dollars.

as i mentioned earlier, i will be taking your list to the vet on my next visit and discuss your recommendations with her. thank you.

[Traci]

I don't think any of us are in a "great" financial situation....it just comes down to getting a proper diagnosis in which to treat the most effectively.

Your vet knows she can try to reduce the costs for you during this diagnostic stage. She is suspecting hepatic lipidosis, but even if she were, she knows that home care is as vital to kitty's recovery as opposed to extensive testing, treatment, etc. If she was willing to simply send kitty and you home, with no feeding schedule, no direct or explicit treatment instructions, then she is largely at fault for not concluding a diagnosis.

Yes, these diagnostics can get expensive, yes, owners sometimes must decline due to financial restraints, but there are ways to reduce the costs where necessary. For example, having suspected HL, she could at least offer to retest the liver enzymes (which can be broken down to include the most obvious)...opt for testing bile acids to rule out obstruction, liver shunting, other various liver problems, associated pancreatitis, etc. etc. The blood testing mentioned earlier is the least expensive at this point, as opposed to an ultrasound or ultrasound-guided needle biopsy.

Please read again the links to other posts provided in this forum, so that you understand hepatic lipidosis and the agressive treatment required in order to predict a favorable outcome. We do not know at this point IF HL is a concern, I would hate to think your vet is treating this as if, yet not ruling out other problems that could be mistaken for HL, thereby your kitty not getting the appropriate treatment and care she deserves.

The multiple infections and weight loss and poor response to antibiotics are extremely concerning. Dehydration is also a major concern here, the liver largely depends on proper hydration (as well as sufficient nutrition) to function properly. Your vet, knowing this, should have at least discussed sub-q fluids administration at home, a feeding schedule, discussed possible change in antibiotics, etc etc. The main concern is kitty is not responding to current treatment as we would hope. Again, this might be inidcative of an entirely different condition progressing that is going undetected.

We're not questioning the level of care you can give your kitty...as a matter of fact, I'm almost questioning your VET's approach to this, which is why a second opinion may get you further. Liver disease is a serious condition in which it can fail rapidly, and without knowing what other secondary health concern may be lurking and progressing, a risk is being taken with kitty's health. ALL primary diseases carry the potential of secondary health problems, infections, etc....the proper diagnosis and treatment can mean the difference between recovery and failure of treatment.

I wouldn't wait to take this "list" to your vet next week, you have the option of calling her and talking with her over the phone, and reaching some agreement with testing options, or at the very least, getting a proper feeding schedule and fluids administration discussed so that you can do as much for kitty at home as possible.

Forced feeding is seldom sufficient for most liver cases. Forced feeding also is a stress concern, which could actually induce further anorexia, vomiting, etc. It is for this reason that your vet needs to discuss a schedule with you, the proper amounts, times of day to feed, add fluids support, antibiotic approach, and following up on any progress made (or that your vet is available to you should your kitty fail to respond)