Logan update:
Monday morning his RBC was at 20. Monday afternoon he got anesthesia and feeding tube and Monday night his RBC dropped to 17 and this morning his RBC remained at 17.
His electrolytes are still abnormal, but, she said she couldn't med him for that yesterday because of the anesthesia.
She said he did vomit once, but she wasn't overly concerned about it.
The liver test came back showing fatty tissue issues as well as infection of some sort - I couldn't catch the infection, but she said it is a concern and is going to start him on Pravamox for it.
Other than that, she said if he continues good today, and his RBC doesn't drop, we can take him home tomorrow.
So, you know, with this Dr. , its so hard to get a read because she's very to the point, these are the facts, done.
All in all, I think things are good, considering everything. We expected liver issues, but it also seems like it can be dealt with? She did mention something about a long term concern, but hard to say what that meant. What do you think about this and overall?
Kitten with mystery illness - definitely anemic...
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LoganPenelope
- Posts: 35
- Joined: Fri Mar 25, 2011 11:48 am
Re: Kitten with mystery illness - definitely anemic...
Is he still on fluids maintenance (IV)? The electrolytes should normalize soon enough if still on fluids, it could be he is still responding to the second transfusion.
Is he urinating, normally? Did she do a urinalysis?
I think you meant to say clavamox, yes? This is a broad-spectrum antibiotic commonly used to treat liver problems. If any liver infection is present, it is most likely secondary, due to his immunocompromised state. However, it's not uncommon for liver infections to develop at any time with or without concurrent disease. They are usually treated with antibiotics, with nutritional and fluid support when necessary.
Fatty tissues indicates lipids, on the liver, which in turn, most likely indicate hepatic lipidosis. As long as he continues to respond to treatment, fluids, antibiotics, raises his RBC's, and as long as the feeding is aggressive, it can be "cured". This can take some time though, depending on how much damage to the liver. This could also explain the electrolytes, since most of his fluids are being eliminated through urine, and the liver is trying twice as hard to filter out natural toxins and repair itself. The continuation of fluids (although a more metered dosage) and the aggressive feeding schedules are the mainstays in treating hepatic lipidosis.
The longer he is able to keep food down without vomiting, the more calories/protein he will take in, in which to regenerate the liver. This can take anywhere from a few weeks to a month or longer, depending on the cat and their true nutritional needs. If she sends him home soon, you will have to be EXTREMELY DILIGENT in following the vet's recommended feeding schedules, medication administration, and get a complete hand-out for the feeding schedule (this is specific, including hours to feed, how to flush the tube with water before and after, what to watch for in terms of vomiting or dislodging of the tube, etc) - you will not want to leave the clinic without having fully discussed everything in Logan's treatment with your vet, and make sure you fully understand the instructions. Likewise, you also want availability to the vet in case you have urgent questions or if you are uncertain of any potential symptom that may occur.
As for long-term concern, I'm not sure what she's getting at, if she was talking specific to the liver. My guess is she may be a bit concerned about his overall liver function and wants to ensure there is no lasting damage to the liver. This is rare in hepatic lipidosis, once recovered, cats rarely ever develop the condition again. It's not impossible, it's just rare. Usually, it is due to not having sufficient nutrition in a small time frame (i.e., two weeks), insufficient water intake, or being overweight and suffering a rapid weight loss which affects the liver's function and causes hepatitis. Stress can also cause it, so ensure that all stress is reduced at all times (this applies to any FELV+ cat anyway, since stress can be a precursor to the development of any disease as well as any secondary infections).
She could also be concerned about his FELV+ status, in that his immune response is weakened, but she and you are doing everything you can to mitigate that.
Please talk to her at length before any consideration of bringing him home. You want assurance that his RBC's and packed-cell-volume are adequate, that there is no risk of falling back to abnormal levels, and that you fully understand his nutritional and medication treatment at home. Prepare to monitor Penelope so that she doesn't get rambunctious with Logan - play and activity should probably be reduced and only under your strict supervision. Ideally, he should be kept comfortable, limited activity, and separated from Penelope during sleeping/napping so you don't compromise them playing and moving that feeding tube. He is also most likely still weak and underweight, so he will be tired and will need rest, quiet, but lots of love from you!
I'm not saying he can't be around or close to Penelope, just saying you want to ensure he is comfortable around her and not allowing play or anything else to interfere with his health/comfort at this point. She might actually be a bit standoffish at first because she will sense and smell all the clinic scents on him - don't fret about this, just reintroduce them slowly and gently.
Is he urinating, normally? Did she do a urinalysis?
I think you meant to say clavamox, yes? This is a broad-spectrum antibiotic commonly used to treat liver problems. If any liver infection is present, it is most likely secondary, due to his immunocompromised state. However, it's not uncommon for liver infections to develop at any time with or without concurrent disease. They are usually treated with antibiotics, with nutritional and fluid support when necessary.
Fatty tissues indicates lipids, on the liver, which in turn, most likely indicate hepatic lipidosis. As long as he continues to respond to treatment, fluids, antibiotics, raises his RBC's, and as long as the feeding is aggressive, it can be "cured". This can take some time though, depending on how much damage to the liver. This could also explain the electrolytes, since most of his fluids are being eliminated through urine, and the liver is trying twice as hard to filter out natural toxins and repair itself. The continuation of fluids (although a more metered dosage) and the aggressive feeding schedules are the mainstays in treating hepatic lipidosis.
The longer he is able to keep food down without vomiting, the more calories/protein he will take in, in which to regenerate the liver. This can take anywhere from a few weeks to a month or longer, depending on the cat and their true nutritional needs. If she sends him home soon, you will have to be EXTREMELY DILIGENT in following the vet's recommended feeding schedules, medication administration, and get a complete hand-out for the feeding schedule (this is specific, including hours to feed, how to flush the tube with water before and after, what to watch for in terms of vomiting or dislodging of the tube, etc) - you will not want to leave the clinic without having fully discussed everything in Logan's treatment with your vet, and make sure you fully understand the instructions. Likewise, you also want availability to the vet in case you have urgent questions or if you are uncertain of any potential symptom that may occur.
As for long-term concern, I'm not sure what she's getting at, if she was talking specific to the liver. My guess is she may be a bit concerned about his overall liver function and wants to ensure there is no lasting damage to the liver. This is rare in hepatic lipidosis, once recovered, cats rarely ever develop the condition again. It's not impossible, it's just rare. Usually, it is due to not having sufficient nutrition in a small time frame (i.e., two weeks), insufficient water intake, or being overweight and suffering a rapid weight loss which affects the liver's function and causes hepatitis. Stress can also cause it, so ensure that all stress is reduced at all times (this applies to any FELV+ cat anyway, since stress can be a precursor to the development of any disease as well as any secondary infections).
She could also be concerned about his FELV+ status, in that his immune response is weakened, but she and you are doing everything you can to mitigate that.
Please talk to her at length before any consideration of bringing him home. You want assurance that his RBC's and packed-cell-volume are adequate, that there is no risk of falling back to abnormal levels, and that you fully understand his nutritional and medication treatment at home. Prepare to monitor Penelope so that she doesn't get rambunctious with Logan - play and activity should probably be reduced and only under your strict supervision. Ideally, he should be kept comfortable, limited activity, and separated from Penelope during sleeping/napping so you don't compromise them playing and moving that feeding tube. He is also most likely still weak and underweight, so he will be tired and will need rest, quiet, but lots of love from you!
I'm not saying he can't be around or close to Penelope, just saying you want to ensure he is comfortable around her and not allowing play or anything else to interfere with his health/comfort at this point. She might actually be a bit standoffish at first because she will sense and smell all the clinic scents on him - don't fret about this, just reintroduce them slowly and gently.
..........Traci
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LoganPenelope
- Posts: 35
- Joined: Fri Mar 25, 2011 11:48 am
Re: Kitten with mystery illness - definitely anemic...
I think he is still on IV because he has the IV thing still in his paw/arm.
He does urinate normal and they have reported he drinks water on his own too.
Yes, I probably misunderstood her and it is clavamox.
We have made very clear that we are in no "rush" to get Logan home. We told them, "Look, at this point we've spent a lot of money. We're not trying to save a $150 just to get him home. If he needs to stay for any reason, PLEASE keep him here." Her response "Yes, you've made that very clear". lol.
Thanks for all the pointer with Penelope too. Really good information!
Luckily my wife and I both have our own business in which we work from home office a lot, and when one of us is out, generally, the other is home. So he will have close to 24/7 supervision
He does urinate normal and they have reported he drinks water on his own too.
Yes, I probably misunderstood her and it is clavamox.
We have made very clear that we are in no "rush" to get Logan home. We told them, "Look, at this point we've spent a lot of money. We're not trying to save a $150 just to get him home. If he needs to stay for any reason, PLEASE keep him here." Her response "Yes, you've made that very clear". lol.
Thanks for all the pointer with Penelope too. Really good information!
Luckily my wife and I both have our own business in which we work from home office a lot, and when one of us is out, generally, the other is home. So he will have close to 24/7 supervision
Re: Kitten with mystery illness - definitely anemic...
Well, I and you should probably leave it to your vet's opinion on whether he can go home soon enough. If he is better than stable, and those RBC's and PCV are improved, and that he isn't vomiting food very often, is hydrated well, then sometimes, we like to get them home to the owners as soon as possible because the pets generally do better at home in their natural and familiar environment, and with no stress and distractions from the clinic. You just want to be sure he is stable, better than stable first.
They may or may not still be giving IVs on a continual basis. Sometimes we leave the IV in, in the event we will need to reinstate fluids or IV medications and to avoid another venipuncture in another leg. When the fluids are turned off, we flush the port to avoid clotting or air. My guess is they are metering it slowly, and watching to avoid too much perfusion (fluid overload). They are monitoring his hydration status at various times of the day, as well as his vitals, so they'll know when to increase or decrease the fluids.
I'm thrilled to hear one or both of you are at home, this will certainly benefit Logan during feeding schedules via his feeding tube - it's so important not to skip any feeding schedule or medication schedule.
They may or may not still be giving IVs on a continual basis. Sometimes we leave the IV in, in the event we will need to reinstate fluids or IV medications and to avoid another venipuncture in another leg. When the fluids are turned off, we flush the port to avoid clotting or air. My guess is they are metering it slowly, and watching to avoid too much perfusion (fluid overload). They are monitoring his hydration status at various times of the day, as well as his vitals, so they'll know when to increase or decrease the fluids.
I'm thrilled to hear one or both of you are at home, this will certainly benefit Logan during feeding schedules via his feeding tube - it's so important not to skip any feeding schedule or medication schedule.
..........Traci
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LoganPenelope
- Posts: 35
- Joined: Fri Mar 25, 2011 11:48 am
Re: Kitten with mystery illness - definitely anemic...
Logan's new update looks good still:
Last night and this morning his RBC was steady at 17.
His Electrolytes are better.
His liver bilirubin went up from 6.2 to 8.3
But his ALT, or was it ALC - I heard ALT, my wife heard ALC - but it went down from 571 to 440. What do you think of that?
She says he's ready to go home at 2pm today. She said she feels that his rehab is now all oral and that he would benefit from being at home. She is going to go over everything with us and give us written instructions and schedules as well.
Oh also he has not vomited and is taking his feeding tube well.
I'm sure they'll tell us, but some of our concerns include how we'll know what his RBC is going. I know that they've been up and stable since Saturday night, (3.5 days now), but naturally still concerned.
What do you think? And thank you again for the time you've put in with us, it is really amazing
Last night and this morning his RBC was steady at 17.
His Electrolytes are better.
His liver bilirubin went up from 6.2 to 8.3
But his ALT, or was it ALC - I heard ALT, my wife heard ALC - but it went down from 571 to 440. What do you think of that?
She says he's ready to go home at 2pm today. She said she feels that his rehab is now all oral and that he would benefit from being at home. She is going to go over everything with us and give us written instructions and schedules as well.
Oh also he has not vomited and is taking his feeding tube well.
I'm sure they'll tell us, but some of our concerns include how we'll know what his RBC is going. I know that they've been up and stable since Saturday night, (3.5 days now), but naturally still concerned.
What do you think? And thank you again for the time you've put in with us, it is really amazing
It could have been ALT, or ALP (ALP is also known as ALKP), or AST. Both ALT and AST are common parameters to monitor when suspicious of liver disease. The ALP is sometimes more useful when there is suspicion of biliary system problems (like obstruction, biliary sludge, etc) and sometimes muscle mass or injury. The ALT is the one usually most likely to rise in the three digits, and I suspect this is the one your vet was referring to.
There is no ALC parameter.
The fact that it has lowered is a good sign, and sign of improvement, that the liver is starting to regenerate. However, the high bilirubin is still of concern, so your vet may require you bring Logan back in about a week for a recheck on the liver enzymes.
Detecting a reoccurance of anemia, signs to watch for: lethargy; refusal to eat; pale or jaundiced mucous membranes (whites of eyes, gums and tongue inside the mouth, inside of ears, and part the fur on the abdomen to also find jaundiced skin); crouched or sternal position; nausea and/or vomiting; dehydration ( see here for how to check hydration); irregular heartbeat and respirations (can be slow, or fast, or starting slow increasing to rapid); discolored urine, usually very dark yellow or brown-tinged, sometimes traces of blood in urine or feces; can present with either a fever or lowered body temperature; increased weakness, tiredness and reluctance to move about. At any hint of any potential symptom developing, no matter how slight, contact your vet immediately and be prepared to get him back in for bloodwork.
With luck, he will continue to improve, and once he gets more quality nutrition, he should improve greatly. If you have any questions at all, do not hesitate to contact your vet at once. Keep all stress reduced to the barest minimum.
Again, don't leave the clinic without a written instruction sheet that outlines the feeding schedules and amount of food per feeding, as well as any medication schedule.
I think overall, it appears he has gotten through this crisis, but you're not out of the woods yet, since the focus is now on regenerating the liver. Not having vomited is a great sign. Weight gain, albeit slight at first, will also be a good sign. Back at home in his own environment will most likely even help him improve greatly.
There is no ALC parameter.
The fact that it has lowered is a good sign, and sign of improvement, that the liver is starting to regenerate. However, the high bilirubin is still of concern, so your vet may require you bring Logan back in about a week for a recheck on the liver enzymes.
Detecting a reoccurance of anemia, signs to watch for: lethargy; refusal to eat; pale or jaundiced mucous membranes (whites of eyes, gums and tongue inside the mouth, inside of ears, and part the fur on the abdomen to also find jaundiced skin); crouched or sternal position; nausea and/or vomiting; dehydration ( see here for how to check hydration); irregular heartbeat and respirations (can be slow, or fast, or starting slow increasing to rapid); discolored urine, usually very dark yellow or brown-tinged, sometimes traces of blood in urine or feces; can present with either a fever or lowered body temperature; increased weakness, tiredness and reluctance to move about. At any hint of any potential symptom developing, no matter how slight, contact your vet immediately and be prepared to get him back in for bloodwork.
With luck, he will continue to improve, and once he gets more quality nutrition, he should improve greatly. If you have any questions at all, do not hesitate to contact your vet at once. Keep all stress reduced to the barest minimum.
Again, don't leave the clinic without a written instruction sheet that outlines the feeding schedules and amount of food per feeding, as well as any medication schedule.
I think overall, it appears he has gotten through this crisis, but you're not out of the woods yet, since the focus is now on regenerating the liver. Not having vomited is a great sign. Weight gain, albeit slight at first, will also be a good sign. Back at home in his own environment will most likely even help him improve greatly.
..........Traci
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LoganPenelope
- Posts: 35
- Joined: Fri Mar 25, 2011 11:48 am
Re: Kitten with mystery illness - definitely anemic...
Logan is officially back home A very tired kitten, but, his numbers held overnight and his RBCs are steady at 17.
So here is our medication:
Clavamox, 1ml, 2x per day.
Cyclosporine, 25mg Capsule , 2x per day
Prednislone 5mg tablet, 1.5 tables, 2x per day
Denamarin, 90 mg, 1 tablet once daily
He's on a diet of IAMS high calorie diet, which is currently at 10ml, 3x per day, and gradually increasing.
He goes back to the vet Friday for numbers check.
All in all, they were happy with everything and now it's time for bed rest and calories. I'm sure he'll appreciate being here where it's quiet, and we're with him to slowly work to get better.
As expected, he is very weak. Lays a lot, but has been moving, and even meowed once or twice.
He has some minor jaundice in the eyes, and in the ears. The vet is aware and believes the medication, combined with food, should take of things.
Thank you again Traci for all your amazing help! Logan thanks you too
A very tired kitten, but, his numbers held overnight and his RBCs are steady at 17.So here is our medication:
Clavamox, 1ml, 2x per day.
Cyclosporine, 25mg Capsule , 2x per day
Prednislone 5mg tablet, 1.5 tables, 2x per day
Denamarin, 90 mg, 1 tablet once daily
He's on a diet of IAMS high calorie diet, which is currently at 10ml, 3x per day, and gradually increasing.
He goes back to the vet Friday for numbers check.
All in all, they were happy with everything and now it's time for bed rest and calories. I'm sure he'll appreciate being here where it's quiet, and we're with him to slowly work to get better.
As expected, he is very weak. Lays a lot, but has been moving, and even meowed once or twice.
He has some minor jaundice in the eyes, and in the ears. The vet is aware and believes the medication, combined with food, should take of things.
Thank you again Traci for all your amazing help! Logan thanks you too
Re: Kitten with mystery illness - definitely anemic...
I'm so happy to hear he is home, he will most likely heal faster being at home.
I'm also glad the vet wants to see him as soon as Friday, this will give you peace of mind on the blood values. I'm sure your vet will be on top of this, but just in case, make sure at each vet visit that Logan's weight is recorded.
I'm sure your vet has already instructed you, but just a tip in case she didn't. When administering food/water into the tube with the syringe, push the syringe's plunger very very slowly so that it isn't forced quickly. If forced too quickly, he might vomit soon after. Remember, the tube is at the stomach, so you want to administer the syringe's contents slowly. Remember to administer a bit of water with the syringe before and after each feeding session. (unless your vet directed you differently).
I'm also glad the vet wants to see him as soon as Friday, this will give you peace of mind on the blood values. I'm sure your vet will be on top of this, but just in case, make sure at each vet visit that Logan's weight is recorded.
I'm sure your vet has already instructed you, but just a tip in case she didn't. When administering food/water into the tube with the syringe, push the syringe's plunger very very slowly so that it isn't forced quickly. If forced too quickly, he might vomit soon after. Remember, the tube is at the stomach, so you want to administer the syringe's contents slowly. Remember to administer a bit of water with the syringe before and after each feeding session. (unless your vet directed you differently).
..........Traci
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LoganPenelope
- Posts: 35
- Joined: Fri Mar 25, 2011 11:48 am
Re: Kitten with mystery illness - definitely anemic...
Yes we're definitely on it. Part of the paperwork included his current weight and it will be monitored. Also, they were clear to make sure to be very slow with the feeding and signs to watch for in case we go too fast.
We did ask how long the tech's were taking, and they reported 10 minutes for 10ml. We set up a timer, put it to 15, and calculated it based on 1ml at a time to make sure we were as comfortable as possible.
We also flush with 10ml of water before and after feeding.
We were also given a bandage kit to rewrap on a daily basis with a dabble of neosporine around the entry point.
Thank you!!!
We did ask how long the tech's were taking, and they reported 10 minutes for 10ml. We set up a timer, put it to 15, and calculated it based on 1ml at a time to make sure we were as comfortable as possible.
We also flush with 10ml of water before and after feeding.
We were also given a bandage kit to rewrap on a daily basis with a dabble of neosporine around the entry point.
Thank you!!!
Re: Kitten with mystery illness - definitely anemic...
Good to hear, you will do fine!
Just a word on the bandaging, be very careful you do not bandage too tightly, but also not too loose that the tube is not secure at the base of his neck. If the vet sent home vet-wrap with you (this is the sort of sticky, pliable colored bandage - it is the red bandage in your vet visit pictures), it can tighten as you work with it, be careful!
Please keep us updated on how Logan is doing and feeling if you can.
Just a word on the bandaging, be very careful you do not bandage too tightly, but also not too loose that the tube is not secure at the base of his neck. If the vet sent home vet-wrap with you (this is the sort of sticky, pliable colored bandage - it is the red bandage in your vet visit pictures), it can tighten as you work with it, be careful!
Please keep us updated on how Logan is doing and feeling if you can.
..........Traci