Cat liver issues

[Traci]

Why didn't the vet prescribe pain medication? Can you call them and ask?

The famotadine is Pepcid, it will help with preventing ulcers in the stomach or intestine - none of the meds will cause drowsiness. Pain medication however, like buprenorphine, might, if the dose is too high.

That said, I would strongly suggest Benny is on low-dose oral buprenorphine (in suspension form). If the dose is too high, it can cause drowsiness as well as suppress the appetite a bit, so that's why it needs to be low dose. Again, any time the pancreas is inflamed, it can cause pain, which in turn, will cause anorexia.

Is Benny still on an antiemetic? What about antibiotics?

Did the vet give you a feeding schedule for Benny? Is he still eating on his own? What about fluids?

[christymexico]

Hi, his pancreas , b12,folic acid, cbc. thyroid are all normal
his bun was down to 3.3 from 6.0 although his alt is still 240 ..he is not yellow anymore
we tried limited ingrediant can food all types..intestine, w/d and he would have none of it
so he is eating his fancy feast fish very well
he is drinking and eating and playing with his toys
he is still skinny and i can tell he is tired from all this
we are inside a nyc apt and he is an outdoor cat so i can tell he is depressed and missing the outdoors...
we will go again on monday for chem profile and cbc again..we have a flight for friday the 16th back to mexico if all goes well
I will ask about pain meds but i dont think he is having any pain. he is running and jumpimg and chasing toys..he gets tired easily though..this was a hard one/is a hard one on us all..
I will keep you all updated and thank you for the help
still on ursodial and denamarin daily..
christy and benny

[Traci]

Christy, I'm glad to hear Benny is doing so much better and the jaundice appears to have cleared, this is a good sign.

It may be too late for pain medication now, what I was inferring is that any time there is a pancreas problem, it is almost likely to be a painful episode and these cats should always be on veterinary prescribed pain medication immediately upon suspicion of a pancreatic episode - which is why I questioned why the vets at NYC didn't have Benny on it!!

Please read this: INDOORS ONLY!. By allowing Benny outdoors, you increase his risk for numerous hazards, and with just a little bit of creativity on your part, you can make his INDOOR environment safe, happy and healthy.

Why is Benny still on ursodiol? This is a medication that should probably NOT be used in pancreatitis cases (and in this case, triaditis) - what is the vet's reasoning for continuing this? You are NOT treating this on your own, are you, without the vet's instruction/supervision?

[christymexico]

Hi traci,
i think maybe you are misunderstanding me.
I do not treat my cat without vets supervision and advice. ever.
I am a volunteer nurse in mexico , so when I am there I do what he orders by email, as benny has never been sick in 12 years... when I am in nyc we go visit weekly for blood tests and speak daily by phone.

He does not have triad disease, as first thought.
His pancreas is fine, and there was only a slight thickening of the intestine.
I believe if my doctor thought he was in pain he would have told me.. He has been our vet via email since my cat and dog(who passed) for the last 10 years.he is the owner of his practice,and i trust him.
so benny...
He is eating and drinking well and no longer has diareah but he is still so tired.,poor kitty..and when benny and I are outside in our fenced yard, he is still walked on a leash. I leash trained him at 3 monhths and he loves it..we walk the beach together.
he is on the ursodial and denamarin now and famotadine. nothing more at the time
we will go in for yet another round of bloods on monday and hopefully we can go home on our friday flight.
i am at around 4grand with flights at this point and am staying on my friends couch. very ready to go home with a healthy happycat..but willing to stay if the bloods are not improving..
thanks again
christy and benny

[Traci]

Thanks for clearing up some of my questions. But, I still question the use of the ursodiol, would be interested in the vet's reasoning for using it.

Hopefully, the next bloodwork will show a more normalized ALT, but please do discuss with your vet, possibilities like IBD or gastroenteritis, both of which can cause symptoms that Benny first presented.

Upon returning to Mexico, please keep your vet updated on Benny's progress and please watch him like a hawk - sometimes those conditions that are semi-diagnosed (or assumptions), may wax and wane or seem to resolve but may occur again at any time (particularly under stress) - which may need extended treatment or further diagnostics to rule out something else occuring.

Likewise, I'm concerned when you say Benny is so tired. Please ask the vet if he has fully checked Benny's heart health/function, thyroid function etc.

Keep us updated please, and know we're thinking of, and hanging in there with Benny and you!

[christymexico]

hi well the ursodial is for his hepatitis..it has helped so much, he is hardly even yellow a bit in his ears now and his gums are super pink.
he will be on this for the next 2 months
yes, the biopsy of cholangiohep showed chronic with no infection and we believe it is an offshoot of the IBD..he will begin on predsloane next week for a 6 week course.
now we are home in mex..our last alt 160 and tbil 1...still high
but he is eating and drinking ..we continue with denamarin also.
his thyroid test was norman but we did feel 2 nodules a bit enlarged, although during sickness the results may be false neg h said, so will retest.
He is just so weak..he lost almost 4 pounds..i think the whole sickness was hard on him and slowly he will regain his strength. i am watching him like crazy. I was terrified to return but could no longer stay.

[christymexico]

oh yes, the med was cerenia..it saved the day..it was almost feeding tube time ...it was a wonder drug for him..
he is now eating fancy feast. i tried all in vet and pet store and he snubbed it..
i will follow up in 2 weeks here in mexico with full bloods and send to nyc
thanks so much for all the advice.
i know diabetes in pets, this is new territory..but we seem to be recovering..i know it may be chronic so will always stay on top of it..christy and benny

[Traci]

Christy, ask the vet if the famotidine dose may need to be reduced. If Benny isn't vomiting, and if the vet doesn't think esophagitis or stomach/intestinal ulcers are present, then the famotidine may not be necessary. It should always be used with caution in liver disease, and it should not be used long term UNLESS there is a very specific problem that warrants it's use.

Famotidine can also cause tiredness, although rare, it can occur in some cats.

[christymexico]

ahh ok
well i am tapering off his famotadine the past few days
i gave him for the trip cuz it was a long one from nyc and in the car..

he seems better each day..
he was out in sun today but still so weak..but jeez after what hes been through.
I cannot thank you enough. When we are here in Mex its so hard to get help.
He is still a bit yellow, cant wait for that to go...my last post had a typo
his tbili is 1.7
so its still up there..
will cut out the famod. in total manana

[christymexico]

Hi we are doing ok here..have to do bloods again next week.
we will begin predsilone tomaorrow 2. for 3 weeks then every other day the same dose..
I hope it gives him some energy..
christy and benny