Opinions on fatty liver/possible pancreatitis problem

I had your article faxed to the vet along with a plea to try 5mg
prednisone (or prenisolone) as well as SAM-e and Actigall if they are
available. I also asked about a few other things such as the possibility
of treating for cholangioheptatis without a diagnosis, and anti-vomiting
agents. She didn't call us back today. That frustrates me immensely,
considering we may be running on limited time here.

To the group:

I am thinking about getting a second opinion tomorrow, but I don't know
what the costs will be like. Will they charge to do bloodwork/x-rays all
over again? Will the original vet resent the fact that we went to someone
else, or be cooperative? Any anecdotes you have are fine.

If food is being vomited, what is a decent amount of water to give to
ensure she is not getting dehydrated? We are giving 6cc water in place of
food when she has vomited.

I am getting pressured to euthanize her, but I am firmly against it until
we have exhausted the options. We have spent so much money on diagnosis
and treatment ($500-800 so far, most of it was not on my watch) that it
hardly seems wise to give up at this point, especially considering no
treatment has even been attempted aside from dietary, and she has been
stable for the past week if not slightly improved from the rotten state
she was previously in. Why put her to sleep when you've barely tried and
she is not in any obvious pain?

I don't know if the vet is just plain stonewalling me, or if she is really
concerned about the complications of treating undiagnosed afflictions.
But what harm could it do to try Actigall, SAMe, or a low dose of
prednisone? Trying out the various Rx that would be prescribed anyway
seems to be cheaper than trying to obtain a conclusive diagnosis in cases
like this.

The current situation is that she is in a catatonic state most of the
time, has occasional diarrhea (but produced a solid turd today), seems to
be urinating normally, occasionally gets up and walks around when she has
something on her mind (like escaping the bathroom), and vomits
approximately 1 of 3 feedings, while not interested at all in eating on
her own. The only thing that seems to have been even mildly successful in
controlling the vomiting is Pepcid. Metaclopramide and Butorphonal (for
pain) had no observable effect on the vomiting or her general state. She
grinds her teeth occasionally, and seems to do it more frequently when she
is about to vomit. She does not seem overtly jaundiced anymore, so we may
have the fatty liver under control, but will need a blood panel to verify
that.

Ryan Underwood dumped this in
news
I am thinking about getting a second opinion tomorrow, but I don't
know what the costs will be like. Will they charge to do
bloodwork/x-rays all over again? Will the original vet resent the
fact that we went to someone else, or be cooperative? Any anecdotes
you have are fine.

I emailed you but I'm not sure if you got it. SamE (denosyl) and Actigal
were what my Shadow got for HL along with ABs when he first had the
feeding tube put in, no steroids while the feeding tube was in; it may
inhibit healing IIRC. You can take your bloodwork results and xrays with
you for a second opinion; you paid for them. The xrays may be on loaner
with a deposit but I've never understood that. Ask your vet flat out for
a referral to a specialist with the understanding that if you're denied
you're going anyways. If the bloodwork is old (ie, even a week or more,
the specialist may want to do it again but they can test for specific
values such as ALT, AlkPh, biliruben and not have to do a full workup.
When Shadow was sick he had weekly tests run on these values alone. As
for the emotions of your current vet, not sure. Mine referred us out
because they just weren't experienced enough, nor had the equipment to go
any further with a cat who wouldn't eat and was dropping weight quickly,
and was incredibly nauseous.

--
Cheryl

Ryan Underwood dumped this in
news
I am thinking about getting a second opinion tomorrow, but I don't
know what the costs will be like. Will they charge to do
bloodwork/x-rays all over again? Will the original vet resent the
fact that we went to someone else, or be cooperative? Any anecdotes
you have are fine.

I emailed you but I'm not sure if you got it. SamE (denosyl) and Actigal
were what my Shadow got for HL along with ABs when he first had the
feeding tube put in, no steroids while the feeding tube was in; it may
inhibit healing IIRC. You can take your bloodwork results and xrays with
you for a second opinion; you paid for them. The xrays may be on loaner
with a deposit but I've never understood that. Ask your vet flat out for
a referral to a specialist with the understanding that if you're denied
you're going anyways. If the bloodwork is old (ie, even a week or more,
the specialist may want to do it again but they can test for specific
values such as ALT, AlkPh, biliruben and not have to do a full workup.
When Shadow was sick he had weekly tests run on these values alone. As
for the emotions of your current vet, not sure. Mine referred us out
because they just weren't experienced enough, nor had the equipment to go
any further with a cat who wouldn't eat and was dropping weight quickly,
and was incredibly nauseous.

--
Cheryl

On Mon, 05 Apr 2004 21:43:43 -0500, Cheryl wrote:

I emailed you but I'm not sure if you got it.

Actually, my mom forwarded me your email (It went to her account because I
was at her house when I originally posted).

SamE (denosyl) and Actigal were what my Shadow got for HL along with
ABs when he first had the feeding tube put in

What sort of antibiotics did Shadow get? I'm not sure if Pnut received
any, because I wasn't there when it was done.

no steroids while the feeding tube was in; it may
inhibit healing IIRC.

I was thinking about that. I also thought of the possibility of giving
steroids while the tube was in, and if a positive response occurred,
allowing her to get herself into better shape, then removing the tube and
steroids later, letting the wound heal and dealing with the sickness
potentially returning, and then resuming steroids at a later point.
Unfortunately I thought about all that after faxing my vet. Maybe this is
why she is so reluctant to try steroids. I also specifically mentioned
prednisone when perhaps she is more comfortable with something else like
prenisolone. But I'm puzzled why we didn't at least get a call back to
discuss it.

You can take your bloodwork results and xrays with you for a second
opinion; you paid for them. The xrays may be on loaner with a deposit
but I've never understood that. Ask your vet flat out for a referral to
a specialist with the understanding that if you're denied you're going
anyways. If the bloodwork is old (ie, even a week or more, the
specialist may want to do it again but they can test for specific values
such as ALT, AlkPh, biliruben and not have to do a full workup.

I'm glad you have experience with this. Do "specialists" typically charge
"special" rates or should it be in the ballpark I can afford?

When Shadow was sick he had weekly tests run on these values alone. As
for the emotions of your current vet, not sure. Mine referred us out
because they just weren't experienced enough, nor had the equipment to
go any further with a cat who wouldn't eat and was dropping weight
quickly, and was incredibly nauseous.

Our vet seems pretty insistent on an ultrasound and/or biopsy before going
any further. I'm having trouble seeing the point in that, and getting
further explanation or getting her to let us try anything is proving
difficult. Like I said, I don't know enough about her to know whether it
is out of concern, incompetence, or malice. I highly doubt the last one,
and really do suspect the first. But I really wish there had not been a
lapse in communication today.

I just had my sister check the cat's gums today, and she claims that they
are pink and no longer light yellow like before. So perhaps we have the
liver under control. Maybe if we have another blood panel done, the
current vet would be a little more aggressive about doing something if it
shows that we have significantly reduced the HL over the past week.

Thanks for your thoughtful reply!

On Mon, 05 Apr 2004 21:43:43 -0500, Cheryl wrote:

I emailed you but I'm not sure if you got it.

Actually, my mom forwarded me your email (It went to her account because I
was at her house when I originally posted).

SamE (denosyl) and Actigal were what my Shadow got for HL along with
ABs when he first had the feeding tube put in

What sort of antibiotics did Shadow get? I'm not sure if Pnut received
any, because I wasn't there when it was done.

no steroids while the feeding tube was in; it may
inhibit healing IIRC.

I was thinking about that. I also thought of the possibility of giving
steroids while the tube was in, and if a positive response occurred,
allowing her to get herself into better shape, then removing the tube and
steroids later, letting the wound heal and dealing with the sickness
potentially returning, and then resuming steroids at a later point.
Unfortunately I thought about all that after faxing my vet. Maybe this is
why she is so reluctant to try steroids. I also specifically mentioned
prednisone when perhaps she is more comfortable with something else like
prenisolone. But I'm puzzled why we didn't at least get a call back to
discuss it.

You can take your bloodwork results and xrays with you for a second
opinion; you paid for them. The xrays may be on loaner with a deposit
but I've never understood that. Ask your vet flat out for a referral to
a specialist with the understanding that if you're denied you're going
anyways. If the bloodwork is old (ie, even a week or more, the
specialist may want to do it again but they can test for specific values
such as ALT, AlkPh, biliruben and not have to do a full workup.

I'm glad you have experience with this. Do "specialists" typically charge
"special" rates or should it be in the ballpark I can afford?

When Shadow was sick he had weekly tests run on these values alone. As
for the emotions of your current vet, not sure. Mine referred us out
because they just weren't experienced enough, nor had the equipment to
go any further with a cat who wouldn't eat and was dropping weight
quickly, and was incredibly nauseous.

Our vet seems pretty insistent on an ultrasound and/or biopsy before going
any further. I'm having trouble seeing the point in that, and getting
further explanation or getting her to let us try anything is proving
difficult. Like I said, I don't know enough about her to know whether it
is out of concern, incompetence, or malice. I highly doubt the last one,
and really do suspect the first. But I really wish there had not been a
lapse in communication today.

I just had my sister check the cat's gums today, and she claims that they
are pink and no longer light yellow like before. So perhaps we have the
liver under control. Maybe if we have another blood panel done, the
current vet would be a little more aggressive about doing something if it
shows that we have significantly reduced the HL over the past week.

Thanks for your thoughtful reply!

You should be giving your cat sub-q fluids daily while this is going on,
especially since your cat is vomiting. My cat Sadie had symptoms very
similar to what you are going through (she was diagnosed via ultrasound
with a blocked bile duct that eventually led to her death 9 months later
as surgery wasn't an option for her.) I gave her about 200 mls of fluids
every day for months. She was also on an unusually high dose of
prednisolone (anything less made her get very sick), and also received
Sam-E and milk thistle every day along with metoclopramide and Zantac
(it has less drug interactions than Pepcid) and I believe it helped a
great deal. I also gave her cyproheptadine to stimulate her appetite and
slippery elm as well to help soothe her digestive system.
I would highly recommend you get a second opinion ASAP. If you have a
university vet school near you that would be the best place to go,
otherwise get a referral to see an internal medicine specialist if you
have one in your area.

Megan



"The only thing necessary for the triumph of evil is for good men to do
nothing."

-Edmund Burke

Learn The TRUTH About Declawing
http://www.stopdeclaw.com

Zuzu's Cats Photo Album:
http://www.PictureTrail.com/zuzu22

"Concerning all acts of initiative (and creation), there is one
elementary truth the ignorance of which kills countless ideas and
splendid plans: that the moment one definitely commits oneself, then
providence moves too. A whole stream of events issues from the decision,
raising in one's favor all manner of unforeseen incidents, meetings and
material assistance, which no man could have dreamt would have come his
way."

- W.H. Murray

You should be giving your cat sub-q fluids daily while this is going on,
especially since your cat is vomiting. My cat Sadie had symptoms very
similar to what you are going through (she was diagnosed via ultrasound
with a blocked bile duct that eventually led to her death 9 months later
as surgery wasn't an option for her.) I gave her about 200 mls of fluids
every day for months. She was also on an unusually high dose of
prednisolone (anything less made her get very sick), and also received
Sam-E and milk thistle every day along with metoclopramide and Zantac
(it has less drug interactions than Pepcid) and I believe it helped a
great deal. I also gave her cyproheptadine to stimulate her appetite and
slippery elm as well to help soothe her digestive system.
I would highly recommend you get a second opinion ASAP. If you have a
university vet school near you that would be the best place to go,
otherwise get a referral to see an internal medicine specialist if you
have one in your area.

Megan



"The only thing necessary for the triumph of evil is for good men to do
nothing."

-Edmund Burke

Learn The TRUTH About Declawing
http://www.stopdeclaw.com

Zuzu's Cats Photo Album:
http://www.PictureTrail.com/zuzu22

"Concerning all acts of initiative (and creation), there is one
elementary truth the ignorance of which kills countless ideas and
splendid plans: that the moment one definitely commits oneself, then
providence moves too. A whole stream of events issues from the decision,
raising in one's favor all manner of unforeseen incidents, meetings and
material assistance, which no man could have dreamt would have come his
way."

- W.H. Murray

On Mon, 05 Apr 2004 22:47:10 -0500, zuzu22 wrote:

You should be giving your cat sub-q fluids daily while this is going on,
especially since your cat is vomiting.

Doh! Nobody told us that. We were under the impression that the water in
her food and what was used to flush her feeding tube would be sufficient.
She does appear to be mildly dehydrated, as the skin doesn't snap back
quickly when pinched. She will definitely be getting sub-q fluids
tomorrow.

My cat Sadie had symptoms very similar to what you are going through
(she was diagnosed via ultrasound with a blocked bile duct that
eventually led to her death 9 months later as surgery wasn't an option
for her.)

Was this a gall stone, or some other form of blockage? Why did surgery
turn out not to be an option? We checked for gall stones on the X-rays,
but it is possible that something else is amiss. We didn't know if
spending $250 on an ultrasound or even more on tissue biopsies would be
likely to turn up anything that would be treatable anyway. In your case,
it sounds like it did not, unless there was some specific reason the bile
duct blockage was not treatable.

I gave her about 200 mls of fluids every day for months. She was also
on an unusually high dose of prednisolone (anything less made her get
very sick), and also received Sam-E and milk thistle every day along
with metoclopramide and Zantac (it has less drug interactions than
Pepcid) and I believe it helped a great deal. I also gave her
cyproheptadine to stimulate her appetite and slippery elm as well to
help soothe her digestive system.

We are giving her vitamin E and milk thistle in her A/D and I/D. We mix a
can of food with 32 to 40 cc of water and try to feed 25-30cc at a time.
Usually she will only keep this down after having been given some acid
reducer.

I would highly recommend you get a second opinion ASAP. If you have a
university vet school near you that would be the best place to go,
otherwise get a referral to see an internal medicine specialist if you
have one in your area.

Thanks.

On Mon, 05 Apr 2004 22:47:10 -0500, zuzu22 wrote:

You should be giving your cat sub-q fluids daily while this is going on,
especially since your cat is vomiting.

Doh! Nobody told us that. We were under the impression that the water in
her food and what was used to flush her feeding tube would be sufficient.
She does appear to be mildly dehydrated, as the skin doesn't snap back
quickly when pinched. She will definitely be getting sub-q fluids
tomorrow.

My cat Sadie had symptoms very similar to what you are going through
(she was diagnosed via ultrasound with a blocked bile duct that
eventually led to her death 9 months later as surgery wasn't an option
for her.)

Was this a gall stone, or some other form of blockage? Why did surgery
turn out not to be an option? We checked for gall stones on the X-rays,
but it is possible that something else is amiss. We didn't know if
spending $250 on an ultrasound or even more on tissue biopsies would be
likely to turn up anything that would be treatable anyway. In your case,
it sounds like it did not, unless there was some specific reason the bile
duct blockage was not treatable.

I gave her about 200 mls of fluids every day for months. She was also
on an unusually high dose of prednisolone (anything less made her get
very sick), and also received Sam-E and milk thistle every day along
with metoclopramide and Zantac (it has less drug interactions than
Pepcid) and I believe it helped a great deal. I also gave her
cyproheptadine to stimulate her appetite and slippery elm as well to
help soothe her digestive system.

We are giving her vitamin E and milk thistle in her A/D and I/D. We mix a
can of food with 32 to 40 cc of water and try to feed 25-30cc at a time.
Usually she will only keep this down after having been given some acid
reducer.

I would highly recommend you get a second opinion ASAP. If you have a
university vet school near you that would be the best place to go,
otherwise get a referral to see an internal medicine specialist if you
have one in your area.

Thanks.

Doh! Nobody told us that. We were under
the impression that the water in her
food and what was used to flush her
feeding tube would be sufficient. She
does appear to be mildly dehydrated, as
the skin doesn't snap back quickly when
pinched. She will definitely be getting
sub-q fluids tomorrow.

Make sure to consult with your vet about how much you should give as too
much can be harmful. Generally speaking, giving 100 mls a day to even a
healthy cat is pretty safe and is more or less a "maintenance" dose.

My cat Sadie had symptoms very similar
to what you are going through (she was
diagnosed via ultrasound with a blocked
bile duct that eventually led to her
death 9 months later as surgery wasn't
an option for her.)

Was this a gall stone, or some other
form of blockage?

The best we could come up with was that chronic inflammation had caused
scar tissue to develop and block the bilr duct (she had IBD for some
time before this happened and that may have been a contributing factor.)

Why did surgery turn
out not to be an option?

Bile duct surgery is a very delicate and not always successful procedure
and it was very possible that if they were able to fix it that the scar
tissue would develop again and she'd be right back where she started. At
the time when this was discussed Sadie, while still happy and having a
decent quality of life, also had so many issues at that point that
putting her through such an invasive surgery was likely more than she
would have been able to handle. I was really torn about what the right
thing to do for her would be and did have an appointment with the
specialist at the U to discuss it further, but her chest suddenly
started filling with fluid and couldn't be controlled so I had no choice
but to make the decision to euthanize and we never made it to the
appointment. :-(

We checked for
gall stones on the X-rays, but it is
possible that something else is amiss.
We didn't know if spending $250 on an
ultrasound or even more on tissue
biopsies would be likely to turn up
anything that would be treatable anyway.
In your case, it sounds like it did not,
unless there was some specific reason
the bile duct blockage was not
treatable.

When you deal with an issue like this, it really is a matter of going
step by step and ruling things out using whatever technology is
available. If it were me, I would go ahead with the ultrasound as it is
a good tool for figuring out what is wrong and can give a much better
picture than an xray. Yes, there is a chance that it won't reveal
anything, but there is also the chance that it may. You won't know until
you try, and even if you do get a definitive diagnosis but it turns out
to be something that isn't treatable, at least you will have some
answers and be able to make informed decisions rather than guesses.

Megan



"The only thing necessary for the triumph of evil is for good men to do
nothing."

-Edmund Burke

Learn The TRUTH About Declawing
http://www.stopdeclaw.com

Zuzu's Cats Photo Album:
http://www.PictureTrail.com/zuzu22

"Concerning all acts of initiative (and creation), there is one
elementary truth the ignorance of which kills countless ideas and
splendid plans: that the moment one definitely commits oneself, then
providence moves too. A whole stream of events issues from the decision,
raising in one's favor all manner of unforeseen incidents, meetings and
material assistance, which no man could have dreamt would have come his
way."

- W.H. Murray