If this is your first visit, be sure to check out the FAQ by clicking the link above. You may have to register before you can post: click the register link above to proceed. To start viewing messages, select the forum that you want to visit from the selection below. |
|
|
Thread Tools | Display Modes |
#1
|
|||
|
|||
Opinions on fatty liver/possible pancreatitis problem
We have a 6 yr old tabby who was recently introduced (February) to a new
member of the house, a maine coon mix from the local shelter. He brought what appeared to be a cold home with him, which he transmitted to Pnut. During most of February, she was dealing with the effects of the cold or upper respiratory infection. The new cat completely recovered and is fine now, and never had a problem to begin with. In early March, we noticed Pnut was looking rather grim. We started trying to take stock of when she was eating, and couldn't determine if she was in fact eating sufficiently. After a week of moping around and looking rotten, we took her to the vet on March 19. The vet diagnosed jaundice and fatty liver, and sent us home with a feeding tube and a bunch of Hill's A/D to feed her. It has been extremely difficult to keep any food down her for the past two weeks. She will vomit at least once per day on average, and went a few days when we were unable to get her to keep anything down. I will elaborate on our feeding strategy further down. Apparently we had not paid enough attention to her when she was ill with the cold to realize she had stopped eating to the point where she was losing weight and developing hepatic lipidosis. The house is full of busy people though, so when she is depressed and hiding due to an illness, keeping tabs on her isn't exactly the first thing on our minds. From the testing at the vet, the blood work looked normal except for elevated liver values and slightly elevated pancreas values (though I am told the latter is rather meaningless in general). An x-ray turned up no gall stones or obstructions. The vet has been reluctant to give any more information or suggestions besides to have an ultrasound done at a cost of $250. I am reluctant to do this because I feel very strongly that the cat is suffering a pancreatitis and/or I.B.S. inflammation episode brought on by the previous month's cold and/or the stress of being exposed to a new cat. It seems that the ultrasound will only serve to rule out terminal illness, and not provide a conclusive diagnosis in any case. Before you dismiss the self-diagnosis I just tossed out there as a logical leap, let me give you a bit of background. In late 2002, after a previous cat died of unrelated problems (NRG anemia), Pnut underwent a similar episode to what is happening now, though much less severe. She simply stopped eating, developed jaundice, was diagnosed with fatty liver, and a feeding tube was installed. We fed her A/D until she started eating on her own again. She has always had periodic random vomiting during her adult life, maybe once per few weeks on average. Most of the time it is a clear liquid similar to bile. We could never tell what would bring this on. She also loves to raid the trash despite our best attempts to keep her out of it, which seems to be a risk factor for chronic pancreatitis. Right now, we are trying to keep her nourished with Hill's A/D and recently I/D which I tried to see if it would have any effect. Anti-vomit pills (Metaclopramine) and painkiller (Butorphanol) have little to no effect on the vomiting. The only thing that seems to help her keep food down is giving antacid, 1/4 of a 10mg pepcid pill 1 hr before eating for the first time that day. If she misses that dose, she will vomit all feedings until it is given. If she gets that dose, she usually will not vomit until an evening feeding. I tried I/D as an attempt to "go easier" on her digestive system than A/D. An initial feeding was kept down OK, but an evening feeding (10 hrs after antacid was administered) was vomited 2.5 hrs after feeding. In a nutshell, we give antacid in the morning, then try to feed at least 20cc and at most 40cc of a mixture of one can A/D or I/D with 32cc warm water, three times a day. If she vomits, we cease feeding for at least six hours and try again later. We flush the feeding tube with 5cc warm water. If she vomits, she will vomit anywhere from immediately to 3 hours after a feeding. She is passing vaguely normal-looking fecal matter (occasionally diarrhea) and appears to be urinating regularly, so at least something is working properly. She is very likely to vomit when agitated or disturbed, so we leave her in a closed but ventilated bathroom most of the day. Only the bathroom's visitors disturb her, and she occasionally vomits when a visitor has just used the facility. (The smell?) The vet suspects triad syndrome, and so do I, though I more highly suspect a simpler combination of pancreatitis and fatty liver that are working in cahoots with each other (similar to how cholangiohepatitis and pancreatitis provide a feedback loop for each other in a triad syndrome situation). It seems I am in a textbook catch-22 situation. To address the fatty liver/jaundice, I need to feed her enough to prevent body mass from being re-appropriated as an energy source. But if I feed her, it would aggravate any pancreatitis that is present. The possibility of a I.B.S. episode instead of pancreatitis also exists, but the vet will not prescribe corticosteroids without ruling out a pancreatitis episode (since they may make an already difficult pancreatitis situation even worse). Ruling out the pancreatitis is done through the ultrasound, and I am told that even if the pancreas is not visible on the ultrasound, that is not a conclusive diagnosis one way or the other, just a best guess. Also, to avoid aggravating pancreatitis, I should be feeding high-carb foods. But it is questionable as to whether they will provide sustainable nutrition to a critter whose body is designed to run primarily on proteins and fat. I (and Pnut) am up a creek. I can't afford the ultrasound or any more conclusive diagnosis involving tissue biopsies. I can't afford inpatient treatment. I _can_ afford the diet/Rx foods and the time to spend with her concocting her food mix, feeding through the tube and cleaning up messes (as I have throughout the last week). However, I will not be the primary caretaker in the coming weeks, so I need to come up with some kind of protocol that "covers all the bases" so to speak. I have 3 scenarios I wish the group to consider: 1) Triad syndrome. I.B.S. causes pancreatitis and cholangiohepatitis, followed by hepatic lipidosis. 2) Hepatic lipidosis caused by not eating due to acute pancreatitis or a chronic flare-up. 3) Hepatic lipidosis caused by not eating due to I.B.S. flare-up. Liver disturbance triggers pancreatic reaction. Sort of an "acute" triad syndrome. I have looked at other possibilities, such as parasites, FIP, distemper, etc. None seem to fit the circumstances and none were even suggested by the vet. The vet has generally agreed that we are probably looking at triad syndrome or something approximating it. But she has offered very few suggestions for treatment. She suggested cancer at one point, but I can't help but think cancer would be an _extreme_ coincidence considering the circumstances (new cat in the house, new cat brought a cold, and anorexia was undetected for a period of time). Why would a cancer wait until exactly now to start generating symptoms? How do I explain the previous episode and chronic random vomiting? It seems (from reading) that the only avenue of success with pancreatitis is to withhold food and water for at least 24 hours, preferably 48; but more than 24 hours requires hospitalization with IV fluids. I am curious how successful these approaches typically are. I have a feeling I would be laughed out of the state if I suggested an approach that included withholding food to my vet, with the cat already suffering from fatty liver. Is 24 hrs typically safe, assuming the cat is given under-the-skin fluids to support her that day? Is this to be considered a reasonable tradeoff between trying to solve the highly suspected pancreatitis, and not aggravating the fatty liver/wasting problem too much in the meantime? What I need is options. I would like any of the following: - Suggestions for treatment _in the case of_ one of the aforementioned disease scenarios, to give me an idea of the scope of the problem I'm likely to be dealing with. This will help me decide whether or not euthanization is the best option for us in the long run, as much as it would pain me to make that choice. - Suggestions to pass along to the vet. She may not have all the bases covered in diagnosis, nor have relayed all the options to me. If I can "jog her memory" or get her to do some research on possible angles, it may help us all out. - Suggestions to stabilize the current scenario or how to improve on my current methods of feeding/nursing, to pass on to the primary caretaker for the next week. Anecdotal suggestions are ok, i.e. "This worked for Fizban when he showed the symptoms you have described". I am looking for dietary suggestions (_what_ is good to feed her) as well as procedural suggestions (_when_ and _how much_ is good to feed her). Remember that I have been nursing her for two weeks. She is stable and not in a state of shock, but her stable state is not exactly that great, and may be invisibly deteriorating. I would like to try to target the most likely underlying problems, since I don't have the resources for a proper diagnosis (and such diagnosis seems to be nebulous at best). As of today, she was given antacid in the morning, given 20cc I/D mixture at 2:00pm, which she kept down, given 20cc I/D at 7:00pm, which was vomited at 9:30pm (perhaps due to a disturbance), and I gave 10cc water at 11pm. Tomorrow is Sunday, so I won't be able to see a vet for about 36 hours at this point. Help me formulate a plan of action! I'd like to go in to her office Monday armed with information instead of frustration. Thanks for any insight your experiences can provide. |
Thread Tools | |
Display Modes | |
|
|