# When NOT to treat a cat with hepatic lipidosis?



## 81lives (Jul 12, 2011)

I keep reading that 'when caught in time, there is a good chance of survival,' but I can't seem to find any information describing what 'caught in time' looks like--either in enzyme ranges or the physical symptoms of the cat. I am trying to find out at what point the cat is considered too far along in the disease to recover, or, in other words, at what point the cat should not be put through an attempt at treatment. Does anyone here have any experience or knowledge about this?

One of the cats in the rescue I work with, Spot, was taken to the emergency vet clinic Wednesday night and diagnosed with liver disease. The vet suspects that the cat had been eating less out of grief (after being surrendered by her owner) resulting in fatty liver disease. I don't know the details of the bloodwork, except that the bilirubin was 12. The ER vet hospitalized the cat with IV fluids, prednisone, and a couple of other things. The enzymes had not improved by Friday morning, and the ER vet felt her chance of survival was not great and advised not continuing with treatment. One of our volunteers took her home that afternoon for 'hospice' care, until she becomes uncomfortable. To my knowledge, she has offered food but is not force-feeding or administering fluids.

These decisions are always hard for me, as I tend to want to try everything possible to save the cat, but I am wondering if giving up is the right choice in this case. I keep reading that using some sort of feeding tube is fairly routine with this disease, and that it takes time to see a change in enzyme values (which won't change at all without food--right?). I know there is risk involved in the procedure to insert the tube, but I guess I am not clear on what sort of shape the cat would need to be in to survive the surgery. This cat is obviously not feeling her best but she is still acting relatively normal--alert, responsive, talkative, able to jump and walk around, wants to be petted, etc. Would it be worthwhile to try? And isn't doing nothing essentially allowing the cat to starve to death?

I apologize for my ignorance; I know very little about this disease, and my family has been led down the premature euthanization route by this ER clinic in the past so I just want to make sure we do right by this kitty.


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## Carmel (Nov 23, 2010)

I'd be syringe feeding the cat.

Recently my aunt's cat had pancreatitis and I was force feeding her roughly 5 oz of food daily for two weeks. In that time she just sat on the bed mostly unmoving unless she had to use the litter box, when she would jump up and down off the bed and be able to walk over to it. We also used an appetite stimulant. She got over her sickness and is back to normal now... if we hadn't syringe fed her an hour or two daily she in all likelihood would not be alive.

I think not trying to give the cat a chance is awful... how about contacting the one that surrendered the cat and letting them know its condition?


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## Venusworld21 (Oct 23, 2012)

Our girl had this, twice. The first time, she was 7 years old and had an attack of pancreatitis (unknown origin). We didn't realize it until one day I picked up the 17 lb cat and almost threw her over my shoulder. We rushed her to the vet where they immediately diagnosed hepatic lipidosis (the pancreatitis was painful and caused her to not eat. Since she was fat to start with, the fat being broken down by her body and dumped into her bloodstream shut down her liver). Her ears were yellow (ears and eyes are, apparently, the easiest places to see the jaundice). She stayed at the vet for two more days. After that she stopped eating and they said we could either put her down or do the feeding tube. They put in the feeding tube and after another 5 days at the vet (so a week total) she came home. From there I spent another 3 weeks tube feeding her and pushing 5 different kinds of medicine down her. The tube started to infect, and she was allergic to the "main" type of antibiotics and impossible to pill, but starting to eat on her own again, so we took a risk and had the vet remove the feeding tube to stop the spread of infection. She ended up eating on her own and recovering.

A year later, for unknown reasons, the pancreatitis returned. We caught it much sooner this time, as we'd been watching her like a hawk the entire year after her initial illness, but eventually she got to the point where she wasn't eating again. She HATED vets and pills and the entire process, and she really didn't seem to want to go through it again. Since that was her second pancreatitis flare up, it was likely to be chronic and recur throughout her life. We made the sad choice to put her down instead of putting her through another month or more of treatments she hated which she may or may not have survived. She was only 8 years old.

From a rescue standpoint....the treatments our girl had were very expensive (well over $1500) and I know that is very hard for a rescue to bear for a single, adult cat. If she were "not young" (over 5 or so), I would probably agree with the decision not to pour money into her. However, if she's not eating she will die. If they're going to let her die, I feel it would be more humane to put her down than to provide hospice care. Is this rescue no-kill? Is that why they won't just euth her?


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## Stryker (Apr 2, 2007)

Hi *81lives* ! ('gotta tell you, that username's got me scratching my head!) (9 cats, maybe?:wink

First, I have to say that this story is really gripping for me...my focus is always about the cat and, right from the get-go on this one, my blood pressure is already up there....



81lives said:


> I keep reading that 'when caught in time, there is a good chance of survival,' but I can't seem to find any information describing what 'caught in time' looks like--either in enzyme ranges or the physical symptoms of the cat...


I can't give you numbers ranges immediately but, perhaps with some digging, perhaps I can pull some up.....BUT, just on the face of it, this is not a cat that I would be giving up on, based solely on this:


> This cat is obviously not feeling her best but she is still acting relatively normal--alert, responsive, talkative, able to jump and walk around, wants to be petted, etc.


and, then supported by (what appears to be) near-negligence, certainly ignorance by way of, perhaps, inexperience on the part of this "Vet". TREATMENT for HL is *FEEDING* and supporting the liver's recovery with *specific supplementation*, and *TIME *(there are a couple of others, too)....BUT, to expect to see improvement in 30 hours is simply incomprehensible (which is where the suggestion of incompetence comes from).

Before I go any further, I need to know what influence you could bring to bear on the situation. Are you in any position of authority in the org? Could you convince someone in authority to turn this decision around? Are you willing/able to take on the cat yourself?

Given the cat's current "presentation", it sounds to me that it's likely the HL could be reversed (at minimal cost) with


aggressive assist-feeding by syringe
direct liver treatment with Milk Thistle PLUS SAMe (usually Denamarin is used)
perhaps some minor additions, for nausea/stomach acid etc

Ideally, a feeding tube should be used (and its placement is no big deal/concern) - some reading for you here: Feeding Tubes For Cats by Lisa A. Pierson, DVM :: assisted feeding of cats, feeding sick cats - that said, a cost-estimate (from a COMPETENT Vet) would allow for a rational decision to be made on going that route.



> I am trying to find out at what point the cat is considered too far along in the disease to recover, or, in other words, at what point the cat should not be put through an attempt at treatment.


So, in a nutshell, if Spot has no other major health issue, he is certainly (based on your description of his current "presentation") NOT 'too far along/gone......BUT, the sooner the decision to treat is made, the better.

(There's also the issue of this "Vet" to consider...any "workarounds" possible on that front?)


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## 81lives (Jul 12, 2011)

Thanks for the input, guys. After researching hepatic lipidosis and reading your replies, I plan to talk to our org's director today about trying to save this kitty. Question for those of you who have dealt with this--did you give fluids as well as food? Or was your kitty drinking water on its own?

*Carmel*--Thank you for sharing your experience. It really helps to know that your kitty just sort of laid around at first and still bounced back. This gives me hope that Spot's condition could improve, and that force feeding her could be worth it. Unfortunately, Spot's former owner surrendered his cats because he was losing his home; he is basically homeless now. Our director had a contact # for him at a friend's house early on, and she spoke to him about the cats not wanting to eat; he said he would try to come and see them (the friend lived about an hour away), but he never did, and the director has not been able to get in touch with him since. This is such a sad, heartbreaking situation.

*Venusworld21*--Thank you as well for sharing your experience. I am so sorry that you lost your precious kitty.  It did help to hear that your kitty had lost a good bit of weight and was jaundiced, and yet your vet was still able to place the feeding tube. I will keep this in mind going forward. I am not sure of the cat's age, but she is under 5 years and would be highly adoptable (long hair, exotic looking, very sweet). Plus, the tragedy of the whole situation (being surrendered and growing sick from grief) makes me want to help her if possible. Part of the decision not to pursue treatment was the ER vet's statement that the feeding tube would cost 'several thousand dollars;' that doesn't sound quite accurate to me, but even if it was, it sounds like syringe feeding is also an option. Yes, we are no-kill; however, we do euthanize cats who are too ill to recover. I'm not really sure what the thinking was behind going the hospice route this time, but I totally agree; in this case, it seems cruel to do nothing.

*Stryker*--Yep, you guess it--9 cats! :lol:

I am right with you on the elevated blood pressure. I have never had a positive experience at this emergency clinic; and this one was no different. After I left her at the clinic Wed night, it was nearly impossible to get ahold of someone to find out her condition, and in all of our interactions, they were far more interested in money than meeting the needs of the cat. Thanksgiving day, the director and I were both calling trying to find out what was going on; they did not answer or return our calls for 5 hours, and I only managed to learn something by finally getting the receptionist. When she put me through to the doctor, the doctor acted like it was an annoyance to have to talk to me. 

Anyway, when I started doing some reading about this disease, I was really confused that this vet was basing the cat's chance of survival on whether her values had changed in a single day and without any feeding whatsoever. When I did talk to them Thursday afternoon, they said she was improving--sitting up, etc. So at that point we're thinking she is going to make it; then a different volunteer called on Friday since I had to work, and I heard secondhand what the vet had to say. This is the volunteer who took Spot for 'hospice care.' It took me a bit to step back and question the prognosis and do some research; and let's just say now I am extremely frustrated. I just hope and pray it is not too late to do something as a result of this vet's uninformed recommendations.

To answer your questions, I am not in a position of authority exactly, but I would say I am in a decent position to convince our director. I am a long time volunteer, and I go to her house several times a week to help care for the cats. I am willing and able to step up for this cat; none of the treatments you mentioned would present a problem for me. 

The vets she saw so far were all part of the 24-hour emergency clinic, but they are not vets we work with regularly. We have several in the area who treat our cats; I like some more than others. I think we will need to find one who will work with us to try to treat the cat, because even without the feeding tube she will probably need something for nausea to prevent her from drooling or vomiting the food.

I am going to speak to our director about all of this when I see her in a few hours. Wish me luck! I will let you all know how it goes.


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## Venusworld21 (Oct 23, 2012)

Do they have a non-emergency vet they can work with on this? Emergency vets are always more expensive of course. My "regular" vet was the one who did our girl's feeding tube. The $1500 I threw out was total cost of care (including a week at the vet's office, special food, medications, and the surgical placement and then removal of her feeding tube. They also did an ultrasound of her pancreas). I realize that rates vary from place to place, but "thousands" for a feeding tube is ridiculous. I want to say Tinners' was around $300-400 (It was 3 years ago). What area are you located in? I'm sure there has to be a cheaper vet nearby than the emergency vet.


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## Venusworld21 (Oct 23, 2012)

On the syringe feeding, you're going to be liquifying whatever you put down them (our girl's concoction was wet food mixed about half and half with warm water to make a "soup"consistency, and then I ground up all the pills into powders and added them into that) so in theory that should be enough water for her. We didn't give Tinners any extra water, besides what she was already getting as part of her tube feedings.


The other thing with this is that time is critical. It's great that she's doing alright now, but if she goes very long without eating, or eating insufficiently, it will continue to get worse. If you're going to tube feed her and find a new vet, start asap. As I mentioned above, our girl went from "normal" to being on death's door in less than a week.


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## Carmel (Nov 23, 2010)

Venusworld21 said:


> The $1500 I threw out was total cost of care (including a week at the vet's office, special food, medications, and the surgical placement and then removal of her feeding tube. They also did an ultrasound of her pancreas).


See, that's _super_ cheap. I paid 1,200 dollars for a three day vet stay when the cat had pancreatitis. All that was for was IV fluids and their administration and a few medications they tried. It was 1,600 total and all that incorporated on top of the vet stay was some x-rays. If we'd done the ultrasound, which we held back on, that would've been 400+ more dollars. If we'd wanted a feeding tube that would've been 1,000+ dollars all on its own.

Based around my experiences that's why I'm suggesting force feeding with a syringe, if you have the time and the cat isn't super resistant it is much more cost effective. Make the can of food as think as you can while still allowing the syringe to be able to take in the food. You don't need to add much water... but it still takes a long time to do.


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## Venusworld21 (Oct 23, 2012)

I definitely agree that syringe feeding is the route to go, if kitty will tolerate it. But "thousands" in the plural, seems really high for a feeding tube. I pay human medical claims all day--it'd be high for a human one as well. 

(Cost breakdown on that $1500 was roughly $100/day for the vet stay, and most of what they did was fluids/IVs, so $700. Ultrasound was $300, so $1000 total. $300 or so for feeding tube, so $1300 total and then another couple hundred for food and meds.)


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