# High bilirubin count



## NatalieLucy (Jul 2, 2010)

My 11yr old Cat Liza isn't doing to well. Noticed a couple of days ago she was off her food and not drinking anything she got really weak and so we took her into the vet. She has lost 5lbs and was really dehydrated they have her on an IV drip tonight. Her blood tests came back and her bilirubin was high. Is this a good indication of Liver disease? Is this curable, or life threatening? The vet said when she's got more energy they can perform a biopsy or u/s, which will be expensive. I really do not know what to do, I'd feel really guilty if we put her to sleep and find out her problem was curable. Anyone had any experiences with their cat did they get better?


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## laurief (Jun 22, 2008)

I'm sorry to read of Liza's illness. The following link will be very helpful to you in deciphering her blood test results:

http://www.broadwayvh.com/site/view/832 ... 92sm55i901

Make sure you get copies of all of her test results from your vet so you can see for yourself which blood values of out of normal range.

This is what that site has to say about high bilirubin:

"Bilirubin is a product in red blood cells (RBC). When it is released from natural or diseased destruction of red blood cells, it is processed (or conjugated) in the liver. Therefore, a high bilirubin usually indicates either excessive RBC destruction (such as with haemobartonella infections or immune mediated hemolytic anemia) that is overwhelming the liver’s ability to process it, or when there is primary liver disease, especially a biliary obstruction, which disables the liver’s ability to process the bilirubin. When this occurs, abnormally high amounts of bilirubin start to build up in the blood. If the bilirubin gets too high, the skin of your pet can start to turn jaundiced, or yellow colored, as a result of this buildup in the blood. This is most often noted in the whites of the eyes, inner ears and on the gums."

Is Liza jaundiced? If so, I would assume that a biliary obstruction is likely, which I believe can be surgically corrected. Haemobartonella can also be cured in many cats. Here's an article on that:

http://www.peteducation.com/article.cfm ... 16&aid=292

You won't know Liza's prognosis until you get a firm diagnosis of the problem.

Please keep us updated on her condition. I will keep good thoughts for a full recovery.

Laurie


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## Heidi n Q (Nov 22, 2006)

My Malibu was diagnosed with Hepatic Lipidosis, or fatty liver. Yes, this is life-threatening. Yes, sometimes it is curable, but treatment is intense and you must be dedicated. My Mallie had to be force-fed to supply her systems with nourishment, stop the effects of her body trying to turn fat-to-fuel which clogged her liver and replenish the body reserves she had lost. She recovered.
Malibu's issue was brought about by an unknown illness that caused her to stop eating and made her body try to utilize itself. You need to know if *this* is your cat's issue or if it is a physiological issue requiring surgical intervention.
Best of luck,
heidi =^..^=


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## SpaceyKP (May 8, 2010)

Did her blood work show any other problems, in addition to high bilirubin?


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## NatalieLucy (Jul 2, 2010)

Thank you all for your messages! It's very frustrating because our Vet won't tell us much! She just said she had a high bilirubin count as she suspected because her Urine was a sticky yellow color. She didn't mention anything else that was abnormal. Liza is still in the vet and is still on IV drip, she did eat this morning which is good. My vet was going to ween her off the fluids to see if she will drink on her own and not get so dehydrated. What is frustrating me is she won't tell us anything else! Ok so we know she's got a high bilirubin count but what is causing this, what diagnostic testing do we have to do to find out what's causing the problem and is it curable or life threatening? She did mention a biopsy but she said Liza wasn't strong enough yet for that kind of testing. I would like to take her home tomorrow for the long weekend as we are looking at a high enough bill already but I worry about her getting dehydrated again. We can probably take some fluid bags home, but I don't know if I can put them in properly. 

Laurie - Thanks for the link! Liza didn't look jaundiced she wasn't yellow. 

I just want to know what we're up against and if me and my husband have to prepare ourselves for her passing. We adopted her from the humane society 6yrs ago she's had her fair share of suffering she was abused by some cruel person. I can't bear to see her so sad and sick. But I also don't want to give up on her just yet especially if her condition can be cured. 

Sorry for my long post.


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## laurief (Jun 22, 2008)

NatalieLucy said:


> Thank you all for your messages! It's very frustrating because our Vet won't tell us much!


Then it's time to find a new vet or to get VERY INSISTENT with your current one. Don't allow your vet to blow you off. You are not paying her to NOT inform you of your cat's condition. She has a professional obligation to fully inform and advise you. It is NOT ACCEPTABLE for her to withhold information from you, and you're the only one who can put a stop to that unprofessional behavior.



> She just said she had a high bilirubin count as she suspected because her Urine was a sticky yellow color. She didn't mention anything else that was abnormal.


Insist on copies of all of Liza's test results so that you can research the findings yourself. I can direct you to various websites on which you can begin to familiarize yourself with test results interpretations. The sites won't make you a diagnostician, of course, but they will education you enough to make it possible for you to have a well informed, intelligent, and hopefully productive discussion with your vet.



> I would like to take her home tomorrow for the long weekend as we are looking at a high enough bill already but I worry about her getting dehydrated again. We can probably take some fluid bags home, but I don't know if I can put them in properly.


Your vet can teach you how to administer subQ fluids at home, and I can provide you with links to online tutorials. If Liza is still badly dehydrated, however, she may require continuing IV fluids at the vet's. SubQ fluids are very useful for maintaining hydration at home, but IV fluids are necessary to make up the initial deficit of a badly dehydrted cat. You need to discuss this with your vet.

Laurie


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## NatalieLucy (Jul 2, 2010)

Thank you for your reply Laurie. I went into the vet today with a bunch of questions and was very insistent on answers. She said she's not sure if she'll survive or not she's hoping her liver will regenerate. We decided to keep her in until Monday shes still pretty dehydrated so an IV would be better for her and to see if we can continue to flush the high billirubin out, her urine has gotten a lighter color so that's an indicator that maybe it's getting flushed away. She will more than likely do another blood test on Monday to check her count. She's hoping it is a viral infection/hepatitis and her body just has to fight it off. If she starts to get better then we'll know if it's viral and if not then it could be Liver disease of some kind, but she won't know if it's terminal unless she does a biopsy. Which we probably won't do just as it's so expensive for us. If she's doing better Monday she will come home and we will do the SubQ fluids. The online tutorials would be helpful! 

I forgot to ask for a copy of her blood work I will get a copy of that. Before we left we went back to see Liza and she was all happy to see us she was purring away. I hope she pulls through! Thank you for the information and the advice it is very helpful and needed.


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## laurief (Jun 22, 2008)

NatalieLucy said:


> I went into the vet today with a bunch of questions and was very insistent on answers. She said she's not sure if she'll survive or not she's hoping her liver will regenerate.


Did you ask her about the possible diagnoses (haemobartonella infections, immune mediated hemolytic anemia, biliary obstruction) mentioned in the quote from Broadway Veterinary Hospital that I provided in my first response on this thread? Those are diagnostic possibilities that would be worth investigating.



> We decided to keep her in until Monday shes still pretty dehydrated so an IV would be better for her


I think that was a wise decision.



> If she's doing better Monday she will come home and we will do the SubQ fluids. The online tutorials would be helpful!


Below are links that you should find helpful. A few important points that are overlooked in some of these links and/or need to be emphasized are 1) make sure you fully CLOSE the roller clamp on the IV tubing BEFORE you spike the bag, 2) when starting a new bag, after you have assembled the bag/line/needle, take the sheath off of the needle (don't touch the needle or put it down on any surface - keep it sterile), open the roller clamp, and allow the air in the line to bleed out until fluid starts to come out of the needle. Then close the roller clamp and replace the needle sheath. You only need to bleed air out of the line on the new bag once. It won't be necessary to do it again after that, and 3) as soon as you finish an admin, replace the used needle with a new one so that the used, contaminated needle doesn't stay on the line any longer than necessary.

http://www.felinecrf.org/giving_sub-qs_giving_set.htm
http://www.weirdstuffwemake.com/weird/s ... juice.html
http://www.vetmed.wsu.edu/ClientED/cat_fluids.asp
http://members.aol.com/aquila111/subq/webinstruct.html
http://partnersah.vet.cornell.edu/Cat-O ... id-Therapy (ignore the advice on giving fluids at room temp)

Let me know if you have any questions about this technique.



> Before we left we went back to see Liza and she was all happy to see us she was purring away. I hope she pulls through!


Poor Liza. I wish she was home with you, but the IV fluids are probably critical for her right now. I'm glad you were able to spend time with her today. I wish there was a way you could go see her again tomorrow, but I don't suppose that'll be possible. With any luck, she'll be coming home Monday. I'm pulling for her!

Laurie


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## SpaceyKP (May 8, 2010)

You'll definitely want to get the full blood test results. A couple months ago, my kitten had a similar problem. He was not eating and lost almost 2 lbs (he was only about 7.5 lbs) and just not acting like himself. The vet noticed he was really dehydrated and his urine was very dark. They kept him there and on IV fluids for the day. His initial blood work came back that afternoon showing a high bilirubin count, high white blood cells, and a blood toxicity of 2+. They gave him some antibiotics and let me take him home for the night. The rest of his blood work came in the next day and his neutrophils were high and everything basically pointed to liver failure. They did an X-ray to check his liver and found a lot of fluid in his abdomen. There were about four things it could have been, but the vet was pretty sure it was FIP. He stayed at the vet on fluids for a couple more days. He did okay at home at night, but his blood pressure was pretty low the last day at the vet. Before taking him home for the weekend, the vet did another X-ray and found more fluid in his abdomen, which is a classic sign of FIP. Unfortunately, Leo never made it through a whole day at home that weekend. Necropsy is required for positive FIP diagnosis, and we never had that done, but the vet was 99% sure that's what he had. Sadly, FIP is hard to diagnose and has no treatment. Leaving Leo on IV fluids gave him a few more good days and gave me the chance to spend a good day with him on the weekend, but otherwise, there wasn't anything we could do for him. 

I hope your kitty gets better soon!


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## NatalieLucy (Jul 2, 2010)

Laurie - She did mention it could be the Infectious Anemia she has put her on antibiotics just in case. She's covering all bases, but I guess it's a waiting game to see if she responds. Thanks for the links on the tutorials, I won't be able to get a demonstration from the Vet Monday (if she comes home) as I can't take time of work. So my husband is picking her up. 

Spacey - Thank you for your response, I will definitely ask for those blood test results for me to do my own research. I'm sorry to hear about your cat wow he was just a kitten? Yeah Liza has lost 4lbs in 6mths she's normally steady with her weight she's always been around 13lbs now she's down to 9lbs and she lost another pound over night which could be just fluid. 

The house isn't the same without her, and my other cat is feeling lonely without her too. I hope she comes home soon.


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## SpaceyKP (May 8, 2010)

Leo was about 11 months old when he died. FIP is most common in kittens under two years of age and cats over 7 years because they are most likely to have under developed, compromised or weakened immune systems. FIP isn't very well understood, but it starts out as a feline coronavirus, which are relatively common viruses. Cats with healthy immune systems generally just fight them off like any other virus. At most they show slight signs of a problem like diarrhea or a slight fever for a few days. But in some cats, the coronavirus mutates into the FIP virus. It isn't understood why or how the coronavirus mutates. Unfortunately there isn't just one strain of coronavirus that mutates, so that can't even be tested for. Once it mutates into the FIP virus it attaches on to the white blood cells. So instead of fighting off the virus, the virus actually uses the immune system to travel throughout the body and attack the organs and sometimes nervous system. It is not treatable because it uses the cat's own immune system against him and most medications will increase immune system activity, making it worse. Sometimes steroids are used to suppress the immune system which can slow down the spread of the FIP virus, but it doesn't really help much and can create other problems.


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## NatalieLucy (Jul 2, 2010)

I'm so upset right now. I've been reading the articles about dry vs wet canned food. We always fed Liza dry food I'm upset we might have caused this issue what if she has Fatty Liver disease and we caused it.


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## laurief (Jun 22, 2008)

NatalieLucy said:


> I'm so upset right now. I've been reading the articles about dry vs wet canned food. We always fed Liza dry food I'm upset we might have caused this issue what if she has Fatty Liver disease and we caused it.


Hey, instead of beating yourself up with the what-if's, congratulate yourself for investing the time and effort in educating yourself. I suspect that most of us who are over the age of 10 have fed kibble to our cats. All of these revelations about kibble vs canned are relatively new in the feline nutrition arena. To paraphrase Maya Angelo, you did the best you could with the information you had, and when you knew better, you did better. Now you know better, so now you can adjust Liza's diet after she gets home.

You'll never know whether or to what degree her previous diet contributed to her current health crisis. It may not have had anything to do with it at all. Don't dwell on negative thoughts. Keep a positive outlook for Liza. She needs all the good vibes flowing her way that she can get. Focus on the healing. Liza needs your love, not your guilt.

Laurie


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## SpaceyKP (May 8, 2010)

Laurie is so right. I felt that way with Leo but I realized there was nothing productive that would come of it. Sometimes things just happen. There are some cats who could be fed the crappiest dry food its entire life and live to be 22. But there are also cats who are fed the best canned food or raw diet there is and they only live a few years, or less, because they are just genetically predisposed to something. There are plenty cats who lived long healthy lives on dry food before all the new information about wet food came out. You can't blame yourself. If you are worried about her food, then you need to take what you know now and apply it to everything you do in the future. It's always good to remember lessons learned from the past, whether or not you actually made a mistake. Otherwise, you only need to look back into the past and remember that Liza has a wonderful life with you, that you obviously love her and care for deeply, and that she has such a great life because of you. And Liza needs you to show her that you love her and you plan on doing the best you can with all the new information you have. Cats know when we are upset and stressed, so she will be so much better off if you are happy and loving around her.


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## NatalieLucy (Jul 2, 2010)

Thank you both, that's exactly what my husband told me. We did the best we could with what we knew and we have given her loads of love since we adopted her. She is now back with us but has since lost more weight and is still not eatting or drinking. The vet had to force feed her this morning, they loaded her up on Subq fluids and took some more blood work to compare the billiruben count. She is withering away and just so weak, we do not know what to do. The vet hasn't told us she's at the point of putting her to sleep yet, but I'm thinking if she's not eatting or drinking then there's not much we can do. All the symtoms seem to match up to fatty liver disease in my eyes. Do cats pull out of this disease? Should I start trying to force feed her with a syringe?


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## laurief (Jun 22, 2008)

NatalieLucy said:


> All the symtoms seem to match up to fatty liver disease in my eyes. Do cats pull out of this disease? Should I start trying to force feed her with a syringe?


Regardless of her diagnosis, she MUST take in adequate food and water in order to sustain life. If she does have hepatic lipidosis (fatty liver), the ONLY treatment is assist feeding for as long as it takes for her to start eating on her own again, and this can sometimes take months. The following links will provide you with lots of tips, tricks, and support to assist feed your girl:

http://www.felinecrf.org/persuading_cat_to_eat.htm
http://www.assistfeed.com/
http://www.yahoogroups.com/group/Feline ... ed-Feeding

If you can not convince her to eat on her own, you MUST assist feed her if you want to give her a chance at recovery.

You should also be administering subQ fluids at home to keep her properly hydrated. This could easily make the difference between life and death for your cat.

Laurie


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## NatalieLucy (Jul 2, 2010)

Thanks Laurie! 

Well today was interesting my husband took Liza to the vet and she said her blood work was worse than Wednesday she was leaning towards Fatty Liver Disease. But she thought that Liza was too far gone and it was best to put her down. She gave my husband a phone number of a lady that comes out to the house and does it, so when he called the lady she asked what was wrong with Liza and he told her FLD. She told my husband to get a second opinion as cats with FLD almost all recover with the correct treatment. She gave him 3 places to call and so he called a place called the "Cat Clinic" he took her there. They had all her records faxed over the vet there had a completely different take on Liza. She said that she wasn't on deaths door not by any means she's still pretty feisty, she was surprised that the other place didn't put Liza on an Appetite stimulant. The only way to be sure what it is, is to do a biopsy and an U/S well I was concerned about the money and if Liza was strong enough. She had mentioned Liza would do just fine with the biopsy as it was local atheistic. The biopsy was cheaper than our other vet so we decided to go for it and see what is going on. The U/S showed that it was a diseased Liver but looks like no tumors. So we'll have to see what the results say, we should know more by Friday. They gave Liza an appetite stimulant and she has started eating not much but it's a start. 

There is hope for Liza, we are so glad we got a second opinion.


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## SpaceyKP (May 8, 2010)

I'm so glad the second vet gave Liza a better prognosis and that she is eating again. I think it's sad when vets don't give you alll the options and just giveup a little bit. They can't get attached to every animal they see but they shouldn't forget how attached we are. I know it can be a daunting and messy task but you should consider some assist feeding if you haven't already. Even if she is eating some assist feeding will help even more. I read a lot of stories online about cats who were in liza's condition and made recoveries because of assist feeding. It could make a huge difference in her recovery.


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## laurief (Jun 22, 2008)

NatalieLucy said:


> he called a place called the "Cat Clinic" he took her there.


Good for you and your husband seeking a second opinion! I wish more folks would do that when confronted with a doomsday vet with a doomsday prognosis.



> The only way to be sure what it is, is to do a biopsy and an U/S ... So we'll have to see what the results say, we should know more by Friday.


I'm so glad you had the tests done. I'm eager to know the results of the biopsy when they come in.



> They gave Liza an appetite stimulant and she has started eating not much but it's a start.


Which appetite stimulant did they give her and at what dosage? It's great that she started easing again, but it's critically important that she eats a weight-maintaining amount every day, so you'll need to assist-feed her to make sure that she gets enough food into her system. Always offer food to her to eat on her own first, but if she doesn't eat enough, then assist feed to complete the daily nutritional requirement.

Keep us updated on her progress!

Laurie


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## NatalieLucy (Jul 2, 2010)

The biopsy came back positive for Fatty Liver. Laurie they gave her Mirtazapine for the appetite stimulant and so far she has been responding quite well. She's been eatting more and more each day. At the start she was just licking the gravy off the top but now she's eatting some chunks of food. I have been assist feeding her if she hasn't been eatting a lot and it's taken some time but now she is getting more used to me feeding her. She is way better than she was...she's not so weak and is more herself. It's going to be a slow process from what I've read but at least she won't need a feeding tube. I'm so thankful that she's starting to look like herself again, and to think we were seriously thinking of putting her down.


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## laurief (Jun 22, 2008)

I'm so glad to hear that she's improving and starting to eat more on her own, regaining strength, and becoming more cooperative with assist feeding. These are all great steps toward a complete recovery for your girl. She's so fortunate to have such a dedicated, loving family. You're doing a wonderful job with her nursing.

Keep it up!

Laurie


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