# high bilirubin count



## HollySue (Sep 1, 2008)

Several days ago my oldest cat (12 years old), Charcoal, was diagnosed with a high bilirubin count as well as being severely constipated and dehydrated, and running a 104 degree fever. She's an indoor/outdoor cat, but I am keeping her indoors while medicating her with Baytril, as directed. She is hardly eating, and doing is some drinking. The vet gave her an enema, and also some I.V. liquids.

She'd been on a Science Diet Light dry diet for years, and due to her starting to lose weight a few months ago, I switched her to Science Diet Senior. Tomorrow I will go buy several kinds of canned food, as she is still eating very little. She did accept a bunch of Greenies, one by one by hand. I didn't want to give her too much at once, fearing she'd barf.

I've done some reading on high Bilirubin counts in humans, and it more or less lines up with what I can recall the vet told me by phone. 

Is anyone else dealing with this in their cat? Crisis always seems to occur with my cats or birds on weekends and/or holidays. I can not reach the vet until Tuesday. I'm frustrated and worried.

This cat has never cared for canned food, but I have to try again. The vet said to force feed her, if necessary. This seems harsh using dry food. She won't eat canned tuna (human grade). I also tried to tempt her with fresh grilled salmon last night, but she refused that also. She is used to hunting and eating her catch almost daily, from what I can tell, but the vet wants her kept in the house so I can monitor her eating and pooping.

Holly


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## doodlebug (May 13, 2006)

The high bilirubin level means she has Hepatic Lipidosis (aka Fatty Liver disease). Below is a link that describes this. This is a very, very serious condition. You really need to get food into her asap, you can't force feed dry, you need to get wet food into her with a syringe. The longer you wait to get food into her, the less likely you will be able to reverse this. 

You will need to thin the wet food with water and use a syringe to get it into her. 

http://www.marvistavet.com/html/body_he ... dosis.html


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## Smirkitty (Apr 19, 2008)

You can get an oral syringe at almost any pharmacy. If they don't have any out, the pharmacist will have some behind the counter. Try to get a 5cc one, you may want to cut down the tip a small amount to widen the opening, but if you had water to the wet food, you should be able to manage. You'll want to do smallish bites at a time. I've never had to force food, only meds, hopefully someone will have some good advice on the best way to so this.


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## HollySue (Sep 1, 2008)

Thanks for the syringe idea. I just glanced over the article you posted, and will read it better tomorrow. 

I have some syringes, and the idea of enlarging the opening is great! Thanks to both of you. I hope more responses with more good ideas come in.

Charcoal has always been very thin, since she adopted me at under a year old. Her weight loss was 4/5 of a pound, which for her is a lot. She is suddenly very boney. 

My other two cats are harassing her to a certain extent. It is nearly impossible to separate them, as we live in only two rooms. She used to like to hang out in my office when I see clients, but I don't think she'd be happy locked in there all alone. 

Holly


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## Heidi n Q (Nov 22, 2006)

I was able to save my Malibu in late 2006 when she developed hepatic lipidosis / fatty liver. I did have to force feed her, however at the time I was force feeding her, her condition was so deteriorated that she did not struggle during the feedings. The vet was concerned about me being able to do it. Most pet owners cannot bring themselves to DO the force feeding that is necessary to save the cat. 

The ONLY thing (IMO) that will bring the bilirubin count down is to get enough food into them that the liver stops trying to utilize their body fat and uses what the cat eats, instead. You have to feed enough canned food to not only sustain the cat but also replenish what the cat's body has used (the weight loss). I preferred the Eukanuba Max Calorie canned food because it had twice the protein (14%) of Hill's A/D (8.5%). Surprisingly, Friskies has 10% protein, but the Hills and Eukanuba canned foods are puree'd for ease of syringe force feeding and are much more suitable.

I would feed Mallie about every 3-4 hours all through the day. I only slept for 6hrs at night, so that was the longest she went without a feeding. I think I tried about 10-20ccs at each feeding, starting with the smaller amount and working my way up to 20ccs as she tolerated it w/out vomitting.
I would prepare the syringe and sit on the floor with my knees up and covered with a towel then scruff Mallie onto my lap with her bottom in my lap and her head at my knees. I would put the syringe at the corner of her mouth and slowly squeeze the food in, allowing her time to swallow. I used the edge of the towel to wipe her face. I would also (with the smaller syringes) open her mouth and squeeze the food at the back/roof of her mouth. Mallie would shake her head and fling the food, that is why I used both methods to get it into her. It was upsetting to do this to her, but I found if I spoke to her while I force-fed and explained why I had to, it helped ME to remember the goal was saving her life and I HAD to do it. I also visited her (I kept her isolated in the MBR to prevent her wasting energy dealing with the other housecats) in between feedings to let her know I cared and loved her. Encouraging her to fight to live.

She survived and it changed our relationship. She was a formal feral who was pretty distant and after treatment, she is my lap-kitty who sleeps on my head or against my chest at night.
Good luck to you and your kitty,
Heidi


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## HollySue (Sep 1, 2008)

I sure wish that vets would give very specific directions in cases like this. I've never been faced with this situation before. I'm very grateful that this board and you knowledgeable folks are here.

Holly


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## Heidi n Q (Nov 22, 2006)

I edited and added more to my above post when I saw you asked about force-feeding ideas...
CatForum helped ME when I went through this with Mallie. They(we)'ll help you, too.
h


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## HollySue (Sep 1, 2008)

I just dug through the critter cabinet, and located a 3 ounce can of Science Diet kitten food, put it into a small food processor, and added warm water until it was thin enough to work in the small syringe I have on hand. I took Charcoal into the bathroom, held her as suggested, and fed her about 1/3 of the soup. I 'm hoping that is a good amount on top of all of the greenies she had a bit earlier. I'll likely wake up after 6 hours to use the bathroom, and will feed her more. 

Please advise if this is sufficient for now. She has been walking around, and requesting to be picked up earlier. She is a lot more energetic than when she had very compacted stools stuck in her intestines. I will be able to buy more cans of food. According to the data on the can, 3 cans would be good for her current weight, if she was a growing kitten. So how much more should she have to make up for the weight she has lost? And do I want kitten, cat, or senior canned food, in order to fatten her up again? Whatever has the highest protein and fat count?

I'm getting too tired, so I need to tuck in the birds, and settle the other cats down for the night. I will look in on this as the last thing I do before bed now. 

Thank you all so much for this initial help.

Holly


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## Smirkitty (Apr 19, 2008)

I suspect that kitten food will be higher in fat and nutrients, which your cat needs right now. Again, I've never had to do this before, but I did want to make this thread stays bumped so you can get more advice.

Would KMR be good for this kitty as well?


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## HollySue (Sep 1, 2008)

I'm new to this board -- what is KMR? Thanks

Holly


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## melysion (Mar 12, 2007)

i have no advice but want to send lots of healing thoughts to your kitty ....


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## doodlebug (May 13, 2006)

HollySue said:


> I'm new to this board -- what is KMR? Thanks
> 
> Holly


Kitten Milk Replacement...baby kitty formula. 

You could use it to thin out the wet food instead of water. 

How's she doing today? Have you gotten any food in her?


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## HollySue (Sep 1, 2008)

Thanks Doodlebug. I wish I'd had that acronym spelled out before, but I will go back into town tomorrow anyway.

Charcoal has finished the other 2/3 of the small can of science diet from last night; that'd be 2 ounces with a fair amount of water. She fought me pretty well as I squirted the soup into her mouth. She also ate maybe 8 greenies before that. I plan to give her more "soup" after I post this to the thread. 

I bought two different style baby syringes -- one usual and the other has a squeeze ball at the top. I'm hoping that will be easier to use since my right arm and hand isn't working well after a serious fall connected to a fender-bender I did close to 3 weeks ago. I also bought a quick responding digital thermometer so I can monitor her temperature. 

Would soy milk be a good thing to use until I get the KMR? Is it similar?

Holly


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## doodlebug (May 13, 2006)

It's actually good that she's fighting you :lol:. Have you tried wrapping her in a towel? It will keep the claws at bay. 

The KMR would be good to add, but not essential if you're getting food into her. Sorry about that, we tend to think everyone knows what we mean...KMR is actually a brand name as well as the generic name for kitten formula, so we tend to use it interchangeably. 

I wouldn't use soy milk, it doesn't have the same vitamin/nutritional structure as KMR and some cats have soy allergies. Cows milk has lactose which gives many cats diarrhea, so that's not an option either. The water is fine, it will help keep her hydrated which is a big help in this situation. 

It's good that she'll eat the greenies, it means she's not really deep into this. What happens is that when the cat doesn't eat and the bilirubin levels go up, it makes them feel nauseous so they continue not eating and it's a big vicious circle. The only way to break it is to force them to eat so the bilirubin levels go down and the nausea abates. The fact that she'll take the greenies means she's getting past the nausea for something she really likes and that's a good sign...


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## melysion (Mar 12, 2007)

what about buying some of that really high calorie prescription food rather than the kitten food?


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## HollySue (Sep 1, 2008)

I put the soy milk in and fed her some before coming back to read your latest response, Doodlebug. What symptoms should I watch for if she has soy allergies? This afternoon's soup was made with Iams chicken, and it is terribly grainy even after adding the soy (now I wish I'd used water.)

She isn't being overly nasty with her claws. but I do have quite a few puncture in my flesh.

At least I'm finding out that SingHa, my rescue Siamese male loves canned food. Katrina, my rescue calico female from her namesake hurricaine in LA doesn't seem to care what can I open, and has no interest in licking out the empty can.

I am a lot more used to forums for my small parrots. Does this board have a glossary of acronyms?

I've got top ice my arm and opposing hand for a half hour now, so I'll be back later. Thanks for all the help. I am reasonably sure that Charcoal will be okay. What is the suggested ratio of canned food with dry food now considered good for a healthy cat? I've always just fed dry, of very good quality.

Holly


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## doodlebug (May 13, 2006)

My experience with soy was projectile vomiting...it wasn't milk though, it was a food based in soy protein for a cat with IBD (inflammatory bowel disease). 

Nope, sorry no an acronym dictionary here...

Well, ideally the best diet for a cat is as much wet food as you can get in them. If you can do 100% wet...great. If not, getting to 75-80% wet is a reasonable compromise. There's a sticky at the top of the page on why wet is better than dry. This site also has some great nutritional articles:

http://www.littlebigcat.com/index.php?action=library

My cats get about 4 oz of wet and 1/8 cup dry per day. I keep the dry in their diet because I know there are times when I just can't be home to feed them wet.


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## HollySue (Sep 1, 2008)

I need to back up, and ask some questions. I have had Charcoal for almost her entire life. She has always been very slender. The vet did a CBC panel, and subsequently had it confirmed by an independent lab. The only thing that was off at all was the bilirubin levels, which were high. The vet never mentioned Hepatic Lipidosis or Fatty Liver Disease as the cause, but did describe some symptoms that might lean that way. The last couple years have been very stressful for me and all of my pets. There is no way to pin down one specific stressful event.

Is it definite in the minds of the members who have been helping me here that my cat is in full blown Hepatic Lipidosis disease? Are there various stages that precede it, which require less aggressive treatment? 

Putting all this food forcefully into Charcoal's belly has exhausted her. Is this to be expected? Should I try just putting globs of canned food into her mouth and stroking her throat?

The soupy mixture is 60-65% cat food and the rest liquid to thin it out. That means she has only had i ounce of canned cat food from today's mixture, and 2 ounces from yesterday's mixture. Can this possibly be enough food to get her well? I am stopping after about 10 syringe-fuls, being maybe 4 ccs each after I deduct off for waste and partially full amounts. I can't see giving her more than that, as her belly gets distended on it.

Holly


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## HollySue (Sep 1, 2008)

That's a thought, melysion. I didn't see your post earlier, as I was drafting my response. I will ask the vet about Rx food tomorrow, along with specific questions about the diagnosis. But if the Rx food is several dollars per can, I likely won't be able to afford it. There are way too many problems associated with severe shortage of cash as opposed to bills. I'm sick of it!

Holly


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## Heidi n Q (Nov 22, 2006)

HL/FL isn't the cause of a high bilirubin count, it IS a high bilirubin count and what the condition, symptoms are called.
There is no other treatment for it other than getting/making the cat eat.

Because Charcoal is eating some food on her own, I do not think her condition is as advanced as my Malibu's was. I had to force feed Mallie for about 7 days before she offered to eat on her own. Perhaps if you can tempt your kitty to eat anything on her own, that would be good. You can also swipe a 'glob' of food onto the roof of her mouth to get her to eat, rather than syringing it into her... She just needs to eat to reverse the effects of the high bilirubin count.

Hope that was helpful,
Heidi


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## HollySue (Sep 1, 2008)

Yes Heidi, that is helpful.

I spoke with the vet, and she says that Charcoal was not quite to the point of being diagnosable with HL, but could easily have slipped into it. She's very pleased that Charcoal has put some weight back on, and that her fever is down into normal range. I will pick up some of the Rx canned food later today, on my way to my doctor.

I forced Charcoal to eat some canned food this morning, and she got it all over the place. It wasn't gummy enough to stick to the roof of her mouth.

Charcoal's coat is looking nice and smooth and glossy again. She was looking very raggedy for the last week.

Holly


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## HollySue (Sep 1, 2008)

Charcoal ate some Hills a/d (forced) this evening. She complained, but less forcefully with this food. And for her teeny size, the vet says she will get her full caloric count with 1/4 can. So, would 1/3 of the can be enough to fight the bilirubin? I'm reasonably sure I can get that much into her through the day. She came running from the bedroom when I called the cats for treats (Greenies). I'm also starting her on 1/2 dose of the stool softener, as the poops that I believe are hers are still shrunken, likely from when she wasn't eating a week ago.

Holly


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## Heidi n Q (Nov 22, 2006)

I think I remember my vet wanted me to get 1-1.5 cans into Mallie. I remember being astonished about how much she wanted me to get into her. I think I managed a little over a half can a day? Maybe almost 3/4? But Mallie was a big cat with a usual weight of 11 pounds. At the vet with her HL/FL diagnosis, she had dropped down to a thin and bony 9 pounds.
When she finally began eating on her own (_I had several different kinds of tempting cat foods for her_) she recovered pretty quickly. It took a while for her weight and scruffy fur to improve, but I could tell she felt better.


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## HollySue (Sep 1, 2008)

This vet doesn't have any history with me. I've used that office for close to 15 years, but I started with a woman who I really likes and trusted who left to raise her kids. So her younger male associate bought the practice, and I learned to trust him. I've met with this new woman a couple times, and don't have any negative feelings, but haven't developed any positive ones yet. I really dislike changing medical personnel once I find those I like. I am considering shopping around because I'm not happy with their price structure, since I am so strapped.

Holly


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## HollySue (Sep 1, 2008)

Charcoal ate some dry food on her own this morning. I also gave her some a/d, forced. She's starting to seem like she is getting back to herself. I'm really pleased.

Holly


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## Heidi n Q (Nov 22, 2006)

Good news. Very good news that she is eating on her own. Once you see her eating fairly well, you can stop the force feeding, just keep an eye on her to make sure she continues to eat and doesn't backslide.
h


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## HollySue (Sep 1, 2008)

Thanks, Heidi. Charcoal ate a normal sized lunch. I plan to continue to force some of the a/d for a few days, to help her put on some extra weight. I'm feeling some definite relief.

Holly


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## doodlebug (May 13, 2006)

Sounds like you're headed in the right direction...congrats!


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## HollySue (Sep 1, 2008)

Thanks, doodlebug.  I'm very grateful for the help I have found here.

Holly


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## kittycatlover (May 12, 2005)

*liver cancer?*

I wrote another posting about being worried about our yellow tabby. Now the vet called us with the results. 

He said her total bilirubin levels are very high, but the liver function tests are elevated but "not that bad". He thought it would be fatty liver disease, which would cause the total bili levels to be so high, but my kitty is eating, actually very well, so I won't have to force feed him.

So the vet is recommending an ultrasound of his belly (specifically his liver) to the tune of $441.00, then a biopsy, all for a total of $945.00. Ouch! He is thinking "liver cancer". Okay, worst case scenario. 

My husband and I don't know what to do. Obviously, like most others we are not so well off that we can give him $945.00 right now. Oh, and the vet is cash only, no credit. But we want to do what is best for our kitty.

Do we go ahead with the ultrasound and biopsy, then find out he has liver cancer, and treat to the tune of thousands of dollars, and bottom line have him die a painful death? 

The vet thought hepatitis might be a probability....infectious would be treated with antibiotics, inflammatory would be treated with prednisone. But neither of these, from what I understand, can be further diagnosed by the blood work that has already been drawn.

Help!!!!!


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## HollySue (Sep 1, 2008)

Oh my! What a miserable situation and decision. That's a huge amount of money!! Years ago, when it seemed pretty certain that my Siberian Husky had cancer, I made a decision to euthanize him. He was getting old, and I didn't want him to go through the surgery and then many months to recover, not to mention chemo and/or radiation. I had no money. Putting him down was the right decision in my situation. That is not something that anyone can tell another to do.

Hopefully others here can offer useful ideas to possibly help your kitty to recover. My response is based only on the possibility of cancer. I'm sorry...

Holly


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## Heidi n Q (Nov 22, 2006)

KCL... Wow. (you may want to start a new thread for your kitty. If you have, I'll move my post to there.)
$945 to search for liver 'something' in a cat who is not showing drastic symptoms, is eating and behaving normally and blood tests are not giving the vet any other indications of problems, making these procedures basically a fishing expedition into your pocketbook...

*_Key here is that the cat is not showing any other outward symptoms of something being wrong with it. Nothing physical and nothing else in the blood work._*

Well, for me, the decision(s) would go along these lines:
1. If I had some monies I could spend for my kitty, I would get a second opinion.
2. If I did not, I would keep my kitty at home (since he seems happy, healthy and in no pain) and know my time with him may be limited. I would love him and enjoy him and make him happy for as long as I could. Then, when he was telling me he no longer enjoyed life, I would consider The Big Decision. (TBD, that is what I call euthanasia).
ALSO...HL/FL cats can take a while to recover to a lower bilirubin count. It could be that your cat was HL/FL and is recovering. Maybe wait/see and have another blood test in a month to compare any differences?


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## kittycatlover (May 12, 2005)

Thank you all for your comments! 

One of the things that made us take him to the vet this time was his weight loss. He is a long haired kitty so its hard to visualize how skinny he is, but when we pet him, you can definitely tell. And how he acts? Mostly normal, but less energy, I guess? He certainly has an appetite! Everything I have read here, push-push-push the foods, so that is what we are doing. 

He has always been finicky, but at the present time, he loves the Beef and Chicken Fancy Feast. Its 1100 pm here, and he's gone through 4 full cans today. So I don't think I can feed him any more. Thats in addition to the dry that is sitting out all the time.

So we have decided to compromise on what to do. We already spent over $300 on the blood work, and don't have the cash flow to spend an additional $900+, so we are just going with the simple ultrasound ($400+). 

Heidi, you really made me THINK when you wrote "$945 to search for liver "something"......basically a fishing expedition into your pocketbook."
So I'll have some comments to make to the vet in the morning. 

The vet also said "nothing to eat or drink after midnight"....for an ultrasound? I'm an RN, and I've never heard of this for a human. THAT would be inhumane, as far as I'm concerned, based on the amount he is eating. 

Sorry for rambling on and on....

And by the way, our kitty's name is "Hedgie", like a hedge-hog! When he was born, he was a little round orange ball, minus a tail.


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## queen of the nile (Aug 16, 2003)

Just a quick note:

There is an extensive list of diseases that can cause an increased bilirubin level, and fatty liver disease is only one of them. Usually there are increases in other liver enzymes with fatty liver, not just bilirubin. Either way, it is excellent that you are getting food into your kitty, because regardless of whether or not fatty liver is the cause of her illness, ensuring adequate food intake is essential!


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## Heidi n Q (Nov 22, 2006)

Wait a minute, now...
With your recent post, there IS something wrong with your kitty. 

Please do not tear into your vet for wanting to do expensive tests, I made my comments based on the limited information in your initial post, which was blood tests. Your latest post says Hedgie isn't as healthy as I thought he was because he is bony and has less energy even though he is eating large amounts.

Did his blood tests indicate _anything_ else that could be wrong and point towards a diagnosis?

Me? I don't have large amounts of money for 'maybe-its-this' diagnostics. I understand the use of these diagnostics to help the vet make a determination, I just don't feel it is always in the owners financial best interests wiht certain diagnosis (incurable cancer), though it is all directed at helping the cat. I treat the symptoms of what we see in front of us with the use of blood tests and physical exams as our primary indicators with my vets. Further decisions about treatment and their cost and effectiveness are made at the time it is brought up, with success-rate being foremost in my decision making process, right after cost. 
I love every one of my cats, but loving them until my bank account is empty does not allow me to be of any help to the other cats we have.


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## kittycatlover (May 12, 2005)

Our vet's blood work on Hedgie says no diabetes, thyroid tests pending, somewhat elevated liver enzymes, and elevated bilirubin. 

We really trust this vet....he is excellent. So I am trusting his judgment without going for a second opinion. But I also refuse to submit Hedgie to further painful testing (i.e., liver biopsy), to only find that he has liver cancer, which in my heart I am afraid that is. 

We will do the ultrasound this morning, find out the results this afternoon, and sit tight. We will continue to love him and nurture him the best we can, and if necessary, make all the right decisions in his best interest, and the interest of my pocketbook, so as not to deny my other animals.

Thank you for all your thoughts and comments! I will let you know what happens.


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## kittycatlover (May 12, 2005)

Hello all!

We have Hedgie back home after his ultrasound, which did give us a bit more information, and more questions, but at least a plan of care.

We did find out that the ultrasound was performed by a critical care-internal medicine veterinarian, so we got a second opinion right on the spot!

His liver is slightly larger than normal, but no sign of any obvious tumors. He has no enlarged lymph nodes. His gall bladder and all bile ducts look fine. His intestines all look normal. 

So their combined diagnosis is that his weight loss and jaundice could be one of three things: very atypical fatty liver disease, cholangeohepatitis, or small cell lymphoma of unknown origin.

The worst case first, the small cell lymphoma, can only be diagnosed with a biopsy, which we have elected NOT to do. And the vets agree with our decision. They told us that unless we would be willing to subject Hedgie to rounds and rounds of chemotherapy, at a cost of $2,000 to $4,000, with no guarantee of success, and all the horrible side effects, why put him through the pain of a biopsy. 

As for the atypical fatty liver or cholangeohepatitis, we are taking the conservative route....low dose Prednisone to help reduce the inflammation, and Lactulose to reduce the ammonia levels in his blood. Our vet did tell us that the Prednisone will help him feel better, but could potentially make the lymphoma worse in time, if that is what it is. 

We just want our little Hedgie to feel better for the remainder of his days, no matter how long or short that may be.

Any comments or similar experiences???


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## HollySue (Sep 1, 2008)

I'm just glad to hear that Hedgie will be able to enjoy time with you. Perhaps the symptoms will just resolve themselves with food, medicine, and love.

Holly


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## Heidi n Q (Nov 22, 2006)

I had a kitty who had to remain on a low dose of prednisone for a long time. She was under a vet's care; with the pred she felt great, without it, she got mouth sores and declined in weight and energy. She eventually had to have all of her molar teeth removed.

She had about three good (great!) years on prednisone, but then developed acute congestive heart failure and I had to have her euth'd one night when she was having trouble breathing and her pink-parts (nipples) were turning purple from lack of oxygen.

The pred gave her a great quality of life, even though it shortened her life.
Be aware and enjoy while you can. Who knows, perhaps he'll do great and only need the med for a short time!
Heidi


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