Important to all cat owners

I don't think I've written about this here yet, but those of you who are also on kettunainen's friends list will know by now that one of our cats, Miko, is very sick and has been in the animal hospital for nearly two weeks now, hooked to an IV, while they try to figure out what is wrong with her. But as of today, they got the results from the biopsies they did while doing exploratory surgery on her a few days ago: hepatic lipidosis, or fatty liver disease.

This is the same thing Bastian died of -- well, technically he died of being put to sleep, but he was dying and it was all we could do for him. But this time we are hoping to have caught it in time, and the vet thinks she has at least some chance of recovery. Tomorrow they are putting a tube in her stomach through which we can feed her until she starts eating again on her own, and the day after that she comes home so that we can look after her here.

The stomach tube thing is not as drastic as it sounds. The only effective way to reverse this condition is force-feeding, and apparently it is less stressful to the cat than being syringe-fed the way she has been. It's a little port in the side of her stomach through which we can put in liquid food, which I suppose would be more pleasant than having it forcibly squirted down one's throat. Once she recovers, assuming she does, the tube can be taken out.

But the reason I'm posting this is mainly that, prior to having these experiences with Bastian and Miko, we didn't know about hepatic lipidosis at all, and it's apparently actually fairly common. And is invariably fatal if not treated, but has a decent chance of being reversed if it's caught in time and treated properly.

So, if you have a cat, especially (but not only) a cat which is older and/or overweight:


Quotes below are from VetInfo.com, with my comments interspersed between them:

Hepatic lipidosis occurs when a cat stops eating for any reason. This causes the cat's body to begin to use fat stores as fuel. Cats are inefficient users of fat (their livers are not good at transforming fat into energy). Because the cat doesn't utilize the fat well, it begins to accumulate in the liver cells, eventually interfering with their ability to function. Cats that have this condition will die, in most instances, without appropriate treatment.

So basically it's caused by not eating - which may be as a result of another health condition, anything from diabetes to dental problems to an upset stomach from eating house plants or swallowing string or something, or from stress, or just not liking their food. In some cases they don't ever find out why the cat stopped eating - it just did, and this disease was the result.

Diagnosing hepatic lipidosis can be difficult using routine blood chemistry testing. Sometimes liver enzyme levels will not change despite this disease. Bile acid testing gives a better indication of the ability of the liver to function and liver biopsy is the best way to be certain of the diagnosis. A needle biopsy is usually sufficient to confirm this condition.

So if your cat is showing symptoms consistent with FHL and your vet just wants to do blood tests, that's not enough. Ask for a liver biopsy.

Cats with hepatic lipidosis often act like they want to eat, approach food and then turn away from it as if they are nauseous or just can't force themselves to eat. Some cats with this condition appear almost normal in activity and attitude while others are quite depressed.

Again, the not eating is the most important thing to watch for. They may appear otherwise healthy right up until they get really, really sick, and by that time it might be too late. We didn't know Bastian was sick until he was basically dying.

The treatment is to force feed affected cats. Sometimes this can be accomplished by persistent owners using syringeable foods and a lot of effort. Most of the time it requires placement of a stomach tube and feeding through the tube for several weeks.

Getting nutrition into them by any means necessary is the important thing. Also fluids, as they may not be drinking either. As I mentioned above, the stomach tube sounds bad, but it's easier on them than the alternatives. Also, be aware that you can tube-feed them at home. The vet we took Bastian to said that if we opted to try and treat him, he would have had to stay in the hospital for weeks or months being tube-fed. Miko is going to be coming home and we are going to take care of her here. If you have a cooperative vet who is willing to treat you like a responsible adult, there is no reason in most cases why your cat can't come home after it gets the stomach tube, and it is a hell of a lot cheaper that way, not to mention probably less stressful for the cat.

Other useful things to know:

• Monitor your cats' eating - one of the most common causes is when a cat stops eating for three days or more. The lack of food makes their liver go into crisis. If your cat stops eating, especially if it is an older and/or overweight cat, take it to the vet sooner rather than later. Generally speaking, if a cat doesn't eat for 48 hours, it's vet time, especially with an older and/or overweight cat. A reduction in calorie intake of 75% or more for three days is enough to cause FHL.
  
  
• Obese cats are much more likely to get it (although any cat can, and Miko was not overweight at all when she got sick), so keeping your cats' weight under control can help reduce the risk. But don't try to make them lose too much weight too fast - cutting their calorie intake too sharply can cause the disease rather than preventing it.
  
  
• Older cats are also more at risk, and you should pay particular attention to making sure they eat, and watching for sudden weight loss.
  
  
• Do not, whatever you do, ever, when you find that your cat doesn't seem to like a particular food and won't eat it, keep feeding it to them on the reasoning that "When they get hungry enough, they'll eat it." See above. Three days without eating, or with eating only 25% of their normal amount, is enough to be life-threatening.
  
  
• If your cat stops eating, and you can't afford to take them to the vet right away, try tempting them with different kinds of food (even human food - it's not so much important what they eat as that they eat). In a pinch, try syringe-feeding them canned cat food thinned down with water. Getting food into them early enough can stop the disease before it really starts.
  
  
• You can also give a cat who won't drink water subcutaneous fluids to help keep them hydrated (I did this for my eldest cat Desdemona for about three years before her death). The supplies for this can be bought online from many vet suppliers, and there are tutorials on it on a lot of sites for cats with chronic renal failure, which is what Desdemona had.

Points for looking after a cat who's recovering from it (this is ad much for our own reference as anything):

• Supplement their diet with essential fatty acids and/or SAMe (some people also supplement healthy cats' food with these to prevent the condition).
  
  
• Vitamin and mineral supplements can help - esp. potassium, thiamine, vitamin K.
  
  
• The herb milk thistle is also used by some holistic vets to help treat it.

Some web resources:

• Fatty Liver Disease in Cats AKA Feline Hepatic Lipidosis - includes tips on persuading an anorexic cat to eat (anorexic in this case just means not eating, not the specific psychological condition it refers to in humans)
  
• Feline Hepatic Lipidosis - a personal site from a woman who claims to have nursed several cats with condition back to health at home, using in part alternative remedies
  
• Vetinfo Digest: Hepatic Lipidosis
  
• Feline Hepatic Lipidosis (Fatty Liver) in Cats
  
• TheCatSite.com - Feline Hepatic Lipidosis