Stimulating appetite

Tonight I was emailing with a reader about force-feeding their cat, who is sick with feline hepatic lipidosis. At the same time, I am force-feeding my skinny cat, Prince, who stopped eating recently.

I started looking online for information about kitty eating problems. The first thing I found was this page, which talks about reasons why cats stop eating. Notice that bad teeth is on this list. However, Prince had his teeth out almost 5 days ago, and he's still not eating, so that may not be the cause.

However, this list also includes antibiotics. I looked up what they've got Prince on, clindamycin, and sure enough — it causes nausea, vomiting, and upset stomach, all of which will cause a cat not to eat. There's not much left, only perhaps a day or two, so I'm going to stop giving it to him and see if he'll start eating again.

I also looked for ways to stimulate his appetite. There are a few drugs that can do that, but apparently cat nip does as well. I gave him some tonight, and he ate it quite happily (as did my other cat, who is a cat nip fiend and was not about to be left out!). Hopefully tomorrow, once the antibiotics wear off and the cat nip kicks in, he'll start eating on his own.

Obviously cat nip isn't a cure for fatty liver disease, but it sure can't hurt to give your cat a little and see what happens!

Merry Christmas!

The holidays can be such a difficult time when you have a cat sick with fatty liver disease, a.k.a. feline hepatic lipidosis. I know firsthand, as Cleo was sick with it at Thanksgiving four years ago. It was the hardest Thanksgiving of my life.

This year, we're spending Christmas with another sick cat. My other cat, Prince, hasn't been eating, so I've been having to force feed him. Luckily, he was a fairly skinny fellow to begin with, which keeps him from being at much risk for fatty liver syndrome. That also means, however, that he was a lot closer to starving to death by the time we noticed he'd dropped to a mere five pounds.

After two visits to the vet last week, he went in this Wednesday to have two bad teeth removed and the rest cleaned. He's still sore from the surgery, so we have yet to find out whether it will fix his problem and allow him to start eating again.

I know it's hard to be happy during the holidays when you are worrying about your cat, but try to be thankful that your cat is still with you at all. This means you caught it in time and, with force feeding and persistence, have a good chance at getting him or her well again!

Force-feeding another cat

Four years ago, Cleo had just recovered from her bout with feline hepatic lipidosis, or fatty liver disease. After force-feeding her for four weeks, it was such a relief when she started eating on her own.

Now my other cat, a 12 or 13-year-old neutered male named Prince, is not eating. He has never eaten much, always weighing around 7 or 8 pounds, so when he started getting skinnier we didn't notice at first. It wasn't until recently that we realized he had reached 5 pounds.

I started force feeding him, and took him into the vet. They ran a blood panel, but everything came up relatively normal — creatinine (which is related to kidney function) is slightly elevated, but only one-tenth over what it should be, so no cause for concern quite yet. His potassium levels were also low, but again, just barely.

I knew he didn't have fatty liver syndrome, because he wasn't at all jaundiced. Hepatic lipidosis seems to happen most often in overweight cats, so I guess because he was already fairly lean to begin with, it didn't happen to him. But it occurred to me that tooth problems could definitely be a cause of fatty liver disease, so be sure to have your vet check your cat's mouth when you are trying to determine what made him or her stop eating!

The first vet who saw my cat observed — though only after I insisted he double check — that his teeth were probably causing him some pain. However he wouldn't do anything about it, he said, until Prince started eating on his own. I tried to tell him I think that may be what's causing him to stop eating, but he wouldn't listen to me.

So I took him to a different vet. Prince is now scheduled for a dental cleaning and tooth extraction (one is loose and obviously sensitive) on Wednesday. In the meantime, I am force-feeding him using the Hills A/D and the potassium supplements I got from the vet. Prince is obviously weak and somewhat lethargic, which may have to do with the low potassium levels as well as lack of nutrition. I'd forgotten how hard it can be to get a full day's calories into a cat via force-feeding.

I'm going to try to make a video showing how to force-feed a cat, so stay tuned!

Fatty liver disease: The importance of a good vet

A couple of months ago, I received an email from a reader about the horrible experience she had been through with her cat. Her cat had fatty liver disease, but because her vet kept misdiagnosing the problem, he wasn't treated early enough and didn't make it.

Lisa wanted me to emphasize to my readers the importance of working with a vet who knows how to treat fatty liver disease (and, I would add, understands that fatty liver disease is curable — some vets don't!). I asked for her permission to print her email here, as I think her story expresses the warning better than I ever could!

I just lost my sweet boy Smokey to fatty liver disease. He was only 3 years old.

It all started about 1 1/2 months ago. I asked my husband, "Do you think Smokey is losing weight?" and he said, "You noticed it too." I took him to our local vet the next day and they kept Smokey 2 nights and released him to me on a Friday and said they thought he just had a case of the flu.

I was relieved Smokey was going to be all right. Boy was I wrong! About 1 1/2 weeks later Smokey stopped eating over the weekend so I had to force feed him by hand. I called my vet on Monday and they scheduled a test for him to see if he had a rotten tooth. He was fine, so they then called and asked to run a FelVP test on him that tested negative, which I thought it would since I have 2 other cats which are healthy.

I went to visit him on Wednesday and they didn't do a blood panel or start IV's in him. By Thursday he looked like he was going to die. I told them to start feeding him and give him water, so they put a tube through his nose and on Friday he looked a little better. Then I went to see him on Saturday and he looked bad again. On Sunday I got the results he had liver disease and they kept feeding him through the tube.

On Monday he looked better and Tuesday even better. Then on Wednesday I went to visit him and his tube was out of his mouth and they were feeding him with a syringe. I was so happy! He looked like he was getting so much better. I visited him again on Thursday and he looked even better, but when I went to visit him on Friday I was told he was having a feeding tube put through his neck and I wouldn't be able to see him until Saturday.

He still looked okay on Saturday and on Monday I picked him up and was shown how much to feed him through the feeding tube and how often. By last Sunday he started to go downhill again. On Monday I found a website about fatty liver in cats and how much they should be fed. My vet had me under feeding him so I upped the food intake to 40ml a day and on Wednesday I even upped it to more with the vets approval who contacted another vet about fatty liver.

Well, on Wednesday night his feeding tube fell out of his mouth from his vomiting, which he seemed to do about twice a day. I rushed him back to the vet and they told me he wasn't going to make it so I had to put my poor boy to sleep.

My whole point of this story is to tell other cat owners to make sure there vet knows how to treat fatty liver so they don't have to go through the pain my whole family is going through. He should be alive if he had been treated aggressively from the start over 1 1/2 months ago.

Lisa Horst

Should you euthanize for fatty liver disease?

So you have a cat that is sick with feline hepatic lipidosis, or fatty liver disease. Should you euthanize your cat?

(I've posted before on my feelings about euthanization, so I'll spare you the lecture this time. I figure you can go back and read it if you want to. There was also a great article in USA Today's Paw Print Post on the subject: Veterinarian debates ethics of presenting euthanasia option.)

There are many reasons why pet owners choose to euthanize their animals. I'm going to approach the question of whether you should euthanize a cat with fatty liver disease from a variety of viewpoints, in the hopes of helping someone make their decision.

If you don't agree with euthanizing animals:

There are people in this world who don't believe in euthanizing animals anymore than you would euthanize a person. To them an animal has just as much a right to live as a person and euthanization is therefore murder. Obviously if you feel that way, you probably won't be even considering euthanizing your cat because they have FLD. Actually, I'm not even sure why I included this category, except to say that I think it's a beautiful thing if you love an animal enough to care for it until then end and allow it to enjoy the time it has left with you.

If you believe in euthanization to prevent an animal's suffering:

In the scheme of things, fatty liver disease doesn't make an animal suffer as much as other diseases might. Starvation is the main issue, unless they have something else at the same time that is causing them pain. And if you are willing to force-feed your cat all the food it needs to get well again, technically its days of starvation are over. Sure, it might be a bit cranky about being force-fed or having a feeding tube, but I'm not sure that qualifies as suffering.

If your cat has feline hepatic lipidosis because they also have something else, well, you will have to decide whether the other condition is causing them enough suffering to justify euthanization. I can't help you there, since that is a variable I can't quantify in this blog post. I do, however, suggest testing to see if your cat has something else, rather than assuming it does — many cases of FLD are caused by the situation, and are completely curable.

If you believe in euthanization only if there is no (or not a very good) chance of survival:

If this is your position, most likely you will not want to euthanize a cat with fatty liver disease. Most cases of feline hepatic lipidosis can be cured with just four to eight weeks of force-feeding them. However, you should probably have some tests run before you become too committed, because it is possible that your cat may have something serious (that they won't survive) that caused the FLD in the first place.

If you don't have the time or money to spend on getting your cat well again:

Let's face it, you probably shouldn't have animals. Euthanize your poor cat if you aren't going to commit to caring for it, and don't get another. Pets do require both time and money, so if this is your reasoning for euthanizing your cat, you'd be better off with a pet rock.

(Sorry, I know I wasn't going to lecture, but I just have no sympathy for people with that attitude.)

The bottom line is, fatty liver disease is curable. Most cats survive from this condition, and the ones that don't usually have something else very serious that prevents them from getting well again. Be sure to keep this in mind when deciding whether to euthanize a cat with FLD!

Don't underestimate the role of environmental causes!

I often hear from people whose cats have been diagnosed with fatty liver disease, or feline hepatic lipidosis. One common theme is that people can't believe that a change in the household could possibly have made their cat stop eating long enough to get sick.

However, environmental causes often play a role in fatty liver disease. Cleo suffered liver failure just a month or so after we added a dog to the family. By the time we noticed, she had already lost three or four pounds.

Fear of a dog, or of another cat, or even a dislike of another cat, is plenty to keep a cat away from their food long enough for feline hepatic lipidosis to set in. For one thing, it doesn't take very long — I've read that just two weeks on a reduced diet is enough to make the cat's liver bog down and stop working. In other words, the cat doesn't even have to stop eating entirely for fatty liver syndrome to set in.

Please, please don't underestimate the role that environmental causes can play in feline hepatic lipidosis. If you have a sick cat, consider what changes in the household could have caused him or her to stop eating. And if you don't have a sick cat right now (or once they get better), please please please always keep a close eye on your cat's eating habits, particularly during times of change in the household!

Prevent feline hepatic lipidosis by putting your cat first

This post is about making difficult decisions... also known as putting your pets first even when it goes against your own desires.

But first, let's talk about how Cleo got sick. When my then-boyfriend (now-husband) moved in with me in September of 2005, he brought his dog with him. I'd never owned a dog, so my cats had been more or less spared from that until then.

Prince, my male cat, adapted pretty well. Cleo did not. Unfortunately, we didn't realize she was doing so poorly until after she'd lost 5 pounds and fatty liver disease had set in.

Environmental stress, such as a new dog or cat coming into the household, is often a cause of feline hepatic lipidosis. There are ways to introduce a dog into the family without your cat getting sick and almost dying, but of course we didn't learn this until too late.

The main rules:

1) Put your cat's food where s/he can access it and eat unmolested by the dog.
2) Keep close tabs on how much s/he is eating.
3) Make sure s/he doesn't feel rejected in favor of the dog — some cats get very upset about this.

After nursing Cleo back to health, we followed these rules. For a long time, she had her own gated-off room where she could eat, go to the bathroom, etc. without having to worry about being harassed by the dog.

Later, we even added a new dog to the family. This was after we had moved into our current home, which has a basement she can go to but the dogs can't. Down there she has food, water, and even a bed in the guest bedroom to sleep on. This helps immensely because it makes her feel safe to have someplace she can go where the dogs won't bother her.

But sometimes it doesn't work out this well, and you need to think about what is best for your cat.

My husband brought home a stray puppy yesterday morning. While trying to find a place for him in a no-kill shelter, we started to fall in love with him, and were considering keeping him for ourselves.

Everything seemed perfect. He gets along well with our dogs, is affectionate, and is quickly learning our routine.

All except one thing.

He can get into the basement.

Cleo is extremely upset about him, much more so than when we introduced the last dog. It could be because she senses he's a puppy and has a lot more energy, but I suspect it's more because he invaded her happy place.

It took two days to make our decision, but finally we decided that the joy of adding a dog to the family was simply not worth the risk — however slim — of Cleo getting sick again.