Hepatic lipidosis - frustrating setbacks

Cleo's had a rough couple of days. Yesterday she only kept down just over a half can of food. She's also been having a really tough time with the fluid injections lately, so I let her take a break from them last night.

Today I got 3/4 a can of food into Cleo. I probably could've tried the remaining 1/4 can, but after the vomiting yesterday and the day before, I decided not to push it. I'll go for a full can tomorrow. She did get her fluid injection tonight, but she fought it quite a bit. I wish she would start drinking again so that I wouldn’t have to keep injecting her with fluids every night.

Because of the reduced amounts of food lately, Cleo has been hiding more again. Also, I think she senses the difference now that the holidays are over — Michael spent a lot of time in the study, where she is, during his vacation. My next few days are going to be busy, but hopefully on the weekend I will be able to spend some more time with Cleo. I think she needs more attention — other than feeding times — than I’ve been giving her recently.

Slow recovery from hepatic lipidosis

Cleo didn’t keep much food down today, but I think it was rather my fault: I had slacked off on feeding her much earlier in the day, and so I think I tried clustering her remaining feedings too close together. Better luck tomorrow, hopefully.

I haven't posted many pictures lately, so I'm posting a few tonight. This is one of Cleo on Thanksgiving, when she was out and about, checking out the view outside the window. In the picture, she is just underneath the study window.



Cleo also likes to hide underneath my grandma-rocker from time to time. I have a couple of pillows shoved under there to try to keep her out, but she manages to climb on top of them. Oh well — having them there makes it easier to get her out again, as I can just slide her down off of them.



The pictures with Cleo's head poking out were taken today. Sometimes, she leaves her tail out too; it’s a classic example of "If I can’t see you, you can’t see me."



It seems like it could go on this way for a while: Cleo making small improvements while still needing to be force-fed and injected with fluids, and me washing lots of towels (they get dirty fast, from cleaning the food off her face as I feed her and mopping up what she doesn’t keep down).



It's worth it, though — she's my baby. Isn't she cute?

No more anti-nausea medication

I haven't tried giving Cleo the anti-vomit pills at all today. Instead, I’ve given her four meals of a quarter can each time, and she's kept it all down (so far). This seems to work better, and Cleo seems to be gaining strength as well as the ability to keep more food down at a time. She also is becoming more tolerant of her feedings — she doesn't complain when I first pick her up to feed her, and she doesn’t start growling at all until partway through the feeding itself. She still has not drank on her own — which means I'll be giving her the nightly fluid injection here shortly — but hopefully, if she continues improving at this rate, she will start drinking soon.

Anti-nausea medication for hepatic lipidosis: Part 2

I am beginning to doubt the usefulness of Cleo's vomit-inhibiting medication. Although she kept everything down on Wednesday, she's thrown up every other day since she started the prescription — twice yesterday. Doesn't really seem any better than it was before she was on the meds.

Cleo kept down the morning dose of her meds, as well as a third of a can of food. This evening, however, she threw up her meds almost immediately, along with a small amount of food and a large amount of stomach acids. (Thankfully it seems that most of her earlier meal had already left her stomach.) I didn't try to give her another pill; I just split her remaining half-can into two smaller meals. So far, she’s kept down both.

I think Cleo is complaining less about her force-feedings. She doesn't start growling or hissing at me when I pick her up — she actually endures it with very little protest now. She growls at me a little when I feed her, but not with as much gusto now, and only when the syringe is in her mouth — between "bites," she's quiet. She forgives me faster now, too — sometimes right after I let her go, she puts her tail in the air and looks over her shoulder, waiting for me to pet her.

I'll tell the vet that the meds don't seem to be working. If she still keeps throwing the pill up, I’ll try splitting each day into four quarter-can meals; perhaps she'll start keeping them down.

I also am hoping that Cleo will start drinking on her own soon. After her final feeding tonight, she kept licking her chops, and it occurred to me that she might be thirsty. I brought her fresh water and put it right in front of her face, and she made motions like she was going to start drinking, but then she gagged a little and turned away. I guess her nausea is still bad enough to keep her from wanting to drink. Yet another night of having to give her fluid injections... That's my least favorite part.

A difficult Thanksgiving

Today was a discouraging day. Although Cleo was still very alert ‐ she watched birds out the window, jumped up to sit on Michael's desk, and purred frequently — she also threw up the anti-vomit pill in the morning, and threw up an entire meal in the evening. I think I may have gotten almost two-thirds a can into her today, not counting what she threw up. Also in the evening, her water injection went badly — apparently I stuck the needle in a sensitive spot, as Cleo just about jumped out of my arms. I didn't give her the usual amount of fluid because it seemed to hurt her so badly. I don’t think she's in any danger of dehydrating, as she pees quite a bit, so I'm not too worried about that; however, the vomiting combined with accidentally hurting her has left me feeling rather upset.

I guess I have to be thankful that Cleo is alive and has a good chance of recovering. With any luck, tomorrow will be a better day.

Anti-nausea medication for hepatic lipidosis

Cleo's anti-nausea medication has changed my life. Whereas before I had to plan my day around her meals — usually six feedings, spread out evenly throughout the day so that she didn’t get too much at once and throw it all back up — I can now feed her two large meals, 45 minutes after giving her the pill, and two smaller meals. Feeding her also doesn’t take as long, now that I don’t have to worry about her throwing it up if I go too fast. Instead of planning my entire day around feeding Cleo, I now have to plan only a few hours' worth. Perhaps soon I’ll be able to feed her just two meals a day — one after each pill.

Once again, the day has seen improvements. Cleo is more and more active every day. She has apparently been playing with her mouse, as I discovered this evening that one of its ears has been ripped off. And just this morning, when the window in the study was open, Cleo jumped onto the windowsill to look out. It’s so good to see her taking an interest in these things!



Cleo also spent some time today washing her face. This is the first time she's cleaned herself (that I know of) in weeks, maybe even more than a month.

I also am pleased to report that I got a full can of food into Cleo today, and (as of yet) she's kept it all down.

Oh, and she also pooped again today! Now that she is getting more food, her turds are getting to be a healthier size and frequency. Amazing, the things that make me happy these days!

A light at the end of the tunnel

Good news — Cleo kept the medication — and a sizeable meal, a third of the can — down this evening! Right now she’s using the litter box... I’m sure you don’t want a picture of that…

As far as statistics go, however, she has now pooped three times since I started force-feeding her (boy was it a relief the first time, as it had been awhile); she also weighed in this morning at 8.8 pounds, only one-tenth under her weight a week and a half ago, so while she has not gained any weight she has apparently stopped losing it at the terrifyingly rapid pace that earned her a trip into the vet. So while she is still very sick, there is definitely a light at the end of the tunnel! (And not the kind that they tell you to stay away from, either...)

Cleo goes to the vet's

I took Cleo to the vet today to have her urine rechecked. She still has a urinary tract infection, which means she'll be on antibiotics for at least an additional two weeks. I did find out that the normal intake of food is between 1 1/4 and 1 1/2 cans of this special food each day, so the 3/4 of a can she's been keeping down lately is pretty good. I'’m hoping to have her up to a full can each day by the end of the week.

All in all, the day was pretty traumatic for Cleo. Although she was never too crazy about car rides and vets, she has had some pretty bad experiences there since she came down with fatty liver disease, so she was pretty nervous today. She still purred for me when I petted her, though. However, then the vet drew the urine sample, after which Cleo was brought back to me looking rather harassed. To make matters worse, when I got home I discovered she’d peed in the carrier, which meant that she got another bath. (The same thing had happened the last trip to the vet, when she got her ultrasound and her first urine check.)

Cleo has been vomiting almost every day, although sometimes it’s only small amounts; however, the vet said that was too much, and gave me medication that will keep her from getting nauseous. After giving her an hour or so to settle in after her bath, I gave her a dose of the medication. I'm supposed to feed her 45 minutes after giving her the meds, but when I checked back I discovered she'd thrown it up. I spread her meal out, instead of giving her all one big one as I’d been planning, and she kept it all down. However, I find it highly amusing that she threw up the pill that was supposed to suppress vomiting... We’ll see how it goes with the next dose, later this evening.

Small improvements

Even small improvements cheer me. Although Cleo vomited again tonight, it was several hours after her last meal, and I think she kept most of it. I’m hoping to get 3/4 of the can into her again today.

Cleo spends a lot of time hiding behind my stuffed, antique, grandma-style rocker (below).



Tonight, in an attempt to lure her out, I bought her several new toys. She seemed particularly excited by the mouse, as she started purring and arching into my hand as I pet her. I think she even played with it for a few minutes before she tired, as the mouse was wet and had a tooth hole when I checked back a little later.



Cleo certainly seems to be acting a bit more like herself. Lately, she's been reacting more favorably to attention: instead of only purring when her head was scratched (and growling if any other part of her was touched), she is now arching into full-body petting, like she used to, and lifting her tail quite a bit more. She even talked to me a little tonight, after I gave her the toy: she meowed a few times, and then peeked out from behind the chair when I moved a few feet away.



As I said, the little improvements are so encouraging. Tomorrow, Cleo goes in to the vet for a checkup. (On top of everything else, she’d had a urinary tract infection, and is on antibiotics for it. The vet needs to recheck her urine.) I will, of course, continue to update Cleo's Progress.

Week 1 with feline hepatic lipidosis

Cleo was always a pretty hefty cat, so I knew when she stopped eating and started hiding that something was very wrong. My boyfriend and his dog had moved in with me about two months earlier, when I started noticing the changes in Cleo. She hadn’t warmed up to the dog yet, but despite the hisses and snubs, she seemed to be going about her daily business at first. It seemed like it all happened quite suddenly: Cleo hiding all the time, not eating, gagging and dry-heaving, losing weight... Cleo as a skinny cat for the first time since she was a kitten.

I took Cleo to the vet almost right away. At first they didn’t know what it was, but I felt sure that the gagging and dry heaving indicated she had something ‐ a hairball, a foreign object — stuck somewhere. When I took Cleo in for X-rays, the vet noticed that Cleo’s skin had developed a yellowish tint that he hadn’t noticed the previous day, indicating liver failure. I okayed the blood tests, and in the meantime started doing some research of my own. After lab work and an ultrasound, the vet confirmed what I’d already come to suspect: Cleo has hepatic lipidosis, or a "fatty liver."

Basically, what this means is that Cleo stopped eating as much when the dog joined the family, and her body started to metabolize her considerable fat stores as energy. The cat’s liver is not equipped to handle this, and becomes backed up with fat. It's a condition that has a very high recovery rate when treated correctly; essentially, this means that for the next 4-6 weeks (or longer), I will be force-feeding Cleo. Once her liver starts functioning normally again, she should start eating on her own, but until then she won’t want to.

It's been about a week since Cleo's diagnosis. She won't drink on her own, so once a day I give her an injection of IV fluid. I also have to feed her special food that I buy at the vet. The food is of a very fine consistency, which is easily passed through the tip of a syringe, especially when mixed with a little water.



When I first started force-feeding Cleo, she had gone so long without eating that I could only get about 48 CCs of food into her without her vomiting. Lately, she’s been doing a little better — I’ve been able to get almost 3/4 of a can into her each day. (The normal amount would be a little over a can of this food each day.) She's starting to move around a little more, instead of just crouching in one place all the time (she's in the study with a baby gate across the doorway, so that she may feel safe from the dog). However, even though the food is helping her, she still hates feeding times — with a passion.



When I feed Cleo, I wrap her up in a towel so that she can’t struggle too much. However, so far she’s been pretty good. Once she’s wrapped up in the towel, she will just sit there on the floor. She even held still to have her photograph taken.



Once she’s all wrapped up, I hold Cleo in my arms like a baby and feed her with a 12 CC plastic syringe. I have to go pretty slow — 1/2 to 1 CC at a time to allow her to swallow and keep it down. She hates this part, and I often have to use one hand to keep her head turned toward me. To get her to open her mouth, I stick the syringe into the corner of her mouth. She growls and complains the entire time, even when she’s licking her chops, so it ends up sounding like myah-myah-myah-myah. Emma, the dog, seems pretty concerned; every time I feed Cleo, Emma comes and lays on the other side of the gate with her chin on her paws.



Cleo will no doubt come through this all right, but it will probably take some time. For the time being, she is sporting a bad haircut on her belly, a necessary evil to allow for the ultrasound and a certain diagnosis. You can see in the picture the yellowish cast to her skin.



This will no doubt be a rough couple of months for me, but I would rather nurse her myself than have to hospitalize her. I'm not too keen on her have a surgically implanted feeding tube to her stomach, either, so I'll do my best to get her all the food she needs via syringe feeding. Thank goodness I am now home freelancing; if I were working full time or — God forbid — traveling, it would be virtually impossible for me to give Cleo the care she needs without hospitalizing her.



I will update this page periodically with news of Cleo's progress, so be sure to check back!