URGENT: Diet and Treatment Advice Needed - Liver Inflammation

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Critter Mom

Critter Mom

Member Since 2014
Saoirse had an ultrasound today and an abnormality showed up in her liver. It may be inflammation. Our vet is scheduling further diagnostic tests this week.

In line with my vet's recommendations, I'm giving Saoirse chicken and broth tonight to help her recover from the anaesthetic.

We're letting Saoirse recover fully from today's anaesthetic and then we are starting her on a supplement containing SAM-e, silybin, vitamin C and vitamin E (brand name is Samylin).

I would be grateful for any advice on the following:

* what to look for in terms of food protein and fat content.
* any mineral percentages that needs to be considered.
* ingredients to avoid.
* additional supplements that can help support the liver.
* whether there are any support groups for cats with liver issues.

Because of Saoirse's pancreatitis issues it's proving extremely difficult to find a food that will agree with her that is also dependable in terms of quality and consistency. I got another iffy batch of her regular food a couple of weeks back so I had to give her something else. She can tolerate Liquivite recovery food so I've been giving it to her as a stop-gap for the last couple of weeks (not overjoyed about that) in anticipation of getting blood tests done for allergies (results will be in next week). However, with the results of today's scan, as a matter of urgency I want to try to find a new food for Saoirse that will meet Saoirse's diabetic needs but put the least strain on her liver. Here's a link to the nutrition profile of the food she's currently on:

http://www.liquivite.co.uk/about-liquivite

I've done a quick scout online and seen that fish is a no-no for liver problems. The Liquivite has fish oils (not salmon oil btw as that makes Saoirse nauseated). I am wondering whether that might be what's irritating her liver? I'm really not one bit happy about having had her on it so long (it's low-ish protein, high-ish fat, low carb) but I can't seem to find other foods which she can eat without increasing her digestive discomfort and which won't negatively impact her blood glucose levels. (Allergy test blood draw scheduled for a few weeks ago had to be abandoned because Saoirse got too stressed before the pre-op checks.)

I respectfully request that no-one posts anything potentially alarming on this thread (no matter how well-meaning or helpful it might be). My vet has stressed the urgency of getting an accurate diagnosis, and I'm trying not to worry myself unnecessarily. I just need constructive advice right now. I'm feeling very fragile. Saoirse needs me and if I get panicked I will be no good to her.

Help!
.
 
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Milk thistle has a long history of use for liver support, I'm wondering if anyone has experience using this in cats. http://onlinelibrary.wiley.com/doi/10.1111/jvim.12002/abstract

Edit: silybin is the active component of milk thistle. Hope it helps, the research on it looks pretty good. I'd also ask the vets to review the meds she's been on the the past few weeks. Some meds can cause a transient inflammation that goes away when it's reduced or stopped.
 
Thank you both for your replies.

Saoirse has already been on a supplement containing milk thistle (Nutramed) for a while but I think the maritime pine bark included in the formula may have been irritating her digestive tract. Saoirse hasn't had the supplement for a few weeks. Our vet has recommended the SAM-e /silybin combo. He says the SAM-e is the better of the two as long as she can tolerate it. It comes in tablet form so I hope it doesn't upset her stomach.

-Meya

The only medication she's on at the moment is ondansetron for nausea. Co-incidentally I've been reducing the dose over the last week or so. I must check out how it's metabolised.


- Eliz,

Thank you for that valuable link. I've visited that page before many a time when I was looking for things to help Saoirse but I had forgotten about all the additional supplements that were listed. There's definite merit in the taurine suggestion. The Smilla kitten food had a high level of taurine and any time I've got hold of good batches of it, it has been the food that Saoirse has agreed best with Saoirse. I wish the quality was reliable. The last batch badly impacted her BG numbers and she had difficulty trying to eat it. (Hence the Liquivite stop-gap. ) I must run the suggestions past our vet.
 
Hi Aine

When remi had trouble with his liver (cholangihepatitis ) he was given

Denamarin and Destolite (urso-deoxycholic acid) to begin with. Then when that didn't solve it he was given a broad spectrum antibiotic in combination with a steroid. There are lots of treatment options so please don't panic. Like pancreatitis it is a matter of trial and error.

Water soluble vitamins are often given.

My left over denamarin went out of date at the end of January this year but if you want I am more than happy to send you the 18 tablets I have left. PM with your address if you want them. They are foil sealed and in their original pack so I can't see they would have gone bad.
 
Hi Sarah,

Thank you for your kind offer. Denamarin sounds similar to Samylin so I think I'm good on that score. Did you give the Denamarin in pill form or mixed into food? Also, what is the destolite for?

My vet's reluctant to prescribe steroids if they can possibly be avoided because he's worried about Saoirse becoming insulin resistant and hard to regulate. How long before Remi's FD Dx did he have the steroid treatment? I've been wondering whether cholangiohepatitis might be what's up with Saoirse. I know that I can research it but right now I'm in a heap. Are there any salient points that you can think of to give me a steer? Did Remi get any mineral supplements?
 
Critter Mom said:
There's definite merit in the taurine suggestion.
Click to expand...
Taurine is easy to obtain, so you could start that as soon as you (and your vet) decide that it's appropriate. It probably has little or no taste because my cats have never noticed it in their food (I give my oldies a pinch of taurine about every other day). I understand that any excess is excreted in the urine.
 
Sorry I just read the title and you actually wanted dietary advice and I didn't give you any and actually I am not sure I have any to give. Just trial and error from my point of view.

The destolite thins the bile in the gall bladder and helps it flow and this seems to help the liver (not very scientific explanation sorry).

The denamarin tablets are big and it says not to break them up as the coating is protective so I gave it with a five ml syringe of water as a chaser. It actually made remi throw up a few times hence the left over tablets.

Re the steroids this was before his diabetes diagnosis by about two years and so it didn't have a direct influence on his diabetes but I think I would hesitate to give it to him now unless really necessary.

The antibiotic had the most direct and beneficial affect on his illness and symptoms. He was on them for a couple of months.

Re the supplements besides the denamarin he had the usual vit b injections but nothing much else but the water soluble vitamins are meant to be really useful. Vitamin b and e.

As for typical treatments ideally you would narrow down the cause /type first and the treat accordingly. I have saved a good document somewhere and will dig it out tomorrow if that is okay. Did you they do all the usual blood tests- ALT, etc.
 
Sarah, I'll take every last bit of advice I can get! Thank you so much.

Questions (sorry for bullets - bit of a struggle to communicate right now with the PTSD issues + added stress):

* Which antibiotic?

* Was it B-complex?

* What clinical signs, if any, did Remi show with the cholangiohepatitis? (That would be really helpful to know.)


phlika29 said:
It actually made remi throw up a few times hence the left over tablets.
Click to expand...

I've seen similar comments from other caregivers on the web when I was researching SAM-e. I hope Saoirse can tolerate it OK.

The vet did pre-op bloods last weeks and the values were all good. However, when he centrifuged a sample today there were pointers to possible jaundice in the blood plasma. (I need to start getting hard copies of test results. I have no visibility of the numbers.) It was a bit of a land when I got the ultrasound result today.

Thanks for thinking of the document for us.
 
BTW, Sarah. Did you ever investigate acupuncture? It works well in humans for some liver problems.

I've tweaked the thread title, BTW.
 
Elizabeth and Bertie said:
Taurine is easy to obtain, so you could start that as soon as you (and your vet) decide that it's appropriate. It probably has little or no taste because my cats have never noticed it in their food (I give my oldies a pinch of taurine about every other day). I understand that any excess is excreted in the urine.
Click to expand...
Taurine is an amino acid, a protein building block. As such, it may have some ammonia as part of its break down by-products.
 
i'm sorry, i'm on the run so this will have to be brief. have to leave for the airport in a few minutes.
severe liver disease and acute kidney disease knocked alex out of remission in 2010. she was on death's doorstep and not expected to live, but recovered against the odds.

treatment consisted of:
denamarin (small coated pills, no problem pilling or keeping them down, give on empty stomach at least one hour prior to feeding)
ursodiol
taurine
fish oil
B complex and B-12 vitamins
vitamin E
metronidazole
clindamycin
sub-q fluids
sometimes pepcid ac

i did not feed a special diet. basically, i gave her anything she'd eat. i had to assist feed... often (round the clock when necessary). a vet tech who used to post on the FDMB a lot used to say "food is like medicine for the liver". i tried to get as much food into her as i possibly could. the goal was to get her normal amount of food into her plus half of of that every day. it took about 6 weeks of intensive nursing til her appetite returned to normal.

this helped, too: Suggestions on How to Stimulate Kitty's Appetite. unfortunately, alex relapsed a few times after that (scroll down her ss). all we could do was start all over again. she did pretty well after that. i lost her last fall to oral cancer... her liver was in pretty good shape.

in addition, i carefully monitored her BG often because i wanted to keep her under 200... in the 100s whenever possible because it was obvious she felt better when her BG numbers were lower.

i tried to document this on her 2010 Spreadsheet, but i'm not sure how well i did because i was beyond exhausted everyday. i know i neglected to record a lot of vomiting.

hope this helps a little. i'll check back when i can.
sending positive thoughts...
 
Aine,
I just saw a post from Vyktor's Mum on another thread about B12, raising the question over it's appropriateness if there may be cancer in the picture.
I sincerely hope cancer isn't in the picture but thought, if B12 supplementation is being considered, you may want to be aware of any possible negative aspects.
How big are the zobaline pills?
.
 
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Aine

Sorry I went to bed last night before your reply but actually Jill's list is an almost exact replica of what remi was given.

The ursodoil is the same as the destolite in the uk. The a/b was synulox and I think initially another one (will look up his old records). I briefly gave sub q at home and the injections is vit b12 I think.

I didn't give any oil based supplements due to his pancreatitis.

Remi's main symptoms merged with pancreatitis and so I am not 100% sure what was related to what but in essence ongoing vomiting, pain, poor condition of fur, lethargy and in the end jaundice. He responded quickly to the a/b injections he got at the emergency vet but quickly deteriorated when they wore off. He just wasn't getting better for weeks even when on all the usual pancreatitis supportive meds.

His liver values were very high and so was his bilirubin and spec fPLI (over 50).

No I have never tried acupuncture for remi but have used it myself and found it to be very good. I am not sure that the stress of taking him somewhere would outweigh the benefits.
 
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Thank you all for your replies. My PTSD's in overdrive trying to take all this in but I'm very grateful for the list of things to look at and discuss with our vet.

I had acupuncture treatment myself years ago. I used to get a patch of psoriasis on the instep of one of my feet. It would flare up, calm down but would never go away. Two acupuncture treatments cured it completely. It went livid purple after the second treatment and I thought I would tear my own skin off it was so itchy, but by morning it was just pale pink; better than it had been in years. It healed completely within a week or so, with no trace of scarring. I was gobsmacked at how powerful and effective the treatment was.

Saoirse's booked into Langford Small Animal Hospital (part of Bristol University's Veterinary College) for the week after next. I actually feel worse than during the first days of Saoirse's diabetes Dx. At least at that stage I had some idea of what to feed her. I'm in knots about the food situation. What little I've been able to look at online has ambiguous information about whether to restrict protein or fats. I feel sick with worry. :(
 
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Thank you so much, Jill. I really like technical (even if I have to read it ninety-'leven times because of the PTSD).

BTW Saoirse's appetite is good, although she does want me to warm her food a little. I think the current diet is constipating her a bit (dry-ish stools). I need to give her a little psyllium husk. Is that OK?

There are too many things going on at the moment. I have more tabs open in my browser windows but it's getting me nowhere because when something makes me anxious what little bit of concentration vanishes completely. Thank you for giving me one document to focus on.
 
When remi had his cholangihepatitis flair Bristol was where my vet suggested he refer remi for further tests. I couldn't afford it because of the amount I had already spent so in the end my vet spoke to the specialists over the phone on a number of occasions and so I would think you are taking Saoirse to the best place possible.

With regards food if I had to choose I would go for a high protein diet with low fat and low carbs.
 
((((Aine & Saoirse)))) I am so sorry to hear this- sending healing vines and hugs(gentle ones!) Thank you for keeping us posted.:bighug: The article Jill sent is an excellent one!
 
Hi Aine

I was wondering how things are going. Have you had any test results back yet or been to your appointment?
 
Hi Sarah,

Thank you so much for checking in on us. Had some results back:

Liver - all in normal range - no jaundice.
Slightly elevated creatinine but in line with Saoirse's age.
Rest of blood work all OK.
Spec fPL - 17 (disappointing - it was 18.3 during her flare last year).
Histology - 2 skin nodules (removed) - sebaceous origin - completely benign.

Still awaiting the allergy test results. No improvement worth mentioning in BG levels after dental as yet but vet says post-dental discomfort may be affecting that. Food problems continue. :(

Some normal poop but today only one small cylinder that was very dry (but a good colour).

Saoirse has her appointment at Langford next Tuesday morning.
 
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Critter Mom said:
Slightly elevated creatinine but in line with Saoirse's age.
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Hi Aine,

There's some useful info on this page from the Tanya website about creatinine (and apparently, raised creatinine can also be caused by pancreatitis):
http://www.felinecrf.org/diagnosis_blood_chemistry.htm#creatinine

Really hoping that the allergy test results turn up something useful, especially if it will signpost you to more foods that Saoirse can eat...

What is your concern about Saoirse's BG levels? Are they raised above her 'normal' level? (Couldn't find recent data on your SS)

Eliz
 
Hi Eliz,

Thanks for the link about creatinine levels. I did not know that pancreatitis could affect them.

Saoirse has a new spreadsheet for this year.

Current Spreadsheet

Her numbers are trending upwards, and her clinical signs have deteriorated since cessation of Lantus treatment. She's also not processing nutrients properly (coat is rusting again). Food is key to keeping Saoirse in good numbers, and I can't find a food she can tolerate that keeps her BG numbers in the optimum range for her specific needs. I think her pancreas needs more support than it's getting. Will be looking at pancreatic enzymes shortly. Our vet has finally OK'd trialling them.
 
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