Thorough Diagnostic Work & Careful Treatment Saves Lives

Question:

Our cat Ginger is 13 or 14 (do you think I’m not protecting him if I use his name?) has lab results that show elevated liver enzymes and BUN indicating that his kidneys are not functioning as they should. He’s not dehydrated and his white count is normal.

 

Since he has improved a little on the Amoxicillin, there’s a possibility that he has a low grade chronic infection that has caused his liver to become inflammed. The plan for now is to keep him on the meds for 3 or 4 more weeks, and to feed him a special food for cats with kidney disease. We can redo lab work in a month to see if the levels of those things change.

 

He seems to be eating better and he looks a little less like death is hovering over him. Still he’s at least 13 and could be as much as 17, so his time is not far off. Wow, I can’t imagine what it must be like to care for an elderly parent, when this is so hard.

 

Dr. Nichol:

Ginger sounds like a pretty sick cat. That does not mean that he can’t do well. As with most medical conditions, the more that’s known about him the better able his doctor will be to help him.

 

The kinds of problems that could cause Ginger’s symptoms include cancer, infections caused by bacteria or viruses (such as feline leukemia), acetaminophen (Tylenol), breakdown of red blood cells, chronic inflammatory disease of the liver itself, and fatty liver disease (hepatic lipidosis). The latter is the breakdown of fat in the liver of overweight cats. While the underlying cause of these problems is often non-life threatening, fatty liver disease often kills-even with treatment.

 

In addition to the excellent lab work-up Ginger has had, I recommend x-rays and possibly an ultrasound evaluation. Chest and abdominal x-rays have the advantage of screening for cancers-these are a major cause of liver disease with jaundice in older cats. Moreover, ultrasound images will allow a small sample of liver tissue to be taken for biopsy. This will make for a much more specific diagnosis.

 

Effective treatment will depend greatly on the cause of Ginger’s illness. Medications that are helpful for many cats include Amoxicillin (a very good choice by Ginger’s doctor) and metronidazole. The latter is another antibacterial that penetrates the liver well, compliments amoxicillin, and has a good anti-inflammatory affect on liver tissue.

 

The movement of bile through the “plumbing” of the liver may be a big part of Ginger’s problem. Actigal (ursodeoxycholic acid) is a human drug that often helps to reduce swelling of these areas of the liver. It helps move fluids within the liver. Sick livers get well faster with Actigal.

 

Supportive treatment is also quite important for kitties struggling with liver disease. Newer treatments are SAM-E and vitamin E (health food stores). The diet recommended by your veterinarian sounds good. A low protein, low sodium intake will help reduce stress on Ginger’s liver.

 

Finally, I advise you to give Ginger fluids by injection under the skin (subcutaneously). This will provide a “flushing” affect that will keep his liver and kidneys more free of accumulated toxins. It will also keep him well hydrated which has the added benefit of helping him feel better and eat better too. Subcutaneous fluids can be given daily or every other day. It’s quite easy; cats seldom object.

 

With Ginger already showing some signs of improvement, he may do OK. It sounds like he has competent medical care. I’ll say a prayer for him.