Our Journey with Feline Hepatic Lipidosis

Feline Hepatic Lipidosis...I had NEVER heard of such a thing.  In all my years of owning a cat, never once did I know that they could get this disease...

The night before she started acting so sick...she was in the bathtub!

But they can... and apparently it is VERY common, and can range in severity.  When caught and treated, cats can have over a 90% recovery rate, and depending on the cause, it may never reoccur.

Our sweet Riley woke up on Saturday September 16th not feeling very well.  She was very lethargic and seemed to be in a lot of pain for some reason.  She would cry no matter when or where you touched her and she would cry out and growl when she would try to jump on our bed.  I thought it would pass, but as the day went on - it didn't.  She also was still VERY lethargic on Sunday, though the pain seemed to be a bit better.  She had no interest in doing anything other than laying on our bed though - including eating or drinking.  I decided to give her a few more hours but if she wasn't much better on Monday morning, we were going to go see our local vet.

Thus our journey began.  I called the vet first thing Monday morning and made her an appointment for 2pm.  She was seen and he immediately noticed that she was very jaundiced.  In cats, you can see the yellow skin changes in their gums and eyes most commonly, but you could also see it in Riley's ears and the pads on her feet.  I felt absolutely horrible for not noticing because once he pointed it out, it was blatantly obvious.  He decided he would draw some labs and call us in about an hour with a plan.  I of course went home and cried the majority of that hour because we just didn't know what was going on with our Riley girl, but we knew it wasn't good.  When the vet called, he noticed that things were very strange.  Her bilirubin was 12, and for a cat, normal is less than 2.  Her creatinine didn't seem to elevated and her liver seemed to be okay at that point, but she was still very sick and recommended that we take her to the specialty/emergency vet in Johnson County.

While we waited for the vet to call, you could tell she was just miserable.

Deric and I decided we would take her and see what they recommended.  My coworkers had had great experience there in caring for their animals, so off we went to Mission Emergency Veterinary Services (MEVS).    We saw Dr. Wall, one of the cardiology specialists, there who happened to be on-call for the evening for things that we came in.  She was absolutely wonderful!  Riley of course had perked up a little when we got there, but Dr. Wall agreed that something was a-foot because of her bad jaundice.   They decided to do an ultrasound of Riley's belly.  With that we found that her gallbladder was angry - so Dr. Wall suspected she'd had a gallstone which she had passed at that point.  This seemed to explain her pain from Saturday, however it was still concerning.  She gave Riley some antibiotics and anti nausea medication to hopefully help her have an appetite again and avoid any further problems.  Riley's liver looked okay at this point, however it was also found that Riley also has two very different sized kidneys.  She probably had this since birth, and other than just something we now know, isn't really a big deal.  Dr. Wall suggested we go back to our local vet on Thursday for more lab work to make sure that Riley was in fact improving.....well....

Waiting at MVES

We got everything down Riley for two days despite her best efforts, and force feeding her watered down tuna just wasn't going very well.  When she went back in Thursday afternoon for more lab work, her labs were worse.  Her bilirubin was now 18 and her liver just didn't look quite as good as it had two days prior.  Our local vet was going to send over the labs and wait for recommendations from the specialty vet - but it was 4pm on Thursday when all of this happened so home we went.  Friday, I decided to call and follow up because I had not heard anything up to that point, which concerned me because Riley definitely was not herself and still very yellow.  Once I reached someone, they recommended she be admitted because she was definitely dehydrated and most likely needed some more tests to be run - so home I ran Friday afternoon to grab our poor baby.

Riley HATES the pet carrier (like guns-a-blazing, hissing, feet spread wide so she won't fit through the door type HATE), but she was feeling so poorly at this point she barely had the energy to get in, I almost had to just lay her in there.  When we arrived at MEVS, one of the other emergency internal medicine vets was there for the evening and took one look at her and told us she definitely needed to be admitted at a minimum for fluids.  We went over the costs (don't ask) and what the plan would be.  She got her IV started and I got to say goodbye.  This was the first night I slept decently in almost a week because I knew she was in good hands, but that did not make it easy for me to be away from her.  

You can see how yellow her belly was here without the fur...and she was just plain miserable

Saturday morning the 23rd, both Deric and I decided we would go visit after rounds and get an update on our plan.  Unfortunately when we arrived, Riley was actually worse not better.  She had encepholopathy which is where her liver wasn't getting rid of the toxins it is supposed to and they had built up in her system and were making her goofy.  She wasn't holding her head straight and kept making strange noises.  She also couldn't get comfortable.  This was also when we met Riley's angel, Dr. Bangert - the internal medicine doctor on for the weekend who would be overseeing Riley's care.  She planned to do more labs and look at Riley's belly again that day and would call us with an update later in the afternoon.  She did just that about 3 hours later - Riley was definitely diagnosed with Feline Hepatic Lipidosis.  FHL is a condition cats get when they do not eat.  Cats cannot convert their fat stores into energy like humans can when we are sick, and though they try, their livers become very overwhelmed and cannot continue to function normally.  The cure for FHL...food/to eat!  Riley's bilirubin was over 20 at this time and Dr. Bangert recommended a feeding tube.  They would place this directly into Riley's esophagus and she would be able to come home the next day if all went well.  They would give her a few feeds before she came home with us, and we would be shown how to do all of this for her.  Dr. Bangert said after about 4-6 weeks it most likely would be able to come out depending on how well Riley did and when she began eating on her own again.

The last picture I took before she got admitted to the hospital, you can see her yellow ears in this picture

Deric had bought me tickets to see Tim McGraw & Faith Hill that Saturday night and since MVES is 24-hours we got to stop by and see Riley after the concert.  It was so nice and helped me sleep so much better that night.  She had her tube and her cute little Kitty Kollar on (this cute blue polka dot collar to help keep her from messing with her tube), and she had had one feeding at that point.  She'd done really well and they were very hopeful she'd come home the next day without too much problem.

Sunday afternoon, we again drove over to MVES to pick up our girl.  She had been doing really well with both her feeds and her medications so she was free to come home, but would need to come back in 3 days for labs and a check up.  So home we went!  Our first feed and such went pretty well at home, since it had been so many day since Riley had had a full meal we started very small with only about 10cc of food, 10cc of water, and then her medications which all in all totaled about 30cc of liquid combined.  She wasn't a huge fan of her new collar though because it prevented her from sleeping in the strange positions she loves so much - like with her head buried in the side of her furry bed!

Still rocking the red bandage from our IV and unhappy about not being able to contort her body to sleep

She had so many medications we had to write down everything to keep track of what happened when 

Our first night home with her new accessory...she wasn't very happy about it

Our schedule for the next several days included me getting up at 5am to give her her medications, feed her at 6, go to work, come home at 5 and give her her medications, feed her at 6 or so, and then feed her again with her medications at around 11pm.  It was absolutely exhausting, but she was worth it and doing as well as could be expected.  She was on SO many medications including prednisone, amoxicillin, lactulose, urosdiol, and kitty zofran.

Back to the vet she went on Wednesday, and we did not get the news we'd hoped for.  Her bilirubin continued to climb despite our efforts, but they thought she was still doing okay so on we pressed with her care.  She didn't have to go back for a week, though - hopefully!  This is also when we met Dr. Bangert's reguarly tech Ashley - Riley's second angel.

She loves sitting in the window so we were trying to help her feel some better, thankfully we had some nice weather and could get her some fresh air.

But the next day - September 28th -  I took her back to the vet because she seemed VERY full.   We would feed her and she would just look at me like "please stop mommy I am going to explode".  Her belly was very hard, she had decent bowel sounds (yes I was listening to them with my stethoscope LOL), she was vomiting with feeds now which they really did not want her to do because it can cause her tube site to become infected, and just continued to feel absolutely horrible and she also still had yet to go to poop and it had been over a week since she got her tube.  Boy am I glad that I did.  We knew Dr. Bangert was going to be out of town during this part of the week, and that's why Riley had been back on Wednesday, so Riley saw one more vet in the office again, a wonderful vet named Dr. Grigsby (but Ashley was there and could fill her in on how Riley had been).  Dr. Grigsby had to do an enema on poor Riley because since she didn't go to the bathroom at all at the very beginning of this, the poo in her gut became very hard and Riley could not pass it and became impacted.  So she really was very full and wasn't really digesting the food we were giving her.  They were able to get her all cleaned out and feeling better!  The vet still assured me it was totally normal for her not to have pooped much at this point.

I had a local symposium for work that Friday the 29th and the entire day, I just stressed and stressed about her and that she really wasn't much better, though I didn't really know what to expect.  She was going potty once in awhile, not eating or drinking much on her own (really none at all), and she had not pooped in over a week!  Though the vet assured me this was normal and they acted like this happened all the time, it was still very hard to see her so sick.  Saturday September 30th was really the first time she stayed awake for any amount of time and also would get up and scratch on her post for a few seconds!

She did finally figure out she could get comfortable by laying on her elephant toy.

It was Fall, and kind of chilly.  She would get so cold without her fur, we started keeping her covered with a blanket.

She went back Tuesday for her regular checkup, which went about as well as the first one... but knowing they were there for support was helpful for me because I had to leave the next day after work for a conference in Washington DC so Deric was going to be the King Kitty Nurse at our house until Saturday night.  She even kind of cared that evening about what was going on outside like the "old days" even for just a minute.  However, despite doing somewhat better, she was very dehydrated still so we were sent home with Sub-q fluids for her.  We inserted a needle into the skin between her shoulder blades each night and let about 100+ cc of fluid flow in via IV tubing for her.  This prevented her from having to go back to the hospital for another IV.  Her kidneys were really unhappy at a creatinine of 4.0 since she was so dehydrated as well.  We also added a couple of new medications including clindamycin (another antibitoic in case we were wrong about the gallstone and she'd actually gotten into something) and Reglan (to help her bowels wake up and maybe help her appetite).

During one of her feeds

Occasionally she'd look kind of perky...

So Wednesday arrived, not much change that morning - it was absolutely heartbreaking to leave her - but Deric did such a wonderful job with her.  She loves him anyway but he is so patient with her especially when she is sick.  It was so sweet.  Off I went to DC and about 5pm our time, Deric calls and Riley's gut officially woke back up and she had pooped all over herself, our bathroom, and her bed.  Poor Deric!!  The first night I am gone and she just gives him a huge job.... Luckily my parents were able to come over and help Deric and give him their extra bed, because Riley ruined hers and she was spending the majority of her days in it at that point.

Boy after that, that was kind of her turning moment!  She was like a new cat when I got home - though not even close to normal, but so much better (if that gives you an idea of just how bad she was)  She finally started to perk up just a little bit, still not really wanting to eat or drink though.  She went back to the vet the Tuesday after I returned home, October 10th - and things were ever so slightly better!  We, at this point, were celebrating every single small victory we could get.  The vet made sure to call right away after her labs were back because she was so excited Riley finally had such an improvement.

She finally looked a little better!

The following day, she really started to show some interest with wanting to sit in the window at home, lay on our bed (which at this point we had to help her to get onto because she'd been in her bed so much she was too weak to jump up there) but her energy was coming back.  She still didn't have much interest in food - especially her food.  She loved jerky treats and the food they'd been eating but through all of this she developed horrible food aversions (like a human when we are sick and apparently this is normal) and both her food and the treats she loved so much made her gag.  Because of this, we'd been leaving some Meow Mix the vet had given us in with her at night just in case she decided to help herself.

We were 3 weeks in at this point - I knew we probably were not going to get her tube out in 4 weeks, she just wasn't ready so on we pushed with her crazy regimen of needing to be fed.  At the end of week 4, I had another work trip I had to take overnight, so Deric was once again in charge - though much easier this time around :)  Over the course of weeks 3, 4, and 5 she started not wanting to lay so still to be fed, or she'd go in and play in her litter box, or need to go poop.  It turned into a bit of a cat circus at our house.

By October 12th - she had eaten a few pieces of dry food and her bilirubin was down to 5!  HUGE improvement!  At 3.5 weeks after her tube placement, and 4.5 weeks since she got sick - Riley got a great progress report at the vet.  She really just needed to eat on her own at this point!! So on we marched....

Riley went back to the vet once a week over the course of this time, and it wasn't until week 5, that we finally were able to start spacing out her fluids some because she'd decided that people food would be great for her.  She was eating a little at night fairly regularly, but mostly sneaking food away from our plates when we weren't looking during the day - which is a big no-no at our house!  We got them a water fountain to entice her to drink at the end of October - which ended up being a HUGE hit and both Riley & Lily love it.  It keeps their water so fresh and cool!  I have to fill it almost twice per day!  Around October 16th she showed a little bit of interest in toys, which was a good sign but totally new for our ever-so-lazy cat who was never super interested in playing at all!  My cousin also came to visit at the end of week 5 for a concert, so it was nice that Riley was doing some better by that point so she could sleep in our room at night and we didnt' have to worry quite so much.

The end of week 5 into 6 - she was really getting her personality back. We had bought her a new toy because she'd showed some interest, and she managed to destroy one of them in a matter of hours....smh! On October 30th we got a great report and Riley's bilirubin was 1.9!   We also added a little bit of an appetite stimulant to help push her a long a little to get that tube out!

I had never been so excited to see or hear this!

We also snuck in a little thank you gift for everyone at the vet who had become very important people to us because they gave us our Riley girl back!  We made "Riley" cookies as a thank you for each of them, because they all think she is hilarious and just so sweet!  I appreciated my mom and sister's help with them because they took quite awhile to ice....

Weeks 5 into 6, we got to cut back on her feeds, encouraged her to eat on her own (we were now feeding her some of the food my parents had because Lily would sneak in the room and help herself and Lily is VERY allergic to Meow Mix), and still pushing fluids a couple of times per week.  We potentially could have pulled her tube right after her appointment in early November but decided to leave it one more extra week just to be really sure.

We were hoping this was our last visit with the tube!

6 weeks and 3 days after it was placed on November 9th - we got to remove her feeding tube!  (7 weeks and 3 days after she got sick)  It was so exciting and so scary all at the same time!  I was so happy to have it gone, and hopeful Riley would do wonderfully.  Her bilirubin was 1.4!  However her weight was down just a smidge to 6.5lbs and she had been about 6.8lbs.  She had to go back in 1 week to make sure she gained some weight because some cats can develop an absorption issue which would keep her from gaining weight like she was supposed to.  She also had to wear her soft collar for another week or so just because she liked to scratch her site and we wanted to give it time to really heal well.

She couldn't wait to be able to sleep in any strange position she could get herself into

No Feeding Tube!

We switched their food to science diet and a grain free option and mixed them together and both cats LOVE them.  When Riley went back on November 21st, she was at 7 lbs!  She had gained a half of a pound in a week!  She has been playing, and being her spunky normal self, maybe even better than since before she got sick!  She has to go back one more time after the first of the year to make sure her kidneys continued to recover from everything that was going on, but otherwise she is home free!  We are however still waiting for her fur to grow back! :)

My adorable co-pilot!  She was still pretty fur-less but doing very well.  We graduated to no carrier because she was getting so car sick (I know that isn't the best option but it was better than puking every time to and from the vet)

Riley went back to the very on January 9th and everything looked great!  Her weight was up to 8lbs, which I suspected because I'd been weighing her at home, and they were thrilled with this!  The only thing is her BUN - a measure of her kidney function - was up at 38 (normal is less than 37) so it is something they want to watch.  It may have always been that high with her single kidney essentially, but just to be sure they wanted to see her back in six months.  I was so happy with her care.  It was consistent great care.  They try so hard to keep your baby with the same provider which is so important on journies like this, and I think it made all the difference.  I cannot thank the staff enough for all of their care and concern while we were there!  Everyone was so excited for Riley to do well and only come back as needed instead of every week! If you're ever in need, which I hope you're not, I highly recommend MEVS!

She is doing wonderfully, though it is so funny how attached to us she has become through all of this.  She wants to sleep between us at night, she likes to be under my blanket when I am sitting on the couch on my lap, or she wants to sit next to Deric in his chair...she always wants to be with us.  They toy I mentioned we bought her in October - came with 3 attachments to it - she has effectively destroyed all 3 attachments and now just chases the string through the house on a regular basis.  She loves to play now!  Everyone with fur in our house seems to be feeling well.  I brushed Riley for the first time in 6 months this weekend and boy did she hate it, but her fur has finally grown back enough it needed to happen badly!!!  I also wish I had videos to upload of her playing and talking to the birds.  They are so funny and give me warm fuzzies to know we didn't have to say goodbye to our sweet girl just yet!  Cheers to our happy and healthy little kitty!

Our last vet visit for 6 months!!

Chilling out at home, looking all healthy