Liver and Gall Bladder Problems in Cats

Liver and Gall Bladder Problems in Cats

also see Renal failure

also see Cholagiohepatitis/Hepatitis

also see Triad Syndrome

also see Hepatic Lipadosis

also see Kidney Disease

also see Urinary Problems

also see Diabetes

also see Liver and gall bladder problems in cats 2

vetinfo.com

Congenital portosystemic shunt in kitten

Question: Dear Dr. Richards, I have a question. I will try to be as brief as possible. In September of last year I took in a stray black kitten. During the Christmas holidays he had a seizure. He was diagnosed as being a "shunt kitty". One of the signs according to my vet, is the gold/orange eyes. That is the least of it. He went through a seizure which was horrible to see. Head pressing, blindness, unable to stand and I simply can't remember what else.

He was put on valium at the emergency vets and spent the night. It took about a week to get him back to his normal activity and he was placed on Lactolose. We did a biopsy of the liver and a scan. My doctor said if we found the blood vessel(s) responsible for this condition, an operation could correct the problem. Nevertheless, the scan and the biopsy proved nothing.

Since that first awful seizure, he has one slight episode. I diligently give him Lactolose three times a day (every time he eats, he gets his medicine). Because of the unbelievable diarrhea it causes, I now mix rice in with his KD Feline Science diet.

Okay, now to my question. What can I do for this little guy? He is thriving, as a matter of fact he is standing on my keyboard right now. My vet tells me to keep on doing what I have been doing. We could go a step further and do exploratory surgery and a contrast liver scan. That would cost $3,000. Besides the enormous cost, he would be in danger and he has a 50% chance of surviving these procedures. Even then, we may not have any conclusive information once both tests are done.

According to what I have been told, there is very little information on "shunt kitties" because they are usually put down once the owner finds out what is wrong. I know his little life will be shortened because of this. I will do whatever I need to as long as his little spirit is happy and he continues to pester my older cats.

Dr. Richards, is there anything new on the horizon that you know of to help this little guy? I tried not to fall in love with him. As you can tell by my letter, it didn't work.

Thank you for your anticipated answer. I know you are really inundated with questions so I will be very patient until you can get to me.

Thank you again.

My sincerest regards, Pat

Answer: Patricia-

Congenital portosystemic shunts are not as common in cats as they are in dogs but they are not extraordinarily rare.

There was a correlation noted between copper colored eyes and cats with liver shunts but this has to be considered in light of the fact that there are lots of cats with copper colored eyes who do not have shunts -- while it might be a true observation, the eye color doesn't seem to occur because of the shunt. So this is probably something that should be taken into consideration but can't be depended on as a sure sign of a liver shunt.

I am not sure from your note whether there is a conclusive diagnosis of a liver shunt, or if there is documented liver insufficiency. I am assuming that the biopsy did not show another liver disease as being likely but this wouldn't rule out other causes of seizures. I can't tell for sure what type of scanning procedure was done. Plain X-rays are not very helpful in determining if a liver shunt is present. Ultrasound examination is more helpful, but often is inconclusive, as well. Transcolonic portal scintigraphy can usually establish whether a shunt is present or not and is not too expensive. The major drawback is that the equipment required usually makes this a test only done at veterinary schools. X-rays using contrast considered to be the most specific test for this condition.

I would want to know what the results of a bile acid response test were at this point. This will tell you if there is a decrease in liver function compatible with the diagnosis of a liver shunt. It is a relatively inexpensive test and it only involves taking two blood samples, one after a twelve hour fast and then one two hours later, with a meal fed in between. If there is a decrease in liver function then it makes more sense to continue the treatment long term. If there is not a decrease in liver function then it would be a good idea to look for another explanation for the previously observed seizure activity.

The object with lactulose is to produce a soft stool that is just barely formed. If it is causing diarrhea, it would be best to reduce the dosage. Hills k/d (tm) diet is a low protein diet. While this has been documented to be OK in treatment of problems requiring low protein diets, even in kittens, adding rice further lowers the protein level. It is possible that you may be getting close to the lower limits of necessary protein with this mixture. Please ask your vet about lowering the lactulose dosage and about whether or not adding the rice in the amounts you have been using are a potential problem.

I can not provide exact statistics for survival and improvement post-surgically in cats. This isn't because there is a big lack of a available information, though. It is just because there seems to be some variation in the figures reported and in some cases because the reporting format makes it hard for me to be sure of what the figures mean. I think that your vet's overall prediction of a 50% long term success rate (both survival and continued recovery lasting longer than a year or so) looks about right, but I think it would be best to get specific information from the surgical facility that you might considering using for the procedure.

There is some chance that your cat may have hepatic microvascular dypslasia, which would not be treatable surgically. If surgery is possible, the prognosis is variable, depending on the shunt location, the skill of the surgeon and the complications encountered during surgery. In a cat that was doing well without surgery, I think I'd have to think really hard before considering it. However, I think that I might at least have the diagnostic procedures done. I would do this because I would want to know if this is the problem, so I didn't overlook something else and because I would want to have the most information possible to best determine the prognosis with and without treatment. Just because you go far enough to be sure of the diagnosis does not mean you have to proceed with the surgery. If this note causes you to have additional questions, please feel free to send them.

Mike Richards, DVM 9/18/2001

Liver disease in cats- "triad syndrome" or "triaditis" possible

Question: Dr Richards: My 12 year old male cat is starting to have some liver problems, after a blood test was taken on a routine exam. His count is 113, and he is on Lipo-tabs and S.A.M.E. also i am going to start him on Actigall. Can you explain the 113 count, is this a high number, and can you tell me anything else that will help him. He is not experiencing any problems at this time, is 12 young to be getting liver problems. Any thing else you can suggest, or is this the normal course for cats. Thank you Debbie

Answer: Debbie-

I need to know what the name of the blood chemistry value the 113 number is for. Is this the ALT value, alkaline phosphatase (alk phos) value or a different one? If you can let me know this information, I can give a more specific answer. If not, just let me know and I'll try to explain what the possible values are for the different liver enzymes. Mike Richards, DVM

Yes, It was the ALT. Thank you

Answer: Debbie-

In cats, almost any rise in the ALT value is considered to be significant. So even though this isn't an extremely high value for an ALT, it is high enough to warrant concern.

ALT rises occur in cats for a number of reasons but the most likely possibilities in a twelve year old cat are hyperthyroidism, cholangiohepatitis, hepatic lipidosis (if the cat is not eating) and pancreatitis leading to secondary blockage of bile flow. There is a condition in cats in which pancreatitis, cholangiohepatitis and inflammatory bowel disease occur at the same time, which is being referred to as "triad syndrome" or "triaditis" at the current time. Keeping this possibility in mind is a good idea. Usually there is vomiting and variable appetite along with weight loss in cats with this condition.

We usually test for hyperthyroidism when there are rises in liver enzymes in older cats which are discovered in lab work but are not causing clinical signs. This is especially true if there is weight loss, an increase in appetite or an increase in heart rate. Your vet may be reasonably certain this is not present based on the examination. If so, it is just something to file away in case further symptoms develop. It is also a good idea to be sure that there is no evidence of feline leukemia virus and to try to rule out liver cancer through X-rays, ultrasound or biopsy of the liver.

We usually try antibiotics early in cholangiohepatitis because they seem to help some cats. We use amoxicillin and sometimes amoxicillin/metronidazole combinations. I think that it is justifiable to try antibiotics without doing a biopsy or culture of bile, but some vets prefer to do this testing first and that is also definitely justifiable. If there continues to be evidence of liver disease after antibiotic therapy and recheck of the lab values in two to four weeks, then we usually do feel best if we can get a biopsy of the liver to see for sure what is happening, if that is possible. Sometimes biopsy results don't help much but it is still worth the effort, I think.

Over the long run, we have had the best luck with ursodiol (Actigall Rx) and have just started using SAM-e within the last six months. I really don't have a feel for how well SAM-e is working, yet, but it is recommended by several veterinarians who are very knowledgeable about liver disease.

Most cats with cholangiohepatitis seem to do well for a long period of time and many of our patients have lived out their normal life span despite having this condition and it is possible to treat hyperthyroidism and the triad syndrome, as well.

Mike Richards, DVM 4/6/2001

Liver disease in Cat

Question: Hi, I have some questions regarding liver disease in cats. My,female,cat is called Ginger and she is 16-years-old. She has always been in good health and vets can never believe she is that age. The vet here in Prague had one look at her eyes and told us that Ginger had very serious liver damage and when the eyes are as yellow as this it's usually too late to do anything. A blood test seemed to confirm the diagnoses. One result, the ALT, was 41.7 (norm being 0.17-2.00). We were told we'd have to put her on a protein free diet, no more cat food,no more chicken, no more tuna,no more anything! She took to the food o.k.,for a few weeks,then she got fed up with it. I wasn't going to starve her so I asked the vet if I could give her her normal food. She said I could give her boiled chicken and fish, no catfood.She's still eating like a horse. She still doesn't seem ill. The vet is quite surprised by this but still thinks that it's just a matter of time. I can't believe it because she seems so well and happy. Is there any chance that the diagnoses is wrong? Or is there any other reason why her eyes would be yellow? Blood tests can be wrong, or at least inconclusive, can't they? Any advice would be greatly appreciated. Thanks Sheila

Answer: When the scleras (the white portion of the eyes) turn yellow, it is usually due to liver disease or to internal bleeding. It is unlikely that this is a case of internal hemorrhage since Ginger continues to feel well and eat well. So some sort of liver disease is likely. This may be a primary disease or a secondary problem, such as hyperthyroidism which has raised the blood pressure enough to cause liver damage. This seems possible due to the continued strong appetite, which is characteristic of hyperthyroidism. The most common form of liver disease in cats is probably cholangiohepatitis. This sometimes occurs in conjunction with pancreatitis in cats and sometimes this will lead to sudden jaundice. Cats may live a long time when they have cholangiohepatitis. Controlling the levels of dietary protein does sometimes help to make cats with cholagiohepatitis feel better and may slow the progression of the disease. It is important that cats eat, though, so we often compromise on the diet. Hepatic lipidosis is the other common liver disease in cats. It usually occurs after a cat stops eating for three or more days but sometimes can occur more quickly. It would be unusual to see this problem without at least some period of inappetance, but we have had a couple of hyperthyroid cats or diabetic cats, apparently as a side effect of those conditions. It is more important to evaluate the patient than the lab symptoms. It is likely the lab values are correct but since Ginger continues to eat and feel OK, it is important to consider the long term implications of her problem. It is helpful to consider a liver biopsy or an educated guess as to the most likely liver disease and then to provide appropriate therapy. For cholangiohepatitis, ursodiol (Actigal Rx) is helpful in many cats and low dose prednisone has been used successfully in some cases, as well. Using a lower protein diet is helpful, as well. If hyperthyroidism is present based on elevated T4 (thyroxine) levels, it would be a good idea to treat that problem, as well. Hopefully Ginger continue to feel well.

Mike Richards, DVM 9/15/2000

Medications used to treat liver disease in cats

Question: Dear Dr. Mike, I think veterinarians must be some of the nicest people in the world. My local vet, puts up with our nine p.m. panic calls and now I feel we have another compassionate and talented vet in our corner. Thank you. I will let him know of your service as I think it will interest him. Woofy's blood work was a mixed bag- he is evidently producing enough lipase and amylase but his liver is is still infected, though he runs no temperature, his weight has stabilized at seven lb.. 4ozs. We still have him on Urisidol twice a day and Carafate which seems to help him keep things down. I have noticed that the whites of his eyes are more white and less bloodshot. His appetite and energy level of the last few days has not been great, but it has gotten warmer in Southern California too. He still appears interested in the world, and mostly comfortable. The diet of Hill's L/D and K/D are what my vet has recommended too, though it has take some grated turkey breast to get him to eat it. Lord this is work! I am going to write the nutritionist you recommended, and I will let you, know what his next blood panel shows. My only question is in the arena of antibiotics- is there anything other than the Urisidol that might help him out? He has had the Metradiazanole. Doug is being careful not to give him anything to upset his tummy. Thanks again, Teal

Answer: Teal - Antibiotics are helpful in two circumstances in cats with liver disease. In some instances, cats have bacterial hepatitis. This isn't especially common, but many vets are more comfortable if they give an antibiotic like amoxicillin, sometimes in combination with metronidazole, in order to rule out this possibility. This is especially true if a liver biopsy or culture taken during surgery has bacterial growth. More commonly, veterinarians use the antibiotics metronidazole and neomycin to decrease ammonia absorption from the gastrointestinal tract, making it easier for the liver to do its job and lowering serum ammonia levels, which cause problems like hepatic encephalopathy (inflammation of the brain due to high ammonia levels). Lactulose is also helpful for this effect. We usually start with lactulose and then use antibiotics when there are signs of systemic problems relating to ammonia but some vets like to start antibiotics sooner. Another medication to consider is Denosyl (Rx), which is a "SAMe" product. This medication is favored by some of the leading experts on liver disease but there isn't a lot of documentation for its beneficial effects, yet. Still, it is something to consider.

Hope this helps some.

Mike Richards, DVM 8/4/2000

Liver Disease in elderly diabetic cat

Question: Dear Dr. Richards:

Our 15 year old male American shorthair tabby names Thor was diagnosed about a year ago with diabetes. By the time he was diagnosed, he already had peripheral neuropathy on both his back legs and was shuffling about on his hocks. He was eventually well-controlled on Humelin Insulin twice daily. We also decided to treat him with biweekly and then weekly acupuncture which miraculously restored the use of both of his legs. We also treated him with homeopathy and eventually could reduce his insulin to 1/2 Unit in the AM and 1 Unit in the evening. His fructosamine level remained below 450 and he was doing remarkably well. This is the good news... About 4 months ago he started vomiting on occasion and was diagnosed with mild hepatitis. We again treated him homeopathically with good results and that episode appeared to subside. However, about 6 weeks ago, he was not doing well: vomiting almost every night and generally having low energy. His bloodwork at that time revealed SEVER hepatitis with his alk. phos. and enzymes off the charts. He refused to eat or drink for about 3 weeks. We kept him alive by hydrating him daily and force feeding him as often as we could. We treated him homeopathically and allopathically: Amoxicillin for about 2 weeks. Actigall daily, Pepcid AC daily, metocloprimide 1 ml before meals, hepatic enzymes, etc. An ultrasound and liver biopsy revealed nonspecific hepatitis, cholangeitis and inflammations of the bowel. At that time, no food seemed to be passing his stomach area and he would simply vomit everything we fed him after a few hours. He rapidly lost weight and eventually was skin and bone. His ears glowed bright yellow from the jaundice == his bilirubin at the time was about 10. We were preparing to take leave of him and reconciling ourselves to the fact that he was very close to transitioning to death. As a final desperate measure, we tried Prednisone -- 5 mg per day. He immediately started eating and drinking voraciously and proceeded to steadily improve. Everyone was astounded at this miracle. He has now regained his former weight (approx. 10 LB) and his jaundice has all but resoled (last bilirubin was 0.6). He remains on the Prednisone 5 mg per day (now 5 weeks) and 3.5 U Humelin twice daily. A recent fructosamine was 420. However, his liver enzymes remain extremely high although they have all improved substantially since the initial values. Alk phos. is 252 (N 102); ALT 770 (N 10-100; down from 886); AST 266 (N 10-100). We continue to give him Pepcid AC daily, hepatic enzymes, sylimarin (Milk Thistle) to help repair the liver, chromium picolinate for the sugar regulation, a product from Ameridan labs called Mega Beta (Beta 1,3-D Glucan) that has been found to support the immune system and in certain cases of hepatitis C to bring about a total remission. His appetite remains good but he does drink excessively -- due to the Prednisone and diabetes. His energy level is excellent, as is his general mood. We feed him a combination of Petguard and Wellness wet food and W/D dry food (that he absolutely loves!). We live in a state of uncertainty however as our Vet suspects that he may have underlying lymphoma. If this is the case, it is only a matter of time before the Prednisone stops working and he crashes again. He has palpable lymph nodes in his abdomen that since we have been giving him the above regimen, have decreased in size from 3 cm to 1 cm. What, in your opinion, could still be cause damage to the liver cells resulting in them leaking these enzymes at such a high level? Could this be some form of cholangeio-hepatitis and if so, what is the cause? Is this similar to hep C in humans, caused by a virus? Is there anything else that we could possibly be doing to support the liver and help it repair the damage to the liver cells? How long do we continue with the Prednisone (our Vet has suggested at least another tow weeks at this dosage before reducing to 2.5 mg per day)? Is there any other way of establishing a more definitive diagnosis of lymphoma other that a gut biopsy that we have decided to forego? As you may have deduced, we are devoted to our beloved kitty and companion and have done all that we can think of to support his life and make him comfortable for as long as possible. Any suggestions you may have would be much appreciated. I have been unable to obtain much info regarding support of a damaged liver in cats anywhere and also relatively little info on lymphoma. Your website is a fantastic source of information. Thank you for you dedication to helping us all take better care of our furry friends. Kind regards, John & Adrian.

Answer: John and Adrian- It is going to be hard to figure out what to do next without a biopsy of the liver. It may be possible to get a diagnostic sample of the liver using a fine needle aspiration technique. This can be done using a regular hypodermic needle to aspirate cells from the liver and can be done in most instances without sedation or anesthesia. Only a small sample can be obtained in this manner and that sometimes isn't enough but it is still worth considering this approach if a surgical biopsy is not possible. Another alternative is an ultrasound guided biopsy of the liver, using special biopsy needles that take a larger sample, which avoids surgery but usually does involve sedation or anesthesia. Cholangiohepatitis, a fairly common form of liver disease in cats, will sometimes respond to prednisone. When it does the usual recommendation is to taper the prednisone off over the course of two to three months. Some cats require low doses of prednisone for longer than that, though. As time goes on you will be able to work out which is the case for Thor, whether you know what the actual diagnosis is, or not. Lymphoma is a strong possibility, as well. It will sometimes respond to prednisone for a long time. Chemotherapy is helpful, as well, but it would not be reasonable to start chemotherapy without a diagnosis. A liver biospy may, or may not, be helpful in making this diagnosis, since it wouldn't be possible to rule it out if it didn't show up in a biopsy of the liver. I understand why you want to avoid surgery at Thor's age and with Thor's problems. You and your vet have worked out a treatment protocol that appears to be working well, despite the fact that some liver enzyme levels remain elevated. I think it would be reasonable to stay on this course and to see if the prednisone dosages can be lowered over time. If it is too hard not to have a diagnosis, then you might want to consider one of the less invasive liver biopsy techniques and try to get a diagnosis so that you have a better idea of why the medication is working and what the prognosis might be. Except for feline leukemia virus, feline immunodeficiency virus and feline infectious peritonitis, I am not aware of a virus that can cause hepatitis in cats but it is possible that there may be one. I wish I could help you more with this. Mike Richards, DVM 6/13/2000

Fatal liver problem

Question: Dear Dr. Richards: I'm devastated over the loss of my cat, Kitty Kitty, on 1/31/00. I had him a little over 9 years and didn't know his age. The vet thought he was about 13 or so. Blood work about 4 years ago showed high liver levels. He would vomit once in a while, but other than that he seemed fine, so I left him alone. (At the same time, our dog also had liver problems. Can a dog and cat contract something from one another?) On 8/13/99, Kitty Kitty had blood work before his first teeth cleaning. His liver levels were so high that the vet's office didn't do the cleaning, fearing the anesthesia, and also whatever problem he had because it was the highest liver reading they had ever seen. I was given a 2-week supply of antibiotics to see if maybe the problem was infection related, and told they'd do the teeth cleaning if the levels were better. He fought so much trying to get the pills down him, I felt bad and didn't pressure him; he seemed fine, and all we were doing was trying to clean his teeth, so I felt it was best to just leave him be at that time. Please note that I've always taken care of my pets. Kitty Kitty was well cared for and made his routine visits for shots and whatever else was required. Cost is not an issue, just the wellbeing of my animals. I should also mention that he was an inside/outside cat until about 4 years ago. He was neutered, but liked to fight and at least once a year he'd make a vet visit for a severe infection. He seemed susceptible to infection. (He was pure white with a pink nose and ears - does that have any bearing?). When I made him strictly an indoor cat, he had a feline aids test, which tested false positive. We did another test that was negative. Upon adopting a kitten 3 years ago, both cats were given blood tests and the leukemia and feline aids tests were negative. The kitten has always been inside (except for when I found him). Back to the August blood test. On 8/13/99, the ALT was 1670; AST 296; and billirubin .1 (white cell not available). (Prior test 7/17/99: ALT 361; AST 140; billirubin .1; white cell count 4.8.) Kitty would vomit, usually by his food bowl, maybe a couple of times a month, but on the evening of 1/19/00, he vomited about 10 times around the house; some was food, some liquid that included brownish color. He seemed OK the next day, Thursday, and I believe he ate that day, but that evening I put all the food up and just left water out. That night he vomited a couple of times after drinking the water; the vomit was clear. On Friday I took him to the vets. He weighed in at about 15 pounds; I know he was overweight. They drew blood, gave him a Vitamin K shot, and did an ultrasound test on the liver, which looked OK. The blood test on 1/21/00 showed ALT 670; AST 128; billirubin .2; white cell count 10.3. The vet said normal ALT is 5 to 60, and normal AST 60. The following day the vet did a needle aspiration of the liver and we later found out that the test was inconclusive. My cat was back home after this test and seemed fine. He wasn't all that active, but would still romp around with the other cat, and chase the dog. He ate well and was always eager to eat. I felt it was time to see if his liver ailment was treatable and decided to do a liver biopsy with the needle. He went to the vets 1/31/00, at a time when he seemed to feel good and was very loving. They planned a blood clotting test that day, Monday, and then I was to bring him back the next day for the procedure. As it turns out, Monday evening I went to pick him up and the vet said the clotting test was normal (PT 9.7 seconds; PTT 15.5 seconds), but that they'd like to do the biopsy that evening since their internal specialist wouldn't be in on Tuesday. I said OK and off I went. About 1 1/2 hours later I got a call that the actual biopsy went well, but my cat stopped breathing afterwards. I think they were helping him breath, and then his heart stopped. They tried to get his heart to start, but it didn't and he died. I was shocked, and the vet said it was quite unexpected. I asked the vet to go ahead and send in the tissue for testing. I also found out that the doctor opened his abdomen, before he went to the mortuary for cremation, and she said there was hemorrhaging, which surprised her because the clotting test was normal. I have read some of the other letters people wrote to you about liver ailments, and mostly they refer to cats that wouldn't eat or were really thin. This wasn't the case here. I will certainly let you know the results of the biopsy, but can you offer me any insight at this time? I'm loaded with guilt, wishing I had just left him alone instead of dragging him out of his warm bed Monday morning, subjecting him to this. My heart is broken. Thank you, Dr. Richards. Sincerely, Clarissa P.S. Should I have any concerns about my two other animals in the house; a cat (Lucky)and dog(Bailey), both about 3 years old? We lost our dog referred to above on 1/18/97; she was 15 years old.

Answer: Clarissa- I am nearly certain that you do not have to worry about Lucky and Bailey as a result of Kitty Kitty's liver problem. The most common liver diseases in cats are not contagious to other cats and I don't know of any problem with contagiousness between dogs and cats for liver disease. I suspect that Kitty Kitty probably had cholangiohepatitis. This is a fairly common liver disease in older cats. Sometimes this disease is caused by bacterial infection so it was a good idea to use antibiotics. More often it is not, so the fact that you had difficulty administering the antibiotic may not be all that important. Pancreatitis seems to be an inciting cause of this problem in older cats, or at least to occur concurrently pretty frequently. This is not thought to be a contagious problem, either, though. When cholangiohepatitis is not caused by bacterial infection it is difficult to treat. At the present time, Actigall (Rx) appears to be the most favored medication for treating cholangiohepatitis in cats. It is much better to confirm what type of liver disease is present with a biopsy than to try to treat without knowing which of the possible liver diseases is present. Your vet did the right things to try to keep Kitty Kitty safe and it is extremely disheartening that they did not help. Many antibiotics come as both a liquid and a pill, so if you have problems giving pills in the future, it may be possible to substitute a liquid. Compounding pharmacies can sometimes make flavored gels from antibiotics, too. Again, I think there is a very good chance that not receiving antibiotics had little impact on the outcome of Kitty Kitty's illness but this information may be useful in the future. What happened to Kitty Kitty is a nightmare for pet owners and for veterinarians. When the right steps are taken to try to diagnose and treat a condition and a bad outcome occurs, anyway, it leaves everyone second guessing their actions. But the bottom line is that you took the right steps and so did your vet. Sadness is unavoidable but you shouldn't feel guilty. I wish I could help you more. Hopefully the pathology results will help to set your mind at ease. Mike Richards, DVM 2/11/2000

Liver problems

Question: Dear Dr. Mike, I can't thank you enough for such a prompt reply. The situation here has become quite complex and frustrating. Zoe's bloodwork is not back yet this morning. I am interested to see if she is anemic. I will have the vet go back and recheck Fletcher's and Lily's bloodwork for anemia as well, but as far as I can remember neither of them showed any signs of anemia. I know that Tularemia occurs here as well as Yersinia. I don't know about hemobartonella or leptospirosis, but will ask the vet to look into them. Another potential problem is Hanta virus. This fall was the first reported case in the area I now live in. As far as my vet and I know Hanta virus is not something that cats contract like plague. None of the cats involved are related. All my cats were strays. The interesting thing is that the three kittens I have, who joined my household after I moved here are not sick. So far it is my three cats that I moved here from Minnesota that have gotten sick. Fletcher's illness was very perplexing until the hepatic lipidosis developed. He was a fat cat, even when he was little. The only thing we could come up with was the possibility of the odor destoying chrystals in the clumping litter I used as a possible causitive agent. The vet called the manufacturer and they said that the chemical in the chrystal would cause liver damage if ingested. I stopped using scoopable litter at that time. With Lily getting sick, we thought maybe it was still that, although I had not been using the litter for several months. Now with three other cats, outside of my household, having shown up at the vets with similar symptoms this possibility doesn't seem likely. I have been concerned about my property being contaminated, but am not sure about that now either. The one thing that is common here is dust. I live in a very rural area and the roads are dirt and base course gravel. This produces an alkaline dust that is blown everywhere on windy days. However, since it has always been this way (before I moved here) it doesn't seem likely this would be the causative factor for a sudden increase in liver problems in the cat population here. As I said this is a very rural area, semi arid with the rainy season being in july and august, where we get rains everyday. There are a lot of cats in the area, most being barn or "outdoor" cats that are not vaccinated. There are many strays as well. FIP is something that has been in the forefront of our concerns, but 4 of the six cats were tested and came up negative. The fact that most cats here are not well looked after brings up the possibility that more have been affected by something and no one recognized it. If a cat goes "missing" or dies most people here don't think a think about it. Basically the cats are wanted for one purpose only and that is to keep the rodent population down due to fear of plague and hanta virus. Before Fletcher got sick I had no idea about the dangers of hepatic lipidosis. I have never "free fed" the cats. They all have their own dishes and get fed morning and night. I make sure to see that everyone is eating and not whether or not they eat all their food. You also mentioned the fact that SD should not be fed for longer than six months. This is concerning, since Zoe has been on it for four years. My vet her just recently switched her over to cd/s. I am hoping that this is a better long term choice. Zoe gets bladder infections as soon as she is switched over to other food, even science diet feline maintenance. I can't tell you enough how greatful I am for your response the the suggestion of areas to look into further. Thank you! Denise

Answer: Denise- I checked with Hill's today and asked them why their feeding guides say that s/d should not be used long term. The vet I spoke with, whose name I can't remember, said that s/d diet is very acidifying and that is contains a high level of sodium. This can cause problems if any other disorders develop that are affected by these effects, such as heart disease, kidney disease or hypertension. It is necessary to monitor the acidity of the blood, potassium levels and kidney function on a periodic basis when using s/d diet long term. There are patients who do better if they stay on s/d, according the technical vet for Hill's but they do not recommend this on a routine basis. This is not likely to have been a factor in the development of increased bilirubin levels but it would still be a good idea to get a general blood chemistry panel that allows assessment of the above parameters. Hopefully these values will be in the panel your vet has asked for. The pH can be estimated using total CO2 from a blood panel. I hope that Zoe is improving at this time and that the blood work is good news. Mike Richards, DVM 4/10/2000