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8/29 Purrdy - liver issues

Discussion in 'Lantus / Basaglar (glargine) and Levemir (detemir)' started by Vyktors Mum, Aug 29, 2016.

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  1. Vyktors Mum

    Vyktors Mum Well-Known Member

    Joined:
    Nov 15, 2011
    8/8

    Purrdy went for his vaccinations today. He has lost a little weight but mostly it has been redistributed. His bones are more prominent and weight has moved to his Cushings gut. In particular the vet noted an enlarged liver. She suggested it was fatty liver because of his diabetes, I am not convinced.

    With the Cushings we have not been able to keep Purrdy regulated in the normal range however I think his control is pretty good (in fact the vet has commented that he is the best controlled diabetic that they have - not a good reflection on their management but a great reflection on the job mum does :)) and we know from urine tests that his renal threshold is quite high and isn't breached until he heads into the yellows (seems to be around 220).

    His eyes aren't jaundiced although his right eye changed colour a couple of months ago and the vet noted that there is a slightly raised area on that cornea indicating that there's a problem on the way.

    He has no issue with his appetite and his heart was good.

    Has anyone else seen reasonably well controlled diabetics that are eating well develop fatty liver?

    I think it's more likely related to his Cushings but I'm not sure what that means. Is the end result the same as far as liver condition goes? I think the main treatment for fatty liver is usually to get the cat to eat but we have no problems there so what if anything else can we do? Would a blood test (his last was in April) be likely to reveal anything helpful either way? The vet didn't suggest doing anything just noted it.

    The vet did suggest that he needs a dental (lots of tartar build up on the back teeth) - going to have to have big chats with the vet about how to do that one if we proceed - their thoughts were to give him a half dose of insulin in the morning and then keep him on a sugar drip while they operate :rolleyes: Has anyone else had the vet suggest that???


    @Tuxedo Mom I think you are the only other Cushings cat mom around so your input would be of particular interest. I remember you saying a while back that it was likely that organs would start to go before skin started tearing badly (he only gets the odd small tear currently). If the liver is Cushings related would this just be a natural progression indicating that his days are getting numbered or is there something we could be doing to help him? In relation to the dental, is there anything extra to watch out for with a Cushings cat?
     
  2. Tuxedo Mom

    Tuxedo Mom Well-Known Member

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    Cushing's is a horrible disease. It is thought that the Cushing's is what causes the diabetes, since it is like being on steroids all the time. That is why it is so hard to try to regulate a Cushing's kitty.

    What test was used to give the diagnosis of Cushing's. Was it determined whether it was pituitary based or adrenal based?

    With Cushing's usually by the time that the disease progresses to tearing skin it is already far on. Because the adrenals, pancreas and liver are constantly working from the excess cortisol being secreted it puts a lot of stress on those organs. I have used Milk Thistle as a liver support, but I really don't know if it is helping or just making me feel better that I am doing something. I also use extra Vit E and Fish oil which act as antioxidants and some degree of anti-inflammation.

    There is a drug that is used very commonly on dogs with Cushing's that has been tried with limited results on kitties. It is Trilostane also known as Vetoryl, which basically helps prevent the body from "processing" the extra cortisol so that the effects are not as pronounced. It would require biweekly ACTH stimulation testing of the cortisol levels in order to determine the correct dose. If there is insufficient cortisol it can cause Addison's disease which can be life-threatening. It is comparable to Cushing's being hyperglycemia and Addison's being hypoglycemia. I chose not to pursue this route since this drug can be hard on the kidneys and liver and with my Tuxie, the stress of having to go for regular biweekly testing which requires a 2 hour stay would cause his pancreatitis to flare. and create more issues.

    There are also surgical treatments, but the risk factors were far too high for my liking,

    I hope this information is of some help and if you need more I will help in any way I can.


    ETA When Tuxie had his dental there were no issues, but the dental was done very early in the treatment process and before Cushing's had been considered. Tuxie has the start of fatty liver disease, believed to be from the Cushing's but it has not progressed much. I was told that he is more at risk of fatty liver and to make sure that he does not go any period of time without eating.

    :bighug: :bighug: :bighug:
     
    Last edited: Aug 29, 2016
  3. Doodles & Karen

    Doodles & Karen Well-Known Member

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    Jun 2, 2015
    Oh Serryn, I'm so sorry to read this about dear Purrdy. Glad to hear he has no troubles with eating so that must be a good thing. I don't have any insight but certainly sending tons of vines and prayers for that sweet boy. :bighug::bighug:
     
  4. Amy&TrixieCat

    Amy&TrixieCat Well-Known Member

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    Feb 14, 2011
    I don't have any answers, but wanted to pile on prayers for Purrdy...yes, you and your Mum are doing an amazing job with him :bighug::bighug::bighug:!
     
  5. carfurby

    carfurby Well-Known Member

    Joined:
    Feb 19, 2012
    I'm sorry Purrdy may have fatty liver. I'm glad he is eating good. Sending prayers.
     
  6. tiffmaxee

    tiffmaxee Well-Known Member

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    Nov 15, 2013
    I wish I could offer answers but I don't know anything about this. Prayers and vines that it hasn't progressed and you can find the right support for him. :bighug::bighug::bighug:
     
  7. Vyktors Mum

    Vyktors Mum Well-Known Member

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    Nov 15, 2011
    He never did get tested, as the vet said, if it looks like a duck, walks like a duck and quacks like a duck... He has the classic symptoms - pot belly, increased appetite, hair loss, bruising, black heads, skin growths, infections and tears, PU/PD continuing even in extended periods of normal BG numbers and of course the high dose can't be properly regulated diabetes. We had looked into the treatment options and like you decided against surgery or trilostane so there didn't appear to be much point in testing.

    Purrdy also turned diabetic in late 2014 so maybe your milk thistle has been doing some good :) it can't hurt to try anyway so we may as well give it a go. What form do you get it in, what is the dose etc? It had crossed my mind that fish oil might help with the inflammation - sounds like I might be on the right track with that. I hadn't considered the importance of anti-oxidants so will look into that too. Very helpful information, thank you.

    Thanks for the kind thoughts for Purrdy guys and the :bighug:
     
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  8. Tuxedo Mom

    Tuxedo Mom Well-Known Member

    Joined:
    Dec 2, 2014

    Everything you describe is indicative of Cushing's. The other symptom with Tuxie is symmetrical hair loss and no hair regrowth. He had an U/S done the first time in January 2015 and the hair has never grown back. So far he has has only a few minor skin tears that have managed to heal. I am very careful when I tent his skin so as not to pull too tightly on the skin. As with Purdy, even when he does manage to run in good healthy numbers for a few days the PU/PD do not change.

    Milk thistle is usually given at 10mg per pound. Tuxie is 15 lbs so he gets 150 mg. It can cause diarrhea so if this happens you would need to discontinue it. I buy mine at a local health food store...175mg capsules with no additives. I open the capsule and use not quite all of the powder. I mix it with a very stinky food since it does have a funky taste. My guy is a food vacuum so he eats everything that is put in front of him. You can also get it in liquid form, but I haven't done much research on that.

    The main thing with a tendency towards fatty liver is to not let your kitty go any length of time without eating. When Tuxie has had his occasional pancreatic episodes I get him in for fluids, cerenia and bupe as soon as I see any hesitation on eating...which for him is highly unusual.

    I have taken so many extra steps to try to keep him going. I try to buy local organic meats since they are raised without growth hormones or steroids. Commercial meats will still contain traces of steroids, even though they are minuscule. He has enough extra cortisol produced by his body without adding anything extra to the pot.

    The most common form of Cushing's is PDH, which is a pituitary tumour, similar to acromegaly, but it causes different hormone to be released. This type is more prone to the waxing and waning of symptoms that the ADH or adrenal based type. It can be challenging, but even without medical intervention they can still have a decent QOL.
     
  9. Wendy&Neko

    Wendy&Neko Well-Known Member

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    Feb 28, 2012
    (((Serryn and Mum))) So sorry another challenge is falling your way.:bighug:

    Just one suggestion, the folks at the Royal Veterinary Clinic have a Diabetes Remission clinic and are studying all the variations on diabetes, including acromegaly and Cushings. They have been very helpful to me and Suki when we emailed them. You might want to put together a list of questions and see if they have answers or know someone else to contact. I occasionally cruise their Facebook page and have seen reference to Cushings kitties before. They do the surgery there, but realize it's not an option for everyone and are helpful on options. I just took a look at their Facebook page and found they are doing a new drug trial for acromegaly. The last one they tried, paseireotide, works but is very expensive and originally used in human Cushings.
     
  10. Marilyn and Polly

    Marilyn and Polly Well-Known Member

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    Apr 2, 2014
    Once again, this place and the people who "live" here is amazing! I have no helpful information. But I do have :bighug::bighug::bighug::bighug: for you and your mum. And lots and lots and lots of over the ocean vines going your way.

    Marilyn and Polly
     
  11. Carol & Murphy

    Carol & Murphy Well-Known Member

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    Aug 9, 2015
    Murphy has an enlarged liver (due to triaditis and past hx of hepatic lipidosis) - my vet has him on denamarin for liver support - 1 pill once a day

    When he was recovering from hepatic lipidosis, he was on Vit E 200 mg once a day
     
    Last edited: Aug 29, 2016
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  12. Tricia Cinco(GA) & Harvey

    Tricia Cinco(GA) & Harvey Well-Known Member

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    Jul 18, 2011
    {{{Serryn}}}

    I'm so sorry Purrdy is going through this. Your mum is lucky to have such a great advocate for a daughter. If anyone can keep him comfortable, I know it's you. Sending loads of vines and :bighug:s.

    @Marje and Gracie might have some suggestions for liver support. She has done a lot of research on it, I believe.
     
  13. julie & punkin (ga)

    julie & punkin (ga) Well-Known Member

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    Feb 17, 2011
    Not an area I know a lot about, but I'm sending buckets full of vines for our little buddy, Purrdy. @Tuxedo Mom Mary Ann, you've done a wonderful job with Tuxie. Thanks for your good explanations here about Cushing's.

    Serryn, there are a couple of other links about Cushings in the "Where Can I Find?" thread. I don't know if there is anything new in there, but thought I'd mention it.
     
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  14. Marje and Gracie

    Marje and Gracie Well-Known Member

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    May 30, 2010
    I'm am so sorry, Serryn. Dealing with other issues in addition to the diabetes is a challenge.

    @Tuxedo Mom is the best source for Cushing's info and I see she has posted but it is my understanding that "normally" you would not potentially see fatty liver disease unless kitty is anorexic for more than 48 hours or if the calorie consumption has Ben reduced by over 50% for several days. There are a few liver enzymes that might be elevated with FHL but if he's eating the same amount, I'd be surprised unless it is somehow equated with Cushings.

    Milk thistle is good. So is Vitamin E but if you give it, it MUST be water soluble and liquid because fat soluble vitamin E cannot be absorbed by a damaged liver. I only found one source of water soluble, liquid vitamin E that did not have glycerine (which raises the BG). It's made by Yasoo. I don't know if you can get it there but if you look at the ingredients, perhaps you can find something equivalent. For Gracie's 8.5 lbs,she got 75 IU/day which translated into 3.75ml a day. You would need to discuss with your vet but there is research on Vitamin E.

    Sending you many, many prayers and vines for your boy.
     
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  15. Tuxedo Mom

    Tuxedo Mom Well-Known Member

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    Dec 2, 2014

    With Cushing’s the liver gets overworked from trying to process the excess cortisol throughout the body. This can causes an elevation in the liver enzymes ALT and ALP. A Cushing's animal is at greater risk of developing fatty liver disease which is why they must not be allowed to go without food for any length of time as fatty liver can develop quicker in Cushing's animals.

    ETA This is another good page on Cushing's in layman's terms. It is based on dogs, but most of the same principles apply to kitties.

    http://www.lbah.com/word/canine/cushings-hyperadrenocorticism/

    In rereading this article it reminded me of another symptom Tuxie has. Thyroid tests will often come back as low or low normal. Tuxie's was on the borderline of low and low normal. Hypothyroid is very unusual in kitties in any other case.
     
    Last edited: Sep 1, 2016
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  16. Vyktors Mum

    Vyktors Mum Well-Known Member

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    Nov 15, 2011
    we have started him on the milk thistle this morning, he's a vacuum too (also part of the Cushings I gather - he was a grazer before) so no problems getting it down, paws crossed for no poop issues. Amazingly the lady at the human health food store mum went to is a naturopath specialising in animals! She also said something about giving taurine but mm was still clutching her heart from the cost of the milk thistle and not absorbing information properly lol! I'll be going to visit mum at the end of the month so we'll stop back in and see her again to see what info we can glean from her.

    @Tuxedo Mom Purrdy also has the symmetrical hair loss and the low thyroid tests on the normal test. I've had them investigate that further before, checking more of the Ts and they've come back ok. Interesting to know that's another Cushings symptom. Looks like the growth on his eye may be as well, if it's corneal plaque.

    We have Vit e but it's not the water soluble type. The site with the yasoo says it will do international shipping but I can't enter an Australian address, have emailed them but wondering if you know of another option in case I don't get any joy from them.

    Thank you everyone for your suggestions and support.
     
  17. Tuxedo Mom

    Tuxedo Mom Well-Known Member

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    Dec 2, 2014

    I use taurine when I make my kitty food. I also add extra to both my kitties' food. The best one I have found is NOW taurine...you can buy it in the powder form or in capsules. The health food store I buy from doesn't carry it in powder form so I use the 1000mg capsules which costs me $13.50 Cdn for 100 capsules. Most commercial foods will have adequate taurine added to it, but since I make my own and I cook it slightly I like to add extra to it. Besides what I add to my home made I add 1 capsule (1000mg) split between 2 every second day. Taurine is good for the heart and the eyes. A good natural source of taurine is raw heart, liver or kidney (organ meats)...preferably grassfed with no hormones or steroids. One of my kitties will not eat raw, but my Cushing's guy thinks it is a special "treat".
     
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  18. Tuxedo Mom

    Tuxedo Mom Well-Known Member

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  19. Tuxedo Mom

    Tuxedo Mom Well-Known Member

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    I don't know if you followed Rose and Zoey with their Cushing's. She chose to use the trilostane route, but sadly Zoey was at too late a stage. Here is her profile page if you want to read through:

    http://www.felinediabetes.com/FDMB/search/1682394/
     
  20. Vyktors Mum

    Vyktors Mum Well-Known Member

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    @Tuxedo Mom yes I did and it was just so awful. She's one of the reasons we have chosen to go the least interference path. We accept that isn't a winnable fight so will just support him and keep him comfy until he's not. We will not be fighting to the bitter end.
     
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  21. Tuxedo Mom

    Tuxedo Mom Well-Known Member

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    That is the route I have taken as well. Considering how dismal the prognosis is Tuxie is still doing well over 1 1/2 years since he was diagnosed. Because I pushed the point against all odds according to the vet, he was diagnosed as early Cushing's, since I didn't wait for the usual tale-tell signs. But I consider myself and him lucky that we have been able to deal with this disease and are doing well (anti-jinx) at this time. :bighug: :bighug:

    ETA His glucose numbers are definitely no something to write home about, but I do the best and adjust as I see fit. With a Cushing's kitty it is very hard to follow a protocol, since their bodies are not working "normally". Tuxie can run high for 3-4 days then suddenly hit hypo numbers. The fluctuations in the hormone process caused ny the tumour makes it very hard to judge what is happening,
     
    Last edited: Sep 1, 2016
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