Partial biliary outflow obstruction

[BenjaminP]

1. 
   
2. Your pet's name: Luna
3. Approximate age: 5 years old
4. Sex: female
5. Neutering status: spayed
6. Breed: russian blue
7. Approximate weight: 7 lb
8. What's their BEAM (behavior, energy, appetite, mood
   1. Behavior: good
   2. Energy: lower than usual, but better than it was a few weeks ago
   3. Appetite: up and down, down over the last 24 hours
   4. Mood: very relaxed and quiet, not as spry as she used to be
9. Diet: eats a lot of Koha food single meat pate, rabbit is her favorite
10. Vaccination history / exposure to toxins, other medication:
    1. Possible lily exposure in June this year, she received 3 days of IV fluids and 3 more days of subq fluids. Her renal labs are completely normal now, it is unlikely she ingested any of the lily
    2. Kitten vaccines and rabies only
11. Primary problem, when it began and if there was anything else happening around that time
    1. In the middle of July she had a decreased appetite for a day or so, then she started vomiting and was very distressed. I took her to an emergency vet surgeon and they removed a GI obstruction in her small intestine. They could not identify the obstruction and did not save it for me to investigate (which bothered me). She was in the ICU for several days following surgery because she had gone septic from a perforation caused by the obstruction. They did say it was some sort of piece of fabric. And this cat has never been known to eat anything other than food, even when she was a kitten. I suspect it was a bandage of some sort from when she stayed overnight to get IV fluids for the lily exposure.
    2. Once she got home she was in recovery mode following the surgery. Her appetite and mood were improving, but after 2 weeks her appetite began to decrease again. Something seemed off with her so I took her to an emergency vet again. I suspected there was a surgical complication at the suture site.
    3. They did labs and an ultrasound on her. Her bilirubin and liver enzymes were elevated, and her gallbladder and liver looked bad on the ultrasound.
    4. This second treatment started on 8/19/21. They placed an e-tube for feeding and medications.
    5. She is currently on prednisolone, meropenem (she didn't get better after a few days of clavamox, flagy, and orbax), cerenia, mirtaz, and buprenorphine as needed.
    6. As of 9/1 her liver enzymes have slightly improved, but her bilirubin is stuck at 7.5. They have said if she doesn't respond to a few more days of steroid they recommend surgery or euthanasia. I don't like either of those options and so I am seeking out alternative opinions.
12. Is the condition better or worse from exercise, heat, cold, time of day, certain foods, emotional upset, being touched, excitement, etc?
    1. Tough to say, I cannot determine her biliary blockage amount
13. Has any diagnostic work been done? Diagnosis if available (you can attach your diagnostic tests to the post if you have them)
    1. Ultrasounds: last one shows her biliary and pancreatic ducts are distended, although her gallbladder and liver have vastly improved
14. Current and previous treatment
    1. Current: ursodiol, mirtaz, prednisolone, cerenia, meropenem, fortiflora
    2. Previous: same except instead of meropenem she was on orbax+clavamox+flagyl
15. Other health concerns
    1. Interested in supplements and therapies to help her liver, gallbladder, ducts, and overall health/inflammation

 

[Dr. Jeff]

Wow Benjamin! What an ordeal Luna has already been through in her young life so far.

Do you work with a vet homeopath or general holistic vet?

I ask because for proper management of her care, the very best thing is to work closely with an integrative vet, local vet/internist and vet homeopath expert.

However, regardless of her current vet care team, there's a ton that you can do at home! At the same time as continuing to mindfully monitor her with your vets, and have less need for drugs as she gets better and better.

The first thing to start with, as you undoubtedly now, is getting her to eat better and better. The goal is for her to eat whatever you offer her to eat!

Is she eating now? If so what? She might eat a little bit of warm rabbit (since she likes the Koha rabbit).

Can you get her to purr or play? Purring, playing and petting can raise her cellular energy and ability to heal. That's the basis of the Happiness Protocol which you may want to start right now:

The Happiness Protocol in Your Pet's Life

At HA! we are committed to much more than helping pets become dis-ease free. We promote restoring and maintaining vitality, balance, energy, & happiness.

www.holisticactions.com

I'm so glad that you were able to schedule time to talk next week. Would you be flexible to talk sooner?

Also, if you could upload her recent vet visit notes and test results, that would be great.

I look forward to talking soon.

 

[BenjaminP]

Thank you for your kind reply!

I am in touch with a semi-local DVM with advanced training in nutrition and alternative therapies. I have a video consult with her Monday as well, after ours. Unfortunately I work everyday (Fri, Sat, Sun) until Monday, so Monday will be the best day. It looked like you had openings Friday but I work all day that day. I am off today if you have any times left (although I know it's later now)

I will continue to see her internist and hopefully the complementary medicine can be synergistic with the traditional therapy.

She is eating shredded pure chicken, and Koha pates. I don't have any raw rabbit at the moment. Her appetite is down slightly over the last 2 days, but it is much better than it was 2 weeks ago.

She is sleeping a lot, more than normal. She has never purred a lot, but she does pur in the morning and at night when she lays on my chest. I try to make her pur as much as possible. She is interested in playing and likes to watch the toys moving. I am definitely trying to keep her as happy as possible.

I will review the happiness protocol next. I attached her most recent vet note and lab values.

Thank you again

 

[Dr. Jeff]

Wow, you work each day over the weekend!

We can talk after work or just wait until Mon.

 

[BenjaminP]

Yes unfortunately, but I am glad to be off Monday.

My cat is has stayed about the same over the last few days. The main problems being her jaundice and lack of energy. I am very nervous about her internist appointment on Monday. They seem ready to throw in the towel, but she has periods when she appears so well and vital, I could never imagine euthanizing her in this state.

Looking forward to the talk. Right afterwards I have another call as well for an initial consult with an integrative vet.

I am doing everything I can to keep her happy in the meantime.

 

[Dr. Jeff]

Fantastic that you are staying positive, collecting data (at the internist) and being proactive (with the integrative vet)!

I'm looking forward to speaking tomorrow 3:30 ET.

BTW-If you Skype and would prefer to meet by video, please send me your Skype name so we can connect. Mine is drfeinman.

Also, do your best to stay optimistic (even after your internist appointment).

 

[BenjaminP]

Yes, I am doing my best to stay positive for me and her. I actually put the wrong day, internist appt is on Tuesday (that’s the one I’m nervous about). Today at 4 ET I am talking to an integrative vet after your call, and I’m looking forward to those.

She has been going through cycles. She starts most days off seeming to feel good. She has great appetite, purs a lot, and wakes me up at around 6 am for food and petting. As the day goes on and into the night her energy is down and she looks less happy. I feel like she is close but needs more to get past her very serious issues. As mentioned before, her internist has run out of ideas. And I feel her internist has done a great job and is well qualified (she is a diplomate/boarded), but hopefully there are alternative treatments or supplements she is unaware of.

edit* As of now I do not have skype but will look into making an account.