Prelude
Saturday May 29
This is the day we first noticed Jezebel's persistent vomiting. All of our cats puke once in a while, and we normally don't pay much attention unless the cats seem in real distress. Jezebel however vomited several times that day, always bringing up a bright turmeric-yellow liquid. This is also the day we realized neither of us had seen Jezebel eat much over the last few days (we'd been free-feeding our cats). We tried offering Jezebel some food but she refused.
Sunday May 30
Michael had brought some tuna home the previous night, so I tried offering some to Jezebel. She licked it and ate a few flakes. She seemed to be doing a bit better. Later I went to the grocery store and picked up some tins of the cheap smelly food, just to be sure she ate something. She ate a reasonable about of it, and so we assumed the episode was over. Later in the evening she threw up again, so we decided to take her in to the vet first thing the following morning.
Monday May 31
Michael brought Jezebel to our local vet at 10am. The vet did an x-ray, which didn't reveal anything abnormal and ruled out any blockages. She also did some bloodwork, which we would have to wait until the following day for some results. The vet noticed Jezebel had lost weight since the last visit. Jezebel was also slightly dehydrated so they gave Jezebel some subcutaneous fluids and kept her for a few hours to (unsuccessfully) try to get a urine sample. We brought her home on Monday afternoon. Jezebel still seemed fine, only slightly tired.
Tuesday June 1
By this point Jezebel, while still relatively happy, was starting to show some signs of weakness. We would notice her stumble a bit when she jumped, and her steps became more cautious. The bloodwork came back and was inconclusive, revealing only some possible slight abnormality in the pancreas. Our vet recommended we admit Jezebel to their clinic to be put on an I.V. for two days to see if she would bounce back. Unfortunately, the clinic does not have 24 hour supervision, so this meant Jezebel would be left alone overnight. We expressed concern with this, and asked if we could instead bring Jezebel in during the day to put her on an I.V. and take her home at night. The vet didn't seem to think this would be effective, so she suggested a 24-hour veterinary emergency hospital. We decided to think about it for a few hours and started doing some research on the internet about what could possibly be happening with Jezebel. By searching for "yellow" and "vomiting" we figured out Jezebel was vomiting because her stomach was empty. We still couldn't figure out why she wouldn't eat, particularly if there was no blockage. By doing more searches for "vomiting" and "inappetence," we stumbled upon a few descriptions of Hepatic Lipidosis, or Fatty Liver Syndrome. This is where we first started to suspect the real cause of Jezebel's illness.
By late afternoon Jezebel's condition still hadn't improved so we requested that our vet forward all Jezebel's files to the 24-hour hospital. We brought Jezebel to the hospital around 8pm. The triage nurse examined Jezebel, and noted her colour was good (no yellow in the ears). She seemed to think Jezebel was in better shape than most cats being admitted ("We get the worst of the worst here"), but that the fact that she hadn't eaten since around Thursday was a major cause for concern. The vet on duty then examined Jezebel at length, and agreed to have her admitted and put on I.V. Unfortunately there had been a mixup and Jezebel's most recent bloodwork and xrays hadn't yet arrived at the hospital. The staff tried tracking down the results of the bloodwork by calling different labs, with no luck. This was extremely frustrating. Without the results of the bloodwork, the vet on duty had very little to go on except a physical examination of the cat. He explained that they would put her on an I.V. for a few days, and that, best case scenario, she would bounce back, begin eating again, and get well. He explained the worst case scenario, Hepatic Lipidosis, and the treatment, which would involve putting a tube into Jezebel's stomach and force feeding her until her liver recovered. (By this time, we had already done a lot of research about Hepatic Lipidosis; I was glad we did, because the vet on duty had a very thick accept which we could hardly decipher. Because we had already looked up details about Fatty Liver Syndrome, we were able to follow pretty much everything he was saying.)
At the time, the vet on duty seemed optimistic about Jezebel's chance of recover on the I.V., since she looked very good and was showing no signs of jaundice. We said goodbye to Jezebel, and the vet took her to the back to get her hooked up. I hated seeing the vet walking away with that little black cat!
Once we got home, we got back on the internet and started doing some more research on Hepatic Lipidosis. We learned about possible causes, including a change in diet. We had recently switched the cats' food to a new brand on April 15, about a month and a half earlier. We remembered Jezebel turning her nose up at the new food, then reluctantly accepting it. Then we found the following statement on one of the websites describing the condition:
"Approximately 2 weeks of eating 1/2 - 3/4 the normal amount of food is needed to develop a fatty liver."
We were horrified. We were convinced at this point that Jezebel had developed Hepatic Lipidosis, since it was easy to see Jezebel hadn't been eating as much after we switched the food. Before she got sick, we weren't concerned about her food intake; we were convinced a cat would never actually starve herself.
We called the vet hospital back to speak to the vet on duty, and explained about the change in food and Jezebel's gradual refusal to eat (we hadn't dwelled on it during the initial consultation). While speaking to the vet, he mentioned they had found Jezebel's file, which we were happy to hear (we'd been ready to call up our local clinic and tear a piece off of them).
Wednesday June 2
At noon, the vet hospital called us to request permission to do an ultrasound on Jezebel. This was to examine her liver. We agreed, and they did the ultrasound the same afternoon. They also asked if we could suggest any of her favourite foods, since the staff had so far been unable to tempt her into eating. We explained that we had pretty much already tried everything.
Thursday June 3
By Thursday there was still no improvement in her condition. By this time the specialist who had done the ultrasound strongly suspected Hepatic Lipidosis. The only way to confirm the diagnosis was with a biopsy under general anesthesia, which we agreed to. The specialist explained that he would do the biopsy, look at it immediately, and if the biopsy confirmed Hepatic Lipidosis, he would immediately install a feeding tube through her stomach wall.
By Thursday night the surgery had been done. The biopsy had confirmed the diagnosis we knew all along. Jezebel had been outfitted with a stomach tube. We asked about a possible discharge date; the staff explained that Jezebel would have to be started on the feeding tube at the hospital and monitored for at least a few days; we would not be able to bring her home until Monday at the very earliest. Until there was nothing we could really do but wait. We had planned a trip out of town over the weekend, which had been up in the air since the onset of Jezebel's illness. We decided to go out of town after all. We asked if we could visit Jezebel before leaving and they encouraged us to do so whenever we wanted.
Friday June 4
On Friday morning we visited Jezebel in the hospital for the first time. We were both amazed at how nice of a facility it was; far nicer than many human hospitals we'd been to! This put us at ease. Jezebel seemed tired and groggy, but doing relatively well considering the major surgery she had just been through. She purred when we stroked her neck. The staff were all incredibly friendly, helpful and compassionate. We were glad we had decided to bring her to the 24-hour hospital rather than leaving her unsupervised at the local clinic.
Saturday June 5
On Saturday afternoon we received a phone call at the place we were staying out of town from the specialist. He expressed some concerns about Jezebel, and explained that she hadn't been tolerating the tube feedings very well. He explained that they were going to add another anti-nausea medication to the mix to try to prevent the vomiting. The challenge was to balance the risk of vomiting with the risk of not getting enough calories in her.
Sunday June 6
We drove home late Sunday night and decided to stop in to see Jezebel at about 3am (!). Jezebel seemed no worse, no better than the last time we had seen her on Friday morning. We stayed with her a little while then went home.
Monday June 7
On Monday things took a definite turn for the worse. We visited Jezebel at 5pm and immediately noticed the bright yellow tinge in the skin above her eyes, where the fur is more sparse. The staff explained that they were going to try resuming feeding that evening, since she had been doing relatively well all day with no vomiting. Jezebel was very agitated while we were there, got up and started pacing in her cage. She then threw up, at which point the staff decided to further postpone her feeding. We suspected that the nausea and vomiting was brought on by her sudden movements.
Tuesday June 8
On Tuesday morning we visited Jezebel again and met with the specialist. By this time Jezebel looked worse than ever. She was severely jaundiced, and could hardly move. The specialist explained that the situation was bad. He told us that despite the treatment, her bilirubin levels were going up, not down as expected. The normal bilirubin level for a cat is 0-10; Jezebel's bilirubin levels since the stomach tube was put in were as follows:
June 3: 79
June 4: 99.6
June 5: 124.4
June 6: 177.4
June 7: 322.4
The specialist explained that the jump from June 6 to June 7 was a serious cause for concern. He explained that he was going to add some holistic treatment, including vitamins and other supplements. It was clear Jezebel was very ill by this point. When I lifted her up from the exam table to place her back in her cage, her back end was wet, and I suspected she had lost some bladder control too. Before we left I tucked a piece of soft blanket I had brought with me around Jezebel. The previous night I had cut one of the cats' blankets into four smaller squares. We slept with the piece of blanket, the idea being that the smell of us would at least reassure and comfort her somewhat while she was in the hospital. We continued to bring a new piece of blanket every day for the rest of the week.
We visited Jezebel again in the afternoon and got the results of that day's bloodwork, which showed the bilirubin had gone up again to 412.3. We were crushed. The specialist phoned us later that night and we agreed that the only option was to go on with the treatment and hope that Jezebel would eventually respond.
Wednesday June 9
We visited Jezebel in the morning and again in the afternoon. She continued to purr each time we stroked her neck or her chin. By Wednesday they had to shave her throat in order draw blood. Jezebel was still weak, but her colour seemed better--while her skin was still a bit yellow, it wasn't nearly as striking as it had been when we first noticed it on Monday. By this time, however, we were doubting ourselves--we weren't sure if the yellow colour was really going away, or if the initial shock of the colour had just worn off. We waited patiently for the results of the morning's bloodwork, which came in later that afternoon. Jezebel's bilirubin had gone up (again) to 430.3. We were a bit discouraged, but relieved it hadn't increased as much as the previous day.
We did more internet research, and found this bit of encouraging information from www.vetinfo.com:
"It is important to evaluate how the patient feels when thinking of what lab values mean. This is particularly important with liver disease. Lots of times we see patients who are clinically much improved before the liver values start to fall--and the clinical improvement (increased appetite, activity, etc.) usually is a reliable sign. Not always, but usually."
More finger-crossing.
Thursday June 10
This day was the turning point for Jezebel. We visited her first thing Thursday morning. This time, we were absolutely convinced she was looking better. The results of the bloodwork came back in the afternoon--her bilirubin level had fallen to 294. I almost cried. We returned to the hospital in the evening to see her again. One of the technicians had printed out a chart for us along with a graph, showing all the values of the bloodwork done to date.
The vet on duty went over the results of the bloodwork with us. She noted that while the bilirubin levels were getting better, Jezebel's red blood cell count was low. She suggested a blood transfusion over the weekend, starting Friday morning. (I had NO idea they did blood transfusions for cats!) I asked about the risks, and she explained that though there was always a chance of rejection, they took every possible precaution to minimize this possibility. They would first check Jezebel's blood type (type A or type B), then match it with one of their in-house donor cats. They would then combine both cats' blood in a tube and watch for a reaction. Finally, they would do the transfusion very slowly, and monitor Jezebel for any sign of anaphylactic shock. We asked the vet if she thought the benefits of the transfusion would outweigh the risks, and she assured us they would, so we agreed.
Friday June 11
We visited Jezebel twice again on Friday. We found out Jezebel's blood was type A. The transfusion went ahead without any incident. Later in the afternoon, during our second visit, one of the technicians bounced over to us to show us Jezebel's latest bilirubin count--it had dropped to one hundred and something. The staff were genuinely excited about Jezebel's comeback.
Saturday June 12 and Sunday June 13
When we visited Jezebel on Saturday, the staff gave us a separate room to ourselves to spend time with her. She was still hooked up to her IV, but at least she could walk around a bit. The staff noted that she had been very alert and active--a remarkable change from just a few days prior. By Sunday morning Jezebel was being fed 100% of her daily caloric needs via the tube, with no vomiting. We visited her twice that day, once in the separate room, then the second time back in her cage. One of the technicians had moved her to a big dog pen instead of a normal cat pen to give her lots of room to stretch her legs and explore. The staff at the hospital were, by this point, quite attached to her.
Monday June 14
On Monday morning, Michael called the hospital, hoping to speak to the specialist about an approximate discharge date. The specialist's assistant came on the phone instead, and told us we could take Jezebel home that very same afternoon. We made an appointment for 2pm to meet with the specialist and go over our feeding and aftercare instructions. It was the happiest day I'd had in recent memory.
This is the day we first noticed Jezebel's persistent vomiting. All of our cats puke once in a while, and we normally don't pay much attention unless the cats seem in real distress. Jezebel however vomited several times that day, always bringing up a bright turmeric-yellow liquid. This is also the day we realized neither of us had seen Jezebel eat much over the last few days (we'd been free-feeding our cats). We tried offering Jezebel some food but she refused.
Sunday May 30
Michael had brought some tuna home the previous night, so I tried offering some to Jezebel. She licked it and ate a few flakes. She seemed to be doing a bit better. Later I went to the grocery store and picked up some tins of the cheap smelly food, just to be sure she ate something. She ate a reasonable about of it, and so we assumed the episode was over. Later in the evening she threw up again, so we decided to take her in to the vet first thing the following morning.
Monday May 31
Michael brought Jezebel to our local vet at 10am. The vet did an x-ray, which didn't reveal anything abnormal and ruled out any blockages. She also did some bloodwork, which we would have to wait until the following day for some results. The vet noticed Jezebel had lost weight since the last visit. Jezebel was also slightly dehydrated so they gave Jezebel some subcutaneous fluids and kept her for a few hours to (unsuccessfully) try to get a urine sample. We brought her home on Monday afternoon. Jezebel still seemed fine, only slightly tired.
Tuesday June 1
By this point Jezebel, while still relatively happy, was starting to show some signs of weakness. We would notice her stumble a bit when she jumped, and her steps became more cautious. The bloodwork came back and was inconclusive, revealing only some possible slight abnormality in the pancreas. Our vet recommended we admit Jezebel to their clinic to be put on an I.V. for two days to see if she would bounce back. Unfortunately, the clinic does not have 24 hour supervision, so this meant Jezebel would be left alone overnight. We expressed concern with this, and asked if we could instead bring Jezebel in during the day to put her on an I.V. and take her home at night. The vet didn't seem to think this would be effective, so she suggested a 24-hour veterinary emergency hospital. We decided to think about it for a few hours and started doing some research on the internet about what could possibly be happening with Jezebel. By searching for "yellow" and "vomiting" we figured out Jezebel was vomiting because her stomach was empty. We still couldn't figure out why she wouldn't eat, particularly if there was no blockage. By doing more searches for "vomiting" and "inappetence," we stumbled upon a few descriptions of Hepatic Lipidosis, or Fatty Liver Syndrome. This is where we first started to suspect the real cause of Jezebel's illness.
By late afternoon Jezebel's condition still hadn't improved so we requested that our vet forward all Jezebel's files to the 24-hour hospital. We brought Jezebel to the hospital around 8pm. The triage nurse examined Jezebel, and noted her colour was good (no yellow in the ears). She seemed to think Jezebel was in better shape than most cats being admitted ("We get the worst of the worst here"), but that the fact that she hadn't eaten since around Thursday was a major cause for concern. The vet on duty then examined Jezebel at length, and agreed to have her admitted and put on I.V. Unfortunately there had been a mixup and Jezebel's most recent bloodwork and xrays hadn't yet arrived at the hospital. The staff tried tracking down the results of the bloodwork by calling different labs, with no luck. This was extremely frustrating. Without the results of the bloodwork, the vet on duty had very little to go on except a physical examination of the cat. He explained that they would put her on an I.V. for a few days, and that, best case scenario, she would bounce back, begin eating again, and get well. He explained the worst case scenario, Hepatic Lipidosis, and the treatment, which would involve putting a tube into Jezebel's stomach and force feeding her until her liver recovered. (By this time, we had already done a lot of research about Hepatic Lipidosis; I was glad we did, because the vet on duty had a very thick accept which we could hardly decipher. Because we had already looked up details about Fatty Liver Syndrome, we were able to follow pretty much everything he was saying.)
At the time, the vet on duty seemed optimistic about Jezebel's chance of recover on the I.V., since she looked very good and was showing no signs of jaundice. We said goodbye to Jezebel, and the vet took her to the back to get her hooked up. I hated seeing the vet walking away with that little black cat!
Once we got home, we got back on the internet and started doing some more research on Hepatic Lipidosis. We learned about possible causes, including a change in diet. We had recently switched the cats' food to a new brand on April 15, about a month and a half earlier. We remembered Jezebel turning her nose up at the new food, then reluctantly accepting it. Then we found the following statement on one of the websites describing the condition:
"Approximately 2 weeks of eating 1/2 - 3/4 the normal amount of food is needed to develop a fatty liver."
We were horrified. We were convinced at this point that Jezebel had developed Hepatic Lipidosis, since it was easy to see Jezebel hadn't been eating as much after we switched the food. Before she got sick, we weren't concerned about her food intake; we were convinced a cat would never actually starve herself.
We called the vet hospital back to speak to the vet on duty, and explained about the change in food and Jezebel's gradual refusal to eat (we hadn't dwelled on it during the initial consultation). While speaking to the vet, he mentioned they had found Jezebel's file, which we were happy to hear (we'd been ready to call up our local clinic and tear a piece off of them).
Wednesday June 2
At noon, the vet hospital called us to request permission to do an ultrasound on Jezebel. This was to examine her liver. We agreed, and they did the ultrasound the same afternoon. They also asked if we could suggest any of her favourite foods, since the staff had so far been unable to tempt her into eating. We explained that we had pretty much already tried everything.
Thursday June 3
By Thursday there was still no improvement in her condition. By this time the specialist who had done the ultrasound strongly suspected Hepatic Lipidosis. The only way to confirm the diagnosis was with a biopsy under general anesthesia, which we agreed to. The specialist explained that he would do the biopsy, look at it immediately, and if the biopsy confirmed Hepatic Lipidosis, he would immediately install a feeding tube through her stomach wall.
By Thursday night the surgery had been done. The biopsy had confirmed the diagnosis we knew all along. Jezebel had been outfitted with a stomach tube. We asked about a possible discharge date; the staff explained that Jezebel would have to be started on the feeding tube at the hospital and monitored for at least a few days; we would not be able to bring her home until Monday at the very earliest. Until there was nothing we could really do but wait. We had planned a trip out of town over the weekend, which had been up in the air since the onset of Jezebel's illness. We decided to go out of town after all. We asked if we could visit Jezebel before leaving and they encouraged us to do so whenever we wanted.
Friday June 4
On Friday morning we visited Jezebel in the hospital for the first time. We were both amazed at how nice of a facility it was; far nicer than many human hospitals we'd been to! This put us at ease. Jezebel seemed tired and groggy, but doing relatively well considering the major surgery she had just been through. She purred when we stroked her neck. The staff were all incredibly friendly, helpful and compassionate. We were glad we had decided to bring her to the 24-hour hospital rather than leaving her unsupervised at the local clinic.
Saturday June 5
On Saturday afternoon we received a phone call at the place we were staying out of town from the specialist. He expressed some concerns about Jezebel, and explained that she hadn't been tolerating the tube feedings very well. He explained that they were going to add another anti-nausea medication to the mix to try to prevent the vomiting. The challenge was to balance the risk of vomiting with the risk of not getting enough calories in her.
Sunday June 6
We drove home late Sunday night and decided to stop in to see Jezebel at about 3am (!). Jezebel seemed no worse, no better than the last time we had seen her on Friday morning. We stayed with her a little while then went home.
Monday June 7
On Monday things took a definite turn for the worse. We visited Jezebel at 5pm and immediately noticed the bright yellow tinge in the skin above her eyes, where the fur is more sparse. The staff explained that they were going to try resuming feeding that evening, since she had been doing relatively well all day with no vomiting. Jezebel was very agitated while we were there, got up and started pacing in her cage. She then threw up, at which point the staff decided to further postpone her feeding. We suspected that the nausea and vomiting was brought on by her sudden movements.
Tuesday June 8
On Tuesday morning we visited Jezebel again and met with the specialist. By this time Jezebel looked worse than ever. She was severely jaundiced, and could hardly move. The specialist explained that the situation was bad. He told us that despite the treatment, her bilirubin levels were going up, not down as expected. The normal bilirubin level for a cat is 0-10; Jezebel's bilirubin levels since the stomach tube was put in were as follows:
June 3: 79
June 4: 99.6
June 5: 124.4
June 6: 177.4
June 7: 322.4
The specialist explained that the jump from June 6 to June 7 was a serious cause for concern. He explained that he was going to add some holistic treatment, including vitamins and other supplements. It was clear Jezebel was very ill by this point. When I lifted her up from the exam table to place her back in her cage, her back end was wet, and I suspected she had lost some bladder control too. Before we left I tucked a piece of soft blanket I had brought with me around Jezebel. The previous night I had cut one of the cats' blankets into four smaller squares. We slept with the piece of blanket, the idea being that the smell of us would at least reassure and comfort her somewhat while she was in the hospital. We continued to bring a new piece of blanket every day for the rest of the week.
We visited Jezebel again in the afternoon and got the results of that day's bloodwork, which showed the bilirubin had gone up again to 412.3. We were crushed. The specialist phoned us later that night and we agreed that the only option was to go on with the treatment and hope that Jezebel would eventually respond.
Wednesday June 9
We visited Jezebel in the morning and again in the afternoon. She continued to purr each time we stroked her neck or her chin. By Wednesday they had to shave her throat in order draw blood. Jezebel was still weak, but her colour seemed better--while her skin was still a bit yellow, it wasn't nearly as striking as it had been when we first noticed it on Monday. By this time, however, we were doubting ourselves--we weren't sure if the yellow colour was really going away, or if the initial shock of the colour had just worn off. We waited patiently for the results of the morning's bloodwork, which came in later that afternoon. Jezebel's bilirubin had gone up (again) to 430.3. We were a bit discouraged, but relieved it hadn't increased as much as the previous day.
We did more internet research, and found this bit of encouraging information from www.vetinfo.com:
"It is important to evaluate how the patient feels when thinking of what lab values mean. This is particularly important with liver disease. Lots of times we see patients who are clinically much improved before the liver values start to fall--and the clinical improvement (increased appetite, activity, etc.) usually is a reliable sign. Not always, but usually."
More finger-crossing.
Thursday June 10
This day was the turning point for Jezebel. We visited her first thing Thursday morning. This time, we were absolutely convinced she was looking better. The results of the bloodwork came back in the afternoon--her bilirubin level had fallen to 294. I almost cried. We returned to the hospital in the evening to see her again. One of the technicians had printed out a chart for us along with a graph, showing all the values of the bloodwork done to date.
The vet on duty went over the results of the bloodwork with us. She noted that while the bilirubin levels were getting better, Jezebel's red blood cell count was low. She suggested a blood transfusion over the weekend, starting Friday morning. (I had NO idea they did blood transfusions for cats!) I asked about the risks, and she explained that though there was always a chance of rejection, they took every possible precaution to minimize this possibility. They would first check Jezebel's blood type (type A or type B), then match it with one of their in-house donor cats. They would then combine both cats' blood in a tube and watch for a reaction. Finally, they would do the transfusion very slowly, and monitor Jezebel for any sign of anaphylactic shock. We asked the vet if she thought the benefits of the transfusion would outweigh the risks, and she assured us they would, so we agreed.
Friday June 11
We visited Jezebel twice again on Friday. We found out Jezebel's blood was type A. The transfusion went ahead without any incident. Later in the afternoon, during our second visit, one of the technicians bounced over to us to show us Jezebel's latest bilirubin count--it had dropped to one hundred and something. The staff were genuinely excited about Jezebel's comeback.
Saturday June 12 and Sunday June 13
When we visited Jezebel on Saturday, the staff gave us a separate room to ourselves to spend time with her. She was still hooked up to her IV, but at least she could walk around a bit. The staff noted that she had been very alert and active--a remarkable change from just a few days prior. By Sunday morning Jezebel was being fed 100% of her daily caloric needs via the tube, with no vomiting. We visited her twice that day, once in the separate room, then the second time back in her cage. One of the technicians had moved her to a big dog pen instead of a normal cat pen to give her lots of room to stretch her legs and explore. The staff at the hospital were, by this point, quite attached to her.
Monday June 14
On Monday morning, Michael called the hospital, hoping to speak to the specialist about an approximate discharge date. The specialist's assistant came on the phone instead, and told us we could take Jezebel home that very same afternoon. We made an appointment for 2pm to meet with the specialist and go over our feeding and aftercare instructions. It was the happiest day I'd had in recent memory.
posted by Kathleen at 2:00 p.m.
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