Cat with liver issues; how to get balance of food right with vomiting risk (higher carbs needed)

[mrrossi]

Hi all

Wondering if someone can help suggest any other options for the problems my lovely 14 year old boy Tiggy (indoor cat, British shorthair) is having. Trying to find the right balance to him eating enough but not vomiting so much nor pooping so much (Diarrhea).

Have been to the vet several times over the last year but not having much luck. Long story but trying to keep brief and include the main detail (sorry it's so long):

He has a liver issue and is taking Pet Wellbeing Milt Thistle drops (silymarin). He's a bit fussy but can usually get these drops into his food but recently he's been rejecting food with more than a couple of drops (struggling to get his full dose in a day). No other liver supplements have been successful (fully rejected/can't get him to take pills etc).

For years he was on a semi BARF diet - never really succeeded and he ate raw beef most of the time, with an occasional egg yolk or cooked chicken. He was never fussy, always ate everything. He was a little overweight at almost 5kg (was 4.5kg for a long time).

Approx. 18 months ago supermarket stopped selling that particular beef and he's mainly been eating 'high quality' protein rich brands of cat food, more recently, Natures Menu Chicken & Turkey. However, he became more fussy and often wouldn't eat, his weight dropping to between 4.2-4.5kg.

About 9 months back he started vomiting regularly. Diagnosed with liver issues and that's when I started trying silymarin and eventually found the Pet Wellbeing drops.

Over time he's got worse and his weight dropped to 3.5kg. Pet prescribed steroids (prednicare) and some laxative drops to 'settle' his stomach. Also a change of diet (more on that later - complex and not had much luck). They seemed to help at first but he started having incredibly loose poos and missing his two litter trays constantly, pooping all over the house... not pleasant.

I purchased a third litter tray and eventually a 4th; now having one in the hallway (where he kept pooing repeatedly) and an extra in the conservatory (where his previous 2 are/were). Also tried some other litter types he seems to prefer more... long story short, the poo situation got much better, but only after I decreased and then fully removed the laxative medicine from his diet.

Situation recently has been he's only taking the steroid and milk thistle but his poos are still incredibly wet and he occasionally poos on the floor still. I think he can't make it in time...

Note that he is drinking a lot more water than he used to (vet had said he was a little dehydrated) after I installed a cat water fountain (he LOVES that thing!!).

Also note he has had de-wormer (he doesn't go out as such but did use a catio in summer where he would occasionally chew grass reaching through the chicken wire).

Diet: vet suggested the higher protein diet was no good for him due to his liver being unable to 'process' it hence the sickness and hence the prescribed steroid and laxative - both supposedly being stomach "settlers" and reducing his sickness. They did (although never 100%) BUT I think the laxative effect has possibly been far worse than the vomiting! Anyway, he's never liked dry food (kibble) and wouldn't eat several brands but he will OCCASIONALLY eat a few mouthfuls of Hills i/d (the special one for digestive issues) kibble which is great - but it's not enough.

Effectively I need him to eat a higher carb diet; but he just refuses. I've even tried lower quality foods (4% meat) that lots of cats love and he's just not interested.

I've tried making my own cat food with several online recipes. Pumpkin was a failure, as was rice, even egg soaked rice (and he LOVES egg yolk but there's only so much I can give him). Haven't tried mixing in carrot or sweet potato yet but heard they are high in Vitamin A and I need to keep that down with liver issues??

So today, I've made the executive decision to stop the steroid (prednicare) as I feel he's still vomiting and it's possibly making things worse (possible side effects are actually vomiting anyway and Diarrhea!). His weight is perhaps BELOW 3.4kg now... he looks so thin and feels so bony it really makes me want to cry.

Note, he doesn't show any other signs of illness - whites of his eyes are white and he's not lethargic (except after he's vomited a lot - but once he eats again after, he's fine and purrs very happily).

Also tried antacids (vet suggested) & other 'digestive drops' but he just refuses his food then, no matter how much I try mixing with other 'favourite' foods & various combinations.

I have managed to find some beef from another supermarket that he WILL eat.

The real question is now:

Do I over feed him more high protein food / beef / chicken (which I know he'll eat) and risk the vomiting, but hope he's eating enough to gain weight, and with the prednicare stopped hope he's not loosing weight from the excessive pooing? And continue with milk thistle (as much as I can get away with without him rejecting said food)?

OR

Do I continue to try and force him to eat more high carb foods (perhaps try mashed carrot/sweet potato mixed in) but risk him not eating so much (but hopefully vomiting less)? I did try the Nature's Menu 'senior' that has rice and he ate some much he seemed to vomit MORE - from a previous experience years back I think it's the cranberry in it, but can't say for sure...


Anything else I can try? I have just bought one of those 'angled' food stands in case the angle he's eating at is prompting sickness in his 'older' age...

Many thanks for listening
Ross & Tiggy

[fjm]

WARNING: do not stop the Prednicare without first consulting your vet - stopping it suddenly can be EXTREMELY DANGEROUS.

I have a dog (Poppy, toy poodle) who was diagnosed with acute liver failure just over two years ago, and has coped with chronic liver disease ever since. She started on 5mg Prednidale (approx 1mg/kilo), reduced after a few months to 2.5mg, and after she showed increasing signs of iatrogenic Cushings early last year further reduced in slow steps to 1mg. She also takes Denamarin (includes silymarin), and Destolit to thin her bile, as that has been part of the problem. The Prednidale reduces inflammation in the liver, so we do not want to cut it out altogether.

With some difficulty I got her eating RC canned hepatic with extra chicken breast as she needed a higher protein level than it provides. Sufficient protein, the higher quality the better, is essential for the liver to repair itself, and very low protein/plant protein are only really necessary if there are signs or encephalopathy or other clinical reasons. Like your cat she had regular bouts of diarrhoea - I found a good probiotic helped (I am currently using Protexin Bio-Premium), especially when combined with a very small dose of Metronidazole every 2.5 days. SIBO (small intestine bacterial overgrowth) is often associated with liver disease, and this regime seems to help to keep things in balance. If you are home cooking oats are better than rice - when Poppy was refusing the commercial diet I concocted an oats, egg and chicken recipe that covered most of the nutritional bases, especially when supplemented with a Vetzyme B+E tablet. Dogs are much easier to get eating than cats, of course, especially when on steroids, but inappetence can be a sign that the liver issues are getting worse. I have found fat and glycerine, even in tiny quantities, will trigger a bout of diarrhoea, so I take care to avoid those as far as possible.

Hope that all helps a little - but once again, DON'T SUDDENLY STOP THE PRED! If you do want to stop it needs to be phased out very gradually.

[fjm]

PS I should have mentioned that Poppy is on 4 small meals a day, with regular snacks in between. The aim is to have the stomach never too full or too empty. Too big a meal and she is liable to vomit.

The following is from a presentation on nutrition for dogs with liver disease - cats would be similar, but are less able to digest many carbohydrates:

General High palatability, High digestibility
Protein Restricted to a minimum of 2.1 g/kg/day (10-14% total calories), High quality
Fat 2-3 g/kg/day (30-50% total calories)
Carbohydrate 5-8 g/kg/day (30-50% total calories)
Moderate level of soluble and insoluble fibre
Micronutrients Increase B-complex vitamins to twice adult maintenance
Consider vitamin C supplementation at 25 mg/kg/day
Supplement with Zn sulphate (2mg/kg/day) or Zn gluconate (3 mg/kg/day)
Restrict sodium

The chicken breast I use, without skin or fat, is 28% protein - 50g of chicken gives 14g of high quality protein.

[mrrossi]

Hi fjm and many thanks for the quick and detailed response!

Ah yes, Id forgotten about probiotics, it was something I'd started looking at before - will have another look and see what I can find (a very quick google suggests there's a Protexin Bio-Premium for cats too).

On the prednicare point, thanks for the warning - although note he's on a very small amount; only half a 1mg pill daily i.e. 0.5mg. I didn't intend to stop 'dead' and should have elaborated further; the plan was to miss one today, give him some tomorrow, miss the next day (or maybe give him 2 days in a row then miss one) etc and gradually phase out. But fair point and thanks - I'd best discuss with the vet too.

Interesting about the fat triggering Poppy - perhaps the egg yolk is too much fat for Tiggy? I had him eating half a yolk daily as that was the best way to get him to eat the prednicare.

I hadn't come across oat based cat food / recipes before but, again, a quick google suggests that may be a good idea for cats - maybe he'll like more than rice? Certainly worth a try... many thanks, much appreciated!!!

Tiggy is currently fed about 5 or 6 small meals a day as I too found that too much in one go could make him sick.

Thanks again!

[fjm]

Phew - glad you were aware of the dangers of suddenly stopping the steroid. Had me worried there!

[Mollycat]

I don't know a lot about liver issues but a couple of things are jumping out at me.

Please give him access to grass. It's really important even if we don't fully understand how but the cat's natural drive to eat grass is just as strong as the drive to do their claws. If you don't want him eating wild growing grass through the wire please provide a pot of it indoors, wheat grass is really easy to grow. Unless he eats very long strands it should not make him vomit and there is speculation the oils in it are a digestive help.

You mention that Tiggy ate a lot of beef - is it possible his liver issue was caused by vitamin A toxicity? Beef liver is especially high in vitamin A and long term feeding of too much beef liver is the main route for overdose - not carrots or sweet potato.

[mrrossi]

Thanks Mollycat. The problem with the outdoor grass is that he goes crazy and eats a ton and then almost immediately vomits it back up!!

Maybe I can try the wheat grass again; he used to have a small amount of that and I can control how much he eats easier if it's in a pot rather than readily available (although the catio has been out of action for months now anyway due to poor weather).

Yes he used to eat a lot of beef and that could have been the cause of liver problems although he also had access to a plant (seemed he was able to lick it through the catio wire) that is known to cause liver problems in cats (I don't recall it's name now); as soon as I realised he could reach it / it was dangerous obviously this was removed (last spring).

[mrrossi]

Hi again

So it's no going well. Gradual easing off the prednicare has not helped with the diahhrea. It's nearly always liquid and it's only going in the tray 25% of the time.

I was doing well with the diet (although no joy with oats or rice, he was eating some of the Hills I/D dry food and another 'digestive' aid wet food, if I mixed it with other meat) and he hadn't been sick for six days but the pooping hasn't improved and he's been fussier the last 3 days eating.

He looks so thin, I swear the pooing is making him loose more weight than the vomiting ever did.

Yesterday evening & today I could only get him to eat chicken, he wouldn't eat anything else. Gave him small amounts and hoped it wouldn't trigger the vomiting...

Sadly he just had a huge vomit.

I'm just trying to get an urgent appointment with the vet, in the meantime, any suggestions?? Should I feed him more chicken (he's always ravenous after being sick)? Or nothing? Or try to get him to eat some dry food / "digestive aid" wet food?

Thanks in advance

[fjm]

Have you discussed vitamin B with the vet, especially B12? I would talk to the vet as soon as possible, but in the meantime I would do whatever is necessary to keep him eating. A balanced hepatic diet is ideal, but not much use if he simply won't eat it. I would encourage him to eat small portions of the vet-recommended food, and if he won't take it feed small frequent meals of whatever he will accept. And I would go back to the original dose of Pred - Poppy had D&V when her dose was halved, and after that I reduced it in extremely small steps over a month or so. Hope things improve soon.

[Mollycat]

When Bobby had D&V issues at first it was controlled by vitamin B injections. His was probably either IBD or lymphoma, not liver problems, but it really helped and my vet suggested Cobalaplex or equivalent, an oral supplement of B vitamins with particular emphasis on B12, as FJM says. After a while it wasn't enough and we progressed to steroids, which was also a disaster when we tried to halve the dose as recommended - it's a big drop really.

[mrrossi]

Thanks both. I managed to get a video conference call with the vet and agreed to stay off the Prednicare for now and get him hydrated and back to eating better. She said the colour and consistency of his stools suggested the correct process wasn't going on in his stomach and pointed out that the Protexin Bio-Premium I'd started using was more of a 'maintenance' thing rather than a 'treatment' and has recommended the Pro-Kolin as a way to 'fix' his gut process. Apparently he looses a lot of electrolytes due to the diahrea. On the dehydration side she's suggested cat soups and after trying 3 unsuccessfully I'd found a lamb one he slurped down very happily this morning! He's been easting plain chicken and raw beef well, in small amounts, and I've managed to get some digestive drops (for upset stomachs) and the milk thistle drops into those. She said once he's more hydrated and 'happy' he should be less fussy and eat the lower protein/hepatic diet food. I tried a little mixed with chicken and the Protexin Bio-Premium this morning and he's eaten a good amount, so that's great! Just waiting for the Pro-Kolin to arrive.

I didn't see the vitamin B comments before I spoke to the vet unfortunately. I'll look into it/mention next time I speak to her, thanks!

She did say if I can't get him hydrated/back eating hepatic food then he may need to come into the vets to have an i/v drip for a day. Fingers crossed with the soup and the Pro-Kolin I can get him back to health and avoid that (don't want to stress him) but will keep a close eye on his dehydration (by doing the neck pinch test and monitoring what he's drinking / his stools etc).

I've also ordered Oralade to try to help more replenish his electrolytes.

Thanks again

[Mollycat]

I'm astounded that Pro-Kolin hasn't been tried before but anyway - you are checking with the vet before giving ANY kind of alternative remedies? Very innocent herbal products and even vitamins and minerals can interfere with drugs and medicines, and even foods in some cases. Like blood thinners and grapefruit in humans. There is a very good online drug interactions checker but note interactions may be different in different species so you cannot rely on something like that for pets. The only way is check with the vet.

[mrrossi]

Hi Mollycat. The primary issue which the vet was addressing before was his liver issues (milk thistle helping with that now) and vomiting. The vomiting was diagnosed as being down to the liver being unable to cope with his high protein diet, rather than any gut imbalance.

Clearly he now has a gut imbalance (he didn't have diahhrea before the prednicare or laxative which were prescribed to help the vomiting) and they've now suggested the Pro-Kolin.

Anyway, that's arrived but I'm struggling with it a bit. He won't eat it in his food; they recommended putting on his paws so he'd lick off but it's such a horrid substance and hard to rub off onto him - it falls on the floor, he runs off etc... I'm managed to get some on him yesterday and a bit more today. I could still see the stain of yesterday's on him for a few hours (i.e. he hadn't licked it off) but don't see it now... although there is a horrible grey smear on the white radiator cover he sits on so he may have just rubbed it off on there!! I'll keep trying / google for tips...

Yes appreciate the risks / complications of mixing products / remedies etc and have discussed everything with the vet.

Having some good success with the soup now so hopefully will get on top of his dehydration (although he did do a liquid stool again a couple of hours ago... hoping the Pro-Kolin will help with that).

[fjm]

I have had most success with cats and Pro-Kolin by just squeezing it straight into their mouths - my cats have always been pretty easy going though. It never needed more than a few doses so as long as chicken or something high value was also involved they didn't get too upset. Practice squeezing it first though, or it goes everywhere. The dogs consider it an acceptable treat unless they are feeling really yuck, when again I just squeeze it into their mouths.

[mrrossi]

Hi - bit of an update!

The Pro-Kolin has worked wonders... kinda.

I've really struggled to smear it on him; it immediately congeals and lumps up. I'm trying to spread quickly on different paws/back legs, his side, wherever I can/he can lick... but a lot remains on my hands.

CANNOT disguise it in any food. He's waaay too fussy. I don't know if it's the taste or smell, it's just a "NO" from Sir Tiggs.

He MUST be licking some off him though... as yesterday he produced his first SOLID stool in weeks. And it didn't even smell! And there was just ONE (instead of 3-4 wet poos). He even had more wees, which shows he's better hydrated.

His appetite is much better too; and again today, he only did one SOLID stool at lunch time.... BUT:

A wet one this evening.

He's had less of the Pro-Kolin today/yesterday evening, as I was failing to administer.

I've just gone and smeared a load all over him (NOT a happy cat) upon immediately discovering the wet stool. Hopefully he'll get some into him... but I keep finding grey smeared greasy lumps all over the house.

Clever cat is learning to rub it off him, rather than lick off!! Arrrrghhh!!!

I've tried to feed directly to him, tried a smaller syringe and direct squirt into his mount, but I'm really rubbish at it. Checked loads of online videos but I just can't force his mouth open. I'm too squeamish... I couldn't be a vet, that's for sure.

Anyway, if he doesn't get some into his system soon, I'm going to get the help of a friend who's more likely to have success.

What I wanted to ask though here was:

Is there another good ALTERNATIVE to Pro-Kolin?

One that's less slimy / easier to get on his fur (and less easy for him to rub off) / less "flavoursome" so I can sneak it into his food??

Many thanks!! Again!!!

Ross

[fjm]

There are loads of different digestive pastes - Pro-Kolin is one of the best but if you search online you will find lots of options. The finer the tube the easier it is to slip between the lips, even if you can't get his mouth open, so choose the smallest tube available. I've used Logic, amongst others. All are similar - kaolin to bung up, something to soothe, pre/pro-biotics to aid recovery.

[Mollycat]

Are you trying to get a nozzle in the front of his mouth? Much easier, safer and less distressing to go through the side. The front tiny teeth are easily broken and any cat worthy of the name should protest at having anything poked in there and the mouth must be open.

If you take the side of the mouth, there is a gap behind the fangs - you still need to open the mouth slightly but it's much easier and less stressful for everyone concerned.

[mrrossi]

Thanks again both, really appreciate your answers!

I had some more luck last night. I mixed some fresh chicken and some of his fave wet food (that has some natural jelly in it) and managed to quickly mash a smaller dose (1mm) of Pro-Kolin into some of the chicken and some of the jelly, and then mix the lot together.

He's eaten a good portion overnight; not all, and I can see a couple of grey smears leftover, but I reckon he's had some (at least 0.5mm). No stool overnight and two wees so that's a good start, and he seemed really hungry this morning, so I've repeated the same - no complaints, and he's pretty much eaten the lot!

I think maybe I was trying to put too much in at a time / he was less hungry / more fussy at those times. I'll try again with another 1mm in a few hours when he's hungry again and can hopefully repeat this method again and again

[fjm]

Sounds like good progress and, as Mollycat says, perhaps I should have specifically said that I slide the nozzle between the lips into the gap behind the canine! But if he is taking it in food that is far less stressful for everyone.