Hepatitis & Holly
Holly’s Visit to the Specialist 9/14/11:
I haven’t been feeling well lately so my friends at Best Friends tested my blood and found out I had hepatitis! They started me on some icky medications that made me sick, which I didn’t like at all. I stopped eating so they had to feed me chicken, which I like much better than my regular food. When my liver didn’t get better after two weeks of medication I got to go see one of the internal medicine specialists at Lakeshore Veterinary Specialists. This was an adventure because I haven’t been outside the building since 2004! I didn’t want to hold still while they shaved my belly and did an ultrasound scan of my liver so I had to be sedated. Now my belly is cold and bald! It looks funny.
Dr. Byl said the ultrasound showed I have a disease called cholangiohepatitis. I have bad stuff in my gall bladder. Now I have to be on even more medication to try to make me better. If it doesn’t work I will have to have a liver biopsy. I hope I get better so I don’t have to have surgery. I guess I’ll have to keep taking those icky medicines. It would be better if I would eat special food for my liver but I don’t want to! I like my chicken much better. I think I’ll just eat that. The nice thing about being sick is everyone fusses over me so I feel special. Of course I’m always special but now I’m extra-special! Maybe I’ll get some get-well cards from all my friends!
Today we got my urine test results back. The ultrasound yesterday showed there was some material inside my bladder, perhaps crystals, so they tested my urine. It shows an infection, even though I’ve been on two different antibiotics for the past two weeks. Oh dear, another problem! There are crystals in my urine, too, but that is probably secondary to the infection. Hopefully they will go away. My regular W/D food helps to prevent those crystals from forming but I haven’t been eating it since I haven’t been feeling well.
Dr. Boss says that testing urine should always be done when a cat is sick because often things like this turn up. Now we have to figure out what antibiotic to use that will treat both a urinary tract infection and my hepatitis. She decided to stop both my antibiotics for the next four days so she can culture the urine on Monday to see what type of bacteria is infecting my bladder or kidneys. That means I may feel even worse this weekend but it will be worth it if it tells us what the right medication is. I want to get better!
Megan is usually my friend. She brushes my teeth! She’s being mean to me now though. She is poking me with needles to give me something they call sub-Q fluids. Dr. Boss said I’m not drinking enough water and fluids will help to flush the infection out of my kidneys and bladder. I don’t like it at all! I think I’ll go pout for the rest of the day.
My blood tests look better and I feel better too! Dr. Boss wants me to donate a urine specimen too but so far I’ve not been cooperating – I like to play hard to get pee. Now I just have to continue my medication for another month or two. I’m tired of taking all those pills but I guess it’s worth it. I didn’t like feeling sick. Now I’m going back to my window perch to watch the birds!
My ALT liver enzyme is continuing to go down and I feel great! I’m ready for a new adventure! Hopefully it won’t involve shaving my belly!
You’ve probably forgotten about my hepatitis problem by now – I know I’ve tried to forget it myself. My liver enzymes never returned to normal though, and last week my recheck showed that my liver was significantly worse than on my last two rechecks, even though I am still taking my medicine. Dr. Boss talked to Dr. Byl about surgery to biopsy my liver. They did some extra tests to see how my pancreas and intestines are functioning and it looks as though I may have a small intestinal disease, such as inflammatory bowel disease (IBD), as well as hepatitis. I am scheduled for surgery next Thursday, to get biopsy samples of my liver, pancreas and intestines. Dr. Boss is doing my surgery so I know I’ll be OK – she loves me, I can tell. I’m still scared though. At least I’ll get to wear a fentanyl pain patch after surgery. I feel good when I have one of those on and I eat well too!
Sorry it’s taken me a while to update this. I’ve been a little out of sorts! Dr. Boss didn’t want to send out bad news so she asked me to wait to update you all until we knew I was doing better. My surgery went well but I was getting jaundiced – she said the fat inside my belly was all yellow, eeww! My friends here at the clinic were worried that I would go into liver failure. I am doing OK now though. I have to wear a funny blue collar or I would spend all day licking my incision. When I try to jump onto things with the collar on, sometimes I fall down. Everybody feels bad for me – but sometimes they laugh at me anyway. If you come in to the hospital I’d be happy to show you my shaved belly and my surgery scar!
My liver biopsy showed that I have chronic inflammation but not an infection, so I don’t have to take those icky antibiotics anymore. My own body is creating the liver inflammation; there were lots of lymphocytes in my liver. This is a type of white blood cell that polices the intestines against bad bacteria and viruses – or so they tell me. Cats sometimes have a problem with these cells invading into tissues and getting out of control. This can happen in the pancreas and intestines, as well as the liver, but my intestinal and pancreatic biopsies were normal, only my liver is affected.
We are continuing prednisolone, a steroid, to try to suppress the lymphocytes and decrease the inflammation. I am still taking milk thistle, s-AME and Denosyl and I am now also taking ursodiol, to help my liver to function better. Megan took me to see my friend Dr. Kluslow for acupuncture and she added some herbs to my regimen. Acupuncture can help any inflammatory process so we are helping my liver cells will be healthier after a few weekly treatments. My next blood tests will be in 10 days or so. Boy, am I tired of being poked with needles! I’m very good about taking pills though (which is a good thing since I have to take them for the rest of my life), and I fell asleep at my second acupuncture treatment, once I realized all those tiny needles didn’t hurt very much. A little poking and then I got very relaxed and felt very good. If you ever need acupuncture, don't worry, it's not so bad!
I'll send out another update when we do my next blood tests. I sure hope all my medicines make me better!
June 3, 2012:
I'll bet you've forgotten all about me and my liver disease but I haven't forgotten. I still have to take several medicines every day, though the dosages have been decreased. I also go to see Dr. Kluslow for acupuncture every three weeks. I like getting acupuncture, it makes me relaxed and sleepy. I don't like the car ride though. My blood tests are slowly but steadily getting better. Dr. Boss says I probably will never be quite normal and I will probably have to take icky medicines the rest of my life but I feel good now. Hopefully I'll continue to feel good! I can't believe it's been more than 6 months since this started. I'll bet you didn't realize how long you can battle hepatitis - I sure didn't!
July 9, 2012:
My latest blood test shows that I am stable - my liver may never go all the way back to normal but I can live with that. My prednisolone dose has been cut way down and I am off the antibiotics. Hooray, less pills to take!
February 14, 2013:
We started Holly’s blog in order to keep all her friends up to date on how she was doing during a long bout of hepatitis. We kept this page on the website afterwards to use to explain liver disease to clients who also have a pet with hepatitis. Several different types of liver diseases can affect pets and diagnosis and treatment can be lengthy and frustrating. Despite months of aggressive treatment, Holly’s liver will never be completely normal and she will probably be on low-dose medication for it for the rest of her life. Other pets get better quickly with no lingering damage – there is a lot of variation from pet to pet as far as how they do. We don’t want to discourage pet owners from treating their pets with hepatitis but we do want you to be aware that it can be a long road with lots of bumps along the way.