Hepatic Lipidosis
(Fatty Liver Disease)
Note: This page is not going to be written the way I’ve written the others. Even though quite some time has
passed since Alex left me, it’s still hard to deal with and I’m left with too many unanswered questions to write
extensively about this issue. I feel there are several websites that explain hepatic lipidosis far better than I can,
some including pictures and diagrams. I will happily provide you with those sites at the end of this page. What I
will do is provide some basic information on the feline liver and through my experience with Alex, what I would
do differently now that I’m better educated about it.

Hepatic lipidosis is one of the most common causes of liver failure in a cat and stems from the basic feline
design. Cats evolved as predators of small birds and rodents, eating multiple small meals throughout the day.
Their physiology is geared towards a completely carnivorous diet and with the predisposition that cats live lean
and never have the opportunity to develop extensive fat stores.

This all changed when cats became domesticated. The modern house cat has every opportunity to become
overweight and while this may not be immediately disastrous, it can be a recipe for serious illness on so many
levels. If a cat becomes ill for any reason and stops eating, their liver
may become infiltrated with fat and fail.
Normally, in starvation, fat is moved from the body's storage depots to the liver for processing into lipoproteins.
But the feline liver was never intended to handle huge amounts of mobilized fat. Complications can also arise
from the high dietary protein requirement that is unique to cats; protein malnutrition develops very quickly when a
cat doesn't eat.

The average cat with lipidosis is middle-aged, was at one time obese but has lost at least 25% of its original
body weight, has a poor appetite, and may have an obvious upset stomach (38% will have vomiting, diarrhea or
constipation). Cats that are especially weak may have electrolyte imbalances and/or vitamin deficiencies from
their liver disease.

There are some pet food companies where vets write in recommendations and articles on their websites. Some
of these actually recommend your dog or cat fast for 24 hours each week, basically performing the same kind of
system cleansing process as humans do!! Not only is this NOT recommended but it’s downright dangerous and
seems crazy to me for a vet to even think of telling people to do this to their pet. It’s okay to give your pet’s
tummy a rest for a half a day or so to let their systems calm down and readjust. But to do this continuously and
for more than 12 hours at a time is appalling to me. Even though the fasting risk for dogs isn't the same as it is
for a cat, fasting any pet each week for a 24 period is still not recommended. A veterinarian of all people should
know the dangers that can develop from this practice.

Let’s say your cat has an underlying condition that’s currently under control. Mix in withholding food once a week
for a 24 period and now you’ve just stressed out their entire system for no good reason. If one organ isn’t
functioning properly because, let’s say your cat is borderline diabetic, you’ve just caused the pancreas to start
working too hard, then the liver, then the kidneys, etc. Unless you have x-ray vision, can read your cat’s mind
and they told you it’s okay to withhold food…DON’T!

It's a completely different situation if your cat is under a personal vet's care, and a fast is issued because it
improves the accuracy of certain tests such as a PLI or a B12 and folate deficiency test. Although I don't think
most vets would recommend a cat fast for too long, if at all, if they are experiencing liver inflammation. We
couldn't fast Alex at that time for that very reason.

There are obvious, visible signs of liver problems; one being jaundice. A cat’s normal skin color is pink. But when
a cat’s liver is compromised, the skin on their ear flaps, lips and gums usually are the first places to change color
and become yellow. Severe jaundice is visually present on their undersides, stomachs, eyes, paws, etc. If your
cat has seemed ill, depressed, isn’t eating properly
and develops a yellowish color anywhere on it’s skin or eyes,
and/or develops a fever, please bring your cat to a veterinarian immediately. If liver disease is present, there is
no time to waste. A biochemical profile must be done, and usually antibiotics are administered via slow,
continuous,  IV fluids. Your cat may have to be hospitalized for a few days depending on the severity of the
jaundice and what the profile indicates. There are also other forms of liver disease such as cholangiohepatitis
and cholangitis but regardless, the signs of liver inflammation and/or liver failure are the same and so is the
urgency of testing and treatment.

In hindsight there are many things I wished I’d done differently for Alex. It all seemed so fast with her, I hardly had
any time to wrap my head around what was happening.

First, I would have immediately put her on Denosyl or Denamarin at the very first sign of an inflamed liver and got
her enzyme levels down before it had gotten out of hand. By waiting to start this treatment, almost six months
later, the damage was already done. Hepatic lipidosis was already present and it was too much stress on her
body to try and turn things around at that point. Her liver had affected her pancreas and she was producing too
much bile. The professional advice was to give her liver as much of a rest as possible and let it heal itself, but in
her case it did absolutely no good. By the time I started any vitamins, Omega oils, diet changes, all natural
therapies, the disease was well underway and at an advanced stage. Of course there’s no way to know for sure
if any of that would have curbed her disease or could have given her the advantage to fight it better, we’ll never
know. I just know that if I had it to do all over again, I would not hesitate for a single day to start these other
treatments.

Along those same lines, don’t forget that any and all medications, including all natural supplements and herbs,
have to be filtered and processed through the liver. In fact, there are some medications that require that the vet
monitor and check the liver enzymes periodically as it can do some slight damage or push it to work too hard. All
of that can have an exhausting effect, even if there isn't currently any enlargement or inflammation. Whenever
one organ in the body has inflammation or disease present, it almost always puts an added strain on the
surrounding organs and/or other organs that rely on it to function.

One feeds off of the other and if the liver is over-working, the pancreas will start to overwork, the kidneys, the
intestines, the bowels, etc. Always keep in mind the chain of reaction that’s going on inside of the body. The
same goes for other diseases that are present before lipidosis, such as kidney or renal disease, pancreatitis,
inflammatory bowel disease, etc. Theses diseases will in turn put strain on a properly functioning liver and cause
some overworking of this organ to filter out the toxins being produced from these other organs.

I would have also gone with my gut and given her Actigall (ursodiol) instead of trying other medications that just
made things worse. The steroids cranked up her liver inflammation instead of bringing it down, the antibiotics did
the same, so none of it worked. In fact, all it did was put her into seizures, which she’d never had before. As I
stated on her medical history page, Alex had a seizure once she was put on Flagyl. I didn’t know this is at the
time but when a cat has liver disease, there is a danger of seizures. Not in every cat's case, but it can happen.
That seizure is what pushed her over the edge to become severely jaundiced and cause her liver to start failing. I
don’t know that it was that particular medication that did it or if she was just on the verge and it was just a matter
of time before this happened. It seemed that no matter what we gave her, she had a negative reaction to it. A
side note about ursodiol; If  your cat is on this medication you should supplement with 250-500mg per day due to
increased urinary losses of taurine. There's a possibility that chronic use of Ursodiol in cats may deplete the
body of taurine.

A high ammonia level can also cause seizures and may happen with severe liver disease. This may be why Alex
was so sensitive to the Flagyl, she may have had a high ammonia level and was already close to the seizure
threshold. A high ammonia level isn't something that shows up on any chemical profile, it has to be specifically
ordered and if the level is high, it can be overcome with intensive treatment. I don't know for sure if Alex's levels
were high but because she became severely jaundiced within hours of the seizure and had to receive IV fluids,
antibiotics and partial hospitalization, this may very well be the case. I do know that during the very first day of
treatment she started recovering immediately and was doing very well.

To my vet’s credit, a week before Alex died I talked with her about giving Alex Actigall and the final decision was
left up to me. But at the time, Alex had been on Denosyl for awhile, had a good appetite and her coloring looked
98% better than it had before. Her opinion was that she didn’t really need it and because Alex had so many
terrible reactions to medications she was leery of giving her anything else. I just didn’t know what to do, so I
chose not to give it to her. Neither my vet or myself had any way of knowing she’d suddenly develop an infection
a week later and be gone so quickly. But if I had it to do again, I’d have given her the ursodiol much, much earlier
when her liver inflammation was first diagnosed.

Ursodeoxycholic acid (ursodiol) is a choleretic. It improves the flow of bile through the tiny ducts into the gall
bladder and from the gall bladder into the intestine. By doing this, it facilitates the removal of toxic bile acids (as
well as other toxins excreted in bile) from the body. Ursodeoxycholic acid also appears to have beneficial effects
in normalizing immune reactions in the liver and may be useful in the treatment of cirrhosis and chronic active
hepatitis.

Bile is a fluid used to excrete toxins as well as to prepare fat for absorption into our bodies. Some bile acids are
simply lost in the intestine and eliminated in stool and some are reabsorbed, or recycled, for reuse by the liver. If
more bile acids are required than were reabsorbed, then the liver has to produce more. If the liver is failing,
reabsorbed bile acids are not captured by the liver for reuse. Instead they’re passed through the liver and into
the body's circulation.

I also would have started her immediately on B12 injections from the moment she lost her appetite. What I
believe now is that B12 is a MUST with all of these GI and intestinal disease. It’s water-soluble, non-toxic and
can greatly increase absorption of nutrients and hunger levels without the use of appetite stimulants.

My vet is a very good vet and did the absolute best she could for Alex, I truly believe that. She loved Alex as she
does all her patients and was wonderful with her. But just like being your own health advocate, you need to be
your pet’s as well. Even more so as they can’t tell you what they want, what’s working and what isn’t. My vet was
absolutely against trying a raw diet, as many are, and now I wished I had. I now know that handled properly, a
raw diet can actually be safer than some dry foods. A raw diet isn’t a cure but it has certainly done wonders for
many cats to alleviate the symptoms and improve their condition and health.

Again, I don’t know if it would have worked or frankly if she would have even eaten it. But these are all teaching
moments and my goal is to teach you to educate yourself, educate your vet, bring new ideas to the table about
your cat’s treatment and above all, listen to that little voice in your head and heart when it’s telling you something
is, or isn’t right. I hope that Alex’s history and the education I received from it can help you make better choices
for your cat if need be.

Some materials used in this article were written and provided by:
Dr. Wendy C. Brooks, DVM, DipABVP
www.marvistavet.com/html/hepatic_lipidosis.html
www.veterinarypartner.com/Content.plx?P=A&S=0&C=0&A=1455
www.marvistavet.com/html/body_ursodiol.html

Here are some links on feline liver disease, some are from medical journals and veterinary articles:
www.veterinarymedicine.dvm360.com/vetmed/article/articleDetail.jsp?id=325516&sk=&date=&pageID=3
www.jn.nutrition.org/cgi/reprint/128/12/2733S
www.vin.com/proceedings/Proceedings.plx?CID=WSAVA2006&PID=15828&Category=2675&O=Generic
www.pets.webmd.com/cats/cat-liver-failure
www.manhattancats.com/Articles/jaundice.html

This is a great reference page on Actigall (ursodiol)
www.veterinarypartner.com/Content.plx?P=A&A=549&S=1&SourceID=52

This website talks about dogs with GI and liver disease but has valuable information and does refer to these
diseases in cats also.
www.dcavm.org/05dec.html

This website is for humans but is extremely informative on how the liver works and what it does in general along
with explaining different liver diseases, conditions and their treatments.
www.labtestsonline.org/understanding/conditions/liver_disease.html
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