Attention Cat Lovers: Make Sure your Cat Doesn't Have HL
Several weeks ago, I left California for Wisconsin with three cats. I now have two. The third, Meg, died of a condition that is fatal in cats if untreated but often fully preventable or curable if caught early. Knowledge of hepatic lipidosis, or HL should be part of Cat 101—as basic as “don’t feed your pet chocolate.” And yet, it isn’t.
I was dreading the move to Wisconsin. It was necessary, because University of Wisconsin is unfortunately not located in San Diego, and I am starting a graduate program there. I didn’t want to leave California, nor did I want to torture my poor cats with a cross-country car ride, and yet I had to do both. Odds are that Meg’s death is a direct result of the move, and my ignorance. I had no idea that while humans can fast for a day or so, cats cannot. Not even for a few days.
When a cat stops taking in enough calories, her body begins to metabolize its own fat for energy. In humans, that’s called going on a diet and our society generally views it as a good thing. But cats are not equipped to live on fat. Therefore, when this happens, their livers become clogged with fat. (“Hepatic” refers to the liver and “lipidosis” to the fat.) Then the cat starts to feel ill and really does not feel like eating, causing the problem to get worse until it results in liver failure and death.
In Meg’s case, she stopped eating the day we left California and she did not eat for at least four out of the six days we were on the road. She resumed eating once we reached Wisconsin, but she did not eat enough. With three cats, it’s hard to keep track of who eats what. It was two weeks before we went to the vet, after she’d lost a fourth of her body weight and peed on my floor.
Meg is a fat kitty. My friends use euphemisms like “big boned” or “fluffy,” but my cat is enormously fat. Obese, middle-aged cats like Meg are most at risk for HL. When she started losing weight, I was happy. I knew her weight was a risk factor for health trouble, but I had no idea that rapid weight loss is dangerous in cats—and it's deadly if it goes untreated.
The good news is that this is preventable and treatable. The prescription is food. When caught early enough, the condition has an excellent recovery rate. And you have to buy cat food anyway, so if you’re lucky, you won’t even require expensive vet care and drugs.
But then there’s the bad news. First, the initial period of eating too little that triggers the condition might be due to some other health problem. If your cat feels sick and stops eating because she’s got, say, cancer, she’ll need more than food to make her better.
Second, if you don’t discover your cat’s hepatic lipidosis early enough, then getting the cat food into the cat will require a feeding tube and all sorts of other expensive vet care.
Once you reach the vet with a cat who hasn’t been eating, there are a few ways to diagnose the problem. In Meg’s case, since she was pretty far gone, the dead giveaway was the yellow pigment of her jaundiced skin, particularly on her ears. The weight loss was also a cue.
To confirm the problem, a vet might test the cat’s blood for elevated bilirubin and other liver-related enzymes like ALT (alanine aminotransferase). If they are elevated, the vet knows there is trouble in the liver. A liver biopsy is needed to confirm the diagnosis. Vets often wish to do an ultrasound to see if there’s anything else amiss that caused the cat to stop eating in the first place.
Vets are not all equally capable of handling HL. While their knowledge of the condition might be excellent, Meg’s first vet painted an overly rosy picture of what was going on. She recommended hospitalization and tube feeding but when I said I could not pay the projected $1000-$2000 it would cost, she did $90 of blood tests and then let me take Meg home with a few cans of wet cat food, subcutaneous fluids to administer daily, and liver supplement pills.
Among the important tidbits she neglected to mention: cats with HL are often extremely nauseated. At this point, Meg was still willing to eat about half of the calories she needed for the day. When I force-fed her the other half, she threw it up. Prescribing a medication for nausea can help the cat get the food down and keep it down.
Another point the vets missed: Once a cat with HL begins eating again, the level of potassium in the blood often plummets. For Meg, this happened about a day after the initial vet visit. It reached catastrophe level around 1am on a Saturday night, and we had to go to the kitty ER. At that point, she was walking like a drunk and falling over, signaling neurological problems.
Soon thereafter, she was not able to walk at all. When the emergency vet examined her, her reflexes were so poor the vet could flick her fingers right in front of Meg’s eyes and the cat did not even blink. The vet said, “I’m not even sure she can see.” She warned me that Meg could be in liver failure, in which case she probably could not be saved. She suggested testing her blood sugar and also noted that if ammonia was building up in her, that was another signal that this was the end.
At this point, it was time to decide if I was going to pay up to save my cat or not. While it’s hard to fork over hundreds or thousands in vet fees, I felt it was wrong to let Meg die from a curable problem just because of money. The vet made a plan for the cat and had me cough up a deposit of $544 – the minimum her treatment would cost in the short term. We agreed that if the tests showed liver failure, I’d come to say goodbye to my cat and get a large refund.
The tests showed what should have been predictable: her potassium was terribly low. Meg still had a chance at life, provided I could pay up. That night, friends came together and raised the money to pay for her care.
If your cat gets HL and it gets to such a severe level, be prepared to pay and be prepared for a lot of work. But better yet, don’t let the problem get there. Watch your cat’s food consumption, and regularly weigh your cat so you spot any sudden weight loss. This is particularly important during stressful times like moving or introducing a new cat, or even just changing to a new brand of cat food. Some cats will avoid a new food they don’t like long enough to trigger HL.
If a cat will not eat and using a large syringe to feed her with cat food by mouth does not work, there are two options. The better option is installing an esophageal tube (E tube) via a hole in the cat’s neck. The cat can be fed wet cat food through this tube, and once installed, the tube does not hurt and can be used for a long time. It can take a cat several weeks to start eating on her own again.
However, placing an e-tube requires anesthetizing the cat, and a very sick cat might not survive anesthesia. That’s where the second option comes in: a nasogastric feeding tube (NG tube) that goes through the cat’s nose and into her stomach. It’s intended as a short-term measure (up to a week) and placing it requires no anesthesia. The cat must be fed a liquid diet through this tube.
Since Meg could not handle the anesthesia, she required an NG tube. Had she lasted a little longer, she would have needed to have it swapped out for an E tube.
Aside from food, the cat may require other care to overcome HL. A dehydrated cat might need fluids. Subcutaneous fluids are less expensive than intravenous (IV) fluids and owners can administer them at home, but Meg’s vet felt that IV fluids were needed. In her case, she required potassium ASAP and it was more effective to give it to her through an IV.
Medication for nausea and appetite stimulants can also help a cat suffering from HL. A liver supplement called Denemarin is also used to help detoxify the liver. Some cats with HL also develop anemia. Of course, if HL was caused by another condition, the vet will need to treat the underlying condition.
Meg’s five-day stay in the hospital was a nightmare. Every 12 hours, a different vet took over, sometimes meeting her for the first time. Meg suffers badly from stress and anxiety when she’s away from home or away from me (after all, that’s what I suspect caused this problem), so her time at the hospital was a stress overload for her. She laid on her side listlessly, eyes wide open and staring at nothing. She had no interest in food and lay down in her own urine.
This was the cat who greeted me when I visited each day. But after holding her in her favorite spot on my chest, petting her, talking to her, and even singing to her (my sincere apologies to the vet staff, who had to listen to my renditions of Dar Williams, Regina Spektor and lots of Broadway musicals), my Meg would slowly return to me. After several minutes, she would begin to purr. At the end of an hour, she meowed and wriggled and wished to be set down. She tried to walk (not very successfully), and at one point, she found a nice corner, did her business, and flopped away like a seal.
The vets took Meg’s behavior as proof she was too sick to make it, not as evidence of stress. They refused to believe that she behaved differently when I visited and that she would perk up a little once she came home.
I had planned to bring Meg home after two days, but her temperature dropped and the vet kept her in an incubator. Twice, the vets on duty counseled me to put Meg down. They thought her demeanor indicated something more serious, like a tumor. As a shot in the dark, they put her on an antibiotic. I seriously considered giving up, but I wanted to consult the vet who initially admitted Meg before deciding.
The vet greeted me with good news: Meg’s temperature had stabilized. She could come home. At home, I could feed and care for her. She had a long way to go to recover, if she would recover at all, but the vet felt she wasn’t suffering so there was no harm in trying. Yet, she was also so sick the vet thought it was “not wrong” to euthanize her. The vet sent Meg home with a week’s worth of food and medications with instructions to take her to see a vet in five to seven days. (The total vet bill was $1700.)
As soon as Meg came home, her personality returned. She cuddled, purred and even used her litterbox—at least briefly. Over the next several days, her strength slowly began to return. At the end, she still had trouble walking, but she was improving. She was still on a liquid diet through an NG tube, and I had to feed her and give her medications five times a day, around the clock, including middle of the night feedings. She went to the bathroom all over due to stress. It was like being a single parent with a new baby—one who won’t wear diapers. In short, it ws hell.
Navigating the different vets, with their various opinions, shortsightedness and mistakes, would have been impossible without the help of a Yahoo group devoted to helping owners of cats with HL. Lack of information got Meg and me into this debacle, and lack of information at the beginning might have been what cost Meg her life.
After a week at home, Meg was stronger and happier. She was still peeing everywhere, but she had started grooming herself again and she purred a lot. She’d climb into my lap for cuddles every chance she got. I have no explanation for why, after a week of solid improvement, I found her dead. Perhaps her liver was just too damaged before I became aware of the problem and started treatment.
No cat should die of HL. It’s fully preventable. Yet, once it reaches the point at which Meg was diagnosed, some pet owners might have no choice but to put their cats down because of the bills alone. At that point, there’s no time to lose, and a simple misstep like failing to prescribe nausea meds could cost a cat her life.
The Humane Society of the U.S. has a list of groups nationwide that offer assistance with vet bills for pet owners in need.