Dooley still challenged

[Jacq]

Wow John. I have been following Dooley's health issues, and what a complicated kitty he is. I sure hope that all turns out well for him and you. Please take care of yourself, as without your own health, you won't be able to take care of him. Lots of prayers and positive vibes coming to you, my friend.

 

[John Popp]

Thanks Jacq!

He's not really all that complicated, I just think the urgency of his care needs and 3 vets made it complicated. Once he elevated his needs to that of a specialist, we shouldn't have got anyone else in between and also used their emergency facilities. Just a really tough call to make when you know they are struggling and the immediate choice is a 5 minute or hour long drive for them to find relief.

 

[SV Dad]

Hey JP,
I know you're trying to get a hold of me but I have horrible cell phone coverage, and barely any internet where I'm holed up for a few days (Nothing bad, my youngest son just earned his biophysics PhD and the family went to the graduation.)
From what I am gathering in this thread, his blood is not fully filtered through his liver, secondary to an unexpected anatomical shunt. And it sounds like the best plan is to close off the shunt to get normal hepatic blood flow. This makes sense in that the lactulose is being used to pull the ammonia out of his blood stream as the liver should be doing this. In humans, the liver has the capability to regenerate, I'm guessing cats can too. What I think the vets want to do is do a first surgery to reduce the shunt flow and give the liver some time to regenerate and adapt to the increased blood flow. Then go back in and block the shunt and put the full flow to the liver when they feel the liver has the capacity to handle full flow. This makes sense to me. You have any questions send me an email. I'll try to help out where I can. I'm pulling for Dooley!

 

[Rafiki]

Cat livers are like human livers - they can regenerate and repair themselves once the issue is resolved. Dog livers cannot and that is why liver fibrosis in a dog gives them less than 3 years to live.

 

[admin]

Hey JP,
I know you're trying to get a hold of me but I have horrible cell phone coverage, and barely any internet where I'm holed up for a few days (Nothing bad, my youngest son just earned his biophysics PhD and the family went to the graduation.)
From what I am gathering in this thread, his blood is not fully filtered through his liver, secondary to an unexpected anatomical shunt. And it sounds like the best plan is to close off the shunt to get normal hepatic blood flow. This makes sense in that the lactulose is being used to pull the ammonia out of his blood stream as the liver should be doing this. In humans, the liver has the capability to regenerate, I'm guessing cats can too. What I think the vets want to do is do a first surgery to reduce the shunt flow and give the liver some time to regenerate and adapt to the increased blood flow. Then go back in and block the shut and put the full flow to the liver when they feel the liver has the capacity to handle full flow. This makes sense to me. You have any questions send me an email. I'll try to help out where I can. I'm pulling for Dooley!

That makes total sense to me as well RD

 

[John Popp]

Hey Mike,

Just wanted to go over the adverse reactions of the Keppra and the Lactulose. He has some loose stools on occasion, is oft agitated and irritable and seems to be a bit wobbly. Not that any of those things seem outside the boundaries of the medication, just trying to get a feel if the dosage needs reduced.

Thanks

 

[SV Dad]

JP,
I dug into this a little bit. I'm thinking the levetiracetam (Keppra) is being utilized as prophylactic seizure prevention as high blood ammonia levels make this a strong possibility.
That being said, it might be the levetiracetam is causing some agitation, irritability, and unsteadiness. But I have to give considerable weight to the thought that the increased ammonia levels might be producing these effects.
The loose stools are most likely from the lactulose. This medication is most commonly used as a stool softener. Fortunately, it was found to have the property of removing ammonia from the blood (I call this a twofer, two actions from one drug). This is the only medication I know of that can remove ammonia.
Again, all of this is making sense. Get more blood passing through the liver, the liver removes the ammonia by converting it to urea, and the kidneys remove the urea.
I'm really amazed the vets figures this out.
Hang in there Dooley. You've got skilled vets trying to get you better, along with all of our hopes.

 

[John Popp]

Oddly the specialist believed it could be a liver shunt on the first visit. Then all the other issues arose and we were really just chasing symptoms.


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[John Popp]

JP,
I dug into this a little bit. I'm thinking the levetiracetam (Keppra) is being I'm really amazed the vets figures this out.
Hang in there Dooley. You've got skilled vets trying to get you better, along with all of our hopes.

Sorry I didn't say thank you before Mike!

I haven't seen Dooley for a couple days as I was sick in bed ahead of a trip overseas. He's been doing well, he was happy to see me and had the happy poof tail and ridgeback going on, which he's never displayed before.

He managed to pull a king size pillow under the less than an inch space of his bedroom door. He also has busted out and seen the other cats who supposedly all looked at him as if he was an alien and certainly not a cat.

My sister said he is still having bouts where he is just agitated. Generally at 3am which is when he and Dino would tear it up. He'll bite at comforters and pillows shaking his head as well as taking a sibling type nip at the present caretaker. I guess someone needs to do Dino's job while he's away.

Anyway, gone for a week again and hoping he remains healthy and stable until his follow up appointment.

Oh and most of all, thanks again Mike!

 

[John Popp]

I understand Dooley is doing quite well, his stools have firmed up and he's up to his usual tricks. All the home inspection stuff has came up clean so no mold or other issues we know of. Hopefully we will be able to bring him back home after I return from Sweden.

Still awaiting word on the next step to see what the course of action is. Will need to figure out how to do segregated feelings and hopefully map out a modified raw diet in the interim. Just glad he's stable and happy for the moment, and would love for him to see his brother.