John Popp
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Thought I would start a separate thread on this disease and treatment. There's a lot of other things involved with our boy Dooley's case and that thread is unmanageable for people needing to get an understanding of things.
The liver provides a number of functions, removing toxins from the blood supply, produces protein, breaks down old blood cells and has the central role in all metabolic processes. With Hepatic Microvascular Dysplasia, HMD, many of the smaller blood vessels on a microscopic level are either absent or haven't properly developed. These microscopic vessels are what delivers blood to the liver cells, and their absence minimizes liver function.
One of the signs which can be revealed on X-rays is the proportional size of the liver. As there is some anecdotal information that a serval has a proportionally smaller liver than domestic cats , it's not an end all identifier of disease as liver size doesn't reveal liver function. Other signs can be shortness of breath, wobbly or seizures. Often the clinical signs don't begin to appear until the cat begins to reach maturity.
Diagnosing the issue from the vet's end begins with a complete set of labs checking for low blood protein, glucose, ammonia and nitrogen levels. Liver enzymes will be reviewed, but it's possible to get a false negative if they come back normal.
Perhaps the most useful test is measuring Bile acids. These will review both bile acids and ammonia which is quite fragile and needs to be done quickly after the sample is drawn. The benefit of these tests are that you get fasting results as well as after eating. In our case we have used these tests to measure changes in diet, changes in meds and changes in food quantity.
As the clinical signs for HMD are the same as for a liver shunt, which is more common, it's a good idea to get an ultrasound. While the ultrasound isn't certain to reveal a pronounced shunt it can certainly reveal the absence of one. The only certain way to reveal a liver shunt is exploratory surgery and in the case of HMD a biopsy. One last note on liver shunts, they are simply a blood vessel bypassing the liver, and a shunt can create micro vascular dysplasia, but not the other way around.
Treating HMD begins with a reduced and easily digestible protein diet. HMD is not a condition which can be remedied by surgery. The issue with limiting protein is there are only two natural sources for calories for our cats, fat and protein. This is where the balancing act begins as it's difficult to get all the needed calories without a little bit of carbohydrates. Fortunately cats are pretty tolerant of fats, so if you are creating a recipe with a doctors assistance, you can get something that's palatable.
For commercially available prescription diets it's best to opt for a k/d diet as opposed to one designed for liver disease. The primary reason is the l/d diets use a lot of soy and dairy based proteins which isn't exactly the easiest thing to get your cat to eat.
The medication regimen is a bit odd although speaking with RascalDad here and our IM vet we have our head wrapped around it. The 3 primary medications are all what RascalDad referred to as two-fers. They have their primary function but additionally have a secondary function which aids in liver disease. Keppra, which is given as an anticonvulsant, Amoxicillin to remove toxins and Lactulose to make sure the digestive tract is regular. All of these medications either bond with things like ammonia or metals giving them greater value in treating the disease.
We also use Denamarin for liver support and despite it not doing anything for the underlying condition, there is no harm in it's use and it does support good liver function.
Lastly, spreading meals out can reduce stress on the liver and make sure there isn't a big load of protein to digest. We've found best success with mixing the meds with food so its not so invasive for the cat, although there is a fine line quantity to make sure they eat it all. If they don't eat all the food with their medicine, there is a chance you can see neurological signs show up, opening up the risk of seizure.
Here's a quick shot of our cats daily medicine and feeding regimen.
7am Denamarin
8am Food and Meds
9am Remainder of first meal
4pm Food and Meds
5pm Remainder of second meal
11pm Denamarin
12pm Food and Meds
1am Remainder of third meal
I'll update this over time and clean up the medication descriptions. The big thing is as dire and grim as things may seem you can make a path to cope with the disease and have a happy and healthy pet as well
The liver provides a number of functions, removing toxins from the blood supply, produces protein, breaks down old blood cells and has the central role in all metabolic processes. With Hepatic Microvascular Dysplasia, HMD, many of the smaller blood vessels on a microscopic level are either absent or haven't properly developed. These microscopic vessels are what delivers blood to the liver cells, and their absence minimizes liver function.
One of the signs which can be revealed on X-rays is the proportional size of the liver. As there is some anecdotal information that a serval has a proportionally smaller liver than domestic cats , it's not an end all identifier of disease as liver size doesn't reveal liver function. Other signs can be shortness of breath, wobbly or seizures. Often the clinical signs don't begin to appear until the cat begins to reach maturity.
Diagnosing the issue from the vet's end begins with a complete set of labs checking for low blood protein, glucose, ammonia and nitrogen levels. Liver enzymes will be reviewed, but it's possible to get a false negative if they come back normal.
Perhaps the most useful test is measuring Bile acids. These will review both bile acids and ammonia which is quite fragile and needs to be done quickly after the sample is drawn. The benefit of these tests are that you get fasting results as well as after eating. In our case we have used these tests to measure changes in diet, changes in meds and changes in food quantity.
As the clinical signs for HMD are the same as for a liver shunt, which is more common, it's a good idea to get an ultrasound. While the ultrasound isn't certain to reveal a pronounced shunt it can certainly reveal the absence of one. The only certain way to reveal a liver shunt is exploratory surgery and in the case of HMD a biopsy. One last note on liver shunts, they are simply a blood vessel bypassing the liver, and a shunt can create micro vascular dysplasia, but not the other way around.
For commercially available prescription diets it's best to opt for a k/d diet as opposed to one designed for liver disease. The primary reason is the l/d diets use a lot of soy and dairy based proteins which isn't exactly the easiest thing to get your cat to eat.
The medication regimen is a bit odd although speaking with RascalDad here and our IM vet we have our head wrapped around it. The 3 primary medications are all what RascalDad referred to as two-fers. They have their primary function but additionally have a secondary function which aids in liver disease. Keppra, which is given as an anticonvulsant, Amoxicillin to remove toxins and Lactulose to make sure the digestive tract is regular. All of these medications either bond with things like ammonia or metals giving them greater value in treating the disease.
We also use Denamarin for liver support and despite it not doing anything for the underlying condition, there is no harm in it's use and it does support good liver function.
Lastly, spreading meals out can reduce stress on the liver and make sure there isn't a big load of protein to digest. We've found best success with mixing the meds with food so its not so invasive for the cat, although there is a fine line quantity to make sure they eat it all. If they don't eat all the food with their medicine, there is a chance you can see neurological signs show up, opening up the risk of seizure.
Here's a quick shot of our cats daily medicine and feeding regimen.
7am Denamarin
8am Food and Meds
9am Remainder of first meal
4pm Food and Meds
5pm Remainder of second meal
11pm Denamarin
12pm Food and Meds
1am Remainder of third meal
