Dear Sinéad, Siouxsie and Thomas:
My 10-year-old cat has been healthy his entire life. Two weeks ago we changed food. He was unable to defecate and began oversleeping and having trouble getting around. We brought him into our vet (who we are not familiar with as our vet had retired). She said he was probably constipated and prescribed a laxative. He didn't improve so we brought him back. She took blood tests, x-rays, and did an ultrasound. The blood tests showed a problem with his kidneys. The ultrasound showed fluid in his abdomen. She said he probably had liver cancer and my husband made an appointment to have him put to sleep.

This was too fast for me. I made another appointment after talking to a friend who is a nurse. She drained some of the fluid from his abdomen, prescribed a diuretic, and rehydrated him in preparation for the diuretic. He seems more comfortable, but is not eating very much. I want to get a second opinion but need information and ideas about what else could be wrong. Is there any other possibility or treatment? There is still no definite diagnosis. Please help. I know I may just need to face the possibility that he has liver failure or liver cancer, but if there are other possibilities that could be treated I want to know. Thank you in advance for any help or advice you may have.

~Mrs. P.

Sinéad: Is it possible that your husband misheard the vet and she said that the liver enzymes, not the kidney enzymes, were elevated? The symptoms you're describing -- fluid buildup in the abdomen, depression (oversleeping), and digestive/appetite issues -- are more consistent with liver disease than with kidney disease.

Siouxsie: If a cat has a damaged or diseased liver, the levels of liver enzymes, such as ALT, AST and ALP, go outside the normal range. These variations show up in blood tests. Of course, severe liver problems can cause imbalances in other organs such as the kidneys, too.

Thomas: We're pretty sure your vet has used every diagnostic tool at her disposal. The fact that she ran blood tests and did X-rays and an ultrasound examination of your cat tells us that she ran every kind of noninvasive testing we know of.

Sinéad: It is possible for a vet to do a needle biopsy of the liver. In the needle biopsy, the cat is sedated or put under anesthesia and a needle is stuck through the abdominal wall into the liver. Some cells are drawn out of the liver through the needle and examined under a microscope to see what kind of damage is taking place. Cancer cells can be identified most clearly through a needle biopsy.

Siouxsie: However, a cat with poor liver function is a very poor surgical risk. The liver is the organ that filters out toxins such as drugs used in surgical procedures, and a cat whose liver is not functioning well will not be able to eliminate these toxins efficiently. The results could be potentially fatal. So we don't blame your vet for not wanting to subject your cat to surgery or drugs.

Thomas: Furthermore, ultrasound technology has really advanced since it was first developed. It is possible to get very high-resolution images that are easy to read, and many technicians and vets are specially trained in interpreting ultrasound images with high accuracy.

Sinéad: I had an ultrasound exam once because I had an episode a few years back where I got some sort of infection in my liver. They had to sedate me because I didn't want to sit still for them. What did they expect? They shaved my tummy and put me upside down on a cold, hard table! Humph!

Siouxsie: Your main question, Mrs. P., seems to be whether or not there are illnesses other than cancer or liver failure that could cause these symptoms. The answer is yes. Sinéad alluded to one of those causes above.

Thomas: Cats can develop hepatitis, an infection in the liver that causes swelling and elevates liver enzyme levels. Hepatitis is generally treated with a course of antibiotics and a nutraceutical (pharmaceutical vitamin/mineral supplement) called Denosyl.

Sinéad: I'm glad to say I made a full recovery from my bout of hepatitis. Hepatitis in cats is very treatable and it's not a forever-disease like the kind humans get. Most cats that get an infection in the liver do make a full recovery as long as the infection is discovered early.

Siouxsie: The thing is, the hepatitis doesn't cause permanent damage to the liver unless it becomes very advanced. Also, the liver is remarkable because it can repair itself better than just about any other organ in the body, as long as it has adequate support.

Thomas: Another liver disorder suffered by cats is hepatic lipidosis, or fatty liver disease. This illness generally strikes very obese cats who suddenly stop eating. However, even slim cats can get hepatic lipidosis if they don't eat for a few days at a time.

Sinéad: In hepatic lipidosis, fatty tissue builds up in the liver and stops it from functioning properly. Hepatic lipidosis is treatable, but it takes a lot of time and effort and not all cats with hepatic lipidosis survive.

Siouxsie: Certain poisons can also damage the liver. Unfortunately, in many cases of poisoning (accidental or otherwise), the damage is so severe that even the remarkable capacity of the liver to repair itself is overwhelmed.

Thomas: We can't tell you the prognosis for your cat. If you have any doubts about what's going on, it would be a good idea to seek out a second opinion. However, you have to be ready for your second opinion to tell you the same thing as the first opinion.

Sinéad: Most vets are fine with their clients seeking a second opinion, particularly in the case of a potentially fatal illness. But don't lose any time; arrange for your second opinion as quickly as you can.

Siouxsie: If you opt for supportive care for your cat, there are some alternative remedies that can help. These remedies are to be used in conjunction with, not instead of, standard veterinary treatment. We can't stress this enough. Liver disease is not something to take lightly or to attempt to treat by yourself.

Thomas: The Veterinarian's Guide to Natural Remedies for Cats, compiled by Martin Zucker (1999, Three Rivers Press, New York) suggests giving a cat with liver disease milk thistle, an herbal remedy. This can be given in capsule form (one 250mg capsule daily) or in a liquid "glyceride" tincture.

Sinéad: Let me explain about herbal tinctures. Herbal remedies are usually preserved in an alcohol base. Cats don't like the taste of alcohol, and of course, alcohol stresses the liver -- something you don't want if your cat already has liver problems. However, some herbal remedies are preserved in a glycerin base; these are referred to as glycerides or clearly marked as preserved in glycerin on the label. Health food stores generally carry a great selection of herbal remedies, and your best bet to find the stuff is in your local health food store. They can be ordered online, too.

Siouxsie: One of the vets interviewed for the Veterinarian's Guide also suggests using glutamine, a 500mg dose twice a day. Glutamine is an amino acid that strengthens the digestive system, which can help the liver to function better. Give this and any other supplements with meals.

Thomas: Veterinarian Jean Hofve also recommends that in addition to standard therapy, you use a glandular formula called Livaplex. This product contains glandular extracts, vitamins, minerals and herbs that support liver function. It is available through veterinarians, who can order it from a company called Standard Process (1-800-848-5061). Give one tablet a day mixed with food.

Sinéad: To help you understand more about liver disease, we found some material for you online. At PetEducation.com, there is a whole section of the site on liver and gallbladder disease in cats. It contains articles about symptoms and diagnosis of liver disease as well as the treatment of liver disease.

Siouxsie: What it comes down to in the end is that you and your husband are going to have to make the best decision you can with the information you have. Some forms of liver disease are quite treatable; others like cancer and liver failure are much less so.

Thomas: If your cat does indeed have cancer, your options are limited to chemotherapy treatment (if your vet believes the cancer is treatable and it isn't widespread) and supportive/palliative care (if the cancer is widespread and aggressive). We're not aware of any liver transplants being done on cats, and we're not sure you'd want to put your cat through such trauma even if such surgery were possible and within your means.

Sinéad: On the other hand, if he has hepatitis or lipidosis, it's possible and even probable that he will recover.

Siouxsie: Whatever course of treatment you choose, always consider your cat's quality of life. It's him you need to consider first and foremost. If he's extremely sick and isn't going to get better he will thank you for letting him go.

Thomas: We hope we've been able to help you come to a decision, Mrs. P. We're sorry you and your kitty are going through such trouble.

Got a question? Need some advice? E-mail us at advice@paws-and-effect.com. None of the material in this column is meant to be a substitute for regular veterinary care.