Tigger with Dr. K.Wilhelm
Tigger's Struggle
With Fatty Liver Disease.
“Tigger” Gessner is a very sweet 5-year-old tiger-striped cat. He has always enjoyed eating very much, and as of December 2004, he weighed 18 pounds 14 ounces. His illness began in May 2005. Paul, his owner, noticed he was vomiting for about a week and rapidly dropping weight. Tigger's physical exam on May 19th showed he was dehydrated, depressed, and jaundiced (a yellow color to the skin and gums). He had lost 4 pounds, weighing in at 12 pounds 11 ounces. His blood work showed elevations in all of his liver enzymes, which is consistent with an illness called Fatty Liver Disease.
Fatty Liver Disease is a well-documented illness that can occur whenever a significantly overweight cat stops eating. When the cat stops taking in calories, it's body breaks down the stored fat and transports it to the liver. There, in a healthy cat, the fat is converted to usable energy to support normal body systems. In a markedly overweight cat, so much fat is transported to the liver that the liver becomes overwhelmed and shuts down. The liver failure creates further nausea and lack of appetite, leading to worsening of the cycle. The treatment for the disease is eating, eating, and more eating. This stops the breakdown of fat and relieves the extra work on the liver. Unfortunately, the cat will not eat on his own so the calories must be forced into him.
Tigger spent several days with us and really got familiar with the hospital and staff.
In Tigger's case, we decided to place a feeding tube directly into his esophagus as a port to deliver a blended liquid diet. He went home the next day with feeding instructions and anti-nausea medication. However, he continued to vomit. Inadequate calories from the vomiting lead to persistence of Fatty Liver Disease. He was brought back to the clinic and boarded for a week to allow smaller, more frequent feedings and provide supportive care for the vomiting. A barium swallow was also performed to be sure no intestinal disease existed. By the end of the week, his vomiting had improved and he was again sent home. However once home, the vomiting worsened and he became dehydrated once again. We admitted him but this time we were unable to control the vomiting with medications. He was placed on a continuous slow drip of liquid food, which did improve his attitude but not the vomiting. Repeat blood work on July 1st showed he had become a mild diabetic. This was a new finding. As soon as he was started on insulin, his attitude immediately improved and the vomiting stopped. After about 4 days, his diabetes corrected itself and insulin was no longer needed. Two days later, he was eating on his own and gaining weight. After he was eating well for 5 days without vomiting, he was sent home. Tigger continued to do well at home.
The development of diabetes was a very interesting complication. Diabetes is common in very overweight cats. Initially, obesity causes the body's own insulin to not work well. Through time, the disease progresses and the body's supply of insulin runs out. This leads to the need for insulin administration. Insulin is responsible for transporting glucose from carbohydrates into the body's cells where it can be used for energy. Without insulin, the body feels as if it is starving because it can not get energy from the food it eats. This is why diabetic cats are hungry and eating all the time but losing weight.
Tigger's diabetes was caught very early before his own insulin supplies were gone. This is why it corrected itself and we were able to get him off the insulin quickly. The development of diabetes explains why the fatty liver disease was so difficult to treat. The diabetes was preventing the food we were giving him from being properly absorbed. Because he couldn't absorb the calories, his fatty liver disease wasn't able to correct itself
Today, Tigger is home and doing well. He is currently at a good weight. His blood glucose is still slightly high but not high enough to be considered a diabetic. However, if he gains weight again, he could become diabetic again. Because of this risk, we are keeping him on a strict low-carbohydrate diet. Hopefully, if he stays a good weight, neither problem will reoccur. With Paul as Tigger's dedicated owner, we are confident this can be achieved.
Paul and Tigger
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