Such a small thing to notice. A tiny thing, indeed. It meant nothing, yet could have meant everything.
A single drop of drool.
Sheba stuck her tongue out and, uncharacteristically, a single drop of of drool fell.
The evening of October 4, 2011, the very day Sheba, Queen of, was honored and pleased to be Cat of the Day on the delightful Cat Loves website, Sheba’s mama noticed the little droplet.
A cat may drool for many reasons. Some cats, when blissfully happy may drool. Mama knew a boy, Dusty, who would soak Mama in his joy to he held and loved. But Sheba did not drool.
Mama watched Sheba more closely. The next day, about noon, she saw many, many drops falling from Sheba’s mouth as she tried to sleep. Yet, in all other ways Sheba seemed fine. She had eaten with gusto, chased the sister-kitten, Arwen the Elf Princess, gotten pets, and prowled her realm. Normal, normal, normal… save for the drool.
Within hours Mama was rushing Sheba to the vet. Why the panic? Why the concern? Seven years earlier that dear boy, Dusty, had been lost to liver failure. He was only about three years old, as Sheba is, and had been normal, normal, normal… save for some drool, drool happening when he wasn’t being cuddled and in bliss. It was drool with a tinge of blood. Within days, Dusty, sweet Dusty, was gone.
Be warned: Drooling can be one of the first signs of liver problems!
At the vet Sheba was examined by a good doctor we’d seen before. He first checked her mouth for problems, such as things stuck in her teeth, or blocked salivary gland. These are the most common causes of abnormal drooling in cats. If your cat is drooling, first check the mouth and teeth. He also checked her throat and, again, found nothing amiss.
Sheba’s weight was the same as it had been. Weight is always an important thing to know and track. Cats losing weight, especially if it’s fast, can warn of dire problems.
Sheba’s mama reported Sheba had been eating fine. There is a cat liver problem that can occur called Feline Hepatic Lipidosis. It primarily involves cats not eating. But Sheba was eating.
Then the vet said the words Sheba’s mama most loathes: Wait and see.
Wait and see… Come back in two weeks to check again. Wait and see…
How many kitties had Sheba’s mama and papa lost mere days after someone said, “Wait and see”?
We do not wait. Blood tests were ordered. A T4 thyroid test was also ordered. Your vet will not suggest this test. Ask for it! Insist upon it. Later Tasha’s tale of why the thyroid test is so important will be told. Do not wait for your vet to suggest. Use your own judgement and knowledge. At the insistence of Sheba’s mama, the blood tests were ordered. There would be no waiting to see if Sheba survived the two weeks.
The blood tests came back with a ALT value of 345, when normal should not exceed 100. A high ALT, Alanine transaminase, value can be a sign of severe liver damage. The first symptom… drool. Mama began to cry with fear of losing darling, sweet Sheba.
Wait and see, the vet dared to say again. Come back in two weeks and retest. Instead, Mama asked for, and got, an immediate referral to the University of Minnesota Veterinary Medical Center, one of the best in the world. We would have gone even without the referral.
Less than twenty-four hours after seeing that single drop of drool, Sheba was being examined by the best. Sheba, Queen of, was not enjoying the attention, and could sense her mama’s fear and worry, but what must be done must be done.
Left overnight at the hospital, Sheba got an exam, an ultrasound, checking for liver shunt (a treatable genetic liver problem), and a fasting liver function test. Unfortunately, a fine needle aspiration of liver cells, for which Sheba had to be sedated, did not result in enough cells for the test. Sheba spent the night in fear, and fear of abandonment, which is her greatest fear. Mama spent the night crying.
The next day, October 6, 2011, was Sheba’s mama’s birthday. The only thing desired as a gift was to have Sheba home and well.
The U of M doctor said all of Sheba’s tests came out normal. Though we had wracked our brains and searched the house, Mama and Papa had found little to nothing that Sheba could have gotten in to which could damage her liver–A drop of eucalyptus bath oil? Maybe, so now banished forever from our house. Some mold on a wood floor by a water dish? Ripped out and cleaned up, though the doctor said respiratory problems were more likely from mold. Nothing else could be found to account for the problem.
An “insult” to the liver, was the possible cause suggested, when all other possibilities had been eliminated. Playing too rough, hitting something too hard… those were possibilities. If that is the case–and we don’t know–a full recovery is likely. The liver has good regenerative and healing ability in such cases.
Sheba, Queen of, came home with Mama the evening of October 6th. Whether too fearful to leave her carrier to use the litter box in the kennel she had been in, or too dopy from the sedation, Sheba had peed in the carrier. Shebas do not like such things and was trying to keep the icky wetness from touching her. Fortunately, Mama had brought the pink cushion from her bed so Sheba, very grateful, had a clean dry bed for the ride home. As soon as she arrived, Sheba ate two cans of TikiCat salmon and chicken food (human-grade, no grain), for Shebas do not eat hospital food. Now Mama cried for happiness as Sheba–after a much-appreciated sponge bath–settled down for a long cuddle and love.
Sheba was given SAMe (S-Adenosyl) with Milk Thistle and B vitamins to take. The pills are huge, but she is so far swallowing them with little problem. Milk Thistle has been used for thousands of years for helping improve liver function. As it was prescribed by the U of M Veterinary Medical Center, Milk Thistle definitely falls in the “not flaky” herbal remedy category, but self-prescribing and dosing could very well be dangerous to do, so use caution. The SAMe also has some soothing qualities, as high liver values mean there are toxins in the blood which can make a cat aggressive just because there are poisons in the system.
The cost of it all… $300.00 for the first vet visit and tests, $50.00 for antibiotics prescribed but not given as the U of M disagreed with our vet’s prescription of them, $800.00 for the U of M… there will be at least another $200.00 for the retest. That’s a lot of money for a drop of drool, and we are most grateful we were able to afford it (or put it on an over-loaded credit card, as the case may be). The prices are included here so you readers, who may find useful information and advice in this tale, know what to expect.
Now we do wait. Sheba, Queen of, has a blood test, to retest, on Friday, October 14, 2011. We are very hopeful as the excess drooling has stopped.
Update, 11-06-11: Sheba’s second ALT test on October 14th gave a vastly improved value of 137, down from the first test of 408. Optimistic the liver “insult” was, indeed, a temporary thing, and with the vet’s agreement, the SAMe/milk thistle was stopped. A retest on November 4th, however, gave the horrifying and frightening ALT value of 489–higher than the first test which has so alarmed us.
The only factor different was the absence of the SAMe/milk thistle, which we immediately resumed. As for environmental factors, we know of none in the house. We use few chemicals for cleaning or otherwise; have nothing about that she could be getting into and eating. To get a comparative test, and confirm if there were environmental factors affecting Sheba, we took her sister-kitten, Arwen the Elf Princess, age 1, in for a blood test. Arwen’s bloodwork came out normal.
The vet did suggest that something that heartened us quite a bit. She said that if Sheba had something like liver cancer the SAMe/milk thistle would not have lowered her ALT values. It is possible Sheba simply has a genetic condition or predisposition to liver issues. It is also, then, possible Sheba will be getting milk thistle for the rest of her life. And, please God, Long May She Reign!
Update, 12-14-11: After the SAMe Milk Thistle prescription ended, we waited another week and took Sheba back for a retest. The ALT liver value had shot up to 438, higher than ever! The only change in that time was stopping the SAMe. It is possible Sheba has a permanent, genetic liver problem.
We got a prescription of Denamarin, which is the equivalent of the SAMe the University of Minnesota had prescribed. The Denamarin (see their website) has smaller pills, which are easier for Sheba to swallow. Denamarin has no known side-effects and no known danger of overdose. It is considered a nutraceutical, considered the equivalent of a vitamin and is regarded as completely safe to give to Sheba every day for the rest of her life, if needed.
After three weeks of the Denamarin, Sheba’s ALT liver values had again dropped. Though not completely normal values–though we are hopeful the next test will be–the values were moving in the right direction again.
The change in Sheba, in her mood and behavior, were very clear and evident after only a few days taking the Denamarin. When her liver values are high Sheba spends all her time sleeping in a closet. When she does come out she is a bit grumpy and nasty to her sister-kitten, Arwen. After taking the Denamarin for a few days she perks up, sleeps less, and returns to being the fun, playful, sweet-tempered and loving, three-year-old she ought to be. A slow decline into grumpiness and excess sleeping is an easy thing to miss in a cat, being expected behavior, so it is something to look closely at in your cat.
Denamarin is now a supplement/medication I heartily endorse. Thankfully, it is available online so expensive monthly visits to the vet are unnecessary. The price on Amazon.com is not much lower than I pay from the vet, but the convenience and ability to have extra on-hand is wonderful. Be sure to find the right dose size for your cat’s weight. A warning: Do not just get Milk Thistle extract from your health/vitamin store. Those meant for humans contain alcohol, some as much as 75% alcohol.
Another update on the next retest after two months with Sheba taking Denamarin will follow some time in January.
After taking the Denamarin for several months we had Sheba tested again. Her liver values had gone back up. They were not as drastically high as at first, but had not dropped as well as they had with only two weeks of the prescription from the University of Minnesota. We researched and found a formulation of S Adenosyl 100 (SAMe) – available without prescription at Amazon.com – that more closely matched the U of M’s original prescription.
Though usually not patient to “wait and see” when checking health concerns for Sheba and our other fur-babies, this time we did wait several months for a retest. It was Sheba’s own behavior that made us feel at ease to wait. Again she became more happy and loving, and progressively more lively and fun. All of these were signs of a Sheba feeling well. She also put on a little weight, sleeking up nicely.
Then came the retest of Sheba’s liver function… Normal.
Normal, normal, normal!
So impressed was our vet with the results that she is recommending their entire veterinary practice change their standard prescription from Denamarin to S-Adenosyl. If you follow the link to Amazon above for S-Adenosyl, the review by G. Rule was written by my husband, Sheba’s papa. We’re convinced, and have the lab results to back our opinion, that S-Adenosyl is the better choice.
Though Sheba, Queen of, may be getting a daily pill for the rest of her life, she stands a good chance of having a long, happy rest-of-her-life. Long may she reign!