17 year old, elevated liver enzymes

[Catlady1982]

I took my almost 17 year old girl to the vets on Monday as she’s lost quite a bit of weight. That’s her only symptom, she’s eating, drinking, toileting, moving fine, not lethargic, very bright.
He couldn’t find any obvious physical signs and said she looked really good for 17, so I opted for a full blood panel which he said might give an indication of anything going on. The appointment cost me £250 in total.
Blood results back yesterday show elevated liver enzymes, and nothing else, which he basically said could have many causes. An ultrasound is £600 or he said they could give some general antibiotics etc and recheck bloods after, which would be around £350. Other option is hospitalisation for investigation (expensive) or do nothing and let nature take its course.
I don’t have insurance for her and I’m lacking savings.
Pragmatically, she’s 17 and I don’t feel it’s worthwhile paying a fortune (that I don’t have) to find out BUT my heart is struggling and saying what if it’s something reversible or manageable and she could have years left.

I’m torn and would love any opinions to guide me

Not a cat but my dog has elevated liver enzymes which vet believes is due to liver toxicity after years on anti seizure drugs. I was offered a scan but the vet admitted that it wouldnt change anything at my dog's age (16) and would be too much at her age. Be careful about antibiotics as they made my dog worse and I stopped them. For some reason they always jump to a possible infection but antibiotics strain the liver.

I'm treating my dog holistically with milk thistle and a hepatic liver supplement. You would need to look into what's suitable for a cat but milk thistle is generally the number one go to for the liver.

I appreciate you have a cat not a dog but in my opinion as she's still fine in herself.It would be worth looking into what you can do to support her system..

That’s really helpful, thanks. I did see about milk thistle and omega-3 when doing some research last night. I’m leaning towards a supplement and watch and wait approach I think, especially as she’s showing no other signs of illness.

How long has your dog had the raised liver enzymes?

Glad it helped. My dog has had raised enzymes for at least 3 years but she's been fine and healthy until a few months ago when she started weeing and drinking a lot and became lethargic, so I took her in for blood tests. Her enzymes had doubled in a year. Her ALKP is around 1750 and ALT is around 500. The former should be between 50 and 220 I think! Vet gave me antibiotics but her symptoms worsened, so I stopped. Instead I started her on a hepatic liver supplement plus herbs containing milk thistle which I sprinkle on her food. She has improved so isn't lethargic anymore although it's clear she is frail and probably won't last another year. In herself though she is much better. That's why I think it's well worth trying this approach with your cat- supplements can help a lot. Also, probiotics might be worth trying as I was originally given these along with the antibiotics. But do be careful with the antibiotics- not saying don't give thrm to your cat but keep an eye on any lethargy etc. The ones I was given are very bad for liver disease! I hope your cat has years left.

Aw that’s really positive!
I will definitely look into the supplements. I’d be happy if I could get a bit of weight back on her too. I didn’t ask what the numbers were but he said it does indicate something happening with the liver at the moment. Like you say though, with so many possibilities antibiotics might not be the best idea if her liver is already struggling

Yeah I would definitely try and support her system first before thinking about antibiotics, especially as she seems ok. In my dog's case the supplements helped within a fortnight. I give her hepatic liver supplements from amazon but I don't know if there's a cat version. Best of luck to your dear cat.

With the weight loss I would look into inflammatory bowel disease/enteropathy. Weight loss can be the only symptom. I wish I’d taken it more seriously. Novel protein (a strict diet with a single protein they have never eaten) has made a big difference but I think his little body is too weak from all the inflammation. He’s the same age. Cats are known to ‘suffer in silence’ with these things and a vet told me they hide things until they no longer can.

I would avoid antibiotics if you can, unless there are clear infection markers there I guess. Just to say that ultrasound would be the way to get a hint if this is the diagnosis, they can usually do it just with sedation. It depends on the skill of the operator, so going to a referral hospital and having it done once would be best. I wish I’d done it. Having said that, it may not make any difference at their age, but you could go ahead with conservative treatment (diet, supplements) and avoid the heavy meds with some knowledge.

Thank you for commenting @smooththecat, that’s another really helpful response.
Vet said there were no raised white blood cells, which to me says no infection so I’ve definitely gone off the idea of antibiotics.
I’ve got some milk thistle and probiotics coming today and thought about a diet change but she really likes the food she’s on and with the weight loss not sure I want to rock that boat. I’ll probably offer her a bit more in small amounts and see if the combination of everything helps put a bit of weight back on. She’s hungry and still enjoying and asking for food. I might supplement her with extra treats but I have 2 others who expect the same treatment lol

There is no issue with saying you’ll take no action or investigation . That’s what we usually do when our animals are older, as they don’t understand so it’s anll distressing, and quality of life really matters to us. That’s with a vet in the family and insurance for us - so you don’t have to worry about taking that approach. It is a very valid one. If you do, just remember cats often hide pain. A day too early rather than a day too late is my view. It is so hard though. Big hugs.

@FebruarySnowStormsthis is so true. It’s really hard being a custodian for a pet that can’t verbalise how they feel. We have to keep their best interests at heart