Over a year ago, I lost my 7-year-old rescue cat, Echo, to severe heart disease. Well, I’m slowly re-populating my house, and just adopted a 7-year-old tortoiseshell cat named "Lily." The reason why? My other 14-year-old cat, Seamus, is desperately lonely without any other four-legged friends in the house.

Previously, Seamus and Echo loved each other. They slept together, ate together, and wrestled together (typically at 2 a.m. around my head). Ever since seeing the strong bond that Seamus and Echo had, I became a firm believer in a two-cat household. (Thankfully, I’ve been fortunate enough to have cats that got along with each other and actually enjoyed each other’s company.) Keep in mind that not all cats will get along, and I find that the more cats you have, the more inter-relationship fighting you will see. Sadly, some cats just don’t get along, and as there is a natural pecking order in life, fights can occur.

So, that’s how I acquired Lily. This shy little girl was getting beat up in her household, so I decided to adopt her and see if a household with fewer cats would be up her alley. Now, I knew it’d involve a few days of hissing and growling initially, but I’m staying optimistic and hoping for the best: that Seamus and Lily will become best of pals soon. Despite a slow acclimatization to my house and Seamus, however, Lily went off hiding. It took me hours before I found her (tucked behind storage boxes in my basement).

So, why should I care and what should I do?

While this blog isn’t going to be about acclimating new cats, I wanted to warn people about the potential medical emergencies that can occur when you inappropriately introduce cats: not eating.

While Lily was hiding, I went out of my way to make sure she had a safe place to access to a litter box, water, and most importantly food. That’s because you can’t just say, "I’ll just let her hide in the basement for a few days, and she’ll come out once she’s hungry." Why? Because cats can only go 3-4 days without eating before they can potentially go into liver failure.

Hepatic lipidosis, which is fatty infiltration to the liver, occurs when cats — especially obese ones — go without food for a few days. It’s also known as "fatty liver," and can be extremely costly to treat.

In the ER, some of the most common causes for hepatic lipidosis that I’ve seen include:

• Introduction of a new diet (never go "cold turkey" and change your cat’s diet suddenly — this should be done over a period of weeks!)

• Introduction of a new pet (e.g., dogs, cats)

• Introduction of two-legged newborns

• Stressful situations (e.g., visiting guests who live in your house for a few days, scaring your cat away)

Clinical signs of hepatic lipidosis include:

• Anorexia
• Hiding
• Lethargy
• Icterus/jaundice (a yellow tinged color to the gums or skin)
• Dehydration
• Vomiting
• Scant feces (i.e., no feces in the litter box due to lack of eating)
• Weight loss
• Muscle wasting
• Drooling (a sign of nausea)

More severe clinical signs include low blood pressure, abnormal clotting (e.g., bruising, etc.), and even death if left untreated.

The diagnosis and treatment for hepatic lipidosis includes blood work to evaluate the white and red blood cells (a complete blood count), a chemistry workup (to evaluate the kidney and liver function, electrolytes, protein, etc.), a urinalysis, and potentially a clotting test. Additional tests may include X-rays, abdominal ultrasound, and aspirates or biopsies of the liver. Treatment typically includes intravenous fluids, a temporary feeding tube (which may be necessary for weeks), anti-vomiting medication, vitamin K (to help activate liver clotting factors), medications to improve the blood pressure, and potentially even plasma transfusions in severe cases. Unfortunately, treatment can run into the thousands.

So how do you avoid this and save yourself thousands of dollars (and your cat a feeding tube)?

When it comes to cats, do everything slowly. Slow acclimatization is imperative so your cat has time to handle the stress and adjust. In the meantime, I’ll keep you posted on how Lily befriends Seamus!

Do you have any horror stories or personal experiences with fatty liver?

Next week: more on "yellow cat syndrome."

Dr. Justine Lee

Image: Don’t Hide in the Closet; Come Out! by Alan Chan / via Flickr