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Gastroenterology (Expert Forum)
AIH - Diet and Cat Bites
This forum is for questions regarding Gastroenterology issues such as Acid Reflux (GERD), Barretts Esophagus, Colitis, Colon/Bowel Disorders, Crohn's Disease, Diverticulitis/Diverticulosis, Digestive Disorders, IBS, Stomach Pain.
AIH - Diet and Cat Bites
by Geri-S, Oct 17, 1998 12:00AM
I have AIH and I've been taking Imuran and Prednisone since December, 1997. Right now I'm on a tapering dose of Prednisone and down to 11 mgs. daily from a high of 30 or maybe 40 (I don't remember!)
I've been through pre-transplant evaluation at a major transplant center in California because initially my condition was serious enough so that it was thought I would have to have a transplant. The medication has stabilized me and except for occasional problems, I'm doing well.
During the pre-transplant evaluation I was seen by a Dietician at the medical center and I was told that it is important that I maintain a high protien diet, eating large quantities of protiens daily, mostly meats. This is the opposite from the understanding all other AIH patients at an autoimmune support forum I follow have been told. Despite this, the dietician was very specific and even went into details, including the number of grams required daily. I can't locate the worksheets she gave me and I need to confirm that HIGH, not low protiens are indicated for AIH patients. If this is relevent, when I had a liver biopsy last November, cirrhosis was stage IV on a scale of I to IV.
My other question is about cat bites. I was also warned that I shouldn't even own a cat (I have three). I was told that a cat bite could be fatal. My understanding is that there is something in a cat's saliva that can cause serious infection to anyone taking immunosuppressive drugs and doctors have compared it to injections of a deadly poison. In fact, I was warned that if I am bitten by a cat, I should go immediately to an emergency hospital. I was also told that I must get rid of my cats, which I'm not going to do.
Apparently this danger is not caused by risk of toxoplasmosis, but is a separate kind of problem. Since my illness and since I've been taking the medication, I've been bitten lightly several times with no problems until a few weeks ago when one of the cats lightly nicked my wrist. Within hours my arm was red, swollen, throbbing with pain and clearly, seriously infected. I was successfully treated with antibiotics but since then there have been a couple of light grazing of my skin from our most rowdy cat and even pinpoint spots immediately begin to redden and swell. I immediately hold the area under running water and rub Neosporin into it and it seems to work though even a tiny scratch leaves a scar. My local specialist (I live in Nevada, the transplant center is in California) has told me that I must get rid of my cats and I understand why he says this but it just isn't going to happen. I couldn't do that.
Specifically, I'm asking for confirmation that cat bites can be as dangerous as I've been told. No one on the support forum I follow has been warned of this by their doctors and they even appear to doubt that this can be true. Can you clarify this for me and tell me what the source of the problem is with cat bites?
Thanks for any help you can offer.
Geri
I've been through pre-transplant evaluation at a major transplant center in California because initially my condition was serious enough so that it was thought I would have to have a transplant. The medication has stabilized me and except for occasional problems, I'm doing well.
During the pre-transplant evaluation I was seen by a Dietician at the medical center and I was told that it is important that I maintain a high protien diet, eating large quantities of protiens daily, mostly meats. This is the opposite from the understanding all other AIH patients at an autoimmune support forum I follow have been told. Despite this, the dietician was very specific and even went into details, including the number of grams required daily. I can't locate the worksheets she gave me and I need to confirm that HIGH, not low protiens are indicated for AIH patients. If this is relevent, when I had a liver biopsy last November, cirrhosis was stage IV on a scale of I to IV.
My other question is about cat bites. I was also warned that I shouldn't even own a cat (I have three). I was told that a cat bite could be fatal. My understanding is that there is something in a cat's saliva that can cause serious infection to anyone taking immunosuppressive drugs and doctors have compared it to injections of a deadly poison. In fact, I was warned that if I am bitten by a cat, I should go immediately to an emergency hospital. I was also told that I must get rid of my cats, which I'm not going to do.
Apparently this danger is not caused by risk of toxoplasmosis, but is a separate kind of problem. Since my illness and since I've been taking the medication, I've been bitten lightly several times with no problems until a few weeks ago when one of the cats lightly nicked my wrist. Within hours my arm was red, swollen, throbbing with pain and clearly, seriously infected. I was successfully treated with antibiotics but since then there have been a couple of light grazing of my skin from our most rowdy cat and even pinpoint spots immediately begin to redden and swell. I immediately hold the area under running water and rub Neosporin into it and it seems to work though even a tiny scratch leaves a scar. My local specialist (I live in Nevada, the transplant center is in California) has told me that I must get rid of my cats and I understand why he says this but it just isn't going to happen. I couldn't do that.
Specifically, I'm asking for confirmation that cat bites can be as dangerous as I've been told. No one on the support forum I follow has been warned of this by their doctors and they even appear to doubt that this can be true. Can you clarify this for me and tell me what the source of the problem is with cat bites?
Thanks for any help you can offer.
Geri
Doctor's Answer
by HFHSM.D.-D.M., Oct 17, 1998 12:00AM
_
Dear Gerri:
Thanks for the questions. You want to know if you should be on a high protein diet and if you have to get rid of your cats to be a liver transplant candidate.
Liver specialists (hepatologists) have gone back and forth over the years as to whether patients with advanced liver disease should be on high protein or low protein diets. As a result, we’ve left a lot of patients confused. We now feel pretty strongly that most patients will benefit from a high protein diet. We feel this way because we now appreciate how important good nutrition is in maintaining the health of our liver patients. There are a few patients who cannot tolerate high protein diets. They are prone to a specific problem called hepatic encephalopathy but it does not sound like you are such a patient. As a result, I am in agreement with the nutritionist at your transplant center. It sounds like you’re in good hands.
Your second question is more complex and I found it very interesting. The condition that your Nevada specialist is worried about and which you may have is something called “cat scratch fever” or “cat scratch disease”. This is an infectious condition cause that can cause fever, redness and enlarged lymph nodes after a cat scratch or bite. It is usually extremely benign and self-limiting, however, there are unusual reports of it causing much more serious illness. The patients who developed the more severe or life-threatening illness were usually immuno-compromised. A few of these patients who developed severe “cat scratch disease” were organ transplant recipients. They were immuno-compromised as a result of medications they have to take to keep their organ from being rejected.
Having said all that, it is difficult to give you specific advice. At Henry Ford, we don’t have our potential liver transplant candidates get rid of their pets though we do have them be extremely careful with their pets right after the transplant when they are on a lot of immuno-suppressive medications. On the other hand, you and your cats seem especially prone to this problem. I think you should discuss this with your transplant specialists and see what they think and what they required. Sometimes, there is no absolute right answer and it is a matter of patients and their physicians balancing risks and benefits.
I hope this information is helpful to you. I know you have asked a couple of questions to MedHelp and I enjoy your questions. Please let us know if you have any more. You can always contact us directly at Henry Ford at (313) 916-8865. If you are in the Detroit area, we would always welcome to come see us. We have a very active group of liver specialists and an active liver transplant program.
This response is being provided for general informational purposes only and should not be considered medical advice or consultation. Always check with your personal physician when you have a question pertaining to your health.
Dear Gerri:
Thanks for the questions. You want to know if you should be on a high protein diet and if you have to get rid of your cats to be a liver transplant candidate.
Liver specialists (hepatologists) have gone back and forth over the years as to whether patients with advanced liver disease should be on high protein or low protein diets. As a result, we’ve left a lot of patients confused. We now feel pretty strongly that most patients will benefit from a high protein diet. We feel this way because we now appreciate how important good nutrition is in maintaining the health of our liver patients. There are a few patients who cannot tolerate high protein diets. They are prone to a specific problem called hepatic encephalopathy but it does not sound like you are such a patient. As a result, I am in agreement with the nutritionist at your transplant center. It sounds like you’re in good hands.
Your second question is more complex and I found it very interesting. The condition that your Nevada specialist is worried about and which you may have is something called “cat scratch fever” or “cat scratch disease”. This is an infectious condition cause that can cause fever, redness and enlarged lymph nodes after a cat scratch or bite. It is usually extremely benign and self-limiting, however, there are unusual reports of it causing much more serious illness. The patients who developed the more severe or life-threatening illness were usually immuno-compromised. A few of these patients who developed severe “cat scratch disease” were organ transplant recipients. They were immuno-compromised as a result of medications they have to take to keep their organ from being rejected.
Having said all that, it is difficult to give you specific advice. At Henry Ford, we don’t have our potential liver transplant candidates get rid of their pets though we do have them be extremely careful with their pets right after the transplant when they are on a lot of immuno-suppressive medications. On the other hand, you and your cats seem especially prone to this problem. I think you should discuss this with your transplant specialists and see what they think and what they required. Sometimes, there is no absolute right answer and it is a matter of patients and their physicians balancing risks and benefits.
I hope this information is helpful to you. I know you have asked a couple of questions to MedHelp and I enjoy your questions. Please let us know if you have any more. You can always contact us directly at Henry Ford at (313) 916-8865. If you are in the Detroit area, we would always welcome to come see us. We have a very active group of liver specialists and an active liver transplant program.
This response is being provided for general informational purposes only and should not be considered medical advice or consultation. Always check with your personal physician when you have a question pertaining to your health.
