Hepatic lipidosis--anyone have experience with tube feeding?

Hi all,

Our cat Callie was just recently diagnosed with hepatic lipidosis and we are currently tube-feeding her. I am really hoping to find someone else who has experience with this just for some support/info, as right now I am feeling very overwhelmed.

We took Callie to the vet last Thursday because she was anorexic and vomiting occasionally, and had started hiding away from us which is very abnormal for her. The vet noticed she was jaundiced and did some bloodwork on her, which showed values consistent with HL or cholangeohepatitis. Callie had completely stopped eating by Saturday so she was admitted to the e-vet and put on IV fluids and antibiotics. She was seen by an internal medicine specialist on Monday and had a normal x-ray and ultrasound, and repeat bloodwork that showed similar values. After monitoring her food intake, the vet placed a feeding tube Tuesday and we took her home that night. We've been tube-feeding for two days now with some ups and downs, and she's still on Clavamox and metronidazole.  

It feels like there's some sort of disaster every other feeding--today we went up from 25mL a feeding to 50mL, and I discovered our larger syringes don't fit her tube and we only have one 25mL, so I had to prep a 25mL syringe twice, and at one point as I was trying to switch syringes I shot food all over my kitchen window and blinds. Kinda tired and a little grouchy this morning--she's worth it for sure but I would love to hear someone tell me that this will become routine and won't take an hour to do each time.

Thanks so much,

Laura

Hi Laura,

Speaking from experience, tube feeding DOES get easier, I promise. Can definitely be exhausting and frustrating initially but you and Callie will soon settle into a routine. Can you get some more 25ml syringes from the vet so you can have one on standby, instead of having to refill the first one? Also, going from 25ml to 50 in one feeding is a pretty big jump, did the vet mention anything about working up to that volume a little more gradually? You want to try to avoid causing Callie to vomit, which can sometimes happen with too much food all at once. How many times a day are you feeding Callie?
 

Sorry for giggling a little at hearing about the food spray all over your blinds. Reminded me of the time my husband thought he'd be helpful by doing one of the early morning tube feeding sessions for my cat. He was filling a syringe but the rubber stopper was at the end of its lifespan, which caused it to be extra sticky. Using brute force, he accidentally flung the container of food slurry into the open cutlery drawer. Then came the swearing while he did his best to clean up the stinky mess. I had to get up, make a new batch of slurry, and feed the darn cat myself. That was the last time he tried to help with THAT. Bless his heart.

Good luck! Let us know how it goes.....

Sometimes we have to laugh at the situation to keep from dissolving into a tired puddle, hehe. We have been feeding Callie every 8 hours since we both work, and my boyfriend is out of town next two weekends so I will have to feed her by myself before and after work. The instructions from the vet were 25mL each feeding the first two days, 50mL each the third day, and 80mL each the fourth day and ongoing. I am going here in a few minutes to get some more syringes (with the locking caps!!) from the vet. We have been mixing about three days of food at a time (2 cans of a/d to 60mL of CliniCare) in our brand new blender (I had to go buy one, lol). We're about 5 hours out from her first 50mL and so far, so good. She hasn't had any vomiting since she came home, which is awesome. Thanks for the positive words.

Wow, I would say you're kind of luck only having to feed her every 8 hours.  We had to feed our Bashful every FOUR hours!  Boy was I tired.  But it definitely gets easier the more you do it.  And getting more syringes will be the ticket.  Get plenty, because the rubber in them will definitely start sticking and once that happens you might as well toss them.  And once you start feeding her more, just do it slowly, or what goes in might very well come right back out.  Been there, done that! 

Is the feeding tube in her neck, or in her stomach?  My experience is with one directly in the stomach, but I think mainly they are putting them in the neck now...much easier from what I understand.

for your little Callie and for you.  Hang in there!  Many of us have done this and are here for questions.

Her tube is in her neck. We both work so we had to put her on an 8 hour feeding schedule (it will stretch to 9 hours some days in this next week because he will be out of town so it's just me). I just started a new job so there just isn't any opportunity to miss (I was able to take my days off for the week right after she came home so that worked out well). Good to know about the rubber sticking--I'll have to scrounge some more from the vet. I think I only have three of the larger size right now. She burped a few times with her 3PM feeding, but so far it sems to be sticking. She always goes right to sleep afterwards.

With Bashful, if we fed him too fast, he immediately threw up.  And the sleeping afterwards is normal.  She's got a full tummy, so she's satisfied.  Now, did anyone tell you that it's ok to offer her food manually, but even if she eats some, you still must continue to tube feed her?  You'll need to discuss this with the Vet, of course, but don't think that once she starts nibbling on her own that you're done, because it may be some time before she eats enough on her own for them to remove the tube.  Did they give you an idea of how long it will be?

Patches was on tube feedings for the same thing. It does get easy it's just time consuming, I tried to go too fast once and poor Patches sneezed food all over the place. I'm sure it was a bad experience for him too. I had to feed him 4 times a day and I was working 12 hour shifts three nights a week. I had to go to just 3 feedings on those days because that's all I could fit it. From what I have read I was lucky Patches was eating well on his own in 2 or 3 weeks and the tube came out a week after he was eating well.

No idea how long it will be. At least two weeks is all I know for sure (that's how long we have antibiotics for). We go back in tomorrow to have her bandages changed and her bloodwork rechecked. We have another cat that is free-fed, so I'm hoping Callie will start to try some of that on her own. She expressed some interest in wet food when she smelled me getting out her slurry mix last night, but when I put some in a bowl she turned it down.

Patches liver enzymes continued to worsen for awhile after I started the tube feedings and even after he acted like he felt better and eating on his own.  When they finally began dropping they dropped really fast.

We're really struggling. We went in for her follow-up yesterday and she had spiked a fever, so the vet added Baytril as a third antibiotic and ursodiol which is supposed to help with her liver function. She seemed to be better tonight, but then her feeding tube got clogged so we had to rush back into the e-vet. After about 45 min they managed to get her tube unclogged (thank God). I'm by myself right now since the boyfriend is out of town this weekend, and I'm just so scared I'm going to mess up. She is very unhappy with me right now (I squirted her and me with water a couple of times when the tube was clogged and then wouldn't let her hide in the closet, not to mention hauling her back to the vet). I feel like this is a test and I'm failing!

Stella1609 said:

I feel like this is a test and I'm failing!

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Aww sweetie, I know how that feels! Just take it day by day and remember that ultimately this is the best thing for Callie. Each hurdle you overcome is one step closer to her getting better.

Regarding the clogged tube, are you flushing it with enough warm water after each feeding? Do you push the food slurry through a sieve after running it through the blender? One trick to eliminating a clog is to put a bit of Coke (regular, not diet) down the tube for an hour or 2 to see if the acidity helps dissolve it. 

There are some other tips on tube-feeding at this site that you might find helpful: http://www.kittykollar.com/Living_with_an_E-Tube.php

Hang in there!! Come back anytime you need a shoulder to cry on or some advice or you just want to vent. And don't forget to spend some quality time with Callie. Does she like getting brushed, or maybe just sitting on your lap while you read a book? Even just talking to her and telling her what's going on can help.

I just got done tube feeding for 3 weeks for our cat that had a foreign body blockage.  You need to feed SLOWLY until she is used to it.  It feels weird for them to not be eating but suddenly have a bunch of food in their stomach.

What we did:

- Waited until our cat was sleeping, or being very lazy.  Then pet him like normal and moved slowly so he didnt freak out

- Have all of your food and syringes ready to go

- Start with 3 milliliters of water to kind of pre flush the tube

- Feed however much you are supposed to (directed by vet) we started with 15mils every 6 hours the first day, 30mils the next, 60 after that

- We fed slowly... 5mils over about 30 seconds.  If he got up or didnt feel like eating, Id quickly recap the tube and let him walk around until he was relaxed again

- When you are done, flush the tube with 10mils of water.

It becomes very easy once you and the cat get used to it.  Also, make sure that you blend the food in the blender... what we did is blend it with clinicare until it was a smooth enough consistency.  

Probably the most important advice I can give is wait until she is sleeping or very very calm.  Otherwise she is going to move quick and you get stuff everywhere.  Trust me, when I first had to do it I was so worried I was going to screw up, but then it got very very easy.

Finally, make sure that you change the bandages every 2 or 3 days, whether you do it or the vet.  Our guy got a nasty infection because we left the bandages on for 4 days (he fought me hard when I tried to change it).  Also, scratch under her bandages (away from the incision) she will love it... it itches something fierce, like when we have a cast.

Good luck!

Also, dont scold her or yell if she doesnt want to eat... it will make her dread when you get the food and syringes.  If you are worried about clogs, make sure you flush the tube with 10 milliliters of water every couple hours.  We did that and never had a problem.

To get our cat to eat, we enticed him with treats instead of food... we would just place like one or two on the carpet and he would eat.  After a few days he was eating more and more, so I would place the food down right after he ate the last treat and he started to eat that instead.  It took about two weeks to get him to eat.

Thank you both for the encouragement. I got up at 2AM to do an extra feeding since she missed her afternoon one with the blockage and she kept it all down--yay! I think Coke is how the e-vet ended up knocking the clog loose. We blended her food in the blender on liquify (2 cans of a/d to 1/4 can of CliniCare) so I don't think it's the food, unless it backed up when she threw up yesterday am? I had just pushed her meds and she's on three ground up pills now, so I think that may have been it. I will try giving them with more water tonight. I've been feeding about 2-3 mL every couple of minutes--last night's 50mL feeding took about 40 min.

She's normally super cuddly so we just drape her across our laps and pet her while we do the feeding. Last night I think she was just tired of being messed with--like I said, I squirted water all over her (and in my face) a couple of times before I gave up on the clogged tube and ran her to the vet, and who knows what the vet did to get it unclogged. She seems to get sleepy during the feeding, I guess because her tummy is full! We've been alternating sleeping on the couch with her.

We have another cat that is free-fed so there is always food available, and I've been occasionally offering her homemade treats from the fancy pet store. So far no interest . She hasn't even been home a week yet, though, so it's still early.

When I was tube feeding the vet had me mixing the A/D half and half with water so what was going into the tube was like water, but do things the way your vet recommends. I would think mixing it the way I did would also mean more feedings which could be why the vet has you doing it the way you are doing it. Getting a cat through this is a long sometimes frustrating process but the cat getting enough food so the liver quits trying to use fat stores is the most important part of the treatment.

You're getting some great advise here, and it WILL get easier the more you do it.  Try not to get discouraged . By the time your boyfriend get back in town, you'll be a pro .  Hel'll be so impressed (just don't let him off the hook...make sure he shares all this fun with you )

Stella1609 said:

Thank you both for the encouragement. I got up at 2AM to do an extra feeding since she missed her afternoon one with the blockage and she kept it all down--yay! I think Coke is how the e-vet ended up knocking the clog loose. We blended her food in the blender on liquify (2 cans of a/d to 1/4 can of CliniCare) so I don't think it's the food, unless it backed up when she threw up yesterday am? I had just pushed her meds and she's on three ground up pills now, so I think that may have been it. I will try giving them with more water tonight. I've been feeding about 2-3 mL every couple of minutes--last night's 50mL feeding took about 40 min.

She's normally super cuddly so we just drape her across our laps and pet her while we do the feeding. Last night I think she was just tired of being messed with--like I said, I squirted water all over her (and in my face) a couple of times before I gave up on the clogged tube and ran her to the vet, and who knows what the vet did to get it unclogged. She seems to get sleepy during the feeding, I guess because her tummy is full! We've been alternating sleeping on the couch with her.

We have another cat that is free-fed so there is always food available, and I've been occasionally offering her homemade treats from the fancy pet store. So far no interest . She hasn't even been home a week yet, though, so it's still early.

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When you try to give her the treats, try a single one.  For some reason that worked with our cat.  Its like he saw one on the carpet and needed to eat it.  So we would put down a second, then he ate that too.  He would stop after 4 or so, but it was a start.

Also, try different treats.  Our cat wouldnt touch one type but would pick at another

Oh Stella,

I went through the exact same thing you are in May and June. I promise, promise, promise it gets better.

My cat Lulu had severe hepatic lipidosis towards the end of May and was hospitalized for four days. When we brought her home, it was so hard. She was on pain meds, mirtazapine, clavamox, and Demarin, along with feeding every six hours. She was so weak, she could hardly walk and wanted to spend her time under the bed.

My husband and I were so sleep deprived, stressed and emotional. We have another cat who was so mean and would go out of his way to pass her and hiss.

I have to laugh - my husband went out of town about a week after Lulu came home and what happened? I clogged her tube when I was feeding her the ground up Demarin. I ran to the store in the rain for sparkling water. I proceeded to squirt it all over myself, the cat, and scare her to death in the meantime. After that didn't work, I ran to the store in the rain for a bottle of caffeine free Coke, which didn't work either and wound up all over me, the cat and my couch. My friend ended up driving Lulu and I to the emergency vet during rush hour traffic, who was thankfully able to pump a bunch of ginger ale into the tube to unclog it. I felt like such a failure. So, I completely understand!

Lulu had no interest in any food or treats at all for the first two weeks at least, maybe more. Remember, you're feeding her super rich, highly caloric food at regular intervals, so it could be that she's simply not hungry right now. Maybe don't offer anything for a while, so as not to create any food aversions.

Believe it or not, towards week 3, my cat would follow me when I had the syringes with food and water in them and sit down next to me purring. It became our new normal. I never thought any of us would get through this, but we did. And, you will too. During this whole grueling process, I kept telling myself, one day at a time, just keep moving forward.

Please let me know if I can help you out at all, or provide you with any other things we did that helped us out.

Take good care,

Beth

Oh, I so know what you are going through! As others have said, it gets easier and easier. I've fostered four cats with feeding tubes now and I've had all kinds of accidents and problems happen, including a night-time rush to the emergency vet. 

I've always used AD or Recovery mixed with water and more recently with Rebound (which pumps in more calories), and I've always started with a minimum of 30ml three times a day, moving to 40, 50, even 60 three times a day over a week.  I use the  25 ml syringes also because those 50ml ones are clunky to handle.  I always fill up two or three syringes with the food (it's easier to manipulate the plunger if the syringe isn't full), one syringe with water, and plenty of damp paper towels. I'm away from home 12 hours a day so when I'm caring for a feeding tube foster I give one feed as soon as I get home, care for the others and myself, take a nap for a few hours, and give another feed before getting a short night's sleep.

When moving to higher quantities of food, I've learned to watch the lips of a cat for signs they have reached their "full" point. Once a cat starts licking its lips, I stop because it's a sign they are on the verge of throwing up.  Sometimes, I've had to give a little, see the lip licking, pause for several minutes if they haven't had nearly enough food, then go back again.  As others have said, it's a slow process.

It sounds like you are doing well and her lipidosis isn't really extreme because she hasn't thrown up yet. I'll bet she will be licking tentatively at some wet food in just a few weeks.

I helped my daughter with tube feeding when her Emily was diagnosed with caner last year in March.  She also was getting Chemo and prednisone by mouth with a syringe.  We found with the tube feedings, don't rush it. We would do a little at a time and wait about 3 to 5 minutes before we would push the plunger again.  That way you are not over loading the stomach all at once.  By the way Emily is off Chemo and seems to be doing quite well, hope it continues.

I hope this helps you.  Good Luck