Safe way to INCREASE calories in food?

My 15 lb, 7-year-old cat recently became clumsy, irritable, jaundiced, and anorexic; after blood work showed probable pancreatitis and HL, she was in clinic for 3 days for IV fluids/antibiotics and syringe feedings, then sent home with slightly improved liver/pancreas indictors but lower albumin and higher bilirubin, and with Cerenia, Clavaseptin, Baytril, Denamarin, Mirtazapine, and transdermal Codeine.

Improbably, she seems to be improving in almost every way--except she hates feedings. She doesn't vomit, but she hides, and fights, and spits out what she can. As she is regaining strength and mobility, the fights are getting fightier. She is getting less than 1 can of recovery wet per day. She is curious about food, but won't eat. Food seems to be causing her discomfort, if not outright pain. 

She is also very constipated; things are moving a bit the last few days, but there are eight to ten cans of food still sitting in her digestive tract. The treatment and drugs were phenomenally expensive; I'm tapped out financially. A tube is out of the question. The vets have been comprehensively unhelpful in providing advice on supportive care. 

Any ideas to help with the feeding? I'm hoping the increasing hostility to food is from constipation or the medications, although I'm not naive; I know she may have a serious illness I can't treat. But when I can get food into her, I'd like to maximize the impact. Is there a way to increase the calorie content in her feedings? Given the pancreatitis and possible HL, should I be wary of glucose and fats? I feel weird about grinding up dry food with water to syringe that, given the constipation. I'm really not knowledgeable about this stuff, though; I'd appreciate any thoughts on this. 

Hi kitchenette and welcome to the forum!

What's perfectly clear to me is that, if she's constipated, she'll have a revulsion to any food.

IF constipation is a NEW symptom for her, I would put the blame on the Codeine. Codeine is known to cause constipation. So, if constipation has occurred after the codeine was started, then that's most likely the problem - or, at least contributing to it.

I don't want to oversimplify a complicated medical condition and I will only tell you what I would do. There is a very safe laxative that you could try (with all the usual and valid disclaimers like "check with your Vet first" etc) It is Miralax and you can read about it in this reputable website: http://felineconstipation.org/prevention.html#OsmoticLaxativesPrevent   If your Vet is not knowledgeable about it, s/he will find lots of references on the Veterinary Information Network (VIN), an online forum for Vets.

There's one point I will add: if she hasn't passed ANY stool, she may well need en enema first, as the stool could be impacted. But, if she has been leaving any stool in the box, it would be fine to start the laxative.

That's what I'd be using immediately to "get things moving". Timing is obviously critical, because where she is showing improvement after all of this, you don't want regression.

I'll also tell you that, with the probable Pancreatitis, if I were in your shoes, I would definitely be putting her case in front of these people: http://pets.groups.yahoo.com/group/...=1&t=search&ch=web&pub=groups&sec=group&slk=2 That has to be the absolute all-time-best source of information, advice and support to people like yourself....it is a very busy group and, in my experience with these groups, you'd be best advised to use a new/separate email address when joining. Again, that's where I'd be.

Hope this helps! Keep us posted.

BTW, is this Vet's a cat-only practice?

Hmmm, this is honestly the first time I have ever heard of codeine being used as a pain reliever for cats, although I did just read up on it since opening this thread, and see that it is definitely an option...just never heard of it being used. 

I totally agree with White Shadow about using Miralax for constipation.  I would just call the Vet and ask if it's ok to use.  It's works miracles, although it may take a day or two to really become effective, and as long as she is on codeine, she may need to take it.

As far as the syringe feeding...are you mixing the A/D with water?  Are you warming it slightly?  Are you s l o w l y syringing it into her month just a little at a time, into the side of her mouth, not directly down her throat?  Have you tried wrapping her up tightly in a towel so she cannot struggle, and of course, talk to her softly as you are feeding her.

I don't quite understand the crushing of the kibble and adding water.  Is this something you are doing trying to add more calories, or what.  Why not just give her more A/D?  I would try to stay away from kibble entirely, because with pancreatitis, she needs to stay very well hydrated, and kibble is drying.  And, yes, you need to stay away from high fat food.  That's why A/D is such a good choice.  Now, are you familiar with Whole Life chicken, or Pure Bites chicken.  These products are 100% freeze dried chicken.  They aren't cheap, but if you buy then in the dog department, they are a lot less expensive.  Even my kidney cat would eat these when he wouldn't eat anything else, and they have lots and lots of protein.  However, they are not 100% nutritionally complete, so you cannot use them alone.    But they might help to stimulate her appetite.  But she is already taking mirtazapine, which is an appetite stimulant, and that doesn't seem to be doing the trick.  I think the HL is not allowing her to eat yet. 

I did read on another thread where a member was adding KMR to her cats A/D to add more calories.  You  might try that.  I think she just sprinkled it on top, so you could probably just mix some up with water (if you got the powdered vs canned) and mix it in before syringing.  But you might call your Vet about that too, to make sure that the fat content in KMR isn't too high!

for your girl

Thanks for the replies and the well wishes! 

I'm glad to see I was doing things pretty right The burrito-roll towel thing; slow, side-of-the-mouth feedings; diluting food (I had to do this so she couldn't spit it out as easily!). She hated it anyway--but I'm glad to know it probably wasn't my fault. 

I had already discontinued the Codeine, but when I spoke to the vet (and yes, it's a cat-only clinic) a couple days before I posted she said that no, Codeine doesn't cause constipation in cats and, no, constipation doesn't cause pain in cats; if my cat was in pain, we should euthanize. I guess that's the short story of why I posted here, haha. 

When I pressed the issue, the vet said I could try a hairball remedy, and it was all I could get my hands on over the weekend anyway--it has probably worked. Banana insists on using a shared litter box (she hates the other cat, but will happily poop in the same place as him) and fastidiously burying her business, so it's often hard to say what belongs to whom, but she seems to have had a few BMs.

Over the weekend I also ran out of the recovery food, so I grabbed some kitten food with a kind of similar fat/calorie profile and pureed it with water.

Success--I hope. Since then Banana has readily eaten 50 ml at a go (I aim for 50 but was often having trouble getting to 30), and this morning ate more than 70--I only stopped feeding her because I had to leave for work. Yesterday she ate a couple of cat treats on her own (not the pure bites--she has always hated those; she came to me from foster care a year ago a very stubborn dry-food addict and timing for a switch has never really been right), and today she definitely chewed up a few, although it's unclear if she actually swallowed any. I don't know if it's the food, or the laxative, or the fact that we ran the course of medications on Friday, but since I posted feedings are LESS of a fight (she still runs and hides from feedings, but she isn't actively spitting out the food), and calories LESS of a worry; I have my fingers crossed things will hold up going forward. 

She is becoming stronger and more like herself, but we're not out of the woods yet: she is still jaundiced (2 1/2 weeks and counting), and by her third or fourth meal of the day will be lying under the furniture moaning. It's tough to see so much progress in some areas but not in these. A couple days after I took her home from the clinic, the vet called to check in and expressed surprise Banana was still alive, and I have no idea what to make of that (OR the fact that she prescribed five hundred dollars' worth of medication to an animal she expected to just go home and die). As it looks like she may make it to the end of the month, I'll be able to get some more tests done--it's unfortunate that I think I'll have to look for a new vet. 

In my opinion, any vet who would suggest euthanasia without even trying to see if there something is that can be done, is not a vet I would ever want to go to! 

Thought I would post a bit of an update re: the difficult feedings. Certainly the laxative was effective and the medications aren't off the list as a culprit in the feeding problems, but one major stumbling block was really simple: my cat hated the food. Once I started feeding her regular cheapo canned food, feedings stopped being a problem, and she was getting enough calories. I tried the recovery food again, and she spit it out. Luckily, my other cat thinks it's ambrosia. 

She is now eating on her own, but left to her own devices will only eat dry, so I syringe feed wet early in the day. Still not ready to say she is recovered or WILL recover, but still some progress. Hopefully the suggestion to try a different food is helpful to someone else in a similar situation.

My cat with large cell lymphoma had partial intestinal blockage when he was first diagnosed and he did very well with tuna flavored laxatone, i used half a fingerful and wiped it on his tongue. Laxatives do make it harder for your kitty to absorb nutrients, but like your cat, my boy was eating less and less, and part of that was because at some level he probably knew stuff was going in more than it was coming out, and he was vomiting as well. 

I am glad to hear your kitty is eating more normally now. My boy cat also prefers the crunchies, I think when they are ill, it is like eating saltines and gingerale compared to stuff they associate with possible upset. I try to give my boy more bland stuff in the morning, and make sure the texture is easy to eat, I add a little water so he can lap it up, like natural balance wet food turkey, salmon, or chicken & liver. As the day wears on, and he begins to feel more normal, I give him stronger tasting stuff and by dinner time I can bring out the fancy feast sliced beef or sliced chicken. I still add water so it is easier to lick too, lol. 

Also my boy seems to like the royal canin wet baby food, the stuff for the youngest possible kitten lol. It is probably loaded with protein and calories so it might not be a bad idea to try for your cat, as long as there are no major dietary restrictions. I have found too that my kitty rotates in what he likes from day to day, he is on chemo so that may be part of it. But as a rule, he wants bland easy stuff to eat in the morning and more adventurous at night, and I have to rotate food as he does get tired of it. 

Oh last but not least, we did give him chicken lunchmeat and he went so crazy for it that we had to put it away and never give him any more of it, as he was refusing other food and trying to hold out for it LOL.