Meal sizes for fatty liver kitty

runekeeper

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What a crappy year. I had to put down my Caspurr at the very end of 2012, then her brother in February and now my last kitty has been diagnosed with fatty liver disease. But I was told to try feeding him at home first to see if I can improve his liver function before considering more invasive options. I'm no stranger to syringe feeding,as I did it for Caspurr when she couldn't eat. But she was also pretty weak and didn't struggle....too much. Kip is sick and an old man, but boy he sure is wily. He puts up a pretty big fight when I force feed him, and considering he also has a heart murmur, I'm sure that just makes feedings suck even more.
I was told to feed him a small meal every 2 or 3 hours. The thing is I have no idea what constitutes a small meal for a cat, especially when it's watered down enough to go in a syringe. Earlier today I got half a can of Fancy Feast in him, and later on gave him some chicken baby food. He ate a little of the baby food on his own, but left probably half the jar, so I fed him that via syringe a few hours later. And he definitely does not like; he's been hiding in the corner since I fed him about 20 minutes ago. From what I know, the biggest concern for a kitty with fatty liver disease is that they eat. First priority is food in general, second is the quality of their meals. Though part of me is worried that Kip will come to associate food with stress with the syringe feeding. Tomorrow he goes to the vet for a shot of vitamin B12 and I'm going to see how he likes Hill's Science Diet A/D and maybe some canned kitten food (which I think is about the same nutritionally as A/D and not as expensive).

Any suggestions from folks about what else I can feed him? He won't drink goat's milk, but he likes cow's milk. Not sure about raw egg yolks (which I've been told are okay maybe 1-2 times a week for kitties). Could I maybe mix an egg yolk with some baby food and warm water? Would that be too disgusting to feed him? I've never had a cat with a fatty liver, so I'm not sure where to begin besides getting food into him. About how many cc would you say to give him at a time?
 
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runekeeper

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Will do that tomorrow. I think I recall hearing something like 20-30 calories per pound of Kitty's weight, but I don't know if I should be feeding him per pound of his current weight or per pound of his ideal weight. I hope I didn't feed him too much today - I got a jar of baby food and a small can of wet food in him, which he hated me doing.
 

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Everything I'm about to say should be run by your vet, but here's my thoughts.  It sounds like you basically know what you're doing. 

It's my understanding, that when a cat has stopped eating and is at risk for hepatic lipidosis, you want to try to at least get in 1/2 of their normal food intake, to keep the liver functioning.  This will still result in weight loss, so hopefully you can get his normal, full calories and nutrients in him.  One of my cats had to have a feeding tube last year.   My cat weighed 12 pounds, and the doctor was hoping to get 250 calories into him each day, split into several small meals.  I would take that much in the canned food (that she designated), add about a third of water, pureed it, and divided into 5 or 6 meals.  The concept should remain the same for syringe feeding.   (By the way, my cat does not normally eat 250 calories a day, but that was what the doctor said to feed). 

I don't know what your cat's current weight is versus his ideal weight.  If he's lost a lot of weight, I'd probably choose an in-between weight and go from there.  A jar of baby food (not a complete food for a cat, but good in a pinch) is 80-100 calories.  A half can of Fancy Feast is about 75 cals. I think that was a good start. 

When my cats have stopped eating for whatever reason, I know the Hills A/D is a good way to get a little food in them, quite stinky, very smooth.  I always keep a can or two in the cupboard just in case.  For syringe feeding, it requires no additional water added, just a wooden spatula to direct it into the syringe.  Last time my kitten needed a little food help, I put the A/D in the syringe, but she basically lapped it up from the tip.  Next time I offered it to her on her plate.  If fed a lot, it can make the stool soft.  I usually combine it with Gerber's baby chicken or real cat food as soon as they'll eat it. 

I've read that fatty liver disease (in people) is often associated with a lecithin/choline deficiency, and cats require both.  Egg yolks are probably the best source.  If your cat will eat raw egg yolk (not the whites), then I would definitely add that to his food options.  I'd go as organic as you can.  I've not tried to get it into a syringe before, but it shouldn't be hard.  I think a yolk has about 50 calories.  Like the baby food, it's lacking taurine and a balance of calcium.  I think you could give him one every day for the short term, especially if he's also eating other balanced food (although that too might make his stools soft).  If you are feeding only the yolk and baby food for very long, you'll need to add some taurine and ground eggshells (someone else can help you with how much).  And no, it doesn't sound disgusting. 

Once he's healthy, you might talk to your vet about an egg lecithin supplement.  A lot of people on this site give their cats 1/2 capsule to help ward off vomiting fur balls - the lecithin breaks down the fats that bind the fur.  The supplement also includes choline. 

Hopefully he will soon be back to eating his regular food and getting appropriate nutrition with a functioning liver.  I'm sorry you and your cat family have had such a rough year. 
 
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runekeeper

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Well the vet was no help. I asked how much a small meal would consist of and her initial suggestion was a tablespoon of water/catfood slurry, but then she went on to say that wouldn't be enough to sustain him. So why say it then?! Then she said given his condition is caused by him not eating, there is no way to feed him too much right now. Unfortunately, he will not eat the A/D on his own and is even starting to go off the baby food. But I also think force feeding is doing almost as much harm as it is good. He's been acting very different since I began syringe feeding - he seems more tired, isn't cuddly, doesn't want to sit next to me when I use the computer like he's done for years, and sometimes hides when he sees me coming. Up until yesterday he was acting normal and now he seems worse. I worry he won't be the same cat even if I can get him back to normal.

For now, he's got baby food, a few cans of A/D and some chicken I intend to boil for him. I worry I'm going to have to force feed him for the rest of his life at this rate and I wonder if it's worth it for him to be unhappy and live longer or to be happy and eat the whole 5 calories a day he's been eating. What's more important for a kitty? His health or his happiness? I might just be in a bad mood myself, but I just do not have high hope for him...probably because I thought my other cats had curable problems and they both were terminally sick. Kip's probably the same and I just don't know it.

I don't know if I should continue force feeding when it's stressing him out so badly and when it may not even help. If his liver is worse after all this syringe feeding, I'm not sure what to do by that point because it may not be fatty liver disease if that is the case. Just knowing the luck my cats have been having, he probably is dying and I'm fooling myself thinking he'll get better. But I can't bring myself to put him down yet. I won't give up on him yet, but I need to draw a line regarding how far I will be willing to allow testing and treatment to go.

Force feeding has made him eat on his own even less. Prior to doing this, he would pick at his kitten chow and would eat baby food and deli meat. After two days of force feedings, he won't eat or drink anything by himself. I think because he's feeling worse from stress.
 

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Try some other brands of food. The Sheba brands are a little more expensive, but my cats love it when I put some in with their normal food. I use the Turkey in gravy. It has small chunks, so you couldn't force feed it without pureeing it. 

I understand how you feel about force feeding and the quality of Kip's life. Sometimes, there is nothing we can do for them. I hope Kip starts eating more soon.
 

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I am so sorry to hear about Kip. Will he lap up kitten milk replacer? Its not ideal but high in calories as is kitten food. I know fancy feast makes a kitten canned food that is high in calories. I guess either one could be force fed. I just thought higher calories might help.
I really hope he starts eating on his own soon.
 
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runekeeper

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Thank you for the suggestions. I did almost grab Sheba food once before, but I think I ended up getting some other thing, but next time I'm at the store, I'll get a can and see if he likes it. Unfortunately, the "irresistible, delicious" A/D is of no interest to him, and since starting force-feeding, he's also stopped eating baby food. But I gave him some chicken that was boiled in broth and he will eat that on his own. So I give him a bit every few hours instead of force feeding. While the A/D might be more balanced for a cat's dietary needs, I would rather give him something a little less nutritionally sound that he'll eat voluntarily than put him through the stress of forcing food down his throat.
 

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Eating on their own is always better!  My cats are not great syringe feeders, so I understand.  And I realize you are now concerned about your cat eating any food in any manner, but earlier, you were wondering about quantity of food for syringe feeding.  I read something today regarding feeding a sick cat.  It said the recommended total calories is 50 kcal/kg of the cat's IDEAL weight.  It also said for syringe feeding, the cat's mouth can safely hold 1 ml at a time.  It recommended having the cat face away from you, feed with a 1 ml syringe (which is tiny), placing it at the back/side of the mouth, start at 6 ml per feed, and work up to 48 ml per feed.  To be honest, I can't imagine putting the syringe in my cats' mouth 48 times at one feeding, they would never allow it.  I'm just repeating the instructions. 

At this point, I might start by buying an assortment of canned foods (any canned foods) at your local cat food store and offer lots of options via plate.  See what he might be interested in.  If he's not interested, it's time to consider a feeding tube.  Expensive, but no fuss, no muss. 

My heart goes out to you and your cat. 
 
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runekeeper

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Doing the 50 calories per kilo of ideal weight for kitties, Kippy would need about 200 calories a day (I'm going by a scale of 10 pounds, which I think is healthy for a grown male cat). I seriously doubt I'm getting that much in him, but he is definitely eating on his own. I just worry...if he does come out of this and get better, will he actually eat cat food ever again? Unfortunately if he doesn't eat cat food, I won't just be able to leave it there and expect him to eat when he's hungry because he's already proven he won't do that at all. I think there's about 200 calories in a cup of boiled chicken, but that's a lot for a cat to eat.
I use a 3 mL syringe for feeding, but since Kip doesn't like to sit still, I can only get about one mL into his mouth at once anyway, though today he was considerably better about being force fed than the last couple of days. I don't know if he just wasn't feeling well or he was used to it. I also sawed the tip off the syringe, which lets me get more into the syringe instead of half air, half food.
 
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runekeeper

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One thing I'd like to ask: Would it be okay to give Kip heavy cream? I know, cats shouldn't have dairy and I know I shouldn't give him any, but milk is one of the very few things Kip is still interested in. Kippy likes low fat milk, and he inhales whole milk, so I bet he would inhale cream. Also, from what I'm seeing regarding heavy cream, it is higher in fat and lower in lactose than milk, so it might be a little easier on his system.. Plus there is 50 calories (give or take) in one tablespoon. So five tablespoons would give him all the calories he'd need in a day, on top of any chicken he eats and any EnerCal I smear on him.
Would that be a very bad idea? I know he shouldn't have milk, but at this point, anything he's willing to eat that won't kill him I'll give to him. Especially since his stress is making him feel and act worse than before.
 

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If he tolerates it then I would probably give him what he will eat. At least a little bit, but watch for diarrhea of course. I really hope that the more you can get him to eat on his own that he will get his appetite back. KMR might also be good if he will freely drink milk; it also contains dairy but has taurine and other vital supplements. I know I would probably give my cats what they would eat in your situation.

I do agree that you need to get him to eat something, and eating of his own will is better. I've never dealt with fatty liver disease in one of my cats, so hopefully someone else can be of more help.
 

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One thing I'd like to ask: Would it be okay to give Kip heavy cream? I know, cats shouldn't have dairy and I know I shouldn't give him any, but milk is one of the very few things Kip is still interested in. Kippy likes low fat milk, and he inhales whole milk, so I bet he would inhale cream. Also, from what I'm seeing regarding heavy cream, it is higher in fat and lower in lactose than milk, so it might be a little easier on his system.. Plus there is 50 calories (give or take) in one tablespoon. So five tablespoons would give him all the calories he'd need in a day, on top of any chicken he eats and any EnerCal I smear on him.
Would that be a very bad idea? I know he shouldn't have milk, but at this point, anything he's willing to eat that won't kill him I'll give to him. Especially since his stress is making him feel and act worse than before.
You may want to try goats milk- it is more easily digestible for cats. Have you tried fortiflora to attract him to the food?  It is kind of like kitty crack and my cat who has been off food for a week will get interested in the food if I sprinkle some on. Also treats are a good way to get extra calories mine is eating temptations and freeze dried chicken in between syringe feeding. 
 

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My Miuku had fatty liver disease, what a horrible adventure it was, but eventually all became good.

I did use blender to make wet food work better with syringe.

For holding it was not the easiest part, but I did go on my knees, but cat between my legs and gently sat on top of him so that he can't get up, then put other hand to chest of him, thumb and index finger to base of his jaw, using those fingers I could control his head, using palm I could keep him from crawling forward, had to use toes to keep him backing out, but only touch is needed, he senses there is object that he does not see so he was not forcing himself to that direction, other hand I did use to operate syringe, from side of mouth in as he opened his mouth when I placed syringe in and then squirting enough quick that stuff ended up to back of tongue, then lifting his nose up and holding until he swallows.

He did learn quite quick to fake swallow though.

It was really messy, not fun at all, but it id kept him alive and he became a very trusting cat that I can take on my lap anytime I want, which he was not before that torture.

That was food, easy part, but then there was antibiotics which did actual cure, it did smell bit same as orange and cats do hate smell of orange, it was really the same procedure but it was lot more difficult to get him swallow it.

Cleaning his coat was hardest part as usually always half of the stuff came out from the mouth, it was on my hands, legs, floor really really messy and as he was skittish feral origin that barely let me touch him, that was quite bit of struggle to wipe him clean.

I felt like being some middle age torturer doing that, but without doing it he would died.

Now amount that I should of been feeding should been around can of wet food per day, now trying to get that much in with syringe is just not going to happen, so at most it was 1/4 can a day that I was able to feed into him.

It was however enough to keep him alive and to get him interested of eating.

His condition was quite bad to begin with, when I got him out from the vet he was unconscious for 8 hours, I had to keep him warm with my body heat, which of course resulted being covered with cat pee as there is no bladder control in cat that is passed out. He was so weak that he could not stand, but with hard work he came out ok from that and has never turned down a plate of food since that experience.

As big syringe as one can fit into cat's mouth is best, imo. keeping nose up while squirting forces cat to swallow as getting so much stuff in, horrible thing to do, but not much options there. I really hope that I don't need to do anything of such ever again, but there is not knowing why cat stopped eating and when cat stops eating he gets fatty liver quite soon, so there is always a chance that such happens again.
 

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I don't know about 5 Tablespoons, but Natascha Willie (of TC Feline) gives one of her cats 1-2 T of half & half every morning to settle the cat's tummy.  She says it's best to give a couple hours away from other food (don't know why).  She says that it's not enough to cause lactose problems, and yes, that would be good calories.  If your cat already likes milk, it would be worth a try, at least for the short term.  One of my cats has a little bile problem in the morning, and I've been thinking about giving cream to him, early AM, to see if it helps. 

Did you try to giving Kip the raw egg yolk?  It is such nutritive food and would be easy to eat.  Was it you on a different post that said your cat also has mouth/teeth problems?  And like I mentioned above, the lecithin/choline is suppose to help with fatty liver. 

You might try changing meal time and location up.  I have a cat that sometimes has a hard time eating at the designated meal time.  I've wondered if she feels pressured to finish her food within a certain time period, so she just stops eating?  Anyway, I'll save her food, then put she and the food in a bedroom with the door closed, away from the other cats and bustle of the house.  Lo and behold, when I peek in a little while later, the food is gone.  Is there a spot that you could leave Kip and delicious smelling food alone for awhile?  He may be feeling the "pressure" with all the force feeding and just choose to not eat. 

I've also read that cats can be especially hungry at 3 or 4 AM. Part of their nocturnal cycle?  I won't get up to feed mine then, but you might try leaving some cold wet food out before you go to bed.  It will stay fresh enough through the night, and maybe Kip will eat when the lights are out?  If you are concerned about the freshness, you could somehow put a blue ice under the bowl or use something like a cat feeder with an ice pack system. 

Good wishes!
 

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 re giving cream, I would say it depends on whether dairy causes him to have upset stomach /  diarrhea because obviously that would be terrible and make it even harder to nourish him.   ( That's the reason people say not to give milk and cream to cats -- many of them do have trouble with it.  But not all.   If you know he can tolerate cream and likes it, I don't see why it would be a problem to give him some.  Perhaps you can see if he would eat/ drink it mixed with some cat food since he really does need the mix of different nutrients that would be in cat food. ( For example feeding just cream and cooked chicken  would not provide taurine.   )  

Of course right now the main thing is just getting food in him.   but you don't want to go on too long feeding an unbalanced diet.    With him already having a heart problem you don't want an imbalance of electrolytes or lack of taurine since those things can affect the heart. 

Re amounts of calories / cat food. 

  The short version: 

 Wellness Chicken is even  higher in calories than the Hill's A/D - hich is 220 calories per can --  higher than Hill's A/D which is 180 cal/ 5.5 oz can.     -- and actually the Wellness is better quality and  cheaper, and a similar  smooth pate style that can work in a syringe mixed with a bit of warm water.  Innova Evo 95% is also high calorie and in a smooth pate consistency.

I would be trying to feed him  about 1/8 of a 5.5 ounce can of high calorie food per feeding, with 8 feedings a day,   to try to get a can into him per day.  That would = about 2/3 to 1 ounce per feeding -- that is BEFORE diluting for syringe feeding.   As far as how much you feed in the syringe it depends how much water you need to add.    but it might work out to about 25-30 cc per feeding.   I like to use feeding syringes at least 10 cc size so you dont have to keep refilling it as often ( or have so many of them lined up)   I have a 30 cc one that  i think works well for this. 

The long version: 

1. figure out how much you should feed total each day ( not counting added water) Food amount is usually figured based on ideal weight.  30 calories per pound would be too much for most cats especially neutered cats.  20 calories per pound is more realistic as a starting estimate , but unless they are quite active , even 20 calories can be too much,  and on the other hand might not be enough for a very small active cat. 

 With assisted feeding, the caretaker is usually wondering what is the minimum I have to get into this cat? .   Dr. Lisa Pierson says she has never seen a cat get hepatic lipidosis on at least 15 calories per pound of ideal weight.   ( It is in this section.   http://www.catinfo.org/#Transitioning_Dry_Food_Addicts_to_Canned_Food_    )  .  I would think the same minumum amount would apply to a cat trying to recover ;  obviously more would be better.     I don't  know Kip's ideal weight  but   if 10 pounds which is about average, that would of  mean he should get at LEAST 150 calories.   That would be about 2/3 of a 5.5 ounce can of Wellness Chicken or Turkey  ( regular pate style)   

   Better yet if you could get a whole can per day in him.  

If you don't already have this link, here's a chart that has calorie amounts for many canned and raw cat foods.   ( The "prescription" diets are at the end.  )  http://www.catinfo.org/docs/FoodChartPublic9-22-12.pdf

2.  Then   divide by the number of feedings.    If you're supposed to feed him every 2 to 3 hours,  I'm not sure if that means every 2 to 3 hours round the clock ( including getting up in the night a few times). which would mean 8 to 12 feedings a day.    Whether that is necessary depends on his condition.  I know it is not always recommended  but ask your vet.

    Otherwise  if you subtract about 8 hours for sleep,  it ends up being about 5 to 8 feedings a day.

I would really aim to try to feed 1 can a day of one of the high calorie pate style foods.  so just approximately divide the amount in the can into number of feedings.   If you some days don't get the whole can in, but manage 2/3 that is probably still OK. 

If it gets too stressful trying to get food into him,  it might be easier on both of you to put in a temporary feeding tube.  That 's not really as drastic as it sounds and it is lifesaving for many cats with HL.   Here is a good article on them that mentions different kinds of tubes.  http://www.catinfo.org/?link=feedingtubes

Good luck to you and Kip.  I hope you get him through this and he will have more happy years with you. 
 
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runekeeper

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Actually, Kip seems to tolerate syringe feeding better now. He does flail a tiny bit, but not like before. However, he also absolutely refuses to eat or drink anything on his own now. He won't eat cooked chicken, drink milk or even drink water on his own. I really wanted to take a day off from the force feeding to see if he'd eat chicken all day, but he won't even do that. So I can't stop the syringe feedings now. I left him some chicken in his kitty bed and all of it was still there when I checked on him when I woke up this morning. So now I'm force feeding him food and water. I don't know why his appetite has gotten worse, but I don't think I can afford to stop the syringe feedings when he won't even take water.
As far as feedings, I usually give him a heaping teaspoonful of A/D thinned out with just a little water (so feedings can be shorter and he can be less stressed) and maybe a few milliliters of water with it (though I'm definitely not getting the recommended 2-4 ounces of water in him a day). I don't know what's going on that's putting him off his food completely now. Would stress do this? And if so, why is he tolerating the syringe feedings more than before, but eating less on his own?
 

jtbo

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Actually, Kip seems to tolerate syringe feeding better now. He does flail a tiny bit, but not like before. However, he also absolutely refuses to eat or drink anything on his own now. He won't eat cooked chicken, drink milk or even drink water on his own. I really wanted to take a day off from the force feeding to see if he'd eat chicken all day, but he won't even do that. So I can't stop the syringe feedings now. I left him some chicken in his kitty bed and all of it was still there when I checked on him when I woke up this morning. So now I'm force feeding him food and water. I don't know why his appetite has gotten worse, but I don't think I can afford to stop the syringe feedings when he won't even take water.
As far as feedings, I usually give him a heaping teaspoonful of A/D thinned out with just a little water (so feedings can be shorter and he can be less stressed) and maybe a few milliliters of water with it (though I'm definitely not getting the recommended 2-4 ounces of water in him a day). I don't know what's going on that's putting him off his food completely now. Would stress do this? And if so, why is he tolerating the syringe feedings more than before, but eating less on his own?
Sounds to me that sickness is progressing, my vet said best cure to be food and then more food, as much as one can make in, that is supposed to get liver working again. Not eating and drinking is part of fatty liver, sickness causes loss of apetite, but often sickness is because not eating in first place, reasons can be anything, in my cat's case it was impossible to tell what it was that originally made him not to eat, but sickness is such that it completely kills all desire to eat and drink, so only way to keep cat alive is to put lot of food in, condition is fatal unless treated.

Here vet orders antibiotics as there it is infection of sorts that follows that condition, then if condition continues other functions starts to shut down which results death, so it is extremely important to keep force feeding and lots.

It is then slow recovery, liver luckily is rebuilding itself in cats if enough food is given, vet also said that giving too much is impossible as it comes out one way or another, but also she said that I will not be able to overfeed cat and how right she was, took so much effort and time to even feed part of planned one can a day that I was not able to feed even a can.

It can take even two weeks until cat starts to eat again, just stay strong, never give up, if cat gets enough food it will recover eventually, but there is not much more to do than feeding with syringe, I have not heard that antibiotics had been given in US, but maybe that depends from the case.

edit: Oh yes, I did remember that I always gave cat opportunity to eat by himself, if he did not eat, then it was syringe feeding, I think that he did eat once or twice and then I did not syringe fed, just some psychology for cat, you can eat on your own or you will be fed with syringe, eventually he found out that eating himself is so much better :)
 
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finnlacey

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I'm a little confused as to why a feeding tube has not been suggested by the vet yet? A kitty who's gotten to this point should have a feeding tube inserted which is a lot easier on both of you for feedings and gets them to eat much easier than syringe feeding alone. 
 

jtbo

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I'm a little confused as to why a feeding tube has not been suggested by the vet yet? A kitty who's gotten to this point should have a feeding tube inserted which is a lot easier on both of you for feedings and gets them to eat much easier than syringe feeding alone. 
Here vet did refuse, she said it is not done, ever in such cases, but of course US is again different, can be that there are differences between areas in here too. That would make things easier of course for RuneKeeper.
 
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