Should I get my cat a feeding tube?

As my screen name suggests, my cat's name is Phoebe.  She's 17 3/4 years old.  She stopped eating in November 2012, but giving her mirtazipime (sp?) did the trick and as soon as I saw the bowl wasn't going down, I'd give her a pill (much to her chagrin) and then she'd start eating again within hours.

A few weeks ago, the pills stopped working.  She went though a variety of foods that she ate a little for a day or two (one weekend, eating like crazy, and then it died down again).  She started throwing up her food about 10 days ago - I also had to start feeding her with a syringe. 

Finally, on Christmas Eve night, I had to take her the 24/7 pet hospital, because she was starting to look for places to die (at least that's my theory - her sister did it when she died - going to weird places she's never been in the house).

The thing is she's had a number of blood scans and her kidneys are not that bad.  Not bad enough to have her stop eating.  Nothing else in the blood work shows anything.

So, she spent the last two days in this hospital and they did everything - X rays, ultrasounds, more blood and urine and more.  Still don't know for sure what it is.  They started her on steroids two nights ago, but she still won't eat.

When, I visited on Christmas Day, she really didn't meow at all.  She's a huge talker normally.  I expected more of the same tonight.  Instead she was lively as heck.  Went crazy when she saw me.  The techs said they love her, because she's such a talker and when they talked to the other cats she would get mad (definitely her personality.  She's by far the friendliest cat I and anybody has met her has known).

So, I was left with four choices.  Euthanasia (not when she's acting normal!).  Very aggressive - doing biopsies (they figure since they can't find anything that it's a lymphoma most likely).  She's too old for that - and then to have chemo - forget it I think! 

So, it was really two good choices - take her home to see if she'll eat when not surrounded by barking dogs, etc.  or have them put a feeding tube in tomorrow (he made it sound like I better get it done very soon - but this place is big $ and I'm not 100% sure they're just not draining me more - he made it sound like he's the only one who could do it and he leaves at 3PM tomorrow). 

So, unfortunately, although she's acting like her loving self and drinking water (which she had stopped before I took her in), so far she isn't eating anything.

I never heard of feeding tubes until tonight.  He said that cats tolerate them well.........So, I guess I'm asking if they really do?  And, what kind of life would she (and I) have if we went this route?

Thank you!!

My cat had a feeding tube for hepatic lipidosis.  Cats do tolerate them very well but I can't see having one put in without a specific diagnosis.  She has only been on the steroids for 2 days I would give them a little more time to work.  The fact that there is a marked improvement in her behavior that shows that she is feeling better may mean she will start eating.

Thanks!  I was wondering how long it should take the steroids to work........One good thing is I just saw her eat for the first time in days.  It was about 3-4 Pounce.  I know it's not the greatest but to see her eat gives me such a good feeling. 

I really like your idea of waiting to see if they work before moving to the tube!

I agree about waiting a bit longer and seeing if her improved behavior leads to more eating, but I'm used to seeing feeding tubes as short term solutions to get a cat past a non-eating crisis, not as a long term treatment.  Sometimes a feeding tube can give them enough energy to regain their appetite.  Discuss the short term value with your vet and see what kind of time frame they are thinking about if it comes to this.

Hi phoebephan and welcome to TCS!

First, some info for you from a reputable source: http://catinfo.org/?link=feedingtubes

Interestingly, I was just reading an science based article which included a piece on cats refusing food - when the food wasn't meeting their nutritional needs...this is instinctual, hard-wired behaviour.

It is well known that, as cats age, they loose some of their former abilities to digest/metabolize/benefit from essential nutrients.....there are a couple of papers I'd like to share with you about senior/geriatric cats and some of the things that have been shown to be beneficial in countering these effects......

Perhaps I'll be also be able to retrieve  the paper I referenced first up above.....

I have to run off now......I'd really advise you to pick up a special "recovery" food from your Vet: "Hill's a/d"....it's a high protein and fat meat-only product that is processed smooth enough to flow through a feeding syringe. I think you need to begin assist-feeding......be absolutely super careful that she doesn't choke...they can aspirate the liquid easily, breathe it in, and this frequently results in a deadly form of pneumonia. So, just insert tiny drops of the liquid food into the SIDE POCKET of her mouth, nEVER toward the back/down the throat...withdraw the syringe and let her swallow, and repeat giving her rests in between. Get into the mindset of ASSIST FEED rather than force feed - it truly makes a world of difference in reducing the stress levels of BOTH the feeder and the cat.

She may well have stomach acid issues as well......it naturally occurs when they don't eat and is often the reason that they resist eating....."human" Pepcid AC works well to control this. The tablets are bitter, though, and need to be followed by some food or liquid (tuna juice/broth/liquid food) to cover the taste. More here: http://www.felinecrf.org/nausea_vomiting_stomach_acid.htm#famotidine

For assist-feeding, just watch:
 

I'll be back later, hopefully with some reading for you. I hope some of the above helps.

I think her cat is hospitalized.

He had said it could be long term - for the rest of her life.  Or if she starts eating again, they can take it out at any time. 

Sorry on that last reply.  I tried quoting Stephen - and answer his question about short vs. long term but I guess the quote doesn't show up. 

That's a great article you linked, White Shadow - thanks!  Very timely and valuable info. 

And, yeah - two weeks ago, my normal vet (that I couldn't go to because of the holidays) - they just handed me some syringes and didn't tell me anything on how to do it..........Phoebe started eating again, but then I did have to syringe feed a few days later.  I totally did it wrong - a whole bunch straight down the middle!!

I don't know if I would want to use a feeding tube long term but that's a decision for you to make.  There has to be a reason why she isn't eating.  It could be lymphoma but it could also be IBD, it's hard to tell them apart even with a biopsy.  A steroid will help with both.  I really think since nothing showed up on bloodwork which is normal with IBD/lymphoma that a steroid would be a better choice long term.  They may need to change dose or even the steroid.  Some cats do better with one steroid over the other.  The steroid of choice is prednisolone but it has been difficult to get for awhile.  Some vets use prednisone which works for most cats, the liver converts prenisone to prednisolone.  Since my kitty probably has liver damage from having had fatty liver she is now on dexamethasone.  

I wish the vet wasn't putting pressure on me last night.  Basically saying he's done at 3PM today and because then it's the weekend, who knows when I can get it done.......I would think he's not the only one at a 24/7 hospital that can do it??

She's not eating today, so this might be the way to go, but now I don't know who to call..............Or maybe I can syringe feed her through the weekend and then see about the feeding tube?  She definitely needs to eat, as she's feeling weaker. 

Putting in a feeding tube is an easy quick procedure it's not something that only one vet can do.  If you do decide to go that route sooner is better because of the anesthetic.  It's a very short procedure and I think they actually use a light anesthetic but it is still better to have it done before she gets weaker.  Is she still on a steroid?  Even if the feeding tube is put in she will probably need to continue on the steroid.  A feeding tube really does the same thing as syringe feeding, it is just easier and less stressful on both the human and the kitty.

I don't know why some vets use scare tactics and pressure people.  I am like you, I start thinking in terms of them being money hungry.  I think some people become vets simply because they are better with animals than people, they just don't do well when it comes to communicating with people.

Denice said:

 
Putting in a feeding tube is an easy quick procedure it's not something that only one vet can do.  If you do decide to go that route sooner is better because of the anesthetic.  It's a very short procedure and I think they actually use a light anesthetic but it is still better to have it done before she gets weaker.  Is she still on a steroid?  Even if the feeding tube is put in she will probably need to continue on the steroid.  A feeding tube really does the same thing as syringe feeding, it is just easier and less stressful on both the human and the kitty.

I don't know why some vets use scare tactics and pressure people.  I am like you, I start thinking in terms of them being money hungry.  I think some people become vets simply because they are better with animals than people, they just don't do well when it comes to communicating with people.

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Oh, now I think I got the quote system to work..........Yeah, Denice - I was already paying way over the estimate last night just for the two days.  And, then he seemed to be pushing a little more than earlier for biopsies, but then backed down easily when I said come on - she's almost 18 and anorexic - she can't go thru all that and chemo. 

She is on prednisone.  I gave her one about two hours ago, and that is what she was getting in the hospital. 

Since syringe feeding and feeding tube get the same result, I really can just syringe feed her now until I get a time where they can do the procedure, right?  (To me that is part of the pressure that I was feeling.  Why wouldn't the vet yesterday not even mention syringe feeding - it was "if she doesn't eat right away, get her in by 3PM.  Nothing like try syringe feeding to see if that will get her going, and at least she'll have some nutrition, while we can decide in a few days?)  I knew she wasn't going to immediately come home and go to her bowl and start eating! 

He's leaning towards lymphoma over IBD because he thinks the steroids would have worked in terms of her eating by now if it was IBD. 

I think too vets have a tendency to push the feeding tube because many people won't stick with syringe feeding enough to keep a cat from going into fatty liver disease.  I didn't get a biopsy done for my cat we are just treating for IBD with a steroid.  There are many of us here who didn't get the biopsy done.

Denice said:

 
I think too vets have a tendency to push the feeding tube because many people won't stick with syringe feeding enough to keep a cat from going into fatty liver disease.  I didn't get a biopsy done for my cat we are just treating for IBD with a steroid.  There are many of us here who didn't get the biopsy done.

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That makes sense.  I think I would be OK trying to get her thru the weekend with syringe feeding, though, wouldn't I?  I've been using baby food, since that's the last thing she would eat.......Does anybody know how much and how often I should do this?

If I remember correctly a jar of meat baby food has 76 calories in it.  The rule of thumb is 15 calories per pound of a cats ideal weight per day to be safe as far as fatty liver goes.  A 10 pound cat would need 150 calories or 2 jars of the meat baby food.  You will probably have much better luck with multiple small meals.  You need to make sure that it has no onion in it just the meat and broth.

It's best to feed small amounts very frequently when you have to syringe feed.  Like 5-6 small meals per day.  As for cats tolerating a feeding tube, most don't mind them, but there are some that do not tolerate them well.  We have a kitty with distemper in our clinic right now who has a feeding tube.  He finally ate some chicken today with gusto. As long as you are getting enough calories into your cat with tube feeding I think you are okay without the feeding tube, but it is your choice.  If you don't want to use the baby food you can get either Recovery or a/d from the vet, those foods have a lot of calories and are easy to syringe feed. 

Thanks!!  I am going to pick up some A/D from the vet right now. 

Per White Shadow's request, I am updating this thread.

Nothing has really changed, other than the fact that I did pick up the Rx cat food from the vet and am now syringe feeding her that instead of the baby food.  For the most part, she doesn't seem to mind it too much.

She's definitely getting weaker.  She's a total shell of herself, but I can't put her down while she has some of her personality left.  And, per the vet, she's not suffering (not sure if I can trust anything he is saying at this point, as he was selling me on the feeding tube at that point - I have told him I'll wait till he's back on Thursday and syringe feed her in the meantime, and then make a decision then). 

I tried to re-read this thread, and I don't think it was mentioned. Has your vet talked to you about using another type of appetite stimulant? I know in your original post you said the Mirtazapine stopped working. There's another one called Cyproheptadine, but it has to given every day (versus every three days with the Mirt).

The A/D has more nutrition than baby food, so that should give her more of the vitamins and minerals she needs.