Another Hepatic Lipidosis tube fed cat in need of help

I would try sitting on the floor with him in between your legs and his front paws on your thighs,maybe even have your knees raised and have him sitting up with his front paws on your knees if you can and see if you get the same back flush.  If so, then maybe try the coke thing (but just that small amount).  He would definitely not be as prone to acid reflux if he's eating  sitting up,I wouldn't think.  Hopefully that will solve the issue

Gosh, that's still a new one on me, and I've read LOTS of issues with cats on feeding tubes.  Live and learn, as they say. 

Thank you all for the input! I feel better that it is not one more thing that has added to the overall angst. I do try to work around his position rather than taking him someplace else and having him sit upright. Whats odd is that this happens only randomly even when he's in the same position. So I'm guessing the gastric reflux is what is pushing the contents out. Could  the reflux also be irritating his esophagus to where it's causing the distress?

I know little about gastric reflux but will have him more upright.  

Mrsgreenjeans, I've read that article and think I'm feeding slow enough. I try to do 2-3 cc's per minute. I'll try slower but I'm not sure how much slower I can go. I feel I'm harassing him all the time already and slowing down will make it seem I'm always pushing something thru. 

I will try a carbonated flush but if water and food is going thru can it still have a blockage?  

Denice, Justin has sat quietly in the "lets just get it done" style but has also gotten up and some times has gotten up and walked away as soon as he sees me coming armed with food. 

Thank you Wendykins for your thoughts. It might be interesting to compare labs to see how different or the same these kitty's are. 

I'm off to try another feeding but I plan to give him some pepcid and ondansetron first. 

Again, thank you all for your ideas and input and time you've taken to point me to more help. I so appreciate it. Thank you all.

One more question - do you guys favor Cerenia vs Odansetron? I have both on hand and the vet who I consider his primary doctor and not the clinic who is following this problem was concerned he was on Cerenia daily for several weeks and never had the 2 day washout period. When I saw the primary vet he was not on it but it did get restarted a few days later at the same time all the other meds, pepcid, odensatron, and lactulose  were stopped and the SamE was continued to be held. At that time the vet felt "less was more" for the time being.

I was told to give Cerenia every other day as needed and have been doing that but have been thinking of going back to the odansetron given he's still somewhat nauseous while taking Cerenia. 

Again, thank you!

The one I have seen used by most people here is the Cerenia.  I looked up both of them and they affect different receptors in the brain.  I know nothing about the difference in how they work, it would probably be which one works the best for your kitty.  Neither will help with excess acid though only nausea.  The Pepcid would help with excess acid.

Denice, Thank you for checking about the differences. I've done that also but what scares me is what I don't know about how the differences react to his medical picture. I want to trust the vets know what is best but I've been thinking otherwise as I read and learn about some of the folks' stories here.  

This tiny little creature will be the death of me yet. This evening when I went to give him the odansetron and pepcid a little before I planned to feed him the moment he saw me his little face lit up,  he meowed and began getting up. Whatever had made him so very nauseous earlier seemed to have past. I did give him the meds and then about a half hour later gave him 15 cc's of Max Cal. I set him in my lap and he purred and sat quietly throughout and the last cc or 2 he was getting antsy but he did great overall. Way better than I anticipated. 

So I'm hoping to do a repeat in a few minutes and plan to get up every 3-4 hours thru the night to try to get in more calories in. 

 In hindsight I was wondering if I got too rambunctious in getting 200 calories into him yesterday as I upped the feeding to 25 cc's and spaced them about 7 hours apart as the vet wants me to feed every 8 hours.
 

When I began giving him only Max Cal last Friday I started with an every 3-4 hours and only 15cc's then every 4-5 hours with 20cc's on Sunday. Maybe I went up to fast and 25 cc's every 7-8 hours is too much and too far apart and kicked up todays and last nights acid overload?

Prior to Friday I was giving him 20cc's Clinicare with 5cc's Max Cal every 8 hours and he was only getting 30 calories per feeding. And this was on a good day when he didn't vomit. If he'd vomit I was to wait 12 hours before resuming feedings and give less if he appeared nauseous. But in doing this I felt he was never getting enough calories and we were always starting over and at lower amounts as he's been nauseous so much of the time.

I'm hoping with upping the calories and shortening the times between feedings the nausea will decrease and the feedings will be tolerated better for him. It's really not that difficult when things go well.

Again, thank you to everyone who had ideas and thoughts. It's so appreciated. <3 

Sorry for the second post but I forgot to add this to above: 

To those who use Cerenia - I'm curious, do you always do the 5 days on and 2 days washout period?

I'm assuming this is done to lower possible side effects..?

I was not told to do this and used Cerenia for about 6-7 weeks, daily. The primary vet was not so big on using this for cats, especially with no washout period and didn't offer an alternative. 

I used Cerenia for two weeks, 5 days on 2 days off, then I guess just 5 days on. Since nausea was not a huge issue for Abigail, and she did not vomit (at least not often) the vet felt that it could be discontinued without adverse effect. Of course, sighs....tonight she threw up her feeding. I'll set an alarm and try again in a few of hours.

Sebastian is still on a maintenance dose of Cerenia for his chronic pancreatitis - 5 days on (Monday through Friday), 2 days off. I opted to have the 2 days off on the weekends when I am home and can keep an eye on him and watch for signs of nausea. He's been on this Cerenia schedule since October 2013 and will likely be long term.

Cerenia depletes Substance P in the brain, so the break is so that it can replenish itself. Long term use without a break can cause side effects such as tremors as a result of this depletion.

How's the old guy doing today?  What's his name, BTW?

Hopefully this new regime is agreeing with him

Hi Mrsgreenjeans, thanks for checking on my little guy. He's doing better but at the same time not good. Last night I notice a lot of drainage at the tube site. Took him I. To ER and was told its starting to get infected. So now he's dealing with that and the tube feedings are not going well at all. I'm wondering if the wrap they put on is causing some if of this?

I'm back at ER right now to have it checked and hopefully find out why the food is oozing back more than ever.

This morning he was eating and seemed to enjoy it. Yesterday he ate food too so he's improving but has a way to go. Hopefully he can get thru this infection without needing the tube removed!

When you say he was eating was he eating on his own?  If he is starting to eat on his own that is a very good sign.  Something definitely doesn't sound right with the tube itself, maybe the infection has been there for a while and has been creating the issues you have been having with the feeding tube.  Hopefully it's something that can be cleared up without removing the tube.

Denice said:

 
When you say he was eating was he eating on his own?  If he is starting to eat on his own that is a very good sign.  Something definitely doesn't sound right with the tube itself, maybe the infection has been there for a while and has been creating the issues you have been having with the feeding tube.  Hopefully it's something that can be cleared up without removing the tube.

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Agree!  I don't think you got good instructions about the tube period.  Did they tell you about cleaning the outside of it to avoid infection?  At the insertion site?  On a daily basis?  While you were there last night, did they weigh him?  Is he holding his own, and possibly gaining any? 

Hi Denice and mrsgreen,

Yes he was eating when I offered him canned and was enjoying it. This morning he ate x 2 so for the past three days he's been eating - not a lot but 1/4 teaspoon is way better than not a lick or shunning whats on the plate as though it might attack him!

Last night, after a different vet checked the tube site she didn't see any infection and said to stop antibiotics. She felt the site looked just fine and that it was perhaps normal drainage. I do have an appointment late Monday with his primary doctor. I want he to take a peek at it and I'll let her change the dressing.

They have him wrapped up quite well. I just have the top of the tube sticking out and up at the back of his neck. I'm not liking that so much as I cannot see whats moving thru the tube but I'll manage over the weekend. I'm now removing the syringe after getting in the mL and watching it until it moves to ensure stuff is moving down. Their thought is that he's not empty enough to get more in so give even less volume, more often and don't get hung up on getting in 25mL per feeding. 

In the past I'd been instructed to check the site daily and clean it if there was drainage. But it's been dry since shortly after this tube was inserted. I cleaned it when there was a bit of drainage early on but since then I've just checked it and left it alone. I encountered a fabulous tech last night who helped me better understand the how's and why's and she said to clean it gently with hydrogen peroxide on a q-tip every 3-ish days to reduce any bacteria that may be lurking.

They X/R'd the tub placement and it's in the correct place. It was working for them but this tech got the back flow also. She said just go slower to allow it to get in without overloading his tummy. She was doing about 1 mL every 30 seconds and waiting seeing that it dropped thru before doing another. I was doing that yesterday but not much was going thru.

And drum roll please.... he gained .24 of a pound!!!! YAY!!!!! this has been the first gain for a while and it was wonderful to hear this.

His mood has been so great these past few days so I'm reading this to mean that he is feeling a tiny bit better. Yes he's a senior kitty and yes he's not running about like a care free little kitten but he's definitely not ready to give up or be done with all of it, imo.

Thank you both for caring!

 @ mrsgreenjeans, I wanted to thank you for posting that link the other day to the grace site. I'd seen it back a while but in rereading it again plus your comment on positioning him more upright  reminded me of that important detail.

With my nervousness of him vomiting and all the other issues I did forget that at times.  Since your post I've have ensured his head and paws are more upright. This I feel  has helped lessen the flinches or subtle nuances I would usually get. I also feel it's helped lessen the overall vomiting as he's had less episodes and less volume over the past few days.

It may just be coincidental as maybe he's just getting that tiny bit better also. It's hard to discern but we do know it all adds up to help lessen the nausea etc.

I'm so glad you reminded me of this. It's not as though I was letting his head dangle down over the side of the sofa but there were times when he was curled up sleeping. I would leave him like that thinking he'd maybe doze through and not notice me.

In hindsight I wonder how much this added to him not tolerating the feedings. It makes purrfect sense and I regret not tuning into this better when I first read that article. 

I was so hung up on getting volume/calories in and hung up on the speed and focused on slowing it down. Properly position him was never mentioned when we started. The focus was going slow to reduce nausea/vomiting while working to get in the calories in. 

Thanks!

I'm SO glad to hear he's acting a bit happier AND that he's gained a little weight   Both of these are good signs

Also, so glad I  could be of assistance   That makes my day

I remember when Patches started eating a little on his own he started to recover much faster.  Even a little bit is very good, when they are deep into this they won't eat at all.  

Kate007 said:

And drum roll please.... he gained .24 of a pound!!!! YAY!!!!! this has been the first gain for a while and it was wonderful to hear this.

Click to expand...

I agree that this is great news! 

Continued vibes for your boy... 

Hi,

I wanted to let you know that my sweet boy lost his battle. Things happened very quickly last week. I'm still reeling and working to adjust and come to reality with the fact that he is gone. For whatever reason losing this little guy has been so difficult.

Last Saturday I took him into the E Clinic because my little guy was so nauseous. The ER doctor was great and while she was checking him over I noticed that his ears were looking yellow! I asked her if she thought so too and she did - but also thought it could be the lighting.

I'd just had him at the doctors on who were following him for the liver issue on Wednesday and his labs had improved.

I'd brought a copy of them along Saturday and we decided to check them again. These were extremely elevated! I was stunned and so upset. She kept him in the ER hospital until Mon. morning  - on IV fluids, hoping to flush him out and bring the levels down and on tube feeding by pump.

On Monday I got him in to see the Liver Vet. She repeated the U/S and labs again. The labs remained elevated and the U/S had not changed from the prior U/S so she started him on antibiotic's.

On Tuesday evening I was having terrible issues with the feeding tube back flowing and he was so nauseous and now was salivating a lot so I scooped him up and took him into the E Clinic again. They X/R'd  the tube and it was ok - they said to try to feed him what I could and contact his Vet in the am. He was very thin and had been losing a tiny bit of weight each time he was weighed.

As the evening wore on I was not able to get any food into that tube due to his nausea. Every time I'd even pick the syringe he'd begin salivating and I didn't have the heart to try to get some food into him and risk making him vomit.

By the middle of the night he was not able to stand unless I was holding him and he was unable to pee.

 I knew it was time to let him rest in peace so in the early morning hours he made his way over the Rainbow Bridge. 

I miss him terribly. He was the best kitty ever!

I love you forever JJ. Rest in peace Sweet boy <3

I am so sorry for your loss.  You did everything you could, unfortunately sometimes these kitties don't make it.  You can wright a memorial for him in the crossing the bridge forum.  http://www.thecatsite.com/f/19/crossing-the-bridge

I'm so sorry JJ lost his battle. It certainly wasn't for lack of trying on your part!
Rest in peace, little one.

This thread will be closed now, as per TCS policy.
K kate007 when you feel up to it, please consider posting a tribute thread in Crossing The Bridge.