Fatty liver disease, feeding tube addiction and when to offer food- Please help

I made a post about two weeks ago here about my cat Princess' diagnosis of hepatic lipidosis- fatty liver disease. After our initial FAILS at syringe feeding by mouth we decided to have a feeding tube put in. That was done on Friday September 5. She stayed at the hospital from Thurs the 4th until 9 pm on Saturday the 6th when we took her home. Since then we have been faithfully tube feeding her increasing amts of food (Hills A/D, now she is at her max, 66 cc 3x a day) along with pepcid, ursadiol and amoxycillin. (Diff times of day.) She's doing better- more active, playful, alert - more like "herself." (Before she was lethargic and depressed, only crouching in one area.)

I've been searching the web religiously for info on FHL- so many conflicting reports! Some sites say 2-3 weeks for recovery, others 3-6, others say expect months of tube feeding for the appetite to return to normal. Obviously anyone who has done this before knows how taxing it is! We love her to death and were willing to do the "aggressive nutritional support" to reverse the liver damage.

We have, at the urgency of our vet, offered her some food- dry, treats, canned at various times- all of which she has declined. Many sites say do NOT offer food during recovery bc it will further her "food aversion," which she definitely has, clearly the hallmark of this disease.

I would love some support/advice as this is a tough time.

1) what is the expected recovery time for a cat with FHL, feeding through an esophogeal tube?

2) should we be continuously offering food to her, and if so, what, and how often?

Your help is appreciated

I wanted to edit my post but didn't see how- the other question is- can a cat get "addicted" to a feeding tube? She seems to be very relaxed and purry during her feedings, doesn't mind it a bit! My fear is she discovers tube feeding more "enjoyable" than eating actual food and refuses to eat normally because she likes the tube.

My kitty had a feeding tube in for about a month.  He began nibbling at food the 2nd week and was eating normally by the 3rd week.  Recovery times vary, I believe that my kitty recovered a little quicker than average.  I have never heard of a kitty becoming addicted to the tube feedings.  I didn't try to force him to eat, I just left kibble down for him so if he wanted to eat it was available.  After he was doing more than just nibbling a little at the kibble I started offering a little wet food, again I didn't try to make him eat it was just there if he wanted it.  I think food aversion happens with forced feeding, it is one of the possible bad side effects of syringe feeding through the mouth.

Well that is reassuring news--about the "addiction" fear. We are just having trouble grappling with the uncertainty of how long it's going to take, and whether she will pull through or not. I just keep praying she gets her hunger back soon!

PS I'm glad your kitty did well and made a full recovery with the help of the tube

My HL kitty was on a feeding tube for four months.  Sorry, it was so long ago that I honestly don't remember at what point he actually started eating SOME on his own, but do know that just because they start eating again doesn't mean you can pull that tube.  They can easily stop eating again in a heartbeat, so they still need to be monitored closely for quite some time.

Best of luck to you and your little one.  At least she isn't fighting you, and is keeping the food down.  That's good thing .  Do you have her on some liver supplements like Denamaren, or some other forms of Milk Thistle and/or Sam E (aside from the items you already mentioned)?  They are very good to help the liver recover.

Hi;

They don't get addicted to tube feedings. You can offer food in addition to the tube feedings provided that the tube is only there for the anorexia and not another issue such as strictures etc. Just leave a small amount of food in a bowl and see if you find her nibbling on it. Still even when she starts eating on her own it is a good idea to leave the tube in for another week.

You can talk to your vet about reducing the feeding times and or altering the schedule to fit yours a little better but you cannot exceed the amount you are feeding right now and you shouldn't start changing things up if what you are doing is working right now. Is it just the being home three times a day that is the problem or is it the time involved in the feeding?

@mrsgreenjeens  - Thank you for your reply  That is a long time (4 months!) and we are, frankly, afraid of that type of recovery time.  This weekend will be two full weeks. I'm not expecting a full recovery by this time but it *is* challenging. She keeps her food down very well, minus one time we fed her too much too fast, and haven't had a problem since. When she "gulps" while we feed I just give her a break. I watch YouTube videos or work on schoolwork while I feed her so I don't rush.

I heard Denamarin is good for cats (and dogs) w/ liver issues, so I had ordered some off of Amazon, along with a piller and "Greenies" pill pockets. The thing about Pcess is she HATES being pilled, and giving her the appetite stimulants the vet initially prescribed (begins with a C, I forget, they did nothing) upset her a LOT. Drooling, spitting, you name it. We watched so many vids on how to do it to no avail. It was so bad to the point we were just throwing away the pills as they disentegrated in her mouth (probably tasted really gross, poor girl.) We simply couldn't get them in her.   Given that she is already under a great deal of stress, we elected (and the vet agreed) to give her meds in liquid form, so they go thru the tube only. Mucchhhh easier! When I found out that Denamarin cannot be crushed I returned it, even though the vet said it was good (they didn't prescribe it or even mention it to us, I bought it myself).

Anyway, I am on the hunt for a liquid form of Denamarin or similar (milk thistle maybe) if that will help her. She's taking 3 other meds and I don't want to overwhelm her!

@Quiet Glad to hear feeding tube "addiction" isn't a "thing." We were quite worried because she does seem to really enjoy the process for the most part, or at least not mind.

My boyfriend and I both work full time; he has an early schedule where he leaves earlier and gets home earlier. Currently we do 66 cc 3 times a day which was ok'd by the vet- 5 am, 3:30 pm (when bf gets home, I'm still at work) and around 9:30 pm just before bed. We know four feedings would be ideal but short of quitting our jobs we just can't do that. I don't have a flexible job and can't take non paid time off, that means every hour I miss comes out of vacation time- there has been a lot of that used up already. I guess the good part is she seems to be tolerating what we're giving her pretty well.

Currently we have a bowl of dry food and fresh water in her "room" and I have not noticed her showing any interest. She's licked some wet food and treats but she always turns her head away like she's disgusted.

OK, my own little girl (currently with a liver issue but NOT HL)  is horrible to pill also, so after two weeks on the Denamaren and many bloody fingers from fingers from  scraping across her teeth, we also searched for a liquid equivalent.  I think we have found it, and I'm still waiting for it to arrive.  Here's what I have ordered:  http://www.onlynaturalpet.com/produ...ium=email&utm_campaign=orderdetails2014&nco=N     I figure it's better than nothing.  You can also order Milk Thistle in powder form and add that to her food in the feeding tube.  Just google Milk Thistle powder. 

She is probably turning her head away from the food right now because with HL, sometimes the ACT of eating makes them vomit.  I honestly don't understand it, but if the food goes directly into their stomachs, it can usually stay there, but it's the getting there that's the issue.  So....just smelling that food is probably making her nauseated right now

Four months for my old guy was probably out of the norm.  That was at least 15 years ago, and they didn't have him on ANY other meds, so nothing else to help him heal, and it was before I knew anything at all about cats, and before the internet was so widely available to do any research.  And we had to assist feed him every four hours!  Luckily I worked days and my husband worked nights, so we could accomplish the feat, just didn't get much sleep.  It twas like having a newborn

Oh thank you! I ran that medicine by the vet hospital that's been treating her, they'll let us know if that's ok to use and what dose to give.

It's been a rough day, I'm at work and my bf came home to find that she had basically ripped off her bandage and had to get it changed, even though we changed it on Sunday. Oy!

I do think nausea is a big problem. I feel so bad for her, I know that being nauseous is the pits - poor dear. And at least you got through it--but yes, it is like having a newborn. Everyone at my work knows about our "cat crisis" and luckily my boss is really understanding. That helps.

One of my cats developed a fatty liver. We had to syringe feed her 4-5 times a day, and we did it for a good month, maybe 5 weeks. In time you cat will get its appetite back. It's frustrating at times, but know that all the cat needs is food and it will get better. In terms of what to feed your cat, if the hepatic lypodosis was not due to a different underlying problem, like ibd, whatever it was eating before, should be fine to continue. I would reccoomend grain free foods, as cats really don't need grains at all in their diet, and the extra sugar just leads to increased weight and other health issues. 

I didn't see that any of her meds are actually for nausea.  Is there a reason for that?  (maybe they effect the liver adversely?)  My furbaby with liver issues was given Cerenia to keep her from vomiting, so I'm thinking there shouldn't be any issue with it and the liver.  I know she's on antacids and something to help with bile flow , but not an actual anti-emetic.  Maybe that would help?  Can't hurt to ask. 

@mrsgreenjeens  - she isn't on anything for nausea, just pepcid for "heartburn," but bf hasn't been giving it to her bc he's too lazy to crush the pill... who can blame him really, the ursidol and amoxy are a lot to administer now. We plan to take her to the vet on Sat for a checkup and bandage change. Her bandage slipped again yesterday, exposing the stoma, and bf had to take her to the vet AGAIN. She was given a "sticky" bandage so hopefully that will stay on better.

No sign of appetite yet. It will be 2 weeks tomorrow night. I guess it's still early in the game, but we had hoped she would at least be picking by now. There are still things we haven't tried though... so we're going to persist!

Giving something for nausea would probably be well worth the effort, since she's more likely to try eating on her own if she isn't nauseated.

Why don't you have the vet hospital show you how to do your own bandage change. They aren't that hard and it will reduce stress and cost. With the pills I don't see what the problem is in giving. Just crush the pill with the back of a spoon and put into the tube with water or mix with the food. The Pepcid should be before food so just put it into a syringe with water and it will dissolve and then put it in the tube and flush with a couple cc's of water (warm) then proceed with the feeding as instructed. With any other medications as long as they can be given together just put them in the food or dissolve with water in a 3cc syringe.

Mine has been on the tube a little over 2 months now. We thought she was better after 3 weeks because she ate (normal for her, but not enough). Became nauseated again, vomited, more jaundice), so we went back to aggressive tube feedings. She is eating about 1/2 of the small cans of wet food and noshes on the dry. We still tube feed her 65-70 ml of slurry 4 times a day. Maybe one day.........

Anyone know if you can give cat a pill with an e-tube in place?

I couldn't do the feeding tube for my cat, but I syringe fed her for 8 weeks.  I could tell she was felling better, but it was like she was used to me string feeding her (even though she hated it) and would not eat on her own.  So, I gave her an appetite stimulant that my vet had issued (mirtazapine) and put the food in front of her and voila.  She ate on her own.  Once she ate on her own that day, I only syringe fed her if she didn't eat at least a big can per day.  But you are right, I think they adapt and get used to being fed whether it be by tube or syringe and do not eat on their some times.  But, the appetite stimulant worked for us.