Help kitty just got a feeding tube

squeakyflorida

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Hi there I'm new to site my kitty just got feeding tube. I'm in the dark her, any tips? Really hospital advised no foods till tomorrow, just had the placement 5:30pm eastern, the tube outside the body is 7.5 inches long wrapped around her neck with port in front of her neck. Secured with "Kittykollar". Please any input would be much appreciated,




Two worried pet parents
 

crimmie

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Sorry you are going through this...I'm new here too.  I may be in your shoes at some point here...  I have no experience with a feeding tube, but I would say to follow your vets orders.  Poor kitty...why was the tube placed?  
 
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squeakyflorida

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Squeak has hepatic lipidosis. We tried assisted feeding via syringe, failed at getting requiered ML's into her. We can start tube feedings tomorrow. Tonight She's still very lethargic from the anesthesia. I'm concerned the Tube/port is too long. How's she going to get comfortable with tube wrapped around her neck and port up under her chin?


What should I look for with feedings. How many ML's should I push if instructions are 1/2 can science diet A/D?
 

stephenq

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Squeak has hepatic lipidosis. We tried assisted feeding via syringe, failed at getting requiered ML's into her. We can start tube feedings tomorrow. Tonight She's still very lethargic from the anesthesia. I'm concerned the Tube/port is too long. How's she going to get comfortable with tube wrapped around her neck and port up under her chin?


What should I look for with feedings. How many ML's should I push if instructions are 1/2 can science diet A/D?
Take the 1/2 can of A/D, and either smoosh it in the back side of the syringe, or draw it up through the front if you can, and count the ML's.  Are they saying to do 1/2 can per meal or per day?  Tube feeding is generally much easier than syringe feeding orally, but you have to go slow and watch for signs that you are going too fast.  If your cats starts licking her lips while you're feeding, it means you're going too fast and she's getting nauseous and you need to pause until she stops the licking, and then slow down generally.

It's also important that you clean the port after feeding as per your vet's instructions.  All of this is a life saving technique that has a high success rate.

What was the cause of her original loss of appetite?
 

denice

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My vet showed me how to do it before I took him home, I think it's odd they didn't do the same for you.

My vet had me mixing the food half and half with water so it was very thin.  I was feeding 60mls of the diluted food 4 times a day.  The syringe they gave me was marked and was a 30 ml syringe so it was 2 syringes each time.  Patches stayed at the clinic until they had him worked up to full feedings.

Denamarin really helped my kitty.  Even after he was eating well his numbers wouldn't come down so the vet had me start giving the Denamarin.  His numbers came down after starting the Denamarin, it could've been a coincidence but it is something to ask your vet about.

You also want to go real slow just as in syringe feeding.  Give a little wait a bit and give a little bit more.  It would take me 15 to 20 minutes to finish a feeding.
 
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mrsgreenjeens

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I will admit I've never seen a "get-up" like the one Squeak is wearing before, but it actually looks pretty neat.  Nice and tidy.  You need to have the tube fairly long so you can maneuver around, so I'm thinking perhaps you need to unvelcro the collar so the tube is long in order to feed him  ,then wrap it back up around him after cleaning him up?  Just obviously not too tight, or too lose. (I just googled the Kitty Kollar and they say have one finger under it and that's the right tension on the Kollar.  Here's their website:  http://kittykollar.com/living-with-an-e-tube/changing-the-kitty-kollar/   I just can't believe they didn't give you instructions.   In viewing the Kitty Kollar video, that tube is shorter than any I have ever seen.  On your girl, can you double back the tube and secure it under the same vecro fasten so the port is on the back of her neck.?  How many strips of velcro ARE there?  I would be good if there were at least 2 to really hold the tube in place, because once she starts moving around, you don't want it to be able to catch on anything. 

Everything Denice said is true.  You will probably need to thin down the A/D somewhat so you can suck it up into the syringes, then go R E A L L Y slow.  If you go too fast, all that food may came right back out.  I did that one time.  Just emptied the syringe all at once and the whole thing came right back out.  Boy did I feel horrible. 
  But we learn from our mistakes.  From then on out it was nice and slow.  And I gave my Bashful feedings every four hours..can't remember how much though because it was a very long time ago, and his tube was directly in his tummy versus esphophagial. 

If the Vet didn't mention giving any type of liver supplements, then I would give them a call and ask about them.  If you don't want to try to pill her, there are things you can add directly to the syringe while feeding her, like Milk Thistle and Vitamin E, minimum

.

.
 
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squeakyflorida

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First of all thanks everyone for your feedback I'm so glad I found the site!

January 2014 Squeaky, female not yet 12 years old. . Was diagnosed with pancreatitis and hyper thyroid. Treatment began with Lasix and prednisone and Methimazole transdermal. February2014- March2014 shes developed idiopathic plural effusion. Requiring five five needle aspirations. At one point they saw a consolidation in the lung and thought it might be cancer. Nothing definitive Regarding cancer of lung or metastis. We opted to not get tested as the vet stated life expectancy six months. Her lungs are currently clear of consolidation. The lungs have been clear since June 2014.we continued to treat with treat with Lasix ,Prednisone & methimazole. Follow up blood work in February 2015 showed increase in T4 levels. The vet increased Methimazole by 50%. successfully bringing T4 levels down to normal as of June 2015.

Now June 13, 2015 Squeak (13 1/2 yo) presents with vomiting once a day for four days. Weight loss and lethargy-loss of appetite. She became anorexic. She spent 2 1/2 days in vet hospital with supportive fluids, her regular meds with the exception of methimazole (which has been stoppped). suspected diagnosis hepatic lipidosis primary cause possibly include differential diagnoses include: Lymphoma, inflammatory bowel syndrome, infection, drug toxicity. We attempted to assist feed her to reverse the hepatic lipidosis without success. Ultimately feeding tube was placed and happy to report after researching and reviewing other blogs and feedback from folks on the site Squeaky was able to tolerate 60 ML's of food. We have been feeding very slowly thru the tube to avoid reflux or vomiting. Meds are being administered into tube all liquid compounded ( Lasix, prednisone, antibiotic, Reglan, urisadil, denamirin). Squeak has never had general anesthesia and I am concerned she is still lethargic 24 hours postop. However, she has also been without nutrition for greater than nine days. That could have some impact as well. Any feedback from parents with hepatic lipidosis kitties and feeding tubes? How soon can we expect to see increase in activity? She is and has been drinking lots of water pre-and post up, and using litter good urine output and one tiny bowel movement today. Our understanding is if we can get the nutrition going we can reverse The hepatic lipidosis.
 
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squeakyflorida

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Thanks Mrs. Green jeans, we found the site last night that's why we were freaking out about the length of the feeding tube. My husband is doing the feedings during the day the squeaky is his baby girlbut ironically she would only let me do the syringe feeding LOL. Squeaky is tolerating the tube feedings well so far. The kitty collar site is a great source of information regarding tube feedings and purchasing the appropriate syringes. We also found that placing Squeak on a foam wedge where her head was higher than her stomach is supposed to assist in the flow of fluids.
 
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squeakyflorida

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Also wanted to add all her meds are compounded liquid form, tuna flavored given orally prior to feeding tube. Before tube Squeek was getting Lasix, prednisone. Administrated by my hubby. Squeak would just lick it off the syringe!!! Locating a compounding shop that can compound meds in liquid form with tuna flavor was a blessing!
 

mrsgreenjeens

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So glad things are going well.  are you crushing the Denamarin to give it via syringe prior to feeding?  Everything I've ever heard says it isn't effective unless given whole....we had a real problem with our girl when trying to give her that, finally just had to give up because it's kind of big and she's under 5 lbs yet has the jaws of a pitbull.  We discussed many options with her Vet and finally came up with just giving her Vitamin E drops in her food.  And, yes, compounding pharmacies are a God send
  We use them for transdermal gels for our girl's appetite enhancer AND for he Fanotudine (Pepcid A/C) shots since she's impossible to pill.  BTW, our little one does NOT have HL, but kidney disease with a side order of slightly raised liver values
.    But we DID have an HL cat many, many years ago


So, back to Squeak (sorry, I'm easily sidetracked
)   Now seeing the new picture with the tube doubled back, it DOES seem a little long.  Next time you go see the Vet, I would have them cut it off a little bit.  I'm sure they can do that and  just put either a new port on or the same one back on.  I'm afraid once Squeak starts feeling better and moving around more, that loop might get caught on something, since it's so big.  unless there is any way you can pull the port forward and secure it under the line that's actually running through the collar.  Or if you have a hairband or something you could put around the kollar and use to hold down that loop?  Something just to keep it from getting caught on things as she walks around?

as to her lethargy, I imagine it will take some time for her to gain back much energy.  Nine days without nutrition is a long time.  My HL cat was actually on his feedng tube for four months.  Some cats bounce back within a couple of weeks, some take much longer, and I'll be honest, some don't make it.
  What did your Vet say her chances were?  I don't  notice her being yellow in the pictures...is she?  My guy was really yellow, and I've seen pix of black cats where it was pretty noticeable.   Anyway, she's getting good nutrition, she's not throwing up, she's on antibiotics, the ursodiol is good for her liver,  not sure about the denamarin, but even crushed should be better than nothing, IMHO, she's getting her other meds, so seems like she's in great hands


I'm wondering if she had a pancreatitis issue that caused this in the first place?  I guess no way to know.

that she starts to perk up soon.  Oh, and BTW, once she starts to nibble at food does NOT mean you can stop the tube feeding.  She will need to do both for awhile
 
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squeakyflorida

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We had the Denamarin compounded to liquid form. Mfg brochure states shouldn't be crushed because coating protects pill from digestive enzymes of stomach. Will call pharmacy to see how they compounded. Her IDX blood test shows negative for pancreatitis. Ultrasound .lit up but could be scar tissue from last years bout. Studies we have read is 60-90% chance to reverse HL, issue is what's underlying cause for anorexia resulting in HL. I'm off next 4 days so hubby and I are on kitty observation. Sadly we have to keep her from her mama as Mama kitty ALWAYS attacks her initially when she comes back from vet. We ordered new collars from kittykollar that aren't so wide and better syringes from them. The ones from vet degrade after several uses and Washings. O ring syringes supposed to last and work better. We are hopeful but not unrealistic of her chances. Fortunate that we could give her the care she needs. We were torn weather or not to place tube. So kitty prayers all around for our baby:angel:

Oh inside of her ears showed signs of jaundice las Saturday.
 

mrsgreenjeens

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Wow!  Interesting on the Denamarin.  I just checked our compounding pharmacy and they don't do it
  That's too bad because my girl needs it.  I DID read, however, that if you crush it, you should try to remove the enteric coating, and then give twice as much for it to be effective.  (at least that's how I understood it).  I got that from a 10 plus year old blog from the manufacturer's site)  Anyway, moot point at the moment.

I've got a cat who always growls whenever anyone comes home from the Vet.  Know what helps?  Brushing both parties without cleaning the brush off.  First brush Squeak along her shoulders (if you can), or side, just a couple of strokes, then immediately brush Mama cat, then go back to Squeak.  This transfers the scent from one cat to the other so she doesn't smell so foreigh.  Do this several times and it may help ease the transition. 

Yes, definitely CAN survive HL.  I wondered if the Vet drew blood what he thought after seeing her liver values?   Sometimes they are absolutely thru the roof, and even so sometimes the cats survive.  The feeding tubes help immensely...much better than trying to syringe feed without it. And you bet you need GOOD syringes as they will be getting LOTS of use.  Order plenty, because even the best will start to stick after awhile.

I am ashamed  to say that with our Bashful, we didn't realize there was a  problem until we noticed how yellow he was...especially the area between his eyes and ears.  This was when we were free feeding and working tons of hours and just didn't pay enough attention to what was going on.  I think we had 3 cats at that time too, so the food dish was still being emptied, so we were none the wiser.   Hopefully I'm a lot wise now (with age comes wisdom AND experience). 

for your baby girl. 
 

denice

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My kitty survived.  He went through this 4 1/2 years ago and he is still here.  It is a long recovery though and my kitty anyway was so sick.  When he did start to recover it was a night and day thing.  One day he was laying around and staying under the bed a lot and the next day he was acting normal again.  It did take a long time for his liver enzyme numbers to begin dropping though.  The one my vet watched was his ALT and it actually continued to rise even after he was eating well on his own.  That was when the vet suggested the Denamarin.
 
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squeakyflorida

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Her labs the first visit 6/16: ALT 3459 u/l, ALKP 225 u/l, TBilli 4.7 mg/dl
6/22 after attempting syring feed and off thyroid meds ALT 858, Tbil 10.8
As of wed with fasting(tube placement day) her labs were.: Chem4, electrolytes: ALT was increased (1516 U/L) and TBili increased (12.xx mg/dL)

Here's 6/22 notes: Feeding tube placement
Diagnosis/Assessment:
- Inappetence: suspect hepatic lipidosis, but also consider an underlying primary disease process, which could include infectious disease, inflammatory, neoplasia, other
- Elevated liver enzymes, hyperbilirubinemia: possible causes include methimazole toxicity, hepatic lipidosis, secondary to pancreatitis and subsequent inflammation and cholestasis, cholangitis, neoplastic disease (lymphoma, carcinoma, other), infectious diseases (cholangitis/cholangiohepatitis, parasitic disease, fungal disease), other
- Liver nodule (historical, no significant change from previous measurements)
- Hyperthyroidism: historical
- Heart murmur (historical)
- Pleural effusion (idiopathic): historical
Medications:
• Prednisolone 5 mg/mL #60 mL: Give 1 mL by mouth every 12 hours.
• Denamarin 90 mg tabs #30: Give 1 tab by mouth once daily.
• Ursodiol 100 mg/mL #20 mL: Give 0.5 mL by mouth once daily.
• Vitamin B12: This is recommended once weekly for 6 weeks then every other week for 6 doses.
• Cerenia 10 mg/mL #5 doses: Give 1 dose (0.5 mL) subcutaneously once daily.
• Mirtazapine and Reglan: Continue as previously directed.

Anyone with tube feeding experience, she gets really sleepy after food & meds. Is that normal? She will walk short distance then stop and "rest". She's sleeping a lot & staying close to either me or my hubby. When laying down on carpeted floor she changes position a lot, again is that normal? This is only day 2 of feedings we will get approx 60ml's in her today by midnight.
 
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mrsgreenjeens

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I honestly don't know how to read the liver values, just wondered what the Vet thought were her chances after viewing them.  But as Denice mentioned above, her little guy's ALT went UP first, then back down, so what's happening here to Squeak seems to be mirroring that. 

My guy was on his feeding tube probably at least 15 years ago, so I don't remember how he reacted after his feedings, but seems like most cats after a regular meal take a nap.  And remember, she's got to be low on energy because of that lack of nutrition she had.  She just trying to catch up now so lots of resting/sleeping is quite normal, I expect.  Also, changing positions may be due to the tube and collar....hard to say exactly.

So is 60 msl 1/2 of a can of A/D?  That doesn't sound like very much.  Denice was feeding 60 mls FOUR times a day.  (and I can't remember how much I was feeding, but was doing two biggish syringes every 4 hours - Bashful was a BIG cat...not sure how big Squeak is)
 
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squeakyflorida

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Vet advised 60ml's a day (1/2 can) of A/d first 3 days then we increase, vet wants her at 220ml's a day . Our kitties are grazers, dry food out all day. She's a tiny thing last weight was 8lbs, so going to be interesting. We are day 3 of tube feeding and exhausted! Not counting the 4 days I attempted syringe feedings (4hrs to get her to sorta take in 5ml's at a time)! No idea how you guys with kids handled those every 2 hr feedings! I think we finally figured a decent schedule we have liquid meds that have different admin times from feeding times. We are gonna bump up her food slowly to ensure her little tummy can handle it! Oh and hey http://kittykollar.com folks were soon helpful! They can custom make the feeding tube collars and were key in helping us get the correct syringes for Squeaks port and overnighted the supplies in time before those cheap syringes crapped out. Can't express enough my appreciation for this site and everyone's feedback. Thank you
 
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squeakyflorida

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Denice, is it normal to hear gurgling when you take cap off tube prior to feeding?
 
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squeakyflorida

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Feeding tube setback:
Today is day 4 feeding via EFT, starting at 4:45am Squeak handled (med all compounded to liquid) Demeron then 1 hr later Ragland, then 30 min later, lasix,pred &16 ML's food.
With approx 4Mls water flush pre/post each administration

11:00 am regland, 11:30 urisidiol and antibiotic. She got real squirmy while getting meds started licking her lips. ttried to get away from us. 2 open mouth breathes, Then she vomited before we could start food. Very brown liquidy mess, Tube seems ok, vet says hold feeding till 6pm. Regland 1/2 hr before and give antibiotics 15 min after food. We have one injection left of Cernia debating whether or not to give it too her. Would have to wait 6 hrs before feed again. She's been off Cernia since 6/25 Thursday. Vet would not give us additional 5 day injections. Guess they don't want them on it for greater than 5 days in a row

2 things may have caused nausea/vomiting.
1. I blended science diet a/d with 16ml's water vs yesterday where I just free poured so food while liquids may have been a little thicker than yesterday (to much for to handle?)
2. We gave liquid antibiotic prior to food (caused nausea) would think she'd still have food in tummy from 6:00 am feeding

I could just cry! She's been doing so good! Since vomiting she's peed twice & drinking from water bowl. Stayin in small spaces in guarded position with 4paws tucked under her. She came out to me when I laid on floor to pet her, purring and single meows(squeaks) when I speak to her. I'm sleep deprived, worried and want her to get better now. We take the feeds super slow 1ml a minute. Feeling defeated right now:sniffle:
 
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mrsgreenjeens

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It's natural to be feeling depressed, but with this type of illness, there are going to just be bad days
.  It happens. 

Did she vomit almost immediately after she got the antibiotic?  I don't know if it was the antibiotic that caused it or not, because it doesn't sound like it was in her long enough to cause it, however, it doesn't take a  cat long to digest their food (2ish hours), so her tummy should have long been empty, especially with just 16 mls of food in it from 6 a.m. (if I'm understanding correctly)
Denice, is it normal to hear gurgling when you take cap off tube prior to feeding?
When you want to "tag" someone, type an @ sign and then start typing their name.  A dropdown with names will appear.  You need to select the person from the dropdown menu and then they should automatically be notified that you need them
  Their name will show up like this @Denice (in blue) so you know it worked.  I have now tagged Denice for you.  My question on that gurgling...does it do it all the time, or only the time when she actually vomited? 

BTW, Cerenia is normally given 5 days on, 2 days off.  So....today would normally have been the day to start it up again.  THAT could be the issue...time will tell.

I honestly don't think it's that the A/D is too rich, considering you only give her such a tiny amount, and that should have been well digested already.  (should have been anyway). 

So all those meds are supposed to be given on an empty stomach?  I'm guessing so, but honesty don't know since when we had our HL cat, I don't think they even had any of these meds. 

Try to remain calm.  As I said, there will be good bad days with this.  It doesn't mean she's not recovering.  My own kidney cat is having a bad day today too. (she also vomited this morning, not really like her lately)   Some times they just have bad days, which makes US have bad days too.
 

misty8723

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The kitty collar site is a great source of information regarding tube feedings and purchasing the appropriate syringes. We also found that placing Squeak on a foam wedge where her head was higher than her stomach is supposed to assist in the flow of fluids.
This is the length Cindy's feeding tube was. I can't remember why the vet said they liked to leave it that long.

One suggestion is that you measure the length and make sure it doesn't start slipping out.  Cindy's came out once, but it's pretty easy for them to put it back in.  She also had the Kittykollar.
 
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