An e-tube mystery for a recovering constipated kitty

[kittyquester]

After hours of forum digging and a couple of stumped vet visits, I thought I'd consult the biggest kitty community I've found to see if anyone else has had a similar experience with their cat's e-tube (esophogostamy tube in neck). Everything seems fairly textbook about his feedings, EXCEPT, every day, even if almost no air goes INTO Charlie Toaster (because we're very careful about avoiding air bubbles), he seems to be producing gas that comes back UP the tube, forming a long bubble in the part of the tube that's outside his body, usually a few hours after a feeding-- I'd say every day, at least a 1-2" bubble worth of gas accumulates there. (Unlike some e-tubes I've seen, Charlie's is a clear/transparent tube.) I can't easily "pull" the gas bubbles up and out of the tube using a syringe; almost like it has extra vacuum pressure? The vet also found it strange, but not overly concerning, since he's otherwise doing well and I guess she didn't hear anything worrying when she checked him out quickly listening in with a stethoscope. She's extremely busy currently, so we haven't been able to do much following up or additional tests since his e-tube was placed and his emergent constipation problem was solved, though we're moving toward a diagnosis of IBS I'm guessing.

A bit more context if it helps-- for now, Charlies's back to normal or maybe even better-than-normal functions peeing and pooping perfectly with a combination of diet change (now on Royal Canin Fiber Response Gastrointestinal Diet) and lactulose (for stool softening), with Cerenia daily to suppress nausea, and plenty of water. On the flip side, he's still more lethargic than usual, and he hasn't fully regained his once healthy appetite. He avoids all forms of wet food, even the Churu treats he once loved. He only seems able to handle about 50 max cc in a single sitting of any combination of food and water and meds, before it's clear he's feeling full and might vomit, and we always stop when those signs begin. I'm wondering if both the inappetence and what I'm guessing is his obvious gassiness might be related to the lactulose medication? We'd love to taper that off, and we're sort of just waiting for our vet to have the time to help us evolve his care plan. So-- biggish pockets of air going UP the tube, from his tummy or esophogus-- is that okay? Normal? Possibly a clue to his IBS (or another) diagnosis? I'd love to know if anyone else ever saw the bubble effect come up the tube, to either put my fears at ease or give me some more insight to take to our vet. Thank you!

 

[FeebysOwner]

Hi. I really no nothing but what I have read regarding e-tubes. Are you clamping the line before you remove the cap, as well as when you pre-flush, start feeding, stop feeding, and post flush, re-capping? Any time you don't, air will enter the line and his stomach. Is there any chance he is laying too flat while being fed, which can cause reflux, which could include air as well? Does the cap still fit snuggly?

It might be that you need to feed less at one time, as opposed to waiting to start seeing signs of what could be food overload.

I have also read that pulling back on the syringe can often be met with resistance, at which point in time the process needs to be stopped immediately - and this can be commonly a sign that your cat has not digested enough food to begin another meal. I suppose the resistance could be from the air build up but pulling back on the syringe - one way or the other - means to stop.

If you really think the lactulose could be the cause, can you use another form of a laxative, or perhaps even Miralax instead?

I hope others who know from direct experience will come along soon and have some ideas for you!

 

[kittyquester]

Hi. I really no nothing but what I have read regarding e-tubes. Are you clamping the line before you remove the cap, as well as when you pre-flush, start feeding, stop feeding, and post flush, re-capping? Any time you don't, air will enter the line and his stomach. Is there any chance he is laying too flat while being fed, which can cause reflux, which could include air as well? Does the cap still fit snuggly?

It might be that you need to feed less at one time, as opposed to waiting to start seeing signs of what could be food overload.

I have also read that pulling back on the syringe can often be met with resistance, at which point in time the process needs to be stopped immediately - and this can be commonly a sign that your cat has not digested enough food to begin another meal. I suppose the resistance could be from the air build up but pulling back on the syringe - one way or the other - means to stop.

If you really think the lactulose could be the cause, can you use another form of a laxative, or perhaps even Miralax instead?

I hope others who know from direct experience will come along soon and have some ideas for you!

Good questions! Luckily our vet hooked us up with one of the multi-port tubes where we have a kind of lever to open/close the tube before the "port", and ensure no air gets in even when the cap is removed briefly to attach a luer-lock syringe. Our vet did think it might be possible some component of the tube system might be leaking a bit of air somehow even when closed, but when checking it out she ditched that theory? It's odd! I do wonder about reflux though-- he's mostly sitting upright or in loaf pose while we feed/med, but actually, the only way we can get him to stay still long enough is to also be dangling a fun toy for him to watch-- so maybe he's breathing in extra air because he's excited about the prey? Hm... I wonder if something in the RC recovery food itself might cause the reflux? Perhaps we could try a different wet food diet, though the big calorie boost is nice.

Either way I do think both the reflux and the full tummy are worrying signs, and good thought too that I'd like to switch to miralax once I get our vet's go-ahead. Thank you for taking the time to share your ideas, it is much appreciated!