Hi, I've been reading and reading the trials and tabulations of those who've had a cat using a feeding tube for nutrition. Our story is our 17 year old male was diagnosed in Feb with HL and cholangiohepititis and possible pancreatitis. A tube was inserted and we've been on a roller coaster ever since.
The days are up and down. I've never been able to get in the needed calories for more than a few days before we encounter another issue - tube vomited out that was due to constipation. Tube reinserted and we started over with small feedings. He's continued to vomit here and there. I'm instructed to not feed again for 12 hours. But in doing this I'm never getting anywhere.
The vet had him on just Clinicare - 30cc per q 6 hours.
2 weeks ago I took him to a different ER for my concern of constipation. This vet was concerned he was not getting enough calories and suggested I add Max Cal and work to get more food into him.
I did this and noticed I heard less stomach noises as the food increased but he does continue to get nauseated and vomits. He's vomiting less volume but still seems to feel so crappy during these times. Other days when he's seeming to feel better he will sleep in the living room rather than hiding in the closet curled up in the corner.
Saturday Sunday he did well - got in almost 200 calories until late Sunday evening when he vomited. Since then I've been giving him maybe 5-6 cc's for Max Cal with water flushes and plan to do this through out the day.
He does well, then does not do well. He is currently taking Regaln 1 mL 3 x a day; ursodial 0.8mL once a day; prednisolone 1mL daily. He was on Cerenia and Ondansteton and Lactulose but these were stopped 1 week ago with the thought that these were causing stomach distress and adding to the vomiting.
I have given him Cerenia and Odansetron here and there as I'd rather he not feel nauseated and I've started Miralax instead of Lactulose to help reduce the constipation as I feel he needs something but his calcium was elevated at his last labs and I saw that Lactulose can sometimes result in elevated Calcium levels.
I have to say I've been underwhelmed with the care he's received at the clinic that inserted the tube and is following him for all of this. I'd been initially told the feeding tube would be easy for him and that cats tolerate these very well and that this was reasonable to proceed with given his renal issues are very stable and he was ok otherwise.
I've felt I've been inflicting so much torture on my poor sweet guy. His last labs had improved very much and the doctor was please and feels continuing is the right thing to do.
At a prior weekend visit to the ER at the tube insertion clinic the doctor I saw left me reeling as she felt it was time for the "hard conversation" because he was constipated and dehydrated and weak. She implied this was all unkind for him. I asked that she do the enema and that I would consult with his regular doctors.
Since then I feel so lost and really don't know where to turn or what to do. I took him to his regular vet who was concerned he was never getting enough hydration. She sent home fluids which has helped so much. She also said he NEEDS MORE CALORIES.
I feel I've only added to his deterioration listening to the clinic doctors who seemed ok with him getting 120 calories of Clinicare a day for a long time that he's been starving in spite of having a feeding tube.
Any ideas would be appreciated. I get the feeling from various vets that it's time to give up but at the same time I feel he's never gotten enough calories or proper hydration consistently. But in spite of this his labs have improved. I have to wonder how much better would he be had he received more calories and hydration early on? He's been a trooper through all of this. Last night he purred as he slept nest to me. He's weak and so thin but I have to think if he'd get more calories this could be lessened?
Is it ok to feed him sooner than 12 hours after he vomits? This morning he vomited a small amount of clear saliva after I gave him his Reglan and water flush. After that I gave him Cerenia. A few hours later I gave him 6cc of Max Cal plus water flush and he's not vomited since. I plan to give him another 5-6cc throughout the day in addition to 100mL of iv fluids.
Thanks for any ideas you might have to offer
The days are up and down. I've never been able to get in the needed calories for more than a few days before we encounter another issue - tube vomited out that was due to constipation. Tube reinserted and we started over with small feedings. He's continued to vomit here and there. I'm instructed to not feed again for 12 hours. But in doing this I'm never getting anywhere.
The vet had him on just Clinicare - 30cc per q 6 hours.
2 weeks ago I took him to a different ER for my concern of constipation. This vet was concerned he was not getting enough calories and suggested I add Max Cal and work to get more food into him.
I did this and noticed I heard less stomach noises as the food increased but he does continue to get nauseated and vomits. He's vomiting less volume but still seems to feel so crappy during these times. Other days when he's seeming to feel better he will sleep in the living room rather than hiding in the closet curled up in the corner.
Saturday Sunday he did well - got in almost 200 calories until late Sunday evening when he vomited. Since then I've been giving him maybe 5-6 cc's for Max Cal with water flushes and plan to do this through out the day.
He does well, then does not do well. He is currently taking Regaln 1 mL 3 x a day; ursodial 0.8mL once a day; prednisolone 1mL daily. He was on Cerenia and Ondansteton and Lactulose but these were stopped 1 week ago with the thought that these were causing stomach distress and adding to the vomiting.
I have given him Cerenia and Odansetron here and there as I'd rather he not feel nauseated and I've started Miralax instead of Lactulose to help reduce the constipation as I feel he needs something but his calcium was elevated at his last labs and I saw that Lactulose can sometimes result in elevated Calcium levels.
I have to say I've been underwhelmed with the care he's received at the clinic that inserted the tube and is following him for all of this. I'd been initially told the feeding tube would be easy for him and that cats tolerate these very well and that this was reasonable to proceed with given his renal issues are very stable and he was ok otherwise.
I've felt I've been inflicting so much torture on my poor sweet guy. His last labs had improved very much and the doctor was please and feels continuing is the right thing to do.
At a prior weekend visit to the ER at the tube insertion clinic the doctor I saw left me reeling as she felt it was time for the "hard conversation" because he was constipated and dehydrated and weak. She implied this was all unkind for him. I asked that she do the enema and that I would consult with his regular doctors.
Since then I feel so lost and really don't know where to turn or what to do. I took him to his regular vet who was concerned he was never getting enough hydration. She sent home fluids which has helped so much. She also said he NEEDS MORE CALORIES.
I feel I've only added to his deterioration listening to the clinic doctors who seemed ok with him getting 120 calories of Clinicare a day for a long time that he's been starving in spite of having a feeding tube.
Any ideas would be appreciated. I get the feeling from various vets that it's time to give up but at the same time I feel he's never gotten enough calories or proper hydration consistently. But in spite of this his labs have improved. I have to wonder how much better would he be had he received more calories and hydration early on? He's been a trooper through all of this. Last night he purred as he slept nest to me. He's weak and so thin but I have to think if he'd get more calories this could be lessened?
Is it ok to feed him sooner than 12 hours after he vomits? This morning he vomited a small amount of clear saliva after I gave him his Reglan and water flush. After that I gave him Cerenia. A few hours later I gave him 6cc of Max Cal plus water flush and he's not vomited since. I plan to give him another 5-6cc throughout the day in addition to 100mL of iv fluids.
Thanks for any ideas you might have to offer