hepatic lipidosis

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SuperEeyore - 29 Dec 2005 17:14 GMT

Our cat Katie is a very sick kitty. She was grinding her teeth after
eating for a while, and then quit eating and lost quite a bit of
weight. When we got her in to see the vet, they tested quite a bit of
things and concluded she did have a bit of liver disease, but agreed
it was probably a dental issue. So they cleaned her teeth and removed
a really bad tooth.

Afterwards she still didn't eat, and she favors her mouth in much of
the same way she did before that surgery on the tooth. They ended up
putting an esophigal tube in so we could force feed her in case it was
hepatic lipidosis. The first two weeks of that tube being in were
touch and go because her tummy just wouldn't hold down much food. By
the time they had us bring her back in, her ears were starting to turn
yellow, and her liver blood work showed worse numbers. We ended up
having a needle biopsy and an ultrasound done to rule out cancer or
blockages. Those tests concluded it was indeed hepatic lipidosis.

They ended up pulling her tube back out by an inch to see if that
would make her more comfortable, and it did. While she still had some
acid reflux swallowing, she was taking almost 3/4 of her daily food
goal. After four days she had even gained an ounce. We were feeling
really encouraged. I changed the bandage and there was some red at
the insertion point of the tube, so we took Katie back in to find out
she has a mild infection. We started antibiotics, and I was still
feeling rather encouraged.

Then the stitch holding her tube in place came out, and the whole tube
fell out yesterday. I am so upset because she was starting to turn
around. (Three weeks of fighting the hepatic lipidosis, but
technically only 4 days of positive effort because the vomitting was
over)

The vet gave us 24 hours to get her to eat. They even gave Katie a
shot to encourage that hunger reaction. She was so beside herself
with wanting to eat while the shot was in full force, but her mouth
stayed clamped shut.

I'm not sure her vet has really dealt with this condition before. She
chose the feeding tube she did, because she personally has not done a
stomach tube before. She also was surprised that Katie didn't lick at
the food. The vet is suggesting that we may want to get xrays while
she is under sedation of her jaw to make sure there are no
abnormalities.

I suppose what I want to ask is, if we were only a week into
positively fighting the hepatic lipidosis, would Katie not opening up
for food be that odd of a reaction? I thought everything I read
through google (I haven't searched the usenet archives yet) said that
the desire for oral food comes back after 6-8 weeks of forced
feedings.

Suggestions or thoughts?

Laurel

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Phil P. - 02 Jan 2006 15:44 GMT

> Our cat Katie is a very sick kitty. She was grinding her teeth after
> eating for a while, and then quit eating and lost quite a bit of
[quoted text clipped - 50 lines]
>
> Laurel

My best advice would be to find a vet whose experienced in treating hepatic
lipidosis ASAP. This is not a disease that you want a vet to learn how to
treat on your cat. First of all, very few vets use esophagostomy tubes in
cats with HL because the tube and associated neck wrap are very
uncomfortable and stressful for cats- and avoidance of stress is one of
major concerns in cats with HL. Most vets use a PEG tube (percutaneous
endoscopic gastrostomy). PEG tubes are considered the treatment of choice
for cats with HL by the vast majority of vets because its relatively safe,
simple, cost-effective and most importantly, because cats adapt to PEG tubes
so well that you have to withhold tube feeding periodically to see if the
cat will eat voluntarily.

Force-feeding also is usually not a good idea for cats with established HL
because many cats develop an aversion to food because of the association
between food and the stress and unpleasant experience of being force fed-
even if they like the food. Its also very difficult to get the cat to eat
enough food to reverse the disease. I've treated several cats with HL- so I
can say with absolute certainty, in the clinical phase of the disease the
*only* reliable and effective treatment option is PEG tube feeding.

Its impossible to tell how long it will take to reverse the disease. It
could take a few weeks or it could take a few months. It depends on the
treatment and seriousness of the disease. The important thing is HL can be
reversed in about 80% of the cases- at least that's about what our success
rate has been.

For more information on HL and PEG tubes, please visit my site:

http://www.maxshouse.com/Feline_Hepatic_Lipidosis.htm

http://www.maxshouse.com/managing_peg_tubes_and_feeding_t.htm

Best of luck,

Phil

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Larry - 02 Jan 2006 20:34 GMT

Phil, I disagree with regards to recommending use of a PEG vice an E-tube.
Inserting a PEG is major surgery compared to an E-tube. My Mario had an
E-tube and did fine. I am also a member of Yahoo's Feline Assisted Feeding
group and most go for the E-tube for relatively short term use such as for
HL.

Signature

Larry - Owned by ten cats

> My best advice would be to find a vet whose experienced in treating hepatic
> lipidosis ASAP. This is not a disease that you want a vet to learn how to
[quoted text clipped - 31 lines]
>
> Phil

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Phil P. - 03 Jan 2006 02:06 GMT

> Phil, I disagree with regards to recommending use of a PEG vice an E-tube.
> Inserting a PEG is major surgery compared to an E-tube.

I think you've been misinformed. Done properly, PEG tube placement takes
less than 10 minutes and allows the use of an ultra short-acting anesthetic
agent. A PEG tube is placed by using an endoscope and the tube can be
removed without surgery or anesthesia.

E-tube placement with the new ELD shoehorn applicator has supposedly
improved E-tube placement- but the problem is with the E-tube itself in
cats- not just the placement.

My Mario had an

> E-tube and did fine. I am also a member of Yahoo's Feline Assisted Feeding
> group and most go for the E-tube for relatively short term use such as for
> HL.

Again, I think you've been misinformed. HL can take several weeks to a few
months or longer to reverse. Cats generally do not tolerate an E-tube and
the neck wrap- especially for that length of time. Cats adapt to PEG
tubes-especially low-profile tubes- much better than to E-tubes. Since its
almost impossible to accurately estimate how long tube feeding will be
necessary, a PEG tube is the method of choice. Many vets oppose PEG tubes
simply because they don't own an endoscope or they're unfamiliar and/or
inexperienced in PEG tube placement. An experienced vet can place a PEG tube
easily and quickly (<10 minutes).

Sometimes short-term (<5-7 days) tube feeding is all that's necessary to
jump-start a cat's appetite or stabilize the cat for PEG tube placement. In
these short-term cases, a nasoesophageal tube is the best choice.

I'm very glad an E-tube worked well for cat.

Phil

> > My best advice would be to find a vet whose experienced in treating
> hepatic
[quoted text clipped - 35 lines]
> >
> > Phil

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