Tube feeding for liver disease??

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Bill from Tampa - 17 Aug 2003 20:12 GMT

We have a "rescued" cat, Katie, who became nauseated and was retching, and
not eating. She is overweight. Our vet did blood work, and then an
abdominal sonar and fine needle liver aspiration biopsy, and tells us that
Katie has hepatic lipidosis, and cholangiohepatitis, and pancreatitis. (her
total bilirubin was about 2.5, alk phos 350 or so, AST slightly up). We
have tried to "force feed" her pureed wet cat food, but it is a struggle,
and unpleasant for Katie, and does not seem to get very many calories in
her. The vet advised placing a feeding tube (probably a gastrostomy) to get
her adequate nutrition.

Does anybody have experience with cats who have this seemingly nasty
combination of problems? Our vet, who is helpful and sharp, seems a bit
vague about the chances of her surviving. I've done google searches and one
article suggested that cats with hepatic lipidosis and pancreatitis have
only a 20% chance of survival with optimal treatment.

We are struggling with the decision- to have a feeding tube surgically
implanted, and put Katie through the pain of anesthesia, surgery, and then
daily care of the gastrostomy tube site -- versus just letting nature take
its course (which seems to be a fatal one...). A friend of ours had a cat
with hepatic lipidoses, several years ago, and had an esophageal feeding
tube placed in the neck (our friends husband was a vet so I would suppose
it was done with appropriate care etc) - but the outcome was not good.
There were lots of complications at the site of the tube placement
(abscess, drainage) and the cat ultimately died anyway. Katie does not
seem to be physically in pain currently, just tired and doesn't eat
anything.

Thanks for any suggestions or ideas!

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Cheryl - 17 Aug 2003 21:48 GMT

> Does anybody have experience with cats who have this seemingly nasty
> combination of problems? Our vet, who is helpful and sharp, seems a
> bit vague about the chances of her surviving. I've done google
> searches and one article suggested that cats with hepatic lipidosis
> and pancreatitis have only a 20% chance of survival with optimal
> treatment.

Hi Bill. Sorry Katie is not doing well. I went through the same thing
this time last year and it's all in the archives of this group on
google if you want to read my ordeal with Shadow. He had severe
hepatic lipidosis which took 2 months of feeding through a tube to
bring him through, but he did very well. Once the tube site healed a
little (PEG tube), he didn't really seem to notice it was there most
of the time, and it was easy to get the amount of food into him he
needed but you have to take it slow. If Katie is nauseous, you'll
likely have to build up to getting enough food into her. Most of the
meds were fed through the tube as well -- the ones to heal the liver.
The only one that wasn't was Denasyl which has to be given whole by
mouth.

Shadow made it through his feeding tube ordeal but he was diagnosed
with Inflammatory Bowel Disease (IBD) when he had a biopsy done while
he was under for the feeding tube placement. This disease is proving
harder to deal with. Good luck.

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Karen Chuplis - 18 Aug 2003 02:56 GMT

> We have a "rescued" cat, Katie, who became nauseated and was retching, and
> not eating. She is overweight. Our vet did blood work, and then an
[quoted text clipped - 25 lines]
>
> Thanks for any suggestions or ideas!

Many here have and come through well. I've read the survival rate at FAR
higher than 20 %!!!! I think that you should very definitely go for it. I
would at any rate, because though it sounds like a LOT of effort it seems to
be very treatable with the feeding tube. Do a search on groups.google.com in
this NG and you will find a lot of info.

karen

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Phil P. - 18 Aug 2003 05:43 GMT

> We have a "rescued" cat, Katie, who became nauseated and was retching, and
> not eating. She is overweight. Our vet did blood work, and then an
> abdominal sonar and fine needle liver aspiration biopsy, and tells us that
> Katie has hepatic lipidosis, and cholangiohepatitis, and pancreatitis. (her
> total bilirubin was about 2.5, alk phos 350 or so, AST slightly up).

Which type of cholangiohepatitis - Suppurative cholangiohepatitis,
nonsuppurative cholangiohepatitis? The biochemical abnormalities for both
are similar.

We

> have tried to "force feed" her pureed wet cat food, but it is a struggle,
> and unpleasant for Katie, and does not seem to get very many calories in
> her. The vet advised placing a feeding tube (probably a gastrostomy) to get
> her adequate nutrition.

Force feeding is usually not a good idea. Most cats resent force feeding
and usually are uncooperative. They also become stressed and rarely eat
sufficient amounts of food for effective treatment. Cats with HL are very
ill and severely stressed and additional stress should be avoided. Cats
also seem to develop food aversions rapidly -- the association between food
and the unpleasant experience of forcing may delay the cat's return to
eating o her own. So in the initial phase of the disease the only reliable
treatment is tube feeding - PEG tube.

Sometimes nasoesophageal (NE) tubes are used to get sufficient calories into
exceptionally weak and debilitated cats to stabilize and strengthen them
before PEG tube placement. NE tubes are easy to place through the nose into
the stomach and require no surgery and minimal or no sedation. NE tubes are
best suited for short-term feeding (a few days) - but sometimes its long
enough to jump start the cat's appetite.

> Does anybody have experience with cats who have this seemingly nasty
> combination of problems?

About half of the cats that survived the first 3 months after diagnosis
(cholangiohepatitis/hepatic lipidosis) survived between 1 and 5 years (this
is not an absolute because some cats died from other, non related causes) -
some cats survived even longer than 5 years. A lot depends on the type and
seriousness of the cholangiohepatitis.

Our vet, who is helpful and sharp, seems a bit

> vague about the chances of her surviving. I've done google searches and one
> article suggested that cats with hepatic lipidosis and pancreatitis have
> only a 20% chance of survival with optimal treatment.

Odds are for horse races... not cats. I learned a long time ago to take the
"odds" with a grain of salt when they pertain to cats! I suggest you do the
same. Cats are amazingly resilient creatures - *never* underestimate the
resiliency of the cat!

> We are struggling with the decision- to have a feeding tube surgically
> implanted, and put Katie through the pain of anesthesia, surgery, and then
> daily care of the gastrostomy tube site

A PEG (percutaneous endoscopic gastrostomy) tube can be endoscopically
placed through the body wall directly into the stomach, its a relatively
safe, simple, procedure (providing the vet knows what he/she's doing).
Here's how its done:

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

Removal is even simpler. PEG tubes are considered the treatment of choice
for cats with HL by the vast majority of vets. Most cats adapt so well to
PEG tube feeding that you'll have to withhold tube feeding occasionally to
see if her appetite returned!

-- versus just letting nature take

> its course (which seems to be a fatal one...). A friend of ours had a cat
> with hepatic lipidoses, several years ago, and had an esophageal feeding
> tube placed in the neck (our friends husband was a vet so I would suppose
> it was done with appropriate care etc) - but the outcome was not good.
> There were lots of complications at the site of the tube placement
> (abscess, drainage) and the cat ultimately died anyway.

Esophagostomy tubes are rarely used in cats today since the advent of the
PEG tube. Cats are very uncomfortable with Eso tubes and the neck wrap that
goes with it - which can cause moderate to severe stress -- and stress is
the one thing you want to avoid the most in cat with HL.

Katie does not

> seem to be physically in pain currently, just tired and doesn't eat
> anything.
>
> Thanks for any suggestions or ideas!

I've been through it more than a few times -- I'd go with a PEG tube without
hesitation. Here's some more information.

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

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

http://www.maxshouse.com/Enteral-Assisted_Feeding.htm

I wish you and Katie the very best of luck.

Keep the faith!

Phil.

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Cheryl - 19 Aug 2003 01:41 GMT

> A PEG (percutaneous endoscopic gastrostomy) tube can be
> endoscopically placed through the body wall directly into the
> stomach, its a relatively safe, simple, procedure (providing the
> vet knows what he/she's doing). Here's how its done:

^^^^^^^^^^^^^^^

I'm glad you added that. I'm sick of rehashing what happened to
Shadow because it was probably rare for so many complications to
happen, but it definitely needs to be said.

> http://www.maxshouse.com/percutancous_gastrostomy_tube_pl.htm
>
> Removal is even simpler.

[repeat your comment about competence of the vet]

PEG tubes are considered the treatment

> of choice for cats with HL by the vast majority of vets. Most cats
> adapt so well to PEG tube feeding that you'll have to withhold tube
> feeding occasionally to see if her appetite returned!

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Angio - 20 Aug 2003 00:25 GMT

> Force feeding is usually not a good idea. Most cats resent force feeding
> and usually are uncooperative. They also become stressed and rarely eat
[quoted text clipped - 4 lines]
> eating o her own. So in the initial phase of the disease the only reliable
> treatment is tube feeding - PEG tube.

I think you have to also look at your cat's tolerance level. Joel was
dx when he was about 4 years old. He was jaundiced and lost from 20
lbs to 13 lbs. We were never offered the option of a PEG tube (our vet
never mentioned it could be done) so we force fed him with soft food
and water in a 60cc syringe. We were very persistent and when we
thought we might be stressing him we would just love on him a while
and try again. A majority of food was more on us and him than in his
tummy but small amounts got in and along with meds he starting eating
on his own. That was 10 years ago and he is still doing great. Good
luck with your sweetie. Try not to worry about statistics, you have
good thoughts coming your way.

> Our vet, who is helpful and sharp, seems a bit
> > vague about the chances of her surviving. I've done google searches and
[quoted text clipped - 57 lines]
>
> Phil.

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