Tuesday, August 13, 2013

Feeding a Sick Paulie

Yes, even a veterinarian's cat will get sick.

Paulie, our "special" orange kitty, gave us quite a scare. It started with a few episodes of vomiting all over our bedspread (which was wonderful to find right before climbing into bed at night....), and then it progressed to refusing all meals. After the second or third day of Paulie's food strike, it was time to take action.

I did all the tests that I recommend  for my own patients: Blood work, Xrays, testing for FIV/ FeLV, and even Abdominal Ultrasound.  All of his tests came back normal.

We started appetite stimulants, anti-nausea medicine, and a stomach anti-acid.  Paulie would sniff the food, then sadly walk away.  As a doctor, it was very distressing for me because I still did not have a diagnosis, and I did not know how to fix him.

This scenario occurs sometimes with our feline patients.  The danger is, if a cat does not eat for more than a few days, their liver can actually become compromised.  As the body breaks down fat at a rapid pace to make up for lost calories, the fat can deposit in the liver and cause severe inflammation and jaundice. This is called "hepatic lipidosis", and it can be fatal.

The question then becomes, "How do I feed the patient if I don't know what's wrong and I'm not sure what to do?" 

The answer: A temporary feeding tube, or "Nutritional Access Port".

Poor little Paulie....

When I mention this option to owners, I often get looks of hesitance, fear, and sometimes horror. They imagine family members or friends in the hospital with feeding tubes while they lay sick.  The thought of "artificially" keeping someone alive seems wrong to many.  I beg you to think differently when it comes to our feline friends.

A temporary feeding tube, or "Esophagostomy Tube", is a soft rubber tube that is placed in the side of the cat's neck.  It can be placed under light anesthesia, and it is then stitched into place and wrapped up with soft padding.  Once awake, the cat can resume his normal activity.  He can still be offered food, given medications, use the litter box, and play with toys.

Until the cat starts eating on his own, canned food can be liquefied with water and slowly put through the tube with a syringe (usually a very large syringe, holding up to 60 ml).  Usually the cat sits quietly in your lap, the couch, or his bed during the 10 - 15 minutes it takes to slowly squirt the food down the tube.  Medications can be crushed, mixed with water/ food, and given down the tube as well.  Tube feeding is usually done about 3-4 times a day in order to maintain the caloric needs of the pet.

Paulie getting some nutrients.... and love.... during one of his feedings

This method of treatment is much more favorable to forceful syringe feeding by mouth. Cats HATE being syringe fed by hand, and it is nearly impossible to give them the calories they need this way.  Forcing food and medications by mouth can lead to resentment and aversion, especially if the pet is nauseated or in pain. It is messy, stressful, and just plain unfair.

Paulie at home, enjoying life with his E-Tube.  Here he is still able to jump 5 feet up onto his perch!
With Paulie, he started feeling stronger the day after the tube feeding was started.  Due to his lifelong history of being thin, picky about food, and intermittent vomiting, I made the assumption that he might have Inflammatory Bowel Disease. I started appropriate steroid therapy and a prescription "novel protein" diet of Hills d/d Venison and Sweet Pea.

After three days of tube feeding, steroids, stomach supportive medications, and his new diet, Paulie started to eat dry food by himself!  The great thing about the tube was he could keep eating as much food as he wanted on his own, but I could also supplement him with liquid meals through the tube to make sure he consumed enough calories. 

I  brought Paulie home to continue his supportive care. The other cats thought he looked a little silly with his special contraption, but they were glad to see him nonetheless.  Paulie immediately visited his regular scratching post, litter box, and favorite couch.  He was able to sleep in our bed and look out the window.  His quality of life was unchanged, and he got a little extra attention during his "special" feeding times.

After a week, he was eating well on his own, and I removed the tube.  No anesthesia is required to remove the tube.  The neck is simply unwrapped, the stitches are cut, and the tube is pulled out.  A bandage is placed over the neck for a few days to allow the hole in the skin to heal.  Infection rate is low as long at the bandaging is replaced regularly (every 5-7 days) and the tube site is scrubbed clean as needed.  I have had patients that keep a feeding tube for many weeks without consequence.

I encourage all of you to consider the option of a feeding tube if your veterinarian ever recommends it for your feline friend.  Appropriate cases include cats with hepatic lipidosis, inflammatory bowel, intestinal cancer, oral tumors, oral surgery, kidney failure, etc.  I can tell you first hand, it is the most stress-free way to support your cat if they can't or will not eat!!

- Dr. Schock
This message has been "Paulie Approved!"