Feline hepatic lipidosis: Is a feeding tube right for you?

I've been talking to a cat owner recently who is trying to decide whether to have a feeding tube inserted in her cat's esophagus. This is a common suggestion that vets make when a cat has feline hepatic lipidosis, a.k.a. fatty liver syndrome or fatty liver disease, but in my opinion it's not always necessary. Whether you opt for a feeding tube is a personal decision that should be based on you and your cat's needs, not the vet telling you it's "standard procedure."

The absolute biggest reason to opt for a feeding tube is if you are unable to feed your cat enough via force feeding, but you would be able to with a feeding tube. For instance, if your cat is fighting you so much that you physically cannot get enough food into him or her via force feeding. A high protein diet is essentially how you jump start their liver and get them well again, so it is imperative that you feed your cat as much as possible of the recommended daily quota for their weight.

A feeding tube is not, however, a solution for vomiting food back up, or a lack of force feeding because you don't have the time. You will still have to give the cat frequent, smaller meals, even with the feeding tube, because it is nausea from the liver failure that causes them to vomit, not the force feeding itself.

Some vets claim that the force feeding is too stressful on the cat, and therefore a feeding tube should always be used. To that I have to say, "And surgery isn't?" I mean, come on, if a cat is starving to death and feeling very weak and sick, they don't exactly have the reserve of physical strength to recover from surgery.

I am not a vet, but I personally believe in going with the least invasive treatment required. If you can nurse your cat back to health via force feeding, then why would you choose to put them through the surgery to have a feeding tube inserted? If you aren't able to get enough food into them via force feeding, then of course the feeding tube may be necessary, but I guess what I'm getting at is that you shouldn't put your cat through that unless it is necessary.

Cats with fatty liver disease: Delilah's story

Written by Delilah's owner, Heather


Delilah in late July 2008, before fatty liver disease

Delilah is a 13 year old tabby cat. Delilah picked me when she was about a year old, when she showed up at my door step as a stray.

Delilah had not had any medical problems until the fall of 2008. Then there were many life changes for her and myself. I graduated college and began a new job. She began getting sick at the end of July in 2008.

Delilah was a portly cat, and I noticed she seemed listless and reclusive and she had lost some weight. I did not think this was a bad thing to begin with because she could stand to lose some weight. I was very wrong.

I moved to a new residence and noticed that Delilah seemed to get worse. She no longer sat with me, or slept beside me as she used to. She hid under the couch in the living room. I took her to the animal clinic, and broke down in tears because I thought I could have done something earlier.

By this time Delilah was extremely jaundiced. Her once green eyes were now yellow as well as her ears and gums. Delilah was diagnosed with fatty liver syndrome, and I was terrified since I did not know anything about it. My vet seemed very optimistic. Delilah spent a week in the hospital and I visited her every day and she still looked like the sick little cat I had brought in the week before.


One week after feeding tube placement

When she got to come home it was with an extra attachment, her freshly placed feeding tube. Feeding Delilah was stressful and seemed like a lost cause. She also took several different medicines orally for nausea and her liver.

The first week Delilah threw up daily and was only taking in about 20 cc of food through the tube in one sitting. She did not gain weight, in fact she lost more. She was also severely dehydrated when she went back to the clinic.


Two weeks after feeding tube placement

The second week I began to keep a journal of how much food she was getting, what time she would vomit, and if she had gone to the litter box. This provided me some peace of mind because it allowed me to see any progress she made.

My twin and I force fed and pilled Delilah for the next several weeks, and she got weekly trips to the clinic. I would call my vet almost daily to ask questions and often I felt stupid or that I was being over sensitive about everything Delilah did. I fed Delilah 4 times a day, and often she did not get the required amount because she would either vomit or start to push away.

The four feedings were difficult because it meant making time for them. I would get up an hour earlier than I typically did just to prepare the food for her, and try to get it into her before I had to get to work. When I came home from work it was the same routine.

Delilah also took several medications orally. This was not enjoyable for me or Delilah. She took one for nausea, one for her liver, one for acid reflux, one to boost her potassium, and one for constipation (put through the tube).

It wasn’t until Delilah changed medicine for nausea that she began to come out of hiding. She originally was on a medicine called metoclopramide, which she would take about 15 minutes prior to a tube feeding. She switched to a medicine called Zofran or Ondansetron. This medicine was extremely expensive ($50 for 2 pills), but for the difference it made in Delilah I would have paid much more. My vet told me that this drug is used in human patients that are going through chemotherapy. I had high hopes for this medicine.

Delilah also switched foods from science diet a/d to Iams max calorie. This made a difference. Once Delilah began to take Zofran she drank water from a bowl. The next evening she finally ate something on her own. Delilah is not a cat who likes treats or wet food, so I used goldfish crackers from Pepperidge farm. That evening Delilah ate 3 of them and I felt like shouting from the roof of my apartment complex. I was on cloud nine because I knew all the tears and hard work were not wasted and Delilah was going to pull through.


After removal of the feeding tube

I continued to force feed Delilah small amounts and she began eating more. Just in time for Halloween Delilah finally got her tube removed.

In the beginning it was extremely hard, and the vomiting was non-stop. Many nights I thought it was useless, and I was making her last days worse than if I had just let her alone and not tried to force feed her. I cried many nights at the thought that I was going to lose my baby. But with perseverance on my part and Delilah’s strength we made it through the difficult time. So, if you are going through the same with your cat don’t give up! Fatty liver does not have to be fatal if you are willing to put the work into it, and ride the emotional roller coaster.


Complete recovery from fatty liver disease!

When fatty liver disease is fatal

I state repeatedly throughout this blog that fatty liver disease is CURABLE. This is temporary liver failure and most cats make it if they are force fed and if the condition that caused them to stop eating it taken care of. Sometimes they stopped eating because of an environmental cause — in my cat's case she was afraid of the new dog. Other times it is because they are already sick with something else — cancer, for instance. It's also common for cats to hide when they are injured outside; by the time you find them (if you find them at all), fatty liver disease has already set in.

Unfortunately, not all cats recover from FLD, also called feline hepatic lipidosis. Months ago I was in communication with a young lady named Yiddle, whose cat, Jack, developed fatty liver disease. (Jack's picture is the one at the beginning of this post.) Unfortunately, Jack didn't make it, and died after a short hospitalization.

The story has an unexpected happy ending, though, as Yiddle soon fell in love again, with a tabby rescue cat named Toby. I'll put his picture and a picture of Yiddle's other cat at the end of this post.

In the meantime, though, I'd like to share the email Yiddle sent to me after Jack's death and Toby's rescue. This email really touched me, and made me feel that even though Jack didn't make it, everything happened for the best.

Hallo Katherine,

Thank you. We will always miss our Jack. I think by the time we noticed he wasn't eating much, it may have been too late. He was very overweight to begin with, but he had lost 4 lbs. already. Even though he was very sick, he fought the force feeding very hard. I would swaddle him up as tight as I could and then even wrap my legs around him and still he would struggle free. It would take several rounds of that to get through one feeding. At the end of each feeding, he and I were both exhausted and knew we had another one coming up in about an hour and a half. I tried to take care of him at home but he developed diabetic complications and a low blood count. I hated to have to take him to the animal hospital but he had several doctors and aids who fell in love with him and gave him the best care they could. They let me visit as often as I wanted for as long as I wanted, so I spent many hours just holding him and talking and singing to him each day. My son and his dad also visited him every day. I think he had more visitors than I did last time I was in the hospital! We are going to bury his ashes (and his blankie) on my grandma's farm when it is spring. He will have the company of generations of beloved family pets there.

I thought it would be a long while before my heart would be ready to love another kitty, but we were at the Humane Society this weekend with friends and we met one we knew we had to bring home. Toby was listed as "special needs" cat, so he had been at the Humane Society since October. He has "wool sucking syndrome" - he likes to "nurse" on blankets and his owners gave him up because he chewed a hole in a couple of their blankets. He was adopted a few weeks ago but his new owners found they couldn't handle the sucking behavior either so they returned him to the Humane Society. For us this was a perfect match - Jack used to do that too, since he was a tiny kitten! The moment I picked Toby up, he started to purr. Toby came home with us, we bought him his own blankie (which he adores, I haven't seen him nurse on anything else yet) and he has fit into our house wonderfully.

I will never ever forget our sweet Jack, but having Toby and his "blankie" is like having a little bit of him back.

Thank you for keeping up your website. Even though I lost my Jack, you gave me some hope during those dark days. I appreciate that more than I could tell you.

Thank you again,
yiddle

Coming up: Two new stories

It's been a while since I've added to this blog, but I'm always getting comments and emails from people whose cats have fatty liver disease, a.k.a. feline hepatic lipidosis. In fact, I have two new stories to share with you, which I will blog about in the coming days.

As always, I encourage anyone dealing with feline hepatic lipidosis to read this blog in its entirety, leave comments, or even contact me. I am not a vet or anything like that, but I have had personal experience with fatty liver disease and force-feeding a cat, as have most of the people whose stories and comments appear on this blog.

Of course, I always love to blog about recovered cats, so please feel free to email me if you'd like me to include yours.