Cat not eating, so tube feeding... is this amount normal?

[LemNem]

History: My best buddy cat is about 11 years old now and a little over a week ago, he got very lethargic and wasn't eating much. I gave him a couple days to get over it, since he was still eating a few bites here and there. Since he wasn't getting over it, I brought him to the vet. General health check was good, except for being underweight. Teeth good and all that. They ran bloodwork and a few tests, which came up mostly clean. A few values were slightly off, which was expected after not eating much and the stress of a vet visit. They gave him a shot of some anti-nausea and sent him home with some anti-nausea medication as well. He ate a little bit after getting home, but the next day refused to eat anything. I brought him to the vet again and they kept him for the day. He had a mild fever on admission, but that resolved quickly. They ran bloodwork again, but that came back about the same as before. At the end of the day, they recommended I transfer him to emergency care, especially with the weekend of the 4rth coming up (vet was going to be out for a few days). I did. The emergency specialist ran a bunch of tests, which didn't find much. They installed a feeding tube in the neck and released him to me with an anti-biotic and stimulant.

Diagnostics:
1) AFAST-gb ok, AFS=0.
2) Serum chemistry showed a total bilirubin of 3.2
3) CBC showed a moderate anemia non-regenerative at 23% and mild neutropenia.
4) Lateral thoracic radiograph confirmed E-tube placement.
5) FeLV/FIV -negative.

Anyway, the tube feeding is going well so far, but I'm worried about the day 3 amounts I'm going to hit tomorrow.

Day1: mix 17mL of A/D with 17mL of water and administer slowly every 6 hours.
Day2: mix 30mL of A/D with 30mL of water and administer slowly every 6 hours.
Day3: mix 60mL of A/D with ~60mL water and administer slowly every 6 hours.

On day 3, I'll be hitting 120ml (60 food w/ 60 water) and that seems like A LOT. At 3.2kg, some charts I found estimate ~180ml of stomach capacity for the average cat of that weight. They confirmed the amounts with me yesterday and I'm not sure why I'm second guessing it so much, but does that seem excessive? I'm worried he'll vomit up his medications when I get to the big amounts on day 3. First feeding of Day 2 has gone well though.

I'm very worried to, since they can't find anything really wrong to treat specifically. I really have tried everything to get my cat to eat. He usually eats a wide variety of Temptations dry food and Friskies Gravy Sensations wet foods. His favorites are non-processed chicken and canned salmon. He hasn't been interested in food. I've tried FortiFlora topper and even some catnip, to no effect.

 

[Antonio65]

Hi L LemNem , and welcome to TCS.

I'm sorry that you had trouble with your cat's appetite. It seems to me the vets didn't understand what is at the origin of the lack of appetite, but they placed this E-tube in order to feed your cat and prevent him from going into Hepatic Lipidosis.
The plan they prepared for you, with day 1 at 17 ml and day 3 at 60 ml of A/D is used to counter what it is called Refeeding Syndrome, that is when a cat hasn't been eating for a few days, it may be not healthy to feed the cat the full amount of energy, but it is necessary to start with 1/3 (one third) or the daily RER on day 1, 2/3 on day 2 and full RER on day 3.

Now, if your cat is 3.2 kg, his RER should be 165 kcal a day. As far as I remember, A/D has an energy content of 1150 kcal/kg, that means that at day 3 you're giving him 265 kcal a day, which, in my opinion is much more than he needs.
And also such a volume of food might be enough to have him vomit up, especially because the 60 ml of food have been watered down with the same amount of water.

From what my experience with an E-tube is, such a volume of food is too much to be handled by a sick cat's stomach.
Of course I cannot tell you to do different from what your vets told you, but I would kindly ask them if it is really necessary to add so much water to the A/D wet food, which is soft enough to be passed in E-tube

I'm not a great fan of Hill's food. On occasions like this I have always preferred the R/C Recovery, which has a higher content of energy per kg (hence less volume to be given) and is more fluid, so it's easier to push it down with the syringe.

 

[LemNem]

I guess I have some instincts... 60ml on the plan seemed to go well this morning, but when I checked on him at launch, I found he had vomited it up at some point. I called the emergency specialist, and they really couldn't advise me on much, other than saying it would be okay to ramp him up slower. Not long after, he followed me into the kitchen yowling terribly like he was in pain. That only lasted 20 seconds or so, but I whisked him right back to his regular vet for a drop-off / work-in appointment. I'm doing everything I can and I'm just so scared. I'll get to hear from them later, but no news yet.

 

[LemNem]

60 ml being the 30/30 mix, not even on the 120ml yet.

 

[Antonio65]

Again from my experience with the E-tube, vomiting up the food might mean the cat has been fed too quickly, or too much.
I don't know how fast you syringe that food down the tube, and how much food at each push.
Any idea from the vets of why he stopped eating?

 

[LemNem]

They've not been able to find a reason for his not wanting to eat. I've gone really slow with the tube feeding, but I feel like the amount is too much, too fast. He's at the vet now, but I haven't had an update yet.

 

[Antonio65]

The key should be to assess the reason for his lack of appetite, as you can imagine, because even if you/the vets solve the tube feeding issue, your kitty needs to restore his autonomous eating habits.

My cat had stopped eating a couple of months before they were able to detect that deformity in her bile duct I had told you about, but her liver conditions were degraded already by that time.
The liver is hard to treat because there's little you can do to heal it. Only a few supplements can be used and it is necessary to face the problem promptly.

 

[LemNem]

This story has a sad ending. Non-regenerative anemia was recorded at 8% at the vet and he was crashing. I had him transferred back to the emergency specialist for a possible blood transfusion as a last ditch option. The let me know that the likely cause was an auto-immune disease causing his body to attack his red blood cells. It would take a while for immune-suppressive drugs to kick and almost certainly multiple blood transfusions in the mean time, and even with all that, it was likely a poor outcome. I couldn't put him through all of that for just a slim chance so I decided to give him a peaceful end. He's been through enough already. This was the most painful day of my life.

The key should be to assess the reason for his lack of appetite, as you can imagine, because even if you/the vets solve the tube feeding issue, your kitty needs to restore his autonomous eating habits.

It's just as you say, no amount of tube feeding or blood transfusions is going to save him without a definite cause and treatment option. I wish I could have done more for him.

 

[Antonio65]

I'm sorry to read this sad ending.
Non-regenerative anemia is something that happens out of the blue and not always an explanation for it is found.

I take care of a feral cars colony, two of them fell sick and was taken to the vets. Both of them had non-regenerative anemia, and both had type B blood.
Well, one of them is still alive and perfectly healthy, after a long term of cortisone. Her blood was almost like water, nearly no sign of red blood cells. The vets said the best thing was to let her go, but I wanted to try. She was on the brink of death two years ago, now she's a healthy and happy cat.
The other cat didn't make it, we were late...

I'm so sorry for your precious kitty. Now he's at the Bridge and he's saying thank you for all you did for me.
Take care of yourself.

 

[Kittenplay]

History: My best buddy cat is about 11 years old now and a little over a week ago, he got very lethargic and wasn't eating much. I gave him a couple days to get over it, since he was still eating a few bites here and there. Since he wasn't getting over it, I brought him to the vet. General health check was good, except for being underweight. Teeth good and all that. They ran bloodwork and a few tests, which came up mostly clean. A few values were slightly off, which was expected after not eating much and the stress of a vet visit. They gave him a shot of some anti-nausea and sent him home with some anti-nausea medication as well. He ate a little bit after getting home, but the next day refused to eat anything. I brought him to the vet again and they kept him for the day. He had a mild fever on admission, but that resolved quickly. They ran bloodwork again, but that came back about the same as before. At the end of the day, they recommended I transfer him to emergency care, especially with the weekend of the 4rth coming up (vet was going to be out for a few days). I did. The emergency specialist ran a bunch of tests, which didn't find much. They installed a feeding tube in the neck and released him to me with an anti-biotic and stimulant.

Diagnostics:
1) AFAST-gb ok, AFS=0.
2) Serum chemistry showed a total bilirubin of 3.2
3) CBC showed a moderate anemia non-regenerative at 23% and mild neutropenia.
4) Lateral thoracic radiograph confirmed E-tube placement.
5) FeLV/FIV -negative.

Anyway, the tube feeding is going well so far, but I'm worried about the day 3 amounts I'm going to hit tomorrow.

Day1: mix 17mL of A/D with 17mL of water and administer slowly every 6 hours.
Day2: mix 30mL of A/D with 30mL of water and administer slowly every 6 hours.
Day3: mix 60mL of A/D with ~60mL water and administer slowly every 6 hours.

On day 3, I'll be hitting 120ml (60 food w/ 60 water) and that seems like A LOT. At 3.2kg, some charts I found estimate ~180ml of stomach capacity for the average cat of that weight. They confirmed the amounts with me yesterday and I'm not sure why I'm second guessing it so much, but does that seem excessive? I'm worried he'll vomit up his medications when I get to the big amounts on day 3. First feeding of Day 2 has gone well though.

I'm very worried to, since they can't find anything really wrong to treat specifically. I really have tried everything to get my cat to eat. He usually eats a wide variety of Temptations dry food and Friskies Gravy Sensations wet foods. His favorites are non-processed chicken and canned salmon. He hasn't been interested in food. I've tried FortiFlora topper and even some catnip, to no effect.

Hi! I used to be a vet tech & now I care for neonatal kittens & cats with health challenges. If you knew what was in Hill's Pet Food you'd vomit it up too. I'm guessing your kitty needs your help to educate yourself (unfortunately the pet food regulatory companies are not doing their job as they have monetary interests in allowing commercial pet food companies to sell disgusting food).

As time is of the essence give him goat milk asap & start feeding him a HUMAN GRADE cat food (the only way you will get cat food that won't make your cat sick because it doesn't contain feces & the other crap in feed grade pet food)!

Why Feed Human Grade?

The Honest Kitchen Prowl for cats has been great for my cats & kittens. I'd put him on that pronto. To entice him to eat it sprinkle Nutritional yeast on top, not fortified but one that comes with all of the b vitamins naturally. Raw is best but if you arent ready to feed raw at least feed human grade.

To learn about pet food, the truth about pet food is a great start. Also check out Dr. Karen Becker's videos. Shes a holistic vet meaning combo of Western & Eastern medicine vet who treats the entire body of the pet. She recommended raw to me & I have seen my cats turn around from having major health problems to being well.

The reason most old school vets discourage raw feeding is because pet food manufacturers funded their programs at vet school & they aren't reading the current research. It's becoming more & more popular & I think it makes sense. A cat in the wild doesn't cook his food! i've also seen such improvements in many cats! The FDA allows garbage real garbage in pet food. That's probably one reason at least why your cat is vomiting.

Here's a link to a Dr. Becker video. I'm sorry if I seem pushy. I just adore cats & want to inform others to educate themselves as we owe it to our fur children!

Goat milk pronto!

I hope your kitty gets better soon!

This story has a sad ending. Non-regenerative anemia was recorded at 8% at the vet and he was crashing. I had him transferred back to the emergency specialist for a possible blood transfusion as a last ditch option. The let me know that the likely cause was an auto-immune disease causing his body to attack his red blood cells. It would take a while for immune-suppressive drugs to kick and almost certainly multiple blood transfusions in the mean time, and even with all that, it was likely a poor outcome. I couldn't put him through all of that for just a slim chance so I decided to give him a peaceful end. He's been through enough already. This was the most painful day of my life.



It's just as you say, no amount of tube feeding or blood transfusions is going to save him without a definite cause and treatment option. I wish I could have done more for him.

I'm sorry about your kitty . My heart goes out to you. In the future & for others with kittens & cats you can always try the mother milk-goat milk & then a raw whole prey diet when the kitten can eat solid food. Their ancestral diet is the way to go. The multi billion dollar pet food industry puts diseased animals & literally trash in our pet food & it's making pets sick or not eat. Kittens are so fragile. Commercial milk replacers don't provide enough calories for a growing kitten by volume & they usually contain casein, a milk protein that is difficult for kittens to digest.

Holistic vets are educated to treat the whole animal but traditional old school vets are trained in school to shun species appropriate diets & to recommend & push commercial pet food that is detrimental to our cats' & kittens' health. A way environment is absolutely necessary for a young or sick kitten or cat, 85 degrees room temp. & also a heat source until 6 wks or older. They cannot regulate their own body temp. & are too fragile to thrive if we don't provide what mother nature provides for them in their natural environments.

In defense of using goat milk for bottle feeding kittens

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Love & Light!
Tara