What was your experience helping your cat recover from fatty liver disease?

meowrissa_bratton

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My 8 year old Beans was recently diagnosed with hepatic lipidosis due to anorexia from stress (we just moved and she knew what the boxes meant - went on strike). I've had her home for a few days with an e-tube and I have a few questions about other peoples experiences with the recovery process....

Questions for other cat owners helping their feline through the beginnings of fatty liver disease: (Any additional tips/tricks with e-tube feeding or how I can better help her recovery are welcome!!!)

1. How long did you have to tube feed until your cat started to show signs of interest in their normal food again? Just interest - not eating it on their own.​
2. How long did your cat slobber/smack their lips from nausea? Beans has been blowing spit bubbles consistently for the past week and while she has seemed to get better at home the last few days, she is still slobbering a lot and I'm not sure if that symptom should be lasting this long.​
3. How did you heat up the slurry wet food mixture before dispensing it through your cats e-tube?
Everything I have found online only states to test it on your wrist prior to feeding (like you would a baby bottle) but I don't know how warm it should be and am afraid I'm serving it too cold.​
Notes below are from the ER doc who treated Beans' illness (for context)

Diagnosis: Hepatic Lipidosis
Time of Presentation: Thursday 05/28/20 6pm

  • Beans, a 8 years old Female Spayed Domestic ShortHair, presented on Emergency for further evaluation of elevated liver values, and anorexia.
  • Owner reports that patient vomited bile once Sunday morning (05/24) and Sunday night. She vomited yellow again Monday morning(05/25) and became uninterested in food that afternoon.
  • Patient was taken to the RDVM on Tuesday and administered SQ fluids along with an anti nausea injection. Patient has not vomited since then but owner states that she has been hypersalivatory and has not eaten anything at all.
  • Owner returned to the RDVM on 05/28 and CBC/Chemistry and abdominal radiographs were obtained, and patient was referred here for continued care.
Beans transferred to Internal Medicine on Friday, 5/29/2020 for ongoing care and diagnostics.
  • Abdominal ultrasound and liver aspirate were performed, providing a diagnosis of hepatic lipidosis. At this time an underlying medical reason for her condition has not been identified; we suspect her anxious personality and recent household move has been the trigger.
  • Beans had an esophageal feeding tube (E-tube) placed on 5/29/2020. Unfortunately she vomited the end of the feeding tube the following morning, necessitating another quick anesthetic procedure to replace the tube with a new one. We have been slowly feeding Beans a conservative volume of food (Royal Canin Recovery), which is being escalated in volume at a slower rate than I usually administer with these patients. Beans has been able to tolerate these feedings with no additional vomiting.
  • Therapy for Beans has also included the following: IV Unasyn, IV Cerenia (stopped after 2 days), IV ondansetron, metoclopramide via E-tube, IV pantoprazole, SQ vitamin K1, and supplements via E-tube (Denamarin, L-carnitine, and taurine). Once discharged from the hospital amoxicillin was to be continued via esophageal feeding tube. Gabapentin was initiated to try to reduce some of her anxiety in hospital.
  • Recheck biochemistry panel on 6/1/2020 showed persistent degree of ALT elevation with ALP, GGT, an bilirubin increasing further. There may be progressive cholestasis occurring since we are slowly introducing nutrition to Beans. Brief recheck with ultrasound showed a diffusely hyperechoic liver and normal gall bladder, no effusion was noted.
  • Owner was given instruction how to administer food and medications on 6/1/2020. She elected to take Beans home that evening to see if that could help reduce her anxiety in the hospital. Owners had unpacked their boxes, hoping their new home would be inviting for her.
Home Care Instructions:
Amount of Recovery diet to be fed via syringe and frequency:

For the first 24 hours, please offer 30 ml per feeding, doing 4 feedings per day if possible (120 ml per day). If 4 meals is difficult to administer, consider 3 meals per day, 40 ml each time. Increase by 10 - 20 ml per day every 1 - 2 days to a final volume of about 200 ml per day. We will adjust this as needed for her response.
Medications:
1. S-Adenosylmethionine Chewable 112.5mg (1/2 tablet) crushed with water every 24 hours 1 hour prior to feeding
2. L-Carnitine 250mg mixed into food daily
3. Taurine 500mg mixed into food daily
4. Metoclopramide 2mL every 8 hours for nausea
5. Amoxicillin 2.3mL every 12 hours with food
6. Gabapentin 1mL every 12 hours as needed for anxiety/pain


Here is a medicine/food log I've kept for the past 4 days Beans has been home
Tuesday 6/2
Wednesday 6/3
Thursday 6/4
Friday 6/5
SAdenosylmethionine Chewable 112.5mg6:30a 5:30a5:00a8:30a
L-Carnitine 250mg7:30a8:30a8:30a9:30a
Taurine 500mg7:30a8:30a8:30a9:30a
Metoclopramide 2mL4:30a
12:30p
8:30p
5:30a
12:30p
8:30p
5:00a
1:00p
9:00p
8:00a
4:00p
9:00p
Amoxicillin 2.3mL4:30p8:30a
10:50p
3:30p1:30p
Gabapentin 1mL8:50a
8:50p
11:15a - regurgitated it 5 min/decided not to continue
Food 15mL 7:30a
20mL 12:30p
30mL 4:30p
20mL 10:30p


Total: 85mL
40mL 8:30a
40mL 4:30p
40mL 10:50a



Total: 120mL
45mL 8:30a
45mL 3:30p
45mL 12:00a



Total: 135mL
15mL 9:30a
30mL 1:30p
15mL 4:30p
30mL 6:30p
30mL 11:00p
20mL 1:00a
Total: 140mL

Pic 1: Going to ER vet 05/28/2020
Bean1.jpg


Pic 2: First day home after 3 nights in ER 06/01/20
Bean 2.jpg


Pic 3: Late night feeding on the 3rd day she was home (first time she has laid on me in over 2 weeks!!!! Normally I can't get her off of me....)
bean 3.jpg
 

white shadow

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Hi meowrissa_bratton.

Right off the bat, the ultimate kudos go to that quality, consummate Vet who treated Beans! She - and you - have received 5-star treatment and service! Textbook perfect! That Vet's a treasure.

There's a specialized online community that's been around for almost 20 years, and whose focus is this very topic - feline assisted feeding. It's not a 'busy' group, so I expect folks will get more attention there these days. They use the pre-forum format of email 'list serve' - I find it easiest to get a new, separate generic email account for these communities. You'll find them here: groups.io - Feline Assisted Feeding. Groups like these are the go-to's for the best expertise when dealing with the complications of particular feline diseases/conditions..... because of their unique focus.

Kathy, who runs it, also maintains this homepage: assistfeed.com.

Dr. Lisa Pierson, a feline specialist with particular interest in nutrition has a piece on her site on feeding tubes - while it's more an overview, it could introduce you to Dr. Pierson's other nutrition pages there. I'm sure you'll find your way around from here: catinfo.org - Feeding Tubes for Cats. Large, heavy cats are most at risk for HL (and diabetes, etc.), and that website has been a lifesaver for many folks and their cats. Dr. Pierson is another one who 'knows her stuff' !

Hope that may help!
.
 

Mamanyt1953

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It took Hek a full two weeks to be what I consider "normal," and she had incipient hepatic lipidosis, and did not require a feeding tube, just syringe feeding. So, probably, at least that. That's a guess. She may have recovered faster if we had tube-fed. She is back to normal (other than being overweight...we're working on that), but I NEVER let her go 48 hours without eating. At the 46 hour mark, I'm on the phone to the vet and the cab company. Thankfully, that doesn't happen often.
 

mrsgreenjeens

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The only thing I can say (other than WOW, you're doing a fantastic job keeping everything straight and taking such good care of Beans!) is I'm wondering if possibly you are giving the food a little too fast? When my guy was on a feeding tube, if I pushed on the syringe with a heavy thumb, the food would come right back out a few minutes later. So I'm not sure how slowly you are pushing it, but the slower the better, IMHO. Even with the anti-emetic on board, it's still possible she's pretty nauseated if her tummy goes from empty to too full too quickly. You might ask the Vet if you can get a different anti-emetic if the Metoclopramide isn't really working and you are feeding her slowly.

As far as heating goes, it's been at least 20 years since we did this, so I honestly can't remember, but I would think you could set the food in some warm water to heat it up, or use warm water when you blend it up, or use a microwave, but if you do that, I would use the defrost setting and then only do it for a few seconds and of course, stir the heck out of it to make sure the heat is evenly dispursed, and still check it like you would a baby bottle. You just don't want it to be cold. Nor too hot.

I see she has on a KittyKollar. They have great info on their website, including feeding tips. Also cleaning tips, etc. Have you been over there? Those things are the best thing since sliced bread Wish that had been around when my guy had his tube in.

Well, looks like I had more than one thing to say, huh? That's me...can't stop typing once I get started :rolleyes2:. Anyway, I hope the ER Vet explained to you that it's quite normal for their liver values to get worse before they get better, even after they start treatment, so not to freak out or anything :alright:

OK, as to interest in her food, until she stops slobbering, I wouldn't even attempt to try to get her to eat on her own. But once that gets under control, just try to give her a little bit of the slurry every time you make up her syringe. She make take a lick or two. Or every try to give her a favorite treat or two. Some cats quickly return to eating on their own. Come don't. My guy was on his tube for four months, but he was really bad. Plus once they start eating, the tube stays in for awhile in case they relapse. Also, my guy wasn't receiving ANY medications to aid in his liver recovery. My, how Veterinary Medicine has improved since those days.
 

daftcat75

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You already have a Kitty Kollar so there goes my first recommendation.

Is she receiving an appetite stimulant and anti-nausea medication?

If she's getting Cerenia, that does cause anorexia in some cats. There are other anti-nausea medications to try if you suspect that might be the case here.

For temperature, I'd say luke warm. Warmer than room temperature but cooler than you like your bath water. I would pick up a candy thermometer and run it under your sink stream until it reads about 90-95F. Now you can feel that water temperature to see what that feels like. If that's too much trouble, go with warm but not hot. About as warm as you might drink your coffee or tea before deciding it's too cold. Remember that's a direct line to her stomach. It's better to go too cold than too hot. She'll spit it up if it's too cold or otherwise let you know it's too cold.

Clarify with your vet, if you haven't already, how many calories she needs in a day. Make sure she's getting that no matter how many feedings you have to break it up over. It's super-important to re-feed her back to health. But also give her opportunities to nibble on her own throughout the day/night.

Ask your vet about subcutaneous fluids and B-12 shots. These are often game changers for a number of conditions. Since they are both water soluble, any excess is peed out. Little risk with the potential for lots of reward.
 

daftcat75

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Re-reading your post:

What's the amoxicillin for? Does she have an infection? This could be affecting her appetite. Clarify with the vet if this is necessary.

Gabapentin can cause foaming. You may also want to check if this is necessary.

While my Krista didn't have HL, she did need a feeding tube for a short period of time. I found when I gave her a few days break from all her meds and then introduced them one at a time, I was more able to find which ones were suppressing her appetite. Don't do this without your vet's advice and consent.

For heating up the food, I'd draw a hot water bath, and then let the syringes sit in that bath for a few minutes. The cool syringes and the hot water will exchange heat and meet somewhere in the middle. This will be better than using the microwave which has the potential of creating hot spots as well as possibly destroying nutrients.
 

BlackCatOp

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What a cute kitty and sorry she has been sick! Have you communicated with your vet regarding the drooling?

My suggestion would be to switch back to using Cerinea and Zofran. Zofran is a really good anti-nausea. Also, Royal Canin has new liquid diets that may be easier to tube feed that maybe you could ask your vet about.

Wishing Beans to feel better soon!
 
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