Hepatic Lipidosis: Or, Should I Put a Feeding Tube in My Cat?

I’ve gotten quite a few hits from people searching for information on hepatic lipidosis, so I thought I’d put together one convenient entry for people wanting to read about a specific case to help them decide whether to use a feeding tube to cure this liver disease.

My short answer to, “Should I put a feeding tube/peg tube in my cat?” is yes, if you can afford it, have the time and energy to feed the cat through it, and the cat isn’t about to die from their primary disease. The experts say that implementation of a feeding tube has a 70-80% chance of curing hepatic lipidosis/fatty liver. It worked for my kitty and, although it was rough going for the first week or so, it was worth it. I wasn’t ready for my lovely kitty to die, if he could be made well again, and it’s great having the spunky bugger back in full form.

My kitty, Cherubino, was diagnosed with moderate feline lymphoma and inflammatory bowel syndrome. Whether from the stress of the cancer, the stress of the chemo, or the stress of having pills shoved down his throat, Cherubino, an erstwhile glutton, stopped eating. Fat at over 19 lbs. before the cancer, down to 16.5 at the time of the diagnosis of the lymphoma, he was checked into the hospital weighing 10.5 lbs., not so much on death’s doorstep but in death’s foyer. He was severely dehydrated and very much a shadow of his former self. Not grumpy, just pathetic and scrawny.

He received fluids, vitamins and his cancer was checked. The oncologist strongly suspected hepatic lipidosis (later confirmed by cytology and biopsy). Once Cheru was strong enough and his blood counts sufficient for anesthesia, his liver was aspirated to ensure that the lymphoma hadn’t spread. It hadn’t and a feeding tube was put in.

When the oncologist first told me that a feeding tube was basically the only cure – I didn’t think appetite stimulants and syringe feedings would work, since Cheru may have been stressed out by popping the pills -- I was a bit creeped out. After talking to my primary vet about his success with feeding tubes, learning that cats object to this a lot less than an oral tube, realizing it was either this or a dead kitty, I decided to go ahead. Besides, at this point we had spent so much money already, that there was no point of not going all the way.

Cheru had the tube put in on a Friday and came home on Monday. The tube was in for 7 weeks total, although I didn’t feed him through it the last 2 weeks but kept it in for a bit after a round of chemo just to make sure he was continuing to eat on his own. It took him a few weeks to eat on his own again once the tube was in, and then just a little bit, but by 4-5 weeks he was eating full meals on his own.

He never fought the tube feedings. He would let me pick him up and snuggle in my lap as I slowly fed him, often purring once the warmed food started reaching his stomach. He vomited a bit at first (see my tips below) and had a few bouts of diarrhea, which was very embarrassing for him, but after the first couple weeks all that stopped.

I gave Cheru Reglan about ½ hour before each feeding and mixed Denosyl/SAMe in his food once a day. We discontinued the leukeran and prednisone treating his cancer until he started eating on his own again.

Tips for tube feeding at home:

If you haven’t already, buy a bottle of Nature’s Miracle. It removes vomit odors like magic. And buy a huge pack of cat wipes for grooming under the sweater and in case of diarrhea. A clean cat is a happy cat.

GO SLOWLY! The vet techs aren’t kidding. Go slower than you think is slow enough, at least the first few days at home. If you’re using Feline A/D, that stuff smells even worse coming back up than going down. And there is nothing more discouraging than spending 15 minutes feeding your cat only to have to clean up puke minutes later.

If your cat vomits more than once, reduce the amount of the feeding. I figured rather than giving my cat the 90 cc prescribed, having him puke it up, and then having to skip the next feeding, it would be better to keep him at 60 cc for a few feedings and then gradually increase 5-10 cc’s a day.

Flush warm water before and after each feeding and each medicine. You really want to keep the tube from blockages. If it blocks, 1 cc of carbonated beverage should clear it out (I never had to do this.) Also shooting the last cc of water in your syringe really fast help clean everything out.

Get a few extra sweaters/surgical socks from the vet. They will get soiled and unravel and it’s undignified enough for a cat to wear a sweater, let them at least be clean. Wash them by hand, they’ll last longer. Tie them with a hair tie or rubber band at the top, behind the head where they can’t get to it, if your cat is sporting the low rider look. You want to keep that sweater on, so they can’t mess with the tube.

Beg your vet, purchase, or ask any friends in the medical profession to score you as many syringes as possible. I found loading up all the syringes for the next day(s) and putting them in a Ziploc bag in the fridge saved a lot of time every day – versus having to wash and load them three times per day.

Isolate your cat. This way you can cover the furniture with old sheets and towels and not have to clean up cat ick from more than one room. It was difficult for me, as I was used to Cheru having the run of the house, but he really was happier in the guest room away from the other cats. The other cats could tell he was sick and didn’t really want much to do with him, anyway. We visited him throughout the day. At night, we would carry him down to watch a movie with us (plop him in our laps) or I would read in his room. Often, I would sleep part of the night with him in the guest room. Love helps kitties heal.

Person I used to know

I wasn't even thinking of doing an entry about him on my new blog (yes yes, will be under construction for some time, working on a few other things here, probably shouldn't have even posted about it), but here is the first person to make Crain's 40 Under 40 list who was at my wedding. Yes, techie friends abroad, I know -- well, knew -- Jason Fried. I even almost dated him, but that is an amusing story best told in person. And he is really a ton cuter than his picture.

There's nothing like the 40 Under 40 list to make one feel like an underachiever. (Cue Morrissey: We Hate It When Our Friends [and friends of friends] Become Successful.) Not that it's ever been a particular ambition of mine to make the 40 under 40 list; if it were, I probably wouldn't have left the scintillating world of commercial real estate finance and, perhaps, even applied myself to it. Anyway, I have 6 more years, who knows what I will accomplish? And you nasty little smart asses thinking, "Yeah, if they have a Stay at Home Moms under 40 List," well, you can just, just, just, shut up. Waaaa. It's not easy being green, man.

Bureau of Funny Walks

The previous post notwithstanding, Yelena is getting much better at pulling up, standing and walking holding on to our hands. Sometimes she looks like she's auditioning for a Monty Python remake: she pulls her right knee up really high before putting her foot down and then puts her left foot down with her knee rather rigid and none of the drama of the right. The hilarity and cuteness must be witnessed to be believed.

Isn't that ponytail the duckiest? And baby's got cheeks.

Action shot

Alternate titles: Pride goweth before the fall. I can't stand up for falling down. Boom!

Squats and giggles

I'm a total postapotamus today. I don't need a nap when I sleep until 9.

Yelena is currently on a "Hi," boycott. Oh well, it was cute while it lasted and I'm sure there will be many a repeat performance, just on her schedule, not ours.

She is very much into her own schedule; fortunately, she is very sweet tempered about it, so we can't really mind too much. At physical therapy last week, she was squating down to pick things up and coming back up on her own. Evette was surprised and declared that this skill was more advanced than walking. Damnit, Yelena, haven't you read the book? Don't you know you're supposed to do things in a specific order, like all the other kids?

Speaking of all the other kids, here's an interesting article about TV watching and autism on Slate. I think they're really on to something. (Four hours a day?! For a toddler?) Sure, Yelena may not be mobile but at least she doesn't greet me with a blank stare.

We have a new game. When I ask her, "What does a cow say?" her eyes light up. She has always loved a good moo. Last week I asked her and said, "A cow says... mmm," a few times and each time she squeaked in anticipation, releasing with a giggle fit when I finally uttered the long-awaited moo. It only works so-so with other animal noises. She also cracks up when I sing something really high and then sing it really low. I love my giggle-puss.

Very considerate developments

My goodness, this is my 300th post. Maybe the network will buy me a Porshe.

The past few nights Yelena has slept over 12 hours. Mon dieu! She's gone to bed at her regular time -- cooing herself to sleep, after some soporific boobie and cuddling -- postponed her 4:00 wake up to 5:45, and then slept until 9:00! She's still taking one nap, but she's pretty much resisting letting it go much more than an hour. Really, I'll gladly swap 20 minutes less of nap for an hour more sleep at night.

She's also been much more into table food. Saturday, at shul, she ate most of my lunch: babaganosh, humus, guacomole, the vinegary tomatoes from the salad, pita, egg salad. Man, she is crazy for babaganosh -- I guess my passion for eggplant was passed to her through my breast milk. This past week she also added beans to her repitoire. They weren't hot, but they were pretty garlicky and oniony. When we went to sushi for my birthday she ate gobs of tofu and eagerly slurped 5 large spoonfuls of my miso before I realized she probably had just consumed her sodium intake for the week. (Other parents give their kids fries, mine likes miso.) She also ate her first gnocchi in homemade tomato sauce and loves the carrot kugel recipe from Marsha. It's been great truly integrating her into dinner time.

Girl's best friend

Cherubino is very patient with Yelena. She's been grabbing tufts of fur and handfulls of whiskers and he doesn't really seem to mind. Around Yelena, Theo is pretty much the way he is around adults. "Love me, love me, oh my God, I can't handle the love!" I like this picture of them back to back. There are no pictures of Yelena with Despina. Why? Because she always manages to stay just out of arm's reach of our little rugrat.

New blog

You ever wonder what happened to people you used to know? Of course you do. Depending on your nosiness and free time, I bet you google them whenever you're procrastinating or have a dream about someone you haven't thought of in years. It turns out a lot of people I used to know are up to pretty interesting stuff, so I've decided to blog about them. Perhaps, when they're in the throes of a vanity search, we will reconnect, although that is certainly not the motivation for this exercise. Perhaps they will just sue me for libel. I figure if they're in the public domain with a website, then I am free to reminisce and critique.

I am hoping this will be an interesting project, but I'm going to keep in separate from this blog, since I think most of you are just looking for pictures of Yelena.

Moderately exciting house news

Last week we finally came to an agreement with the neighbors with whom we share the private alley behind our house. The permit has been released, a surveyor has surveyed, and the curb will be cut sometime, hopefully, soon. (The City has even agreed to remove the immature tree on their side of the sidewalk.) Once we get around to paving the private alley we will have off-street parking and the ability to build a garage. Considering deeded parking goes for at least $20k around here -- and a garage would add at least $40k of value to our house -- them's some good returns.

Not so exciting Mila developments

If you are squeamish, or wish to avoid overly personal information, just skip this post. Go to the previous one or the subsequent one and don't blame me, or say "gross" or ask "Why is she sharing this?" If you disregard my warning, you only have yourself to blame.

Aunt Flo returned today, the bitch. November 3 would have been two years without the bloody nuisance but, no, she had to come back today with her cramps and her bloating and her messiness. It was bound to happen sooner or later, but I've been hoping for the late late later. We're down to nursing only 3, maybe 4 (with the 4th as a 2 minute security top off at 4:00 a.m.), times within 24 hours so I guess that was a trigger but I am not happy about this development.

And, no, I am not going to try to get pregnant in 2 weeks to avoid this, but don't think the thought hasn't crossed my mind.

Exciting Yelena developments

Yelena is pretty consistently saying, "Hi," when she first sees one of us. (Sometimes it sounds a bit like "Hiya," which has it's own panache.) It's very cute and friendly of her. Alas, still no repeat of, "Mommy," but she has said, "Yeah," a few times in response to a questions. For the record, the questions were things like, "Do you want boobie?" and "Do you want a cookie?" Who wouldn't say, "Yeah" to those?

In the past few days she's been pulling herself up on her wagon, passing back and forth from my hands to the wagon and back again, pivoting out to the side of me holding only one hand, and taken a few baby steps while still holding on. Progress, slow and steady.

After much gnawing, the sixth tooth has finally emerged. Four top, two bottom.

One nap gal

The past couple weeks Yelena has been taking only one nap, from around 11ish to 1ish, give or take a half hour. Since this change, she's been going down at night very easily, sleeping until 8, and waking up cooing and kicking instead of crying.

Today, due to a 1:00 appointment, she went back to her previous nap schedule of a morning nap and a short afternoon nap. Doom. It took bloody forever to put her down tonight. She just wasn't having it. She gained a half-hour this afternoon, but lost an hour and a half at bedtime. Although she was sleepy by 3, with this negative sum sleep it would have been better if I had just kept her awake in the afternoon.

Screw all the sleep experts, with their a baby age x should be getting y amount of naps for z amount of time. When I followed their advice about putting a baby down 15 minutes earlier every night, that failed drastically, too. Gee, I can put my baby down at 8:30 and she'll sleep through the night, or I can put her down at 7:30 and have her wake up 5 times. Like most things in parenting, I am learning that following my instincts and my daughter's cues result in a happier mommy and a happier, well-rested baby.

Operatastic

Just got back from the first opera of the season to a dark and quiet house. Eli successfully put Yelena to bed, not too much later than her regular bedtime. It's taken fourteen months, but I appear to have some boobie freedom!

The opera was Turandot. Beautiful production, but I've got to ask, is that any way to start a marriage?

We've moved up to Row B, still on the aisle. We just need to put a hit on the people in front of us and we'll have seats for life. I used to have Dress Circle fantasies, but the acoustics in the upper balcony are really the best in the house. I'm so glad I contibuted to the annual fund this year, even if my charity wasn't altogether altruistic.