I have to say that when Kuching got his belly and his left side shaved in preparation for the surgery to insert the feeding tube, I really flipped out,” says Dr. Deborah Hirschmann of Rhode Island. “‘Oh my God, I don’t want him to die naked,’ I told the tech who shaved him. I have three cats, but he’s very special to me.”
Kuching, eleven and a half, needed a feeding tube because of his worsening kidney disease that made him more and more uninterested in eating. “I was at home visiting my parents for the holidays,” Dr. Hirschmann says, “and when I came back he looked awful — skinny, dehydrated, horrendous. His kidney values were through the roof — 10 times normal. And he had horrible ulcers in his mouth, which can happen with kidney disease. He had lost more than 10 percent of his body weight — down from almost 9 pounds to 7.75.”
It’s a common scenario. Your cat has kidney or liver disease and has become less and less willing to eat. Or he has a stricture in his esophagus that doesn’t allow food to travel easily from the mouth to the stomach. Or he is struggling with an oral or facial tumor that makes chewing and swallowing difficult to impossible. How can you keep him from compromising his health even further with too few calories, or from eating a diet that isn’t optimal for his medical condition?
The issue of insufficient calories becomes even more critical for a sick or injured cat than for a healthy cat. A healthy animal who’s not eating enough can at least compensate for the lack of food in the short term by turning to fat stores for calories. But a cat who is ill or injured undergoes what is known as stressed starvation, meaning that instead of using fat stores for nourishment, his body keeps using protein stores from muscle, which results in a loss of lean body mass that can make him even sicker, adversely affecting wound healing, immune function, overall strength, and ultimately, his prognosis.
Fortunately, a well-outfitted veterinary hospital can equip your cat with a feeding tube that allows food to bypass the mouth. There are two types of tubes for at-home feeding of cats who clearly will not be able to eat enough on their own for more than three to five days and are at significantly increased risk of malnutrition. An esophagostomy tube, or E-tube for short, is placed in the esophagus, while a gastrostomy tube, or G-tube, goes directly into the stomach. Owners can then squirt food with a syringe into the tube, and from there it continues on its way through the gastrointestinal tract pretty much just as if it had been swallowed. “Many cats go home with an E-tube or a G-tube,” says Tufts veterinary nutritionist Lisa Freeman, DVM, PhD, DACVN.
The right tube for your cat
It’s a little safer and easier to place an E-tube than a G-tube. “The cat has to be anesthetized,” Dr. Freeman says, “but just very briefly. And the technique for placing the tube through the cat’s neck and into the esophagus is “pretty quick and easy,” she explains. A G-tube, on the other hand, needs to be placed into the stomach either surgically or with endoscopic guidance. G-tubes are necessary when the esophagus is not working properly, say, as the result of decreased motility or if it has within it an obstruction. That’s the kind of tube that Kuching has.
Although both tubes can have possible complications, neither procedure is terribly risky, and owners should feel comfortable about having their cat get an E-tube or G-tube, if that’s what’s called for. The doctor will often put it in while performing another procedure that requires anesthesia so the cat doesn’t have to be anesthetized twice. Even if it’s not crystal clear that a cat will need a feeding tube upon leaving the hospital, it’s better to put one in place if it’s believed one might be needed than to find out later the cat won’t eat and have to come back.
With a G-tube, the cat will have to wear an Elizabethan collar, at least at first, so he doesn’t start tugging at or licking the tube or trying to get at the small wound created by the doctor to insert it. Such collars are not necessary with E-tubes because cats can’t reach the spot on the neck where an E-tube goes.
Whichever tube your cat ends up with, “99 percent of the time it will be commercially available food” that gets squirted in with a syringe, Dr. Freeman says. You don’t have to mix up a homemade recipe and, in fact, that can be dangerous as most homemade recipes are not nutritionally balanced or sufficiently high in calories.
Your veterinarian will simply tell you which food to buy depending on your cat’s health status; sometimes it can even come from the supermarket rather than being purchased by prescription in the doctor’s office. You will most likely be instructed to blend it with a specific amount of water so that it turns into a slurry that can easily be injected. You will also be told to warm the food to body temperature before feeding.
Feedings should be done slowly, usually over the course of five to 10 minutes (more if your cat is having any trouble tolerating the feedings). They tend to occur three to four times a day, and the tube should always be flushed with warm water before and after each feeding to preventing clogging. Keeping the tube capped between feedings is also important in order to keep out any debris and to further reduce the risk of clogging, which can happen if the tube dries out uncapped and then you go to put food through it later.
Dr. Hirschmann’s feedings with Kuching take about 10 minutes each. “Initially,” she says, “his stomach was tiny because he hadn’t been eating much. I could only get in one to two teaspoons at a time. Now I can give him many more teaspoons at a single feeding in the same 10 minutes. If I try to shove it in faster, it’ll make him vomit. I know that when he starts licking his lips, he feels nauseated, and I have to slow down.”
Along with feeding your cat through the tube, you’ll have to maintain it, keeping it clean and keeping it in place. With an E-tube, you will be instructed to put a pad around the base of it. You will also need to change the pad regularly for hygiene purposes. Further protection comes in the form of a wrap that covers the site at which the tube enters the neck. That will help if your cat tries to rub it against something. The tube, about as thick as a pen, sticks out from the body anywhere from a few inches to a foot, and keeping it covered will help stop it from catching on something and being pulled out accidentally.
The wrap will periodically need to be cleaned and checked. If it becomes wet or soiled, a visit to the vet for a new wrap will be in order. For an E-tube, you can also use a commercial cloth collar instead of the wrap.
G-tubes requires a pad and bandage and bandage changings, too, along with checking to make sure the tube remains in the correct position. And whether E-tube or G-tube, Dr. Freeman says, “the tube site needs to be checked once a day to make sure there’s no redness, swelling, discharge, or other sign of possible infection. Everything should be in order. If it looks ‘funny,’ call the vet,” she advises.
“Wrapping the tube and organizing it to make the cat most comfortable takes a little getting used to,” says Dr. Hirschmann, herself a veterinarian — but one with scant feeding tube experience as she is a general practice vet whose office doesn’t handle most feeding tube cases. It’s also hard at the beginning, she says, because the cat has skin stitches. In Kuching’s case, there was an abdominal incision to place the tube. “But you get used to it,” comments Dr. Hirschmann.
Of course, it’s very important to monitor body weight. Sometimes the amount of food must be adjusted in order to maintain weight, or increase it, if necessary. The underlying reason for the insertion of your cat’s tube also needs to be carefully monitored.
How long will be necessary?
The length of time that a cat is fed through a tube depends on the underlying disease. “Most animals have them in anywhere from a couple of weeks to a few months,” Dr. Freeman says. “In some cases, with a special G-tube, it can be left in permanently, say, if a cat has a permanent motility problem in his esophagus. The tube itself has to be replaced once in a while because they wear out. But a cat can go through life with a G-tube, if necessary. The same is true for people. There are instances in which they’re on G-tube feedings for life.”
Don’t be upset if your veterinarian tells you your cat will remain on tube feedings from now on, say, if he has advancing kidney disease. It can be very beneficial in helping to maintain optimal nutritional status and, in many cases, improving quality of life as well as length of life. That’s the situation with Kuching. “His tube will be permanent,” Dr. Hirschmann says. “He doesn’t have a very prolonged life expectancy, unfortunately. If he makes it six months, I’ll be really happy. In the meantime, he’s happy; he’s comfortable.”
In other cases, a cat will gradually go from being completely tube-fed to eating more and more food by mouth and less by tube until the tube can finally be removed. Cat owners should note, however, that a G-tube must be left in for at least 10 to 14 days, even if your cat starts eating enough on his own before that.
The reason is that a tight wound called a fistula has to heal and create a snug junction between the stomach and the body wall, and it takes on the order of a week and a half to two weeks (or more, if the cat has poor wound healing) for that to happen. If the tube comes out ahead of time, food leaks from the stomach into the abdomen – an emergency situation. — Larry Lindner