Put a feeding tube in or not, that is the question

[tiggy2]

HI

I'm new to the site but have read a fair number of post and fine the advice here very good so here I go.

I have a 15 year old female with early stage CRF. She has been steadily losing weight for months and the final suggestion by my vet is to put a feeding tube in.

She does eat, Wellness brand wet food (took about 2 months to get her on that), but obviously not enough to maintain or put on weight. SHe's down to 9.7 pounds from over 12 pounds. My Doc. wants to get her onto the low protein diet, but of course she won't eat that, hence the suggestion of the feeding tube to get her to switch to the low protein diet.

Her thyroid is OK had that checked before we found out it was CRF.

So feeding tube or no. It goes in tomorrow)

Sorry for the delay.

[mikischo]

Welcome to pets.ca. Although most veterinarians push their low protein prescription diets for CRF, many other people do not recommend them. Wellness brand wet food (the one your cat is currently on) is one of the foods recommended by others, especially the chicken, turkey, and chicken and beef varieties because they are not too high in phosphorus. Growler's cat, Duffy, was diagnosed with CRF in 2007 and she has an excellent thread that you may want to look at. Here it is:

http://www.pets.ca/forum/showthread.php?t=45017&page=1

It is a very long thread. She has a shorter version but I can't find the link at the moment. I will look for it later. Growler comes on here every day and when she sees your post, she will have some more information for you. If you don't have a copy of your cat's most recent bloodwork, it would be helpful if you ask your vet for a copy and post the numbers here.

Here is another excellent website that contains a lot of good information on CRF:

http://www.felinecrf.org/

[tiggy2]

Growler's cat, Duffy, was diagnosed with CRF in 2007 and she has an excellent thread that you may want to look at. Here it is:


Thank you for the speedy reply

I've read Growler's posts and been on the other CRF sites, hence I got my cat on the wellness brand..thanks for that. My other cats are doing better on it)

We checked the blood work, can't remember the numbers but I do remember they indicated Tus was in the early stages of CRF, Phosphorus levels were normal, but there was protein in her urine.

I don't understand why she continues to lose weight even though I feed her every 4 hours or so. She'll eat close to a tbls per feeding, sometimes more.

Mind you my other guys are loving it, so much so that they are getting a tad fat(

[mikischo]

You said that she eats just under a tablespoon every 4 hours or so. Is that about 3 to 3.5 oz or so per day? How does that compare to the amount she was eating before she started losing weight and how large is her frame? Was 12 lbs. a good body weight for her frame size? I am just wondering if the weight loss is just due to eating less than previously or if there is something else at play here.

There are other people on this board who have had their cats put on feeding tubes for various reasons. I believe sugarcatmom is one of them and she also comes on here daily and will also give you some good information. It is possible a feeding tube would be helpful to help her to eat more if you feel that what she is getting is not sufficient, but I also do not recommend using the prescription low-protein diets. I lost my own cat this year at the age of 18. He also had heart complications. He was diagnosed with early stage CRF in 2007 and in late January of this year, I decided to follow the vets recommendation to put him on a prescription low-protein diet even though his CRF was relatively stable. By mid-March (after being on the low-protein diet for six weeks) his CRF had suddenly worsened rapidly. I'm not saying that this might not have happened anyway, but the switch to this type of diet was obviously not helpful and I sometimes wonder if it might even have been a contributing factor.

There are also medications available to help with the proteinuria. Has your vet discussed this with you? An ACE inhibitor such as Fortekor (benazepril) is sometimes used in conjunction with amlodipine to treat proteinuria.

[tiggy2]

How does that compare to the amount she was eating before she started losing weight and how large is her frame?

She used to eat dry food, so to measure that was impossible as I have 4 others who ate it as well. She was a little over weight, small cat in general. She should weight I figure around 10 pounds, but she has lost muscle mass. So aside from the constant weight loss, (1/2 pound a month), it's the muscle mass that concerns me.

Is that about 3 to 3.5 oz or so per day?

It's probably around 3 oz's of food, I've never measured it that way, but not enough to gain or maintain the weight.

but I also do not recommend using the prescription low-protein diets.

I am in agreement, so why do the vet's push it so much? For one thing it has tons of by-products in it.

There are also medications available to help with the proteinuria. Has your vet discussed this with you? An ACE inhibitor such as Fortekor (benazepril) is sometimes used in conjunction with amlodipine to treat proteinuria.

I don't think they (vet) knew about this, but I will mention it. So much information to try and put together and not a lot of confidence in presenting it.

I would like to try alternative ideas to a feeding tube, because she is eating, but the vet did not have any. The suggestion of a stimulant was tossed out due to it's side effects of hard on the kidney's.

So I'm at a loss as to what to do

[sugarcatmom]

Sorry, took me a while to respond and you've already answered some of my questions.

Originally Posted by tiggy2

It's probably around 3 oz's of food, I've never measured it that way, but not enough to gain or maintain the weight.

Definitely needs to eat more. Try some of the tips I mentioned, but what you're aiming for is about 20-30 calories per lb per day. 3 oz of Wellness is only about 100-120 calories, and she needs at least 200 calories a day to maintain 10 lbs.

Originally Posted by tiggy2

I am in agreement, so why do the vet's push it so much? For one thing it has tons of by-products in it.

They don't know any better. Vets get woefully limited education on feline nutrition, and what they do get is provided by the very pet food companies (ie Hill's) whose products they then sell out of their clinic. Big conflict of interest.

Originally Posted by tiggy2

The suggestion of a stimulant was tossed out due to it's side effects of hard on the kidney's.

But starving and weight loss are even harder on the kidneys. As is a surgical procedure involving anesthetic. So if some of my tips to get her eating more don't work, I would seriously revisit the possibility of an appetite stimulant. You don't have to use it all the time. There is a good one called mirtazapine that is very effective.

[sugarcatmom]

Hi tiggy2,

Is your kitty on any supplements or medication? Have you tried appetite stimulants? If you could get a copy of her latest lab results, that would also be helpful.

While putting in a feeding tube can be a life-saver in many situations, it should be more of a last resort thing, when other less invasive options have failed. And I also agree with mikischo that you don't want to go the low-protein route. That won't help at all in the weight gain department.

To get her eating more, you might have to try offering her a few different brands and flavours of wet food. Some other good ones to try besides Wellness are Innova Evo 95% venison or beef, Nature's Variety Instinct, and Precise has some good low phosphorus flavours as well. Does she like raw or lightly cooked chicken breast? That would be an excellent source of quality protein.

You can also top-dress her canned food with stuff like powdered freeze-dried meat treats (Halo Liv-a-Littles or Real Food Toppers, for example). Even pulverizing some of her favourite kibble and sprinkling it on top might help. Parmesan cheese or cat nip can also work.

Without knowing what you've already tried and what her blood work results are, I'd say that it's too early to go with a feeding tube, especially if it's just to force a completely inappropriate low-protein diet into her. How long is the vet thinking of keeping it in her? What happens when it comes out? It just doesn't make sense to me.

[tiggy2]

Thank you for getting back to me. I've just cancelled the feeding tube as I'm not 100% comfortable with it either and now that I have touched base with you guys I might be able to come up with some other solutions.

Tus does eat, just not a lot per feeding. She likes the Wellness brand and if she snubs that I sprinkle Sasha's blend on it and lap lap we go

I don't know what kind of supplements to give her. As for the appetite stimulant, it was tossed out because the vet felt it was too hard on Tus's kidney's. Are there other's that are not hard on the kidney's.

I will be asking for copies of the test results today and I hope you guys will stick with me to at least guide me in a direction..through the path of overload of information)

Thanks again