Cats - Hepatic Lipidosis - Tube Feeding

[tklow]

I saw some posts asking about tube feeding and figured I should share a few things I've learned this past month.

First, I have learned why it is so important to make sure your cat is NEVER overweight. As owners, we don't worry too much if they are a little fat. We worry about them being too lean. We forget that a wild cat is a true carnivore that is always lean. But we don't always know WHY it's so bad for a cat to be fat. Now I know:

A cat, unlike a human or a dog, cannot metabolize the fat that breaks down in the body when it stops eating for any reason. We can live off our fat stores, cats cannot. They aren't evolved to because in the wild, they stay lean. Even if your cat is a couple of pounds overweight, s/he is at risk.

My cat, Lurch, was 13-14 lbs and he's a big cat. So he was maybe 1-2 lbs too heavy.

One day he stopped eating. We do not know why. Maybe a virus, maybe a blockage that later resolved.

Within only a few days his liver filled with fat that he burned off while not eating. He got fatty liver syndrome, or hepatic lipidosis. A cat can get this as quickly as 2 days after not eating at all. Once the liver clogs with fat, the cat is gravely ill and will most likely die if not given enough nutrition to reverse the metabolic process that led to the problem.

Now, my vets had often said that it's not good for a cat's liver to go without food. I certainly did not understand the danger of having a pudgy cat or that the resulting liver damage could kill him in a matter of days.

We noticed Lurch was not eating over the course of a few days and had our at home vet come over and take blood. 2 days later the results were in and we were advised to go to an emergency vet hospital right away. We spent 6 long hours at the hospital and he was admitted into internal medicine. He'd lost 3 lbs and there was no movement at all in his gut.

Over the next week he had an exploratory abdominal surgery to confirm lipidosis and look for any underlying cause (they suspected lymphoma). He had bone marrow taken as well. The cost to us for the first week was $6000. He also was transported to another hospital during this time for ultrasound. After several tests his lipidosis was declared idiopathic (no known cause).

Here is the thing: without food a cat with HL will almost certainly die. With nutritional support, the chance of recovery is over 90%. So this was not a case where we could in good conscience have him put down. He has a good chance of total recovery.

So far our bills have exceeded $10,000. The time commitment has also been huge as he has a surgically implanted feeding tube through his neck. Until this week he was on four feedings a day through the tube and each one takes 20-30 minutes including filling the tube, feeding him, and clean up. We have to rebandage his neck every day or two and keep a sock on his back foot to keep him from clawing the tube. We have a cat pharmacy and clinic station set up in our home due to all of the meds, supplies, etc. We even have a dedicated blender and sieve for mixing his food.

There have been some complications too: the other day he threw up his feeding and the tube came up with it. We had to race back to the hospital (a 20 minute drive) to get a new tube put in. When he first brought the tube up he was choking on it and it was terrifying, but he quickly chewed it off.

However: ultimately, I would advocate for the tube, and here is why.

I've read a lot of research and it indicates that for many cats, force feeding is too stressful. Also, it's very very difficult to get enough calories into a cat this way. It can help during the first day or two that they stop eating, but we rarely catch it that fast. After that, if you aren't getting enough calories in, the fatty liver problem begins. Once the cat has HL, evidence suggests that force feeding is almost never effective.

The tube, for all its problems, allows you to administer medication and food in a way that lets you know exactly how much kitty is getting. We noticed improvement in the first week. It can take up to 8 weeks for the liver to totally heal, but we're at 5 weeks and blood tests show his liver enzymes and bilirubin are now back to normal -- hence, his liver is better and it's just a matter or getting him eating right again.

Someone said in another thread that they worried that with a feeding tube, the cat would not eat, therefore it's probably better not to get the tube. That seems like a reasonable thought, but it's apparently not true. Leaving a cat hungry to see if he'll eat only leads to this issue. Had we gotten food into him sooner a lot of this would have been warded off.

For the first 2 weeks he would not eat anything, though we offered food many times a day. But even with the heavy tube feedings, he did start eating, a little at a time, and now he's eating very well on his own. Tube feeding has settled his tummy enough that he feels better about eating. We're down to 3 feedings a day and may go down to 2 in a few days. We hope his tube will be out by Christmas.

Does the tube hurt him? I would say no. He often lays down with the tube side of his neck down and shows no signs of discomfort. He does not flinch when we feed him, and in fact, often falls asleep (you have to put the food in really slow). He does try to scratch at it, so we have to keep that foot covered, as noted. And we have to make sure to keep the bandage in place.

Every day he has a little more energy and is more like his old self. Yes, he's gone through hell, but we're not prolonging the life of a cat who will never be healthy again. We put him, and us, through this because he's getting better and most likely will have many years of healthy life (he's 7 years old right now). And while the tube annoys him (the sock bugs him more though), he's mostly in good spirits, curious, and does not seem to be in pain now that his surgery scar has healed). We do call him Franken-kitty due to the tubes and all the shaved parts on his once lush, chinchilla like coat.

Please learn from us: don't be afraid to have a very lean cat. They are meant to be lean. If your cat is fat, even a little, talk to your vet about getting his weight down, slowly. Remember, a cat does not get fat on his own: we do it by feeding too much. If you think you are already feeding very little, but kitty is fat, well.... it's not too little. I made Lurch fat because I was worried about his little brother being too thin, but really, the little guy will push his way in and get food if he wants it. He's skinny, but very healthy.

I've also learned a ton about tube feeding and caring for a cat with this illness so I'll answer any questions that might arise if I can.

[chico2]

tklow,very interesting read,you and Lurch certainly have been through a lot,but I am happy he's recovering

[Love4himies]

Thank you for this information, it is so very important to keep our pets lean.


I am, however guilty of having two cats who are overweight and have tried so hard to keep their weight down, but with a multi cat household it is not so easy to do.

[sugarcatmom]

Glad to hear Lurch is on the mend. Having been through HL with a cat before it can certainly be a scary disease! One thing I'd like to add though is that a cat doesn't have to be fat to get it. They certainly are more prone to getting it, but even cats with an ideal body condition can develop fatty liver when their caloric intake isn't sufficient.

Originally Posted by tklow

If your cat is fat, even a little, talk to your vet about getting his weight down, slowly.

Honestly, most vets are the last people that I'd consulted when it comes to feline nutrition, but especially as it pertains to "dieting". They push completely inappropriate prescription kibble with way too much carbohydrate content and not enough protein - exactly the opposite of what ALL cats, and particularly overweight cats, should be eating. This site has the best info available regarding chubby felines and what to feed them: http://www.catinfo.org/?link=felineobesity

Originally Posted by tklow

Remember, a cat does not get fat on his own: we do it by feeding too much.

Not quite as simple as that. Carbohydrates, the main ingredient in most dry foods, have a propensity to cause weight gain in cats. So it is possible to feed diet dry foods in vet-approved portions and still have a fat cat. See the above link on why that happens.

Originally Posted by tklow

If you think you are already feeding very little, but kitty is fat, well.... it's not too little.

It's possible to cause nutritional deficiencies in cats if they don't get the proper portions of commercial cat food. Rather than just feeding less and less, a better idea would be to feed the right foods (ie - quality meat-based wet) in the correct amounts for the cat's size, age and activity level. Increasing the amount of exercise would also be a crucial.

[tklow]

Good points re: feeding, though my cat has been eating nothing but premium quality cat food, mostly grain and corn free, high meat foods with lots of protein (Evo, etc.). This diet did get him leaner, but he was still a bit porky.

But yes, I should have noted that even thin cats can get HL, though fatter cats are much more at risk.

Vets vary. For many years I found they were all pushing nothing but Science Diet, which my cats have never done well on. However, in recent years I've noted a change and it's a lot more common to get good advice about better cat diets, including all meat or high meat diets, hypoallergenic diets, etc. Finding a good vet is definitely key. Simply put, Hills puts a ton of money into marketing to vets and that can have an impact on what they suggest.

[sugarcatmom]

Originally Posted by tklow

Good points re: feeding, though my cat has been eating nothing but premium quality cat food, mostly grain and corn free, high meat foods with lots of protein (Evo, etc.).

Wet or dry? That can make a huge difference. ALL of the grain-free (which doesn't mean starch-free, since they just swap corn for potato) kibbles are very high in calories, so even though they may be lower carb than other foods, they still aren't a good choice when it comes to cats. Dry Evo has a whopping 602 kcal/cup (possibly the highest calorie dry food available), and less than 10% moisture. An average 10lb adult indoor cat likely wouldn't need much more than 200 calories per day, which would be 1/3 of a cup. That's 1/6th of a cup twice a day. I doubt there are too many people precisely measuring out such small portions.

[tklow]

Sigh: I don't suppose anyone has had any luck with clearing a blocked feeding tube?

I've been back and forth to the vet hospital way too many times this month. His new tube is longer and thinner. I expressed concern when we got it, but they seemed to feel it would be fine. It's blocked up in the first two days despite our very vigilant sieving of his food and clearing the tube before and after each feeding with plenty of water.

We've tried the vet's suggestion of putting a little coke through the tube but it's blocked solid. Squeezing the tube along the exposed length does not reveal any obvious lumps. I'm looking at another trek in this evening.

I honestly cannot imagine how most people could do all this. Aside from the enormous cost, how would someone who does not work from a home office manage four feedings a day for 4-6 weeks? We bought a new house at the start of November and delayed our move for 2.5 weeks as we had to have him able to go longer without a feeding before we booked movers for a full day -- but we don't alway have that luxury. I also just dropped half the courses in this semester of my post-graduate program ($2000 and 30 hours of sessions in the hole) because I work all day and have spent easily 30 hours in vet visits, waiting, and travelling back and forth to get to the hospital for various emergencies and check ups (the regular vet clinics do not deal with this issue). Our new car budget went to vet bills.

You accept that when you get a pet you will take care of them to the best of your ability and you do so much for the little guys, but there does come a time you wonder how much more you can give up. That said, my cats are 6 and 7 and I've always taken in rescues that have had serious problems in their yound lives, and the worst previous problem has been 1 minor occurance of conjunctivitis and one cat who had a bout of feline urinary crystals many years ago... we've been lucky.

More lessons learned: 1. Have pet insurance. and 2. ... hmm ... I'm not sure What the solution is for the time and scheduling issues, but having a pet ambulance in the city would sure help. At one point we had to drive 25 mins to hospital 1, then 30 mins to the other side of the city, check him in, wait 3 hours for his ultrasound to be done, then bring him back to clinic 1, then home. That's a whole day.

I wonder if there is a possibility of a support network for pet owners in large cities... you could at least share equipment (I've bought a baby scale, blender, metal sieve, lots of baby socks, plastic containers for mixing, and a mortar and pestle for his meds).

Anyway. Venting. Looks like we'll be going back this evening if that tube won't clear. Maybe when this is all over I'll be able to help someone else out with some of this.



RE: the feeding question. I know everyone has different ideas as to what the absolutely "correct" diet is and that people can be very passionate about what has worked for them. I'm always learning more and monitoring my cats to find out what they do best on. There are many web sites that claim to have the absolute answer, but there is also evidence to counter many of these claims.

I've settled into feeding both wet and dry. 25 years of owning cats and I've never once had to have any dental work done, but it seems my friends who only feed wet have massive dental bills -- one friend has had 10 cats in 20 years and almost all of them have had multiple instances of costly dental work after the age of 6 or 7. Yes, I know, there are many sources which declare that dry food definitely does not benefit teeth. Fair enough. But there is also some evidence to suggest why this might be a factor: in the wild, cats crunch on the bones and feather spines of prey. While dry food does not scrape the teeth, it does give them something to use their teeth for and this pressure in turn can help keep gums firm. My personal experience has led me to feel there is some benefit to it in moderation, and yes, I've been told this is just plain wrong .

The thing is: I've had many rescue cats, including one two that were expected to have very short lives, so we're often dealing with cats who need exceptional nutrition and extra care. I adjust my cats' diet from time to time and we note what changes we see. In the last few years I've noticed that my cats have done extremely well on Castor and Pollux organic food. In fact, despite using many premium brands over the years, I can honestly say (again, just my experience) that there has been a really noticable, substantial difference with this food for my particular cats. My big russian blue used to shed so bad we could not touch him. We'd tried all kinds of diets and supplements to no effect. The shedding -- and hairballs -- are almost 100% resolved on C&P, he slimmed down a little, and he's got lots of energy, clear eyes, and excellent teeth. My little guy, Grue, was a rescue that was found in a remote area at 4 weeks of age. He'd nearly starved to death and had several serious illnesses before the the age of 4 months. He was always scrawny with patchy, stiff fur and not a lot of muscle, and he had compromised kidneys and bad breath from the time he was young. On the C&P he's filled out, gotten strong and glossy, and has tons of energy. His bad breath cleared up and his blood work indicates improved kidney function. Again, this is only my experience, but seeing my cats doing so well I'd be remiss not to continue with what I've had success with regardless of current opinion (and what scares me is the common opinion on the ideal diet seems to change every 5-10 years, quite dramatically, so it might be wise for cat experts to be a little more cautious because we're always learning more!). We're still working to resolve an ongoing diarrhea problem with the little guy, but one thing at a time.

I like hearing about what has worked for others as this all helps to inform us on working toward improved care for our pets.

[sugarcatmom]

Originally Posted by tklow

Sigh: I don't suppose anyone has had any luck with clearing a blocked feeding tube?

Have you tried room temperature or warm Coke? And make sure you're using Classic Coke, not Diet Coke. Might need to do it a few times. Also try back-suction, where you attach the syringe with the plunger depressed and pull back on it. If all that fails, try poking a very thin wire through that is not much longer than the tube itself, kinda like a using a plumbing snake for a clogged drain.

Originally Posted by tklow

It's blocked up in the first two days despite our very vigilant sieving of his food and clearing the tube before and after each feeding with plenty of water.

What type of food are you using? Do you put the food through a blender for several minutes and then sieve it? Are you putting any supplements through the tube that may have clogged it?

Originally Posted by tklow

I honestly cannot imagine how most people could do all this. Aside from the enormous cost, how would someone who does not work from a home office manage four feedings a day for 4-6 weeks?

With great difficulty. I drove home from work every day for over 3 months. For 3 separate situations (not all tubes were HL related in my case). Ya, it's not fun and I totally commiserate with you on this. You do the best you can. Some people can only do 3 feedings a day, or they have a friend/neighbour/vet-tech come over and do one of the feedings. I can tell you that I was totally exhausted while going through this. Especially for the last 'episode', when my kitty (Egypt) was sooooo sick from IBD and it took at least an hour for each feeding because otherwise he would vomit everything back up. I'd do it all over again in a heartbeat if I had to.

Originally Posted by tklow

I know everyone has different ideas as to what the absolutely "correct" diet is and that people can be very passionate about what has worked for them. I'm always learning more and monitoring my cats to find out what they do best on. There are many web sites that claim to have the absolute answer, but there is also evidence to counter many of these claims.

I don't advocate what works for me, I advocate what works for cats. And since they evolved over many millenium eating meat-based wet food (ie mice, birds, insects), I'm gonna go with that. There is plenty of evidence to suggest that is the ideal feline diet (how would they have survived this long otherwise?), along with growing evidence showing the harm that kibble causes (ie diabetes, kidney disease, dental disease, inflammatory bowel disease, allergies......).

Originally Posted by tklow

25 years of owning cats and I've never once had to have any dental work done, but it seems my friends who only feed wet have massive dental bills --

Genetics plays a large role in this (luck of the draw). Dry food truly does not clean teeth, but of course neither does canned food. The only diet that would have a positive impact on dental health is a raw diet with bones to crunch through, as you pointed out. The ideal feline diet. If that's not an option, then regular teeth brushing may be necessary.

Originally Posted by tklow

(and what scares me is the common opinion on the ideal diet seems to change every 5-10 years, quite dramatically, so it might be wise for cat experts to be a little more cautious because we're always learning more!).

Again, cats evolved eating meat. Fresh WET meat. We need look no further than that. Kibble is a recent invention in the grand scheme of things (and first came about as a way to dispose of waste products from human industrial agriculture), and has done more harm to feline health than any other thing. Any "cat expert" that says kibble is the ideal choice is not a cat expert at all.

Originally Posted by tklow

We're still working to resolve an ongoing diarrhea problem with the little guy, but one thing at a time.

Sorry to hear about the diarrhea. What have you tried so far? Ever consider a raw diet with no grains and minimal plant matter?

[tklow]

Oh, and I missed one inquiry: yes, for the diarrhea we did try a raw grain free diet for a couple of months. There was no noticable difference. We also did a few types of hypoallergenic diet and tried both FortiFlora and Diareze. This kitty had some serious problems when his organs were developing so it could be a lot of things. We're getting some tests done on his poop to check for a couple of things that were not checked before. He's healthy otherwise, but obviously this situation will affect him over the long term.

[Love4himies]

Not all meats will work well with cats. My coworker has her cat on a raw diet because all commercial diets give her cats the runs like you wouldn't believe . And, she can't feed her cat any chicken, only beef (and mice) as chicken does not digest well in this cat. She ended up having to purchase the additives online as she can't use chicken bones. She also has to add pumpkin to bulk up his stools. Her cat used to be a mouser and got most of his food by mousing, but since he is getting older he doesn't hunt so much and doesn't like being outside in the winter. The poop problems started happening after they started feeding their cat commercial diets a few years ago.

So what I guess I am trying to say is that you may have to try different raw meats to find if one is having a negative affect on your kitty's bowels.

[tklow]

Interesting idea re: different meats.

It's certainly worth continuing to try new things. You have to try each thing for a few weeks sometimes to really know how it's working so we're slowly working through the different options!

RE: the tube, well... kitty threw up his tube again about 3 hours ago. His internal medicine specialist had said that if it happens again, we'll try him without the tube and see how he does. So, I just took him to the local vet and had the tube removed, and we're monitoring him closely to see how it all goes. As mentioned, his bilirubin and liver enzymes have been back to normal for a week and he's gained well over a pound, so I think he's ready. Crossing fingers. It's horribly distressing when they vomit up the tube and start choking on it -- for both the cat AND the humans!

If he isn't maintaining his weight, we'll have to revisit the tube.

My gut feeling is that he's brining up the tube because he's ready now to be rid of it. I can tell by watching him that he's feeling quite good now, has more energy, and is in good health again. He's alert and seems to be in a good mood, he's friendly and purring again, and he's a completely different cat from the very sick one I got home from the hospital 5 weeks ago. So far it seems that the treatment has been very effective and well worth all of the time we put in. A few weeks ago we were quite worried that we'd put him and us through all of this only to never have him fully healthy and happy again, or to lose him in spite of the treatment. It's great to know that what we and the vets have been doing really does work.

[sugarcatmom]

Originally Posted by tklow

As mentioned, his bilirubin and liver enzymes have been back to normal for a week and he's gained well over a pound, so I think he's ready. Crossing fingers.

Got my fingers crossed for ya! If his appetite isn't strong enough, maybe get some appetite stimulants (mirtazapine works great) from the vet, if you haven't already.

Originally Posted by tklow

It's horribly distressing when they vomit up the tube and start choking on it -- for both the cat AND the humans!

If he isn't maintaining his weight, we'll have to revisit the tube.

Hopefully you don't have to put another tube in, but if you do, maybe go with the PEG tube instead of the E-tube. It goes directly into the stomach through the cat's side. While the surgery for it is a bit more invasive, it's also not as easy to dislodge it.

[tklow]

Well, so far he's eating okay and he weighed a little heavier today than yesterday, so that's the best case scenario right now.

I was wondering about the PEG tube as well -- I'd read about it and heard that it can be easier to deal with when you have one in for the long term. I'll inquire about that if we end up having to retube.

I examined the portion of the tube that came out of his stomach this time and the first time (since he chewed them off and left them on my floor). the first tube had a wide opening the full width of the tube: the second tube ended with a round tip and a two holes on either side of the tip -- so the food would have to travel to the end of the tube, then push out to the sides through holes much smaller than the body of the tube. It's easy to see how such a tube would become blocked because any small amount of food or debris resting at the bottom would clog the whole thing. I can't imagine that type of tube is intended for providing food. It looks like it would be more suited to water and medication only. I have some questions as to whether the vet on call that late night was as experienced with the tubes...

[Susique333]

I was so happy to find this forum. Out 10 yr old kitty has fatty liver too. She was becoming lethargic and it suddenly became aware to me that we had not filled her automatic feeder in a while. If I was putting her food in a bowl daily I would have known how much she was eating! Once we got the diagnosis of fatter liver (blood test) we threw out that automatic feeder! The VET put her into the animal hospital and after she stabilized, inserted a feeding tube into her neck. He has done many of these cases so we felf confident. We were VERY fortunate to have a week at the hospital, surgery to insert the tube and a case of HILLS L/D prescription food (which comes already pureed and strained) come to only $490. We are now 3 weeks later and kitty is doing very well. The hardest part is making her sit still for 4-5 feedings a day. We use one can (and sometimes a little more) of L/D mixed with 1/2 cup of water, divided throughout the day. I mix it every morning and keep in the fridge, warm a filled syringe in warm water before feeding. No clogging as of yet, it is a French #18 tube. We also mix in 100mg of Milk Thistle (per Vets request) to aid in liver regeneration. We have had 3 episodes of vomiting which was my fault, I was impatient and feeding too fast. I warm the food to my skin temp and if I push the bolus in 5 cc's per 10 seconds at a time, she keeps purring. Today Im thrilled as she stole 8 pieces of the dogs kibble this a.m. which means her appetite is coming back. Vet recommended switching her to canned food once shes better, right now she prefers dry. We will cross that bridge when we get to it! All in all, I can say this is certainly something everyone should try if their cat gets this condition. Once we fell into a routine it takes no more than 15 minutes per feeding. Good luck to anyone who's cats get this condition!!

[14+kitties]

That is one of the dangers of those automatic feeders. They were made for our convenience. I wish they would be taken off the market. Maybe if someone sued the manufacturer when their cat got sick.... But the thing is no one would win because by using it we assume a lot of the responsibility ourselves. It is so easy to think that kitty has food they are eating and therefore we don't check.
I am glad your kitty is starting to steal food. Now would be a great time to start the process of switching her to a grain free, by product free canned food. Wellness, Evo, Natural Balance, Nature's Variety, Weruva, etc. are all good brands that are grain free.
A good site to check is www.catinfo.org . There is a large amount of information there about feeding cats the proper diet. There are also tips for transitioning a kibble addict to canned food.

[Susique333]

Originally Posted by 14+kitties

That is one of the dangers of those automatic feeders. They were made for our convenience. I wish they would be taken off the market. Maybe if someone sued the manufacturer when their cat got sick.... But the thing is no one would win because by using it we assume a lot of the responsibility ourselves. It is so easy to think that kitty has food they are eating and therefore we don't check.
I am glad your kitty is starting to steal food. Now would be a great time to start the process of switching her to a grain free, by product free canned food. Wellness, Evo, Natural Balance, Nature's Variety, Weruva, etc. are all good brands that are grain free.
A good site to check is www.catinfo.org . There is a large amount of information there about feeding cats the proper diet. There are also tips for transitioning a kibble addict to canned food.

Thank you for the reply! When Oreo got sick, I straight away started educating at "Google University" to learn as much as possible about this condition. The Catinfo.org was one of the 1st sights, lots of info to be had there!

[NH Mom of 3]

I'll know better after the ultrasound tomorrow, but blood work indicates early stages. My sweet, docile 11 year old yellow tiger short hair has gone from 11 to 8.5 since the holidays. I didn't notice right away because I have two cats and the bowls always seemed to empty evenly and also her disposition has been the same. She also was the first to run to her dish for her wet food early in the am.

My vet isn't overly communicative so I am arming myself with research about HL when I take her in tomorrow. SusieQ333's post sounds very familiar. I have found a recipe for kitty glop and feed my cat additional feedings with a dropper if she goes too long without visiting her dish. It's amazing in that is seems to STIMULATE her appetite! She meanders over to her dish about 30 minutes after I "GLOP" her! This has happended 3 times so it can't be a coincidence. I too, added milk thistle after getting an OK from a vet, but I am doing small doses of 10mg per day until we get a confirmed diagnosis. She still like her treats so the vet gave the OK to feed her more just to keep the calories flowing. She is also on Clavomax as a "just in case".

My question is how many calories daily are necessary to not only maintain but regain some weight to restore her to full health? I am reading anything from 100 to 200 to 300. Since she grazes lightly all day, I am going for 200 since she keeps everything down.

I am hoping for the best.. I'm supposed to leave town the end of the month to help my sister with our 85 year old mother who has clear signs of increasing dementia.. so I am very torn..but my sister needs the help. I am lucky to have a cousin who is a "people" ultrasound tech. who is willing to care for my 2 babies while I'm away. She is good about medical procedures. I hope for the best results tomorrow from Sparkle's ultrasound and that there are no severe underlying issues.

I don't know how she got this.. is she sad my son went away to college? Is it the winter blahs? Did she and my other cat have a disagreement? They have been together 6 years now. I am home all day and NOTHING in our ritual has changed.

They say once cured, it rarely comes back.. Let's hope so. I'll keep you all posted.

I am so grateful to have found this forum.. It feels comforting to talk with others coping with the same situation.