Feeding Tubes

Feeding Tubes for Cats Lisa A. Pierson, DVM Feeding tubes save lives and are not used as often as they should be for anorexic patients. Unfortunately, when most people hear the term "feeding tube", they tend to panic - feeling like this is the end of the road for their cat. However, feeding tubes should not necessarily be viewed as a doom and gloom 'last ditch effort' or as a 'heroic measure'. I often hear people say "oh, I would never put my cat through that!" Unfortunately, these folks are not recognizing the tremendous value of feeding tubes to support ill patients while they heal from a temporary illness or injury. Most cats are not bothered by the tubes at all! The human is the one who is bothered by it as the cat just goes about its daily routine. Anyone who has ever tried to syringe-feed an ill cat for very long recognizes the stress that is involved for both the cat and the human. Not only is it very time-consuming, but the critical issue is that it is often very difficult to meet the caloric and hydration (water) needs of the cat with this method. Feeding tubes are not right for every situation and case selection requires thoughtful consideration - *keeping the patient's* best interest in mind - not the human's. For cats that are suffering from a chronic, terminal illness such as renal failure or cancer, it is my feeling that a feeding tube is not necessarily appropriate to use in these cases. It is a matter of personal choice to prolong the inevitable in our pets and caregivers need to think long and hard before they put a feeding tube in a patient with a terminal illness when euthanasia may be a much more humane and loving decision to make. Feeding tubes do require a short period (~10 minutes) of general anesthesia to place and this is often a concern when the patient is very debilitated. This is why it is better to put a feeding tube in an anorexic patient sooner rather than later. See below for some pictures of feeding tubes that can be used to greatly reduce the stress to both the feline patient and the human caregiver. Please note that most cats don't even notice them and they can eat and drink with them in if they choose to do so. The first tube that is shown is a pharyngostomy ("P") tube. It goes into the side of the neck as shown and enters the back part of the oral cavity and then heads down the esophagus. Some veterinarians prefer to use an esophagostomy ("E") tube which goes in lower down the neck. Either tube works well. Another type of feeding tube is called a PEG tube and is shown at the bottom of this page. This type of tube takes more expertise to place and must stay in for a minimum of 2-3 weeks unlike P or E tubes which can be removed at any time. PEG tubes also have a bit more risk for complications associated with them. Each case has to be considered individually when deciding which type of tube to use. Here are some pictures of some of my recent patients/foster cats with feeding tubes: Poor Chase (abandoned by his owners) was very sick with hepatic lipidosis ("fatty liver" disease), pancreatitis, and IBD. His hepatic lipidosis made it critical that he receive adequate nutrition to save his life but given his illness, he was unwilling to eat. If syringe feeding was attempted, he would salivate copiously and would not swallow the food. It would also trigger more vomiting causing a great deal of stress for both of us so a feeding tube was put in place and he was fed a very small volume of pureed canned Wellness every 2 - 3 hours. It is highly doubtful that he would have survived without a feeding tube. You can see the tip of it hanging off to his right. Chase did vomit many times with this tube in place but, fortunately, the tube never came up which can be a complication when feeding tubes are used in vomiting cats. (2/06 update: Chase is now healthy and in a loving home.) Here you can see the tube entering the side of his neck and the sutures holding it in place. This area needs to be kept clean and neosporin applied. Here is a picture of a makeshift collar that I used to keep Chase's tube in place. It is fashioned in such a way that it will breakaway if caught on anything. You can also use body wraps like shown below but if the weather is too hot, I prefer to just use a safety type of collar. Chase would never have had the pleasure of wearing his Santa hat had it not been for a feeding tube. This very handsome boy posed for this picture December, 2006. ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Here is Misty with her feeding tube in place after she had to have a kidney removed. She is wearing a "Critter Wrap" that held her tube in place but these wraps keep the cat too hot and do not allow them to groom themselves so I prefer to use an Elastikon tape collar rigged so it would break away if caught on anything. (See Chase's picture.) Misty is shown here eating with her tube still in place. Once she was eating well on her own, I removed the tube. (By the way...I had her 'dress' on up side down in this picture..oops..no wonder she walked funny since it was goosing her in the armpits...) Misty is now back in her adoptive home. (She was my original rescue and in order to keep the costs down, I did the surgery aftercare at my home before sending her back to her adoptive parents.) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Molly was extremely obese and it was drastically affecting her health. She could barely walk and could not clean herself and was, in all probability, headed for diabetes. The problem was that she absolutely refused to eat canned food and getting her on a healthy diet was her ticket to a happier and healthier life. She had already been returned to our adoption agency because of her lack of cleanliness. Molly was being fed a small amount of a very low quality and species-inappropriate diet of Hill's dry r/d and a shock collar was being used to keep her away from her housemates' food. Since dry food is a very unhealthy and illogical diet for a carnivore and is the type of food that led to Molly's debilitated physical state, it was critical that she be transitioned to a canned food diet. Unfortunately, she had other ideas and wanted to continue eating dry food so a feeding tube was put in when she was under anesthesia for a dental cleaning. She was then fed pureed Wellness for the next 2.5 weeks. At that time, she started eating canned food on her own and the tube was removed. She has lost 6 # and now runs and plays like a normal cat. Molly looks grumpy in the picture to the left but she really is a very sweet cat. Actually, it was shortly after these pictures were taken that I figured out how to make a nice breakaway collar so that she would not have to wear this awful dress. As you can see by these pictures, a feeding tube does not restrict their activity. Molly was able to hang out with her buddies like a normal cat. ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Some of you may have seen Bennie on my Feline Obesity page. Bennie had his feeding tube in for about 5 weeks. I only used it for the first 2-3 weeks but I kept it in for another ~2 weeks just to make sure that he was going to eat well on his own. When it came time to feed him, he would crawl in my lap and just purr away. He was not bothered by the tube at all and would play like a normal cat during the 5 weeks that the tube was in place. Feeding Bennie movie. This is not a very good movie but it was the best that I could do without help. The next two pictures were taken just a few hours after Bennie had the feeding tube put in. As you can see, he is none the worse for wear after his trip to the clinic which also included a dental cleaning - which I always do if I have any of my cats under general anesthesia. As soon as I brought him home from the clinic and gave him a meal through his tube, he was much brighter and more alert than he had been prior to the tube placement. After his first feeding, he rolled over for a belly rub. ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ And finally, my much loved Sundance..... Even though these are not good pictures of a PEG tube, I had to put them on this page to honor my precious boy. I rescued Sundance from the 'euthanize list' at our local shelter. He weighed a nice 10 pounds at the time. He was then adopted out to what I thought was a loving home but the people returned him to me 2 years later as an emaciated 4.5 pound cat. They had not sought any veterinary care for what turned out to be lymphoma. I immediately put a PEG tube in him and within a couple of months he returned to a robust 10 pounds of pure love. Unfortunately, Sundance lost his battle with cancer and I had to put him to sleep which darn near killed me. I still cry over him and that was 7 years ago.... You can see the PEG tube port near Sundance's shoulder. This tube went directly into his stomach entering from the left side just behind the ribcage. Sundance was never bothered by this tube and lived a normal life for the 3-4 months that it was in. I do want to comment that if the diagnosis of terminal lymphoma would have been made prior to the tube placement, I would have opted for euthanasia rather than to prolong the inevitable with a feeding tube. If your veterinarian recommends a feeding tube for your sick kitty, please do not hesitate to utilize this life-saving tool. November, 2006 Lisa A. Pierson, DVM** Information on this site is for general informational purposes only and is provided without warranty or guarantee of any kind. This site is not intended to replace professional advice from your own veterinarian and nothing on this site is intended as a medical diagnosis or treatment. Any questions about your animal's health should be directed to your veterinarian.

	FELINE NUTRITION Feeding Your Cat Printable version Feline Diabetes and Carbohydrates Feline Obesity The Carnivore Connection to Nutrition in Cats Debra L. Zoran, DVM, PhD, DACIVM Commercial Canned Food Choices Stores in the South Bay area of southern CA (Torrance, Lomita, Redondo Beach, Rancho Palos Verdes, etc.) that carry high quality canned food. Making Cat Food Protein/Fat/Carbs Chart MORE CAT INFO The Litter Box Feeding Tubes Pilling Cats and Dogs- The Dangers of Erosive Esophagitis TLC Cat Rescue and Adoptions Drop Trap/Remote Control Trap Building a Drop Trap Robbie's Barium Study Miscellaneous pictures Recommended Reading - book by Dr. Elizabeth Hodgkins My Rescued/Adoptable Cats and Kittens Ant problem solution Dr. Pierson's tall, dark and handsome men

Feeding tubes save lives and are not used as often as they should be for anorexic patients.

Unfortunately, when most people hear the term "feeding tube", they tend to panic - feeling like this is the end of the road for their cat. However, feeding tubes should not necessarily be viewed as a doom and gloom 'last ditch effort' or as a 'heroic measure'. I often hear people say "oh, I would never put my cat through that!" Unfortunately, these folks are not recognizing the tremendous value of feeding tubes to support ill patients while they heal from a temporary illness or injury. Most cats are not bothered by the tubes at all! The human is the one who is bothered by it as the cat just goes about its daily routine.

Anyone who has ever tried to syringe-feed an ill cat for very long recognizes the stress that is involved for both the cat and the human. Not only is it very time-consuming, but the critical issue is that it is often very difficult to meet the caloric and hydration (water) needs of the cat with this method.

Feeding tubes are not right for every situation and case selection requires thoughtful consideration - keeping the patient's best interest in mind - not the human's. For cats that are suffering from a chronic, terminal illness such as renal failure or cancer, it is my feeling that a feeding tube is not necessarily appropriate to use in these cases. It is a matter of personal choice to prolong the inevitable in our pets and caregivers need to think long and hard before they put a feeding tube in a patient with a terminal illness when euthanasia may be a much more humane and loving decision to make.

Feeding tubes do require a short period (~10 minutes) of general anesthesia to place and this is often a concern when the patient is very debilitated. This is why it is better to put a feeding tube in an anorexic patient sooner rather than later.

See below for some pictures of feeding tubes that can be used to greatly reduce the stress to both the feline patient and the human caregiver. Please note that most cats don't even notice them and they can eat and drink with them in if they choose to do so.

The first tube that is shown is a pharyngostomy ("P") tube. It goes into the side of the neck as shown and enters the back part of the oral cavity and then heads down the esophagus. Some veterinarians prefer to use an esophagostomy ("E") tube which goes in lower down the neck. Either tube works well.

Another type of feeding tube is called a PEG tube and is shown at the bottom of this page. This type of tube takes more expertise to place and must stay in for a minimum of 2-3 weeks unlike P or E tubes which can be removed at any time. PEG tubes also have a bit more risk for complications associated with them.

Each case has to be considered individually when deciding which type of tube to use.

Here are some pictures of some of my recent patients/foster cats with feeding tubes:

Poor Chase (abandoned by his owners) was very sick with hepatic lipidosis ("fatty liver" disease), pancreatitis, and IBD. His hepatic lipidosis made it critical that he receive adequate nutrition to save his life but given his illness, he was unwilling to eat. If syringe feeding was attempted, he would salivate copiously and would not swallow the food. It would also trigger more vomiting causing a great deal of stress for both of us so a feeding tube was put in place and he was fed a very small volume of pureed canned Wellness every 2 - 3 hours. It is highly doubtful that he would have survived without a feeding tube. You can see the tip of it hanging off to his right. Chase did vomit many times with this tube in place but, fortunately, the tube never came up which can be a complication when feeding tubes are used in vomiting cats. (2/06 update: Chase is now healthy and in a loving home.)

Here you can see the tube entering the side of his neck and the sutures holding it in place. This area needs to be kept clean and neosporin applied.

Here is a picture of a makeshift collar that I used to keep Chase's tube in place. It is fashioned in such a way that it will breakaway if caught on anything. You can also use body wraps like shown below but if the weather is too hot, I prefer to just use a safety type of collar.

Chase would never have had the pleasure of wearing his Santa hat had it not been for a feeding tube. This very handsome boy posed for this picture December, 2006.

Here is Misty with her feeding tube in place after she had to have a kidney removed. She is wearing a "Critter Wrap" that held her tube in place but these wraps keep the cat too hot and do not allow them to groom themselves so I prefer to use an Elastikon tape collar rigged so it would break away if caught on anything. (See Chase's picture.)

Misty is shown here eating with her tube still in place. Once she was eating well on her own, I removed the tube. (By the way...I had her 'dress' on up side down in this picture..oops..no wonder she walked funny since it was goosing her in the armpits...) Misty is now back in her adoptive home. (She was my original rescue and in order to keep the costs down, I did the surgery aftercare at my home before sending her back to her adoptive parents.)

Molly was extremely obese and it was drastically affecting her health. She could barely walk and could not clean herself and was, in all probability, headed for diabetes. The problem was that she absolutely refused to eat canned food and getting her on a healthy diet was her ticket to a happier and healthier life. She had already been returned to our adoption agency because of her lack of cleanliness. Molly was being fed a small amount of a very low quality and species-inappropriate diet of Hill's dry r/d and a shock collar was being used to keep her away from her housemates' food. Since dry food is a very unhealthy and illogical diet for a carnivore and is the type of food that led to Molly's debilitated physical state, it was critical that she be transitioned to a canned food diet. Unfortunately, she had other ideas and wanted to continue eating dry food so a feeding tube was put in when she was under anesthesia for a dental cleaning. She was then fed pureed Wellness for the next 2.5 weeks. At that time, she started eating canned food on her own and the tube was removed. She has lost 6 # and now runs and plays like a normal cat.

Molly looks grumpy in the picture to the left but she really is a very sweet cat. Actually, it was shortly after these pictures were taken that I figured out how to make a nice breakaway collar so that she would not have to wear this awful dress.

As you can see by these pictures, a feeding tube does not restrict their activity. Molly was able to hang out with her buddies like a normal cat.

Some of you may have seen Bennie on my Feline Obesity page. Bennie had his feeding tube in for about 5 weeks. I only used it for the first 2-3 weeks but I kept it in for another ~2 weeks just to make sure that he was going to eat well on his own.

When it came time to feed him, he would crawl in my lap and just purr away. He was not bothered by the tube at all and would play like a normal cat during the 5 weeks that the tube was in place.

Feeding Bennie movie. This is not a very good movie but it was the best that I could do without help.

The next two pictures were taken just a few hours after Bennie had the feeding tube put in. As you can see, he is none the worse for wear after his trip to the clinic which also included a dental cleaning - which I always do if I have any of my cats under general anesthesia. As soon as I brought him home from the clinic and gave him a meal through his tube, he was much brighter and more alert than he had been prior to the tube placement. After his first feeding, he rolled over for a belly rub.

Even though these are not good pictures of a PEG tube, I had to put them on this page to honor my precious boy. I rescued Sundance from the 'euthanize list' at our local shelter. He weighed a nice 10 pounds at the time. He was then adopted out to what I thought was a loving home but the people returned him to me 2 years later as an emaciated 4.5 pound cat. They had not sought any veterinary care for what turned out to be lymphoma. I immediately put a PEG tube in him and within a couple of months he returned to a robust 10 pounds of pure love. Unfortunately, Sundance lost his battle with cancer and I had to put him to sleep which darn near killed me. I still cry over him and that was 7 years ago....

You can see the PEG tube port near Sundance's shoulder. This tube went directly into his stomach entering from the left side just behind the ribcage. Sundance was never bothered by this tube and lived a normal life for the 3-4 months that it was in.

I do want to comment that if the diagnosis of terminal lymphoma would have been made prior to the tube placement, I would have opted for euthanasia rather than to prolong the inevitable with a feeding tube.

If your veterinarian recommends a feeding tube for your sick kitty, please do not hesitate to utilize this life-saving tool.