3/14 Cain Back home with feeding tube

Discussion in 'Lantus / Basaglar (glargine) and Levemir (detemir)' started by Jennifer&Cain(GA), Mar 14, 2014.

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  1. Jennifer&Cain(GA)

    Jennifer&Cain(GA) Member

    Joined:
    Apr 1, 2013
    Hello!

    Previous condo.

    Looks like I'll be renting a condo here for the (hopefully) short term. I'll start taking BG levels again too. Well much more frequently than two weeks between.

    Cain is back home. He's very loopy. Keeps turning in circles. He went to the litter box and urinated some, but I think he's trying to poop and not being successful. I need to pull him out of it soon so he doesn't try sleeping in it again. Oh, I just checked on him. He's in the other litter box (we have two for both cats) and trying to poop. Poor guy.

    Okay, so I got a lot of instructions and they said I could start feeding him tonight, once most of the anesthetic has worn off. Cain tried escaping out of his carrier a bit on the way back to the car cause I have one that you snap on the top and they were taking the top of it off to access him easier. And the back part wasn't snapped on very well. Thankfully I noticed it before I took more than a few steps outside of the office. Mainly cause I saw Cain's head partially sticking out, mostly his nose. :lol:

    I hope I can do this well. Just looking at him makes me worried. I worry about when I need to clean the area around the tube. It already kinda squicks me out a bit. I'll get used to it (I hope), and hopefully Cain will too without much trouble.

    Brownie keeps hissing at him when she went to investigate. I'm not sure if it's the smell on him or what. She was fine with him last night when I brought him back home from my vet. *shrug*

    And I just found him trying to get behind the dryer. Luckily I went and checked on him again. He has a nest of blankets at the side of my bed but once he's more aware I'll put him on my bed. I don't want him falling off and hitting the tube right now.

    Thank you very much, everyone, for the healing vines and prayers, and the help and vines for me. I'm still frazzled and I'm sure feeding him will become habit (thank goodness I have a phone that can do multiple alarms now) but I appreciate it all. Y'all are a bunch of good eggs. :D :YMHUG: :YMHUG:
     
  2. Squeaky and KT (GA)

    Squeaky and KT (GA) Well-Known Member

    Joined:
    Jul 19, 2011
    Oh I'm SO glad he's home. Of course you can do this and do it fine....remember when looking at the insulin needle kinda "squicked" (<-new grin) you out? This will become just as routine...

    BIG HUGE HUGS!!!
     
  3. Dyana

    Dyana Well-Known Member

    Joined:
    Dec 28, 2009
    I'm glad he got the feeding tube.
    At first, you'll need lots of wet paper towels and maybe a towel to put under him. It is a little messy at first, but you'll get used to it. Hopefully, Karrie and others with experience will come along to help you with pointers.
     
  4. Ella & Rusty & Stu(GA)

    Ella & Rusty & Stu(GA) Well-Known Member

    Joined:
    Jan 11, 2010
    Hi again, Jennifer,
    You and Cain will do just fine. Of course he's loopy from the anesthesia and from the surgery itself, but by tomorrow he will have gotten used to his tube. It will be so much easier for you to get the right amount oF food and meds into him with the tube. karrie has lots of tips that she can give you. Tonight Brownie isn't used to the smell of the post surgery and the other vet's office, but those smells will wear off.
    We are thinking of you and sending very positive thoughts for Cain's speedy recovery.

    Many hugs and scritches,
    AND VINES!

    Ella & Rusty
     
  5. Karrie and Maverick

    Karrie and Maverick Well-Known Member

    Joined:
    Oct 22, 2010
    Has the Pancreatitis group given you info on tube feedings?
    Will you be doing fluids at home?
    Did you get a prescription for ondansetron?
    Can you post all of the instructions that you were given and what medications he is on? share with the Pancreatitis group.
    Pancreatitis is dehydrating and he may be constipated or in too much pain.
    Cain is dealing with a lot. Pain from pancreatitis and horrible nausea from the liver disease.
    The gang here will give you advice on the diabetes - you need to keep DKA at bay. Have you tested for ketones yet?

    They may want you to join the Yahoo Feline Assisted Feeding group but I will leave that to the gang on the pancreatitis group. Three groups is a lot to manage. The FAF group has pictures on how to change the bandages when you need to do this.

    Did you do a tube feeding yourself at the vets? Its really important to go SLOW. 1/2cc and wait thirty seconds. Especially for the first few days. You'll learn to get in a rhythm.

    There is so much info to share.

    The key things:
    1. warm up the food to room temperature. Warm food is less likely to vomit. If he hasn't gotten ondansetron he will be feeling nauseated. This is a guarantee with liver disease. Until you address nausea he will still feel very unwell especially when fed. Ondansetron is a must. Let the pancreatitis group know you need help getting your vet to prescribe this and they can give you good advice.
    1.5 Do NOT do a preflush. This isn't needed. Just do a 6-8ml water flush after feeding and recap the tube. Water takes up valuable space where calories need to be.
    2. Stop if you see signs of nausea - lip licking/lips smacking, teeth grinding, and definitely stomach lurching. You want to minimize vomiting as the end of the etube can come up through the mouth. If he vomits wait a half hour and try feeding again. Go slower. You may not be able to get full feeds in. A half feed is better than a full feed vomited up.
    2.5 Most cats cannot handle more than 35-40cc's total volume including water post flush.
    3. Be in a contained comfortable area. Like a bathroom. If Cain bolts drop the syringe. You can't hold him back with the tube and could pull it out. Its easy to clean up a mess.
    4. Use the feeding time as a bonding experience. Talk to him, Sing to him, Tell him how beautiful he is, Pet him, Brush him, Love him.
    5. I would keep him away from the other cat(s) until he has gotten through the crisis stage. Block off any areas where you can't get him like under the bed. Make sure his tube can't get caught on anything. Is it taped up behind his head so he can't get a paw in it? Some members of the FAF group cut off the end of a mens sports sock and put it around the bandage/tube as an extra layer of protection. Make sure it is not tight. I know you are low on funds. I really recommend the kittykollar from kittykollar.com. It is incredible for cats with etubes.
    6. You really should do a couple of night time feedings for the first two weeks. Calories will be one of the key things to get him through this.
    7. Some vets think you need to aspirate an etube - pull back with an empty syringe. If your vet told you to do this let me know. It would make me think he placed the tube directly in the stomach which would be an incorrect placement. Most vets know not to do this but on FAF lately it seems to be happending more than usual.
     
  6. Karrie and Maverick

    Karrie and Maverick Well-Known Member

    Joined:
    Oct 22, 2010
    I sent you another PM.

    Don't forget to get diabetes advice!!! :) :) :)

    AD I believe is high in carbs. Max Cal isn't. But MaxCal may be too much fat for a pancreatic cat. The pancreatitis group will be able to best advise the best food. Let them know he is out of remission and his blood glucose is rising. So you want ideally less than 10% carbs. And you need to avoid DKA. You can keep both groups updated so they know what you are feeding and how much etc.
     
  7. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Senior Member Moderator

    Joined:
    Dec 28, 2009
    Jennifer --

    I'm sure the feeding tube will help. It will be an adjustment for you both but food is essential! Several people who's kitty's had feeding tubes found this collar to be helpful: kitty kollar. It helps to keep things in place and out of the way.
     
  8. julie & punkin (ga)

    julie & punkin (ga) Well-Known Member

    Joined:
    Feb 17, 2011
    just want to lend you a little moral support, jennifer. :YMHUG:

    how is his blood sugar?
     
  9. Tricia Cinco(GA) & Harvey

    Tricia Cinco(GA) & Harvey Well-Known Member

    Joined:
    Jul 18, 2011
    I'm so glad you were able to get the tube. I know it's scary and intimidating, but remember you probably felt that way when you started dealing with FD, and look how well that turned out! I want to reiterate Karrie's advice to go slowly when feeding. That was probably my biggest problem - I tried to give him too much too fast. You must let the tube clear - you don't want it all backed up.

    Sending more hugs and healing vines. I'll be praying all goes well for you and Cain! :YMHUG: :YMHUG: :YMHUG:
     
  10. DD & Tinkerbell

    DD & Tinkerbell Well-Known Member

    Joined:
    Dec 28, 2009
    It's wonderful news that Cain got the e-tube! Tawny had one and she did great w/it. It was a few yrs ago (late 2011) but if I remember correctly I fed her thru the tube no more than 30 mls per feeding. She never vomited, not even once. She started doing better, getting her strength back, quickly. It was a bonding experience for us and I would talk to her and pet her and love on her thru out the whole e-tube feeding process.

    Listen to Karrie. We did exactly what she said and it worked. Going slow is key, and if you see the food start to back up out of the hole where the tube is inserted into the body, STOP. We did have an issue at one point where, if I recall, all but one of her stitches around the tube had come loose but I called the vet and they said bring her back and they would reinsert it at no charge and they did and everything was cool after that. I don't remember how they came loose, b/c she never pulled at it or anything that I remember. Maybe I should go back and read all the old posts.

    Karrie, or whoever knows...don't I remember not to give mirtazapam w/a feeding tube? There was some med to definitely not give Tawny while she had the tube. I don't know if Cain has been getting mirtz or not but if so, Jennifer, did the vet say anything about this?

    We had 2 kitty kollars, made it much easier to have one to wash and one to wear, and they were lifesavers. They work beautifully and if you can get one or two, do.

    Oh, and don't forget to test for ketones!

    We'll be watching over you.
     
  11. Jennifer&Cain(GA)

    Jennifer&Cain(GA) Member

    Joined:
    Apr 1, 2013
    BG is 354. Still very elevated but I'm hoping it'll come down soon.

    Well I found out my bottle of ketone strips might not be good anymore. I tried to test but either it was no trace, I didn't get enough urine on the strip, or the strips are bad. I'll try to get another one tomorrow.

    I did not get a prescription for ondansetron. The only medication Cain is being given is Ursodiol at .25ml a day. I asked them to show me how to wrap his neck with bandage but they almost forgot to show me that. No tube feeding showing there. I was going off the instructions off the sheet and what you said to go slow. I hope I did it right. I didn't get any bandages from them and I'm supposed to clean and check it once a day, two days at most. And to put neosporin around the incision but not in it. So I left them a voicemail and they're open till noon tomorrow so I'm going to make sure to wake up early and ask them questions. Hopefully I'll remember to write some questions down so I can ask it. I'll ask about the ondansetron and fluids. The tube is very opaque so I won't be able to see food coming back up it. I paid attention to Cain's head to see if there was any issues. I think it weirds him out but he's pretty woozy still. He's turning in circles only to the left and trying to hide his head.

    I fed him 10ml so far and in about an hour I'll feed him another 10ml.

    I am being told that for days 1-3 I'm feeding 10 to 15 ml every 2 to 3 hours. Days 3-6 to give 20-30ml every 3 hours. Days 6-10 give up to 60ml every 4 to 5 hours. It also says to leave dry food out but yeah that's not happening. I told them that I'm going to be leaving out his usual food that I feed Brownie as well and see if he's interested in eating it at some point. But yeah, lukewarm or baby bottle temp water to flush it out (10ml) then feed him, then flush it out again with the same amount then cap the tube. I was told not to leave the cap off for long. Unfortunately, either I didn't replace the cap properly or Cain knocked it out, when I got out of my shower the tube was uncapped. I grabbed a new one real quick but it was probably open a minute.

    I've blocked off the path they use to get under my bed. I'll try to clean up the floor before I go to sleep.
     
  12. julie & punkin (ga)

    julie & punkin (ga) Well-Known Member

    Joined:
    Feb 17, 2011
    i think it's important to restart insulin, jennifer. that's really high. you don't want to have ketones.

    sounds like you're off to a good start. :YMHUG:
     
  13. Marje and Gracie

    Marje and Gracie Senior Member Moderator

    Joined:
    May 30, 2010
    I agree with Julie that you need to restart insulin.

    Sending many vines!
     
  14. Jennifer&Cain(GA)

    Jennifer&Cain(GA) Member

    Joined:
    Apr 1, 2013
    Oh I was hoping I wouldn't have to restart him so soon. hmm I have an old pen in the fridge. I haven't checked it's liquid yet. It's from the original batch I bought last year so I bet it's not good anymore.

    Hmm I'll see what the last of my prescription will be, which hopefully it's still in Walmart's system. What dosage should I start him on? (Shoot I'll need a refresher course in shooting. :lol: )

    Right now Cain is resting his head on the containers under my bed on the towel nest next to it. He's still very wobbly and wanting to hide in dark places. I made a box for him but it's not as big as it should be. Sometimes he'll slowly walk that way or to where it was earlier in the night. Poor baby. I need to block off a part near the washer cause he's seeking dark places and that's where I have some borax stored. nailbite_smile
     
  15. Anne & Zener GA

    Anne & Zener GA Well-Known Member

    Joined:
    May 26, 2011
    I wish I was more help. At least I can send support and cheer you both on. Sending heaps of vines for Cain and hugs to you Jennifer.
     
  16. Ella & Rusty & Stu(GA)

    Ella & Rusty & Stu(GA) Well-Known Member

    Joined:
    Jan 11, 2010
    Hi Jennifer,
    If your Lantus is no longer good, you could look into getting the Lantus savings card:
    http://www.lantus.com/sign-up/offer...VQ6-33575109576-VQ15-1t1-VQ16-c-VQ14-58228089
    Many of the people here have used this offer. Rusty is on Levemir, so I don't know exactly what kind of prescription is required in order to use the Lantus card, but I hope that others will chime in and tell you. In any event, it can't hurt to request one. It's a great deal financially: $25. per pen for up to $300. worth of pens. If you start up your spreadsheet again, the dosing experts here will be able to help you with Cain's dose. Put the ? symbol in your subject heading and the word "dose" to get experienced eyes on this problem. How long ago did Cain fall out of remission? At the onset of the pancreatitis? When Rusty had pancreatitis his blood glucose went up (that's how we knew something was wrong).

    I hope that today will be much less traumatic than yesterday and that things will go smoothly with this new learning curve. My DH and I would like to help you get Cain a Kitty Kollar. I'll be sending you a P.M. later today.

    Hugs and scritches,

    Ella & Rusty
     
  17. Karrie and Maverick

    Karrie and Maverick Well-Known Member

    Joined:
    Oct 22, 2010
    I'm typing on an iPad till later and I hate using it.

    You really need to get anti nausea meds. I will post an article later you can show your vet. Tell him you have nothing to lose and have read it's very helpful for cats with liver disease. Ask for a script for 4mg pills and give 1/4 pill twice a day. Tell him to look it up in his plumbs guide. Feeding him without it would be like feeding you with the stomachs flu. Even though you may not be vomiting you are miserable. The research exists for this. It hit home when my dad died from liver disease and he could verbalized how bad he felt.

    Do not do the pre flush! Use that for 10mls of food. Trust me.

    I wouldn't use bigger than a 20ml syringe. Get a lot of them they start sticking after a while. 60ml syringes are insane to tube feed with and you risk aspirating the lungs especially if the plunger zooms unexpectedly.

    Do a 10 ml Luke warm post flush. Feelings should take a half hour or so when you start.

    I would ask the pancreatitis group about his head. Is he still drooling? This could be a sign of brain issues that if related to liver disease lactulose can help alleviate.
     
  18. Tina & Rocky

    Tina & Rocky Well-Known Member

    Joined:
    Dec 19, 2013
    EXCESSIVE DROOLING IS A SIGN OF DEHYDRATION!!!!

    I'm sorry to yell this at you-- but are you still giving him sub-qs????

    A cat DOES NOT WANT TO EAT when he is dehydrated. I have been dehydrated and it makes you VERY SICK TO YOUR STOMACH AND NAUSEOUS..

    You need to give him MORE SUB-QS, and, YOU MUST ADD WATER TO HIS FOOD!!!

    The wobbling is from dehydration. You get very, incredibly dizzy....it's just makes you feel AWFUL!!!

    Cain can die from simply dehydration, you know, right?

    If you can't give the sub-qs, if you don't know how, you MUST get him back to the vet again right now.

    The feeding tube is NOT going to work if you cannot keep Cain hydrated.


    Cats that have pancreatitis need continuous electrolyte fluid support and not just tap water.

    Cain has pancreatitis and he first became painful and dehydrated, so he would not eat anything for you. You were not able to syringe feed him enough food so his then went on to develop Fatty Liver Disease at the same time. He has both of them.

    Were you able to get the Buprenor for Cain yet? What is your timetable for getting the correct pain medication for Cain?
     
  19. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Senior Member Moderator

    Joined:
    Dec 28, 2009
    Yelling is not helpful. Jennifer is doing everything she can for Cain. The information can be useful; the delivery is not. If it were me, I'd probably stop reading my kitty's condo which means that none of the information people are posting is getting to Jennifer.

    Drooling is also a sign of nausea, among other things, and that list of things that drooling is a symptom of is long. Drooling MAY be a symptom of dehydration. There are ways to tell if Cain is dehydrated: if you pull up on the skin along Cain's back, does it readily go back into place? If you touch his gums, are they tacky or dry? Dry gums and the skin not going back to normal are indicative of dehydration. I'm assuming that Cain's vet ran blood tests. These will be a more accurate indicator of dehydration.

    Keep in mind that the food that's going into the feeding tube needs to have liquid added to it in order to get down the tube. This should help to keep Cain hydrated. The question is whether he is sufficiently hydrated. Checking his skin and gums will help to answer that question as will asking the vet if his blood work suggested dehydration.

    Jennifer -- was the Lantus in your refrigerator opened? If not, the expiration date on the pen may indicate that it's still good. The unopened pens have a long shelf-life. If it was opened or if it's past the expiration date, do fill out the link to the Lantus card that Ella provided. It's a huge savings. You need to buy one pen at a time for the $25 per pen offer. With numbers this high, I agree with Julie and Marje, start Cain back on insulin. It will probably help him to feel better. How about getting him started on 0.5u?

    If your unsure of whether the ketone strips are good, use them to test yourself. If the color on the strip is what you got when you tested Cain, good -- he doesn't have ketones!
     
  20. Tina & Rocky

    Tina & Rocky Well-Known Member

    Joined:
    Dec 19, 2013
    Jennifer-

    I am sorry for yelling at you and being judgmental of you. I know that you are feeling very sad, and you are probably very frightened of how Cain is acting right now. I've been there too. I know it. I've felt it too.

    I'm going to stay way from your condo because it's obvious to me that the others here pooh-pooh the idea that Cain is still dehydrated. This is how the entire event started though...I believe that Cain is nauseous because his body is not re-balanced yet, and others here disagree with me. I believe the anti-nausea pill with help Cain, but I believe it is treating a symptom and not the cause. I believe ultimately that Cain still needs those sub-qs throughout his entire pancreatic episode/fatty liver episode. Getting him that Buprenor would majorly help relieve his pain as well.

    Many blessings to you and Cain, Tina
     
  21. Marje and Gracie

    Marje and Gracie Senior Member Moderator

    Joined:
    May 30, 2010
    I seriously do not think anyone is trying to ignore or dismiss the fact that Cain also needs fluids and pain meds. I know Jennifer is aware of this and she is doing the best she can. Taking care of this sick of a kitty is time consuming and so it would be difficult for her to have the time to tell us everything.
     
  22. Shelly & Jersey

    Shelly & Jersey Well-Known Member

    Joined:
    Feb 1, 2014
    Hi Jennifer,

    I just wanted to stop by and tell you that I'm keeping you and Cain in my thoughts and prayers. I have no advice for you - other than to just take one day at a time.

    Lots of healing vines are headed your way!
    Shelly
     
  23. Linda and Scooter & Jack

    Linda and Scooter & Jack Well-Known Member

    Joined:
    Nov 9, 2012
    Hi Jennifer:

    I too wanted to pop by and tell you I have been watching your condo's for the last few days.

    You are an amazing owner and wonderful Mom. Cain is in good hands. You are doing great. Follow the instructions from the folks here and I am sure Cain will do well.

    Prayers for both of you thru this.

    Linda
     
  24. Jennifer&Cain(GA)

    Jennifer&Cain(GA) Member

    Joined:
    Apr 1, 2013
    Awww thanks all. I appreciate the good vines and well wishes and everything. :YMHUG: :YMHUG: :YMHUG: \M/
     
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