Friday, December 2, 2016

Esophagostomy tubes (E-tubes) and cats

 There are a number of reasons that a veterinarian might recommend the placement of an esophagostomy tube or e-tube if your cat is ill. The most common reason to place a tube is due to poor appetite - whether from pancreatitis or cancer or other illness. Other reasons could be to give fluids and medication to a cat in renal (kidney) failure or in the case of an oral or facial injury that makes it difficult for the cat to eat. Many people are concerned about the idea of placing a tube in their cat's neck because they fear that it will bother the cat, or it may look strange, or it may be difficult to maintain, but in reality, most people find that their cats are not bothered, the tube is surprisingly easy to maintain, and it is not as strange to look at as they thought. We thought that we would share a couple of recent experiences with you, and we invite you to share your own experiences, if you have had a cat with a tube placed.

An esophagostomy tube is a tube that is placed in the side of a cat's neck and sutured into place. The opening to the tube is located behind one ear, and the other end is located near the spot where the esophagus meets the stomach. There is a cap on the end of the tube behind the cat's ear, and the cat wears a small cloth collar to help protect the tube site and prevent too much motion of the tube.

Ms. Poof - 



Ms. Poof with her tube
We would like to share our experience with the feeding tube that we decided to use for our cat. 
At age 15 she has develop kidney disease. After several weeks of trying different ways to maintain her weight and make sure she got enough fluids, Drs. Bailey and Demos spent a great deal of time helping us though several treatment plans 
They offered the potential use of the feeding tube.  It sounds much worse than it is!  We decided to try it
The procedure was quick. Our cat is fairly fussy, but she has had no reaction. The little cloth collar doesn't bother her at all- and she would never tolerate a regular collar.
This has made caring for her so much easier. We can get her the necessary fluids and can also administer any necessary medications-we all know how stressful it is the get a cat to take a pill! She plays and eats and sleeps normally with the tube. 
I would recommend giving serious consideration to using the tube if the doctors make the suggestion. The entire staff at Exclusively Cats are phenomenal.
They care for our cats as if they were their own. 
I'd be happy to talk to anyone about our experience. 


Peabody, our renal failure kitty -

Thanks for asking me to write about our experience with Peabody and using an e-tube while he was
Peabody snoozing with his buddy Lewis
in renal failure. Peabody was our second renal failure kitty. His sister, Kimba Girl, had it as well. Kimba lived to be 18, and she was on sub Q fluids for 18 months. She just kept going and going! Still, it was quite a commitment to give her the injections every day, more injections as time went on. She accepted them quite well.
Peabody and Lewis sharing a heated bed
We were given the option for an e-tube with Kimba, but we truly thought that once she was on fluids, it would only be a matter of months. We didn’t want to put her through the surgical procedure at 16. Since we had to give her injections for well over a year, we knew that, for Peabody, we would do the tube right off the bat, because he could be on fluids for quite a while.
Peabody enjoying the outdoors with his tube
I was, at first, surprised by how long the tube stuck out from his neck. I was concerned about his collar bothering the tube. He had to wear a little cloth sleeve to protect the tube incision site as well. For the most part, it didn’t seem to bother him and, while we did have a few challenges with the tube, I believe it was a good choice for Peabody overall.
Our cats do go outside in the yard a bit. This was the hardest adjustment, because Peabody could not eat grass once the tube was in. The grass-induced vomiting put him at risk of coughing up the tube. Still, he wanted to go out every day and enjoy the sun, roll in the dusty driveway, rub his face in the catnip, and eat grass. As a result, I spent plenty of time just following him around the yard monitoring him to ensure he didn’t eat any grass. Sometimes I stood in the sun, for 10, 20, 30, minutes, while he just nosed around, rolled, etc. I must admit it drove me nuts sometimes, but I’d love to do it one more time with him.
As luck would have it, he did vomit the tube up in our living room just a couple weeks after having it put in. It is something that happens. We just did not give him fluids that day, & got him back to the vet the next day, and the tube was replaced.
The incision site needs to be cleaned daily. This did not prove to problematic; I just did it before or after giving the fluids, while the cat was already next to me. I kept the supplies in a little bowl, and I did it on the sofa. Peabody did not like to be carried to the bathroom counter for such things.
We did run into an unusual problem about 9 months in. We noticed some sort of black stuff –
possibly a mold – growing inside the tube. Very weird. Not sure how it ever got in there. We tried pushing a tiny syringe of coca cola thru it, but that did not work. I even bought some tiny pipe cleaners, dipped it in cola, and tried to scrub the tube interior, with no improvement. However, by doing that, I think I tugged a bit on the stitches attaching the tube to the neck, so we once again had to take him in and have that addressed. Since the tube had this mold, it had to be replaced – again – and it was stitched up again. We had no further problems with the tube. The good vets at E-Cats indicated they had never seen that before, so it’s unlikely you would run into that particular concern.
As far as giving the fluids, there are several advantages of using the tube. First, it is so much easier
Peabody's tube did not interfere with his favorite sport - extreme napping
than using bagged fluids, heating it up, filling syringes, and giving your cat several 2 oz injections. I just put warm tap water in a mug, filled a 2 oz syringe from the mug, and took the syringe and mug to the sofa. I would no sooner sit down and Peabody would hop up next to me, purring. He loved getting his water. He curled up and just purred loudly while I slowly pushed the water. I assume it felt warming, and filled his belly. He was always happy to have it. It was a very loving experience.
Another advantage of giving the fluids through a tube, is that it was easier for my husband to do participate as well. His eyesight is not the best, so filling the syringes quickly and making sure he was injecting the cat properly was difficult for him. That meant most of the work fell to me, and it was hard for him if I was out of town. With the tube, he could easily give Peabody the fluids and have some nice “sofa-time” with sweet Pea.
As Peabody occasionally got constipated, we needed to give him some Miralax every day. With
Kimba, we added it to her food, and could never be sure if she ate it, or one of the other cats. With Peabody, we just stirred the Miralax into the cup of warm water, and it went in with his fluids. Easy peasy.
The little cotton collars do need to be laundered. Peabody’s tube stuck out quite a ways, and I was always concerned about it hurting if he got in a tussle with another cat, or while scratching. I sewed a little piece of elastic to the collar so that I could tuck the tube under that, and keep it “hugging” closer to his neck.
A loving memorial to a singular cat
We now have our 3rd renal failure kitty, Lewis. Lewis was recently put on fluids just for a few days, and he improved. Eventually we know we will have to make the choice again – do we give him daily injections or the tube? A major factor will be that Lewis likes to go outside much more than Peabody, and his favorite thing is eating grass. We will have to decide if we want the convenience and ease of the tube for ourselves, or to let him continue to enjoy the yard and eat grass. We’ll have to wait and see.