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May the Force Feeding Not Be with You
July 30, 2018 (published)

Imagine yourself in the throes of the stomach flu (or a very, very bad hangover): Your stomach is doing flip flops, waves of nausea mercilessly keep coming, and the thought of anything that even remotely resembles food causes you to mentally calculate how quickly, if presented with, say, a Saltine cracker, you could make a mad dash to the toilet. Now, with those thoughts clearly in mind, imagine your loving partner or spouse approaching you with a turkey baster filled with gruel that he or she wants to squirt into your mouth. Syringe feeding is not only unpleasant, it also can cause aversion to food so that the patient is reluctant to eat. After all, ya gotta eat, goes the argument.

I believe our nauseated and ill cats and dogs must feel the same way when their well-intentioned, but ill-informed, human companions decide that it’s time for force feeding.

Cats and dogs can become hyporexic (eating less than normal) or anorexic (not eating any food) from a variety of illnesses. What they don’t do is calorie restrict due to mental health issues or because they want to “punish” us. A cat or dog who doesn’t eat is ill and even a few days of not eating can cause significant problems. For a cat, anorexia of just two days can cause fatty liver disease (hepatic lipidosis), which is life-threatening.

Those who are not eating need to be nutritionally supported. Many clients decide to take matters literally into their own hands/fingers and rub a small amount of baby food on their animals’ gums or hard palates several times a day. While this is a noble gesture, a jar of baby food contains only about 90 calories and won’t make a dent into the caloric needs of an 11-pound/5-kilogram cat (who needs 220 calories EACH DAY just to maintain basic body functions) or a 30-pound/13.6-killogram dog (who needs 479 calories, just to keep going). Sick animals require even more calories than well ones, so many jars of baby food need to be fed each day. It goes without saying that food designed for itty bitty humans is not a balanced diet for dogs and cats.

Force feeding is often stressful for the patient, who most times needs to be restrained in order to get the required volume of food in. While there are some cats who are fine with being sat up on a lap while wearing a towel for a bib, like a “kitty burrito,” most cats consider that to be an unnatural act. Dogs are often willing to take a few laps of gruel, but then turn away. 

In frustration and desperation, some clients “graduate” from feeding by hand to the feeding of small meatballs, but this also is problematic. Oftentimes these food orbs are not swallowed or only partially make their way down the esophagus (the tube that connects the mouth to the stomach), and so have the added risk of choking.

The previously mentioned turkey baster is sometimes employed, but this method risks aspirating (inhaling) food into the lungs. It’s also possible that the stream of liquefied food causes retching and even vomiting. In my clinical experience, less than half the contents of a turkey baster actually gets into the patient; the rest winds up on the floor, walls and the person wielding said baster.

So, with finger feeding, food meatballs and syringe feeding off the table, so to speak, how do we get food into our animal companions who won’t eat? The answer, feeding tubes, typically horrifies clients. Most humans equate feeding tubes with dire, last-ditch efforts to keep the Grim Reaper at bay. When I’ve recommended a feeding tube to clients for their anorexic pet, I’ve typically been met with wide eyes and horrific tales of relatives, friends and neighbors who were tormented by these devices in their final days. The fact is that in human medicine, feeding tubes are often (but not solely) used to stave off the inevitable. In veterinary medicine, we use feeding tubes to support patients so that they can recover.

When I had my own feline-exclusive practice, there was hardly a week in which we didn’t place a feeding tube. The only complaint we received from clients regarding placement was, "Why did I wait so long?" In fact, my staff and I typically received many thanks after the tube was placed and the kitty recovered. Over the years we amassed a number of feeding tube fans who were able to talk with on-the-fence clients and convince them with testimonials as to the ease and comfort of the tubes.

There are a number of feeding tubes that can be placed and much depends on the size of the patient and the veterinarian’s assessment of how long the patient will need to be nutritionally supported.

Esophagostomy tubes (E-tubes) are the most common feeding tubes placed in cats and dogs. Placement is done under anesthesia, the left side of the neck is clipped and prepared as for surgery; a small surgical blade is used to make an opening in the neck and the tube is placed. The tube is sutured in place and covered with a surgical wrap. Food is placed in the tube (which extends to the stomach) via syringes and the beauty of this type of feeding is that the exact number of calories needed can be given over several feedings a day. The client is required to check on the tube placement site daily and cleanse it. While skin infections can occur, these are easily treated with antibiotics. When the patient is eating normally, the tube is simply pulled out, the neck bandaged overnight and the small incision heals quickly and uneventfully.

Gastrostomy tubes (G-tubes) are placed directly into the stomach, usually by endoscopy, although they can be placed during a surgical procedure. Dogs and cats who need very long-term feeding, can have low-profile tubes placed. These tubes lie flush with the skin of the abdomen.

Naso-gastric tubes are typically only used for hospitalized patients. These are inserted directly in the nostril and, because of their small size, are limited for use with liquid diets and usually only for a few days’/weeks’ duration.

Cats and dogs who are well enjoy their food, whether they daintily pick at it throughout the day or inhale it in a matter of seconds. Those who don’t eat need to be evaluated as soon as possible by a veterinarian and, if the decision is made to place a feeding tube, it’s good to remember that these can truly be the life savers that help our animal companion be well again.

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