ANOREXIA

 WHEN PETS STOP EATING: MANAGEMENT OF ANOREXIA

 
(original graphic by marvistavet.com)

Appetite loss and appetite reduction are very important factors in illness assessment and they must be recognized and reported as soon as possible. Acceptance of favorite foods often determines if a pet should be hospitalized or not. A couple of "off days" is generally not a big problem as long as the pet maintains hydration one way or another and recovers promptly but recurring episodes of poor appetite or slow gradual reduction in appetite are important and frequently point to a chronic progressive illness. Nutritional support not only helps the pet recover but buys time to keep the pet stable while diagnosis and treatment are worked out. The pet must be fed in order to get well.

The term “anorexia” means simply “eating no food.”
Many people get confused by the human eating disorder “anorexia nervosa.”
When the veterinarian says the pet has anorexia,
it does not mean the pet has a distorted view of his or her body;
it simply means the pet is not eating.

So how do we get a pet to eat? We will review some techniques here. Be sure to check with your veterinarian regarding the proper amount of food to feed and which foods are acceptable.

Don’t wait for the appetite to completely disappear before seeking veterinary assistance.

Pets with poor appetite are sick, and if you wait until the appetite is completely gone it may be too late for recovery. This is particularly true for cats. As the appetite fades, the pet must depend on stored fat for nutrients. When large amounts of fats are mobilized to meet energy demands, they must be processed by the liver before being used for calories. The feline liver is not designed to handle large amounts of fat and will fail in a condition called hepatic lipidosis.

First offer canned food

       
(all original graphics by marvistavet.com)

If you think your pet’s appetite is poor but are offering only kibbled food, your first step is to get some canned food and offer that. Most animals find canned diets far more palatable than dry foods and you may find that this step alone fully alleviates the problem. There is a misconception that canned food is somehow of poor nutritional quality. In fact, canned food and dry food differ primarily in their water content and thus in texture. If one considers the food without water, the unprepared diet is basically a powdered meat mix similar to a flour. It can be baked into a kibble or steamed into a canned food. Canned foods differ in quality just as dry foods do. See if the pet will eat a canned food or mixture of dry and canned food. Adding a flavored broth or cooked egg is also helpful in enticing the pet to eat a kibbled diet.

Second, offer a delicacy

(original graphic by marvistavet.com)

Foods that are generally regarded as delicacies among pets include: canned chicken, cooked egg, and canned tuna. Recovery formula diets (such as Hills a/d® and Royal Canin Recovery®) are generally well accepted.

(original graphic by marvistavet.com)

With the exception of the recovery diets, these treats are not nutritionally complete but can make a good “jump starters” for pets. A pet that has not been eating may feel continued discomfort until he or she begins eating again. Something tasty may be necessary to get the appetite re-started.

Do not simply put the food in a dish in front of your pet.
Instead, rub a small amount on the teeth or spoon a little in the mouth so that the pet can get a taste.
Don't be surprised if he spits it out; we are just trying to get the taste of the food in his mouth.
Hold the bowl up to the pet's nose so that the aroma is inescapable.
You may find that coaxing in this way gets the appetite started.

A NOTE ON GOURMET CAT FOODS (YES, DOGS EAT THEM, TOO):

A NOTE ON STARTING THERAPEUTIC/PRESCRIPTION DIETS:

If the pet is supposed to eat a prescription diet but will not do so,
do not attempt to starve the pet into eating the prescription food.

Many pets prefer to eat in private. Be sure other pets at home do not bully or distract the sick pet.

In a multi-pet home, it may be difficult for the sickly or elderly pet to eat without the younger pets taking his or her food. Many animals wish to eat at their leisure particularly if they do not feel well. Consider giving your pet a private area and his or her own dish. Never feed multiple pets from the same bowl as one is sure to get the lion’s share of the food to the other’s disadvantage. Many pets like to eat overnight when no one is watching.

MEDICAL ASSISTANCE

Appetite stimulating medications are available

There are presently several products available that can create a sense of hunger:

Capromorelin: This is a daily oral liquid for dogs which mimics the natural system of the body for generating the sense of hunger. It is best given daily, rather than only on bad days and currently it is licensed only for canine use.

Mirtazapine: This is a pill originally developed as an anti-depressant for humans but was found to have appetite increase as a side effect. It is available as a tablet, typically given daily for dogs or every 2-3 days for cats, or as a transdermal gel for cats which is applied daily to the inner surface of the ear.

Cyproheptadine: This is a psychoactive anti-histamine which has an appetite stimulation side effect. It is available as a pill and is typically used twice daily.

Prednisolone/Prednisolone: This hormonal anti-inflammatory has a number of uses in the treatment of immune mediated conditions, inflammatory conditions, cancer therapy and many other situations. One of its side effects is increased appetite and it is sometimes used for this effect, though because it affects so many body systems, it is generally not used for its appetite effect alone.
These medications represent non-invasive ways to medically improve appetite.

ASSISTED FEEDING

Non-invasive methods are all well and good but the bottom line is that an animal that does not eat will get sicker and ultimately die. Receiving nutrients is the basis of recovery and one cannot simply wait around for days for medications to work. Nutrients must be delivered ideally in a way that is not stressful for either the pet or the human caretaker.

Feeding tubes are the least stressful method of delivering nutrition.

Feeding tubes can be placed through the nose, throat, directly into the stomach or into the intestine. Liquid diets are delivered through the tube, usually with no resistance from the patient whatsoever since the mouth and face are not manipulated.

Gaining in popularity is the Esophagostomy or "E" tube. This tube is placed in the esophagus via an incision in the side of the neck. A bandage or special cloth collar may be used to hold it in place though many patients do not require a wrap of any kind. The placement procedure is fairly short and the tube is comfortable for the pet. Protective cone collars are not generally needed and the pet can go about his or her life with the tube in place. The larger size of the tube allows for blenderized diets which can be prepared at home for less expense than prepared liquid diets. Feeding does not require fussing with the pet’s face and thus is more comfortable. Bandages must be kept clean around the area and tubes must be kept in place for a minimum amount of time to allow for proper scar tissue to form sealing the feeding hole to the outer tissue. When the time comes, the tube can be pulled and the hole seals up. These kind of tubes require brief surgical placement and thus anesthetic risks apply. For more information on managing an esophagostomy tube (also known as an “E” tube), click here.

“Bear” with feeding tube into his neck (esophagostomy).
(images used with permission)

Nasogastric tubes which go through the nose require no anesthesia to place but do require an Elizabethan collar to prevent the pet from yanking the tube out. They can accommodate only liquid diet because of their small diameter and are difficult to manage at home. Most animals will not want a piece of equipment attached to their face and will try to remove it. N-G tubes are best used for patients that are too sick to try to pull out the tube. Alternatively, they can be placed for the feeding process and then removed. Feeding tubes can similarly be placed in the stomach and protrude from a belly bandage. The "G" tube has all the advantages of the "E" tube and is favored by some doctors. Again, the tube diameter is large enough to accommodate a slurry rather than a liquid and the tube is comfortable to wear and use. A brief surgery under general anesthesia is required to place the tube.

Nasogastric feeding tube

Syringe Feeding

If necessary, calories can be provided by syringe feeding, either using a liquid diet or a slurried diet. There are several disadvantages to this technique. First, the pet is not going to like it an there will be struggling, stress, and mess. The pet may be too sick to withstand stressful feedings and creating on-going unpleasant feeding experiences can result in what is called "food aversion" where the pet may not ever have a normal appetite again. Feeding too quickly can lead to choking or food aspiration if the feeder is too aggressive. Further, syringes may be difficult to manipulate. All that said, syringe feeding may be a better choice for a pet who is not a good anesthetic candidate or where the feeding tubes described above are too expensive.

(original graphic by marvistavet.com)

Syringe feeding can be messy especially if the pet is uncooperative and some sort of paper towel or cloth bib is probably a good idea. Be sure you know how much of the food you are supposed to feed per meal and per mouthful. The technique should be demonstrated by hospital personnel before you are on your own. A number of videos are available with additional tips on YouTube.com.

The Canned Food Meatball Method

The canned food method can also be used to efficiently feed a pet. Advantages are less risk of aspiration than with a liquid diet as the texture of the diet is more natural and possibly more comfortable feeding depending on the pet. Further, regular canned foods can be used for this technique; special products are not necessary. The disadvantages are that feeding will be a negative experience for the patient. There will be mess and some stress and possibly struggling. Food aversion is a potential complication whereby the patient may never have a normal appetite again even after recovery from the original disease if feeding is a very negative process. Further, there is more bite potential than with the syringe as one uses one's fingers in the pet's mouth; this process is only for docile cooperative patients.

To employ the meatball method, small meatballs are made out of the food and the pet is basically "pilled" with them in the same way one would give the pet a pill. As with syringe feeding it is important to know how much to feed per meal. It is also vital to know how big meatballs should be and to be able to determine when the pet has finished one meatball completely and is ready for another. Feeding too aggressively can be dangerous to both of you.

Syringe feeding and Meatball feeding are more labor intensive than tube feeding but,
on the other hand, they are less costly and the pet is not exposed to anesthetic risk.

Nutritional support is essential to proper recovery
and it is important to realize that there are many techniques available
to see that the pet does not suffer extra debilitation from malnourishment.

If you think your pet has a problem with weight loss or inadequate appetite,
do not wait until the problem is extreme;
see your veterinarian for a proper evaluation promptly. 

A Feline Assisted-Feeding Newsgroup is available and can be joined by going to:

http://www.assistfeed.com/WhoToAskForHelp.htm

This page is also part of the Chronic Renal Failure Center.
Other Pages in the Chronic Renal Failure Center:

• Kidney Failure: Where to Begin
• Fluid Therapy In Renal Insufficiency
• Dietary Therapy
• Appetite Management (this page)
• Renal Anemia/Red Blood Blood Cell Loss
• High Blood Pressure
• Calcium/Phosphorus Balance
• Glomerular Disease: Urinary Protein Loss
• Dialysis
• Kidney Transplants
• External Links for Further Information

Page last updated: 8/28/2020