Cami update 5-2

By the time I got up this morning I knew she was getting blocked up again. That's even with 100ml sq fluids last night. She had to stay at the vet for an enema and tests. She has mega-colon and what we have been doing is not enough for her. Lactalose dose was tripled (to 3ml bid), cisapride was doubled, Miralax is added, Potassium is added.

I can no longer afford to take her to the vet. This has cost me $3400 already in two months. I have none of that money (put it all on CCs) and will have to take it all out of my former IRA and now emergency fund. I already know there will be no money left when I hit retirement age - or after another 1-2 years, actually. Anyway, I just can't afford Cami's care anymore. I can find the meds for much, much cheaper online, but if she needs $435 in vet treatments every week I can't do it. And I asked about giving enemas at home and was told that they are so dangerous to do they won't teach me and if I decide to do them anyway the vet will refuse to see Cami again. This is odd to me since I know people that have done enemas on their cats at home. My sister being one of them.

Anyway, I have no choice but to consider euthanasia the next time she gets blocked. I absolutely hate making a death decision based on money and not the cats health, quality of life, or treatment possibilities. If I had the money I could probably keep her well enough for another year or two, I'd guess. The vet said that eventually they stop responding to the meds.

I am very sad and depressed. Cami has been difficult, but she is starting to bond with me and feel at home here. I think she feels safe and I am going to have to betray her sometime in the near future. All I wanted to do was save her life and treat her diabetes. Well, I know there are no guarantees. On top of all of this, Beau is having issues and needs a check up and blood work. Something is not right with him. I feel bad for neglecting him.

 

Hi, Sheila ~

I don't make it to FDMB often these days, but I did see your post about Cami and her megacolon. Oh, Sheila, you've done so much for sweet Cami. {{{Sheila and Cami}}} There's got to be another, less expensive way to manage her megacolon.

Let me tell you about our 15-year-old cat Bob that also has megacolon. He was first diagnosed in January of 2008 with such severe constipation that surgery was recommended. My husband and I felt that surgery was an extreme option, and we were fortunate to find an internal medicine vet who was able to deobstipate Bob when two of our regular vets couldn't.

For a year and a half after Bob's diagnosis, we had him on Cisapride and Lactulose along with regular home enemas. To call it a challenging time is a bit of an understatement, but we did what we needed to do. As we were doing more internet research about chronic constipation and megacolon in cats, we found this very helpful web site: http://groups.yahoo.com/group/Feline_Megacolon/
By the way, I don't agree with your vet about the enemas. Of course, you can learn to do them at home safely for Cami.

On the Feline Megacolon board, we learned about the use of MiraLAX (often called MiracleLAX by members) to treat constipation and megacolon in cats. In early 2009, we started Bob on MiraLAX, along with guar gum and psyllium powder, sprinkled on his canned food. We were gradually able to discontinue the Cisapride, Lactulose, and, best of all, the enemas. For the past three and a half years, we’ve had Bob well regulated on just the MiraLAX and fibers, a much easier process for Bob and ourselves.

Since MiraLAX is a dose-to-effect medicine, we kept upping Bob's dose until he was having very soft BMs, almost diarrhea. And then we started gradually adding the fibers to his canned food to firm up his stools. Bob gets 1 1/2 teaspoons of MiraLAX every day spread over several feedings. He also gets 2 1/2 teaspoons of the fiber mix spread over the same feedings as the MiraLAX. If Bob doesn't have a BM in 48 hours (something rare for Bob), we increase his MiraLAX by 1/8 to 1/4 teaspoon that day. We're fortunate that Bob will eat his canned food with the MiraLAX and fibers mixed in (and Bob's a picky eater).

Cats with megacolon often require a much higher dose of MiraLAX than the typical 1/8 to 1/4 teaspoon twice a day for cats with "normal" constipation. Here's an older posting I saved from the Feline Megacolon board about higher doses of MiraLax. If you do a search there, you can probably find more recent postings on the subject.

http://groups.yahoo.com/group/Feline_Megacolon/message/34091
higher dose of miralax

Posted By:
baywatchcats

Mon Apr 19, 2010 2:58 pm |

My boy gets up to 1.5 tsp of Miralax, once or twice/day. Sometimes I give it
with 2 caps of Cisapride, sometimes not.

I asked my vet this (who is an AAFP vet that I've had for 15 years ) and she
said there is no standard maximum dosage. You just have to go by the
results and raise it up or down.

Karen
Baywatch Maine Coons

Sheila, I know a lot of members of the Megacolon forum, as well as members here, are opposed to using fiber for cats with chronic constipation or megacolon. Guess I have a different take on that from our experience with Bob and a few other cats we've helped. First of all, I'd never recommend fiber for a cat that's currently constipated/impacted, only once the cat is having movements. Our pet sitter, who also works at a shelter, told us that psyllium powder is used there to treat both constipation and diarrhea in cats. Following her advice over the years, we've treated both constipation and diarrhea successfully with psyllium powder.

Well, I've written a book... I think for Cami, Sheila, you should consider trying MiraLAX, upping the doses until you get some good poop action. Certainly worth a try for your sweet furgirl. Continue using the lactulose and cisapride as you increase the MiraLAX...that's what we did with Bob.

Thinking of you and Cami this morning and sending lots of loving hugs,
Eva

 

More on home enemas for cats:

My husband, Ken, taught himself to give Bob-cat enemas at home. He used Pet-Ema Enemas, both the 6ml and 12ml sizes, that we bought at Amazon.com. Bob is a large cat weighing 16 pounds so he often needed the full 12ml amount. The 6ml size might be plenty for Cami. Ken said his tips for you, Sheila, would be to lubricate the entire part of the enema syringe that will be inserted into Cami. We used Surgilube Lubricating Jelly, but KY Jelly or Vaseline would work too. This makes insertion easier for you and for Cami. Ken said it helps, too, if you warm the enema tube before using it. I like this description from one of the Amazon.com reviewers: "It is good to warm it by standing it in a plastic glass and letting hot water run into the glass for about 4 min. DO TEST the warmth!!! Gently shake the syringe take the cap off and squirt just a little on the inside of your forearm just like they did baby bottles in the old days. It should be warm, not hot and not cold."

Ken said you need to insert the enema tip gently into Cami's anal opening. If you're gentle, Sheila, then an enema should be safe for Cami. You'll need to have Cami near her litterbox with newspapers all around because she'll likely need to go fairly quickly. Some cats get nauseated and tend to vomit after enemas, but this can happen even at the vet's office.

Note: The Amazon.com reviewers have some good tips that you might find helpful.

We used:
Pet-Ema Feline Pet Enema, 125 mg, 6 ml
http://www.amazon.com/Pet-Ema-Feline-Pet-Enema-125/dp/B001BBXGXA/ref=cm_cr_pr_product_top

Amazon.com reviews of 6ml with some good tips:
http://www.amazon.com/Pet-Ema-Felin...iewpoints=0&sortBy=bySubmissionDateDescending

Pet-Ema Enema For Dogs and Cats, 250 mg, 12 ml
http://www.amazon.com/Pet-Ema-Enema-For-Dogs-Cats/dp/B001BBXD9C/ref=pd_sim_petsupplies_1

Amazon.com reviews of 12ml with some good tips:
http://www.amazon.com/Pet-Ema-Enema...cm_cr_pr_top_helpful?ie=UTF8&showViewpoints=0

Surgilube® Lubricating Jelly
http://www.amazon.com/Surgilube®-Lubricating-Jelly-Flip-Tube/dp/B000E23WJU/ref=pd_sim_hpc_2

Sheila, taking our cat Bob to the vet's every time he got stopped up become too expensive for us. That's why Ken started giving Bob enemas at home.

Please let us know if we can help in any way, Sheila.

Take care,
Eva

 

Poor Cami- not good news at all.

There are several people on the board and FB who give their cats enemas at home for the cost savings. If Cami has recently been de-blocked start upping the Mirilax as it will do nothing against poop already there.

 

Thank you Eva. I found and joined the yahoo group last night and searched around their files. I will me buying miralax today and getting her started on it. I thought miralax WAS psyllium husk?

What does guar gum do for them? What about pumpkin? I know that adds fiber and softens stool. I have been adding it for a week now, but she still got blocked up so it either doesn't work, she needs more, or it is having an adverse effect.

This vet is a board certified internist who I have used for specialty things since Beau's diagnoses of CHF in 2002. I like her and she is very good. I don't know where this "threat" from her is coming from. She knows that I have managed three FDs, the CHF, subq for 4 cats now. I ask good questions (Cami is on probiotics, Denamarin, pumpkin and subqs because I asked about using them and the vet thought they were all excellent suggestions). I understand the risks of home enemas, which is why I wanted her instruction on them. I think the risk is more associated with the way they do them at the vet's with tubing and all that. The pre-made ones you are talking about seem pretty safe. I mean, there are home human baby enemas. That's got to be just as risky. I may find myself using them and just not telling her about it. Geeze. She is a premium vet that my regular vet refers to for complicated/specialty stuff. I'd like to not burn that bridge.

Heather, she is recently deblocked. Apparently she passed "a large amount" of stool after the enema yesterday afternoon and she just had a large stool here - looked pretty normal - as in not hard and not a huge diameter either. So that is all good. I am keeping my fingers and toes crossed for her to stay unblocked and for me to find the formula that works for her.

 

Sheila, here's a description of what MiraLAX is and how it works:

http://miralax.com/miralax/why-mira...randed&utm_content=sNXvDKAd3|pcrid|5500344812
How MiraLAX® works

"Water is vital to your body for healthy living, and to help your digestive system stay regular. Constipation may occur when stool moves slowly through the colon, which could allow too much water to be removed. This can make the stool hard, dry, and difficult to pass.

MiraLAX contains Polyethylene Glycol 3350, which is a completely different way to treat constipation. It works by gently replenishing the water to your digestive system, which helps naturally cause a bowel movement. This water both increases the frequency of bowel movements and softens the stool, making it easier to pass. Nothing works better than MiraLAX laxative to relieve constipation and soften stool with no harsh side effects.
No sudden urgency
No cramping
No bloating
No gas

So, if your current laxative isn't providing relief without harsh side effects, it's time to experience the MiraLAX difference."

Psyllium husk powder and guar gum are both fibers. Pumpkin also contains a lot of fiber, but for our cat Bob, psyllium husk powder has always worked better.

Here's a description of psyllium husk powder:

"Psyllium is a true dietary fiber, even though it is classified by some as a laxative or mucilaginous fiber, and is a convenient way to increase intake of dietary fiber because of its high mucilage content. This bulking agent swells considerably when added to liquid, which can help to support healthy gastrointestinal transit time. This bulking action and healthy transit time can play an important role in maintaining healthy gastrointestinal function.

This pleasant tasting powder mixes easily with your favorite liquids. Known for their uncanny ability to bulk over 100 times their original density, Psyllium Husk Powder offers an excellent source of natural fiber, essential to the promotion of digestive regularity."

Here's a description of guar gum:

"Guar gum is a fiber from the seed of the guar plant.

How does it work?
Guar gum is a fiber that normalizes the moisture content of the stool, absorbing excess liquid in diarrhea, and softening the stool in constipation. It also might help decrease the amount of cholesterol and glucose that is absorbed in the stomach and intestines."

Eva

 

Thanks, Eva.

I am now totally confused (trust me, I don't usually reach this state with this stuff...)

Anyway, I rechecked my discharge instructions and she is supposed to get Metamucil/psyllium husk, NOT Miralax.

From what you are saying, and what is on the yahoo group site, she needs both or Miralax more than metamucil.

Right?

 

Yes, Sheila. I'd get Cami started on Miralax right away in addition to the Lactulose, Cisapride, and Sub-q fluids. You're going to need to experiment with the dosage of Miralax to find the amount that works best for Cami. I'd start her on at least 1/4 teaspoon of Miralax twice a day mixed in her canned food if she'll take it that way. If necessary, you can mix the Miralax in water and syringe it into her mouth. You want to start seeing fairly soft movements for Cami. Then you can start adding more fiber, such as Metamucil (which is psyllium) or plain psyllium husk powder, to Cami's canned food to provide more bulk in her diet.

To me, the way to avoid more blockage and the need for enemas for Cami is to keep increasing the Miralax until you get some good, regular poop action from your dear furgirl.

Please let us know how you're both doing once you start the Miralax.

Hang in there, Sheila! You'll get this figured out.

Eva

 

Sheila -

Grayson gets just shy of 1 tsp twice a day. I mix it with his FF, and add at least one can of water. We started with 1/4 and moved up rather quickly. He's now staying regular and his poops are normal again. You can get there!

I know how frustrating it is. My vet didn't want to instruct me to do enemas either - said the risk was that you could tear the (bowel?) causing more problems. But folks on the Acro group - especially Ingrid/TC gave them regularly. I tried initially with an ear syringe - which probably was too forceful. but I would think the child's enema would be less powerful. Also, when the vet did a physical exam, the blockage was deeper than her finger could reach. Some people also massage the blockage to break it up and get it to move (in conjunction with the enema).

It's a very challenging time, but knowing all you went through with Jeddie, I'm confident you can manage Cami's condition at home. The key is getting that Miralax into her... a little with every bowl of food would be a good start! Good luck!!!

 

She is getting 1/4 tsp in each bowl of food - 3 times a day. She pooped about 3 times today, too!

Unfortunately, her BG is climbing really fast. Weird because she came home from the ER overnight with really low BGs (70-80s) and they stay low for 4-5 days before slowly climbing. Yesterday they shot up. She is near 200 now. Sigh. It has to be from one of the medications or from pain or blockage - except they are highest today and she passed a lot of stool today, so I don't know.

Gotta go do the evening round of meds with her. And SQs.

 

Hi, Sheila ~

How are you and Cami doing this morning? "She pooped about 3 times today, too!" -- Great news from yesterday, Sheila. Let us know how she does today...or maybe tomorrow morning...in the poop department.

Did Cami's higher BG numbers start when you began the Lactulose? Just curious. I know this veterinary endocrinologist doesn't think Lactulose raises BG in cats: http://endocrinevet.blogspot.com/2011/12/q-will-lactulose-affect-blood-sugar.html
But I'm not so sure that's true for all cats. I've read that "Lactulose given orally to humans results in only small amounts reaching the blood by absorption through the small intestine probably by a nonmediated diffusion mechanism. The small increases in blood sugar are probably attributable to the small amounts of galactose and lactose also present in lactulose syrup." - http://www.medsafe.govt.nz/profs/datasheet/a/Alphalactulosesyrup.htm
and "Lactulose given orally to man and experimental animals resulted in only small amounts reaching the blood." - http://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=A340218E-C406-4DA6-A347-75F5B8025A3A

I wonder if Lactulose could raise Cami's BG is she's sensitive to the effects of small amounts of galactose and lactose? For now, I think you should continue the Lactulose until you see how well Miralax is working for her.

Hope you and your furry four have a good weekend, Sheila.

Take care,
Eva

 

Eva, if you look at her SS, you can see the BGs in relation to the meds given. If she is responding to lactalose with higher BGs, there was a lag time. In fact, her BGs were much lower after the 1st and 2nd blockage incidents, although of course I have no BG numbers for the 24hrs of her hospitalization. She came home from that very well hydrated and her BGs stayed really low for 5 days. I even started skipping tests thinking the subQ fluids were keeping her hydrated and her BG low. Then she just started climbing, espcially after the lactalose dose was raised. So, maybe there is a threshold for each cat where a higher dose of lact pushes them over the edge. If you read the information on the product it says to "tell your doctor is you are diabetic..." so they have to know there is some effect there on BGs.

Still, insulin dosing is workable around these things, I just have to figure out the dose that works (of lev). I just got a 252 at +10, Arrgh! I just hope its the med and not from pain or something. She is still so bloated and gassy.

I was gone all day today from shot time to +10, but there was a nice, huge poop for me when I got back! The thing that I notice the most is that the diameter is smaller - more normal - than ever before with her. That has to be a good thing.

 

Sheila, just wanted to let you know that if you have a Costco store you can buy from, they sell the same stuff as Miralax (polyethylene glycol 3350) just with a different name for less $. Costco's is named LaxaClear and you can get 3 large bottles (17.9 oz) each for less than 2 large Miralax bottles there. So sorry you and Cami having such a tough time.

 

Thanks, Carol. I ended up buying the Safeway generic that I am sure is cheaper than the brand name, although it was mis-shelved and I couldn't find the price listing for it.

More poop tonight flip_cat but her BG is even higher. Guess I need to do a curve or something to figure out what's going on. I don't think she is rebounding though. And she is hissing at me when I come near her sometimes. She is just really upset by all the pills and gooey stuff being shoved down her throat and needles stuck in her back. Sigh. I feel so bad for her.

 

Hi, Sheila ~

Sounds as though you're finding the dose of Miralax that will work for Cami. Miralax and Lactulose are both similar types of osmotic laxatives. And from what I've read, Miralax causes fewer gastrointestinal problems, such as bloating, than Lactulose and is safer for diabetics. Sheila, over this next week, if Cami continues to have regular poop movements, you might find that you can start slowly tapering off on the Lactulose. You can increase her Miralax if you need to.

"And she is hissing at me when I come near her sometimes. She is just really upset by all the pills and gooey stuff being shoved down her throat and needles stuck in her back. Sigh. I feel so bad for her." -- Oh, poor sweet Cami...and Sheila. I'd hate all that being done to me too.

Our cat Bob hated all the stuff we were having to do for his megacolon...the Lactulose, Cisapride, and home enemas. We were so glad to learn about Miralax and to find out how well it worked for Bob. Over several months, we were gradually able to discontinue the Lactulose, Cisapride, and enemas, while increasing Bob's Miralax. This might not work for Cami...but it might, Sheila. We've helped three other kitty beans with megacolon cats find the right doses of Miralax. All three were able to discontinue the Lactulose, but one needed to keep the Cisapride with the Miralax for her cat with motility issues.

I believe the problem for some cat owners is that they don't increase the Miralax dose high enough to be effective. They get stuck on the idea that the maximum dose is 1/4 teaspoon twice a day. Since Miralax is a dose-to-effect drug, you need to increase the dose until it gets good poop action for your cat. And as we all know, every cat is different so Miralax might not work as well for some cats as others. However, I think to give Miralax a fair try, a cat owner should try upping the Miralax dose until poop happens .

"Grayson gets just shy of 1 tsp twice a day. I mix it with his FF, and add at least one can of water. We started with 1/4 and moved up rather quickly. He's now staying regular and his poops are normal again. You can get there!" -- I see that Lu figured out the right dose for Grayson. And it's working well...great job!

Sheila, please keep us posted on Cami's progress. Thinking of you both this morning.

Take care,
Eva

 

A poop a day! That is what we want.

 

Hi Sheila,

I'm just dropping by to let you know I'm following your thread and cheering you and Cami on in the poop dance. You're getting great advice from Eva and LuAnn and I have nothing to add. While I know I went though most of this with Harley too, he had so much going on at the time, the learning curve was very steep as I struggled to learn all about pancreatitis, IBD, mega-colon, changing from ProZinc to Levemir, and keep him eating that most of what I tried and what worked or did not work for him is kind of lost in a fog. Maybe it's like childbrith - best that you can't remember the pain.

I'm sending tons of feel good vibes to both you and Cami. :YMHUG: cat_pet_icon

 

Thanks everyone!

She did well today in the poop department. I think it's actually a little on the soft side, BUT I'm not going to change things yet. She is getting between 3/4-1 tsp total a day of Miralax. And she is eating a TON of food right now. Do any of these meds cause increased appetite?

The other thing I wonder with her increased BG is if she is finally getting some real nutrition with the meds. And, maybe her OTJ was "false" from not getting enough nutrition into her blood stream to even cause a BG spike, but now it is and her pancreas is not able to keep up. She's sitting in the 200s now. The vet said she had put on weight last Thursday and I said, "Well, she's bloated" and she said, "No it's real weight". Not sure how she could tell - except that there is, for the first time, some thickness to her skin on her back. I think she may actually have some fat there. And her extreme thinness and muscle wasting was brought up as a possible cause of the mega colon. The colon in muscle too and her body has been stripping her muscles for months now.

It would be really great if I could get her off lactalose and cisapride. Lactalose because it is just nasty stuff, all sticky and gooey and she hates getting it and the cisapride because it's horrendously expensive. The best price I can find will cost at least $.90 a day. I was shocked when I started pricing and found the local pharmacy that my vet phoned the script into is 60% more expensive than several other online compounding pharmacies. Like $1.25/capsule vs $.44/capsule.

 

Good Morning, Sheila and Everyone ~

"She did well today in the poop department." -- Great news from yesterday, Sheila! " I think it's actually a little on the soft side, BUT I'm not going to change things yet." -- I think you want Cami's poop on the soft side if you're going to try to wean her off the Lactulose and Cisapride.

We had our cat Bob's stools very soft, almost diarrhea-ish, as we tapered off his Lactulose and dropped his Cisapride. I was so worried he would get blocked up again. And actually we dropped his Cisapride cold turkey because we didn't think it was helping Bob. But we were in a different situation with Bob, Sheila, than you are with Cami. We could tell the Miralax was helping Bob more than the Lactulose and Cisapride because, as we increased his Miralax, we were having to do fewer and fewer home enemas (Bob is afraid of Latex gloves to this day...poor Boy).

I'm not convinced that all cats with megacolon need drugs other than Miralax to alleviate the constipation problems. And you'll see this supported on the Feline Megacolon board where some cat owners are using only Miralax for their cats. Depends on the individual cat, what's causing the constipation and if the dose of Miralax is high enough. We have a friend whose cat has intestinal motility issues causing stool not to pass easily through her cat's colon. The vet thinks there's nerve damage In her cat's colon so Cisapride with Miralax works better for that cat.

"And she is eating a TON of food right now. Do any of these meds cause increased appetite?" -- How wonderful to hear Cami's eating so well, Sheila! I haven't read that either Lactulose or Cisapride typically causes increased appetite. But who knows with that ECID thing. Maybe Cami is feeling better overall now? One way to tell if the drugs are improving her appetite or not will be to see if her appetite decreases as you slowly lower her doses of Lactulose and then Cisapride.

Even though Cisapride is so much more expensive than Lactulose, Sheila, I'd suggest trying to taper Cami off Lactulose first. Lactulose and Miralax are both similar osmotic laxatives, drawing water into the colon and stools, while Cisapride is a stimulant type laxative.

Keep us posted on how you two are doing, Sheila.

Take care,
Eva

 

"Maybe it's like childbrith - best that you can't remember the pain." -- Sometimes that can be such a blessing, Laura, when we need it the most. {{{Laura and Harley}}}

Hugs,
Eva

 

Kristalose instead of syrupy, nasty Lactulose:
Just wanted to mention that Lactulose now comes in a mild-tasting powder, Kristalose, that can be added to a cat's canned food. Not sure why vets never suggest it. It has the same caution for diabetics as Lactulose though.
http://www.vetrxdirect.com/product/view/kristalose-powder-lactulose-for-cats

Sheila, I don't think you're likely to need Lactulose long term for Cami, but I wanted to mention Kristalose for anyone following along.

From Mar Vista Animal Medical Center -- Warning about Lactulose for diabetic cats:
http://www.marvistavet.com/html/body_lactulose.html
•Lactulose should not be taken by diabetics. Even though lactulose is not readily absorbed by the mammalian intestine, there is still a small percentage which is absorbed. In addition, there may be some unbound fructose or galactose in the syrup, enough to be a problem for a well-regulated diabetic.

Eva

 

Eva, I do hope she can come off the lactalose soon, but I think the syrup is a better choice for her because I can make sure she is the one getting it. Even though the others almost never eat from her dish I would not want Beau getting into it and falling off the OTJ wagon.

Does anyone know if pumpkin increases BGs? It is a carb.

I received the 3 Pet-emas that someone here sent me (they have already been thanked ) and I am hoping I never have to use them, but we are creeping up on one week from the last enema and that seems to be the marker of progress. I should get one of those construction safety signs: "XX days Accident-Free!" and change it to "Enema-Free" :lol:

I am very interested to observe that she is a) not drinking a ton of water any more and b) using the litter box almost exclusively over the pee pads. I watched her walk into the room that has two LBs and a XL god crate tray lined in pee pads and pause and look from a LB to the pads a few times and choose the LB to pee in. Good Job, Cami!

Not sure about the water thing. I had a cat over 20 years ago that was in really bad shape with CRF (crept up on me over many months I am sure). Her BUN and creatinine were really high and the vet said he could try subq fluids and it might help but would probably only last a few day (this was before anyone was doing them at home). He said in rare cases one "dose" of 100-150 ml seemed to "reboot" the kidneys. (he probably didn't use the term "reboot" back then...) So I had him do it and brought her home thinking she would be gone in a week. She lived another 14 months until cancer took her. I just wonder if that one day (26 hrs) on IV fluids was enough to reboot Cami's kidneys and now they are functioning so much better, able to concentrate her urine. Her water intake is 50-65% less now. I don't think that 100ml of SQs every other day would make that much difference.

 

Eva - thanks for the info on Lactulose!