Constipation in cats. UPDATE: Not feeling well after enemas.

Discussion in 'Feline Health - (The Main Forum)' started by cornad, May 15, 2010.

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  1. cornad

    cornad Member

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    Mar 18, 2010
    I've noticed that my cat has become increasingly constipated. We put him outside, he digs to make a poop, and nothing came out. This happened 5 times yesterday. Before receiving his diagnosis of feline diabetes an x-ray revealed that he was severely constipated. But after receiving insulin and becoming re-hydrated he began to pass stools on a regular basis. But now, it seems he is constipated again.

    Our vet spoke about an overnight visit or something along those lines to remove the impacted feces. But I've read online (and here) about uses of laxatives (like miralax) and their success. Are non-invasive methods usually recommended first?

    What do you suggest?

    Thanks! confused_cat


    UPDATE: Yesterday Spencer started acting funny, eating less. Later in the night, I felt him guarding/flinching his stomach when I held him. Now in the morning he's refusing to eat again and guarding. No vomiting. I don't think I should give him Miralax if he's not eating?

    He asked to go outside, he went outside walked around a lot, smelling things. He didn't even want to come back inside. I took him in to try and feed again, even his favorite ham. Did not want it. Well he licked his lips but didn't take a bite. He's resting now and purring. When I pet him and put pressure on his ribcage, I feel him recoil/guard.

    I really don't know what this is. What could this be?!
     
  2. Maria & Suzie

    Maria & Suzie Member

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    May 9, 2010
    Re: Constipation in cats. What to do first?

    Hi,

    If it really is impacted and really, really stuck, a vet probably needs to be involved. Having said that, I had a cat who had been in an accident and as a result of nerve damage, he could not push his poo out. After trying to help him with oral laxatives, which just gave him stomach aches, irritated bowels, created a mess and didn't help long term, the vet showed us how to do enemas.

    Not as horrible and awful as it sounds. We had a large syringe, with instead of a needle on the end was a plastic tube. Luke-warm water & a bit of salad oil in the syringe, a bit of vaseline on the tube, popped it into his rectum, gently injected the water. Put him outside and within 5 minutes, out it all came again, gently, taking the poo with it. (no scary explosion or anything). Granted, as the cat's end part of the bowel was paralyzed, he could not feel us put the enema in, so he stood very still and was very co-operative, which may not be the case for a "normal" cat.

    I'd still talk to a vet first, but you can suggest gentle enemas rather than oral laxatives.

    Also, something is causing the constipation.... is he eating dry or wet food? Enough water? If he's diabetic, wet food is much better for him in any case, lower carbs, and more fluids intake of course for the constipation.

    Hope this helps & hopefully some more helpful tips will come along.

    Good luck !

    maria
     
  3. Connie & Em (GA)

    Connie & Em (GA) Member

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    Dec 28, 2009
    Re: Constipation in cats. What to do first?

    are you sure it is constipation and not blocked and not peeing? the former is a problem, the latter is much more so.

    Both really are a trip to the vet. Since you aren't sure of the reason for the constipation, you don't want to throw medication at the problem thinking it is just dry stool, since it could be a blockage or something else.

    Connie
     
  4. cornad

    cornad Member

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    Mar 18, 2010
    Re: Constipation in cats. What to do first?

    I'm bringing him the vet as soon as possible (closed Sunday). Hopefully Monday. The vet says if he vomits or stops eating to bring him to the emergency vet before then. I guess I feel very paranoid and scared. I'm having issues finding transportation and the funds.

    I hope everything will be okay within a day. I'm quite sure he is urinating but I'm not 100% sure because we have two cats that share a litter box.
     
  5. JJ & Gwyn

    JJ & Gwyn Member

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    Dec 28, 2009
    Re: Constipation in cats. What to do first?

    It depends on how long he's been blocked and where it's occuring. Miralax and similar medications are useful to help prevent constipation from recurring, and can be helpful in clearing mild cases. But if there's something else going on or there's a severe case of constipation, then medical intervention may be necessary. In those cases, giving medications like Miralax could actually make things worse.

    You said that your cat was having problems with constipation, then got rehydrated and got better, and is now having problems again. One thing I would suggest is having your vet run a kidney panel on your cat. Many cats have lower kidney function as they grow older -- about half are diagnosed with kidney problems before age 9, about half after that. Lower kidney function can cause varying degrees of dehydration, and any amount of dehydration can contribute to constipation. Given that your cat's constipation went away after he was rehydrated, kidney function is something you might well want to get checked.

    If he does have lowered kidney function, you can help support the kidneys by switching to a more kidney-friendly diet, possibly giving potassium supplements, and encouraging increased water consumption (adding water to his food, switching away from dry food if he's on it, changing water more frequently, cleaning water bowls or fountains thoroughly and regularly, installing a pet fountain, putting down additional bowls of water at each end of every floor). And, depending on what the kidney function is, whether the previous suggestions help, and your cat's other health issues, you may want to talk with your vet about giving small amounts of sub-cutaneous fluids. If the constipation *is* being triggered by kidney issues, then increased water through-put (either through drinking or sub-Q fluids) can help both the kidneys and the constipation.
     
  6. Gina & Yittle (GA)

    Gina & Yittle (GA) Member

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    Dec 30, 2009
    Re: Constipation in cats. What to do first?

    Yittle recently got constipated due to having to take a narcotic and be kept from moving too much after a leg injury. We ended up mixing small quantities of 100% organic canned pumpkin (no other ingredients or sweeteners) in with his food. While the pumpkin does contain carbs it only raised his blood sugar about 10 points or so.

    The pumpkin worked well the first week and then we were able to take him off the narcotics. Unfortunately he caught a cold or something and between the last of the constipation and the cold he stopped eating on us. That created a bit of a vicious cycle in that if we would eat, we could get pumpkin in him and he'd feel better. But he wouldn't eat, so we couldn't. Since Yittle is in diet-controlled remission the Vet ok'd us giving him a dose of Laxatone for the constipation along with some appetite stimulants. That seems to have done the trick - obviously it would not have been appropriate if he still had high blood sugar but since he had been off insulin for several months we agreed it was an acceptable risk to let him have a single dose. Not surprisingly, while he'd never liked it when he was younger and had hairballs he now thinks Laxatone is yummy because its sweet and dosing him was very easy.

    Vet also suggested we could keep giving him small quantities of pumpkin if he had more issues later, or even a bit of smashed up really ripe mango. (Like a teaspoon or so) because it would help with stomach/bowel mobility. I suppose its the enzymes in it. Again, thats because he's OTJ and we're monitoring his blood sugar, I wouldn't suggest it for a cat who's blood sugar was not well controlled.
     
  7. Maria & Suzie

    Maria & Suzie Member

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    Re: Constipation in cats. What to do first?

    Being stuck during the weekend with a sick cat always make things scarier. The vet needs to see him of course, but over the weekend re-assure yourself with that as long as the cat does not seem to be feeling really ill from it, like the vet said, he'll be ok till Monday. If he's still eating and drinking, particularly the drinking is key, those are good signs that it is not bothering him all too much, not more than he'll be okay till Monday.

    If you are not sure if he's still urinating as he should be, you could try locking him into a separate room with the litter tray until you see some litter tray activity, and then you are sure it's him urinating and not the other cat.

    Is he long or short-haired? Long-haired cats can more easily get blockages due to the extra fur they ingest....

    Deep breaths, you are aware there is an issue, you have plans to take him to the vet, and in the meantime you say he still seems ok, so just watch him for signs, and let the signs he is giving you that he feels ok re-assure you.

    Maria
     
  8. cornad

    cornad Member

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    Mar 18, 2010
    Re: Constipation in cats. What to do first?

    He's refusing to eat his breakfast. Even his old dry food in which he loves. He sneaked and ate that yesterday.

    He's too smart.

    I went to give him his food/breakfast and he refused. I persuaded him more and he just licked it. Then he made me follow him to the basement where his litter box was. He went in, then pee'd then walked out. I tried to give him his old food that was nearby, he smelled it and didn't eat it. Soon after he made me watch him in the litterbox again, he was straining and made this strange cry/whine I've never heard him make in 16 years. I got so scared and sad.

    He stepped out and started vomiting right away but nothing came out really (because he didn't eat), just spit. He basically told me what was up and communicated that he's really not feeling well.

    So I think it's time. I should take him to the emergency vet. I'm trying to find a way to get there and get the money together =/.
     
  9. cornad

    cornad Member

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    Mar 18, 2010
    Re: Constipation in cats. What to do first?

    Also, Spencer has Diabetes and Stage 2 Kidney disease. That might be a reason for his dehydration/constipation. I try to put a can of water in his food each feeding and offering water after he eats. He usually goes for it.
     
  10. Maria & Suzie

    Maria & Suzie Member

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    May 9, 2010
    Re: Constipation in cats. What to do first?

    At least you know he is urinating ok.

    Yes, I agree, the vomiting means it's time to follow the vet's advice and take him in.

    Good luck and let us all know how it goes ! For what it's worth, there are lots of people rooting for you & Spencer !!!

    Maria & Suzie
     
  11. cornad

    cornad Member

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    Mar 18, 2010
    Re: Constipation in cats. What to do first?

    He's at the vet now, over night. Fluids and enemas.

    I'm scared and worried. I never had him away from home, overnight, in 16 years.
    It was very costly, I can only see it getting more expensive when we pick him up and have him transferred to his regular vet's office.

    He was very fussy and curious on the ride (walk, bus, subway, and more walking) there. I decided to pick him up and just hold him while we walked to the office. Then he was trying to push as I held him. Two small pebbles came out, all gray looking. After that he became very lethargic and weak, luckily we were 2 blocks away from the office at that time.

    The vet at the ER said she hears a heart murmur and Spencer probably has heart disease too. I'm so overwhelmed it's not even funny. :cry:
     
  12. gingerand((calliope))(GA)

    gingerand((calliope))(GA) Member

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    Dec 28, 2009
    Re: Constipation in cats. What to do first?

    I'm so sorry about this. I know how awful it feels to leave your kitty at the vet's office, overnight.

    Calliope became impacted 3 or 4 times and had to go to the vet for the enemas to get fixed up, every time. By the time, she went for the last time, I learned from this board about giving the miralax, daily, which is what I did. We never had the impaction issues again, after that, so perhaps, after this trip to the vet, you can start the miralax and prevent this in the future. It really worked for us.
     
  13. Tim & Chris

    Tim & Chris Member

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    Mar 7, 2010
    Re: Constipation in cats. What to do first?

    I'm sorry your Kiity has to be away from you overnight. At least he's getting the care he needs. One other thing to
    consider. Tim, my diabetic kitty, was having reoccurring problems with constipation. He had an enema at the vet & that didn't do anything for the problem long term. The vet did XRays to look for blockages and found that Tim has Mega Colon.
    From what I understand it is not uncommon for older cats to have this. The size of the colon shrinks and makes it hard for them to poop. Tim takes Lactulose, which is like Miralax according to my vet, daily. He rarely has problems with
    constipation any more. I hope your boy has something easy to treat and gets better really soon.

    Chris
     
  14. cornad

    cornad Member

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    Mar 18, 2010
    Re: Constipation in cats. What to do first?

    I really suspect he has megacolon.

    It has been difficult because my mother has been really unsupportive this time around. We get into fights about money and treatment for Spence, and all she can say is that he's going to die anyway. I'm frustrated because I'm a student and quit my job last September to give full time to a nursing program. I know she has the money available to help but she has a very fatalist view about everything, especially our 16 year old cat. I refuse to let my cat die of constipation, especially since it's affecting his quality of life AND it can be fixed.

    For everyone's sake I hope the enemas will do the trick instead of the more costly manual extraction.

    Thanks for all the support guys, really means a lot.
     
  15. Maria & Suzie

    Maria & Suzie Member

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    May 9, 2010
    Re: Constipation in cats. What to do first?

    He's been your faithful friend & loving companion for 16 years. Of course you want to do everything you can for him. I sympathize with your money concerns, but it's hard to put a price on the unconditional love he has given you over the years, so you are doing the right thing by following your heart.

    He may be a little scared at the vets', but I'm sure he is smart enough to understand that he is receiving help.

    Whilst this sort of constipation can be life-threatening, there is a good chance it can be managed in the future, just look at the good tips you have gotten from the folks on this board who all have cats who live with constipation issues that are managed.

    Hang in there, Spencer loves you as much as you love him, I'm sure he's doing his very best to tough this out !

    Maria & Suzie
     
  16. sugarpura

    sugarpura New Member

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    Feb 24, 2010
    Re: Constipation in cats. What to do first?

    Hi, I see you have received plenty of good advice and I would like to say now that you know this can happen you should work on prevention, i.e., keeping his stool moist and moving along on a daily basis. Below is a great website you may want to visit to learn all about constipation in cats. Best regards. Sugarpura

    http://www.felineconstipation.org/
     
  17. cornad

    cornad Member

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    Mar 18, 2010
    Re: Constipation in cats. What to do first?

    Spencer is back! The vet said the enemas did a great job and he passed A LOT of stool.

    He didn't need to be transferred or have a manual extraction. They gave me lactalose and told me to give him 1ml 2-3times a day.

    I hope this works and he doesn't get constipated again. He was soo active and excited for his second subway ride home!

    :mrgreen:
     
  18. cornad

    cornad Member

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    Mar 18, 2010
    Re: Constipation in cats. What to do first?

    I found Miralax in our medicine cabinet, what is the recommended dose for cats?

    Thanks again!
     
  19. Emmy & Dude

    Emmy & Dude Well-Known Member

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    Dec 28, 2009
    Re: Constipation in cats. What to do first?

    I feed both of my kitties raw food with just a little low-carb FF and both do become constipated from time to time. About once a week, I sprinkle app. 1/8 tsp. of miralax on the food, add some warm water and since it's tasteless, they eat it all. It seems to help keep the constipation away, especially for my 16-year old Dude, the diaabetic.

    Good luck - am so happy to see the enemas worked and your baby is doing better. Just keep a watch on him and add the miralax as needed - it surely does work for my two.

    Emmy & Dude (& Mittsi too)
     
  20. Mary & Stormy Blue

    Mary & Stormy Blue Member

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    Dec 29, 2009
    Re: Constipation in cats. What to do first?

    1/8 tsp 2X per day, mixed into his food, is what I give my kitty, Stormy Blue. He has CRD and gets constipated at times due to that.

    ~M
     
  21. Gina & Yittle (GA)

    Gina & Yittle (GA) Member

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    Dec 30, 2009
    Re: Constipation in cats. What to do first?

    Glad he's home and doing better!!!
     
  22. Maria & Suzie

    Maria & Suzie Member

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    May 9, 2010
    Re: Constipation in cats. What to do first?

    Very happy for you & Spencer ! So glad the enemas worked, and so glad you were determined not to give up on Spencer !

    I don't have cats with constipation issues, but if you follow all the good advice given here, you can find the best way manage his constipation issues and hopefully prevent it from going this far again.

    Fabulous news, Go Spencer !!!

    Maria & Suzie
     
  23. cornad

    cornad Member

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    Mar 18, 2010
    I'm taking him to the vet again. It's too scary.
     
  24. dian and wheezer

    dian and wheezer Well-Known Member

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    Dec 28, 2009
    hope all goes well
     
  25. Maria & Suzie

    Maria & Suzie Member

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    May 9, 2010
    Let us know how it goes, we are all rooting for you & Spencer !!!

    Maria & Suzie
     
  26. JJ & Gwyn

    JJ & Gwyn Member

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    Dec 28, 2009
    Sorry, I've been erratic on the boards lately.

    I agree that the need here is to work preventive medicine: increased water intake, either through some of my previous suggestions, or through sub-Q fluids which you can give at home. (If your vet will give you scripts and you get your own supplies, it's much cheaper; I think ours costed out to ... I dunno, probably about $40 a year.) I strongly suspect Spencer may have reduced kidney function, which is helping to trigger the constipation. When was the last kidney panel run, and what were the results?

    Lactulose is good, and we used it for a long time. I'm not sure whether you're giving it to Spencer via oral syringe, or whether you're mixing it in with his food; either should be okay, and the food is a *lot* easier (and often less messy).

    We also eventually used Miralax, which ended up being cheaper for us in the long run. You can add that to the food as well. One of the key things with Miralax is that you *have* to increase water intake for it to work properly. If you go with Miralax, start with 1/8tsp twice a day, and adjust the dosage as needed.

    You may want to read this article on the managment of constipated cats, and share it with your vet. Table 2 at the bottom is very useful, with a bunch of different medications that work in different ways. You can experiment with the meds and see what works best for Spencer. Also, some medications have less effect as time goes by; if and when that happens, you can use the table to change or supplement medications as necessary.

    It's also a very useful table when considering what medications Spencer should be on. For example, there are a number of cats on the boards here who are on Pepcid A/C. However, we used Zantac instead, because Zantac can help with intestinal motility and Pepcid doesn't. So if Spencer does need medication for some problem or other, it's work consulting the table and seeing whether one of the possible medications might also help with his constipation issues.

    As mentioned earlier in this thread, megacolon can be a concern, but it can also be treated (to various degrees) at home. Gwyn had megacolon for several years, and we ended up doing most of her treatment at home. This included things like giving her enemas. That sounds horrible, but it really wasn't. By monitoring her intake and output, I had a fairly good idea how well/bad off she was, and I tried to give her enemas as needed.

    If the need for enemas continues, I'd suggest having your vet show you how to give enemas at home; it's much more cost-effective, and you can do it whenever the need arises, without having to worry about night / weekend /holiday hours. I resisted the idea of learning enemas for at least 3 years before I finally caved and, having learned how to do them (at least on Gwyn), I can't see what I was resistant to. You have to be careful, and go slow and gentle, but once I started, it was a *huge* relief to have control over something that was so very important to Gwyn's health.

    If you decide to give enemas at home, you really do need to get a vet or a tech to show you how to do it. You can accidentally damage the anus or colon, which would be Bad. But it took probably less than five minutes for my vet's tech to show me how; and I had another one show me a month or so later, just to get a refresher as well as all of her personal hints and tips.

    If you go with home enemas, do *NOT* use the normal enemas that are available in the drugstore; many of them have ingredients (phosphates) that are toxic to cats. The glyercerin enemas for babies should be safe; there are also glycerin suppositories for babies that are available, but I found them almost impossible to successfully insert fully. On baby glycerin enemas, I'd like to note that I tried them and disliked them; the insertion edge of the bulb was both large and rather rough; I much preferred using my own syringes. At one point, I did try transferring the material from their bulb to my syringe, with limited success, but then either Jess or JoJo suggested using a 50-50 mix of warm water and KY jelly, which would have a similar effect, and I never tried them again.

    There are a range of ingredients you can use for home enemas, starting with plain warm water to water-plus-mild-soap to water-plus-KY to DSS enemas. Gwyn had constipation issues for 16 years. By the time we started home enemas, plain water wouldn't work and water-plus-mild-soap was mostly ineffective. We used water-plus-KY for a long time, with DSS enemas to supplement as needed, and eventually, toward the end when Gwyn generally just could not defecate on her own, we switched to mostly DSS enemas. The DSS enemas you'll need to get from your vet or online (may need a prescription).

    This is going to sound weird but, if you give home enemas, remember that your cat's comfort during the enema is important. If you use water, make sure it's warm but not hot; cold or even lukewarm water can cause cramping. Use lots of lube to get the syringe in. When I was doing water+KY enemas, I would lube the tip of the syringe, press it in a bit, eject a little KY, press in and out a little to spread the KY, then press in a bit more and eject some more liquid. That cut down on the discomfort of the insertion, and helped lubicate things for easier output. Remember that the less uncomfortable your cat is during the enema, the less they'll fight you when you need to do it again. (I will acknowledge that we used a kitty mask for the second several enemas, while both sides worked out their issues.)

    If you watch your cat's anus after giving the enema, you can tell when he starts to push. If Spencer does have megacolon, weakened muscles, is more impacted than normal, or various other things, you can help things along. When he starts to push out, take two fingers and press inward on either side of his anus. That helps open the anus a bit and can help with the ejection. ... If it helps, think of this like popping a pimple: there's pressure inside, you're just adding some outside so that the internal pressure works on it's own.

    Note that enemas usually work in waves: depending on how bad things are and what materials you're using and how irritating they are, there's a first ejection of harder material, then a short wait, then a second ejection of somewhat softer material, then another wait and maybe a third ejection of soft material. If things have been backed up for a while, there may even be a fourth or fifth ejection of increasingly loose stool.

    We kept aloe vera baby wipes on hand (*without* alcohol in them -- that stings!), and used them to catch the material as it came out, and also to help clean Gwyn's butt afterward. Depending on how bad things are, the anus may be sensitive, but it really isn't fair to have them clean up everything themselves, especially for older cats who generally aren't as agile as younger ones. Keeping the fur trimmed around the anus can help a lot; you might ask your vet or groomer for a perineal shave.

    After the enema was over, I would dispose of the baby wipes (you can find some that are flushable, or just put all the stuff in a plastic grocery bag, tie it shut and throw it in the garbage), then I'd go wash my hands extremely thoroughly and give Gwyn some treats for being such a good feline and cooperating so incredibly well. (She would also get lots of praise and affection during the entire process as well.) I also found a couple of stores that carried hand sanitizer in quart containers, so I could indulge my new-found "my hands aren't clean" fetish.


    Regarding the heart murmur and possible heart problems: The heart murmur may be very mild and have little impact on Spencer's lifestyle, or it may be more major. Really, the only way to tell is to get an echocardiogram (an ultrasound of the heart), preferably by a board-certified cardiologist. Ours ran about $250 in the metro DC area several years ago. Gwyn's first heart problem (a murmur) showed up at age 4 months, and the problems progressed over the years to include hypertension, hypertrophic cardiomyopathy, and several strokes, including one that paralysed her for two months. With patient and supportive care, she recovered from almost everything, including the paralysis.

    While the echocardiogram was expensive, I never regretted it. Because of it, I knew exactly what was wrong with Gwyn's heart, and we had options for medications lined up if and when they were needed. Because we knew the degree of her problems, we also knew to limit the amount of sub-Q fluids she got and to try to reduce stress in other ways. And we got a very detailed set of instructions for future vets to follow in the event that Gwyn needed anesthesia, to limit the potential side effects that might cause for her. I know that money's an issue, but I wanted to throw that out for consideration.

    And ... I think that's about it on my end. I hope things are going well for you and for Spencer.

    -- Jean and her Gwyn
     
  27. cornad

    cornad Member

    Joined:
    Mar 18, 2010
    Back from the vet.

    Something is definitely wrong with his tummy. When I held him, he flinched in pain. Our vet could barely get a good palpation because he was very tense and guarding his stomach. She suggested an ultrasound but I explained that the vet bill for his emergency constipation treatment (from only a few days ago) was almost $900. The ultrasound is $400. She suggested that he might have an infection in his tummy from the constipation procedures--the ultrasound could see the exact cause or fluids in his abdomen. My mother has absolutely refused to help financially at this point, I'm completely stressed.

    Later on I spoke to my sister and we just decided that we need to do the ultrasound but by the time we came back and decided, the ultrasound tech left for the day. She gave us antibiotics (Clavamox) for him. And fluids. We have to make another appointment for Saturday. He also got a Fructosamine test for his diabetes to see if he is really in remission or not.

    Spencer is SO dehydrated, its unbelievable. He received 100mL of fluids in the office and it did not even form a pouch like it normally does. It was so quickly absorbed. Poor cat. We were taught how to give fluids at home as well. They suggested 100mL a day until he starts eating and feeling better. Then every other day, then taper from there. Once Spencer gets fluids he is a different cat. When he was at the emergency vet, he was so energetic and after that it decreased when he got home. He looked so weak during today's visit.

    But good news, as soon as we got home he ate. Dry food but at least he is eating SOMETHING. I'm going to back to wet tonight but the fact he ate anything is amazing. But he lost 1lb over 2 months, the vet is concerned and so am I. From 11 to 10lbs.

    I really hope his pain goes away and he eats :(
     
  28. cornad

    cornad Member

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    Mar 18, 2010
    Jean thanks for that, I'm continuing to do research for cats and constipation.
     
  29. Lisa and Merlyn (GA)

    Lisa and Merlyn (GA) Well-Known Member

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    Dec 28, 2009
    Hi there, you have been thru the wringer.. I am so sorry. Sending you and Spencer cyber hugs.

    Merlyn had constipation issues on and off, but it got worse even with sub q fluids for his kidneys. We ended up in the ER with him bleeding from his rear and crying and being totally blocked. At the ER, the vet discovered that he has severe enlargement of the heart and on the xray..so the ER vet didnt want to try to get the poo out.. they just made him comfy til the next day when the reg vet could get the poo out.

    I believe that while Merlyn would probably have been prone to constipation generally, the heart condition made it worse because he was weaker, and couldnt push the poo out as easily even when it was normal poo and not hard. Lactulose I believe made his tummy upset, so we started using miralax to keep the poo soft..easier to push out.

    At this point..and this is just my non vet opinion, I would not do an ultrasound of his belly, I would do one of his heart. Sub Q fluids for a heart kitty is a delicate balance. Merlyn dehydrated very fast without them so I found that balance. If you are going to be giving fluids more regularly for his kidneys/constipation you need to know if he just has a harmless murmur, or if he has heart disease such as cardiomyopathy. Cardiomyopathy can cause fluid build up in the lungs (pulmonary edema) or around the heart (pleural effusion) and there is something called ascites which is fluid in the abdomen. A common cause of ascites is also cardiomyopathy/heart disease.

    Merlyn, with medications, lived 2 and half years after his heart diagnosis.

    I know the whole money thing and it stinks.
     
  30. JJ & Gwyn

    JJ & Gwyn Member

    Joined:
    Dec 28, 2009
    > Jean thanks for that, I'm continuing to do research for cats and constipation.

    No problem; constipation in cats is (unfortunately) something I have a fair amount of experience in.


    Regarding the abdominal ultrasound: if you're getting it done anyway, you might ask whether / how much the price differential would be to include the heart in there as well. I'm not certain whether you're seeing someone who works in your vet's practice (which sometimes makes things quicker and easier) or a specialist for the ultrasound.

    We had a *lot* of ultrasounds done over the years and, since our vet didn't have an ultrasound on premises, we always went to specialists (radiologists, cardiologists, neurologists, oncologists, etc). The process for consulting specialists generally falls into four areas: review of cat history and medical records; shave the cat and do the ultrasound; interpret the ultrasound; and present the results. If you can combine the abdominal and cardiac ultrasound together, there are parts of that process that can be combined; it might give you a better insight into Spencer's health while keeping costs down somewhat. Of course, if you're seeing someone associated with the vet, some of the process may be shortened anyway. But it probably can't hurt to ask what the price difference would be.


    If you do bring Spencer in for a consult, you'll want to bring as much information as you can with you. Definitely include any recent bloodwork, lab results, or x-rays, as well as any slightly older labs / x-rays that might be useful for comparison. And, if he had a semi-recent abdominal ultrasound, you can bring that in for comparison as well.

    You may also want to write up a summary of Spencer's major medical history, highlighting problem areas (give rough date and age at time of problem, symptoms, diagnosis, and treatment [something like: "Sept 2006 [age 12.5]: noticed increased intake and output of water, weight loss. Fructosamine test indicated diabetes. Switched to low-carb canned food and started .5u Lantus (glargine) insulin twice a day"].) If the major medical history is long, include a summary of current or ongoing problems. Also include a separate list of all medications, including strength and frequency of administration; and a list of foods that you normally offer. Make sure that Spencer's full name ("Spencer Smith" or whatever) is at the top of each page; also put your name and contact information and your vet's name and contact information on the first page. (I actually had a flash drive with all of this stuff on it that I kept in my purse, so that I could do an on-site print-out if we had to make a fast run to see a new specialist or an emergency vet.)

    Basically, the idea is that the more information you can supply, the better informed the radiologist will be and the more useful the results you may get.

    Oh -- and when you get Spencer home after the ultrasound, help him clean the shaved skin as well as the fur around the shaved area. The jelly they use can contribute to diarrhea (not something you're concerned about ATM, I know), but it can also sometimes cause some stomach upset.

    I'm sorry things didn't get further along this afternoon, and I hope Spencer gets better quickly!

    -- Jean and her Gwyn
     
  31. cornad

    cornad Member

    Joined:
    Mar 18, 2010
    I guess where my mind keeps wondering is what complication is this? What could this be? Pancreatitis? Is it really an infection? Will these antibiotics work?

    As for the discount, I don't know. The specialist comes to the clinic everyday it is opened. If Spencer does not eat, I feel that I should address the abdomen problem first because it's hindering his ability to eat. That's why I feel it should take priority at this point. He has already lost weight. He did not have a murmur until this emergency visit. Our vet thinks it could be appear under stress or sickness; which I know is very true in humans. $400 for a single ultrasound is a lot and I'm seriously running out of money and/or credit.

    My big sister wants me to take an easy, breathe, stop googling and researching things about his abdominal pain. I really feel on edge, maybe I should for a little awhile and just relax.

    I just hope with everything these antibiotics work. What a week...
     
  32. Gina & Yittle (GA)

    Gina & Yittle (GA) Member

    Joined:
    Dec 30, 2009
    No advice, just letting you know you and Spencer are in my thoughts and prayers (hugs).
     
  33. Maria & Suzie

    Maria & Suzie Member

    Joined:
    May 9, 2010
    Keep him hydrated as best as you can. Getting fluids in him is actually more important than food (though that is important too of course). The glucose in the fluids is what perks him up, and can encourage him to eat. Try to think of particularly good/strong smelling wet food that he absolutely can't resist, entice him with what you can right now.

    If he's letting you all know where it hurts, then that's probably a good indication of where to focus on first. However, how enemas can cause an infection in the stomach sounds a little far-fetched to me... hmmm.... I think the key is to try to figure out what caused the very severe constipation in the first place.... (and did the severe constipation perhaps cause some sort of after-effect in itself rather than the treatment for it....)

    Has he received oral laxatives? Some cats can get a tender tummy from that (but still, so much that he is flinching in pain seems unlikely...).

    Fingers crossed the anti-biotics help, keep a close eye on him, fluids, fluids, fluids. Wish I could be of more help.

    Thinking of you guys, I always check this post when I go online, rooting for Spencer !

    Maria & Suzie (sending thoughts from across the Atlantic)
     
  34. JJ & Gwyn

    JJ & Gwyn Member

    Joined:
    Dec 28, 2009
    Just thinking ... has he had bowel movements since the enema? If so, how much / how frequently? I'm wondering if the stuff that's in his colon now may not be moving as quickly as it "should" be. And if you've been giving him a lot of stuff to help with constipation that hasn't passed through his digestive tract yet, that may be causing cramping / discomfort / etc.

    Of course, there're other possibilities too -- pancreatitis, twisted intestines, some sort of infection or inflammation, etc. Whatever it is, I hope that it resolves well and quickly. (hugs) to you both --

    Jean and her Gwyn
     
  35. cornad

    cornad Member

    Joined:
    Mar 18, 2010
    I gave him fluids this morning, he did not want to stay, I accidentally gave him an extra 30mL because I tried to get him to sit still and look at the bag. First time, ugh, I think he will be okay. He looks very dehydrated still.

    I don't see any improvement. He ate about 10 treats and 2 bites of ham. Not really interested in eating at all, a lot of flinching in pain. All he wants to do is go outside and sit in his bed in the shade. At least he had the energy to wake up and come out when I came downstairs to ask to go outside.

    Only thing that new is that he is oozing diarrhea like a drop or so every couple of hours. We saw a small poop on my rug and that's it. He has not really gone after his enemas. Our vet yesterday said she did not feel any stool in his colon and so did the emergency vet. He's not eating. I think the diarrhea is also a product of the antibiotic.

    All I want is him to start eating. It's obvious he is still in pain and feeling sick.
     
  36. JJ & Gwyn

    JJ & Gwyn Member

    Joined:
    Dec 28, 2009
    Antibiotics can cause stomach upset. Between stomach upset, vomitting, and constipation (now diarrhea), you may want to talk with your vet about giving him some Zantac 75, 1/4 pill twice a day, for a few days. As with Pepcid A/C, the Zantac should help with any possible stomach upset and may help with the vomitting (depends on whether the vomitting was triggered by stomach upset or something else). And, unlike Pepcid, Zantac can also help with intestinal motility.

    Also, considering the discomfort that he's currently in and that you won't be getting the ultrasound until Saturday, you may want to talk with your vet about starting some painkillers and maybe also some appetite stimulants. Though your vet may want to wait for the results of the ultrasound before prescribing anything -- I'm really not at all sure what's going on here, nor what's safe to suggest and what's not, so it's really good that you're getting further tests done.

    (hugs) to you both --

    Jean and her Gwyn
     
  37. Maria & Suzie

    Maria & Suzie Member

    Joined:
    May 9, 2010
    Well, if they flushed out his colon with enemas and he is not eating, then there probably isn't anything in there to come out. What little there is becomes diarrhoea because of the anti-biotics and from any oral laxatives he may have gotten....

    Depending on what type of product they used for the enema, that could be irritating his bowels too. I've heard of humans get cramps and light intestinal bleeding from hardcore enemas. I think I told you I had a cat and we gave him enemas ourselves, lukewarm water with a teaspoon of cooking oil, all natural and gentle and it worked like a charm.

    But, you're not in that zone right now. I Wouldn't worry about giving him 30ml too much fluid, he's so dehydrated that he'll just absorb that small extra amount. Good for you for giving him sub-q's. It's not fun, but it's what he needs right now. Keep at it!

    Jean's suggestion of some painkillers is good, perhaps his stomach and intestines are cramping. I can't help but wonder if the current pain is associated with the vet having no choice but to be quite vigorous with his methods to clear the blockage, maybe had to use some strong enemas.... And we're all still wondering what caused the impaction to begin with...

    Tough one to figure out, none of us are vets of course, but the collective experience of us all does add up...

    Keep stroking him and let him know you love him, it will give him comfort and strength. You are doing everything you can for him!
     
  38. cornad

    cornad Member

    Joined:
    Mar 18, 2010
    Going in for the ultrasound tomorrow (EARLY!). Spencer looks a little better than last night. Last night he really scared me, he looked so miserable. It really broke my heart. Right now he's in pain I can tell but hes just resting (and hiding).

    My bestfriend is coming along, I'm very happy about this; I'll probably need the support. AND she's giving us a ride to the vet, finally a break from the subway--what a treat.

    I know the ultrasound will probably let me know whats wrong but I notice the pain is coming from under his ribs on his right side mostly. Maybe pancreatitis? When I touch it, he literally jumps/flinches in pain, then I jump. confused_cat

    Well no more guessing for the night, thanks for all the support again.
     
  39. Karen & Smokey(GA)

    Karen & Smokey(GA) Well-Known Member

    Joined:
    Dec 28, 2009
    Just wanted to let you know we'll be thinking about you and praying you get to
    the root cause of this. And that Spencer feels better soon.
     
  40. Gina & Yittle (GA)

    Gina & Yittle (GA) Member

    Joined:
    Dec 30, 2009
    I hope you get some answers today and can find a way to help Spencer.
     
  41. cornad

    cornad Member

    Joined:
    Mar 18, 2010
    Back from the ultrasound.. they think it's pancreatitis. Our normal vet wasn't there but they took a blood sample to check for sure. We won't get the results for 3-5 days but I did not get a clear idea what the treatment for pancreatitis in a cat really is. He's NOT eating. They gave us a appetite stimulant for him, I pray that it will work. Has anyone had any success with it? I got baby food, this Nutri-Cal gel? It's a high calorie gel, has anyone heard of it? Any success?

    I kind of force fed him a few ounces of food but I'm scared he'll choke or vomit. He's losing more weight since Sunday, 4oz to be exact. He needs food fast. Gosh, I'm so scared. The only good news from today is that his Fructosamine results are back and great numbers. His diabetes is really in remission.

    I asked about pepcid ac for his stomach pain, I was told I could but I didn't get an answer of how much. This vet did not really seem to care very much.

    I gave him fluids, washed him up, and now he's resting.

    I guess my question is, what is the treatment for cats with pancreatitis? Thanks guys.
     
  42. JJ & Gwyn

    JJ & Gwyn Member

    Joined:
    Dec 28, 2009
    We had acute pancreatitis twice, years apart; fortunately, we never had to deal with chronic pancreatitis, so folks who've dealt with that may be able to give you some more info on dealing with the chronic form (if that's what Spencer has), and they'll probably have more hints on how to handle things than I will.

    My very first recommendation is something that it sounds like your vet didn't do: painkillers. The sooner you can start on painkillers, the better, especially since it seems like Spencer's been dealing with this for a few days now.

    Pancreatitis is *incredibly* painful, and dealing with any form of constant pain is *incredibly* draining. It's so terribly easy to feel that there's no end in sight. If your hasn't already given you painkillers, go back and demand them. I happen to like buprenex, but some vets won't dispense it, so get whatever you can. (And don't be tempted to give human painkillers like aspirin or tylenol.) When we used buprenex for pancreatitis, we started with .25mL every 12 hours -- but it seemed to wear off toward the end of the dosing period. I asked my vet if it was okay to give half the dose twice as often (.125mL every 6 hours); she said it was, and that dosage seemed to work extremely well for us.


    When she had her attack, Gwyn seemed reluctant to move around, probably because of the pain issues, so I got up every two hours, around the clock, and brought food and water to her so that Gwyn didn't need to make any effort. I also made sure the food was not anything Gwyn would have to "work" to eat -- ie, no thick pates that she'd have to break pieces off of, no lumpy something-in-gravy that she'd have to try to get on her tongue. I did use A/D, regardless of the carbs; it's nicely syringeable direct from the can. By the second attack (*years* later), I'd run a taste test and knew exactly what her favorite foods were, and she was only allowed those when she was ill, so we used a mixture of those and A/D.

    [You might want to check Janet and Binky's food charts. IIRC, A/D is high in fat, and ISTR that fat can contribute to pancreatitis flare-ups in cats with chronic pancreatitis. Hopefully, some of CP folks here can chip in with info on that.]

    We also re-arranged the area so that she didn't need to move more than necessary: the food and water were close by, and we moved the litterbox to several feet away. We tried to keep Gwyn on the floor, but she insisted that she preferred the couch, so we used the encyclopedias to build a very lowly sloping set of steps up to the couch so she could get up and down without jumping. Even so, I slept next to her and, at any indication that she wanted up or down, I lifted her up/down.

    Sub-Q fluids were very necessary; my vet prefers Normosol-R, though other vets prefer LRS. I don't think it matters much which Spencer gets, as long as he's kept hydrated. My vet also added extra vitamins to the fluids, to help. We gave fluids daily until the attack passed.


    IIRC, the dosage for Pepcid A/C is 1/4 tablet once or twice a day as needed. If you don't already have Pepcid on hand, I'd actually suggest considering Zantac 75 instead. It'll help with the same nausea / vomitting problems as Pepcid, but can also help with intestinal motility (ie, it can help with the constipation as well).

    Speaking of intestinal motility: I should note that buprenex is a great painkiller and I dearly love it -- but it's an opiate and can temporarily decrease stomach motility. So if you get buprenex, you might want to give a little extra consideration to the Zantac over the Pepcid. If you go with Zantac, it's 1/4 pill twice a day, though you can front-load that with 1/2 pill twice a day for the first day.

    We also increased Gwyn's normal dose of prednisone (steroids) during the attack -- I think we went from 5mg a day to 10mg per day. That helped control the inflammation.


    Appetite stimulants are great. The two main appetite stimulants are cyproheptadine and mirtazapine. Mirtazapine is longer lasting, but some cats can get really wired on it; for pancreatitis attacks, my vet prefers cyproheptadine. It needs to be given more frequently (every 12 hours), but caused less agitiation in the rest of Gwyn's system during a period where she needed to rest and preserve her strength. My vet also prefers transdermal appetite stimulants, which you gently rub on the inside of their ears, and I've found that I prefer that as well. If your vet can't supply exactly what you want, I'd ask if there was a local compounding pharmacy that could make some.

    Getting Spencer to eat is very important! Things that can help increase appetite are appetite stimulants, painkillers, sub-Q fluids, steroids, and stomach meds like Pepcid / Zantac.

    Foods: as I mentioned, we went with foods that involved minimal effort on Gwyn's part. I pureed some of her food, and some of the other food was already in puree form. When I fed her, I would tilt the bowl toward her so that she could push the food against the bottom of the bowl to help get it in her mouth (minimal physical effort to eat).

    You might also try other foods that Spencer might find appetizing: treats that he doesn't normally get to have (even if they will spike his BG levels), maybe some cheese or bland deli meats. Some folks have had luck sprinking bonita flakes or catnip or parmesan cheese over top of the food. Or feeding tuna juice. You can try warming it up a bit; that often helps. Or put the food on your finger and offer it to him that way. Or try dabbing it on his paw or mouth, see if he'll auto-groom the food off. Baby foods sometimes work well -- Gwyn was particularly fond of Beechnut's Beef+Beef Broth and Veal+Veal Broth baby foods. (Not the Gerber versions; Gwyn says that those suck.)

    When you say you're force-feeding Spencer, what type of food are you giving him, and how? Like, are you shoving chunks of meat in his mouth, or are you syringing pureed food? If you're syringing food into his mouth, make sure that you're aiming for the pouch of the cheek and down toward his throat. If you aim for the throat, it's very easy for Spencer to aspirate the food into his lungs.


    You might also want to check out Jojo's post on chronic pancreatitis and how to treat it. You can find that here, and it has lots of great info in it. Her summary of things that may be used to help treat pancreatitis includes:
    And ... I think that's about all my brain is going to regurgitate on the subject at the moment.


    ETA: you may want to think about starting a new thread, this one asking for help in treating pancreatitis. I'm suggesting that because the title of this relates to constipation, and so may well be overlooked by folks who have lots of experience on pancreatitis but little experience with constipation issues.
     
  43. cornad

    cornad Member

    Joined:
    Mar 18, 2010
    Okay good idea. I will do.
     
  44. Maria & Suzie

    Maria & Suzie Member

    Joined:
    May 9, 2010
    Keep up the fluids, and a tip for force-feeding = does he still have all his teeth? My Suzie does not, so I did not mess with a syringe when I needed to force feed her, I sat next to her, and with right hand, push in little rolled balls of soft food sort of by the right corner of her mouth and pushed it gently towards the back of her tongue. Less mess & stress for both of us. If he does have teeth and is not struggling, you could try this too. Then you can feed him cat food that is more nutritionally correct for him than baby food, and the cat food is sort of more concentrated, so less of it will keep him going better....

    I hate force-feeding, but sometimes you have to do it to keep them going...

    Our thoughts are with you !

    Maria & Suzie
     
  45. Gina & Yittle (GA)

    Gina & Yittle (GA) Member

    Joined:
    Dec 30, 2009
    Yittle's taken both cyproheptadine and mirtazapine twice now for appetite issues. I sort of think the cyproheptadine worked better, but it could just that both times we started with the mirtazapine and while it worked it wasn't working fast enough so we switched to the cyprohptadine and everything finally worked itself out and he started eating again. Might just be a case of the other drug needing more time then I was willing to give it (if he wasn't eating a lot better after the first dose and 36-72 hours then we switched.

    Yittle has also taken buprenex for his leg. Worked great for the pain, was easy to administer, constipated him so fast it wasn't funny. Since Spencer's numbers are good I'd suggest you make sure you try to work in the organic canned pumpkin as soon as the appetite stimulants get him eating again. I'd also say that right now, when he's not eating - if he wants a few kibble let him. Its more important that he eats.

    I'm glad you got some answers, now at least you know what you have to work around.
     
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