Constipation

Hi all. I posted on main forum with no response. I wanted to know if I can give Colace to Pepper long term? It is the only thing that I can get in her, and she goes within a day.

 

I wish I could help. Have you tried looking for info from reputable sites Online?

 

Yes, I can't find anything. The ER vet said to give it to her,. But didn't say for how long. She won't take anything else. If I give her the lactulose she stops eating her food completely. I ran out of options.

 

Would it be worth calling the ER clinic to ask?

 

I will call after 6 pm when they open. Thank you for your fast response.

 

@Kris & Teasel So I called and they can't answer the question. They said they are not familiar with long term use. Ugh! On top of that, I set up my daughters nanny cam and was able to watch pepper during the day. Well, low and behold the food I leave out for her at night.....she's eating her night meal less than 2 hours before I get up and feed her again. I also found out that DH is feeding her less than 2 hours before I get home. Can you say sabotage? I don't think it's on purpose, but I'm wondering why I sometimes get blues ps and sometimes reds/blacks. I feel like I wasted 6 months trying to get her regulated.

Where do I go from here? Do I start over? DH won't test during the day when I'm at work.

 

Hells bells! No, I wouldn't start over. How about a timed feeder for the daytime and try giving her a bedtime snack before you go to bed but don't leave any food out after that? Is she an only kitty?

Re Colace: how often have you given it so far? Have you assessed whether its effect lasts for only one poop or does she have a couple on separate days after a single dose? Maybe experiment with the minimum number of doses that results in a reasonable number of poops over a week? I'd keep asking on the forum too.

Also - maybe get a full curve done soon to assess the dose she's on?

 

I posted the same comment I sent you in the main forum as well.

I am beyond pissed right now. How do I know if this dose is correct if I can't get mid day cycle tests? Knowing that her ps numbers are mostly food related. Ugh! I definitely need to get a timed feeder, but how do I get her extra water in her food?

I give the Colace to her every other day and she will poop about 3-4" total every other day, sometimes every day since she's been getting it. I've only been giving it to her for the 1-1/2 weeks.

I will do a curve this weekend. Should I do a 12 hours or 24 hr curve?
Yes, only kitty.

 

You've probably seen these:
http://veterinarymedicine.dvm360.com/all-bunged-unclogging-constipated-cat
http://www.felineconstipation.org/acutetreatment.html
Colace falls in the category of laxatives and, as such, can likely lead to dependence in order to poop - as in humans. A member on the Lantus forum, @Carol in Chicago, deals with the constipation issue in her kitty, Rosie. Enemas are involved. She might have some advice for you.

 

It's impossible when you're at work all day and that's why a before bed test every night is a good idea, along with more in the middle section of the daytime cycles on days off. A curve will help you to sort out where she is at this point - this weekend?

 

I read here that people add water to the food in the feeder dish for the early meals and an ice cube for the later meals.

 

I will do a curve on Saturday so that I can see how she responds when I am home and she's not getting her food less than 2 hours before her meal.

 

She's so lazy. The Dr mentioned that she could possibly have CKD because of elevated blood tests, but also said that vet stress can cause elevated tests as well.

 

I don't have any expertise in that area. There are many members who do and some are good at interpreting bloodwork results. Something else you could ask about on the main forum.

 

When I took my hiatus away from FDMB I asked on FB. That's when I was told about her results being a stage 2 CKD and someone else said that vet stress can cause elevated test results. Thanks anyways @Kris & Teasel you're always such a great help and support for Pepper and I.

 

Hi Missy & Pepper! Sorry to hear you are having several problems. First thing with constipation is the very helpful link Kris already shared. I don't use colace myself, but understand from published info that the correct dose is 50mg 1x daily. Please review the acute treatment details as there is a caution that colace is bitter and can result in foaming at the mouth. From felineconstipation.org: "if a vet approves use of Colace/docusate sodium, avoid the taste and the risk entirely by pilling a Colace capsule, 50 mg. size, and chase the capsule with food or water"

I wanted to mention I do use Lactulose. I have heard other members mix it in food, but I give it by syringe 2x / day prior to meals. This is a dose to effect medication, so you will have to determine the most effective dose. In my experience, not enough has no impact and too much causes excessive gas. Rose gets 1.5ml 2x daily. I also use it in enemas as needed, but hopefully you won't need to do that.

I can't comment on insulin dose as I'm a lantus lady, but I do see some higher numbers in Pepper's SS that I know are frustrating you. Hope the curve you have planned will help fill in the blanks. Meanwhile, one thing I have learned is that I can tell if Rosie has a constipation problem brewing by looking at her SS. Her insulin dose was all over the place going up and down from 2 - 6.5U the answer was all in her constipation problem. If she had a problem, her BG climbed up, naturally I increased insulin, but when the constipation problem was resolved, her insulin needs quickly changed. It was a wild ride until I learned how much it affected her.

The other thing that jumps out at me is your discussion of CKD. This is tough because constipation is so related to proper hydration. Yes, you should add additional water to all meals and review current labs with vet for best treatment options. Labs from 11/20/17 don't look bad at all WRT CKD, so maybe there is more recent info. While stress can certainly increase blood sugar, I don't know that it increases kidney values. Best to have the basics checked (i.e BUN, Creatinine). Maybe UA and if you are worried or vigilant, SDMA. I give Rose additional water in all meals / snacks and she also receives daily SQ fluids. When we started this journey, she had no signs of CKD, but it was actually a crisis of constipation and some type of infection that revealed underlying CKD. If you do have CKD in the picture, I would be remiss if I didn't also point you to Tanya's site for the wealth of information available. Invaluable.

Sending all my best to you and Pepper. Hope she feels better very soon!

 

Thanks so much for this, @Carol in Chicago.

 

Thank you so much for reaching out. We have tried everything with Pepper. She was very constipated on top of having absorptive leasions on her gums. She was brewing a nasty infection until she got 2 of her teeth pulled. She was dehydrated because she wouldn't eat or drink, which caused the bad constipation. So the blood tests were from an ER visit when she was sick with infection. Pepper has always been a constipated kitty. She had a hairball blockage at 6months old and had to have ER surgery to save her life. We have tried sisapride (sp?), Lactulose, miralax, pumpkin. She will avoid her food all together with it in it and then never eat that flavor again. If I syringe it in her mouth, she will make herself vomit. Giving her the 50mg capsule of Colace is so much easier. I chase it down with a few bites of food and she doesn't seem to mind. I'm not convinced she has CKD (yet). I do have a bag of saline for subq fluids, if needed. On a good note I have not given her the Colace in a couple days and she just pooped a 10 inch turd (no Colace tonight for her). I've been giving it to her every other day. She does have a spot on her kidney that can be seen on her x-ray from when she was constipated. I hope this gives some kind of insight with my baby.

 

Given all the poop issues, I’d use the Colace judiciously. Maybe discuss it with your own vet next visit?

 

If you can pill her, could you put the Lactulose into a capsule? You can buy empty pill capsules online, and I'm sure someone around here can tell you what size to get.

I'm also giggling a little that you are measuring her poops. Oh, the things we do for our kitties! That's love.

 

That made me lol! When you have a constipated kitty you have to give measurements. Hahahaha

 

@Djamila that's a great idea about the capsules.

 

Can the vet tell you why she has a constipation problem? For example, Rose takes Cisipride for motility. She can form soft stool, but has trouble passing it due to a lack of GO motility. I made the mistake of giving her pumpkin early on. It adds bulk - that wasn't her problem. She just can't get it out ( which is why I'm now known for giving enemas at home)

I believe Cisipride is available in trandermal and also pill form of that would help.

So glad there is not serious CKD!

 

@Kris & Teasel Pepper is 166 at +4.5. She's still got 2.5 hrs before nadir

 

She may be a little more reactive than usual tonight because she got out that giant poop. (Constipation raises BG). It looks like a safe trajectory though. I think you can go to sleep and not need to worry.

 

I've given pepper very small enemas throughout her whole life. Nobody can tell me why the constipation without charging me a ton of money.

 

If she bounces in the morning do I keep same dose or lower it?

 

My hunch is she'll be high in the morning, so just keep this dose. If she's low (below 200) in the morning you might need to reduce a little. This is looking like a good cycle though, so you would try to avoid reducing if you can. You want more like this!

 

I think she’ll be safe.

 

Were these enemas successful? If so maybe you could use them along with Colace or Lactulose given in a gel cap.

 

The enema's aren't very successful. I feel bad constantly having to poke her little butt all the time.

 

Pepper's amps was 403 this morning. She definitely bounced. She hid under my bed all night last night, which is not like her at all. Poor baby. I wonder if she went too low during the night. Her food bowl was clean when I got up. Not one speck of food on it.

 

I'd say she probably stayed in safe numbers last night given that she was 166 approaching the usual nadir time. Don't worry about the bounce. The weekend curve numbers will be very helpful. It's great that she ate well but she might be uncomfortable if she's bunged up. I like the idea of trying lactulose in a gel cap.

 

@Carol in Chicago here is Pepper's xray from the last ER visit with her bad constipation. You can also see the spot I was talking about on the side view on her kidney. You'll probably have to zoom in. I'll also try to find the lab results from the vet, when she was discussing CKD.

 

Here is a copy of her most recent blood tests, from when she was sick. When they were saying possible CKD. They never did a urinalysis.

 

I'm not a vet, but I would not diagnose or stage CKD off one lab report on a ill animal. For one thing, dehydration can make a mild situation look really bad. Having said that, there are some kidney numbers in this lab report that should be followed up on and watched. Assuming she is clear of the infection and properly hydrated, I would recommend re-running the blood work to review kidney function. It is best to put these results in your SS labs tab. It really helps to see things over time.

When considering kidney problems, I like to see UA to review urine concentration and nip anything simple like UTI. SDMA is also another good data point for early indications of CKD if your vet has access to it (IDEXX).

I don't know what an xray can tell regarding kidneys - hard to know what is there. US would be more helpful here, but expensive and I'm not sure it is indicated yet.

If Colace is working for you, I would keep going with that. What I would recommend to you at this point is learning more about how to "feel" if there is a problem in her abdomen. While I love xrays, I can't do them at home to see a big poop problem. If you can "feel" it yourself, it will help you know when she needs help. There is a write up in the earlier link shared from felineconstipation.org regarding how to feel the abdomen. Just for a reference, when my Rosie was badly constipated, my vet showed me how to feel it - OMG it was like a handful of rocks! So - you never want it to be hard, and you don't want there to be a large volume.

10 inches is impressive. I hope that solved the problem and she was just tired from the effort. We worry when they hide, but I hope she just needed some rest.

 

With that being said, she is not eating her usual volume of food today. Can a bounce make her feel icky? Because at this point, I don't think she's constipated or as constipated anymore.

 

Yes. I think that can happen, but I also think constipation makes them feel full and then they can be reluctant to eat. Also, at least in some cats, constipation will push up BG.

I hope you can continue to watch her and figure out what is going on.

 

Thank you. This dance is not fun.