Diabetes, Megacolon and an update on Leonardo

Hello again,
My first post was http://www.felinediabetes.com/phorum5/read.php?8,922546,922655#msg-922655 now in read-only status, and while I have a question, I wanted to give an update and just reiterate how great I think this forum is. If you look at the linked article you will see it was from Jan 2008. Leonardo has been off insulin for a little over two years now !!! He still suffers from MegaColon and that's bringing me around to my questions...
He has been really happy, but he's had to have the cicapride and lactolose as a part of his diet again for awhile. Recently he REALLY got backed up, and we found a NEW vet as I REFUSE to go back to the original one. In fact, we now know that the diet he was on by that first vet is what CAUSED his megacolon. Not directly, but their answer to everything was to add pumkin pie filling. Really, I'm not kidding. That cat loved it, but they also never told us how much to give him, so he got over fed... Not totally the vets fault... but... had they just helped us find the right diet... well that's a poop under the bridge.
Anyway... the new vet seems more in tune, they are really into cats there too.

On a side note, before I get to the issue at hand... Leonardo did visit the old Vet one more time recently due to his MegaColon. They seemed more interested in telling us about his major dental problems and knocking him out so they could clean him out. He came home and took two days to recover and the result was him just getting more backed up.....

Here's how our visit to the NEW vet went. I'm posting this as testimony that if you don't really like your vet.. THERE ARE OTHERS. First thing she feels under him and confirms he's REALLY plugged up. She proceeds with a further exam and notices the plaque on his teeth, and before we could say anything, she recognized it as calculous and popped it off with her finger nail. A couple of pretty big chunks. You could have knocked us over, but the CAT was obviusly now in LOVE with the Vet. He just relaxed as it must have relieved so much pressure. And, she saved us a PILE of feline dental costs right there in a couple of seconds. The old vet didn't even try anything like that. She then commented that under the calc, his teeth looked pretty good, and we should bring him back for a cleaning when he feels better. Ok... I'm liking this Vet at this point. The cats been there for 15 minutes and already he feels better and she hasn't even addressed the "real" problem yet. So she tries this DSS <sp> enema first hoping maybe that would be enough, and it wasn't. So we ask how long will he have to stay for them to clear him out. She states it will take maybe an hour or so. HUH?? No overnight, drugs, anesthesia ??? Nope... She uses a gas mask that just makes the cat not really care much... as soon as they take the mask away, the cat gets up. Well, after an hour or so she came out... it was rough for the doctor... and I don't need to post the details, but they cleaned up Kitty and home we came. He was "leaking" so we had to confine him to a tile floor bathroom for a day, but he was essentially "recovered" in a matter of hours of getting home. So no overnight visit, no lengthly recovery, a fraction of the cost of the last time at the old vet, and a VERY happy cat. Did I mention the old vet didn't even check his blood sugar on that visit? The new Vet did a FULL blood workup...

So what am I saying... ALL VETS ARE NOT EQUAL. ok... time to move on... and by the way.. the full bloodwork came back that we have a healthy cat. Nothing out of the normal zones. We have this forum to thank for that.

So here's the question..... They (new vet) suggested "IAMS Intestinal Low-residue" Vet formula cat food to help him deal with his megacolon. It seems ok, but I really can't find any comparative data and wondered if anyone else had a diabetic cat that also had megacolon and what you use for diet, do you know anything about this IAMS Vet Formula Low Residue etc.. As much as I like this new Vet... I'm not taking anything for granted any more. This food is expensive. nearly $2.00 for per 6oz can. We were using Precise Feline Foundation for that past couple of years.

Thanks in advance for any input or thoughts on this. What constitutes "low residue" etc...

And again, we are so grateful to this site and forum that saved our cats life.

 

> He still suffers from MegaColon and that's bringing me around to
> my questions...
> He has been really happy, but he's had to have the cicapride and
> lactolose as a part of his diet again for awhile. Recently he REALLY
> got backed up

Has Leonardo had his kidney function checked recently? A lot of older cats have lower kidney function (average age of diagnosis is 9). Lower kidney function frequently causes varying degrees of dehydration, and any dehydration can contribute to constipation. Given that Leonardo's growing older and having more difficulty with constipation, I would ask the vet to run a kidney panel. Given his history of constipation and megacolon, if there is lower kidney function, I'd have a discussion with the vet about the risks and benefits of starting subcutaneous fluids earlier than normal. That's what we did with our Gwyn, who has had constipating IBD for 16 years now, as well as some degree of megacolon.


> So she tries this DSS <sp> enema first hoping maybe that would be
> enough, and it wasn't.

Yes, DSS enema. Since this vet seems reasonable and Leonardo has a history of constipation, you might ask her whether they might show you how to do enemas at home. It's something that my vet suggested to me for several years and which I resisted (I was scared of hurting Gwyn). But I've been doing them on my own for several years now and, looking back, I wonder at how resistant I was. It's very comforting to know that, if Gwyn gets backed up, I can try to take care of it in my own time. No worries about nights, weekends, holidays, getting an appointment, whatever. It's also cheaper and less hassle. Bonus: I can use gentler enema materials first and give them longer to work than a vet might, then move on to the harsher materials if necessary. (DSS enemas qualify as 'harsher' in my book; I prefer KY-jelly-and-water enemas when I can get away with them.) Also, since I can do it on my own, I don't need to wait until things are clearly problematic before taking action.


> So here's the question..... They (new vet) suggested "IAMS Intestinal
> Low-residue" Vet formula cat food to help him deal with his megacolon.
> It seems ok, but I really can't find any comparative data and wondered
> if anyone else had a diabetic cat that also had megacolon and what you
> use for diet, do you know anything about this IAMS Vet Formula Low
> Residue etc..

I'm afraid that I can't help you here. While Gwyn is diabetic with megacolon, we've never got her into remission so we don't worry if we have to use a higher-carb food; we just adjust the insulin as necessary. You might try a can or two and see what that does to his BG levels? (Do you still have your home-testing kit?)

When we had been on cisapride for a while and started needing a little more 'oomph!', our vet supplemented the cisapride with miniscule amounts of cascara, which she said sometimes helped improve the effectiveness of the cisapride. We eventually stopped both the cisapride and the cascara due to Gwyn's heart problems.

Another thing you might want to look into is Miralax, instead of (or in addition to) lactulose. A lot of us with constipation-prone cats are using that to help with constipation. We generally start with 1/8 tsp twice a day and adjust as necessary. It's available in the digestion section of most pharmacies.

There's also this lovely article on the management of constipated cats that you may want to read and share with your vet http://www.theveterinarian.com.au/clinicalreview/article757.asp. I have it bookmarked because of Table 2 at the bottom, which lists groups of drugs that can help with different aspects of constipation. I like it because, if one drug stops being as effective, you can use the chart to supplement or replace your current drugs of choice with another drug that may work better. (For example, while both Pepcid A/C and Zantac can help with nausea, Zantac can also help with constipation. Therefore, while most folks here on the board use Pepcid, Gwyn gets Zantac.) And I don't know if the MaristaVet article on megacolon has anything you don't know, but I link it here anyway, just in case http://www.marvistavet.com/html/body_constipation_and_megacolon.html.

Finally, the folks on the Yahoo feline-IBD group may be able to help you with info on the megacolon; I've seen it come up semi-regularly on the list there http://groups.yahoo.com/group/FelineIBD/. There's also a feline megacolon group here http://groups.yahoo.com/group/Feline_Megacolon, but I haven't joined the group and know nothing about them.


I'm afraid that's about all the help I can think of off-hand, though I'll be happy to try to answer if you've any other questions.

-- Jean and her Gwyn

 

Wow, that was an awesome answer. The history of Gwyn is similar to Cody's experiences.. Cody was diagnosed with FD 2 3/4 yrs ago, then megacolon, and in the last 6 mos heart problems.

I would like to second many of her points and add 1-2. All of these have been approved for us, by our vet:

We used cisapride until we found out he had heart problems and I always have wondered if the 2 are related. As you know it was taken off the human market because of heart related issues. I was glad to stop paying the compounding pharmacy ($$$)

At the suggestions of the FDMB I recently switched from lactulose in his food, to Miralax, and it is looking very promising.
We are still trying to get the exact right dose but i think it is going to be 1/4 t BID in food. I had to use so much lactulose I always was suspicious it affected BG, (still not sure, too many other things going on to be sure but he is doing better).

I strongly support her ideas of home enemas. I keep close tabs on how his stomach feels, and how long since he's pooped and never let things get to the vet dis-impaction stage (again). I also resisted this, but it is really not that bad. The worst part is the bubble bath and hairdryer if things get too messy :lol: Also we use warm water only and it works fine, with vaseline on the rubber tip.

The other thing that helped his megacolon A LOT is daily home sub cutaneous fluids( Lactated ringers). I just couldn't add enough water to the food (soup) to keep him from getting dehydrated ( FD and Lactulose both suck out his fluids). Again this sounds a lot worse than it is. It takes about 5 minutes, and for a cat used to daily testing and shots, its just one more step. I order fluids from vetsupplys . com which has saved me a lot of $ and aggravation going thru my vet. You do need a Rx and vet guidance to give the proper amount of fluids.

I'm going to be sure to save those links - thanks JJ and Gwyn!

 

> We used cisapride until we found out he had heart problems
> and I always have wondered if the 2 are related. As you know
> it was taken off the human market because of heart related issues.

I don't *think* cisapride causes heart disease. As I understand it, the problem was that, if you were on certain heart-related medications or had certain heart problems (which might not even been diagnosed), adverse events were more common and, when they occured, were Significantly Adverse. I do know for a fact that Gwyn's first heart problem was diagnosed when she was a mere four months old, *way* long before we ever heard of cisapride.


> we use warm water only and it works fine, with vaseline on
> the rubber tip.

For a stronger enema, you can add some very mild soap to the warm water, or some KY jelly. My "harshness ranking" is water -> water+soap -> water+KY -> DSS. I try to keep to the gentler end of the scale when I can, to avoid Gwyn having to strain too much, and hopefully avoiding any excessive strain on her heart. And, yes, using warm water (not cold or tepid) makes a big difference in enema comfort!


> You do need a Rx and vet guidance to give the proper amount of fluids.

This is particularly true if your cat has heart problems; sub-Q fluids can put a strain on the heart as well.


> I'm going to be sure to save those links - thanks JJ and Gwyn!

You're more than welcome; I'm glad someone can get some use out of Gwyn's history!

 

MilesKB...how is your cat doing? Mine is going through a similar pattern...Diabetes, megacolon and I think he may have heart problems from his breathing since we started the cisapride. Did you ever find a remedy for your cat that works? and how long he been on it?

I am going to try the iams low residue...but does anyone know the carb count? will this be ok for my diabetic cat? He has went on remission before but will this contribute to his diabetes? Thanks.

 

If you post a new topic asking this question on the Feline Health board I'm sure someone will be able to answer it.


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