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Atypical constipation - ideas?

post #1 of 14
Thread Starter 
My ten-year-old (diabetic, controlled with caininsulin) golden tabby (Frobisher, also known as the sweetest kitty in the land) has recently had constipation, but the presentation is unusual and it's troubling me.

Starting at the middle of last week, he atypically vomited several times over 24 hours. After an x-ray (Weds. of last week), the vet diagnosed constipation and gave an enema, but the resulting stool was not particularly hard, in part because he was on a pumpkin-supplemented diet. He did not begin natural bowel movements after, and the vomiting continued. A repeat visit on Thursday, subcutaneous fluids for mild dehydration, and another round of enemas later, a little bit of hard stool and "mostly liquid" was produced, leading the vet to think that the constipation should be cleared.

Unfortunately, that hasn't yet happened. His vomiting has improved somewhat since then -- what was once a large amount of mostly-watery vomit has turned into what I'd consider "more normal" vomit, and he's doing it a bit less frequently. However, he still hasn't had a normal bowel movement despite lactulose and mineral oil as laxatives; he also doesn't seem to be straining or trying for a bowel movement at all. The vet drew blood on Saturday for a workup with the results back for Monday, but that's just likely to rule out liver and kidney diseases.

Frobisher is still eating, but noticeably less than usual (thus he's on a bit less insulin than normal to prevent hypoglycemia). Likewise, he still acts normally when he's not nauseated but is probably more fatigued than usual -- it's hard to be sure what's his behaviour and what's imagined from worry.

He also shows no signs of abdominal tenderness, nor could the vet feel any unusual masses, with the caveat that he's overweight so it might be difficult to tell. There's no particular pattern to his vomiting, except that it seems more likely 4-7 hours after he's eaten. Also, there's no blood in his vomit or (enema-produced) stool, nor is there any unusual amount of bile in his vomit. He's been on metoclopramide (2.5mg twice daily) for about 36 hours now, but that hasn't made any dramatic change yet.

At this point, my financee and I are both confused about what this could be. He's not acting typically for simple constipation, but his symptoms also aren't severe enough to immediately say there's an intestinal obstruction, cancerous or otherwise.

Presuming he doesn't improve spontaneously in the next day, we'll have an ultrasound done, but it feels like we're shooting in the dark. Has anyone here had a cat with similar symptoms, and if so what was the diagnosis?
post #2 of 14
Did the vet do any blood work? If so, what were the result? A search for vomiting in a diabetic cat turns up information on ketoacidosis:

http://felinediabetes.com/ketones.htm
http://www.peteducation.com/article....&articleid=199
post #3 of 14
I'm Nekhbet's fiancee -- both of us are new to the site.

We've been to our vet four times in the past week. We expect that our vet will call us tomorrow with the results of the blood test, but she said upfront that she didn't expect it would give us anything useful, since he recently had a blood test for his sugar about two weeks ago.

The main concern is that he hasn't had a BM in several days, even after the enemas. It's like his bowels have just stopped working entirely, but we don't know what on earth would cause something like that -- and leave him with a relatively good appetite.

It just doesn't seem to add up.

Any thoughts would be appreciated -- thanks!

ETA: He has been urinating, but not excessively.
post #4 of 14
Thread Starter 
As for the ketones (thanks for the suggestion, cloud_shade!), it seems unlikely. If anything, he's been urinating less than normal rather than excessively, and he has no odd odor on his breath.
post #5 of 14
That is odd. Have you noticed any bloating? Is there a chance he's defecating somewhere else? You may want to try to measure (ick, I know) how much he's vomiting to see how much is likely staying down. Honestly, an ultrasound isn't a bad idea.
post #6 of 14
I hope he will be ok.
post #7 of 14
Quote:
Originally Posted by cloud_shade View Post
That is odd. Have you noticed any bloating? Is there a chance he's defecating somewhere else? You may want to try to measure (ick, I know) how much he's vomiting to see how much is likely staying down. Honestly, an ultrasound isn't a bad idea.
There's been no bloating that we've noticed, and our vet has been checking for that each time we visit. Also, we live in a one-bedroom apartment, so trust me, if he was defecating somewhere else we'd notice pretty darn fast.

As for the vomiting, we've noticed a change in that originally he was vomiting mostly water. Lately his vomit has been more like mushy, partly-digested food, and there's been less of it. This change happened after he had the enemas, so we're wondering if there's some kind of blockage which doesn't show up on the x-rays, and its moved further along his intestines.

If I had to guess, I'd say he's vomiting only about a quarter of what he eats. Maybe even less? It's definitely not anywhere near what he's eating.

Thanks mews2much -- so do we!
post #8 of 14
Thread Starter 
Quote:
Originally Posted by Ronronne View Post
If I had to guess, I'd say he's vomiting only about a quarter of what he eats. Maybe even less? It's definitely not anywhere near what he's eating.
Right. Between Friday evening and early Sunday morning, he'd gone about 30 hours between vomits. (He's since vomited early Sunday evening, so about 10-11 hours there.) At least for part of the past couple days, then, he simply hasn't vomited enough to account for what he's eaten.
post #9 of 14
Well, we talked to the vet this morning and Frobisher's bloodwork was nothing out of the ordinary. His sugar was high, but we were expecting that because I've been giving him less than his normal dose of insulin since he has occasional vomiting.

He spit up twice last night but didn't actually throw up. Still hasn't had a BM. He's now been without a BM since Thursday, which is when he had his last enema.

After discussing it with the vet over the phone, we're going to take him back in today so they can do another round of x-rays and enemas to clear him out. Then we'll try another medication to see if we can get his bowels moving before we take him across town for an ultrasound.

He's just gonna LOOOVE us for all these vet visits and enemas...

Sometimes you'd never know anything was wrong with him, like right now for example -- he's starting a playfight with our other cat.
post #10 of 14
Hi! My 10 year old cat had the same problem last year, watery vomit, constipated. The vet did several enemas, which didnt work. Because he is large, about 20 lbs, she couldnt feel any abstructions in his abdomen, but after an x ray she found that he had a big blockage of feces. She sedated him and manually "pushed" the blockage out of him. Since then I have given him fiber tablets mixed into his food and we havn't had a problem since!
post #11 of 14
Quote:
Originally Posted by Deb314 View Post
Hi! My 10 year old cat had the same problem last year, watery vomit, constipated. The vet did several enemas, which didnt work. Because he is large, about 20 lbs, she couldnt feel any abstructions in his abdomen, but after an x ray she found that he had a big blockage of feces. She sedated him and manually "pushed" the blockage out of him. Since then I have given him fiber tablets mixed into his food and we havn't had a problem since!
That's interesting! Was your vet not taking x-rays before the first few enemas, or did the blockage just not show up well until he was cleared? Our vet has been taking x-rays everytime they do an enema. The first time they saw he was completely blocked with feces and they got 8 inches out with the first enema (sorry if that's TMI). They took another x-ray, did a second enema and got more out along with a lot of water, so they figured he was clear.

They're going to do another x-ray and enema today so we'll see what happens.

Our boy is quite large too. We've been trying to keep him on a diet but his weight is usually between 17 to 18 lbs. In fact, we've been feeding him plenty of canned pumpkin over the past few months to give him more fiber and fill him up so he doesn't eat as much "real" food -- but he got blocked with the pumpkin! Which is just weird...
post #12 of 14
No, the vet tried the enema's first, then she did an x ray. So, it seems that your vet is doing xrays everytime. That's good! My boy was also very dehrydrated, he wasn't drinking at all, so now I add a couple of tablespoons of water to his food along with the fiber just to be sure he is getting enough water. The fiber tablets are called Pertomalt, they sell them at Pet Supply and 800 pet meds. Is your kitty drinking water just fine?
post #13 of 14
Quote:
Originally Posted by Deb314 View Post
No, the vet tried the enema's first, then she did an x ray. So, it seems that your vet is doing xrays everytime. That's good! My boy was also very dehrydrated, he wasn't drinking at all, so now I add a couple of tablespoons of water to his food along with the fiber just to be sure he is getting enough water. The fiber tablets are called Pertomalt, they sell them at Pet Supply and 800 pet meds. Is your kitty drinking water just fine?
Frobie is drinking reasonably well, and I'm moistening the food I give him. The vet checks dehydration everytime as well, and so far he hasn't been dehydrated.

We just got him back from the vet (again!) after another enema and round of x-rays. His colon was full again before the enema and somewhat enlarged, but his small intestines were pretty clear. So the new tentative diagnosis is idiopathic megacolon, which as far as I can understand means, "We don't know why your kitty's colon isn't pushing anything through."

We're to pick up a new drug for him tomorrow that's supposed to stimulate the smooth muscle of the colon. Hopefully that will be enough to allow him to evacuate on his own. If that doesn't work then it's time for an ultrasound. Personally I'm hoping it's megacolon because all the other possibilities are much scarier.

Five visits to the vet in a week and most of those involving enemas! Our poor boy is probably going to disown us pretty soon!
post #14 of 14
Well I hope that new drug for him will help out!

Poor guy! Keep us posted.

Vibes for him......
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