New Behavior, Cisapride, megacolon, etc.....

I've got a thread in here from almost 2 years ago that relates the year and a half of craziness we went through with Brownie.  Eventually, the new vet decided that even though it didn't SHOW, she had megacolon.  She's been on 2.5 mg (.5 ml) of Cisapride twice a day.  She has access all the time to dry food - Royal Canin Gastrointestinal fiber Response if I recall correctly.  AND the two cats share a small amount of wet food Hill's i/d with an ounce of chicken broth with Miralax at a rate of 1 1/2 tbsp per 16 ounces of broth.  Which, if I'm doing it right should be a bit over 1/4 tsp per meal. 

This has been the norm for at least a year and a half.  She WAS defecating overnight most nights.  We know this because she's isolated in a room overnight. 

Recently (maybe 6 weeks) ago, she started becoming inconsistent in her defecation.  Stopped going at night, went more during the day.  But not daily and not consistently.  She's been spending her days in the office with me so two days ago I got to see her urinate and defecate.  No problems, no straining, stool soft but firm.  She hasn't done EITHER since.

We have TWO problems...  What's going on with the defecation?  Once on Cisapride, especially with the Miralax, shouldn't she consistently be going?  And does the fact that she's NOT mean there's something wrong?  Could the Cisapride be defective?  Can it fail?  It's not old - we just started this bottle a month ago.

Other problem is that left to her own devices she doesn't ALWAYS use the litter box.  She'll go right in FRONT of the litter box in the laundry room.  Not ALWAYS, just SOMETIMES.  We decided she's got a mental problem because of the problems before she was diagnosed.  We think it's related to "home" because when we travel she ABSOLUTELY CONSISTENTLY uses the litter box in the 5th wheel.  But at home, she'll sometimes go right in front of the litter box...

If she hasn't gone by morning I'm going to see if I can get her into the vet tomorrow...

BUT, food?  I've been told i/d is GREAT.  And i/d is TERRIBLE.  The the Royal Canin is GREAT.  And TERRIBLE. 

The vet says that in some cases, going to the Gastro fiber Response has "fixed" megacolon cats.  No more need for Cisapride.  Well, we're STILL using Cisapride and Miralax, so

the "cure" hasn't happened.  Is there some OTHER dry food we should be using?  Some other WET food we should be using?  Putting MORE Miralax just makes her stool really loose so that doesn't appear to be a fix...

Is there a procedure change we need to try?  We give her the .5 ml of Cisapride right before feeding the wet food, morning and evening.  She usually eats it but not always.  At $80/bottle I hope the next step ISN'T adding more Cisapride...  Does Cisapride stop working?  Is there SOMETHING else we should be using instead of Cisapride?  Is there a significantly less expensive source for Cisapride?

Does ANYONE have any ideas about getting her to use the littler box ALL THE TIME?  And yes, we have SIX boxes.  And YES, they get scooped a LOT.....

We've tried eight different litters.  Made no difference.  We've used Cat Attract - cats could care less and it gave my wife headaches.

We've used Feliway.  Neither cat cared.

First and foremost, if she's not being regular, I presume we need to get her regulated again...  Back to going at some reliable interval so she'll go predictably.  Even better, does ANYONE have ideas get get her back to consistenly using a littler box?  'Cause I cannot babysit this cat 18 hours a day so she doesn't go in the laundry room.

Sorry for the disorganization of the topic...  I'm feeling a bit disorganized at the moment... 

Edited post

@dkperez : I read your previous thread regarding the litterbox problems you have been having with Brownie and see that you have gone through a lot of tests, changes in diet, changes in vets and in general have tried a lot of things. For this reason I deleted my original response as it contained things that you were already aware of or have tried already.

I don't know what the answer is for Brownie, but I do stand by my opinions on the use of Cisapride, the use of laxatives on a long term basis and that cats should not be consuming a lot of grains. In fact, increased fiber is the last thing a constipated cat needs. I read through your other thread that the one indication for the diagnosis of megacolon was the large stools that Brownie was producing. If Brownie had been on the Fibre Response or food containing a lot of grains, then this could explain the large stools. From what you have described in your other thread this issue sounds more behavioural than a physical one.

There is one other thing you might try and that is to add 'small' amounts of coconut oil and organic apple cider vinegar to her wet food. About an 1/4 teaspoon each. Coconut oil is good for many things including being a good anti-fungal and digestive aid. The apple cider vinegar acts as a scrubber but also helps the body to absorb calcium. Sometimes malabsorption of calcium can cause problems with constipation just like it does in humans. You might also want to try going with a larger litterbox container. I had been using the standard sized litterbox for years but with our new addition (little tuxedo boy), he started pooping outside the box. He is still young but very long-bodied. At first I thought he was just having difficulties in getting the hang of things. Then I got the idea to go to a large flatbed tupperware box and there has been no further incidents outside the box. Some cats need a lot of space to do their business.

I would keep doing what you are doing. Maybe even increase the dose of miralax if you are not getting good results. The bowel is VERY complicated.  I got a virus which paralyzed my stomach, small and large intestine.  I lived off of miralax for years, now am on prucalopride and linzess. Cisapride is similar to prucalopride but has more of a risk of QT enlongation and sudden death due to heart problems.

You want to use the lowest possible dose of Cisapride as is possible. 

There are nerves in the intestines which can be damaged, there are also ICC pacemaker cells which control contractions.  Both can be damaged or destroyed due to various causes and once destroyed are nearly impossible to fix. 

All you can do is treat symptoms. Increase the miralax... Maybe increase the cisapride if the vet says it is safe. Try other laxatives and fibers.

If the cat is getting worse, it is possible that the bowel has additional damage and is getting worse over time. It is possible there is another disease (pre-cancer) or something else going on, it is possible there is an autoimmune reaction targeting the nerve cells in the bowel.

Unfortunately there are no tests to tell for sure, and there is little to no effective treatments other than what you are doing.

There are other medications for constipation: Amitza, one other drug else used for opioid induced constipation, but I don't think any of those other drugs have been tested in cats.  I'm not sure linzess or prucalopride have been tested in cats either.

I am completely reliant on medications to control my bowels. Without them my GI tract is paralyzed and nothing moves. It is a very frustrating disorder, as the medications are not nearly enough and even on liquids I have a hard time maintaining my weight.

Good luck. You may need to make some tough choices in the future if your cat continues to get worse.  It is a very painful disorder (if the meds don't work well enough), so making sure your cat is having a bowel movement once a day or at least every other day, is crucial to keeping the cat comfortable.

If the cat has vomiting, it is possible gastric emptying is delayed as well.  That can be treated with domperidone. Hopefully your cats upper GI tract is still functioning properly.

Thanks for the replies.......  First thing, after putting the note in here Monday night, I figured on a vet visit Tuesday.  So, of course, Tuesday morning she used the litter box in the office with no problem...  and then nothing again until Wednesday evening.  I got to see her go Tuesday morning and again, no straining, no hesitation, no problem....  Unfortunately, last evening she wasn't in the office with me, and my wife wasn't paying attention, so Brownie went into the laundry room and went in front of the litter box.  By the way, this is the THIRD box we've had in that location, each one larger than the last.  The current box is a 20 GALLON Rubbermaid container with a big cutout in the side.  We tried that because previously the boxes have had LOW sides and we thought she might want higher sides...

>I don't know what the answer is for Brownie, but I do stand by my opinions on the use of Cisapride, the use of laxatives on a long term basis and that cats should not be consuming a lot of grains. In fact, >increased fiber is the last thing a constipated cat needs. I read through your other thread that the one indication for the diagnosis of megacolon was the large stools that Brownie was producing. If Brownie >had been on the Fibre Response or food containing a lot of grains, then this could explain the large stools. From what you have described in your other thread this issue sounds more behavioural than a >physical one.

In the "old" thread, I described (I think), how we and the vet got to megacolon.  They ran tests and tests and did the equivalent of a colonoscopy.  Didn't think it was megacolon.  We finally SAW her try to go in the trailer and saw the straining and constipation.  It HAD to take her at least 60 (I believe more like 90) seconds of what appeared to be HEAVY straining to finally pass any stool.  With all that and seeing

the stool, the vet finally decided it was megacolon and we started the Cisapride.  I don't remember your recommendation(s) for food (I'll go look back at the old topic), but can you recommend again a good food regimen that both cats can eat?  Our other cat is a tiny female with no problems.  We leave dry food out at all times and both cats nibble.  The wet food is a small amount morning and evening as a treat, and both cats eat that.  So, is there a particular dry and wet set of foods we should try?

I agree that the location is somehow behavioral...  She'll use other litterboxes, but if left alone, she may use one of the boxes, or she may go in front of the box in the laundry room.  She'll sometimes go for up to a week, using a litterbox, then go in front of the one in the laundry room.  By the way, she's a 10 pound female, so she's FAR smaller than the box in the laundry room, and at least two of our other boxes are also very large.  It's purely anecdotal, but I believe she's been mentally scarred by the period when she had trouble going and remembers the pain of straining.  But, why only SOME TIMES?  And always in THAT area?  Other times, she'll use the litter box fine...

>There is one other thing you might try and that is to add 'small' amounts of coconut oil and organic apple cider vinegar to her wet food. About an 1/4 teaspoon each. Coconut oil is good for many things >including being a good anti-fungal and digestive aid. The apple cider vinegar acts as a scrubber but also helps the body to absorb calcium. Sometimes malabsorption of calcium can cause problems >with constipation just like it does in humans. You might also want to try going with a larger litterbox container. I had been using the standard sized litterbox for years but with our new addition (little tuxedo >boy), he started pooping outside the box. He is still young but very long-bodied. At first I thought he was just having difficulties in getting the hang of things. Then I got the idea to go to a large flatbed >tupperware box and there has been no further incidents outside the box. Some cats need a lot of space to do their business.

I presume I should try one or the other of the additives (at least initially).  I'll get some apple cider vinegar and see if it helps her become more "regular".  One of the questions I have is that having read a bunch of things about megacolon, and a bunch about Cisapride, and been in the megacolor group over on yahoo, is that everything I'm seeing says the equivalent of "give the cat the dose of Cisapride, then within 15 minutes feed the cat.  Within 15 minutes or so, the cat will have a movement."  Definitely is NOT happening.  For example, she's been in the office with me today, was fed at 06:30 this morning (wet food with broth with Miralax), it's now 14:05 and no urination OR defecation.  She's napped, been up and down the giant cat tree a few times, had some crunchies (dry food is out all the time) groomed the small cat, had another nap, got a scruffle and tummy rub, more crunchies, and is now sound asleep again.  For whatever reason, the Cisapride absolutely does NOT cause a quick movement...  She'll have her second does in 3 - 4 hours and another bit of wet food with broth and Miralax, and she MAY go this evening or she may NOT go this evening or overnight.... 

She was previously going pretty much overnight, every night.  We didn't have to watch her during the day 'cause she only rarely missed a night and went in the laundry room.  In the last month or so, that's changed and she's no unpredictable.  Oh, and we've got one low-sided box that's a flat box the same as I store photographic prints in.  It holds 25, mounted, matted 16 x 20 prints with at least 3 inches of empty space on each end...  An ocelot could use this thing..........

Anyhow, I'll try the vinegar and see if that does anything...  I presume it's safe for the other cat to consume if she decides to have some wet food?  And again, recommendation for an optimal set of foods?

>I would keep doing what you are doing. Maybe even increase the dose of miralax if you are not getting good results. The bowel is VERY complicated.  I got a virus which paralyzed my stomach, small and >large intestine.  I lived off of miralax for years, now am on prucalopride and linzess. Cisapride is similar to prucalopride but has more of a risk of QT enlongation and sudden death due to heart problems.

We've increased the Miralax but it seems to make her stool really soft, almost runny.  We normally used 1 TBSP Miralax in 16 oz of broth.  When she got inconsistent we went to 2 TBSP of Miralax in 16 oz, but it was actually into being runny.  So, we backed off to 1 1/2 TBSP... 

>You want to use the lowest possible dose of Cisapride as is possible.

On two occasions when it seemed like she hadn't had a movement in a extraordinarily long time, the vet had us give her an extra dose of 2 1/2 mg at bedtime.  But, normally, it's a 1/2 ml does morning and evening, which I believe is 2 1/2 mg per dose.  According to the vet, that's a small dose and could be doubled.  I'm not a fan of medicine any time, so I'd just as soon not give her more than we need to.

>All you can do is treat symptoms. Increase the miralax... Maybe increase the cisapride if the vet says it is safe. Try other laxatives and fibers.

>If the cat is getting worse, it is possible that the bowel has additional damage and is getting worse over time. It is possible there is another disease (pre-cancer) or something else going on, it is possible >there is an autoimmune reaction targeting the nerve cells in the bowel.

>Unfortunately there are no tests to tell for sure, and there is little to no effective treatments other than what you are doing.

>There are other medications for constipation: Amitza, one other drug else used for opioid induced constipation, but I don't think any of those other drugs have been tested in cats.  I'm not sure linzess or >prucalopride have been tested in cats either.

I've got a call into the vet to see if he wants me to bring her over.  When he calls back I'm going to see if he's got any ideas on other medications or different food.  Unfortunately, you're right.  We're treating symptoms, and if she's go CONSISTENTLY overnight, that would be OK.  We wouldn't have to babysit her to keep her out of the laundry room.  We tried closing the door...  She went right in front of the door in the kitchen.

>I am completely reliant on medications to control my bowels. Without them my GI tract is paralyzed and nothing moves. It is a very frustrating disorder, as the medications are not nearly enough and even >on liquids I have a hard time maintaining my weight.

>Good luck. You may need to make some tough choices in the future if your cat continues to get worse.  It is a very painful disorder (if the meds don't work well enough), so making sure your cat is having a >bowel movement once a day or at least every other day, is crucial to keeping the cat comfortable.

>If the cat has vomiting, it is possible gastric emptying is delayed as well.  That can be treated with domperidone. Hopefully your cats upper GI tract is still functioning properly.

The good news for us is that she seems comfortable.  I think WE worry a lot more about movements than SHE does...  It's just the change that has us concerned.  As I said earlier, I've seen her go and there doesn't appear to be any straining or pain.  She's not vomiting at all, so I don't think we have any additional problem there.  Our underlying problem is that she doesn't defecate consistently in one of the many litter boxes.  Fortunately, there's a rubber mat in front of the box in the laundry room and she uses that.  She will NOT, however use it if we put paper down.  And, as I said, if we don't let her into the laundry room, she goes right in front of the door to the laundry room......  I think the cat has a mental issue! 

dkperez said:

 
Thanks for the replies.......  First thing, after putting the note in here Monday night, I figured on a vet visit Tuesday.  So, of course, Tuesday morning she used the litter box in the office with no problem...  and then nothing again until Wednesday evening.  I got to see her go Tuesday morning and again, no straining, no hesitation, no problem....  Unfortunately, last evening she wasn't in the office with me, and my wife wasn't paying attention, so Brownie went into the laundry room and went in front of the litter box.  By the way, this is the THIRD box we've had in that location, each one larger than the last.  The current box is a 20 GALLON Rubbermaid container with a big cutout in the side.  We tried that because previously the boxes have had LOW sides and we thought she might want higher sides...

>I don't know what the answer is for Brownie, but I do stand by my opinions on the use of Cisapride, the use of laxatives on a long term basis and that cats should not be consuming a lot of grains. In fact, >increased fiber is the last thing a constipated cat needs. I read through your other thread that the one indication for the diagnosis of megacolon was the large stools that Brownie was producing. If Brownie >had been on the Fibre Response or food

In the "old" thread, I described (I think), how we and the vet got to megacolon.  They ran tests and tests and did the equivalent of a colonoscopy.  Didn't think it was megacolon.  We finally SAW her try to go in the trailer and saw the straining and constipation.  It HAD to take her at least 60 (I believe more like 90) seconds of what appeared to be HEAVY straining to finally pass any stool.  With all that and seeing

the stool, the vet finally decided it was megacolon and we started the Cisapride.  I don't remember your recommendation(s) for food (I'll go look back at the old topic), but can you recommend again a good food regimen that both cats can eat?  Our other cat is a tiny female with no problems.  We leave dry food out at all times and both cats nibble.  The wet food is a small amount morning and evening as a treat, and both cats eat that.  So, is there a particular dry and wet set of foods we should try?

I agree that the location is somehow behavioral...  She'll use other litterboxes, but if left alone, she may use one of the boxes, or she may go in front of the box in the laundry room.  She'll sometimes go for up to a week, using a litterbox, then go in front of the one in the laundry room.  By the way, she's a 10 pound female, so she's FAR smaller than the box in the laundry room, and at least two of our other boxes are also very large.  It's purely anecdotal, but I believe she's been mentally scarred by the period when she had trouble going and remembers the pain of straining.  But, why only SOME TIMES?  And always in THAT area?  Other times, she'll use the litter box fine...

>There is one other thing you might try and that is to add 'small' amounts of coconut oil and organic apple cider vinegar to her wet food. About an 1/4 teaspoon each. Coconut oil is good for many things >including being a good anti-fungal and digestive aid. The apple cider vinegar acts as a scrubber but also helps the body to absorb calcium. Sometimes malabsorption of calcium can cause problems >with constipation just like it does in humans. You might also want to try going with a larger litterbox container. I had been using the standard sized litterbox for years but with our new addition (little tuxedo >boy), he started pooping outside the box. He is still young but very long-bodied. At first I thought he was just having difficulties in getting the hang of things. Then I got the idea to go to a large flatbed >tupperware box and there has been no further incidents outside the box. Some cats need a lot of space to do their business.

I presume I should try one or the other of the additives (at least initially).  I'll get some apple cider vinegar and see if it helps her become more "regular".  One of the questions I have is that having read a bunch of things about megacolon, and a bunch about Cisapride, and been in the megacolor group over on yahoo, is that everything I'm seeing says the equivalent of "give the cat the dose of Cisapride, then within 15 minutes feed the cat.  Within 15 minutes or so, the cat will have a movement."  Definitely is NOT happening.  For example, she's been in the office with me today, was fed at 06:30 this morning (wet food with broth with Miralax), it's now 14:05 and no urination OR defecation.  She's napped, been up and down the giant cat tree a few times, had some crunchies (dry food is out all the time) groomed the small cat, had another nap, got a scruffle and tummy rub, more crunchies, and is now sound asleep again.  For whatever reason, the Cisapride absolutely does NOT cause a quick movement...  She'll have her second does in 3 - 4 hours and another bit of wet food with broth and Miralax, and she MAY go this evening or she may NOT go this evening or overnight.... 

She was previously going pretty much overnight, every night.  We didn't have to watch her during the day 'cause she only rarely missed a night and went in the laundry room.  In the last month or so, that's changed and she's no unpredictable.  Oh, and we've got one low-sided box that's a flat box the same as I store photographic prints in.  It holds 25, mounted, matted 16 x 20 prints with at least 3 inches of empty space on each end...  An ocelot could use this thing..........

Anyhow, I'll try the vinegar and see if that does anything...  I presume it's safe for the other cat to consume if she decides to have some wet food?  And again, recommendation for an optimal set of foods?

>I would keep doing what you are doing. Maybe even increase the dose of miralax if you are not getting good results. The bowel is VERY complicated.  I got a virus which paralyzed my stomach, small and >large intestine.  I lived off of miralax for years, now am on prucalopride and linzess. Cisapride is similar to prucalopride but has more of a risk of QT enlongation and sudden death due to heart problems.

We've increased the Miralax but it seems to make her stool really soft, almost runny.  We normally used 1 TBSP Miralax in 16 oz of broth.  When she got inconsistent we went to 2 TBSP of Miralax in 16 oz, but it was actually into being runny.  So, we backed off to 1 1/2 TBSP... 

>You want to use the lowest possible dose of Cisapride as is possible.

On two occasions when it seemed like she hadn't had a movement in a extraordinarily long time, the vet had us give her an extra dose of 2 1/2 mg at bedtime.  But, normally, it's a 1/2 ml does morning and evening, which I believe is 2 1/2 mg per dose.  According to the vet, that's a small dose and could be doubled.  I'm not a fan of medicine any time, so I'd just as soon not give her more than we need to.

>All you can do is treat symptoms. Increase the miralax... Maybe increase the cisapride if the vet says it is safe. Try other laxatives and fibers.

>If the cat is getting worse, it is possible that the bowel has additional damage and is getting worse over time. It is possible there is another disease (pre-cancer) or something else going on, it is possible >there is an autoimmune reaction targeting the nerve cells in the bowel.

>Unfortunately there are no tests to tell for sure, and there is little to no effective treatments other than what you are doing.

>There are other medications for constipation: Amitza, one other drug else used for opioid induced constipation, but I don't think any of those other drugs have been tested in cats.  I'm not sure linzess or >prucalopride have been tested in cats either.

I've got a call into the vet to see if he wants me to bring her over.  When he calls back I'm going to see if he's got any ideas on other medications or different food.  Unfortunately, you're right.  We're treating symptoms, and if she's go CONSISTENTLY overnight, that would be OK.  We wouldn't have to babysit her to keep her out of the laundry room.  We tried closing the door...  She went right in front of the door in the kitchen.

>I am completely reliant on medications to control my bowels. Without them my GI tract is paralyzed and nothing moves. It is a very frustrating disorder, as the medications are not nearly enough and even >on liquids I have a hard time maintaining my weight.

>Good luck. You may need to make some tough choices in the future if your cat continues to get worse.  It is a very painful disorder (if the meds don't work well enough), so making sure your cat is having a >bowel movement once a day or at least every other day, is crucial to keeping the cat comfortable.

>If the cat has vomiting, it is possible gastric emptying is delayed as well.  That can be treated with domperidone. Hopefully your cats upper GI tract is still functioning properly.

The good news for us is that she seems comfortable.  I think WE worry a lot more about movements than SHE does...  It's just the change that has us concerned.  As I said earlier, I've seen her go and there doesn't appear to be any straining or pain.  She's not vomiting at all, so I don't think we have any additional problem there.  Our underlying problem is that she doesn't defecate consistently in one of the many litter boxes.  Fortunately, there's a rubber mat in front of the box in the laundry room and she uses that.  She will NOT, however use it if we put paper down.  And, as I said, if we don't let her into the laundry room, she goes right in front of the door to the laundry room......  I think the cat has a mental issue! 

Click to expand...

Hi dkperez, 

Ok, so clearly the litterbox is large enough, based on your descriptions of the various boxes. I must say that I had quite a chuckle as I was reading these parts .. Re. the location, it sounds as though your girl associates the laundry room as a safe place to go, despite the odd accident. Cats are very sensitive to changes in their environment. The litterbox should be somewhere quiet and safe with easy access. Sights, sounds, raised voices or sudden noises, being interrupted in the middle of a bowel movement, things we may take for granted but very much a significance to a cat. Even moving a litterbox from one side of the room to the other can have the effect of causing a cat to go elsewhere. I wouldn't worry too much about using different litterboxes so long as she is using them regularly.

One thing I left out of my last edit is, I believe that once a cat has experienced chronic constipation, their systems go through a change and what once was may not return. Your cat is older and even though pooping every day is ideal, she may not always be able to achieve this for different reasons. You say that she is currently not straining or experiencing discomfort but is having a normal bowel movement when she goes which sounds like things are okay. This is not to say that we stop trying as pet owners but that we just need to think differently and adjust expectations when it comes to what is reasonable based on what went before. Our Max goes either everyday, or sometimes every second day. As long as this doesn't become every 3, 4 or 5 day, I am satisfied. As I've mentioned previously, we had Max on Cisapride and Royal Canin High Fibre diet, neither of which always resulted in daily poops. We stopped the Cisapride in lieu of managing with Lactulose as necessary. Max began pooping more regularly. I noticed that Max got very boated on the Royal Canin food which I attributed to the high grain content. We recently stopped this in lieu of serving a low grain diet. In the new year I will be looking into getting all cats off dry in lieu of all wet or raw diet.

One thing I noticed from your latest comments is that it sounds as though you are serving more dry food than wet food. This needs to change. As cats are obligate carnivores meaning that they need meat in their diet to thrive, meat needs to be the primary source of food for the protein and moisture it provides. This is especially important for cats who are prone to constipation. I feed our cats Wellness grain-free chicken wet food each morning to start the day. They then all get one quarter to one-third cup of dry two times for the balance of the day and that's it. I feed the cats all of their meals at the same time - 5:00AM, 10:00AM and 4:00PM. Routine is important and food should be seen as a source of energy and nutrients. Cats don't need food for energy during the night. When they know they will be fed at a certain time, they look forward to this. I used to leave food out but Max started to put on weight.

Re. the Miralax dosing, I would not increase this if doing so is causing loose stools. You don't want to end up at the other extreme. We used Lactulose with good results but only give this as necessary - not everyday.

I would make the following suggestions before doing the apple cider as it doesn't sound like Brownie is constipated :

Switch to giving more wet food. A good quality wet food that is preferably grain-free. Wellness, EVO, Natural Balance, Nature's Variety.

Switch to feeding the dry food at specific intervals and regulate the quantity to an appropriate portion based on weight. Don't leave dry food out. Its not clear to me if you are still serving the Royal Canin fibre food but I would suggest the portion control and if extra fibre is necessary, try supplementing with pumpkin. It would be ideal to get away from the royal canin as the amount and kinds of grain it contains is really not good for cats. There are holistic dry foods that contain psyllium, which is the ingredient in royal canin that helps cats to poop, but this is a decision and conversation to have with your vet. The coconut oil you can start anytime, but do start small. A quarter teaspoon in wet food. When you see that this is well tolerated, gradually increase to a teaspoon.

Hope the above helps. Do let us know how things are going.

I'm glad the tale of the litterboxes brought a chuckle!  You should have seen it when we were testing litter...  First, they had to pass the human smell test - some of the stuff out there has SO MUCH perfume it'd gag a maggot!  We had THREE boxes in the room, each with different litter.  And had to figure out who liked which one!  Expensive litter, cheap litter, clay litter, wheat litter, litter with pine, shredded news papers from the shredder, litter with baking soda, litter with febreeze, litter with cat attract, we had at LEAST 10 or 12 different litters......

And, of course, Skyy, our 5 pound gray female who THINKS she's an ocelot, LOVED THEM ALL!!!!!!  She'll actually jump in the litter and sing while she excavates like she's creating a new basement.  Looks like a hydroplane with a rooster tail as the litter flies out behind her!  She can actually CLEAR the sides of the 20 gallon tote....  And, of course, the BEST time is when one of the staff (that would be US) cleans the box and fills it with NEW litter!  The problem is, it's hard to yell at her 'cause she SO proud of herself, and so happy.  You can tell she's having a ball...  Sings and prances around with her head up and her tail in the air, just proud as can be!  And yes, she has TONS of toys to play with, which she does.  She just clearly LOVES to dig!  We THOUGHT she would outgrow it, but both cats are 7-years old now and she STILL THINKS SHE'S A KITTEN!

Fortunately, our daughter has a cat that ISN'T a spoiled house princess so she inherited about 200 pounds of cat litter we tested.  And they DEFINITELY had preferences.  Some didn't work well, some stuck to the cat, some tracked all over, some just got gummy.  NOBODY like the shredded paper.  Neither seemed very fond of stuff with crystals.  Nobody like the stuff with cat attract (my wife was relieved 'cause she HATES the stuff - it gives her an instant headache).  Apparently they can read 'cause NEITHER would go anywhere near the generic "cat litter" stuff.  We ended up with them liking one of the Tidy Cat litters and Sweat Scoop.  Hey - we test toilet papers, right? 

But, back to the subject at hand.........

I was going to take Brownie in, but the vet called me and we had a conversation......  His opinion - don't change the Miralax.  We accidentally reduced it once a while back and her stool immediately started to get harder.  We caught it almost immediately, but the droppings were definitely changing within a day....  So, at present we're using just over 1/4 tsp per dose...  What we HAVE done is go back to MEASURING the broth...  My wife feeds the most often and had started "eyeballing" the dosage, and I think we were giving her more than an ounce...  The vet recommended NO changes to the broth/Miralax.

Because her interval has changed, he DID recommend that we increase the Cisapride in small increments.  We've been giving .5ml, which is 2.5mg per dose.  He suggested go to .6 for a couple weeks and see what happens.  Go to .7 if we want...  So we're working on that. 

Mostly we're keeping a closer eye on her.  She DEFINITELY DOES NOT go immediately after the Cisapride.  It appears she's now at around every 36 hours.  One of the problems is that with two cats using the litter boxes you can't tell who went if you don't see it.  So, we're watching Brownie much more and checking when she gets out of the litter.  So, of course, she's now acting PERFECTLY...  Uses the litter box in the office with me and today about 36 hours after the last movement and 3 hours after breakfast, she used the litter box in the laundry room......  Not in front of it, IN IT!!!!!  Happy dance!!!!!!! 

As far as food..........  Our vet is a big fan of the Royal Canin Gastrointestinal fiber.  But, if you've got an alternative for the dry food, I'd sure give it a try......

And we can certainly try the Wellness to see how the cats do.  It sounds like we need to change the amount we feed...  We've BEEN giving about a fifth of a can of i/d twice a day which both cats share.  This was supposed to be an optional treat.  It sounds like we need to increase the amount and possibly feed the wet food separately.  So, we'll try changing procedure a bit.

Of course, it COULD be the conversation I had this morning...  While both ladies were laying in their beds next to me in the office, I showed them pictures of GOLDFISH and explained that if they DIDN'T STRAIGHTEN UP they could be replaced by QUIET, pleasant pets that DON'T THROW LITTER ALL OVER, and DON'T POOP ON THE MAT IN FRONT OF THE LITTER........

I"m hoping this little chat has the desired effect!  I'm not SURE though, because during my lecture, BOTH cats yawned and closed their eyes.......

dkperez said:

 
I'm glad the tale of the litterboxes brought a chuckle!  You should have seen it when we were testing litter...  First, they had to pass the human smell test - some of the stuff out there has SO MUCH perfume it'd gag a maggot!  We had THREE boxes in the room, each with different litter.  And had to figure out who liked which one!  Expensive litter, cheap litter, clay litter, wheat litter, litter with pine, shredded news papers from the shredder, litter with baking soda, litter with febreeze, litter with cat attract, we had at LEAST 10 or 12 different litters......

And, of course, Skyy, our 5 pound gray female who THINKS she's an ocelot, LOVED THEM ALL!!!!!!  She'll actually jump in the litter and sing while she excavates like she's creating a new basement.  Looks like a hydroplane with a rooster tail as the litter flies out behind her!  She can actually CLEAR the sides of the 20 gallon tote....  And, of course, the BEST time is when one of the staff (that would be US) cleans the box and fills it with NEW litter!  The problem is, it's hard to yell at her 'cause she SO proud of herself, and so happy.  You can tell she's having a ball...  Sings and prances around with her head up and her tail in the air, just proud as can be!  And yes, she has TONS of toys to play with, which she does.  She just clearly LOVES to dig!  We THOUGHT she would outgrow it, but both cats are 7-years old now and she STILL THINKS SHE'S A KITTEN!

Fortunately, our daughter has a cat that ISN'T a spoiled house princess so she inherited about 200 pounds of cat litter we tested.  And they DEFINITELY had preferences.  Some didn't work well, some stuck to the cat, some tracked all over, some just got gummy.  NOBODY like the shredded paper.  Neither seemed very fond of stuff with crystals.  Nobody like the stuff with cat attract (my wife was relieved 'cause she HATES the stuff - it gives her an instant headache).  Apparently they can read 'cause NEITHER would go anywhere near the generic "cat litter" stuff.  We ended up with them liking one of the Tidy Cat litters and Sweat Scoop.  Hey - we test toilet papers, right? 

But, back to the subject at hand.........

I was going to take Brownie in, but the vet called me and we had a conversation......  His opinion - don't change the Miralax.  We accidentally reduced it once a while back and her stool immediately started to get harder.  We caught it almost immediately, but the droppings were definitely changing within a day....  So, at present we're using just over 1/4 tsp per dose...  What we HAVE done is go back to MEASURING the broth...  My wife feeds the most often and had started "eyeballing" the dosage, and I think we were giving her more than an ounce...  The vet recommended NO changes to the broth/Miralax.

Because her interval has changed, he DID recommend that we increase the Cisapride in small increments.  We've been giving .5ml, which is 2.5mg per dose.  He suggested go to .6 for a couple weeks and see what happens.  Go to .7 if we want...  So we're working on that. 

Mostly we're keeping a closer eye on her.  She DEFINITELY DOES NOT go immediately after the Cisapride.  It appears she's now at around every 36 hours.  One of the problems is that with two cats using the litter boxes you can't tell who went if you don't see it.  So, we're watching Brownie much more and checking when she gets out of the litter.  So, of course, she's now acting PERFECTLY...  Uses the litter box in the office with me and today about 36 hours after the last movement and 3 hours after breakfast, she used the litter box in the laundry room......  Not in front of it, IN IT!!!!!  Happy dance!!!!!!! 

As far as food..........  Our vet is a big fan of the Royal Canin Gastrointestinal fiber.  But, if you've got an alternative for the dry food, I'd sure give it a try......

And we can certainly try the Wellness to see how the cats do.  It sounds like we need to change the amount we feed...  We've BEEN giving about a fifth of a can of i/d twice a day which both cats share.  This was supposed to be an optional treat.  It sounds like we need to increase the amount and possibly feed the wet food separately.  So, we'll try changing procedure a bit.

Of course, it COULD be the conversation I had this morning...  While both ladies were laying in their beds next to me in the office, I showed them pictures of GOLDFISH and explained that if they DIDN'T STRAIGHTEN UP they could be replaced by QUIET, pleasant pets that DON'T THROW LITTER ALL OVER, and DON'T POOP ON THE MAT IN FRONT OF THE LITTER........

I"m hoping this little chat has the desired effect!  I'm not SURE though, because during my lecture, BOTH cats yawned and closed their eyes.......

Click to expand...

LOL! That's hilarious. It's nice to read that you have a good sense of humor throughout all of the trials and tribulations!

We use a low-dust litter, clay-based and it does the job. We've tried the silica which is a very good litter. Does not harbor odors and lasts longer than any other, but it is expensive. Plus not all of my cats liked it as the texture is quite different to walk on.

Re. the Cisapride, I respect your decision and choice. Just be very careful. There can side effects such as respiratory distress and sudden heart complications associated with this drug which is why it is no longer readily available to humans. The risks were one of the main reasons for my decision to stop it with Max. If by chance you haven't had the discussion regarding risks associated with Cisapride, with your vet, here are a couple of links : http://www.ehow.com/list_6303045_side-effects-drug-cisapride-cats.html / http://blog.petmeds.com/pet-pharmacy/cisapride-use-in-cats/#.UrcMm7RiW6I (the second talks about possible drug interactions while taking Cisapride - If you were contemplating giving the coconut oil, probably not a good idea according to this article, as anti-fungals may pose a potential conflict with Cisapride.

If nothing changes with the increased doses of Cisapride, then I would really question the efficacy of it with your vet. It could be that the Miralax is doing all the work?

Congrats that Brownie had a good bowel movement, IN the litterbox this time. That's great! Hope you gave her lots of reinforcement and encouragement. You might even try giving her a little treat when she goes in the box. This can have the effect of changing whatever bad association she's had with the box, into something positive? Worth a try.

Re. the Royal Canin, yes, a lot of vets swear by this, although pardon the skeptic in me, I think its partly to do with the fact that it is a vet prescribed diet and there are financial benefits for vets in pushing this. It does work but the results are very soft, big poops that make me question how much nutrients are being absorbed. At least this was the case with Max. He got very bloated on this food. I contribute the results to the psyllium content and the wheat and corn for blowing him up. If you are interested in looking at other better dry foods, there is Acana and Origen which are good grain-free dry foods made in Canada, but available in the states. There is also Innova EVO, GO brand (new), Wellness CORE and Natural Balance to name some of the top foods. If hairballs are the contributor to constipation or there is the possibility of a loss of motility, then adding pumpkin and the occasional apple cider vinegar, is my go-to preference now.  I have tried the apple cider vinegar with max and he had a very good bowel movement not long after. Dose of no more than 1/4 tsp in the wet food as you don't want to interfere with ph levels. Give only as needed, not every day.

Hope Brownie continues to do well. You must post some pictures at some point! Merry Christmas!

I've continued watching the cat(s).......  Brownie DOES go in the litter box in the office if she's IN THE OFFICE when she needs to go.  Yesterday morning she left my office and in the two minutes I lost track of her, she went into the laundry room and went on the mat in FRONT of the big, blue, litterbox!  BUT, last Saturday, she went into the laundry room in the evening, went INTO the big, blue, litterbox and went IN there!  I, of course, gave her MANY "props" when she came back out, AND broke open the treats, accompanied by much praise!

As near as I can tell from watching her carefully, it APPEARS that Brownie is on an approximately 36 hour schedule.  Last Friday morning about 3 hours after her morning dose and food.  Saturday evening about 2 hours after her evening dose and food.  Yesterday morning 2-3 hours after morning dose and food.  She's currently in the office with me and I'll keep an eye on her.  It does NOT appear that increasing the Cisapride from .5 ml to .6 ml (2.5mg to whatever it would be in .6) has made ANY difference in the timing.  What I HAVE noticed on the dropping left on the mat is that the droppings are "softer" than usual.  They're usually slightly firmer, so I wonder if the additional Cisapride is affecting that.  We're carefully measuring the broth/Miralax, so she's not getting overdosed on that.

In my quest to be as predictable as possible, we have not started the apple cider vinegar.  If I don't see any change in frequency in the next week, we'll have to decide if we go to .7 or .75 ml as recommended by the vet, or go back to .5.  I'm expecting that a 20% increase in Cisapride SHOULD have some perceptible effect.  If not, I'm disinclined to increase the dose further.  I went out prior to talking to the vet and researched more on Cisapride and I'd prefer to avoid the side effects they listed.........

Although, I know that prior to starting the Cisapride, large doses of Miralax did not relieve Brownie's constipation.  So, changes will be made slowly and gradually in hopes of seeing the impact.  But, I'm going to see if I can find the EVO, GO, or Wellness (I believe the local pet supply store has Wellness) foods and give them a try...  I'd love to find food that will reduce Brownie's need for Cisapride...  I'd REALLY love to find a cat psychiatrist that can talk to Brownie and find out WHY she periodically decides to defecate right in FRONT of the litterbox and USE the litterbox other times!

Oh, and in other news, the small, wacky, gray cat (Skyy) has manifested a GREAT fondness for carnations!  My wife brought home a small bouquet in a small vase, and so far it get knocked over daily, the carnations get chewed on whenever Skyy remembers they're there, and periodically flowers, as well as any Christmas ornament with the poor luck to be at the bottom of the tree, are found in various locations around the house!

But, with ALL that, when there are no cats, the house is FAR to quiet and empty, so if I have to periodically retrieve an ornament, ball, toy, flower, bottlecap, or even pick up a bit of feces, its a price worth paying.

Carnations, as lovely and innocent as they may seem, can actually be toxic to cats from what I have read so I would caution against allowing Skyy to nibble and chew on them. Symptoms of toxicity would be digestive upset, drooling and skin rashes.

Hi,

I came across this thread because my 17 yr. old kitty has recently needed the help of Cisapride and a laxative to poop regularly - and I am hoping to find a different medication to replace the Cisapride, so far with no luck.

Please excuse me if I missed something, but it seems to me that you had not considered Brownie's position in the 'animal hierarchy' that has inevitably developed within the home.  If another animal is dominant (higher in the order) than Brownie and it is marking that laundry room box as 'it's own' through spraying, rubbing of scent glands or simply a very fragrant and recent pee - Brownie may be trying to please both you and it's feline superior by going close to the box, but not in it.  When the dom cat's scent is fainter it may seem ok to actually go in the box but when Brownie arrives to find it has been strongly reapplied, and thus re-asserted, it may seem too transgressive to barge in and lay his own scent over it.

Could be something else related to the complex relationship that forms between cats who share territory and I'd try looking for ways your other animals may play into the pattern.  Seems like you've tried everything else!!  (My little guy needed a huge, very high plastic storage bin to be converted because as he aged he began to pee sideways instead of down... the things we do....)

Good luck and hope you've resolved the problem(s) by now.