litterbox behavioral changes while weaning off Cisapride - should I be concerned?

I first wrote about Tim and all of his issues here: http://www.thecatsite.com/t/272867/...ion-urinary-crystals-food-sensitivites-asthma.

To summarize, Tim had two really bad constipation episodes. After the first one in March 2011, we added a water fountain, as the emergency vet who cared for him felt the constipation was due to dehydration and we hoped he would drink more water. After the second one in June 2013, we added a second water fountain at the other end of the house and shifted both cats to a canned food diet with dry food as an occasional snack. After a follow-up visit to the vet in January, we eliminated dry food entirely for Tim.

Since June, Tim has been on Cisapride, 5 mg once per day with his morning meal. At this time, the vet had said we could eventually reduce the dose. Tim has been pretty regular  - a bowel movement every 24-36 hours. And at every Cisapride refill, I have asked if we can reduce the dose; the answer was no. At the follow-up vet visit in January, I explained Tim's regularity and that we had shifted him to a wet food diet. The vet agreed we could give him one capsule every other day.  No timeframe was mentioned.

Then the incidents I wrote about in my first post began and I decided to keep him on his regular dose of Cisapride until we sorted out his food. Tim experienced a few minor changes here and there, likely due to food changes. But he's remained pretty much on schedule - he's primarily an early morning guy, though sometimes he goes up to 36 hours before his next bowel movement. At a visit with a holistic vet, after hearing about Tim's regularity and stool quality, she agreed we should wean him off Cisapride. She also agreed with one capsule every other day. But she indicated that if he continues to do well throughout that week, then just stop the Cisapride.

We started the weaning process this week. Tim had Cisapride on Tuesday, Thursday, and Saturday (yesterday) mornings. We skipped Wednesday, Friday, and Sunday (this morning). We also added one capsule of Proviable DC (probiotic) once per day beginning on Wednesday morning. Tim has had pretty normal bowel movements every morning except Thursday or Friday (I can't remember now). However, we are 90% certain he went the night before - with two cats, it's not always easy to tell.

Now to my observations about Tim's litter box behavior. Tim is a digger and a scratcher. That's normal for him - he will dig and scratch and turn and repeat a couple of times. This has been good for me, as I can often hear him prepping and I am therefore able to get in the room with the litter box and observe and satisfy myself that all is good. Then he does his thing and digs and scratches some more.

Yesterday I spent the day dealing with paperwork in the home office, where the litter box is located. Once or twice, Tim got in the litter box and scratched a bit, then got out. I also noticed him sitting in front of the litter box once or twice. He had had a very respectable bowel movement earlier in the day and he is urinating fine, too. This happened this morning, as well; Tim has not yet had a bowel movement (but neither has his sister, who is on a very similar schedule - maybe the time change is throwing them off!) But this behavior seems "new" and, as I am weaning him off Cisapride, I just want to make sure he's not becoming constipated.

I also wonder if maybe he's finally feeling better, due to dietary changes, addition of the probiotic, and less medication. We've noticed some positive behavioral changes just this week, as well, and I wonder if Tim is experiencing quality of life improvements and this litter box behavior is just part of the package - as I mentioned above, he has always enjoyed scratching and digging before taking a bowel movement.

Would appreciate hearing from anyone who has a cat that does this, and/or who has weaned their cat off Cisapride.

Thanks!

Edited to add: Tim just had a decent bowel movement. So he is still pretty regular; I am not noticing any significant change with this aspect of his litter box habits with the reduction in Cisapride dose. Just the minor behavior changes. Thanks!

Glad to read that Tim just had a BM! I would think with the introduction of the probiotic, this is no doubt helping to make Tim feel better, gut-wise and will go a long way in helping to keep him regular.

Max was on cisapride at one point, but not long enough for the need to wean him off (not quite two months), so I can't really offer much insight on this point. I stopped the cisapride as we (my husband and I) saw little to no improvement and I was not comfortable in leaving Max on a medication that had the potential for serious side effects. Cisapride is no longer available for human use. Today Max is on Slippery Elm, Probiotics and Salmon Oil and is having BMs every 12-24 hours. When we stopped the cisapride, Max was put on doses of lactulose and began having regular BMs right off the bat. That was some time ago. Since going to SEB and probiotics, I can't remember the last time I had to use a laxative on Max.

What I can speak to is, when you replace dry food with wet food, you can expect smaller and less frequent BMs as the nutrients in the food, if its good quality, will be more efficiently absorbed with less waste being produced. Dry food being denser and depending on what its made from, can create more bulk than wet food. I am also of the opinion that dry food bulk may create more sensation in the colon than smaller stools from wet food which 'may' explain why Tim doesn't do as much of a dance in the litterbox these days. That said, Max has always been a scratcher in the box, some circling before doing his business. I made the switch to 75% grain-free wet food last October, with about 25% of good quality grain-free dry (currently Nature's Instinct), and his habits in this respect have not changed.

I'm a little confused .. you mentioned the 'incidents' which is what you say led you to keep Tim on the cisapride. Have there been incidents after the cisapride as you mention the cisapride first and then the incidents.

As a suggestion to help you going forward, you might want to start keeping notes going forward, of the days that Tim goes and also record the amount of food given, type, time, and if you changed anything in the diet or introduced any new supplements/stopped a supplement, introduced a different litter. I started a journal for Max way back when he first started having problems with constipation (2+ years ago now), and still keep it up. A journal can be an invaluable reference for troubleshooting but also for documenting what is working.

Originally Posted by oneandahalfcats  

... I was not comfortable in leaving Max on a medication that had the potential for serious side effects.

What I can speak to is, when you replace dry food with wet food, you can expect smaller and less frequent BMs as the nutrients in the food, if its good quality, will be more efficiently absorbed with less waste being produced.
 
I'm a little confused .. you mentioned the 'incidents' which is what you say led you to keep Tim on the cisapride. Have there been incidents after the cisapride as you mention the cisapride first and then the incidents.

As a suggestion to help you going forward, you might want to start keeping notes going forward, of the days that Tim goes and also record the amount of food given, type, time, and if you changed anything in the diet or introduced any new supplements/stopped a supplement, introduced a different litter.

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Thanks, oneandahalfcats, for your reply and sharing your experience with Max! I've been following your thread that details how you're managing his constipation and have found your experiences very useful! I'll provide a little more information about Tim.

Cisapride: I researched Cisapride when Tim was first prescribed and was somewhat alarmed that this drug was not allowed for human use due to some pretty severe side effects. The vet said it would likely be temporary, and his constipation episode in June 2013 was so severe that we decided to take the temporary risk. I was disappointed each time I asked the vet about decreasing the dose and eliminating Cisapride altogether and only wish I had stood up to the vet and insisted we stop, as I felt Tim's constipation was caused by dehydration.

Food and bowel movements: When we switched Tim to a canned food diet during the summer of 2013, we noticed his bowel movements became smaller, due to what you describe. (With previous cats and dogs, we had already seen greatly reduced quantity and frequency by feeding better quality dry foods.) Switching wet food brands altogether has reduced the size and quantity even more, as well as the smell (a wonderful bonus). A bowel movement roughly every 24 hours is pretty normal for both cats now.

Incidents: Tim has not had any constipation incidents since June 2013. But his January vet visit revealed some struvite crystals in his urine. The he started severe vomiting. And the vet mentioned possible mild asthma. The vet didn't have any answers and the medications were not helping. All of these together caused me to look long and hard at Tim's diet and make changes. Because I was going through a lot of different food brands and formulas, I decided to keep him on Cisapride for a while longer until I got his food somewhat settled. He has settled into primarily Nature's Variety Instinct LID, with the new addition of the rabbit (not LID). Will gradually add a few other select brands to increase variety.

Great suggestion on keeping better notes. My memory is usually pretty good, but as you can see I don't remember the exact day that Tim had a BM the night before instead of his usual morning. It was of no consequence at the time because every 24 hours is just an average and when he produced the next morning, I wasn't worried. But when I was home with him yesterday and saw him step in the box and scratch once or twice, then step out without having done anything, I began to wonder. I am really hoping this somewhat odd behavior is simply due to Tim feeling better and having new sensations, instead of "I need to poop but can't" - especially since he is just as regular so far on a half-dose of Cisapride.

I wanted to add some of the other behavioral changes we've recently seen. I would consider most to be good.

1. Tim used to sleep a lot. A lot. When Abby was still active around the house after breakfast, Tim would immediately go somewhere and lie down. On Thursday, the second day of his probiotics, I noticed he was hanging with Abby instead of lying down. This behavior has consistently continued. I should note Abby and Tim are littermates, so the same age. They are fed the same diet, other than Tim receives probiotics.

2. Tim used to hide a lot. Mostly under the bed. When he was a bitty kitty, he hid under other furniture items that he can no longer get under. He would also hide away in the deep, dark corners of closets. Abby would hide on occasion, but come out after a short while. Tim would stay hidden all day. We thought that was just him. Once we switched him to wet food and resolved his constipation, that behavior stopped, though he still spent a lot of time sleeping (see #1), which seemed like an improvement at the time!

3. Tim was always a chewer, even from day one. We first thought it was just kitten chewing but he never grew out of it. He would especially like to grab onto the end of a toothbrush and chomp on it, if he could. Needless to say, toothbrushes are put away. When he was having a particularly bad reaction to asthma medication recently, his chewing became even worse and he destroyed the end of a pen I was writing with among other things. Now he has no interest in chewing, not even the end of my toothbrush. I can only guess that he chewed because he didn't feel good. Last week when his lower lip and chin swelled, he chewed a bit. But when the swelling went away, the chewing stopped.

4. Tim was always a talker. Obsessively. Sometimes he howled. We thought he was a vocal cat and would engage in conversations with him, thinking it was cute. He talks a lot less now. About the same as Abby. Doesn't howl anymore. They both really only talk and carry on when they think I'm not preparing their meal quickly enough! And they "chatter" when hunting lizards and birds out the windows or patio door.

5. Tim has gone into the litter box a couple of times over the past two days, scratched a bit, then hopped out without doing anything. Additionally, he sat outside the litter box for a few moments, then walked away. He is urinating and passing stools in normal amounts and frequency. I've not seen this behavior before, though, and it puzzles me. His other behavioral changes suggest he is feeling better and maybe this is some weird part of that. Alternatively, maybe he feels like he needs to poop but nothing comes out. As he is pooping and urinating normally, I am trying not to be concerned but was wondering if anyone could shed any light on this.

AbbyNTim said:

 
I wanted to add some of the other behavioral changes we've recently seen. I would consider most to be good.

1. Tim used to sleep a lot. A lot. When Abby was still active around the house after breakfast, Tim would immediately go somewhere and lie down. On Thursday, the second day of his probiotics, I noticed he was hanging with Abby instead of lying down. This behavior has consistently continued. I should note Abby and Tim are littermates, so the same age. They are fed the same diet, other than Tim receives probiotics.

2. Tim used to hide a lot. Mostly under the bed. When he was a bitty kitty, he hid under other furniture items that he can no longer get under. He would also hide away in the deep, dark corners of closets. Abby would hide on occasion, but come out after a short while. Tim would stay hidden all day. We thought that was just him. Once we switched him to wet food and resolved his constipation, that behavior stopped, though he still spent a lot of time sleeping (see #1), which seemed like an improvement at the time!

3. Tim was always a chewer, even from day one. We first thought it was just kitten chewing but he never grew out of it. He would especially like to grab onto the end of a toothbrush and chomp on it, if he could. Needless to say, toothbrushes are put away. When he was having a particularly bad reaction to asthma medication recently, his chewing became even worse and he destroyed the end of a pen I was writing with among other things. Now he has no interest in chewing, not even the end of my toothbrush. I can only guess that he chewed because he didn't feel good. Last week when his lower lip and chin swelled, he chewed a bit. But when the swelling went away, the chewing stopped.

4. Tim was always a talker. Obsessively. Sometimes he howled. We thought he was a vocal cat and would engage in conversations with him, thinking it was cute. He talks a lot less now. About the same as Abby. Doesn't howl anymore. They both really only talk and carry on when they think I'm not preparing their meal quickly enough! And they "chatter" when hunting lizards and birds out the windows or patio door.

5. Tim has gone into the litter box a couple of times over the past two days, scratched a bit, then hopped out without doing anything. Additionally, he sat outside the litter box for a few moments, then walked away. He is urinating and passing stools in normal amounts and frequency. I've not seen this behavior before, though, and it puzzles me. His other behavioral changes suggest he is feeling better and maybe this is some weird part of that. Alternatively, maybe he feels like he needs to poop but nothing comes out. As he is pooping and urinating normally, I am trying not to be concerned but was wondering if anyone could shed any light on this.

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Here is one possibility re. the litterbox visits without going .. As probiotics work to restore imbalances in the gut, it could be that Tim is experiencing some side effects associated with this which can involve mild cramping or rumbling in the tummy. Thinking he needs to go, the sensations from this may lead him to the litterbox.

Side effects of probiotics are rare and usually pass once the imbalance gets sorted out. My husband and I are taking the same probiotic that the cats are getting, and when we started I recall experiencing a bit of gas and weird rumblings but this passed and all is good now.

Quite often people report a renewed sense of energy and vitality once probiotics have worked their magic. This sense of wellbeing doesn't happen overnight, but between the diet, regular BMs and probiotic, it could be that you are starting to see some positive indicators that Tim is feeling a whole lot better and in turn leading him to feel like being more social.

Best of luck for continued good progress as you move through the transition from the cisapride.

oneandahalfcats said:

 
Here is one possibility re. the litterbox visits without going .. As probiotics work to restore imbalances in the gut, it could be that Tim is experiencing some side effects associated with this which can involve mild cramping or rumbling in the tummy. Thinking he needs to go, the sensations from this may lead him to the litterbox.

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Thank you so much for suggesting this. I wondered if this could be the case and I hope it is. I know that every time I've cleaned up my own diet, in the short term I have experienced some intestinal discomfort. I am trying not to worry too much about Tim, as long as he remains regular. Which he is, so far. We are nearing the end of our week at a half dose, then will taper further for another week. Thank you!

Quick update on some of the behavior things. I think I just need to let this play out, as Tim could be experiencing lots of sensations due to the addition of the probiotic and less Cisapride in his system. I will (truly) worry if something seems severe and bad, or if he appears to take a step back.

1. Tim is still more active and keeps up with Abby.

2. Tim still hides under the bed on occasion, but doesn't stay long. He's naturally a bit skittish and seems to run under the bed by habit at times.

3. The inappropriate chewing has stopped for now, and hopefully for good.

4. Tim talks, but not like before. More like a normal cat. The howling seems to have stopped.

5. The funny litterbox business seems to have decreased. I'm at work all day during the week, so hard to say for sure. But over the weekend, it was only in the times before and after he had a BM. Yesterday morning, I noticed him do this only one time. This morning, he may have done this one time but I'm not sure if he jumped out of the litter box because he was more interested in eating than pooping! - I had just gotten up and I usually feed them very first thing.

Tim's BMs are still pretty regular now that he's been on a half-dose of Cisapride for a week. He sighed/grunted yesterday. Nothing like that today, though he did lick his lips mid-way through. Even on full Cisapride, he would sometimes sigh/grunt while in the box. Tim is a cat who makes a similar sound on occasion when he stretches or shifts relaxation position, so I don't think it's bad but will continue to watch for straining/discomfort. One of his pieces this morning looked very small and dry; upon closer inspection, I noticed it was all hair! This is super exciting as this means his hair is going out the correct way instead of up as a hairball. He hasn't coughed up a hairball in almost a month and he used to cough them up almost weekly.

Tim recently started licking his lips on occasion. I know this is sometimes a sign of nausea, but he doesn't act nauseated so I'm not sure what it is. Neither is the holistic vet; this is something we spoke about last week and during a follow-up phone conversation yesterday and I will continue to watch. Sometimes he acts like there is something in his mouth - he licks, opens his mouth, and then runs off, sometimes under the bed. I need to catch him one of these times and take a look in his mouth. Teeth and mouth were checked last week. I've seen him lick his lips just before vomiting, but I truly cannot remember if that was the same as I'm seeing now.

All in all, I'm pleased with the behavioral changes I'm seeing. If anyone can shed any light on the lip licking thing, I'd love to hear about it.

Originally Posted by AbbyNTim  

Tim recently started licking his lips on occasion. I know this is sometimes a sign of nausea, but he doesn't act nauseated so I'm not sure what it is. Neither is the holistic vet; this is something we spoke about last week and during a follow-up phone conversation yesterday and I will continue to watch. Sometimes he acts like there is something in his mouth - he licks, opens his mouth, and then runs off, sometimes under the bed. I need to catch him one of these times and take a look in his mouth. Teeth and mouth were checked last week. I've seen him lick his lips just before vomiting, but I truly cannot remember if that was the same as I'm seeing now.

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In case anyone is interested, Tim's behavior is still really good and things have, in fact, improved. And I think we finally got the lip-licking and jumping-off-furniture-and-running thing resolved.

In late March, Tim's lower lip swelled again and he was engaging in this odd behavior, so we went back to the holistic veterinarian. After looking him over and discussing his diet and behavior, she theorized indigestion or acid reflux and prescribed a short-term course of pepcid ac. This behavior stopped almost immediately on the pepcid and I kept him on the prescribed dose of two times per day for a week or so, until we accidentally missed a dose. He seemed fine, so I dropped him to one time per day. Then again missed a dose and he was fine. A few times I saw him lick his lips or heard his tummy gurgle and gave him a pepcid. As it helped, I decided to use pepcid on an as-needed basis. He's not had any pepcid in over a week.

At the same time, I made some true "bone broth" in an effort to aid his intestinal situation and gave this to him daily.  I think this helped, too, but we ran into an issue with hard stools, possibly due to "bone broth" being an excellent source of calcium. I am reducing the amount of "bone broth" I give him, watching both for lip-licking and hard stools in order to optimize things.

The crazy litterbox behavior has stopped. He still digs and scratches as much as ever, but only when he is preparing to have a movement. I suspect he was experiencing what oneandahalfcats described. I am not watching him in the litterbox any more, so no idea if he is grunting/sighing. But he generally goes very early in the morning and we can hear him scratching when we're in bed. Based on the interval of time between his pre-scratching and burying, I'd say things are coming out just fine. We decreased his cisapride dose further, so he now gets one 5mg capsule with two days in between. We'll do this for another couple of weeks and either decrease the dose further or possibly just stop.