Cisapride - regular vet vs. holistic vet

AbbyNTim said:

 
I started another thread some time back about Tim's progress with Cisapride weaning: http://www.thecatsite.com/t/274139/cisapride-regular-vet-vs-holistic-vet. We had been doing well, but now I am feeling very nervous about our progress with Cisapride weaning. There are moments when I am afraid the damage has been done - that 9+ months of Cisapride have caused Tim to become dependent on this drug. We are going to keep pressing on, but I may return with Tim to the holistic veterinarian this week to discuss his progress.

We are now skipping three days between doses. The dose is a 5mg capsule that he takes around 5:25 each morning with his first plate of food. I did not realize this was keeping him almost on-the-dot regular until we started skipping two days. But as he was still going roughly every 24 hours, I was happy. Then he started having a few 36-hour stretches, but because the quantity wasn't huge and he didn't seem to have any trouble in the litter box, I tried not to worry and in time became okay with that. Now he is going pretty much every 36 hours, give or take, with slightly larger stools. He went 48 hours between his last bowel movements, which really worried me, and the quantity was significant - definitely 48 hours worth. We almost called the vet's office, as she has instructed us to contact her if he goes 48 hours without a bowel movement, but did not need to as he went yesterday morning at almost exactly 48 hours from his last one. He had Cisapride yesterday morning (minutes before the bowel movement, so I don't think it had anything to do with it), but hasn't gone yet this morning, which has me a little concerned; it's been 26 hours now since his last movement.

A little over a week ago, the holistic veterinarian had us start Tim on a small amount of psyllium to increase motility as we decrease Cisapride. She knows I am terrified of his stool bulking too much and perhaps leading to megacolon. We started with 1/2 capsule, which is 1/8 tsp. His next stool was pretty large, so she had us drop down to 1/4 capsule (1/16 tsp). I am blending the psyllium with plenty of water to make a liquid and smooth out any "fiber balls" before mixing with his food. But I am not sure it's working for him, as his frequency hasn't increased, yet his stool size has a bit. I sent average stool measurements to the vet and she does not think he's in danger of megacolon. But I'm just so nervous right now.

Tim went through two terrible constipation episodes where he had enemas and was hospitalized for a couple of days. We did not see any warning signs and didn't know he was sick until he was vomiting and panting; we rushed him to the emergency vet both times. After the second episode, we made changes to his diet by transitioning him to wet food. I'd like to get him on raw, but the holistic vet is worried about transit time while he's on Cisapride. At the same time, I am worried he will have to remain on Cisapride. From what I recall, when he gets constipated, he just stops going. We did not see straining or unproductive visits to the litter box; we are unsure about appetite as we were free-feeding back then; there was no elimination outside the box. The only thing we noticed, as we alternate litter box duties, was less; each thought the other was scooping all the poop. Now we share our litter box findings to avoid this in the future.

Each time we reduced Tim's Cisapride dose, he had a "lag", where it seemed his body needed to adjust to the reduced dose. Perhaps this is what we are seeing now. But 48 hours! And no poop (so far!) the day after a Cisapride dose! Both are a little concerning. I will just need to watch him and if we have a second 48-hour stretch, back to the holistic veterinarian we go. I am not going to change anything with Tim until I discuss with the vet, but for discussion purposes, is anyone aware of anything natural we can try that would stimulate him without increasing the bulk of his stool?

Any thoughts are appreciated.

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AbbyNTim said:

 
@jcat, can you recover what @oneandahalfcats posted on the thread that you merged into this one? I am very interested in reading this, as I've been following Max's progress with constipation, including taking off cisapride. @oneandahalfcats, is it possible to re-post here?

Thank you,

Tim's very anxious cat-mom

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oneandahalfcats said:

 
I just sent you a PM hoping that you saw my post in your inbox. Hopefully the mods can find it and put it back. If not, I will re-post. Stay tuned.

 

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GoHolistic said:

 
Admittedly, I have never really tuned in to this thread until now and had a lot of catching up to do.  

  I have a few questions.

With Tim's vomiting, constipation, nausea and food sensitivities, has inflammatory bowel disease or other GI condition been ruled out? Has he had x-rays or an ultrasound recently? Have your vets ever recommended a contrast (dye) motility study?

I know you've dabbled a bit with probiotics, and I think slippery elm bark, too. Have you considered digestive enzymes? They can help with absorption of nutrients (and thus perhaps less stool) and I've heard others say that they've helped keep their kitties regular. Also, do you have Abby and Tim on an omega-3 fish oil supplement? Omega-3s can also aid in digestive health and may help Abby with her skin flakes.

Did the holistic vet ever mention using George's Aloe Vera (no latex, which is what is toxic to cats)? You wouldn't want to use it all the time, but perhaps once or twice a week in rotation with some of the other things you are doing to keep things moving.

Personally, I'd be careful with psyllium. It is a bulking fiber, as you know. Unless the psyllium is making Tim to go every 24 hours, I'd be hesitant. Otherwise, if he's going 48 hours without a bowel movement, then you have both the stool and the psyllium building up in his colon. Perhaps this is why you've noticed the larger stools recently.

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oneandahalfcats said:

AbbyNTim said:

 
I started another thread some time back about Tim's progress with Cisapride weaning: http://www.thecatsite.com/t/274139/cisapride-regular-vet-vs-holistic-vet. We had been doing well, but now I am feeling very nervous about our progress with Cisapride weaning. There are moments when I am afraid the damage has been done - that 9+ months of Cisapride have caused Tim to become dependent on this drug. We are going to keep pressing on, but I may return with Tim to the holistic veterinarian this week to discuss his progress.

We are now skipping three days between doses. The dose is a 5mg capsule that he takes around 5:25 each morning with his first plate of food. I did not realize this was keeping him almost on-the-dot regular until we started skipping two days. But as he was still going roughly every 24 hours, I was happy. Then he started having a few 36-hour stretches, but because the quantity wasn't huge and he didn't seem to have any trouble in the litter box, I tried not to worry and in time became okay with that. Now he is going pretty much every 36 hours, give or take, with slightly larger stools. He went 48 hours between his last bowel movements, which really worried me, and the quantity was significant - definitely 48 hours worth. We almost called the vet's office, as she has instructed us to contact her if he goes 48 hours without a bowel movement, but did not need to as he went yesterday morning at almost exactly 48 hours from his last one. He had Cisapride yesterday morning (minutes before the bowel movement, so I don't think it had anything to do with it), but hasn't gone yet this morning, which has me a little concerned; it's been 26 hours now since his last movement.

A little over a week ago, the holistic veterinarian had us start Tim on a small amount of psyllium to increase motility as we decrease Cisapride. She knows I am terrified of his stool bulking too much and perhaps leading to megacolon. We started with 1/2 capsule, which is 1/8 tsp. His next stool was pretty large, so she had us drop down to 1/4 capsule (1/16 tsp). I am blending the psyllium with plenty of water to make a liquid and smooth out any "fiber balls" before mixing with his food. But I am not sure it's working for him, as his frequency hasn't increased, yet his stool size has a bit. I sent average stool measurements to the vet and she does not think he's in danger of megacolon. But I'm just so nervous right now.

Tim went through two terrible constipation episodes where he had enemas and was hospitalized for a couple of days. We did not see any warning signs and didn't know he was sick until he was vomiting and panting; we rushed him to the emergency vet both times. After the second episode, we made changes to his diet by transitioning him to wet food. I'd like to get him on raw, but the holistic vet is worried about transit time while he's on Cisapride. At the same time, I am worried he will have to remain on Cisapride. From what I recall, when he gets constipated, he just stops going. We did not see straining or unproductive visits to the litter box; we are unsure about appetite as we were free-feeding back then; there was no elimination outside the box. The only thing we noticed, as we alternate litter box duties, was less; each thought the other was scooping all the poop. Now we share our litter box findings to avoid this in the future.

Each time we reduced Tim's Cisapride dose, he had a "lag", where it seemed his body needed to adjust to the reduced dose. Perhaps this is what we are seeing now. But 48 hours! And no poop (so far!) the day after a Cisapride dose! Both are a little concerning. I will just need to watch him and if we have a second 48-hour stretch, back to the holistic veterinarian we go. I am not going to change anything with Tim until I discuss with the vet, but for discussion purposes, is anyone aware of anything natural we can try that would stimulate him without increasing the bulk of his stool?

Any thoughts are appreciated.

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Yes, Slippery Elm Bark or alternatively, B-12 shots, could help Tim at this point.

Any time you stop or decrease something that has been used to assist the emptying of the digestive system, be it a laxative or cisapride, there are bound to be slow-downs as you are basically asking the colon to wake up and do the job that the cisapride has been doing. The system needs time to adjust and start working on its on. Obviously its important for Tim to have regular BMs, and so to help him through this transition, maybe he could benefit from some slippery elm, B-12, OR a stronger probiotic.   

I can't remember which probiotic you have been using, but I seem to recall that it contained 5 billion CFUs or something like this? If yes, you might want to pick up something with 10 CFUs and see if this can help. I am using the Natural Factors Double Strength which has 10 billion CFUs : http://www.naturalfactors.com/caen/products/detail/2879/acidophilus-and38-bifidus-. Its worked wonders for Max, as he hasn't been getting slippery elm, but continues to go every day.

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AbbysMom said:

Is this the post?

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AbbysMom said:

Is this the post?

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oneandahalfcats said:

AbbysMom said:

Is this the post?

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Thanks Karen. Yes, this was the post from today before the merge.  

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Originally Posted by oneandahalfcats  
 

Yes, Slippery Elm Bark or alternatively, B-12 shots, could help Tim at this point.

Any time you stop or decrease something that has been used to assist the emptying of the digestive system, be it a laxative or cisapride, there are bound to be slow-downs as you are basically asking the colon to wake up and do the job that the cisapride has been doing. The system needs time to adjust and start working on its on. Obviously its important for Tim to have regular BMs, and so to help him through this transition, maybe he could benefit from some slippery elm, B-12, OR a stronger probiotic.   

I can't remember which probiotic you have been using, but I seem to recall that it contained 5 billion CFUs or something like this? If yes, you might want to pick up something with 10 CFUs and see if this can help. I am using the Natural Factors Double Strength which has 10 billion CFUs : http://www.naturalfactors.com/caen/products/detail/2879/acidophilus-and38-bifidus-. Its worked wonders for Max, as he hasn't been getting slippery elm, but continues to go every day.

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oneandahalfcats said:

 
@AbbyNTim: I started to reformulate a reply when the post came back, so here are a few more thoughts

I see from your last response that the probiotic you are currently using does contain 5 billion rather than 10 billion CFU. I have a hunch that if you upped this to 10 billion CFUs, that you might see some action in the form of more regular BMs. I have been using Natural Factors Double Strength that contains 10 billion CFUs and this has worked wonders for Max. So much so, that I stopped the Slippery Elm weeks ago.

Regarding things like Aloe Vera, I looked at this at one point and think it has some merit in terms of being beneficial to cats on some level, but not enough is known about how much and how well, cats would handle this. Aloe Vera has very definite cleansing properties and for this reason you would need to be very careful about how much you use, and ensure that only juice from the inner leaf is used. As you can't always be sure about the source of aloe vera, its something I decided not to pursue.

Slippery Elm is a source of fiber, like psyllium, but it works differently in that when you add water to SEB, it forms a jelly-like substance which works to coat and soothe the intestinal tract. When you add water to psyllium on the other hand, it expands to form bulk. If there is insufficient water intake, psyllium will use what is available, and continue expanding which can make constipation worse. That said, I really don't think the amount you are currently giving Tim is consequential. Psyllium does work for humans and some cats, but it might not be the right solution for Tim. Slippery Elm on the other hand has worked for many cats in not only preventing constipation and relieving diarrhea, but it is also effective in alleviating nausea and vomiting in pets suffering from non-GI illnesses.

At this point I think your next step should be to crack that bottle of SEB and give it a try, and look into getting some stronger probiotics to see if these things can help to give Tim a push.

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AbbyNTim said:

 
Thanks, @oneandahalfcats. I am definitely going to try the stronger probiotic tomorrow. I already have it at home in the refrigerator.

Regarding psyllium and slippery elm: I had read about psyllium's ability to expand in water and form bulk. In an attempt to counteract that, I have been mixing the psyllium with water and smoothing out all "fiber balls" before adding it to Tim's food. Interestingly, mixing psyllium with water creates a very slick, jelly-like substance, as well, so I was hoping it worked similar to slippery elm. I may give the psyllium (mixed with plenty of water) a few more days and, if I am just seeing increasing stool size without increasing frequency, switch to slippery elm. How were Max's stools on slippery elm? Did they increase or stay about the same? I am trying to avoid bulking Tim's stools, as I'm terrified of the thought of megacolon. Slippery elm has added appeal to me as we seem to still be dealing with occasional mild nausea.

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oneandahalfcats said:

 
Yes, psyllium starts out as a liquid (think metamucil), but the effect is to increase bulk whereas slippery elm stays a jelly-like consistency to coat the digestive tract.

In the first week of using slippery elm, Max's first BM was simply amazing! .. In fact my first post in my ongoing thread documented this first result. I hadn't seen a BM like this from Max in some time. It was substantial as in keeping with a cat his size (whereas his previous stools were always under-sized), moist and just really healthy looking. Max's BMs generally are all the same in size. The important thing to keep in mind, is that as long as stools remain moist and easily passed, there should never be a concern for megacolon. Megacolon comes from poop that accumulates, becomes hard and remains too long in the colon time and again.

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