Cisapride - regular vet vs. holistic vet

oneandahalfcats said:

 
Glad to read that Tim had a BM

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Thank you!

Another nice one this morning. Less volume, nice texture, and less time (48 hours to 40 hours to 32 hours). Dare I hope for 24 hours and a BM tomorrow morning? Time will tell.

Glad I have the extra litter box. The third one isn't being used, but with a few changes, the two boxes in the same room are being used regularly (previously they ignored the second box). I am trying to stay away from that room as much as possible until all of us (especially me!) settle down.

Originally Posted by AbbyNTim  

Dare I hope for 24 hours and a BM tomorrow morning? Time will tell.

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Super excited to report that he went right on "schedule" this morning. Nice texture, much less volume; actually on the smaller side of normal for him, which makes sense considering we've had extreme heat and winds here the past couple of days and he's eaten much less. I am so pleased that he went with very little cisapride in his system and without his colon being so full.

Excellent! 

AbbyNTim said:

 
Super excited to report that he went right on "schedule" this morning. Nice texture, much less volume; actually on the smaller side of normal for him, which makes sense considering we've had extreme heat and winds here the past couple of days and he's eaten much less. I am so pleased that he went with very little cisapride in his system and without his colon being so full.

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Wow. Tim is on a roll ..

Curious here .. Did you switch up for the stronger probiotic as you had indicated that you would be doing, or changed nothing?

GoHolistic said:

 
Excellent! 

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Thank you!

oneandahalfcats said:

 
Wow. Tim is on a roll ..

Curious here .. Did you switch up for the stronger probiotic as you had indicated that you would be doing, or changed nothing?

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Haven't changed anything yet. Decided I should give what I was doing a little more time, especially since we had just reduced his dose of cisapride. I do want to get him off the psyllium, as the thought of bulking fiber and constipation makes me nervous, so plan to discuss a stronger probiotic, digestive enzymes, and slippery elm at our next appointment.

And the next appointment may be tomorrow morning, as it turns out. Tim has developed diarrhea as of just an hour ago. I'm not sure what's up, and it appears to be the same thing Abby started experiencing yesterday. I thought I had given Abby too much Miralax yesterday morning, but now that Tim has the exact same thing, I'm concerned. We're taking Tim's fecal sample for analysis (and if Abby has another liquid stool, hers, too) and both cats may go as well, depending on how they do overnight. I may take them for no other reason than to get fluids; it is extremely dry right now and I want to avoid dehydration. The funny thing is, both are acting fine. Other than Abby having Miralax yesterday morning, which she's had before, we've changed nothing. I hope I didn't get a bad batch of food.

The diarrhea from last week seems to have been a bump in the road. Probably due to too much rich food inadvertently introduced at once. Both cats are back to normal now and things are going well. They are still eating a slightly lower-fat diet (Nature's Variety Instinct canned rabbit), but a couple of days ago I started gradually adding the higher-fat protein (LID turkey) to their morning meal. So far, they are tolerating this, so will continue the gradual add until they are back to turkey in the morning and rabbit in the evening. The only supplement I am giving the cats is a probiotic with their morning meal.

In terms of BMs, after the litter box activity on Thursday and into early Friday morning last week, both cats were cleaned out and did not produce a BM until very early Sunday morning; one right after the other. Abby went again that night and has gone every night since. Tim has gone every morning since, at almost the exact same time each morning. And this is on his greatly reduced dose of cisapride: a 5mg capsule with three days between doses. We will probably continue this pattern for two more cycles, then will have to decide by May 17 whether to add another day between doses or stop altogether.

Because Tim is pooping regularly and well, I am not adding psyllium to his food. And, in fact, most days I pick the peas and carrots out of the food, but leave them in one or two meals every three or four days. I am pleased with his progress and may reserve the tiny dose of psyllium (1/16 tsp) for extra support (motility and a tiny bit of bulk to help stimulate sensations) on the first few days when his dose is reduced. That seems to be when he needs a little extra help, while his body adjusts to less cisapride and then starts doing it on its own.

I am not sure what this means, but Tim had a pretty significant hairball on Tuesday. We are pretty sure it was him, as Abby has them very rarely and she passed a large amount of hair in her stool that night. Tim's not had one in about three months and I was a little disappointed, but not surprised that it happened within days of his stomach being upset and his insides likely very inflamed. While I don't like hairballs, I am happy it came out instead of being stuck. He has since been passing hair in his stools, so hopefully things are settling down. As it's shed season, we're brushing both cats more in order to minimize the hair they ingest and in turn have to pass one way or the other.

I am also continuing my own work to keep myself from being too stressed. I know it's a bit of a circle: As long as both cats are pooping regularly (12-36 hours, depending on the cat), I am happy and relaxed. When I am happy and relaxed, so are the cats. When the cats are relaxed, Tim is less aggressive and both cats poop better and regularly. When both cats poop regularly, I am happy and relaxed. We're in a good place right now and I hope nothing breaks our circle. I am also happy the cats did not run under the bed and hide as I was preparing to leave for work this morning; they've been doing this for a couple of weeks and it makes me sad. Hopefully, this morning was a good sign that they are more relaxed and trusting.

LOL....your comments about the cycle made me laugh. I know exactly what you mean!

I'm glad that things are going well right now.

Glad to hear progress is still being made. Cisapride (5mg) once every three days is a tremendous change from what Tim was on in the beginning. Really, you are almost there.

And yes, 'tis the season of the hairball. Brushing like crazy and wishing I had one of those few cats that enjoy being vacuumed.

GoHolistic said:

 
LOL....your comments about the cycle made me laugh. I know exactly what you mean!

I'm glad that things are going well right now.

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cocheezie said:

 
Glad to hear progress is still being made. Cisapride (5mg) once every three days is a tremendous change from what Tim was on in the beginning. Really, you are almost there.

And yes, 'tis the season of the hairball. Brushing like crazy and wishing I had one of those few cats that enjoy being vacuumed.

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Thank you both. Yes, things are going well, not great, but well.

Came home to another hairball and Tim just had one of his coughs. As I brushed him this evening, it seemed as if I could hear his tummy gurgling. The only change today was a bit more turkey. Hope that isn't turning into a problem. We'll see how it goes tonight, which will dictate whether I continue with the same amount of turkey or go back to the smaller amount.

Tim is doing pretty well. Another early morning BM, and this was right before his once-every-four-days cisapride dose, so it means he did it almost all on his own with practically no cisapride in his body. I'm very happy and hope this continues. While I'm tempted to stop cisapride now, I don't want to rush it and instead will make an appointment with the holistic veterinarian next week to discuss his progress and next steps.

I am just a little curious about Tim's slight nausea, however. He was drooling a bit this morning and after last night's tummy gurgling and the two hairballs this week, I am a little suspicious of the NVI LID turkey. The consistency definitely looks different and I noticed this change last week a day or so before both cats had terrible diarrhea. My husband and I decided to resume the small amount of turkey for a few more days, then try bumping it up again to see how he does. I told my husband "no treats" because we need to isolate this. My only issue with keeping the cats on just rabbit is that it's lower fat, but we can always add some fish oil to bump that up. Another topic for discussion with the holistic vet next week.

Lastly, to try something more natural for Tim's tummy upset, I gave him his very first dose of slippery elm bark last night. It was a tiny dose; only ~1/16 tsp mixed in a lot of water then mixed into his food. It didn't gel as much as the comparable psyllium/water mixture, but hopefully it still worked as it should. Tim's BM this morning was nice, a little large and comparable to some of his psyllium BMs, but nice texture and again very similar to his psyllium BMs. I am not planning to give him this or psyllium again for at least a couple of days, but I wanted to see how he would do and whether he would eat food with it mixed in (of course he did, Tim eats just about everything). Also, I am hoping it might help with his nausea, instead of using Pepcid AC.

Still in a pretty good place. Hope it continues.

Tell me again why you're trying turkey instead of some other protein? Is chicken off the table? Do they have allergies? I'm just wondering if maybe poultry doesn't agree with Tim. 

GoHolistic said:

 
Tell me again why you're trying turkey instead of some other protein? Is chicken off the table? Do they have allergies? I'm just wondering if maybe poultry doesn't agree with Tim. 

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When Tim started vomiting after every meal in early February, one of the common ingredients was chicken. I am not positive he's allergic to chicken, but I suspect he may be. Two days after I brought him home from the veterinarian, he vomited chicken after several meals of no chicken and no vomiting. We decided then, no chicken for a couple of months. We fed him a small amount of Tiki Cat chicken in early April and he had a couple of coughing sessions in the 24 hours following that meal; he'd not coughed since early February. So I still suspect chicken, at least processed chicken.

Tim had been doing very well on the turkey, so I was hoping his issue was just chicken and not all poultry. Now I'm not sure, given the diarrhea last week, the tummy upset last night and this morning, and the coughing session last night. Once Tim is off cisapride and we are certain he's feeling pretty good and pooping regularly, then we are going to address his other issues, including experimenting with chicken and other proteins. I am trying to keep him stable and feeling good until this process is complete. He is definitely improved and I can tell he feels better, I am just sad that I'm seeing some of the same symptoms we saw in early February, though not nearly as extreme, and wonder what's up.

p.s. I also suspect the cisapride in some of his nausea. Previously, I have noticed slight drooling on the days I gave him the medication. So that's why we're not ditching the turkey yet but will wait to increase the quantity when it's not timed so closely to his cisapride dose.

Another 24-hour BM from Tim this morning; he is on a great roll. Definitely expected as he had cisapride yesterday morning. This morning's, however, was a little on the soft side. I see two possibilities: 1) even though we dropped the turkey to the smaller amount, perhaps turkey just doesn't agree with Tim any more, and 2) maybe the cisapride is moving things along quicker than they should be and it's not needed anymore. I mention this because I have noticed, over the past few weeks or so, his BMs contain pieces that are too soft the day after a cisapride dose. We're going to continue the same small amount of turkey over the next few days to see what happens. No other changes. And I will definitely make an appointment with the holistic vet to discuss Tim's progress- maybe it's time to stop cisapride or do a final taper.

I've heard of cats who can't eat chicken also can't do turkey or duck, or as I like to say, "things with wings." 

Tim is getting cisapride every three days, correct? How about continuing to increase the number of days in between doses until you reach a point in which you and your vet think its okay to stop? I had to do this with Caesar when he was getting mirtazapine. We went as far as seven days in between doses before deciding it was okay to stop.

GoHolistic said:

 
I've heard of cats who can't eat chicken also can't do turkey or duck, or as I like to say, "things with wings." 

Tim is getting cisapride every three days, correct? How about continuing to increase the number of days in between doses until you reach a point in which you and your vet think its okay to stop? I had to do this with Caesar when he was getting mirtazapine. We went as far as seven days in between doses before deciding it was okay to stop.

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I sure hope he doesn't have a problem with "things with wings", but time will tell. I would really like to get him back on the turkey, so I'll continue the very gradual add. But otherwise, trying to keep things steady and consistent.

Thanks for the suggestion; after thinking and discussing over the weekend, my husband and I are thinking along similar lines. Tim is currently getting cisapride every four days; we skip three days between doses. Based on the half-life of this drug, I think I want to add another skip day before we decide to just stop. Chemistry is not something I know much about, but it appears cisapride has a 10-hour half life and therefore takes about a week to completely clear the body. It's below 1%, however, by day 4. So I'd like him to go a couple of days with a super low percentage and see how he does. Based on the last communication with the holistic event, she mentioned adding another skip day rather than stopping entirely. I intend to email her with our plan to confirm.

Tim broke his 24-hour streak yesterday and went 36 hours instead. I think he will go another 36 hours and get back on his morning schedule. Now that I'm keeping detailed records, I see that both cats' BMs are off when we have these high-pressure systems that produce extreme heat, high winds, and very low humidity- Tim is less frequent and Abby's stools dry out. We are currently experiencing one and we've had quite a few this spring, of course as I attempt to wean Tim off this medication.  

Are you adding water to Abby's food?

I tried once again to mix the miralax into Cochise's food to cut down the number of times a day that I shove meds down her throat. She is a grazer. She had one bowel movement this week that looked like hard rings of small meals. She insists on 3 different flavours on the plate. She wasn't eating the food that had the medicine in it. So it was a close call. I'm still mixing the miralax in her food, but now I mix it, along with her amino/b12/iron liquid 2x daily in a teaspoonful of the food that is her absolute favourite and is one of the worst foods for her. A compromise.

cocheezie said:

 
Are you adding water to Abby's food?

I tried once again to mix the miralax into Cochise's food to cut down the number of times a day that I shove meds down her throat. She is a grazer. She had one bowel movement this week that looked like hard rings of small meals. I'm still mixing the miralax in her food, but now I mix it, along with her amino/b12/iron liquid in a teaspoonful of the food that is her absolute favourite and is one of the worst foods for her. A compromise.

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Oh, yes, a good amount of water, but it didn't seem to help. So last time we had one of these systems, I gave her a tiny amount of psyllium mixed with her evening meal for a couple of days, which did seem to help. So we started that again over the weekend. So far, so good. If I know it's weather-induced, I can deal with it. These things make my head hurt; not surprising they might affect the cats, too.

It sure sounds like you have your hands full with Cochise. Can you give her a smaller amount of food with the entire miralax dose mixed in to make sure she gets it? That's how I initially gave cisapride to Tim- I'd give him a tiny portion of food with his capsule mixed in so I'd be sure he consumed it. I had to do this early on because both cats were adjusting to timed feeding after almost four years of free-feeding. Now they are used to timed feeding and gobble what I put down; I feel very fortunate in this respect.

My cisapride comes in a tablet form and she won't touch any food that contains  the crushed tablet. Before, I was shoving 4 meds down twice a day. Now she gets cisapride and pepcid ac shoved down her throat; and miralax and amino/b12/iron mixed in a tiny bit of food; and the sub-q fluids every second day. It's easier on her peace of mind. I'm letting her continue to graze. If I only put food out for a short period of time, she'll lose weight very quickly and she has little weight to spare. Hot here too, but humid and thunderstorms building.

Sidenote: She never was a big dry food eater but there was always a bowl in case she wanted a nibble. Since the constipation problem, she's never touched dry food. Her choice. Smart kitty.

cocheezie said:

 
My cisapride comes in a tablet form and she won't touch any food that contains  the crushed tablet. Before, I was shoving 4 meds down twice a day. Now she gets cisapride and pepcid ac shoved down her throat; and miralax and amino/b12/iron mixed in a tiny bit of food; and the sub-q fluids every second day. It's easier on her peace of mind. I'm letting her continue to graze. If I only put food out for a short period of time, she'll lose weight very quickly and she has little weight to spare. Hot here too, but humid and thunderstorms building.

Sidenote: She never was a big dry food eater but there was always a bowl in case she wanted a nibble. Since the constipation problem, she's never touched dry food. Her choice. Smart kitty.

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Oh, she is a smart girl! Tim would go back to dry food in a minute if I'd let him. No chance, at least not while we're weaning. I may let him snack on dry food eventually, once I'm comfortable he's going regularly. I still think his constipation was due to a diet of dry food, so as long as the cisapride-damage hasn't been done, I think he'll be fine moving forward as long as he's eating canned and/or raw and/or home-cooked. Considering what Cochise is going through, I'd probably let her do anything she wanted.

I think I am really lucky with Tim. I can bury 1/4 pepcid ac in his wet food and he generally eats it. If not, I can pop it in his mouth and he swallows, not much shoving needed.

Tim had a wonderful BM late last night. A little unexpected, as his recent pattern was to have two 36-hour stretches back-to-back in order to get back on his morning schedule. But I am happy about this one for a number of reasons: timing (just over 24 hours), texture (moist and firm), size (right in his average range), and very little cisapride in his system since he had his last dose on Friday morning and we were planning to dose him again this morning.

Tim has been on this dose for three weeks now and we were planning on making the change later this week. But given how well he's been doing for the past week, we decided to decrease his dose effective today. So we skipped cisapride this morning; this makes four days without a dose and we will give it to him tomorrow. We'll continue to skip four days between for the next few weeks. Another factor in our decision is I am feeling rather relaxed and calm about things and think I am in a good place to deal with any bumps as he adjusts to an added day with little to no cisapride in his system. Finally, Tim himself seems much more relaxed; he is playing like he did when he was a kitten (so nice to see!) and he seems so happy right now.

Tim will continue daily probiotics. I am considering alternating the tiny doses (~1/16 tsp) of psyllium and slippery elm to get the benefits of both, at least until we get over any "lag" due to the dose decrease. Have inquired with the holistic veterinarian about this plan, plus the possibility of adding fish oil to at least Abby's food. Here's hoping!