This is my first post on this forum. I have seen a lot of good advice here and I am hoping someone here can answer my questions.
The backstory:
I have a 15 year old ragdoll (male, neutered). For some history: he has always, since birth, been a scrawny little thing. He averaged about 10 lbs (but he is very long) for most of his life, but is now in the 8.0 - 8.5 lbs range. He has always had hairball problems, and I have gone through many vets early in his life to try to alleviate this, but the end result was that he just liked to groom himself a lot, and to try to get him to eat some hairball prevention food/formula of some type. He has also always been super picky about food, and I have not helped matters by trying to cater to his every need (and always giving him what he wants).
We eventually found some hairball prevention food that he liked, and that helped him a great deal for a long time. The company recently changed the formula ("new improved flavor") and ever since then he will not go near the stuff (he does not even acknowledge it as food). His hairballs haven't been too great a problem though (not as much grooming with his advancing age) so we haven't worried about it too much. He would typically vomit once or twice a week with mostly hair in the vomit.
He has also been chronically constipated for most of his life. Again, much of this is due to the hair (you can see a great deal of hair in his poop), but he rejected all treatments for constipation. His constipation got worse and worse until around 6 months ago, when he did not go for almost a week (we let it go this long because he kept trying so hard, and trips to the vet make him very anxious as the vet he has had his whole life is now an hour away -each way- and the vet could not make a home visit for about a week). We eventually took him to another vet as an emergency measure. They gave him 3 enemas and kept him there for 6 hours. He would not go and looked miserable. We told them how nervous and anxious he gets at the vet and they let us take him home. After a few hours at home he eventually went. That vet recommended Miralax (which our original vet had no problem with) and that has helped his constipation enormously. We have previously been giving him around 1/8th of a teaspoon daily (in his favorite food, the chicken gravy from 9Lives Chicken Dinner; he doesn't actually eat the food, just the gravy). His bowel movements are still only once every other day or every few days, but he no longer has to strain to get them out.
Fast forward to the present.
Last Sunday, he vomited 12 times in a row. This was just after a very large bowel movement. It was some hair, mostly stomach acid. He ate nothing Sunday. Monday he ate about 50% of his normal intake. Tuesday he ate nothing and I called the vet (the original one hour away one) and they could get him in the following morning. Wednesday morning he ate a lot! I was so happy and I thought maybe everything was ok. We still took him to the vet and the vet did x-rays, and blood and urine work (in-house, so we could get all the results in 30 minutes).
The first surprise was the x-ray. He was almost completely filled with feces (despite the enormous bowel movement a few days ago). The vet said he was actually completely full from his stomach (valve or something that opens to the intestines) all the way to his anus. He pointed at some and then compared their size to his pelvis (pretty similar). He said priority one was to get the cat pooping. He said if the cat is this full of feces this often he may only eat when he feels he has room. He upped the dose of Miralax from 1/8th teaspoon to 1 teaspoon daily.
The next bad news was the blood work. His BUN and CREA levels were not normal and the doctor said that he had kidney problems. We had blood work around 4 months ago and those levels were fine then so it is a recent development. The calcium levels were also very high. His calcium levels were historically a bit high, and the vet said that it could be that the calcium is higher from: a) holding feces in his intestines for so long, b) the kidney problems, or c) intestinal cancer. Of course the cancer was very worrying, but the vet said an ultrasound was not very good for detecting that, and he did not want to put the cat under anesthesia to do a biopsy of the intestines. When I asked why, he said he would prefer not to use anesthesia on the cat from this point forwards anyways, and even if it was cancer, he did not think my cat would do well with chemotherapy, so to just let it be and hopefully it was one of the other two options.
I was very distraught and I did not ask as many questions as I would have liked. The vet prescribed k/d hills (I bought every flavor wet and dry that they had) and said it was important that the cat went on a low sodium diet, but it was more important that he keep eating.
That day after coming home, the cat was very scared, but did manage to eat a lot of the new k/d dry foot (right out of my hand!). He ate almost 1/2 a cup in one sitting and I thought our problems were solved! He ate a little more that day, but not a lot. The next day he ate pretty good (around 80% of normal) but we had to mix in some normal food (his healthiest normal food, as we have always given him a huge buffet to choose from) alongside the new k/d. He won't eat any of the k/d wet food but has eaten some of the dry food but not nearly as much since the day he devoured it. He keeps smelling it, then he might take a few bites, then move on to his normal food. Today he has eaten very little (around 20% of normal). He also managed to poop out what appears to be the entirety of the feces collected in the intestine. It was a massive amount (I'm not exaggerating, but if put together is around the length of my forearm). On one end it was hard, but the other end was fairly soft.
A few caveats, a few numbers, a few questions:
Please don't tell me to prepare myself for the worst. I am already crying nearly non-stop and have been unable to eat for a few days. The vet has said he could last for years if we can manage the symptoms (and if he doesn't have cancer) but every time he does not eat it is like a knife through my heart.
Please also don't tell me all the things I have done wrong (giving him too many foods to choose from, catering to his every need instead of what is best for him, waiting too long to take him to the vet): I go over every mistake I have ever made in his 15 years of life (and there were too many) and I will never forgive myself for them. Nothing you say will make me feel worse than I already do. I lost my other baby a year and a half ago and I think of her every day and what I could and should have done different every day of her 19 years of life.
Numbers:
BUN was 52 mg/dL
CREAtine was 3.1 mg/dL
CA (calcium) was 13.0 mg/dL (4 months ago it was 11.8 mg/dL, still slightly higher than normal)
GGT was 5 U/L
Thank you for reading this enormous wall of text, and if you could answer some questions I would be eternally grateful.
1. The BUN/CREA put him at lower Stage 3 correct? This is a "manageable" stage correct?
2. Does the calcium (4 months ago and today) give any of you a better idea which of the three options might be causing the calcium to be high? Could this be "Idiopathic hypercalcimic"?
3. GGT is liver function correct? The vet did not mention anything about liver but the number is clearly high. Is this a problem and what does it mean?
4. Is Miralax long-term ok? Is 1 teaspoon a day long-term ok? Of course if his bms stay too soft we will lower it until they get too hard again (or he struggles).
5. Would a calcium blocker be something to consider?
6. Would an antacid be something to consider for his vomiting/stomach acid issues?
7. A big question regarding food.
I have only given him a few days to try the k/d out, but he has eaten none of the wet food and other than the first day, very little of the k/d dry food. I don't want to starve him to try and get him to eat that food. I have put some of his healthier normal foods down with mixed results.
I have also ordered a dozen or so special foods that are all low sodium so that hopefully we can find something he likes. Should I try to go grain-less? Will this help him in any way? If his pooping is more or less normal with the miralax, will grain-less help his pooping or anything else?
Also, what other things should I be looking for in these other foods? Should the phosphorus be high or low? As an example, the k/d food has phosphorus ranging from 0.4% to 0.55%, while his current foods go all the way up to 1.6%. Is something like 0.7% ok?
Should the protein be high or low? This seems to vary greatly from food to food. How about fat and carbs?
I feel so helpless and clueless and would appreciate any help you might be willing to give. I do have a call in to the vet but I may not hear from him until Monday so that is why I decided to post here.
Thank you.
The backstory:
I have a 15 year old ragdoll (male, neutered). For some history: he has always, since birth, been a scrawny little thing. He averaged about 10 lbs (but he is very long) for most of his life, but is now in the 8.0 - 8.5 lbs range. He has always had hairball problems, and I have gone through many vets early in his life to try to alleviate this, but the end result was that he just liked to groom himself a lot, and to try to get him to eat some hairball prevention food/formula of some type. He has also always been super picky about food, and I have not helped matters by trying to cater to his every need (and always giving him what he wants).
We eventually found some hairball prevention food that he liked, and that helped him a great deal for a long time. The company recently changed the formula ("new improved flavor") and ever since then he will not go near the stuff (he does not even acknowledge it as food). His hairballs haven't been too great a problem though (not as much grooming with his advancing age) so we haven't worried about it too much. He would typically vomit once or twice a week with mostly hair in the vomit.
He has also been chronically constipated for most of his life. Again, much of this is due to the hair (you can see a great deal of hair in his poop), but he rejected all treatments for constipation. His constipation got worse and worse until around 6 months ago, when he did not go for almost a week (we let it go this long because he kept trying so hard, and trips to the vet make him very anxious as the vet he has had his whole life is now an hour away -each way- and the vet could not make a home visit for about a week). We eventually took him to another vet as an emergency measure. They gave him 3 enemas and kept him there for 6 hours. He would not go and looked miserable. We told them how nervous and anxious he gets at the vet and they let us take him home. After a few hours at home he eventually went. That vet recommended Miralax (which our original vet had no problem with) and that has helped his constipation enormously. We have previously been giving him around 1/8th of a teaspoon daily (in his favorite food, the chicken gravy from 9Lives Chicken Dinner; he doesn't actually eat the food, just the gravy). His bowel movements are still only once every other day or every few days, but he no longer has to strain to get them out.
Fast forward to the present.
Last Sunday, he vomited 12 times in a row. This was just after a very large bowel movement. It was some hair, mostly stomach acid. He ate nothing Sunday. Monday he ate about 50% of his normal intake. Tuesday he ate nothing and I called the vet (the original one hour away one) and they could get him in the following morning. Wednesday morning he ate a lot! I was so happy and I thought maybe everything was ok. We still took him to the vet and the vet did x-rays, and blood and urine work (in-house, so we could get all the results in 30 minutes).
The first surprise was the x-ray. He was almost completely filled with feces (despite the enormous bowel movement a few days ago). The vet said he was actually completely full from his stomach (valve or something that opens to the intestines) all the way to his anus. He pointed at some and then compared their size to his pelvis (pretty similar). He said priority one was to get the cat pooping. He said if the cat is this full of feces this often he may only eat when he feels he has room. He upped the dose of Miralax from 1/8th teaspoon to 1 teaspoon daily.
The next bad news was the blood work. His BUN and CREA levels were not normal and the doctor said that he had kidney problems. We had blood work around 4 months ago and those levels were fine then so it is a recent development. The calcium levels were also very high. His calcium levels were historically a bit high, and the vet said that it could be that the calcium is higher from: a) holding feces in his intestines for so long, b) the kidney problems, or c) intestinal cancer. Of course the cancer was very worrying, but the vet said an ultrasound was not very good for detecting that, and he did not want to put the cat under anesthesia to do a biopsy of the intestines. When I asked why, he said he would prefer not to use anesthesia on the cat from this point forwards anyways, and even if it was cancer, he did not think my cat would do well with chemotherapy, so to just let it be and hopefully it was one of the other two options.
I was very distraught and I did not ask as many questions as I would have liked. The vet prescribed k/d hills (I bought every flavor wet and dry that they had) and said it was important that the cat went on a low sodium diet, but it was more important that he keep eating.
That day after coming home, the cat was very scared, but did manage to eat a lot of the new k/d dry foot (right out of my hand!). He ate almost 1/2 a cup in one sitting and I thought our problems were solved! He ate a little more that day, but not a lot. The next day he ate pretty good (around 80% of normal) but we had to mix in some normal food (his healthiest normal food, as we have always given him a huge buffet to choose from) alongside the new k/d. He won't eat any of the k/d wet food but has eaten some of the dry food but not nearly as much since the day he devoured it. He keeps smelling it, then he might take a few bites, then move on to his normal food. Today he has eaten very little (around 20% of normal). He also managed to poop out what appears to be the entirety of the feces collected in the intestine. It was a massive amount (I'm not exaggerating, but if put together is around the length of my forearm). On one end it was hard, but the other end was fairly soft.
A few caveats, a few numbers, a few questions:
Please don't tell me to prepare myself for the worst. I am already crying nearly non-stop and have been unable to eat for a few days. The vet has said he could last for years if we can manage the symptoms (and if he doesn't have cancer) but every time he does not eat it is like a knife through my heart.
Please also don't tell me all the things I have done wrong (giving him too many foods to choose from, catering to his every need instead of what is best for him, waiting too long to take him to the vet): I go over every mistake I have ever made in his 15 years of life (and there were too many) and I will never forgive myself for them. Nothing you say will make me feel worse than I already do. I lost my other baby a year and a half ago and I think of her every day and what I could and should have done different every day of her 19 years of life.
Numbers:
BUN was 52 mg/dL
CREAtine was 3.1 mg/dL
CA (calcium) was 13.0 mg/dL (4 months ago it was 11.8 mg/dL, still slightly higher than normal)
GGT was 5 U/L
Thank you for reading this enormous wall of text, and if you could answer some questions I would be eternally grateful.
1. The BUN/CREA put him at lower Stage 3 correct? This is a "manageable" stage correct?
2. Does the calcium (4 months ago and today) give any of you a better idea which of the three options might be causing the calcium to be high? Could this be "Idiopathic hypercalcimic"?
3. GGT is liver function correct? The vet did not mention anything about liver but the number is clearly high. Is this a problem and what does it mean?
4. Is Miralax long-term ok? Is 1 teaspoon a day long-term ok? Of course if his bms stay too soft we will lower it until they get too hard again (or he struggles).
5. Would a calcium blocker be something to consider?
6. Would an antacid be something to consider for his vomiting/stomach acid issues?
7. A big question regarding food.
I have only given him a few days to try the k/d out, but he has eaten none of the wet food and other than the first day, very little of the k/d dry food. I don't want to starve him to try and get him to eat that food. I have put some of his healthier normal foods down with mixed results.
I have also ordered a dozen or so special foods that are all low sodium so that hopefully we can find something he likes. Should I try to go grain-less? Will this help him in any way? If his pooping is more or less normal with the miralax, will grain-less help his pooping or anything else?
Also, what other things should I be looking for in these other foods? Should the phosphorus be high or low? As an example, the k/d food has phosphorus ranging from 0.4% to 0.55%, while his current foods go all the way up to 1.6%. Is something like 0.7% ok?
Should the protein be high or low? This seems to vary greatly from food to food. How about fat and carbs?
I feel so helpless and clueless and would appreciate any help you might be willing to give. I do have a call in to the vet but I may not hear from him until Monday so that is why I decided to post here.
Thank you.
