Cisapride cat and potential issues with the medication

My newest cat family member joined us as a rescue. He used to chase our birds and so I started feeding him so he wouldn't chase the birds.  He was, at the time, an intact male and I wasn't sure if he had a home or not, but suspected he did not since he was not neutered.  In September 2013, he was gone for a couple of weeks and then showed up having tremendously difficulty walking. We took him in and then got him to the vet. No microchip but he had a shattered pelvis. He also had a slipped vertebrae that one specialist was concerned could affect his tail and his nerve function for elimination. He probably got hit by a car.

My regular vet had a set of X-rays from the break, certain that he'd need surgery but the specialist determined that as bad as it looked, he could self-heal by being confined for 8 weeks with limited places to roam. That worked, but the injury had left him with a colon full of stool that was tough to eliminate. Our guess is that during the two weeks we didn't see him, he was holed up somewhere until he could make it back to our house. I'm guessing with a broken pelvis, passing stool was painful and so he didn't do it. Throughout that 8 weeks he did pee and poop but it clearly wasn't easy for him to "assume the position."

With some daily miralax and extra water, he got somewhat cleaned out but still needed an enema after the 8 weeks was up.  The vet didn't want to do the enema while he was healing for fear of dislodging a broken bone to the point where he wouldn't recover. My regular vet contended that in her opinion, the injury made his anal opening smaller and therefore he'd always be prone to constipation. In fact when we first brought him in, we heard horror stories of owners who went above and beyond to keep their kitties regular with prescription enemas. She tried to tell us we would be facing a lifetime of having to help him go. She was also pretty sure his tail was broken and that added to his issues. But we felt that a cat that made that kind of effort to get to us, deserved every chance.

He healed up, did very well on the diet and miralax but then about a year after his injury had healed, he got constipated again and needed an enema and so my vet put him on Cisapride.  Now he gets 1cc of Cisapride with morning and evening meal. He's still not an every day pooper but the size of his stool is large, which tells me that he doesn't have a decreased capacity for elimination due to any physical change but probably has some nerve changes that interfere with the urge to go until he has no choice.  I've noticed that he sometimes vomits before he eliminates but it's a clear liquid. I wasn't sure if it was him or one of the other cats but observed it recently.

Do others who have cats on Cisapride see this as a side effect? To me it's been great because it seems to have helped him stay pretty regular and without it I think he might not survive.

I feed him a combo of Primal and Stella and Chewy freeze-dried because I can add quite a bit of warm water to make a broth. That helps keep things fairly regular and it gets water into him. He's not a big sipper at the water bowl and will not eat canned food with additional water.  He's a big fan of meal time.

Major kudos to you for being so caring for this cat that had so many medical issues. I'm sure it's taken a lot of time and energy, not to mention money, to get him to such a healthy place.

I don't if that's a side effect of Cisapride or not. I've only used it one time for a few weeks. I have seen that when a cat is straining some due to constipation, the force of pushing with their intenstinal muscles so hard causes them to throw up that white foamy liquid. Since cisapride acts to get those muscles to contract, I wonder if that has something to do with it. If it's at all similar, then I would guess that your cat is feeling some distress in these moments, and it might be good to talk to your vet to see if there's something you can do to make him more comfortable or if dosages can be adjusted. But I'm just speculating here and could be entirely off.

I'm not super familiar with raw feeding and what those brands are like, but could the bone content of either be making things more difficult? I know too much bone can contribute to constipation, and he may be extra sensitive to it given his situation. You probably know more about that than I do, though.

I wondered about that too, the distress and straining can cause it. I've also wondered about the bone content since I've seen a few things about that potentially exacerbating constipation. The only reason I went in that direction is that earlier in the healing process, he also developed some crystals in his urine and seemed to be straining to urinate. The vet didn't find an infection but the crystals and of course, immediately suggested special food for urinary issues. The food was awful and he wouldn't eat it. Looked at commercial canned foods that were for urine issues and I didn't care for the ingredients that were added to make it more acidic and supposedly more likely to help with urinary issues. So I went to my local pet food store that has all the high end foods. They had a list of the products that were good for cats with urinary issues and one was the freeze dried primal raw. I gave it a try and he loved it.

He's not fond of canned food now after these couple of years on the other.

My guy has been on cisapride, twice a day, since September of last year. 

I swear that it is a miracle drug for him! I also give him 1/4 tsp of Miralax mixed with water twice a day. I add that to his food. 

Artie was having a very hard time pooping, until we got this combination together.

The specialist he sees has not problem with him continuing on with the cisapride. 

In fact, we just came from there.

The vomiting could be because he needs to poop...constipation can do that to a cat.

Good luck... and ((hugs)) to you for taking such good care of this injured little one.