Constipation and throwing up

We have a 3 year old Cornish Rex named Phoenix. He is our 3rd Rex. His current brother is 16 years old and they are best buddies.
About 2 weeks ago Phoenix started throwing up a couple of hours after he ate. But not after every meal. After 4 days of this we took him to our vet and when they xrayed him they found him very constipated. They gave him an enema and we went home. 3 days later back to the vet. Same treatment and then lots of blood work. NOTHING turned up in bloodwork. Next step was an ultrasound where they saw thickening at the upper colon wall. Took him to specialty vet hospital and another ultrasound did not show the thickening. So they could not needle biopsy. They saw continued constipation, NOT Megacolon.
Next day upper and lower scoping without seeing anything like masses or objects. They took biopsies and we are waiting for results. I am spending a lot of time at the hospital with them. They are very gracious about me being able to hang out with him. He had a good meal today while I was there. Other thoughts are motility issues, Intestinal Bowel Disease? Any other thoughts from folks on this site would be greatly appreciated. Thank you

Oh dear. Was the throwing up after he tried to use the litter box? Straining hard enough from constipation can cause cats to vomit.

If they aren't seeing any inflammation, it's not likely IBD and they're just throwing that out there because they don't know what's actually going on. The vets I've been to have all been able to get a sense of motility from the physical exam.

My then 4 year old cat went through something similar when I first adopted her. After 4 enemas, 2 x-rays, 1 anal gland expression, and an ultrasound in 2 weeks, I finally found a vet that focused her studies on nutrition. At her worst she was vomiting, crying, not eating, lethargic, dehydrated, and had a fever. Now, she's symptomless except she only goes every other day on average, and her stool is still a bit dry and small. What causes this constipation is still a mystery, but I have been able to keep it under control after doing a lot of experimentation and help from that vet. Bear with me, it's been a long saga, but I've included it here so maybe what we've tried can give you some insight.

I tried both keeping the cat on the food her foster fed her (and apparently had no constipation issues on, although I don't know how much I believe that because she was having "litter box avoidance issues" in her foster home that I never learned the details about) and feeding her high quality canned (Wellness CORE) and neither made a difference. Since then I've tried her on a lot of different good quality canned foods and there's never been a noticeable difference, so I've ruled out any specific ingredient causing her problems.

What helped her get over the initial worrying bouts of constipation was a combo of mixing extra water and 1/4 teaspoon Miralax with her meals in the morning and evening (when her appetite was low I added the Miralax to some Gerber baby food to make sure she ate the full amount), and also Cisapride for 2 weeks as prescribed by the vet. Cisapride stimulates the intestinal muscles to contract, and although she does not have megacolon, I think recent lack of use of those muscles due to the constipation made it necessary for something extra to kickstart that movement again. After those 2 weeks she was kind of okay again, and I kept adding Miralax, and also a fiber my vet recommended called acacia fiber powder. This is tasteless, but it works the same way as canned pumpkin by absorbing water and making the stool softer and also feeding the good gut bacteria.

The mixture of Miralax and acacia fiber in with her food worked okay for a while . She would have a bowel movement only every other day, but the vet said that was good for her. Sometimes she wouldn't go in the litter box though, which was a sign to me that she was experiencing pain. Things stayed like this for about 4 months. Not perfect bowel movements but not constipated to the point where she needed to see a vet or have an enema again. She was healthy at her annual exam in December (I adopted her in July).

The miralax and fiber have started to lose their effectiveness overtime, however. I've tried a lot of different remedies, some that have worked well and others not so much. I noticed if I ever added something with a hint of cellulose or other insoluble fiber that she wasn't used to, it would have pretty instantaneous results and everything would get pushed out, but she would get very uncomfortable, be crying in pain, and running around the house. So I mostly stay away from any kind of fibrous supplement now. I do not give Miralax every day, just every few days or when it's been a couple days since a bowel movement, and that seems to be how it works the best. The same for the acacia fiber. If I add too much of either she'll get soft stools make her very uncomfortable and get stuck in her fur, so I have to kind of monitor that.

The best thing I've tried is probiotics. I add them to every meal now, and she ALWAYS goes in the litter box, which is huge and means she's not uncomfortable! Her stool is still a little on the dry and small side, but I think they help a great deal because she feels so much better. I've been using Pet Ultimates Probiotics, but I might switch to just an acidophilus capsule and see if it works as well. I'm also considering adding enzymes.

My theory for this idiopathic constipation is that her digestive system got out of sync somewhere along the way. She was overweight when I got her from food that contained too much potato, and she doesn't like to drink water, so that on top of the stress of being adopted was too much and threw things out of wack. The food that she eats is processed, cooked, canned food, which even the best contains extraneous plant ingredients and not any intestinal flora that a wild animal would get from eating the guts of its prey. A raw diet is something I might pursue in the future, but I will want to be very careful with that because my girl is FIV positive and I don't want to take any risks with exposure to pathogens. So, I feed her high quality canned foods with lots of extra water added plus the probiotics, and maybe that is getting her digestive system closer to how it should be functioning. The vet said carrageenan in the Wellness was not likely to have created this mess, but just to be safe I've eliminated carrageenan from her diet. Her treats all freeze-dried pure meat. She gets brushed thoroughly every day, because a lot of that hair ends up in her stool otherwise and makes things worse. She's also losing weight, which has increased her energy and activity levels some, which I think must be helping somewhat.

Things I have tried that were not successful but might work for other cats:

-Pumpkin (she just wasn't a huge fan and I couldn't tell if she had lack of appetite from constipation or she just didn't like it so I stopped adding it to her food)

-Slippery elm bark - it's supposed to lubricate the intestinal tract, but worked too well for comfort

-Lactulose - Prescribed by the vet, but Miralax worked better

-Psyllium husk - another fiber, but it made her really uncomfortable as well. I did use it early on when she would start to go a couple days without a bowel movement just to push everything out and avoid going back to the vet for yet another enema

Nature's Variety Instinct food is now part of her rotation, and the first few times I fed it to her she had comfortable bowel movements immediately after. It doesn't have quite a dramatic effect any more, but I still feed it and I think it has something to do with the montmorillonite clay in the ingredients. I also feed Holistic Select and Whole Earth Farms.

Sorry for dumping all that info on you. I hope something in there is helpful, and I really hope your kitty is feeling better soon. I know how frustrating and worrying this gets!

ETA: Don't let a vet prescribe any sort of dry food diet. I didn't emphasize this enough above because my cat had already been on canned food so dehydration was not the original culprit of her constipation, but water intake is very important and an all canned diet is so much better than dry!

You are very kind to take the time and share all this information. I finally got a chance to read it all carefully. Since I wrote that original note I have gotten the biopsy reports and have a little more information about what's going on for Phoenix. For one thing he is a Cornish Rex so there are no hairball issues. This health crisis came on suddenly. It turns out that he does have some mild to moderate inflammation in his stomach and in his colon. The throwing up could be caused by acid so he is on tiny amounts of Pepcid. They were giving it to him in his IV in the hospital and it seemed to have worked. I brought him home tonight and have started him on a one quarter tablet of a 10 mg Pepcid twice a day. Also he is taking 1 mL of lactulose twice a day to soften his stools. I am encouraged to hear that normal bowel movement can be every other day and it doesn't have to be that perfect type. When you have two cats it gets a little tricky to keep your eye on these things too.
About six weeks ago I changed his dry food brand. He has been eating crunchy food and wet food all along. Now I have to simplify his food and give him small quantities also. I was stupidly giving him all sorts of dental treats and science diet TD and Temptations treats too. I had been feeding him Origins dry food and then switched him six weeks ago. So he is back to Origins. And one type of wet food. He also was been getting three different varieties of wet food because his older brother who has no teeth eats wet food and it's hard to give one and not the other. He is super finicky so that's why such a variety. I made a high-quality cat and dog food for my pets many years ago. I used Dr. Pitcairns book to make the food. I did it for a long time. I am seriously considering doing it again.
I hear your concerns about petfood. I am definitely reevaluating this Phoenix is an avid water drinker. And his wet food/dry food intake is 50-50 so I am not concerned about dehydration. That definitely doesn't like Metamusil.
The biopsy also showed that there are some cells in the colon from one area which could be indicators of small cell lymphoma. For another $350 we can have that extensive test done with the existing sample that they still have. The sample will stay good for two weeks so I think it's probably a prudent thing to do. If that comes out positive we have a whole new kettle of fish.
Again thank you so much for all of your info. I will stay tuned on this site and report any updates that I have.

I did not answer one of your questions. He does not throw up after he try's to use the box. We think it's a nausea issue. This morning he has kept down 1 teaspoon of wet food after having. 1/4 Pepsid 1 1/2 hrs before. Still waiting and hoping for good bowel results after all the enemas this week.

try the miralax. My guy has IBD. He is on a novel protein diet. He does not have the diarrhea which is usually associated with IBD. He has constipation issues. When he is constipated, he will not eat and vomits.

I use Natures Variety Rabbit, along with 1/4 tsp of Miralax mixed with water-twice a day, along with the cisapride twice a day. This regimen has worked wonders. 

I also discover he is allergic to chicken. As soon as he would have chicken, he came right over to me and vomited.. I finally associated the two. 

Good Luck!

Hi again.  I noticed you communicated with Mommyofthree708 about constipation.  You and I have the common IBD as well.  Here is where we are now:

I took Phoenix to a holistic vet.  She confirmed what I had been thinking in regard to the throwing up.  Since his food was undigested 3-4 hours after eating I thought that maybe here is where the problem started.  She pronounced it as stasis of the stomach.  If the food takes a ton if time to digest and then it takes a long time to travel the rest of the way too, then the moisture is sucked out and hence the constipation.

She prescribed:

Khan herbals (human grade and in kitty doses)  called Harmonize the Stomach

An enzyme to help digest proteins and not starch. 2 times a day 

1/4 teas of Miralax once a day

He is still taking anti-emetics (Ondansetron) 2mg and 1/2 of 10 mg of Pepsid 2 times a day (using the generic Pepsid but NO ADDITIONAL ingredients)

 

He is on total protein only diet (I cannot wrap myself around raw) so we found Evangers Whole Sardines and also a brand called Hound and Gatos.He is a fussy boy to begin with so that ads to the challenge.  We are going 7 plus days at a time without throwing up now. I am relieved.  Poops are good and mostly daily now.

By the way, we get immediate throwing up reaction to chicken as well as our older cats Science Diet KD!

Take care and thanks for your reply.