Constipated, Obstipated. At a loss

Arloandme

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Hi everyone, I wonder if anyone can provide some insight and give me some sort of relief from the sleepless nights.

My beloved tuxedo cat, Arlo (1.5 years old), has been struggling and not quite right for almost 3 weeks now. It started with refusal of food, then he didn’t produce a bowel movement for a couple of days. This was over the weekend, I spoke to an emergency vet who wasn’t too concerned and took him to the usual vet first thing Monday morning. Arlo was otherwise fine in himself and they couldn’t feel much stool, they wondered if it might be dental although when looking in his mouth, they said it looked healthy. They gave him an anti-sickness injection and sent us away. The next day he still hadn’t used the bathroom though was eating a little bit. I took him back to the vets and they gave us lactulose to try, at a very low dose. 0.5ml three times a day. His eating got better and he produced a BM (hard, not a healthy one) every two days. It got to Wednesday and it had been 3 days without a BM, he was eating as normal at this point and I was adding water to his wet food and withholding dry food. I was still really concerned about him, I called the vet the next morning and brought him straight there. The vet did a physical exam and could feel lots of stool, they sent us straight to a veterinary hospital in another town and mentioned megacolon. I was absolutely beside myself with worry and went straight there, Arlo was there all day and received blood work (result - fine, nothing untoward, red blood cell count slightly on the high side) an x-ray (result - totally impacted with faeces, no blockage from a foreign object and no fracture etc.), IV fluids and an enema under sedation. I’m told there was a LOT of hard stool. They sent us away with antibiotics and a very high dose of lactulose, 3ml 3x a day. They instructed me to keep adding water to his food, and reintroduce the dry food.
That evening when we got home he was RAVENOUS. He ate a pouch of wet food, a mackerel loin, some dry food with added water and was still looking in the bins for more!
The next morning, he had a BM around 9.30am and it was very loose - which I’d expect following the enema and all the lactulose. He ate as normal, was in great spirits. I would mention that I tested positive for COVID this evening.
The next day, Saturday, another poop in the morning around 10am, this one very healthy. Smooth, normal healthy colour and quantity. The day after that (now Sunday), he had another poop again around 10am, this time a little darker and more textured but still soft/mushy and healthy. Eating fine. Monday came around, another poop (hoorah!) but not until 4pm ish. Same texture and consistency as the previous day. Tuesday came around. He refused his breakfast when I put it down. I continued with the lactulose in the syringe as normal and also some water in a syringe since he wasn’t eating or using the bowl/fountain/glass. No poop whatsoever. He eventually went back to his food and over the course of the day ate around 2 pouches of wet and a handful of dreamies.
Wednesday has came around, no poops as yet, he’s refused his breakfast this morning but did go back to it 20-30 mins later and eat 3/4 of it. Continuing with the lactulose. I would mention the past couple of days he is urinating quite a bit - 3/4 times daily.

I’m worried he’s becoming impacted again. I am going to phone the vets this morning, as they instructed me to if he doesn’t produce a BM for two consecutive days as he is at risk for megacolon.


Does anyone have any advice, insight, words of reassurance? What should I ask at the vets this time? (I’m still COVID positive so someone else would need to take him). Any advice is welcome. I am absolutely beside myself with worry, and want my lovely Arlo to be healthy and well.
 
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Arloandme

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You could try adding psyllium to his food, its a fibre, a pinch sprinkled on or mixed into his food twice a day. Also you could try lick e lix or the equivalent, just one tube a day. Try to give him as much water as you can.

https://www.tesco.com/groceries/en-GB/products/272409717
Thank you for your reply, I am very grateful. I’ve heard about psyllium I will look into it.
Unfortunately he won’t have lick e lix, or any paste/pate type treat or food. He is quite picky.
Trying my best to keep his water intake up, adding it to his wet food, I have a designated glass, bowls, and fountain but he doesn’t have much interest at the moment (after his enema and treatment he was drinking very well for 2 days then it diminished again). I am trying to encourage with a cat milk and water mix, and when that fails I am giving him water with a syringe slow and often.
 
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Arloandme

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Update - he has another vet appointment this afternoon, my Mum will take him since I am still COVID positive. She is going to call me when she’s there so that I can talk to the vet as well.
 
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Arloandme

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Update - Arlo’s been to the vet and they said there is no stool in his colon, so he’s not impacted again at the moment which is a relief.

It’s now Thursday and he hasn’t had a BM since Monday afternoon. He also hasn’t eaten since yesterday morning, and I am syringe feeding him water as he won’t drink
If no joy by Friday (tomorrow), they’ll take him in again for further testing and look into hypercalcemia (though I am convinced his slightly elevated calcium levels are a result of all the lactulose - I want to take him off the lactulose because of this and the fact that he clearly is not responding well to it) and megacolon again. They will probably look at starting cisapride as well.

If anyone has any positive results from cisapride, as well as an alternative to lactulose (don’t believe we have Miralax in the UK), please let me know.

Thank you
 

catloverfromwayback

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Hi, my Daisy has been on Cisapride for about 40 days and it’s definitely helping her. She has early megacolon.
You may find Miralax under a different name. It isn’t sold as that in Australia, either, but I got her a big container of Osmolax, which is the same.

eta the generic drug name is Polyethylene Glycol 3350.
 
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Arloandme

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Hi, my Daisy has been on Cisapride for about 40 days and it’s definitely helping her. She has early megacolon.
You may find Miralax under a different name. It isn’t sold as that in Australia, either, but I got her a big container of Osmolax, which is the same.

eta the generic drug name is Polyethylene Glycol 3350.
Thank you SO much for your response and your help. I pulled up a Google search for Polyethylene Glycol 3350 and it returned a few results, I think it’s Macrgol here (brand names Movicol, Laxido, CosmoCol). I will mention this to the vet (he’s due to call me at some point today) and ask if we can change over to something like that instead of the lactulose as I just don’t have a good feeling about it anymore. Hopefully a changed laxative and the Cisapride will help him. I’m pleased the Cisapride has been working well for Daisy, that’s great news!

I will speak to the vet again today, most likely Arlo will be back at the vet hospital tomorrow for further treatment and tests.
 
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Arloandme

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Update - spoke with the vet (he is GREAT!!! and really seems to understand what I am going through with this, though I do feel terrible for calling so much).
Arlo will have another appointment tomorrow morning for another enema, a change of his laxative and most probably a Cisapride script. Fingers crossed for him. (And for me because I am losing my mind!!!)

Thank you all.
 
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Arloandme

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catloverfromwayback catloverfromwayback if you don’t mind me asking, how long did it take Daisy to ‘go’ after starting the Cisapride? Arlo had an enema yesterday, there was not much there but was there was hard pellets. He had a dose of Cisapride last night and he’s had a dose of Cisapride this morning with 0.5ml lactulose and some Katalax paste off my hand. Not sure when to expect results.
 

catloverfromwayback

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catloverfromwayback catloverfromwayback if you don’t mind me asking, how long did it take Daisy to ‘go’ after starting the Cisapride? Arlo had an enema yesterday, there was not much there but was there was hard pellets. He had a dose of Cisapride last night and he’s had a dose of Cisapride this morning with 0.5ml lactulose and some Katalax paste off my hand. Not sure when to expect results.
Just looking back, it was after the third dose (she has two per day and had started the day before) that she did a good-sized poo. She’d been on Osmolax for a while, and slippery elm bark, but they weren’t producing consistent results. It was 4.20pm the first day when she had her first dose, then 8.30 am and 7.50pm the next day, and she did her poo at 8.05pm. I was a bit twitchy about how long it seemed to be taking, but my vets did say that it can take some cats a while to start reacting to it.
 
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Just looking back, it was after the third dose (she has two per day and had started the day before) that she did a good-sized poo. She’d been on Osmolax for a while, and slippery elm bark, but they weren’t producing consistent results. It was 4.20pm the first day when she had her first dose, then 8.30 am and 7.50pm the next day, and she did her poo at 8.05pm. I was a bit twitchy about how long it seemed to be taking, but my vets did say that it can take some cats a while to start reacting to it.
Thanks for your reply, it’s very helpful. Arlo has now had 4 doses, one on the evening of his last enema on Friday, then Saturday morning and Friday evening, and now this morning. Nothing in the litter tray in the way of poops yet, I am beside myself with worry. I have Smooth BM Gold due to be delivered today, heard very good things about it. Although, I’m really really starting to think it’s a big motility issue (where from I have no idea) rather than a dehydration/constipation issue. I omitted to mention during all of this that he doesn’t even attempt to go to the litter tray to poop. There’s no straining, no attempts. It’s as if he doesn’t remember he has to poo or doesn’t feel any inclination or desire. Hopefully he goes soon, and maybe an increased Cisapride dose is an option I don’t know. But if this doesn’t work, the next step is probably an internist or surgery which I am terrified about and don’t know how I’d finance it.
 
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Sorry, typo in my previous reply.
Arlo has now had 4 doses, one on the evening of his last enema on Friday, then Saturday morning and SATURDAY evening, and now this morning :biggrin:
 

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Thanks for your reply, it’s very helpful. Arlo has now had 4 doses, one on the evening of his last enema on Friday, then Saturday morning and Friday evening, and now this morning. Nothing in the litter tray in the way of poops yet, I am beside myself with worry. I have Smooth BM Gold due to be delivered today, heard very good things about it. Although, I’m really really starting to think it’s a big motility issue (where from I have no idea) rather than a dehydration/constipation issue. I omitted to mention during all of this that he doesn’t even attempt to go to the litter tray to poop. There’s no straining, no attempts. It’s as if he doesn’t remember he has to poo or doesn’t feel any inclination or desire. Hopefully he goes soon, and maybe an increased Cisapride dose is an option I don’t know. But if this doesn’t work, the next step is probably an internist or surgery which I am terrified about and don’t know how I’d finance it.
Daisy was just the same - no straining or crying at all, no signs of distress, just not going. The vets are assuming it’s early idiopathic megacolon. She’s young to get it (only 4) and poor Arlo is even more of an outlier if he has the same thing!
I wonder if he has anything to do yet, after that minimal empty out with his enema?
I asked the vet about surgery because that is eventually the only way to deal with megacolon when the motility agents stop working (ie the colon gets too distended). He basically said no, it’s a last resort, the risks with bowel resectioning are so high - something that the vet sites I’ve read online barely mention. They’re all “very high success rate”.
 
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Daisy was just the same - no straining or crying at all, no signs of distress, just not going. The vets are assuming it’s early idiopathic megacolon. She’s young to get it (only 4) and poor Arlo is even more of an outlier if he has the same thing!
I wonder if he has anything to do yet, after that minimal empty out with his enema?
I asked the vet about surgery because that is eventually the only way to deal with megacolon when the motility agents stop working (ie the colon gets too distended). He basically said no, it’s a last resort, the risks with bowel resectioning are so high - something that the vet sites I’ve read online barely mention. They’re all “very high success rate”.
Oh thank you so much, that puts my mind at rest a little because the other similar stories I’ve read, the kitties are at least attempting to go to the litter tray, but like Daisy, Arlo doesn’t show any signs of straining, distress, he just doesn’t go! You’re probably right, there is probably not much poop there yet to come out especially because I’ve essentially been withholding the dry food. It’s just so mentally draining all of this, isn’t it? I hope Arlo follows Daisy in doing well on the Cisapride. Thank you so much, your replies mean the world to me in a very difficult time!
 
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