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I apologize in advance for the length of this post.
My furbaby Chester is in trouble. We've treated him for megacolon for 3-4 years with cisapride and lactulose. We were giving him 1.5 ml cisapride 2x/day and 3 ml lactulose 2x/day. The vet had him eating basic canned wet food exclusively. No dry at all. After being boarded at the vet while we had to travel for work, Chester needed an enema - which we'd avoided for nearly a year. He hasn't been right since. That was in January. We ended up having to increase his lactulose to 4.5 ml 2 x per day. His stools were getting clay-like from all the lactulose and it still wasn't working. After more enemas maybe a month or so apart, he got backed up again and the vet had to put him under and go in to break up the blockage with an instrument. He told us at that point that Chester needed surgery to remove his colon. But he's 18 and I'm afraid he won't survive the surgery.
As we were checking out and taking Chester home to think about it for a few days, an employee there told us about Fiber Response and suggested we try it. It was the opposite of the low residue approach we'd been taking but we figured it was worth a shot if our vet okayed it and he did. The vet also told us to add Miralax to his wet food. So then we cut his canned food in half and added half his calories from the fiber response. At each meal, he got 1/6 of a cup of fiber response dry and 1/4 of a 5 oz can of wet food mixed with 1/4 tsp of Miralax. He was still getting 1.5 ml cisapride 2x per day and we cut his lactulose down to 3 ml 2x per day.
He farted. And farted and farted and farted. Foul smelling farts! Darn near killed us. But we didn't care BECAUSE HE WAS POOPING! Big ole formed but softish poop every day. Things went on like that for maybe 6 weeks. It was the best he'd been in YEARS and I was convinced that we'd licked the problem. But we hadn't.
The farting stopped over time and we assumed it was because he'd adapted to the new diet. I still think that's the case but I don't know for sure. But gradually his bowel movements became smaller and farther apart. (Over the course of 2-3 weeks, I'd say.) Somewhere during this time he started leaving "microturds" behind after he'd gotten up from laying down. They could be anywhere from the size of a raisin to the size of an olive. He seemed to have no idea it was happening. It wasn't producing an awareness of needing to use the litter box as far as we could tell. They were in his beds, in the middle of the floor, in OUR bed at night...wherever he'd lie down. We thought it was a sign that maybe the cisapride dosage was too high now and on the vet's advice we lowered it from 1.5 to 1.0 ml 2 x per day for a couple of days. His bowel movements got worse. So we stopped that and went back to his normal dose. Then he stopped going at all. The difference this time is that there are no unproductive trips to the litter box. Usually when he gets backed up we'll see him posture to poop and nothing happens. This time, he made no effort to posture to poop. He'd go in, pee, and walk away. So at that point he was leaving his "microturds" around the house, was clearly backed up, and was making no effort to move his bowels at all.
I took him back to the vet last Tuesday. They did two enemas and did get him "mostly cleaned out". He came home Wednesday evening. He did have another small bowel movement in his litter box that night. And I've seen nothing since. It's Sunday afternoon So almost 4 full days since a confirmed bowel movement. There's a chance that we missed something as we have 5 litter boxes and 4 other cats. But I don't think so. He feels "full" to me (I don't mean that I can feel his colon. His belly always feels so tight and distended to me I'm confused about how people say they can feel that. I just mean that he feels heavy...like he needs to go.) The vet told me - based on the fact that the Fiber Response seemed to be helping - that maybe we should cut the wet food down even more (say to 1/8 of a can per meal) to make sure he eats the dry food. It's not working. Chester now doesn't really want to eat much of the Fiber Response. He loved it at first but now he'd much rather have the wet. His appetite has fallen off significantly in the last few days. I'm wondering if he's nauseous. Nothing about this situation is going in the right direction.
I should also say that he clearly has some arthritis in his hips now and some spondylosis in his lumbar spine. (Is it called "lumbar" in cats?) The vet has wondered if there isn't a neurological issue arising from the spondylosis or a pain/avoidance issue arising from the arthritis. However, Chester still makes small jumps like up onto the couch or onto the bathtub to ask for a sink drink.
Chester drinks a LOT of water. So much so that I've periodically asked my vet to do blood work looking for diabetes, renal trouble, metabolic issues...so far the values have all come back within normal ranges. We sent some blood to a lab at Texas A&M and they said he might have IBD so he's on prednisone every other day. Honestly I'm not sold on that diagnosis and can't say I've seen any difference whatsoever related to the prednisone. The point is, for an 18 year old kitty, he's pretty darn healthy other than the megacolon.
If he doesn't move his bowels by Monday morning, naturally I'll call the vet again. But then what? They're going to tell me that we're back to the point of needing to do surgery and I'll be back to thinking that he won't survive it because he's 18. He doesn't act like he's in pain most of the time. He purrs. He asks to be picked up and gives hugs. He looks fantastic. He seems so healthy in every other way. It's killing me to consider euthanizing him or putting him through a hard surgery that will likely kill him. I don't know what to do...what to try. I'm afraid to try to change too many variable at once. I'm afraid to not try anything. I love him to pieces. I'm feeling pretty desperate. He's counting on me and I don't have any answers. In the last 3 years I've lost a brother, a sister, a father-in-law, 3 geriatric rescue kitties/furkids, and a dog. I don't want to say goodbye to my "old man" too. I'm not ready. And there's nothing about the REST of his condition/attitude that says he's ready to go either. (I wouldn't be selfish if he was....when it's clear that it's time, I put my big girl pants on and let them go.) I have to know I tried everything I could before I agree to surgery or euthanasia. (Just tying that word makes me lose it.)
Again - sorry for the length of this post. And I'm sure you've answered these questions 101 times in the past. I'm sorry for asking again. What would you suggest that I do next? I have a day to decide what my plan is going to be since I'm probably going to have to call the vet tomorrow morning. I'm so, so sad. I really thought we'd found our answer. :-(
Thoughts? Should I try increasing the Miralax from 1/4 tsp twice a day? Should I try increasing the cisapride from 1.5 ml twice a day? Should I ditch the dry food? Should I try slippery elm? Should I have them do another enema tomorrow and try to start out fresh again? I'd normally never ask anyone other than my vet about medicines and dosages. Same vet for over 10 years. But he seems stumped now. He just wants to do surgery and frankly I feel like he's given up. There are "baby docs" there (recent grads from U Penn) and the office has experienced a lot of turnover and the whole place seems to be in disarray. I don't have the same level of confidence I used to, sadly.
Anyone have experience with any of this?
P.S. Does anyone know if the Yahoo group about cats with megacolon is still active? I read about it during my manic research stint this weekend and people raved about it. I found it and joined and posted a version of this novella but so far no one has looked at it or commented.
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My furbaby Chester is in trouble. We've treated him for megacolon for 3-4 years with cisapride and lactulose. We were giving him 1.5 ml cisapride 2x/day and 3 ml lactulose 2x/day. The vet had him eating basic canned wet food exclusively. No dry at all. After being boarded at the vet while we had to travel for work, Chester needed an enema - which we'd avoided for nearly a year. He hasn't been right since. That was in January. We ended up having to increase his lactulose to 4.5 ml 2 x per day. His stools were getting clay-like from all the lactulose and it still wasn't working. After more enemas maybe a month or so apart, he got backed up again and the vet had to put him under and go in to break up the blockage with an instrument. He told us at that point that Chester needed surgery to remove his colon. But he's 18 and I'm afraid he won't survive the surgery.
As we were checking out and taking Chester home to think about it for a few days, an employee there told us about Fiber Response and suggested we try it. It was the opposite of the low residue approach we'd been taking but we figured it was worth a shot if our vet okayed it and he did. The vet also told us to add Miralax to his wet food. So then we cut his canned food in half and added half his calories from the fiber response. At each meal, he got 1/6 of a cup of fiber response dry and 1/4 of a 5 oz can of wet food mixed with 1/4 tsp of Miralax. He was still getting 1.5 ml cisapride 2x per day and we cut his lactulose down to 3 ml 2x per day.
He farted. And farted and farted and farted. Foul smelling farts! Darn near killed us. But we didn't care BECAUSE HE WAS POOPING! Big ole formed but softish poop every day. Things went on like that for maybe 6 weeks. It was the best he'd been in YEARS and I was convinced that we'd licked the problem. But we hadn't.
The farting stopped over time and we assumed it was because he'd adapted to the new diet. I still think that's the case but I don't know for sure. But gradually his bowel movements became smaller and farther apart. (Over the course of 2-3 weeks, I'd say.) Somewhere during this time he started leaving "microturds" behind after he'd gotten up from laying down. They could be anywhere from the size of a raisin to the size of an olive. He seemed to have no idea it was happening. It wasn't producing an awareness of needing to use the litter box as far as we could tell. They were in his beds, in the middle of the floor, in OUR bed at night...wherever he'd lie down. We thought it was a sign that maybe the cisapride dosage was too high now and on the vet's advice we lowered it from 1.5 to 1.0 ml 2 x per day for a couple of days. His bowel movements got worse. So we stopped that and went back to his normal dose. Then he stopped going at all. The difference this time is that there are no unproductive trips to the litter box. Usually when he gets backed up we'll see him posture to poop and nothing happens. This time, he made no effort to posture to poop. He'd go in, pee, and walk away. So at that point he was leaving his "microturds" around the house, was clearly backed up, and was making no effort to move his bowels at all.
I took him back to the vet last Tuesday. They did two enemas and did get him "mostly cleaned out". He came home Wednesday evening. He did have another small bowel movement in his litter box that night. And I've seen nothing since. It's Sunday afternoon So almost 4 full days since a confirmed bowel movement. There's a chance that we missed something as we have 5 litter boxes and 4 other cats. But I don't think so. He feels "full" to me (I don't mean that I can feel his colon. His belly always feels so tight and distended to me I'm confused about how people say they can feel that. I just mean that he feels heavy...like he needs to go.) The vet told me - based on the fact that the Fiber Response seemed to be helping - that maybe we should cut the wet food down even more (say to 1/8 of a can per meal) to make sure he eats the dry food. It's not working. Chester now doesn't really want to eat much of the Fiber Response. He loved it at first but now he'd much rather have the wet. His appetite has fallen off significantly in the last few days. I'm wondering if he's nauseous. Nothing about this situation is going in the right direction.
I should also say that he clearly has some arthritis in his hips now and some spondylosis in his lumbar spine. (Is it called "lumbar" in cats?) The vet has wondered if there isn't a neurological issue arising from the spondylosis or a pain/avoidance issue arising from the arthritis. However, Chester still makes small jumps like up onto the couch or onto the bathtub to ask for a sink drink.
Chester drinks a LOT of water. So much so that I've periodically asked my vet to do blood work looking for diabetes, renal trouble, metabolic issues...so far the values have all come back within normal ranges. We sent some blood to a lab at Texas A&M and they said he might have IBD so he's on prednisone every other day. Honestly I'm not sold on that diagnosis and can't say I've seen any difference whatsoever related to the prednisone. The point is, for an 18 year old kitty, he's pretty darn healthy other than the megacolon.
If he doesn't move his bowels by Monday morning, naturally I'll call the vet again. But then what? They're going to tell me that we're back to the point of needing to do surgery and I'll be back to thinking that he won't survive it because he's 18. He doesn't act like he's in pain most of the time. He purrs. He asks to be picked up and gives hugs. He looks fantastic. He seems so healthy in every other way. It's killing me to consider euthanizing him or putting him through a hard surgery that will likely kill him. I don't know what to do...what to try. I'm afraid to try to change too many variable at once. I'm afraid to not try anything. I love him to pieces. I'm feeling pretty desperate. He's counting on me and I don't have any answers. In the last 3 years I've lost a brother, a sister, a father-in-law, 3 geriatric rescue kitties/furkids, and a dog. I don't want to say goodbye to my "old man" too. I'm not ready. And there's nothing about the REST of his condition/attitude that says he's ready to go either. (I wouldn't be selfish if he was....when it's clear that it's time, I put my big girl pants on and let them go.) I have to know I tried everything I could before I agree to surgery or euthanasia. (Just tying that word makes me lose it.)
Again - sorry for the length of this post. And I'm sure you've answered these questions 101 times in the past. I'm sorry for asking again. What would you suggest that I do next? I have a day to decide what my plan is going to be since I'm probably going to have to call the vet tomorrow morning. I'm so, so sad. I really thought we'd found our answer. :-(
Thoughts? Should I try increasing the Miralax from 1/4 tsp twice a day? Should I try increasing the cisapride from 1.5 ml twice a day? Should I ditch the dry food? Should I try slippery elm? Should I have them do another enema tomorrow and try to start out fresh again? I'd normally never ask anyone other than my vet about medicines and dosages. Same vet for over 10 years. But he seems stumped now. He just wants to do surgery and frankly I feel like he's given up. There are "baby docs" there (recent grads from U Penn) and the office has experienced a lot of turnover and the whole place seems to be in disarray. I don't have the same level of confidence I used to, sadly.
Anyone have experience with any of this?
P.S. Does anyone know if the Yahoo group about cats with megacolon is still active? I read about it during my manic research stint this weekend and people raved about it. I found it and joined and posted a version of this novella but so far no one has looked at it or commented.
Reply
Delete