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Cat Forum / Health and Behavior / September 2005Harriet isn't doing well
Harriet, a bookstore cat, was in the hospital twice last month for severe constipation. She was completely blocked, and received enemas & fluids both times. She was put on a prescription diet (Eukanuba Low Residue canned) and Lactulose 1ml daily. Since there's another cat at work, it's been hard to know if Harriet has been pooping. Since her second hospitalization, I had witnessed her using the box twice but both times she just left one small turd. I decided to take her home for the long weekend. I brought her home with me on Friday night, and brought her back to work this morning. She only passed one small turd over the weekend. She used the box to urinate as usual. Since we've been back at work, she's been in the box outside my office several times but doesn't do anything. Last night at home she made several trips to the box in my bedroom as well, with no results. I called the vet, and he's supposed to call me back within the next 90 minutes. Last time I had asked what happens if the food/Lactulose don't solve the problem and he evaded my questions. We can't exactly take Harriet to the vet every week for enemas. Someone (Phil?) had mentioned baby glycerin suppositories, so I'm going to ask about that when I speak with the vet. Other people have mentioned adding pumpkin or fiber to her food, but that would end up increasing the amount of waste, which she is not able to eliminate. That's why they prescribed the low residue food, not that it's doing any good. I'm very worried about her. She must be very uncomfortable but she's not showing it. She's only 8 years old, and we don't want to lose her. -- Liz > Harriet, a bookstore cat, was in the hospital twice last month for > severe constipation. She was completely blocked, and received enemas & [quoted text clipped - 28 lines] > -- > Liz Speak to your vet Colace -its a stool softener that comes in disposable enema syringes (Disposaject). It also comes in capsules that might be a little easier to administer. Keep the faith. Good luck. Phil > Speak to your vet Colace -its a stool softener that comes in disposable > enema [quoted text clipped - 6 lines] > > Phil Phil, I took Harriet back in a little after 3pm. The vet said that they'll empty her out today, and tomorrow start her on cisapride (Propulsid). He said I can also give her the Lactulose twice a day. I asked about another stool softener but he said to stay with the Lactulose. We've had Harriet on only wet food for several weeks now. She's not too crazy about it but she's getting better at eating more when it's put down, instead of taking a tiny taste & walking away. Do you think that the Eukanuba Low Residue food is a good choice, or are there good quality premium cat foods that are just as good? Wellness? Petguard? Also, I've still been giving her a piece of freeze dried chicken as a treat each day. Should I cut that out? -- Liz > I took Harriet back in a little after 3pm. The vet said that they'll > empty her out today, and tomorrow start her on cisapride (Propulsid). > He said I can also give her the Lactulose twice a day. I asked about > another stool softener but he said to stay with the Lactulose. Poor girl. I hope this will solve her problem, Liz. Candace > > Speak to your vet Colace -its a stool softener that comes in disposable > > enema [quoted text clipped - 13 lines] > He said I can also give her the Lactulose twice a day. I asked about > another stool softener but he said to stay with the Lactulose. The Lactulose dose might be too low. What's the dose? In chronic cases, I've had pretty good luck with 0.5 ml/kg q 8-12 hrs, (2 ml q8hr for a 9 lb cat) - You might have to taper the dose if she develops diarrhea or a lot of gas. I usually leave the diarrhea alone for a day or two and then very gradually taper the dose. I think aiming for stools on the softer side of normal gives you a wider margin of safety and more time to adjust the dose if you notice the stools starting to harden up a little. I think cisapride will help a *great* deal. Why didn't your vet start it sooner if he was able to get it? Cisapride and lactulose are the ideal combination for chronic constipation. Please let me know how she does on them. > We've had Harriet on only wet food for several weeks now. She's not > too crazy about it but she's getting better at eating more when it's > put down, instead of taking a tiny taste & walking away. Do you think > that the Eukanuba Low Residue food is a good choice, or are there good > quality premium cat foods that are just as good? Wellness? Petguard? To tell you the truth, I don't see a major difference between Euk Los Res and SD Turkey & Giblets. But please don't make any dietary changes without speaking to your vet. The most important thing right now is that she eats- Turkey & Giblets is much more palatable and might stimulate her to eat more. What was her regular diet before she developed constipation? > Also, I've still been giving her a piece of freeze dried chicken as a > treat each day. Should I cut that out? If you want to give her treats- try to give her moist treats. Its *very* important that she eats and drinks. At this point- it probably doesn't matter what. Malnutrition and dehydration can slow down colonic transit time and allows the colon to absorb more water from the feces making them even drier and harder. Canned food is obviously better because of the increased water intake- however <gag> more water is lost to fecal moisture with dry food which is maybe what you want -- providing she's drinking plenty of water. Constipation in cats can be very difficult to manage because it can become self-perpetuating. i.e., she feels pain when she tries to poop, so, she voluntarily holds in the poop which makes the feces drier and harder and difficult if not impossible to pass. I hate to say it, but sometimes the only way to get a constipated cat to start pooping on her own again is to give her mild diarrhea from which she won't feel any pain. Once she's pooping, gradually taper the lactulose dose until the stools are formed but still on the soft side of normal. Its very important that she remains wee hydrated during this time. You might want to think about getting her DrinkWell fountain to stimulate her to drink more. Please keep me posted on her progress. Best of luck. Phil > The Lactulose dose might be too low. What's the dose? In chronic cases, > I've had pretty good luck with 0.5 [quoted text clipped - 4 lines] > safety and more time to adjust the dose if you notice the stools starting to > harden up a little. I forgot to ask how much she weighs now. Last year at her annual checkup, she was around 11 pounds. She has definitely lost some weight, so she's probably between 9-10 pounds; closer to 10. She had been getting 1ml of Lactulose daily, and the vet said to give it to her twice a day now. > I think cisapride will help a *great* deal. Why didn't your vet start it > sooner if he was able to get it? Cisapride and lactulose are the ideal > combination for chronic constipation. Please let me know how she does on > them. I don't know why he didn't offer it last time. From what he said, I didn't think they'd be able to get it and that it was no longer an option. I just gave her the first capsule this morning. > To tell you the truth, I don't see a major difference between Euk Los Res > and SD Turkey & Giblets. But please don't make any dietary changes without > speaking to your vet. The most important thing right now is that she eats- > Turkey & Giblets is much more palatable and might stimulate her to eat more. > What was her regular diet before she developed constipation? Boith Harriet & Stinky were eating SD Light, wet & dry. Harriet preferred the dry *much* more than canned. I'd give them the canned for dinner and she would usually only eat a little bit. Now that she hasn't been getting any dry, she's eating more of the canned at each meal. Still, she's only been eating a total of maybe 1/2 of a can (6 oz can)on her good days. Many days it's not even half. I have some Wellness Chicken flavor, and SD Chicken & Liver cans at work that I haven't brought home to my cats yet. I'll see if I can find the SD Turkey & Giblets today, and see how she reacts to that. I've only got one can of the prescription food left, so I have to go back to the vet again to get more. I wasn't able to carry the food & Harriet back to work yesterday. > > Also, I've still been giving her a piece of freeze dried chicken as a > > treat each day. Should I cut that out? [quoted text clipped - 7 lines] > food which is maybe what you want -- providing she's drinking plenty of > water. She does drink water. She loves the Drinkwell fountain in my office and comes in for long drinks 2-3 times a day while I'm here. She urinates normally, several times a day. I think she had been urinating more, because she'd go in the box to try to poop. When she couldn't, she'd often just pee a little. > Constipation in cats can be very difficult to manage because it can become > self-perpetuating. i.e., she feels pain when she tries to poop, so, she [quoted text clipped - 6 lines] > hydrated during this time. You might want to think about getting her > DrinkWell fountain to stimulate her to drink more. Last month she had pooped out of the box several times. She still goes to the box(es) often, with no results, but she doesn't seem afraid of trying. She did eventually give up and poop elsewhere. A couple of times she would drop one piece on the rug, and then go back into the box to finish. Right now, diarrhea would seem like a blessing! The vet did say to watch for it after he said I could increase the Lactulose. I picked her up yesterday morning, and today will be her first day on the Cisapride and Lactulose X 2. With her increased medication schedule, I'm really worried about the weekends. There's nobody here on Saturday who will do it, which is why I had been coming in. Sundays are covered for now. I told my boss that we might have to get a cat sitter in for Saturdays, because I'm getting tired of working 6 days a week. I'll check the bulletin boards at the vet's when I go for more food. -- Liz > > The Lactulose dose might be too low. What's the dose? In chronic cases, > > I've had pretty good luck with 0.5 [quoted text clipped - 10 lines] > been getting 1ml of Lactulose daily, and the vet said to give it to her > twice a day now. Personally, I think the dose is too low. I think its wiser to start with the higher dose I mentioned and just taper the dose if she develops diarrhea. At least a little diarrhea will give her immediate relief. > > I think cisapride will help a *great* deal. Why didn't your vet start it > > sooner if he was able to get it? Cisapride and lactulose are the ideal [quoted text clipped - 60 lines] > vet did say to watch for it after he said I could increase the > Lactulose. > I picked her up yesterday morning, and today will be her first day on > the Cisapride and Lactulose X 2. With her increased medication [quoted text clipped - 4 lines] > week. I'll check the bulletin boards at the vet's when I go for more > food. What are the chances of bringing her home over the weekends until her constipation resolves? I think its imperative that she doesn't miss a dose- you might lose any ground you've gained by missing doses. Speak to your vet about upping the lactulose to 0.5 ml/kg q 8-12 hrs- this is an approved dose and not simply my opinion. If you would like, I'll send you the drug monograph for lactulose. Best of luck, Phil. > Personally, I think the dose is too low. I think its wiser to start with > the higher dose I mentioned and just taper the dose if she develops > diarrhea. At least a little diarrhea will give her immediate relief. The first vet she saw, who originally prescribed the Lactulose, had mentioned upping the dose. I've spoken to a different vet the last two times, though. The other one doesn't seem to be in when I call. I know that diarrhea isn't pleasant but even that would be better than nothing coming out. I'll see if I can talk to the vet tomorrow. > What are the chances of bringing her home over the weekends until her > constipation resolves? I think its imperative that she doesn't miss a > dose- > you might lose any ground you've gained by missing doses. I do plan on bringing her home again this weekend. She doesn't enjoy it, but it doesn't completely freak her out either. As long as my cats can't actually see her, everything is peaceful. Tiger, 15 years old, didn't even care that Harriet was here and ignored her. Otto had some issues, but even he managed to spend time in the bedroom with Harriet with very little trouble. They both slept on the bed for awhile, with a blanket bunched up down the middle (one on either side). Otto acts completely normal when Harriet is locked in the bedroom. If he can't see her, he doesn't think about her. If I let him back in the bedroom, he looks out the window, sleeps on the floor under the bed, checks out the litter box and only when he finally sees Harriet again does he react. Otto isn't very bright. -- Liz > > Personally, I think the dose is too low. I think its wiser to start with > > the higher dose I mentioned and just taper the dose if she develops [quoted text clipped - 5 lines] > that diarrhea isn't pleasant but even that would be better than nothing > coming out. I'll see if I can talk to the vet tomorrow. Good idea. Mention to him that the current dose isn't working and that the other vet also mentioned a higher dose. The dose I mentioned (0.5 ml/kg q 8-12 hrs, [2 ml q8hr for a 9 lb cat]) is in the high end of the recommended doses. The possible adverse effect of a higher dose is diarrhea- which isn't such a bad prospect at this point. You can always taper the dose once she becomes regular. You might also want to ask him about giving Harriet milk. Milk works wonders in some constipated cats- I'd let her drink as much milk as she wants right now and taper that dose also once she starts pooping regularly. I hope the vet didn't prescribe a conservative dose of cisapride, also. At this point, I think she needs aggressive pharmacologic management (0.5-1.0 mg/kg q8-12h- probably 1 mg/kg q8hr). I gotta feeling Harriet would do much better under the other vet's care. The current vet seems a bit too conservative for Harriet's case. Just my opinion. Constipation must resolved quickly in cats because it can become self-perpetuating and lead to megacolon. > > What are the chances of bringing her home over the weekends until her > > constipation resolves? I think its imperative that she doesn't miss a [quoted text clipped - 12 lines] > sleeps on the floor under the bed, checks out the litter box and only when > he finally sees Harriet again does he react. Otto isn't very bright. Bringing her home doesn't sound like it stresses her out very much. Giving your other cats- especially Otto- a little extra attention might help him understand Harriet isn't taking over his turf or you and help him adjust to her presence a little easier. I'd probably keep them separated- might be safer and less stressful for all concerned- especially Harriet. Stress and/or intimidation might cause her to voluntarily inhibit defecation. Your dedication is certainly admirable! Best of luck, Phil. > Good idea. Mention to him that the current dose isn't working and that > the [quoted text clipped - 3 lines] > diarrhea- which isn't such a bad prospect at this point. You can always > taper the dose once she becomes regular. That's what the vet said, too. If she does have diarrhea, the dose would have to be lowered. > You might also want to ask him about giving Harriet milk. Milk works > wonders in some constipated cats- I'd > let her drink as much milk as she wants right now and taper that dose also > once she starts pooping regularly. Harriet does like milk. I often eat breakfast at work, usually cold cereal with skim milk. She loves to lap up some milk when I'm finished. My cat Tiger, at home, also loves milk and I'd always let her have some when I finished my cereal. She never had any problems from the milk, but she rarely gets any now since I don't eat breakfast at home. I'll offer Harriet a little milk today. > I hope the vet didn't prescribe a conservative dose of cisapride, also. > At > this point, I think she needs aggressive pharmacologic management (0.5-1.0 > mg/kg q8-12h- probably 1 mg/kg q8hr). The bottle doesn't indicate a dose, it just says to give 1 a day. They're capsules with white powder inside. I've just been poking them down her throat. I don't trust putting any medication in her food, since she doesn't always finish what she's given. > Bringing her home doesn't sound like it stresses her out very much. > Giving [quoted text clipped - 4 lines] > safer and less stressful for all concerned- especially Harriet. Stress > and/or intimidation might cause her to voluntarily inhibit defecation. There's been less hissing & growling so far during this visit. Harriet is still doing most of it but Otto has mostly given up. Tiger still doesn't care about or notice that Harriet's even here. She just wants to get into my bedroom to drink from Harriet's water bowl. Tiger loves to drink and even though she has a Drinkwell fountain (which she uses all the time) she's always available if another water source shows up. She was drinking warm water out of a new foot bath I got this week. I went in to check on Harriet before and couldn't find her. My bedroom isn't big and there are a limited number of places she could hide. I could NOT find her. Then I heard some rustling and checked under the bed for the third time, and saw a lump in the fabric that coveres the bottom of the boxspring. I have no idea how she got in there, and I couldn't find any rips in the fabric or any loose edges. I left and the next time I checked she was on the bed. Last night, after I got home and fed my cats in the kitchen & Harriet in the bedroom, I opened the bedroom door. Otto went in but there were no noises, so they were probably ignoring each other. Later, Otto got into the armoire for a nap. I was in the kitchen making dinner and eating. Later on I went into the bathroom to check the box, and there were two loads of poop. One looked bigger than my cats normally make (bigger in the turd size, not overall quantity). I thought Harriet left the bedroom and used that box but I can't be sure. This afternoon I put my cats in the bedroom so Harriet could roam free for awhile. Later, I switched them and shut Harriet in the bedroom. After that, I saw poop in the bedroom box but I couldn't remember if I had checked it before returning Harriet. So, I *think* that she did poop but I'm not positive. I'm not going to let them interact unless I'm in the room, so I can be sure who's doing what. -- Liz > > Good idea. Mention to him that the current dose isn't working and that > > the [quoted text clipped - 28 lines] > throat. I don't trust putting any medication in her food, since she doesn't > always finish what she's given. Must be a locally compounded formula because cisapride doesn't come in capsules- only small white (10 mg) or blue oval tablets (20 mg) with P/10 or P/20 debossed on one side and "Janssen" on the other. Janssen used to make a liquid suspension version of cisapride which was great for medicating hard-to-pill cats. I think you should find out what the dose is- I gotta feeling its way too conservative. Cisapride should be dosed at leased 2x a day 30 minutes before each meal- its probably more effective if given 15 minutes before each meal. Actually, I think you should switch vets a.s.a.p. before Harriet develops megacolon from poorly treated constipation. I really mean that. The lactulose dose is too low and the cisapride wasn't prescribed correctly. > > Bringing her home doesn't sound like it stresses her out very much. > > Giving [quoted text clipped - 12 lines] > always available if another water source shows up. She was drinking warm > water out of a new foot bath I got this week. Sounds like you have mellow cats. You're lucky! ;-) > I went in to check on Harriet before and couldn't find her. My bedroom > isn't big and there are a limited number of places she could hide. I could [quoted text clipped - 3 lines] > rips in the fabric or any loose edges. I left and the next time I checked > she was on the bed. I had that problem with my cats, too. I put a fitted sheet on the bottom of the boxspring. Works like a charm. > Last night, after I got home and fed my cats in the kitchen & Harriet in the > bedroom, I opened the bedroom door. Otto went in but there were no noises, [quoted text clipped - 4 lines] > overall quantity). I thought Harriet left the bedroom and used that box but > I can't be sure. Hopefully, its was Harriet's. I'd bet you never thought you'd be so happy to see a turd! Only people who've treated a constipated cat know what I mean. > This afternoon I put my cats in the bedroom so Harriet could roam free for > awhile. Later, I switched them and shut Harriet in the bedroom. After > that, I saw poop in the bedroom box but I couldn't remember if I had checked > it before returning Harriet. So, I *think* that she did poop but I'm not > positive. I'm not going to let them interact unless I'm in the room, so I > can be sure who's doing what. Good idea. Its very important for you to know if she's pooping again and how much. I don't mean to sound gross- if you find out the poop is her's, you might want to squeeze it (use a paper towel or ask your vet for a few exam gloves). You can tell if the meds needs to be tapered by the consistency of the stools before she develops diarrhea. Harriet is certainly lucky to have a friend like you! Best of Luck, Phil > Must be a locally compounded formula because cisapride doesn't come in > capsules- only small white (10 mg) or blue oval tablets (20 mg) with P/10 [quoted text clipped - 12 lines] > The lactulose dose is too low and the cisapride wasn't prescribed > correctly. The vet did say they had to have it compounded. I'll try to call them on Monday and find out the dose, and ask if she should be getting it twice a day. She is now on the Lactulose 2ml twice a day. Since she's a work cat, giving it to her more than twice a day really isn't possible. I also have been giving her both medications after she eats. I usually get in an hour or so after everyone else, and whoever gets in first feeds the cats. I'm going to tell them to wait until I get in. I'll have to try to wake up earlier, I guess! > Hopefully, its was Harriet's. I'd bet you never thought you'd be so happy > to see a turd! Only people who've treated a constipated cat know what I > mean. I went into my bedroom about 15 minutes ago. Look at the litter box and see a turd!!! I was so excited!! It was just one, and it was maybe slightly larger than what my cats (and Stinky) create, but it wasn't like the large round balls she was producing last month. I told her what a great cat she is over & over. Unfortunately, it's already been flushed. When I scooped it, it didn't seem mushy. I'll grab a plastic baggie next time and give it a feel. When she was making those round turds last month, they were very hard. -- Liz very happy to see cat poop > > Must be a locally compounded formula because cisapride doesn't come in > > capsules- only small white (10 mg) or blue oval tablets (20 mg) with P/10 [quoted text clipped - 17 lines] > day. She is now on the Lactulose 2ml twice a day. Since she's a work cat, > giving it to her more than twice a day really isn't possible. 2 ml/b.i.d. might be OK- Its just a little low for an initial dose. > I also have been giving her both medications after she eats. I usually get > in an hour or so after everyone else, and whoever gets in first feeds the [quoted text clipped - 7 lines] > I went into my bedroom about 15 minutes ago. Look at the litter box and see > a turd!!! I was so excited!! That's great! I know exactly how you feel. LOL! It was just one, and it was maybe slightly > larger than what my cats (and Stinky) create, but it wasn't like the large > round balls she was producing last month. I told her what a great cat she [quoted text clipped - 6 lines] > Liz > very happy to see cat poop Don't forget, her stools will be smaller from eating Wellness canned than Science Diet Light. The Wellness canned is more digestible. So don't be disappointed by small stools. I think switching her over to canned food was a very smart move. Please keep me posted. Good luck. Phil One more thing. For her dinner at work, I decided to give her some Wellness I had bought for my cats. I gave her 1/3 of a can (5.5 oz can) of Chicken and she ate it all. I gave her some more (1/2 can total) and she ate it all. It was the most she's eaten in over a month and she seemed to really enjoy it. -- Liz > One more thing. > > For her dinner at work, I decided to give her some Wellness I had bought for > my cats. I gave her 1/3 of a can (5.5 oz can) of Chicken and she ate it > all. I gave her some more (1/2 can total) and she ate it all. It was the > most she's eaten in over a month and she seemed to really enjoy it. That's great! Try to get her to eat her total daily caloric requirement. Its very important for her to eat consistently- at this point it really doesn't matter what. Not only to stimulate gastrointestinal transit but to also ward off hepatic lipidosis (fatty liver syndrome). If she hasn't been eating her daily energy requirement and meeting her daily potassium requirement for that long, you might want to speak your vet about a potassium supplement. Potassium depletion can adversely affect colonic smooth muscle function. Constipation and anorexia often go hand in hand and can develop into a vicious cycle. Good luck, Phil. > That's great! Try to get her to eat her total daily caloric requirement. > Its very important for her to eat consistently- at this point it really [quoted text clipped - 14 lines] > > Phil. I can usually get her to eat at least 1/3 can (5.5oz can) at each meal. She seems hungrier in the evening and eats her food quicker. She tends to eat a little, walk away, and come back several times. I don't like leaving the wet food out too long and will take it away after awhile. She has been finishing her evening meals within half an hour; sometimes it's more than an hour in the morning. She still begs for treats but I've been trying not to give her too many. -- Liz > > That's great! Try to get her to eat her total daily caloric requirement. > > Its very important for her to eat consistently- at this point it really [quoted text clipped - 22 lines] > hour in the morning. She still begs for treats but I've been trying not to > give her too many. The fact that she's eating and not anorexic or vomiting are very, very good signs! Is she acting depressed at all? I was thinking that maybe she became constipated from eating dry Science Diet Light without drinking enough water. That could do it. If she's adapting to canned Wellness, I'd keep her on that- just let your vet know. The most important thing is to keep her eating (then pooping :->) Good luck, Phil. > I was thinking that maybe she became constipated from eating dry Science > Diet Light without drinking enough water. That could do it. If she's [quoted text clipped - 4 lines] > > Phil. The thing is, she always drank a lot of water. At least it seemed like a lot to me. I was only at work 7-9 hours a day, but I'd always see her take at least two nice, long drinks every day. She would sometimes spends several minutes at a time lapping water. My cat Tiger does the same thing, but I think she makes many more trips to her Drinkwell than Harriet does. I've seen my cat Otto drink maybe three times. He prefers drinking water out of dirty dishes in the sink. -- Liz > > I was thinking that maybe she became constipated from eating dry Science > > Diet Light without drinking enough water. That could do it. If she's [quoted text clipped - 12 lines] > I've seen my cat Otto drink maybe three times. He prefers drinking water > out of dirty dishes in the sink. Do your resident cats eat canned or dry food? The rule of thumb is a cat's water needs in milliters are guestimated as equal to the cat's metabolizable energy requirement in kilocalories (kcals)- (1 oz/lb is better). IOW, a 9# neutered cat has a daily energy requirement of about 180 kcals and a daily water requirement of about 180 milliliters or about 6 oz. A cat eating canned food that contains 78% moisture will consume about 4.25 oz of water from her food and only needs to drink about 1 3/4 oz./day. A cat eating dry food that only contains 10% moisture only consumes about 1 1/2 oz from her food and needs to drink at least 4 1/2 oz of water. If you use the 1 oz/lb guideline- the cat need to drink 7 1/2 oz. -- and probably more if the dry food is high in fiber as Science Diet Light. I'm beginning to think switching Harriet over to the canned food might be helping her the most. Phil
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