CKD cat and constipation options --home treatment and vet

[oyster]

I have been through the search results and read a lot of useful info. I would still like some suggestions, options, etc. as to what else to do for Oyster.
My 17 yr. old cat was diagnosed with CKD 3 years ago. He is in Stage III of the disease now. He is on the Royal Canin renal diet as well as some other brands listed on Tanya's CKD web page. I have gone through her info. thoroughly and follow most of the advice given there. He eats only wet food except for the 5 kibbles I throw into his wet food once a day to motivate him to start eating. He has a partiality for kibbles which he sadly cannot have.
This is the first time he has been constipated. We have been to the vet 3 times this week because Oyster cannot clear his bowels on his own despite being given enemas, infusions (I'm guessing that's subcutaneous fluids), appetite stimulant (injected), and lactulose. I am told to give him no more than 2ml of lactulose, twice a day. The vet doesn't think he needs B12 shots even though Oyster is not eating. I have been syringe feeding him a tonic (RecoActiv Kidney), as well as homemade broth and water every 30-45 min. Two X-Rays have been taken,one showing a compacted bowel and the second X-ray (taken today) was a lot better but Oyster is still not expelling faeces himself. I was given gel today for performing the enemas at home.
The short story is that the vet doesn't thinks he can do more for him. So, I am turning to the online community. We have access to two vets in my rural area--one is not good, and the one we see is fairly decent. But I just can't understand how a bout of constipation can lead a vet to throw their hands into the air and sort of give up on him.
So my question is, what else can I demand they do? ( I am not in the US).Or what can I do to move things along and get him to eating again? (I have read the various suggestions on this forum but right now my cat is not feeling tempted by his old faves either).
Miralax is not sold here but a different product which has sorbitol and sodium citrate used as a suppository. Vet says not to use but online reviews say people have used these on cats (they make tiny tubes for animals). So, I am thinking of buying these but will daily enemas be all right for his intestines and colon? (I read the thread that asked a similar question but didn't get an answer as to whether enemas everyday may be harmful).
Anything else I can do to help him regain bowel movements and an appetite?
Thank you.
p.s--He hates pumpkin. I can only get into him if I syringe feed it. He has been getting slippery elm bark twice a day since this constipation episode started.

 

[FeebysOwner]

Hi. Polyethylene glycol 3350 is the active ingredient in Miralax, so look for generic products with that ingredient. Most folks start out with 1/8 tsp a day, then increase to twice a day if you don't get results with 24 or so hours. It can be increased again, if needed, to 1/4 tsp once a day, and then 1/4 tsp twice a day. You mix the powder in a very small amount of water, and then add it to his food.

A lot of CKD cats are taking PG3350 daily due to constipation. Personally, I would not do enemas - but you could also try a small sliver of a baby suppository. It might be that your cat is at the stage for regular sub-Q fluids, so you may want to find out from your vet if this is something you can do at home - it just takes some getting used to. A lot of CKD cats by the time they reach Stage III also receive routine sub-Q fluids. Starting out low at first and increasing if, and as, needed. 50-75 ml a couple of times a week might help enough to reduce the constipation. Pumpkin can go either way, in terms of helping with diarrhea and/or constipation, depending on the cause. So, I would think you don't need to try this as a solution. Although, that is also true of slippery elm, but I have seen it used more often in cats with CKD.

Is he on any anti-nausea meds or an appetite stimulant?

 

[oyster]

No, he is not on any medication. He has a therapeutic diet and I give him the supplements recommended on Tanya's CKD page. He gets Omega 3s, Vit. B-Complex, (as well as methylcobain) and Slippery Elm Bark if he gets constipated. He hasn't had any issues with constipation or nausea before this. I also add a couple of teaspoons of homemade broth to his food everyday. He is also on homeopathic medicine.
I will call the vet and ask for subq fluids and if I can administer them at home.
Thank you for the suggestions.

This is the only medicine I could find with PG3350. It has a lot of ingredients unlike the US Miralax.

Macrogol Hexal® plus electrolyte powder for the production of a solution: active ingredients: Macrogol 3350, sodium chloride, sodium hydrogen carbonate, potassium chloride. Areas of use: for the treatment of constipation (especially for prolonged constipation) in adults, teenagers and older patients. Use in children under the age of 12 is not recommended. Contains sodium, sorbitol and potassium.

 

[FeebysOwner]

Then, I would guess lactulose is your best bet. Have you compared that to the ingredients in this other product you found?
Here are some previous posts related to using lactulose, if they can help any.
Search Results for Query: lactulose | TheCatSite

 

[oyster]

I was able to read page 1 of the Search results and got some helpful ideas. Apparently, lactulose is not always helpful and should not be used long-term. Will continue reading more...Thanks.
I have found a different product--Kinderlax electrolytefree which has 4mg of Macrogol 4000 (synonym for polyethylene glycol). So, if someone in Germany is looking for a product with only PG in it, this is one that I found.
Tanya's CKD German info also some suggestions but I think they must be outdated because all the German brands suggested there had electrolytes. Hope this helps someone else.

 

[stephanietx]

I would try Miralax and Pepcid (not Pepcid AC and you can get the generic). Give him 1/2 tablet, usually at night, a day.

 

[oyster]

I have another problem. Oyster has had foam in his urine since Tuesday. I specifically asked the vet about it since we have seen him 3 times this week. Oyster has constipation, is listless, has very little appetite, is rapidly losing weight, and has foamy urine. I now read about that on Tanya's CKD page and don't know what to do.
Our vet refused to consider that to be a contributing factor to his debilitating condition.

 

[mysterylover]

I am dealing with constipation in all three of my cats - one I know is CKD 2. For now, adding Weruva Press Your Lunch at least clears the hard stool out (but does not soften it really), so I am seeking other options - but something about the sunflower oil that is like third ingredient and the mix of two gums and high water content helps every time. I try to give it last meal of the day but have also added it to every meal when desperate.

I had read that pumpkin has too much phosphorus and potassium for CKD, but my CKD cat is picky, especially since she had teeth removed in December due to tooth resorption, so I have that to deal with as well. I am thinking that, if the pumpkin is in a low-phosphorus food, maybe it is not as bad for her. I have not tried psyllium husk for fear it might add bulk, but I also keep reading how Miralax is not good for CKD because it takes water into the stool that the kidneys could use or could dehydrate, but constipation is not good either, for sure.

Anyway, I thought I would mention the Press Your Lunch. It is sort of a rescue laxative - and my cats all love it- like Jello pate- I add a water to make it smooth. Phosphorus is under 1, and even 1/4 to 1/2 teaspoon works for my cats. ---Oh, one of my cats pees a bit when straining to poop - not sure if the foam you are seeing is part of that or not.

 

[mysterylover]

I hope your baby feels better soon!!!

 

[mysterylover]

By the way, if you can get the Press Your Lunch where you are (or even Weruva Jeopurrdy Licous pouch, which seems more available), it is smooth, so could be syringe fed.

 

[Kflowers]

I see you're giving your cat omega 3 supplements are you aware of this recall?

list of all omega 3 recalled supplements

60+ Brands of Omega-3 Supplements for Pets Recalled - Petful

 

[oyster]

Update: Oyster is currently on subcutaneous fluids (we learn fast when our fur babies are in crisis). He has been prescribed Semintra for his proteinuria and Amodip for his blood pressure which was above 180 mmHg. I am giving him PEG 4000 (similar to Miralax) and he is pooping normally now. I will stop it for the weekend and see how he does. He is eating a bit more but he is still not his "old self."
Overall, he is on the mend and I have hopes he will not leave us anytime this week. I can only hope from day to day.
During this episode, I have ditched the old vet who did nothing, recommended nothing, prescribed nothing. I found a new vet which was very hard to do in this area and she seems to know much more about cats and kidney disease. I am still reading about all the other issues and I hope I can be Oyster's advocate.
As for Weruva--sadly, we don't get this in Germany. We have other products that seem to work well. Also, the Omega-3 recall doesn't affect me here. But thank you for the warning. It's always good to be vigilant.

 

[fionasmom]

Please keep us posted about Oyster. I am glad that there is some improvement and that you were able to find a proactive vet.

 

[oyster]

Since I posted on Friday, things have gone downhill again.
Oyster hadn't pooped over the weekend, so I had to use a glycerin suppository. That worked. But then, he stopped eating completely.
I took him to the vet on Mon. and he got blood drawn and had a urine cystocentesis. He and I were traumatized by that experience.
The vet gave him a shot of Prevomax which is a generic form of maropitant which is used to prevent nausea. He came home and ate a tiny bit so I was elated.
Alas, my joy was short lived because we are back to not eating, not pooping and I am force feeding him, as well as giving PEG.
I have given him a shot of Prevomax today but that hasn't seemed to do the trick. On top of that, he developed a cold and was sneezing and snorting all weekend. So, I did inhalation twice with him and he seems a lot better now. The sneezing has stopped. But he is still not eating or pooping.
I have cooked chicken for him, put tuna in his bowl, his favorite equivalent of Fancy Feast, kibbles (which he usually adores)and I am getting the same response. I don't think it's nausea because he is no longer licking his lips and turning away his face...
The kidney support group suggested that his blood pressure dropped too suddenly as he read at 180 mmHG on his first trip and at 120 mmHg on Mon. So, I have dropped Amodip for a week to see if his appetite will return. The vet approved but was reluctant since his BP is really good now.
I am at my wits' end and am just continuing to force feed him and will give him a suppository if he hasn't pooped by tomorrow morning.
I have two other cats who are clamoring for attention and are very disturbed at the change in their schedules so I am stretching myself really thin between my human and fur babies.
All the help and support here and on the kidney support group is invaluable. Thank you so much and for all your suggestions and help.

 

[Sarthur2]

I had an older cat — about 16 years old — who had CKD III, and she needed sub-q fluids 2-3 times a week, plus a B-12 and a Vitamin K shot weekly, along with nausea meds. She would perk up quite nicely for the better part of the week after her B12 and K shots and fluids, then begin to fade again. She absolutely hated the CKD food, but craved actual table food proteins such as chicken, salmon, and beef. I caved and let her eat what she liked just to keep her going. We struggled for close to 3 months at the end, though she lived nearly 3 years fairly normally from her initial renal insufficiency diagnosis until it progressed to stage III.

She was also growing tumor lumps on her head and other areas which we figured were cancerous. She was too old for biopsies or surgery, and when she stopped eating and became too weak to walk she crossed the Rainbow Bridge recently. By that time she was also having terrible diarrhea.

Not sure why your vet will not allow B12 shots, but I see you are supplementing B on your own.

CKD is a cruel disease in cats, and it is very sad to watch our cats wither from it.

I wish Oyster all the best in coming days. You are certainly doing everything you can to support him through this!

 

[oyster]

Update: I spoke to the vet about Oyster's blood results today. Sadly, I am left clutching straws. The vet recommends euthanasia as his creatine levels have skyrocketed to 10 mg/dl. Kidneys are shutting down, she says. I think there is an infection and can be treated but he has not been eating since Monday. I have been force feeding him. Behaviorally, he is doing very well--not lethargic, alert, but nauseous. He has not eaten and has constipation.
So, while his blood test numbers are really up and he is not eating, his behavior is not one of end stage. I will make up my mind over the weekend because in the end, this is about his quality of life. I cannot fail him now after 17 years of love and devotion. I am sure all animal/cat lovers know how that feels.