Constipation questions - IBD or cancer

[desertcat]

Hello, all. My 12-year-old male tabby has been dealing with sensitive bowel issues off and on during his life, but it's been worse since last fall. It started off with horrible diarrhea in November that the vet suspected was caused by the addition of a new kitten in the home. My older cat is sensitive, and I think the new kitten was at least part of the problem. After giving him lots of extra attention and using some calming plugins around the house, the diarrhea faded and he seemed like his usual self. Fast forward to last month, and he suddenly became extremely constipated. After his regular vet gave him four enemas without success, I took him to the emergency vet. Many dollars later, and after a two-night stay in the ICU, my cat's bowels were cleared. The ultrasound they performed to find the cause was inconclusive, and they could only see thickening of the intestines. The internist at the emergency vet suspects either IBD or cancer, but cannot know without a biopsy. Due to costs, I decided to hold off on the biopsy, and the vet put my cat on 5 mg of prednisolone daily. Our regular vet also gave me a prescription for lactulose, 3 mg two or three times daily.

Everything was going well for the first few weeks until my cat decided he couldn't stand the lactulose taste anymore. The last time I tried the lactulose a couple of days ago, he threw it up five minutes after swallowing. I decided to try Miralax, and now most days that is what he gets. Here is my main concern right now: About three or four days ago, I noticed that my cat will occasionally sit up and look like he is having contractions or spasms in his abdomen. They only last for a moment and sometimes are accompanied by a gassy sound or even grunting. Then he seems fine again. He is still eating well and drinking water, and wants more food than I give him due to the prednisolone. He seems to be in good spirits and is still very affectionate with us in general. He only seems distressed when these spasms happen a few times during the day.

Just a little while ago, I noticed that he had one of those episodes. About thirty minutes later, he went to the litter box and passed some soft stool. Now he's resting, but every now and then I hear a grunt come from him. However, I cannot tell if the noise I am hearing is gas or a rumbling stomach or if he is actually grunting. When this happens, it looks like he's trying to pas gas or start a bowel movement or has cramps. It's frustrating for him and for me.

I have made a followup appointment at the emergency vet for this weekend. They will check to see how the prednisolone is helping with his intestines since they're concerned there could be a mass developing slowly. My regular vet is also concerned that kidney problems could be causing the constipation, but unfortunately her office is now closed until May. I find myself worrying more and more about my cat. No matter what the issue is, my main concern is keeping him out of pain and as happy as possible. Is it possible that the laxatives could be causing cramps and that this is what I am seeing when he has these spasms? Could it be a side effect of the prednisolone? What can I do to make him feel better at home until I see the vet this weekend? Any words of wisdom are much appreciated.

 

[daftcat75]

Is his weight stable? If so, it's *probably* not cancer. Unfortunately, the only way to really know for sure is the biopsy. And you'd have to taper him off the prednisilone, under vet guidance, as that could make the biopsy inconclusive.

Now this is only anecdotal so it's only worth what you paid for it.

My Krista was cruising along for about a year and a half with the "IBD or cancer" diagnosis. She would occasionally stop eating due to teeth problems or a bout of pancreatitis. But when those were resolved, she'd regain the weight again. Until she couldn't. Sometime late last year she started having liquid stools *all* *the* *time*. She didn't poop solids for months no matter what we tried. I got her on prednisilone and that didn't help. My vet wouldn't prescribe chemotherapy without a cancer diagnosis. I talked to the owner of the practice who agreed with me that the diagnosis was riskier than the drug and overrode her. Since starting the chemotherapy alongside the pred, her stools are mostly solid these days. I requested a follow-up call with the owner of the practice to discuss her progress and further options. But I'm sure we're both convinced that it's lymphoma by now.

So, if his weight is stable, then it's probably not cancer. But that doesn't mean it can't become cancer later. Keep an eye on his weight.

As for what you may be seeing, it's probably the laxatives or he could still be constipated. Soft stools paradoxically could be a sign of constipation as it's the only "stuff" that can squeeze past the impacted stool. Is he also eating dry food? If so, you should probably discontinue that as that's irritating to the bowel and the kidneys. Dry food is dehydrating and that could be the cause of the constipation. Your worst wet food will be better than your best dry so find something he likes to help the transition. Fancy Feast Classic pates is a good place to start. It's cheap, but a decent recipe (not much in fillers or garbage ingredients), and most cats like the stuff.

 

[desertcat]

Thank you for the detailed reply. Yes, his weight seems to be stable. Before he got the "cleanout" about a month ago, he had actually gained a pound, but that could have had something to do with how constipated he was. He looks and feels about the same weight now. No noticeable weight loss, but I will find out for sure on Saturday. He has a ravenous appetite due to the prednisolone, but I am still only feeding him twice a day.

He has been on a canned food diet for several years. He was on Friskies canned for a couple of years, but is now on Fancy Feast pate. I have been mixing in 1/4 teaspoon of Miralax plus water with each meal for the last few days. I am wondering if I should try the lactulose again and see what happens.

I'm not sure if he is constipated again or what is going on. When he was severely constipated before, he started straining all over the house and would sometimes pass spots of dark diarrhea. When he goes now, he uses the litter box and the stool is soft/partially formed and medium brown. Sometimes he passes a good amount, other times it's a small amount. These spasms he's having are new, which leads me to think it could be the laxatives causing issues. I pray he's not constipated again because I do not think that I can afford another overnight stay. I just wish that we could get this under control and buy him a few more years.

I appreciate the information about your kitty. I hope that she will be with you for a long time still.

Is his weight stable? If so, it's *probably* not cancer. Unfortunately, the only way to really know for sure is the biopsy. And you'd have to taper him off the prednisilone, under vet guidance, as that could make the biopsy inconclusive.

Now this is only anecdotal so it's only worth what you paid for it.

My Krista was cruising along for about a year and a half with the "IBD or cancer" diagnosis. She would occasionally stop eating due to teeth problems or a bout of pancreatitis. But when those were resolved, she'd regain the weight again. Until she couldn't. Sometime late last year she started having liquid stools *all* *the* *time*. She didn't poop solids for months no matter what we tried. I got her on prednisilone and that didn't help. My vet wouldn't prescribe chemotherapy without a cancer diagnosis. I talked to the owner of the practice who agreed with me that the diagnosis was riskier than the drug and overrode her. Since starting the chemotherapy alongside the pred, her stools are mostly solid these days. I requested a follow-up call with the owner of the practice to discuss her progress and further options. But I'm sure we're both convinced that it's lymphoma by now.

So, if his weight is stable, then it's probably not cancer. But that doesn't mean it can't become cancer later. Keep an eye on his weight.

As for what you may be seeing, it's probably the laxatives or he could still be constipated. Soft stools paradoxically could be a sign of constipation as it's the only "stuff" that can squeeze past the impacted stool. Is he also eating dry food? If so, you should probably discontinue that as that's irritating to the bowel and the kidneys. Dry food is dehydrating and that could be the cause of the constipation. Your worst wet food will be better than your best dry so find something he likes to help the transition. Fancy Feast Classic pates is a good place to start. It's cheap, but a decent recipe (not much in fillers or garbage ingredients), and most cats like the stuff.

 

[molly92]

If there's a larger systemic issue going on, I don't have much experience, but for constipation as a symptom, I recommend looking into a good acidophilus based probiotic. After several rounds of enemas and constipation remedies and medications, this was the only thing that worked for my cat and has for years. Half a capsule of PB8 Nutrition Now on every meal is what I do.

 

[daftcat75]

Your choices aren't only lactulose and Miralax. You can try a small amount of psyllium (1/16th to 1/8 tsp) in his food. Or you can try pumpkin puree (1/2 tsp to 1 tsp.) Make sure it's only pumpkin puree and not pie filling with spices and sugar added. Psyllium and pumpkin will add stool bulk while Miralax will not. I honestly don't know anything about lactulose.

A probiotic is a good suggestion too.

I would try only one of these at a time. Give it a week unless it's really obvious it's not suitable (e.g explosive diarrhea.)

 

[desertcat]

Thank you, daftcat. My regular vet recommended trying pumpkin, but the emergency vet blew it off like it wouldn't matter, so I never tried it. At this point, I will try it. I don't think it could hurt, and I appreciate your suggestions.

He's had a pretty good night. I haven't noticed any of his spasms in about seven hours. He had dinner and wanted to be petted a lot after he ate. About twenty minutes ago, he had a large bowel movement in the litter box. It was mostly soft, but had some formed stool within it. Maybe that's why he's feeling better. He got a big amount out of his system. I am hoping that the vet can help me to find the "sweet spot" in regards to his laxative. Too little and he gets constipated. Too much and it's soft and runny. I guess at this point it's preferable to be soft and not rock solid.

One thing I noticed tonight was a small drop of blood on the litter box liner after he finished. I noticed this one other time about two weeks ago. I think this is from frequent straining, but I will mention it to the vet on Saturday. It makes me nervous to see blood, but it was a small amount and I would guess his poor bowels are going through a lot at the moment. It might not necessarily mean the worst is imminent, but it makes me nervous.

 

[desertcat]

My cat seemed a little better today. He was social, affectionate, ate well, and had no spasms. I think the big bowel movement he had last night has helped him to feel better. I've had to start giving him liquid prednisolone that smells like cherry cough syrup, because he started spitting out the pills and I can't get him to swallow them. The liquid medication makes him foam at the mouth and it's torture for him. When I take him for the followup ultrasound tomorrow, they're supposed to give him a flavored liquid that I'm hoping will help.

His appointment is in the morning and I am nervous that they will tell me something bad. But for now, he seems happy and that's the most important thing to me. I hope that we will get some positive news, or at least something we can work with.

 

[desertcat]

Not five minutes after I posted this, he walked in the room and had one of those spasms with a loud grunt, the first I'd noticed today. And then came over and flopped down on my feet for me to pet him. He's rolling around and purring now. He can't be feeling too bad if he's acting this way. I just don't know what those spasms could be.

 

[daftcat75]

Every cat is different and mine is toothless now. She was suffering from painful tooth resorption. After several rounds of extractions with non-dental specialist general vets, I took her to a veterinary dentist and said, "make this the last dental procedure she'll ever need."

I have been able to get Krista to pill herself with the pred. I cut the pill in half and coat each half in just enough food for the yeast to stick. I open up a capsule of sacchromyces boulardii (a yeast probiotic) into a snack baggie and roll that food covered pill half into it. This holds that little bit of food on the pill and also makes it tacky for the last piece of this medicine bite. I wrap the yeasty pred half in a bonito fish flake. The yeast makes it easy to make it a tight wrap so she's not going to pull the flake off and leave the yeasty pill. The whole thing is barely bigger than the pill half itself. I put that on a plate for her and she takes the whole thing into her mouth. She "chews" at it a little--as much as a toothless cat can chew anything--and then swallows it. And then I repeat for the second half. And finally I put a spoonful of her food on the plate as a reward so that she's taking her medicine with food. The remainder of her food goes on her regular plate and I put it down in her regular spot. I do the pilling on the kitchen counter so that if she does fling the pill (which she used to do before I wrapped it in the fish flake), she will fling it against my coffee maker or the floor rather than under an appliance if I served her medicine bites on the floor.

I can't say this will work with your cat. I don't know if a cat with teeth would actually bite into the pred and taste how bitter it may be. I'm not even sure how much damage "Her Toothlessness" is doing to the pill when she gums at it before swallowing. But she takes each half usually in one go every night. It might be something to experiment with while you're waiting for a liquid flavor he likes.

 

[desertcat]

We just got home from his ultrasound. We did not get good news. The vet says it's now clearly cancer, though they can't be sure what kind it is without a biopsy. He suspects it's carcinoma of the bowel. He said that surgery is no longer an option due to the size of the area. He said that chemotherapy treatment at their center could cost as much as $5000 (or maybe more) without a guarantee it will help. At this point, my cat will be on hospice care. I'll be giving him prednisolone to, I hope, keep the cancer at bay as long as possible and also keep him energetic, which he has been since getting the medication. The vet said that if he starts to go downhill or looks to be in chronic pain, they could possibly give him medicine to help the pain, or we can make the tough decision that is inevitable now.

My regular vet will be closed until May 10th, but I might e-mail her and see if she has any other ideas for treatment. Unfortunately, I suspect she will tell me to follow this vet's advice because he is a specialist. I am very sad today after hoping for an IBD diagnosis. It just seems that this cancer is aggressive. At his ultrasound a month ago, they could not even see it, and now it's large. I am glad I am working from home for the foreseeable future as at least I can be with him all day.

 

[daftcat75]

Horrible news! So sad and I'm so sorry for you both.

Would a chemotherapy treatment like chlorambucil (Leukeran) help any? That's what Krista is getting. It seems to be helping her because her stools went from liquid for months to solids with the occasional bonus pudding poops.

At this point, you can ask for a higher dose of the pred to prolong the inevitable and make him more comfortable. I wouldn't worry about the side effects of long-term pred use at the higher dose.

And if you aren't already, I would recommend feeding him smaller meals more often rather than two large meals a day. This will be easier on him and it more closely follows a cat's natural preferred style of eating. I feed Krista eight times a day. She yells at me if I try to collapse her meals back to six a day. For the overnight, so I'm not waking every three hours, I put those portions into timed feeders.

 

[desertcat]

Thank you for the tips. My cat has teeth and, unfortunately, got to the point last week that he could sniff out the pill no matter where I tried to hide it. I tried sardines, hot dog slices, everything stinky. And he knew every time. If we tried to pill him by hand, he would hold it in his mouth and then spit it out. He was determined not to take it.

Luckily the specialist gave him chicken-flavored prednisolone this morning. I think this will help.

Every cat is different and mine is toothless now. She was suffering from painful tooth resorption. After several rounds of extractions with non-dental specialist general vets, I took her to a veterinary dentist and said, "make this the last dental procedure she'll ever need."

I have been able to get Krista to pill herself with the pred. I cut the pill in half and coat each half in just enough food for the yeast to stick. I open up a capsule of sacchromyces boulardii (a yeast probiotic) into a snack baggie and roll that food covered pill half into it. This holds that little bit of food on the pill and also makes it tacky for the last piece of this medicine bite. I wrap the yeasty pred half in a bonito fish flake. The yeast makes it easy to make it a tight wrap so she's not going to pull the flake off and leave the yeasty pill. The whole thing is barely bigger than the pill half itself. I put that on a plate for her and she takes the whole thing into her mouth. She "chews" at it a little--as much as a toothless cat can chew anything--and then swallows it. And then I repeat for the second half. And finally I put a spoonful of her food on the plate as a reward so that she's taking her medicine with food. The remainder of her food goes on her regular plate and I put it down in her regular spot. I do the pilling on the kitchen counter so that if she does fling the pill (which she used to do before I wrapped it in the fish flake), she will fling it against my coffee maker or the floor rather than under an appliance if I served her medicine bites on the floor.

I can't say this will work with your cat. I don't know if a cat with teeth would actually bite into the pred and taste how bitter it may be. I'm not even sure how much damage "Her Toothlessness" is doing to the pill when she gums at it before swallowing. But she takes each half usually in one go every night. It might be something to experiment with while you're waiting for a liquid flavor he likes.

 

[desertcat]

Thank you again for the advice. I will try anything now to keep him comfortable and with us as long as possible. I know that you have a lot of experience with this, unfortunately.

That's a good idea about smaller meals. He's only been eating twice a day, and maybe that is part of why he has to strain. I will try feeding him at shorter intervals.

I am not sure if the specialist will offer him any chemotherapy without a biopsy and the full treatment. That's how it sounded on the phone, anyway. I would have to pay for all the testing and the full treatment, which would be several thousand dollars I do not have right now. I paid almost $3000 just for him to have his first ultrasound and two-day bowel flush last month. This facility is very expensive.

I am going to e-mail my regular vet and see what she can offer. Since they're not open until May 10th, I don't know what good it will do. By the time she can see him, it may be too late.

The specialist actually advised I cut back the dose of prednisolone to every other day. Do you know why this would be? It seems to me that he should be getting more of it, not less, but unfortunately I was not in a good state of mind and forgot to ask him why. Maybe he just thinks it's pointless since it clearly did not help much over the last month to slow the growth of the cancer.

Horrible news! So sad and I'm so sorry for you both.

Would a systemic chemotherapy treatment like chlorambucil (Leukeran) help any? That's what Krista is getting. It seems to be helping her because her stools went from liquid for months to solids with the occasional bonus pudding poops.

At this point, you can ask for a higher dose of the pred to prolong the inevitable and make him more comfortable. I wouldn't worry about the side effects of long-term pred use at the higher dose.

And if you aren't already, I would recommend feeding him smaller meals more often rather than two large meals a day. This will be easier on him and it more closely follows a cat's natural preferred style of eating. I feed Krista eight times a day. She yells at me if I try to collapse her meals back to six a day. For the overnight, so I'm not waking every three hours, I put those portions into timed feeders.

 

[daftcat75]

I don't understand why he would cut the dose either. Can you get a second opinion or email your regular vet even if their office isn't open? Maybe search the internet for a tele-medicine vet that can review the ultrasound notes and his file without an in-person visit.

Krista's regular vet didn't want to give chlorambucil without a cancer diagnosis. I had to go over her head to the founder and owner of the practice and plead with him that the diagnosis would be riskier than the drug. The diagnosis would be a biopsy that would require a tapering of the pred as well as a recovery period for a cat that didn't have any more weight to lose or a way to gain any lost weight back. Fortunately, he agreed with me. I recently consulted with him a few days ago about the continued pudding poop incidences and that she still isn't gaining weight despite eating close to 10 oz a day. I wanted to increase her chemo dosing interval but he wanted to try her at a higher pred dose first.

Krista continues to impress me with her resilience and her spirit through this all. If you never had to clean her litterbox (or the carpets afterwards), you'd say, "that's one skinny cat" but you probably wouldn't suspect that she has a particularly stubborn case of cancer. Just this morning, she waited until I sat on the toilet (she's sneaky like that) to jump on the stove top counter she's not supposed to be on to see if there was any scraps or splatter she could lick.

If a vet thinks it might help, chlroambucil is cheap. I have an anchovy-flavored liquid I give twice a week that will last about two months for $50. That's it. One zero. Not three.

 

[desertcat]

I e-mailed my regular vet and will see what she thinks about the drug you mentioned. Thank you for the recommendation, and maybe it would help to extend his time, even if just for a few months. At the rate things are going now, I expect he won't make it more than a few weeks without some other intervention.

I am trying to make my peace with what is coming. I have been through this before, but not with this type of cancer; and with my other cat, I had no warning. He never acted like he was sick. One day, I found him foaming at the mouth and suffering, and the vet found a tumor on his kidney. We had to euthanize him the next day. I had no time to say goodbye, and at least I have that opportunity this time. But it's still very sad and very hard as I have a special bond with this kitty. He's been with me since he was seven weeks old, and it's hard to imagine life without him.

 

[Elbee]

I just read through your posts and I am so very sorry for what you are going through. We went through much the same with our 11 year old cat Lu a few years ago. A couple of months of being told it was IBD and then it was not.

Keep him comfortable and give him lots of love. A friend who has taken care and hundreds of cats over the years gave me what was very good advice and it helped my decide what to do- she said, "Better a week too early than an hour too late".

Everyone will make different choices and you will make the one that is right for you and your buddy.

Take care.

 

[desertcat]

Thanks, Elbee. I am sorry about Lu and that you had to experience this.

Yes, my husband and I talked it over tonight, and we are just going to spoil him as much as we can until it's his time. If my veterinarian has any other ideas to help him, then we'll try it, but I just have a feeling that we may only have a couple of weeks with him.

I think that your friend's words are wise, and that's my position right now. As soon as I notice a big shift in his behavior, I am going to prepare myself to call the emergency vet and take him in.

One thing that is on my mind right now is that I don't believe any veterinarians are allowing families in with their pets due to the public health situation. I could not accompany him to the ultrasound today and had to sit in my car. I suspect if I have to take him in before the stay-at-home orders are lifted that he will be alone for euthanasia, and I hate that thought so much. I pray that he'll be comfortable until we're past that date, and I feel terrible for anyone who is in that position.

I just read through your posts and I am so very sorry for what you are going through. We went through much the same with our 11 year old cat Lu a few years ago. A couple of months of being told it was IBD and then it was not.

Keep him comfortable and give him lots of love. A friend who has taken care and hundreds of cats over the years gave me what was very good advice and it helped my decide what to do- she said, "Better a week too early than an hour too late".

Everyone will make different choices and you will make the one that is right for you and your buddy.

Take care.

 

[daftcat75]

My cat before Krista, Cabernet, I came home to her foaming at the mouth. That was a Sunday. She had a tumor removed from her mouth and biopsy on Mon or Tuesday. By Friday, I got the terrible news that it was malignant (cancer.). That weekend I searched Yahoo or Alta Vista (this was 14 years ago and I’m not sure if Google was the dominant one yet.). The best advice I found was give your cat daily “cat scores.” How much is he acting like a cat’s cat? Does he eat? Does he enjoy time in the sun? Or staring out the window? Does he want to be with you? Or be in his favorite spots doing things he enjoys? When his scores are consistently in the toilet such as spending most of his time under a bed or in hiding, doesn’t eat, doesn’t want to be with people, doesn’t want to do many or any of his previously favorite things, that’s about as objective as you can make this difficult decision. Only you can decide what your score cut-off is and how many days to give him at that score. For Cabbie, she spent that weekend under the bed or in the dark bedroom rather than with me or sitting in the sun. I’m not sure how much she ate that weekend. But not very much. I knew much less about cats back then to monitor her eating. I just saw several days at “3” or below and changed her oncology appointment that next week to a different kind of appointment.

I don’t know about your current vet or the hospital that did the ultrasound. But Krista’s vet makes an exception to “no parents allowed” for euthanasia. They understand how important it is to both parent and animal to be with each other in those last moments. I hope when it’s time, they’ll make the same exception at your facility.

But until that time that his scores are consistently low, don’t underestimate just how resilient cats can be. I thought Krista wouldn’t make it another couple weeks so many times over the last couple of years through pancreatitis, liver disease, her teeth, when she was pooping liquids for months, and lost all this weight. But she just keeps going and doesn’t show any sign of wanting to give up. I finally stopped trying to make that decision for her and trust that she’ll tell me when it’s time. Until then, I kid with my friends and family that she just may be immortal and outlive us all. She’s been through so much and keeps on going. I hope yours proves to be that resilient too.

 

[DesperateMistrustful]

I'm so sorry for what you and your baby are going through.

I've been to lots of vets throughout the pandemic and they're all making visitor exceptions for euthanasia. You will have to wear a mask and gloves but they'll allow you inside. Call all around if your current hospital doesn't allow it for some reason. If funds allow, look into in-home euthanasia vets in your area and ask if they're still operating. Both of the palliative vets near me are working but one had greatly reduced hours. It would probably cost $400-$800 depending on a few factors. Again, I empathize and am so sorry. <3

 

[desertcat]

That is good to know. I guess I assumed no one was allowed inside, period. I have considered contacting a mobile vet to see if they'll come to my house when the time comes. I guess I will see how my cat is doing and who is available before I decide. Ideally, I'd like to take him to his regular vet because he is used to going there and they know him, but it may not be an option since they are completely closed until the restrictions lift.

I'm so sorry for what you and your baby are going through.

I've been to lots of vets throughout the pandemic and they're all making visitor exceptions for euthanasia. You will have to wear a mask and gloves but they'll allow you inside. Call all around if your current hospital doesn't allow it for some reason. If funds allow, look into in-home euthanasia vets in your area and ask if they're still operating. Both of the palliative vets near me are working but one had greatly reduced hours. It would probably cost $400-$800 depending on a few factors. Again, I empathize and am so sorry. <3