Ibd? Constipated Cat. After The Enema...

sidneykitty

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I posted recently about my Amber's potential IBD diagnosis - here. Wasn't sure if I should continue that or start a new thread.

Last night, Amber was not acting herself. She was hiding and being antisocial and when I checked on her, she would yowl loudy when I touched her stomach. She was sitting awkwardly/couldn't get comfortable and was walking in a weird hunch/crouched position and I knew something was wrong. It seemed like her abdomen but I wasn't sure if she had hurt a limb falling or something.

We brought her in to emergency and they said it seemed like her stomach really hurt. X-rays showed constipation. She has been constipated before, but never this bad. She was in so much pain. A couple of years ago she was straining in the box and we brought her in, tested everything, deduced she was constipated and gave her lactulose. At this time, she started receiving 1/4 tsp Miralax per day and this seemed to make a big difference.

Amber just recently had all her bloodwork done as well as an abdominal ultrasound (see prior thread). Everything was normal. We slowly shifted her to a LID diet for possible IBD starting around Jan 10. I am wondering if the new food somehow clogged her up... her ultrasound was on Jan 7 and it appears she was not full of poop then as it was not mentioned. The vet last night said it has probably been building up for a while. But she has been having regular poops as I monitor closely.

Last night, she got an enema, pain meds and Cerenia. They said the poop that came out was not super hard which is good.

She is now only supposed to get wet food, we will start her on B12, and her Miralax is getting doubled to 1/4 tsp twice daily.

We got home at 1:30am last night and its now 11:30am. She hasn't had any poop since coming home. She had a bit of wet food this AM. She is supposed to get gabapentin for pain but she didn't finish all the food it was mixed in with. This morning she has been hanging out near the litterbox and I've seen her get in and get out without doing anything. I'm wondering if this is normal? Should I expect her to poop again soon or should she have already? Should I expect her to feel like she still has to poop after the enema, hence she's hanging out by the box? Anyone have experience with this?
 

Furballsmom

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Hi!
I don't know about the hanging out by the box behavior, but she might be a bit empty yet from the enema and not really have any poop to get rid of yet?
 

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Between the enema (and the sensation it can cause for a while), the possible shortage of pain meds, and small amount of food, as well as the short span of time that has transpired, give it a bit more time before getting worried. She could be hanging out by the box because of the sensation left over from the enema.

Hopefully, within the next 12 hours or so - especially if she eats more, she will poop for you!
 

daftcat75

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She needs to eat to poop. If she got an enema last night, give it a day (or two) for her next poop.

Which LID food is she getting? Some of them have clay (!!) which could be stopping her up. You’re on the right track with Miralax there: more moisture without adding bulk.

Tiki Cat and Rawz are two great limited ingredient foods that aren’t marketed as such. But they’re both basically meat, organs, moisture, and supplements. That is all (!!) you need in a food. If it has clay or cranberries or other fruits, vegetables, or grains, view that food with much suspicion.
 
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sidneykitty

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Well she seems to be returning more to herself. I went out for a bit this afternoon and when I came home she greeted me at the door which is a regular thing she does. Then she even went and sat by her food dish and gave me her very polite "feed me?" stare. I'll take that as a good sign...

I guess she probably felt weird after the enema and maybe that's why she was sitting by her box and I imagine the whole experience was quite traumatizing. :(

I was mostly worried if she hadn't got all the poop cleared and still had a bit stuck up higher that was going to cause problems but you're all probably right that she probably just has nothing left to poop now. Thanks for the reassurance!
 
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sidneykitty

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Whoops hit post reply before I was done, sorry!

She was getting Natural Balance Green Pea & Venison for dry and we were giving her Fancy Feast salmon for wet. Now I'm not sure what to do since we have to cut the dry - do I stick with the FF salmon - its not really LID or try something else?

I picked up a number of cans of Merrick LID duck, Natural Balance LIDs (which have clay...) and one other brand I can't recall. So I can try those with her if we need to switch her off the Fancy Feast, but she needs to eat it for it to work and she is very picky about her wet food. I worry about hepatic lipadosis when messing with food too much - want to make sure she gets enough calories and will eat!
 

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How many wet meals a day does she get? Maybe reduce the portion size and increase the number of feedings. That’s one IBD management strategy. Now with extra meals, you can try the guest star transition. Rotate (slowly over a few days) a new food into just one of her meals. This way if it doesn’t work out, you only affected one meal and you can easily rewind to the leading meal. If it does work well, you can always transition another meal until eventually your guest star has become the new leading actor. That frees you to look for another guest star until you’ve built the ensemble cast that works best for your cat.
 

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We tried raw, pre mixes, cooked (it worked, but getting a complete diet can be tricky) and our IBD cat is doing good on Fancy Feast, so far. It's been about a year.
Is the salmon a gravy or shred style, or is it pate?
daftcat75 daftcat75 made a good point, take what you'd feed in two meals and split it up into 3 or 4. A digestive tract like that seems to appreciate smaller meals, easier to process vs. a boat load of food hitting the stomach all at once. Picture yourself after a bout with the flu, a smaller meal here and there will sit better than sitting down to a huge meal when your stomach is still a little green.
 

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Check with your vet first of course, but 1/4 tsp per day of Miralax (or store brand equivalent) sprinkled over wet food has been an absolute godsend for my constipated kitty.
 
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sidneykitty

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Previously I was feeding her wet food in two goes one around 4pm one around 9pm. Now that she's on all wet, I'm doing it in three-four goes per day. She has always liked nibbling/grazing throughout the day as opposed to big meals, so I thin k this will work out well.

She was getting 1/4 tsp Miralax a day before, now she is getting 1/2 tsp a day. She gets the salmon pate.

Spoke to the vet and they did assure me if all the poop was cleared out Friday night it might be a bit until she has to go again while everything catches up.

The good news is Saturday night she did come sleep in our bed and Sunday she was sitting on our laps again and being her usual sweet and social self! So she must be feeling better. Now I am focusing on preventing this happening again! I suppose the wet-food only diet will help.
 

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This is wonderful news!! Thank you for the update!
The wet diet should help, yes, :heartshape: :sunshine:
 
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sidneykitty

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Ohh I hope so! We can always add Lactulose as well if she needs it. Now I am just anxiously awaiting her next poo! Thanks everyone for your thoughts and assurances.
 
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sidneykitty

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The good news is - we've had our first poop! :hyper: I hope it continues to flow smoothly ...
 
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sidneykitty

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I do have a few questions about IBD that I've been sitting on for a while if anyone has experience.

1. I have concerns about her getting enough calories eating only wet food. I previously had her calculated at needing 180kcal/day, which I realise now is a bit more than she does need. The vet said she was 1 lb overweight at 9lbs and should be 8lb so her caloric needs are closer to 160.

The FF salmon pate I feed is 92 kcal/can which means she needs to eat 1 3/4 can per day. Is that reasonable? I worry it will be too much volume for her. I would expect her to lose weight switching from dry to wet especially considering her old dry food had a lof of grains/carbs/questional ingredients. Is there a way I can supplement with additional calories somehow in line with the special diet or anything else to ensure she is getting enough?

2. If it is lymphoma vs. IBD, would I expect her symptoms not to improve with just the diet/without medications and further treatment? ie, she would continue vomiting and getting constipated?

I don't plan to do a biopsy at this stage given she is 14 and she has heart disease given that it may not yield useful information if a troublesome spot of her intestines were missed and cancer/IBD would likely be treated the same either way.

3. Is there anything else I can do to support her GI health? She's getting Miralax but to me that's more of a masking of a symptom than a treatment even though it will help prevent constipation. I'm giving probiotics as well, but I also don't want to be adding too many powders to her food to turn her off eating. Is there anything else (like a supplement) that can help with GI motility and digestion?

The emergency vet read over Amber's u/s report and talked to me about triaditis something that hadn't been mentioned by my regular vet at all. She also recommended we start her on B12 but my regular vet wants me to bring her back in to get it even though we'd discussed it previously. I'll call them today and see what I can do. It might even put me at ease to have someone feel her colon again.

4. Is there anything you think I should watch out for? Especially keeping triaditis in mind. When does IBD reach the stage of needing meds like pred and antibiotics? Can I expect her to reach that stage eventually or will the diet change do the job for us? I guess that's what I'm mostly confused about - is the diet enough or does she need something else, too?

Thanks in advance...!
 

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In addition to IBDkitties.net, I consider this article to be really valuable though very dense with science.

https://feline-nutrition.org/health/feline-inflammatory-bowel-disease-nature-and-treatment

Let’s see if I can answer a few of these.

1. Calories: because her digestion is compromised with the IBD, she may need even more calories than 20/lbs. She’s also a senior cat which makes her protein requirements higher to prevent skinny old cat syndrome (muscle wasting as they get older and their digestion gets less efficient.). I’d aim for 30 cal/lbs of ideal bodyweight (not where she’s at now), and weigh her no more frequently than once weekly. To get to this number, you’ll likely have to increase the number of meals and decrease the portion size of each meal to keep her from getting stuffed and not eating another meal and also her gut and butt will appreciate mouse-sized portions rather than two big piles of food a day. When I was getting Krista through the worst of it, she was eating 1.5 oz (42 g) as many as six times a day. Through trial and error, I found 2 oz is her stomach size. Any larger a meal and she’ll have great discomfort or give it back. For Krista, whose ideal weight is closer to 9 lbs and she’s also 14, I aim for 220 to 240 calories a day or 6 to 8 oz of food per day. When we were still on scheduled feedings, that amounted to 4 by 2 oz.

2. Lymphoma is the progression of IBD. Left unmanaged long enough, the immune reaction of IBD goes haywire. The rule of thumb I have heard is that if you can stabilize her weight loss and even put weight back on her, it is most likely not lymphoma. Cancer eats calories.

3. Yes. There is more you can do. On the page linked above, several headings in, there is a section called “Treating IBD - Using an Introductory Diet.” The short version of this is that IBD is the result of intestinal inflammation that causes food particles to leak into the blood stream. The immune system which is geared towards recognzing protein patterns of foreign invaders creates an immune respose to the food proteins. To heal IBD, you must first cool the inflammation and heal the leaky gut. The introductory diet is raw meat and bone broth. Feed that for 2 weeks and that should soothe the inflammation: it should heal her and seal her. If you do this much, then reintroducing novel to her proteins will be that much easier because you’re not trying it on an already inflamed and leaky gut.

B-12 is a must with IBD. If she’s lost any weight to IBD, then she’s nutritionally compromised. B-12 is weird in that B-12 is needed to absorb B-12 from the diet. So if she’s losing weight, she’s probably already having a hard time getting nutrition from food alone. B-12 injected subcutaneously (under the skin vs in a vein) is safe and easy and it should be the very first step of any GI disorder’s treatment. If it is not needed, it gets harmless excreted in the urine. But if it is needed, it makes such a huge difference. Amber likely will not put weight back on without starting the B-12. But once she does start it, you should see a huge improvement. I think a lot of vets are afraid that the difference B-12 makes will mask making a proper diagnosis. If you’re not going to do the biopsy, then you’re pretty much at the end of the diagnosis road and you should begin the B-12 treatment.

4. Pancreatitis and choleangiohepatitis, the other two points in triaditis, rarely happen on their own. They are both usually the result of carry-over inflammation or bacteria leaking from IBD. Get the IBD under control and you greatly improve the chances that Amber won’t have to deal with pancreatitis or liver inflammation further down the road.

As for meds, I’m not the Dr here but this is what I’ve learned from a holistic supplement supplier.

Pred is used to suppress the immune reactivity of IBD. But long-term steroid use can affect other organs. If you can do the introductory diet of raw meat and bone broth, you can probably avoid pred. As for antibiotics, I think they are only appropriate if they have done a cytology and confirmed there is an infection and the antibiotics they are prescribing are effective against that infection. Otherwise, they could just be setting you up for antibiotic resistance further down the road when you may actually need them. Cool the inflammation, stop the leaky gut, and you reduce the risk of bacteria from the gut leaking to other organs.

I wish we had done the introductory diet. I thought it was going to be too hard or too gross or whatever my reservation was. But when I finally started her on raw (it was easier this summer when Rad Cat was still in business), the difference was overnight! It was almost like she was faking it the entire time.

I think if you can do the two week introductory diet, then start her back up on a high quality protein wet food only, several small meals a day, plus the B-12 treatment, you should see a fairly quick recovery. She’ll always be sensitive to the proteins she’s had most often during the time her gut was leaking so you’ll likely still need to find stable proteins for her. But it will be that much easier when her gut and butt aren’t angry all the time regardless of what’s transiting through them.

If you’re still not sold on the introductory diet, I healed Krista’s gut with products from Vitality Science. It took longer and was much more frustrating because I wasn’t sure which was doing what, and how long it would take, and she wasn’t crazy for most of the supplements. In hindsight, I would have switched to raw sooner if I knew the difference it was going to make. But she did get through IBD and pancreatitis without steroids.

They have a product guide but I’d probably go with the TRV or TRDV:

Vitality Science | Natural Remedies For Dogs And Cats
 
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sidneykitty

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Thank you daftcat, for your advice. That's such a good point about calories I didn't even think of. The saga continues, however...

Well, she was doing really well before this constipation episode. She had more diarrhea Tuesday and nothing since. Her appetite has been way down the last two days so I brought her back in today for a recheck.

I started her on B12 today. She'll get it once weekly for the next 6 weeks. They recommended I have her eat z/d with probiotics. She is not still constipated, which was my worry, as they did a second xray and it was very different, not all plugged up with poo. They said she has poo in there that is soft enough to come out on its own. Also mentioned it looks like she has some arthritis on her lower spine, which could be causing extra pain while making bowel movements.

As soon as we were in the door, she made for the box and had more stinky soft poop. She was licking her lips while doing this then vomited. She did this once more since we got home. I just don't know what to do now...we've literally just been to the vet and they didn't see any blockage or reason to be concerned on her x-ray. If I hadn't just been to the vet I'd be really worried. Could it all be just from the enema? The vet said diarrhea can just be from that.

I just feel like I just don't know what to do now. I don't know what to feed her. I don't know how to give her enough calories. This vet even mentioned I could feed her dry food which I understood was not an option due to her constipation. I'm so confused and I just want to make her feel better. Does this mean the diet I was giving her before isn't working and I should try something else? I guess I will try the z/d and see how it goes...I'm just worried too much diet changing is going to do more harm than good. Now I'm wondering could it be something else? My poor kitten. :( I only remembered today she will be 15 in April... I guess her good health wasn't going to last forever.
 

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Whatever you decide to feed try to give it long enough for her to heal. It’s not going to happen overnight, even on vet food. But as long as the good meals outnumber the reactions and the reactions are getting less frequent, you’re on the right track. Keep a food journal of what you’re feeding, how much she ate, and whether she had a reaction. You can use this to track calories too. Food journal will be essential for helping find patterns but also encouraging you through rough patches. You can use it to test feeding schedules and portion sizes too.
 
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sidneykitty

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So would you keep feeding her what you have been even if she has one reaction or bad day? I am doing exactly that - but I need to make myself a more organized system.

If she stops eating what she normally eats or is able to eat, what do you do? Feed her something she will eat even if it is not under the restricted diet? In that situation I'd always rather she ate something than nothing... I don't know why but I've always been very scared/worried of hepatic lipadosis with my cats.

Any idea how long it will take B12 to start showing it is helping? Yesterday was her first dose she is going to get it once a week for 6 weeks.
 

daftcat75

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If it's one bad reaction or one bad day, then yes, keep feeding it. Stay on the plan and give it time to work. Her gut wasn't injured in a day and it won't heal in a day either. Keep a food journal to know if the reactions are increasing or decreasing in frequency.

These days, I try to keep three different foods in Krista's diet. She may hairball one up and hold a grudge against it. Having more than one she can eat helps us weather those grudges. Having three foods instead of two also helps us weather out supply issues since she's eating Rawz these days and of the three stores I can find it, each lacks at least one of her proteins.

This is of course a huge limitation of an elimination diet. It's so restrictive that if she barfs up her one food and holds a grudge, then what? If Krista barfs or has a hairball, I give her 24 hours to fast if she wants to. After 24 hours, I'll try to get her to eat whatever she will eat. But nearly all of the time, it resolves in 12-18 hours. It just feels like forever because of that constant fear of hepatic lipidosis.

As much as I resisted raw at first, knowing how much a difference it made for Krista literally overnight, I would have done the Introductory Diet (raw meat and bone broth for two weeks) for her had we to do it over again. The raw meat and bone broth, assuming it's not a protein they are allergic/intolerant to, will provide easy digestion with no extra ingredients to irritate. The gelatin and collagen in the bone broth will help rebuild the inflamed gut. Assuming you can find some clean foods like Rawz, Tiki Cat, Pure Vita, etc that won't re-trigger the inflammation, you should be able to resume a wide variety of foods after the two week healing period. I posted a link about it in my other post above.
 
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