Megacolon - Time To Euthanize?

[dkb817]

I'll see if I can sum up my cat's story here:

We originally adopted Ally when she was 2-3 years old as an Emotional Support Animal (I'm disabled due to Panic Disorder). Barring a revelation that she was blind in one eye and would occasionally get minor infections in said eye, she was perfectly healthy for the next 2-4 years.

Sometime in winter of 2012/2013, I noticed that she was straining when trying to use the litterbox and eventually, she gave up on the litterbox and started using her bed as an alternative. When we noticed that there was blood in her stool, we took her in to a new vet for her first de-obstipation, where she was kept overnight, given plenty of fluids, and was manually cleaned out from severe constipation. The vet gave us some Lactulose and sent us on our merry way with a brand spankin' new bill of over $300, something that was extraordinarily tight on one income (My Dad was the only source of income at the time, as I wasn't completely disabled enough to qualify for government assistance). This has mostly done the trick in managing her constipation issues over the last few years, adjusting as needed and with the occasional enema (I think before this weekend she had only required 2, maybe 3 enemas).

About a month and a half ago, my Mom and I moved into a new house. We expected Ally to get constipated from the stress, but she took to her new room like a fish to water. However, I noticed at some point last week that she hadn't really poo'd in a few days and her appetite had decreased to where she was refusing her kibble (She cannot tolerate wet food, makes her vomit every time). We managed to get an emergency appointment with a new vet who confirmed my suspicions that Ally has megacolon and probably has the entire time we've been dealing with chronic constipation, sedated her, gave her some fluids, and gave her two enemas - This time the bill came to about $300+.

Within maybe 2 hours of being home from the vet, Ally began vomiting - a trend which continued for roughly 12 hours, off and on. She was also leaking a bloody/mucus discharge from her rear end, and was refusing to eat anything. While I wasn't worried about the lack of poo per say, I WAS worried about her not eating, as I know that can lead to fatty liver.

Concerned, my Mom and I took her to the Emergency Vet, who once again had to sedate Ally, gave her some sub-q fluids, a shot for nausea, and sent us away. The bill this time was an additional $200 (It would have been way more if the vet had done x-rays or blood tests)


Now, it's Sunday (nearly Monday), and not much has changed. Ally has tried to poo twice today, but very minimal stool came out and even then, it was mostly blood. Even though I rarely see her drinking water, she's urinated several times per day. She also straight up refuses to eat - won't eat her old kibble, would barely touch 2-3 small pieces of chicken that I tore up for her. The only thing she's really able to eat are some of her Temptations Treats - but a 20lb cat cannot live off of treats alone.

My Mom and I have reached the decision that this has to be it; As bad as it sounds, we financially cannot afford any further treatment - not after the initial vet appointment, the ER bill, and a bill from our old vet prior to moving that ran something like $400. Our savings are tapped out and neither of us has good enough credit to qualify for anything like CareCredit (thanks student loans -__- ). The stress of going to the vet so much, having to be sedated (she's almost feral towards vet staff), being on several different meds, and having to fight her to take the meds in the first place is no way for her to have to live. We currently have her corraled into a little mesh puppy play yard thing, surrounded by puppy pee pads so that if she does leak, it doesn't make a huge mess.


I guess I'm mostly just looking for reassurance that I'm not completely in the wrong for saying "Enough is enough" and opting for euthanasia rather than spending money we don't have on something that isn't a guaranteed fix.

 

[dkb817]

I should also add that on the way back from the vet on Friday, Ally had some pretty massive stools in her carrier - but it's been nearly liquid, if that, ever since.

 

[danteshuman]

Is it possible she was so constipated she got stopped up... then finally went #2? If the laxative pushed the blockage through watery runs might follow behind it. If so it would be a shame to put her down. If so giving her a few days to see if her stomach even out with her new food/medication (and you keep her hydrated) what harm is there in giving her a few days?

 

[danteshuman]

We had a 19 year old cat that had broken the last vertebrate (and had to loose her tail.) She peed every time she fell asleep. Unforgently when she got older she got chronically constipated. It caused her to loose weight and we took her in because she cried every time she went #2. The vet sedated & x-rated her. Her colon was enlarged and she had a massive poo 2-3 times larger than it should be! The vet said she could go in and break up the poo while she was asleep BUT because her colon was so enlarged she would just get constipated again. The vet gently nudged us to put our baby down for her sake. We cried but let her go that day.

Is that what you meant when you said mega colon? What is your vet recommending?

 

[Yodasmom]

You are not in the wrong for considering euthanasia. I am in a similar situation. I have an otherwise healthy cat whose colon simply will not work. Two de-obstipations and every medication the vet has been able to come up with later, I am worried we are getting nowhere. And my bill is approaching $2,000 in just two weeks. My cat has also had chronic constipation for years, but up until 2 weeks ago, it was well controlled with Lactulose. She has other problems as well, but we have been able to get those mostly under control in the last week (back pain, eye and ear problems).

We did the second de-obstipation this past weekend. She is on new food and we adjusted the medication (lactulose, cisapride, cascara, tried Miralax). If this doesn't work, the vet says the only other option is the big colon surgery, that costs $4,000 to $6,000 and my vet doesn't even do it. We would have to go somewhere like the U of Penn animal hospital. I just can't justify spending that kind of money, especially when she could end up with life-long diarrhea from the surgery, and she has a luxating patella (knee cap) that is also likely to need surgery in the next couple years.

I love this cat and I feel sick over this. She's not even 9 years old yet. So you are not alone. You have to remember that you gave the cat the best life you could while you could. You are not obligated to go into financial ruin to save your cat. It sounds like you have tried really hard.

 

[epona]

OK I firstly want to say that if she is sick and there is no treatment, I would not judge you badly for giving her a dignified end to her life.

You say though that she vomits when she eats wet food - one of mine vomits when he gets an entire pouch of wet food at once, because he bolts it too fast. There are various ways around this - try a go-slow bowl (a bowl that is shaped to slow a cat down while eating), or feeding a small amount of wet frequently.

While my own vomit boy was recovering from a recent health issue, I was feeding him small amounts of wet food 7 or 8 times a day - every time I tried to reduce that number of feeds and feed a bigger amount in 1 go, he would eat too fast and bring it up. So have you tried smaller portions of wet more frequently (wet would help with constipation), or using wet food with a bowl designed to slow down eating?

Of course you know what is best for her - you can judge whether she is happy enough to carry on, perhaps there are some things you could try, or if it's hopeless and she is in misery then you know the correct thing to do, however upsetting it is for you. Wish you and your cat all the best xx

 

[maggiedemi]

Have you tried different canned foods? There must be one that won't make her vomit.

 

[di and bob]

My heart goes out to you, it is one of the hardest decisions you can make, and no matter what you decide, your heart will break.No one can tell you what to do, it is a decision you will have to make out of the love in your heart. When there is no permanent 'cure', when the suffering and pain is the whole future, there is only one choice that matters. Existing in a world that offers no joy, no happiness anymore, or being released from that painful existence. I say existing, because that is what it is, it is no longer living. If she lives in a world that promises future endless vet trips, endless pain and suffering, you will find the strength in your heart to end that suffering.
I don't know why this kind of suffering is allowed, why we have to make a decision that hurts so very bad. But when you look into those eyes, you know what you have to do, for her, not for you. I will be there in spirit,there are so many who have traveled this road. Gather strength from all of us who care for and love these precious ones. We freely offer our thoughts and prayers. Give that sweet head a kiss from me, I'll pray for you all. Take care......

 

[dkb817]

danteshuman - Yeah, that's almost the exact scenario we're going through with Ally right now. She's had a few enemas over the years that tend to work more often than not, but within just a few months, we're right back where we started. Even when she's not in the middle of an episode, she was only having #2's once every day to every other day, which her new vet says isn't great either. She ate a bite or two of food while I was asleep - but a 20 lb cat can't really survive by only eating a bite or two of food every couple of days.

I haven't spoken to the vet yet today (He told me they'd call on Monday to check in after the enemas on Friday) - but the vet at the emergency clinic said they'd probably want to put her on Cisipride, in combination with the Lactulose. With Ally being as picky about her food when she IS eating it, I can't see that working out long term (and she gets downright mean when we try to just give it via syringe; It would definitely be a two person job, and the only person who'd be able to help me is my Mom, who is on blood thinners and can't afford to have my cat clawing the crap out of her)


Y Yodasmom - That's where we're at, as well. Between a past vet bill in mid to late February and now the cost from Friday and Saturday, we're sitting at nearly $1000, which was all of our savings. I'm all for treating an animal while you can, but we also can't end up in the poor house, trying things that only really help in the short term.

epona / M maggiedemi - We've tried different brands, different flavors (she never did seem to care much for the fish or dairy flavors, so we stuck with chicken and turkey mostly), different methods of giving it to her, all to no avail. The vet suggested smearing it out on a plate to slow her down, and even then, she only licked the gravy off (which she promptly threw up onto the plate, so that clearly didn't work). Our last cat loved wet food and lived to be 22-23 years old, so I'm aware of the benefits with feeding wet food, but the harm she was causing herself by repeated episodes of vomiting just wasn't worth it.

di and bob - That's the hardest part. She ate a few bites of her kibble while I was asleep (never thought I'd be so relieved to wake up to the sound of her crunching her food), and let me pick her up, so she acts like she's feeling a bit better today.

My concern is just how long the uptick will last. Will we wind up being right back here in a matter of days/weeks? Is a life full of forced medications, repeated vet visits (and the sedation, ememas that go along with that because she HATES the vet), and repeated constipation episodes really the life I want for her?

Am I considering Euthanasia just because the continued care is hard on me, rather than hard on her?
It's a really hard decision to make, especially when she's acting okay this morning - but do we want to wait until she IS super sick and in pain, or do we make this call now, and have our last memories of her be good ones (rather than of her sick, screaming, in pain, miserable)?

 

[di and bob]

You don't want to euthanize when they are feeling well, it is easier for our hearts to accept if they are acting unwell and tired of living. We left our Burt to live out his life without all those hated vet visits, and medications, and enemas. Ending your life is never easy, every living thing is programmed to fight it as long as possible. But you don't want to extend the misery either, a day too early is so much better than a day too late. see if the vet will give you an injection or even a liquid that can be given in the side of the mouth, to be given if the pain suddenly flares up and becomes too much to bear. I wish I would have had one for that last few hours. If she begins to avoid you, keeping to herself, looking tired and miserable, that is the time. I cry for your pain.

 

[epona]

Yeah, make a list of things she enjoys - once she's gone a day or so without doing any of those things, or showing an interest in them, that can be a good measure.

I know people say "you'll know when it's time" - and that is true because you do take note of these things subconsciously - but making a written note of stuff like eating, activity, interest in the world, wanting cuddles, enjoying laying in a sunbeam - making a record of all of those things can make it easier to spot when the "sitting hunched up in the corner" days outweigh the good sign of enjoyment in life things. Also keeping a kind of loose record of that sort of thing can be useful in reminding yourself that you did the right thing at the right time, afterwards.

 

[kpc1024]

I am in the same damn boat. I have a lovely cat, who is a little zonked from seizure meds but recently has stopped being able to defecate. I gave him enemas, deobstipated, disimpacted, medication, laxatives. Nothing works. I tried at all. I hate it that he will still wiggle his tail happily when I pet him but cannot go. It is an essential bodily function. I know I cannot go and have the vet take out the poop every single week. It isn't good for me or him. This is the worst.

 

[kpc1024]

Did you make a decision, btw?

 

[kpc1024]

You are not in the wrong for considering euthanasia. I am in a similar situation. I have an otherwise healthy cat whose colon simply will not work. Two de-obstipations and every medication the vet has been able to come up with later, I am worried we are getting nowhere. And my bill is approaching $2,000 in just two weeks. My cat has also had chronic constipation for years, but up until 2 weeks ago, it was well controlled with Lactulose. She has other problems as well, but we have been able to get those mostly under control in the last week (back pain, eye and ear problems).

We did the second de-obstipation this past weekend. She is on new food and we adjusted the medication (lactulose, cisapride, cascara, tried Miralax). If this doesn't work, the vet says the only other option is the big colon surgery, that costs $4,000 to $6,000 and my vet doesn't even do it. We would have to go somewhere like the U of Penn animal hospital. I just can't justify spending that kind of money, especially when she could end up with life-long diarrhea from the surgery, and she has a luxating patella (knee cap) that is also likely to need surgery in the next couple years.

I love this cat and I feel sick over this. She's not even 9 years old yet. So you are not alone. You have to remember that you gave the cat the best life you could while you could. You are not obligated to go into financial ruin to save your cat. It sounds like you have tried really hard.

Where are you with your situation? As I replied below, I am in the totally same situation.

 

[Yodasmom]

Y Yodasmom - That's where we're at, as well. Between a past vet bill in mid to late February and now the cost from Friday and Saturday, we're sitting at nearly $1000, which was all of our savings. I'm all for treating an animal while you can, but we also can't end up in the poor house, trying things that only really help in the short term.

It sucks, but sometimes it is just the reality. The other issue is that Yoda may need knee surgery in the future. I was prepared for that, but if I pay for both the colon and the knee in addition to what I have already spent on the constipation, I will be in the $10,000 range. There is also the back pain, which the vet says is likely arthritis (although it didn't show on the x-ray). And I have a full time job, so I can't stay home all day to monitor her. I'm already giving her 5 medications on a daily basis, many of those twice and one three times. I was willing to do all that, but I just can't go as far as the surgery. Which makes me feel like crap, since she is only 8 going on 9 and still a relatively young cat.

 

[Yodasmom]

Where are you with your situation? As I replied below, I am in the totally same situation.

We have been attempting to address the situation for 2 weeks. Yoda had a second de-obstipation and multiple enemas on Saturday and I brought her back home on Sunday. She's acting just fine, especially since I started her on the prednisone for the back pain. She is taking Lactulose twice a day and Cisapride 3 times a day. Plus a Cascara herbal supplement recommended by a specialist. Plus the prednisone and cosequin for the back and knee problems.

The laxatives are working at making her poo very soft. Everything they pulled out of her on Saturday was soft. But her colon is not contracting, so she isn't getting any messages that she needs to poop. The Cisapride is supposed to help that, but we are going on two weeks of Cisapride with no results. I spoke with the vet this morning and he is having me increase the dosage to see if that can make anything happen.

We are giving this one more try. If she doesn't have a bowel movement this week, we will have exhausted all medical options besides surgery. At that point, I will have to decide whether to euthanize her immediately, or wait until she starts to feel the effects of not having gone. I feel like I've tried. $2,000, 4 x-rays, blood work, and two de-obstipations.

 

[dkb817]

I spoke with the vet this morning (glad he called himself rather than having a tech do it; benefit of a smaller vet practice) who was super sympathetic to my concerns, told me that in the roughly 10 years Ally has been alive that we've gone above and beyond in an effort to make her comfortable, happy, and healthy. He also agreed that you don't necessarily want to wait to make that call until a cat is showing signs of pain and misery, since most cats are so composed and only show pain when it is REALLY bad. I mentioned the financial aspect and was told "Look, we wish it wouldn't come down to financial concerns - but sometimes it just does. You've done what you can, there's no shame in that", which was honestly surprising (probably because the very first vet we took Ally to several years ago guilted us about not wanting to spend thousands of dollars, and once withheld her Lactulose medication when I said I didn't necessarily want to aggravate things by doing a rabies vaccine on top of everything else).

He said we were going to go a little off script and that in an effort to get her to eat more, we could try whatever she'd eat - not necessarily just pet food. I know she was a fan of scrambled eggs, chicken, things like that, so we'll be giving that a try later this afternoon.

If she's not much better off in a few days, it'll be time to consider euthanasia - but there's no harm in giving it another couple of days.

 

[foxxycat]

danteshuman - Yeah, that's almost the exact scenario we're going through with Ally right now. She's had a few enemas over the years that tend to work more often than not, but within just a few months, we're right back where we started. Even when she's not in the middle of an episode, she was only having #2's once every day to every other day, which her new vet says isn't great either. She ate a bite or two of food while I was asleep - but a 20 lb cat can't really survive by only eating a bite or two of food every couple of days.

I haven't spoken to the vet yet today (He told me they'd call on Monday to check in after the enemas on Friday) - but the vet at the emergency clinic said they'd probably want to put her on Cisipride, in combination with the Lactulose. With Ally being as picky about her food when she IS eating it, I can't see that working out long term (and she gets downright mean when we try to just give it via syringe; It would definitely be a two person job, and the only person who'd be able to help me is my Mom, who is on blood thinners and can't afford to have my cat clawing the crap out of her)


Y Yodasmom - That's where we're at, as well. Between a past vet bill in mid to late February and now the cost from Friday and Saturday, we're sitting at nearly $1000, which was all of our savings. I'm all for treating an animal while you can, but we also can't end up in the poor house, trying things that only really help in the short term.

epona / M maggiedemi - We've tried different brands, different flavors (she never did seem to care much for the fish or dairy flavors, so we stuck with chicken and turkey mostly), different methods of giving it to her, all to no avail. The vet suggested smearing it out on a plate to slow her down, and even then, she only licked the gravy off (which she promptly threw up onto the plate, so that clearly didn't work). Our last cat loved wet food and lived to be 22-23 years old, so I'm aware of the benefits with feeding wet food, but the harm she was causing herself by repeated episodes of vomiting just wasn't worth it.

di and bob - That's the hardest part. She ate a few bites of her kibble while I was asleep (never thought I'd be so relieved to wake up to the sound of her crunching her food), and let me pick her up, so she acts like she's feeling a bit better today.

My concern is just how long the uptick will last. Will we wind up being right back here in a matter of days/weeks? Is a life full of forced medications, repeated vet visits (and the sedation, ememas that go along with that because she HATES the vet), and repeated constipation episodes really the life I want for her?

Am I considering Euthanasia just because the continued care is hard on me, rather than hard on her?
It's a really hard decision to make, especially when she's acting okay this morning - but do we want to wait until she IS super sick and in pain, or do we make this call now, and have our last memories of her be good ones (rather than of her sick, screaming, in pain, miserable)?

Just one more question-everyone posted good questions!

Did you try the following meds yet-
Cerenia
Pepcid AC
which are available as injection=I had a bity hissy cat who we used injections when she was elderly-we knew it was end stage but it was more to keep her comfortable.
They do have topical meds to put in ear but those didn't work for me. I found that injection pepcid AC helps with vomiting and Cerenia with nausea. Together they worked great. When a cat has an upset tummy they probably won't eat- you can try these meds- have them send you home with 3 or 4 days of these set up as injections. the Pepcid AC is 12 hour but some vets give it once a day. Cerenia is 24 hour.

Also if you want to learn=sub fluids combined with above medications may be enough to get your cat over the hump at least till you figure something out. If then these medications don't work-then you know you have done all you can. The Pepcid AC is dirt cheap via script injection but the cerenia is more money. I hate to see you put your baby to sleep until you try these together. Maybe it will help...maybe not.

 

[foxxycat]

I spoke with the vet this morning (glad he called himself rather than having a tech do it; benefit of a smaller vet practice) who was super sympathetic to my concerns, told me that in the roughly 10 years Ally has been alive that we've gone above and beyond in an effort to make her comfortable, happy, and healthy. He also agreed that you don't necessarily want to wait to make that call until a cat is showing signs of pain and misery, since most cats are so composed and only show pain when it is REALLY bad. I mentioned the financial aspect and was told "Look, we wish it wouldn't come down to financial concerns - but sometimes it just does. You've done what you can, there's no shame in that", which was honestly surprising (probably because the very first vet we took Ally to several years ago guilted us about not wanting to spend thousands of dollars, and once withheld her Lactulose medication when I said I didn't necessarily want to aggravate things by doing a rabies vaccine on top of everything else).

He said we were going to go a little off script and that in an effort to get her to eat more, we could try whatever she'd eat - not necessarily just pet food. I know she was a fan of scrambled eggs, chicken, things like that, so we'll be giving that a try later this afternoon.

If she's not much better off in a few days, it'll be time to consider euthanasia - but there's no harm in giving it another couple of days.

Foods to try:
plain yogurt
meat babyfood
KMR kitten milk replacement formula- stick with PetAG brand-they have canned and powder-you can make a mixture and add pate cat food to it
kitten formula cat food-wet or dry
tuna-light tuna is more smelly than white tuna=my girls love chicken of the sea light tuna
shrimp-they like these chopped up in tiny pieces
cooked salmon/haddock/cod if you can afford it
Hamburger
chicken
livers or other organ meat
turkey
pork
deer meat
eggs scrambled
rotisserri chicken-no bones-skin would be ok if it's not seasoned

suprisingly my girl who is fussy only eats those meats above when raw...so I don't think it would be bad to cut a 1" cube of meat and dice it up tiny tiny in a bowl for your kitty...if you are considering euth at this point these foods won't hurt and may just perk up the hunger. I always give my girl a good sized chunk of raw meat when I am cooking-it's only 2 times a week but she seems to enjoy it. So maybe one of these will help?

 

[kpc1024]

We have been attempting to address the situation for 2 weeks. Yoda had a second de-obstipation and multiple enemas on Saturday and I brought her back home on Sunday. She's acting just fine, especially since I started her on the prednisone for the back pain. She is taking Lactulose twice a day and Cisapride 3 times a day. Plus a Cascara herbal supplement recommended by a specialist. Plus the prednisone and cosequin for the back and knee problems.

The laxatives are working at making her poo very soft. Everything they pulled out of her on Saturday was soft. But her colon is not contracting, so she isn't getting any messages that she needs to poop. The Cisapride is supposed to help that, but we are going on two weeks of Cisapride with no results. I spoke with the vet this morning and he is having me increase the dosage to see if that can make anything happen.

We are giving this one more try. If she doesn't have a bowel movement this week, we will have exhausted all medical options besides surgery. At that point, I will have to decide whether to euthanize her immediately, or wait until she starts to feel the effects of not having gone. I feel like I've tried. $2,000, 4 x-rays, blood work, and two de-obstipations.

It is incredibly frustrating. I am on my last try with my guy. I am trying Cisapride as well. Not seeing great results. Like your guy, he just isn't pushing it out. I go for a recheck on Wednesday to see how full he is after they put him under and totally cleaned him out last Wednesday. Since then, he only pooped a little, but I guess that is hope he is capable of it? I don't know. It just sucks to look at your beautiful cat and know you may have to put him down because he cannot take a frickin' dump. Obviously, an important issue but it sounds so dumb saying it.
You can only do so much. it is horrible to put them down when they aren't otherwise miserable, but someone said it is better to put them down a week too early than a day too late, and save them the pain. ugh. The stress of the entire situation and the back and forth to the vet is excruciating. Let me know what happens. So sorry you and your little guy have to deal with this