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Lynn Morgan
Lynn Morgan,
Category: Cat Veterinary
Satisfied Customers: 1
Experience:  Associate Veterinarian at Frankfort Animal Clinic
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I have a Himalayan cat that is approx. 8 years old (she was

Customer Question

Hello, I have a Himalayan cat that is approx. 8 years old (she was a rescue). Has a history of digestive issues. In 2011 she tested positive for clostridium. The last few years, she has had a history of constipation that usually results in me having to give a high dose of lactulose or have a vet give her an enema.
This past August, I took her to the vet for weight loss, lethargy, loss of appetite and sinus issues. Her highest weight has been 8.5, but she had gone down to 7.5 within a matter of a few months, and a few months later she went down to 6.5. The vet treated her for a few days to try to remove the very hard feces that was stuck inside her, and a couple of times thought she had felt a growth while doing so. The first time she thought she found one she did an x-ray and it eased her worry about it, and the second time she thought she found one she encouraged me to take her to a hospital to get an ultrasound. I rushed her to an emergency vet within an hour, and the ultrasound found no growth. She stayed in the hospital two days to receive fluids, get treated for a sinus infection and get treated for constipation.
Upon returning home from the hospital, she had an increased appetite and had very normal bowel movements, which she hadn't experienced for a while. Her energy was back, even in a way I hadn't seen in months.
I've noticed over the past few days she has a loss of appetite again, and I feel that she is a little lighter when I pick her up. She has become lethargic this week, and tonight she just in general acts like she doesn't feel good. She's been sneezing a lot again, which always makes me wonder if she's not able to smell the food and, therefore, doesn't care about eating it. But she is also hunched over at times when she stands, which is something I notice her doing when she is constipated. It's really difficult to tell when she is constipated because I have three cats and am away at work during the day, so I'm not around to see her go or always know who's doing what.
Can you please tell me your thoughts, and next steps? I am also contemplating what vet to take her to ... the vet that thought she had discovered a growth would not give her an enema for the constipation, which has been a solution in the past with a different vet (that has now passed away). The last vet that treated her was the emergency vet hospital nearby, and they said I could bring her in tonight but they are currently full and treating many "red zone" cases right now.
Thanks for your help.
Submitted: 7 months ago.
Category: Cat Veterinary
Expert:  Lynn Morgan replied 7 months ago.

Hi there. Dr Lynn here. Sorry to hear about your kitty. Give me a few minutes to respond to your questions.

Customer: replied 7 months ago.
Thank you, ***** *****
Expert:  Lynn Morgan replied 7 months ago.

Has your cat been diagnosed with 'megacolon'? This is usually treated with lactulose like you have described and frequently requires enemas.

Customer: replied 7 months ago.
No, she has not. They have mentioned that it's not that, or to that point, before.
Customer: replied 7 months ago.
I just looked at megacolon online and want to note that she did take cisapride as well during her Aug. hospital stay, and I see that is often a medication for it as well.
Expert:  Lynn Morgan replied 7 months ago.

When I'm dealing with a cat with frequent bouts of constipation I like find out why they are constipated. Frequently it is due to diseases that cause dehydration (like chronic kidney disease) or disease of poor motility (and these can be difficult to sort out). Has any blood work been done to identify chronic disease or has any general xrays been done to look for masses or spinal cord disease?

Customer: replied 7 months ago.
Bloodwork has been done, and I know they looked specifically at kidney issues, since that is common with persian and himalayan breeds. They said that from what they can tell, her kidneys are functioning properly but we should keep an eye on that. She has also had a history of drinking a lot of water, so I have had her kidneys tested twice. The only general xray a vet has done is when the vet thought she felt a growth during a fecal exam, and wanted to do it as an initial step to see what she could find.
Expert:  Lynn Morgan replied 7 months ago.

If bloodwork is normal and I can't find any abnormalities with xray, we will often diagnose this as megacolon and treat it empirically. Cisapride helps with colon motility and lactulose helps keep the feces softer. Sometimes increasing the fiber will help (but you really need to experiment because sometimes it makes it worse). Adding miralax to soft food (1/8 teaspoon daily) is a simple thing to try.

Customer: replied 7 months ago.
Her bloodwork came back fine. She had some high levels when she was first admitted to the hospital that then became normal the second day there.
Customer: replied 7 months ago.
I have a hard time giving her enough fiber because she has skin allergies and requires a hypo-allergenic diet. She eats Prescription Diet d/d. Which is why I feed her canned pumpkin, often one teaspoon per day.
Customer: replied 7 months ago.
She does not like miralax and stays away from it.
Expert:  Lynn Morgan replied 7 months ago.

pumpkin is another good source of fiber. do you feel like the constipation is controlled a little or not at all

Customer: replied 7 months ago.
I feel like she was having ver large bowel movements when she first came back from the hospital but has gradually had smaller and harder bowel movements since then. And her lethargy, light weight and no desire to eat tonight has me very concerned. She isn't purring when I brush or pet her, which is unusual and concerns me more.
Should I be concerned that the ultrasound missed anything? The hospital doctor was confident they found nothing. I have been confident as well, but would like your opinion...
Customer: replied 7 months ago.
Also, I've been confident in the ultrasound because they were thinking it was a growth that was blocking her from having bowel movements, and with the large bowel movements she was having afterwards I saw that there is nothing like that to block.
Expert:  Lynn Morgan replied 7 months ago.

I ultrasound regularly and tell owners that a normal ultrasound does NOT rule out disease. It can confirm disease if seen but if there is disease in the wall of the intestines, the US can look normal. Some diseases are diffuse and require a biopsy to identify.

Customer: replied 7 months ago.
Thank you. Could her blood work come back normal as well? Should I request a biopsy at this point?
Expert:  Lynn Morgan replied 7 months ago.

Chronic GI disease can be frustrating and difficult to sort out. If you are feeling frustrated you may consider consulting with an Internal Medicine doctor - they specialize in these things. They can perform endoscopy and evaluate the colon and if necessary biopsy the wall. This is less invasive than surgery and often gets us an answer quicker than experimenting with medication for months

Expert:  Lynn Morgan replied 7 months ago.

And yes, with chronic GI disease blood work is usually normal. You can run specialized tests to see if the is problems with absorbing (cobalamin and folate) but these only test the small intestines, not the colon.

Expert:  Lynn Morgan replied 7 months ago.

hope this has been helpful

Customer: replied 7 months ago.
Thank you so much.
Expert:  Lynn Morgan replied 7 months ago.

Good luck. Lynn