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Old September 24th, 2010, 12:59 AM
Caesar's Mom Caesar's Mom is offline
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Recurrence of constipation after subtotal colectomy

My 14 year old cat was born with idiopathic megacolon that did not respond to medication. He underwent a subtotal colectomy at age 6, following by constant very bad diarrhea that did not respond to antibiotics, fiber, or diet changes. After 8 years of terrible post surgery diarrhea, my cat's stools became very firm about one month ago. Last night, I had to rush him to an emergency hospital where they determined he had terrible constipation and sepsis (without perforation) from the feces migrating through the unperforated intestinal wall. He almost died and is not out the woods yet. _Why this terrible constipation after years of terrible diarrhea? His constipation was poorly controlled prior to surgery, so I fear it will recur. What can be done for him to control both his constipation and diarrhea (antibiotics, fiber, food changes never worked). His care has cost over $3,000 in the last 24 hours. I can't afford to do this again.
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Old September 24th, 2010, 07:16 AM
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sugarcatmom sugarcatmom is offline
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Yikes, what a terrible ordeal for both of you!

What is your cat eating now, and what foods have you tried in the past?

Have you ever tried any supplements like slippery elm bark?
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Old September 24th, 2010, 08:31 AM
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mikischo mikischo is offline
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Hi, Caesar's Mom. I'm sorry you and your kitty are having such difficult time.

Sending for a full and speedy recovery from the sepsis.

Have the vets been able to offer you any insight yet as to what might have caused this issue? I have read that, in some cases, the scar from a subtotal colectomy can result in a narrowing of a portion of the remaining intestine which could cause constipation issues to recur. However, one would think that, were that the case, there would have been problems long before this, not eight years later.

There are a few things that can be helpful in maintaining a balance and aiding in the prevention of both constipation and diarrhea. Slippery elm bark, as mentioned by sugarcatmom, is one of them. A low residue diet can also be helpful. Many canned foods fit the bill. You may already be feeding that.

How is your boy doing today? Please keep us updated on how things are going.
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"The animals share with us the privilege of having a soul." -Pythagoras
"The soul is the same in all living creatures, although the body of each is different." -Hippocrates
"Let us be loving, hopeful and optimistic. And we’ll change the world." -Jack Layton
"Be the change you want to see in the world" -Gandhi

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Last edited by mikischo; September 24th, 2010 at 10:29 AM.
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Old September 24th, 2010, 11:46 AM
Caesar's Mom Caesar's Mom is offline
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Now kidney values are climbing

Caesar is recovering well from the sepsis and would have been able to come home on antibiotic pills today. However, his kidney values are now climbing. This could continue and he could die, or the creatinine may stabilize and/or lower. He needs several more days so on IV fluids to determine.

HOWEVER, it will cost $600-$1,000 per day at the emergency vet. My regular vet doesn't provide 24 hour care (and is only open until 3pm on Sat and not at all on Sunday) and he would only be looked in on twice a day over the weekend by a vet tech. My regular vet doesn't want to chance taking over his care until Monday. We have already spend over $3500 since Wed night. My husband wants to "pull the plug."

Because of the many years of uncontrollable diarrhea, Caesar no longer poops in a litter box. He is confined at home to a room with linoleum and he doesn't get the human or cat interaction that my other cats have. His quality of life is not great.

I am conflicted here. He is 14, not great quality of life, will probably need multiple meds and vet visits to try and control the kidneys, diarrhea, constipation, etc. to avoid a repeat of this week. My husband is angry about the cost (and we really can't afford this right now), and doesn't like the cat much because of his litter box issues. Frankly, my love for him has diminished over the years because of the constant clean up. I still love him obviously since I've just spend $3500 trying to save his life and I've been crying over him for 2 days. I would feel like I was betraying his trust if I put him down prematurely, and I know I would have strong guilt. On the other hand, he may die in a few days anyway (after spending another $2,000).

I know no one can tell me what to do. I am miserable either way. I have other (healthier) cats whose health would be seriously jeopardized if they got sick in any way right now. In other words, we might not be able afford to treat them for a sudden ailment because Caesar is using up our vet fund and then some.

Ideas and thoughts are welcome. Thanks for letting me vent my stress and concerns here.
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Old September 24th, 2010, 01:39 PM
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mikischo mikischo is offline
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I can understand the turmoil you are going through.

We do have a veterinarian, Dr. Lee, who volunteers his time on this forum. If you would like, I can PM him and he might be able to offer you some better feedback that might help you with any decision you may have to make.

Cats can recover from acute kidney failure, but at this point in time nobody can predict what the outcome would be in your kitty's case, and I see you do have several other factors to consider.

Nobody knows your situation better than you. It is obvious that you love your kitty and be assured that whatever decision you make, we will be here for you.
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"The animals share with us the privilege of having a soul." -Pythagoras
"The soul is the same in all living creatures, although the body of each is different." -Hippocrates
"Let us be loving, hopeful and optimistic. And we’ll change the world." -Jack Layton
"Be the change you want to see in the world" -Gandhi

Kitties: Punky (13), Tweeky (6), and Sassy (7)

SweetMickey 1991 to May 24, 2009

Last edited by mikischo; September 24th, 2010 at 02:12 PM.
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  #6  
Old September 24th, 2010, 02:37 PM
loopoo loopoo is offline
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Nothing I can say here that hasnt been said... kitties can rebound from high numbers and kidney disease most definitely, there are other factors, and maybe some could have more advice on some ideas to help with you there too that you havent tried.
...I am so sorry you are going through this with your kitty. As someone said you know your kitty best and obviously love him. prayers out to you both for whatever decision you make.
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  #7  
Old September 25th, 2010, 02:40 PM
Caesar's Mom Caesar's Mom is offline
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Caesar is coming home tomorrow

Caesar's kidney values are going down, so the vet will send him home tomorrow. He will have chronic kidney failure and will need daily fluids to start and possibly an oral medication or two. The vet hopes that proper hydration with sub-cu fluids will prevent a recurrence of the constipation that caused him to go septic. He also hopes that if we keep him just a little bit dehydrated, he won't have the terrible diarrhea he's had for the last 8 years (since his colon was removed).

We are going to do this for him and hope for some quality time. I promised my husband that once fluids do not keep him feeling well, or if he develops any more significant complications, we will stop his care and put him to sleep. I put my promise into a letter to Caesar (silly, I know). He's my baby and I love him. I'm going to value this time that we have together and make the most of it. I will let him go next time, but at least I will have had this last opportunity to love him and to say goodbye.

Thanks to all of you for your helpful suggestions and caring concern. I appreciate all of you and am very grateful. - Caesar's Mom
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Old September 25th, 2010, 02:54 PM
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Love4himies Love4himies is offline
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Slippery Elm bark does wonders for Jasper and his intestinal issues, it wouldn't hurt to give it a try.

Sugarcatmom asked what he is eating; that can make a huge difference on his bowel movements and is even more important now that he may be in the start of renal failure. Both her and Growler know a tremendous amount on cat nutrition so if you could provide your kitty's food info they may be able to give you some advice.

Sending lots and lot your way
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Rose semi feral, a cpietra rescue, female tabby (approx 7 yrs)

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Old September 25th, 2010, 02:58 PM
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What diet is Ceasar currently on? Have you tried Wellness, Nature's Variety, any no grain, no by product cat foods available a good pet stores. Dry food is an absolute no no for cats. Especially cats with health issues. I can't see dry foods helping a cat with chronic bowel issues.
When you have time take a look at www.catinfo.org . It is a wonderful website written by a vet who has spent many many hours researching pet foods. It may help you decide what is the best choice for Ceasar.
I am so glad he is coming home. Many many of us have spent tons on trying to keep our furries healthy. We all feel your pain.
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Old September 25th, 2010, 03:47 PM
Caesar's Mom Caesar's Mom is offline
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Caesar's food

To all that asked (with my thanks): Caesar has tried all the vet diets to no avail. However, I did switch to Avoderm and Wellness canned (all my cats eat canned food) when I read about the benefits of no grain foods. Caesar likes the food (he likes all food). I think it would have been beneficial for him, but he was already in the throes of kidney failure and dehydration and I didn't know it. I'll be checking with the vet tomorrow on diet, but I am going to push for these no grain canned foods and see what he says.

A holistic vet I visited for the first time last month also started him on digestive enzymes and weekly vit b12 shots, but again I think we started too late to see a difference before the kidney failure/sepsis incident.

She mentioned Slippery Elm Bark, but wanted to introduce changes slowly so we didn't start that yet. She also suggested a raw food diet (or cooking it if I prefer) that I can order online -- some kind of rabbit and bone combo. I was a little afraid to try it since he doesn't have most of his colon anymore and is susceptible to digestive issues. Now I'm even more afraid to try it!!

I have a cat that was born with terrible constipation issues, removed his colon only to have terrible diarrhea issues, went back to constipation while in untreated renal failure, and is back to diarrhea now that he is hydrated again at the hospital. The diarrhea is awful but at least I'll know he's not dangerously constipated again. Having no colon and both constipation AND diarrhea issues make him unpredictable.

I'd love to hear about other foods that have been successful in similarly sick kitties. Thanks so much!
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Old September 25th, 2010, 04:11 PM
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mikischo mikischo is offline
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Caesar's Mom, I am happy to hear that Caesar is improving and will be coming home. I had thought that Caesar might have been suffering from acute kidney failure as a consequence of the sepsis. If he already had undiagnosed chronic renal failure prior to this, it makes sense about why he had the constipation episode. My Mickey had chronic renal failure and one of the first symptoms with him was problems with constipation due to being unable to maintain adequate hydration. There are many of us on here who have or have had kitties with CRF, so we can identify with a lot of these issues.

You will find that purchasing subq fluids from your vet can be very costly. If you don't already know this, you can get the fluids and supplies at a fraction of the cost from some pharmacies and medical supply houses. In my case I found a medical supply house that had a warehouse in my city. It makes a tremendous difference to your pocketbook if you can find a cheaper source than your veterinarian.

If you have not already found a cheaper source, here is a link that might give you some ideas where you might even be able to find them locally.

http://members.verizon.net/~vze2r6qt/supplies/local.htm

P.S. I don't think the letter to Caesar was silly at all.
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~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"The animals share with us the privilege of having a soul." -Pythagoras
"The soul is the same in all living creatures, although the body of each is different." -Hippocrates
"Let us be loving, hopeful and optimistic. And we’ll change the world." -Jack Layton
"Be the change you want to see in the world" -Gandhi

Kitties: Punky (13), Tweeky (6), and Sassy (7)

SweetMickey 1991 to May 24, 2009
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Old September 25th, 2010, 05:00 PM
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Love4himies Love4himies is offline
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A properly prepared raw diet is best for you kitty. I make it for my kitties and is really not too difficult.


I follow the recipe post in this website:

http://www.catinfo.org/?link=makingc...ecipe_Together. She also posts a recipe for CRF cats.

A raw diet is the least residual diet you can feed your kitty because it doesn't contain any fillers that your cat can't use efficiently.
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Jasper, male Ragdoll ?? (approx 10 yrs)
Rose semi feral, a cpietra rescue, female tabby (approx 7 yrs)

Sweet Pea RIP (2004?-2014)
Puddles RIP (1996-2014)
Snowball RIP (1991-2005)

In a cat's eye, all things belong to cats.-English Proverb

“While we are free to choose our actions, we are not free to choose the consequences of our actions.” Stephen R. Covey
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Old September 25th, 2010, 06:44 PM
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mikischo mikischo is offline
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Quote:
Originally Posted by Caesar's Mom View Post
To all that asked (with my thanks): Caesar has tried all the vet diets to no avail. However, I did switch to Avoderm and Wellness canned (all my cats eat canned food) when I read about the benefits of no grain foods. Caesar likes the food (he likes all food). I think it would have been beneficial for him, but he was already in the throes of kidney failure and dehydration and I didn't know it. I'll be checking with the vet tomorrow on diet, but I am going to push for these no grain canned foods and see what he says.

Actually a number of people on this board give Wellness to their CRF kitties, in particular the Chicken, Turkey, and Chicken and Beef formulas, as they are lower in phosphorus than many other brands of canned cat food. Great that Caesar has a healthy appetite and that this brand already meets with his approval.

A holistic vet I visited for the first time last month also started him on digestive enzymes and weekly vit b12 shots, but again I think we started too late to see a difference before the kidney failure/sepsis incident.

I don't know that it was necessarily too late. IMO the constipation was primarily due to his inability to maintain adequate hydration due to the CRF. Now that he will be on subq fluids, hopefully the constipation issue will not be repeated.

She mentioned Slippery Elm Bark, but wanted to introduce changes slowly so we didn't start that yet. She also suggested a raw food diet (or cooking it if I prefer) that I can order online -- some kind of rabbit and bone combo. I was a little afraid to try it since he doesn't have most of his colon anymore and is susceptible to digestive issues. Now I'm even more afraid to try it!!
Slippery Elm Bark is a very safe herb that has helped a lot of kitties with digestive issues as well as constipation or diarrhea. Hopefully this will be beneficial for Caesar when you start using it. Growler, who has a very informative CRF thread on here, had her CRF kitty on a raw diet but also highly recommends the Wellness formulas mentioned above.

You will have to go with your own comfort level as to what you choose. Great that you are consulting with a holistic vet.

You have had to deal with a lot of issues and you have a great attitude.
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"The animals share with us the privilege of having a soul." -Pythagoras
"The soul is the same in all living creatures, although the body of each is different." -Hippocrates
"Let us be loving, hopeful and optimistic. And we’ll change the world." -Jack Layton
"Be the change you want to see in the world" -Gandhi

Kitties: Punky (13), Tweeky (6), and Sassy (7)

SweetMickey 1991 to May 24, 2009
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Old September 27th, 2010, 01:37 PM
Caesar's Mom Caesar's Mom is offline
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More bad news for Caesar

Yesterday morning the vet called to say that Caesar is jaundiced and now has fatty liver disease. They also had to back off his IV fluids Saturday night as he started to retain water and would have gone into congestive heart failure. He won't eat at the vet because he doesn't feel good, so the fatty liver disease will not reverse without a feeding tube. The vet didn't recommend the tube. He said Caesar's cardiovascular system can't handle the fluids needed to bring his kidney values down further. The kidney values won't stay where they are for long (in his opinion), and we probably won't be able to increase them again for fear of the congestive heart failure. So even if we do the feeding tube for up to 6 weeks in an attempt to reverse the liver damage, Caesar's kidneys won't get the fluids they need to keep him feeling good for long. Best case with the tube and the treatments available, Caesar might have a month to live.

I took him home yesterday. I know there is no crystal ball and the vet could be wrong, but he probably isn't. I couldn't put him to sleep there. He responded to me and wanted to be with me. I want these last few days with him at home, where he is not scared and he can be peaceful. I'm syringe feeding him some baby food, but he doesn't really want it. He is drinking a lot (and getting sub-cu fluids), and he still gets up to pee but not really for anything else. He just lays in his bed.

I realize there is almost no hope for him unless we go the "heroic" route with him again, and even then the vet thinks a month is the best we can get out of it. I still have that tiny, tiny bit of hope though. I don't want to let Caesar down again though. I don't want to unknowingly let him get so acutely ill as he was Wednesday night at the emergency vet. I don't want him to ever feel miserable again. The problem is that cats are so stoic. He might be feeling borderline miserable now and I wouldn't know it. I definitely know he doesn't feel good right now.

I am having so much trouble letting him go. He's been my sweet baby for 14 years. I love him so much. I feel as if I betrayed him by letting him get too sick (I should have realized what was happening), and I'm betraying him by not trying the feeding tube, and I'm betraying him by giving up on him. No matter what anyone says, I feel guilty for all of these reasons.

I could really use your thoughts on finding the strength to let go. I am feeling pretty lost right now.
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Old September 27th, 2010, 02:00 PM
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Love4himies Love4himies is offline
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I am so sorry

Your feelings are so very normal. I don't think there is one person on this board that doesn't feel guilty about letting their kitty go. It is the most unselfish thing you can do and one of the hardest decisions you will ever have to make.

Only you can make that decision of when the right time is. When his bad days outnumber his good days, then, IMO, it is time.

We are here for you.
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Jasper, male Ragdoll ?? (approx 10 yrs)
Rose semi feral, a cpietra rescue, female tabby (approx 7 yrs)

Sweet Pea RIP (2004?-2014)
Puddles RIP (1996-2014)
Snowball RIP (1991-2005)

In a cat's eye, all things belong to cats.-English Proverb

“While we are free to choose our actions, we are not free to choose the consequences of our actions.” Stephen R. Covey
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Old September 27th, 2010, 03:21 PM
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mikischo mikischo is offline
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I'm so sorry to hear what you and Caesar are going through.

First of all, I can understand your having that hope and it is not entirely unrealistic. A feeding tube is the easiest and most effective route to go when treating fatty liver disease and it is less stressful for both the cat and the caregiver. That being said, there are many cases where fatty liver disease has been reversed by force feeding. It is great to hear that he is drinking on his own. If you go this route, it is best to do force feeding in smaller quantities spread over 6 feedings a day rather than too much in one feeding and it can take 3 to 6 weeks before the cat is able to start eating sufficient quantities on his own. Baby food does not have nearly enough nutrients to sustain him. Although I am not a fan of most prescription diet foods, there are exceptions. One of the best products you can get for this purpose is Hill's A/D which you can get from the vet. It contains a lot of nutrients and works very well for syringe feeding with only a small amount of water added. This is what I fed to Mickey when he went through a period where he was too ill to have any appetite to eat on his own. As you have already discovered, most cats are not particularly happy with being force fed, but it is necessary if you want to give him the best chance for recovery.

As L4H said, only you can decide when is the time to let him go. Most of us on this board have been through this and we understand your pain. I went through this last year with Mickey. I have been through this before but for me last year was the hardest. Letting go is very difficult and no matter what, I think most of us find ourselves dealing with the what ifs. Just try to enjoy the good things each day. You will know when it is time and we will be here to offer you our support.
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"The animals share with us the privilege of having a soul." -Pythagoras
"The soul is the same in all living creatures, although the body of each is different." -Hippocrates
"Let us be loving, hopeful and optimistic. And we’ll change the world." -Jack Layton
"Be the change you want to see in the world" -Gandhi

Kitties: Punky (13), Tweeky (6), and Sassy (7)

SweetMickey 1991 to May 24, 2009

Last edited by mikischo; September 27th, 2010 at 08:30 PM. Reason: Corrected a sentence.
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