? 01/16/2023: MICIO UPDATE AMPS:154 / 56@ +3

[MISSY + Simone&MICIO (GA)]

Here's an update on Micio, my special boy that recently have been facing a tougher time than usual.
@Diane Tyler's Mom, @Bron and Sheba (GA) , @Suzanne & Darcy , @Wendy&Neko , @Jodey&Eddie&Blue sorry I haven't kept you updated. Looks like I entered a pretty dark place lately and haven't been able to physically and mentally focus on reality...guess it's called life.

Micio still with us, barely though after another big scare last night.
Constipation have been a major concern lately: I've tried fibers, pro/prebiotics of any kind, added fat on his diet, egg yolk, Miralax (wich only cause him bloating and more GI issues) and, despite the controversial blogs, studies and people experiences, I tried Lactulose once again: 1ml twice a day for a few days did actually helped and surprisingly his BGs were ok but then, all of a sudden here comes the spike but not sure if it was caused by his disease, the Lactulose or something else. Lately I've notice Micio has a darker color nose and, despite me trying to clean it up thinking it's just from food, it's not getting better; I also feel a few bumps with a bit of scab and he's very sensitive to it. Not a specialist on it but I have a bad feeling as (growing up)I had a cat before with nose cancer and I know how bad and rapid it can develop. But still hoping is not Micio's case.

Anyway, a couple of weeks ago, he had an episode of constipation where he really struggled to defecate (and by the way, I'm with him every single time he goes to the bathroom and hold him up when he poop cause otherwise he'll crash ) and at the end he was left with no strenght and also his front right paw wasn't "functioning" well anymore. Only after several days he finally started walking better but still, not as normal anymore. Almost like if he had a mini stroke or something.

Last night, same thing happened but worse: the struggle to push made him panting for 10-15 minutes, his heart rate was very elevated, poop and vomit in the same time and finally crashed and laid on the ground completely exhausted. Then slowly his breath returned to normal and rested through the night.
This morning he looked much better, still walking wobbly but with good appetite. Seems to me that these episodes really worsen the ability of using his arms and legs normally, he also not as coordinated and seems confused at times.
Seriously thought he was going to have a cardiac arrest.
I've always felt that, when the time come, Micio would tell me and I know we're very close now...I've always promised him I wouldn't hold him or let him suffer but man ....I don't know where to find the strenght to make that decision.


MY QUESTION IS: should I try again and continue with Lactulose? Should I not be worry about his BGs if they'll go high again?
Don't really feel like taking him to the vet cause I know how much stress it would cause him ...just want to make him comfortable though.

Thanks again for being there when I need(ed).

 

[Diane Tyler's Mom GA]

Hi Simone I'm sorry but I wouldn't know whether to tell you to try the lactulose again. Hopefully @Suzanne & Darcy will be on later with some advice.
My heart breaks just hearing the trouble Micio is having and being so exhausted that he falls over. Makes me tear up reading about it.
Hopefully one of the members you tagged will see this .♥♥

 

[Diane Tyler's Mom GA]

Previous post
https://felinediabetes.com/FDMB/thr...-minutes-after-meal-help.272349/#post-3032566

 

[Suzanne & Darcy]

Here's an update on Micio, my special boy that recently have been facing a tougher time than usual.
@Diane Tyler's Mom, @Bron and Sheba (GA) , @Suzanne & Darcy , @Wendy&Neko , @Jodey&Eddie&Blue sorry I haven't kept you updated. Looks like I entered a pretty dark place lately and haven't been able to physically and mentally focus on reality...guess it's called life.

Micio still with us, barely though after another big scare last night.
Constipation have been a major concern lately: I've tried fibers, pro/prebiotics of any kind, added fat on his diet, egg yolk, Miralax (wich only cause him bloating and more GI issues) and, despite the controversial blogs, studies and people experiences, I tried Lactulose once again: 1ml twice a day for a few days did actually helped and surprisingly his BGs were ok but then, all of a sudden here comes the spike but not sure if it was caused by his disease, the Lactulose or something else. Lately I've notice Micio has a darker color nose and, despite me trying to clean it up thinking it's just from food, it's not getting better; I also feel a few bumps with a bit of scab and he's very sensitive to it. Not a specialist on it but I have a bad feeling as (growing up)I had a cat before with nose cancer and I know how bad and rapid it can develop. But still hoping is not Micio's case.

Anyway, a couple of weeks ago, he had an episode of constipation where he really struggled to defecate (and by the way, I'm with him every single time he goes to the bathroom and hold him up when he poop cause otherwise he'll crash ) and at the end he was left with no strenght and also his front right paw wasn't "functioning" well anymore. Only after several days he finally started walking better but still, not as normal anymore. Almost like if he had a mini stroke or something.

Last night, same thing happened but worse: the struggle to push made him panting for 10-15 minutes, his heart rate was very elevated, poop and vomit in the same time and finally crashed and laid on the ground completely exhausted. Then slowly his breath returned to normal and rested through the night.
This morning he looked much better, still walking wobbly but with good appetite. Seems to me that these episodes really worsen the ability of using his arms and legs normally, he also not as coordinated and seems confused at times.
Seriously thought he was going to have a cardiac arrest.
I've always felt that, when the time come, Micio would tell me and I know we're very close now...I've always promised him I wouldn't hold him or let him suffer but man ....I don't know where to find the strenght to make that decision.


MY QUESTION IS: should I try again and continue with Lactulose? Should I not be worry about his BGs if they'll go high again?
Don't really feel like taking him to the vet cause I know how much stress it would cause him ...just want to make him comfortable though.

Thanks again for being there when I need(ed).

My heart is very heavy as I read this update on Micio. It does sound as if the struggle with severe constipation is really taking a toll on him. I also can understand how you must be mentally, emotionally, and physically exhausted. I am not a good person to advise on how to let go. I don’t want to let go, but I don’t want my babies to suffer. But I always try my very best to do everything before letting go. At this point, I don’t think you have much to lose by trying the Lactulose again. You said it did help. I am not sure that BG is the number one concern at this point. I think it is to get him pooping without too much struggle. The struggle is weakening him and must be very distressing for him as well. I think if Micio were my cat, I would try the Lactulose again.

 

[Suzanne & Darcy]

Now having said all that, I just want to send love and hugs and prayers for Micio and for you!

 

[Suzanne & Darcy]

And I do see those few yellows on his spreadsheet, but I would like to say that the stress and pain that severe constipation cause can definitely raise BG levels all on its own. I doubt it was caused by the Lactulose because his BG was doing so well while taking it for those several days.

I hope his nose will be okay. My kitty Marcus, who looks a lot like Micio (the Turkish Van look) has what we think is squamous cell carcinoma on his nose and I am having it removed next Monday the 23rd (and I am freaking out because we had to wait that long to get it removed.) I was told squamous cell is slow growing but there are other types. I pray Micio’s nose will get better. The poor boy doesn’t need any other problems.

 

[Jodey&Eddie&Blue]

I'm so sorry to read about Micio's struggle and understand how difficult it is for you both. I cannot advise on the Lactulose. I can say, however, that Blue once had a terrible period of constipation and I tried everything as well. I ended up bringing him to emergency and they inserted a nasopharangeal tube into his stomach as an intervention and it truly did do what it needed to do but it took 2.5 days. I knew Blue was in good hands and they had advised against an enema and to go this route as it would be less stressful (it was) and more effective. Blue hasn't had constipation since then as they recommended a daily dose (very small, sprinkled in his food) of PPEG3350, which is also Restoralax. It was recommended that he be given it into perpetuity and, as I said, it works as it is a stool softener and doesn't affect BG.

Sending you and Micio all good thoughts and hope things get better for you both.

 

[tiffmaxee]

I’d try cisapride and adjust insulin accordingly. If my cat my goal would be to see if I could make him comfortable. I’ve had to make the decision with all of mine and a kind vet told me to try everything and then never second guess my decisions.

 

[Wendy&Neko]

We have lots of caregivers give Lactulose and/or cisapride to their cats, without impacting blood sugars. Besides, quality of life is much more important than blood sugar values at this point. @Max & Lori Max gets Lactulose and @lbeachstace Buddy gets both lactulose and cisapride. If necessary, Micio might also need an enema from the vet, also seen kitties here need that.

 

[Suzanne & Darcy]

I believe I mentioned in your last thread about Cisapride. I mentioned that you would have to ask your vet about using it since Micio has a heart murmur. It may be okay. I used it in Darcy, but no heart murmur to consider. I believe that the Cardiac problems that were associated with the use of Cisapride were in humans and were not something that was seen in cats. OBTW, you can use both Lactulose and Cisapride together. It is an Rx item so I am not sure if your vet would even go along with it.

 

[Suzanne & Darcy]

Here is the info on Cisapride from felinecrf.org with the cautions about the heart and also a caution about using it with Miralax (PEG 3350) and Ondansetron, but you stopped the Miralax, I believe, because of the gas and bloating problem (maybe dose too high.). Cisapride may not have the desired effect anyway if his colon muscles/nerves have been damaged (mega colon.). Did you ever join that Facebook group I mentioned- the Feline Megacolon group?
Here goes:

Cisapride (Propulsid)
Cisapride is another medication used for cats with constipation caused by reduced motility. Trade names are Prepulsid or Propulsid.

Cisapride works by activating certain muscle receptors. Constipation and obstipation in small animals (2020) Defarges A Merck Veterinary Manual says "Anecdotal experience suggest that cisapride (0.1–0.5 mg/kg, PO, bid-tid) effectively stimulates colonic propulsive motility in cats with mild to moderate idiopathic constipation."

According to RxList, cisapride was withdrawn from the human market in 2000 because of serious heart-related side effects which caused some human deaths.

However, cisapride appears to be safe to use in cats. Constipation and obstipation in small animals (2020) Defarges A Merck Veterinary Manual says "No significant adverse effects have been reported in cats treated with cisapride at dosages of 0.1–1 mg/kg, PO, bid-tid)." Plumb's Veterinary Drug Handbook states "Adverse effects appear to be minimal in veterinary patients; vomiting, diarrhea, and abdominal discomfort can occur." It does add "Although no reports have been noted in dogs or cats, prolonged QT intervals or other cardiac arrhythmias are possible but unlikely." You may wish to avoid cisapride if your cat has heart problems.

Dosage recommendations are as follows:
Constipation and obstipation in small animals (2020) Defarges A Merck Veterinary Manual says "Anecdotal experience suggest that cisapride (0.1–0.5 mg/kg, PO, bid-tid):" bid-tid means 2-3 times a day.
Plumb's Veterinary Drug Handbook says: "As a promotility agent (extra-label): Initially, 2.5 mg per cat PO twice daily preferably 15-30 minutes before food. Dosages may be titrated upwards, if tolerated, to as high as 7.5 mg per cat PO 3 times daily in large cats."
Cisapride can take time to work. Plumb's Veterinary Drug Handbook does mention that it can be given in conjunction with lactulose, psyllium or pumpkin, so you can continue to use these treatments while waiting for cisapride to work.

Because cisapride was withdrawn from the human market in the USA, cisapride is only available from compounding pharmacies in the USA, though it may be possible to obtain it commercially in other countries. Chewy sells cisapride in the USA in the form of compounded soft chews for cats.

Cisapride interacts with a number of medications, including cimetidine (sometimes used in CKD cats for gastric hyperacidity), which according to Plumb's Veterinary Drug Handbook "may lead to increased cisapride levels with an increased risk for cisapride cardiotoxicity," and benzodiazepines such as diazepam (Valium), the effects of which may be made stronger. It also reduces the effects of ranitidine, but since both medications have similar mechanisms, you are unlikely to be giving both cisapride and ranitidine for constipation.

Drugs mentions a moderate interaction between cisapride and PEG3350 (MiraLAX) which I am sometimes asked about. The site states "cisapride can cause an irregular heart rhythm that may be serious and potentially life-threatening, although it is a relatively rare side effect. The risk is increased if you have low blood levels of magnesium or potassium, which can occur with bowel cleansing preparations or excessive use of medications that have a laxative effect. Do not exceed the dose and duration of use of polyethylene glycol 3350 recommended on the product label or prescribed by your doctor." This warning does not concern the ingredients in PEG3350 but rather the fact that PEG3350, when used for bowel cleansing, may also remove electrolytes such as potassium, and this may increase the potential risks of using cisapride. This will not apply to most people using PEG3350 to control constipation in their cats, but discuss with your vet if you are using both products.

Ondansetron is often used in CKD cats to control nausea. However, Drugs states that "Using cisapride together with ondansetron is not recommended. Combining these medications can increase the risk of an irregular heart rhythm that may be serious and potentially life-threatening, although it is a relatively rare side effect." This warning applies to humans, but check with your vet if you need to use both these medications.

 

[tiffmaxee]

Another thing to consider is I noticed that ondansetron caused constipation with Max. I always ended up needing to increase his miralax when on it.

 

[Max & Lori]

My cat Max has inflammatory bowel disease and has bouts of constipation. The diarrhea has improved with diet change and Budesonide. He now has constipation of which most of the time he gets from being in high numbers too long. Diabetes itself can cause dehydration because water follows glucose out of the body mostly because of urinary frequency. Then that makes the constipation worse. It’s kind of a vicious circle.
My point is saying all of that is making sure Micio gets extra water every day by adding it into food, have a water fountain, etc. Probiotics and fiber are also needed. I add baby food squash to Max’s food and that helps a lot. He’s also on a probiotic every day. In addition to that, he gets 2 cc’s of lactulose twice a day. It does not impact his BG. Sometimes I alternate days with lactulose and Miralax when it’s particularly bad.
I am so sorry your little buddy is having such problems. I feel your pain. I am in the healthcare field so I understand human anatomy and physiology well, but not so much in animals. When you mention the cardiac episodes, it makes me wonder if all of that straining with bowel movements is stimulating his vagus nerve and slowing his heart rate. I know that can happen in people and they can actually lose consciousness from it. Maybe that would improve if you could relieve the constipation. I definitely would try the lactulose again and also talk to your vet about all of his symptoms. I wish I had more to tell you that would help right now, but it’s worth trying to increase his water and try the other things I mentioned in addition to the lactulose. Wishing you all the best.

 

[MISSY + Simone&MICIO (GA)]

Hi Simone I'm sorry but I wouldn't know whether to tell you to try the lactulose again. Hopefully @Suzanne & Darcy will be on later with some advice.
My heart breaks just hearing the trouble Micio is having and being so exhausted that he falls over. Makes me tear up reading about it.
Hopefully one of the members you tagged will see this .♥♥

And I do see those few yellows on his spreadsheet, but I would like to say that the stress and pain that severe constipation cause can definitely raise BG levels all on its own. I doubt it was caused by the Lactulose because his BG was doing so well while taking it for those several days.

I hope his nose will be okay. My kitty Marcus, who looks a lot like Micio (the Turkish Van look) has what we think is squamous cell carcinoma on his nose and I am having it removed next Monday the 23rd (and I am freaking out because we had to wait that long to get it removed.) I was told squamous cell is slow growing but there are other types. I pray Micio’s nose will get better. The poor boy doesn’t need any other problems.

Thanks. Wishing you good luch with your Marcus, hope everything goes ok

 

[MISSY + Simone&MICIO (GA)]

I’d try cisapride and adjust insulin accordingly. If my cat my goal would be to see if I could make him comfortable. I’ve had to make the decision with all of mine and a kind vet told me to try everything and then never second guess my decisions.

I agree, whatever makes him comfortable...already gave him some Lactulose this morning. Weird how my vet never suggested Cisapride before (which I've just learned about it): he suggested Miralax but I told him that doesn't do any good for him and, when I mentioned Lactulose, he totally disagreed cause he thinks is just sugar and bad for diabetes...

 

[MISSY + Simone&MICIO (GA)]

I believe I mentioned in your last thread about Cisapride. I mentioned that you would have to ask your vet about using it since Micio has a heart murmur. It may be okay. I used it in Darcy, but no heart murmur to consider. I believe that the Cardiac problems that were associated with the use of Cisapride were in humans and were not something that was seen in cats. OBTW, you can use both Lactulose and Cisapride together. It is an Rx item so I am not sure if your vet would even go along with it.

Thanks for the heads up, will continue with Lactulose for now and, if ever need to ask the vet for Cisapride, will keep that in mind.

 

[MISSY + Simone&MICIO (GA)]

My cat Max has inflammatory bowel disease and has bouts of constipation. The diarrhea has improved with diet change and Budesonide. He now has constipation of which most of the time he gets from being in high numbers too long. Diabetes itself can cause dehydration because water follows glucose out of the body mostly because of urinary frequency. Then that makes the constipation worse. It’s kind of a vicious circle.
My point is saying all of that is making sure Micio gets extra water every day by adding it into food, have a water fountain, etc. Probiotics and fiber are also needed. I add baby food squash to Max’s food and that helps a lot. He’s also on a probiotic every day. In addition to that, he gets 2 cc’s of lactulose twice a day. It does not impact his BG. Sometimes I alternate days with lactulose and Miralax when it’s particularly bad.
I am so sorry your little buddy is having such problems. I feel your pain. I am in the healthcare field so I understand human anatomy and physiology well, but not so much in animals. When you mention the cardiac episodes, it makes me wonder if all of that straining with bowel movements is stimulating his vagus nerve and slowing his heart rate. I know that can happen in people and they can actually lose consciousness from it. Maybe that would improve if you could relieve the constipation. I definitely would try the lactulose again and also talk to your vet about all of his symptoms. I wish I had more to tell you that would help right now, but it’s worth trying to increase his water and try the other things I mentioned in addition to the lactulose. Wishing you all the best.

Thank you, that makes sense. Micio ( and my other 14 yrs old cat Missy) has been on raw meat diet for about 11 years; been supplementing that with EZ for the last 5 yrs (was using Alnutrin before), plus many other daily supplements like pro/prebiotics, omega 3, (S.Boulardii when needed), fibers, liver supplements...with diabetes cats drinks lots of water now, I have raised fresh water bowls everywhere and scooping pee all day long . I did noticed that, when he goes for poop and I hold him so he won't fail, a tremendus amount of visible twitching that I can also feel in my hands/arms and always wonder what that is...many times I told that to different vets but they had no clues. Even when sleeping his twitches definitely increased and especially every single time he starts drinking water, his front arms twitches a few times.
Hope he'll have it easier

 

[Suzanne & Darcy]

Simone, I hope we did not overwhelm you! Please let is know how Micio is doing.

 

[Chrispooky12]

Here's an update on Micio, my special boy that recently have been facing a tougher time than usual.
@Diane Tyler's Mom, @Bron and Sheba (GA) , @Suzanne & Darcy , @Wendy&Neko , @Jodey&Eddie&Blue sorry I haven't kept you updated. Looks like I entered a pretty dark place lately and haven't been able to physically and mentally focus on reality...guess it's called life.

Micio still with us, barely though after another big scare last night.
Constipation have been a major concern lately: I've tried fibers, pro/prebiotics of any kind, added fat on his diet, egg yolk, Miralax (wich only cause him bloating and more GI issues) and, despite the controversial blogs, studies and people experiences, I tried Lactulose once again: 1ml twice a day for a few days did actually helped and surprisingly his BGs were ok but then, all of a sudden here comes the spike but not sure if it was caused by his disease, the Lactulose or something else. Lately I've notice Micio has a darker color nose and, despite me trying to clean it up thinking it's just from food, it's not getting better; I also feel a few bumps with a bit of scab and he's very sensitive to it. Not a specialist on it but I have a bad feeling as (growing up)I had a cat before with nose cancer and I know how bad and rapid it can develop. But still hoping is not Micio's case.

Anyway, a couple of weeks ago, he had an episode of constipation where he really struggled to defecate (and by the way, I'm with him every single time he goes to the bathroom and hold him up when he poop cause otherwise he'll crash ) and at the end he was left with no strenght and also his front right paw wasn't "functioning" well anymore. Only after several days he finally started walking better but still, not as normal anymore. Almost like if he had a mini stroke or something.

Last night, same thing happened but worse: the struggle to push made him panting for 10-15 minutes, his heart rate was very elevated, poop and vomit in the same time and finally crashed and laid on the ground completely exhausted. Then slowly his breath returned to normal and rested through the night.
This morning he looked much better, still walking wobbly but with good appetite. Seems to me that these episodes really worsen the ability of using his arms and legs normally, he also not as coordinated and seems confused at times.
Seriously thought he was going to have a cardiac arrest.
I've always felt that, when the time come, Micio would tell me and I know we're very close now...I've always promised him I wouldn't hold him or let him suffer but man ....I don't know where to find the strenght to make that decision.


MY QUESTION IS: should I try again and continue with Lactulose? Should I not be worry about his BGs if they'll go high again?
Don't really feel like taking him to the vet cause I know how much stress it would cause him ...just want to make him comfortable though.

Thanks again for being there when I need(ed).

I'm sorry that you & your baby Micio are going through this. I really hope what everyone has suggested helps. My boy has had constipation for years & I finally found what helps him. Ever since I started giving him 1/4 of a tsp of slippery elm with bark 1 time a day every other day mixed with about a tablespoon of water & a tablespoon of beechnut beef baby food he has been pooping fairly normal. I don't know if this will help your boy, but I just wanted to share my experience with you lots of hugs & prayers from me & Panzer

 

[MISSY + Simone&MICIO (GA)]

I'm sorry that you & your baby Micio are going through this. I really hope what everyone has suggested helps. My boy has had constipation for years & I finally found what helps him. Ever since I started giving him 1/4 of a tsp of slippery elm with bark 1 time a day every other day mixed with about a tablespoon of water & a tablespoon of beechnut beef baby food he has been pooping fairly normal. I don't know if this will help your boy, but I just wanted to share my experience with you lots of hugs & prayers from me & Panzer

Thanks. Have been using SEB mixed with George's Aloe for upset stomach or diarrhea for my cats for many years and it does work wonderfully but with caution though as, if given with prolonged time, it'll cause constipation in my cats....really glad it works for your Panzer . So true that every cat is different

 

[MISSY + Simone&MICIO (GA)]

Simone, I hope we did not overwhelm you! Please let is know how Micio is doing.

You didn't, you guys are great and I'm grateful for all the help I'm getting with Micio.
He had another constipation episode last night but even worse....preparing myself for the ER next cause I'm not going to let him go through all of this again and again...
Will keep you updated

 

[Suzanne & Darcy]

You didn't, you guys are great and I'm grateful for all the help I'm getting with Micio.
He had another constipation episode last night but even worse....preparing myself for the ER next cause I'm not going to let him go through all of this again and again...
Will keep you updated