Acromegaly and Constipation

Do other people have problems with this? I have noticed Bootsie’s stools are quite formed and dry since she was diagnosed. Recently she had a bout a constipation that required a trip to the vet and 3 enemas. She was better for a bit but now despite 1/4 tsp Miralax every day and she does seem to be drinking more she is straining to stool and often not producing anything. I have considered trying glycerin suppository splinters to see if it would help but I may need to take her back to the vet. Thanks for any advice.

@Wendy&Neko
@Suzanne & Darcy
@Diane Tyler's Mom

 

Lots of good info here: https://www.felineconstipation.org/

GI problems are not uncommon with acros. Mega colon also something to be on the look out for. Lactulose is something some caregivers give. Miralax can be dose to effect, maybe try twice a day or upping the dose?

 

Exactly what I was going to say, but then you and I already talked this morning. The glycerin suppositories are okay as long as glycerin is the only ingredient. The site Wendy linked is the place to be. I would increase Miralax to twice a day. If she’s drinking a lot then it may be time for bloodwork to check her kidney function. I hope she can poop soon. Going to the vet for enemas is the worst, I think, although sometimes necessary.

 

Both Blue and Eddie get PPEG twice daily (1/8 tsp mixed with large meals). No more constipation. In fact, sometimes the opposite and stool is too soft in which case I reduce dose for the day...

 

Thanks for all the help and advice. I could not find and suppositories without other ingredients, supplies of this type of product were limited and not on shelf’s. Go figure. Anyway I took her to the vet today. They did and X-ray which showed she did have stool in the colon but did not have any obstruction or mega colon. They gave digital stimulation and sub-q fluids and gave me some Lactulose to use with her until her stools are softer. She did poop on her own about 1030 a substantial amount which was formed and not rock hard but definitely on the firmer side. So now my question is about the Lactulose - it is prescribed to be given 2x/day until stools are soft, consistency of play dough. Does that sound ok, she won’t get diarrhea now will she? Is 2x/day ok as the website does not suggest a dose.

 

I have used Lactulose. Lactulose, like Miralax is a “dose to effect” medication. You are not currently in a critical constipation situation so, in my opinion, it is better to start with a smaller dose and work your way up so as not to cause diarrhea. Also, you are using it in conjunction with Miralax, so you have to take that into consideration. I’m sure the vet was thinking of not wanting her to get blocked up. And they probably were not aware of her poop later on, were they? It would not be unsafe to give it twice a day, but you could cause diarrhea and then have to back off the Lactulose. I would not be surprised if you have to play around with how much to give along with the Miralax.

Here’s what Helen, author of the felinecrf site, says about the dosing.
Lactulose Dosage

Lactulose is a "dose to effect" treatment, but as with any medication, it is better to start with a low dose and increase only as necessary, so as not to cause the opposite problem of diarrhoea.

• Plumb's Veterinary Drug Handbook says that cats may be given 0.5ml per kg (0.25ml per lb) of bodyweight per day up to 2-3 times daily. This would mean a daily total of 1.0-1.5ml per kg or 0.5-1.0 ml per lb of bodyweight.
  
  
• This means you would give a 5kg (11 lb) cat 5.0-7.5ml daily.
  
  
• Some people start at just 0.5ml (per cat) once a day, but this may well need to be adjusted depending upon the cat's response.
  
  
• It does take a couple of days for lactulose to work, so do not give too much too soon.
  

Lactulose: How to Give

I found out the hard way that, if you syringe lactulose in to your cat's mouth, it's a good idea to wipe your cat's chin with a damp cloth after using it, because, being sugar-based, it is incredibly sticky. You may find it easier to mix the lactulose with food; some people use a little baby food each day for this purpose.

 

Oh, and you probably already know this, but Lactulose is composed of synthetic indigestible sugars (made from lactose) that are broken down in the colon and draw water into the colon and soften the stool. I never saw any increase in Darcy’s BG when he was on it. He ate his dose mixed into some favorite cat food, but if you get in on their fur it can get really crusty and sticky.

 

Ok - thanks for the info. I gave her it in her food but only gave 1 1/2 mls but she did not eat all the food. Maybe later. I am going out town so Larry will be in charge of her for 2 weeks. Makes me nervous but he loves her too. Going to visit my mom in TX.

 

Have a great trip! Yep, Larry usually does a pretty good job with Bootsie. It will keep him on his toes. And I know you will be communicating with him every day, multiple times a day. It will be okay.

 

Did you increase the Miralax to twice a day or not? That may be all she needed (although you were right to take her to the vet... I just mean that maybe all she needs going forward.)

 

Note from https://www.drugs.com/cons/lactulose.html
Other medical problems
The presence of other medical problems may affect the use of lactulose. Make sure you tell your doctor if you have any other medical problems, especially:

• Diabetes—Use with caution. May make this condition worse.

From: https://www.ncbi.nlm.nih.gov/books/NBK536930/
2) Diabetics: Although only a small fraction of lactulose undergoes systemic absorption, diabetes patients must use it with caution due to a potential to cause hyperglycemia in diabetic individuals as have been documented in a few studies.[15][16]

The above is because lactulose contains some digestible sugars, it is not pure.
Lactulose Description
Lactulose is a synthetic disaccharide in solution form for oral or rectal administration. Each 15 mL of Lactulose solution contains 10 grams Lactulose (and less than 1.6 grams galactose, less than 1.2 grams lactose, and 0.1 grams or less of fructose).

https://www.drugs.com/pro/lactulose.html

 

Thanks Larry for the info. At this point it does not seem to be affecting her sugars but I am not giving the dose prescribed by the vet. I cut the dose in half and continued to give the Miralax.