Sorry, I've been erratic on the boards lately.
I agree that the need here is to work preventive medicine: increased water intake, either through some of my previous suggestions, or through sub-Q fluids which you can give at home. (If your vet will give you scripts and you get your own supplies, it's much cheaper; I think ours costed out to ... I dunno, probably about $40 a year.) I strongly suspect Spencer may have reduced kidney function, which is helping to trigger the constipation. When was the last kidney panel run, and what were the results?
Lactulose is good, and we used it for a long time. I'm not sure whether you're giving it to Spencer via oral syringe, or whether you're mixing it in with his food; either should be okay, and the food is a *lot* easier (and often less messy).
We also eventually used Miralax, which ended up being cheaper for us in the long run. You can add that to the food as well. One of the key things with Miralax is that you *have* to increase water intake for it to work properly. If you go with Miralax, start with 1/8tsp twice a day, and adjust the dosage as needed.
You may want to read
this article on the managment of constipated cats, and share it with your vet. Table 2 at the bottom is very useful, with a bunch of different medications that work in different ways. You can experiment with the meds and see what works best for Spencer. Also, some medications have less effect as time goes by; if and when that happens, you can use the table to change or supplement medications as necessary.
It's also a very useful table when considering what medications Spencer should be on. For example, there are a number of cats on the boards here who are on Pepcid A/C. However, we used Zantac instead, because Zantac can help with intestinal motility and Pepcid doesn't. So if Spencer does need medication for some problem or other, it's work consulting the table and seeing whether one of the possible medications might also help with his constipation issues.
As mentioned earlier in this thread, megacolon can be a concern, but it can also be treated (to various degrees) at home. Gwyn had megacolon for several years, and we ended up doing most of her treatment at home. This included things like giving her enemas. That sounds horrible, but it really wasn't. By monitoring her intake and output, I had a fairly good idea how well/bad off she was, and I tried to give her enemas as needed.
If the need for enemas continues, I'd suggest having your vet show you how to give enemas at home; it's much more cost-effective, and you can do it whenever the need arises, without having to worry about night / weekend /holiday hours. I resisted the idea of learning enemas for at least 3 years before I finally caved and, having learned how to do them (at least on Gwyn), I can't see what I was resistant to. You have to be careful, and go slow and gentle, but once I started, it was a *huge* relief to have control over something that was so very important to Gwyn's health.
If you decide to give enemas at home, you really do need to get a vet or a tech to show you how to do it. You can accidentally damage the anus or colon, which would be Bad. But it took probably less than five minutes for my vet's tech to show me how; and I had another one show me a month or so later, just to get a refresher as well as all of her personal hints and tips.
If you go with home enemas, do *NOT* use the normal enemas that are available in the drugstore; many of them have ingredients (phosphates) that are toxic to cats. The glyercerin enemas for babies should be safe; there are also glycerin suppositories for babies that are available, but I found them almost impossible to successfully insert fully. On baby glycerin enemas, I'd like to note that I tried them and disliked them; the insertion edge of the bulb was both large and rather rough; I much preferred using my own syringes. At one point, I did try transferring the material from their bulb to my syringe, with limited success, but then either Jess or JoJo suggested using a 50-50 mix of warm water and KY jelly, which would have a similar effect, and I never tried them again.
There are a range of ingredients you can use for home enemas, starting with plain warm water to water-plus-mild-soap to water-plus-KY to DSS enemas. Gwyn had constipation issues for 16 years. By the time we started home enemas, plain water wouldn't work and water-plus-mild-soap was mostly ineffective. We used water-plus-KY for a long time, with DSS enemas to supplement as needed, and eventually, toward the end when Gwyn generally just could not defecate on her own, we switched to mostly DSS enemas. The DSS enemas you'll need to get from your vet or online (may need a prescription).
This is going to sound weird but, if you give home enemas, remember that your cat's comfort during the enema is important. If you use water, make sure it's warm but not hot; cold or even lukewarm water can cause cramping. Use lots of lube to get the syringe in. When I was doing water+KY enemas, I would lube the tip of the syringe, press it in a bit, eject a little KY, press in and out a little to spread the KY, then press in a bit more and eject some more liquid. That cut down on the discomfort of the insertion, and helped lubicate things for easier output. Remember that the less uncomfortable your cat is during the enema, the less they'll fight you when you need to do it again. (I will acknowledge that we used a kitty mask for the second several enemas, while both sides worked out their issues.)
If you watch your cat's anus after giving the enema, you can tell when he starts to push. If Spencer does have megacolon, weakened muscles, is more impacted than normal, or various other things, you can help things along. When he starts to push out, take two fingers and press inward on either side of his anus. That helps open the anus a bit and can help with the ejection. ... If it helps, think of this like popping a pimple: there's pressure inside, you're just adding some outside so that the internal pressure works on it's own.
Note that enemas usually work in waves: depending on how bad things are and what materials you're using and how irritating they are, there's a first ejection of harder material, then a short wait, then a second ejection of somewhat softer material, then another wait and maybe a third ejection of soft material. If things have been backed up for a while, there may even be a fourth or fifth ejection of increasingly loose stool.
We kept aloe vera baby wipes on hand (*without* alcohol in them -- that stings!), and used them to catch the material as it came out, and also to help clean Gwyn's butt afterward. Depending on how bad things are, the anus may be sensitive, but it really isn't fair to have them clean up everything themselves, especially for older cats who generally aren't as agile as younger ones. Keeping the fur trimmed around the anus can help a lot; you might ask your vet or groomer for a perineal shave.
After the enema was over, I would dispose of the baby wipes (you can find some that are flushable, or just put all the stuff in a plastic grocery bag, tie it shut and throw it in the garbage), then I'd go wash my hands extremely thoroughly and give Gwyn some treats for being such a good feline and cooperating so incredibly well. (She would also get lots of praise and affection during the entire process as well.) I also found a couple of stores that carried hand sanitizer in quart containers, so I could indulge my new-found "my hands aren't
clean" fetish.
Regarding the heart murmur and possible heart problems: The heart murmur may be very mild and have little impact on Spencer's lifestyle, or it may be more major. Really, the only way to tell is to get an echocardiogram (an ultrasound of the heart), preferably by a board-certified cardiologist. Ours ran about $250 in the metro DC area several years ago. Gwyn's first heart problem (a murmur) showed up at age 4 months, and the problems progressed over the years to include hypertension, hypertrophic cardiomyopathy, and several strokes, including one that paralysed her for two months. With patient and supportive care, she recovered from almost everything, including the paralysis.
While the echocardiogram was expensive, I never regretted it. Because of it, I knew exactly what was wrong with Gwyn's heart, and we had options for medications lined up if and when they were needed. Because we knew the degree of her problems, we also knew to limit the amount of sub-Q fluids she got and to try to reduce stress in other ways. And we got a very detailed set of instructions for future vets to follow in the event that Gwyn needed anesthesia, to limit the potential side effects that might cause for her. I know that money's an issue, but I wanted to throw that out for consideration.
And ... I think that's about it on my end. I hope things are going well for you and for Spencer.
-- Jean and her Gwyn
![JJ & Gwyn [GA]](/FDMB/data/avatars/m/0/167.jpg?1419296044){kind=avatar}
