> Thank you for your replies. Kee Kee is approximately 4 years old.
> I think his kidneys were checked the time before last when he was
> hospitalized for this (last Spring).
Okay. I thought Kee Kee was older than he is (think it was a comment in one of your other posts about Kee Kee being the old cat). For some reason, I also thought this was a more recent problem than it appears to be. As constipation seems to be a recurring problem for Kee Kee, you might want to take him in to the vet for a thorough check-up -- or to another vet, if your current vet hasn't found anything.
When Gwyn was four, she had recurring bouts of lethargy, mild fever, and constipation on about a ten-day cycle, and she was losing weight. I brought her in to her regular vet, who suggested some problems and treatments (none of the tests showed anything), but with no success. Tried two other vets at different practices, with the same results. After several months, it finally got to the point where I felt I could only guarantee that Gwyn would be healthy enough to go to one more vet before things started sliding irrevocably downhill.
I called a really good friend of mine at the UofP vet school and gave her all of Gwyn's symptoms and non-effective treatments, and asked her to run things past some of the professors there. I wasn't looking for a diagnosis; I wanted her to ask the vets: if they had a cat with these symptoms who probably didn't have a lot of time left to spend on diagnostics and bad treatments, who would they take her to see? It universally came back for this one vet, who I took Gwyn to see. They ran a few tests and did a full intestinal biopsy and came back with a diagnosis of inflammatory bowel disease. Which hadn't occured to the other vets as the constipating form of IBD is fairly rare in cats (most have the diarrheal form).
We put Gwyn on prednisone and lactulose, and that kept her stable for a lot of years. We later added (and eventually discontinued) pumpkin, cisapride, cascara, metamucil, and probably some other stuff I've forgotten over the years. I've also learned to give sub-Q fluids -- mostly for her kidney disease, but it helps with the constipation as well -- and enemas (not nearly as bad as you think they are). At the moment, our main treatment consists of prednisone, Miralax, Zantac, sub-Q fluids, and enemas. Gwyn's had constipation issues wax and wane, but are always there in some form or other. On the other hand, in three short weeks, she turns 20, so she's been dealing with this for almost 16 years now.
That said, finding the right vet to do the diagnosis was the key to Gwyn's recovery. If I'd gone to yet another local vet, I honestly don't know what would have happened. If you can find a vet in your area that's skilled in digestive problems or who's a recognised diagnostician for odd problems, I'd recommend going to see her/him.
> I will try to get him to drink more water. He has been getting 3cc of
> liquid Lactulose daily. He also gets a sprinkling of Miralax in his food.
The water's great. Regarding both lactulose and Miralax: having used both, I definitely prefer Miralax. YMMV. (Actually, the cascara was only to enhance the effect of the lactulose, so I don't think it'd work with Miralax.) Anyway ...
Besides seeing a specialist, the one other thing I'd recommend is this article on the managment of constipated cats
http://www.theveterinarian.com.au/clinicalreview/article757.asp. I have it bookmarked because of Table 2 at the bottom. It's a lovely list of different types of medications that can help relieve constipation in various ways. So if one medication becomes less effective, you can consider switching or supplementing with a medication that works in the same fashion or that may complement it in some way. Table 2 is one of the main reasons that Gwyn gets Zantac instead of Pepcid A/C -- besides helping with nausea, etc, Zantac also helps with Gwyn's constipation; Pepcid doesn't. (*sticks tongue out at Pepcid*)
Good luck to Kee Kee, and to you --
Jean and her Gwyn