# Cat seems constipated but doesn't act like it



## Lilygirl123 (Aug 31, 2009)

Hi. My cat is 18 years old and has a hyperactive thyroid and diabetes. He is currently in remission from the diabetes, and his thyroid is kept well under control with medication. When he became diabetic, I switched him to a wet food only diet, (Fancy Feast with less than 10% carbs), and he's been pooping less frequently since then. He has had constipation issues in the past, but they were resolved with Metamucil and Lactulose. But last week Wednesday he started having problems. Before he would poop every 2 days like clockwork, at almost the exact same time give or take an hour. Sometimes he would go everyday, but since he's been fed a wet food diet, it's been mostly once every 2 days. My vet said this was normal since wet food doesn't have as much fibre and filler as dry food. But last week he was even slower than usual, going 6 to 8 hours past his usual 2 day time frame. His stools were still normal, though. Right now he hasn't gone for almost 2 and a half days. I talked to my vet and she told me that as long as he's not showing signs of discomfort that I shouldn't worry. She said no stool in 4 or more days was more concerning. When he was constipated before, he always showed signs, like walking in and out of the litter box, straining with little hard stools coming out, licking his rear end, that kind of thing. But he's acting completely normal now. No change in behaviour, no frequent trips to the litter box or straining, peeing fine, his appetite is very good, and he drinks enough water. I'm really scared that it could be his kidneys. I'm waiting today and giving him Lactulose, and if he doesn't go at all today, I will take him to the vet tomorrow. Any advice would be appreciated. Has anyone here had this kind of problem with their cat before?


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## laurief (Jun 22, 2008)

From your description, it doesn't sound like your cat is currently constipated. I suspect he is either eating less or eliminating somewhere other than the litterbox. In any event, it would be a good idea to take him to your vet for a blood chemistry and thyroid test to see where his organ function currently stands. At 18 yrs old, I'd be surprised and VERY impressed if he doesn't have some degree of renal insufficiency. It's important to know if he is having renal problems because that will impact how you control his hyperT. If he does have CRF in addition to hyperT, the diseases and their manaqgement can be successfully balanced. I've been doing that with my hyperT and CRF boy, Billy, for almost 2 yrs now.

You're obviously taking very good care of your boy and are monitoring his condition closely. He's a lucky cat to have such a dedicated caretaker.

Laurie


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## Lilygirl123 (Aug 31, 2009)

Thanks, and you're right, he's not constipated. He just went 20 minutes ago and had a large, normal looking stool. I'm just afraid that his bowel movements will continue to become more infrequent. I just hope he can regulate himself again.

I had a T4 done on him about 2 weeks ago, and everything is normal and great in the thyroid department. He had a blood chemistry done around Christmas last year and his kidneys values were in normal range. I know I should get that done again soon. Just need to save up the money for it. I really hope there's nothing wrong with his kidneys. It's been something I've been fearing ever since I learned about renal failure in cats. I know cats with kidney problems can go on to live for a long time, but with a combination of a hyper thyroid and the diabetes, if he were to get renal failure he might not be with me much longer.  I'm hoping the wet diet will help kidney function.

Edit: I forgot to add that I checked the house to make sure he wasn't going anywhere except the litterbox and found nothing. His appetite is actually pretty big too.


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## laurief (Jun 22, 2008)

Infrequent bowel movements aren't a problem as long as he's not constipated or loose.

It really is very important that you have that blood chemistry run as soon as you can swing it. If he is in renal failure, which is likely at his age, the earlier you catch it, the better his prognosis for successful management of the disease. The canned food is helping with his hydration, but it'll be even better if you turn that food into a thick soup by adding water. The more water you can get into your boy on an ongoing basis, the healthier you'll be able to keep his kidneys and other internal organs.

Laurie


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## Lilygirl123 (Aug 31, 2009)

If a cat gets renal failure, would there be symptoms? I mean, I know a cat can hide their discomfort really well, but wouldn't they be drinking and peeing a lot, decreased appetite, or at least have an unkempt coat? 

When my cat became diabetic 2 years ago, my vet thought he had renal failure, but his kidney values had been normal. Do all older cats get renal failure? If a cat gets it, do you have to give them those fluids under their skin? I'm really afraid of that.


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## laurief (Jun 22, 2008)

> If a cat gets renal failure, would there be symptoms? ... wouldn't they be drinking and peeing a lot, decreased appetite, or at least have an unkempt coat?


Usually there are symptoms but not always. Sometimes by the time you notice symptoms, the disease has progressed so far that it's very difficult or impossible to stabilize the cat. That happened with my cat, Bitsy, and I'll always feel guilt about not having recognized his illness earlier. Don't wait for obvious symptoms. Get bloodwork run regularly (at least every 6 mos) on elderly cats to keep an eye on organ function.



> Do all older cats get renal failure?


No, but many do. Actually, I expect ALL cats would develop renal failure at some point if another illness or injury didn't kill them first. At 18 yrs old, your cat is already past the "average" feline life expectancy of 15-16 yrs, so his organs are almost certainly losing efficiency and some degree of function.



> If a cat gets it, do you have to give them those fluids under their skin? I'm really afraid of that.


It's true that many CRF cats require supplemental fluids. In fact, your cat's constipation problems may imply that he isn't keeping himself adequately hydrated on his own already. I understand your fear of administering subQ fluids. I think we all start out there. But if your cat should require them in the future, you'll find that they really aren't all that scary once you learn the technique and get some practice under your belt. Of course if it's something you absolutely can't handle, you can always take your cat to the vet for fluids as necessary, or perhaps even hire one of the vet techs to come to your home after office hours to do it there. At least one of the online CRF support mailing lists maintains a database of volunteers who will help folks in their area care for their CRF cats, including subQ fluid administration. So there are resources out there if you should find yourself in need.

Laurie


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## Lilygirl123 (Aug 31, 2009)

Thanks for the info. My cat currently seems really healthy except for the infrequent bowel movements I was worrying about. He stays in diabetic remission, his thyroid is at a normal range. I'm very happy about his health, especially considering his age. I don't think he has CRF yet, (at least I hope not), although his kidneys are most likely not functioning like they used to now that he's a senior. My vet said annual blood panels were good, but because he's older, it makes sense to have it done every 6 months. I'll get one done ASAP.

I want to keep him more hydrated by putting water in his food, and hopefully that will help with his bowel movements. Is that spring water that comes in a bottle ok to give him? Would it be too cold for him to keep it in the fridge?

I read on a website once that there was a new way to give subQ fluids. I believe the vet inserts a contraption underneath the cat's skin and it automatically gives him fluid when he needs it. Have you heard of this? I think that would be a real breakthrough in treating renal failure.


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## laurief (Jun 22, 2008)

> his kidneys are most likely not functioning like they used to now that he's a senior.


That's pretty much the definition of CRF.



> My vet said annual blood panels were good, but because he's older, it makes sense to have it done every 6 months.


Things can go downhill for seniors very quickly. That's why many vets recommend blood panels every 3 months for geriatric patients. I personally think every 6 months is adequate unless the animal has specific symptoms of illness or has a chronic illness that requires more frequent monitoring.



> Is that spring water that comes in a bottle ok to give him? Would it be too cold for him to keep it in the fridge?


Spring water really isn't necessary. Tap water should be fine. But if your cat prefers spring water and drinks it more readily, go for it. Same with water temp. Give him what he drinks best. You might also consider buying a pet fountain. Many cats seem to love drinking moving water from a fountain.



> I read on a website once that there was a new way to give subQ fluids. I believe the vet inserts a contraption underneath the cat's skin and it automatically gives him fluid when he needs it. Have you heard of this? I think that would be a real breakthrough in treating renal failure.


You're probably referring to the port that can be implanted in the cat that makes it unnecessary to stick him with a needle. They're not without risks, though. They can cause infections and other problems in the cat. I think the general consensus of the people on the CRF mailing lists is that their risks outweigh their benefits.

Laurie


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## doodlebug (May 13, 2006)

Have you been giving him the metamucil and/or lactulose on an ongoing basis? I didn't get the impression that you are. Adding some fiber on a regular basis could help with the frequency and hardness of his poop. Additional options for adding fiber are Benefiber or slippery elm. 

http://www.littlebigcat.com/?action=lib ... lipperyelm


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## Lilygirl123 (Aug 31, 2009)

Laurief, thanks for the tip about adding water to his food and making it into a soup. I did that for his afternoon feeding and it worked like a charm! At first I was afraid he wouldn't eat it because he's pretty finicky about anything different, but he gulped it down no problem! And I noticed a change in his coat right away. He usually has a shiny, soft coat, but it became even healthier looking with that extra hydration. It's amazing what a little more water can do!

It's too bad about that port thing. It would make treating the disease so much easier. Hopefully they can improve it so there won't be anymore risks. I really hope so because if I have to do it one day, I would prefer the needleless way! it was hard enough for me to give my kitty insulin needles when he needed it. I'm not so good when it comes to needles!

Doodlebug, I am actually giving the Metamucil on a daily basis, and since he's been slower lately, I've been giving him more Lactulose and increased his dose. It seemed to do the trick this morning. The Metamucil used to work really well and I wouldn't need anything else, but it doesn't seem to have the same effect anymore.


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## laurief (Jun 22, 2008)

> Laurief, thanks for the tip about adding water to his food and making it into a soup. I did that for his afternoon feeding and it worked like a charm! At first I was afraid he wouldn't eat it because he's pretty finicky about anything different, but he gulped it down no problem!


I've never had a cat refuse canned food soup as long as the canned food is one they'll eat. In fact, cats generally LOVE soup they can lap up easily. Think of what they do with canned food that is chunks in gravy. They ALWAYS lap up the gravy first.



> And I noticed a change in his coat right away. He usually has a shiny, soft coat, but it became even healthier looking with that extra hydration. It's amazing what a little more water can do!


Absolutely! Nothing improves coat texture and gloss the way proper hydration does. CRF caretakers know that better than anyone else. It's one of the ways we can tell when our cats need fluids.



> I'm not so good when it comes to needles!


I don't think any of us enjoy sticking needles in our cats, but we do it because we know how much better those fluids make them feel. It's all in the mindset, you know.

Laurie


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## Lilygirl123 (Aug 31, 2009)

I know what you mean about the needles. It took me some time to get used to poking my kitty with needles when he needed insulin, but I forced myself to do it for his sake. He was more borderline diabetic and diet change was the most important, but he did need a little insulin to jump start his pancreas.

He does find the soup easier to eat. He loves it! But now he's not drinking enough from his water dish! He used to drink quite a bit in the mornings, now he just licked at it twice, then walked away. But his coat is still looking better than it did before. Usually it's a little dry and brittle in the mornings, then gets silky during the day, but this morning it doesn't feel dry, and I can see no dandruff flanks either.


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## laurief (Jun 22, 2008)

Water is water and hydration is hydration. It doesn't matter whether he gets the fluid he needs in his soup or in his water bowl, as long as he gets it. When cats are receiving subQ fluids, they sometimes quit drinking altogether. That just tells us that they're adequately hydrated.

Laurie


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## Lilygirl123 (Aug 31, 2009)

True, and he seems to be getting more hydrated from the water with the food than he would drinking from a dish because more gets into him. I really appreciate your help, thank you.


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## laurief (Jun 22, 2008)

Now that he's taking in more fluid, he'll also be urinating more. Since B vitamins and potassium are flushed out in urine, you may need to supplement both in his diet. Vitamin B-Complex can be mixed directly into his soup, as can potassium gluconate. B Vits are safe to give to any cat, but you probably shouldn't supplement potassium until after you have his blood chemistry done so you know where his blood potassium level is right now. High potassium can be dangerous. Many elderly cats, though, have low blood potassium which can cause weakness, esp. in the hind legs. 

Both Vit B-complex and potassium gluconate can be purchased wherever vitamins are sold.

Laurie


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## Lilygirl123 (Aug 31, 2009)

Thanks for the tip. He had weak hind legs when he was hyperglycemic a long time ago, but they got better. He still walks stiff at times. I'll talk to my vet about adding vitamins.


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## laurief (Jun 22, 2008)

Do you remember if your vet diagnosed the weakness as diabetic neuropathy? The treatment for diabetic neuropathy is Vit B12 in the form of methylcobalamin, and folate (another of the B vits) to activate the methylcobalamin. I give Billy (hyperT, CRF, and hyperPTH) 500 mcg of methylcobalamin and 100 mcg of folate daily, along with B-Complex and a slew of other supplements and meds.

B-Complex, extra methylcobalamin and folate, and potassium gluconate (if his blood potassium level is below 4.0) may be very beneficial for your boy.

Laurie


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## Lilygirl123 (Aug 31, 2009)

My vet didn't do much other than diagnose him with diabetes. The hind leg weakness started when he became diabetic, so I assume it was neuropathy. It went away when his BG was in normal levels and has not reoccurred since he's been in remission. He actually runs pretty fast still, and jumps to high places. His walking is stiffer now at his age, though.

I give him 3 mL of liquid Methimazole twice a day for his hyperthyroidism, and it has worked way better than the pills. As soon as we started him on liquid we could lower the dose a lot. This disease actually hardly ever gives him trouble. Only a few times we had to up the dose because his thyroid was acting up, and one time we had to lower it. He's had a hyperactive thyroid for about 5 years.


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## laurief (Jun 22, 2008)

What's the concentration of the liquid methimazole? How many mgs does he take daily?


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## Lilygirl123 (Aug 31, 2009)

I really don't know. How do I find that out? 

It does say 20mgs on the bottle. It's a small bottle that lasts him about 2 months, sometimes a little more.


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## laurief (Jun 22, 2008)

Hmm. The bottle should say how many mgs of methimazole are in one ml of liquid. Read the fine print. It must be on there somewhere. If not, you could call the pharmacy or vet where you bought the prescription and ask them. They'll have it in their records.

Laurie


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## Lilygirl123 (Aug 31, 2009)

Actually I think it means 20mg per ml because it says on the label 20mg/mL.


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## laurief (Jun 22, 2008)

That can't be right - not if you're giving 3 ml twice a day. That'd be 120 mg of methimazole daily, and it would certainly be lethal. 10 mg daily is considered quite a high dose of methimazole. Many hyperT cats are controlled on 2.5 mg daily.

Maybe you're giving .3 ml twice daily. That would make more sense, though it would still be a high dose of methimazole at 12 mg daily.

Laurie


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## Lilygirl123 (Aug 31, 2009)

Sorry, I meant to say .3. I always get that mixed up!

He used to be on a higher dose when he was on pills. This dose keeps him at normal level, and I haven't had to change it in about a year and a half. His T4 test 2 weeks back showed him at a much lower and more normal level than the last time when he was in a high normal range.


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## laurief (Jun 22, 2008)

That doesn't make sense to me, either, since methimazole is methimazole no matter what form it is delivered. I don't understand why he would be on a higher dose in pill form than in liquid, unless you were still in the adjusting phase of the medication. It took several months for me to regulate both Billy and Tommy on meds to get them to euthyroid.

Here's one important reason why you should get your cat's kidney values checked regularly. If he does develop renal insufficiency, you'll want to dial back the methimazole a bit to bring his T4 back to the upper range of normal. Managing both hyperT and CRF is a balancing act because hyperT actually helps keep the kidneys functioning at a higher level by keeping them infused with extra blood. If you manage the hyperT "too" well, it can't give that extra support to the kidneys, and they will suffer. So the trick when dealing with a cat who is both hyperT and CRF is to keep T4 as high normal as possible without causing hyperT symptoms such as weight loss and heart murmur to recur.

Laurie


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## Lilygirl123 (Aug 31, 2009)

He got the pills only once a day, and I guess he just couldn't adjust to them for some reason. I like the liquid because it's so much easier to give to him.

Wow, having a cat with both a hyper active thyroid and CRF sounds really complicated! What if a cat doesn't have CRF? Is it necessary to keep him in the high end of normal then? If he doesn't have CRF, I would rather keep him as normal as possible since he seems so much healthier now that his thyroid is functioning more normally than before.


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## laurief (Jun 22, 2008)

> He got the pills only once a day, and I guess he just couldn't adjust to them for some reason


Unless you were giving him some sort of time-release methimazole, he should have been getting the pills twice daily. Some vets have clients give pills just once daily because it's easier for the client, but it's certainly not in the best medical interest of the hyperT cat.



> having a cat with both a hyper active thyroid and CRF sounds really complicated!


It can be, esp. if the diseases are diagnosed late. I was fortunate in that Billy was diagnosed in the early stages of both hyperT and CRF, so I was able to stabilize him fairly easily. Tommy's hyperT was much more advanced, but she doesn't have CRF. Both cats are doing well now.



> What if a cat doesn't have CRF? Is it necessary to keep him in the high end of normal then?


No, if there is no renal insufficiency, it's best to keep the T4 as low normal as possible in an elderly cat. I try to maintain Billy's T4 in the high normal range and Tommy's in the low normal range. Easier said than done when dealing with a progressive disease and a med that doesn't maintain a perfectly steady T4 level over the course of a day.

Laurie


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## Lilygirl123 (Aug 31, 2009)

I'm guessing the vet thought it was easier for me to give him one dose of pills a day, but they didn't ask me about it so I didn't know. If I had, I would have gladly done it twice a day to maintain his health. That's probably why his levels became so much better after getting the liquid since he's always gotten it twice a day. He didn't do too bad on the pills though, but his thyroid did seem to act up more often.

I think his hyperactive thyroid was diagnosed in the more advanced stages. If I find out his kidneys are fine, I'll keep him on the same dose so he stays in the normal levels he is now. 

The water in the food really seems to be working well! He had a bowel movement last night, and it was before the 2 day mark this time! I'm so relieved! I hope that extra hydration continues to keep him regulated like this.


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## laurief (Jun 22, 2008)

When my first hyperT cat was diagnosed, even my vet told me it was fine to give methimazole just once a day. It wasn't until I did my online research that I discovered that hyperT cats are much more evenly regulated when dosed twice daily. Makes perfect sense, of course, that splitting the daily dose between two doses 12 hrs apart is going to provide a more even T4 blood level throughout any 24 hr period. I expect that when you were dosing pills once daily, your cat's T4 level was having big swings throughout the day. So those "acting up" periods were probably directly related to the time of day his blood sample was drawn relative to getting the methimazole dose.

Laurie


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## Lilygirl123 (Aug 31, 2009)

Exactly. Two doses evens things out. And I found it was the same thing with insulin. I had my cat on Lantus which in people is a 24 hour insulin, but for cats, 12 hours. Often he would have a normal BG at his second dosing time so I would skip his shot. It led to him being hypoglycemic by the morning. My goal was to get him into remission, but skipping the shot kept resulting in higher BG numbers in the morning. It was quite frustrating. Someone on the feline diabetes board told me to always give him some insulin. No matter what, he had to have a shot twice daily. If it was less than a half unit, he wouldn't have a hyperglycemic attack, especially on a gentle insulin like Lantus. So I did this, and within less than 2 weeks, he was back in remission (he had been in remission before and came out of it a year later.) I'm hoping this time it's permanent. I think it will be if he doesn't develop any illnesses that could affect his BG. Diabetes and a hyperactive thyroid is also a tricky combination, but luckily his thyroid stayed pretty normal during this time.


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## laurief (Jun 22, 2008)

Just think of how much our kitty kids are teaching us about these diseases, their interactions, and their management. Although none of us ever want to see our animals ailing, I appreciate the lessons they teach me because those lessons are the ones I pass along to other people managing the same diseases in their animals, and those lessons make me a more skillful and knowledgeable caretaker of generations of animals to come.

There is value in every struggle my animals and I have faced. It's my job to recognize and utilize that value so that there's more to all of this than just sickness.

Laurie


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## Lilygirl123 (Aug 31, 2009)

That's true. Once you take care of an animal who has become ill, you become an expert in the disease or diseases they have. I know so much about diabetes now because I had to learn about it to effectively treat my cat. Now I try to help as many people as I can who's cats have just been diagnosed with diabetes. It seems a lot of vets don't know about the new ways to treat this disease, like testing blood glucose at home. I counted on the expertise of others on the internet who actually have diabetic cats to treat, and took their suggestions over my vet's. I think experience can be more important than things learned at school. 

I just wish there were cures for these really nasty diseases. I know you can do radioactive iodine to permanently heal the thyroid, but my guy is definitely not a candidate for that.


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