chronic vomiting, no other symptoms in 10 year old cat

[arrianym]

Hello! Apologies for this long post but i would really appreciate any help <3 i am a medical student with not a lot of funds but am willing to pay if it means my cat will feel better. I also have insurance but my maximum amount per year is almost reached

HISTORY prior to problem
- I adopted a 10 yr old cat almost a year ago. She had a history of chronic vomiting about once to twice a month. Also years of untreated ear infections and obesity (not severe). Owner thought this was normal and proceeded to feed her generic pet food as well as deli cheese and meat for snacks (Yup...)

- When I adopted her she was throwing up every other day. I switched her to I/d food (which I still had from my previously deceased cat). She immediately stopped and barely vomited excluding the occasional hair ball for about 6 months.

- I did a yearly blood test at the vet a few weeks after adoption and they noticed high Fpl levels indicative of pancreatitis. They did an Ultrasound and diagnosed her with triaditis (pancreatitis, cholecystitis, enlarged liver, inflamed small bowel)

- I was instructed to give daily ursodiol for gall bladder and cerenia for pancreas/nausea every 3 days. She did great for the previously mentioned 6 months.

- However, I was instructed to switch her to z/d food as vet thinks she had an allergy, given her ear infections and GI symptoms. I did so in December 2019.

CURRENT PROBLEM
Symptoms: Chronic vomiting usually in the morning, since January 2020. Behavior even now is COMPLETELY normal, she is energetic and playful, regular bowel movements and urination, always begging for food and eats it all, cuddly, doesn’t express pain when abdomen is palpated. Vomit is usually orange-brown sometimes clear.

Timeline and Details: In January she began throwing up once a week in the morning, which progressively increased to every day for 3 days after about a month (I was talking to the vet throughout this, but she said I can wait until our prescheduled ultrasound appointment as it did not seem emergent, since her behavior was normal). However I took her earlier once she began throwing up daily. She was given fluids and an Xray. Vet said she was very constipated and gave me a laxative, thinking this may cause her nausea. Didn’t help. They then did the ultrasound as scheduled a week later.

• ultrasound showed slight improvement / no change: liver is still enlarged, muscularis of jejunum (small bowel) is thick. She continues to throw up and vet has no more ideas. I take her to emergency room…they transfer her to internal medicine and they do another ultrasound and GI panel. GI panel is completely normal, vet says GI is functioning properly and she does not have pancreatitis (yay?). Their ultrasound was positive for thick jejunum, same as the previous one.
• doctor thinks this is either IBD or intestinal lymphoma and says next step is endoscopy with biopsy. However, she recommends i try switching her to I/d first since she did well on that…and it could avoid an intense, expensive procedure if successful.
• 5 days into I/d no vomiting at all. Then vomiting for 3 days. I call vet. They say i can try taking her off of ursodiol as this can have vomiting side effect. I stop ursodiol. No vomiting for 72 hours…then vomiting today.

MY THOUGHTS

• she eats her I/d very fast so maybe she is too hungry in between meals, bile is building up, and causes her to vomit in the morning…especially because she has no other symptoms. though she was vomiting with z/d in january which she didn't finish off as fast, and was in the bowl throughout the day. However, perhaps she would benefit from an antacid?
• she has IBD/lymphoma, and endoscopy is the way to go (even though it is insanely expensive)
• it can’t be allergies because she was throwing up with z/d, which is processed in a way that prevents allergic reactions. But im not 100% sure on this…perhaps the z/d was bothering her stomach in some way. But then why is she continuing to throw up 2 weeks later on the I/d? Could it have been the ursodiol this whole time? Maybe she is still recovering from it...
• I am worried that even the biopsy will yield nothing and the chronic daily vomiting is not gonna stop...I will greatly appreciate any advice.

 

[LTS3]

A biopsy is expensive so many people opt to do an ultrasound instead and then just treat the cat for IBD-like symptoms. Treatment usually involves both medicine and diet until the cat can be diet-managed. There is more info on IBD here:

IBDKitties – Helping Save Lives…One Paw at a Time

www.ibdkitties.net

Feline IBD

Address the root cause of IBD in your cat. Treat inflammation and gut dysbiosis with proper tools to restore health, not just manage symptoms.

www.rawfeedingforibdcats.org

My vet was able to diagnose my cat with IBD just from an abdominal palpation and feeling thickened instestines. We still did both an ultrasound and biopsy to confirm IBD.

Anti-nausea and antacid medicine may be helpful along with a steroid to calm intestinal inflammation. Ask your vet.

Is the Z/D canned or dry? Canned foods are preferred over dry for cats with IBD and / or food sensitivities. Prescription food isn't always needed. The vet would like my IBD cat on Z/D but I continue to feed a raw diet. There are limited ingredient novel protein diets sold in pet stores that you can try instead of Z/D.

You can seek out a second opinion from another vet if you feel your cat isn't getting to the bottom of why your cat is constantly vomiting. Some vets just do "band aid" fixes to treat symptoms but don't bother to get to the underlying cause of the symptoms.

 

[lisahe]

Vomit is usually orange-brown sometimes clear.

she eats her I/d very fast so maybe she is too hungry in between meals, bile is building up, and causes her to vomit in the morning…especially because she has no other symptoms. though she was vomiting with z/d in january which she didn't finish off as fast, and was in the bowl throughout the day. However, perhaps she would benefit from an antacid?

Am I correct in inferring that she is only vomiting up liquidy stuff early in the morning? How often do you feed her? And how much time?

We have a cat who tends to vomit liquid in the early morning if she doesn't have a small snack during the night. This is not uncommon -- our vet has a cat who does the same thing -- and an autofeeder can feed the snack. Edwina also eats very quickly: she's very insecure about her meals (she's a rescue cat) and will also overeat and regurgitate if not fed often enough. We feed her five small meals a day plus a nighttime snack. This generally prevents her from vomiting up bile; she does still occasionally have a lapse but not enough to consider antacids. The most recent lapse was Thursday when she was waiting for her lunch and vomited clear "egg white" liquid five or six hours after her breakfast. The insecurity I mentioned is a very large part of her problem even though she has been fed well for more than six years: I think her (very palpable) nervousness makes the stomach acid build.

So my suggestion would be to first see what happens with some meal changes -- amount, frequency -- and then consider food sensitivities since the ear infection can indicate that. (We saw that in our previous cat.) But that's a whole other post!

 

[arrianym]

A biopsy is expensive so many people opt to do an ultrasound instead and then just treat the cat for IBD-like symptoms. Treatment usually involves both medicine and diet until the cat can be diet-managed. There is more info on IBD here:

http://[URL]https://www.ibdkitties.net/

[/URL]

http://[URL]http://www.rawfeedingforibdcats.org/

[/URL]

My vet was able to diagnose my cat with IBD just from an abdominal palpation and feeling thickened instestines. We still did both an ultrasound and biopsy to confirm IBD.

Anti-nausea and antacid medicine may be helpful along with a steroid to calm intestinal inflammation. Ask your vet.

Is the Z/D canned or dry? Canned foods are preferred over dry for cats with IBD and / or food sensitivities. Prescription food isn't always needed. The vet would like my IBD cat on Z/D but I continue to feed a raw diet. There are limited ingredient novel protein diets sold in pet stores that you can try instead of Z/D.

You can seek out a second opinion from another vet if you feel your cat isn't getting to the bottom of why your cat is constantly vomiting. Some vets just do "band aid" fixes to treat symptoms but don't bother to get to the underlying cause of the symptoms.

Thank you so much for your advice. I am leaning towards doing the biopsy if this continues. I would just try treating with steroids but the vet said that chance of IBD or intestinal lymphoma is 50/50 among cats because both present similarly and they are both equally common. She said if I give steroids, a biopsy will no longer be able to be done so in the case that it is lymphoma and I treat for IBD, it will be really hard diagnosing. This is the second vet that I spoke with about the biopsy (the first was the emergency room doctor), and they both seem to agree that this is the next step. It is insanely expensive but I feel like I have no other choice. Hopefully I’ll get a diagnosis.
However, maybe I’ll try an antacid first and see if that helps? And maybe just put her on wet food exclusively.

 

[arrianym]

Am I correct in inferring that she is only vomiting up liquidy stuff early in the morning? How often do you feed her? And how much time?

We have a cat who tends to vomit liquid in the early morning if she doesn't have a small snack during the night. This is not uncommon -- our vet has a cat who does the same thing -- and an autofeeder can feed the snack. Edwina also eats very quickly: she's very insecure about her meals (she's a rescue cat) and will also overeat and regurgitate if not fed often enough. We feed her five small meals a day plus a nighttime snack. This generally prevents her from vomiting up bile; she does still occasionally have a lapse but not enough to consider antacids. The most recent lapse was Thursday when she was waiting for her lunch and vomited clear "egg white" liquid five or six hours after her breakfast. The insecurity I mentioned is a very large part of her problem even though she has been fed well for more than six years: I think her (very palpable) nervousness makes the stomach acid build.

So my suggestion would be to first see what happens with some meal changes -- amount, frequency -- and then consider food sensitivities since the ear infection can indicate that. (We saw that in our previous cat.) But that's a whole other post!

Thank you so much for your insight! Yes I think maybe feeding more frequently might help. I usually just feed her in the morning and at night. However when I was feeding her dry food, she ate it throughout the day which was why I felt comfortable feeding her so far apart. And she began vomiting when being fed that. I tried last night feeding her wet food with a side of dry food so she would have a snack at night and she has not thrown up this morning so fingers crossed. I do think you have a point because she always tends to vomit 5 or 6 hours after being fed. Maybe she would benefit from more frequent feedings and a medication, like an antacid or antinausea. But if this continues I think I might have to go for an endoscopy

 

[lisahe]

However, maybe I’ll try an antacid first and see if that helps? And maybe just put her on wet food exclusively.

Thank you so much for your insight! Yes I think maybe feeding more frequently might help. I usually just feed her in the morning and at night. However when I was feeding her dry food, she ate it throughout the day which was why I felt comfortable feeding her so far apart. And she began vomiting when being fed that. I tried last night feeding her wet food with a side of dry food so she would have a snack at night and she has not thrown up this morning so fingers crossed. I do think you have a point because she always tends to vomit 5 or 6 hours after being fed. Maybe she would benefit from more frequent feedings and a medication, like an antacid or antinausea. But if this continues I think I might have to go for an endoscopy

Yes, I'd definitely try putting her on exclusively wet food during the day, feeding more frequently (be sure to spread the food out on a plate rather than mounding it), and continuing to leave a small snack of dry food for the night. It might also help to raise her dishes off the floor a few inches. Our experience with Edwina (our barfer) is that if she's going to vomit up bile from hunger that happens at least five or six hours after her last meal. If she vomits about two to three hours after her last meal it indicates a food sensitivity (at least this is what has happened with potato, agar-agar, and green-lipped mussels in her food). If she regurgitates her food immediately, she's just eating too fast. Of course your cat's digestive system may work completely differently from Edwina's but (based on what others on the site have mentioned for their cats) those seem to be fairly typical timelines.

What is your cat's name, by the way?

What makes this all so difficult is that you may have multiple things going on. As we've seen with Edwina! In our experiences with her, I've found it very helpful to use a food and symptom diary to sort through her typical timelines with symptoms and foods. Nearly anything in food can cause a reaction so if the different meal schedule doesn't work -- particularly given that Hills foods have corn and/or wheat in them and both can cause sensitivities, as we saw with our previous cat -- I'd try a very simple canned food recipe, preferably with a novel (or at least different) protein and as few fillers, thickeners, and the like as possible. LTS3 mentioned feeding a raw diet to their IBD cat: we feed our cats quite a bit of raw food, too, both because they love it and because it's easier to find simple recipes (and limited-ingredient foods with proteins like pork, duck, and venison) in raw food than canned. I also make homemade cooked food that the cats love. Thank goodness for pork!

One other thought, since you mentioned that your cat had been constipated. When Edwina had been barfing last summer, the vet's first reaction was to suggest a motility drug. Cats' motility drops with age and you said your cat is ten, so this could also be a contributing factor. Edwina was then only about six and she didn't have any constipation issues, so even though motility seemed like a reasonable diagnosis (there was sometimes hair in what she was barfing up and hairballs become more problematic when motility drops), motility didn't quite seem right to me, given her sensitive gut. That's when I went through all sorts of processes of elimination and finally got to the green-lipped mussels, which are in one of the supplements I used to make cat food. As soon as I took that out of her diet, the vomiting stopped. And the vet was very surprised! Though I wasn't. I just wish I'd focused on the mussels earlier: they were my first suspect but I thought they seemed to be the least likely since she'd been eating food with that supplement for some time (a year or two?) without problem. Then again, food issues can develop over time.

I understand that you may end up with endoscopy no matter what happens but I've also found with our vet, who's very good, that the more (responsible) things we're tried and the more information we can give, the better for helping to sort out the larger picture.

Fingers crossed on the meal schedule! And beyond!

 

[arrianym]

Her name is Minnie

Our experience with Edwina (our barfer) is that if she's going to vomit up bile from hunger that happens at least five or six hours after her last meal. If she vomits about two to three hours after her last meal it indicates a food sensitivity

Update: I tried feeding her the z/d wet food today in frequent portions, and she three up 3-4 hours after her last feeding so it indicates to me that there is something in there bothering her stomach. However, she was still throwing up every few days after switching her back to the I/d food which is telling me that there is something more going on. Because she did well on I/d for months prior to switching to z/d in December. So i don't know if there is an allergic reaction to the I/d necessarily?

Although her GI function is normal (absorption, etc), perhaps she could have IBD or intestinal lymphoma. That's at least what the nurse said. I think I will schedule the endoscopy for next week. Maybe in the meantime I will ask to try an antacid and if she improves, I will hold off on the procedure. And I guess I will continue giving her I/d, because it was literally the only food I tried that didn't cause her to vomit before her symptoms began in January? I would love to try raw but I am on a limited budget and am already spending so much on these vet appointments and tests.

the only reason I am still considering an antacid / biliary vomiting syndrome is because she has no other symptoms other than throwing up. And it occurs after hours of not eating, in the morning.

I just feel so lost and exhausted from doing all of these expensive tests and not getting any answer. That is my fear for the endoscopy hopefully the vet prescribes me an antacid tomorrow and it works. Or the endoscopy yields a diagnosis. Thank you for all of your advice, and let me know if there is anything different/else you think I should be doing

 

[LTS3]

Z/D contains chicken which is a common allergen / cause of sensitivities in cats especially IBD ones. The chicken is hydrolyzed which is supposed to not cause a reaction but who knows with some super sensitive cats Consider feeding a novel protein food (venison, lamb, kangaroo, etc) to your cat instead.

Your vet can request a courtesy consult from a veterinary school for more ideas. VIN.com, a vet only web site, may be helpful too.

 

[arrianym]

Z/D contains chicken which is a common allergen / cause of sensitivities in cats especially IBD ones. The chicken is hydrolyzed which is supposed to not cause a reaction but who knows with some super sensitive cats Consider feeding a novel protein food (venison, lamb, kangaroo, etc) to your cat instead.

Your vet can request a courtesy consult from a veterinary school for more ideas. VIN.com, a vet only web site, may be helpful too.

thank you! do you have any brand recommendations that are on the affordable side and stomach sensitive?

 

[lisahe]

thank you! do you have any brand recommendations that are on the affordable side and stomach sensitive?

Has Minnie been eating mostly chicken?

My biggest/best additional suggestion at this point would be the same as LTS3 : trying a different diet. If Minnie's diagnosed with IBD you'll have to do that anyway.

It's hard to say what the best place is to start, though, since there are multiple approaches you could take. I tend to take the smallest first steps possible so -- even knowing that chicken might be the problem -- if price and availability are a concern (they usually are!), I might start with something that's just a simple chicken recipe, if only to take the grains in the Hills out of the equation. This might be a little risky if chicken really is the main problem but in some senses it's the path of least resistance: it's very hard to completely avoid chicken, so it's a tough one to take totally off the menu. OTOH, figuring out the reason for food-related vomiting is largely a matter of trial and error and it can take a fair number of changes to realize a small ingredient (like the agar-agar and mussels that were so bad for our cat) is causing the problem so I'd want to give the chicken a try. Even something like Sheba pate (cheap, readily available at the grocery store, and very decent food without any outrageous ingredients) might be a place to start. It looks as if nearly all of their pates, including turkey and beef, contain some chicken. One of the purest chicken recipes you could feed would be Tiki Cat, which Petco sells; it's considerably more expensive, though.

If you want to take a different approach, by starting with a protein Minnie is unlikely to have eaten before, you might want to check into brands like Hound & Gatos, which makes reasonably priced foods with pork, lamb, and other proteins. Our cats used to love the lamb, though they didn't like other H&G flavors. But the food now has agar-agar so I can't feed it. There's also Nature's Variety Instinct, which our cats hate but which makes foods like venison and rabbit. Many cats love it and lots of people on the site have said it works really well for their cats. Another brand is Merrick, whose "limited ingredient diet" foods are cheaper and readily available at Petco. Our cats used to love their turkey and duck... until the recipe changed to include pea protein (which I hadn't noticed and am totally against!). Pea protein or not, it's an option.

No matter what you choose, check the ingredients carefully. I think I already mentioned keeping a food and event log: being able to find patterns is really important, though sometimes quick, dumb luck figures things out really quickly! (That's how we learned that potato is so bad for Edwina.)

Fingers crossed again!

 

[LTS3]

thank you! do you have any brand recommendations that are on the affordable side and stomach sensitive?

Try these:

BLUE Basics® Limited Ingredient Cat Food | Blue Buffalo
Limited Ingredient Diet - Grain Free Cat | Merrick Pet Care
Cat Food - Limited Ingredient Diet - Kohapet
Instinct Limited Ingredient Diet | Instinct Pet Food
RAWZ | 100% Rendered Free Cat Food

 

[arrianym]

Has Minnie been eating mostly chicken?

My biggest/best additional suggestion at this point would be the same as LTS3 : trying a different diet. If Minnie's diagnosed with IBD you'll have to do that anyway.

It's hard to say what the best place is to start, though, since there are multiple approaches you could take. I tend to take the smallest first steps possible so -- even knowing that chicken might be the problem -- if price and availability are a concern (they usually are!), I might start with something that's just a simple chicken recipe, if only to take the grains in the Hills out of the equation. This might be a little risky if chicken really is the main problem but in some senses it's the path of least resistance: it's very hard to completely avoid chicken, so it's a tough one to take totally off the menu. OTOH, figuring out the reason for food-related vomiting is largely a matter of trial and error and it can take a fair number of changes to realize a small ingredient (like the agar-agar and mussels that were so bad for our cat) is causing the problem so I'd want to give the chicken a try. Even something like Sheba pate (cheap, readily available at the grocery store, and very decent food without any outrageous ingredients) might be a place to start. It looks as if nearly all of their pates, including turkey and beef, contain some chicken. One of the purest chicken recipes you could feed would be Tiki Cat, which Petco sells; it's considerably more expensive, though.

If you want to take a different approach, by starting with a protein Minnie is unlikely to have eaten before, you might want to check into brands like Hound & Gatos, which makes reasonably priced foods with pork, lamb, and other proteins. Our cats used to love the lamb, though they didn't like other H&G flavors. But the food now has agar-agar so I can't feed it. There's also Nature's Variety Instinct, which our cats hate but which makes foods like venison and rabbit. Many cats love it and lots of people on the site have said it works really well for their cats. Another brand is Merrick, whose "limited ingredient diet" foods are cheaper and readily available at Petco. Our cats used to love their turkey and duck... until the recipe changed to include pea protein (which I hadn't noticed and am totally against!). Pea protein or not, it's an option.

No matter what you choose, check the ingredients carefully. I think I already mentioned keeping a food and event log: being able to find patterns is really important, though sometimes quick, dumb luck figures things out really quickly! (That's how we learned that potato is so bad for Edwina.)

Fingers crossed again!

Thank you so much for your suggestions! Yes I think she does eat mostly chicken. I will try another food and hopefully that will help

 

[IndyJones]

You mentioned she eats quickly. Is it possible to feed her small amounts at once or try using a slow down bowl?

 

[lisahe]

Thank you so much for your suggestions! Yes I think she does eat mostly chicken. I will try another food and hopefully that will help

I hope it helps! FWIW, when I stopped feeding Edwina the food with the green-lipped mussels, we saw a change pretty quickly. Every cat is different and she wasn't vomiting daily like Minnie but even so she seemed happier, more playful within a day or two.

Good luck! (And please let us know what happens! )