Senior Cat Vomiting, Potential Ibd??

[sidneykitty]

Aw, thanks! Ha I always call her plush... yes, I guess it could be but I'd rather be safe than sorry. Thanks so much for your supporting words. I'm trying not to jump to conclusions about cancer. But I'd rather know than not. Then part of me thinks maybe she's fine, she hasn't vomited at all this week, maybe I'm over-worrying... but I'd rather have it looked at.

Edit: and I should say I joined this site when my first cat was diagnosed with lung cancer that had spread from her abdomen..everyone was so supportive and wonderful I appreciated it so much.

Oh I find UrineOff works really well on the vomit!

And ach sorry! I think I misunderstood your question about the avatar! Not to worry, it was my fault.

LTS3 , I am a bit surprised it might be IBD to be honest because she hasn't had diarrhea or weight-loss, but now I've read that vomiting is a common sign. Not every case will present the same in every cat just like humans. I know strep throat commonly presents with a fever but when I was a kid I got it every winter at least once and never with a fever. I had to convince Dr's to culture me and every time it came out positive!

Yes, I guess I'm not really sure about these hydrolyzed diets... I'd rather go for a novel protein even if it means I have to get a non-Rx food. Thanks for the link! I feel very tentative about raw diets, but I will check it out! How is your kitty doing now and how long was the diagnosis?

 

[LTS3]

Leroy was diagnosed last January. He's doing fine now. He's been off pred since October and doing well. The only thing he takes is B12 monthly and probiotics and digestive enzymes in his food daily.

Raw diets are helpful but not necessary. Any bland-ish LID type novel protein food helps. Canned is preferred over dry.

Blue Buffalo Basics
Merrick Limited Ingredients
Koha Limited Ingredient
Natural Balance LID
Instinct Limited Ingredient Diet | Instinct Pet Food
RAWZ | 100% Rendered Free Cat Food
Single Novel Protein Grain Free Wet (not Raw) Food? Help!
Your favorite brands of "novel protein" canned cat food
Recs For Low-carb, Grain-free Pork Without Chicken Or Fish?
Canned - Pure Vita - Natural Holistic Pet Foods
NutriSource Pet Foods

Rawz is probably the best one out there since it's junk / filler free. It is pricey ($2.99 a can where I am) and may be hard to find at independent pet stores. A few online web sites sell it.

 

[Kflowers]

Always act to cover as many possibilities as you can, but try to stay optimistic. You don't Amber to sense your fears and she will, because she's a cat.

 

[momof3b1g]

Hi @FeebysOwner! Yes, actually that is a very good point. I am very worried that if it is IBD it will become cancer. Waiting too long isn't something I want to do again. The u/s is the only way we'll really know anything at all. I'm calling the vet this morning to ask a few more questions (I'm wondering if her B12 levels were checked on bloodwork) and then may book the u/s at that time. Do you know if I would change her food and proceed with the u/s or should I keep her diet the same until then? ( will ask the vet this as well) Thank you!

sabrinah, I have tried, but I haven't seen much of any trend. I guess part of the problem is I try to feed her a different wet food every night as she seems to get sick of things easily. She often will not eat her wet food at all, its been a battle trying to get her to eat any since I adopted her and she was on dry only. Sometimes I have to really coax her into eating it and other times she'll just chow right down.

Definitely it could be her stomach being empty...I notice vomiting is almost always happening overnight after she gets wet food (but doesn't always eat it all).

B12 is something I want to ask about as the vet didn't mention it at all to me. I used to work at a cat hospital and I know almost all our IBD cats had low b12 and really improved with supplementation.

I was concerned the vet recommended the Royal Canin Hypoallergenic diet to me as it only comes in dry and I'd really like to keep her eating at least some wet food especially with her constipation. I'm hoping she gives me a few alternatives with cans to consider when I call today.

Thanks again

Yes I hate that. We just started shy guy on the hydrolyzed protein diet. We were at 50/50 transition and today he threw it up. :/ still giving him his regular canned food until he is 100% on the new food and then will switch over to see if it helps. He has been throwing up within 20 minutes of eating.

 

[sidneykitty]

Glad to hear Leroy is doing well! What kind of digestive enzymes does he get? Wow thanks for the list that's amazing. I've had a look into some of these brands already and hope we can find something Amber will like.

Very true, Kflowers... I am trying hard to be positive and comforting to her, letting her know its going to be okay, we will take care of her.

momof3 - I'm sorry to hear that! its so hard to change a kitty's food and illness makes it so much more difficult... I'm thinking of you, hoping things improve for shy guy.

Tomorrow is the ultrasound day... hoping for the best possible results and also that she doesn't get too stressed during the procedure.

 

[sidneykitty]

Sorry for the double-post... I had a random thought today about novel protein and rabbit. If Amber has had real rabbit before (like she used to go outside and hunted all kinds of things, rabbits included though I don't know if she ever ate them) would that exclude rabbit from the possibilities?

 

[daftcat75]

Rabbit will probably be fine. It's usually repeated exposure to the same food plus a leaky gut that leads to the immune reaction and the vomiting or diarrhea and inflammation. But there's also a possiblity that none of the new foods will work until the leaky gut and the overactive immune system are addressed. Raw meat and bone broth will soothe the leaky gut and not feeding the same thing you've always fed should stop giving the immune system something it recognizes and mobilizes against.

Here is a very science-y article about cats and IBD. You can skip ahead to the Diet section for more details about the raw meat and bone broth diet. It's not meant to be permanent. But it's a short tummy rest period. As the symtpoms clear up, you can slowly reintroduce more species-appropriate foods (meat and organs, no grains, little to no vegetables, vegetable proteins, or starches.) On the budget side, that's Fancy Feast Classic pates. On the higher end, it's Rawz. And then there's a whole lot of nonsense foods in between. If the first five ingredients aren't of animal origin, put it back.

If Amber will eat the hydrolyzed diet and it doesn't trigger her, then that plus steroids, possibly other medicines for nausea, vomiting, and appetite stimulation are the vet recommended alternative to raw meat and bone broth.

 

[LTS3]

I use Dr. Goodpet Feline Digestive Enzymes 4 oz I just give a sprinkle, less than 1/8 teaspoon.

 

[daftcat75]

Forgot to provide the article link:
Feline Inflammatory Bowel Disease: Nature and Treatment

 

[sidneykitty]

Thanks so much, daftcat75 ! Good to know. And thanks so much for the link.

Thanks - I'll look into where I can get thosedigestive enzymes if it turns out to be IBD!

Amber's home from the ultrasound...she's hungry but we're waiting for her mild sedation to wear off before she eats. Otherwise she's just sort of spaced out a little. I'm sure it was scary sitting on the table that long.

Good news is they did not find any masses. Should find out full results in the next couple of days. They also got the urine sample they couldn't get the other day. So may have some answers or more info soon-ish...

 

[daftcat75]

If Amber can maintain or gain weight once you have stablized her symptoms, that's a fairly clear sign that you're not dealing with lymphoma. Since you're catching it relatively early (three months is not that long), I would skip the biopsy for now, and try an IBD treatment, either steroids plus symptom management, or the raw meat and bone broth introductory diet followed by better, species-appropriate food choices. It doesn't necessarily have to be raw though many IBD cats are seemingly cured overnight just by switching to raw. Raw can be a lot to start with. You can look into some premixes like EZ Complete or Alnutrin to add occasional raw meals into rotation. IBD cats tend not to do so well with bone though so you'll likely want to consider a boneless raw plus a premix.

Whichever treatment you go with, if Amber has lost any weight to this, I would ask about B-12 shots. I would actually insist on B-12 shots because they make such a dramatic difference if they are needed. They are harmlessly excreted in the urine if they are not. I wish B-12 shots were prescribed as liberally as antibiotics for the good they do.

Digestive enzymes don't work for all cats. Krista can't take them. She always looks like her food is eating her whenever I gave her enzymes. But she's got great poops and she's clearly deriving nutrition from her food by her coat quality and her weight gain. So I don't believe she needs them.

Potential nonsense warning: I don't have anything to back this up, but I suspect that digestive enzymes are more beneficial to the loose stools/diarrhea forms of IBD. The vomiters are clearly producing enough acid that Krista is probably opening up the protective pods in her stomach rather than in the small intestine where it's supposed to happen. That's my wholly un-researched theory anyway.

So watch Amber's face and posture after she's eaten a meal with enzymes. I think the article I sent along has some examples. If she looks like Krista in the attached images, don't give her the enzymes. If her poops are good and her coat isn't dull, she probably doesn't need them.

 

[LTS3]

I buy the digestive enzymes from Amazon. You can also buy directly from the company. Prozyme is another brand some people use.

Digestive enzymes don't work for all cats.

Yes, my other cat would vomit after getting even a teeny bit of digestive enzymes with her food. So I stopped giving it to her.

I suspect that digestive enzymes are more beneficial to the loose stools/diarrhea forms of IBD.

Leroy's had diarrhea while on digestive enzymes I did feed him a different brand of raw at the time (one meal I think) so that was likely why.

 

[daftcat75]

Leroy's had diarrhea while on digestive enzymes I did feed him a different brand of raw at the time (one meal I think) so that was likely why.

That's why I included the potential nonsense warning. I pretend to know a lot of things. But I don't pretend to know about this. I just know not to give them to Krista because of that poor pained face she gives me every time.

 

[sidneykitty]

Thanks so much for your advice and input!

I got the ultrasound results (and urine) back and.... well, its confusing. Its not IBD?

Here's the overall findings:
Assessment:

1. Bilaterally echogenic kidneys. In feline patients, this may represent incidental fatty infiltration. Fibrosis, inflammation, or less likely diffuse mineralization can also have this appearance.
2. Echogenic urine. This is a nonspecific finding and may represent incidental fat, cells, crystals, or protein.
3. Minimal gallbladder sludge without cholelithiasis or wall thickening. This is believed to be an incidental finding but follow-up is suggested based on laboratory test for cholestasis.

Comments: no definitive abnormalities are seen to explain the patient's gastrointestinal signs. Diffuse intestinal disease such as IBD or lymphoma remain possible though no sonographically apparent changes are seen. Biopsy would be required for definitive diagnosis. Chronic pancreatitis is also a consideration as a normal sonographic appearance does not exclude this condition. The changes to the urinary tract are of unknown significance and may be normal in a feline patient. However, follow-up is suggested based on pending urinalysis results.

The only thing slightly off on the urine was "trace" amounts of blood.

HUH? I am so confused. So this could mean pancreatitis or fatty liver disease?? Urinary something?? Kidney disease?

The vet told me to read the report and call her back and wasn't really immediately saying we needed to do x, y, and z...she did suggest de-worming again even though Amber was de-wormed one month ago.

 

[daftcat75]

Blood in the urine can come from the extraction itself. If they had to stick a needle into her bladder to remove some urine, that's how trace blood can get there. I'm thinking if there was habitually blood in the urine, there would be some blood test result also confirming this condition (anemia?)

Have you tested for pancreatitis? The test would be Spec fPLI or Snap fPL or some form of an fPL (feline pancreatic-specific lipase: an enzyme specifically manufactured and released by the pancreas whose presence in high amounts in the blood would be a result of of inflammation of the pancreas, aka pancreatitis)

Another you might test for is EPI (exocrine pancreatic insufificiency) with the fTLI test. My understanding is that EPI mostly manifests itself as loose stools/diarrhea rather than vomiting.

If Amber is still eating on her own, I wouldn't suspect fatty liver. Also, I would expect that result to show up in the ultrasound.

Ask the vet is there is a form of IBD or a stage of IBD where it hasn't thickened the intestinal walls yet.

Biopsies are invasive and they have their limitations. The biopsy is performed by essentially snaking your cat one end or the other with a camera and forceps. As you can imagine, there is a lot of intestinal length that is not reachable by an endoscope. If the affected portion of Amber's GI tract is outside the reach of the endoscope, a biopsy is a waste of your money. On the other hand, an endoscope can see the inside surface of whichever end it is inserted in. I suppose (don't quote me on this) that an early stage of IBD could be a surface level inflammation that hasn't resulted in a thickening sufficient for ultrasound imagery. But this is sort of a gamble. You could stick a camera down her throat and get back a "nothing remarkable" result.

Tell the vet to interpret the results for you and suggest a next step. That's her job, not yours!

 

[sidneykitty]

I am waiting for her call back now, but momma is/was panicking a little... you have eased my mind a little. I will let you know what the Dr says!

Yes, I had forgotten they can get blood in the urine when they take it via needle. (all my knowledge/logical reasoning goes out the window when I worry...) Thank you!

She did get the Spec FPL test done because we considered pancreatitis and it was normal.

Have not heard of the EPI test, but that is good to know.

Yes, she is eating on her own. Sitting by the food bowl for meal times, eating all her food. She does sometimes have a few days where she doesn't finish all her dinner, though..

I'm not sure I'd proceed with a biopsy at all to be honest. I had decided if there was thickening and it was lymphoma vs. IBD we'd just treat it the same, I guess, at least as far as I know..

I guess I'm so worried now because this is involving so many body parts - liver, bladder, kidneys. Will wait and see what the vet says, but she didn't sound at all worried on her initial call.

 

[daftcat75]

I can't comment on kidneys and I'm hoping Krista never gives me the experience to do so.

The only way to tell the difference between IBD and lymphoma is a biopsy. However, as I mentioned earlier, you can make a reasonable assumption that it is probably not lymphoma if you can stabilize her weight or even gain weight once the vomiting symptoms have cleared up.

I'd kick this back to the vet and ask how she wants to spend your money next.


IBD is often a diagnosis of exclusion meaning it can cost a fortune to rule out everything else.

Has Amber lost weight? If she has, ask about a B-12 shot. Other than that, I would either look into the hydrolyzed protein but a lot of cats don't go for this or a simple, yet species-appropriate food like Fancy Feast Classic Pates.

Or...if she can eat chicken (Krista can't), pick up some chicken breast, chicken liver (or liver plus giblets), and some chicken bone broth (just the bone broth--no seasonings, no salt!), and feed a week or two of either raw chicken and giblets plus bone broth or lightly cooked chicken and bone broth. If no vomiting, feed this for two weeks. Then introduce something like Fancy Feast or anything that's almost or entirely animal-based ingredients plus the supplements. Any vegetables, starches, or gums should be viewed suspiciously as possible vomiting triggers.

 

[sidneykitty]

Thanks, daftcat75 ! Well she is not losing weight. She actually gained a small amount of weight in the last month and the ultrasound report said she was 1 lb overweight, but this is a new vet. My previous vet from before we moved said she was a perfect weight and wouldn't want her to lose any at her age.

Heard back from the vet... she said its nothing! She said to de-worm her and see if that helps. She said everything found on the u/s is "pretty normal for a cat her age" and that "cats are pukers". Looking at this vet's bio, it seems she has a lot of horse experience? I'm not really sure what to think of this. I've always brought my cat to a cat-only vet, but this one is walkable from my house and Amber gets very stressed in the car, so I opted to try it. Now I am having second thoughts.

She also recommended starting her on B12 injections because it can't hurt, an easily digestible diet or novel protein diet with Fortiflora probiotic.

My plan is to de-worm again just in case, switch her to a novel protein, keep monitoring closely and see how we go from there. Any further advice on switching to a novel protein diet? Is it best to do gradually the same as any other food transition?

 

[daftcat75]

If a vet tells you cats are pukers, find another vet. Although hairballs and barfing are common among cats, this isn’t a normal condition. Even hairballs point to a disturbance/impairment in GI motility. Egg yolk powder (foodfurlife.com has it) works well for busting up hairballs and allowing them to pass in the correct direction.

Take the food transition slowly. Krista will hold a grudge against food she has barfed. When we do food transitions now, I start by shifting only one of her meals at a time. I also reduce the portion size to make the newness easier. She normally gets 2 oz meals. So for a transition, I may reduce this to an ounce and a half. And then split that a half ounce new to an ounce old. I usually wait for the next poop to see it’s treating her well on the “back 9” before I increase the ratio to 2/3 new to 1/3 old. Give it another day or two. And finally all new. For that meal. At that time, I can also increase it back to her normal portion size. If needed, I can repeat for her other meals. Not only does it make it easier on her but it makes it easier on me to pull her back to the old food if the new food isn’t working for her. Or if she decides to reject the new food, I’m not stuck without a food she will eat.

 

[sidneykitty]

Yes...that's exactly what I thought. Unfortunately I didn't have the courage to question the vet on this fact over the phone. I just sort of said uhhh okay.... she did say it could be very early IBD with even thickening along the entire intestines that was so slight it could not be detected on the ultrasound.

Amber has not vomited in over a week. There is a part of me second-guessing and wondering if she's just had a bit of stomach upset? I remember I had accidentally been feeding her a jar of old dry food. After she threw up I got rid of the old and opened a new, fresh bag. All her lab work, urine, ultrasound overall were normal, so what does that point to? Food intolerance?

The vomiting has been very on and off. In October, it was the same thing. For about a week she'd vomit a couple of times, then nothing for a while. Then it would happen again, then nothing. In November I think she was totally fine. So its been very inconsistent.

Anyway, I de-wormed her again last night. I'll stop by some pet stores today to explore my options for a novel protein and probiotics.

Amber has always been very picky on her wet food. The last few days, however, she has been just crazy about Fancy Feast Classics Salmon Pate. I mean she is chowing it down. She's never eaten it this consistently before. She almost never does this with wet! Usually she licks some of the gravy, eats a bit and walks away...

I'm wondering if that's something I could try to continue feeding her or should I go completely off any of her older foods and reintroduce after the recommended 6-8 weeks? Or is it 12 weeks? I guess I am hesitant to try a new wet food if she suddenly likes this one so much!

That sounds like a great plan as far as transitioning her food! I am going to try that method and see how she goes.