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Vomiting in Cats
Vomiting and overeating
Vomiting
Vomiting in Cats
Chronic Vomiting
Chronic vomiting in cats
Vomiting
Vomiting cat
Vomiting in cats
Chronic vomiting / feeding through stomach tube
Chronic vomiting and picky about water
Vomiting blood
Vomiting cat
Vomiting and heart problems
Nonproductive retching/vomiting
Vomiting, not eating
Vomiting Burmese
Vomitingalso see IBD
also see Digestive Problems
also see Kitten Problems
also see DiarrheaQuestion: Dear Dr. Richards,
First of all I want to say how much I appreciate the work you are doing!
My question concerns a 1-1/2 year old domestic short hair cat I'm fostering for our local shelter. She
seems to have a problem with overeating. Over a five-month period she's gained what seems to be a lot
of weight for a cat her size! She's become quite plump. I have quit leaving the dry food out all day
because, unlike my own cats, she seems to gorge on it. I have also noticed her throwing up
undigested food from time to time. I have attributed this to hairballs, but have never actually seen her
throw up a hairball.I have an appointment for her with one of the shelter's veterinarian's but it isn't until next week. I was
wondering if you know of any medical problems that could cause this combination of symptoms. I have
also seen her behave a little strangely from time to time, doing things such as chasing her tail.Thanks. Wendy
Answer: Wendy-
Hopefully the vet at the shelter was able to find a cause for the vomiting. Being able to gain weight is a good thing, so that part of the history is in her favor. Vomiting is pretty easy for cats to do and there are lots of things that cause vomiting due to this. Gorging on food seems to be able to induce vomiting in cats, without having to have an underlying cause such as disease or parasites.
Vomiting in kittens can occur when they have intestinal parasites, such as roundworms, tapeworms
or coccidiosis. This can occur due to food sensitivities (food allergies, inability to digest certain
foods). Inflammatory bowel disease can start at a young age and vomiting is sometimes the only sign
that this condition is present. Most problems with vomiting hairballs are probably really problems
with decreased intestinal mobility due to inflammatory bowel disease or other motility disorders.It may take several efforts to rule out potential causes of vomiting and zero in on the problem in your
kitten. This is one of the conditions where it may take a lot of cooperation between a client and
veterinarian in order to get to a diagnosis and find a treatment plan that works. Once in a while it
works out that the first problem found, such as intestinal parasites works out to be the primary cause
of the vomiting and treatment is successful on the first try, but you can't count on that.Good luck with this.
Mike Richards, DVM
12/12/2000Question: I have an 11 yr. old cat named Natasha. She has had oxalate stones removed about 2 yrs
ago. Since then there have been a few urinary problems that have since been cleared up
w/Amoxicilin quite a long time ago. She is now on the food CD-0 & is doing fine. However, I
recently (about 4mos ago) adopted a new cat (Sugar) who is 3 yrs old. They are far from the
best of friends. Natasha only urinates 1x per day. She started to hold back her urine, so
every morning I take her into a separate room (alone) so that she can eliminate in privacy &
no sign of blood. However, she is drinking tons and tons of water. I know that the CD-o is a
low sodium diet, but it also should increase water consumption. However, the water
consumption seemed to have quadrupled since the addition of the new cat. Coincidence?
Nerves? I dropped off a urine sample, but it was not clear enough to check for crystals (too
much litter go in it). However, the Vet thought the concentration was good. Whatever that
means. She will not use the No Sorb litter. I am dropping off another sample today, but I
think that It also may or may not be clear enough. All other behaviors seem normal. She is
also very over weight, about 14lbs. She drinks (I believe-hard to say w/2 cats) approx. 3/4 of
a bowl of water (average size plastic bowl). Should I be concerned about liver, kidneys,
diabetes or am I just over-reacting? I am a bit of a "nervous Nelly". I try not to take her to the
Vet as she seems to be traumatized each time. Not sure if it traumatizes me or her.Anyway, please give me your input on the above. Your professional opinion would be greatly
appreciated. Thanks a bunch!I forgot to mention that she also sometimes tilts her head to the left. I attributed that to the ear
infection that took almost a yr to clear up.
I also forgot to mention that she throws up 1-2x per week. Hairballs? I give her the hairball treats,
which seem to help.Shari
Answer: Shari-
Unfortunately, vomiting occurs for a lot of reasons in older cats. The most common causes are
inflammatory bowel disease, kidney disease and hyperthyroidism, but other disorders can cause
this problem, as well. A number of my clients have reported a decrease in vomiting when
feeding one of the new hairball formula foods -- several companies make these. Hyperthyroidism
will eventually require a trip to the vet to diagnose, unless your vet is willing to make a housecall.
You can work on trying to figure out if the other problems are present using serial urine samples
and response to dietary changes while waiting to see if this is necessary, though.Good luck with all of this.
Mike Richards, DVM
9/10/2000
Question: I have a seven year old DSH who vomits several times a week within five
minutes of eating. She has just had a physical and nothing was found.
She gobbles her food, eats a large quantity, and throws it up, usually
barely chewed. She eats dry food which is clearly still recognizable as
individual pieces. She is one of two cats in the household and we leave
food out for them. Our other cat is a grazer and eats a small amount
many times a day. The cat with the vomiting problem races in and eats
as if it is her last meal. She will also return and eat again only a
few minutes after throwing up. If we limit her consumption to a small
quantity, she doesn't throw up, but this requires close monitoring and
causes problems with our other cat who only eats a little bit at any one
time from a bowl food which is left out all of the time. The vomiting
and associated behavior seems like a behavioral problem. Any advice?Answer: Jay-
Vomiting is a frustrating problem in cats because cats seem to vomit more
easily than most other species. There are many cats who vomit fairly
frequently who have no other signs of illness, such as weight loss,
dehydration, inappetance or diarrhea. Trying to figure out what is inducing
vomiting in these cats can be difficult and expensive. In patients who are
otherwise pretty normal, it is hard to figure out whether to make this effort.The most common causes of vomiting in cats are probably inflammatory bowel
disease, cholangiohepatitis, pancreatitis, cancer, kidney disease,
hyperthyroidism and heartworms. There are many other causes, including
parasites, mechanical obstructions (hiatal hernias, esophageal strictures,
etc) and infectious diseases.Eating too fast is probably not a common cause of vomiting in pets but I
suspect that there are patients who have this problem for no other reason
than over-enthusiastic eating.So at this point, you have to figure out whether or not this is a problem
that requires a diagnosis and treatment other than the treatment you have
already figured out works (feeding small meals more frequently).I think it is OK to try to treat this sort of problem without a diagnosis,
as long as the cat doesn't have symptoms like weight loss or lethargy and
as long as the treatment attempts involve things recognized to be safe.
Several of our patients with vomiting problems have responded really well
to the Science Diet Hairball Formula (tm) food, so I think trying it is a
reasonable thing to do. Some patients respond very well to feeding smaller
amounts of food more frequently, as you have discovered. There are metered
feeding stations that deliver small amounts of food throughout the day if
you want to take a high tech approach to this problem. A lower tech
approach is to put the food into a container that it is hard for the cat to
extract it from and let her work at until she gets all the food. I haven't
really seen this as a recommendation for this problem in the literature but
one of my more inventive clients made a tall thin food container that takes
the cat a long time to empty, which helped his cat. Another possibly
helpful approach is to use a fatty acid supplement like 3V capsules which
sometimes produce enough anti-inflammatory effect to help with chronic
vomiting. Lastly, I think it is reasonable to try a medication for
esophageal or gastric inflammation, like famotidine (Pepcid AC Rx) or
ranitidine (Zantac Rx) to see if they will help. Enough cats with apparent
"gluttony" problems respond to one or another of these treatments to make
me think that this problem shouldn't be automatically considered to be
behavioral in nature. Your vet may have additional "simple" approaches to
this problem which have worked for him or her, too.If you try these approaches and they don't work well for your cat the next
stage in figuring out what to do is to consider X-rays to rule out
obstructions, a general blood chemistry panel, urinalysis and complete
blood cell count to rule out other systemic illnesses and for cats over
five years of age, a test for the serum thyroxine (thyroid hormone) level
would also be a good baseline test. It may be necessary to do more
invasive testing, such as an endoscopic examination of the gastrointestinal
tract, as well.There is one disadvantage to trying a couple of treatment options prior to
making an effort to diagnose an underlying cause. In some cats, early
recognition and treatment of inflammatory bowel disease, chronic
cholangiohepatitis or a systemic illness can make it possible to treat
these conditions more effectively.Hope this helps some.
Mike Richards, DVM
6/16/2000Question: My cat keeps throwing up. I thought perhaps he was expelling hairballs (he
is a long hair persian) but there is no hair in the puke. I have taken him
to the vet before and they seem to think he is healthy, but he still throws
up quite a bit. I have given him petramalt to help with hairballs, but he
throws that up, too. I have not changed his food or anything and I have not
been giving him any human food, so I don't think it is an allergic reaction.
What can I do? Is there some kind of medication you can recommend?Julie
Answer: Julie-
Several of my clients have been using the new Hairball Control Formula from
Science Diet, with good success. I had not been recommending this food
since it was pretty new and I didn't have much information on it and these
clients volunteered the information that they were having success with this
diet, so they must think it is helping a lot.I think that chronic vomiting is a sign of inflammatory bowel disease more
often than it is a sign of hair accumulation in the digestive tract but it
doesn't matter much what the cause really is if the treatment works and
doesn't cause complications of its own.If a change to this food doesn't help, then you have to decide if the
vomiting is severe enough to warrant a diagnostic work up and treatment,
usually by giving medication long term or intermittently as necessary. If
treated early, it is sometimes possible to get inflammatory bowel disease
to clear up and stay away, so there is some reason to consider pursuing
diagnosis and treatment even when the vomiting is only an intermittent problem.Hope this helps some.
Mike Richards, DVM
5/22/2000Question: Dr. Mike,
I have been reading as much as i
can on your digests about chronic vomiting in cats but can' t seem to match
up our Calvins' symtoms. He is a 9yr old dsh tabby who weighs 13.7 lbs now vs
15.5 at last yers vet visit. We have another cat, Hobbes , who was diagnosed Feb. 2
with CRF, and all our attention was focused on him for the last couple of months.
Hobbes seems to be doing very well even with astronomically high #'s but we didn't notice
until last week that Calvin was not eating like his normal glutton self , had
lost weight, and was vomiting MUCH more than normal.
The vomiting has been a normal occurence with him since he was about
6 mos old as he always had trouble with hairballs even wih us giving him Laxatone
but with the weight loss and lack of appetite I immediately took him in for a full blood panel
and T4. The only values even remotely out of normal ranges were Sodium @ 144,
Glucose @ 245, and CPK @ 105. The CPK was expected as he is as close to being
a truly WILD cat as can be and still be a domestic pet. He went ballistic
with the vets and assistants trying to handle him. Even I can't pick him up
for more than 30 seconds without risking a substantial loss of blood. ( He is
an indoor cat-never been outside since he was 7 wks old ) I tell people his
genes are a throwback to before cats were domesticated. The glucose really
doesn't have me concerned as I am very familiar with diabetes as I am a
diabetic myself and have seen absolutely no symtoms for that.He has stopped eating dry food altogether but will eat canned food into
which we have mixed Laxatone and 1/4 tab Pepcid 2x day. There are no tooth/
gum problems. His BM are normal, urinary movements normal , but he still
sits in a corner for hours in never-never land , although returning to
begging for food at varios times. He even ignores me when I have the cheese
out of the fridge ( UNHEARD OF IN THE PAST !! ) He doesn't even beg when I
have the milk out ! ( Normally tries to trip you up so you'll spill it ! ) I
read in your postings and spoke with our vet about allergies and a possible
endoscopy to try to find out what's wrong with him. Any suggestions would be
greatly appreciated as our Furrballs are our children and we'll do ANYTHING
to make sure they're healthy and well.
Hobbes is currently under the care of Dr. Ed
Fallin at VRCC in Rockville and I'm thinking seriously of having our regular
vet refer Calvin to him as their knowledge and facilities are so much
greater.
Thanks so much,
sorry this is so long !!!
SteveAnswer: Steve-
The most common causes of vomiting in older cats are:
inflammatory bowel disease -- there are several causes of this, including
intestinal lymphoma (a form of cancer), food sensitivities and immune
mediated disordersa combination of inflammatory bowel disease, pancreatitis and
cholangiohepatitis (a liver disorder), called triad syndrome for want of a
better namehyperthyroidism
renal failure
Vomiting can occur for reasons other than those listed above but those are
the most common causes.With the clinical signs that you are seeing and with the lab results, the
two most likely problems would be inflammatory bowel disease and the triad
syndrome. We have seen high blood sugars values in some of the cats with
triad syndrome but cats can get their blood sugar very elevated during
times of stress and anxiety. We have a cat in our practice who can hit 275
during an office visit but who never has positive urine glucose levels at
home.I think that asking for referral to Dr. Fallin would be a good idea in this
situation. I think that he has the capability of doing an endoscopic
examination of the gastrointestinal tract and would be able to do a liver
biopsy if it seems indicated at some point during Calvin's visit. This
type of testing is the quickest way to get to an accurate diagnosis of the
problem. Also, it may be necessary to do more sophisticated testing of the
thyroid hormone levels, depending on what test was used originally. The
total thyroxine (total T4) level is a good screening test in cats for
hyperthryoidism but a few cats with the disease are missed by this type of
testing and if there are suggestive clinical signs, such as an enlarged
thyroid gland, it may be necessary to retest for this. A small percentage
of cats stop eating and appear to be lethargic with hyperthyroidism,
instead of having the more common signs of increased activity and increased
appetite despite losing weight.Checking for glucose in the urine would be a good idea, too. It is
possible to do this if you can limit Calvin to one litterpan and exclude
everyone else from it for a day. After he urinates, scoop out a small
amount of the litter that is wet and mix it with an equal quantity of
water. Swirl it around and then test the water for sugar using a glucose
test strip (I am pretty sure you can buy these over the counter, or you can
ask your vet for a couple of them). There should be no sugar in the urine,
so if the test is positive for glucose even in small amounts it is
significant. Diabetes will sometimes not cause the typical signs of
increased drinking and increased urination in some cats until pretty far
into the disease. So it is still a good idea to try to rule this out, even
though an increase in blood glucose due to stress seems likely in a cat
with Calvin's stress level during vet visits. If you have done this testing
prior to seeing Dr. Fallin the results will be useful to him.The odds are good that a treatable condition can be identified with further
testing.Mike Richards, DVM
4/11/2000Q: Cat vomit (ugh). Not a pretty sight in the morning to wake up to on the carpet. I have
been brushing her and applying a store bought gel on her paw once a day
that is supposed to stop her problems with this. I feed her only
premium dry cat food (usually Science Diet). Any advice? Is it better
to stick with one label or diversify it? Thanks in advance.A: m-
I think that most vomiting in cats is due to either inflammatory bowel
disease or skin disease that is leading to itchiness and hair ingestion.
There are a number of other causes, but these two are almost certainly the
top two in our practice.We usually look very carefully at the skin. If there is any sign at all of
skin disease then we try to treat for that first. My own cat has allergic
skin disease and she starts to vomit whenever her skin starts to flare up.
We usually use corticosteroid injections to treat her but if she was easier
to give pills to I think I'd use oral antihistamines and/or corticosteroids
as necessary.If there are no signs of skin disease then we usually try to look for
causes of inflammatory bowel disease. We start out doing a fecal exam for
parasites. If this is negative then the next course of action varies a lot,
depending on the cat's circumstances and the owner's circumstances. We
recommend lab testing, sometimes including feline leukemia testing, a
general chemistry panel, blood cell counts, food trials for food allergy,
X-rays or intestinal biopsy by endoscopy. Clients vary pretty widely in
how far they want to go with diagnostic testing prior to trying treatment
to see if it works. In general, it is usually better when possible to
actually get a diagnosis prior to initiating treatment but that is often
not possible.Most cats with inflammatory bowel disease will respond one of the following
treatments: addition of fiber to the diet, limited antigen (one protein
source) diets, metronidazole (Flagyl Rx) or corticosteriod administration.
The problem with this approach is that you end up with a treatment that is
really intended for long term use -- without knowing FOR SURE if that is
necessary. In some cases, this is an acceptable circumstance, especially
when fiber or other dietary additives work.Your vet can help sort through these possibilities.
Mike Richards, DVM
6/10/99
Q: Dear Dr. Richards,
I am writing to get advice on our cat, "Patches".
We acquired her about seven months ago, when my wife found her in our
backyard. She was obviously abandoned by some previous owner. We fed her,
bought her a hutch and a heater, and, when the heater broke down during a
particularly bad period of post-Christmas weather, brought her inside.About a month after first finding her, we succeeded in catching her
(this didn't require any great effort) and brought her to a local vet. He
pronounced her free of disease, vaccinated her, and cleaned her teeth and
extracted one which was seriously decayed. During his examination, he
showed us the scar left by a previous spay operation, and guessed her, based
on the condition of her teeth, to be eight or nine years old. This,
combined with her easy acceptance of us, led us to believe that she had been
abandoned.Over that time, she has gone from eating literally enough for two cats
(she was seriously malnourished when my wife first found her), to her
present diet of about 2 1/2 ounces of canned food and perhaps 1/4 - 1/2 cup
of kibble per day, plus one or two cat treats (the Whisker Lickin's® brand),
a teaspoon or so of Linatone® supplement, and an indefinite amount of grass
(which she gets both indoors and outdoors).Unfortunately, she vomits -- almost always undigested food, with no
apparent blood -- with some frequency. Her vomiting is very variable in
frequency; she may go several weeks without an incident, but today she
vomited twice, although my wife tells me that the second time was entirely
her indoor cat grass.My questions are:
1) Could the Linatone be making her vomit? We first added it to her
food last fall, before we brought her indoors, on the assumption that it
would not only help condition her coat, but provide her with extra calories
for the cold weather as well. Since she has now become primarily an indoors
cat, however, perhaps the Linatone is not good for her digestive system?2) Alternatively, could the Linatone be hiding or preventing some
problem? Like most cats, she is reluctant to be brushed (the only times
when she has snapped and swiped at my wife have been when she attempts to
brush her), and, of course, with the spring she is shedding her winter coat.
Could the vomiting be due to her ingesting large amounts of loose hair, and
the Linatone in the food be preventing some more distressing manifestation
of this?3) Could the vomiting be due to sheer over-feeding? My wife normally
gives her fresh food at about noon and 18:00, and we allow her to snack on
the kibble during the day. Her appetite has greatly decreased since we
brought her indoors, due perhaps to her no longer needing to resist the
cold, and also to the lack of exercise during the past few months (although
we expect that this last will change withe coming of warmer weather). Cats,
I believe, are usually good self-feeders, but my wife thinks that her
stomach may have shrunk over the winter, and that her vomiting is in
consequence of her trying to cram in too much food.-John
A: John-
I don't think that the Linatone is likely to be causing the vomiting. It
seems unlikely to me that a lack of exercise is likely to be the problem,
either --- except perhaps that some cats probably groom less when they have
other things to do. Grass eating is sometimes associated with vomiting but
most cats can eat grass without vomiting so there is a strong likelihood
that it is not involved, either.I really can't recall seeing this written anywhere, but it is my personal
opinion that a lot of chronic vomiting in cats is related to itchy skin
conditions. These may not be readily apparent if there are not sores or
areas in which the hair is completely licked off. This leads to ingestion
of hair in much greater quantities than would normally occur and to
vomiting. Of course, this is just my theory and I have no scientifically
valid information to back it up with. Skin disease is not always readily
apparent in cats, so this is something that is worth having your vet check
into, possibly. If treating the skin condition only partially controls the
vomiting we have better luck long term with the fiber supplements, such as
Vetasyl (TM) for cats, than we do with the petroleum jelly/iron products
like Laxatone (TM).If there is no skin disease present there are still several possible
problems that have to be ruled out. There are some common causes of
vomiting in older cats. Hyperthyroidism is frequently associated with
vomiting. This disorder produces weight loss despite a normal or increased
appetite, often associated with increased activity as well. This varies
some and there are cats that have decreased appetites or seem lethargic but
still have hyperthyroidism. Decreases in kidney function are common in
older cats and can lead to vomiting. Inflammatory bowel disease (IBD) is
also commonly seen in older cats. In some cases, IBD is associated with
food sensitivities or food allergies. A dietary trial designed to eliminate
foods that a cat may have sensitivities can sometimes help to eliminate
vomiting associated with this condition. There are medications, including
metronidazole and prednisone, that can help with inflammatory bowel
disease. Intestinal lymphoma (a form of cancer) causes chronic vomiting in
some older cats. Liver disease and chronic pancreatitis are other possible
problems that can lead to chronic vomiting.Usually we start trying to sort through these problems with a good physical
exam and a general blood chemistry/wbc screen. We test for total thyroxine
(TT4) serum levels in cats over 9 years of age, to try to rule out
hyperthyroidism. After that, we may try a food trial or recommend
intestinal biopsy. Usually by the time we get to the intestinal biopsy
stage we have referred the patient to an internal medicine specialist
because we don't have an endoscope at our practice.In most cases, it is possible to reduce or eliminate the vomiting by
discovering and treating the underlying cause. In intermittent vomiting
there are sometimes questions about when the vomiting is bad enough to
consider looking for a diagnosis if the more invasive tests, such as
biopsies, seem necessary. There isn't a clear answer to this question but I
tend to think that there is more discomfort than just the vomiting and
usually want to try to find a solution if the cat is vomiting more than
once or twice a week.Hope this helps.
Mike Richards, DVM
4/27/99
Q: Dear Dr. Richards,
Both I and my husband are eager to get acquainted with your newsletter, and especially the option to send in an occasional question. We live in Mexico, and even though we like our Mexican veterinarian, he does not have the latest techniques or information on the latest in cat care.
My questions concerns my cat Arnold. He is almost six years old, and since being a kitten, Arnold has regurgitated his food. Sometimes it happens frequently, then he can go a week or two without any problems. Sometimes he gobbles his food too fast, but as a rule not. He's usually the last to get at the food, the other two cats taking their turn first. CATNIP, The Tufts Univ. newsletter had an article on the problem once, but it did not provide an answer to this ongoing problem. Maybe you have some material on this subject. Nobody has even indicated that this might be a health hazard.
I'm looking forward to hearing from you, and also reading your newsletter.
Sincerely, Pirkko
A: Pirrko- Vomiting in cats occurs for a lot of reasons. It can be hard to get a
definite diagnosis of the cause of vomiting but it is frequently possible
to control the vomiting (at least lessen the frequency) with medications or
dietary changes.In a cat that started vomiting at a young age there are several things we
try to eliminate early in the diagnostic process. We check fecal samples
looking for worms and other parasites, treating what we find. We routinely
deworm cats, even if we don't find worms on a fecal exam. Once in a while
this seems to help. The new dewormers are pretty safe and we think this is
a reasonable first step for many cases of vomiting, even chronic ones, if
it hasn't been done previously. Then we try to eliminate food allergies by
trying a food trial for 6 to 8 weeks. This consists of a diet with a
protein source that the cat has never eaten before. We use lamb, venison,
duck or similar protein sources to try to find something that the cat
hasn't had in its diet (beef, chicken and tuna are common in cat foods).
This works often enough that we think it is worth trying in most cases,
too. Sometimes we continue to try dietary changes, adding fiber the diet or
using highly digestible diets to see if we can control vomiting in that
manner. This helps more often with diarrhea than with vomiting, though.
After that, diagnosis and treatment gets a little more complicated.A general chemistry panel and cbc should be run to make sure that there
isn't organ damage leading to the vomiting. There usually isn't but you
don't want to miss something like this. If this is normal a decision has to
be made as to whether to try to treat for vomiting without a diagnosis or
to try to get a diagnosis and then treat. The reason this choice is
difficult is that the best way to find out what is going on is to get
biopsy samples from the intestinal tract, which is usually done with an
endoscope. It is somewhat expensive to do this and cats have to be
anesthetized. Most vets have to refer patients to a specialist for this.
For these reasons, many clients and/or vets prefer to try treating for
inflammatory bowel disease rather than attempting to make a definitive
diagnosis. We use both approaches.We use metronidazole long enough to see if it helps. Usually ten days is
long enough to get a good idea if the cat is vomiting more than two or
three times a week. If it does help but the problem returns when the
medication is stopped, then it becomes more likely that inflammatory bowel
disease (IBD) is present. At that point we may try using prednisone or
injectable corticosteroids to see if they will control the vomiting on a
more long term basis. This is a compromise at this point ---
corticosteroids have enough side effects that it is a lot more reassuring
if there is a diagnosis before they are used long term. On the other hand,
we have used prednisone on an every other day basis for 30 to 60 days in a
number of cats whose IBD seems to disappear and not return or to return
after a long interval.While these disorders are less likely since Arnold has been chronically
vomiting since a young age, there are some more serious disorders that can
lead to chronic vomiting - such as lymphoma (cancer) of the intestinal
tract and chronic pancreatitis.In older cats (usually older than 6 to 8 years) hyperthyroidism and a
chronic liver disease will often cause vomiting. If there is significant
weight loss associated with vomiting these are even more likely. I doubt
that is a problem in Arnold's case, though.Mike Richards, DVM
4/8/99Chronic Vomiting /Feeding through a stomach tube
Q: Dear Dr. Mike,
I'd like to thank you for your site. It's given us a lot of support
through a hard time, and given us a lot of confidence in our vet.
Our cat Truffles is age 6, spayed female, domestic long hair, indoor
only. She's got a large frame, but started out a little overweight (14.5
pounds). In late January, she dry heaved a few times one night, bringing
up a little stomach fluid. In my old cat, it would have been just a
hairball, but my girlfriend, the cat's long time owner, felt that this
was very unusual behavior. We took her to the vet and got a 150 cc
camelback of water, with some vitamins and Reglan. She vomited again that
night. The next day we noticed she wasn't eating, and we weren't sure how
many days that had gone on, perhaps a few. Truffles went back in and
ended up staying for a week.
During that week, she was on an IV for fluid, reglan, amoxycillin,
and flagyl. She had little appetite. We decided on an exploratory
surgery, but that found no obstructions. Samples were taken of liver,
pancreas, and intestine. Her liver looked small and "nutmeg colored," so
the vet assumed lipidosis and put in a nasal feeding tube. The tests came
back with normal values, no sign of lipidosis, and so we pulled out the
tube and nervously took her home.
Over the next week, her appetite grew a bit, and we thought she was
on her way back. We hoped that perhaps she had had a blockage that
cleared, or that the antibiotics had cured something. After a week at
home, she vomited a large hairball, not surprising given how much
grooming she did after her stay in the hospital. The next day she vomited
a few more times. This vomit was thick and yellowish, perhaps bile
colored, but also perhaps the color of her food. Her appetite went back
down. She'd eat a bit of baby food, particularly hand fed, she'd lick her
dry food but only eat a kibble or two. We should have brought her back in
sooner, but we put up with this for two weeks, getting half a jar of baby
food into her on good days with a lot of patience.
We finally brought her back in for another blood test, and gave her
a worm pill just in case (thanks to your digest). We scheduled an
ultrasound and fine needle biopsy of her liver. The blood test came back
with ALT slightly elevated (don't remember the number) and ALK phos at
only 152, low for lipidosis, so the vet suspected chologiohepatitis.
However, the aspirate came back with definite lipidosis, so we had a
specialist put in a feeding tube. This operation gave the specialist a
look at her digestive tract, and she saw no signs of inflammatory bowel
disease. At this point, she was down to 12.5 pounds, from 14.5.
She came home with the feeding tube on February 22nd, four weeks
ago. She started out taking twice daily doses of reglan, flagyl, and
moxycillin. At the vet's recommendation, we started feeding her 4x/day
with 35cc of clinicare at about a cc per minute. We hoped to get her up
to 55cc per feeding in a week. However, she has vomited nearly every day,
sometimes twice a day, throwing up an entire feeding, sometimes
immediately, sometimes an hour or so after feeding.
The antibiotics ended after a week, but she stayed on the reglan,
and at a specialist's advice, we added a 250 mg L-carnitine divided over
the 4 meals. Over the next few weeks, she got a 150cc camelback of water
with some B vitamins every Saturday, and that seemed to perk her up. Her
mood is good, considering, and her eyes have never gotten jaundiced. Her
weight has been holding at 11.75 pounds, and we averaged about 80-100
cc's of clinicare (80-100 calories) staying in the cat every day.
We kept a detailed chart, but didn¹t see much pattern to her
vomiting, except that she threw up slightly more often after her morning
feeding. We tried feedings as small as 20cc, and she¹s vomited, but we¹ve
occaisionally gotten feedings as large as 45cc to stay down. We have
tried varying the reglan- she started at 1.5cc 1/2 hour before the first
and last meals of the day. We've tried 0.5cc before every meal, mixed
with the meal, and skipping it entirely. We've done the same with the
L-carnitine (we got it in a liquid form, glycerine base, with vitamin B
added). We saw no change in the pattern, but our vet has been very
reassuring that these things can take this long.
Recently, a new problem has surfaced. On Sunday March 7th, at about
4 or 5 in the morning, Truffles began to lick her chops, chewing at
nothing and swallowing. This turned into foaming, large strands of thick
saliva, and some dry heaves. She was at times wild-eyed and nervous, at
other times quite depressed. The foaming and hypersalivation lasted
several hours, and afterwards she seemed tired but purred a lot. During
the episode, I tried to get some reglan into her, but it didn't help, she
still vomited, foamed, and drooled.
The next day, our vet gave us two syringes of 0.1 cc
perchlorperazine for vomiting in case of a recurrance. We all hoped it
was a one time event, that she'd eaten a spider or something. However, it
occured again on Thursday the 11th, at about the same time in the
morning. The perchlorperazine seemed to have no effect, the whole episode
was the same as Sunday. After this episode, we dropped the reglan and
L-carnitine, and went onto cisipride and flagyl. Within hours of taking
the cisipride, Truffles suddenly had a bit of an appetite. She eats a
bit of dry food now, and is grooming herself. The vomiting has basically
stopped. We used to feed her at a rate of 0.5cc every 30 seconds, but
we¹re now going at twice that, with no trouble at all.
On Monday, 3/15, she threw up her food, but we hoped that this was
due to some kitty grass she ate. We took the grass away, and began to
feel really good about the new medicine and her situation. It became easy
to feed her, even big feedings of 50cc.
We've had a couple terrifying episodes where Truffles suddenly
bolted, with a huge, heavy syringe of food attached to the feeding tube.
If you end up posting this on your website, let me reassure readers in
similar situations that the PEG tubes can take a lot more than I
initially thought, and the cat seems more frightened than hurt. We still
try to avoide these adventures at all costs.
On Thursday, we put her back on L-carnitine, this time trying a dry
capsule. She got 250 mg over her four feedings. She had dry heaves early
the next morning, Friday the 19th. We decided to stop the L-carnitine,
but she still had a bad foaming episode this morning, Saturday the 20th.
Our vet is out of town, but her partner said he has seen L-carnitine
cause stomach acid problems in dobermans, and he recommended that we try
half a pepcid tablet before bedtime. We¹re probably never going back on
the L-carnitine, we really hope that¹s the source of the problem.
Your digest has told me that hypersalivation is a sign of liver
trouble, so our quiet fear is that she may be growing worse, despite
outward signs of improvement. The fact that it occurs at night, the
longest period without food, gives us hope that it is triggered or
aggravated by acid in an empty stomach and further aggravated by the
L-carnitine. We¹re hoping we can treat that. Any comments on this
problem? could we be overlooking something, is it worth running another
blood test or any other tests?
My fears make me wonder if the clinicare is too fatty (40% calories
from fat), if her liver is now clogged with a toxic dose of all this
medicine, or if the original, unknown problem is still troubling her.
We'd be going nuts, searching the house for toxins, but her sister, a
littermate, is doing fine. We¹ve checked her teeth for trouble, but they
seem ok. When she does eat her food now, she seems to chew a lot but not
swallow much; there are a lot of crumbs left in the bowl. Our plan is to
hope for the best with the salivation, and feed her lots of clinicare for
a week or so, then see if she can sustain herself eating normally, and
then really hope that the original problem has gone away.
Finally, I'd even be happy for just other ways to secure the feeding
tube; the band of sticky vet-wrap we use really annoys her, and if you or
any readers have suggestions, I'd appreciate hearing them.thanks very much, Roger
A: Roger-
I don't have a good way to secure/bandage the PEG tubes to offer. We have
used vet-rap or similar products in most cases.Cisapride can help a great deal with vomiting associated with feeding
through a stomach tube. When vomiting continues it is a good idea to
recheck the lab values to make sure the liver disease is not progressing
and to make sure that potassium and phosphate levels are not dropping
severely. Cats that don't adjust readily to tube feeding may have another
problem, such as pancreatitis or inflammatory bowel disease, contributing
to their inability to keep food down. Your vet is already exploring these
possibilities so all I can do is encourage you to hang in there and to
suggest continuing the diagnostic process.I can't tell you whether or not the carnitine is contributing to the
vomiting. It is nice when supplements can be tolerated but usually it is
also considered to be reasonable not to use them when they are not well
tolerated.Warming the food given to body temperature can make it easier for the cat
to tolerate it. There are other foods that are used, such as a/d diet from
Hills, that some cats tolerate better than the Clinicare diets. In some
cases it is necessary to feed a continuous drip of food for two or three
days and then start feeding in large amounts again --- but I don't think
you need to go back and start this way since you are having some success.The Clinicare diets are on the high-fat side but they are commonly used
since they are easy to feed. Since I know they can be successful it is hard
to decide how important it might be to switch foods.I wish I could help more.
Mike Richards, DVM
3/22/99
Chronic Vomiting and picky about water
Q: Dear Dr. Mike, My cat is a 6 year old domestic long hair named Wyeth. For nearly a year, he has been vomiting within an hour after he eats. It doesn't happen all the time, but most of the time. We try not to feed him too much at one time, and we usually only feed him once or twice a day. I was noticing that when he eats, he seems to have a hard time chewing up his food (it's cat chow special care, he had a urinary tract infection a few years back and can't handle the ash) and when we feed him moist food, which is only about once or twice a month, he usually just licks off the gravy or whatever is softest. Do you think that the vomiting is because he just isn't chewing up his food because his teeth are bothering him, or that he is gorging himself? It usually comes out looking about the same as it went down. Could it be something else?
I have one other question. He used to drink water out of this awful old cup we kept in the shower, and he wouldn't drink water from anywhere else. So I put it up where he couldn't get to it and bought one of those waterers that has the upside down pop bottle on it. We've had it a month, and I tried putting tape on it to measure how much he drinks, but it hardly goes down at all. I am worried that he isn't drinking out of it. If he's not drinking out of there, I have no idea where he's getting his water from, but he seems to be fine. Is there a way I can tell if he's using it, or make it easier for him to use it? He won't go near the thing if he knows I'm watching. I'd appreciate anything you can tell me! Thank you, Becky
A: Becky- Chronic vomiting in cats over the age of five years of age is most commonly from inflammatory bowel disease or hyperthyroidism (too much thyroid hormone). There are a number of other causes. Since this is a frequent problem, discussing this with our vet would be a very good idea. His teeth could be bothering him but I really think that is a rare cause of vomiting.
Cats do not always drink much water. Marking the bottle is a good idea and unfortunately, I can't think of a better one.
Mike Richards, DVM
Michal Response: Call me sentimental - I'd give him his awful old cup back .
Q: I have a very large (but very unfortunately smaller than it was) animal
family -- 4 dogs (rescued) and 3 cats. I lost 2 beautiful and much loved cats to
FIP last year (they were both rescued as young kittens from same litter).This morning I discovered that one of the animals (I believe one of the
remaining cats) vomited bright red blood. Since I don't know which one they
are all at the vets under observation but I have just moved to this area
from Memphis, TN and I am a little nervous about the diagnostic skills of this
new vet.I guess my questions are:
(1) possible causes of bright red vomited (possible projectile) blood? I am
guessing foreign body, possibly ulcer.(2) one of the cats is on Buspar and has been for 4 to 5 years. 10mg
twice a day. He is deaf and a "stalker". Does not play well with others.
Perhaps I have been unfair to the rest of my animal family but I have been trying to
keep him alive (i.e. not euthanize him) if at all possible. I wondered if
Buspar could cause ulcers or some horrible organ damage if used daily for so
long. This new vet was not familiar with Buspar.I know that obviously you can't tell me what is wrong with one of my animals
without examining them but I hoped that you might have a few suggestions.Thank you.
Thank you for any help you can give me.
A: Dear S-
Buspirone is not very likely to produce side effects that would produce
vomiting or bleeding. I am not aware of any long-term cumulative effects
associated with this medication. I think it is an unlikely suspect in the
current problem.There are a number of possible causes of blood in vomitus. Intestinal
parasites, gastric ulcers, blood from the respiratory tract, ingestion of
toxins such as warfarin based rodenticides, heartworm disease,
gastrointestinal foreign bodies, bleeding disorders and other causes are
all possible. A single episode of vomiting with blood is not that unusual
in pets and is often hard to pinpoint a cause for. If the vomiting recurs
and it is possible to identify the cat who has the problem it will be
possible to begin testing to see if the cause can be identified.Good luck with this.
Mike Richards, DVM
Q: My cat has been vomiting for three days. He is at the vet's over night and
has had abdominal surgery. The vet could not find an obstruction but the liver
was small and looked yellow. It is functioning okay but he is still retching and
drooling . She has given him shots for this but it is the only thing that will
stop it. The surgery was preformed because of the uncontrollable vomiting
and now we still don't know what the cause is. The blood is okay no clues. We
have to wait days for the result of the liver biopsy. I am so scared
for my cat. Will we find out in time to save him? No fever. Indoor cat first
sign of trouble very bad gas one week before and runny stools. Please help me I do
not know if I should seek more help for him or wait. If you have any advice
for me I would REALLY BE HAPPY!Respectfully,
DEC
A: D-
The single most important thing to do in this situation is to make sure
that your cat continues to eat, even if it must be force fed or fed through
an implanted stomach tube. A very likely problem is hepatic lipidosis.
Usually the liver looks normal sized to me with this condition but
otherwise can look like what you described. It won't hurt to feed your cat
if there is another liver problem and it might hurt to delay force feeding
if hepatic lipidosis is present. Your vet is probably already doing this
but if not you should ask why not.Hopefully you will get the biopsy results soon.
Mike Richards, DVM
Q: Dear Dr. Mike: I have a cat who just turned 1 year old this month. I took him to the vet a few weeks ago because he was vomiting three to four times a week. He vomited mostly food, but some hair and mucus also. The vet gave him Laxatone and that worked for awhile. Then the vomiting returned and I called the vet again. She said to cut out canned food and just give him dry. I did that and it worked. Now, he is on Laxatone once a day and only dry food and seems to be doing OK. More seriously, the vet noticed a heart murmur when our cat was being examined for the vomiting. Since then, we have had an ultrasound done and I just found out that he has hypertrophic cardiomyopathy. Our vet told us he has about 2 years left to live and gave him a heart medication called Diltiazem 30 mg he must take every day. This will slow down his heart rate so the muscle doesn't have to work as hard and will not thicken as quickly. He is not on asprin. Did the vet prescibe the right medicine?
Dr. Mike, our cat has never had a fecal exam. Could there be a link between his vomiting and the heart problem? Your web site page noted that cardiomyopathy could be caused by hyperthyroidism. I was quite devastated when I heard the prognosis because I really do love my cat very much. Is there anything else I should or should not do? Your help is appreciated. Sincerely, Denise
A: Denise-If you live in an area in which heartworm disease is possible you might consider testing for this. It can cause vomiting and obviously can cause heart problems. It is likely this testing was done if indicated but it may be worth checking. While one year of age seems young for effects to occur our clinical impression is that cats are affected by the presence of heartworms even before they mature in some cases, perhaps as short a time as 4 months or so after exposure (it usually takes about 6 months for heartworms to mature after the mosquito injects the larvae).
It is likely that cardiomyopathy is the problem since you have had an ultrasound exam done. It is still worthwhile to consider possible underlying causes of the cardiomyopathy, although hyperthyroidism is very unlikely in a cat less than 5 years of age.
Diltiazem is the most commonly prescribed medication for cardiomyopathy and works in many cats. I am a little confused by the two year prediction of lifespan since I am under the impression that many cats live much longer than this despite having cardiomyopathy if it responds to medication. I hope this is the case with your cat, too.
If diltiazem doesn't work some cats will respond to beta blockers. If you do not think diltiazem is working it might be worth discussing this with your vet.
Mike Richards, DVM
Nonproductive retching/vomiting
Q: My 11 yo female (overweight) cat has been dry heaving for the last two weeks. Assuming she was shedding more hair than normal (for the summer), I bought Petromalt and have been giving that to her daily. Additionally, I have been combing her regularly. She continues to dry heave but has not thrown up any hairballs yet. All other characteristics seem to be fine and she acts normal in every other way. Can this problem be caused by a new shag rug that she lays on frequently or chewing on leaves from an indoor palm tree?
A: Mauiwon- I think it would be best to have your cat examined by your vet if the signs of nonproductive retching/vomiting persist. It is very easy to confuse coughing and retching in cats and this can be a sign of respiratory or cardiac disease (vomiting is a commonly mentioned sign in the history of cats with heartworm disease, for example). Please have your cat examined by your vet if you have not done so already and the signs continue.
Mike Richards, DVM
Q: Dear Dr. Mike, I am the proud parent of a 4 year old cat. He has long fur and has had problems with hairballs in the past. Sunday and Monday of this week he would vomit when he ate but there was little hair found. Since he has not been eating like he normally does and has been inactive. He had a bowel movement on Wednesday afternoon but not since (today is Friday). I gave him hairball remedy on Monday, Tuesday, and Wednesday. Now he won't eat like usual and he won't take the hairball remedy. Do you have any suggestions of what could be causing the problem? He stays inside all of the time. Thank you!
A: My first thought would be that your cat may be experiencing inflammatory bowel disease. It is important to rule out other problems like parasites (do sometimes occur even in housecats) and food sensitivities. If the vomiting and inappetance continue, please take him to your vet for an exam. Not eating is a problem for cats due to the possibility that it will induce hepatic lipidosis which is a difficult problem to deal with once it starts. In any situation in which a cat does not eat for 3 or more days a good veterinary examination is warranted.
Good luck with this.
Mike Richards, DVMQ: Dear Dr Mike, I have an 18 month old black Burmese cross female cat. She seems very healthy but has this tendency to vomit occassionally straight after eating. This happens probably 2 to 3 times a week. She is on IAMS and loves it, I give her no more than required - our other cat, a 7 month old kitten eats a little more, she seems to need it. The Burmese is highly reactive (vomits immediately) after some tinned fish, which I give them about once a week as a treat...but she holds cooked Chicken down. If she seemed at all ill I'd rush her to the vet, but this just seems a bit strange...allergy?/rushes food?, or should I get her checked out immediately. They are wormed regularly and have had all their shots and are spayed. Thank you so much for this amazing service! Regards, W. (Australia)
A: I always want to make sure there aren't intestinal parasites like roundworms when a cat is throwing up a lot. Most of the time this isn't the problem but it is nice when it is, because it is so easy to treat. Checking a general blood panel to rule out things like kidney and liver disease is a good idea. Most of the time they aren't the problem, either. Which is a good thing. Then you get down to a set of problems collectively referred to as "inflammatory bowel disease" or IBD in cats.
IBD is best diagnosed by intestinal biopsy. This would be OK if there was an easy way to get intestinal biopsies but it does complicate making a definitive diagnosis at most veterinary practices. Either abdominal surgery or endoscopic examination of the intestines is necessary. Abdominal surgery seems like overkill to get a diagnosis and endoscopy requires equipment and skills not commonly available at veterinary practices, yet. While there are probably several possible underlying causes for this, like allergy, food sensitivities for other reasons, immune system disorders, etc., the treatment is pretty much the same for all of the causes. So we feel justified in our practice making a good guess and then treating for this problem.
Most of the time this problem is responsive to treatment with corticosteroids. Using cortisones for a couple of months will often suppress the problem sufficiently that it won't recur. Sometimes metronidazole (Flagyl Rx) will work when used for shorter periods of time. We often try this first and if it works and the problem doesn't recur, great. If not, we use corticosteroids for a longer time period. Oddly enough, feeding soft-moist cat foods (the ones that come in foil type bags and feel like Play-Doh) will sometimes help with this problem. I don't know why.
The first step is to rule out other problems. There probably is no rush but when it is convenient you should take your cat to your vet. There does appear to be some advantage to treating this problem early in its course, if it does turn out to be IBD.
Good luck!
Mike Richards, DVMQ: Dr. Mike, We have a 14 year old tabby female. She has always been an indoor cat. The past 3 or 4 years she has had a problem with occasionally vomiting. Some times the vomit has fur in it but most times not. Changing her food would usually stop the problem for a while, but eventually the problem comes back. Now it seems even changing her food does no good. She seems healthy otherwise and is not losing weight, but the problem bothers us because of our concern for her, and also it is a problem with he mess it creates. The vet just says to change her food. Any ideas?
A: I would want to check a fecal exam, check thyroid levels and do a general blood panel on any cat of this age with chronic vomiting. Older cats sometimes become more susceptible to roundworm infection as their immune systems become weaker. I recently did a lot of testing on a cat prior to doing a fecal exam and its vomiting cleared up with deworming. I was sort of embarrassed by the fact that I should have thought of the fecal exam first. If worms aren't present, then more extensive testing is necessary. Hyperthyroidism is just too common a cause of vomiting in older cats to overlook it. Some cats don't lose weight early in this disease. Kidney failure is also pretty common and some cats with chronic renal failure will vomit regularly. If these things were not found to be present with bloodwork, it may be worthwhile to consider treating for inflammatory bowel disease (IBD) or to consider asking for referral to a veterinary specialist with the means to diagnose IBD -- usually done with biopsies taken with endoscopy. There are anecdotal reports that soft moist cat foods are beneficial in cats with IBD -- so if you change foods again before doing any other workup you might want to consider trying one of these foods (Happy Cat is the only brand name I can think of but there are more). I really think it is worth trying to get a diagnosis in most cases of vomiting in cats. Discuss this with your vet again.
Mike Richards, DVM
Last edited 01/24/05
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