Question: 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.
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 12/12/2000
Question: 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.
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?
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 6/16/2000
Question: 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?
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 5/22/2000
Question: 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 !!! 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 disorders
a combination of inflammatory bowel disease, pancreatitis and cholangiohepatitis (a liver disorder), called triad syndrome for want of a better name
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 4/11/2000
Q: 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.
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.
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.
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 4/8/99
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
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
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 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!
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
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, DVM
Q: 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, DVM
Q: 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
Michael Richards, D.V.M. co-owns a small animal general veterinary practice in rural tidewater Virginia. Dr. Richards graduated from Iowa State University's College of Veterinary Medicine in 1979, and has been in private practice ever since. Dr. Richards has been the director of the PetCare Forum...