Chronic Vomiting In Cats

Chronic Vomiting/Anorexia in Cats

Does your cat vomit more than once per month or have a poor appetite? Does she suffer from hairballs, or eating too fast, or does she have a nervous stomach? For too long, veterinarians have thought that chronic, mild vomiting was secondary to one of those issues. Now we know better, and we can help your cat live a longer and better life.

Most chronic vomiting and many cases of chronic poor appetite in cats are secondary to disease in their small intestine. There is a “continuum” or “spectrum” of small intestinal diseases in cats, with one condition leading to another and no precise boundaries in between them. It looks like this:

The farther your cat progresses into this spectrum, the worse his prognosis will be, and the more sick he will feel.  Our goal is to identify your cat’s disease when it is in one of the first 2 stages, and initiate treatment before it progresses to lymphoma. However, if your cat does have lymphoma, the prognosis now is better than ever before.  Don’t despair.  We can help.

First of all, we want to attempt to identify any causes of inflammation in your cat’s intestines.  This is an involved process, and takes time and a financial investment on your part.  We need to do a blood panel to identify other common causes of illness in cats.  Sometimes chronic vomiting and/or weight loss is caused by kidney disease, liver disease, diabetes, hyperthyroidism, or other issues. 

If these tests come back normal, and they often do, we will need to confirm intestinal disease with an abdominal ultrasound.  This ultrasound examination will allow us to check for problems with the internal organs, look for tumors, and most importantly, to measure the intestines.  If any segments of small intestines are thickened, we will know your cat is somewhere on the small intestine disease spectrum.

Once we have confirmed intestinal disease, we will treat for causes of intestinal inflammation.  Bacterial infection, parasites, or food allergy may be triggering the inflammation, so we need to ensure that we eliminate those triggers.  Our preference is to do everything all at the same time; otherwise this becomes a very lengthy process.

Food allergy.  To see if this is the problem, we feed a hypoallergenic diet (AND NOTHING ELSE!!) for 3-4 weeks.  If your cat improves significantly on this diet, we can continue it long term.  If your pet does not respond to this diet, we will change to a high protein, easily digestible diet like Purina EN or DM.

Overgrowth of certain bacteria in the intestines.  To treat this we get rid of bad bacteria with metronidazole, and replenish good bacteria with a probiotic (typically VSL powder, because it won’t interfere with our hypoallergenic diet).  This is for 2 weeks.

Intestinal worms.  To treat these, we give your cat a 5 day course of fenbendazole, which is a broad spectrum dewormer.

At this time we also like to start supplementation of cobalamin, which is the active form of Vitamin B12.  Cats with intestinal disease are often deficient in B12.  Supplementation helps them feel better, and also helps them to absorb the nutrients in their food more efficiently.

If your cat isn’t back to normal after the above treatment, feels sick, or is losing weight quickly, we have an important decision to make. For a definitive diagnosis, we must do surgical biopsies of the intestines along with biopsies of the liver and pancreas.  95-99% of the time, small intestinal disease falls onto the IBD/lymphoma spectrum.  However, there are occasional cases of adenocarcinoma or eosinophilc enteritis that surprise us.  We can also catch liver and pancreatic disease that may require different types of treatment.

If biopsies reveal that your pet is amongst the majority that have IBD or lymphoma, we treat with prednisolone, a powerful anti-inflammatory drug.  Those with lymphoma will benefit from a drug called lomustine.  Side effects include patchy hairloss and a reversible low white blood cell count.  Lomustine therapy involves a visit here once a month for 6-8 months.  We will first do a complete blood count to ensure that your pet’s white blood cell count hasn’t become too low from the previous month’s dose.  If it’s OK we administer the lomustine dose for that month – easy peasy.  About 40% of cats will have the white blood cell count drop too low at least once, and will need a lower dose of lomustine or more time between doses for the bone marrow to recover.  Interestingly, those cats whose counts become low actually have a better long term survival time!  More than 80% of IBD/lymphoma cats do well and we have had cats live 5 years with lymphoma.

For those cats that are not good surgical candidates, or for families where surgical biopsies are cost prohibitive, we may elect to treat with prednisolone alone or along with Lomustine based on suspicion alone.  Owners must be aware that there are risks to treatment without definitive diagnosis, and a chance we are missing the actual diagnosis, but many patients do very well.