Cat stomach problems
February 9, 2015 5:12 AM   Subscribe

My cat has had problems with what appears to be burping, indigestion, and stomach discomfort for going on a couple of years now. Lately the problem seems to be worsening, as every week or so there's a morning where he's not interested in food and remains curled up on a chair. Any suggestions?

Obviously, the vet has been involved. Last year, he got an endoscopy to the tune of $700, that found no problems other than irritation of the esophageal valve. The vet has suggested a daily Pepcid, changing his diet to a prescription canned food (that contains loads of corn, so I declined), and a drug called Cerenia.

Said cat (I'm in a super-hurry this morn, so no chance to post a pic--sorry!) is on a diet of all-canned food, alternating between Fancy Feast and Nature's Variety Instinct, with some Tiki Cat thrown in from time to time. He is extremely picky, and Fancy Feast is the one he will most consistently eat. I try to feed him kinds without wheat gluten, but of course, the gluteny kinds are the ones he likes the most. The gurping, burping, vomiting and occassional total loss of appetite began when I was feeding him all "Nature's Variety Instinct" (which is a somewhat high-end food), so don't know that the Fancy Feast is to blame.

This morning he's curled tightly in a chair, completely uninterested in food. He just threw up, a small amount of clear, pinkish liquid. Last night he was totally fine. This pattern has happened a few times now in the last few weeks. By afternoon/evening he's typically back to normal and interested in food. I called the vet the first time this happened, and they didn't consider it an emergency, and so couldn't see him that day. He did have his annual physical after this, and the vet seemed to think he looked ok, although he had lost almost a pound since last year.

He is also extremely pill-adverse, and last time I gave him Cerenia he sneezed for about ten minutes afterwards as though it had gone down the wrong tube. The Cerenia did seem to help, but is it a long-term solution? What could be causing this?

I worry that none of the solutions the vets (we've seen multiple) have offered have helped. Is there something else I could try? Homemade cat food?

Also possibly relevant: Cat is 11 years old and indoor/outdoor. (I wish I could make him all indoor, but he came to me this way. I can provide more details on reasons why he goes outdoors if needed.)

Sorry if this is disorganized--I'm writing very hastily before going to work. Has anyone else experienced problems like this? Was it diet-related? Or something else?
posted by whistle pig to Pets & Animals (23 answers total) 2 users marked this as a favorite
Have the vets done an ultrasound or x-ray of the intestines to check for thickened walls or ulcers?
posted by thomas j wise at 5:33 AM on February 9, 2015 [2 favorites]

My cat is about the same age and was having some similar problems. Digestion issues, vomiting, obvious food related distress. My vet put him on a specialized diet for 6- 8 weeks to see if it helped. The food needs a prescription so you'd have to ask the vet.

I was skeptical but the change in him has been obvious. He's much improved. Litter box issues have disappeared. And he Loves the food. It's royal canin PV and after the test period we're supposed to be able to transition to an over the counter venison based food but we haven't gotten there yet.
posted by rdnnyc at 5:40 AM on February 9, 2015

If he's throwing up non-food, he's likely throwing up acid. I can relate; I have had GERD my entire life and multiple esophageal ulcers, and used to throw up stomach acid all the time before I got on a medication that worked AND I changed my diet dramatically.

Your vet recommended a food and you opted not to try it. Other than "it has a lot of corn," is there any other reason why you would not follow your vet's advice? Vets recommend things for health-related reasons. I know corn and wheat are considered fillers in pet food, but you know? Your cat seems to have pretty painful and debilitating acid reflux. Putting "quality" food in his diet is not making him healthy or happy. Maybe it's time to stop this line of thinking and try what your vet recommends: a low-acid food, regardless of nutritional content.
posted by juniperesque at 6:13 AM on February 9, 2015 [6 favorites]

You mentioned Pepcid, are you doing that? It has mostly solved Karl's daily barfing problem. She's on a 1/4 of a 10mg tablet every night. It was a pilling struggle at first, but after a few weeks, it's become a routine we all can deal with.
posted by advicepig at 6:24 AM on February 9, 2015 [1 favorite]

Thanks for the advice so far. I may resume the nightly Pepcid and see if that helps.

This is the reason I opted to avoid the prescription diet suggestion. But obviously, this has not been helping my cat so far. I may reconsider.
posted by whistle pig at 6:38 AM on February 9, 2015

Completely agree with everyone else. Your cat sounds like he has debilitating heartburn in the morning. You wouldn't want to move either. It's really painful.

I... don't understand why you chose not to try the diet the vet recommended? Sorry, but "because corn" is a nonsensical reason if your cat is in pain from regular food. The common recommendation for acid is low-fat, low-protein.
posted by zennie at 6:40 AM on February 9, 2015 [2 favorites]

I feel your pain. I have a picky cat who gets gastro distress and it is a constant battle. I think you have two (opposite) ways to go here: try the vet's diet, or eliminate the gluten.

I would personally try the second before the first since I'm also adverse to corn, but I'm not a vet professional. What I've done is go to a fancy pet food shop, got a whole bunch of different higher quality canned cat foods to see what my cat likes, and get a mix that strikes a balance between price point and taste. For example, I know when my cat is feeling well he'll eat a few of the Nature's Balance LID flavors or California Kitchen Salmon & Sweet Potato. When he's not feeling well those are not palatable enough, so I go for Weruva fish flavors, like Mideast Feast (this is my cat's preference, your cat may prefer poultry or red meat flavors or something else). He'll also eat Friskies during those times, but I bite the bullet and shell out the extra cash just so he's not eating whatever they scrape off slaughterhouse floors in case that worsens his distress. So maybe try more varieties to see if you can eliminate the Fancy Feast? Other ideas: switching to a limited ingredient diet, using one of the frozen pre-made (but $$$) raw foods like Primal, or getting a vet approved supplement line BalanceIt and mixing it in with cooked food as specified by their recipes. The latter you want to work with your vet on because it requires your vet approval to access some of the more specialized recipes.

Then if none of that works, then you could just try the vet food. I understand your reluctance, it sucks to pay so much for such shitty ingredients.

If you're not doing the Pepsid totally give that a shot. It helps my kitty a lot, too.
posted by schroedinger at 6:46 AM on February 9, 2015 [1 favorite]

Pepcid is huge for this stuff. Do it. (BTW, the dosage is generally a cut QUARTER-PILL of ONE 10mg Pepcid, with NO other ingredients. Please don't hastily poison your cat.)

You could also integrate some pumpkin and/or yogurt into your cat's food, as well as probiotics. Cat mileage will vary on this stuff. Pumpkin can help cats retain food longer; yogurt can introduce flora. It'll work differently for everyone. We managed our elderly cat's deathly wasting illness for two+ years with pumpkin and yogurt and Pepcid (okay and some raw meat, but let's not get into that, it was so gross).
posted by RJ Reynolds at 6:49 AM on February 9, 2015 [3 favorites]

Try the prescription food. I have a special needs cat who requires prescription kibble and, while I would prefer to feed him canned food, my ultimate priority is to keep him healthy.
posted by something something at 6:55 AM on February 9, 2015 [1 favorite]

Two more things: Tanya's CRF site is focused on renal failure but has lots of good info on meds, tricks to get cats to eat, and an awesome list of cat foods with nutritional info so you can pick different types based on what your kitty needs (like limiting fat, protein, phosphorous, etc).

BalanceIt lets you enter in your cat's specific medical conditions and needs and spits out recipes based on that, so again, you're taking his issues into account. Though like I said, they will require permission from your vet for any recipes tailored to medical conditions.
posted by schroedinger at 6:59 AM on February 9, 2015 [1 favorite]

My cat is extremely pill adverse too; I use a pill gun so I'm not prying his mouth open to get my finger in there. I've tried pill pockets too, but he figured them out too quickly.
posted by gladly at 7:11 AM on February 9, 2015 [2 favorites]

A vet recommended Gas-X for infants to me; it's a liquid in a dropper, so it's easier to get into the cat. However, I have yet to figure out how to actually buy it. I can't find it for sale anywhere around here, or on the usual sites, so if anyone has suggestions on how to buy this please relay them. (The foster cat that might have needed them has a new home and seemed better).

Re: giving pills -- I think the Pepcid dose is really small, and I've had luck giving tiny pills wrapped in 1/2 or 1/3 Pill Pocket. Just mold the Pill Pocket material around the pill until it's about the same size as a kibble, which many cats eat whole anyway.
posted by amtho at 7:15 AM on February 9, 2015 [1 favorite]

We have a cat in this household who was in a cycle that sounds very similar, right down to the frothy pink vomit stage. I understand why you would like to remove corn and gluten from the mix -- we did. And basically, any time dry food, or gluten of any kind was introduced into the rotation, the problems returned.

The winning combo for us ended up being -- a couple steroid shots from the vet to get him back on his feet. Pepcid, for a couple weeks. High quality grain free food, and nothing else. (Okay, I take that back, each cat gets a small number of Greenies every night). I know your cat is big on Fancy Feast, but perhaps there is another grain free food that would meet his standards? We have three go-to brands: Wellness Core (chicken), Weruva (Paw Lickin Chicken) and various chicken brands of Tiki Cat.

It was a rough time, but we are happy to say he has made a pretty complete recovery. He is a couple years past the issue, 15 years old now, and just got complimented on his excellent test results at his most recent checkup.
posted by instead of three wishes at 7:28 AM on February 9, 2015 [4 favorites]

After one of my cats died in 2008, I wanted my remaining cat to feel comforted so I fed him food that he particularly liked, namely Fancy Feast. I was so worried about the poor little guy that it took a year of vomiting and other GI issues before it occurred to me to consider going back to Wellness. Once I took him off the cheap food, his health improved tremendously.
posted by janey47 at 7:42 AM on February 9, 2015 [1 favorite]

Just a note that my Fancy Feast loving guy took right away to these Weruva flavors: Paw Lickin Chicken, Peking Ducken and Quick 'N Quirky.
posted by gudrun at 9:13 AM on February 9, 2015 [1 favorite]

You haven't mentioned what's happening at the other end of your cat.

Is he pooping regularly? I have an older cat who has terrible constipation (possibly megacolon, but he's not been formally diagnosed) and he will puke and show no interest in food if he's very blocked up. He will sit there all hunched up, looking miserable.

Vet has prescribed lactulose, which we give in a syringe/eye dropper twice a day, and IV fluids twice a week. This apparently reduces nausea as well as helping to get things moving. I'd recommend talking to your vet about that and make sure your kitty is adequately hydrated.

If your vet recommended Hills W/D or K/D or whatever the prescription food is and you still have reservations, keep going with the Fancy Feast or whatever makes your cat happy. Getting him eating in comfort is more important.
posted by vickyverky at 10:05 AM on February 9, 2015 [1 favorite]

Cerenia is also available as an injectable, but you can only get it through a vet, and it is only available in 20 ml vials. My vet kindly puts single doses into syringes for me for use at home. In my experience, it does shut off the vomit switch, but in cats it may not actually help much with nausea. You might have better luck with Zofran (ondansetron) for better total symptom control, especialy over an extended period. And it can be compounded into liquid or treats for easier dosing, or bought at a people pharmacy with a prescription probably more cheaply than getting Cerenia pills from the vet.

I've actually had good luck with Pepcid (famotidine) compounded into transdermal cream, but it isn't a common way to go for many reasons. I have an otherwise very sweet, but unpillable cat, so I get TD or injectable meds when I can. Pepcid is very bitter, so it might go down better when covered in butter or cream cheese, followed by something your cat likes a lot to get it all the way down.

Really, your cat needs help. This worsening of ongoing symptoms is not a good sign and the cat needs to be seen by a vet. It could be IBD that has gotten bad enough to progress into pancreatitis. If your cat hasn't eaten or been able to keep anything down for 24 hours, it is time to insist, especially if cat can't even keep water down. Ask about starting a trial of prednisolone or budesonide, to see if lowering the inflammation in the cat's GI tract helps at all. If the cat is hiding and in pain, a shot of Depo-Medrol can turn things around very quickly, but does have risks.

Fancy Feast, the classics line only, is actually one of the best wet foods available. Low in carbs, and no plant proteins substituted for animal proteins. The "nice" foods in gravy, in any brand, are too high in carbs and usually have carageenan which is a common cause of intestinal inflammation. I personally think that the addition and increased use of plant based fillers, both starch and protein, to most cat foods is what might be causing so many cats to get sick, but that is just my opinion. At this point, whatever you can get the cat to eat is what he needs. People food, treats, anything. Try hand feeding. For dry food, Orijen Cat & Kitten and Wysong Epigen 90 are both animal based, low plant and low carb. The Orijen is more palatable and easier to find. (I also won't feed prescription diets. The ingredients in the Hill's i/d wet and dry are shockingly bad. I also won't feed things containing pea protein or corn gluten. My poor cat gets some cheap wet food, and expensive dry food because he won't eat enough wet food to stay alive. I'd love it if he'd eat Fancy Feast all day long!)

I've gone through IBD with one cat, and have another one with abdominal lymphoma right now. With both of them the major or only symptom was vomiting. To my eternal shame, I let the first cat lose almost half his body weight in a year (22 to 12 pounds) before I took IBD seriously. He was in a lot of pain and was almost ready to die before I was willing to start him on steroids. You may have to pester your vet about these problems. They don't always take feline stomach upset very seriously until a cat is very sick.
posted by monopas at 11:04 AM on February 9, 2015 [4 favorites]

Push to get an abdominal ultrasound for sure, if your vet hasn't run one or suggested it yet. My senior kitty (she'll be 14 this year) has IBD that went undiagnosed/misdiagnosed as other things for years. She takes an oral steroid (prednisolone) now along with monthly vitamin B12 shots and eats hypoallergenic (venison or rabbit-based -- not corn!) food, and has done remarkably well since starting that regimen. Previously she had been on pepcid, and that helped with the puking, but it tended to cause issues at the other end, so to speak, and the steriods made a MUCH more dramatic difference. I am not saying this is what is wrong with your cat, as I am not a vet, but it was seriously like night and day prior to and after finally diagnosing the IBD and treating the intestinal inflammation that was causing her so much discomfort. And it took the clinic close to 2 years to even figure out that maybe an ultrasound would be a good idea.
posted by aecorwin at 12:49 PM on February 9, 2015 [2 favorites]

I am not a vet, but have had two IBD cats, and am a long-time rescue/foster who has dealt with the gamut of digestive issues.

Emphatically NOT seconding those who suggest putting him on the vet recommended diet, and YES, "because corn." The lack of nutritional knowledge in vets is amazing, and the fact that vet prescribed food is a gigantic profit center for them means it borders on criminal, IMO. No corn-based diet will ever help a cat's issues in the long-term, since cats are obligate carnivores as we have discussed on the green ad nauseam.

Inflammatory bowel diseease, which has been mentioned in several posts, can manifest at any point through the cat's digestive system. Some IBD cats have more inflammation in their upper gut, and are vomiters. Some have inflammation in their lower gut, and get diarrhea. Some unlucky cats have inflammation from one end to the other and do both. An endoscopy that found no inflammation is not dispositive. In order to diagnose IBD, a vet has to do an endoscopy/colonoscopy to check the entire digestive system.

The differential diagnosis for IBD is intestinal lymphoma, which is why confirmation by endoscopy/colonscopy and biopsy is important. However, the treatment for both IBD and intestinal lymphoma is essentially the same - steroids, although dosages may differ.

I agree with the recommendation to get an abdominal ultrasound to check for thickening of the intestinal walls. Then proceed from there. If it was my cat, I would then get a colonoscopy and a biopsy.

With an aging cat, you might not want to spend the money and put the cat through the trauma of a colonoscopy. If so, you can just have the vet start the cat on steroids and hope its not lymphoma - just know that the dosage for IBD is lower than the dosage for lymphoma, so if you're trying to hold back the tide on cancer, eventually you will fail. Of course, you will fail at the higher dose too, but if it is lymphoma, you'll get more time. Steroids control lymphoma really well, and pretty painlessly, for the cat until they don't, and then it's a sudden and very rapid decline (a few weeks or less). If it's IBD, your cat will be happy as a clam on the steroids. If pilling is a problem, you can have the prednisolone compounded OR you can request injectable dexamethasone. It's a subcutaneous injection and easy to give. For my senior guy, an injection of dex keeps his symptoms at bay for up to three weeks, versus pilling every three to four days. Some cats don't tolerate dex, however, and it has other potential side effects.

As for what to feed, whatever grain-free food your cat will eat is fine - there are now a bazillion brands to choose from. There will be something that he will eat with the same gusto as Fancy Feast. I second the Weruva recs, and you might also try Merrick canned.

Good luck.

Edited to add: I would consider finding a new vet. A cat-only practice if available.
posted by ereshkigal45 at 2:08 PM on February 9, 2015 [2 favorites]

Thank you for your responses. Hank thanks you too.

I came home tonight and gave him a dose of Pepcid. He seems to be feeling better and gobbled down some cat treats (though is still turning up his nose at regular canned food). I'm headed to the store to get some tuna in hopes of tempting him into eating more (not a regular thing).

Your answers have given me a lot to consider and I will definitely be trying out some of the varieties of food you recommended as well as following up with the vet.
posted by whistle pig at 5:39 PM on February 9, 2015

A random thought: is it possible Hank could be poisoning himself? I don't suppose the symptoms happen to correlate with available chocolate crumbs, for example, or your neighbor's purchase of an ornamental shrubbery?
posted by feral_goldfish at 6:06 PM on February 9, 2015 [1 favorite]

Also, about the crappiness of the prescription diet food: I too have researched that food and been appalled. The things is, I have a (human) friend with Crohn's disease. He had to learn the hard way, several times, that eating healthy food would land him in the hospital. Bran muffin BAD. Donut GOOD.

In some cases (and I do not know whether Hank is one of those cases, but your vet thinks so), good ingredients and sound nutritional principles are less important than medical engineering designed to meet very specific goals.
posted by feral_goldfish at 6:23 PM on February 9, 2015

A lot of good input in this thread. A few thoughts on things I haven't seen mentioned that you could experiment with:

Pills - have you tried crushing the pill and mixing it with a little of wet food? This works great for odorless pills.

I also have a sick cat (14 years old) and we had an episode with an upset stomach/excessive vomiting this past December - pink-ish vomit means there is blood, yellow vomit means bile acid. Some cats start vomiting when their stomach was empty for too long - could you feed Hank earlier in the morning/later at night? If he seems not hungry that early you could also experiment with portion size - feed smaller portions but more frequently.

In terms of getting the cat interested in food again I have found that pastes worked like a charm! I tried Miamor Multi-Vitamin Cream - not available in the US, but here are some other options (Amazon), also this "Cat Ensure" could be of interest. I'd check that the product not contain too much bad stuff, however eventually I decided to let that slide since my cat wouldn't eat anything and I only gave her about two teaspoons a day. Otherwise she's on high quality food without sugar or grains. My cat really liked it and the licking stimulated her appetite, so she always requested food after I gave her that treat/supplement. You could also try mixing that paste with your regular food to make it more palatable.

Also food texture was a big one when my cat had no energy to eat - the most soft/mushy/creamy texture was best. She could just lick it up/gulp it down without much effort. Many high quality brands have a rather tough texture which was too hard to bite/swallow. And any food that had chunks with gravy she just ate the gravy and would not touch the chunks. You could try very soft food on the days Hank doesn't feel great.

I absolutely do think that Hank should be seen by a vet but after one of my cats died of cancer at the age of 7 I am careful with diagnostics. The endoscopy was traumatizing for my cat, personally I would not put a cat through that again. Sure, I had the diagnosis in hand but it did not make any difference in the outcome (cat died way too young). It was not worth my cat's suffering. So I would opt for everything non-invasive - blood work, abdominal ultrasound, anti-inflammatory meds, IV-fluids, shots, etc. and experiment at home what food/supplements/meds/routine have the best result in terms of Hank's quality of life.

Best of luck to the both of you!
posted by travelwithcats at 5:28 AM on February 19, 2015 [1 favorite]

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