Dear Doctor - March 2014
Letters to Tufts Veterinarians
What can I do for my cat?
Q For several months, my 15-year-old cat has vomited every day — sometimes three or four times per day. I took him to my local veterinarian who did blood work and an abdominal X-ray — both of which showed nothing.
However, Tiger continues to vomit. I then took him to another veterinarian, who performed an abdominal ultrasound. Again, nothing was detected. The urine culture taken at that time revealed no infection.
He has had a heart problem for 13 years, which has been controlled by medication three times per day. For that reason, I am reluctant to have him undergo anesthesia for endoscopy or exploratory surgery. The vomiting has a definite pattern. It occurs 98 percent of time between the hours of 3am and 9am. I have taken the food away at midnight and he still throws up saliva. It really doesn’t matter if the food is left out.
Immediately after he throws up, he will eat and never throws up that food. He never throws up during the daytime hours and eats regularly during those hours. He doesn’t appear sick. He had been on Pepcid and it doesn’t help. He also is finishing up a prescription of prednisone, which also doesn’t seem to help. He currently receives diltiazem and benazepril for his heart problem, and fluoxetine transdermally for a spraying problem. He has been on this medication for almost four years to control his spraying.
I thought maybe it was too much medication and took him off the fluoxetine for 2-1/2 weeks and it didn’t make any difference in the vomiting. Of course, he began spraying a lot, so I put him back on it. I don’t know what to do next — short of putting a scope down his throat or opening him up, both of which are dangerous because of his heart condition. What are your thoughts?
A Dear Patricia: My sympathies to you as well as your cat. I will assume your cat’s vomiting problem began only months ago and has not been a long-standing problem (that would give me different ideas). I will also assume he is not losing weight and doesn’t miss meals.
I will therefore discard the likelihood of drug intolerance since he has been receiving his current medications long before this new problem developed. There is a similar problem in dogs called “empty stomach” vomiting that can be solved by offering a meal at bedtime. I will assume from your description that is not the case; however, if you have not tried feeding an extra meal before bed you should try that first.
There are many causes of vomiting, but your description doesn’t indicate to me a particular one. It is interesting that your cat vomits and then immediately eats afterwards without trouble. That makes a blockage of the intestines unlikely. I will throw out a few of the most likely possibilities and then allow you and your vet to decide the next steps: gastric or intestinal parasites, food intolerance, intestinal disease, pancreatic disease, heartworm infection and brain disease.
My recommendations might include a thorough neurological evaluation, fecal flotation, chest X-ray, recheck of the heart disease by echocardiography (including a blood test for heartworm disease) and hypoallergenic food trial.
If the above results reveal no abnormalities, do not resolve the problem and your cat’s heart is in good shape, I might consider gastrointestinal and pancreatic biopsies.
Occasionally, I have patients who vomit for no apparent reason; however, since your cat just starting vomiting at age 14, I would bet there’s an identifiable cause. We just need to keep looking.
Michael Stone, DVM
Clinical Assistant Professor
Cummings School of Veterinary Medicine at Tufts University