Chronic Vomiting in Cats - A Practical Approach Summary of a discussion presented on November 19, 2011 by: Jane Matheys, DVM It’s quite common for people to think that vomiting is normal in cats. Oftentimes, when I ask my clients if their cat has any problems, they will respond that the cat is fine and I later discover that the cat has been vomiting weekly for a couple of years. I’ve learned to specifically ask “Does your cat vomit?” I’m surprised by the number of clients who answer “Yes, but that’s what cats do, right?” Wrong! I’m not sure how this myth started, but the truth is that vomiting in cats is NOT normal. An occasional hairball once or month or so can be expected, especially in a long-haired cat or a cat that grooms others, but vomiting that is more frequent than that needs to be brought to your veterinarian’s attention. So why do cats vomit? The list of causes of chronic vomiting in cats is longer than the number of cat breeds in the world. Some of these include:          Dietary problems: Food intolerances/hypersensitivity or allergies, toxins Diseases of the Esophagus: Gastro esophageal reflux, esophagitis, hiatal hernias Metabolic diseases: Kidney disease, hyperthyroidism, pancreatitis, diabetic ketoacidosis, liver disease, hypoadrenalcorticism, electrolyte imbalances Infectious diseases: Bacterial, viral, fungal and parasites Motility Disorders: decreased peristalsis, secondary to some medications constipation Inflammatory Diseases: Chronic colitis, inflammatory bowel disease, gastritis, cholangiohepatitis Obstructive diseases : Foreign bodies, congenital defects (pyloric stenosis), intussusceptions Tumors: especially of the gastrointestinal track, pancreas or systemic mastocytosis Nervous system disorders: Vestibular disease( inner ear problems), encephalitis This list is too long to cover everything in detail, so I will focus on the more common causes of chronic vomiting in cats. My approach to a cat with chronic vomiting depends on how sick the cat is on presentation. If the cat is still bright and alert and feeling good, I’m comfortable taking a little more time trying to uncover the underlying problem. However, if the cat is not feeling well or not eating, and especially if the cat is older with weight loss or other problems, then I will be more aggressive with my diagnostic testing and treatment. If there is truly evidence of hairballs, I will recommend a hairball diet along with consistent brushing of the coat so the cat won’t ingest as much fur. Occasionally, I will still suggest one of the commercial hairball remedies which are basically flavored petroleum jelly with a mild laxative added. It is vital to ensure that the proper amount is given in the proper way to be effective. I ask clients keep diaries of the vomiting so I can look for frequency and patterns as well as help determine whether our treatments are resolving the problem. If the hairballs have decreased or resolved but the cat is still vomiting, the next step is to determine if food is a factor. I will generally try a grain free diet first, a hypoallergenic diet (to rule out food allergies or sensitivities) next, and then a gastrointestinal diet that has a highly digestible protein component. Some cats eat too quickly and vomit very shortly afterward, oftentimes right back into their food dish. If I suspect this scenario, I will suggest feeding smaller, more frequent meals or I will ask the client to feed the cat from an ice-cube tray or a cookie sheet instead of a bowl. This slows down the eating, and makes it physically impossible for the cat to gulp down big mouthfuls of food. For cats that tend to vomit mostly liquid in the middle of the night or very early in the morning before breakfast, increased stomach acid may be the problem. I have the owners feed a bedtime meal or sometimes use a product like Pepcid to calm the stomach. Never give your cat any over the counter drugs without talking to your veterinarian first! If the cat is allowed outside unsupervised, and especially for cats that hunt, I do a thorough deworming treatment. It is also important to make sure the cat is not ingesting any toxic/irritating material or plants. Many cats like to chew on greens naturally and may vomit from stomach irritation caused by plants, particularly lawn grass. If your cat likes to chew on grass, provide him with organic wheat grass or oat grass that you can find in local markets. It’s less likely to cause vomiting. For older cats or for cats that are very sick on presentation, I’m more likely to recommend immediate diagnostics including blood work, a urine test, blood pressure measurement and abdominal x-rays. Unfortunately, this does not always provide all the answers. Sometimes the cat may need specialty blood tests or procedures like endoscopy with biopsies or exploratory surgery of the abdomen. Inflammatory bowel disease, chronic kidney disease, hyperthyroidism, pancreatitis and gastrointestinal cancer are some of the more common medical problems that can cause chronic vomiting in cats. Remember that annual or semi-annual exams, even for healthy cats, are strongly recommended. Prevention and early detection of illness are the keys to a long and happy life for your cat. Dr. Matheys is now accepting new patients. A feline-exclusive practitioner for 17 years, Dr. Matheys is particularly interested in geriatrics, internal medicine, pain management, and alternative therapies. Jane Matheys, DVM