Worried about Emma - constipated and now vomiting

Hi guys. Emma appears to be having gastro issues recently and I’m not sure what to do. I noticed starting last Thursday that she wasn’t eating as much as usual, and confirmed by Saturday that she was constipated and wasn’t pooping. Luckily she did pass stool that day, after I had given her laxatone and Restoralax (Miralax), and by the time we were able to see the vet on Sunday, she was eating a bit more. The vet confirmed with x-ray that she was backed up but small enough that laxatives could help.

Sunday she passed better stool, and Monday she ate better and passed a good stool in the evening. But that’s where the good news ends. Tuesday she passed no stool at all, and neither today so far. Worse, she’s not eating a lot, and today she started vomiting: a big hair ball in the afternoon with plenty of yellow vomit, and some more hair ball in the evening still with some yellow vomit. Emma used to have IBD or I guess still does, but she hasn’t had any flareups since switching to her low carb limited ingredient wet food.

I’ve tried to space things out and feed small meals but just now she vomited again after I gave her a small bit of food mixed with some added water to help her recover liquids. So she hasn’t pooped as far as I can tell in two days and now has lost liquid through vomiting. Her blood sugar is fine (I’ve tested over the past days) and the vet didn’t raise any other concern when we went in on Sunday, though at that point Emma wasn’t vomiting. I don’t know what to do or what the problem might be.

 

Hi Manuel ,I'm so sorry Emma isn't feeling well
I can tag a few members for you

@Bron and Sheba (GA)

@Suzanne & Darcy

@Wendy&Neko

 

Have you changed her diet at all? Which protein (s) is she getting? Once IBD, it stays. Are you giving any probiotics regularly?

 

That could be a sign of an intestinal blockage.
Does Emma eat objects and other foreign (npot food) material?

 

We haven’t changed anything in her diet - still Koha limited ingredient diet, duck. Right now she seems hungry - but she goes to the food bowl, smells the same food she’s been eating for months, and walks away. If I give her any of the old dry food (hydrolyzed protein, high carb) she will always eat it and get up from wherever she is. But I’ve given her only one or two kibbles in an attempt to get her to start to eat, and she has vomited it out later. She is hungry, but unwilling to eat her food. And she’s vomiting out it hunger, it seems, like she used to in IBD days past.

I worried about intestinal blockage, but on Sunday when we went to the vet they took an x-ray and the vet said it was just backed up. I do find that after vomiting in the last 24 hours or so, she goes to the fake Christmas tree to hide, and appears to lick the stupid fake snow?? But she appears to be doing it either out of compulsive habit (hide) or to annoy me and get attention to feed her (she also goes to the potted plants to eat or pretend to eat them).

She vomited again at 4am EST (four hours after last) presumably out of an empty stomach, which she used to do back when her IBD was acting up. I don’t know whether to try to spoon feed her… feeding her at midnight is what caused her to vomit the second-to-last time.

 

I still have the prednisolone that used to stop her from vomiting. It does spike her blood sugar. Should I give it to her to settle her stomach and allow her to eat? Mind you, she last ate a good, solid meal 12 hours ago, so she’s not absolutely starved. (Around 25 grams of food or 33 calories)

Or I still have some fancy feast chicken I could try. In 6 hours I could go get Fromm lamb pate which she ate for about 2-3 weeks without any problem. Man, I’m just burnt.

 

That sounds like nausea to me. Do you have any Ondansetron (zofran ) or cerenia you could give her?
If not I would ask the vet to give you some. .

 

Thank you. We used to have Cerenia. Can’t find any now so I’ll call the vet when they open. I tried giving a bit of water by spoon about 20 minutes ago and she vomited it up 10 minutes later.

I agree she’s nauseous - same symptoms she used to have before I got her on the regular prednisolone. Back then, she would spend all day vomiting and would have to spend herself, so to speak, before finally she could slowly be reintroduced to food. I guess that’s what has been happening since yesterday: big vomit 3pm, medium vomit 8pm, small vomit 12am, small vomit 4am. Almost every 4 hours. Luckily still no blood, but unlike earlier where the vomit was yellow, the last few times it’s been clear and foamy.

 

That sounds as if she has nothing left in her tummy at all. I’m glad to hear you will ask the vet in the morning for an anti nausea. Try and get some Ondansetron. It’s really good for nausea and can be given three times a day if needed.

 

I’ll see if I can get Ondansetron, thanks. I’ve not been prescribed it in the past so they might be less willing to give it to me without bringing Emma in but we’ll see.

emma went to drink water but I took away the glass because in the past she usually needs at least an hour after vomiting before she can stomach liquids. Poor thing. She’s lying down now again so I’ll try to let her rest for an hour or so.

 

I would not leave her too long without the water if she is wanting to drink.

 

Right. It’s just that when I gave her water about an hour ago, just a tablespoon or less, she vomited it up 10 minutes later. In the past with her IBD she needs a bit of time. But I’ll put the water again down shortly - she clearly needs the hydration and I just don’t want her to be *less* hydrated by vomiting.

 

I understand. Maybe just let her drink a little at a time.

 

Mm, so just before 6:00am, around the time of your message, I brought down the water. A couple minutes later she drank just the tiniest bit, and I took it away. 10 minutes later she vomited it. So I think I'm going to hold off for at least another 2 hours now - 1 hour wasn't enough.

The good news is that she pooped after taking that tiny sip, before vomiting the water back out! And it wasn't super hard - a good stool. She's more mischievous than anything else. It's almost exactly like 3-4 years ago - she thinks I'm starving her, so she causes trouble, but she's so nauseous that anytime I give her even water or food she vomits. In the past the only thing to do was let herself vomit it all out, starve her, and very slowly re-introduce water and food. I probably shouldn't have tried to feed her last night or give her water in the past few hours.

Thanks for your support, Bron. I really appreciate it.

 

Some plants are toxic/deadly to cats & I'm assuming the fake snow on the tree is also. I'm not saying this is why she is puking, but I wouldn't rule it out. I would put them where she no longer has access to them.

 

I’m sorry you are having all this worry about Emma. It is so hard when they are unwell. It might be an idea to take her to the vet with you. She may need an injection of cerenia to stop the vomiting followed by the Ondansetron.
Let us know how you get on.

 

Thanks. The plants have been there forever, and the fake snow has been there since December, so if she wanted to eat them before this time she could have. I suspect she's just being naughty to get my attention. But I'm monitoring her and will put the tree away when I can do so without disturbing others.

Thank you. I doubt very much the vet would see Emma - it takes days to get an appointment usually. I really hope Emma will settle down and just be able to take some water in a few hours. Since they've given me Cerenia before I hope they'll just give it to me without an appointment. It's very difficult for me to get to a vet these days due to poor availability, access, and increased cost; they are all booked quite a while in advance and the one who knows Emma best is on the other side of town where we used to live. But I'll see what they say when they open up in 1.5 hours.

 

Not sure if this is helpful, I don't consider myself an expert, and I do think it would be best to hear back from your vet.

In the past when our cats have been nauseous we try to give them the littlest amounts of something liquid-y that is also very appetizing- Churu, a bit of gravy from canned food on a spoon. We encourage them to lick really small quantities and work up slowly to bigger quantities and then real food.

It seems to be a chicken-egg thing- they puke and feel crappy because they don't have anything in their tummy, but when they do eat they can't hold it down because they feel crappy. I would start really small with something easy to digest and appetizing and work slowly up from there.

It our experience vomiting also turns them off of the food they last ate before vomiting. They will refuse it for several days as they seem to associate that food with getting sick.

 

Definitely true, Erin! I’m starting off with water, giving literally a mL or two (two licks off a spoon) every 15 minutes. It was fine before I left but I am now on my way to try to get Cerenia from the vet. I’ll try out the gravy when I get home - maybe from a different food than the one I have.

 

Home and gave Emma the Cerenia 30 minutes ago. Unfortunately she vomited just before, and she seemed quite queasy when I gave her the Cerenia, but so far she's been good for 30 min.

 

An update - between 1-2 hours after Cerenia I started giving trickles of water and at 2 hours I gave a little bit of water mixed with the tiniest amount of wet food. She took a nap after that and I woke her up (because now it's coming on 20 hours that she hasn't eat anything really substantial) and she seemed quite nauseated upon getting up. Smacking her lips a ton, but no vomit. She was thirsty and so I let her drink for about 10 seconds. She was walking around a bit after that and settled down to rest.

Part of the problem is that, historically, Emma gets nauseous when she doesn't eat / goes too long in between meals. I don't know if this is an IBD thing. So as soon as she seemed less nauseous, about 20 minutes ago, I gave her some more wet food -- still with some water, but about 8-10 grams of actual food. If she's still looking good in an hour I'll give her more.

Thanks again for caring, everyone.

 

Sending prayers for Emma

 

Thank you, dear Diane. I gave her a small amount of food - she initially wasn't that interested. But I tried again 15 minutes later and she just ate another 10-15 grams? Success!

She looks better and I hope it keeps up. I was concerned that she continued to look nauseous even 3+ hours after Cerenia but right now she seems pretty fine, just sleepy. <3 Thanks again.

 

I'm so happy to hear this, keeping my fingers crossed she continues to eat with no problem. Don't make us worry about you Emma ♥

 

She definitely was showing signs of nausea. If cerenia works great. If not ask for ondansetron or did you already? Cerenia and ondansetron work in different ways.

 

You can actually give both Cerenia and ondansetron. They work differently and can compliment one another. You could also ask the vet to give either or both as an injection. It doesn't help if the cat is vomiting the pills back up!!

Baby food (Stage 2 that's only protein with no veggies) may be appealing. Many cats love the stuff!

Just an FYI, I would be worried if my cat was vomiting at the frequency that Emma has been. If the vet thought she was backed up, why didn't the vet consider an enema or suggest you do something for constipation?

 

I hope Emma is eating better today.

Since you are in Canada, it may be difficult to find all meat babyfood. At least it is impossible on the west coast. Alternatives are the TikiCat Mousse products or even something like Churus to get them kick started eating. If she's allergic to chicken, there is a TikiCat Stix (like Churus) but made with duck.

 

Thank you, guys. I will ask about ondansetron - I have a follow-up scheduled with the vet for this Thursday. Sienne, when I went in for a trip to the vet last Sunday they did an x-ray and although they saw she was backed up, but the stools were not huge. Since Emma produced really good stools last Sunday night and then on Monday after I gave her lactulose (and miralax), it looked like that was fine and she was recovering until this Wednesday she vomited.

Things have been mixed since Thursday night, my last update above. She ate about 2/3 of her usual meal on Friday and Saturday, but only one small, harder stool Saturday afternoon (the first since a good stool on Thursday morning). I note that I stopped giving full lactulose on Wednesday and wondered if this is related. Are there any suggested probiotics?

Emma hadn't really been nauseous too much from Thursday afternoon until yesterday and it looked like her appetite was building, so I hadn't considered giving her more Cerenia. But yesterday when I called the vet they suggested giving another dose of Cerenia and more lactulose since there wasn't a lot of pooping happening. Unfortunately Emma foamed at the mouth this time when I gave her Cerenia; I waited the hour for it to kick in but she vomited (out of hunger?). I fed her more slowly again and later tried to give her the lactulose and she just vomited it out after half an hour. Luckily after that she didn't keep vomiting, and she showed decent appetite. She shouldn't have been vomiting, given the fact that she had Cerenia, but to be honest I wouldn't be surprised if she foamed/spat it out and I somehow missed it.

Today she hasn't seemed nauseous and she wasn't eating a whole lot. The vet recommended to stop trying to give her lactulose since she keeps vomiting it and to stick to the Miralax. Emma was eating about 2/3 still, so no tgreat, but I picked up a few cans of Fromm lamb, which she was able to eat a few months ago without spiking her blood sugar or vomiting. I gave it to her just about an hour ago and she ate it up!! Even begged while I was warming it up. So maybe she is just associating her regular food with nausea and is less interested in it? I'll keep on with the Fromm since she seems interested in it and hopefully she'll be able to pass a good stool tonight!

 

For a cat that has IBD, Visbiome is a good product. It's made specially for IBD.

Cerenia is really bitter. You can hide it in a pill pocket if you are lucky, or get a blank small gel cap (size 4, 5, and 6 are good for cat meds), and put that in a pill pocket or just pill her if she will let you.

I think you may be right about her associating her normal food with not feeling well.

 

Thanks! I'll ask about that, too. On the phone the vet had mentioned Fortiflora, which I can see is owned by Purina.

An hour after eating the Fromm, Emma looked queasy... I hurried and gave her the Cerenia and washed it down with a spray of water and a treat. She seemed queasy for another 15 minutes but now is lying down... I think if she stays another 15 minutes we may be in the clear.

FWIW the vet's recommendation was to give Cerenia daily for another few days and try to get her to eat as much as possible. The only laxative she's taking would be the Miralax/Restoralax so hopefully it does the job.

 

Fortiflora is just a single strain of probiotics, not as good as many other out there. But some people use it as a flavour enticement on cats food.

 

I agree and think that is a good idea. Don’t wait until she is nauseated. Get in and give her the cerenia before that happens.

 

Yes, I should have done that. Luckily in this case it seems she kept the cerenia down. I just fed her 15g of her original wet food and she ate it no problem. In a bit I'll give her a bit more, perhaps the Fromm which she seemed to like so much earlier. Although maybe it's not good to be alternating? I don't know. It's a bit challenging to guess.

 

Glad to hear things are a bit better.

 

Doing very well today - she ate an additional 11g before sleeping, then 16g in the middle of the night, and 25g just now. That's about what she normally eats!

Sometime between 2 and 5am she passed a very good stool and two small ones. She was playing with a ball and running around this morning before eating. Terrific! I'll give her another Cerenia this early evening if it means more time like this. Thanks guys.

 

That's awesome news @Manuel!

 

Came back from a follow-up visit to the vet. They did bloodwork and the kidneys and liver are fine, which is great! Vet suspects it could be the IBD flaring up after the constipation, and the stomach still being a bit bothered. Emma has been eating 70-75% of usual, pooped better (every 1.5 days) and played well. She has, however, vomited a single time per evening the last few days, despite not looking nauseous anymore. So they prescribed an antacid (Famotidine) and said if that doesn't do the trick, then to do a 2.5 week stint of prednisolone...

Obviously, I'm a bit worried because the pred is almost certainly what made Emma diabetic. So hopefully the antacid does the trick!

 

Good that kidneys and liver are fine and she's eating pretty good! So strange about the single evening vomits...does she do that right after eating or...?

 

No, not usually right after. I guess we'll see if it the antacid helps!

 

Have you talked to the vet about trying budesonide instead of pred if you need to go back on it? For many cats, it doesn't impact the blood sugars, it didn't for Neko who could not have pred due to her heart.

 

Hi Wendy, the new doctor dealing with Emma is indeed open about trying budesonide. I have a prescription waiting to be filled and will grab it in the next day or so.

While the constipation appears to be under control, unfortunately the vomiting has been continuing on a near daily basis. The antacid hasn't helped a lot, though Emma was really good on Monday and Tuesday (no vomiting, good pooping, decent appetite).
Wednesday she vomited in the evening and didn't eat a lot thereafter, and Thursday morning Emma's blood glucose was low: 2.2, then immediately retested at 2.9. Probably this was because she had vomited the night prior and didn't have many calories. I tried switching to Koha turkey and her appetite went way up. I was happy on Friday because she ate basically with full appetite. Unfortunately the vomiting started around midnight Friday and continued sporadically through Saturday . Likely turkey is not a novel protein.

I tried Koha rabbit since this morning and so far no vomiting. But I also gave her a bit of pred, so that might be making the difference. Her blood glucose at +6 after pred was 113, which the vet said she wasn't worried about. I think I'll try with the pred for a week or two and see if that could give her stomach time to heal without also putting her into high blood sugar. Otherwise I'll try the budesonide and try to go with it longterm, though it is a lot more expensive than the pred.

 

Is the vomiting food? Antacid won't help with that. Foamy vomit is more an indicator of acid tummy in cats with CKD. And yes, there are many descriptions of vomit!

It would be interesting to see where Emma is +12 after pred. It might just be a short term bump. Have you tried tapering the pred dosage down at all? I had a kitty that before pred I tested in the 50's, went up to the 90's on 10mg pred, and back down to the 70's on 5 mg. Current pred kitty (IBD) shows hardly any numbers change at all. She also can't eat the Koha rabbit or anything with green lipped mussels in it. You do have to look at other ingredients too.

 

It's variable. Most recently, with the Koha turkey, she was vomiting about an hour after food, so it's been brown-ish. The other times, with Duck, she vomited not too long after I gave her the antacid - which is supposed to be given 30 min before food, so in those cases she had no food to vomit. (I.e., it was on an empty stomach, so yes it was mostly foam.)

But before I got the antacid last week, it was because she had yellow vomit (bile?) mixed with hairball. It was weird - she was vomiting about once per day, yellow liquid, with that hairball. And it was like, as soon as she vomited, she seemed absolutely fine and had stronger appetite. To be honest I've had a few sleepless nights this week worrying about CKD. We had the blood test and creatinine (1.7mg/dL) and BUN (13mg/dL) were in normal range. ALP at 76, which is on the higher but normal range. I don't even know what to think, especially because I noticed some head bobbing over the past weeks.

I'll get a blood glucose reading at +12 after pred! She hasn't been on it at all so the 0.5 of 5mg pill I gave her today is the first she's had in two months. I really do hope that with a couple of weeks on pred her stomach will have reduced inflammation enough to be healthy without medication. I've been very worn down taking care of her these last 2-3 weeks.

Oh, and I'll see how things work out with this Koha rabbit. She was fine with Koha duck for months so it's sad to see her reject it all of a sudden!

 

What was her urine specific gravity at her last test? Was an SDMA done? And how long ago? It does sound a lot like an IBD flare. A short course of pred may indeed be all she needs.

 

The most recent blood test done 10 days ago was in-house, so no SDMA or urine specific gravity. But last June (2022) she had:
1.029 specific gravity
SDMA 11 ug/dL
ALP 63 IU/L
BUN 14.28 (after converting from mmol/L) and
Creatinine 1.24 (after converting from umol/L)

So creatinine increased somewhat from 1.24 -> 1.7; BUN decreased 14.28->13 ; ALP increased 63 -> 76. Supposedly these are all still within normal range.

Crossing my fingers that the course of pred will do it. And, Wendy, grateful for having your thoughtful support.

 

Emma is at 3.9 at +12 after prednisolone.

 

Just a quick update! Emma didn't vomit Sunday or Monday and so far is good today. I didn't have prednisolone to give her yesterday (nor yet today), so it's possible she's handling the Koha rabbit better, or else the the bit of pred gave enough respite?

Only problem is that Koha rabbit has far fewer calories (literally only 2/3 of what her Duck was) so even though she ate a full can yesterday (160g), with perfect appetite, she got only 141 calories. I have to be careful not to feed her too much or too fast otherwise she could vomit again. But clearly I'm very pleased that she hasn't vomited and has shown excellent appetite.