Athena vomiting

I haven't been visiting this site for a while, but I'm back because of an acute health crisis in one of my own cats.

Athena has a history of eating non-food items, and has had surgery to find and remove a draw-string from her stomach. Athena is currently at an emergency vet. On Monday she vomited twice (I didn't see or hear her do it either time, but there was food vomit on my sheets once in the morning and once in the evening). On Tuesday morning she vomited twice and showed absolutely no interest in food, so I took her into my local vet. My local vet did an x-ray, couldn't find a foreign object or gut organs situated so as to suggest a foreign object. He suggested that it was some type of medical gut disturbance, gave Athena an injection of centrine (smooth muscle relaxant traditionally used to treat vomiting, diarrhea, and gastritis) and famotidine (Pepcid: inhibits stomach acid production), subcutaneous fluids, and send her home with me with centrine and famotidine pills (actually, told me to purchase Pepcid at a drug store and cut the pills into 1/4) and Iams low residue wet food.

Athena got home, and promptly tried to vomit again (but all that came up was foamy white saliva). The local vet told me that the drugs might take a while to work, so I waited. Nothing changed, and Athena wasn't interested in eating. Including the two morning vomits, Athena vomited 5 times on Tuesday. She vomited three time on Wednesday morning (still white foamy vomit, no gut contents). I took her back to the local vet (but it was a different doctor, because the first one left for a conference for a week on Wednesday) on Wednesday morning, and we decided to send her to the emergency and referral vet, who could do an ultrasound and, if they found a foreign object in her stomach, do an endoscopy to take the foreign object. Both the local and e-vet can do exploratory surgeries and take out foreign objects in the intestine, but I was betting that Athena had a foreign object in her stomach.

The ultrasound was "boring"; she looked great. However, the e-vet found an inflamed, possible recent abscess or sore on her left front paw near the dew claw while they had her sedated for the ultrasound (she panicked when they tried to shave her belly for the ultrasound), which the vet suggested possibly might be related to Athena's issues. I'm deeply skeptical, as Athena has been super-friendly, sitting on me constantly, walking normally, kneading with her paws, ect. I suspect that it was an injury at some point during all the transport to and from and vet visits (although she was the picture of calm during the 45 minute drive to the e-vet).

The e-vet from Wednesday, and the second local vet, are really excited about the apparent lack of foreign object. I'm really concerned about this really expensive acute health crisis without an obvious cause.

I want causes and fixes! I'm sure the vets do too, but I'm disturbed by the apparent lack of cause and therefore the risk that this is the first sign of an undiagnosed chronic illness.

I love this cat. I don't have a job right now, and I don't have a lot of money. I've already spent more than I think is sane on this cat, mostly because I'm going for the more expensive diagnostic choices in order to get her better and not just spend thousands of dollars on hospitalization with an IV that I suspected would be followed by the finding of a foreign object after all.

I'll talk to yet another vet, (Thursday e-vet) later today. They are supposed to be offering Athena food this morning, and if all goes well, I'll be taking her home later today.

The second local vet is concerned about pancreatitis, and sounded disappointed that the Wednesday e-vet didn't do any lab tests to rule out acute pancreatitis. However, I think that the Wednesday e-vet thinks that Athena's lack of abdominal pain and what the pancreas looked like with the ultrasound rules out pancreatitis.

I'll post again with more information after I talk to the Thursday e-vet and/or bring Athena home. This thread is mostly for me to get this all down somewhere, and when I have more information I'll be asking advice from people who've either had cats with acute vomiting without an obvious cause, or asking advice about whatever diagnosis the Thursday e-vet suggests. In the meantime, if anyone has suggestions on questions I should ask the Thursday e-vet, your input is greatly appreciated.

Unfortunately, there isn't always a cut and dry answer in veterinary medicine. Sometimes, you have to go "House" style, and just hope you hit the right one. An abcess could definitely explain her symptoms, especially if she is febrile.
The abcess would not have formed enough to be an abcess in that short of a time. She may have cut herself, got bit or scratched, or bit or scratched herself (Yes, I've seen that happen! )

Hope she feels better soon!

Okie

Also, have they tested for pancreatitis?

No fever on Tuesday or Wednesday. My second to-last paragraph in my first post is about pancreatitis. I think that the Wednesday e-vet thinks she's ruled out pancreatitis, but the second local vet doesn't think that pancreatitis has been ruled out.

And, yeah, I know there isn't always a simple answer (even in human medicine), but I still want one. It's also just really hard for me to believe that a vomiting problem in my problem eater cat is not caused by her problem eating.

Originally Posted by Enuja

No fever on Tuesday or Wednesday. My second to-last paragraph in my first post is about pancreatitis. I think that the Wednesday e-vet thinks she's ruled out pancreatitis, but the second local vet doesn't think that pancreatitis has been ruled out.

And, yeah, I know there isn't always a simple answer (even in human medicine), but I still want one. It's also just really hard for me to believe that a vomiting problem in my problem eater cat is not caused by her problem eating.

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Very true. Perhaps it's not a foreign body, but still something she ate? Maybe a bad bug, or lizard?

Pancreatitis usually presents a very painful abdominal palpation, but the lack of pain itself is not a rule out. I'd perhaps discuss that with your vet today. They can do a chemistry that includes amylase and lipase, and/or do bloodwork to the lab to check for feline pancreatitis.

Good luck!

Okie

From what little I've looked up online, it seems that an ultrasound is an expensive but really good way to check for pancreatitis (if the pancreas is not big or otherwise unusual looking), so the ultrasound looking for foreign objects is probably a good way to rule out pancreatitis. And we know that Athena's amylase and lipase level were normal on Tuesday (they did an in-clinic "CBC & GHP", and I'm almost certain amylase and lipase were part of it and normal, but I didn't write that down specifically). I'm thinking that the local vet, who doesn't have an ultrasound machine, just kinda forgot how good an ultrasound is for ruling out pancreatitis. I'm certainly going to bring it up with the Thursday e-vet, though.

Originally Posted by Enuja

From what little I've looked up online, it seems that an ultrasound is an expensive but really good way to check for pancreatitis (if the pancreas is not big or otherwise unusual looking), so the ultrasound looking for foreign objects is probably a good way to rule out pancreatitis. And we know that Athena's amylase and lipase level were normal on Tuesday (they did an in-clinic "CBC & GHP", and I'm almost certain amylase and lipase were part of it and normal, but I didn't write that down specifically). I'm thinking that the local vet, who doesn't have an ultrasound machine, just kinda forgot how good an ultrasound is for ruling out pancreatitis. I'm certainly going to bring it up with the Thursday e-vet, though.

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Yeah, I forgot about the ultrasound, too... that is a great way to R/O pancreatitis.... Hmmmmmmmmm.........

I talked to the Thursday emergency vet, and (without my prompting) he said that the ultrasound did not completely rule out pancreatitis, because it is possible to have pancreatitis without an abnormal looking pancreas on ultrasound.

The current plan is that I'll pick up Athena later today (6pm), giving her a chance to have IV fluids for a little bit longer and injected evening medications. Here's hoping that she keeps getting better, and this will just be a one-time mysterious health anomaly on her record.

Athena is at home, and eating (Iams Intestinal low residue wet food). And right now she's happily curled up on my sleeping spouse. Yeah!

When I picked Athena up, I just talked to the nurse, not the doctor (and, yes, they call them "nurses" and not "vet techs" at this particular emergency vet practice), so I don't really have any more information than I got over the phone this afternoon.

On Monday night, in the second vomit (first vomit was Monday morning), I found a hairball. I've never seen hairballs in the vomits of either of these cats. I wonder if it's possible for a hairball, and the act of vomiting it up, to make a cat vomit and not eat for 72 hours?

When I next talk to my local vet, I'm going to ask
1) If there is any difference in treatment if it's pancreatitis versus general gastro-intestinal distress with no known cause
2) If it was acute pancreatitis if the lab tests they send out would still be abnormal
3) Looking at 1& 2 together, whether or not I need to bring Athena back to the local vet for a blood draw or something else
4) Whether a hairball could have caused all this
5) long term food questions: right now the normal foods for the cats is the very cheap "Fine Feline" (brand of the discount grocery ALDI) wet food and Priority Total Pet Care Nutra Balance Premium Adult Cat food. Does this need to change? What is the difference between regular wet foods and Iam's low residue (which the local vet sold me) and Science Diet's w/d and i/d foods (which the e-vet gave me)?

I know that the general feeling on this board is that vets really don't get a huge amount of training about nutrition, and my local vet does appear to be a bit of an old-fashioned vet, but I'm still going to ask question #5 anyway.

Has any blood work been done, I couldn't tell by your posts?

Glad to know she has been doing a bit better and is home today.

Yes, a hair ball could cause these serious problems but I would think it would likely show up on an x ray or ultra sound.

I have only good things to say about the Hills Prescription Diet ( it is NOT Science Diet, that is the grocery store line) line of foods including w/d and i/d. People think the ingredients are "low quality" but the foods are made the way they are for specific reasons to target specific illnesses. I have a cat on the c/d, thriving. I know another cat on i/d, also thriving.

Keep us posted on Athena!

Originally Posted by otto

Has any blood work been done, I couldn't tell by your posts?

Glad to know she has been doing a bit better and is home today.

Yes, a hair ball could cause these serious problems but I would think it would likely show up on an x ray or ultra sound.

I have only good things to say about the Hills Prescription Diet ( it is NOT Science Diet, that is the grocery store line) line of foods including w/d and i/d. People think the ingredients are "low quality" but the foods are made the way they are for specific reasons to target specific illnesses. I have a cat on the c/d, thriving. I know another cat on i/d, also thriving.

Keep us posted on Athena!

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well said

Yes, a blood panel was done on Tuesday. The results were mostly normal, and the abnormal readings looked to be due primarily to dehydration and possibly stress.

Looking at the can, you're completely correct: the emergency vet did indeed give me cans of Hill's Prescription diet. Both my local vet and e-vet told me to feed these "gentle" foods for a few days and then go back to the regular foods, but I'm wondering if these prescription wet foods or other wet foods would be better long term.

I found a hair ball in Athena's vomit on Monday night, so it wouldn't have shown up on the x-rays on Tuesday and Wednesday or the ultrasound on Wednesday. (I know mentioned the hair ball to the vet on Tuesday, but I don't know if I mentioned it to either of the vets on Wednesday.) I'm wondering if the after effects of a hairball could last so long and be so serious.

Even if one hairball was brought up, there still could be more in her.

Tolly gets very ill from hair balls and the older he gets the worse time he has from them.

His hair is fine as gossamer and I think it sometimes forms a sort of coating on his insides. not a big mat or ball in the gut, but just kind of coating all over. One of the reasons I reached this theory is because often the bits he is able to vomit are flat and thin, not finger shaped, like most hairballs. So I envision those flat thin mats coating his tummy, esophagus and intestines. ick. no wonder he feels sick.

I brush him with a deshedder daily, and use hairball remedy on a schedule, but he still has trouble sometimes, especially in spring and fall.

Some prescription foods are meant for maintenance and some are meant only for short term use. You can read up on them in the Hills Website. www.hillspet.com

click on product, then select "prescription" then "cat" to see the line of prescription foods and information on each one.

I talked to the local vet this morning, and he was deeply skeptical that the hairball that came up on Monday, or any hairball at all, could get her as sick as she got. He's still worried about the possibility of pancreatitis, but right now we're going to focus on getting Athena better at home.

As I said before, the emergency vet practice sent me home with Hill's i/d and w/d. I think because I stuck a pill in the Iams intestinal low residue and Athena figured it out and spit out the pill, Athena is no longer interested in that food, but she's really liking the Hill's w/d. And Artemis is really liking it too. Hills w/d is a "weight control" food for maintenance (it does also say on the Hills website that it's good for gastrointestinal problems, too) and Artemis is overweight. Athena's not overweight, though; right now she's actually a little skinny, presumably because of this "gastroenteritis of open etiology". For right now at least the w/d food is great, because it's a food I don't have to keep Athena from eating. (Athena was trying to get to the food I was trying to feed Artemis, in preference to the Iam's low residue wet food, and putting out just the Iam's low residue wasn't working because Artemis won't eat it.)