Cat vomiting shortly after meals....disagreement with vet on how to proceed.

Hi.  We're having our first major health issue with our 3 approx. two year old cats.  Leo, orange tabby, started vomiting (or regurgitating, done a lot of reading but still not sure which) his entire meal about twice a week 4-5 weeks ago.  There is some definite heaving which makes me think it is vomiting.  This happens within 5 minutes of eating.  Here are some of the facts....

*They eat 2 oz each of Natural Balance wet (not the limited ingredient...contains brown rice) for breakfast.  They eat 3 oz each of Wellness grain free wet for dinner.  They eat several flavors of each, all chicken or turkey with fish/poultry flavor 1-2 times per week. The vomiting does not seem to be related to one certain flavor, though it happens more frequently with breakfast (Natural Balance.) They also get a tiny spoon of wellness dry midday as a snack and greenies (just a few) or CET dental chews.  The treats and dry food have never been vomited.  Just entire meals of the wet food (no hair or funky stuff, just food.)  They have eaten these brands for a long time.  (We have tried rotating in some other good grain free foods like EVO, BG and Felidae.  They were a bit picky about those.)

*Again the vomiting is within 5 minutes of eating, twice a week.

*I'm open to even healthier food (for example going totally grain free) BUT I really don't think the food is the issue.  Someone here on another thread brought up a great point....If the food is the issue wouldn't they need a little time to digest it before vomiting?

* I just waited it out at first to see if it was a hairball issue (but, though my cats have them infrequently, I've never seen them "look" like this with vomiting entire meals right after eating.)

* My gut tells me something is wrong with the mechanics of his food going down.  I raised his food bowl and have just started trying to smush his food into the bowl a little to slow him down (so he can't get big bites.)

*  We went to the vet today with my value being the LAST resort would be changing his food.  As I suspected that is the FIRST thing they want to try (Hills i/d of course....I told them I don't want to do that.)  The vet agreed that the immediate vomiting makes it sound like it is not a reaction to the food, but she stuck with their routine of wanting to change the food first.  She gave him a steroid shot.  She said he may need to come back for a barium/x-ray test or be referred for an endoscopy (they don't do those.)  She also did one of those quick blood tests and everything looked normal.  So, $135 later I have no real answers as to whether something is wrong with the mechanics of his eating.  (Though she did look down his throat a bit....nothing there.)

*I was frustrated and immediately wanted a second opinion, BUT I do really love a lot of things about our vet, mostly that we have a nice bond with them because they rescued two of our cats (Emily and Eko) and we adopted from them.  They are also great about making room in the schedule to see us that day, even though our issues aren't usually very urgent.  I guess I'm saying I don't want to say "See ya" to our vet.  I'm even leery of offending them by not following their advice though I did express my concerns about changing to Hills i/d when I thought what I was feeding was more appropriate. 

*They are indoor cats, but I'll take a stool sample in (to test for parasites) as a precaution.  However, there might be a long wait on that because all 3 cats' body clocks have them pooping in the dead of night these days.

*  Leo shows no other signs of illness and is not losing weight.

I guess my question is, how to proceed while disagreeing with the vet.  Any thought from your experience about anything else I can do?  Anyone know the difference between the barium/x-ray route and an endoscopy.  (I'll research them online later I guess.)  I've seen a lot of good advice on this forum but this is the first time I'm really needing some.  Thanks.

Did you check to see if any of the cat food is on the Diamond Pet Food recall?

This is quite a conundrum.  I had a kitty who couldn't tolerate any kind of fish in her wet food, so you might try eliminating that from his diet.  Other than that, you'll probably have to do your own research and figure out if it's a food intolerance by process of elimination.  Hopefully others will come along who are more helpful.
 

If you do think it is allergies, there are quite a few others on the forums that have encountered this as well.

Some of the common allergens are the ones most available unfortunately, such as chicken, turkey, beef, fish.

Nature's Variety and a few others have introduced some other proteins such as venison, duck, lamb, rabbit, that are not as likely to cause allergies.

But it can take 2-3 months for you to notice a huge change, so patience is a must.  If you do suspect allergies, read the labels carefully, because often, there is more than one type of protein in the food.

Others are likely to chime in who have more knowledge on this topic than myself offering clearer advice.
 

I'm currently in the same situation with my vet, I don't like how she's handling things but I really love the clinic so I really don't wanna change vets. I know how you feel. They have tried to switch my cats from their high quality canned diet to Hills Prescription, and I keep refusing. I know that Hills isn't particularly the best food for cats, and the Wellness I'm feeding them has much healthier ingredients.

First of all, I second what tjcarst said. Is the Natural Balance part of the Diamond Recall? I remember that Natural Balance for dogs was on there. Not too sure if the canned cat food is part of it, I will do some research and get back to you about that.

Its highly unlikely that it's the food doing it, as I assume you're feeding the same thing to your other two kitties? If the other kitties are doing fine it probably isn't the food. Maybe there is a problem like IBD? My cats haven't had any digestive problems (knock on wood) except for the occasional hair ball, so I haven't had much experience in this area.

But vibes for Leo, and hope everything turns out okay. Remember, it's okay to disagree with the vet. When it comes down to it, you know your pet the best and no one can force you to change Leo's food if you don't want to.

I am looking into recalls, but from what I have noticed on forums lately it seems to be Natural Balance dry, not wet.  But I will keep looking into it to confirm.

The part about barium vs. endoscopy reminds me of what I had to do. A barium x-ray is drinking a bunch of digusting stuff and then being x-rayed. I have no idea how to make cats do that. An endoscopy is done under sedation and causes some abdominal discomfort afterward. I know because I had these procedures done on myself. I am sure a cat would be sedated for the barium x-ray too.

If allergies are suspected, what Leo really needs is d/d, not just another brand.

Originally Posted by txcatmom  

*  We went to the vet today with my value being the LAST resort would be changing his food.  As I suspected that is the FIRST thing they want to try (Hills i/d of course....I told them I don't want to do that.)  The vet agreed that the immediate vomiting makes it sound like it is not a reaction to the food, but she stuck with their routine of wanting to change the food first.  She gave him a steroid shot.  She said he may need to come back for a barium/x-ray test or be referred for an endoscopy (they don't do those.)  She also did one of those quick blood tests and everything looked normal.  So, $135 later I have no real answers as to whether something is wrong with the mechanics of his eating.  (Though she did look down his throat a bit....nothing there.)

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Because diet is the foundation of kitty health, I'm leaning toward a food or ingredient intolerance, but I'm not there in your home so can only give advice based on my experience, so please bear with me.

I have to disagree with the vet that immediate vomiting can NOT be a reaction to the food. One of my three kitties is intolerant of beef canned food, and another to any canned that contained fish (back when I fed canned), but not raw beef or fish (I don't feed fish on a regular basis, and definitely not tuna). When fed either of these canned foods that contained beef or fish, it was immediate, heaving upchucking. I'm a member of other cat forums and immediate vomiting is a very good sign that there is an intolerance--whether to an ingredient in the canned or the actual meat. An ingredient can be anything from carrageenan to a meat-by-product, and every ingredient in between. Not saying your boy doesn't have some physical anomaly, but most often it is an intolerance to something in the food.

If kitty is eating too fast, one would think that he would vomit all the foods, not mostly one particular brand. It is good that you are smooshing his food to the plate to see if that helps though.

Could you do a comparison of all the labels of all the brands/types of food to see what they have in common--and what they don't? That might reveal something that could help.

Have you tried adding digestive enzymes to his food?

Ugh. I so hate when you're trying to figure things out and the darn vet (no offense to your vet intended--most would likely do the same) gives a steroid shot. Besides my maybe obvious bias against steroids (except under life threatening circumstances), a steroid is only going to mask any symptoms and make it harder to determine what is going on. Kitty might do better for a short time span, but the symptoms will only return and then you're back at square one.

Anyway, hope this gave a little food for thought...

WhollyCat said:

.Anyway, hope this gave a little food for thought . . .

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Pun intended, Wholly?

I would say the same thing about looking for a food intolerance.

He throws up mostly in the morning? Can you give us an approximation? Is it 50%? 80%? 99%? Does it happen when you're running a little late with meals?

I understand they don't free feed on kibble, correct?

I'm wondering if this is acid build-up overnight, the longest period between meals. Basically, kitty GERD. I'd ask the vet about trying pepcid a/c (given at least one hour after food, late at night, NOT given with food or a pill pocket) to see if that stops the problem.

I switched my cats to raw food in January. Raw feeding creates a more acid environment, so sticking to the schedule is more important. If I'm late with a meal in the morning, I have to feed a little bit of freeze-dried chicken to absorb the stomach acid, or they'll throw up the meal just as you describe. Our kitty Lazlo had a cancerous tumor in his stomach with bleeding ulcers, and was treated for the ulcers and had chemotherapy last year. We've kept him on pepcid a/c (given at night, about 1.5 hours after the meal, right before I go to bed) to prevent the recurrence of ulcers, and he has NEVER thrown up from acid build-up.

I looked up barium x-ray vs endoscopy and found this: http://www.jmpiasi.ro/2005/13(1-2)/9.pdf Basically, the barium/x-ray is good at diagnosing esophageal stricture only; endoscopy is better at diagnosing pretty much everything else.

If the pepcid a/c stops the problem, you might want to consider asking the vet if it's appropriate to give him sulcralfate for a few weeks to a month, just to help any ulcers or start of ulcers heal. Of course, you can have the endoscopy done, because that would see if there are any uclers or lesions. But you may want to start with the pepcid a/c as a prophylactic, just to see if he responds to it. If he does, then at least you have a good idea of the source of the problem without the cost of the diagnostics. :dk:

....BUT.... if this is not primarily a problem in the morning, then I have to agree with WhollyCat. Food intolerance can express itself that way. I, however, would not go the i/d route. I'd go grain-free, with no carageenan, single proteins, and limited ingredients. Unfortunately, that leaves you pretty much with only Nature's Variety. If you don't want to eliminate the carageenan, then you can keep the grain-free Wellness, and try Before Grain, EVO, and By Nature 95% foods.

I am with Laurie.... Sounds like this could be a bit of acid build up going on.... Have they always been eating on a schedule? If not, when were they transitioned?
Also, what time do they eat, and how much per meal -
Breakfast - time and how much; Lunch, Time and how much; and Dinner - time and how much.

Seems that they are getting this: Can you list the times?

*They eat 2 oz each of Natural Balance wet (not the limited ingredient...contains brown rice) for breakfast.
They also get a tiny spoon of wellness dry midday as a snack and greenies (just a few) or CET dental chews.
They eat 3 oz each of Wellness grain free wet for dinner.

EmilyMayWilcha said:

Pun intended, Wholly?

I would say the same thing about looking for a food intolerance.

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Ya caught that, eh, Emily? Yup, pun intended.

I'm wondering if this is acid build-up overnight, the longest period between meals. Basically, kitty GERD.

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LDG (Laurie) also brings up a valid point about stomach acid causing the worst vomiting after the morning meal. Definitely something to investigate. It could also be a combination of intolerance and acid build up. These little guys keep us on our toes.

You've said that all your cats have been eating the same brand of  food, the same amount, at the same time(s) of day and one of your cats has begun to throw up his food, a little more often in the morning but not limited to the morning.

This is what happened to my one cat Toby (his thread is on here, "Toby vomiting and losing weight") and I had the same problem with my vet, feeling like she was being a little too superficial but I felt that I liked my vet too. We did the blood test, the endoscopy, she gave him a shot of covenia (antibiotic, stupid ridiculous thing to do) and she put him on pepsid. I also noticed that Toby threw up more in the morning and he seemed more intolerant of the stronger tasting Natural Balance wet food (i.e. tuna in the AM vs. turkey, not so strong tasting or acid-y). Four or five visits later, over the next 4-5 months she finally did an x-ray which showed a white mass and also that his colon was impacted; ultimately it was a diagnosis of lymphosarcoma.

But your cat could have any one of a number of easy to treat little illnesses, so don't go there immediately (!) 

If you don't think your cat has suddenly developed a food intolerance, you could do what I did, and call your vet in another few days and tell her you just don't think this is the problem. But now you do have an issue- I agree with the poster who was really bummed that she gave your cat a steroid shot. I also think that was the wrong thing to do, since it would even mask a food intolerance, and if he happened to have cancer that is the exact wrong thing to give him and it could mask a proper diagnosis via xray or ultrasound. And in effect she is already treating him for food allergy since the steroid will mask an allergic reaction to another food. 

I could be wrong about something here, so someone else can jump in- Laurie (LDG) has so much experience in this area as so others with a lot more presence on this board. And I agree with her about the stomach acid. You could give him half a pepsid at night and see if that helps him as well. It would make him feel better very likely, and it shouldn't mask a problem so long as you persist with testings for him. Given what happened with my Toby (he's on here a few times for his vomiting) and if you have a gut feeling things are still not right with him, I wouldn't let go without a clean xray and ultrasound which you may have wait to do after the steroid wears off, about 4-5 weeks from now. I'd be interested to hear what others think about ability to diagnose your cat given the steroid shot. 

Great input, thanks guys.  It was really my assumption that immediate vomiting would make it less likely to be a reaction to the food, but the vet did sort of agree (or maybe she was just humoring me.)  So, it is good to know that assumption is wrong. 

Meal times are Breakfast - 7:00 am.  Dinner - 8:00 pm  Snack - 10:30 am  Dental treat - noon  a few greenies here or there not scheduled.  The times are always prompt except snack may vary if I'm not home at that time of day...but it is usually pretty prompt too.

They have been eating scheduled canned meals since I transitioned them right after adoption (at 4 months for Leo.)  He is between 1 1/2 and 2 now.

One interesting thing I should have noted before....All 3 cats gained a pound over 2 months time several months ago (I weigh them once a month.)  I attributed this to the new CET dental chews (which they get just one per day of....but I read they have 16 calories each.)  I cut back on their wet food just a bit (from 3 oz each for breakfast to 2 oz for breakfast.)  I chose breakfast to cut back on because they get the snack midday and I didn't want them hungry during the night if I cut back on dinner.  The vomiting did start soon after the cutting back on the food.  So, it could be Leo scarfing his food down hoping he will get some of Emily's (she leaves some sometimes....but not really now that breakfast is just 2 oz of their favorite food.)  Or, maybe he is just hungrier with the change.  I don't think I'm starving the little fellow.  After the change he lost half a pound in one month's time, but was still one pound over what the vet had as his last weight (taken in January.)  Since he is the biggest cat, I do give him a slightly bigger spoonful of the midday kibble snack and I give my female half a spoon (she is not losing that extra pound as easily as the boy cats....typical, huh?)

But, it seems my cat have always eaten quickly so I worry, "What could be brewing in his system that has caused this change?"  I do think (in an effort to change one thing at a time) that I will really focus my efforts right now on slowing him down a bit.  Last night I fed them 1/2 their dinner then 15 min later fed the rest.  Breakfast is so small I hate to do that to them, but I did take a step in that direction this morning.

Edited to add....Thanks for the list of foods, LDG.  Nature's Variety (Instinct) has been on my mind to possibly try.  Isn't that the one that you can buy in large cans since the dog food is the same as the cat.  I like the flavor choices but my female is picky about anything gamey or exotic.

Also, I've noted that the steroid shot will make it hard for me to know what I'm doing is helping, until it has worn off.

One more thing, when I cook a whole chicken for my family I've started offering a little of the meat and gizzards (whatever you call the random parts stuffed in there) to the cats.  I'm curious what they will do with real meat because I've considered adding chunks of meat for their dental health.  Leo is the most receptive to cooked chicken and has no vomiting with it.  However, it is small amounts.  Do you think this means he tolerates chicken well, or is the amount (no more than a tablespoon or two) too small to tell?   (Sorry for the italics, they were unintentional and I can't get them to go away....lol.)

Yeah, you do pretty much need to wait for that steroid shot to wear off.

As to your question about food intolerance and chicken/gizzards, I don't know if you're planning to feed raw or cooked, but most people find that if their cat was allergic to, say, chicken in a cat food, they're not allergic to a vegetarian-fed or organic chicken fed cooked or raw. Carolina's Bugsy couldn't tolerate chicken; she fed him Ziwipeak canned food. But when she switched to raw, Bugsy didn't have any problems with vegetarian-fed or organic chicken. He does have a problem with throwing up "regular" chicken. So clearly the FEED the animals are fed affects the proteins our cats eat enough that THAT can be a source of the problem. Other kitties aren't as sensitive, but tolerate chicken we eat, but not chicken in pet food (which to me says the issue isn't the protein itself, but an additive in the pet food). :dk:

You can feed up to 15% of their food "unbalanced," so adding chicken and/or gizzards shouldn't be a problem.

Please keep us posted!

I had a cat who frequently threw up.  One of the things I noticed was that if she hadn't pooped in a day, she would throw up.  Perhaps your guy is constipated??  Just throwing that out there as something else to think about and consider.
 

The schedule makes me think it might be acid....

Meal times are Breakfast - 7:00 am. Dinner - 8:00 pm Snack - 10:30 am Dental treat - noon a few greenies here or there not scheduled. The times are always prompt except snack may vary if I'm not home at that time of day...but it is usually pretty prompt too.

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There are three meals packed together in the morning - breakfast, am snack, dental treats at noon. Then a longish stretch for dinner, of about 7 hours, which is ok..... then a very long 11 hour strech for breakfast, where they are only fed 2oz.

Try to even out the qtys you feed throughout the day, and serve a late night meal, right before you go to bed, and see what happens...... It might help you, IMHO. You can also give the dental treats before breakfast, 1/2hr before or so, to prepare his tummy for the main meal.
My schedule is as follows:
8:30-9 am Breakfast
6 pm dinner
11-11:30 late night dinner

All meals are the same amount. If I am late for any meal, I feed them a treat as I am preparing to take care of the acid production.

It's possible to have allergies to something that's perfectly healthy food...

Have you tried making a list of the ingredients of all the foods they eat, and then matching up the ingredients that exist only in the foods that he can't seem to tolerate? Then try foods that have all of those ingredients but one, and see if he's okay with those--kind of a process of elimination thing. This is assuming the cat is okay with all the switching around of flavors. Many cats would not be; but you say he's already eating lots of different flavors... so maybe worth a try? That's what they do when a human has an unknown allergy--track symptoms, track food, until it can only possibly be one thing.

You all have given me some great things to consider.  I think I'll try....

1)  Continuing my effort to slow down his eating a bit.  (Knowing that with the steroid shot it will take longer to see if this is working.  No throwing up since Saturday night, though.)

2)  If throwing up resumes, consider timing the meals differently to see if the acid production mentioned by Carolina could be an issue.

3)  If there is still vomiting, start the long process of experimenting to see whether there is a food ingredient he is sensitive to.

4)  If vomiting gets more severe, consider some of the testing for his "mechanics" of eating that the vet mentioned (barium/x-rays or endoscopy....I still have to research those.)

Thanks for all your input.