Continuing Regurgitation Issues - Questions to Ask Vet

We're taking Casper to his annual vet appointment tomorrow, and I'd like some help in what questions we can ask him in order to get to the bottom of his continuing regurgitation issues.

Background is, nearly 12 years old, a bit overweight (14 pounds), may have the beginnings of arthritis and some minor tarter buildup (not enough that warranted a cleaning yet apparently).  Has always tended toward gobbling his food although lately he's been eating much slower.  We only feed grain free, wet in the mornings (a rotation of various high quality brands) and kibble at night (a combo of half Before the Grain Chicken/Turkey and another grain-free I forgot the name off hand).  He tends to be rather inactive for the most part - although in the past few months he has been getting daily workouts from our new, much younger cat who delights in racing around the house after him.  He seems to enjoy her company 75% of the time.  The other 25% he's annoyed lol.  But, not so much that it ever comes to blows.  Overall health has been pretty good, other than one UTI several years back which cleared up quickly after a vet visit.

The regurgitation is our constant battle.  At first, we thought it was from him eating too fast.  But it happens even if he eats slow.  Then, we thought perhaps it was hairballs, but for the most part, it only happens in the morning.  Then, we thought, ok maybe it's some digestive acid reflux or something because we know early mornings can be an issue for some cats, but now it happens later in the day also now and then.  It also only used to be with kibble (which was much easier to clean up), and now it's with wet food too.  Then we thought, well maybe it's stress but that makes zero sense since before we got Cocoa, he had no stress at all other than when the "enemy cat" (our neighbors cat) would come by the back patio door sometimes. Which was a rarity the majority of the year, it's summer that's the biggest time he's out.  I mean, Casper is seriously laid back and not fazed by much of anything.  Even enemy cat only momentarily unnerves him - and that's because he's defending us from him 

Lately, he does seem like he's famished all the time - but Cocoa (our girl) has a bad habit of poaching on his meals when we aren't looking so honestly, he might really be hungry.  For a tiny thing she eats like a pig (she was a rescue, so that may have something to do with it).

Anyhoo.  We've had many discussions with the vet about this.  We brought him in a couple of months back because he was acting strangely and, wasn't eating pretty much at all.  In the end, after blood tests, senior panel, etc. all came back negative.  He did not, however, have a fecal test run because the two of them are now sharing a litter box and there was just no way we were going to be able to figure out who did what, let alone lock one of them up long enough to wait for a sample from the other.  They both only seem to poop once a day (gotta love feeding good food!).

So, we have no idea what was going on.  He prescribed a medication which made him act really freaking spaced out so we took him off of it.  Babied him with special foods for several days until he started to eat normally (that, was challenging).  So, all in all, again it appears he's one healthy boy with this one lingering problem that doesn't seem to have a cause.

So, we go back tomorrow for his yearly, you know, shots, boosters, have a feel and a poke. etc.  What might we have missed in all of this that we can point out to the vet?  Or, tests we can ask for without breaking the wallet?  Should we get an x-ray for instance to check for a blockage?  Although I honestly don't think that's it, because sometimes, he goes weeks without an incidence of throwing up his food.  There just doesn't seem to be any pattern to it at all, nothing specifically triggering it.  

And again, overall, he's ok.  He's using the box perfectly, drinking as usual, and eating his food (when he can get to it lol - we wind up having to supplement him sometimes and take her in another room).  He sometimes seems to have some sort of "senior" moments, but we might be reading something into what's not there.  

Many thanks for any advice or thoughts you can offer.

Is it always regurgitation (undigested food) or is he sometimes also throwing up clear liquid/bile? How long has this intermittent vomiting been going on?

As for hairballs, otto just posted an interesting article by a vet about why hairballs are never just hairballs. You might want to read it.

It's just food.  No other liquid or bile.  It usually will come up very fast after he eats - most times within 10 minutes or so.  Sometimes, longer, 1/2 hour but never hours later or anything like that.  It's related to eating for sure, somehow.  Or appears to be to us.

It's been going on as long as we have him.  3 years?  I don't know if he did this before we adopted him or not.  He was an indoor/outdoor cat then, and if he did, it's possible my friend wouldn't have known since I believe, he told me he used to just come home to sleep and have meals for the most part (he is neutered and my friend lived in an extremely rural area - NOT that this excuses it).

I saw Otto's post today and did read it.  I'll take another look again to absorb it better.  Thanks V.

Hmm, I'm wondering if it's a food intolerance/developing allergy? I know it's hard with two cats, but you might want to try to put him on a novel single protein diet for a while and see if that helps. Given that all of his tests have come back normal, I think it's worth a shot.

It could be something like IBD, but that's very hard to diagnose without a biopsy, so generally the vets try to rule out everything else first.

We probably could manage that.  Cocoa eats anything so I'd just buy something like Instinct temporarily, which I know is single protein.  He does like their lamb, beef and chicken items.  I heard not to buy the rabbit as it's sourced in China.  I've seen pork also but not so sure about that.  I can also get Hounds and Gatos here, which they like also and, is cheaper.  

How much time typically is needed to rule out a food intolerance?

I am not sure. I would give it at least a week, maybe two.

Well was just reading up on novel proteins.  That, could be a problem as I do rotation foods and he eats nearly all available proteins in rotation that I can get around here.

However, he has not ever had venison, rabbit, or pork.  All the other suggestions are not going to be found in NJ in canned food (such as alligator, bison, elk, goat, etc.).  He's only had quail as an adjunct to chicken in Before The Grain's Chicken and Quail. 

You can try the Nature's Variety Instinct rabbit (source in both China and France, but production in China is supervised), and Ziwipeak venision. Those should be easy for you to find here. :nod:

Something quick & easy to try? Aloe vera juice - George's, in particular. It's not organic (which is very bitter), but it has no preservatives in it, which is important. It's sold pretty much everywhere where we live - Walmart, the local health food store, Whole Foods...

http://www.aloeplant.info/need-a-digestive-aid-for-your-ibs-soothing-aloe-may-be-just-your-fix/

http://www.livestrong.com/article/16004-healing-benefits-aloe-vera-juice/

One teaspoon am, and one teaspoon PM. It's best if given on an empty tummy, but I can't get any of the cats to just drink it, so I mix it with food. The holistic vet said that was fine, it would still help.

I've never seen Ziwipeak anywhere near me in NJ.  I'll call around about it, one of my small local pet stores told me he can get me anything I want, if I buy enough of it.  Although, I'd certainly like to try it first.  I'd hate to buy a lot of it and then wind up not using it.  When I first bought the Instinct beef, while Casper was ill at the vet's direction, he wouldn't touch it.  Spent a fortune on it.  

Thankfully, several months later, I decided to try again.  Cocoa scoffed it up and suddenly, Casper decided he did like it.  So at least it didn't go to waste.

As for the aloe vera, I'll as the vet tomorrow. I suspect he'll be suspicious.  We are in the process of picking a new one (again) but it seems that none around me get particularly good reviews, and the few people we know with pets near us actually use our vet.  But most people, don't ask as many questions and aren't as well informed.  He doesn't seem to like this in us.  Pretty much has told us to stop looking up things on the internet.

AS IF.

sivyaleah said:

AS IF.

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Have you searched to see if there's a holistic D.V.M. near you? http://www.ahvma.org

If you want to PM me your location in NJ, I can ask the local BARF Yahoo group if any of them know of a holistic vet in the area (that's any good). Most of the are from points farther east or south than we are.

If he's a traditional vet, he won't have a clue about the aloe vera juice.

Oh - and maybe there are other locally-owned pet stores you can get to? I realized the store that stocks ziwipeak here is locally-owned, not a chain. We're so far NW, that anything under a 45 minute drive is "close" for us. :lol3:

I did search for a holistic vet a while time ago.  There are none near us.  The closest one was something like 45 minutes away which is just way too far.  In fact, if I remember, there may only be a handful in NJ altogether.  If it were Cocoa, I might think about it because she travels well but Casper doesn't.  He's yowling the moment the carrier hits the back seat.  I can't imagine driving that far and stressing him out like that, and then more stress of being at the vet on top of it.

But, as far as the food, I'm sure I could get it.  I'm in Union County.  I do have a relationship with a very small pet store in town.  He tends to mostly stock dog supplies, but has some for cats as well. and has always told me he is more than happy to get me anything I need.  There are also a couple of other privately owned stores and smaller chains which may have it also.  A bit more of a drive but not so bad as to make it annoying. One is in Summit, one in Garwood and the other in Clark.  Between those, someone surely must stock it.

As a last resort I work in New York.  If I can't get it there, I can't get it anywhere!

BTW, if there IS a holistic vet in Union County that I'm not aware of, awesome.

EDIT: OK, well, now I remember the last time I checked, the website wasn't working right.  There is one in Plainfield, which is close enough, less than 10 miles.  I can deal with that.  I'll look into her for sure.  Thanks for the reminder!

Update: For the interim, in spite of the article just brought up here, the vet still seems to believe Casper's situation is hairball related.  Especially since he is now grooming our second cat too.

He said he's incredibly healthy for his age (12 in a few days), other than some minor tarter buildup.  He lost about 1/2 pound since we last had him in, which was February.  This is good, he was 15 lbs. before.  We're assuming it's because he's become much more active since we adopted Cocoa; there's a lot of playtime going on now between the two of them.  He said this was good and was pleased to hear that we give him krill oil and the glucosamine (sp) as well.

For the record, this was a new vet at the practice we'd never used before and, who was a lot easier to work with.  He actually was glad to know how informed I was about many feline health issues, so the appointment went much better than usual.  The main vet, who owns the practice, well we haven't been seeing eye to eye with him so I think we'll request this one for now on; unless we do wind up switching and seeing the holistic vet.

We discussed possible allergies also.  And de-worming him, which had been a while.  We gave him the first treatment and the next is in 3 weeks.

My BF had been in charge of the hairball goop administration, but admitted to slacking off.  So, we're going to first try a week or so of going back to that and see if it helps.  If not, we're going to start a novel protein diet and see how that goes.  He hasn't thrown up in about 5 days at this point, so it's a good place to start.

If nothing changes at all in the next couple of weeks, I'm going to schedule an x-ray, to be on the safe side and make sure there are no obstructions.  But, even the vet has a feeling this isn't the case based on his history.  

I also had forgotten I froze a bunch of small balls of plain pumpkin, so I'll start feeding those to both of them again.  And, maybe trying the egg yolk lecithin.

We both feel a little more encouraged that there probably isn't anything serious happening at least.  Just need to get a handle on this one thing already.  

Aw, I'm glad you liked this vet better!

nothing turns up on the x-ray.

I have several threads here on going about Mazy's chronic regurgitation. I've been assuming Mazy's problem is from 6 1/2 years on a very bad diet. She's much improved over the year and four months since her diet has changed but still regurgitates 3-4 times a month, sometimes more, sometimes less. Very frustrating. Like your Casper, there is no weight loss, and Mazy is a very active 9 year old cat.

Also like your Casper, I have been able to find no pattern, though I am constantly pouring over my cat journal looking for one.

I have just started her on Slippery Elm Bark twice a week and 1/2 raw egg yolk four times a week. She already takes egg yolk lecithin (one capsule daily) for hair balls. I won't use petroleum based products ever again, I am convinced they are toxic, carcinogen.

She is on a two weeks on, two weeks off regimen with pepcid ac.

Mazy gets a check up every six months, and blood work every year (in June) but has not had x rays or ultrasound, or endoscope. Aside from the chronic regurgitation, she is the picture of perfect health and because of her peculiar horror of stainless steel tables and cages, I won't put her in a position where she has to be in one until the very last resort.

Didn't mean to make this thread about Mazy, but wanted to let you know you are not alone in your struggles.

It's ok Otto, I don't take it that way at all.  In fact, I've read all of your posts about Mazy over time and they have been very helpful.

Casper, had a very poor diet when he came to us.  We adopted him from a good friend when he was 9-1/2.  My friend, was going through a life crisis and couldn't keep him any longer.  He had him since he was a kitten, and was very attached to him, so it was a very well thought out decision on his part - not done lightly.  He knew, we'd be good cat parents for him, as both of us had cats previously, just not at that point in time.

He was eating a combination of Friskies wet and dry.  Not even the classics, it was the one with shreds so everything was chock full of wheat, corn, whatever.  As soon as we got him, I found this site and quickly learned about proper nutrition for felines.  Pulled him off those foods, but perhaps, some damage was done.  He actually had one incidence of a UTI early on when we got him - thankfully, nothing since. I do not really remember how much or if he was throwing up at that time, it's 3 years ago now and perhaps time and age is finally taking its toll on him making it worse.

I share your frustration with their being no clear cut pattern.  He'll go a couple of weeks at times with no incidence, and then suddenly 3 days in a row will regurgitate his breakfast, regardless of type of protein.  Most of the time, it's within several minutes.  And now there are times when he does it later in the day which never used to happen.  He even did it in our bed once - that was a first.  Good thing we noticed before we flopped into it for the night!

Hmm, I wonder if feeding him multiple small meals instead of two big meals would help? Also have you tried elevating his food bowl?

We could try elevating his food dish, certainly.  I did once, but I think it was too high for him as he looked very uncomfortable to me.  How high, is high?

Feeding several meals would be impossible on weekdays normally.  We work full time, and have a long commute into NYC, leaving home at 7am, and come back after 7pm.  The usual feeding schedule is me getting up first, and they get breakfast around 6am.  Dinner, is as soon as I get home, around 7:15pm.  

However, my BF is between working gigs at the moment so we could try it out.  Cocoa won't be thrilled, but she'll have to adjust lol.

I think 2-3 inches is a good height. Depends on how tall Casper is. I would try using a couple of books and playing around with the height to see what's comfortable for him.

Thanks for the suggestion.  He's kind of a big boy, but maybe I put it too tall last time.  I had taken a cardboard box and used that, and it was probably more than 3 inches.  I'm sure we can find something lower.  He does look like he's crouching too much when he eats at times.  

sivyaleah said:

How much time typically is needed to rule out a food intolerance?

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I was just doing some more reading on this, and according to Dr. Karen Becker, antigens from food allergies can stay in the body for 6 weeks, so she recommends doing 3 month long food elimination trials.