Help with My Nauseous Kitty...

Hello all,

My cat Ichabod has had a rough life so far. He just turned 2 last March, and has been struggling with nausea/vomiting a lot lately. He goes through phases where he will vomit, refuse to eat, hover over the water bowl, howl... and then the next day he is fine. These "phases" have happened about three times in the last year.

In April, I took him to the vet again, and did a blood panel for Ichabod. Everything came back clear- no kidney or liver issues, nothing. Since, he's been on as-needed doses of Cerenia and Mirtazipine. I don't give him the Mirtazipine at all anymore, but the Cerenia is necessary. As soon as the Cerenia is out of his system, he vomits. He also has some inflamed back teeth, but I'm not sure it would be enough to cause such severe nausea.

The vet thinks it might be IBD or stomach/intestinal cancer. I'm taking him in next week for an ultrasound to rule some things out. Anyone who has experienced a similar situation, or have advice? I am at my wit's end with trying to figure this out. Thank you in advance!

Also, Ichabod was on Fancy Feast for the first 1.5 years (recommended by my vet, if you can believe it), but I switched him to EVO Duck thinking it might be a food allergy. The food switch has not changed any of his symptoms, though.
 

First and foremost, information that should be helpful to you

http://www.dcavm.org/07sep.html

Thinking about your situation ......Intestinal cancer at age two would be quite unusual but not entirely unheard of. More likely possibilities in a two year old would include chronic gastritis, IBD, and severe food allergy.  

The definitive test for IBD is an endoscopy.  Blood work will not catch it and usually it doesn't show up on an ultrasound either.  I would urge you to schedule an endoscopy as soon as possible.  The ultrasound might show something unexpected, so it is a good idea to have one done as well.   

Also, please demand the fPLI test to find out whether pancreatitis is involved.  Very, very important. 

Diet - a vitally important factor.  Also, whether your kitty is allowed outside without supervision, whether you have plants in your home, etc.  Lots of little, seemingly insignificant details.

Many cats with IBD or just severe digestive problems/allergies can't tolerate anything with grains and vegetables, even if the vegetables come in therapeutic formulas that are supposed to be helpful for such problems.  A plain no grain no vegetable diet, and, even better, a raw diet, can be wonderul for them and cause the digestive tract to calm down and heal. If several of the possible underlying causes mentioned in the article can be ruled out, age two would be an ideal time for making the switch to raw. (Tremendous amount of help right here on TCS would be available to you if you decided to make that choice.) 

It sounds like IBD or pancreatitis to me. IBD can't be definitively diagnosed without a biopsy (which would also check for lymphoma), but most vets will treat the symptoms. The standard treatment is prednisolone for the inflammation, cerenia for any nausea and an appetite stimulant as needed. You're already giving 2 out of the 3. I would talk to your vet about trying pred to see if it helps with the vomiting.

There is a separate blood test that can be done for pancreatitis which is also hard to diagnose. It's called the spec FPL test.

And finally good nutritional management is important for both. IBD and pancreatitis kitties usually have triggers that cause inflammation which causes flare-ups of both conditions. It can be difficult to figure out what the triggers are since each cat is different. Common ones are grains and fish. There is a possible link between carrageenan and IBD, so some people avoid that which is hard since it's in most canned cat foods. Some people have found feeding raw to be very helpful for IBD kitties.

A good site for info is www.ibdkitties.net.

Endoscopy info

http://www.vcahospitals.com/main/pet-health-information/article/animal-health/endoscopy-gastrointestinal-in-cats/117

A  couple of important quotes

While seeing an abnormal lesion or suspicious area gives us valuable information, it is usually necessary to biopsy the area in order to reach a diagnosis. The endoscope has a tiny channel through which a biopsy instrument can be passed. Precise biopsy samples, which consist of tiny "bites" or pieces of tissue cut from the surface tissue or lining of the organ by the biopsy instrument. These samples, called "pinch biopsies" are then submitted to a veterinary pathologist for microscopic evaluation.

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Many diseases cause changes that can only be detected by histopathology, or a microscopic inspection of the tissues. Therefore, even if the organ or tissues appear normal, biopsies are taken. In many cases, biopsy of the stomach of a vomiting cat or of the colon of a cat with diarrhea will be very helpful in determining if disease present.

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Thank you for your input so far. He did get a pancreatitis test, but it came back negative. Any advice on IBD/pancreatitis treatment? Or info on prognosis/life expectancy?

IBD is an autoimmune response that can't be cured only controlled.  If the trigger can be found than it can be controlled without medication and the trigger is often food related.  If a trigger can't be found than it's controlled with as small a dose of a steroid that will keep it in check.  Prognosis depends on the level of control over the inflammation that can be attained.  A history of uncontrolled or poorly controlled IBD does put the cat at an increased risk of lymphoma.

The pancreatitis test.  Was it the fPLI test or something else? 

For IBD treatment, the best, most effective medical treatment is based on the results of an endoscopy.   That's why doing an endoscopy is so important. 

Well managed IBD does not affect life expectancy. However, it's crucial to find the diet that works (canned or raw) and catch any problems along the way as soon as possible and correct them quickly. Little mistakes can cause a recurrence of  inflammation that may need a short course of anti-inflammatory medication to calm things down again.   With a diet that allows the digestive tract to heal, after initial treatment with medication, further use of medication is usually not even necessary.  And these kitties can live great, long, happy lives, well into their late teens, or even longer, until something else gives up in their body due to old age.  (Speaking from experience here.)

Diet has to be tailored to individual need. What works for one kitty may not work for another. 

I would like to caution you about vaccinations.  Important info here

http://www.holisticat.com/vaccinations.html

Can't think of anything else to add at the moment, please ask if you have any questions.

Also, please go over to the nutrition forum, you'll find experts there who can offer you a great deal of help. 

Thank you all for your answers and resources! It was very helpful. I took Ichabod to get an ultrasound on Wednesday, and the vet said a normal cat his age has 2mm thick intestinal walls, and Ichabod's are 4mm, which suggests definitively, to him, that it's IBD. We're currently doing a treatment of 10mg of Prednisolone per day for 3 weeks and then taper down. Does anyone have suggestions for diet? Ichabod hates EVO and raw; if it were up to him, it would be Fancy Feast all the way. Is Dave's a good alternative food? It has some vegetables which I've tried to avoid, but is grain free and the cats seem to like it.
 

I'm not familiar with Dave's cat food, so I can't comment. Generally with newly diagnosed IBD kitties, you want to feed a single novel protein food with as few ingredients as possible because you don't know what is triggering the IBD. Therefore, you want to eliminate as many ingredients as possible. If that works, later you can add more foods back in gradually, but if any food causes a flare-up you will need to compare ingredient lists and see what the possible culprits are and eliminate those. It's really trial and error.

Hi smjones My kitty (10 years old) was recently diagnosed with IBD and intestinal lymphoma via an ultrasound. The age for each cat is very different, but like others have said, the IBD is very plausable. A combo of Cerenia and prednisolone has helped Sparkle immensely! He is also eating Fancy Feast canned food, but just over the past few days has been demaning his crunchy kibble instead (Purina Naturals). I also try to feed him very small amounts 3-4 x per day. 7:00am, 1:00-3:00pm, 7:00pm, midnight. It has seemed to help, too. I don't have much advice, just sending you good vibes