vomiting, cerenia, pepcid and antibiotics

Hi!  I have 2 older girl cats (8 & 12 yrs old) and 1 young male (2 yrs). We were joined last May by my mom and her 4 boy kitty litter mates (1 yr 3 mos) lost their home in the Moore OK tornado. So... 7 cats total. 

Last September, one of the new boys came down with a case of severe vomiting (no diarrhea or other obvious symptoms except a very mild fever). We checked him for blockage and other mechanical issues and finally decided he had either a virus or had developed an allergy to his food. Then his brother came down with the same thing (he ultimately required emergency hospitalization to stop his vomiting) and we leaned towards the virus theory. Two other cats presented with mild vomiting episodes as well. Finally everyone got better.

Then this morning mom's littlest boy kitty (Biscuit) picked at his food before leaving it uneaten (which NEVER happens). Half an hour later he was vomiting fluid. The second time he vomited (fluid again, but with a few tiny mucus-y flecks of blood) we called the vet and headed in. It was EXACTLY like the previous presentation from September. After feeling his abdomen (and saying it felt normal) they gave him fluids and a Cerenia injection and sent him home for observation. They also gave me Amoxicillin and Pepcid in pill form because "it couldn't hurt" for him to have those as well. 

So... Biscuit has spent the entire afternoon sleeping in the same spot... on a towel in a computer chair in mom's room (she's in there too keeping an eye on him). He wakes occasionally to stretch and turn around, but ultimately curls back up and goes back to sleep. The Cerenia seems to be doing its job (knock on wood). 

So my questions - for the moment, until something more interesting develops - is... has anyone ever seen anything like this?

It acts more like a poison than a virus. He was fine at 3am when my husband gave him and his brothers a few bites of food and put them in their bedroom (yes, they have their own room - heh) before he headed to bed).  Then at 7am he wouldn't touch food and by 8am he was vomiting (including flecks of bloody mucus, as if from an irritation). 

I've searched high and low all over the house and found nothing new or unusual that seems toxic. 

Then... has anyone ever seen Cerenia make them sleep? It advertises that it doesn't cause drowsiness... 

And how important are the Pepcid and Amoxi? I'm reluctant to force something into his stomach at this point if he's resting comfortably... just because... 

I guess I'm looking for someone to tell me they've seen this be a bacterial infection... Or heck, just that they've SEEN something like this so I will have some clue what we keep dealing with. Thanks for any input or ideas!

The time between the September episodes and the most recent one makes me doubt that is was an infection unless you have contact with other cats and even then it seems unlikely that it would all present the same way. If you are confident it's not a toxin (which was my first thought), I would look to other sources. What do you feed them? Are they all fed the same thing? What's their water source? Is there any evidence of insects or other small animals that could gotten in the house and been ingested? I am assuming from your description that they are indoor only cats?

I haven't heard of Cerenia causing drowsiness. His sleeping may just be a sign of being tired from being sick and his body needing the rest. I would definitely keep an eye on him but not worry too much yet. If he still seems unexplainably lethargic tomorrow, I would start to worry. As for the Pepcid, it works well for excess stomach acid, but since that doesn't seem to be the problem here, I am not sure it's necessary. As for the Amoxi, were any tests run at the vet's? It doesn't sound like it which is a shame because blood work should show some signs of a bacterial infection. I am not a fan of throwing antibiotics at illnesses without knowing that they are going to be effective (for both pets and humans ), so I would ask the vet why he thinks it would be effective. "It couldn't hurt" frankly sounds like throwing the kitchen sink at something in the hope that something will stick. I really think more diagnostic testing would be good as it seems you never discovered the cause of the problem the last time. It might help you narrow down the search at least.

Definitely not sure it isn't some kind of poison. I just can't find anything obvious. We do have a few spiders in the house, incl a fiddleback from time to time, but have had cats here for 8 yrs and nothing like this before.

He wasn't sick overnite, but the Cerenia was good til @11am. Gave him the 1/4 pepcid at 9am just to try and reduce any stomach acid issues. This am he is still listless and sleeping, but will follow The Red Dot with his eyes... so not totally out of it. Zero interest in food.

The vet should be calling to check on him... thinking about more tests. He definitely doesnt seem better.

Do you have any plants or flowers?

What do you clean with?

Do you give him or them, any people food at all?

What do you feed?

I was not familiar with Cerenia, so I did a search for it.

It is only "approved" for use in dogs, and its used for motion sickness, and should not be given for vomiting, unless the reason for vomiting is known.  The few articles I found, that it had been given to cats, the people said it made the kitty spacey or very drowsey. 

I would not give Pepcid AC, with the Cerenia, since they both do about the same thing, Pepcid AC is used for nausea, and to settle their stomach, so they will eat, as in, they have a upset tummy. 

I am very leary of injectables, given, when the source of the issue is not know. If its pills, and there is a reaction, you can stop the pills, an injection, and there is a reaction, your sca-rood, as its already in there. 

Never let your cat be given Convenia, its an injectable antibiotic, way too many side effects and can cause death, and for the same reason, once its in there, you can't take it back.

You might want to do a search for the Cerenia, alot of not so good things came up.

In searching for it, made me think of something that happened years ago at a show. My cat was sick, person I was riding with would not leave, could not reach my vet, left a msg on her cell, people at the show, who I knew for a long time, and trusted, insisted on giving him a pill, said it was for upset tummys. I "think" it was Cerenia, if not, it was a similar sounding name, that did the same thing, supposedly. When my vet called me back, she "yelled" at me, said never never never, give him anything, without talking to her first. If I was that concerned, I should have asked the show manager for a vet. She said I was lucky, it wasn't my cat that had HCM, it would have killed him, it cannot be given to a cat with heart issues. 

Never accept, I don't know, or it couldn't hurt, that means, the vet doesn't know, and is not going to look any further.

That is not acceptable.

Have you done a CBC and Wellness blood panel, to see if any values are not normal? It should not be done in house, but should be sent to Antech or Idexx. The have specialists, that work with your vet, to help determine diagnosis and treatment.

Your vet, if stumped, should be on the phone, with A&M or Cornell or UC Davis, or Rochester or one of the other vet universities, asking for help, that he/she didn't, would upset me. You might want to consider another vet, or seeing an Internal Medicine Specialist. 

http://www.peteducation.com/article.cfm?c=26+1303&aid=3564

http://www.peteducation.com/article.cfm?c=1+2122&aid=3576

Please let us know, how he is doing, if he was my kitty, he would be on his way to A&M.  (((((Hugs))))))    

Is it the same cat having episodes at different times?   Cerenia and Pepcid are the normal things given for IBD.  There are many kitties here that have taken both, they do only relieve symptoms.  If you are dealing with something like IBD you will never be able to get a firm diagnosis unless you go with a biopsy which very few of us have gotten.  My kitties symptoms can only be controlled with a steroid others have managed to control the symptoms with diet alone.   If this is two kitties that were litter mates it still be IBD because there is definitely a genetic predisposition to it.

The question is, is this a contagious illness or is it environmental?  If environmental you would probably go with plants, OTC human medications, chemicals/poisons, or spoiled or tainted food.  There has been a large in crease in tainted food made with products from China in the past year, this possibility I think should be given some weight.

We don't all agree on this site, so you need to balance the advice given to you with some skepticism, and erply primarily on your Vet. 2nd opinions are never wrong either.

Pepcid is safe and commonly given and I have seen many cats get convenia and cerenia with no ill effects.

here are two very detailed articles on cat vomiting:

http://www.aspca.org/pet-care/cat-care/vomiting

http://www.vetmed.wsu.edu/cliented/vomiting.aspx

Stephen

We have no houseplants. Meds are kept in locked cabinets. If it is a poison, none of the other six cats are affected. The previous illnesses were two different cats (littermates) six months ago (and several weeks apart). He was up and more alert but still queasy this afternoon so we took him back for bloodwork. They ran the cbc twice and it was just a touch low, but not anemic so the vet said it is ok. BUN was a touch low also but also did not concern the vet. All other values in normal ranges. Temp was 102 so... also pretty normal.

He is peeing ok. Twice earlier today (as expected jafter subcu fluids) and again just now...but i noticed one other thing... afterwards he went to two other boxes but didnt do anything. Now he is hiding under my desk. Hiding is not something he usually does, so now I'm more concerned.

Forgot to answer food question. Biscuit gets Royal Canin 27 indoor dry with a little canned thrown in for gravy. Five other cats eat the same dry food. Three also get the canned (usually purina pro plan or low carb fancy feast). Biscuit in particular won't usually eat treats. He gets no people food.

The vomiting with flecks of blood in it sounds very familiar to me.  I had a cat who was doing this, it ended up that she had a Gastric Ulcer caused by Helicobacter Bacteria.  She was put on antibiotics and acid reducers as well as something to coat the stomach.  I'm not saying that's what is wrong with your kitty, just that it happened to mine, so may be a possibility.  Cerenia works really well, it is an anti-nausea drug.  We use it a lot at the vet clinic I work at.  Pepcid stops the production of acid in the stomach.   Being that it has been about 4 months or so, I do not think that the vomiting episodes are related.  Kitties can get things like a version of the human flu which is probably what was going on back in September.  You might want to consider a 2nd opinion if your kitty isn't showing any improvement. 

We'll be taking Biscuit back to the vet this morning. He was so queasy last night that getting even half a Cerenia in him, much less the liquid amoxycillin, was a total waste of effort. Any time we'd get anything in his mouth he'd gag and undo our progress. By the time we were on our fifth try he was so anxious that all he wanted to do was hide (and I don't blame him).  He is still lethargic, no appetite and nauseaous this morning. I can't help but feel that by seeing no change we're losing ground. 

I know the vet will suggest IV and/or subcutaneous fluids (depending on whether or not I want to leave him there for treatment) and a Cerenia injection. I will mention the ulcer possibility as well as the other ideas here. 

When we went through this back in July with the other 2 cats, one got better in @4 days - though it was two weeks before he stopped sporadically vomiting - at least he was trying to eat the whole time.  We were worried about feline infectious peritonitis until the second cat got sick 2 weeks later. He got better too, but only after we hospitalized him at the emergency center on the third night to get his vomiting under control (there is only so much suffering I'm willing to see them go through). He was worse than Biscuit on that score, who only really vomited once last night (and I was up with him watching, ready to take him in). 

Last time around, no one came up with a solid diagnosis... and my vet is an AAHA accredited facility, so I want to believe they do the right things... checking other resources, etc.. The city Animal Emergency Center (with all their vets and experience) came up empty handed too on exactly what was going on, even having the one cat overnight. Ultimately we took him home when he decided to start eating. 

I have no idea what would be best for Biscuit. Honestly... I want some better answers and none of my vets seem to have them.  I was really tempted to take him to the ER vet just because they are the ones that ultimately helped his brother... but as second opinions go, they are VERY expensive. Still... if I thought it would help... 

I guess I will go see my vet again this morning, at least get him something for his immediate comfort. I just hate to keep dragging him over there... he is not a people cat and the stress of the visits sets him back too. And I know I'll have to decide whether or not to leave him for the day.. IV fluids & hospital vs. subcu fluids and home. Sigh. 

I do believe, its what you are feeding him, the Purina, many have had the exact same issues you now have.  I highly recommend you get him off the Purina. Royal Canin is not good either. It has grains in it too.  

http://www.consumeraffairs.com/pets/ralston.html

Here is a good site to read.

http://catinfo.org/

I am familiar with Dr. Pearson's information. We had a diabetic cat and there wasn't much about feline nutrition I didn't read during that time period. 

That is an interesting consumer affairs review. I know quite a few people with nothing good to say about purina products. Really, though, the canned food makes up a very tiny portion of their diet. Mostly it is the RC dry they eat. I'd love to feed them all canned, but 7 cats twice a day canned is a bit much. They've been on the same food for a LONG time though... so it would have to be something in a certain batch of food recently.

The vet gave him the subcu fluids and Cerenia and I brought him home to rest. He slept on my lap for nearly 3 hours - which is a vast improvement over the hiding we've been doing since last night. I'm going to try him on some food (probably chicken broth or chicken baby food) once the meds have had a while to work. He's starting day 3 without food, so I'm definitely treating that as priority one. Otherwise I will try to get some antibiotics in him this evening. The Dr offered to hospitalize him... as I knew they would, but admitted that the only advantage would be getting fluids in him faster than the subcu route... so I opted for the less stressful environment of home. Really, really hoping we see some results soon. 

I'd also like to thank everyone for your suggestions and input. It helps to have the experiences of others to draw on, especially when this particular thing seems to keep happening to us.