"Frequent" vomiting or hairballs once every 2 months can be sign of small bowel disease

Evidence-based medicine research published at the end of December 2013 indicates that too many pet parents and vets think some vomiting is "just the cat," when, in fact, it may be a sign of small bowel disease, or developing small bowel disease. Contrary to intuition, "chronic" vomiting is not a problem based further up the GI system.

Discussion of the published piece:

http://www.veterinarypracticenews.c...c-vomiting-in-cats-isnt-normal-after-all.aspx

http://veterinarymedicine.dvm360.co...ng-cats/ArticleStandard/Article/detail/832271

http://veterinarymedicine.dvm360.com/vetmed/article/articleDetail.jsp?id=831497&pageID=4

The study abstract: http://www.ncbi.nlm.nih.gov/pubmed/24171376

Notable:

A study of 100 cats with a history of chronic vomiting, weight loss, chronic diarrhea or a combination was recently accepted for publication by the Journal of the American Veterinary Medical Association.1 The authors, whom I led, concluded that chronic small bowel disease likely is the cause of these clinical signs in hundreds of thousands of cats.

Chronic vomiting, present in 73 percent of the cases, is so common that many veterinarians and cat owners have made excuses for it.

The top four reported to me over the years are:
* He eats too fast;
* She has a sensitive stomach;
* It’s just hairballs; and
* "He’s just a puker,” to quote one of my clients.

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Also

Another notable finding in this study is that vomiting of hairballs is really not as normal as we have thought. The vomitus of many of the cats contained hair or hairballs more than 50 percent of the time.

I hypothesize that formation and vomiting of hairballs are due primarily to hypomotility of the small bowel. Instead of moving aborally at the normal speed, hair moves slowly, resulting in hairball formation.

I am convinced that the vomiting of hairballs is a sign of chronic small bowel disease if it occurs twice a month or more in any cat; or if it occurs once every two months or more in shorthaired cats; or if it occurs in cats that are not fastidious groomers, i.e., presented with many mats in their hair coats or with heavy dandruff.

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Bold, my emphasis


Finally,

About 25 percent of the cats in the study were presented for an annual examination. I begin my annual examinations with the client completing a history form that asks about several clinical signs. Vomiting is the most commonly reported clinical sign and is often accepted by the client as insignificant based on one or more of the excuses listed above.

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From the study results, that 25% of cats (26 cats) that were just there for an annual examination that the author felt that vomiting should be investigated further?

Twenty-six cats in the study were evaluated as part of wellness examinations. Each of these 26 cats had clinical signs of CSBD [chronic small bowel disease], but the owners did not consider the signs to be clinically important. Explanations provided by the owners for the signs included that the cat ate too fast, was typically nervous, had a sensitive stomach, had hair balls (ie, trichobezoars), or had always had these signs and thus the cat was considered clinically normal. Of these 26 cats, 16 had chronic enteritis, 8 had lymphoma, and 2 had lymphoma and mast cell disease.

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And the owners of those 26 cats had considered the vomiting insignificant.

I am convinced that is why Patches IBD went undiagnosed for so long.  His vomiting went beyond occasional vomiting, he wouldn't be able to keep anything down and would be vomiting bile. He never had diarrhea which is common with IBD.   His first flare was when he was 18 months old.  Because of his age the vet assumed he swallowed something, he was hospitalized and a stack of x-rays were taken.  There would be a flare every few weeks or months and I went to different vets.  He was hospitalized on an IV because of dehydration one other time.  I even had a cat's only vet, a different one from the one that finally got it right, diagnose him with pancreatitis.

I think the fact that it started when he was 18 months old, IBD is typically first diagnosed when a cat is middle aged, and he didn't have diarrhea is why it took so long to get a diagnoses.  Each vet assumed it was something acute even though he had an increasingly long history of severe nausea and vomiting to the point of dehydration.

Interesting about the hairballs.  DeeJay pukes hairballs probably 2-3 times a month.  She is a fastidious groomer though, she has pscyhogenic alopecia so has no hair on her tummy and inner back legs. 

I took my Chumley who was overgrooming to a DVM additionally trained in Chinese Medicine when he mowed his stomach and inner legs clean.

He was diagnosed and treated from a Chinese Medicine perspective and within a few weeks it was quite clear the problem was going to be resolved. The vet had us keep him on the herbals for almost a year, though once off them, the symptoms did not return. We then successfully transitioned to a raw diet. There just is no Western Medicine equivalent for treating that kind of problem. The cause is an "extreme Yin deficiency." Basically, your kitty is "too hot" (not as in a fever) and thus ripping her hair out.

I can certainly attest to this.

I adopted Sebastian in the summer of 2010. I don't remember him vomiting hairballs that much in the beginning, but then it started to get worse and worse. Maybe once a month, then twice a month, then every other week, etc. to the point where it became once a day. These were what I like to call "hair tubes" about  3/4 inches thick by 4 inches long...absolutely massive and must have been painful to bring up so frequently.

In 2013, he was diagnosed with chronic pancreatitis (confirmed) and suspected inflammatory bowel disease (no biopsy done). The inflammation is being controlled by a low antigen diet, steroids and complementary supplements. Like @Denice's Patches, Sebastian never had diarrhea.

Unfortunately, vets that specialize in Chinese medicine are few and far between in my area. We've got lots of traditional vets, but only a couple holistic vets that I wouldn't even consider "fully" holistic. None of them specialize in Chinese medicine.

Hairballs...that's the next thing for me to tackle. I give egg yolks, but I still can't go longer than 2 weeks without giving hairball treats to push out the hair. This last batch of chicken thighs, I totally forgot the egg yolks and vomiting hairballs galore.