Cat with suspected food allergies throwing up blood - on steriod and antibiotic

Our cat Loki has been through a run of tests these past few months. I had another post up asking advice for her severely infected nailbeds and some back lesions. Since that post, a biopsy was run which showed a form of allergy, which we were hoping might be chicken related. About 10 days ago she was put on Prednisone along with the Orbax she was already on, and about a week ago she was switched to Biomox (Amox. Drops) instead as the vet didn't want her on the Orbax for that long of a time. We also switched her to Nature's Variety Limited Ingredient Lamb wet food in the hopes that it might be a food she wasn't allergic to.

About 4 days ago I began to see a bit of mild throwing up, which I attributed to either the change in food or some stomach upset with all the meds. This morning, however, she threw up what appeared to be blood, on an empty stomach before she ate and before her morning medications. My vet, of course, is not available today, and I really don't know how serious an issue this is. Her bloodwork was nearly perfect, skin culture/fungal culture led us to the allergy diagnosis. My hunch is that the throwing up began just a few days after we switched to the Biomox (Amox. Drops).

Does this sound like simply a potential stomach upset that possibly led to an ulcer or the like? She appears to be acting normal otherwise, except she wasn't as eager to eat this morning. Today was also her first skip day for weaning down the Prednisone - would is also be advisable to skip her antibiotic today as well until I can call them tomorrow morning? I know they are supposed to be on an antibiotic with the steroid, but I'm assuming right now it might be riskier to keep putting the meds in her system if they might be causing her to throw up blood.

Any advice is much appreciate. We do have an emergency vet clinic but we've had bad experiences with them. In the past they've simply taken a quick look at our pet and told us they didn't know and to see our regular vet.

I should add that since the prednisone, food change and leaving a cone on permanently, her infections are almost completely cleared up.

It could be any number of things.  My first thought because of her history of autoimmune issues that there is inflammation in her GI tract.  With a week on this antibiotic I don't think that it would be causing this, reactions to antibiotic are usually fairly quick.  If it's related to medicine my thought would be that it is related to tapering off the pred.  Since she has eaten, which is the big concern, I would give the antibiotic and call your vet tomorrow.  

Vomiting on an empty stomach is often a sign of excess stomach acid.  I would ask the vet about giving Pepcid.  It will cut down on the amount of stomach acid.

She began the antibiotic Sunday night, and I'd say the throwing up started perhaps Wednesday or Thursday. She definitely did eat some afterwards and it appears to have stayed down, but I haven't given the antibiotic yet.

I remember that even though this all began as an allergic reaction her claws in particular had become infected.  I would go ahead and give the antibiotic.  Just as in humans, the antibiotic needs to be finished.  I really think if the antibiotic is causing the vomiting it would have happened quicker than three days later.

Was is red blood she through up? Or was it black digested blood? Coffee grind appearance? Could she have gotten into anything? Any trouble giving her the amoxi? Is her blood in the throw up at all related to what time you gave the medications. If it were me I would skip all medications until after talking to your vet

Sorry for the delay. I ended up on a 7 hour drive to rescue a mouse.

The suspected bloody vomit I saw was quite red, and since she hadn't eaten since the night before, it was pretty much just blood and bile, I assume. She threw up on our light gray carpet and the spot was a noticeable, bright red spot about a few half dollars in size. I wasn't able to watch her today as I was out getting the mouse, but my father kept her inside all day and said he didn't see any more vomiting and she also at a bit of her food. Not tons, but at least she was interested again.

She does go outside supervised, so yes, technically she *could* have gotten into something, but we've been watching her like a hawk as she has to keep her cone on so I really don't believe she did. The first couple of throw ups this week seemed to be happening about two to three hours after her evening medicines. Her morning meds this week were pred and biomox, her evening meds just the biomox, and until this morning I've only seen her throw up about two hours after her evening meds.

This morning was her first skip day for the prednisone, and I skipped her morning dose of Biomox (Amox. Drops) since it was the medicine I was most suspecting. I was leaning towards skipping her evening dose as well and calling the vet in the AM to see what they would like to do.

I also noticed that the shivering her body was doing before she began the prednisone (that I thought might be from pain from the infected nailbeds) appears to have returned. The nailbeds look *much* better though, as do her back lesions.

So far she's had 5 days of twice daily prednisone, followed by 5 days of once daily prednisone, and today was her first skip day of "every other day" dosing.

Her system has definitely been through a lot these past few months. She's been on a number of antibiotics (clavamox, orbax, biomox) while we tried to get to the bottom of the issue through numerous tests, as well as a round of ringworm medication when a household member presented with ringworm lesions that resembled Loki's back lesions, and most recently prednisone with more antibiotics - along with a total food change since we were very much leaning towards her having a chicken allergy (we've seen small scabs before when she had chicken based foods but they always went away).

OK.

Are you actually witnessing her vomiting, or just finding the spots afterwards?

A couple of half dollar sized spots of red blood from vomiting is very alarming and something she should see a Vet ASAP for.

When blood is digested it turns black or will look like coffee grinds. Red blood means that there is a lesion before it gets to the stomach. If she has done severe retching with dry heaves I suppose it could be a vein in the esophagus but I have never seen that happen. Is there anyway when you are giving her the pill you could be scratching the roof of her mouth or the back of her throat with a finger nail? I don't know how far you follow the pill with your finger when giving. I also have to wonder if the medication is sitting back there and irritating it. You know how when a pill gets wet it leaves a powder residue. Does she eat right after giving her the medication or do you give her any water after?

What was the medication you were giving for the ringworm? Was a fungal DTM  ever done to confirm or was it just given based on a family member having had it?

When food allergy manifests itself in the skin it usually is severe itching around the face and neck. Is this where the scabs were? Is this why you thought chicken allergy? I will go back and read all your posts.

With food allergy, although there is a blood test that supposedly tests for sensitivity to certain foods, I don't know that it is a valid test. At least that is what I was told by the dermatologist about 3 years ago. There is a test out there but it doesn't work. Things may have changed.

As far as I know the only way to treat suspected food allergy is to feed a novel protein source for about 3 months and during this time no other food or treats etc. You either see improvement in the 3 months and assume that was the issue or you don't and you start all over again with a different novel protein source. (Novel protein source is one the cat has never had before such as duck or venison or even rabbit)

The prednisone can cause GI bleeds when given with any anti-inflammatory.   Has she had anything like that at all? Did they give her Medicam or have you given her anything over the counter? Sorry have to ask. Then again if it was a GI bleed the blood wouldn't be red it would be dark brown to black.

The amoxicillin can cause GI upset and vomiting in some cats.

If it was my cat I would take her in to an emergency vet right away due to the red blood being in the vomit and the continued vomiting. If I was not able to do that then I would hold off on the steroids and the antibiotics until talking to the vet and encourage her to eat. You can try the Gerber blue label baby food in beef or even lamb. Just check the ingredients and be sure it is only the meat, water, corn starch, and maybe citric acid. Nothing else.

I am a bit concerned that if they prescribed an antifungal for the ringworm it can be very hard on a cat itself.  See if you can find out which one and when you were giving it and also when the start of the pred coincides with that.

Hope she is doing better now.

I thought the biopsy only showed an allergic reaction with staph.  I don't think there was any fungal infection.  My IBD kitty would do the vomiting bile and blood when he was in a flare.  This started with tapering off the steroid, that's why I think this is an inflammation issue in the digestive tract.

Could be, but I was under the impression that Sunday was the day she was supposed to skip the pred anyway so it won't hurt to wait until the vet opens and call them before giving it. Pred should be given at night to cats anyway. As for the antibiotics, they are supposed to be given with food to avoid GI upset so if the cat isn't eating well and there is any chance the amoxi is causing the vomiting which it does in some cats, then she would be best waiting till the vet opens and asking them. But like I said in my post I think that she should see a vet ASAP due to such a large amount of fresh blood in the vomit. IMHO

@Quiet

You stated Pred should be given at night? I was not aware of that. May I inquire as to why?

I am actually witnessing her vomiting. I sleep with her now on the couch, and each time she would jump down and begin vomiting. If it was in the middle of the night I woke up and turned on the light. One time she was actually on the couch with me and I leaned her head over the edge so as not to have vomit on our "bed". Yesterday morning with the bloody vomit it was right in front of me. It's definitely been her and not one of the other cats.

Since yesterdays morning bloody vomit, we haven't seen any more bloody vomits. She's been getting some food down again and at most there may have been a bile vomit in the hallway - of which I can't say if that was her or our hallway cat. Yesterday morning was the first and only bloody one we've seen, though we did pull her antibiotics yesterday and it was her first skip day for the pred.

As for damage when medding, I highly doubt it but I would never say absolutely not. She is being given liquid medications, and I always gently wiggle the syringe in the side of her mouth and then slowly squirt in in - while the syringe is still sideways. She's actually very co-operative and doesn't really fight. Again though, I'm sure anything could potentially have happened and I might have missed it.

I've also been on the phone with my vets office and am awaiting my vet's arrival for his opinion before I resume any meds. She's only got three more pred. pills, and she's on her "every other day" dosing for those. The antibiotics are being administered because she's on the pred, so I assume they will stop after as well. All of her infected areas look *very* good and on their way to being almost healed up - the back ones are almost healed and the nailbeds are still a bit swollen but the skin is completely light pink now and no more raw areas. So I'm hoping we can stop the meds for awhile and try to get to the bottom of this with only dietary logging and changes.

For the tests, in order of having them done:

bloodwork: showed nothing more than signs of a minor infection. I was told her bloodwork was "nearly pristine"

bacterial culture: showed staph

fungal culture: negative

biopsy: "severe subacute ulcerative eosinophilic dermatitis"

For the ringworm, she was treated with Diflucan at my request as my father had traditional ringworm lesions on his skin that started at the same time Loki presented with issues. My father does garden a lot and and does a lot of yardwork, so there was always a possibility that the two were unrelated. Her fungal test two weeks later came back negative. There was also at least a week break in between the last dose of diflucan and the first dose of pred.

For the suspected chicken allergy, she was getting small scabs on her upper back, sometimes a few on top of her head. We finally realized that they almost always came about when she was on a chicken flavor of food.  Unfortunately, we failed to make that connection again when we switched them all to a homemade diet of, you guessed it, primarily chicken. While I had hoped she was allergic to the quality of canned food or perhaps any of the by-products, this most likely would have been her highest diet of chicken to date and also her worst outbreak. It's still completely my best guess though on the allergy itself being to chicken, but it seems likely to me.

As for testing, my vet said that the test is pretty reliable for positives but not for negatives. He stated that many animals with allergies will continue developing allergies as they go along, so although they test negative for something now they could easily become allergic to it later. He also said that the test doesn't always catch some of the lesser known allergy triggers. His opinion was that trying to figure it out ourselves with food trials and logging was probably as helpful as running the test.

For Loki's food, we ended up choosing Nature's Variety Limited Ingredient Lamb. I was told that brand was a good one to try for food allergies, but if anyone thinks otherwise please let me know. I just figured she'd probably not likely had lamb before. She's been eating it for about a week now and seems quite happy with it, at least. She was eating it at least a week before the throwing up began. Her wounds are still clearing up, but now that we're weaning off the pred she does seem a bit itchy again. I was told that it could take quite awhile even with the right food for the reactions to stop, so I'm not sure if we are stuck with her on pred at this point or if the itchiness eventually just goes away once her system gets back on track with the right food. I wasn't sure if, even with the right food, we might be stuck in a loop of her scratching because it itches, and then it itching simply because she keeps scabbing herself up even though it might no longer be an allergy issue at that point.

The only other med I can think of that she was on, (beyond the clavamox, diflucan, orbax, pred, and biomox - in that order) was a one time pill given of tramadol, perhaps two weeks ago when her shivering seemed very bad. She didn't seem like herself with that pain medication so after the first pill we didn't give her any more.

@ Denice: (if you've read this far)  

Does IBD show as a definitive diagnosis in any of the tests I had run, or it it diagnosed just off the symptoms? Were you able to manage your kitties stomach upset without the use of steroids, and if so, how?

IBD isn't diagnosed with the tests you have had run.  There is a blood test that checks for absorption of B vitamins.  http://healthypets.mercola.com/site...11/02/inflammatory-bowel-disease-in-pets.aspx  explains the test.  This isn't a long standing issue though so I don't think there is a need to start looking for it.  I think this is a continuation of the other inflammation rather than IBD.  The decrease in the pred could very well be why the itchiness has begun to return as well.

Just got off the phone with the vet's office. They want to discontinue the Biomox but do one more round of the pred, since her nailbeds are not 100% healed. They are *much* better than they were, but the tissue still appears a bit swollen. The back lesions are almost 100% gone, we just need the fur to start growing back in. Also, still no sign of any more throwing up since yesterday morning, and she's back to eating her wet food as usual.

That's good.  I really wouldn't be concerned about the pred.  My kitty has been on a steroid for 3 1/2 years now.  The risk of side effects kick in with long term use, the main one being diabetes.  The diabetes clears up when the steroid is discontinued. 

I'm so sorry to hear that you hit another hurdle with poor Loki. I hope the vomiting was just a temporary side effect of the meds. 

Amoxicillin has the potential to cause nausea and vomiting in cats, so I wonder if she is sensitive to the Biomox.   

Oh, and I wanted to add that my vet also said it is best to give prednisolone to cats at night. It apparently mimics their natural hormone cycle.

Just wanted to update on Loki. She began a second round of Pred. yesterday, we discontinued the Biomox and added Carafate (sp?) to try and soothe her tummy. We haven't seen anymore vomiting since Sunday. She is, however, itchier again - I'm suspecting because we were weaning her Pred. back down, and if we try to remove her cone she very quickly begins cleaning her back and opens the lesions that were almost healed up. It's really discouraging, as she's been in this cone for over 3 weeks now and it just doesn't feel like there is an end in sight. I had hoped that with the Pred. she would eventually get to a point where she could get that cone off permanently, but it looks like our only hope is to get everything healed up 100%, complete fur regrowth and all, before we stand a chance at not having those lesions re-occur.

The kick of it is that the cone itself is irritating her neck and causing a few more sores, though they are currently minor.

I'm also assuming, and correct me if I'm wrong, that her still being itchy after 5 days of twice daily pred. followed by 5 days of once daily pred. does not necessarily mean that the new food we started her on is another one she is allergic to, correct? I've read that it can take weeks or months, even with the right food, before the symptoms of the previous allergy fully resolve. Am I understanding this correctly or should I be concerned that this food is another that isn't good for her (Nature's Variety Limited Ingredient Lamb). She was healing up wonderfully with the cone on, but definitely seemed to be getting more itchy on about the 5th day of her once daily dosing, and then opened up one back lesion today when we forgot to get her cone back on for a few minutes after she ate.

Thanks also for the additional info on dosing the pred. at night. I'll make a note of that when we get her back on her once daily dosing. Right now she's back at twice per day.

Hi

Yeah, it can take up to three months. Have you seen a dermatologist with Loki? It might be a good time to ask for a referral to one. You would be amazed what all that extra schooling and time spent only working on one area of the body can do. It might not be a bad idea to ask about Atopica. It is a treatment my cat was on that is a pretty hard core drug used for allergies in dogs and cats. You have to do a full blood test first and continue to check the blood every 3 to 6 months if I remember correctly. It has been about 5 years since my cat was on it. Just something to ask about. Like I said, it has been about 5 years since I used it so maybe it isn't used anymore in cats.

Carafate is a brand of sucralfate, which is commonly used to treat stomach ulcers. Why was the pred being reduced if Loki's symptoms hadn't fully subsided and the lesions healed? How long has she been on the pred?

Two variables have changed - reducing pred and changing food. How long has she been eating the new food? The NV LID Lamb is a good choice. As long as lamb is novel to Loki (meaning she hasn't had it prior to this), I would continue the food. Allergies are frustrating, and it can take a lot of trial and error. From what you say, though, it seems to me that she is getting itchy again from the reduced pred.

Cats handle pred surprisingly well. Yes, there are side effects, and yes, it isn't the most ideal solution. But I encourage you to have a discussion with your vet about giving the pred more of a chance to get Loki's lesions healed up and that cone off. My Sebastian had a relapse about 5-7 days after reducing his pred, as well.

As to the cone, is it an Elizabethan collar (hard plastic)? Is it possible to give her a break from the e-collar with a soft collar? They are more comfortable. This is the one I have at home:

http://www.pet360.com/product/5282/trimline-veterinary-soft-recovery-dog-collar

It is flexible, so they can find a way around it if determined. But it may deter her enough.

@ Quiet:

I hadn't thought to inquire about a dermatologist, but I'll do some digging around to see if we have any in the area. I know it took me ages to find even one vet in the area comfortable with mouse spays/neuters and she's still an hour away - so we're a bit limited on specialty vets in our area. I'll look into that drug more as well to see if it's still a current option.

@ Go Holistic:

I hadn't even questioned the pred being taken down. I guess I just assumed it was a standard first trial course. Basically, I was given the pills (5mg) and told to give them to Loki twice daily for 5 days, then once daily for 5 days, and then every other day for 5 days. She was doing really well (the itching subsided, lesions were clearing fast and her shivering had stopped) until about the last day of the once daily dosing. When I called to tell the vet, he simply said he wanted to do another round, same dosing as above, and that hopefully she'd be all cleared up by the end or she would need another round. Should I be pushing for Loki to stay on it twice a day until everything clears up? Or should I opt instead for the depo madrol that he initially wanted to give? I turned it down initially as I wanted to make sure Loki didn't have a bad reaction to prednisone - as I didn't want her on a drug I couldn't quickly get her off of. But now that she seems ok with Pred I'm more comfortable with the depo madrol, if it's the better approach. I assume it might be since seems to be taking a beating with so many meds.

I had to look it up, but Loki began eating the Instinct on May 8th and that was the same day she began the Prednisone. And as far as we know, Loki has not been given lamb before. We've had her for 7 years and she's guessed to be about 11, so there's always the chance that she had it before us at the shelter we adopted her from.

As for the cone, this is the one we got because it was clear and had velcro so we could quickly get it on and off for meals, scratches, meds, etc:


I had almost got the flexible fabric one, but she seems to do better with clear ones and it also seems a bit heavy. The one we have now is pretty loose at least without her being able to get it off. I also wondered how easily she would be able to reach her paws with the fabric one. She can find ways to position herself just right with the plastic ones to *almost* get her full paws.

Ohhh, I see. I didn't realize that she started out at that dose. When our vet wanted to start Sebastian on pred, she wanted to start at 10 mg a day. I thought that was too high, so we made a compromise and started him at 7.5 mg a day and then tapered him to 5 mg a day. When we tried to reduce it to 5 mg every other day, that's when he flared up again. He's been on 5 mg a day ever since. I really don't know what to tell you with depo vs. pred. Personally, I would rather pill the pred, but you and your vet will have to decide what is best.

For the depo madrol vs pred. pills, I only suspected it might be a better option due to her doing the bloody vomiting with the addition of this last antibiotic. Given that she stopped throwing up completely once we discontinued the Biomox, I still believe that it was the problem, but I also wondered if perhaps all these oral medications might be taking a toll on her tummy. I'm still not sure how comfortable I feel with the idea of the depo madrol that can't be undone, but I thought since she has been doing well on the Pred otherwise that might be an alternative that would give her stomach a rest. Definitely something I'll be speaking to the vet about, though he was in favor of the depo madrol from the beginning.