Older cat not responsive to medicine - stomach issues

My neighbor is having an issue with his cat.

His cat is older (16-ish) and isn't using the litter box... Pooping in the sink. She's puking up water several times now... (Shes a regular puker but apparently this is worse than normal) And he's been to the care center and they were no help.

The only thing the care center said was that there were organisms in her stomach and gave her Flagyl, azithromycin, and fortiflora... Finished meds, and no improvement.

I sent a message to the vet I go to asking what he thinks... and told my neighbor to call other vets in the area and ask.

I dunno if any of you guys have any other thoughts.

Ive suggested to him changing the litter (to a softer one in case she has joint issues), having a second litter box, and even putting the second litter box near the sink, but apparently nothing is helping.

Any ideas guys? 
 

Thanks.

"She's a regular puker" sounds like this is a problem that's been building up for a long time. Lots of stuff this could be. Could be a food intolerance. Is the cat constipated? Is the poop really hard, or diarrhea? Is it the normal amount, more, less?

Here's a guide to cat poop. (Fun stuff to talk to your neighbor about!) But you should also be aware that small amounts of liquidy diarrhea can also be from constipation or a blockage (for example if it's so blocked up that only tiny squirts can make it around the edges of the giant poop block).

https://en.wikipedia.org/wiki/Bristol_stool_scale

Canned (pure unsweetened) squash or pumpkin helps a lot of cats with pooping problems, both diarrhea and constipation. That could be a starting point. But since she's been vomiting so long I think blood tests might be a good idea. Kidney problems can cause vomiting and nausea, especially if the vomit is clear and foamy (it causes high stomach acidity). If the vomiting is from that, it can be treated with Pepcid or similar (but a kidney diet might also be in order).

Inflammatory bowel disease (IBD) is another option, and that can be caused by food. A starting point for that would be trying a food that has a protein and carbohydrate that the cat's never had before and seeing if that reduces the symptoms. It can take a couple weeks to months to see results from that. Sometimes if the IBD is advanced, the cat will need a steroid (like prednisolone), possibly for the rest of its life. If your neighbor is into the more natural solutions, slippery elm bark or marshmallow root powder can help the digestive tract heal (but other medications might be necessary at first to get the inflammation and everything to a lower level).

Not going in the litter box can be because the cat's in pain while peeing/pooping and starts associating the litter box with pain. Sometimes even after the pain's gone, it's still used to thinking of the litter box as the place where it's butt/etc hurt and it needs to be retrained to use it. This website has a lot of aspects to look at with a litter box, maybe there's something in there that your neighbor can do to make the litter box look more attractive again. (Litter box makeover!!)

http://catinfo.org/?link=litterbox

I would have him take his kitty to another vet. There could be many things at play here.  Did they check for any bladder infections?  Is his cat constantly running for the box and/or sink to relieve herself? 

I agree with Samus that if this keeps happening then the kitty will associate pain with the litter box and stop using it.  I have this problem with my cat, Moses.  When he was 3 yrs old he developed bladder stones and stopped using his litter box.  Started going in the sink (poop, too!)  The vet treated him with antibiotics but it kept recurring and now, 13 years later, he still won't go into a box with kitty litter.  He's cured of the bladder stones but now he only goes into an empty litter pan.  I've tried all kinds of kitty litter but he won't use it.  So....I have to leave empty pans out for him.

Tell your friend to get his kitty to another vet ASAP.

I should have put this in my last post:

Is it actually water the cat is vomiting?  Is she vomiting water right after she drinks it?  Is she eating?  My calico Josie was vomiting the water right after drinking it and she was drinking ALOT of water.  She also stopped eating and when I rushed her to the E-vet (this always happens on a weekend when the regular vet is closed!)  she was too sick to save.  It turns out she was going into a diabetic coma (I didn't even know she had diabetes!) and didn't survive.  I have been grieving ever since and felt a lot of guilt for not catching it quickly enough.

Don't want to scare you but I wanted to share my story.  Again, I would have him take to another vet to rule out this possibility.