Cat vomiting despite anti-emetic

[runekeeper]

Hopefully this won't be too long winded....talked to the vet a bit more, and I need to go to the hospital tomorrow morning to talk to the vet, find out IF the endoscopy is necessary, if it is, do the surgery, and also they want to place a stomach tube. I assume the kind that she would have forever. And then there's the thing in her lung.Basically, I don't know where to draw the line in terms of care. I want to make sure I'm doing everything I can that would be in my cat's best interests....the thing is, I'm not sure what is best for her. I don't know if it's better to feed her a tiny amount by mouth every 4 hours or get the stomach tube so I can hopefully bypass the broken esophagus and put food right in her belly. I don't know what's better - to let her eat by mouth and be hungry all the time, or get the tube and maybe get more food and thus more nutrition into her (and maybe ward off some of the hunger so she doesn't eat the dogs' food).What should I do? I don't want to prolong my cat's life if she's unhappy (and no, she will not get better. She would need the feeding tube forever), but I don't want to give up on her if she still has a will to live. Are stomach tubes very uncomfortable for cats?

 

[carolina]

Well, the endoscopy would tell you what REALLY is going on, so you wouldn't be guessing.... IMHO that's what I would do.
Provided that the issue is fixable, the feeding tube is not forever - it can and will be removed once she can eat without throwing up.... But for now she just HAS to eat, and she isn't able to.
IMHO it is not a matter of letting her eat by mouth and having her hungry all the time - the reality is she will die if she continues like this. She will develop fatty liver disease and that is lethal. And you are very lucky she is not there yet - your cat has going way too long without food.
So, I would do the endoscopy and go from there after having a firm diagnosis.... On my experience x-rays are very iffy..... And on her circumstances, I would get a feeding tube until she is better no matter what, as she needs all the nutrition she can get - I really think a feeding tube will be life-saving for her, no matter what she has. She needs food desperately. After the endoscopy you make a decision.... an informed decision.... That's what I would do if it was my kitty

 

[runekeeper]

If Kitty has megaesophagus, as far as I know, that is incurable. A vast majority of the time, there is no cause for it either. So I think the feeding tube is meant to be a permanent fixture for my cat. Are they meant to be used that way? I don't think her esophageal issue will actually get better, either on its own or with any sort of medical intervention. She still has an obvious appetite, which is one of the things that makes this so hard.IF she would be happy and comfortable, I absolutely have no issue with a feeding tube long-term. I can only assume that, if she was 100% hopeless, the vets would not bring up doing an endoscopy or removing her lung mass (but no idea if its spread at all), inserting a tube, etc. I don't want to prolong her life if she is unhappy or uncomfortable or suffering, but if she could maintain some kind of quality of life for a little while longer without suffering, I would do it for her. But would it be unfair of me to just keep her living with tube feedings? I'm not force feeding her because she does want food...she just is unable to swallow it.Should the vet feel she still needs the endoscopy, she will be getting it tomorrow and hopefully I will be able to figure out what is the best thing to do for her.

 

[carolina]

Has the megaesophagus been disgnosed with 100% certainty? That is my question.... x-rays are quite iffy as far as diagnosis goes.... I would not trust a diagnosis like that coming from an x-ray - that is what I am saying......
As far as the feeding tube goes, it is actually quite comfortable, and the kitties barely feel it....

 

[minka]

Having a feeding tube will not make her unhappy. As long as you can be around to feed her, she won't know the difference between eating and tubing. As soon as her tummy has food in it, she will still feel full and go sleep it off just as she did before.

I know it's hard to not think about possibilities and well-being and life expectancy, but right now, you have to concentrate on what you KNOW. Your cat seems to be happy, still getting around and wanting cuddles, so she is worth saving. She also needs real food desperately. Get the feeding tube in, give her a day to 'eat' and then take her back for the endoscopy to find out what the REAL answers are. And then, we'll go from there...

 

[runekeeper]

What the vet described on the X-ray is that Kitty has a spot in her esophagus that is narrow, and then the lower half is dilated. I was also told that they will diagnose megaesophagus officially if they cannot find a cause for the dilation following the endoscopy. I do know I saw the lung mass quite clearly, though. (That's another surgery I'm very worried about, but I know it's not a short-term issue).Can feeding tubes actually be used long-term? I always thought they were just temporary options. Plus I also worry using one could cloud my judgment on her overall state if she starts to decline rapidly. I know one sign of cats being near the end of their rope is a refusal to eat, and I know with my food-loving cat, it would be a total fire sign. I worry I may prolong her life in a state of discomfort if I were to continue with a stomach tube forever. I do know she's not overly nuts about being held for 15 minutes after eating now because she wants to go walk around and do cat stuff. She does like being held in general, but it has to be on her terms. Even in sickness, she is such a stubborn cat.Hopefully the vet can shed a bit more light on everything tomorrow. And I hope my girl will do alright being put under - she hasn't done that since she was spayed.

 

[carolina]

The food thing is a myth - stop eating when they are about to die. Cats can stop eating for any reason.... Problem is, when they go too long, they go into fatty liver and they will not eat on their own anymore. Food is the medicine for them but you HAVE to feed them.
Only food can break the fatty liver cycle, and it has to be force fed.
Same thing for your cat..... If you wait, she won't eat on her own.... But she can get better with your help.... Your cat has gone far too long without food. A cat can go into fatty liver in just a few days. PLEASE, don't wait anymore. Feed her.... She needs food.
If you gon't I hope you decide quickly and take her out of her misery.... Please don't let her suffer and starve to death

 

[runekeeper]

She will hopefully be getting a stomach tube tomorrow. Whether it's short term or long term, I'm not totally sure yet (I assume long term). I've been feeding her a bit of food that she has been keeping down. It's not enough for a full belly, but the vet instructed me to feed her watered down food (Hill's Science Diet A/D wet food) every 4 hours and then hold her upright for 15 minutes to allow gravity to guide the food down her esophagus. At least until her endoscopy was done.It's not wonderful, but she is keeping these diluted spoonfuls of food down (she gets about 4 teaspoons of actual FOOD in her a day, and about 12 teaspoons of water). I tried giving her the Viyo in the same way, but it came back up. She is keeping the A/D down, though. I don't need to force feed her anything because she does still have a huge appetite. Unless by force feeding, you mean a stomach tube, in which case I agree. I hope with a tube, I can get more into her belly at once and she can actually feel sated again. I wonder why a feeding tube was not recommended from the get go, given my cat's symptoms (I definitely made sure they knew how long she had gone without food).Thank you to everyone who has offered their advice, suggestions, and support during this stressful and upsetting time with my kitty's sickness. I hope tomorrow I can maybe get a little tiny shred of good news about something.

 

[carolina]

 

[runekeeper]

Thankfully, my kitty made it through surgery just fine and she received the esophageal feeding tube rather than the direct line to the stomach. Should she take the feeding tube and subsequent feedings well, she can come home tomorrow afternoon. That was my biggest immediate concern was nutrition, and while I will get more info on how to use the feeding tube tomorrow, I was told I could continue feeding her the A/D food through it.It turns out Kitty does not have megaesophagus - she has a stricture of the esophagus. In fact, the vet had to switch scopes because the first one was too thick to fit through the narrowed spot. Taking a tissue sample from the esophagus was not possible due to the toughness of the tissue itself (I think that was his reasoning for not getting a sample to biopsy). However, he didn't mention the presence of tumors or blockages within the esophagus. Considering my cat has no risk factors for a stricture, the vet was pretty surprised to see it and is assuming there is a tumor causing the problem. I assume one that is outside the esophagus. This is why he is not recommending the balloon catheter dilation surgery for the stricture - IF there is a tumor causing it, dilating the area would cause a fatal rupture.The vet also tried to do a long needle aspiration of the lung mass, but no matter which way Kitty was turned, the mass could not be seen on the ultrasound. So no biopsy there. The vet wants to do a CAT scan to maybe see if there is a tumor causing the stricture (I'm guessing a tumor out the outside of the lungs or throat - the stricture is about 20 cm in from the back of the teeth down the esophagus).I'm not sure where to go from here. I don't know if I should be putting my cat through invasive surgeries at her age - I was terrified she wouldn't come to after the endoscopy. Part of me wants to keep her home and have this be the end of her surgeries, keep the feeding tube long-term and just make her comfortable. But I worry I will hate myself for not getting surgery to remove the lung mass should it turn out to be cancer and then it spreads to the point of screwing up her whole body. At the end of the day, I want her to be comfortable and happy....as much as she can be, anyway. I swear, it's like for every step my kitty takes forward with treatment/diagnosis, she goes back two.So now I'm in another quandary: do I have her undergo dilation surgery and hope she doesn't die, or should I keep her on a feeding tube forever? What of the lung mass? It still strikes me as so odd that her symptoms started so suddenly, yet she has none of the risk factors associated with a stricture.

 

[runekeeper]

Called to check on Kitty today and she's having a bit of a reaction to her feeding tube (fever + lethargy). She's taking food through it well and not throwing it up, but the vet told me if they couldn't get the infection under control with antibiotics, the tube has to come back out. I'm really hoping that doesn't happen because I have no idea how I'm going to feed and sustain her without that tube. A spoonful of food every 4 hours just does not cut it. Also, on the X-ray that was done to ensure proper placement of the tube, the vet saw something near the insertion site that they originally thought was a suture. Then they realized they had no idea what it was and will be having another vet look at it. I have no idea if this is significant, but I was asked to call back in a few hours for an update.

 

[carolina]

Oh boy, poor little girl and poor momma
One step at a time..... For now she is getting nutrition, and that is a GREAT thing. :cross: she will get stronger. TONS, TONS of vibes going your way :rub:

 

[runekeeper]

The vet called me around 9 to let me know Kitty's fever managed to go up a whole degree in about 5 hours despite being on antibiotics, and they feel the fever and lethargy may not be due to any sort of infection in the feeding tube area (because there is no swelling or discharge), but due to cancer. I knew about the lung mass, but now I'm being told she also has a tumor in or on her esophagus, and also that she's been spitting up a lot of saliva because of the stricture (and she can't swallow it). Even though she's taking food well and is urinating, the vet still feels as though she's just getting worse.

I was asked to possibly consider putting her down because she's not going to get any better. I only wish I had known sooner how bad she was so I could have kept her home. I can only wonder if her being put under anesthesia has made her the way she is now. When I brought her in, she was alert, perky, walking around, grooming herself...I have not seen her since Sunday, so I don't know what exactly she looks like or how she's behaving. How could she decline that fast unless it was the direct result of the anesthesia?

I don't want her to suffer....while I was not told to have her put down immediately, the fact that it was even suggested by a vet leads me to believe she must be pretty bad. I am to call for an update tomorrow, and if she's not at death's door, I would like to keep her home for as long as possible without causing her any pain or suffering before letting her go. The only thing I'm truly hoping for is that she hold on a bit longer for me so that I can at least hold her and tell her I love her one more time. I don't care if she doesn't understand what I say....I just don't want her final moments to be alone in a kennel with tubes and IVs in her.

Regardless of what happens to my poor kitty, can someone tell me I have kept my cat's best interests in mind when making medical choices for her? Have I been a horrible owner for subjecting her to so many tests and a surgery, thinking she could maybe have had a couple more months on supportive care? Was the endoscopy the last straw for her?

 

[katherine123]

You have your kitty's best interest at heart. I would do the same thing. I wish you all the best!

 

[kalpanakitteh]

I absolutely believe you had/have your kitty's best interests at heart!  I'm a late-comer to this thread and wonder how you and your critters are doing.

I wish you all the best!

 

[mslily]

My heart is broken. I stumbled upon this thread when searching for an antiemetic for my cat. Please, is there an end to this? Happy or sad, it would help me close the book on your experience. That was a heart-wrenching hour I spent reading through the posts and researching what I didn't understand. You are amazing. What joy you must bring to all of your animals and the people in your life. Best wishes to you, and thank you for sharing so others may be properly educated on the subject. I won't forget it, whether you reply back or not. Thank you.

 

[runekeeper]

Oh wow, I didn't think anyone had seen this since I last updated it! I'm sad to say that this kitty did have to be put down at the end of 2012, but that it was not due to the vomiting or the esophagus issue.

The reason she was throwing up even on an anti-emetic (sometimes vomiting the pill itself) was due to the stricture in her esophagus. Nothing solid could make it past the narrow part of her throat, and when she reached the point of vomiting up water, I was told by her vets to say my goodbyes and put her down. That was just a fluke, though, and she started taking watery food via syringe just fine the following day or day after, and one day I caught her eating kibbles and I waited nearby for them to come back up. But they never did. So I let her keep eating, and she kept it down! Just like that, the vomiting stopped and I no longer had to syringe feed her.

This shocked me because, from what I was told by vets and what I read, an esophageal stricture could not be cured or healed without surgical intervention, and that I'd be syringe feeding her for the rest of her life. I think it was folks here who suggested the stricture may have been caused by inflammation, like a tiny bone shard in canned food, which is why it wasn't a permanent condition. So her vomiting wasn't a digestive issue or even a matter of her being too sick for medication. It was just the pill didn't make it to the stomach and take effect, and even if the pill did made it into her system, it wouldn't have helped. It stayed in the esophagus, which triggered a vomiting reaction. She seemed to have a little trouble eating kibbles after recovering, so for the rest of her time, she had canned food.

I'm still not sure what finally claimed her in the end, though. She had no respiratory symptoms, so I don't know if it was the lung tumor. She was wetting outside her box a couple days before things took a turn for the worst and was generally out of it, but I don't know if this could have been an infection or just her body starting to shut down. All I knew was once she started seizing, I couldn't let her suffer for however long it would have taken for her to pass on her own. But I still had about a month with her between bringing her back home and letting her go, and for some of that month, she acted just like her old self.

One thing I did notice is she really wanted company after I learned about the tumor. I know some cats will become distant when they're sick or dying, but my kitty wanted more attention. This was very not like her; she was always a very independent kitty when she was healthy. With her, it wasn't so much "pet me, please." It was, "I will give you the privilege of petting me." Yes, she was queen of the house and we all knew it.

So her wanting to not be alone was odd. When sick, she always wanted to be on someone's lap, snuggled beside someone, or even snuggling with her brother. Those two usually would smack one another when they got too close, but maybe her brother knew she was ill, as he always let her cuddle with him once she was back home for good.

All I know is she was one heck of a cat and I'm never going to forget her.

 

[mslily]

Thank you so much for sharing.  I'm so glad she got to go home and have some normalcy before it was her time.  Thanks again!