Vomiting--IBD, Virus, Obstruction? Help!

[Libby]

I'm new here, and have a problem. My 1 1/2 year old tabby, Katie, began vomiting and had watery diarrhea starting last Wednesday. I took her to the vet Thursday--blood work and xrays were normal. The vet concluded it could be a virus, and to watch her and give her sub-q fluids and syringe feed her. I've done all that since. Katie went for 5 days without eating on her own, and I've yet to see her drink. (the vet said that was normal considering the sub-q fluids, which I've now cut in half) Yesterday, she began to nibble at dry food.
Over the weekend, it seemed that she threw up every time I fed her--sometimes immediately, sometimes it took up to 2 hours. The vomiting has eased up some, probably every other time she eats she vomits now, but again--either immediately or an hour or 2 later.

The diarrhea stopped Saturday night, but there have been no bowel movements since, at least that I know of. We have 4 other kitties and no way to isolate Katie to watch her litter habits 100% of the time. The vet told me not to worry about it for now, as all Katie had been eating was canned food from the syringe (at the moment she's getting canned d/d).

Her behaviour has improved dramatically--back on my lap, giving me head butts, purring at me. She walks around her food dish begging, but refuses to eat what's there (except for a nibble or 2). I've tried tempting her with anything I can think of , but she's never been a big eater or a "people-food" eater. The vet called to check on her yesterday and was as confused by her vomiting behaviour as I am. They decided for now to treat it as IBD, putting her on prednisone and the canned d/d. If the vomiting continues, they would like to do barium xrays.

I have several questions: could this still be a virus that she's working thru? Why does she either throw up immediately or wait so long? Shouldn't she have had a bowel movement by now? Should I go ahead and have the barium xrays done now to rule out an obstruction?

I'm obviously completely confused by what's going on, and would appreciate some input.

[Traci]

It would be relatively rare for a young cat to develop IBD......a few questions, please?

What were you feeding prior? (and, canned or dry?)

At the time she was vomiting, did she also vomit water or after attempting to drink water? If so, this could in fact, indicate a partial or complete obstruction. Did the vet find anything unusual upon palpation, that is, was she painful when he palpated her abdomen? Did he ever suggest a kitty enema in the event she was constipated? Did he suggest to at least attempt to include hairball remedy on the day he examined her?

Did the vet rule out toxins? (i.e., either something ingested in the home, rancid food, plants, household products, strings, parts off toys, etc)

Did the vet prescribe antibiotics?

Are the other 4 cats experiencing similar symptoms, or anything slightly unusual at all?

Are they all kept strictly indoors only?

Did the vet do a fecal exam to rule out various types of bacteria?

What did the CBC indicate, and was there any evidence of infection or inflammation?

Did the xrays reveal anything unusual at all? Any evidence of inflammation or hairball impaction in the stomach/intestine/colon etc?

Is her oral health optimal?

Is she and the other 4 cats current on their vaccinations?

Yes, she should be having stools, every day, including the day you began syringe feeding her. Your vet needs to adress that promptly. If she had gone a few days with NO food at all, then little stool would be evident, but you syringe fed her, so she should have been producing nearly every day!

His comments about her water intake vs fluid therapy is not entirely accurate, she SHOULD be drinking normally on her own, and she should have the interest to drink. Your vet should also be addressing that more agressively, since he knows that dehydration is quite concerning especially with the limited food and water intake, and combined with the vomiting and diarrhea.

It's been nearly a week with little to very slow improvement, so yes, I would seriously consider getting the barium series done to rule out partial or complete obstruction. Sometimes, it is as simple as a partial obstruction like a hairball in the stomach or intestine, but when combined with addtional food or fur by grooming, this can get much worse in a matter of a day or so. A fecal exam is also in order to rule out bacteria infections, parasitic infection, and importantly, peritonitis (systemic infection as a result of a perforated intestine or leakage in the GI tract). I would also suggest repeating the CBC to check for changes and rule out inflammatory process or infection/peritonitis.

If your vet is slow to work agressive diagnostics, see a new vet immediately. This may not be necessary but I think it would be worth it to get a barium series done, TODAY.

[Libby]

All 5 kitties are indoors only. The vet did question whether Katie could have gotten into any sort of toxin or small item could have been swallowed, the answer being "I don't know how she could have, but with a cat anything is possible."

Her diet before this began was primarily dry food with a small can of moist split between the 5 of them each morning--Katie usually not eating the moist, but licking the can. In addition, she loves crunchy treats thru-out the day.

Her oral health appears to be fine.
As for her water consumption, I don't believe I've ever actually seen her sit at the water dish and drink. She likes a cold drink in the bathtub occasionally.

No antibiotics were prescribed, as her WBC was normal; in fact, the vet said all her blood work was well within the normal ranges.
She doesn't seem to be in any pain, and the vet did palpate her the day of the exam.

Her xrays were amazingly clear--no sign of anything in her stomach or bowels. At the time they were taken, it had been about 24 hours since she'd eaten.

She is current on her vaccinations, as we've only had her for 10 months. She was an outdoor kitty whose 'owner' moved away and left her behind.
As for the other 4, 3 of them have had looser stools lately. I've attributed that to the fact that their diet has been somewhat disrupted; anything Katie is given and refuses generally gets gobbled up by those 3. I know, I need to make more of an effort to keep them on their regular diet.

The vet did mention barium xrays as an agressive form of treatment on the day of the exam. I opted not to do them at that time. He did also say that Katie was awfully young to have IBD, but did start her on the prednisone.

[Traci]

Well if he wanted to rule out bacterial infection, he could have at least started her on a short course of mild antibiotics and seen how she responded (vomiting ceasing, stools forming, appetite improving). Antibiotics may also be a better choice at this point over the prednisone, but that has to be your vet's call. I personally would recommend a short course of antibiotics, but combined with a fecal exam at least.

She very well could be producing stool and you're not catching it, but my concern (and what your vet's concern should be) would be that she may not be producing stools, despite what has been syringe fed. Another concern is her not eating a sufficient amount, you cannot afford to risk her losing a significant amount of weight in a short period of time, nor liver disease as a result of insufficient nutrition and/or poor hydration status.

Call him and discuss the barium series, and ask about antibiotics. If she prefers dry food, and if she isn't eating the D/D, ask about a bland diet like kitty I/D, to at least see if she can keep it down.

You will have to find a way to monitor her stool production....please set out one or more litterboxes and watch her like a hawk to determine if she's eliminating. Even without a stool sample to test, your vet can test with a swab if necessary. A fecal could be a handy diagnostic in this case.

Don't dismiss the potential your other cats could be developing similar signs, particularly with the soft stools, regardless if they have had a few other things outside their normal diet. Depending on what those food types are would determine why they are having soft stools of course, but watch them very carefully as well for similar symptoms, in which you'd then want to rule out toxins or food problems. What is the brand of the food they are eating, the food that Katie was eating prior to getting ill?

I'm not sure taking the "wait and see" approach is a good thing to do at this point...the fact you haven't seen her drinking on her own, the fact she's not eating a sufficient amount, and hasn't short of syringe feeding, and the vomiting continues....all red flags your vet should be concerned and getting more agressive with diagnostics.

I for one, would not wait on this any longer...discuss the barium series, fecal exam, antibiotics etc, immediately.

[Libby]

Everyone eats Purina for Urinary Tract Health, with the one can of Friskies in the mornings.

I called the vet's office and made plans to take Katie in tomorrow morning; told them I wanted a fecal exam and the barium xrays. I plan to write down everything that's been going on with my girl---I keep a running list during the day of the times she's been fed, how much she's eaten, vomited, had her sub-q fluids---hopefully, that will help. (or does it just prove I'm a control freak?) I'll also discuss antibiotics with them, as I really don't see how that could hurt.

watch her like a hawk
I do. I wonder if cats get paranoid? I follow her around the house, she can't leave the room without me on her tail.

Thanks for the advice. Hopefully, I'll have some concrete news tomorrow about what's going on with Katie.

[Traci]

Glad to hear you're taking her back in, but if she declines in any way, don't wait, get her in immediately.

I doubt the Purina is problematic, although any cat can develop a sensitivity to any food at any time. The symptoms indicate something more serious however. A fecal can not only help the vet determine infection, but also salmonella, toxoplasmosis, parasitic infection, bacterials like e-coli, clostridium, campylobacter, etc.

The barium, if it stops at any point after administration, then you know you have a problem. Or, if the barium is slow to move through the intestinal tract, which could indicate an inflammatory process.

Another concern is the fact that she may be regurgitating as opposed to vomiting. Megaesophagus or a stricture should also be ruled out, possibly even aquired myasthenia gravis. When the barium is initiated, your vet should take care to investigate the potential for megaesophagus, etc.

Has she been tested for FELV/FIV? If you can afford to, a quick combo snap test might be useful at least as a rule-out. Vet should also check oral cavities, mouth, etc for any signs of calicivirus, ulcerations, excessive bacteria that may or may not be related to the symptoms.

According to your posts, the symptoms occured rather suddenly and not really over a period of time....did anything unusual happen before that? Any changes in her behavior, routine, anything different in the environment? Try to think back in the event there may be a connection. I ask because of the severity of the symptoms and because the vomiting and anorexia persist. Your vet really needs to be taking this seriously.

[Libby]

According to your posts, the symptoms occured rather suddenly and not really over a period of time

That's it exactly. Wednesday afternoon she begged from crunchy treats and ate them (with help from the others). That night she refused to eat them before bed, and my DH said she had diarrhea. I've thought about it constantly, and can't come up with anything out of the ordinary.

Katie just ate some dry food, all on her own; 15 minutes later it was all back up--regurgitated in a long 'sausage-looking' pile. She's got the appetite, she just can't keep it down. The lack of drinking is worrying me something fierce.

I'll keep all your suggestions in mind when I get her to the vet tomorrow.

[Traci]

Ok, I don't want to keep repeating myself, you obviously understand the seriousness of the situation, but I must caution again, if her symptoms worsen before then, don't wait, get her in on emergency.

In the meantime, please check her vitals, particularly hydration status and mucous membrane coloring, and make sure she isn't getting lethargic, painful, withdrawn, projectile or vomiting blood, etc, any of these symptoms which you'd want to get her in on emergency! Try elevating her food dish, feeding ONLY small amounts at a time (like a half teaspoon every half hour or so as long as she keeps it down, and keep her stress reduced at all costs. Try providing an extra water dish in an area she frequents and feels comfortable in, place an ice cube in it to try to interest her, or allow her to drink from the tap faucet, or put water in a cup/glass to interest her, etc...anything to encourage her to drink on her own. Don't sringe water to her in large amounts, as she could end up vomiting water as well....only a 1/2 teaspoon or teaspoon at a time, slowly.