Question Details
Vomiting In A Cat
by Pamela77 - January 28, 2019    View Case Report
This consult is about my own beloved little cat. I am too close to her to see what she needs and would really appreciate your help. She is very intelligent, feisty and affectionate.

She is precocious and grew up eating homemade food, so she has gotten into trouble several times by eating strange things, like sautéed onions, bird suet, bags of treats etc.

Her routine lab work often showed a lymphocytosis when she was young.

She has always eaten a homemade diet or Primal or (frozen raw diet) and has had minimal vaccinations. She had a rabies vaccination as a kitten (2004) and once again in 2012. She had a bad reaction to the second one - hunched over, trembling, RR lameness and rapid respiration which resolved in 24 hrs. Homeopathy was used immediately and for several months following.

In 2013 -2015 she had some head scratching, a few fleas were found and treated.
Stage 2 CKD was diagnosed with mild BUN/Creatinine elevations and dilute urine however there is a lot of water added to the food. No PU/PD was or is observed.Recently, when she was dehydrated at the vets office she concentrated to 1048. She was on 1/16 tsp rehmannia eight for about a year but it was discontinued because she would not eat her food.

We moved to WA aug 2015 and she was grooming excessively on the abdomen, inner thighs, right flank and tail, presumably stress. We lived through a very disruptive year long remodel in 2016-2017 where she hid in the closet every day and she became fearful.

In March 2018 veterinary dermatologist suspected that the overgrooming might be neurological due cervical disc disease. She was showing very sporadic right forelimb lameness and previous radiographs had suggested cervical disease. We started gabapentin and there was some regrowth of hair. Also the remodel was over.

In April 2018 she started vomited a few times and in June she started vomiting frequently - a few times a week. She had already started licking herself more again despite the gabapentin, so it was discontinued.

Labs were normal except for stage 2 CKD, and a low folate suggesting long term intestinal disease. US was most consistent with IBD, with emerging small cell lymphoma less likely.

In august 2018 we changed her protein from rabbit to venison and increased the amount of food. We stopped giving Crystal, the other cat, her rehmannia 8 because kiki often licked the remains of Crystal’s food. We cleaned out the bird suet that had dropped into her outdoor cat enclosure. She improved for a few months and gained about a pound.

She started vomiting more frequently again late december 2018. She used to be able to eat squash and broccoli and green beans but they have been removed because it seems to make the vomiting worse. She is now vomiting 5 out of 7 days, usually around 4 am, usually a hairball with some liquid and a small amount of food.

Repeat labs now show a worsening folate. She was eating poorly and refused the venison, but ate readily when offered rabbit. (food aversion?)
Her appetite is good to fair.

It could be IBD or small cell lymphoma. I am very reluctant to put her through endoscopy because it would be so traumatic for her. She is a tiny thing, and she fights tooth and nail when restrained.

Her tongue is slightly pale, not wet or dry. Her pulse is toned, but not really superficial, maybe a little deep. Yesterday it felt full, today it feels thin. She continues to overgroom- her abdomen and inner thighs are smooth. She likes warmth, but will also move off the heated bed if it is a warm day. She usually vomits around 4 am, but has done it at all times. Her face is a little itchy now and she may be starting to lick that right flank again.

The local vet is urging pred but I really want to try herbs first. I appreciate your advice.
Replies
by naturevet
January 28, 2019
Hi Pamela,

I would only do a biopsy if it was going to impact your treatment decisions. Here, the time of day data, muted symptoms and pale tongue suggest a deficiency. It's unlikely that a biopsy would disclose acute inflammation when things are quite mild on the surface, so it should be okay to take a tentative step with some kind of tonic, and then jump in there with something like Si Miao San if the response to the tonics is some sort of flare up. In other words, a response to treatment should give you as meaningful information as a biopsy, if you're inclined to try managing with holistic medicine first.

I find myself torn between Wei Ling Tang and Yi Guan Jian as the tonic of choice, so it may be a matter of trying one first, then the other. Both fit the early morning issues, which can be associated with either excessive Stomach Heat and dryness (addressed by YGJ) and Dampness (addressed by WLT). Note, though, that YGJ can Dampen a cold Stomach, while WLT can heat up a hot Stomach, so watch for adverse effects regardless which you try first, and have the other formula at the ready in case you see them.

My guess is to try Yi Guan Jian first, since it is a better fit for her wildness, renal insufficiency, and pruritis as well. The high USG doesn't really support the kidneys being all that much of a concern. Still, you listed them as a secondary consideration so its nice to use a formula that addresses them.

If it aggravated her, then you'd go to Wei Ling Tang next, but I suspect it won't

Hope that helps,

Steve
by Pamela77
July 15, 2019
Back in January we changed her food from rabbit to duck primal and the vomiting stopped. We started yi guan jian 5 days after that. There has been very little vomiting since January. She is holding her weight. Her appetite is not strong. She used to eat everything quickly, and now she often waits to be carried to her food, and she will eat most of it. However, she used to be thinner so perhaps she is just not as hungry as before.

Her tongue is pink, and the pulse is variable. She is still chewing and licking, and that has become more aggressive in the past few months - gnawing and chewing with determination. Her abdomen and inner thighs are completely clean. She has become a little more cranky in the past few months as well, but she has always been a feisty girl.

She is getting a rounded 1/16th tsp BID ji guan jian. We did try giving her a little higher dose around march and her appetite decreased a little about that time so we decreased the dose to 1/16th again.

No further lab work has been done at this time. Should we stay on this herb or progress to a different one? What do you think?

Thank you
Pamela
by Pamela77
August 12, 2020
My question is whether or not to change the herbal formulation. I stopped the herbs entirely a few days ago to see what would happen.
by Pamela77
August 17, 2020
Kiki had stabilized very well taking yi guan jian daily for the past year. The vomiting had decreased to about once a month. Her appetite and weight and stool are good. Over the past 2 months the vomiting has gradually increased and now is about 3 times a week. There is often a hairball in the vomit, along with liquid and some food. It does not occur at any specific time of day.

She has slowly become deaf over the past year. She is more frail - she sleeps a lot, but still will play. She is more fearful. This may partly due to the increased dominance of the other cat in the house, but her world has become smaller and she mostly stays in her heated cat bed by my desk. (she has always enjoyed the heated cat bed, that is not new) She is affectionate when I am at the desk, but doesn't join us in the rest of the house as much.

It is difficult to feel a pulse - she won't be still when being examined- but I think it is thin and a little weak. Her tongue is pink, not pale, with a normal coat.

She still has an area of alopecia on the ventral abdomen from licking herself, but it is much improved from a few years ago.
by naturevet
August 24, 2020
Hi Pamela,

If Kiki is still on YGJ and the vomiting is kicking up, I have two ideas. One is just to increase the YGJ dose and see if that helps. The second is to try a small dose of Minor Bupleurum (Xiao Chai Hu Tang). This is one of the seasons when animals that are going to benefit experience a resurgence in symptoms, and it works synergistically with YGJ, helping to reduce Yang entrapment in the Yang Ming that can create Stomach dryness leading to vomiting.

Hopefully one of those two options works for you!

Steve
by Pamela77
June 9, 2022
After our consult in august of 2020 I stopped the YGJ and I was going to start XCHT but she improved a great deal after stopping the herbs. It was as if a blanket was lifted off of her. I think I let her stay on the herbs too long. She became more active, ate well, and had infrequent vomiting, although she still had a little "urging" (mild regurgitation?) after eating. Her coat became full and thick. She did not groom excessively.

She did well until oct of 2021 when she became acutely ill with vomiting, lethargy, anorexia, tremors and thirst. Labs showed ongoing stage 2 CKD, normal B12 folate, Urine SG 10.40. US suggested pancreatitis. She was eating duck primal and duck answers raw food.

We changed her diet to primal pork raw, stopped the answers food and she was on a gradually decreasing dose of cerenia for 6 weeks. The cerenia really helped her. Then she was on a decreasing dose of pepcid for a few months to see if it helped the "urping" discomfort - it helped a little. But all in all, since december, she ate well, gained weight and was bright and happy.

During May she vomited 4 times and on may 29 she vomited a huge amount of clear liquid. She then was ill for about 10 days - isolating herself, decreased appetite, and lost weight.(almost a pound). She is still not eating very well. Her labs are all normal except for mild CKD, urine SG is 10.41. She started to eat again when we changed her from pork to duck again (food aversion?)

She seems frail, and she has lost muscle tone along her spine, and has weak hind legs. She seeks heat. She still a feisty little sortie, just less effective at it.

I would appreciate any suggestions you might have!!
Thankyou
Pamela
by naturevet
June 10, 2022
Hi Pamela,

Given the intolerance of YGJ and the aggravation in May, Kiki seems Damp. If she is chilly, then maybe try Wei Ling Tang to see if you can improve her appetite?

Steve
by Pamela77
June 10, 2022
Thank you, I bought wei ling tang back in jan of 2019 when we discussed it as an option. The expiration date is 12/21. Do you think it is still any good?
by naturevet
June 11, 2022
Should be, yes

S
by Pamela77
July 1, 2022
Kiki has been on wei ling tang since June 10th, but she is not doing well. She is not eating well and is losing weight. She seems very frail. I stopped the herb for a few days but there is no real change. She vomited a small amount of clear liquid once, and maybe a small hairball another time. We are adding freeze dried and a small amount of canned to get her to eat and have to bring her to the food several times a day to encourage her.
Thank you, Pamela
by naturevet
July 1, 2022
Hi Pamela,

After looking back through the previous replies, there are two pathways to explore.

One is to try the Xiao Chai Hu Tang approach that we talked about, which is especially appropriate if we are thinking she has IBD

The second approach is to try her for a few weeks on Liu Jun Zi Tang, which contains Ginseng to give her a boost, but still drains Damp. I guess I would start there

We commonly use subcutaneous B12 shots on a daily or weekly basis to kick up the appetite.

Lastly, we do adhere to the maxim which is that "nothing should die without having tried steroids". They seem apropos here, and are not contraindicated with any of the other options discussed above

Hopefully this advice helps you out

Steve
by Pamela77
July 1, 2022
I don't know if she has IBD. The intestines were slightly thickened on US, but her B12 and folate are completely normal. She has had this history of episodes of vomiting and anorexia for years though. Her worst illness was october of 2021, when she was acutely ill and she has had aggravations in august and june as well as may.

Do you think B12 helps even if B12 levels are quite good?

I will order both herbs.
by naturevet
July 1, 2022
I do, yes. It seems to create an energy boost regardless
by Pamela77
July 31, 2022
We started her on LJZT and at the same time we offered her venison primal on the plate in addition to duck. (She was on venison a while ago). She ate it readily and we thought it was the herb, but after about a week, the appetite went down again. Then she like the duck primal freeze dried reconstituted but her interest in that has waned. Now she is only interested in canned duck but I am afraid to give her only that because it is what we use to get the herbs into her. It seems she loses interest in whatever she is eating regularly. Perhaps it is a learned aversion because she is ill. She still purrs and wants to be held, and moves about the house. She is not thirsty. She seeks warmth somewhat. Previously you had suggested XCHT. I have it here if that is still what you think we should use, or considering the recent history is there something else?
Thank you
by naturevet
August 1, 2022
Hi Pamela,

I would probably try the Xiao Chai Hu Tang approach here, especially if you feel her pulse is relatively strong for her frame. Remember that if she is reluctant to take the herb in her food, you can create a low potency homeopathic from it, which might free up your food options a bit.

If the latter helps, but her appetite is still a little lackluster, you can team up the XCHT with Bu Zhong Yi Qi Tang.

Prednisone is an option to boost her appetite if all else fails, but if it is IBD, then its immune suppressing effects make it a double-edged sword that only buys a short term gain. Long term, her mucosal immunity needs to be strong and intact to gain control over her microbiome, since dysbiosis is likely one of the causes of the IBD.

Steve
by Pamela77
August 2, 2022
Thank you, I started the XCHT at a very low dose of the granules (that is what I have here right now). It's only been 2 days. Her pulse is not strong for her frame, maybe even a little weak but I am not sure of that - she is a squiggly tortie. Does that information about the pulse change your herbal recommendation? She is eating almost nothing now, only canned food. We will get a blood test today and see what might be happening.

Thank you,
by naturevet
August 2, 2022
I guess see what the bloods show. You can always use all three together: XCHT, BZYQT and a low dose of pred. The herbs should mitigate some of the adverse effects of the pred

S
by Pamela77
August 3, 2022
Here is the update - CBC/chem/T4 all fairly stable except creatinine is 2.8, bun is normal. Previously creatinine was 2.6. US showed her pancreatitis improved from the last US on 12/1/21, and IBD still present, lymphoma unlikely.

She ate like a fiend while at the vet - She had 75 mg gabapentin in order to be handled. Could that have somehow affected her appetite? She also ate well when she got home. We did give her some fluids while at the vet.

The vet is prescribing pred 5 mg SID for the IBD, sq fluids, and b12. Her B12/folate were normal but we did have to give her some food to get the gabapentin into her so that may have affected the B12. I did get a good look at her tongue and it looks a little pale but she was not anemic on lab work.

How does this affect your herbal recommendations? A few years ago when she had severe vomiting likely from IBD we used yi guan jian which was helpful, but it subdued her tremendously, like she was living under a blanket. Thank you for your advice,
Pamela
by naturevet
August 3, 2022
Okay, if she was worse on YGJ and she is going on pred, then try San Ren Tang and see if that gets you where you need to go. It can help the kidneys as well as the GI. If you think the fluids explain her increased appetite, then add in Rehmannia Eight

Use the usual doses of each

Steve
by Pamela77
August 4, 2022
Thank you, I don't think it was the fluids. She ate frantically while I was giving her baby food during the blood draw - it was like a weird gabapentin effect. She hadn't had the fluids yet. She does have stage 2 CKD but I don't know how much it is affecting her. Perhaps the BUN/crt were artificially low because she has been eating so little for the past 10 days. I will start the SRT. If I don't think the fluids explained the increased appetite is there any other indication to use Reh 8?

Also, I can't say she was worse on YGJ. At the time we started it she was vomiting 3 times a week and not doing well at all. We started the YGJ and the vomiting stopped but she became very subdued. At the same time we changed the protein source, and also found that bird suet may have been dropping into her cat enclosure and she may have been eating it. So I can't really be sure which thing made her better then.
by naturevet
August 4, 2022
Well, let's just try that plan and see what she does with it? It should be safe and complement the pred.

S
by Pamela77
October 10, 2022
Kiki started pred 5 mg SID Aug 3 and was quite a bit brighter and finally started eating and less vomiting by Aug 10. She was also on 1/2 tab cerenia SID, visbiome probiotic, gabapentin 15 mg SID and b12 and adequate SQ. She showed mild agitation and thirst on the pred.

She continued to eat well and gain weight from 8.1# to 8.8#. Pred was decreased to 2.5 mg SID Aug 17 and we started san ten tang about 1/16 tsp bid. The we decreased pre to 2.25 mg MWF Aug 21 and she continued to do pretty well and gain weight.. During that time we were traveling for 2 weeks and came home sept 12 to find that she was extremely PU/PD, and found several spots of dried vomit and she was "urping" a lot (almost vomiting and swallowing it). I decreased the pred to 1.25 mg MWF and stopped the gabapentin out of concern for the kidneys. She wasn't eating well and wouldn't take the herbs so we stopped them as well. Labs on 9/23 showed a BUN of 53 (high for her) and CRT 2.5. She had no urine to check for a UTI/kidney infection. We tried again a few days ago and again no urine. Now she is losing weight again, and vomiting occasionally and gulping and "urping". She eats if encouraged, and should be gaining weight with the amount that she is eating - UNLESS the other cat is stealing her food.

I thought of giving rehmannia 8 but without knowing if there is an kidney infection I was concerned about heating the kidneys?

It appears I may to increase the pred dose again, but I'd like to know if there is an infection before doing that. . We have another appointment for US guided UA on Oct 21.

Do you have an herbal suggestion?

Thank you, Pamela
by Pamela77
February 18, 2023
Well it seems kiki needs to stay on pred, Whenever I decrease the dose too much she simply stops eating and starts vomiting. IBD has been suggested on US but B12 and folate have been normal. She is on raw pork primal. She is on 5 mg pred MWF alternating with 2.5 mg the other days, pepcid 1/4 tab per day and no herbs. She was on 1/2 tab cerenia daily until a few weeks ago when her body started to reject it. She has projectile vomiting with cerenia within 30 sec to 5 minutes afterwards. She has a great deal of discomfort with "urping" - mostly non productive regurgitation with gulping and swallowing. She has developed inspiratory stridor - I think from the inflammation in her throat from chronically burning it with stomach acids? She is content, and purrs, and expects to be carried to her food multiple times a day (I wonder who created that problem????) . Her coat is good, tongue is a little pale, pulse is a little weak and she is a frail little old lady. I am not sure if the pepcid is helping. Now that she can't take the cerenia her appetite is not as good and she is starting to lose a little weight. She prefers warmth.

My acupuncturist suggested ban xia xie xin tang/wan as a formula that helps people with regurge. What would you suggest please?
by naturevet
February 18, 2023
It might help, but it has some bitter herbs. If you try it, make sure you use a version with Ginseng.

It might be simpler to try Six Gentlemen first if she is that weak and deficient? It's along the same lines as BXXXT, but without the cold effect

S
by Pamela77
February 19, 2023
OK, She has started to vomit a few times a week and her appetite is down since we can't give the cerenia any more. I don't want to use exactly what he suggested - I'd rather follow your advice. So with the regurgitation and vomiting - would you silll suggest six gentlemen? The main issues are the regurgitation, vomiting, lack of appetite, (IBD?)

Thank you Steve
by Pamela77
February 19, 2023
In addition to my question above, A Time to Heal is out of stock on six gentlemen. Is the natural path one significantly different than a human one if I get it locally? He carries blue poppy and great nature classic and seven forests. None of them are powders.
by Pamela77
February 19, 2023
In addition to my question above, A Time to Heal is out of stock on six gentlemen. Is the natural path one significantly different than a human one if I get it locally? He carries blue poppy and great nature classic and seven forests. None of them are powders.
by Pamela77
February 19, 2023
In addition to my question above, A Time to Heal is out of stock on six gentlemen. Is the natural path one significantly different than a human one if I get it locally? He carries blue poppy and great nature classic and seven forests. None of them are powders.
by Pamela77
February 20, 2023
I have the Natural Path LJZY powder. We gave it to her last summer. I am not sure if it helped or if it didn't. There were many factors at play. She wasn't doing well until we started the pred, and I can't get the dose lower than 5 mg MWF alternating with 2.5 mg the other days. I think she is more pancreatitis than IBD. Sorry for the multiple posts above. Each time I tried to go in and edit it out it reprinted
by naturevet
February 20, 2023
Hi Pamela

If she is reliant on pred, then we need an anti-inflammatory effect. Pred cools and moistens from a Chinese medical perspective, so we need a cooling and moistening influence on the Stomach, which means things like Slippery Elm powder or Yi Guan Jian are at the top of the list. Now you did use YGJ before, but weren't sure how well it went down. You could try sucralfate or Slippery Elm first. They are more superficially acting but not likely to create side effects. If they were well received and she felt better on them, then YGJ should be fine, too.

If those items don't help her, then we are back to looking at Qi tonification and anti-Damp treatments. Six Gentlemen should be helpful. Make sure whatever product you get uses Ginseng. The Kan Essentials Six Gentle Pets has a good recipe and is available in pills or liquid, so if you can't source the NPHC version, that is probably the next best bet. You can de-alcoholize per the label on the tincture. You can also start with the tiny doses that Kan has on the bottles, but for full effect, I would dose according to the schedule located here schedule located here

Hopefully this helps you out!

Steve
by Pamela77
February 20, 2023
Thank you so much Steve. For slippery elm do you mean to just mix it in the food or give it as a separate slurry? She may be a frail old tortie but she is still a tortie! I couldn't get a slurry or liquid sucralfate into her more than once. I can try slippery elm in the food if you think it would help given that way.

We can try yi guan jian again - It helped her a lot years ago, but then it was like a heavy blanket on her. I do have NPHC six gentlemen here and I can order NPCH Yi Guan Jian. If I start the six gentlemen and it is not right for her, what would I look for?
by naturevet
February 21, 2023
There wouldn't be a particular adverse effect from Six Gentlemen if you want to start there. If it doesn't work, then you can move on to maybe try the Slippery Elm powder mixed in her food. If that worked, it means YGJ should help.

S
by Pamela77
February 21, 2023
Can I try a little slippery elm powder in the food even while giving 6 gentlemen? I just didn't know it would work when mixed in food like that?
by naturevet
February 21, 2023
Yes, that should be fine

S
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