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Vomiting And Anorexia In A Cat

by CIVTdvm - December 3, 2020 View Case Report

TCVM: Food Stasis secondary to Spleen Qi Deficiency and generalized Qi stagnation and rebellious LU Qi

Tongue: pale/lavender
Pulse: deep, bounding?

Question: Is Xiao Chai Hu Tang or San Ren Tang more appropriate for Josie right now? or both?
For me, SRT has benefit of aiding peristalsis but in case there is partial obstruction with hairball, not sure if this is safe?

I'm not doing blood work just yet as I did full blood work and abdominal u/s in September for monitoring. She has a hx of stress-induced IBD

Josie's x rays - I will try to attach them. Essentially; no obvious GI obstruction but colon is backed up with feces diffusely and whole GIT is filled with ingesta.
decreased appetite over the last week; we were away last weekend and for the last two weeks have been renovating our bathroom; vomited one hairball last thursday night then vomited just bile a few times i expressed her anal glands today to help stools pass better - both full and right side very impacted - able to empty fully
since tues night:SC Fluids 100-200/day, laxatone paste BID-TID, was giving buprenorphine but stopped as didn't want to constipate her more gabapentin 50mg BID sulcrate 1mL BID, 1 tsp coconut oil SID-BID, (I ordered CBD so will start that when delivered), cerenia 4mg given ONCE tuesday afternoon - none since but I'm thinking maybe I should continue because no overt obstruction on x ray - did vomit three thinner, smaller hairballs Wednesday morning but oral cerenia dose was <=1mg/kg.no vomiting since, but wants to eat just very hesitant and won'thas eaten a mix of kibble (prefers kibble) and recovery RC canned food bowel movements are very normal and regular - smell foul but solid, no mucous/blood, having BM SID as per usual

other questions:should I start on cisapride or metochlopramide?should I give lactulose?should I continue buprenorphine? should I start steroids?

Thanks so much in advance!

by naturevet

December 4, 2020

Hi there,

I would probably start with either San Ren Tang or Wei Ling Tang to help Qi start moving internally. If the cat is cold, then WLT. It will probably help more with appetite, too.

I agree that using opiates could be counterproductive in producing more constipation. Cisapride, metocolopramide and lactulose are all fine to use in tandem with the herbs

Cascara Combination can get things moving if this is a megacolon case, but it sounds like it is not that severe yet

If there is upper GI shut down, you can give the WLT as a herbal enema. To do that:

Give two to three times the normal dose for the patient (see formulas below) TID to QID

Suspend each dose in a maximum of 10 to 15 ml of warm water

Instil into the transverse colon using a small rubber French feeding tube

Use only granular extracts or crushed tablets, never liquid extracts

Hope this helps you out!

Steve

Wei Ling Tang

by CIVTdvm

December 4, 2020

Hi Steve,
Thank you for your reply.
She is normally cold (heat-seeking), however, I am hesitant to use WLT alone for fear it could worsen a potentially acute on chronic GI issue. Would it be wrong to use SRT and WLT or SRT for a couple days then switch to WLT? She has not vomited today or yesterday and still having bowel movements, just eating a lot less at a time. I ordered Alpha Omega Probiotic 8 Plus which contains Marshmallow Root and Slippery Elm Bark - are these safe to use with WLT and/or SRT?
I also am syringing very dilute ginger water and fennel tea and she's taking that. Are these okay with the herbs as well? I don't want to 'over heat' the GI so I'm trying to play it safe but want to help the motility.
Thanks in advance!
(I have not started a prokinetic yet)
I did start CBD as well yesterday - seems to be helping

by CIVTdvm

December 14, 2020

Hi Steve
I am updating you while awaiting your reply.
She is much less bloated but I was still concerned with her food stasis, so I started her on a really low dose of cisapride (1.25mg PO BID-TID) the last 3 days. Today, (and perhaps yesterday - I may have missed it as my other cat likes to devour her food vomitus quite rapidly....I am now keeping her separated in a room during and after meal time to observe..) she vomited / regurgitated immediately after eating canned rabbit food (Rayne Veterinary Diet).
This ironically occurs more often when eating wet food. I did switch her to GI fibre response RC kibble and ordered Hill's Microbiome as she is very picky and prefers kibble. I've been adding restoralax 1/4 tsp BID-TID and that's going well.
She is otherwise super affectionate and playful as always...
Wondering if I should be adding the WLT now instead of cisapride as she is vomiting on that...
Please let me know at your earliest convenience.
Her stools are normal, regular SID.
Tongue - lavender/red
pulse - she prefers not to let me
SC fluids 50-100 mL LRS EOD (was every day but becoming irritated); hydration is ok - just wanted her more hydrated with the meds
She has significant activity at the following points (I've been able to needle them a few times over the last two weeks but was dealing with my other cat's health issues so haven't been able to do enough)
BL-18
BL-19
BL-20
BL-21
*revised TCVM dx: rebellious ST Qi, ST heat, LIV Qi Stagnation, SP Qi deficiency
I was also thinking of Pulsatilla homeopathic because she is very affectionate, warm-seeking and chronic vomiting of mainly undigested food - let me know your thoughts, however, she may benefit more from Phosphorus because of the regurgitation - and even when does not bring up food post-prandial, she tends to eructate and seem uncomfortable for a few hours afterwards.
**I am open to home cooking her diet...however, I need more guidance in this area and am unsure if she will eat it; the only human food she is interested in is sweet potato, coconut oil and peanut and almond butter (which I don't give her)
Questions:
-diet guidance
-use of WLT
-continue CBD?
-use of cisapride and restoralax
-pulsatilla or phosphorus homeopathic

by naturevet

December 15, 2020

Hi there!

Sorry I missed your earlier reply on the 4th. If you feel drawn to anything in particular, try that first, but introduce things one at a time, whether it is herbs, diet change or homeopathics.

My own cat is a morning vomiter, or was until I gave her Minor Bupleurum. It fits the Stasis + Heat + Qi deficiency picture better than WLT. I actually made a homeopathic out of it. I took 1 ml of Kan's Harmonize the Qi, diluted it in 50 ml spring water, succussed it (meaning bounced the bottle of mixture off a resilient surface like a thick soft cover book) about 200 times, and then kept it in the fridge. Each morning I would pull it out of the fridge, succuss it against the palm of my hand about ten times, draw up close to a ml, and then put it in her mouth. It worked quickly for her and is a good IBD remedy for cats.

If the heat disappears from the picture, WLT might be a better choice at that time. Otherwise, if you don't want to try the above, then try one of the remedies. As for diet change, you don't need to find a balanced diet right now, just real food she will eat. For my cats, canned tuna and cooked chicken were popular.

Any drug or supplement she is reliant on for normal function you should continue. The right herb will overcome any adverse effects of the drug if it the drug is otherwise helpful.

Anything that you're unsure whether there is any effect, good or bad, you might as well continue in the interests of not changing too many variables at once. When you do find a protocol that completely resolves her symptoms, then you can discontinue those things one by one

Anything that does not seem to be helping but may be deleterious you should probably stop

Hopefully this helps you out!

Steve

Xiao Chai Hu Tang

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