Question Details
Chronic Vomiting In A Cat
by sophiek - February 13, 2024    View Case Report
Hi Steve,

I have a frustrating cat patient that I'm not making much headway with, so after some advice on the next step.

Ollie is an 8 year old MN DSH.
Problem list;
Chronic intermittent vomiting (usually of initially undigested food and bile or hairballs)
Intermittent inappetence at time of nausea/vomiting
Lip licking, overgrooming, tooth grinding (seems to correlate to when having episodes of nausea/vomiting)
No diarrhoea, if anything can be a little constipated

Treatments trialled in past with another vet;
Pred trial - no improvement
TCVM herbs trial (6 gentleman) - initial improvement then relapse
Prev workup via med specialist - Nov 2020 - Diagnosis: DDx IBD +/- Helicobacter gastritis . Was treated with triple antibiotic combo at this time.
Diet trials - no long term benefits.
Probiotics long term - somewhat helpful
Cerenia injs and tablets - symptomatic relief
Vit B12 injs

He is anxious, timid, but dominant over other cat in house. 100% indoor with access to cat run. Nausea/inappetance/vomiting episodes seem to happen every 2-3 weeks - he will be good for a week, then start to lip lick, then a few days later vomit. He seems good after vomiting, will then eat his meal. Not overweight, has lost weight in past when vomiting episodes have been worse. No increase appetite or thirst noted.
Ollie eats dry food and canned food - I have tried every possible fresh food / air dried / raw / dehydrated treats etc with no luck. The best we have got is switching him to low carb, high protein wet foods.
He is impossible to examine, so my initial diagnosis was really on clinical signs - Liver Qi Stagnation, Liver overacting on Spleen, Spleen Qi Deficiency with Damp. The on my possible list was also TBO (due to Damp) and Stomach Yin Deficiency (secondary to Stomach Heat from TBO)?

I trialled San Ren Tang for 3 weeks - no change (no better, no worse)
Also B12 in St36/Liv13/BL 20 weekly x 6 - no change
He is on Fortiflora probiotic (the only one he'll eat in his food)
He has been on a moderate-high dose of Full Spectrum CBD BID for last 2 months with no real improvement (only the tooth grinding has significantly reduced).

I'm stuck with which herbal blend to try next!
The partial response to LJZT made me wonder if WLT would be worth trialling - addresses the Damp, could be helpful if Helicobacter is still involved, for nausea, gastritis etc)
Also considering YGJ for possible Stomach Yin Deficiency / Liver Qi Stagnation.
Would it be best to pair either one of the above with XCHT (1:1 ratio or other?).

I do think he would respond to an unprocessed diet, but have tried so many things and ways of trying to change him over with no success!

Thanks for your help on this one,
by naturevet
February 24, 2024
Hi Sophie,

I like your idea of Minor Bupleurum as the next thing to try. Shao Yang disharmony is supported by a lack of clear benefit of any particular food. Something that is non-diet responsive indicates the problem is immune mediated (a lack of response to pred notwithstanding). It can stem from an immune deficiency, an immune excess, or both.

In that context, a fleeting response to Liu Jun Zi Tang and probiotics makes sense, since it is dysbiosis that likely fuels most immune mediated disease in small animals. LJZT would have helped improve local gut wall immunity and clear out some pathogens. The probiotics would have given the cat something to colonize the resultant empty spaces with.

Often these cats respond at least in part to Bu Zhong Yi Qi Tang, and I notice many 'BZYQT deficiency' cases get worse on a monthly basis, usually in association with the moon becoming full. It would be interesting to review exacerbations to see if you can make that connection. If so, that's one more reason to suspect local gut wall immune deficiency.

Even if you beef up local immunity on the lumen side of the gut wall, you still have the increased systemic immune response on the lamina propria side of the wall, continuing to cause leaky gut. Prednisone might target that, but dampens local gut wall immunity, allowing pathogenic overgrowth to recur. The net result is you get nowhere.

The notion of this being more than just a GI complaint, but involving instead systemic immunity is corroborated by the overgrooming that occurs when the GI is worse. That finding smacks of a leaky gut mediated allergy.

All things considered, then, these findings are consistent with classic IBD and leaky gut. I would look at XCHT to subdue the systemic immune response that drives itch and tatters the gut wall. I would probably add in something for local gut wall immunity such as colostrum, BZYQT, LJZT, or even mushroom extracts.

Given the Chinese herbal maxim of 'never tonifying an Excess', I'd probably start with XCHT, and expect a limited but evident improvement. I'd then add in the local immune stimulant of choice, such as LJZT or BZYQT.

Hopefully this isn't just drivel, but is actually useful. Please let us know what you try and how things go!

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