Expert: Jessica - 11/1/2010

Question
QUESTION: Hey Jessica,

I'm sure you remember my question about my six years old cat
who got diagnosed with IBD two months ago. He was on
prednisolone on alternate days and was dealing with
everything a bit better than before, until, one day he
started throwing up again... this time he threw up blood
colored vomitus and had bad bleeding in his mouth too
(Gingivitis/stomatitis thing as far as the vet explained
us). After he wouldn't stop throwing up blood and we found
some roundworms in the bloody-red vomit (it was alarming!
Btw, his stool was very dark too), we rushed him to the vet
who gave him Mebendazole for worms and Depo-Medrol (20 mg, I
think) through injection, for the vomitting and all. Depo-
Medrol worked LIKE A CHARM! He stopped throwing up, he
started playing with us again, he ate normally (not too much
and started chewing his food better too) and his stool
returned to the normal color. ALSO, he didn't urinate as
much as he did when he was on prednisolone (he'd drink a
litre of water otherwise).

It was all good for six days. And then this morning, we
noticed he wasn't his usual chirpy-self and was just
drinking water. By afternoon, he started throwing up again
and it was salmon pink with few spots of reddish-ness.By
evening, he was meow-ing in pain and wouldn't stand on his
paws. Took him to the vet again and he gave him Depo-Medrol
again. Right now, he's at the vet's place for the night and
i'm really worried.

What I don't get is, our vet asked us to come back after two
or three weeks for the next dose; not in six days. He was
very confident that Depo-Medrol would last for two weeks at
least. Why didn't it work? Isn't it a long-lasting
medication?

Regards,

Cheryl

ANSWER: Hi Cheryl,

Poor little guy!  Depo-Medrol is a long-lasting medication, but sometimes the dose needs to be adjusted up, depending on the cat's response to it.  If the cat initially responds but the symptoms return within just a week, the dose can usually be increased to improve the time that it lasts.

However, if the tests are available to you, you may want to consider having an ultrasound or at least an x-ray done of your cat's belly.  Sometimes the cause of these symptoms could be a tumor.  X-rays can sometimes pick up irregularities that would suggest a tumor, and ultrasounds are very good for diagnosing growths.  Steroids like prednisone and Depo-Medrol can temporarily reduce the inflammation associated with tumors to alleviate symptoms.  

Best of luck!

Jessica



---------- FOLLOW-UP ----------

QUESTION: Thank you Jessica! We don't have the facility for an
ultrasound in here, but we can get an X-ray done from where
we get him treated. Lets hope it's not something too
serious. We called the vet and he said he'd been drinking
lots of water which might indicate burning sensation in his
stomach or something? Also, he stopped throwing up last
night too. THANK YOU!

Much love,

Cheryl

ANSWER: I'm glad he's feeling better, and I hope he continues to improve! Any time I can help, please feel free to drop a line.

---------- FOLLOW-UP ----------

QUESTION: Just one quick question ... he's still not eating! I tried
force-feeding him and he threw it up after an hour :( No
blood this time, and he's still always very thirsty and
urinating a lot. Should I continue force-feeding him?

Thanks.

Answer
Hi Cheryl,

It's not generally recommended to force-feed a vomiting cat, as this just causes more inflammation, and the cat isn't receiving any nourishment from it.  Does your vet have an anti-emetic he could administer?  If you can get the vomiting to stop for 24-36 hours, then you can try adding food in very slowly.  I would start with just a teaspoon (5 cc's) an hour to see if he holds it down.  If he does well for the first several feedings, try increasing it by another 5 cc's for a few meals.

The best anti-emetic I've come across so far has been Cerenia (maropitant), and this can be given as an injectable or in pill form.  If this is unavailable where you are, then mirtazepine is probably the second most effective anti-emetic that I've used, and I think this should be easy enough to come by.  If your vet doesn't have it, you should be able to buy it at a pharmacy with a vet's prescription.  

Also, a stomach acid reducer may be a very good idea for your little guy, if he's not receiving anything like that right now.  They can sooth a sour stomach and are usually a very good idea for kitties going through a really rough time with belly problems.  Most vets just use Pepcid (famotidine), although some prefer Tagamet (cimetidine).  You should ask your vet what he thinks about treatment with these.  Both of these should also improve his condition if stomach ulcers happen to be his problem.  This would explain the blood in his vomit, though stomach ulcers aren't terribly common in cats.

In addition to his burning belly, the high doses of Depo-Medrol could certainly be contributing to his excessive thirst and urination, as that is a known side effect.  I don't remember if he's had any labs done, or if that is unavailable to you.  But if he has not had blood work done and the option is there, you may want to look into having his kidney values looked at if his stomach doesn't improve with any of these treatments.  Kidney failure causes nausea and vomiting, and it also causes excessive thirst and urination.  I would have a hunch this isn't his issue since he went into a little remission, but it might be something to keep on the list diagnostically.