New member - Vomiting/UTs

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Killua356

Killua356

Member Since 2022
Hello everyone! I hope you and your kittys are having a lovely day.

My sugar cat is currently recovering from DKA; She has a history of being diagnosed as pancreatitis and possible IBD (irregular bowel movement/inflammation to be exact but they couldn’t really give a direct answer..) based on ultrasound 05/22/2022. The strange thing is, even after her blood glucose and ketones became normal, she vomits bile everyday mostly at night or early morning around 3am. She’s responding well to anti-nausea meds (Cerenia/Ondansetron) thankfully but vomits right away without them. My vet wants another ultrasound because of this and if she can’t find anything she recommends endoscopy.

We suspected her vomiting is caused by pancreatitis flare-up but her fPLI on 06/29 came out normal. She still throws up on pancreatic supplement (Lypex); No UTI or kidney disorder either from urine tests on the beginning of July. Besides vomiting she’s peeing & pooping normal, interested in food and seems fine.

The vet told me she didn’t find anything cancerous on Miho’s previous UTs (ultrasounds), but added they may not show small tumors like lipoma which is why she wants to do endoscopy after upcoming UTs. While I understand this may be necessary, my 8 year old friend has been in and out of hospital since May I don’t want to stress her out anymore.. I’m worried about her health being affected by sedation and anesthesia required for both UTs & endoscopy.



Few things for reference:

  • on the beginning of July her ALKP and BUN/Crea were elevated (recorded on SS) but I was told this may be due to recovering from DKA & no UTI or kidney disorder was present on urine culture. I booked for another blood test scheduled this morning to check if her levels have been stabilised but had to cancel bc of her hypoglycemic episode; I’m guessing elevated ALKP might be the possible cause but she was still vomiting on liver supplement (Samylin).

  • She first started vomiting bile on June when her BG randomly went extremely low. No signs of hypoglycemia at this time which was odd. The vet advised to reduce insulin, turned out her body was still throwing ketones even at the normal BG range. Then Boom DKA - which she’s currently recovering from. Fast forward to this morning, she went into hypoglycemic shock when she was given the same amount of insulin as usual the night before & threw up a little after given anti-nausea meds but hasn’t vomited since. I can’t rule out the possibility that her random hypoglycemia/vomiting is somehow related.



Here’s my question:


Is doing another UTs worth it if the vet couldn’t find anything that explains the cause of her vomiting on the previous UTs 2 month ago? There was possible IBD but I don’t want to use steroid given her condition until I’m completely sure. Would it be better to do an endoscopy without UTs revisit or do both?


P.S - If you know anything in regards to what my kitty is going through rn please let me know. I feel like being kept in the dark on this issue any advice will be greatly appreciated.
 
Hello and welcome!

Minnie had IBD and was on both ondansetron and Cerenia. It worked for a few months at first then she started vomiting again. The vet added budesonide and that with the other meds seemed to do the trick. It’s a localized steroid that doesn’t raise the BG in most kitties. It did raise Minnie’s a bit so she was on a higher dose of insulin but at least no more vomiting and I was okay with the compromise. If you have decided not to do the endoscopy, you can ask your vet about it and put her on it. If you plan to maybe do the endoscopy, then you need to wait because it can affect the results. Don’t mean to scare you, but Minnie ended up having aspiration pneumonia from all the vomiting before we got her on budesonide so I recommend not waiting too long if she’s vomiting regularly. Minnie also did have the endoscopy done but only because she ended up in the ER because of the pneumonia. I don’t know that I would have done it otherwise. It’s a tricky decision. I’d ask myself how would the results change your decision regarding the treatment.

the good news is your vet seems to be on top of it and doing all the right things. I don’t know that much about DKA but wondering if that can be the reason for the vomiting. Tagging @Wendy&Neko who gave me great advice back then!
 
Ale & Minnie (GA) said:
Hello and welcome!

Minnie had IBD and was on both ondansetron and Cerenia. It worked for a few months at first then she started vomiting again. The vet added budesonide and that with the other meds seemed to do the trick. It’s a localized steroid that doesn’t raise the BG in most kitties. It did raise Minnie’s a bit so she was on a higher dose of insulin but at least no more vomiting and I was okay with the compromise. If you have decided not to do the endoscopy, you can ask your vet about it and put her on it. If you plan to maybe do the endoscopy, then you need to wait because it can affect the results. Don’t mean to scare you, but Minnie ended up having aspiration pneumonia from all the vomiting before we got her on budesonide so I recommend not waiting too long if she’s vomiting regularly. Minnie also did have the endoscopy done but only because she ended up in the ER because of the pneumonia. I don’t know that I would have done it otherwise. It’s a tricky decision. I’d ask myself how would the results change your decision regarding the treatment.

the good news is your vet seems to be on top of it and doing all the right things. I don’t know that much about DKA but wondering if that can be the reason for the vomiting. Tagging @Wendy&Neko who gave me great advice back then!
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Hi Minnie! Thank you so much for the warm welcome & your detailed response. She’s not vomiting anymore but only because of Cerenia and Ondansetron. I’ve seen on the internet you need to take a break for Cerenia every 5 days but she still vomits during the 24H resting period :( do you take breaks too or just give them everyday?

Did your vet find anything IBD related on your kitty’s ultrasounds, if you ever did one? My vet said the same thing as you did (recommending steroid if I’m not going to pursue endo saying Miho might need to be on higher dose of insulin on steroid). I’m not so much worried about her BG level going higher as she’s usually on the lower/normal range, just worried it might deteriorate her health along with side effects.

My kitty is not in the state of DKA anymore (thank god!) I’m following DKA guide on FDMB which has been super helpful for her recovery ❤️
 
It looks as if you are regularly testing for ketones which is excellent. Please continue with that.
Are you giving lots of snacks during the day and evening as well as the preshot meals?

I’ve just looked at the SS. One suggestion I’d like to make is….can you get tests in during the cycles.?
Lantus dosing is based on the nadir, not the pre shot BG
Also you are chopping and changing the dose a lot which will mess with the depot. It is better to stay with the same dose unless the Bg drops too low, or you need to increase the dose because the BG is too high.
There is no need to stop cerenia every 5 days.
It is not uncommon for post DkA kitties to be nauseated. I would get Miho recovered completely from DKA before I did another ultrasound I think, but see what Wendy says.
Why is she having the pancreatic supplement?
I would suggest posting daily so we can help you more.
 
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In addition to what's been mentioned, my other thought is excess stomach acid if she's vomiting bile. Pepcid can help with that. But if the only vomiting is during that 24 hr rest, then I'd be leaning more towards IBD/lymphoma causing it. Is she constipated at all?
 
Another thought, if she is vomiting bile in the early hours of the morning…it could be from an empty tummy and a build up of acid. Giving a meal at say +8 or 9 at night might stop that. If you had an automatic timed feeder you could set it for each night. My Sheba had that and by giving her a night time snack, it stopped the vomit.
 
I would start with a GI panel blood test, which tests for B12 (cobalamin) and folate levels. This can be a useful tool to see is she needs supplementation.

Without seeing the original ultrasound report, it's hard to say if an endocsopy would work, or whether you need a full thickness biopsy for a proper diagnosis. An endoscopy cannot reach all parts of the GI track. Neko was doing some vomiting (foamy or bile) before she went in for diagnosis on her GI system. She also had CKD so I wasn't sure what was causing the symptoms. Her heart could not take anaesthesia, so a proper diagnosis was not possible. Reiterating what Bron said, you do not need to pause giving Cerenia every 5 days. That's old school thinking.
 
Bron and Sheba (GA) said:
It looks as if you are regularly testing for ketones which is excellent. Please continue with that.
Are you giving lots of snacks during the day and evening as well as the preshot meals?

I’ve just looked at the SS. One suggestion I’d like to make is….can you get tests in during the cycles.?
Lantus dosing is based on the nadir, not the pre shot BG
Also you are chopping and changing the dose a lot which will mess with the depot. It is better to stay with the same dose unless the Bg drops too low, or you need to increase the dose because the BG is too high.
There is no need to stop cerenia every 5 days.
It is not uncommon for post DkA kitties to be nauseated. I would get Miho recovered completely from DKA before I did another ultrasound I think, but see what Wendy says.
Why is she having the pancreatic supplement?
I would suggest posting daily so we can help you more.
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I agree that she needs to be recovered first. It’s been a month since her DKA, tomorrow would be her first vet visit in 3 weeks. While I do want to get the bottom of this vomiting issue not sure if it’s too early for her. Idk what to do..

My answers to your Qs in order:


1. No snacks she doesn’t really like them but she eats wet food. I try to give her what she likes (FF or broth pouches) along with her main meal throughout the day & at insulin time


2. I made a typo on the dosing on my SS sorry about the confusion. I usually give 1U, 1.25 if her ketones/glucose is high. I gave 0.65 today after giving 0.9-1 for few days because she went into hypoglycemia :’( Yes I’m aware Lantus dosing is based on Nadir I’ll test more often so I can get the right dosing advice.



3. Lypex was for pancreatitis. I’ve seen it on another sugar cat community it stopped their kitty’s vomiting but it wasn’t working for Miho. I stopped now


4. I thought it might be due to acid build-up as well so I tried feeding her small meals every 2-3 hours but she still vomited. Like, if I feed her at night she’d vomit in the afternoon. She wasn’t vomiting like this when she was recovering from her first and second DKA, had incontinence and diarrhea though. This time her poop is ok but vomits. Strange..


5. I was told from another community I need 24 resting period for cerenia so it’s confusing who is right! I’ll take your advice & others given that Miho throws up during the interval I don’t want her to lose anymore weight. Thank you for the advice :cat:
 
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Wendy&Neko said:
I would start with a GI panel blood test, which tests for B12 (cobalamin) and folate levels. This can be a useful tool to see is she needs supplementation.

Without seeing the original ultrasound report, it's hard to say if an endocsopy would work, or whether you need a full thickness biopsy for a proper diagnosis. An endoscopy cannot reach all parts of the GI track. Neko was doing some vomiting (foamy or bile) before she went in for diagnosis on her GI system. She also had CKD so I wasn't sure what was causing the symptoms. Her heart could not take anaesthesia, so a proper diagnosis was not possible. Reiterating what Bron said, you do not need to pause giving Cerenia every 5 days. That's old school thinking.
Click to expand...


I asked the vet to send the ultrasound results along with B12/folate test done before but she hasn’t given them yet. Will upload on SS when she does. She’s currently on B12 injection (0.25ml) once a week the vet told me she needs it. Miho’s vomit is foamy and bile too, do you think they’re related? It’d be great if I can sort this out without doing any invasive tests that require sedation/anesthesia. As for Cerenia I’ll give them without intervals from now on thank you :)
 
FrostD said:
In addition to what's been mentioned, my other thought is excess stomach acid if she's vomiting bile. Pepcid can help with that. But if the only vomiting is during that 24 hr rest, then I'd be leaning more towards IBD/lymphoma causing it. Is she constipated at all?
Click to expand...

I’ll ask the vet about Pepcid thank you. I gave her slippery elm during the resting period as I heard this can help with vomiting but it was no use. The vet thinks it might be IBD/lymphoma as well but I keep wondering if they couldn’t find those on ultrasound 2 month ago, can they find anything new now? Her poop is normal slightly liquid-y at times. I saw her going to the litter and coming out 1-2 times without doing the deed but that’s it
 
Killua356 said:
I was told from another community I need 24 resting period for cerenia so it’s confusing who is right! I’ll take your advice & others given that Miho throws up during the interval I don’t want her to lose anymore weight. Thank you for the advice
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There is another cat diabetic site that I would not recommend using, to be honest, so be careful.
When I said snacks during the day I meant low carb food snacks, not treats. Its important that post DKA kitties eat lots of food to recover. FF and broths are perfect for snacks.
Would you mind putting DKA in your signature please so we are aware of it when helping you.
Would you like to start posting daily over on the Lantus forum where you will find a lot of very experienced people to help?
I'll give you the link to it. You post a new thread daily with the date name of kitty and the AMPS and any question. so...21/7 Miho AMPS xxx
LINK to lantus forum

I've just noticed you are from Australia...so am I. I live in Sydney. Here is a link to INFORMATION FOR AUSSIE CAREGIVERS
 
Bron and Sheba (GA) said:
Would you mind putting DKA in your signature please so we are aware of it when helping you.
Click to expand...

It’s already in my signature. Thank you SM for the links and info! I’ll post them soon. I also DMed you in regards to diet questions etc, please check when you have time : >


+

I have discussed with family members and decided not to do UTs tomorrow and wait a bit. Your comment (that she needs time to recover from DKA) stood out to me, but even before posting my gut feeling was telling me something wasn’t right. I wasn’t this anxious when she did liver biopsy during her hospital stay few months ago. Her UTs was originally scheduled yesterday but had to postpone for tomorrow bc of her hypoglycemic episode. It was quite unusual since her last episode was 2021, she was vomiting too even after meds but stopped when I decided not to go that day and hasn’t vomited since. May be this was a sign idk. On top of that she urinated blood on the last vet visit on beginning of July due to stress so I really just want her to fully recover first.

Thanks again all for the responses I really appreciate it!
 
I agree with Bron and everyone who said no need to stop Cerenia after 5 days. That’s dated advise. Minnie would be on it for months at a time. But ondansetron always worked better for her so she was on that daily. And then the budesonide was added. Neither worked alone. She needed all 3

Yes the IBD diagnosis was based on the thickening they saw on ultra sound results. She had a few in her life. She also then had the endoscopy that confirmed it

Great point about snacks or smaller meals throughout the day! I started feeding Minnie at night when I woke up to go to the bathroom. I realized that it was too much time between her last meal at 10pm and breakfast at 7am. I’d leave some low carb fancy feast on a covered bowl and when I’d wake up around 1am I’d feed it to her. She also had snacks during the day. Mainly freeze dried treats, baby food and fancy feast chicken filet. It really helped with the vomiting
 
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If she's getting B12 injections already, there is no point to testing for it. She'd have to go off of it for a while, then test to see what her baseline is.

If there is a GI issue, Pepcid may not be a good thing to add to her meds. Cats need some acid for digestion. Try the small snacks first.

You cannot differentiate IBD from small cell lymphoma without an endoscopy (if appropriate) or full thickness biopsy. The issue is that treatment for the two is different. If you assume IBD and treat for that first, there is some possibility that the cat has both. Ask me how I know. :rolleyes: Good news my girl is 4 years in remission from small cell lymphoma, and IBD is mostly controlled.
 
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