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Sadly, my cat (11 years old, male neutered) was recently diagnosed with moderate inflammation of his intestines (IBD) and a stomach ulcer. It explains his occasional vomiting over the last couple of months, which suddenly increased to the point where he refuses all food and is on a feeding tube. The longer-term vomiting is likely due to the IBD, but the food aversion and severe vomiting is likely due to the ulcer (according to the vet who did the endoscopy). At least it wasn't cancer, it seems like?

My cat is now on a number of anti-nausea drugs (metoclopramide, cerenia, and ondansetron) and also ulcer medication (sucralfate). Of all the nausea things, only metoclopramide seems to actually do much, which makes its 4-5 hour duration rather unfortunate (he'll vomit up to dry heaves despite the other two, though we've only done 2 doses of ondansatron so far). Mostly, he just hides himself away feeling sick and his only enjoyment is chin scratches.

Has anyone else had a cat with a stomach ulcer and have insights on the typical healing process? I am particularly wondering how long the healing process is likely to be. I should ideally be introducing foods to eat, but there is really no point right now when his primary mission in life is currently "hide behind the couch and try not to vomit on myself." However, it is my understanding that his appetite should probably return once the ulcer is resolved.

Does anyone have insight or tips about a typical successful treatment process (e.g. medication issues, dietary, how long it takes a stomach ulcer to heal)?

Update 1: It might actually be the sucralfate that is the only one that does much, rather than the metoclopramide. I tend to deliver their doses close together, and their durations are similar. When I recently gave the sucralate a bit later, he tossed his cookies despite a metoclopramide dose.

Update 2: Unfortunately, the poor boy did not make it. The ulcer would not heal for some reason, leading to persistent anemia and death. Lack of vitamin B12 due to his earlier vomiting might have been a contributing factor (he got a shot, but probably too late). As a note, switching from Hills a/d to Royal Canin Pea-Duck did help him stop vomiting and keep food down, but he was just too weak and couldn't recover. If I could re-do this in a similar situation (ulcer caused by IBD), it would be to:

  1. Switch immediately to a high-calorie rare-protein diet (pea-duck is good, about 190/can, while venison and rabbit are lower-calorie, at least for Royal Canin)
  2. Start on weekly vitamin B12 shots as a preventative measure (they're cheap and shouldn't hurt anything even if unneeded), and
  3. Get regular bloodwork done so you can track trends for healing of the ulcer (at least once per week).
  4. Drooling - be aware that excessive drooling may not be due to nausea, but might be due to anemia also.
  5. Hind leg weakness - be aware that weak hind legs is often related to nervous system issues, such as those associated with vitamin B12 deficiency (which can be caused by vomiting, diarrhea, or lack of absorption due to bad IBD).
  6. Consider switching food as soon as bile vomiting starts to increase (e.g. vomiting on a mostly-empty stomach, rather than during or directly after feeding), since kitty's immune system might have started rejecting that type of food (seems to be what might have happened with Hill's a/d, which worked great for 2 days and then went rapidly downhill). IBD sometimes means the cat's gut will learn to reject certain foods, so just because a food worked well at one point doesn't mean it will be good even a few days later.

All of these in addition to the standard of care (e.g. sucralfate). All of these eventually were used for my cat, but not all of them were immediate (and they could have in theory all been started up-front). There's still a pretty good chance my cat would not have made it, since the ulcer was not healing well, but it might give a bit more of a fighting chance.

  • Have they told you to switch diets to a gastro low fat or something similar (bland diets)? – Rebecca RVT Jul 6 '16 at 9:54
  • I believe sucralfate should be given 2 hours separate from other medications because of the way it coats. Please check with your vet – Zaralynda Jul 7 '16 at 1:33
  • @RebeccaRVT I've got a mix of single-protein prescription diet stuff (e.g., Royal Canin Duck, Rabbit, Venison), and was just about to start him on the PD (duck) though his feeding tube today. He does seem marginally better, but it's still early to say- he could develop an acquired reaction to that (some people think that cats with a leaky gut acquire immune responses to their food over time). – Namey Jul 10 '16 at 21:53
  • @Zaralynda My vets' instructions didn't note that (and their front desk people didn't think sequencing mattered much), but to be on the safe side I'm pushing the sucralfate at least an hour from any other meds (and giving the other meds earlier). It's hard to be 2h before, since I'm giving the sucralfate about every 5h and he needs some time to rest after his feeding (which is ~1h after the sucralfate). – Namey Jul 10 '16 at 21:56
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    @Namey - Yes IBD for cats we also recommend hypo foods or gastro foods as a permanent diet. And we also recommend using sucralfate 1-2 hours before giving medications or food as it can interfere with absorption. Hope he gets well soon, poor guy is now on a feeding tube? :( – Rebecca RVT Jul 11 '16 at 17:03
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I have no experience with that kind of problem. But I do have a slightly off-the-wall suggestion: try some food that is nothing like cat food (so that it won't have the unpleasant association with nausea). Raw vegetables might be a good thing to try because he can play with them, and while picking it up he may get a taste of it and find he likes it. (I had a cat who was inordinately fond of carrot sticks; she would lick them to slivers. She also loved arugula/rocket.)

Of course, you'll want to make sure that whatever you offer him is safe for cats. Avoid anything in the onion/garlic family. You may be able to get him to "drink" some food. Maybe offer him a little cold vegetable or beef broth if you can make it without onion or garlic.

Another option is to make some food into a paste, then apply a tiny amount to his fur. He'll immediately clean himself, which means he'll get a taste of it.

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  • Thanks. Unfortunately, he just won't look at food of any kind currently. Even his water bowl is a no-go. He's also given up on really cleaning himself, so if I put it in his fur, I'll be the one taking it out. :-\ The vet seems to think that the steroids might help, but they need to wait until the ulcer resolves. I'll keep seeing if he's at all interested in anything though, today is a bit better than usual. – Namey Jul 10 '16 at 21:49

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