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Dr L Simmon
Dr L Simmon, Cat Veterinarian
Category: Cat
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Experience:  Veterinarian MVB MRCVS
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I have a cat who is dry heaving most mornings, nothing comes

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Hello, I have a cat who is dry heaving most mornings, nothing comes up except very occasional small bit of froth. This started about 8 moths ago, my local vet did xrays at that time and found nothing. I recently got referred to another vet and the prescribed panacur for 10 days along with antacid tablets for 10 days. Nothing’s changed, I brush him almost daily and he seems 100% other than this pretty much daily occurrence only in the mornings. He sleeps on my bed every night. I have just ordered a brand new mattress in hope that it might be something to do with that. I have a good video of him doing this and then gulping, sometimes hiccuping afterwards, so I’m think8ng it’s more digestive than lungs, but I’m not sure if I should get the mri scan and or ct scan. I didn’t like the sound of the bronchoscopy process they suggested could be done.
JA: I'll do all I can to help. Could be a lot of things that cause lethargy. The Expert will know how to help the cat. What is the cat's name?
Customer: He’s not lethargic thanks
JA: Is there anything else the Veterinarian should be aware of about the cat?
Customer: He was a feral cat for his first year of life before I rescued him, I believe he has some Siamese cross as pale Siamese colour with blue eyes
Customer: replied 11 days ago.
His name is ***** ***** feed hills veterinary formula and I’ve started mixing in royal cannin Hairball control, but I never see him bring any hair balls up ever. He’s outdoor during daytime only. He has small amount of wet food as well, but mainly loves the dry.
Customer: replied 11 days ago.
Other information: he is 8 years old, he does not wheeze or pant or seem breathless at all after chasing his toys, he leaps, jumps and runs happily with no visible breathing problems. I’ve tried off the shelf Hairball pastes and his poos are fine, if anything a always dry and hard. He has bottled water from a cat fountain.
Customer: replied 11 days ago.
Oh and he was very thin when rescued, but that was 7 years ago. He has kept weight on fine and actually got overweight in last few years to around 6.5kg before vet told me to help him lose weight 8 months ago. He is now about 5.5kg.

Hi there, you are through to Dr Linda.

I'm sorry to hear Piggy is having this issue, which has certainly been going on for quite a long time.

There are a number of things that this could indicate and in cats it can be rather tricky (even for vets!) to distinguish vomiting, gagging, retching and coughing from each other.

If there are no other symptoms (such as unexplained weight loss, actual vomiting, runny stool constipation or reduced appetite) the first thing to consider given the symptoms would be 'Bilious Vomiting Syndrome' (https://www.petmd.com/cat/conditions/digestive/how-treat-bilious-vomiting-syndrome-cats), especially as the behaviour tends to occur in the morning. We would have hoped for improvement with the antacids, but it may be that he needs a longer course. Another easy thing to try would be to split his meals into smaller meals so he 'grazes' them throughout the day. Be sure to feed him last thing at night s his stomach is less empty in the morning. I would also consider switching to a sensitivity diet such as Hill's I/D or Royal Canin Gastrointestinal.

It's reassuring that the x-rays taken were normal. Can I confirm that he has also had some basic blood, urine and faecal tests performed? This would be a first step and would certainly be advised before any more invasive investigation. If normal, we may consider e.g. an endoscopic study (small camera that is used to visualise the food-pipe and stomach). Similarly, abdominal ultrasound can be useful in cases like this.

I agree that this sounds more digestive than anything else. However, I would want to confirm that the vet has had a good listen to the heart and lungs and that both sounds completely normal. Similarly, I would want to ensure that Piggy's resting breathing rate (when asleep or completely relaxed) is less than 30 breaths per minute.

As a final thought, ensure there is nothing irritant in the environment such as chemical cleaners he may be eating or cooking fumes/smoke/air fresheners he may be inhaling.

It has been a pleasure helping you out today, and I hope that you feel I have earned a five-star rating. Please remember to rate the service by selecting the stars at the top of the screen, otherwise the website will not compensate me for my time. There is no extra charge for this (it’s included in your question fee). Even after rating, you are more than welcome to continue asking questions. Thank you, ***** *****

Customer: replied 11 days ago.
I have been using a trickle feeder for the dry food since January and this helped him lose weight. So he never goes without food in his stomach, especially once shut in of an evening as he has a 19:00, 23:00, 2am, 5am, along with about 3 other daily feeds. I’ve been doing this for quite a while. This morning his dry heave woke me up and it was just about time for the 2am feed, but he then woke me up dry heaving again just before the 5am feed ! So could he be getting very in tune with the feeder ?! He will over eat if allowed you see so he loves food a bit too much. I’ll have to check on basics. Both vets have listened to heart and lungs a few times. I’ve been to my local vet three times this year and then to this Lumbry Park surgery. I will check his resting respiration. I have 2 Dyson air purifiers in my house, I rarely cook on a stove, I don’t use any air fresheners. Both cats are normally out when I use hairspray and deodorant and my Dyson kicks in and quickly clears the air according to its screen, but might not be doing as good as job as It appears. It shows PPM of pollen, VOCs etc. Seems very sensitive so I hope they help. Do you think the gulping/swallowing afterwards suggests almost definitely digestive rather than lungs ? The Lumbry Park said their X-ray machine is better quality than my local vets and also they have cat specific endoscopes and my local vet only has a general dog/cat one. I really don’t want to have to put him under GA unless really necessary but I also keep thinking I shouldn’t leave it any longer to find out the true cause ?

Wow, so he really is eating little and often!

Can I confirm that this behaviour was happening before the night time feeds? If so, fine and we can continue, but if not it may actually be worth stopping them. Most cats will not eat this often.

It sounds as though you are doing all of the right things and certainly the environment seems ideal, with good clean air.

Gulping and/or swallowing tends to be when they have brought up a little bit of saliva/mucus or when their throat is sensitive/irritated. Indeed, as he has been heaving so much for so long I would be surprised if his throat wasn't irritated. It would likely be worth exploring a longer course of ant-acids, and perhaps using two types e.g. ranitidine with omeprazole. Oftentimes we need to continue these medications for many weeks before we see improvement, especially if the problem has been going on for so very long.

I would agree that if initial diagnostic tests (bloodwork/urine analysis/ faecal exam and chest x-rays) are not providing us with our answer and the medical trial and lifestyle changes (frequent feeding) are not working, we need to take a closer look at things and get to the bottom of the problem sooner rather than later.

I appreciate your reluctance to put him under G.A. but it may well be the best thing so we can finally have our answer.

An abdominal ultrasound would not typically require anaesthetic so may be a good next step if you are especially reluctant for sedation or anaesthetic as most cats are happy for us to do this while awake. However, this method of imaging will not allow us to look on the inside of the foodpipe and stomach, so an endoscopy under G.A may well be the way to go as I suspect this is where the issue lies.

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Customer: replied 11 days ago.
when it started he was having a 22:00-23:00 feed and then nothing until a 6am/7am feed. Yes after this mornings heaves close together he 100% had food in his stomach!
Customer: replied 11 days ago.
It was the lung aspiration thing that Lumbry vet was suggesting that worried me mainly, I can’t bear to lose him for the sake of investigating his lungs with liquid being put into them to just check something which might not be.

I presume you mean a bronchoalveolar lavage. This is a test that is actually done quite commonly and carries minimal risk. It is especially useful when we are ruling in or out lung disease as it is the best way to sample the cells within the deeper airways.

Only a few mls of sterile saline are used and it really is minimally invasive.

It is far more specific than an x-ray as it can tell us with certainty if there is inflammation, what type of inflammation and if there is a chronic infection, which one exactly are we dealing with. Bronchitis and asthma are commonly diagnosed in this way.

Even a negative result would not have been wasted time as it gets us closer to our actual diagnosis. Certainly, if the vet is in any way suspicious of lung disease it should be examined further. It is not always immediately obvious if we are dealing with heart/lung or stomach issues when a cat is retching so it can sometimes take several tests to get to the bottom of things.

Customer: replied 11 days ago.
Ok thanks for the reassurance, I will speak to Lumbry vet in the morning. I’ve only just finished the course of panacur and the antacid, but they suggested leaving it another month to see if things improve. I thought immediate improvement would be obvious ?

If we are dealing with foodpipe/stomach inflammation/ulceration this can take several weeks to improve, so it would not be unexpected for things to take time to start getting better. However, I would be sure to continue the antacids in this case and not to stop after only 10 days.

Customer: replied 11 days ago.
Ok thank you so much for your time, I’ll update you as and when if that’s of help to you Lisa ��

That would be great thank you. All the best to Piggy!