After a lot of lab tests and blood work I was told my cat had really bad pancreatitis. We took him to the Vet because he throws up a lot. They prescribed Cerenia which stopped him from throwing up that same day. I was instructed to give him a dose every day for 7 days. We stopped giving the med on day 7 and now for 3 days he is back to throwing up every night.
He does have hair in his throw up but there are times it is all liquid. We've tried hairball remedies but they were ineffective.
I will be taking back to the vet but want to know your opinion on keeping him on Cerenia long term. Is there another med or natural method of controlling his vomiting that might be better for the long term?
Hi Cleo,
The answers to your questions are not simple, as vomiting in cats is not either, but I do have some suggestions about how to think about what is going on, in case this can spark some helpful discussions with your vet.
Most (not all) cats with pancreatitis alone don’t vomit. Vomiting is really common in dogs with pancreatitis but not so with cats. Most of the time cats simply stop eating.
But there’s a phenomenon we see in cats where we can have a combination of up to three conditions, those being pancreatitis, cholangitis (inflammation of the bile ducts), and inflammatory bowel disease. This is called triaditis. About 50% or more of cats with pancreatitis have also been found to have triaditis, meaning they also have inflammatory bowel and/or cholangitis. The reason is that cats uniquely have a common duct opening shared by their pancreas and common bile duct that empties into the small intestine.
In a cat that is vomiting chronically and has normal bloodwork, I often move my line of thinking to a primary GI condition, namely inflammatory bowel disease. This is often a chronic and progressive condition, with folks noticing over time that their cat vomits more often. This can include throwing up hairballs more often too.
Most of the time pancreatitis in cats is chronic too though bad flare ups can cause a sudden drop in appetite. Because of the chronic nature of IBD and pancreatitis, it’s not uncommon for a cat with IBD to have a positive pancreatitis test too.
My point in relaying all of this is that if your cat is vomiting this often and a test did come up positive for pancreatitis, it may not be the only thing present. Investigation into inflammatory bowel should also be considered.
While hypoallergenic diets can be an important part of therapy for IBD and triaditis, in some cats they require long-term dosing of a steroid, either prednisolone or budesonide, and these are medications that can be given daily. These get to the root of the issue, being immune-mediated inflammation.
There is no cut and dry test for IBD, but abdominal ultrasound can be very helpful in aiding the diagnosis, looking for intestinal thickening and enlarged lymph nodes. The pancreas and biliary tract can also be viewed for chronic changes associated with triaditis.
Cerenia is great for stopping vomiting, but only addresses the symptom. There are some patients at my office who are on it long term to some degree.
Because these conditions can be complicated in cats, seeking referral to a veterinary internal medicine specialist in your area can often be helpful as well.