“Why Does My Cat Vomit?”

The above question is one that we, as veterinary nurses, have all been asked at some point in our careers. While it may seem like a simple question, the answer can sometimes be tricky. Clients will often ask about or mention that their cat is vomiting not only during sick visits but also routine wellness visits.

Proper communication not only is a key factor for maintaining a healthy relationship between the client and the veterinary team, but it also allows us to focus on the patient’s needs. That can give us a clear understanding about the message that the owner is trying to convey. As veterinary nurses, we are regularly at the forefront of communication between the client and the veterinarian.

Veterinary nurses are the ones responsible for asking a comprehensive list of questions that can help guide the attending veterinarian while making a diagnosis. This includes taking a detailed patient history, documenting it, and then relaying that information to the patient’s veterinarian. Together, the clinician, veterinary nurse, and owner can come together to create a treatment plan that is specific to that patient’s needs.

Client Education and Communication

Vomiting in cats is not normal. It is often thought that cats are supposed to vomit or have hairballs when, in fact, that is a myth that many cat owners still believe. When owners pose the question of “Why does my cat vomit?” it may often be accompanied by the statement, “I thought it was normal for them.”

Veterinary nurses need to remember that the information that we have obtained or learned about a particular disease or condition is not always common knowledge to the client—or to the public, for that matter—so we need to be ready to educate clients on whatever subject is being discussed.

When having any discussion with a client, the veterinary team must remember to keep the interaction positive and to not make any judgments. Owners are often nervous or scared when they bring their pet into the veterinary hospital, especially when their pet is sick. One of a veterinary nurse’s many goals is to make the owner feel comfortable throughout the examination and diagnostic process.

To that point, be aware of how you are communicating and interacting with the client. For instance:

• Are you maintaining good eye contact?
• Are you aware of your facial expressions?
• Are you engaging as an active listener?

These will help communicate to the client that you hear them and understand their situation.

Vomiting Feline Patient History

The word “history” can often be defined as a record of events, which includes an explanation of their causes. The questions that veterinary team members, including veterinary nurses, ask can help shed light on not only the current history but the previous history of the patient as well. The information that is obtained needs to be as clear and as accurate as possible, and this can be achieved by asking open-ended questions.

An open-ended question is a question that cannot be answered with a simple “yes” or “no” response. The owner will have to respond by using a statement. This is advantageous because the open-ended questioning elicits more information regarding that patient and what is happening at home in the words of the owner.

When asking the client questions, don’t be afraid to repeat the information back to the client or to ask your questions more than once or in a different way. You can always ask the owner to be more detailed in their responses if you are not getting the information that you are looking for. We need to be confident in what we are relaying to the attending veterinarian; this process can help achieve a clearer picture of what is going on. Refer to BOX 1 for a list of questions to consider asking the client to help the veterinarian determine the best course of action for the vomiting feline patient.

Vomiting Versus Regurgitation

Vomiting or emesis is the forcible ejection of gastrointestinal contents through the mouth, whereas regurgitation is the effortless movement of gastric or esophageal contents from the mouth.^1,2 Knowing the difference between the two is of clinical significance, as they can lead to different diagnostic plans and approaches.

Some of the questions that we need to ask in order to determine the difference can also be used to help gather general information about the cat’s vomiting instances. Veterinary nurses should consider the following pieces of information—and ask related questions—when trying to determine which one is happening:

• Vomiting can occur with heaving, retching, or abdominal compression, but these do not occur with regurgitation.² One question to ask the owner would be, “When your cat vomits, do you see its abdomen move up and down?” A way that we can describe this to clients is that with vomiting, you typically have abdominal movement, whereas with regurgitation, there is little to no abdominal movement.
• Salivation does not typically occur with regurgitation but is common with vomiting. Salivation is the medical term for drooling or an excess flow of saliva from the oral cavity.^1,2
• The regurgitated bolus (the amount of food contained in a single swallow) is usually a tubular shape;^1,2 it may contain hair, kibble, or canned food that was just eaten. Depending on the amount of time that has passed, the bolus may not be a tubular shape yet. If the bolus contains only hair, that is typically referred to as a hairball.³
• A regurgitated bolus will not have bile in it, whereas vomited food may contain bile.²

Keeping the above information in mind, veterinary nurses should now be able to start gathering information from the client.

Once we have received and processed the client’s responses and relayed them to the veterinarian, we can then begin to discuss diagnostic testing that the veterinarian may recommend to help determine possible causes for the vomiting (or regurgitation; regurgitation is outside the scope of this article). Vomiting is a general sign of several conditions and can be classified as acute or chronic.

Vomiting in cats can be associated with hairballs, intestinal parasites, dietary indiscretion, food allergies, diabetes, kidney disease, thyroid disease, neoplasia, gastrointestinal foreign bodies, constipation, and inflammatory bowel disease.^1,3 This is not a complete list of causes, but they are some of the most common ones seen with vomiting cats.

Diagnostic Testing for the Vomiting Feline

The veterinarian will recommend diagnostics based on the presenting complaint, physical examination findings, and the patient history obtained by the veterinary nurse. Depending on the severity of the vomiting, the veterinarian may choose to treat the patient conservatively or to perform more involved diagnostics. A general rule is to go from the least invasive procedure to the most invasive. FIGURE 1 displays a flowchart that the veterinary team may follow to aid in diagnosis of a vomiting cat.

Treatment for the Vomiting Feline

Medication Options

Once the veterinarian has made their diagnosis, the veterinary nurse can begin to discuss the prescribed treatment options with the client. During this discussion, the veterinary nurse should find out the patient’s and owner’s preferred method of medicating. While liquid suspensions may be great for one patient and their situation, it may not be that way for another patient. We should try to be as personalized and individualized as possible in every step of the process.

As veterinary nurses, we know that medications come in many different forms. The most common forms include liquid suspensions, tablets, capsules, and transdermal gels. There are many compounding options available. Compounding can be a useful option because we can match the medications to client (and patient) preference, which increases compliance and results in the best possible outcome for the patient.

Most compounding pharmacies will also have different flavor options or can make a combination of flavors so that the patient is more receptive to the medication. Having different medication forms can also help with owner compliance, as they are more likely to medicate the patient if they know that the patient will respond positively. If the patient is highly food motivated, the veterinary nurse can find out whether the medication can be made into a treat.

Dietary Change

If the veterinarian is recommending a change in diet, discuss the proper transitioning periods with the client. Diet transitions should be done gradually over the span of approximately 7 to 10 days. Instruct the client to:

• Mix 25% new food with 75% old food for 3 to 4 days
• Increase the mix to 50% new food and 50% old food for 3 to 4 days
• Increase it again to 75% new food and 25% old food for 1 to 2 days

Toward the end of the transition period, the cat should be on 100% of the new diet. By using this method, there is a reduced risk of gastrointestinal upset, which may make the vomiting worse. It can also help to decrease the risk of food aversion.

If needed, provide the client with new measuring cups or canned food lid savers. Be sure to follow up the day after the veterinary visit to ensure they understand the transition and are implementing it as described. Follow up again within a few days to ensure the client does not have questions or run into any obstacles.

Treatment Plans

When discussing a treatment plan with an owner, we should continue to ask them open-ended questions. Instead of asking the client, “Do you have any questions?” ask them, “What questions do you have?” If the treatment plan has multiple options, discuss each option individually rather than summarizing them all together. This open communication can aid the client in making an educated decision.

It is important to have the client either digitally or physically sign all treatment plans with what they approve or decline, and this should be saved in the patient’s medical record. If needed, discuss the various financial services or payment options that your clinic may offer. You can direct clients to these services by either giving them handouts or a QR code to scan or by directing them to your website.

Conclusion

Whatever the reason for the client to be asking the question, “Why does my cat vomit?” it should be investigated. In the end, veterinary nurses are there to advocate for the patient and to help comfort, educate, and guide the owner throughout the visit. Open-ended questions are key in maintaining the relationship between the client and the veterinary team. By practicing good communication every time we interact with clients, we can hope to achieve a favorable outcome for our patients.