Bloody vomit - is it related to HCM/Atenolol?

Hello all,

I'm having trouble tracking down information online about my cat's symptoms, and I stumbled across this forum and thought somebody here might have some advice or information.

My 3-yr. old female cat, Mya, was diagnosed with hypertrophic cardiomyopathy (HCM) last December. Since then, she's been on a daily dose of 12.5 mg Atenolol. Her last visit to the cardiologist showed that the Atenolol has slowed her heart rate and prevented the HCM from progressing, at least for the time being.

Last night, she vomited up blood. At first I thought it was a red string, but it turned out to be a thick stream of bloody mucus. It was bright red - it didn't look like coffee grounds. I took her to the emergency clinic, where they did blood work and x-rays. She continued to wretch, especially when the vet palpitated her throat, but only bile was coming up with a hint of blood. The vet said though that she saw fresh blood in her esophagus upon examination.

The diagnosis is gastric ulcers and esophagitis. The vet said that Atenolol should not be causing these problems, since it's not supposed to have any GI related side effects. But I can't help but think that maybe this past year of daily pilling has done damage to her. The vet also said that it's possible that her heart condition could have created vessels in her stomach that could have burst. Before sending her home, she gave Mya an injection of subcutaneous fluids to prevent dehydration, an injection of Pepcid, and Pepcid and Reglan pills for me to give Mya at home. She's now getting six pills a day, spread across three different doses.

I guess I'd like to hear from anyone who has had experience with HCM, Atenolol, gastric ulcers, or esophagitis. It's been a scary 24 hours for me (and Mya!) and I'd just like to arm myself with some more information. I have a follow-up appointment with the vet on Monday afternoon, but anything you all can add would be appreciated.

Thanks to anyone who can help!

Stacy

She's now gettin six pills a day

Are you following the pills with a syringe (3 ml) or two of water? With
that many pills it is especially important. You could also give her a
tablespoon or two of canned or baby food immediately after to not only
help the pills go down so they don't dissolve in her throat, but also to
get her to associate the pills with something good. You could also try
Pill Pockets, which are a treat you can stick the pill in. They are a
bit expensive, but for small pills you can fit two pills in one treat.
Here is an article about pilling cats and esophagitis:
http://www.catinfo.org/pillingcats.htm

Megan



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"Stacy" wrote in message
...

Hello all,

I'm having trouble tracking down information online about my cat's
symptoms, and I stumbled across this forum and thought somebody here
might have some advice or information.

My 3-yr. old female cat, Mya, was diagnosed with hypertrophic
cardiomyopathy (HCM) last December. Since then, she's been on a daily
dose of 12.5 mg Atenolol. Her last visit to the cardiologist showed
that the Atenolol has slowed her heart rate and prevented the HCM from
progressing, at least for the time being.

Last night, she vomited up blood. At first I thought it was a red
string, but it turned out to be a thick stream of bloody mucus. It was
bright red - it didn't look like coffee grounds. I took her to the
emergency clinic, where they did blood work and x-rays. She continued
to wretch, especially when the vet palpitated her throat, but only bile
was coming up with a hint of blood. The vet said though that she saw
fresh blood in her esophagus upon examination.

The diagnosis is gastric ulcers and esophagitis. The vet said that
Atenolol should not be causing these problems, since it's not supposed
to have any GI related side effects. But I can't help but think that
maybe this past year of daily pilling has done damage to her.


You are absolutely *right*. Your vet should have told you to follow the
pills with a water bolus or canned cat food- even water-packed tuna if your
cat won't canned cat food.

Here's an abstract from a study on this exact problem that I posted 4 years
ago when it
was first published. Print this out and show it to your vet:

Newsgroups: alt.cats
From: "Phil P." -
Date: Sun, 30 Dec 2001 06:56:35 -0500
Local: Sun, Dec 30 2001 6:56 am
Subject: The Importance of water after pilling

For the group:

This is an abstract of very recent (2001) study that many vets may not yet
have seen. It addresses a potentially serious problem associated with
pilling cats that has only recently been discovered. We're all aware of the
discomfort of swallowing a pill "dry", however, the problem can be more
serious for a cat. The pill or capsule can become entrapped in the
midcervical region of the cat's esophagus for as long *five minutes*. This
can not only cause discomfort, esophageal entrapment can also cause
esophagitis and esophageal stricture formation.


"Evaluation of esophageal transit of tablets and capsules in 30 cats"

Westfall DS, Twedt DC, Steyn PF, Oberhauser EB, VanCleave JW.

Department of Clinical Sciences, College of Veterinary Medicine and
Biomedical Sciences, Colorado State University, Fort Collins 80523, USA.


"We have reported tablet-induced focal esophagitis and esophageal stricture
formation in cats. The proposed mechanism is thought to be abnormal
esophageal
tablet retention resulting in focal esophagitis with subsequent stricture
formation.

The objective of this study was to evaluate the passage of tablets and
capsules when given alone (dry swallow) and when followed by a water bolus
(wet swallow) to determine if this could, in part, explain the esophageal
stricture formation we have observed in cats. Fluoroscopy was used to
evaluate tablet or capsule passage after administration.

The percentage of dry tablet swallows that successfully passed into the
stomach was 0.0% at 30 and 60 seconds, 6.7% at 90 seconds, 13.3% at 120
seconds, 26.7% at 180 and 240 seconds, and 36.7% at 300 seconds. Wet tablet
swallows successfully passed 90.0% of the time at 30 seconds, 93.3% of the
time at 60 seconds, and 100.0% of the time thereafter. The percentage of dry
capsule swallows that successfully passed was
16.7% at each time interval.

Wet capsule swallows successfully passed 96.7% of the time at 30 seconds and
100% of the time thereafter. For each time interval, wet swallows achieved
significantly greater percentage passage into the stomach when compared to
dry swallows (P .05). This study shows that tablets or capsules given by
dry swallow have prolonged retention in the esophagus compared to those
given by wet swallow.

On the basis of this study, we recommend the routine administration of a
water bolus to cats receiving tablets or capsules PO to facilitate
esophageal clearance. This practice may help prevent medication-associated
esophagitis or stricture formation."

(Excerpt from: The Journal of Veterinary Internal Medicine; Vol 15; Issue 5;
Pages 467-70; Sep-Oct 2001)


The vet
also said that it's possible that her heart condition could have
created vessels in her stomach that could have burst.


Ridiculous. Your vet just doesn't want to admit that he didn't know pills
can become entrapped and retained in the esophagus for as long *5 minutes*
where they can dissolve and induce medication-associated esophagitis or
esophageal strictures.


Before sending
her home, she gave Mya an injection of subcutaneous fluids to prevent
dehydration, an injection of Pepcid, and Pepcid and Reglan pills for me
to give Mya at home. She's now getting six pills a day, spread across
three different doses.


Just be *absolutely* sure to follow each pilling with a water bolus from a
medicine syringe or canned cat food. Give her the water slowly so she
doesn't choke. There's a little gap (diastema) just behind her canine teeth
where the tip of a medicine syringe fits perfectly- so you don't have to try
to force open her mouth.


http://www.maxshouse.com/Illustrations/liquid_meds.jpg

http://www.maxshouse.com/anatomy/man...edial_view.jpg

http://www.maxshouse.com/Medicating_Your_Cat.htm


If your cat won't eat canned food, rub a dab of the food around her mouth
and/or on her belly. She'll lick it off and swallow it whether she likes it
or not. This will clear her esophagus. You can also offer her tuna water.



I guess I'd like to hear from anyone who has had experience with HCM,
Atenolol, gastric ulcers, or esophagitis. It's been a scary 24 hours
for me (and Mya!) and I'd just like to arm myself with some more
information. I have a follow-up appointment with the vet on Monday
afternoon, but anything you all can add would be appreciated.

Print out the above abstract and show it to your vet.

Best of luck,

Phil

Suddenly, without warning, Phil P. exclaimed (06-Nov-05 9:02 AM):


You are absolutely *right*. Your vet should have told you to follow the
pills with a water bolus or canned cat food- even water-packed tuna if your
cat won't canned cat food.


Phil:

What's a water bolus? It sounds like some sort of water-filled capsule,
but I'm betting it's not. Would a squirt of water from a syringe work?

This is the first I've heard of following pilling a cat with water, but
I heard a resounding "DUH!" when thinking about it: Of course! How
many of us take pills dry? Don't we always follow a pill with water to
make sure it goes down? Why *wouldn't* we do this for our cats?

Whenever she'll take it, I'll usually follow a pill with a treat or
hairball med, since she loves the stuff. Water seems better though.

Would think we'd want to be careful though, wouldn't want the water to
go down the wrong pipe, as it were. Would that normally be a problem
with someone inexperienced?

Learned something new today, thanks!

jmc

"jmc" wrote in message
...
Suddenly, without warning, Phil P. exclaimed (06-Nov-05 9:02 AM):


You are absolutely *right*. Your vet should have told you to follow the
pills with a water bolus or canned cat food- even water-packed tuna if
your
cat won't canned cat food.


Phil:

What's a water bolus? It sounds like some sort of water-filled capsule,
but I'm betting it's not. Would a squirt of water from a syringe work?


Same thing. A water bolus is a basically a swallow of water. A bolus could
be food, too.



This is the first I've heard of following pilling a cat with water, but
I heard a resounding "DUH!" when thinking about it: Of course! How
many of us take pills dry? Don't we always follow a pill with water to
make sure it goes down? Why *wouldn't* we do this for our cats?


I know whatcha mean. I'm sure everyone had an aspirin stuck in their throat
at one time or another and it started to dissolve- horrible taste that
wouldn't go away. Why would anyone think dry swallowing a pill is any less
dangerous and uncomfortable for a cat than it is for a human? Its even more
dangerous because feline swallow physiology is more like a human infant's
than an adult's.

Cats are usually easy to pill the first time- but if the pill doesn't go
right down and begins to dissolve in the esophagus-- its a struggle the
second time. That's the main reason why cats are so hard to pill.

I was actually a little surprised when I read the study- like 'who needs to
be told to give their cats water or canned food after pilling? Isn't that
second nature?". But if you think about it, how many vets tell their
clients to give their cats water after pilling? I'm glad the study was done
because at least there's a published reference now.




Whenever she'll take it, I'll usually follow a pill with a treat or
hairball med, since she loves the stuff. Water seems better though.

If you have to pill your cat daily, you can also use a little Vita
Gravy-Feline or Science Diet Mixit. They're both tasty liquids designed to
pour over dry food to help the transition to canned food.



Would think we'd want to be careful though, wouldn't want the water to
go down the wrong pipe, as it were. Would that normally be a problem
with someone inexperienced?


If you use a medicine syringe, just inject the water slowly. There's less
risk of choking or gagging if you inject the water between the teeth and the
buccal wall rather than straight into her mouth.



Learned something new today, thanks!


Your welcome,


Here're some tips on medicating a cat:

http://www.maxshouse.com/Medicating_Your_Cat.htm

Phil

"jmc" wrote in message
...
Suddenly, without warning, Phil P. exclaimed (06-Nov-05 9:02 AM):


You are absolutely *right*. Your vet should have told you to follow the
pills with a water bolus or canned cat food- even water-packed tuna if
your
cat won't canned cat food.


Phil:

What's a water bolus?

A bolus is what moves through the digestive system when you swallow
something.

Originally Posted by Phil P.

"Stacy" wrote in

Ridiculous. Your vet just doesn't want to admit that he didn't know pills
can become entrapped and retained in the esophagus for as long *5 minutes* where they can dissolve and induce medication-associated esophagitis or esophageal strictures.


Just be *absolutely* sure to follow each pilling with a water bolus from a
medicine syringe or canned cat food. Give her the water slowly so she
doesn't choke. There's a little gap (diastema) just behind her canine teeth
where the tip of a medicine syringe fits perfectly- so you don't have to try
to force open her mouth.


http://www.maxshouse.com/Illustrations/liquid_meds.jpg

http://www.maxshouse.com/anatomy/man...edial_view.jpg

http://www.maxshouse.com/Medicating_Your_Cat.htm


If your cat won't eat canned food, rub a dab of the food around her mouth
and/or on her belly. She'll lick it off and swallow it whether she likes it
or not. This will clear her esophagus. You can also offer her tuna water.

Phil, thank you so much for this information. I feel awful - I had no idea that dry pilling was so painful and harmful. It makes total sense though. I'm upset that two different vets and a cardiologist never told me *anything* about the importance of following the pill with water. After reading your message I immediately went out and bought a dropper and have started giving Mya water after each pill - hopefully that will help.

Thanks again for your thorough and helpful response,

Stacy

Originally Posted by

She's now gettin six pills a day

Are you following the pills with a syringe (3 ml) or two of water? With
that many pills it is especially important. You could also give her a
tablespoon or two of canned or baby food immediately after to not only
help the pills go down so they don't dissolve in her throat, but also to
get her to associate the pills with something good. You could also try
Pill Pockets, which are a treat you can stick the pill in. They are a
bit expensive, but for small pills you can fit two pills in one treat.
Here is an article about pilling cats and esophagitis:
http://www.catinfo.org/pillingcats.htm

Megan

Megan, thanks for your response, and for the helpful article. Like I mentioned to Phil, my vets never mentioned giving water with the pills. I will certainly do that from now on, and hopefully it will help Mya. Thanks again.

Stacy