cat very ill for second time, no diagnosis before

Question
Hell Dr. Sherrell,

We have a two year old cat named Sonja that was given to us by a friend of a
friend who would no longer take care of her (that was about 18 months ago).  
She has always been beyond healthy and the most exuberant animal you have
ever met.  One night about two months ago she began vomiting violently
about an hour after eating and acting ill, such as hiding behind furniture,
something she never does.  All that night she would go to drink water but
then vomit it up with convulsions within 30 minutes.  We took her to the vet
the next morning.  She was dehydrated and we all suspected she had an
intestinal obstruction but after two days of tests (including x-rays and
ultrasounds) the vet found nothing except some "liver numbers" that were a
bit off.  Unfortunately this cost over $1000.  She never ate or drank during
the two days at the hospital, but once we took her home she was back to
normal after about 12 hours.

I just got a call from my boyfriend tonight.  About an hour and a half after
eating dinner, Sonja threw up (loudly enough to wake him) and has been
hiding under the bed.  We don't know what to do.  I am out of town for four
more days and we don't know if we should send her back to the hospital for
two more days where she was too stressed to eat or just bring her in for
hydration, or to wait and see.

I know you cannot diagnose, but is there any thoughts what could cause this
intermittent, severe sickness?

Sonja lives with two older male cats, healthy and good relationships, indoors
only (NYC), and absolutely no dietary changes.

Thank you so much for your time.  

Up late worrying on the West coast,

Karen

Answer
Karen -

Call your veterinarian and let him/her know that she is still vomiting.  If an intestinal obstruction has been ruled out  then  other options can be hairballs, pancreatitis, liver disease and constipation. Ask the doctor to review these options with you. Constipation is extremely in cats and often goes unnoticed and undiagnosed. This can cause intermittent vomiting because often cats are so constipated that there is no additional room in the GI tract.  Inside cats are notoriously famous for being constipated[ because they do not get enough exercise and they are usually fed a dry food diet they suffer from a slower GItract than cats that frequent outdoors. Feeding canned food lubricates the GI tract and can help to prevent constipation.   

The loud vomiting does not denote that this is a serious disease; that is just how cats sound when they vomit.  The sounds are awful and the cats really sound as if they are suffering. Do not be alarmed. Often it sounds much worse than it is. Check with your veterinarian to review more options.  You have already spent a great deal of money - more than likely it will not take much more to determine the cause of her sickness. If you do not follow up with the vet then whatever problem she has can become worse and that will certainly cost you more to treat.

Good Luck -

Charlotte Sherrell, DVM