OK, so it wasn’t every day, but it was happening fairly often. That’s why Gizmo’s five-times-a-week hurling habit finally ended in a flurry of blood tests, urinalyses, ultrasounds, and X-rays. Barium was even employed in the end, to no avail. 

Gizmo is my aunt’s cat. He’s a glorious, white mustachioed tuxedo with a slim physique (save that flab on his belly’s "dewlap") on a big frame. He's a vocal one, with an attitude that says he’ll be anyone’s cat as long as he’s petted and fed with non-imposing regularity.

A cool cat, that one. But getting him to stop gacking up his food was a frustrating proposition. I even hospitalized him for a week to perform tests and see what worked for him. Why? Because cats who throw up their food whole — in the absence of other symptoms (such as weight loss) — typically suffer from one of these issues:

1. Gluttony-based speed-eating: OK, so that’s not fair; cats who are truly feeling starved (as when they suffer hyperthyroidism, diabetes, or overly-aggressive weight loss programs) speed eat too. But most shovelers are simply acting the gluttons.

2. Competition-based speed eating: Here’s a behavior problem I often see in multiple-cat households. Here’s when (usually unseen) aggressive interactions between cats leads to one or more of the cats in the household trying to ingest food at a ridiculous rate.

In both of these cases, the upshot is the same: rapid ingestion of the food leads to its getting held up in the esophagus. Most of this rapidly-ingested food never even makes it to the stomach. It comes right back up — within minutes, usually — and looks almost like it did going down.

We call this brand of hurl "regurgitation," which differs from vomiting in that there is no nausea, no gastric upset (not necessarily, anyhow) and no abdominal effort involved in bringing the food up.

Most times it only happens with the dry food, since the kibbles tend to ball up more readily in the esophagus. Sometimes, however, it’s the wet food that comes up, especially with cats who enjoy it so much they’re more likely to consume it with rapid-fire fervor. So even the choice of dry versus wet seems to make a difference … and it’s all individual.

3. Volume and frequency: How much is fed to the cat at any one time can absolutely affect whether cats bring their food back up or not. A ginormous volume all at once is never a good idea. In fact, some cats require three or four daily meals given in tiny amounts, lest they cram out-sized amounts of food down their gullets in ways that ultimately prove ineffective.

Yes, that’s the upshot of 1, 2 and 3: Different cats hack up different foods for different mechanical and behavioral reasons. Then there are some less obvious issues to consider:

4. Esophageal issues: In some cases, cats with esophageal strictures, masses, motility issues (neuromuscular concerns) or ulcers and/or a condition called megaesophagus (uncommon in cats) can display the same sorts of symptoms. X-rays can be fruitful for diagnosis of these conditions but sometimes esophagoscopy (with an endoscope) is the only way to determine what’s up.

5. Stomach issues: Ulcers, strictures, masses, the presence of space-occupying hairballs (trichobezoars), and motility issues pretty much mirror the esophageal problems listed above. The only difference is that when the food comes from the stomach, it’ll look a little more digested, less in the shape of a sausage and will be accompanied by some abdominal effort in the hack-it-up phase.

6. Food intolerances: Food intolerance is the most intangible of all kitty vomiting-slash-regurgitation diagnoses: We don’t know what it is about the food, whether it’s a reaction to the protein, the carbohydrate, an additive, some mechanical characteristic, or some combination thereof. So to diagnose this condition, we’ve not only need to rule out every other possible condition, but play around with ingredients, shapes, sizes, and volumes to see what works.

In the end, Gizmo’s diagnosis was labeled a food intolerance. What finally worked was a bunch of sequential and methodical diet changes designed to tease out his intolerances bit by bit. After a round-robin of about ten brands, lamb and green pea — only a quarter cup twice daily — was eventually determined to be the best for his belly. Rabbit and green pea was a close second. Crunchies were also crucial — as was total volume served.

But I’m still not so sure some motility issues aren’t a factor. In his case, however, as for so many others, repeated testing starts to get prohibitively expensive. Which is why finding the right foods through trial and error is the most commonly employed diagnostic and therapeutic tool in cases like this.

Sure, it’s not ideal, but trial and error is sometimes all we’ve got. At least Gizmo's happy with his lamb and green peas, even if his veterinarian is still a tad curious about what an endoscopy might've shown.

Dr. Patty Khuly

Pic of the day: "Cat Vomit Fountain" by Bogdan Migulski