Why is Daisy the cat vomiting?

Daisy, a 3-year-old domestic short-haired cat, was brought to our clinic late last December because of a two-day history of vomiting, gagging, refusing food and water, and hiding under the bed.

While being examined, the indoor cat assumed a hunched stance, with her neck somewhat outstretched. She was dehydrated, and her pulses were slightly weak.

Her heart was racing, but she was breathing comfortably and her lungs sounded clear. Daisy's abdomen felt normal and did not seem painful when I palpated it. Her temperature, 102.5 degrees, was normal for a cat.

During the exam, Daisy gagged a few times for no apparent reason. I asked her owner if anyone in the household fished or sewed. She said no.

Although Daisy appeared a bit lethargic, she was able to mount a fight when I tried to examine her mouth. With an anxious animal, it can be necessary to triage your battles, so I left her mouth alone for the moment in favor of blood work.

Cats vomit for many reasons, including gastroenteritis, hyperthyroidism, diabetes, kidney failure, and cancer. Blood work could point to any of these diseases.

While the blood work - blood-cell count, blood chemistry, and thyroid hormone level - was processing, I left the room to give Daisy time to settle down. While in the exam room next door, I could hear her retch a few times.

No red flags were apparent in the blood work. The white blood cell pattern was slightly irregular and the blood sugar was elevated, both likely responses to the cat's momentary stress. A few other blood chemistry and electrolyte abnormalities were present, but these were consistent with a cat that had been vomiting and not eating for a few days. Daisy's thyroid hormone level was normal, indicating she was likely not hyperthyroid.

At this point, Daisy was a bit calmer. We wrapped her in a towel for safe restraint and, using a tongue depressor, I gently opened her mouth and lifted her tongue to look at the underside. The base of Daisy's tongue was an angry purple and swollen.

A clear, thin filament was wrapped around the base of her tongue. I said to the owner, "Are you sure there is no fishing line in your house?"

Just then, she recalled an incident that had occurred right before Daisy became sick. While taking ornaments off the Christmas tree, she heard a jingling sound. She turned around to see Daisy batting around an ornament.

Later, the owner found the ornament in pieces but did not think much of it. She recalled the ornament had a long filament for hanging. Very likely, that was the line that became tangled around Daisy's tongue.

Daisy's diagnosis was "linear foreign body," filament, cord, floss, string, thread, wire, rubber band, etc. that is ingested.

Though linear foreign bodies can occur in dogs, they are reported more commonly in cats, particularly young cats, who are naturally more playful.

At Petplan, a Newtown Square pet medical insurance company that covers about 150,000 pets, a full 25 percent of feline linear foreign body claims for 2012 occurred in December, when homes are filled with tempting dangers like ribbons, package twine, and tinsel.

But whatever the type, the line is ingested by the cat. It may then become anchored at the base of the tongue. As the peristaltic waves of the intestines try to advance the fastened string forward, the intestines can "plicate," or bunch up, in the same way pleats are formed along a sweatpants cord when it's pulled tightly.

Unfortunately, gastrointestinal lining is more delicate than sweatpants. The taut string can saw through the membrane, leading to perforations. Gut contents can leak through these openings, causing infection and potentially fatal peritonitis (abdominal inflammation).

About half of cats with linear foreign bodies have the filament looped around the base of the tongue. In some cats, string protrudes from the mouth or anus; attempts to pull it out can cause severe damage.

Common signs of "linear foreign body" are vomiting, gagging, drooling, food refusal, abdominal pain, weight loss, and dehydration.

Intestinal pleating can sometimes be palpated on exam, and X-rays may show obstruction patterns and sometimes string attachments, such as fish hooks or sewing needles.

Though dogs typically require surgery, about one third of affected cats are treated conservatively with success: The string is cut at the base of the tongue and passes naturally in one to three days.

Some cases, such as those in which string is anchored in the esophagus or the stomach by a fish hook or the like, require endoscopy.

If intervention occurs soon after the cat becomes sick, the prognosis for full recovery is excellent.

In Daisy's case, a conservative approach was taken because she was stable, showed no abdominal pain or fever, and had clinical signs of short duration.

The string was cut below Daisy's tongue. She was stabilized with intravenous fluids and sent home on antibiotics, antacids, and antiulcer medication. Her owner was instructed to bring her back if she did not improve and resume eating in the next 24 hours, and to keep all stringy items out of Daisy's reach, especially around the holidays!