Dog Health Questions? Ask a Dog Vet for Answers ASAP
Hi, Dr. K. My aunt has a purebred (unfortunately) Maine Coon cat, about 4 years old. This cat has always had a breathing problem with mucus coming out of her nose, sneezing.I just saw that JA defaulted to dog veterinary when I asked this question from your profile descrip. I'll continue for now, but if we need to start over, let me know how (I cannot edit category here).Anyway, "normal" for this cat is a runny nose, sneezing, snot blowing. No breathing sounds.Last June, the problem got worse with a lot more mucus, more sneezing. She was put on Orbax (7 days) and after 4 days, things returned to her "normal."Then, in December just past, it got worse again. Heavy mucus, tiny tinge of blood within mucus, however less sneezing than "normal". Also accompanied this time by snoring / snorting sounds -- this is the first time for these sounds. I heard them over the phone.. does sound like someone snoring.Again, she was put back on Orbax (7 days).. but this time, no improvement. Taken to vet 01/04, vet wasn't sure what it is: mentioned "rhinitis"; put on a Zithromax (14 days); recommended rhinoscopy.No improvement so far with Zithro (still on), so a rhinoscopy and a few other tests were conducted last week (01/09). I'll be getting this info in hand within a few hours. As of today, the cat is weak, still snoring, needs iv fluids every few days, needs a drug to encourage appetite (will eat and drink a little when on this drug, otherwise, hasn't been); no mucous is running out of nostrils -- both are closed and look bloody (this state presumably as a result of rhinoscopy and cultures).Question: what do we need to do to nail down what this is, and if possible, to treat?
Hello, thanks for the new question although I am very sorry to hear about your aunt's kitty.
The nose anatomy in a cat is amazing, it is built to filter out micro-organisms and foreign bodies and has very fine, intricate bone anatomy and sinuses to do so. If this system is damaged unfortunately it can become a hiding place for bacteria and fungal infections to hide however.
Because this has been a lifelong problem for her we may have worsening of a primary problem or a new condition developing because her nasal architecture has never been normal. Has she been tested for immunosuppressive viruses (feline leukemia or feline immunodeficiency virus) recently? If not that should be done.
I am not surprised that she isn't eating as a big stimulus for a cat to eat is smell. They won't eat what they cannot smell, and if food is tasteless to them they often won't eat. I recommend continuing the appetite stimulant (mirtazapine?) but also get out the stinkiest cat food you can find and warm it and add warm water/broth to it. We need to improve her eating experience. If she isn't eating well her electrolyte levels will be off and she will be weak so fluids are a great idea. If she continues not to eat an esophageal feeding tube should be placed so we don't get into trouble with hepatic lipidosis (fatty liver disease caused by overwhelming the liver with fats broken down for energy to live when they don't eat).
Many cats, especially purebreds from a cattery type situation, carry viral upper respiratory viruses chronically. They may have a flare-up once in their life or here and there when under stress. Signs can range from sneezing, a clear nasal discharge to high fever, lethargy and eye discharge and loss of appetite. In some cases however, either due to a severe infection as a small kitten that destroyed the normal nasal anatomy or because of a chronically suppressed immune system, the symptoms linger throughout their life. These cats we call "snorters" as they will often snore or snort due to chronic infection/inflammation and destruction of their normal nasal anatomy and will have a chronic nasal discharge. The discharge is usually clear, from both sides of the nose equally and the cats don't seem otherwise sick. We almost never see a bloody discharge with these cats unless they are in very dry conditions, are hypertensive and have been sneezing a lot.
The most common cause of viral upper respiratory infections in cats is the Herpes virus so I recommend trying an amino acid supplement called L-lysine at 250mg to 500mg orally twice daily. If this infection is due to Herpes this amino acid interferes with virus replication and will shorten the infection's duration and severity during an outbreak. Good supplements to try are made by the Viralys brand which comes in a powder to add to the food or a tasty gel. You can give this supplement long term at a low level and increase it when the symptoms worsen. There is controversy about whether this really works or not but I have seen some cats improve on it, it doesn't hurt so it's worth trying.
I also recommend using a humidifier to help thin nasal secretions and keep the nasal mucosa moist, both of which help them breathe better and more comfortably.
Because her symptoms have worsened there are a few possibilities.
One is that a secondary bacterial or fungal infection has taken advantage of her damaged nose and is growing in her sinuses/nose. These tend to cause a cloudy, or green or yellow, thicker discharge and often we do see some blood due to the infection destroying normal tissue. It can be difficult to get high enough levels of antibiotics/antifungals to these areas because of the scar tissue and previous damage. And of course we must make sure to use the proper antibiotic/antifungal for the correct length of time. We may need to give medications for weeks to months to clear these infections. Rhinoscopy with cultures (both bacterial and fungal) and flushing is a great idea to look for abnormalities, gather culture samples and possibly flush out a foreign body (like a grass awn). Radiographs of her nose and sinuses are also helpful in some cases. Sometimes a CT scan or MRI of the nose is needed to find the problem area. It is possible that the infective agent is resistant to Orbax or that we are dealing with a fungal infection rather than a bacterial infection.
Another possibility is a polyp or mass in her nose that is painful and is interfering with her ability to get air through her nose. A mass will allow a secondary bacterial infection to thrive as it gives the bacteria nooks and crannies to hide in and grow and stimulates mucous production (great food for secondary invaders) as it is an irritant.
Sometimes we can see a polyp or mass when we perform rhinoscopy or radiographs of the nose but often an MRI or CT is needed. If one of these is seen I recommend a referral to a veterinary surgeon for removal. These are difficult to remove and we want to get it all on the first try.
Hopefully you will get some results back and we can chat further about her. Let me know when you get more information.
Wow, Dr. K. I'm astonished by the incredible thoroughness, detail, and intelligence of your last reply, not to mention the rapidity with which you cranked it out. You never cease to amaze me.To answer your one question, "Has she been tested for immunosuppressive viruses ... recently?"**** No, she hasn't. I've asked my aunt to do.It seems as if #1 priority is getting her back eating / drinking regularly... with that, we'll have TIME to deal with all else. How much time do we have before a feeding tube should be installed? She ate some on Sunday with Mirtazapine.. but has only been having teaspoons since (mostly by syringe feeding).As a result of the rhinoscopy she had, her nose is clogged up and bloody. Is there anything beyond humidification we can do to get these back open?I've looked over her vet exam notes for 2012:03/13/12 -- they noted, "runny nose" but no other issues.06/12/12 -- they noted, "yellow discharge, mild pharyngitis, noises from upper resp." Put on Orbax, 7 days.01/04/13 -- they noted, "congested, yellow + bloody discharge, lungs clear, noises from upper resp"01/09/13 -- Rhinoscopy visit, receipt shows:- SMA Profile (Major)- CBC- Radiographs
- Anesthesia- Biopsy -addt'l tissue histopa- Biopsy -Histopathology Lab Fee- Culture Aerobic - Antech M020- Culture Fungal - Antech M080- Inject Epinephrine/Lidocane Nasal
- Rhinoscopy+Nasal Flush- Phytovet CK Antiseptic flush 4oz- Mometamx 15G/BTL- Ear Smear Cytology
One report from the above came back so far. It states:Histopathology, Full Written ReportBiopsySOURCE:Right and left nostrils.DESCRIPTION/MICROSCOPIC FINDINGS/COMMENTS: MicroscopicDescription: Examined are specimens of nasal turbinate mucosa from the right and left nasal passages. The surface epithelium is hyperplastic with fewfoci of erosion. The stroma is expanded by a mixed infiltrate ofsmall lymphocytes, plasma cells, histiocytes and neutrophilsaccompanied by mild fibroplasia.All received tissue was processed. Microscopic Findings:Mild lymphoplasmacytic rhinitis, right nasalpassage. Moderate lymphoplasmacytic rhinitis, left nasal passage. Comment:Lymphoplasmacytic rhinitis is a common change seen with chronicirritation, allergy and bacterial infection. No specific causative agents, foreign bodies and no evidence of neoplasia are seen on the examined sections.
========================Dr. K, that's all the info I have thus far.Thanks a million!
John, thanks for the further information.
It looks like they flushed her nose and took biopsies but did not take radiographs of her nose/sinuses. It's not appropriate to take radiographs now as her anatomy isn't normal after taking biopsies and flushing her nose.
I assume that they picked areas to biopsy that looked abnormal on rhinoscopy.
I am glad to see there is no evidence of cancer and that they collected samples for bacterial and fungal cultures. I suspect it may be several days before you have those results.
It appears that she must have had an ear infection too as I see ear smear cytology noted and Otomax prescribed.
I would ask if they looked up behind her soft palate for signs of a polyp. A polyp and a secondary infection would explain all of the symptoms she is displaying. We can sometimes see them by looking in the middle ear and up behind the soft palate, but sometimes we need a CT scan or MRI to see them.
I absolutely agree that she needs to eat.
It may help to put sterile saline drops in her nostrils several times a day to moisturize her mucous membranes. Then pat the outside of her nose dry, puncture a vitamin E capsule and dribble the contents on her raw nose. The vitamin E helps with healing and is oily so seals in the moisture.
I would ask too if there is room to increase her mirtazapine dose if she isn't acting lethargic after it. It sounds like it has some effect, but not enough.
If she isn't eating well within 5 to 7 days from her procedure then an esophageal feeding tube is appropriate, sooner if your aunt is unable to get much food in via syringe because she is objecting too much.
The nice part about an esophageal feeding tube is that they can eat even with that in, it does not interfere with eating and swallowing, and it makes medicating them very easy too, it all goes in through the tube.
Please let me know as more results come in.
Hey, Dr. K. As is the "norm" in my highly dysfunctional family, my aunt proved to be extremely stubborn in accepting any of your excellent advice, preferring instead to listen to the relatively uneducated, small-minded, negative vets in her home town. After several rounds of that, I stepped out of the fray. I invited her to speak with you herself via this same thread should she wish to do so.
John, I'm sorry to hear about your aunt but that is par for family, mine included.
Sometimes the closer related you are the less people think that you know. You would think that they would take into account that you are family and have their best interests at heart, but somehow the reverse seems true.
You are to be commended for trying, and I will be happy to chat with her if she would like, but I've learned to have a pretty thick skin and if she chooses another path that is OK with me too, although of course I worry about her poor kitty.
If you hear how things go for her please let me know, and I am here if your aunt needs me. Take care, hope all are well at your house, Dr Kara.
Fyi as a humorous followup... My Doubting Thomas aunt finally went to another local vet where she lives, a very expensive one. She's now discovering he's suggesting all the same things you said to do. And of course, NOW she's doing them.. because it's HER vet. No need to reply.. just wanted to let you in on the vindication. :-)