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Dr. Kara
Dr. Kara, Veterinarian
Category: Dog Veterinary
Satisfied Customers: 14581
Experience:  Over 20 years of experience as a veterinarian.
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Dr. Kara. It's Friedrich's mom. The vet told me to have

Customer Question

Hi Dr. Kara. It's Friedrich's mom. The vet told me to have him finish the Clavamox, Orbax and decongestant, and if he was at least 90 percent recovered from his respiratory infection, he could start the lomustine. We only had a few days left of Orbax, and I thought we were on track. Then I noticed his nose this evening. :'(I feel like we just have one delay after another. :'( I'm probably going to take him to the vet tomorrow. Do you know what this might be? Thank you.
Submitted: 6 months ago.
Category: Dog Veterinary
Expert:  Dr. Kara replied 6 months ago.
Hello, again. I am so sorry that your poor guy cannot catch a break!We can see secondary ulcers and crusting of the nose leather and the furred part of the nose with Herpes virus infections. Calici virus can cause ulcers too, but they are usually in the mouth on the tongue, hard palate and gums, and rarely they affect the joints.Sometimes we can see skin lesions with lymphoma, so that is possible too.But this looks very much like ulcers from a Herpes virus infection. So frustrating I know, but that would make sense with your poor fellow's weak immune system. He may benefit from antiviral drugs at this point, oral famcyclovir for example.Here's a link if you'd like to read more about Herpes skin lesions: think a recheck is in order. Let me know if you have any more questions.
Customer: replied 6 months ago.
Hi Dr. Kara and thank you. It only started to look abraded within the past 30 minutes or so. I will definitely take him in tomorrow.
Customer: replied 6 months ago.
My Blue Mackerel Tabby, Gretl, has likely been a longtime carrier of the herpesvirus, based on her long term chronic ear, nose and throat issues. Is it possible that he caught it from her? He has had indirect contact with her because everyone shares the same living area and litter box. They haven't had direct contact because, as you may remember, Gretl and Brigiette have been avoiding him.
Expert:  Dr. Kara replied 6 months ago.
You are very welcome.Most cats have been exposed to Herpes sometime in their lives, it seems to be everywhere. If we test cats for antibodies to the virus more than 90% will have them, which means they have been exposed. If Gretl is a longtime carrier and has outbreaks with obvious disease symptoms she will shed virus particles, and he could certainly pick them up by using the same litter box, no personal contact is needed.But since they have been living together for a long time he likely has been exposed numerous times previously and never got sick, and that is pretty common in multicat households. Healthy adult cats with normal immune systems simply don't get sick. I think the real issue now is his weakened immune system. This time he was exposed and his immune system couldn't respond appropriately. Not her fault per se, but the state of his immune system.
Customer: replied 6 months ago.
Hi Dr. Kara. I took him to the vets today. The vet can't confirm that it's herpesvirus or related to the lymphoma, but prescribed a topical ointment for his nose (Animax). He wants us to finish the Orbax, wait a few days, bring him in again to check his blood work, and if the values are acceptable, they will go ahead and start the lomustine. The vet was happy that he gained back a pound. I can still feel that his body condition still isn't normal, though. They only analyzed blood cells this time (it wasn't a CBC), and the vet was pretty happy that his values have improved.I completely forgot to ask him about Friedrich's limping since surgery last month. :/ I plan to ask you about that in a separate question, and I recorded video of it.
Expert:  Dr. Kara replied 6 months ago.
Without a biopsy we really can't tell the difference between the skin variant of lymphoma or Herpes skin lesions. But the skin form of lymphoma in cats is really, really rare. And given his recent symptoms, nasal congestion and runny nose, skin lesions from Herpes makes sense and is much more common.I'm glad he gained some weight too, it sounded like that really needed to happen. I suspect that they did a machine blood count on him and may not have checked a smear to check cell lines. That will at least give an idea of total white and red blood cell numbers.Animax is soothing. It's a combination antibacterial/anti-inflammatory ointment and a good medication to use on raw lesions.If the lesions are worsening though an anti-viral may be needed.
Customer: replied 6 months ago.
Hi Dr. Kara and thank you. I understand about requiring a biopsy.Since his discharge from the hospital, the vet advised me to start giving him L-Lysine. I already had it on hand because I give it to Gretl every day.I attached the photo of today's results. I assume that when he is ready to start the lomustine, they will do another machine blood count and not a CBC? I know that they have to do blood work before each treatment.
Expert:  Dr. Kara replied 6 months ago.
Thank you for the copy of the results. I can see why they are happy.His red count came up nicely and he is pumping out more young red blood cells (reticulocytes).His white blood cell count is down and there is a more "normal" distribution, as in less lymphocytes and more neutrophils. This may be a product of fighting an infection however, so we'll have to see what happens.A complete blood count is a machine read analysis (like he had today) and a technician looking at a smear of his blood on a slide under the microscope. The results with a technician reading the slide are more accurate. That's because machines read cells by size, amount of stain they take up, presence of a nucleus or not. If all the cells are "normal" then that will be pretty accurate. But when we have cancer cases their cells don't follow the rules and we can see young cells (which tend to be larger and have more nuclear material) put into the wrong category. A technician can catch that on a smear and correct for that. So they may have machine readings for the most part and add a smear analysis here and there to make sure we aren't getting false results.
Customer: replied 6 months ago.
Okay, thank you.His appetite hasn't been very good today. I'm not sure if it's normal for appetite to fluctuate in animal cancer patients, or the ulceration is affecting it.
Expert:  Dr. Kara replied 6 months ago.
Honestly it could be a combination.With his sore, ulcerated nose I suspect that he has quite a bit of swelling inside too, which means he probably can't smell his food very well and that is likely interfering with his appetite.

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