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Ask Dr. Michael Salkin Your Own Question
Dr. Michael Salkin
Dr. Michael Salkin, Veterinarian
Category: Cat
Satisfied Customers: 24467
Experience:  University of California at Davis graduate veterinarian with 44 years of experience
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My male 13 year old cat has suddenly taken a turn worst over t

Customer Question

My male 13 year old cat has suddenly taken a turn for the worst over the past few weeks. He was healthy and active and now he struggles to breathe, makes snorting sound when breathing, struggles to eat chokes and gags on his food and has lost a lot of weight and there is some sort of discharge that forms a mucusy crust on his nose. We took him to the vet but they couldn't find what is up with him without doing a £700 procedure we couldn't afford. I hope you can help. Thanks, simon
Submitted: 1 year ago.
Category: Cat
Expert:  Dr. Michael Salkin replied 1 year ago.
I'm sorry that your question wasn't answered in a timely manner. I believe that you're seeing the chronic rhinosinusitis syndrome in cats which certainly can entail quite an expense to investigate thoroughly. I suspect that the expensive procedure you mentioned involves scoping and biopsy of Becks's respiratory tract. I'm going to post my synopsis of this syndrome for you and then post what I believe would be a pragmatic and hopefully helpful approach to Becks. I understand your frustration and commiserate with you. Chronic rhinosinusitis is a diagnosis of exclusion when other etiologies have been ruled out (fungal infection by culture, malignancy by biopsy, a pure culture or PCR of common respiratory pathogens). This syndrome is actually a constellation of diagnoses made by biopsy, culture, and PCR (DNA-based) testing. The three broad groups we see are lymphocytic-plasmacytic, eosinophilic, and idiopathic (unknown cause/the most common) rhinosinusitis. This syndrome is one of the most significant causes of sneezing and nasal discharge in the cat. The nasal discharge is generally serous (clear serum-like), but secondary bacterial infections can result in the development of mucopurulent (mucus + pus) discharge and inflammation can be severe enough to cause intermittent hemorrhage. The clinical signs can persist for years.It's postulated that an early severe viral infection may trigger chronic disease. In addition, it's estimated that approximately 80% of cats are latently infected with FHV-1 (herpesvirus), and so another possible scenario for chronic infection is that Becks is exhibiting the symptoms of persistent herpes infection. If FHV-1 can be confirmed by PCR testing, the antiviral drug famciclovir might be helpful.In general, these cases are somewhat refractory to treatment and palliation of clinical signs rather than cure is the goal of medical management. Broad-spectrum antibiotics are often prescribed to manage secondary infections. Administration of antihistamines such as chlorpheniramine at 1-2mg, orally, every 12 hours may lessen clinical signs of disease in some cats. Moistening therapies such as nebulization and saline nasal drops can help loosen secretions and soothe mucosa, particularly in dryer climates. The anti-inflammatory glucocorticoids such as prednisolone may be helpful as well. Prednisolone may be used at a maximum dose of 1-2mg/kg orally, every 12 hours. If a positive response is noted, the lowest dose and the longest dosing interval that is effective should be determined by adjusting the dose over time. Inhaled glucocorticoids can be used as an alternative to decrease the systemic side effects of oral glucocorticoid use and have the benefit of directly affecting the nasal mucosa. Beclomethasone or fluticasone can be administered by metered dose inhaler (MDI) with an inhalation chamber at 1-2 puffs once to twice daily.This syndrome is the bane of too many cats and their vets but hopefully the above approaches will be at least palliative if not curative. Now here's what I might do considering your financial constraints...initiate a broad spectrum antibiotic such as potentiated amoxicillin or a fluoroquinolone such as enrofloxacin; add an antiinflammatory dose (0.5 mg/kg once daily) of prednisolone; purchase saline nasal drops over the counter and point Becks's nose to the sky and drop a couple of drops into each previously cleaned nostril a few times daily - that "mucusy crust" is a combination of mucus and pus - a mucopurulent discharge. Continue therapy for a minimum of 3 weeks and indefinitely if necessary. Please respond with further questions or concerns if you wish.
Expert:  Dr. Michael Salkin replied 1 year ago.
Hi Simon,

I'm just following up on our conversation about Becks. How is everything going?

Dr. Michael Salkin