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Our 13-year-old tuxedo cat has begun to sneeze blood drops.

Customer Question
Our 13-year-old tuxedo cat...

Our 13-year-old tuxedo cat has begun to sneeze blood drops. There doesn't seem to be an injury. The blood only appears when she sneezes. There has been no change in her behavior, appetite, weight, or socialization. We think it started yesterday. We're in the Philadelphia, PA area and it has recently gotten very cold outside. She is an indoor cat, but we have had the heat turned up.

Veterinarian's Assistant: I'm sorry to hear that. What is the cat's name?

Zeiss, it's Yiddish for sweet.

Veterinarian's Assistant: Is there anything else important you think the Veterinarian should know about Zeiss?

She's in good health, is up to date on her shots, and has had her annual exam this summer. She weighs about 12 pounds. We got her from the SPCA when she was a kitten. She was spayed.

Submitted: 5 months ago.Category: Cat Veterinary
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Answered in 6 minutes by:
11/12/2017
Cat Veterinarian: Dr. Kara, Veterinarian replied 5 months ago
Dr. Kara
Dr. Kara, Veterinarian
Category: Cat Veterinary
Satisfied Customers: 18,135
Experience: Over 20 years of experience as a veterinarian.
Verified

Hello, I'm Dr. Kara. I have over 20 years of experience as a veterinarian and I'd like to help. Please give me a moment to review your concerns.

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Customer reply replied 5 months ago
Okay
Cat Veterinarian: Dr. Kara, Veterinarian replied 5 months ago

I understand that you are concerned about Zeiss's sneezing/nasal congestion, now with some bloody mucous and I'd like to help.

How is she feeling otherwise? Any loss of appetite, weight loss, lethargy, or fever?

Was the discharge from both sides of her nose, or just one?

Given her sneezing of course we are concerned with things that cause nasal inflammation.

Sneezing and reverse sneezing are signs of nasal and pharyngeal irritation.

With nasal irritation we can also see a nasal discharge which can be yellow, white, green, mucoid or even bloody in character. In some cases with long term infections or a mass we can even see bleeding and nasal bone destruction and swelling or changes in nose conformation or around the eye.

Possible reasons for these symptoms are bacterial, fungal, or viral infections, a foreign body in the nose, a polyp or mass in the nose or a tooth root infection. Another possibility is a sterile inflammatory condition called lymphoplasmacytic rhinitis.

Lymphoplasmacytic rhinitis is a chronic inflammation and thickening of the nasal mucosa that does not cause any changes in the nasal bones, and is not associated with any sort of infection. It is steroid responsive, but high doses of steroids for long periods of time can be rough on her gastrointestinal tract, liver and kidneys and can cause diabetes. Ideally we get the condition under control with a high dose of steroids and then slowly reduce the dose to the lowest possible to control the condition. Some cats can come off steroids completely for long periods of time without symptoms returning, but most need steroids chronically at lower levels.

Because we need to use immunosuppressive with this disease we want to make sure we look for infectious causes first and rule those out, and get biopsies for a definitive diagnosis.

Allergies, or dry air, are rarely the cause of chronic nasal congestion, cats seem to get itchy with allergies, not nasal congestion.

If this is a very recent issue of short duration then she may have picked up a contagious upper respiratory infection. An upper respiratory infection in cats is just like a cold in you and I, and these are commonly caused by a virus, the most common one being Herpes virus. These are easily caught by breathing in virus particles in the air from a sneeze or nasal or eye discharge. Some cats get sicker than others and young, healthy adult cats seem to tolerate them and fight them off better than very young kittens or older cats. Symptoms range from a mild runny nose and occasional sneeze to severe congestion, coughing, sneezing, fever, eye discharge, and in some cases fatal pneumonia. Sometimes if they sneeze enough they can break a blood vessel and cause bleeding in the nose, leading to sneezing blood.

If this has been short term and you suspect a viral infection you can help her feel better by adding warm water to her food to make it smell more (they don't eat if they cannot smell) as well as making it easier to swallow.
Also the more fluids she gets the better. Offer tuna juice, low salt chicken broth, run the tap if she likes to drink out of the sink.

Take her into the bathroom with you if you run a hot bath or shower as the steam will soothe her sore throat and airways, moisturize her nasal passages and sinuses, and thin the mucous in her respiratory tract.

If her nose become very congested you can use sterile saline to loosen the thick mucous and remove it. She won't like it but it will help her breathe and be able to smell her food better. You can also use sterile saline to remove eye mucous if it accumulates.

You can give her an amino acid supplement called L-lysine at a dose of 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. Good supplements to try are made by the Viralys brand which comes in a powder to add to the food or a tasty gel.

If this becomes a more chronic condition (weeks to months) then diagnosis of a the problem behind these symptoms can be complicated. We may need to perform radiographs of the nose and sinuses looking for changes in the bones or full sinuses, nasal flushes and scoping to collect culture and biopsy specimens and sometimes blood titers to look for the infection (especially if we are suspicious of a fungal infection).

Ideally we would run some blood tests including a complete blood count, biochemistry profile, T-4 level, and feline leukemia and feline immunodeficiency tests, fungal titers, and testing to check to see if her blood pressure is elevated. Cats with kidney disease, heart disease or hyperthyroidism can have hypertension and get nose bleeds. I would check for a fungal infection by checking blood titers for fungal infections found in your area, aspergillosis tends to cause nasal congestion and infections throughout the US.

If those tests come back normal then looking for a tooth root infection or retained root, a foreign body or polyp with a nasal scope and radiographs of his tooth roots, nose and sinuses under sedation would be recommended. A biopsy of any abnormal tissue could be diagnostic.

Some cases require a CT scan to get a diagnosis.

If she starts bleeding more than a little bit you can use a cold compress/pack on the outside of her nose for several minutes at a time. If she is bleeding a lot you can also use a drop or two of Neo-Synephrine to try to stop the bleeding, and then get her seen by a veterinarian.

Best of luck with Zeiss, please let me know if you have any further questions.

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Customer reply replied 5 months ago
She seems perfectly normal otherwise. She is eating well, sleeping well, her weight is good, she is not sluggish or acting strange. We have 2 cats, both live inside. The other cat, a 12-year-old orange tabby, is not exhibiting any symptoms.There is only blood when she sneezes. There's no sign of blood otherwise.
Cat Veterinarian: Dr. Kara, Veterinarian replied 5 months ago

That is unusual then for a respiratory infection.

Perhaps she has an infected tooth root.

I would try adding L-lysine, humidify the air she breathes, and try saline nasal drops.

If this continues then it is time for an exam and some diagnostic testing.

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Cat Veterinarian: Dr. Kara, Veterinarian replied 5 months ago

Hello, I wanted to make sure that you didn't have any further questions for me, and I'd like to know how things turned out for your kitty. If you could give me an update that would be great, thank you, ***** *****

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