Respiratory Problems in Cats

Tachypnea differential

Question: Hi Dr Richards -

My year old lynx siamese kitty has tachypnea. She has
been worked up with an EKG, echocardiogram, and two
chest x-rays, which was negative for cardiomyopathy.
A recent vet visit chest x-ray showed some what looked
to me faint striae, which my vet felt was
asthma-related, and he felt he heard some wheezing, so
he gave her an injection of Depo-Medrol. There was no
improvement (which he said would happen quickly).
I've nixed any further depo injections, having lost a
cat to feline diabetes as a result of those injections
within the past year. I started giving Valyum
L-lysine tablets (500 mg) once a day, about three days
ago, as I suspect she has herpesvirus
tracheobronchitis. She does not sneeze or cough, but
does have what appears to be gingivitis and will
occasionally have a little "gunk" from her left eye.

Could her tachypnea be something else? How else can
we treat it? If I am on the right track with the
L-lysine, how long does it take to see improvement?

Her breathing during sleep is absolutely normal.

And, she had occasional PVCs on her initial ECG, but
seems to have much less arrhythmic activity now. She
eats normally, plays well, acts happy, is vocal, but
when stressed, will breathe fast with her mouth open.

Needless to say, I am concerned and want to provide
her with the best care and quality of life I can.

Thanks -

Pati

Answer: Patti-

Tachypnea occurs most commonly in cats due to heart disease. Hypertrophic cardiomyopathy and heartworm disease are probably the two most common causes. If your cat was not tachypneic throughout its life, so that this is a relatively new problem, heartworm disease would be important to rule out. Dilitative cardiomyopathy is a more unusual cause of tachypnea in cats at the present time because taurine supplementation in cat food has pretty much eliminated this problem. It is still seen on a rare basis, though. It seems unlikely that either form of cardiomyopathy is present with normal cardiac ultrasound examinations but it may be worth repeating this test at a later date, just to be sure. Heartworm disease doesn't always cause changes that are detectable on examination, especially early in the disease when most of the damage is in the pulmonary vasculature. Testing for heartworm disease can be frustrating. It may be very helpful to ask your vet to have the X-rays examined by a board certified radiologist, though. There are changes that occur on the radiographs that seem to be more apparent to radiologists than they are to me (although your vet may be a lot better at reading radiographs than I am).

Almost all cats with asthma have a cough. Increased respiratory rates tend to be episodic and not continuous. Asthma almost always responds to the administration of corticosteroids such as Depomedrol (Rx). Even though these are the usual things that we see with asthma, there is a lot of variation, unfortunately, so it is entirely possible that it may be the problem, or part of the problem. I would want to be sure that I was ruling out as many other possible causes of increased respiratory rate and/or effort before I settled on this diagnosis, though. Asthmatic cats can often by helped at least partially by the use of bronchial dilators and cyproheptadine (Periactin Rx).

Chronic bronchitis does sometimes occur in cats. It is also usually responsive to corticosteroids, although antibiotics seem to be necessary (at least I think so based on my patients) when chronic bronchitis is present. Chronic bronchitis doesn't respond as well to bronchodilators as asthma, usually.

There is a really long list of "other" possibilities. I will just list these with some brief explanations. They are things to consider and may have been tested for already:

1) roundworm migration and/or lungworms --- this is a not too common cause of respiratory distress and/or coughing. We almost always try deworming cats with chronic signs of airway disease -- just in case.

2) anemia -- can occur due to chronic illness, parasites (esp. Hemobartonella), liver disease, other reasons.

3) chylothorax -- this is often associated with heart disease but can occur for no apparent reason. It is usually visible on X-rays, though.

4) bacterial pneumonia --- doesn't seem too likely as a chronic problem

5) fungal pneumonia -- more common in midwest/southwest (esp. southwest) and also usually shows up on X-rays

6) cancer affecting the lungs --- this can be hard to see on X-rays in some cases in cats but is still pretty unlikely

7) Some cats experience rapid respiratory rates due to seizures but this is usually episodic, as well.

8) diaphragmatic hernia -- this is usually due to trauma (like being hit by a car), is usually visible on X-rays

9) hyperthyroidism causes increased respiratory rates in cats but isn't likely in a cat younger than five years of age and so can almost be totally ruled out in your cat's case

10) pectus excavatum (malformation of the sternum) -- it is unlikely that this is present since it can be felt on physical exam and would be visible on X-rays as well.

11) Pain --- any source of pain can lead to increased respiratory rates. This is something that might not occur when the patient is asleep, too. However, this degree of pain usually interferes with normal activity or causes other signs, like depression. Still, I'd want to rule this out as carefully as possible.

12) Some brain disorders lead to increased respiratory rates.

13) There is a report of bronchial dysgenesis in a Siamese cat (bronchi not developing normally) (AVMA Journal, Oct 1990).

14) We had a patient who only had one lung -- to the best of our and several specialist's ability to tell the lung never developed. He was fine until he had minor pneumonia and one lung wasn't enough to cope with it.

It really might help to have the X-rays reviewed by a radiologist. Most veterinary schools offer this service and there are commercial services, as well.

I hope this helps some.

Mike Richards, DVM
7/16/2002

Lung problems - Bordetella Bronchiseptica and other possibilities

Question: Hi Dr. Mike Richard's,

This is a follow up to my first letter (see below). Both of my cats were x-rayed a second time on Jan. 30. Milkbone's lungs are cleared up and the vet said he probably has some feline asthma. Kelly's lungs are about half way cleared so my vet said to continue her Lasix and Clindamycin for another two weeks. Both cat's symptoms are much improved, although Kelly's breathing is still faster than the other cats I live with and somewhat shallow, I believe.
Both of their "voice's" have improved. Instead of silence or a raspy meow, they are more vocal and sounding like their normal selves. Kelly still has occasional coughing, but it does not last long. The vet said she could tap Kelly's lung if I wanted or we could further treat her with the medication first.
I opted to wait on the tap and see how her next xray is after more medication. Another one of my cats has some coughing and now HE is on Clindamycin. The vet suggested I not burn incense or have anything in the area that could irritate their respiratory passages. I have always had a large air filter going 24 hr. per day also. The cats and I live in a basement apartment. I wonder if mold, mildew, aerosol sprays and occasional incense could be causing this? Some of my friends smoke also. Should I try a humidifier? Any ideas or suggestions are greatly appreciated.

Question: Dear Dr. Mike Richards:

      Two weeks ago, I brought my cat, Kelly, a five year old calico mix to my vets. Kelly was coughing only once or twice a day but regularly. She occasionally has had a cough like this before, but I have thought it was hairballs. My other cats have done this also and the culprit in the past has, indeed, been hairballs. I became even more concerned when Kelly began to hyperventilate after being scared by another cat. She was gasping for air for a minute and I asked to get her in more quickly to the vets. A xray showed a lot of white area in the lungs. The vet said it could be tumors or fluid. I was concerned initially about heart disease and she said yes, this could cause fluid in the lungs. I am very concerned. The vet also mentioned the possibility of heartworms when a few days later, I brought in another of my cats with the same cough. His xray was similar except that Kelly's area of whiteness is closer along her sternum. Both cats are on Prednisone starting with two a day of 5 mg tablets for five days and tapering to one tablet per day.
Both are on Clindamycin antibiotic drops 12.5 ml twice a day. Kelly is on Lasix 12.5 mg per day divided into two doses.
    Within just a few days, the cats symptoms improved. Kelly began to be more active and ate more than before. She stopped coughing almost entirely. The other cat, Milkbone Perry, is also not coughing as much, but still sounds congested when he does. Kelly's respirations still seem faster than my other cats and she is not as active as she has been in the past. I have read about some of the possible disorders my vet mentioned on your website and naturally am very worried. They have follow up x-rays ordered for next week. (Jan 30)
     If one or both cats have lung tumors or heartworms, where would be the best place for me to take them for further advice and follow up? I am thinking a specialist or animal hospital of some sort. I live in central NJ, so PA and NY are possible places to go as well.
When I asked my vet what I would do if it were heartworms, she said "nothing." Your website cases indicate there are things that can be tried. Lung tumors, I suppose, would be the worst news. Heart disease could be controlled with meds at least for a while. Where would be best for me to bring them next and is there anything else I can be doing for them now? I am improving their diets with Pet Guard and Nutro Max, limiting their activity and giving them lots of love.
I rescue ferals and have gone through heartbreak many times and it gets harder each and every darn time. Kelly especially is my favorite at present, though I love them all.
Thank you very much for the service you provide.

Dorene

Answer: Dorene-

Bordetella bronchiseptica infection is the only highly contagious cause of coughing that I am aware of in cats. This can be a normal inhabitant of the respiratory tract but in some cases it is also able to cause disease. Most affected cats recover within two to three weeks even without treatment but antibiotics can be helpful. This is most commonly a problem in shelters but there would be a small chance of this disease even in cats who have been living together for some time without exposure to other cats -- but it would be a long shot.

Heartworms are a fairly common cause of coughing in cats in my area but that may not be the case where you are. I can't recall ever seeing this in more than one cat in one household, though.

Roundworm infection with migration through the tissues causes coughing in some cats and also tends to clear up over time. This was thought to be an unusual cause of coughing when I was in school (long ago) but more recent work suggests that it may be more common than we thought. I think it would be odd to see multiple cats with this problem but I might try deworming the group just to be sure.

Coincidental asthma in more than one cat isn't really uncommon, especially if there is aggravation by an environmental contaminant. Cigarette smoke is thought to be the most likely trigger for this but there are other possible triggers and the list your vet gave you sounds like a good one for things to avoid.

I thought about Legionairre's disease (Legionella ?) but I can't recall seeing any proof that occurs in cats.

The last thing is just environmental contamination without a secondary problem. That also seems likely. It might even be worth having the heating and cooling system checked out if these symptoms persist.

Depending on what happens from this point on, you might also ask your vet to send the X-rays to a radiologist to get a second opinion about what might be going on. Radiologists look at X-rays all day and sometimes can detect subtle changes that vets don't usually see or recognize artifacts (film defects, positioning problems) that lead to false impressions that a disease is present. It may or may not be helpful to get a radiologist's opinion but if the problem persists it seems worthwhile to try, to me. It could also help in making the decision about whether seeing an internal medicine specialist is necessary --- if the radiologist suspects an odd disease it would be best to consider a trip to a specialist.

Humidifiers are generally helpful for respiratory conditions and so I would consider that. It would definitely be best to ask your friends not to smoke at your house, if that is possible.

It is good that you are seeing a response to therapy. I hope that things continue to improve.

Mike Richards, DVM
2/6/2002

Chronic snuffling cats and older kittens

Question: Dr.Mike,

I recently (5/01) adopted two kittens from a local veterinary office. I am
disappointed to have to tell you that I think they knowingly placed sick
kittens. One of them has a chronic runny nose and diarrhea (soft stools),
the other has chronic runny eyes. The vet I adopted them from says it's no
big deal, some cats are just chronic snufflers. But, I suspected he was just
covering his own incompetence since both kittens were given to me with round
worms!! I've also been told that both tested negative for feline leukemia
and I've now had them vaccinated against it.

I've changed vets and am pretty much starting over from ground zero with
these guys. Just had them retested for everything. They've also been
started on Revolution. They're now about five months old. The vet I
changed to seems to confirm that these are inconsequential chronic conditions
and in the absence of fever he recommends no medical intervention. I've
never heard of such a thing as a chronic snuffler. Have you? Should I move
on and try yet another vet. I resent being saddled with sick kittens, but
now that they're "my" kittens I've grown to love them and would like to do
what I can to assure they're healthy and being well cared for.

Any insight you might have would be appreciated.
Sue Ellen

Answer: Sue Ellen-

People involved in the sheltering and adoption of kittens often come to accept giving away kittens with upper respiratory infections as a fact of life. Upper respiratory infections in kittens that are housed in circumstances that expose them to other kittens or cats are so common that they just become routine occurrences. These are usually viral infections and so there is a tendency to just live with them, especially when finances for care are limited. Many of these kittens will develop secondary bacterial infections and these can contribute to damage to the nasal passages that becomes a permanent problem, however. Even when there is an effort to control these infections it may not prevent the long term damage. This is one of the biggest problems for shelters and private individuals, including veterinarians, who try to care for and then adopt out kittens. Their choice is a hard one. Do they euthanize the sick kittens who might become well or do they adopt out kittens who may have lifelong illness and lessen their pool of future adopters for their kittens due to the bad feelings that these lifelong illnesses generate?

There are some things that might help resolve the problems that you are having with your kittens. The first thing is to consider the use of an antibiotic that has a good spectrum against the most likely secondary invaders of your kittens' nasal passages. There are several potentially beneficial antibiotics. Our current favorite for the chronic snuffling cats is azithromycin (Zithromax Rx). It is given at 5 to 10mg/kg once a day for 5 days and then every 3 days until a couple of weeks after the upper respiratory symptoms subside, if it is possible to achieve resolution of the signs. In addition, giving l-lysine at 250mg (small cats) or 500mg (big cats) per day on a continual basis seems to help some cats and should not be harmful even if it doesn't work. I do think that it is better to try at least once to eliminate secondary bacterial agents since they are involved in damaging the nasal passages and setting up long term infection problems in some cats.

It is also important to deworm kittens several times as they age. Roundworms migrate in the tissues outside the intestine and are not very susceptible to being killed by dewormers while they are migrating. Eventually they find their way back into the intestine. If deworming isn't repeated at least once, and preferably several times, all of the roundworms may not be eliminated. In dogs, roundworms tend to be controlled by the dog's immune system by the time the dog is an adult but some cats don't seem to be able to manage this and it is necessary to deworm some cats on a regular basis throughout their lifespan. I think it is acceptable just to routinely deworm and check stool samples periodically to be sure it is working but some vets prefer to do fecal examinations and then deworm only the cats who have eggs on the fecal examination.

This is one of those situations in which veterinarians have different opinions on the best approach. If you decide that you would prefer to seek more aggressive care you can either try to work this out with your current veterinarian, who may be more willing to try to help than it appears, or you may have to consider finding a veterinarian who shares your concern. Sometimes it helps to find a feline only practice in this situation, as there seems to be a tendency for this type of practice to more aggressively pursue long term treatment options in some of these chronic disorders of cats. However, there are many veterinarians who see multiple species who share this philosophy.

Good luck with these guys. It is good for them that you are willing to assume responsibility for their care.

Mike Richards, DVM
10/17/2001

Tracheal tumor with secondary infection, Filaroides osleri other possibility

Question: Our 17 year old tabby has just been diagnosed with a malignant tumor in
her trachea. She has had asthma for several years also. Additionally,
she has a secondary infection. the tumor is restricting about 50% of
her air passage.

She is in good health otherwise. She has been give prednisone on
various regimens (same dose, but differing intervals) over the past
several years to control the asthma. When it became worse her breathing
became labored and she would cough excessively.

Monday Morning she was experiencing great difficulty
breathing. We took her to the doctor and a growth was discovered by
touch and confirmed by xray. A wash was done, tests requested and we
found this evening that she has a malignant tumor (type not known) with
a secondary inflammatory infection.

What are our options with upside and downside. We are not second
guessing our Dr., but just trying to gather as much information as
possible. The tumor is INSIDE the trachea.

Thanks. Your quick response will be greatly appreciated.

Don

Answer: Don-

Tracheal tumors are very unusual in dogs and cats. However, they do occur
in rare instances and I am sorry to hear that your cat have been unlucky
enough to have this problem.

It would be very helpful to know what type of tumor was present. Lymphomas
can occur i the trachea and may be as responsive to chemotherapy there as
in other places. So chemotherapy would be a reasonable option in that case.
Other tumors may respond to radiation therapy, although I believe that this
may only be possible for tracheal tumors that occur in the section of the
trachea that is in the neck, not the portion in the chest.

Surgical removal of tracheal tumors is possible in many cases. It is
possible to remove a fairly large portion of the trachea and still be able
to suture the two ends back together. We have dealt with trauma cases in
which at least a fourth of the trachea was missing and have been able to
put the remaining sections back together successfully in our practice.
Unless the tumor is very large, or located adjacent to the larynx or the
point in the chest where the trachea divides into the large bronchi, it
should be possible to remove the entire section of trachea in which a tumor
is located and then suture the two sections of trachea that remain back
together. Your veterinarian may not be willing to do this surgery,
especially if the portion of the trachea affected is inside the chest
cavity. However, it should be possible to refer your cat to a surgical
specialist for an evaluation of whether surgery is an option. I am not sure
how much the asthma would impact on the decision making for surgery.

If a biopsy has not confirmed cancer (washes can be misleading, although in
some cases they do produce pretty definitive results and this may be one of
those cases), there is probably a small chance that that this is an
infection or possibly even a parasite infestation. Filaroides osleri is
supposed to be able to cause granuloma formation in the trachea which would
resemble a tumor, although not usually as large as what you describe.
Capillaria aerophila can also live in cat tracheas but I am not sure
whether it can cause lump formation like Filaroides osleri can. An local
infection might also be possible. Your vet has probably considered these
options and ruled them out, but it seemed best to mention them.

You may want to ask your vet about referral to a veterinary surgical
specialist for an evaluation of the potential benefits of surgery. It is
supposed to produce the best chance for a good long term outcome for
tracheal tumors. Depending on where the tumor is located, a temporary
tracheostomy may be possible, to allow her to breathe easier until is
possible to make a more definitive decision about what to do.

Mike Richards,

Mycoplasmal infections in kittens

Question: Hi Dr Richards,

I am a cat breeder. Recently I had two litters of kittens become ill
with what seemed like two different illnesses. One involved horrible
swollen eyes, a bit of sneezing, discharge from the eyes were clear. These
kittens, luckily, never stopped nursing, but the eyes were horid. The other
condition showed no symptoms except for raspy breathing. I lost three kittens
with this symptom. The first (they were two weeks old) seemed fine when I
went to bed, first thing the next am she was gasping for breath. Usually when
they start to do that, they are dead in a short period of time. Off to the
vet we went. My vet couldn't hear anything in the lungs, and was thinking a
herniated diaphragm. Barium showed nothing. She tried a few other
things and finally gave her a shot of steroids hoping to take down the
inflammation.

Later that day she took the x-rays to the ped specialist . Who
said the lungs looked very consolidated. Through all this the little girl
stayed strong. I started tube feeding her because she couldn't nurse, too
hard to breath. Later that day the gasping became worse and we put her to
sleep. She was the only kitten in this litter with these symptoms. The others all
had the eye involvement.

About a week later two kittens in the other litter started the very
raspy breathing. None of this litter had the eye involvement and seemed fine
up until this point.

My vet had them on triple antibiotic eye ointment & penicillin. The
kittens in the first liter with the eye symptoms were really getting worse. I
was afraid some of eyes were going to rupture. It was Sat and the vet
closed. I change antibiotics and eye meds to Zithromax and Gentocin. In two days
the condition had cleared. Over night results were amazing. One in the
second litter (with the pneumonia only symptoms) was too far gone and we put
her to sleep. The other kitten with pneumonia only symptoms is steadily
improving.

He is now on Doxycycline.

A couple of days ago histopath came back as Mycoplasma. So the
antibiotics I switched to was the right choice. Just knew I had to
something different!

I have no idea where this has come from. I had a girl abort her litter
a month ago but was negative for Mycoplasma.

I have been told I need to dose everyone in the house with
Doxycycline, for 14 days. What would you suggest? I sure don't want this to reoccur. If you agree on the Doxy, what dose and for how long? Does Doxy stain teeth like tetracycline does? Any advice you can give me to get rid of this
problem is most appreciated!

Best regards, Julie

Answer: Julie-

Doxycycline is less likely to stain teeth than tetracycline but it will
do it. Short term use (less than a week) is not likely to cause this
problem but longer term use probably will. The discoloration doesn't harm the
teeth but it is permanent. I suppose this might matter in show cats but I
have not worried about it much for pet cats when I thought the doxycyline
needed to be used for longer periods of time. As far as I know, doxycycline is
currently the antibiotic of choice for mycoplasmal infections cats.
Azithromycin (Zithromax Rx) is supposed to be able to kill mycoplasma
organisms, too, though.

I can't find any information on the specific time period necessary to
kill mycoplasma with doxycycline in cats but there are studies in other
species (dogs, pigs) that show that eight days of therapy is long enough, so
fourteen days is likely to be sufficient.

Mike Richards, DVM
8/13/2001

Can kitty litter dust cause lung disease in cats

Question: A friend of mine recently lost her horse to a lung decease called silicone pneumonia. This is found in some horses in Monterey County, California. I was told that cats have gotten a similar decease from cat litter. Can
breathing the litter particles cause lung decease? If so, what can be done
to prevent it. Is there a particular type of cat litter that can cause this.
Thank You,
Lisa

Answer: Lisa-

If there are reports of silicosis in cats in the veterinary literature, I can't find them. There is one report of suspected poisoning from ingesting cat litter containing bentonite, but the report was not well documented and there have been no follow-up studies on this that I can find.

Cats that have asthma do seem to be sensitive to dusty cat litters, so it is best to use a litter that is as dust free as possible for these cats.

There is a problem with silicosis in horses in California and there have been a few reports of similar problems in chickens but these are environmental hazards associated with problems like living near quarries or chalk factories.

I'm sorry I can't give a definitive answer to this question, but the hardest thing to be certain of is that a problem doesn't exist --- there is always a chance I just couldn't find the evidence for it.

Mike Richards, DVM
12/28/2000

Chronic upper respiratory infections

Question: Hello,

We adopted a family of feral cats a couple of years ago. They were
kittens at the time we adopted them, but they've retained much of their
wild characteristic. Nonetheless, we are very attached to them.
The problem is that one of them, Pixel, has a chronic upper respiratory
problem that presents by her sneezing violently for extended periods of
time. Also, there is a loud snuffling sound to her breathing, probably
due to her nasal congestion. I'm sure that the problem is viral, since
she has just finished a two week course of Amoxicilan 100mg (1/2 tab/day).
What I'm wondering is: is there any treatment for this kind of
condition? I've been told that the disease is probably a form of feline
Herpes, so are there any anti-viral drugs that can help?
I was hoping that she would outgrow the condition, or that it would enter
into temporary remission, but instead it seems to have plateaued.

I appreciate any comments you may have, Rob

Answer: Rob-

Most of the time chronic upper respiratory disease like you are seeing is
the result of early severe viral infection that damages the nasal
turbinates, making it easy for secondary bacterial infections to occur in
the nasal passages. In the case of herpes virus, the virus also sticks
around and causes intermittent problems.

There are no really good systemic anti-viral agents for cats that I am
aware of at the present time. It can be helpful to give l-lysine,
500mg/cat/day. This is an amino acid that interferes with reproduction of
the herpes virus and which can suppress recurrences of the virus if it is
supplemented continuously. Some vets believe that interferon administered
on a seven days on/seven days off schedule is helpful.

Since you can't get rid of the virus, the next plan of attack is to treat
for the secondary bacterial invaders. There are lots of possible choices in
antibiotics for this. Currently, fluoroquinolones like enrofloxacin
(Baytril Rx) and orbifloxacin (Orbax Rx) are commonly recommended, as is
azithromycin (Zithromax Rx). The major advantage of azithromycin is that
it appears to work well even when given every other day or even every third
day.

Using a nebulizer to help moisturize the nasal passages can be helpful.
This is done by putting a cold nebulizer directly in front of a crate with
the cat in it or putting it in a small room with a nebulizer (like a small
bathroom). Decongestants seem to help some cats. We have used
pseudoephedrine orally and neosynephrine nasal drops. Sometimes this seems
to help but not always.

It is likely that Pixel will have this condition for life, even with
treatment. Some cats require l-lysine and/or antibiotics for life to
control the snuffling.

Mike Richards, DVM
11/15/2000

Respiratory infections in cats in group situations

Question: Hi Dr. Mike. I have one suggestion and 3 questions below.

Suggestion: I would be willing to pay more annually or pay per question for this service. You sound extremely busy so perhaps an increase in charges would either pay for an assistant, or reduce the number of people asking questions while maintaining the same income. Just a thought.

1. My first question is about how to reduce incidences of upper respiratory virus among cats in a group situation, in particular at shelters. In an answer on your website to a subscriber on Feline Bordetella,
you refer to an upcoming article:

"I wanted to put some information into this note about controlling
       infectious diseases in shelter situations but I want to research that a
       little more. I do intend to cover this topic in an upcoming VetInfo Digest,
       though. If I don't do it in the next couple of issues please remind me."

There was no date on this one so I don't know if it has already been addressed in one of your digests. I've been a member since 3/2000 so perhaps it's in an older digest--would it be possible for me to get a copy of it, or is it coming in the future? Will or does the article address venilation systems?

2. I am a new foster parent to cats from my county shelter. My current foster was sneezy at the shelter but only sneezed once at my house. She is segregated from my 2 cats but they can sniff each other under the door. I would like her to be able to come out and be in the house with us. Is there a way to reduce the likelihood of the foster cats transmitting a URI to my 2 cats? My 2 are up-to-date on all vaccinations, but would a URI booster vaccination help? (I will only foster one cat at a time but I
might take 2 occasionally. All foster cats are vaccinated for upper respiratory/panleukopenia and tested for FeLV/FIV at the shelter before coming to my house.)

3. My adult male cat has had Haw's syndrome constantly (both eyes) and diarrhea on and off for 3-4 weeks. He's also more tired than usual, but is otherwise normal temp, eating, etc. Can he transmit this to another cat? (i.e. the foster cat; this would make her harder to adopt out). He just tested negative for FeLV/FIV and fecal smear and regular fecal exam were negative.

Thank you so much for your time. Sarah

Answer: Sarah-

I appreciate your offer to pay more for the VetInfo service. Several other people have made similar suggestions and it is really a nice offer. Right now, I am reluctant to raise the fees, though. I do not wish to get into a position where I feel obligated to provide medical advice that constitutes practicing medicine without a license. Also, when circumstances make it so that I really can't answer questions in a timely manner, I feel a little better about the fact that I can afford to refund subscription prices, no questions asked, if someone gets upset by the delay and not feel too badly that I let someone down. At some point, there is a real possibility that there will be enough subscribers that I can cut
down on practice responsibilities

1) a) The only thing that I can say about ventilation at shelters is that it is really worth finding an architect, or engineering firm that understands ventilation and having them design the building from the outset. I did not learn this from doing small animal medicine, though. I worked for some time as primarily a large animal veterinarian and dealt with several pig confinement units. This made me a deep believer in the importance of proper ventilation systems when trying to prevent infectious disease problems in a confined space. In one building, the farmer had made a couple small of changes to the building design - enlarging it slightly and narrowing the intake sites for ventilation by a small amount. These minor changes made it extremely difficult to control infectious diseases in this
building. I know that many shelters are built with a minimum of spare funds -- but this is one area that shouldn't be skimped on.

I have replied to a couple of people recently about controlling upper respiratory diseases in shelters, so you might want to check the question and answer page in case I miss something in the following outline. www.vetinfo.com/Q&A.html ,also check the infectious disease pages FIP and Feleuk.

b) It probably takes closer contact for upper respiratory disease transmission than veterinarians previously thought, so it may help a great deal in shelters and catteries if kittens are just kept separate from each other. Kittens from a litter could stay together, but kittens from separate litters should not be combined and cats should not be allowed to roam freely and interact freely, when infectious disease problems are present.

c) Try to keep the moisture level down in the shelter. It is tempting to use lots of water when cleaning cages and particularly when cleaning runs, but it is better to use less water, when possible.

d) Buy lots of paper towels. Use them instead of sponges, cleaning rags and other things that might be used to clean more than one cage. Throw away the paper towels immediately after cleaning one cage or surface.

e) Wash hands frequently during the day.

f) Intranasal vaccinations of rhinotrachetis (herpes virus) and calicivirus as soon as kittens arrive at the shelter, or when kittens reach 14 days of age, can help to slow spread of viral infections.

g) If treatment with antibiotics is necessary, azithromycin (Zithromax Rx) and doxycycline are probably the best choices in antibiotics. Veterinarians are sometimes reluctant to use doxycycline in very young kittens due to problems with tetracyclines staining teeth during the growth stages but this isn't a big problem with doxycycline.

2) Vaccinations for herpes virus and calcivirus do not protect cats from being infected with the viruses, they mostly work to keep clinical signs of the infection down. So there isn't a good substitute for keeping any kittens that you foster separate from your own cats, for at least two weeks. After that, if they are showing no signs of disease, it is reasonable to let them cats together. Remember that your cats are potentially carriers of herpes virus, as well --- so they pose a small risk to the kitten, especially if there is sneezing or any sign of upper respiratory disease.

3) If your older cat has something infectious, which is possible, he could definitely pass it on to the kitten. Until you know what he has, you have to assume that it is best to keep them separate. Dehydration is the most common cause of both third eyelids showing, which might be a problem due to having diarrhea.

Hope this helps.

Mike Richards, DVM
11/5/2000

Sarah - You will find the other questions Dr Mike mentioned on the feline herpes page. http://www.vetinfo4cats.com/cherpes.html

Michal

Differential for lung problems also Fabreze

Question: Dr. Richards, I hope you can help. My cat, Fancy,
after using Febreeze (that is the only thing that
happened in the household that was different, and she
does not go outside or have contact with strange
cats), started havin resp. prob.that progressed from
backwards sneezing to real sneezing to snotting and
hard coughing. She at first was diagnosed with
asthma, but that proved not to be the case. Nothing
seemed to help. One day her appetite was gone, and
then she went through another several blood tests, one
that showed a slightly elevated white count, which was
lowered with her third type of antibiotic. She was
neg. on all feline diseases, no thyroid prob., no
parasites, nothing. I even tried prednisone when she
was said to have asthma, did not do anything.
Gradually, after another round of antibiotics, which
nearly did her in, she threw up constantly, her
sneezing and snotting and coughing, slowed and then
stoped, but she was left with a problem: She had lost
a fair amount of weight, and needed many meals during
the day. If her stomach got too empty, she would
vomit saliva -type liquid, then cough maybe once or
twice. It took her ages to gain back her weight, and
now that that has happened, she has had a relapse,
sneezing, snotting, etc. I'm still feeding her
frequently, turkey, chicken, quality canned food,
liver, etc. but she of course can't smell it as well
because of her nose. I put her on amoxi, as a chance
measure, she tolerates it pretty well, but so far, no
change, except she had a runny eye 2 days ago, and
that is fine now. ( She is current on all vaccines,
etc.) I use homeopathics, that has helped a little in
the past, so I'm doing that again also. Fancy is only
11 years old, and other than this has been in robust
health. My mom's cat was exposed to Febreeze at the
exact same time. She developed a dry cough, lost her
appetite, and after many tests, x-rays, ultra sound,
she died. She had a lung biopsy done which showed 2
necrotic lobes in one lung, but showed no cause. When
the last doctor looked at all the tests, he said he
couldn't believe they were from that cat, 'cause the
blood tests, etc. showed no disease, or anything. Her
cat was only 8 years old, had always been in great
health, no problems, and our two cats never had any
contact. I hope you can help, I'm out of ideas. I'm
pretty animal health smart, I breed and raise sport
horses, have dogs, large birds, ducks, cats, on and
on, and this is one problem that has remained a total
mystery.
Thank you for caring about the furry
creatures, Dini

Answer: Dini-

I may not be able to help very much but I can provide a list of possible
causes of lung pathology and some differentials (possible diagnoses) for
the problem in your cat.

I can not say that Fabreze (tm) is not the cause of the problems observed,
but it would be unusual if it was. There was a widespread internet and
print rumor concerning Fabreze this spring and the National Animal Poison
Control Center had no cases that suggested a strong link to this product.
With the widespread pressure to look for cases, I think that if there was a
strong toxic problem it would have surfaced. Less common reactions, such as
an individual who hypersensitive to the product may occur so infrequently
that they don't even show up when larger scale investigations are undertaken.

In your cat's case, one thing that I thought about was a nasal polyp. These
can be very hard to find, they can cause nasal irritation, difficulty
swallowing with resulting weight loss and choking or coughing sounds. The
signs are sometimes intermittent but it does seem strange that your cat has
experienced a long remission over the last few weeks. These can usually be
seen when a cat is anesthetized and examined but it can take an endoscopic
examination to find them.

Heartworm disease seems possible with the signs you have seen, if you live
in a heartworm endemic area. Cats do go through very rough periods when an
adult heartworm dies and they may have more than one worm, making it
possible to do badly, seem to recover, then do badly again. If there are
X-rays on file of the chest, a radiologist can tell if this diagnosis is
likely or your vet can look for signs of it, such as enlargement of the
caudal pulmonary arteries. It is not always possible to detect this problem
with X-rays. It is often possible to find it with ultrasound exam and
serology (blood testing) is frequently helpful, as well.

The two retroviruses, feline leukemia virus (FeLV) and feline
immunodeficiency virus (FIV) can lead to on again, off again illnesses. Of
these FeLV is more likely to produce the signs you have seen.

Feline herpes virus is very likely to cause recurrent upper respiratory
infections but the most severe of these usually occur in young kittens and
chronic recurrent severe infections usually occur primarily in cats who had
severe infections as kittens. Sometimes there is a long gap between the
initial infection and subsequent severe signs, but this is fairly rare. I
actually think this is very likely to be at least part of Fancy's problem
based on the history but can not be sure of that, obviously.

Asthma does usually respond to prednisone but it is hard to say it isn't
present based on no response to this medication alone. A tracheal wash
examination can be helpful in identifying signs of this condition and also
helpful in finding infectious causes and other inflammatory conditions
affecting the airways.

Feline infectious peritonitis is always a possible problem when there is
severe illness. It is very hard to diagnose and sure diagnosis is usually
only possible by post-mortem exam. I think this is not highly likely but it
has to be included in the list of possible problems.

Cancer is a very common cause of nasal discharge in older cats. You didn't
say how old Fancy is, so this may or may not apply. Cancer does not cause
much change in lab work in most cases. It can be very hard to find on
X-rays. Sometimes, we just back into this diagnosis by eliminating all the
other possibilities.

The weight loss and need for frequent meals might be due to hepatic
lipidosis, a condition that complicates many chronic illnesses in cats.
Hepatic lipidosis does not always cause significant alterations in blood
enzyme levels usually associated with the liver, making it hard to
diagnose. However, the treatment is to feed a cat and if the cat will eat,
the disease should clear up with time.

These are the things I can think of that might fit the problems you are
seeing in Fancy. There are many more possible problems, I'm sure. In this
sort of situation it sometimes helps a great deal to ask for referral to a
veterinary school or a large referral center. This gives the opportunity
for several specialists to see a patient at the same place, which can be
very helpful in finding a diagnosis.

Your mom's cat could have had heartworm disease, as well, although it is
usually possible to find the worms on a necropsy (post-mortem) exam.
Pneumonia is not unlikely and it can occur for a number of reasons.

There are one or two reports of toxoplasmosis (a disease from protozoan
parasites) causing pancreatitis, gastrointestinal signs and pneumonia, with
necrosis of the lungs. This disorder often has neurologic signs associated
with it, as well.

Fungal diseases, especially cryptococcosis, can cause necrotic pneumonias
in cats.

There is one report of a virus similar to cowpox causing lung necrosis in
one cat. (Hinrichs et al, 1999). Sometimes it does appear that a stray
virus does cause problems in one patient or a small number of patients even
though it is not widely recognized as a pathogen for a species.

I hope this helps some.

Mike Richards, DVM
8/18/2000

Increased respiratory rates (tachypnea)

Question: Dear Dr. Richards:
I'm happy to find your service and hope I can give you enough information so that you can help me. We found Toot 8 years ago in our neighbors garage...he was a kitten with a broken leg and a big mouth. He is an extremely smart, communicative cat and I'm in a dilemma about treatment for his current problem.

Toot is a DSH, neutered, indoor cat. A year ago, before we moved to this condo, he would escape whenever an unwitting guest came in the front door. But since the move to the condo, he is strictly indoors. His vaccinations are current although I have held him off his renewals this year until this problem is resolved.

For about a year, I have noticed his rapid breathing. His flanks would move twice as fast as our other cats' flanks and when he slept next to me, I could hear his breath....somewhat like mothers in natural childbirth are required to do. At that time, there was a "nasal-y" sound to it too....almost like a snore..breaths very staccato.

A veterinary oncologist/internal medicine examined him in January 2000...performed a rhinoscopy and subsequently removed his left tonsil and mass/stalk that was causing gagging. Actually, he wasn't gagging....just chewing as if he had a mouthful of peanut butter. He still does this when stressed or stimulated visually with food...hard to figure out. The tonsil was, according to the vet, a long flap down his throat. A biopsy returned negative for cancer. The right tonsil, although a tad enlarged, was OK and left intact.

A look around his soft pallette revealed nothing unusual. Toot has no temperature, never coughs, only occasionally sneezes, no watery eyes, fur looks good, is a bit over-weight, begs for wheat grass that I grow for him...eats Scienct Diet S/D kibbles and Friskies canned plus fresh cooked chicken, has no litter box problems. His ONLY problem is this rapid breathing which is double fast when he TRIES to purr. His purring mechanism has been on the bum since the breathing
problem.

He recovered from the tonsilectomy well but his rapid breathing remained or returned. An x-ray showed what looked to me like stretch marks in a part of his lungs...Dr. W performed a tracheal wash and took a culture. The fluid from his lungs was clear so we eliminated viral. There was inflammation with no bacterial in the culture.

He responded somewhat to the trach wash and seemed fairly OK with not AS rapid breathing and certainly normal behavior. Dr. W said his x-rays looked better. She gave him a steroid injection.

A month later, his breathing was faster again and in we went. At that time, Dr. W said he's due for a shot again anyway....I asked her what shot and she apologized for not telling me that he needed Depo Medrol every 2-3 weeks.

At that point, I moved to a veterinarian I had wanted to try....because Dr. W was extremely busy with 3 patients at a time when we would go...I thought another doctor would have more time to research the problem.

Dr. Wk took no x-rays, referring only to Dr. W records, prescribed prednisone...20 mg/day for 30 days. He gave Toot an initial injection plus an antibiotic injection, tested (negative) for heartworm and FIV. Next day, Toot's breathing was FASTER so I phoned Dr. Wk.
He dismissed it as a sometimes reaction to the steroid and said hold off on pilling until next day. The next day I gave him a whole pill and read up on prednisone. Not liking what I read about long-term results, I initiated my own regime of 1/2 tablet every other day...hoping that would do something for his breathing but be more gentle. I did continue with the Clavamox until gone...2 x/day. Toot seemed very happy, very up as steroids would do...breathing still rapid....would play
at night aggressively, followed me everywhere, verbal as always for food, food, food.

At check up with Dr. Wks 8/3/200, I admitted to lower doses of prednisone and my dislike for it so Dr. Wk, without x-ray or any other test, administered an antihistamine injection and sent us home with 40 Atarax 10 mg pills...to give 3x day. Also, nothing was mentioned about the danger of abruptly stopping prednisone so I asked. He said since I had given him a quarter tablet two days ago, that was OK...we could stop.

The Atarax pulled Toot way down....his heart sounded like a vibrator but his eyes were dilated and he was not even closing his mouth all the way. Appetite still good, attitude bad. Slept all day. I gave him only ONE tablet in the morning and then quit. I did give him 1/4 tablet prednisone and wonder about continuing that at 1/2 or 1/4 until they are gone.

He is better today but not as he was pre-antihistamine. His breathing is stacatto...a bit labored. He doesn't cough, he's hungry, his fur looks good.

Our condo has carpet and a bit of mildew smell even tho we run the A/C very cold. We are moving to NC into the mountains in two months...temporarily to a home with carpet until our new home is built. The new home - to be completed in March - will have hard wood floors. If Toot's problem is allergies, this may help him.

Do you think he should be tested for lung worm or enlarged heart ...should we check for carbon dioxide (a blood gas sample).

Sorry to be so wordy. Hope you can make sense of this.

Thanks... Donna

Answer: Donna-

It is often very hard to obtain a diagnosis for a patient with increased respiratory rates (tachypnea) and no other sign of illness.

It help some to think about what might cause this problem. Usually, this occurs because there is inefficient oxygenation of the blood, for some reason. The general categories of problems that can lead to this are respiratory illnesses, cardiovascular disease, anemias, cancers or space occupying lesions in the chest and anatomical problems such as pectus excavatum, a condition in which the sternum is improperly formed and restricts the size of the chest cavity. Chest wall trauma that did
not heal properly, may also lead to restrictions in the ability to move air through the thorax. In dogs we see this problem due to laryngeal paralysis sometimes, but I can't recall a cat exhibiting these signs from that cause. Hormonal diseases, especially hyperthyroidism in cats, can lead to increased respiratory rate. Increased respiratory rates seem to occur in some liver disorders and a portosystemic shunt can cause this sign. It would be a little strange to find this problem in an older cats but it sometimes isn't causing much problem and is diagnosed late in life. Finally, obesity, all by itself, can lead to respiratory problems.

It was good to find the nasal or tonsillar polyp and disappointing that it doesn't appear to have been the problem, although there are cats that have more than one polyp. Our experience has been that polyps usually cause the persistent swallowing problem you saw, sometimes cause coughing or nasal discharge and may produce audible upper respiratory sounds (such as snoring) but do not usually lead to tachypnea, even though it does seem possible as a symptom of this disorder.

Lung problems sufficient to cause increased respiratory rates usually do show up on X-rays. It may be worth taking films again and sending the previous films and the new ones to a radiologist for review. A tracheal wash was a good idea. Infectious and inflammatory diseases both cause changes in lung and tracheobronchial tissues that can be detected by tracheal wash.

Lungworms do occur in cats, especially in the South, and are hard to diagnose. We sometimes resort to just treating for these worms to see what happens. Once in a while this really seems to help a patient. Usually we see patients with lungworms initially for coughing, though.

Pectus excavatum is a malformation of the chest caused by improper formation of the sternum. Usually this is really obvious on a physical exam with the chest having a sort of "caved in" feeling if felt from top to bottom and a flattened feeling if felt from side to side. I doubt this was missed, but it sometimes causes really increased respiratory rates without any other clinical signs.

Cardiovascular disease would be a major concern, in my mind, since very good testing has been done to try to eliminate respiratory disease and nothing has been found. The initial best test for cardiovascular disease is simply careful auscultation of the heart. If any murmur can be detected, if the heart rate is too slow or too fast, if there are heartbeats without corresponding pulses or any other abnormality, then heart disease would be more likely. I am pretty sure your vets have already done this, though. The best definitive test for heart disease in a cat is cardiac ultrasound exam. In potentially subtle cases of heart disease it is probably best to have a cardiologist examine the patient. After all that Toot has been through, if he has cardiac disease it probably should be considered to be subtle.

Anemia and hormonal problems are diagnosed through blood work. I would want to check for hyperthyroidism, especially if Toot is losing weight. It might be worth checking for hyperadrenocorticism, as well, even though this is not too common in cats. It causes panting in dogs but I do not know if that is a consistent finding in cats.

Cancers and chest wall injuries probably would have been visible on the previous X-rays but it still might be worth rechecking for these problems.

I do prefer alternate day use of corticosteroids. It is usually safe to discontinue these, even abruptly, when they are being used every other day. I haven't had much luck with antihistamines for respiratory problems in cats but some vets report success.

I realize that I have advocated a number of possible diagnostic options. I think I'd be willing to try the simple things first since this has been going on for some time. So deworming, rechecking the radiographs and running a general blood panel with T4 (thyroid) measurement would be a reasonable way to start. Then I think I'd advocate referral to a cardiologist. You and your vet, who can examine Toot and see what the clinical signs are, may think that a different order of testing is
better. In any case, getting a diagnosis is best, if possible, even though it can be a very frustrating process. You have a good start on it --- lots of things have been eliminated as possibilities -- it is just frustrating that it hasn't helped yet. Unfortunately, I think that is normal for the diagnostic process for this sort of problem. It takes a lot of luck to find the cause early in the diagnostic
process.

I hope this helps some.

Mike Richards, DVM
8/10/2000

"Reverse sneezing" or paroxysmal respiration in a cat

Q: Dr. Mike, We have 12 year old kitty, Runty (for obvious reasons) who has always done this weird kind of reverse sneeze. Her whole body shakes, and for a moment or two after it is over, she swallows as if she has a bad taste in her mouth. Our vet doesn't seem too concerned, but then he's had to rely on our descriptions - she's not good enough to do it in his office. This happens anywhere from one a week, to daily at times, and I can't find a real pattern. do you have any ideas at all? she likes to eat and play (altho she has gotten a bit slower and slimmer as she gets older). thanks for your help...Leslie

A: Leslie

I like to see videotapes of stuff that only happens at home if clients have a camcorder and can get them for me.

"Reverse sneezing" or paroxysmal respiration is not unusual in dogs but we don't see it all that often in cats. In dogs it is not usually harmful. Cats are a little more prone to respiratory signs when they have allergies so antihistamines may be helpful if that is part of the problem. Ask your vet about this if the problem is worse seasonally or other signs of allergy are present.

It is hard to diagnose intermittent problems and since most of these sorts of things aren't too harmful it is hard to get your vet to look into them in detail. Most vets really do hate to propose a detailed diagnostic plan for a problem that they aren't going to need to treat or can't treat -- clients just don't like expensive bills when there isn't a cure.

Mike Richards, DVM

Feline Bordetella

Q: A number of cases of feline bordetella have been diagnosed in my area. As I
operate a cat shelter, I'm looking for info on this bacteria and how best
to treat it should it occur. We've had 4 kittens die of what was diagnosed
as bacterial pneumonia and I'm concerned for the population that was in the
same room as this group. Any info you can give would be helpful.

Thanks.
Wendy

A: Wendy-

I am sorry that this response has taken so long. I put this one aside
because I have seen a fairly detailed article on this condition recently
and I haven't been able to locate it. I'll give you the best summary that I
can from memory and if I find that I have forgotten something or made a
mistake in summarizing the information I will get back to you.

Bordetella bacterial infections in cats are not common except in certain
circumstances. The most likely place for a cat to become infected is an
animal shelter. In shelter circumstances it may make sense to vaccinate for
this bacteria if the disease appears to be present. Upper respiratory
infections in cats are still predominantly viral infections in most
instances, especially if they are chronic infections. Coughing is not a
common sign in viral upper respiratory infections but it is a definite sign
of Bordetella infection. So in a shelter situation in which there are a lot
of coughing cats, there is a good possibility that Bordetella is the
problem. This may also be true of catteries with a number of cats. Outside
of these two circumstances it is likely that Bordetella is a rare cause of
disease in cats.

Adult cats appear to suffer transient coughing from Bordetella infections,
lasting as long as six weeks in some situations but usually being of
shorter duration than this. Kittens do seem to be particularly susceptible
to this infection and when there are coughing adult cats and dying kittens
the possibility that Bordetella is a cause is higher than with either of
the above problems alone. At this time I don't think that it is possible to
know for sure if vaccinating young kittens will successfully control
infection and prevent many of the deaths in this age group. As the vaccine
is used more the success rate will become more apparent.

I wanted to put some information into this note about controlling
infectious diseases in shelter situations but I want to research that a
little more. I do intend to cover this topic in an upcoming VetInfo Digest,
though. If I don't do it in the next couple of issues please remind me.

Mike Richards, DVM

Chronic rhinitis/sinusitis in cats

Q: Dear Dr. Mike,

My 12-year-old cat has a problem, which my vet diagnosed as allergies.
He snores and grunts and he's awake, when he's asleep, and when he
purrs. His eyes are perpetually runny and he occasionally sneezes. He
does not cough and his appetite is good. Allergies are really common in
people in this area, as we have a lot of mold in the winter and pollen
in the summer from grass seed growers. But I have never heard that older
cats can have respiratory allergies as well. I was told to treat his
allergies with chlorpheniramine 2 mg 2x/day, which is supposedly safe
for cats with no side effects, but this cat really was put out by the
medication.

Last summer he was diagnosed with hyperthyroidism for which he was
successfully treated with radioactive iodine. The snoring problem began
before that but has worsened. I am wondering if this problem could be
indicative of cardiomyopathy, which may have happened as a result of his
hyperthyroidism, or of fluid around his lungs. Also, could the
radioactive iodine have harmed his ability to purr?

Any advice is well appreciated. Thank you in advance!

Judy

A: Judy-

I apologize in advance for the length of this reply. I am hoping that you
will be able to sort through this information and make a plan with your vet
to work towards finding a diagnosis and/or treatment for your cat's problem.

There are a number of possible causes of chronic rhinitis/sinusitis in cats.

The first consideration in deciding which of the possible problems is
present is to answer this question as accurately as you possibly can. Was
this problem present intermittently or continuously throughout your cat's
life or did this problem start in the last two years or so? The reason this
is critically important is that the most common cause of chronic rhinitis
in cats is probably rhinotracheitis virus (and sometimes calicivirus)
infection. This usually starts early in life and is often intermittent in
nature at first but then eventually becomes persistent in some cats. If
this is the case it is unlikely that the infection will be cleared up at
this time. It may be managed, sometimes very effectively, though. Often the
viral infection will lead to secondary bacterial infection and tissue
changes that make it easy for bacterial infections to recur. One method of
helping with this problem is to use an antibiotic, azithromycin (Zithromax
Rx, Azithromycin Rx) on a once-weekly basis to help control secondary
infections. I have seen anecdotal references to the success of this
antibiotic in some cats but have not seen a scientific study done in cats
that supports its use. There are studies in humans to support similar use
in our species. In addition, there may be some benefit from using l-lysine,
which inhibits viral replication of herpes virus to some degree.
Antihistamines are sometimes helpful. Chlorpheniramine is commonly
recommended for cats. Pseudoephedrine (Sudafed Tm)is also sometimes
helpful. Neosynephrine (Afrin) nasal drops have also been advocated for use
in chronic rhinitis. In some cases corticosteroids may be helpful but
should be used with caution. Dexamethasone ophthalmic drops may be used
intranasally or even intra-ocularly if the tear ducts are patent.
Temeril-P, a combination antihistamine/corticosteroid has been advocated at
times for this condition as well.

If this condition did start later in your cat's life it is not impossible
that it is still a chronic viral infection but it is less likely. In that
case it is more important to consider a number of other possible problems.
(The diagnostic process may be worthwhile even if it seems like chronic
viral infection is likely). The other possible problems include the
following diseases and disorders and probably others: periodontal disease
or other dental disease, cancer affecting the nasal passages or sinuses,
fungal infections such as Cryptococcus, Sporothrix, Aspergillus and
Histoplasma, capillariasis (a parasite), allergic rhinitis,
lymphoplasmacytic rhinitis and sometimes causes such as traumatic injuries
to the sinuses or disorders that lead to chronic vomiting and secondary
irritation to the nasal passages.

Sorting through all of these problems can be a time consuming process. A
thorough history must by taken to try to get an idea of which disorder is
most likely based on the duration of the problem and the progression of the
signs. A physical examination should be as complete as possible, with
attention paid to dental problems, changes in the shape of the head, lymph
node involvement and signs of systemic illness. Screening blood panels may
be helpful, although most of the time this is probably not true.
Determining feline leukemia virus and feline immunodeficiency virus status
may be helpful. X-rays can be helpful but can be difficult to read. We take
X-rays and then send them to a radiologist for evaluation in most cases due
to this. Flushing of the nasal passages can sometimes be useful, especially
if tumor material or fungal elements are found in the fluid recovered after
flushing. Examination of the nasal passages by endoscopy can be helpful.
Magnetic resonance imaging (MRI) or computerized tomagraphy (CT)
examination can also be very helpful. Allergy testing may be helpful as
well. Much of this work can be done by general veterinary practitioners and
some requires referral to a veterinary referral center or veterinary
college. It may or may not be necessary to do it all, depending on what is
found as the process unfolds.

After having said all that it is necessary to point out a couple of things.
The first is that your cat might not have rhinitis with the signs you are
seeing, although it seems likely. Chronic conjunctivitis, leading to the
runny eyes, is even more likely to be from chronic viral infection,
although allergic conjunctivitis does seem to occur -- but not that
commonly -- in cats. I have not heard of this sort of thing as a side
effect of radioactive iodine therapy. Cardiomyopathy seems to be able to
cause a lot of symptoms but also seems to be unlikely since treatment for
hyperthyroidism usually allows secondary cardiomyopathy to resolve.

I know that this is has been a long note and that it has covered some
material that may not be relevant to your cat's problem. However, this
issue is complex enough that you have to consider all possibilities and it
often takes a concerted effort to sort through all of them.

Hope this helps.

Mike Richards, DVM

Pleural effusion - Chylous or Pseudochylous

Q: Dear Dr. Richards:

Our cat, Suggy, had a hacking cough for several months. Our vet. thought he
had hairballs so she gave us some hairball medicine. The hacking cough
persisted. We took him to the Vet again, and she said that maybe it was an
allergy. So, she gave him an antihistamine shot. The cough disappeared,
but about two weeks after, Suggy started having trouble breathing. We took
him to the vet. again. She found milky fluid in his lungs and recommended that we
give him Bactril and take him for a chest X-ray. Then, she said that
what he really needed was an ultrasound.

We took him for an ultrasound. The second vet. found more fluid in his
lung. He thought Suggy may have a mass on his right lung. He said that all we
could do was wait two weeks and bring him back for another ultrasound.

By this time, Suggy had stopped eating and barely drank. He was growing
weaker everyday.

Three days after the ultrasound, he was not able to breath again. We took
him to the first vet. (our mistake, we should have taken him to the
University of Pennsylvania Veterinary Hospital) who said that he still had fluid in his
lungs, this time of a clear color.

Two days after the first vet. sent Suggy home, we had to rush him to the
University of Pennsylvania Veterinary Hospital. He could barely keep his
head up, could barely breath, and had not eaten or drank in days.

At the Penn Vet. Hospital, he was placed in an oxygen cage in the emergency
room. The emergency room doctor said that she needed to run some diagnostic
tests to find out exactly what was causing Suggy's CHYLOUS EFFUSION. She
said that we still had a small chance of helping him recover.

The next day, Suggy had been moved to Intensive Care. The Intensive Care
doctor said there was nothing else she could do - if she tried to do some
diagnostic work on Suggy that he may suffer from cardiac arrest. She
said he was too weak for her to do anything.

We had to agree to Suggy being put to sleep on Friday, July 31, 1998.

Our question now is: don't you think our first vet. should have clearly
stated that fluid in the lungs is CHYLOUS EFFUSION, that we needed to ASAP
find out what was causing it to treat it?

If we had had the diagnostic work done on Suggy while he was still a strong,
otherwise healthy, cat then maybe we could have started him on treatment
before he was too weak to hold his head up.

What do you think, Dr. Richards?

We are thinking of writing a "disappointment" letter to our first
vet., with a cc: to the Veterinary Licensing Board in Harrisburg, PA, stating how we wish
she would have given us the full picture when Suggy first started hacking
and when she first tapped the milky fluid.

Thank you for your attention to this message.
We really appreciate your concern.
Mournfully yours,
Frances

A: Frances-

I can not tell for sure from reading your email whether the effusion was a
chylous effusion or a pseudochylous effusion. The first is a specific
condition involving leakage of chyle into the pleural space and the second
is effusion that looks like chyle but isn't, which can occur with other
diseases.

Due to the difficulty in explaining pleural effusions I think it is
important to start with an explanation of how the pleural lining normally
functions and then try to explain what can go wrong and what the results
are. This will make it easier to understand why your question is harder to
answer than many that are sent to our web site.

The pleura is the lining of the chest cavity and the lungs. It is a thin
layer of specialized cells that coats the inside of the body wall (the
parietal pleura) and then in a continuous sheet also covers the lungs (the
visceral pleura). The pleura in cats does not segment itself completely
into a right and left side so cats usually do not have pleural effusions on
one side only as happens in some species. Dogs also have connections
between the pleura of the right and left sides of their thorax so they are
similar in this aspect. This is really simplistic but it might help to
think of the pleura as a bag stuffed between and adhered to the lungs on
one side and the body wall on the other.

The pleura normally produces fluid and the fluid is normally absorbed. When
things are working right, there is a small amount of fluid present to
lubricate the two sides of the pleura so they can rub smoothly over each
other. In general, the parietal pleura produces more fluid than the
visceral pleura and this produces a flow of fluid across the pleural space
from the body wall into the lungs as the visceral pleura absorbs the fluid
through small capillaries and lymphatic vessels. Even though only a small
amount of fluid is present in the pleural space at any one time a lot of
fluid crosses the space.

Fluid accumulates in the pleura space when the production and absorption
processes get out of synch. This can happen when too much fluid is produced
by either side of the pleura. It can happen when the pleura can't absorb
the fluid as it normally would but production of fluid remains normal. In
some cases there are disturbances in fluid production and in fluid
absorption which can lead to pretty rapid accumulations of fluid and severe
respiratory distress as the fluid makes it impossible for the lungs to expand.

Heart failure, usually from cardiomyopathy in cats, is one cause of changes
in the fluid pressures. As the heart function decreases blood accumulates
in the lungs because it isn't being pumped out of them. This raises the
blood pressure in the pulmonary capillaries which normally drain the fluid
from the visceral pleura. The pressure in the parietal pleura vessels may
remain the same or lessen. This makes it impossible for the fluid to flow
from the parietal pleura to the visceral pleura so it just accumulates
between the two sides.

If the lymphatic vessels leak or if the pressure in these vessels increases
so that they can't absorb fluid then the pressure changes for a different
reason but the effect is the same. Without the help of the lymphatic
vessels to drain fluid, there is not enough movement of fluid into the
visceral pleura and once again, the result is accumulation of fluid in the
pleural space. True chylothorax occurs when the lymphatic vessels are torn
or leak for some reason. Pseudochylothorax occurs as a secondary change
after another type of effusion has occurred.

Fluid accumulation in the pleural cavity can be classified several ways. It
can be convenient to think of the fluid as either a transudate (fluid
accumulation with very few cells in it and low protein, usually the result
of pressure changes only), modified transudates (fluid with some cells in
it and higher protein) and exudates (fluid with lots of cells, even higher
protein and generally too cloudy or turbid to see through).

Low blood protein levels are the usual suspect when there is fluid that can
really be called a transudate.

Modified transudates occur with lots of diseases, including cardiomyopathy,
heart failure for other reasons, lung damage for any reason, diaphragmatic
hernias, cancer, hyperthyroidism in cats, heartworm disease, feline
infectious peritonitis, feline leukemia virus (usually due to lymphoma),
trauma, bleeding disorders and probably other stuff.

Exudates occur for most of the reasons above if the disease process
continues long enough. The modified transudate may be present for a long
time prior to the disease worsening or may be a very brief stage in the
march towards an exudative process. Some disorders start out as exudates.
Chylothorax due to damage to the lymphatic vessels from trauma, cancer or
for no apparent reason is an exudate right from the start. Pleural abscesses
and infective material from wounds to the chest are exudates right from the
start, too.

Whether the disorder is a transudate, a modified transudate or an exudate,
it is an effusion if abnormal amounts of fluid are accumulating in the
pleural space.

By withdrawing some of the fluid from a pleural effusion and examining it for
cells, protein levels, color, odor and specific gravity, it is often
possible to make a pretty good guess as to the cause of the fluid
accumulation. If the fluid contains cancer cells, if it is a true chylous
exudate or if it looks like and smells like pus examination of the fluid
gives a strong clue as to what is going on.

It is hard to differentiate between chylous effusions and pseudochylous
effusions based on appearance alone. It is possible to get some idea of
what the fluid is by letting it sit overnight and looking for separation of
a "cream" layer or by mixing the fluid with ether to see if it clears. Most
practices don't have ether around anymore, though. Submitting the fluid for
lab evaluation is helpful because true chyle is high in triglycerides and
low in cholesterol. Pseudochyle is lower in triglycerides and higher in
cholesterol.

I am not sure why your vet or the vet who did the ultrasound exam did not
attempt to identify the fluid or did not tell you what it was if they did.
I am also not absolutely certain that the vet at the University of
Pennsylvania was certain that the fluid was a true chylous effusion at the
time that the comment was made (if it was made just after withdrawing the
fluid as it appears to have been in your note) -- the diagnostic tests
might have been necessary to determine whether the fluid was a chylous
effusion or a pseudochylous effusion, especially with the history of it
being clear the last time your vet took a sample.

The problem in answering your question is this: was the fluid really chyle?
If so, then early aggressive treatment may have helped but medical
treatment for chylous effusions is pretty difficult and works best when the
effusion is occurring due to trauma that can heal itself. Surgical
treatment isn't highly successful but can be attempted when medical
treatment isn't working well. If the fluid was a pseudochyle, why was it
occurring? If an underlying cause could have been identified and treated
then there may have been some hope. If the cause was cancer or severe
cardiomyopathy then a good outcome was still pretty unlikely.

If a necropsy (autopsy) was done then you may know the answer to these
questions. If so, it would be best to review it and to try to make an
assessment of the likelihood that treatment would have been successful.
There is more likelihood that the outcome would have been the same than that
successful long-term treatment could have been achieved but it might help
to know that for sure. I think that it would have been best if your vet had
realized that you wanted to treat this situation as aggressively as
possible. It is easy for general practitioners in veterinary medicine to
assume that people do not want to pursue aggressive diagnostic processes
and aggressive therapies where the potential for a good outcome is small.
Despite this, it is important to remember that some clients do want to go
all out and to keep an open mind about that. It is also fair to expect your
vet to make an attempt to explain the disease process so that you can
understand it and make decisions accordingly. It is also pretty easy to
make statements that are more definitive than the situation warrants when
treating emergencies or in intensive care situations. It seems possible
that this happened, too. For this reason, it is equally important for there
to be follow-up and an explanation of whatever lab tests were done when a
patient dies.

It is too late to change the situation now, but your email reinforces the
need for veterinary clients to to remember that there are specialists in
veterinary medicine and that asking for referral to one when any treatment
or diagnostic process doesn't seem to be working well is a reasonable thing
to do. It is not necessary to wait for your vet to suggest this.

I am sorry to hear of your loss. I hope that this explanation isn't
burdensome. It would be best to contact your vet, either by letter or in
person, to discuss all of this and to help to resolve whether more could
have been done. If there was never a definitive diagnosis, either through
the labwork done at the University of Pennsylvania or through an autopsy
exam, it may be impossible to ever know for sure whether the outcome could
have been changed. That would be true even in most cases in which true
chylothorax was present or a disease process severe enough to cause a
pseudochylous effusion was present due to the difficulty in treating many
of the underlying disease processes. It is very very difficult to live with
uncertainty in the death of a pet and I know that is making this whole
thing harder for you. I hope that you do find some resolution through
discussing this with your vet or the vets at the University of Pennsylvania.

Mike Richards, DVM

Chylothorax

Q: Mike, My 5 yr. old male cat has been diagnosed with chylothorax. He had trouble breathing and the did a chest tap after looking at x-rays. The vet put us on a wait and see after talking to vets at Michigan State. He's become very depresed and doesn't eat. It's been about 3 weeks now and he's been tapped 4 times. He seems to breath easier after, but still doesn't eat. Today the vet put in a feeding tube to get some food in him. We were force feeding him, but he got too hard to continue this way. He's a very easy going cat, but this is alot for him to handle. Have you ever seen this fixed without surgury. What about diaretics? He's probably too weak for surgury, so any ideas would be great. Also, would you have any idea of any other experts to talk to. Thanks, Jeff

To the best of my knowledge idiopathic (no cause) chylothorax in cats is somewhat responsive to low fat diets like Hill's r/d (tm). Some cats will be controlled through diet alone but some will not. Surgical correction of the condition is indicated in that case. I do not know of a consistently successful medical therapy but benzopyrone (Rutin Rx) has been advocated and may be beneficial as well.

In cats, lymphoma associated with feline leukemia virus, cardiomyopathy, heartworms, and tumors in the chest are the most common identifiable underlying causes of this condition. Looking for them is important when chylothorax is present.

I hope some progress has been made towards resolution of this problem since you wrote.

Mike Richards, DVM

Vague upper respiratory condition

Q: Dr. Mike, Our adult cat is displaying symptoms analogous to that of sinus congestion. Otherwise, he is perfectly fine. I vaguely remember hearing that similar symptoms can arise from a kind of worm infestation. An important characteristic, however, is that these symptoms are intermittent, not continuous. I happened to recently examine his stool, and did not discover anything noticeable. Is there some cursory way of delineating between a minor problem (allergies, sinus congestion), and a more major problem (asthma, worms) ? We live out in the sticks, and a vet visit would not only be a special trip, but the cat absolutely hates traveling by vehicle. Finally, if we do take the cat to the vet, is it a good idea to take a stool sample along ?

A: By far the most common cause of vague upper respiratory conditions in cats is infection with feline herpes virus -- rhinotracheitis. Just like in people, the herpes virus tends to be quiescent for some time and then flare up and cause symptomatic illness. In cats this is usually conjunctivitis or nasal congestion/sneezing.

That said, there are lots of other possible causes. I am not sure that I would make a special trip to your vet if your cat seems normal otherwise but it would be worth keeping track of these episodes and giving your vet a good history when you do go.

Allergies, asthma, sinusitis from viral, bacterial or fungal disease, dental problems, feline leukemia virus, feline immunodeficiency virus all come readily to mind when thinking about causes of upper respiratory disease signs. Obviously, some of these are serious problems. There may be a worm that causes these signs but I am not aware of one, offhand.

If your cat shows any sign of having more than simple upper respiratory disease (sneezing, congestion) then it would be worth considering a trip to your vet. I don't know of a simple way to tell what is going on - at home or at the vet's. I wish I did because vague clinical signs are the most frustrating ones to deal with. It can take a lot of testing just to figure out that they are minor problems, which frustrates the owners, but missing an important problem frustrates them even more!

Mike Richards, DVM

Kennel Cough - can the cat catch it

Q: Dear doc, my 2 yr old lab has kennel cough, can he give it to my cat? should i give him (dog) childrens cough medicine? also, my 11 yr old birman male cat was misdiagnosed w/ feline luk. 2 yrs ago. it turned out he had a hole in his intestine, i don't remember the technical name of the problem but ever since he has not been able to get back to his normal weight. I have noticed that his eyes shift back & forth from left to right too. he had a check up during x-mas & the vet said it may be nerve damage but I don't believe she was telling me everything because she still feels bad about the earlier mis-diagnoses. can you shed some light on this? Thanks

A: Cats are reported to very rarely develop upper respiratory disease from Bordetella bronchiseptica, the major cause of kennel cough in dogs. I would not worry over this possibility. I can't remember actually seeing a case in which this happened.

There are a lot of different cough medicines on the market. Some have ingredients that would be unnecessary and dosages vary widely between them. Please consult with your vet prior to using any cough medicines you already have on hand.

I am at a loss to help with the disease problem that was confused with feline leukemia. The feline leukemia test kits do produce false positive results in rare instances and if clinical signs of a similar disease were present, I would be inclined to believe them, too, though. That is one of the problems with tests that are usually very reliable. It becomes very easy to believe they are always right.

The rhythmic eye movement is probably nystagmus. This condition occurs as a congenital illness in some cat breeds. I am not sure that Birmans are one of those breeds but it wouldn't surprise me at all. I am not sure you can call this "normal" but it isn't unusual. Cats seem to do OK even though it seems like it would be hard to adjust to your eyes constantly moving back and forth.

Mike Richards, DVM

Last edited 07/08/05