Lung Problems, Is The Diagnosis Correct?

[FelisCatus]

Prepare for a long reply.

I went to the animal hospital today. After a stressful (for the cat) 30 km drive, we were there.

I went inside and talked to the receptionist, and I was really surprised by how serious they were, about the paperwork, making an appointment beforehand etc.. It was like real hospital, which is a good sign in my opinion. I was asked to fill out some paperwork for the first time and 10 minutes after they called me for Count's exam.

The vet started by asking about the problem, which I responded with it is a long story (as you all know), and surprisingly she was willing to listen to every treatment and diagnostic Count went through. She also heard of the breed (maine coon), which was a surprise. After about 10 minutes of talking, she examined Count. She did hear lung problems, and also noticed that the heart felt a bit large. Otherwise everything seemed normal. He gained 200 g since he was last weighed, and his fever was normal-ish.

She looked at Count's earlier blood tests, and she said that the blood tests indicated an infection, and was surprised that there was no bacteria found on the nasal swab. She asked about how the sample was taken, and after learning that it was just a booger hanging out from his nose, but the swab wasn't fully inserted, she said that that test doesn't mean anything, because there wasn't enough sample taken.

She also looked at Count's earlier xray, noticed the problems, but took another xray because it was dated. They took xrays from 2 angles.

Spoiler: Xray Pictures

There were four conclusions made from these:

1. He still has heavy problems in his lung, but the amount decreased
2. There are no lungworms (no fecal test done though, take it with a grain of salt)
3. There is blockage in his intestines. This is also putting pressure on lungs and heart.
4. His heart is too large and putting pressure on his lungs.

Based on these results, we started about treatment. As you can see, there are three problems. We decided to wait a week before prescribing medicine for his intestine blockage because she thinks that the blockage may be a side effect of the heavy medications that were used before. We decided to wait on the heart issue as well because after the pressure from his intestines is gone, it may look normal in an xray. Doing an echo cardiagram costs a fortune too.

As for the main problem, we decided to not do the second and third zylexis shots, since she thinks that it is unnecessary. I will also stop giving theophylline and methylprednisolone. I forgot to ask about virgin olive oil and black cumin oil. She prescribed other medicines which I will get to in a second. I am also supposed to check his heartbeat in a few scenarios, and check if he has any problems with using the toilet.

As for the prescription, I am supposed to give Count 2 medicines orally, and 3 medicines using a nebulizer. Since I cannot put a mask on a cat, I had to make a makeshift enclosure.

The medicines are: (per day)

• 40 mg Azithromycin (pill)
• 1 cc Interferon alfa & isotonic mixture (mix with food)
• 2.5 mg Salbutamol (nebulizer)
• 0.5 mg Budesonide (nebulizer)
• 0.5 cc of something called Genta (nebulizer)

She said that she will call in a few days to check Count's situation. Otherwise she will see Count next week.

What do you think of these? Is Count getting a better treatment here?

(Count is really tired after the vet visit)

Holy, you really went all out it’s nice to see other cat caretakers love there kitty cats so much.

Yes she seems much more knowledgeable.

Kudos to Count for making the long trip!

 

[She's a witch]

it seems he had a professional visit, fingers crossed everything will go smoothly now! As for a nebulizer, it is possible to train a cat to use the mask, although it's a bit more difficult than inhaler because of the noise. But you seem to have a workaround so it's good.
You mentioned he is smaller than he should be, I am wondering if the intestines blockage might have something to do with it. Something to consider after his lungs are taken care of.
Keep all the receipts and show them to the breeder when you're ready.

 

[Noirele]

I agree with you, this vet sounds so much better. The new treatment it's similar to the one we followed for Merlino. He loved the aerosol btw. He just lazily laid there and enjoyed the steam

 

[sidneykitty]

I agree, this vet sounds much better! More knowledgeable and listening to your requests/questions. I'm really happy you got some x-rays done - they can be so helpful to see what's going on.

Seems like a good plan for Count. He's just adorable, by the way, I can see it would be easy to fall in love with him. And I'd be tired, too, if I'd gone through what he has! You're doing such a great job taking care of him... let us know how he is progressing, please! I'm sending both you and Count positive healing wishes!

 

[white shadow]

.
I'm very relieved after hearing about your experience today.

The examination process was well-organized, logical, methodical and thorough. And then, you were presented with the findings in the same way.

Were the drugs and their purpose/intended effects explained to you as well?

What a difference from your previous experiences (which sounded so 'sketchy' to me)! That is the kind of Vet problem-solving that experienced cat-people in 'the West' expect (but don't always get!)

Just as a btw, was this place "Empati Akademi"? (the one you thought you would choose)

Now, about the "blockage in his intestines".......I'm sure you understand "ordinary" or simple constipation, when there is stool in the colon and the rectum that 'simply' can't be expelled (where nothing is wrong with the 'plumbing', but the feces itself has become so dry that it cannot move/flow)......and you also understand a different situation where something 'foreign' or perhaps a growth in the intestine has blocked the way,preventing the stool from moving along. Which of those two situations was she describing when she said "blockage"?

Congratulations for the way you described the whole experience today! I could imagine myself being there and following along.

I bet Count wasn't the only one crashing after all that
.

 

[Count]

You mentioned he is smaller than he should be, I am wondering if the intestines blockage might have something to do with it. Something to consider after his lungs are taken care of.

Possibly. He had some constipation before according to the older 2 vets. You can also see some buildup on the older xray, though much less than this. Maybe something wrong there? Will mention this to the new vet.

The new treatment it's similar to the one we followed for Merlino. He loved the aerosol btw. He just lazily laid there and enjoyed the steam

Good to know this kind of treatment worked for others. Count hates the aerosol, he constantly meows (which he never does normally), and tries to escape by clawing through. Maybe the noise scares him.

He's just adorable, by the way, I can see it would be easy to fall in love with him. And I'd be tired, too, if I'd gone through what he has! You're doing such a great job taking care of him... let us know how he is progressing, please! I'm sending both you and Count positive healing wishes!

Thank you! I will keep everyone updated on the situation here, hopefully this will be the last time we change vets and we stick to the plan this time (unlike the older vets who changed their treatment constantly, as if they didn't know what they were doing)

Were the drugs and their purpose/intended effects explained to you as well?

Yes. The specific purpose for the aerosol ones weren't explained, but the combined effect was, and the other drugs were individually explained.

What a difference from your previous experiences (which sounded so 'sketchy' to me)! That is the kind of Vet problem-solving that experienced cat-people in 'the West' expect (but don't always get!)

Just as a btw, was this place "Empati Akademi"? (the one you thought you would choose)

Yes it was "Empati Akademi". Living in a country like mine has its (many) disadvantages, apparently including poor vet care. Thankfully that seems to be resolved for us now. After this experience, I also feel like the vets before felt sketchy, but I don't understand why. Both vets are well known in the area, and especially the second vet is a old man who appears on TV shows, and writes on newspapers etc., supposedly an expert in this area. Costs a fortune too, much more than Empati Akademi or the first vet.

Now, about the "blockage in his intestines".......I'm sure you understand "ordinary" or simple constipation, when there is stool in the colon and the rectum that 'simply' can't be expelled (where nothing is wrong with the 'plumbing', but the feces itself has become so dry that it cannot move/flow)......and you also understand a different situation where something 'foreign' or perhaps a growth in the intestine has blocked the way,preventing the stool from moving along. Which of those two situations was she describing when she said "blockage"?

Honestly, I'm not sure. I don't think she meant anything 'foreign', but it may be a growth, or just constipation. Either case she thinks it is caused by the meds used before, specifically one of the pills. But now that you say something foreign, I am worried because a few weeks ago Count chewed through some plastic. (His food bowl at the time, now I use ceramic) It eventually came out of his stool thankfully, but maybe some of it still is inside? This was weeks ago btw, so something bad probably would have happened if that was the case, but I'm not sure.

Yes she seems much more knowledgeable.

it seems he had a professional visit, fingers crossed everything will go smoothly now!

I agree with you, this vet sounds so much better.

I agree, this vet sounds much better! More knowledgeable and listening to your requests/questions.

I'm very relieved after hearing about your experience today.

I'm glad everyone thinks the same way. It makes me more confident in this vet.

 

[Count]

Count hates the aerosol, he constantly meows (which he never does normally),

Maybe the noise scares him

 

[FeebysOwner]

Just catching up. Your new vet and the new treatment plan - as the others have said - sounds very promising!

Poor Count and the aerosol . It might be the combination of being confined and the noise. Is he allowed to have anything in there with him? If so, does he have a favorite blanket or toy that he likes to cuddle - maybe giving him some comfort?

Btw, Count is adorable!!

 

[Count]

Just catching up. Your new vet and the new treatment plan - as the others have said - sounds very promising!

I'm glad you feel like that too. She really cares and pays attention. We spent an hour and a half discussing Count's situation yesterday, and there was something that I barely mentioned while taking about something else. If it were me, I would have already forgotten about that but, we had a phone call today about giving pills to Count (it is hard), and while talking about that, she remembered what I said yesterday. I was impressed, she really listens carefully.

Is he allowed to have anything in there with him? If so, does he have a favorite blanket or toy that he likes to cuddle - maybe giving him some comfort?

I will try that. Maybe a toy and a few treats will help.

 

[FeebysOwner]

Are the meds crushable and could be mixed with a small amount of something he likes to eat? If they could be compounded into liquid form, would that work better with him? The liquid could be added to a small amount of food as well.

 

[Count]

Are the meds crushable and could be mixed with a small amount of something he likes to eat? If they could be compounded into liquid form, would that work better with him? The liquid could be added to a small amount of food as well.

I specifically asked for pills because it is impossible to give Count liquid medicine. He hates it too much to the point where wrapping him in a towel, holding him tightly in it by two people while the third person holds him by the back of his head and pushes the plunger on the syringe is not enough. We tried for an hour. (Back when he was prescribed Bactrim by the first vet)

I was able to give the pills that the second vet prescribed by crushing them and adding to canned food, and that was the plan this time too, but he just doesn't eat it. I have to give some liquid and that pill every day to him.

 

[FeebysOwner]

You could experiment with butter/margarine and see if Count would lick that off of his paw. If he would, then you might be able to mix the pill in some and put it on his paw? Of course, that depends on how big the pill is and how many times he would tolerate having to lick it off of his paw in order to finish the pill.

A little bit of cottage cheese (unless he is totally lactose intolerant) to mix the pill with daily isn't going to harm him either, if he would by chance like cottage cheese (my cat does). Same with plain yogurt.

Raw egg yolk (not the whites - they must be cooked) might be another option. If he did like it, one raw egg yolk would probably last a few days, or you could throw out whatever you didn't need once the pill was gone, each day. Low/no sodium gravies are another thing you could try.

 

[Kflowers]

some like peanut butter the kind with fat in it, not just mashed peanuts.

 

[Count]

You could experiment with butter/margarine and see if Count would lick that off of his paw. If he would, then you might be able to mix the pill in some and put it on his paw? Of course, that depends on how big the pill is and how many times he would tolerate having to lick it off of his paw in order to finish the pill.

A little bit of cottage cheese (unless he is totally lactose intolerant) to mix the pill with daily isn't going to harm him either, if he would by chance like cottage cheese (my cat does). Same with plain yogurt.

Raw egg yolk (not the whites - they must be cooked) might be another option. If he did like it, one raw egg yolk would probably last a few days, or you could throw out whatever you didn't need once the pill was gone, each day. Low/no sodium gravies are another thing you could try.

some like peanut butter the kind with fat in it, not just mashed peanuts.

Thanks for the advice. I will try some of these and see if they work. Worst case scenario I can just go to a vet and ask them to give him the pill.

 

[Count]

A quick update, (not much new)

We went to the vet today, she says the condition on his upper lung is better than before, but it is just based on listening with a stethoscope, so I would not take that as solid information. She said we will do a xray next week.

She also asked me to check Count's heartbeat for another week, because she thinks what I measured last week was high. She says a heart condition is possible. Based on the results she will say if an echo cardiogram is necessary or not, but I think I will ask her to do it in either case, I am just waiting for next months paycheck, because it costs a fortune.

 

[FeebysOwner]

Thanks for update. I was wondering... And, yes all of this stuff is very expensive, but I am still feeling good about this vet! Aren't you?

 

[Count]

Thanks for update. I was wondering... And, yes all of this stuff is very expensive, but I am still feeling good about this vet! Aren't you?

I am feeling good about her too. But I wouldn't say for sure until I see solid evidence that this treatment is working. (Xray) As you know, my experience with vets so far was really bad, so I am having a hard time trusting another vet.

As for the cost, honestly what I spent here so far is less than a quarter of what I spent in the first week of the second vet. Or 1/10 of what I spent so far, so I am not complaining about the cost here. I just meant that the echo cardiogram costs a lot, because apparently a animal cardiologist does the exam, and he only comes there on demand.

 

[white shadow]

.
Count - I don't think echocardiogram should be your first diagnostic test.....

Diagnosis
The diagnosis of HCM relies on the documentation of the ventricular wall anomalies by cardiac ultrasound (echocardiography) and the exclusion of other non-genetic causes of hypertrophy such as hyperthyroidism and systemic hypertension. Other testing may include chest radiographs, electrocardiogram (ECG), blood pressure measurement and blood tests......
LINK: Hypertrophic Cardiomyopathy in Cats (HCM)​

Now, this hospital obviously has connections to Veterinary specialists. There is a standard protocol for referral to those folks.....usually starting with consultation...which is normally preceded by the primary care Vet preparing (her) 'workup' (the standardized information required by the specialist for an informed consult).

I have some unfortunate experience with all this as my little white shadow, with suspected hypertrophic cardiomyopathy, was awaiting a cardiac ultrasound appointment when he suddenly passed overnight.

More for you.......from an article by a Veterinary Cardiologist on diagnosing feline heart disease:

Electrocardiography
The ECG is insensitive as a screening test for cardiomyopathy, and probably has a greater positive than negative predictive value for feline heart disease. In other words, a normal ECG does not exclude a diagnosis of heart disease.....

Echocardiography
Definitive diagnosis of cardiomyopathy relies on cardiac ultrasound.....

LINK: http://veterinarycalendar.dvm360.com/feline-cardiovascular-diseases-parts-1-2-3-proceedings (my emphasis)​

- / - / - / - / - / - / - / - / - / - / - / - / - / - / - / -​

What has been happening in the litterbox? How often does he have bowel movements? Can you describe the stool.....how much...it's shape...is it hard or soft?

Is he more relaxed in his nebulizer chamber?

Are you seeing any of the breathing difficulty symptoms you listed in post #1?

Is he still getting the Azithromycin? Any change in his bowel movements since starting it?

How's his energy level? Is he eating well?

Whew!
,

 

[Count]

Count - I don't think echocardiogram should be your first diagnostic test.....

Diagnosis
The diagnosis of HCM relies on the documentation of the ventricular wall anomalies by cardiac ultrasound (echocardiography) and the exclusion of other non-genetic causes of hypertrophy such as hyperthyroidism and systemic hypertension. Other testing may include chest radiographs, electrocardiogram (ECG), blood pressure measurement and blood tests......
LINK: Hypertrophic Cardiomyopathy in Cats (HCM)
Now, this hospital obviously has connections to Veterinary specialists. There is a standard protocol for referral to those folks.....usually starting with consultation...which is normally preceded by the primary care Vet preparing (her) 'workup' (the standardized information required by the specialist for an informed consult).

I have some unfortunate experience with all this as my little white shadow, with suspected hypertrophic cardiomyopathy, was awaiting a cardiac ultrasound appointment when he suddenly passed overnight.

More for you.......from an article by a Veterinary Cardiologist on diagnosing feline heart disease:

Electrocardiography
The ECG is insensitive as a screening test for cardiomyopathy, and probably has a greater positive than negative predictive value for feline heart disease. In other words, a normal ECG does not exclude a diagnosis of heart disease.....

Echocardiography
Definitive diagnosis of cardiomyopathy relies on cardiac ultrasound.....

LINK: http://veterinarycalendar.dvm360.com/feline-cardiovascular-diseases-parts-1-2-3-proceedings (my emphasis)

Correct me if I'm wrong but we are talking about the same thing. I didn't say ecg (electrocardiogram). Echo cardiogram is ultrasound (you can tell from echo, it works with sound).

What has been happening in the litterbox? How often does he have bowel movements? Can you describe the stool.....how much...it's shape...is it hard or soft?

Everything seems normal in the litterbox. I have no idea if what she sees in xrays is this, but I've heard certain heart diesases can cause fluid buildup in there, so I am a bit concerned about that.

Is he more relaxed in his nebulizer chamber?

He is more relaxed, but he still hates it. I put some toys in there, and give a treat right after it is done to make him more relaxed, maybe they helped.

Are you seeing any of the breathing difficulty symptoms you listed in post #1?

No. Haven't heard them for a while, last time I heard them was the day after the day when he was in er.

Is he still getting the Azithromycin? Any change in his bowel movements since starting it?

First day and a half, he had diarrhoea but it is gone now.

How's his energy level? Is he eating well?

He is very energetic and his appetite is back. From outside, other than the occasional sneeze or nose blockage, he looks healthy.

 

[FeebysOwner]

Hi. Wanted to check in and see what is going on with Count? I am hoping things are OK???