Chronic Respiratory Issue - try another antibiotic or do a PCR panel?

[dreamingofdeltas]

Hello. I am new here, so I am sorry if I'm not choosing the right area to ask this. I really need some fellow cat parent advice on this respiratory situation for my boy.

My Avery (8 yo mixed domestic shorthair) has been suffering from a URI (or multiple URIs) since January.

He did have a URI in late November that seemed to go away after a round of Clavamox. His brother did, too, but his brother didn't need antibiotics since he has a stronger immune system and can fend off the virus faster, thus not needing the antibiotic to protect against secondary infection.

In January, Avery's sneezing started up again and gunk eyes. We took him in and the relief vet (our vet was out of town) and he was prescribed eye antibiotics and clavamox.

The back and forth to the vets continued as he would seem better then start sneezing again and getting eye gunk. All in a, he was on 3 rounds of clavamox and a couple of the the eye antibiotics. He ended the third round on Feb. 22 but has sparingly had a few sneezes here and there since. We have added L-Lysine to his regimen, which I thought helped, as the vet feels it is a lengthy herpes flare up.

He also was given famciclovir with the second round of antibiotics by the relief vet but had a reaction where he was instantly groggy and lethargic so we stopped that.

We have fountains for water, feliway diffusers, and stress reduction methods in play.

I thought we were finally over this bout but the past couple of days the sneezing has picked up again.

I reached out to my vet (our regular vet who I love is back and did see him for the most recent visit) and she wants me to monitor for a couple more days since he has no other symptoms. If it persists, we have the option to try azithromycin (a different antibiotic) or do a PCR upper respiratory panel.

Has anyone had a similar situation and would you recommend trying the azithromycin first to avoid another stressful vet visit (those visits do not help the stress factor, which I know can make herpes flare ups worse) or go straight to the PCR panel?

Thank you so much,

A worried cat mom

*If you're on Instagram, my boys are @thegreybrothers - I am that crazy cat mom!!

 

[Mr. Meow]

Hello. I am new here, so I am sorry if I'm not choosing the right area to ask this. I really need some fellow cat parent advice on this respiratory situation for my boy.

My Avery (8 yo mixed domestic shorthair) has been suffering from a URI (or multiple URIs) since January.

He did have a URI in late November that seemed to go away after a round of Clavamox. His brother did, too, but his brother didn't need antibiotics since he has a stronger immune system and can fend off the virus faster, thus not needing the antibiotic to protect against secondary infection.

In January, Avery's sneezing started up again and gunk eyes. We took him in and the relief vet (our vet was out of town) and he was prescribed eye antibiotics and clavamox.

The back and forth to the vets continued as he would seem better then start sneezing again and getting eye gunk. All in a, he was on 3 rounds of clavamox and a couple of the the eye antibiotics. He ended the third round on Feb. 22 but has sparingly had a few sneezes here and there since. We have added L-Lysine to his regimen, which I thought helped, as the vet feels it is a lengthy herpes flare up.

He also was given famciclovir with the second round of antibiotics by the relief vet but had a reaction where he was instantly groggy and lethargic so we stopped that.

We have fountains for water, feliway diffusers, and stress reduction methods in play.

I thought we were finally over this bout but the past couple of days the sneezing has picked up again.

I reached out to my vet (our regular vet who I love is back and did see him for the most recent visit) and she wants me to monitor for a couple more days since he has no other symptoms. If it persists, we have the option to try azithromycin (a different antibiotic) or do a PCR upper respiratory panel.

Has anyone had a similar situation and would you recommend trying the azithromycin first to avoid another stressful vet visit (those visits do not help the stress factor, which I know can make herpes flare ups worse) or go straight to the PCR panel?

Thank you so much,

A worried cat mom

*If you're on Instagram, my boys are @thegreybrothers - I am that crazy cat mom!!

While I am not a vet, if I were in your situation, I'd go for the PCR panel rather than hope a new antibiotic will either work, not cause a bad reaction, or both. While a vet visit can be stressful, I feel that more information is needed, seeing as you've been through a few rounds of meds with no real solution in sight.
It's possible that the PCR can reveal something that he's not showing symptoms of, or something that both vets may have missed.
Keep us posted on how everything goes!

 

[She's a witch]

I’d absolutely go for PCR panel. Antibiotics damage gut flora, potentially causing gut dysbiosis (and there are theories that IBD is caused by gut dysbiosis) so I wouldn’t personally use antibiotics until I know it treats the right thing.

 

[dreamingofdeltas]

Thank you both so much. I called my vet a bit ago and requested to go with the PCR panel option.

They are going to see if they can squeeze us in tomorrow or Saturday!

I will keep you guys posted. Again, thank you so much for the advice.

 

[stephanietx]

This sounds like what my cat went through. We did a culture & sensitivity test of the nasal discharge as well as the PCR URD test. The culture showed a secondary infection (pseudomonas) and the sensitivity test showed the best antibiotic to treat it. The PCR test showed she was positive for feline herpes. We treated the infection and it cleared up after a couple of rounds of antibiotics. Pseudomonas is very difficult to get rid of and is resistant to most meds. Since he's already been on a couple of rounds of antibiotics, I would start looking for a secondary infection.

 

[dreamingofdeltas]

This sounds like what my cat went through. We did a culture & sensitivity test of the nasal discharge as well as the PCR URD test. The culture showed a secondary infection (pseudomonas) and the sensitivity test showed the best antibiotic to treat it. The PCR test showed she was positive for feline herpes. We treated the infection and it cleared up after a couple of rounds of antibiotics. Pseudomonas is very difficult to get rid of and is resistant to most meds. Since he's already been on a couple of rounds of antibiotics, I would start looking for a secondary infection.

Thank you for the advice. They were able to schedule him in tomorrow morning and I asked about if a culture could be done, too, to look for a secondary infection after reading your reply. My vet is in surgery today but they have a note to ask her.

Truly appreciate your help and am glad you guys were able to get over this after a few rounds of antibiotics!

 

[dreamingofdeltas]

Just wanted to follow up that we had both the PCR upper respiratory panel and also a culture and sensitivity test today! We should have the results by the end of next week but are holding off on anything else in the meantime.

The vet feels that it is viral and it very well may be something he just has to live with if nothing comes back. Since he is totally healthy otherwise, just has the darned sneezing, it could just be herpes flareups.

We will see but thank you all for the advice based on your experiences!

 

[stephanietx]

dreamingofdeltas I hope you get some answers!

 

[dreamingofdeltas]

Hello everyone! Our results came back and he was straight negative for everything. No herpes, no infections, nothing.

So while it is good to know he is free and clear of everything, we may just have to live with the sneezing. The vet feels he is healthy otherwise and all of his lab work came back normally, as well.

 

[stephanietx]

Is it possibly allergies? Have you tried an antihistamine to see if that helps?

 

[dreamingofdeltas]

That is exactly what my husband and I were talking about tonight...maybe it is just allergies that are extra bad right now. We are going to also try an air purifier! An antihistamine is a good idea to try, too! Thank you!!

 

[stephanietx]

Also, if you have carpet, vacuum frequently. We give our kitties 1/2 of a plain Claritin (Loratadine generic is fine, too) once a day. We crush into wet food and it works well. You could also look at some of the solutions from Jackson Galaxy's site Spirit Essences. There is one for respiratory issues. I give it to my asthmatic kitty, but it might work for this issue as well.

 

[Jem]

If this becomes too much for the kitty and the allergy meds don't work. One thing you could do is have his sinus x-rayed. Our boy had a URI that lasted a long time. It would get better with antibiotics, then come back, over and over....I felt horrible for him. It turns out, that at some point, the chronic infections made it so the mucus membranes in the sinus cavity wore away, so rather than having some nice wet cushy tissue to trap allergens and "bugs" from getting in, the whole left side of his sinuses were like a giant cave, letting everything in.
So in our case, keeping allergens in the house to a minimum is important, we got a couple of air purifiers and he doesn't go outside. We also changed our litter to a corn based (world's best), but hoping to change to a pine pellet soon. He's an avid digger in the litter box so we wanted a litter that was less harsh/dusty. We make sure that the humidity in the house is good, and if need be, we will put saline drops in his nose to moisturize and clean his sinuses. Our vet also suggested, if we need to, to get eye drops for him. The eyes and sinuses are connected, so when you put drops in the eyes, it will run down, essentially cleaning out the sinuses too. I haven't had to do this yet, as the drops up the nose seem to be enough, but depending on this years allergy season...we may have to.
He no longer gets infections, but he still sneezes and makes snot rockets...that is just what we have to deal with, but he's perfectly healthy.
One more thing. He did have a stubborn infection. And what my vet said was the the constant starting and stopping of antibiotics can make the infection become resistant to medications. Our last ditch effort was to give him one last round of antibiotics (after getting the PCR/culture done) lasting...If I remember correctly...6 weeks....without stopping. We gave him doxycycline every day for 2 weeks then tapered down to every 3 days, to keep it in his system for the remaining 4 weeks. This is what finally worked to get that pesky infection to go away. It turns out his infection was what usually causes URIs in bunnies...not cats, but due to his sinuses, he's now prone to getting unusual infections that most cats would not be as susceptible to. But like I said, now that that last infection is gone, and with our efforts and minimizing allergens, he's fine...just snotty.

 

[dreamingofdeltas]

Also, if you have carpet, vacuum frequently. We give our kitties 1/2 of a plain Claritin (Loratadine generic is fine, too) once a day. We crush into wet food and it works well. You could also look at some of the solutions from Jackson Galaxy's site Spirit Essences. There is one for respiratory issues. I give it to my asthmatic kitty, but it might work for this issue as well.

Awesome, thank you so much for the tips! We definitely will be vacuuming more (we have some carpet) and just ordered an air purifier, too! It is worth a shot!

 

[dreamingofdeltas]

If this becomes too much for the kitty and the allergy meds don't work. One thing you could do is have his sinus x-rayed. Our boy had a URI that lasted a long time. It would get better with antibiotics, then come back, over and over....I felt horrible for him. It turns out, that at some point, the chronic infections made it so the mucus membranes in the sinus cavity wore away, so rather than having some nice wet cushy tissue to trap allergens and "bugs" from getting in, the whole left side of his sinuses were like a giant cave, letting everything in.
So in our case, keeping allergens in the house to a minimum is important, we got a couple of air purifiers and he doesn't go outside. We also changed our litter to a corn based (world's best), but hoping to change to a pine pellet soon. He's an avid digger in the litter box so we wanted a litter that was less harsh/dusty. We make sure that the humidity in the house is good, and if need be, we will put saline drops in his nose to moisturize and clean his sinuses. Our vet also suggested, if we need to, to get eye drops for him. The eyes and sinuses are connected, so when you put drops in the eyes, it will run down, essentially cleaning out the sinuses too. I haven't had to do this yet, as the drops up the nose seem to be enough, but depending on this years allergy season...we may have to.
He no longer gets infections, but he still sneezes and makes snot rockets...that is just what we have to deal with, but he's perfectly healthy.
One more thing. He did have a stubborn infection. And what my vet said was the the constant starting and stopping of antibiotics can make the infection become resistant to medications. Our last ditch effort was to give him one last round of antibiotics (after getting the PCR/culture done) lasting...If I remember correctly...6 weeks....without stopping. We gave him doxycycline every day for 2 weeks then tapered down to every 3 days, to keep it in his system for the remaining 4 weeks. This is what finally worked to get that pesky infection to go away. It turns out his infection was what usually causes URIs in bunnies...not cats, but due to his sinuses, he's now prone to getting unusual infections that most cats would not be as susceptible to. But like I said, now that that last infection is gone, and with our efforts and minimizing allergens, he's fine...just snotty.

Wow. That sounds like the poor fellow had quite the go round with the URIs, too!!

Thank you for all of that information. Did the PCR/cultures themselves show anything in your boys case ? And then that is why you did the 6 weeks of antibiotics? Based on Avery's results, I presumed he doesn't have a bacterial infection since the tests were all negative. But now I'm curious.

He also had the stopping and starting so it makes total sense that this would cause a resistance to antibiotics, just like in humans.

We actually ordered an air purifier last night, after reading a bit more on the allergies. Interesting about the litter...he is a digger, too, and always ends up with litter on his nose somehow! We tried worlds best and they were not fans but maybe pine pellet would be an option to try!

I love the last resort to get his sinus x-ray'd, if we need to. Just like your boy, Avery is happy and healthy otherwise...no other concerns outside of the sneezing.

He seems to sneeze more when he wakes up from a nap. Not sure why but that is something I have noticed!!

 

[Jem]

Did the PCR/cultures themselves show anything in your boys case ? And then that is why you did the 6 weeks of antibiotics?

Yeah, the "bunny infection" thing...My vet wanted to make sure that there was no more starting and stopping of meds, so did the 6 weeks to make sure we kicked it.

Interesting about the litter...he is a digger, too, and always ends up with litter on his nose somehow!

Bynx is a huge digger...he'll sometimes spend 15 minutes in there digging away. He's a black cat too so we really see how much dust is left behind on him.

 

[dreamingofdeltas]

Yeah, the "bunny infection" thing...My vet wanted to make sure that there was no more starting and stopping of meds, so did the 6 weeks to make sure we kicked it.


Bynx is a huge digger...he'll sometimes spend 15 minutes in there digging away. He's a black cat too so we really see how much dust is left behind on him.

Gotcha! And wow, 15 minutes is definitely a lot of digging Avery is only a couple of minutes to create "the proper poop hole" then he is usually good.

We got our purifier today and started running it a few hours ago. Crossing our fingers and toes that it helps...but really appreciate your advice and experiences, as well as everyone else's. Gives me hope that if this still is a chronic thing, maybe we can see about an xray of his sinus cavity!

 

[dreamingofdeltas]

Yeah, the "bunny infection" thing...My vet wanted to make sure that there was no more starting and stopping of meds, so did the 6 weeks to make sure we kicked it.


Bynx is a huge digger...he'll sometimes spend 15 minutes in there digging away. He's a black cat too so we really see how much dust is left behind on him.

One more question for you...did the air purifier start to help "right away" or did it take some time? We have been running it all last evening and today...and he is still just as sneezy. I want to give it time to see if it helps but it says it refreshes the air 5x an hour so would expect the air to be "clean" by now.

Thank you!

 

[dreamingofdeltas]

Hi all!! I just sent this to Jem but in case anyone else has a kitty down the road with a similar issue thought it would be helpful to share with everyone. Avery is doing so much better...out of nowhere! Here is all what happened after my last post:


We opted for a full allergy panel just to see if it could be allergies (came back negative for everything) and asked about the X-ray that Jem had mentioned to check sinus cavity/to see if a foreign object was stuck. Our vet said it would be better to go to a specialist because CT scans (under anesthesia) show a lot more if we wanted a diagnostic workup.

The specialist at Medvet got everything from our vet and said our vet did everything to a tee correct, which made me feel relieved that they didn't miss anything.

And at the end of the day, after examining him and looking through his history , he thinks it may be an immune mediated disease, chronic inflammatory rhinitis. He is not convinced that it isn't the herpes virus...and that even though the PCR showed negative for herpes, if the virus was in an "inactive" state it will show negative even if the kitty has it, as it is a self limiting disease.

He said an easy thing to try would be an anti-inflammatory or steroid to see if that helps. Diagnostically, it is tough as the nose is hard to work up. He said from here, not much that they can do without anesthesia...and we would be looking at a CT scan, an oral exam under anesthesia to look in back in throat for polyps, strictures, etc, and/or a rhinoscopy to take biopsies.

We opted to try Prendisolone first if that could be an "easy" fix without having to put him through more stress but being it wasn't compounded until the end of the Friday after the appointment (they only had cherry and said cats hate cherry but love the chicken marshmallow (barf ) so we said waiting a day or two was okay. My husband and I decided to wait to give prednisone until Sunday...as the internal medicine specialist mentioned if it was the feline herpes infection, a flare up can occur/get worse with steroids and to call right away, if so. But if immune mediated, it could help.

Ironically, 2 days after the visit, which was Saturday, Avery's sneezing decreased dramatically. We decided to hold off on starting the Prendisolone. Since then, his sneezes have been much less and roughly 1-3 a day, as well as "less snuffles."

He did end up having bacterial conjunctivitis (for the first time this entire ordeal) that I noticed last Friday night, as he had yellowish gunk in his eyes. Our primary vet prescribed us Oxaflacin and he is still on it for a few more days but it has cleared up.

He has sneezed maybe once or twice a day max the past week or two and seems so much better - I have no clue if it really was a long virus or an immune mediated disease that got better but I am so thankful!!
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Thank you all so much for your advice and help!