Dry cough turned serious. Worried!

[sierramist]

Hi everyone! We've run into yet another troublesome situation with one of our babies (we currently have four).

My only (sweet and wonderful and gentle) boy is approximately 12 years old — we've had him since 2012, a stray kitten my husband found at a gas station. He's had idiopathic seizures for the past 8 years and takes phenobarbital daily with no other health problems. But long story short, he's my soul kitty. We're bonded like no other cat I think I've ever had.

Within the last several weeks or so, he began having a more frequent dry cough which usually wakes him up from sleeping. He'd cough for a few then recover with usually a little raspy voice (his purr gets louder) for a while. Initially we thought it was just an unproductive hairball cough, but after a while I became more concerned. For what it's worth, my husband thinks he's had a cough off and on for years, though not as frequent and usually after jumping down from somewhere high like the cat tower.

It's been happening every other day or so now, with no other real symptoms other than I thought he might be breathing a little harder than usual. Still eating, drinking, playing, pooping. No panting or open mouth. So out of an abundance of caution I booked a vet appointment thinking maybe asthma? We've been working on our basement lately and he's been exploring down there. Maybe there's more dust or mold in the air, right? So let's see.

This morning was the appointment, and she initially thought asthma also. Didn't hear anything alarming with the stethoscope. We could either go home with some Cerenia and see if that improved anything (assuming it's asthma) or go ahead and do an x-ray to learn more. I opted for the x-ray, and it's probably good I did (those images are attached here, btw, if anyone wants to assess).

I could tell when she came back in — it wasn't good. From what she explained, he has a little fluid on the outside of his lungs so his lung capacity is down, and there's something going on in the front part of his chest around or in front of heart. It's tough to tell. Could be a mass/cancer, infection, or many other things from what I understood. I was so surprised and shattered.

We're getting referred to an internal medicine specialist that happened to have an opening this Thursday and will probably get an ultrasound and a sample of the fluid to hopefully see what we are dealing with. Are there risks with that? They also did a full blood panel in advance, and I'll get the results on that tomorrow.

So the whole thing is nerve-wracking, not knowing. I can't relax. Instinct (and probably some anxiety) tells me it's serious, and the vet was very concerned.

He seems so normal I think I'm also kind of in denial. He had a good lunch, played a little, and is now super relaxed, snoozing happily in a warm sunbeam.

I know no one here likely has definitive answers for me, but I appreciate the support. And if anyone has happened to experience something similar, do let me know! I'll update when we find out more. Right now I'm just scared about the prognosis, and worry this could be the beginning of the end for my Most Precious Boy. Good and/or reassuring thoughts are always appreciated!

 

[Furballsmom]

Hello - I'm sending all sorts of love and prayers

 

[FeebysOwner]

Hi. Sorry, I don't have much to offer, and I cannot read x-rays. Cerenia is probably not what they suggested, as that is commonly used for cat who are vomiting or have nausea. They were likely suggesting Covenia which is an antibiotic, and until you know more, it is probably a good idea to forgo it.

Regarding the ultrasound and fluid sampling process. It is not as bad as it sounds. Most times, it can be done without any sedative. My 18+yo cat has had 3 ultrasounds with fine needle aspirations (FNA - aka fluid or tissue samplings), and while it was on her abdominal area, she only needed a slight sedative the first time to calm her just for shaving her hair.

Make them explain all the aspects when you see the internal med specialist so you know what all is involved and specifically what they are looking for. Tbh, the more you know/understand the less anguishing the process is to go through.

Please keep us posted.

 

[sierramist]

Hi. Sorry, I don't have much to offer, and I cannot read x-rays. Cerenia is probably not what they suggested, as that is commonly used for cat who are vomiting or have nausea. They were likely suggesting Covenia which is an antibiotic, and until you know more, it is probably a good idea to forgo it.

Regarding the ultrasound and fluid sampling process. It is not as bad as it sounds. Most times, it can be done without any sedative. My 18+yo cat has had 3 ultrasounds with fine needle aspirations (FNA - aka fluid or tissue samplings), and while it was on her abdominal area, she only needed a slight sedative the first time to calm her just for shaving her hair.

Make them explain all the aspects when you see the internal med specialist so you know what all is involved and specifically what they are looking for. Tbh, the more you know/understand the less anguishing the process is to go through.

Please keep us posted.

She did say Cerenia, which I thought was odd too (one of our previous cats has taken it for nausea, so I'm generally familiar), but apparently it can be used as an anti-inflammatory? In any case, I think we're beyond that now, or really any additional meds, until we can find out more.

Even the ultrasound makes me a nervous wreck, which might be extreme, but combine a sick cat with my anxiety disorder and... . I just hate putting him through anything remotely traumatic, and oh gosh, I guess he'll have a shaved chest too. Sigh.

I'm just hoping we get definitive answers and some sort of plan. I don't even know what to expect at this point, so it makes my brain imagine all sort of horrible scenarios. Thanks so much for replying.

 

[neely]

It was wise of the regular vet to take your cat's health issue seriously and recommend an internal medical specialist. Try to take it one step at a time and write down any questions beforehand so you are not overwhelmed at the appointment. Depending what the IMS says I would ask if it's necessary to get a consult with another specialist, e.g. cardiologist, oncologist, etc. Our cat has had an ultrasound before and I can assure you he had no trouble whatsoever. I understand your worry and concern and will keep your boy in my thoughts when you see the IMS this Thursday. Sending good vibes your way.

 

[Margot Lane]

Wotta sweetie. Please let us know what happens. Wish I could offer advice but this seems like one for the vets. The best gift you can give him is to get plenty of rest and sleep if you can, so you’ll be more alert when the time comes. Maybe even write down any questions you have… if you do think it’s at all construction related you might write notes on how. Is you basement very old? Tested for radon? Any chemicals used? (Not trying to freak you out here but just think of all possibles while you wait. I’m sure any decent blood test anyway will show results of anything unusual). Deep breaths: keep calm and carry on!

 

[catdad61]

This might be of interest to you concerning Cerenia. It has an off label use to help treat respiratory infections

 

[silent meowlook]

Hi. Your vet is right to be concerned with those radiographs. Is he breathing okay now? It looks as though there is definitely diminished lung capacity. So, you have to monitor the breathing, respiratory rate and effort. Make sure that in case of emergency such as open mouth breathing or extreme respiratory effort, that you know where your closest emergency vet hospital is.

I am not trying to scare you. Just being realistic so you don't wind up in the middle of the night with an issue you are unprepared for.

An ultrasound is a wise next step. Draining the fluid off the of the chest is also needed to allow the lungs to fill normally. So, no matter what you do need to do that, and a specialist is best for preforming a thoracentesis (removing fluid from lungs). All procedures have risks. This is a minimally invasive procedure. But of course, there is always a chance for complications. The results will often help you to know what is going on, but be aware that sometimes it is inconclusive. The ultrasound will enable the specialist to get a better understanding of what is going on.

On radiograph, Xray will show air as being black and fluid as being white. On ultrasound the fluid shows up as black and the air will be white. That is a very simple way of describing it and of course things could be explained further but that would be a book.

There are some products and things you can do for your cat once it is discovered what is going on. At the cat hospital where I worked, in some respiratory cases we would have owners nebulize their cats once a day with medications in the nebulizer.

My own cat has horrible chest x-rays. Hers are different than your cat's. She doesn't have the diminished lung capacity that your cat is showing, but she has nodules in her lungs and the interstitial pattern. My cat also has asthma. I treat her with an inhaler for any asthma/coughing attacks. She is also on prednisolone for her suspect intestinal lymphoma.

I only mention my cat because the lung issues were noted about six years ago and she is still with me:

 

[sierramist]

Hi. Your vet is right to be concerned with those radiographs. Is he breathing okay now? It looks as though there is definitely diminished lung capacity. So, you have to monitor the breathing, respiratory rate and effort. Make sure that in case of emergency such as open mouth breathing or extreme respiratory effort, that you know where your closest emergency vet hospital is.

I am not trying to scare you. Just being realistic so you don't wind up in the middle of the night with an issue you are unprepared for.

An ultrasound is a wise next step. Draining the fluid off the of the chest is also needed to allow the lungs to fill normally. So, no matter what you do need to do that, and a specialist is best for preforming a thoracentesis (removing fluid from lungs). All procedures have risks. This is a minimally invasive procedure. But of course, there is always a chance for complications. The results will often help you to know what is going on, but be aware that sometimes it is inconclusive. The ultrasound will enable the specialist to get a better understanding of what is going on.

On radiograph. Xray. w
ill show air as being black and fluid as being white. On ultrasound the fluid shows up as black and the air will be white. That is a very simple way of describing it and of course things could be explained further but that would be a book.

There are some products and things you can do for your cat once it is discovered what is going on. At the cat hospital where I worked, in some respiratory cases we would have owners nebulize their cats once a day with medications in the nebulizer.

My own cat has horrible chest x-rays. Hers are different than your cat's. She doesn't have the diminished lung capacity that your cat is showing, but she has nodules in her lungs and the interstitial pattern. My cat also has asthma. I treat her with an inhaler for any asthma/coughing attacks. She is also on prednisolone for her suspect intestinal lymphoma.

I only mention my cat because the lung issues were noted about six years ago and she is still with me:

He's breathing okay enough, but I can tell his breaths per minute is elevated, somewhere in the 35-40 range. Possibly a little lethargic, but still wants to jump and play. No open mouth breathing at all. We do have an emergency vet I'm all too familiar with, but it's about 30 minutes away and unfortunately low-staffed. But I'm keeping a very close eye. Luckily I work from home so can continue to check on him through the day.

This morning seems pretty normal, though — took his phenobarbital fine, ate both his wet and dry food as well as usual (he's always a little picky), does his little playful routine under our bed, etc.

Thanks for the additional info on ultrasounds. This will be our first experience with them, but I'm hoping for the best. Wondering if we'll need an echocardiogram, also, if there's heart involvement. The IM specialist will supposedly do lots of diagnostics and if all goes well we will leave there tomorrow with a diagnosis and plan. I like being proactive, so the not knowing yet is tough.

Wotta sweetie. Please let us know what happens. Wish I could offer advice but this seems like one for the vets. The best gift you can give him is to get plenty of rest and sleep if you can, so you’ll be more alert when the time comes. Maybe even write down any questions you have… if you do think it’s at all construction related you might write notes on how. Is you basement very old? Tested for radon? Any chemicals used? (Not trying to freak you out here but just think of all possibles while you wait. I’m sure any decent blood test anyway will show results of anything unusual). Deep breaths: keep calm and carry on!

I mentioned our basement because the timing seemed oddly suspect. His coughing really did ramp up within the last 4-6 weeks or so, and he had been in the mostly-unfinished basement with us a few times during that period (once during a tornado warning!) when normally our cats aren't allowed down there. He jumped into the the "shelf" crawl space to explore where there's dust, debris, insulation, and who knows what else. Our house was built in the 60s.

But I would also think if it were something inhaled he'd have more issues IN his lungs — coughing, sneezing, discharge (which he doesn't have) — not fluid outside them? But there's some inflammation going on too, so who knows. We'll get the blood test back today and see what they say.

 

[sierramist]

So — we have his lab work back. The vet said that for the most part the chem looks normal. Liver, kidneys, thyroid are good.

We thankfully have some good comparisons to previous lab work since we have to do periodic tests to monitor his phenobarbital levels. The last blood draw was this January. CBC had some changes since then. His lymphocyte count was a little low in January, but now that value has come down more. Looking over a longer period of time (back in 2021 the value was much higher), values are trending down.

The question is why. The vet thinks it will depend on what that fluid in his chest is and where the blood cells are going. Is that a lymph node that’s enlarged, for instance. So if we can get a good sample tomorrow hopefully that will be very telling.

I think she's leaning toward cancer as the first suspect here, but I'm trying to stay hopeful. I should have asked this, but I always thought white blood cell counts would go up, not down, if you're fighting something, but I'm definitely no expert. At least, whatever it is, we may have caught it early?

 

[FeebysOwner]

I think cancer, as well as other diseases, can cause lymphocyte counts to increase or decrease - probably somewhat due to the cancer/disease type/location. Fluid accumulation in the chest area will cause the lymphocyte count to lower as the cells are being retained in the fluid that is accumulating.

However, I do want to point out that phenobarbital can lower lymphocytes too, and if that were to be the case, replacing that drug with a similar one can resolve the issue.

Good luck with the sampling tomorrow!!

 

[silent meowlook]

What I did to make myself feel better at home, since I am about an hour from an emergency vet. I got a portable O2 concentrator in case of an emergency. Just to buy some time. They aren’t cheap but it’s worth looking into if it brings you peace of mind like it did me.

 

[sierramist]

Got the actual lab results from the vet and here's a screenshot from the Hematology section, the only area with flags.

 

[silent meowlook]

The low lymphocytes can be caused by stress.

 

[sierramist]

My boy was due for a seizure, and unfortunately had one last night. I'm sure the stress of the vet visit earlier this week didn't help.

His breathing got a little faster afterward but it didn't get too serious. As always, he recovers from it well like it never happened, and I'm somewhat used to it after (counting) 27 documented seizures since 2015, but this makes me even more nervous going into today's internal medicine appointment and the additional testing he'll have to endure.

My stomach is in knots. Praying for the best and trying to prepare for the worst.

We leave soon. Will update right after we get some answers.

 

[catsknowme]

Hoping that you get a diagnosis and plan for action that we can all celebrate!

 

[sierramist]

So, it's his heart. Heartbreaking... but at least not cancer? Not sure if one is better than the other, truly.

The IM specialist vet is amazing, I trusted him right away. They approached his condition methodically looking at his heart first, and dialing in other tests from there. They ended up doing an echocardiogram, ECG, and blood pressure, and it was evident very quickly that it was his heart.

The vet wasn't able to categorize it into a specific type of cardiomyopathy because it seems to have features from a few types, so it's called "unclassified." It has led to congestive heart failure with moderate pleural effusion. He also has atrial fibrillation due to the cardiomyopathy.

We're starting him on four meds today — Plavix (blood thinner), Furosemide (for the fluid), Dilacor (helps the a-fib), and Pimobendan. Whew, it's a lot. The goal is to pull him out of failure and improve his heart function. We'll have a recheck in a week to see how he's handling the meds, and just need to monitor his breathing other than that.

Prognosis is guarded, at 6 months to a year. But I'm hoping, perhaps naively, that we can get this under control and have even more time, considering he's in excellent health otherwise.

It's strange because you generally wouldn't even know anything is wrong. Even after all the tests today he came home, ate lunch pretty well, and just groomed himself and wanted affection. Wasn't visibly upset, didn't hide, etc. Such a good boy.

I'm at least very thankful we have a definitive answer and plan of treatment by skilled professionals, but am also so stressed and sad.

I'll post a new thread soon to gather some thoughts from others with babies that have had similar conditions. Thanks for hanging on with us as we head down this rough road.

 

[silent meowlook]

Ok. Well at least now you know.
I knew a cat named Panther. I met him when he came in for an emergency at the cat hospital.He was in congestive heart failure and was in distress. I thought he would die that night. He didn’t. He was put on medication, Lassix, I forget what else. The owners were cost conscious. He was an indoor outdoor cat. About 14 years old. He went on to live 3+ years after his first episode.

Cats are amazing. They don’t have expiration dates and they don’t care about veterinarians opinions. They never read the medical books. So sometimes you have to look at the cat in front of you and judge from there. He doesn’t know anything is amiss.

 

[Furballsmom]

So sometimes you have to look at the cat in front of you and judge from there. He doesn’t know anything is amiss.

 

[sierramist]

We're only one day into the meds, of course — but so far, so good!

He's taking all of them like a champ, thankfully, and still has an appetite. I timed his resting breaths per minute while he was snoozing and it was down to about 28 or so, which is the first time I've seen it under 30 this week. So we're moving in the right direction, I hope.

Seems maybe a little more tired than usual after the meds kick in, and peeing more thanks to the diuretic, but this afternoon he's been affectionate, playful, and hungry.

I feel a tiny bit more at ease but it's so tough to stop worrying. Now I have to keep an eye out for seizures, breathing issues, and even something catastrophic like a blood clot. He's taking that blood thinner to help prevent clots, but again — there's always that chance. I suppose it's like when a person has heart disease and there's always the possibility of a heart attack. How does one ever completely relax?