Help with Baermann Test

[gvh82]

Hello,
Our Oriental boy has been struggling with asthma-like symptoms this last year (he's on Flixotide 250mcg but not working), so we've asked the vets to test him for lungworm as the symptoms seem very simalar.
My problem is that we were told to collect three samples together in a test tube and then drop them off for testing when we have all three. But my understanding (from looking on the internet) was that each individual sample needed to be fresh - preferbaly under 24hrs from being passed to being tested...
Have I got my wires crossed about this? Or doesn't matter if the live lungworms die before being tested because new eggs will hatch in the meantime? I'm a bit confused and vets didn't seem to know a huge amount about the procedure. Any help would be much appreciated... thank you

 

[Antonio65]

As far as I know, each sample should be individually collected and tested as soon as possible. This was what the vet told me when one of the cats I was fostering had a Baermann test done five years ago.

 

[lisahe]

It's also my understanding that the samples need to be as fresh as possible so the larvae are still alive. ***That said, we haven't done a Baermann test!*** But we suspected one of our cats of having lungworm and thus, with vets' guidance, treated her for lungworm without testing. Our cats have had run-ins with slugs that came through the floor of our veranda so we were already deworming them somewhat regularly anyway. We'll never know if either cat has had lungworms but I do suspect they may have at least contributed to Ireland's problem since they lungworms damage the lungs and cause wheezing/coughing symptoms. She has those but we (her home humans and her vets) don't believe the symptoms are caused by her (presumptive) asthma.

Speaking of asthma and Flixotide... Ireland was diagnosed (x-rays only) with mildish asthma in late 2019 and was getting 250 mcg of Flixotide twice a day, so a total of 500 mcg daily. Both the urgent care vet and the internal medicine specialist recommended that we cut her dose because even inhaled steroids can cause some immunosuppression, which could inhibit response to infection. She's now getting about half that (I still have 250 mcg inhalers but have her take fewer breaths per puff) and certainly isn't doing any worse. What we know for certain, though, is that wildfire smoke makes her symptoms worse. As do seasonal allergies, particularly ragweed. (She had a terrible September because of those!)

I hope you're able to find out what's causing your cat's symptoms, gvh82 .

 

[gvh82]

Thank you for the replies.
I remembered my other cat's breeder was a vet nurse so I asked her as well and she said as long as the samples aren't subject to extreme heat/cold they'll be ok (though she'd only done Baermann on other animals not cats).

lisahe
I thought about asking for lungworm medication straight away as side effects don't seem too bad, but aren't there different types of lungworm that require different treatments? Or did you try a few?
Like you were about Ireland, I'm now a bit suspicious that the coughing/wheezing is definitely asthma. Loki was 'sort of' diagnosed earlier this year when we took him in thinking he might have something stuck. He got prescribed 5mg Prednisolone to begin with which worked. Then he went onto Flixotide with an Aerokat, 50mcg first then 250mcg a month ago neither of which have worked (we're pretty confident he's getting the full, or near to full dose). Now along with the Flixotide, he's prescribed 2.5mg Prednisolone which I'm not happy about because of all the potential side effects. (He already has chin acne/dry mouth from Flixotide/inhaler)
We've more or less ruled out all the usual triggers, we've bought hepa vac, air purifier, bedding washed 90c every week, no aerosols, we don't smoke, high pollen doesn't seem to correspond... and nothing has made a difference, which is what led me to suspect lungworm.

 

[lisahe]

What you write sounds fairly familiar, gvh82! We've also ruled out lots of things that just don't quite "correspond." Since we know there have been slugs on the veranda, lungworm seemed like a natural to suspect. And since slugs carry Aelurostrongylus abstrusus, which cats often get, we treated for that. (If you'd like, I can look for the link to a good article from a vet journal that mentions multiple meds and effective doses for treating Aelurostrongylus abstrusus: it's come in handy for us twice now at vet appointments since they apparently don't see many lungworm cases at all. We're lucky that our regular vet studied with a professor who thinks lungworm deserves a lot more attention!) We only used one treatment: Panacur (fenbendazole granules), which is what both our cats get two or three times a year anyway. There are others, though, including "spot on" treatments, which are certainly easier to administer. She also gets a small daily dose of Cerenia (maropitant citreate), which we think helps her lungs a bit. For the most part, she seems to do pretty well; her x-rays have been the same from late March to mid-June but she's due for another round on the 21st.

We have no earthly idea if Ireland had lungworm but I've seen mentions in scholarly articles that lungworms can damage a cat's lungs; my theory is that she had lungworm (or some other unusual infection, as our internal medicine vet put it) and it damaged her lungs permanently. Nobody's sure what the blob is on her lung but "mucus plug" has been mentioned in two out of three radiologist reports. And lungworms can apparently cause mucus plugs.

All your attempts to find triggers reminds me of what we did for Ireland, too! We changed kitty litters, got two more air purifiers, washed all bedding, washed bedding again, and so on and so forth. Almost everything seemed to help until it didn't. On the bright side, a vet tech said that many of those things probably do help her feel and do better, though they haven't resolve anything permanently. The only thing that we've definitively been able to connect to more coughing/wheezing is the bad air (due to wildfire smoke and ragweed pollen) that settled in last month. And one other thing: she, too, gets chin acne!

 

[gvh82]

lisahe thank you for your help. I've just been looking at Febandzole/Panacur this afternoon. It doesn't seem to have many,or extreme side effects so I think we're going to start him on that even if Baermann Test is negative (I'm dubious about it's accuracy). Would you be able to tell me (if you can remember) what doseage you were giving Ireland? I read a medical journal that advised 55mg daily for 21 days, but the information with Panacur says 50mg for 3 days (I don't know if this perhaps means just as a preventitive rather than to kill a long-term infection?)

Do you mind me asking what Ireland's asthma looks like on a daily/weekly basis? Loki (daily) typically has a couple of long spells of noisy laboured breathing when sleeping, and 1-2 spells of coughing/open mouth breathing that usually range from about 3-10 seconds. We've been researching feline asthma for the last couple of months and we're a bit shocked at how little medical rersearch has been done into, as well as the quality of what we've found. It's frustrating and depressing to try and make informed decisions for Loki's health. The vets' don't seem overly concerned as he hasn't shown signs of pneumonia and his heart sounds strong.

Have you had any success treating the acne. We've just started wiping his chin with witch hazel today. I've cut some strips of soft bedding to put under his chin when using the Arekat as well to see if it helps ( I found some 'Aerokat Koozys' on etsy that I'll get if the material seems to help).

 

[gvh82]

lisahe , I forgot to ask as well if you don't mind: did Ireland's symptoms improve permanently after the Panacur treatment, and if so how much? Thank you

 

[lisahe]

lisahe , I forgot to ask as well if you don't mind: did Ireland's symptoms improve permanently after the Panacur treatment, and if so how much? Thank you

I'll start with this question, which is the easiest to answer, though unfortunately I can only say "We don't know for sure." She took Panacur in April and a spot-on treatment in May (I think?) but still has symptoms that vary in frequency and severity. Beyond that, we added a stable dose of Cerenia at around that time and increased her herbal/probiotic supplement, too. Over all, I think (think?) she's doing slightly better now than she was back in late March when I brought her to the urgent care vet. But that's only "over all" since she had that rough September due to wildfire smoke and pollen. In any case, as I mentioned earlier, lungworm can cause lasting damage so we weren't necessarily expecting to see all her symptoms go away. On a purely anecdotal note, I read online about a couple of cats who had it, were treated, and slowly improved.

And here I have to agree with you about the vagaries of knowledge about female asthma (which seems to blur with a form of bronchitis that's treated the same way) and other lung disorders! It's very, very frustrating, particularly because it sometimes seems as if "asthma" is used as a catchall. Unfortunately, inhaler dosages aren't really handled well (as mentioned above!) since there's not always any attempt to find the least effective dose.

Which leads me to your questions about drugs for lungworm. That's something to discuss with your vet, particularly since first there's the question of choice -- there are several options that seem to have shown pretty much identical efficacy in studies -- and doses may vary depending on the cat's weight. It sounds like you have very good vets -- you're very fortunate! Beyond that, there may be something in Loki's history that would preclude or support using one drug or another due to potential side effects or other factors. (Ireland had already used some of the drugs on the list so that piece was easy for us.) Do you know if Loki has been (or may have been) exposed to slugs or snails? That might also affect your vet's choices or calculations, too. I printed out journal articles and highlighted specifics so they were always at hand when I went to see a vet or spoke with someone over the phone. As always, the actual information varied a lot depending on studies but at least they provided starting points. (I gained particular respect for Italian researchers who do lots of great research on lungworm! I wish more would join them so there could be more of a sense of truly standard diagnosis and treatments rather than trial and error...) Given that prednisolone has worked for Loki, it might also be worth discussing potential anti-inflammatory supplements or (nonsteroidal) drugs with your vet, too.

As for chin acne, I haven't yet been very consistent about any of this, though I've been using a gel on Ireland's chin once or twice a day. I've also been wiping the AeroKat and her (plastic) autofeeder with hydrogen peroxide.

It's hard to summarize Ireland's wheezing/coughing, particularly since we don't often know exactly what causes it. And her "asthma" diagnosis is only presumptive since it was made only by x-ray; it was a "sort of" diagnosis, like Loki's. We do notice that a fair number of her incidents happen when she's picked up or when she rolls around, making us wonder if she has acid reflux that comes into her throat when she's jolted. Or maybe the "bad spot" in her lung gets compressed? We just don't know. We do know for sure that wildfire smoke and pollen bother her. We also know that she loves to sniff the floor, where there is often dust (despite my attempts at cleaning!). And that she seems to do worse when there are rapid changes in barometric pressure. (Cats with lung ailments tend to have more symptoms when the pressure is low...) And we're certain that Ireland is an anxious cat; she and her sister are rescues. Sometimes Ireland will go a week or longer without us seeing or hearing any incidents. But at her worst, she'll go a few days in a row with incidents. Fortunately, most of it is a little lighter now: some wheezing, maybe a light cough. I'm glad she seems to do better (and eat better, too) but I wish I knew what causes this and/or what has helped the most.

 

[lisahe]

P.S. I realized this morning that I forgot to mention that Panacur/fenbendazole doses are especially confusing because it comes in several forms, so, depending on the form, the calculations can get interesting. When I came back I noticed that you're in the UK, which means your options may differ significantly from mine, gvh82 . As I mentioned before, you're fortunate to have good vets! I hope all's going well for Loki.