Recurrent Sinus Infection

all4mom2

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This makes the third fancy antibiotic my senior cat has been put on with no lasting results. One was an injection (costing about $100 plus office visit and exam), and the other two oral solutions - at my request - that I'd never heard of costing around $50 a bottle. The infection with congestion, sneezing, discharge, hard boogers (dried pus), and malaise has returned each time - this last time, within a week. Obviously, I'm frustrated! This has to be VERY uncomfortable for him, and it's very expensive for me. Suggestions?
 

Maurey

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Has he had an X-ray done? My first thought with chronic nasal issues, especially in older cats, are nasal polyps or permanent damage to the delicate bones of the nasal cavity.

Alternatively he may have an infection that’s resilient, like mycoplasma, or something fungal, that he’s not getting the right treatment for, or not being treated for long enough. Has he had a long course of doxycycline? Has he had a nasal swab tested at all, or is your vet shooting in the dark?
 
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all4mom2

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No doxycycline, no swab test, so I guess these are shots in the dark -- one literally a shot!
 

Maurey

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Doxy is generally front line for stubborn infections as it’s effective against mycoplasma and chlamydia if given for long enough. Could you get a second opinion from a feline specialist from a different practice, or is that not realistic right now?
 
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all4mom2

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He's just been prescribed a new one (cyclo-something?) I'm supposed to pick up with a longer course of treatment (15 days versus 7 for the last one, Veraflox; ). If this doesn't work, I'll definitely suggest the doxy and/or try another vet. Am I the only one who feels that she spends a lot of money for NOT a lot of results or satisfaction? Then there's the discomfort of my poor cat...
 

fionasmom

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No you aren't and the cat is not getting any better. Maurey Maurey has already suggested that other tests need to be done, maybe should have been done already, and that you may not have the correct or entire diagnosis.

I have no suggestions which will help you to clarify this except that in these situations I have usually sought out a referral to a specialist, at least a veterinary internist. In the long run, it has saved time and money and discomfort for the cat or dog. It is not to say that your vet is not good, but this might be beyond his area of expertise.
 
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all4mom2

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I don't know that we have any feline specialists around here; just a bunch of generalists who treat both dogs and cats, and I usually end up seeing whoever is available, which is usually the newest and least experienced vet in the practice(s). None of ours even offer emergency hours/services. Perhaps they shouldn't charge so much if they don't know what they're doing? But we meekly pay it and come back for more. I think vets have a real racket on going these days. (The new medication is Clavamox; $25 on Chewy, $50 at the vet's, although at least she didn't require another office visit and exam of him first).
 

Maurey

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Imo, those are quite strange choices of medication in a strange order — IANAV, of course, but seems like a very odd sequence of drugs if they don’t know what they’re treating. Could well be that it’s different in the US, but here and in the UK, a course of Doxy tends to be the first thing offered. Nasal swabs aren’t done every time, as they’re not always accurate or relevant, but the antibiotic selection is kinda wild, imo, especially for first line antibiotic choices. Hopefully the new antibiotics help, but holy shit how new is that vet? It’s so unwise to use relatively niche antibiotics on a patient in a relatively short amount of time, no matter the species. Clavamox is generally for staph, step, and e.coli. Unless they think your cat has e.coli, which, imo, doesn’t add up as your cat would likely be much worse off, the Veraflox should’ve taken care of staph and strep.
 
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all4mom2

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As I said, I had never heard of the Veraflox, and the Clavamox was prescribed once before, but for a dental abscess (?). I'm trying to get him in with another vet before starting the course of the latter. Of course it would be the weekend now! But thanks. This is the kind of feedback I was looking for, as I don't know much about cat drugs!
 
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all4mom2

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UPDATE: New vet okayed the Clavamox this time, but said given the history, would recommend erythromycin on a staggered schedule. It's probably viral/chronic with bacterial/acute episodes. Also pointed out that Clavamox is good for only about a week, and yet the other vet said to administer it for 15 days. Now, upon closer examination, I see the directions indicate giving every 12 hours, and it doesn't look like there's enough in there for more than a week, so I assume she meant 15 doses; not days. Any idea?
 

Maurey

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I’d suggest calling the clinic to make sure. Mine have never needed Clavamox so I hesitate to give advice, as it’s not commonly used here.
 
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all4mom2

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If they were open, I would.
 

fionasmom

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Clavamox can be used for a couple of different durations depending upon the reason for its recommendation. However, it seems your prescription has not been clearly written and possibly might contain a mistake, but none of us can make that determination. Are you covered for the weekend so that you can call on Monday and ask where this is going?
 
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all4mom2

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I mean, I don't have to start it yet (he's not in dire straits; just stuffy and uncomfortable), but there will go two more days that's it's good for. If no one here knows, I'll have no choice but to wait for Monday morning when I'll call the NEW clinic for clarification (I no longer have confidence in the old one).
 

fionasmom

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Since he is not bad off, I would follow your plan and try the new vet on Monday. Please keep us posted.
 
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all4mom2

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I consulted Dr. Google instead, and it is INDEED .5 ML twice a day for cats (15 doses; not days), so we began it this morning. Evidently the prescribing vet just doesn't know how to issue instructions.
 
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