# Cat honking cough



## brianmf (Aug 9, 2011)

Our Siamese (Max) has had an intermittent honking cough and foul breath for about two years now and the several vets I have seen just listen to his chest and say there's nothing wrong. He's had chest X-rays and they seem almost entirely clear. Just last week he had new X-rays and the specialist says his bronchial tubes are a little brighter than usual but she doesn't think that is significant.
I have only recently read that lungworm can cause a honking cough in cats so I asked the vet. She says lungworms are not known in our area (central Belgium).
However, I have read on a UK govt. web site that lungworms are known in the UK and northern Europe.
I gave Max a Drontal pill last week and his cough and breath did seem better for a few days but then came back. I plan to give him another pill next week.
Has anyone here had a similar experience?


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## OrientalSlave (Jan 26, 2012)

He could have asthma which may not show on an X-ray.


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## brianmf (Aug 9, 2011)

OrientalSlave said:


> He could have asthma which may not show on an X-ray.


If it was asthma, I think he would show signs of distressed breathing but his breathing is completely normal. However, he does snuffle and snort, suggesting that he has nasal congestion.
Also, after a coughing session he seems to swallow several times, as though he has phlegm in his throat.


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## brianmf (Aug 9, 2011)

Well I gave Max and Sam their second worming pills last weekend - two weeks after Drontal but Milbemax this time. Since then, Max has coughed a couple of times but less than usual. Again, the foul breath has disappeared which must be significant.
Why would a wormer pill cause bad breath to disappear unless the reason for the bad breath is associated with worms? I can find no information on the Internet on this subject.


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## havoc (Dec 8, 2008)

I think one symptom of worms can be coughing.


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## yankeedo (Nov 3, 2012)

Has your vet tested a poo sample for eggs or completed any blood tests?


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## brianmf (Aug 9, 2011)

havoc said:


> I think one symptom of worms can be coughing.


Yes, that is well known but the honking cough is more specific to lung worms. The thing that seems to be not mentioned much is the foul breath that seems to be associated with Max's honking cough and is relieved by the worming pills.


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## Ianthi (Oct 21, 2008)

Assuming they're in your area, how would he have contracted lungworm though? If he's exclusively indoor then this lessens the risks, unless you've a lot of indoor snails! Anyway after two years with this he's be much worse by now!

I can't explain the link between the wormer and the improved breath (a greatly improved cough could suggest roundworms) but ruling out teeth as a cause of the bad breath, I'm actually more inclined to believe he's got a low-grade chest infection. Has the vet ever prescribed antibiotics?

Our cat once had appalling bad breath and snoffing ( sneezing and coughing!) which incredibly enough he picked up from my neighbours dog! A course of ABs and he was fine in a week!


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## havoc (Dec 8, 2008)

> which incredibly enough he picked up from my neighbours dog!


Was it Bortetella? Kennel cough was in my mind as cats can get it.


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## brianmf (Aug 9, 2011)

Both Max and Sam go outside, even with the current snow on the ground. They both eat grass (and hopefully vomit outside). That seems to be one way to catch lungworm infections as infected snails contaminate the grass.
Antibiotics have the same effect on Max's breath as the worming pills - the bad breath returns a few days after stopping treatment.
Max had a dental descaling about six months ago as the vet thought the bad breath was due to mouth bacteria. The ABs were given at the same time and we thought that was it but, in a matter of days it was back. Both cats also have gingivitis but the vet says that this is virtually standard in pedigree cats these days.
They do not go to the cattery nor come into contact with dogs so I think kennel cough is unlikely.


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## spid (Nov 4, 2008)

I have to say, gingivitis IS NOT standard in pedigree cats - I have a 5 year old Birman and two other peds (but younger) and none of them have gingivitis. Have you tried giving them food they need to gnaw on (not dry biscuits), I used chunks of raw meat and chicken wings (raw) to keep my cats teeth and gums gleaming.

Advocate treats lungworm.


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## Ianthi (Oct 21, 2008)

havoc said:


> Was it Bortetella? Kennel cough was in my mind as cats can get it.


Quite probably Havoc though at the time I hadn't known the dog had it so didn't connect the two. Dog was also vaccinated! So his friendship with the little border terrier lead to this! He even _sounded_ like a dog with the snoffing! None of the others here contracted it though and it cleared up very quickly!


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## Ianthi (Oct 21, 2008)

brianmf said:


> Both Max and Sam go outside, even with the current snow on the ground. *They both eat grass* (and hopefully vomit outside). That seems to be one way to catch lungworm infections as infected snails contaminate the grass.
> Antibiotics have the same effect on Max's breath as the worming pills - the bad breath returns a few days after stopping treatment.
> They do not go to the cattery nor come into contact with dogs so I think kennel cough is unlikely.


Ah!With this additional information (grass) I'm now wondering if he might have a piece of grass/seed lodged somewhere behind his soft palate. FBs like this can set off a bacterial infection which could easily explain the bad breath and why it clears up after antibiotics only to resurface again at a later point. IF it's not (they'd need to put him under to investigate) then a longer course might be necessary if it's a primary infection. There are numerous others apart from kennel cough!

Anyway, I'd stop him eating grass from now on! Even if none lodged there it may well be an irritant and enough to cause a cough.


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## brianmf (Aug 9, 2011)

Ianthi said:


> Ah!With this additional information (grass) I'm now wondering if he might have a piece of grass/seed lodged somewhere behind his soft palate. FBs like this can set off a bacterial infection which could easily explain the bad breath and why it clears up after antibiotics only to resurface again at a later point. IF it's not (they'd need to put him under to investigate) then a longer course might be necessary if it's a primary infection. There are numerous others apart from kennel cough!
> 
> Anyway, I'd stop him eating grass from now on! Even if none lodged there it may well be an irritant and enough to cause a cough.


I'd love to know how to stop him eating grass. The only grass I see him eating is on the lawn and there's not likely to be any seeds there. However, what he gets up to while wandering in the neighbourhood is anybody's guess. All the neighbours know him by name and he's very friendly.
He not coughed at all in the last few days so maybe the wormer is working.


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## brianmf (Aug 9, 2011)

spid said:


> I have to say, gingivitis IS NOT standard in pedigree cats - I have a 5 year old Birman and two other peds (but younger) and none of them have gingivitis. Have you tried giving them food they need to gnaw on (not dry biscuits), I used chunks of raw meat and chicken wings (raw) to keep my cats teeth and gums gleaming.
> 
> Advocate treats lungworm.


Although Max is a siamese and his half-brother Sam is a russian blue, they are both from a breeder who specialises in cross-breeding pedigrees. Our vet says that there is a lot of gingivitis among these cross-bred cats. Possibly higher-level breeders manage to avoid it but a search of the Internet shows that it is indeed widespread.
I have tried them on raw meat but they are very particular and, at nine years of age, not willing to change. 
I don't know if Advocate is available here but I will check. Thanks for the tip.


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## Ianthi (Oct 21, 2008)

He sounds exactly like our (coughing) cat then! Very laid back and friendly- loved by the neighbours.

I have to say in your case the bad breath screams infection to me! I'd definitely mention the possiblity of an FB to the vet!


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## brianmf (Aug 9, 2011)

Ianthi said:


> He sounds exactly like our (coughing) cat then! Very laid back and friendly- loved by the neighbours.
> 
> I have to say in your case the bad breath screams infection to me! I'd definitely mention the possiblity of an FB to the vet!


One FB I and the vet have considered is a polyp but the vet is afraid to do an endoscopy in case that provokes a fatal spasm.
Strangely enough, we have only heard Max cough twice since he had the Milbemax and that was in the first two days. Prior to that, he had a coughing session two or three times every day.


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## brianmf (Aug 9, 2011)

Once again, the cough and bad breath both disappeared for a few days and now it's all starting again.
The mere fact that the wormer has this effect surely suggests that there is some kind of worm infection.


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## Ianthi (Oct 21, 2008)

While there's a definite connection between the two the question is it exactly? I'd discuss your findings with the vet! Apart from lungworm has heartworm ever been suggested?


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## brianmf (Aug 9, 2011)

Well, almost a year since I last posted and Max continues to cough most days. I have taken him to other vets and had him x-rayed again but with no positive results. So I filmed him coughing, as the vets have never seen it before and that, at last, has attracted some attention from our regular vet. I pointed out that there are other videos on the Internet that show cats with a similar cough and a diagnosis of asthma. Of course, suggesting my own diagnosis is not a good idea so the vet prefers bronchitis. Whatever! The end result is the proposal of 10 days on Atrovent with an inhaler that we had to hire from the local pharmacy.
Needless to say, Max does not agree and is objecting very firmly so, I get him in a 'moggy lock' hold and wave the inhaler nozzle under his nose for 15 minutes morning and evening. We're on Day 3 now and he is gradually realising that resistance is futile. He has even put his nose into the jet a few times, as though he realises it is doing him good. The coughing does seem less but maybe we are kidding ourselves. I'll report again when the course is completed.


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## Charity (Apr 17, 2013)

Having just read your complete thread, we had a Siamese recently with asthma. He just coughed all the time but never showed any signs of wheezing. Luckily, he didn't mind the inhaler so was reasonably easy to treat. His x-rays showed shadowing and scarring on his lungs though. I started by just placing it on his face for a few seconds at a time then when he was Ok with it, started using the medication. If you force him, stress will only make things worse and may make him cough more.
By the way, thank you for mentioning the endoscopy. We lost a precious girl in August having this done and our vet never mentioned the risk of a fatal spasm and had no explanation for her death. Now I think possibly this was the cause as she wasn't even ill.


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## brianmf (Aug 9, 2011)

Well, we finished the ten days of inhaler treatment last night and Max was absolutely fantastic with it. After the 3rd day, he just accepted it as though he knew it was for his benefit. After each 15-minute session, when I switched the inhaler pump off, he patted the nozzle and put his nose into it as though he wanted it to continue.
The coughing has certainly reduced but Max still has some snuffling/nasal congestion and of course the bad breath is still there - Atrovent is not an antibiotic.
So, I think we have to observe Max for a few days and then go back to the vet to see if we can try an alternative to Stomorgyl.


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## brianmf (Aug 9, 2011)

Charity said:


> Having just read your complete thread, we had a Siamese recently with asthma. He just coughed all the time but never showed any signs of wheezing. Luckily, he didn't mind the inhaler so was reasonably easy to treat. His x-rays showed shadowing and scarring on his lungs though. I started by just placing it on his face for a few seconds at a time then when he was Ok with it, started using the medication. If you force him, stress will only make things worse and may make him cough more.
> By the way, thank you for mentioning the endoscopy. We lost a precious girl in August having this done and our vet never mentioned the risk of a fatal spasm and had no explanation for her death. Now I think possibly this was the cause as she wasn't even ill.


I'm so sorry to hear about your loss without explanation. That really is tragic but I suppose we have to accept that it can also happen with humans and there is not much we can do about it.
You are right about forced treatment causing stress, particularly in an intelligent animal that can't always communicate his feelings. Max really does try to talk to us and you can often see his frustration when we fail to understand him.
Luckily, he very quickly accepted the inhaler and restraint was not necessary. I felt that he even got to enjoy it.


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## brianmf (Aug 9, 2011)

brianmf said:


> Well, we finished the ten days of ihaler treatment last night and Max was absolutely fantastic with it. After the 3rd day, he just accepted it as though he knew it was for his benefit. After each 15-minute session, when I switched the inhaler pump off, he patted the nozzle and put his nose into it as though he wanted it to continue.
> The coughing has certainly reduced but Max still has some snuffling/nasal congestion and of course the bad breath is still there - Atrovent is not an antibiotic.
> So, I think we have to observe Max for a few days and then go back to the vet to see if we can try an alternative to Stomorgyl.


Well, I called the vet yesterday as Max has started coughing again. She said that it would be a good idea to give him another course of treatment and add Lysomucil to the Atrovent in order to loosen the mucous even more effectively.
So I started that last night and Max was straight into it without any persuasion. I wedge the inhaler nozzle between the cushions on the settee and Max sits with his nose above the nozzle letting the vapours waft around his face. I would never have believed that a cat would sit like that for 15 minutes but he seems to know that it's beneficial. When I switch off the pump, he pats the nozzle as much as to say, "Why has it stopped? I was enjoying that". He really is a gem.


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## OrientalSlave (Jan 26, 2012)

If he has asthma then it cannot be cured but as you are finding it can be managed.


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## brianmf (Aug 9, 2011)

OrientalSlave said:


> If he has asthma then it cannot be cured but as you are finding it can be managed.


I'm not anticipating a cure. He's had the problem for several years already and the vets (several) have really been quite casual about it. The only indication of any cause has been that his bronchial tubes show up on x-rays "more than usual", although this doesn't seem to worry the vets. My own conclusion is that he has chronic bronchitis, which is no more curable than asthma.
As a follow-on from the vaporiser pump, the vet showed us a BabyHaler device to be used with a puffer. Docile and compliant as Max is, I'm not sure that he would be willing to stick his face into that chamber.


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## Charity (Apr 17, 2013)

He sounds a real little trooper, bless him.


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## brianmf (Aug 9, 2011)

Charity said:


> He sounds a real little trooper, bless him.


He's certainly unlike any other siamese we've had. He's incredibly intelligent and talks to us incessantly, watches a lot of TV and zooms around the house either alone or in games of chase with his half-brother Sam.
His behaviour with the inhaler has amazed us and he now goes to it as soon as I switch the pump on.

I'm no longer holding him at all. He just sits calmly on a cushion next to me with his nose in the vapour cloud for 15 minutes. It's extraordinary to see. He must find the damp vapour soothing and he looks really disappointed when I switch off.


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## brianmf (Aug 9, 2011)

Despite Max's keenness to 'take the vapours', I'm not convinced that it is really doing much for him, if anything. He still snuffles and has the occasional cough although perhaps not quite as much as before the treatment.
The last day is tomorrow and I think he will be disappointed because he is now reminding me when it's time to have his morning and evening sessions.
My personal view is that we should also be treating him with antibiotics as he still has a foul breath.


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## Ianthi (Oct 21, 2008)

Yes, Brian I have wondered about the bad breath.

I'm amazed at how well Max coped with the inhaler!


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## brianmf (Aug 9, 2011)

Max recently had a bad bout of coughing so I took him to a new vet last week. For the first time, this vet seemed to recognise the condition immediately and said it is a common problem in pedigree cats, where the trachea narrows and restricts breathing. Dependent on atmospheric conditions, the slightest irritation in that area causes coughing and that further aggravates the trachea. He demonstrated this by lightly touching Max's throat just above the ribs and he immediately went into one of his coughing spasms. The vet said there is a very expensive operation that can be performed or that a course of steroid injections is often progressively effective.
He gave Max a shot and he hasn't coughed all week so that has evidently had a beneficial effect. Unfortunately, I didn't get the name of the product but I will do on the next visit.
Max has coughed a couple of times today so I think I will be taking him back to the vet in a day or two. However, the vet did say that the time between shots would get longer each time.


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## Charity (Apr 17, 2013)

That's really good news, I do wish all vets would recognise the same things. Hope he will be a lot better now.


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## Sacrechat (Feb 27, 2011)

I've just read through the entire thread and glad I did before responding because I didn't notice the dates and when you initially dismissed someone's suggestion that it could be asthma because there was no sign of breathing difficulties, I was going to write and say my Birman girl has asthma and she has no breathing difficulties, just a horrible hacking cough. However, you have now discovered this. 

I find vets alternate between the terms asthma and bronchitis, some saying one others say another. My girl has her spray twice a day every day, especially at this time of year when fungal spores are being produced in abundance. Every now and then, she gets a chest infection that causes her to wheeze and she needs antibiotics. She accepts the spray but still tries to get out of having it whenever she can.


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## brianmf (Aug 9, 2011)

Unfortunately, Max has now developed a stuffy nose and his cough has returned. He is very depressed, in contrast to high spirits last week as he obviously felt a lot better. The vet admitted that the cortisone shot may have impaired his immune system so now he has antibiotics (Ronaxan).
On top of that, his half-brother (Sam) is being nasty to him, presumably because he is snuffling all the time.
Well educated vets should know the difference between asthma and bronchitis as one is a bacterial infection while the other is an allergic reaction.


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## brianmf (Aug 9, 2011)

Despite the snuffling, Max was reasonably bright last Friday evening but was collapsed and listless in his bed on Saturday morning. I took him to the emergency surgery of our regular vets on Sunday morning and they could find no abnormality, apart from temperature of 37 deg. They felt that his collapse was probably due to the cortisone injection given by the other vet allowing a chronic bacterial infection to get a hold. They said to continue the Ronaxan and add Metacam and decongestant vaporiser with a nebuliser pump. However, he would not eat or drink and I resorted to finger feeding him Scence Diet salmon paté, which he accepted. Yesterday, he suddenly showed signs of responsiveness and started talking to me again. Today, he has started eating on his own initiative and seems almost back to normal. Phew, the crisis seems to be over. What a mistake that was to change to a different vet.


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## brianmf (Aug 9, 2011)

Gradually, Max has been regaining his appetite. Tonight, he has started playing chase with Sam so he's evidently feeling well but he still has the nasal congestion with occasional snorting. I haven't heard him cough though. He finishes the Ronaxan antibiotics today so I doubt that is enough to clear the bacteria from his sinuses. I will continue with the nebuliser 2 x per day but there is not much else I can do to help him.


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## brianmf (Aug 9, 2011)

Sacremist said:


> I've just read through the entire thread and glad I did before responding because I didn't notice the dates and when you initially dismissed someone's suggestion that it could be asthma because there was no sign of breathing difficulties, I was going to write and say my Birman girl has asthma and she has no breathing difficulties, just a horrible hacking cough. However, you have now discovered this.
> 
> I find vets alternate between the terms asthma and bronchitis, some saying one others say another. My girl has her spray twice a day every day, especially at this time of year when fungal spores are being produced in abundance. Every now and then, she gets a chest infection that causes her to wheeze and she needs antibiotics. She accepts the spray but still tries to get out of having it whenever she can.


Interesting but the presence of foul breath still suggests to me that Max has a chronic bacterial infection. It disappears whenever he has antibiotics but returns within days of stopping. I'm inclined to think that we just haven't yet found the right antibiotic or that maybe the infection is resistant to antibiotics.


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## brianmf (Aug 9, 2011)

Well, here we are FOUR YEARS later and the saga continues.
My frustration with the dismissive attitude of our usual vet is difficult to put into words but, AT LAST, I have been able to make some progress. A friend recommended me to a new vet who listened very attentively to Max's history and agreed 100% that we should get a sample of Max's nasal mucous analysed. However, she said it is useless to take a swab from his nose as that would be contaminated with a wide range of bacteria. On the other hand, Max has been blowing his nose recently and leaving unpleasant deposits in his bed or on the floor. She agreed that, the fact that he responds well to virtually any antibiotic but relapses soon after the treatment is an indication that he has an infection with a highly-resistant strain of bacteria. She gave me a swab with which to take the sample.
Fortunately, the very next day, Max delivered a very nice dollop on the clean tiled floor and we were able to carefully twirl the swab on the surface to ensure a viable sample. That was sent off to the lab and the report arrived today. It says the sample contained a clear dose of _pseudomonas aeruginosa_. This bug is highly-resistant to antibiotics but the lab recommended Xeden (Enrofloxacin). By coincidence, our regular vet had reluctantly given Max a 10-day course of Xeden tablets only one month ago. It seemed to work very well but he did start coughing and snorting again only two weeks after completing the course.
The new vet says gentamycin is another alternative but she is concerned about its toxicity. She is therefore taking advice and will let me know asap. Meanwhile, Max is on Clavubactin 2 x 12.5mg per day.
Despite his illness, Max continues to be an absolute charmer. His 'almost human' character is irrepressible and he is a source of constant amazement with his routines, discussions and arguments.


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## Charity (Apr 17, 2013)

What a shame its taken such a long time to reach a diagnosis but am glad you know what it is at last. Sounds like Max doesn't let it spoil his enjoyment with life, cats really are amazing. Have you got a photo of your brave boy?


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## brianmf (Aug 9, 2011)

Yes, it is a relief. In fact, the (new) vet just called to say that the expert she talked to says that enrofloxacin is the most appropriate for this bacterium and that 6-8 weeks of treatment is advisable. So I will collect the pills tomorrow and see how we get on this time.
One of Max's foibles is that he does not like having his picture taken. We have dozens of attempted portraits but never once have we been able to capture him with his eyes open - and he does have beautiful blue eyes. When we produce a camera, he either closes his eyes or turns his head away or turns his back. We don't understand how he knows to do this but he definitely has a camera phobia. I will try to upload one when I work out how to do it.

Voila!





  








Max1




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brianmf


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Jun 16, 2015




This our lovely Max in one of his calmer moments.


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## brianmf (Aug 9, 2011)

Here's another with him sitting in front of the inhaler nozzle.



The vapour cloud doesn't show on the photo but it is there, all around his head.


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## brianmf (Aug 9, 2011)

Just an update, after 6 days on Xeden, Max seems to be in good spirits and his coughing is greatly diminished. He is also no longer snuffling. I have long suspected that his coughing is due to post-nasal drip from the upper respiratory tract infection so ...... fingers crossed.


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## brianmf (Aug 9, 2011)

One week off Xeden and Max started snuffling and coughing again. I decided to try another vet and she suggested getting a sample from Max and she gave me a couple of sample tubes with instructions on how to do it. Max obliged the next day by snorting a large dollop on a clean tiled surface. The pristine sample was sent off to the lab and it came back as a clear case of pseudomonas with a number of recommended antibiotics, Xeden/Baytril being one. The new vet said this is a very resistant bacterium and that we should put him on Xeden for 6-8 weeks. Max was so happy on these tablets, it was a joy to see. At 6 weeks, the vet said to stop and see the result. As usual, one week later he started snorting and coughing again. This time, the vet said she wanted to try another antibiotic, Marbocyl P. One thing that worried me is that she suggested 20mg per day. I have read on several web sites that 2mg per kg is the maximum for cats. Max weighs 5kg so 10mg would be the maximum for him and that is what I've given him. He seems OK on these tabs but nowhere near as perky as he was on Xeden. Looks like I need to negotiate with the vet over this.
I have read online that Zithromax combined with Marbocyl is an effective way of breaking down the biofilm that pseudomonas uses to protect itself from antibiotics. Does anyone here have any experience of this combination?


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## Ceiling Kitty (Mar 7, 2010)

_Pseudomonas_ infections can be horrible to shift. One of the ways the bacteria dodge the immune system is by secreting polysaccharides which form a resistant biofilm. They can't get gobbled up by white blood cells when they're safely in their biofilm.

This biofilm makes it trickier for antibiotics to reach the bacteria as well. As you've noted, azithromycin (Zithromax) has been recommended in human medicine for _Pseudomonas_ infections - not for its antibiotic action (technically azithromycin's antibacterial spectrum doesn't cover this bug, although there is literature out there that reports it does) but because it removes the biofilm. Don't ask me how: gap in my knowledge.

Interestingly, azithromycin also appears to have some anti-inflanmatory effects in the airways and improves the integrity of airway epithelium.

It's not licensed in cats, but is used quite commonly in feline medicine. Obviously you have to use human formulations as no veterinary ones exist.

As for marbofloxacin, the licensed dose in the UK is indeed as stated. The dose you have been prescribed is licensed in the States and higher doses are actually recommended for resistant _Pseudomonas _infections.

Rather than just dropping the dose without talking to your vet, I would contact her to make sure she meant to prescribe this dose. Has she spoken to a specialist? They may well have recommended different doses if so.

Due to the nature of this post (drug dosages etc) I am obliged to emphasise the importance of liaising with one's vet before making any changes to medications. Nothing personal.

Have you spoken to the vet about maropitant (Cerenia)? Seems to help in some of these cases, again off-licence.


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## brianmf (Aug 9, 2011)

Well, we seem to be getting somewhere at last. I recently took Max to see a specialist recommended by our new vet, with the aim of carrying out rhinoscopy. The specialist found a small growth high in Max's right nostril so he took a 2mm x 3mm plug biopsy for analysis. He felt this was unlikely to be cancerous and was probably an immune system response similar to that of the gingivitis that both Max and his half-brother Sam have had since birth. He also took X-rays of Max's airways but said there was nothing abnormal, except for a mild degree of bronchial fibrosis. He felt that the pseudomonas infection was insignificant and that it can be found in almost all feline nasal secretions.
We now have the results of the biopsy and they are very reassuring. There is no sign of cancer in the growth nor in his blood test results. There is also no sign of viral infection. The conclusions say that he has severe rhinitis which is inflammatory in nature and probably due to a genetic disposition to allergy. The recommended treatment is methylprednisolone tablets on a descending dose regime over a period of weeks. This is unlikely to provide a cure but may well enable us to find a minimum dose level to relieve the coughing and snorting.
So, we've started the treatment, which includes continuing the Xeden antibiotics to reduce the risk of infection while his immune system is depressed.
I don't know if the pills are already making him feel better but he is extremely excited and vocal at present. He runs around like a mad thing and jumps on Sam at every opportunity.


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## Charity (Apr 17, 2013)

Glad to hear you've got to the root of the problem at last. It must be so good to see him feeling better, hope it continues.


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## brianmf (Aug 9, 2011)

Well, he's been on methylprednisolone 6mg per day for 3 weeks now and, despite the fact that he is as happy as could be, he's not much better and the vet is at her wit's end. Me too. We've reduced the steroids to 4mg p.d. and the vet is saying to wean him off completely. She thinks there is no point in persisting as the treatment could damage him.


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## brianmf (Aug 9, 2011)

Last week, the vet gave me six tablets of Onsior to try out. This is an NSAID with once-a-day dosing. This again does not seem to help so the vet says there's nothing else she can think of. I asked about FHV1 as he's never been tested for that. She's not keen to pursue that route as she says there's no treatment for it anyway. I said I have read that famcyclovir seems to work well but she says it's experimental and has unpleasant side effects.
So, poor Max is back to square one. At least he bears his illness in good humour.


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## brianmf (Aug 9, 2011)

Max had his teeth cleaned 3 weeks ago and the vet seems to have done a good job this time. His breath odour is greatly improved and the gingivitis has also subsided. However, the honking cough and the snuffles continue to re-appear every few days. It really is quite a mystery. He has not shown any desire to go outside in the last three weeks - he is definitely a fair weather cat - so I don't think he is reacting to anything in the garden. The vet says she can only suggest taking him to one of the veterinary clinics attached to a university. They are all more than an hour away by car and there doesn't seem to be much hope of a satisfactory outcome so I think we are going to wait for a bit.


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## chillminx (Nov 22, 2010)

If he were to test positive for FHV-1 it would be worth trying him with L-lysine, an amino acid supplement which interferes with the replication of the virus. Results can be good in some cases.


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## Ceiling Kitty (Mar 7, 2010)

I virtually never test for FHV1 as the majority of cats are positive anyway and it's nigh impossible to interpret. A negative result doesn't rule it out, and a positive test doesn't mean it's the cause of the symptoms.

Famciclovir can be effective in some FHV1 situations, but it is eye-wateringly expensive in the UK (you're usually looking at £10-30 PER TABLET!).

I don't use L-lysine. I know that some people have had good results anecdotally but I've yet to see any scientific evidence that it is effective. Won't do any harm though.

OP - you'll need all the tests to diagnose it, but if you've got a cat with chronic rhinitis then you're unlikely to cure it. It's a case of managing the symptoms.


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## brianmf (Aug 9, 2011)

Shoshannah said:


> I virtually never test for FHV1 as the majority of cats are positive anyway and it's nigh impossible to interpret. A negative result doesn't rule it out, and a positive test doesn't mean it's the cause of the symptoms.
> 
> Famciclovir can be effective in some FHV1 situations, but it is eye-wateringly expensive in the UK (you're usually looking at £10-30 PER TABLET!).
> 
> ...


Thanks for the advice. We're still in wait and see mode but we can see that Max is still in the same state. It's frustrating because the honking is quite severe and he is such a lovely character that it is really distressing to see him coughing like that. He also has the occasional respiratory spasm and I feel so helpless. It only lasts a few seconds but gives the impression that he will one day collapse and that will be the end of him. He also sometimes snorts green snot but has no eye problems and is generally very clean.
Two days ago, both he and his half-brother Sam, had their annual vaccination and the vet used a new vaccine called Leucofeligen. Max had a bad vomitting session about two hours later. I've never seen anything like it before. He was jumping in the air with each vomitting spasm and he made quite a mess of our carpet. Both Max and Sam then slept for the next 48 hours but seemed fine and purred when we stroked them. They seem much better now but I did inform the vet today and she said not to worry if they are recovering.


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## brianmf (Aug 9, 2011)

Max has started sneezing green slime again so I asked the vet if she would please try a dual antibiotic including azithromycin as that seems to be widely touted as a successful treatment for pseudomonas infections. She agreed but, because this drug has not been approved for use in animals, she was worried about the dose to prescribe. We did a bit of Internet searching and conclude that 10mg/kg twice daily seemed the most popular dose used for cats. As Max is 5kg, we decided on 50mg twice daily. The only problem with that is that the human variety comes in 250mg or 500mg tablets. I got 6 of the 250mg sausage-shaped tablets and made an attempt to divide one into five pieces but this was not easy as there is a coating on the chalky tablets and they tend to fracture unevenly.
Anyway, I gave the approximate dose to Max last night, together with a once daily dose of Xeden. A couple of hours later, he seemed very well but a bit hyperactive and talking a lot. 
There was no particular reaction to the azithromycin dose this morning but, with the two antibiotics this evening, he again seems a bit strange. For example, a couple of times he has gone to the other end of the house and started howling. However, when we call him he comes to us and seems OK, if perhaps a bit more playful than usual. I think I will try giving him the Xeden midday tomorrow in case the combination given together is causing this reaction.
Azithromycin apparently attacks the biofilm that pseudomonas uses to protect itself from other antibiotics. It is used extensively in the US, off label, because it has not been approved for animals there either. Even so, there are many reports to be found on the Internet, claiming that it works very well in combination with other antibiotics.
Does anyone here have any experience in this domain?


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## Ceiling Kitty (Mar 7, 2010)

Only what I said in my last post really.


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## brianmf (Aug 9, 2011)

Thanks. Well, Max was indeed a bit hyper last night, wanting to play with things that he wouldn't normally touch. It is either the Xeden (Baytril/enrofloxacin) or the combination that is affecting him because the morning dose of Zithromax has no noticable effect.
He is still sneezing but it is no longer green stuff so I hope this is just the biofilm breaking up and being expelled. Otherwise, Max is being his personable self.


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## brianmf (Aug 9, 2011)

I gave him the Xeden at 5pm yesterday and he started silly behaviour about an hour later. It's not bad enough to feel that he is suffering ill effects but I would be worried to let him out when he is behaving that way. I suspect that he is having mild hallucinations. For instance, he was sitting on a cushion on my lap and behaving quite normally when suddenly it was as though he saw something moving on the cushion and he started biting it. When I tried to stop him, he persisted. Very strange. As I said earlier, he also vocalises a lot more than usual in this state. It only seems to last for a couple of hours. So far, he is sneezing and coughing much less but it is still too early to be sure that the treatment is working.


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## brianmf (Aug 9, 2011)

The same thing happened tonight but the effect (hallucination?) was much less pronounced. I don't know if that means he is adapting to the Xeden. We'll see how he reacts tomorrow evening.


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## brianmf (Aug 9, 2011)

It certainly seems that way. Tonight, he was just a little tweaked up and playful after the Xeden dose but no signs of hallucination. He still has some congestion but we have our fingers crossed that this will clear soon.
I'm sorry this seems like I'm talking to myself but I think it's important to have a record of the progress with this experimental treatment.


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## brianmf (Aug 9, 2011)

This evening, he was just very vocal, demanding that I sit down for him to sit on my lap. This was just an exaggerated form of his normal assertive behaviour. No sniffling and no coughing at all during today.


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## brianmf (Aug 9, 2011)

Just normal behaviour this evening, well after his Xeden dose, A bit of sniffling but no coughing. Fingers crossed that this is still an indication of the mucous being eliminated.


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## lymorelynn (Oct 4, 2008)

Glad to hear that Max is still making good progress


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## brianmf (Aug 9, 2011)

Again, no coughing today and no sniffling but he has had his last Xeden pill this evening so, fingers crossed. I will consult the vet again tomorrow.


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## Gallifreyangirl (Feb 11, 2015)

Glad to hear Max is slowly getting there.


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## brianmf (Aug 9, 2011)

Mmm. I'm still not sure. He is certainly coughing and sniffling less but there is still some mucous present and he did have a short spasm this morning. Of course, we don't know what happens when we are out or at night.
The vet is very pleased but the following days/weeks will tell if her optimism is justified.


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## brianmf (Aug 9, 2011)

Now we have his brother, Sam, sicking up fur balls and blood. The trouble with Sam is that he's very nervous and, when he starts 'glooping', if you take one step towards him, he runs and we end up with him leaving the mess in some difficult to access location. So, more vet visits ahead.


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## brianmf (Aug 9, 2011)

brianmf said:


> Mmm. I'm still not sure. He is certainly coughing and sniffling less but there is still some mucous present and he did have a short spasm this morning. Of course, we don't know what happens when we are out or at night.
> The vet is very pleased but the following days/weeks will tell if her optimism is justified.


Unfortunately, Max is back to the state he was in before the last treatment. He's coughing and snorting green gunge. This pseudomonas really is persistent and I just don't know what we can do. The crazy thing is that he is so high-spirited. He has a five-minute honking session, when you could think he's about to expire, then he goes on a mad dash around the house seemingly to celebrate his recovery.


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## brianmf (Aug 9, 2011)

Just a brief update to say that I am still giving Max daily vaporisation treatments and he still behaves like a little angel. He obviously gets relief from the vapours (Lycomucil and Atrovent). After a week of treatment, he seems to be cough and sniffle free for 2-3 weeks and then it starts again.
Unfortunately Sam has deteriorated and the vet says he has lymphoma, although all biopsies of the stomach and blood tests were negative but an ultrasound scan showed a stomach wall thickness of 8mm and a 2cm tumour outside the stomach. He only weighs 3kg whereas he was 4.5kg before his illness started in December. He is on methylprednisolone 8mg per day and eating well. He also has half a tablet of Cerenia to limit the vomiting. Max is really bewildered as he can't understand why Sam doesn't play any more.


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## brianmf (Aug 9, 2011)

Sadly, Sam had to be euthanised, Only six weeks later, we fell for a lovely apricot male tabby kitten (3 months old) that our daughter was fostering for a refuge. He was already called Timmy and we decided to keep that name. We had him checked over and vaccinated. The vet advised keeping him away from Max initially but said there is little chance he would catch the pseudomonas infection from Max. Once we did introduce them, they took to each other immediately and are now great buddies. Timmy has a lovely character but, like all kittens, he has his naughty streak. Max is gradually teaching him to be less boisterous.
The vet has said she is sure the pseudomonas is secondary to feline herpes virus (FHV) that she is sure both Max and Sam were born with.
Max continues to have flare-ups of FHV but I discovered Herpelysine 250mg capsules (made in the south of France). They come in pots of 100 capsules and can be purchased from various suppliers on line. The vet only had a paste form of L-Lysine so she was impressed by my find, imported a carton and is now prescribing them for other cats with FHV. L-Lysine is not a cure but it stops the virus cells dividing so reducing the intensity of the flare-ups.


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