Chronic Rhinitis In A Cat

Chronic Rhinitis In A Cat

by Steve
(AZ)

QUESTION:

What drugs are best for helping to combat nasal drip and congestion caused by chronic rhinitis that is caused by a) turbinate destruction b) aural polyp c) early stage nasal carcinoma Nasal swab tests are negative for usual viruses and fungii.

This cat has had sneezing for years. He has in the last year developed an scc mass on his nose. He has an aural polyp. He has lately developed horner's syndrome with blood tinged secretions from one eye and sunken eye.
He also is doing alot of head shaking.

Antibiotics were helping with the nasal congestion which causes inappetance, but his current one is losing it's effectiveness. Cyproheptadine also helps with the congestion.

Can you suggest some possible drug combos that I can suggest to a vet (hard to find a good one here) that might a) dry up the congestion b) reduce any pain c) reduce inflammation of the nare. d) help his appetite
e)slow the progression of the nare mass which now bleeds weekly (he paws at it)

Dear Steve:

I am so sorry for your kitty's situation.

I can tell you what I would do in this case, but of course without actually seeing your kitty, you should discuss everything with your vet who has first-hand knowledge of the actual situation.

Actually, it sounds like the veterinary care is fairly complete. My additional thoughts are:

(1) Chronic rhinitis in cats is almost always due to early infection with a herpes virus. As you know, herpes cannot be cured and outbreaks occur from time to time. The treatment that seems to work best is antibiotics only when it's absolutely necessary because over years of treatment, resistance will develop. L-lysine is also given to cats with chronic rhinitis on a daily basis for the course of their lifetime. I have seen improvement with L-lysine and a decrease in the frequency of which antibiotics are required.

(2) You said in your email that swabs were negative for viruses and fungi. I assume bacterial cultures were also taken and probably were negative also if he was on antibiotics at the time. However, if aerobic and anaerobic bacterial cultures have not been performed, they should be.

(3) Aural polyps can occur secondary to chronic ear infections or chronic ear mites or the polyps can cause secondary infection, etc. Is your kitty strong enough and healthy enough otherwise to undergo surgical removal of the polyp? I only mention this because it sounds like the polyp is causing the most problem at the moment.

(4) I don't know if several different antibiotics have been used or the same one repeatedly. I have the most success with Clavamox, but if that has been used frequently, then trying to identify an appropriate one with a culture would be my first choice. If that is not productive, I like a Clavamox/Baytril combination or CefaTabs (or CefaDrops).

(5) Cyproheptadine is very appropriate for the situation and is the best thing for appetite stimulation.

(6) Steroids (prednisolone) has to be used cautiously, but I would most likely be prescribing that. There is so much inflammation associated with both the polyp and rhinitis. Prednisolone would help that as well as stimulate appetite and also slow the growth possibly of the mass.

However, I would definitely cover the immunosuppressive effects of the prednisolone with antibiotics.

(7) Is the squamous cell carcinoma unable to be excised completely? If there was any chance of that and he is ok for anesthesia, that could be considered and removal of the polyp at the same time.

(8) Humidifiers are also helpful.

Again, I cannot say these are absolutely the things to do for your kitty because I don't have first-hand knowledge of his physical condition. I hope though that I have given you some ideas to discuss with your veterinarian.

Good luck, Steve. My best wishes are with you and your cat. Feel free to write back any time.

Thank you, Dr. Neely

Comments for
Chronic Rhinitis In A Cat

Click here to add your own comments

Aug 04, 2008

Not yet, but I will, thanks
by: Steve

Have not discussed polyp removal. One problem is finding a vet that can even do the traction removal method; has experience in this. Also whether or not they have the equipment and ability to determine if the polyp can be removed by traction method. Bulla method requires a specialist surgeon.

What I do not understand is why the tetracycline initially cleared up all the sneezing and breathing problems for about a month, and whether or not the polyp is the site of some persistent infection.
Seems to indicate there is a bacterial infection there, but the nasal discharge was serous, no purulent. Maybe you can shed some light on this?

The link to the lab explaination of the nasal swab pcr tests states that latent HV-1 virus may not be detected: Cf: http://tinyurl.com/6kldak

This may still well be a virus or fungal infection, what do you think?

Thanks much Dr. Neely!

Hello, again,

Yes, I was going to mention to you next time I wrote that while the tests are worthwhile to some extent, there can be false negatives. I still believe strongly this all started long ago with a herpes virus which is, of course, still present.

I also still believe the polyp is causing a lot of the symptoms. I understand that it may be difficult to impossible to find a specialist within your area to remove the polyp. If there's any chance of it, though, and if they conclude he is well enough for surgery, I would recommend it.

I have seen many cats that are like night and day, before and after polyp removal. Many have suffered for years and were not diagnosed properly.

I have also seen many bacterial infections that did not include a purulent discharge visible to the eye. Infections can be "walled off" in certain areas of the body, sinuses included, and no discharge visible to the naked eye.

Keep me posted. And, remember, all you can do is the best you can do. If certain procedures or treatments are not available to cat owners due to geographic location or finances or other logistical reasons, we should not beat ourselves up. You show tremendous love and caring for your kitty and have way beyond what some people will or can do.

Thank you, Dr. Neely

X Close Editor

Aug 04, 2008
Rating

Submitted by: Steve

Title

Comment
Have not discussed polyp removal. One problem is finding a vet that can even do the traction removal method; has experience in this. Also whether or not they have the equipment and ability to determine if the polyp can be removed by traction method. Bulla method requires a specialist surgeon. What I do not understand is why the tetracycline initially cleared up all the sneezing and breathing problems for about a month, and whether or not the polyp is the site of some persistent infection. Seems to indicate there is a bacterial infection there, but the nasal discharge was serous, no purulent. Maybe you can shed some light on this? The link to the lab explaination of the nasal swab pcr tests states that latent HV-1 virus may not be detected: Cf: http://tinyurl.com/6kldak This may still well be a virus or fungal infection, what do you think? Thanks much Dr. Neely! <strong>Hello, again,</strong> Yes, I was going to mention to you next time I wrote that while the tests are worthwhile to some extent, there can be false negatives. I still believe strongly this all started long ago with a herpes virus which is, of course, still present. I also still believe the polyp is causing a lot of the symptoms. I understand that it may be difficult to impossible to find a specialist within your area to remove the polyp. If there's any chance of it, though, and if they conclude he is well enough for surgery, I would recommend it. I have seen many cats that are like night and day, before and after polyp removal. Many have suffered for years and were not diagnosed properly. I have also seen many bacterial infections that did not include a purulent discharge visible to the eye. Infections can be "walled off" in certain areas of the body, sinuses included, and no discharge visible to the naked eye. Keep me posted. And, remember, all you can do is the best you can do. If certain procedures or treatments are not available to cat owners due to geographic location or finances or other logistical reasons, we should not beat ourselves up. You show tremendous love and caring for your kitty and have way beyond what some people will or can do. Thank you, Dr. Neely

Cancel Delete Delete & Ban

throbber Updating Comments page...

Aug 02, 2008

LAB TEST RESULTS THIS CAT
by: Anonymous

ok the tests done were these:

URD/PCR PANEL LAB REPORT:

NEGATIVE FOR:

chlamydophila felis pcr
feline calcivirus pcr
herpesvirsu 1 pcr
bordetlla pcr
mycopasma felis pcr

all negative.

xray of head reading by radiologist shows
calcification in nasal cavity and bulla
chronic inflammation and possible fungal/lymphoma

other vet thought the polyp was probably causing the sneezing and that he was probably deaf in that ear also as a result.

whatever this cat has that is causing his sneezing congestion and occasional reverse coughing has not been alleviated with extended course of tetracycline and normal course of the other antibiotics mentioned in previous comment.

he has head shaking and pawing at ear, but no obvious discharge from ears.

thanks for your help.

Thank you for the additional information. It just further supports my thought that the polyp is causing more problems than anything else right now. Have you discussed with your vet whether your kitty is stable enough for polyp removal and whether he does that surgery?

Aug 02, 2008

Thank you for the additional information.
by: Dr. Neely

Thank you for updating me. I believe Clavamox could be very helpful since it hasn't been used. No, his rhinitis cannot be cured, but can be controlled with intermittent antibiotics and usually lysine. He, of course, has complicating factors. I still believe much of his current discomfort is from the polyp and removing it could be very helpful. As far as having both surgeries at the same time, I can't really say because I don't know how extensive either surgery will be and how his overall health is otherwise and what kind of anesthesia and monitors the surgeon uses. There are many factors to take into consideration before surgery, not only patient factors, but the absence or presence of advancing monitoring systems and the type of anesthetic used and of course, the competency of the surgeon.

Pred has definitely been useful to decreasing inflammation and pain associated with both squamous cell and polyps. The Horner's Syndrome is almost positively associated with the polyp and is not dangerous in and of itself but is a symptom.

Keep me posted, please. Thank you, Dr. Neely

Thank you for updating me. I believe Clavamox could be very helpful since it hasn't been used. No, his rhinitis cannot be cured, but can be controlled with intermittent antibiotics and usually lysine. He, of course, has complicating factors. I still believe much of his current discomfort is from the polyp and removing it could be very helpful. As far as having both surgeries at the same time, I can't really say because I don't know how extensive either surgery will be and how his overall health is otherwise and what kind of anesthesia and monitors the surgeon uses. There are many factors to take into consideration before surgery, not only patient factors, but the absence or presence of advancing monitoring systems and the type of anesthetic used and of course, the competency of the surgeon.

Pred has definitely been useful to decreasing inflammation and pain associated with both squamous cell and polyps. The Horner's Syndrome is almost positively associated with the polyp and is not dangerous in and of itself but is a symptom.

Keep me posted, please. Thank you, Dr. Neely

X Close Editor

Aug 02, 2008
Rating

Submitted by: Dr. Neely

Title

Comment
Thank you for updating me. I believe Clavamox could be very helpful since it hasn't been used. No, his rhinitis cannot be cured, but can be controlled with intermittent antibiotics and usually lysine. He, of course, has complicating factors. I still believe much of his current discomfort is from the polyp and removing it could be very helpful. As far as having both surgeries at the same time, I can't really say because I don't know how extensive either surgery will be and how his overall health is otherwise and what kind of anesthesia and monitors the surgeon uses. There are many factors to take into consideration before surgery, not only patient factors, but the absence or presence of advancing monitoring systems and the type of anesthetic used and of course, the competency of the surgeon. Pred has definitely been useful to decreasing inflammation and pain associated with both squamous cell and polyps. The Horner's Syndrome is almost positively associated with the polyp and is not dangerous in and of itself but is a symptom. Keep me posted, please. Thank you, Dr. Neely Thank you for updating me. I believe Clavamox could be very helpful since it hasn't been used. No, his rhinitis cannot be cured, but can be controlled with intermittent antibiotics and usually lysine. He, of course, has complicating factors. I still believe much of his current discomfort is from the polyp and removing it could be very helpful. As far as having both surgeries at the same time, I can't really say because I don't know how extensive either surgery will be and how his overall health is otherwise and what kind of anesthesia and monitors the surgeon uses. There are many factors to take into consideration before surgery, not only patient factors, but the absence or presence of advancing monitoring systems and the type of anesthetic used and of course, the competency of the surgeon. Pred has definitely been useful to decreasing inflammation and pain associated with both squamous cell and polyps. The Horner's Syndrome is almost positively associated with the polyp and is not dangerous in and of itself but is a symptom. Keep me posted, please. Thank you, Dr. Neely

Cancel Delete Delete & Ban

throbber Updating Comments page...

Jul 31, 2008

Thanx4 your good reply; followup answers; questions
by: Steve

Dr. Neely,

Thanks much for your complete and to-the-point answer to my post.

I am not a vet, so all I know is that nasal swab tests were done during a dental cleaning in which nearly all of his teeth were removed as he had inflammed gums and loose teeth.

Interesting your comment that chronic rhinitis is almost always due to herpes viral infection. I had tried lysine earlier, but it was difficult to determine if it had an effect. The other possibility I had been considering is plasmacytic rhinitis. If there was an effect using the lysine I did not notice it.

I will take a look at the lab test results again and see if I can determine if the bacterial tests you mentioned were done and report back.

I was given an estimate by the last vet for nasal surgery, but that was two months ago and not sure if the tumor is still operable or not. The vet could not tell me with any assurance if surgery would cure the scc and what was causing his sneezing and inappetance. xrays 2 months ago did not show any obvious tumors; but nasal cancer could have developed in the meantime. There is no
disfigurement of the head, but the blood tinged eye discharge and sunken eye/horner's syndrome that developed in the last month is worrisome.

He has been on tetracycline, keflex, clindamycine(antirobe) (sp?), doxycycline. The tetracyclines worked very well initially and were used for an extended period, but are now losing effectiveness. Also the antirobe worked well, but he hates the taste and very difficult to administer. He had serious side effects from the keflex, so had to discontinue that. Clavmox would be my choice as well (interestingly, it's human equivalent augmentin is the drug of choice in chronic sinusitis).

Don't know if he's strong enough to do both the polyp removal and scc removal at the same time.
If the polyp can be traction removed, maybe that is a possibility. Are such dual procedures generally advisable and done?

I read that once there has been turbinate destruction and other nasal changes that nothing except nasal surgery will restore normal function necessary to stop the chronic rhinitis and secondary infections?

I have had some success giving him steam baths in the shower. I tried some common cat antihitamines, but they reduced his appetite and did not seem to clear his noisey breathing.

The previous vet refused to give him prednisone at my suggestion, which I think is also indicated as you suggested. I really don't know what effect predisone or similar will have on SCC, do you?
It is indicated for lymphoma, but have seen nothing on it's use in SCC nare tumors.

X Close Editor

Jul 31, 2008
Rating

Submitted by: Steve

Title

Comment
Dr. Neely, Thanks much for your complete and to-the-point answer to my post. I am not a vet, so all I know is that nasal swab tests were done during a dental cleaning in which nearly all of his teeth were removed as he had inflammed gums and loose teeth. Interesting your comment that chronic rhinitis is almost always due to herpes viral infection. I had tried lysine earlier, but it was difficult to determine if it had an effect. The other possibility I had been considering is plasmacytic rhinitis. If there was an effect using the lysine I did not notice it. I will take a look at the lab test results again and see if I can determine if the bacterial tests you mentioned were done and report back. I was given an estimate by the last vet for nasal surgery, but that was two months ago and not sure if the tumor is still operable or not. The vet could not tell me with any assurance if surgery would cure the scc and what was causing his sneezing and inappetance. xrays 2 months ago did not show any obvious tumors; but nasal cancer could have developed in the meantime. There is no disfigurement of the head, but the blood tinged eye discharge and sunken eye/horner's syndrome that developed in the last month is worrisome. He has been on tetracycline, keflex, clindamycine(antirobe) (sp?), doxycycline. The tetracyclines worked very well initially and were used for an extended period, but are now losing effectiveness. Also the antirobe worked well, but he hates the taste and very difficult to administer. He had serious side effects from the keflex, so had to discontinue that. Clavmox would be my choice as well (interestingly, it's human equivalent augmentin is the drug of choice in chronic sinusitis). Don't know if he's strong enough to do both the polyp removal and scc removal at the same time. If the polyp can be traction removed, maybe that is a possibility. Are such dual procedures generally advisable and done? I read that once there has been turbinate destruction and other nasal changes that nothing except nasal surgery will restore normal function necessary to stop the chronic rhinitis and secondary infections? I have had some success giving him steam baths in the shower. I tried some common cat antihitamines, but they reduced his appetite and did not seem to clear his noisey breathing. The previous vet refused to give him prednisone at my suggestion, which I think is also indicated as you suggested. I really don't know what effect predisone or similar will have on SCC, do you? It is indicated for lymphoma, but have seen nothing on it's use in SCC nare tumors.

Cancel Delete Delete & Ban

throbber Updating Comments page...

Click here to add your own comments

Chronic Rhinitis In A Cat

Comments for Chronic Rhinitis In A Cat

Comments for
Chronic Rhinitis In A Cat