I am looking for help to prepare me for a 3rd opinion on the well being of my kitten. I am scheduled to see another specialist on 4/4/11 and want to be informed and ready for this visit.
I have a sick kitten who was born 9/3/10. He joined our family on 12/16/10. His 1st vet visit was 12/23/10 for an initial check up. He came with 2 sets of vaccines and Rabies vaccine which I have records for. Also, his litter mate brother joined us on 12/1/10. On 12/23 his weight was 3.1 lbs. His brother was 4.5 lbs.
Since I can remember he had a "strange" cough, unlike anything I have heard. It was reported and because he had no other symptoms of illness we were going to watch and follow up because the vet didnt like the idea of a kitten with a cough. He had a 3rd vaccine booster (as required by my vet at 18 or 20 wks) and the cough was worse, but still no illness present. She recommended we do a round of Clavamox to see if this clears his coughing. Within 24 hours of antibiotic he had a double ear infection (stinky drainage), two runny eyes and a really snotty nose with constant sneezing...but NO coughing. By day 4 everything was cleared and I assumed the problem was cured. By day 10 the coughing and sneezing started back up. He was placed on ezithromyacin (sp?) for 5 days and continued to decline. After 5 days he received a full work up, with x-rays (fluid filled mostly grayed out lung fields), given a lungworm injection was placed back on Clavamox for 15 days. Immediate improvement, yet began getting sick again on meds.
He has had two sets of chest x-rays, 2 sets of blood panels, two stool samples, treatment for lung worm, all major virals run---neg. results, toxin panel - neg, Trans-tracheal wash with no diagnosis of pathogens., throat culture too. Ultrasound and echocardiogram. Heart sounds and testing are all normal. Basically I have a kitten with Bronchial pneumonia and URI in a chronic state, but thriving and continues to eat. No fever over 103 deg. He has been on Clavamox, Ezthro?, Baytril, Lasix, Prenisolone and now antii-viral for FHV-1 with Doxycycline. His last weight check was at 6.4 lbs.
His brother has not contracted any illness, but has had minor red/opaque goop from his eyes. Nothing else is wrong with him and he is 8+ lbs to date.
I have discontinued Doxycycline due to severe withdrawl and tummy issues over the last few days and today he has turned around again, but the viral issues are still present.
Besides snorting, sneezing, discharge, he has liquid sounds in his throat. He coughs and gray mucus discharges from his mouth. As of today, his lungs sound clear (compared to before) but cough is constant, snorting, swallowing, gulping, sleeping with is mouth open and tongue out.
Despite all the suffering he has had, he always curls up with someone, purrs, eats and uses his facilities properly. Even his worst days, he just wants comforting from his brother or human family, which is unlike a sick kitty but has been critical many times over the past several weeks.
Do you have any ideas for what questions I need to discuss with the specialist next week. Any support to get this guy to a health state would be appreciated.
Regards, Lisa
Kitten with chronic illness
Re: Kitten with chronic illness
This won't necessarily be specific to questions to ask the specialist but more in the area of rule-outs to discuss with the new specialist once he/she has already reviewed your kitten's past and present health records. I'm assuming the current vet is faxing these records (plus xray copies, ultrasound reports and ECG results) already, to the specialist before or by the time of your new appointment?
There are so many things this could be, and it could be that your kitten has multiple conditions going on at once, rather than one primary condition. He may have been susceptible (lowered immune response) at some point and could have developed secondary infections.
For example:
* Herpesvirus complicated by potential chlamydia or other bacterial or fungal infection.
* Viral infection combined with fungal infection
* Bacterial infection combined with fungal infection
Singular problems could be:
* Heartworm
* Bacterial infection in the lungs
* Fungal infection in the lungs
* A sinus problem resulting in bacterial infection in the lungs
* Oral health, such as teeth growing or overcrowding incorrectly, potentially leading to sinus issues
* Esophageal strictures or obstruction
* Inflammation, stricture or obstructions to the airways, causing secondary bacterial infection
* Feline asthma
* Food allergies (relating to ear problems and even sometimes, coughing although rare for coughing)
* Cryptococcosis (especially if exposed to outdoors, contaminated soil, bird droppings)
* Any combination of the above
Possible environmental problems that could be triggering or exacerbating the problem:
* Dust, dustmites
* Food mites
* Household cleaners, carpet powders, perfumes, aerosols, molds, contaminated soil in potted plants etc.
* Smoking
Minimal workup might include a swab sample for testing for herpesvirus or chlamydia.
New cultures that are very specific for a number of bacterial and fungal agents - please remember that some diagnostic labs only test for what the vet enters into the paperwork - may need to extend the parameters for looking for more than one or two bacteria or fungals. It is not uncommon to find both bacteria and fungal in certain infections. This is why you want culture and sensitivity tests when possible and widen the possibilities in testing. The cost is worth it if an agent is found that was not otherwise suspected.
Urinalysis to detect specific bacterial or fungal infection.
New xray to determine any changes from the last xray and to gauge effectiveness or ineffectiveness of past or current treatment.
More specific testing might include a new tracheal wash and sample for testing, a scope view of the esophageal structure to rule out strictures, obstructions, inflammation, or to rule out sinus problems.
Rule out environmental triggers by process of elimination (novel protein food to rule out food allergies, limit environmental triggers such as those noted above)
It sounds like herpesvirus may already be present, but you must also rule out secondary bacterial infections or fungal infections that must include culture and sensitivity testing. If these are found, then the correct treatment approach using different class drugs usually are effective. Treating with drugs on presumptions without specific testing will almost always worsen the situation because the true cause is not specifically diagnosed in which to treat effectively, and bacteria is always constantly colonizing and spreading. Broad-spectrum antibiotics are generally not the best considerations in these cases unless the bacteria is sensitive to it, otherwise, antifungal drugs target fungal disease, either with or without additional antibiotics.
Do you know if your kitten received vaccinations by parenteral route (injection) or via intra-nasally? The latter is not uncommon to be problematic in some kittens and may cause URI effects, although these effects are usually temporary.
In the immediate sense, make sure he's eating a high quality food to maintain his caloric intake and ensure he is getting plenty of water intake when he's drinking. If possible, let him drink from the tap, or place a couple more full dishes of water throughout the house. Ask the vet for opthalmic ointment to help keep the conjunctiva in his eyes clear and soothed. Wipe any discharge from eyes, nose, mouth, immediately with a very soft, slightly damp cloth. If herpesvirus is confirmed, supplement his diet with L-lysine, you can get this in capsule form from your vet and sprinkle the contents in his food, or your vet may have a paste form for easy administration, it's already metered doses for you.
If the vet feels nasal congestion is too uncomfortable for your kitten, you can try nebulizing, ask your vet for instructions. In worse-case scenario with congestion, he may prescribe pediatric nasal drops to help keep the nasal cavities clear and soothed - DO NOT go out and buy nasal drops or saline drops without first consulting your vet for the correct type - some of these drops are medicated, or inappropriate for cats and kittens.
Ultimately, the specialist should get ALL of kitten's prior and current medical records, xrays. ultrasound results and ECG results and review them so he's prepared in advance for your appointment/discussion. If the specialist is board-certified in either internal med or another similar speciality, he will most likely know how to proceed and will try to keep your costs lowered because he'll already have the records and all the previous lab results at his disposal. Do however, be prepared for another tracheal wash, swab samples or possibly even a scope view (which would require anesthesia), so recent bloodwork and his current vitals upon his new exam must be taken prior to any anesthetic procedure. The specialist may not even want to go that far at this point, he may simply start at getting the cultures done.
Hope this helps?
Your kitten is in my prayers, I so hope the specialist can get this narrowed down for you, diagnosed properly and the correct medical intervention initiated! Please keep us updated, ok?
There are so many things this could be, and it could be that your kitten has multiple conditions going on at once, rather than one primary condition. He may have been susceptible (lowered immune response) at some point and could have developed secondary infections.
For example:
* Herpesvirus complicated by potential chlamydia or other bacterial or fungal infection.
* Viral infection combined with fungal infection
* Bacterial infection combined with fungal infection
Singular problems could be:
* Heartworm
* Bacterial infection in the lungs
* Fungal infection in the lungs
* A sinus problem resulting in bacterial infection in the lungs
* Oral health, such as teeth growing or overcrowding incorrectly, potentially leading to sinus issues
* Esophageal strictures or obstruction
* Inflammation, stricture or obstructions to the airways, causing secondary bacterial infection
* Feline asthma
* Food allergies (relating to ear problems and even sometimes, coughing although rare for coughing)
* Cryptococcosis (especially if exposed to outdoors, contaminated soil, bird droppings)
* Any combination of the above
Possible environmental problems that could be triggering or exacerbating the problem:
* Dust, dustmites
* Food mites
* Household cleaners, carpet powders, perfumes, aerosols, molds, contaminated soil in potted plants etc.
* Smoking
Minimal workup might include a swab sample for testing for herpesvirus or chlamydia.
New cultures that are very specific for a number of bacterial and fungal agents - please remember that some diagnostic labs only test for what the vet enters into the paperwork - may need to extend the parameters for looking for more than one or two bacteria or fungals. It is not uncommon to find both bacteria and fungal in certain infections. This is why you want culture and sensitivity tests when possible and widen the possibilities in testing. The cost is worth it if an agent is found that was not otherwise suspected.
Urinalysis to detect specific bacterial or fungal infection.
New xray to determine any changes from the last xray and to gauge effectiveness or ineffectiveness of past or current treatment.
More specific testing might include a new tracheal wash and sample for testing, a scope view of the esophageal structure to rule out strictures, obstructions, inflammation, or to rule out sinus problems.
Rule out environmental triggers by process of elimination (novel protein food to rule out food allergies, limit environmental triggers such as those noted above)
It sounds like herpesvirus may already be present, but you must also rule out secondary bacterial infections or fungal infections that must include culture and sensitivity testing. If these are found, then the correct treatment approach using different class drugs usually are effective. Treating with drugs on presumptions without specific testing will almost always worsen the situation because the true cause is not specifically diagnosed in which to treat effectively, and bacteria is always constantly colonizing and spreading. Broad-spectrum antibiotics are generally not the best considerations in these cases unless the bacteria is sensitive to it, otherwise, antifungal drugs target fungal disease, either with or without additional antibiotics.
Do you know if your kitten received vaccinations by parenteral route (injection) or via intra-nasally? The latter is not uncommon to be problematic in some kittens and may cause URI effects, although these effects are usually temporary.
In the immediate sense, make sure he's eating a high quality food to maintain his caloric intake and ensure he is getting plenty of water intake when he's drinking. If possible, let him drink from the tap, or place a couple more full dishes of water throughout the house. Ask the vet for opthalmic ointment to help keep the conjunctiva in his eyes clear and soothed. Wipe any discharge from eyes, nose, mouth, immediately with a very soft, slightly damp cloth. If herpesvirus is confirmed, supplement his diet with L-lysine, you can get this in capsule form from your vet and sprinkle the contents in his food, or your vet may have a paste form for easy administration, it's already metered doses for you.
If the vet feels nasal congestion is too uncomfortable for your kitten, you can try nebulizing, ask your vet for instructions. In worse-case scenario with congestion, he may prescribe pediatric nasal drops to help keep the nasal cavities clear and soothed - DO NOT go out and buy nasal drops or saline drops without first consulting your vet for the correct type - some of these drops are medicated, or inappropriate for cats and kittens.
Ultimately, the specialist should get ALL of kitten's prior and current medical records, xrays. ultrasound results and ECG results and review them so he's prepared in advance for your appointment/discussion. If the specialist is board-certified in either internal med or another similar speciality, he will most likely know how to proceed and will try to keep your costs lowered because he'll already have the records and all the previous lab results at his disposal. Do however, be prepared for another tracheal wash, swab samples or possibly even a scope view (which would require anesthesia), so recent bloodwork and his current vitals upon his new exam must be taken prior to any anesthetic procedure. The specialist may not even want to go that far at this point, he may simply start at getting the cultures done.
Hope this helps?
Your kitten is in my prayers, I so hope the specialist can get this narrowed down for you, diagnosed properly and the correct medical intervention initiated! Please keep us updated, ok?
..........Traci
Re: Kitten with chronic illness
Posting a reply as best to my knowledge...
Trans-tracheal wash and culture negative for bacterial, fungal but showed signs if a deep lung infection of unkn origin. Bordatella neg.
Throat culture, negative to pathogen?
Viral testing for FIP, FeLV, FIV, ELISA test run and everything is negative to a serious viral nature.
Oral health is excellent, no signs of mouth ulcers, all teeth have/are moving in/out as they should.
We have an allergic child in household and use environmentally friendly product, no dust mites, no smoking, no candles, etc....however have been using 1:32 bleach, bleaching beds/clothes/blankets, sneezing areas etc and watered down borax spray to carpet for extra assurance to eradicate what we are dealing with since inception of this illness...
for Food...Not sure but coughing existed prior to. Was on Wellness canned food prior to recall. Currently on Weruva canned for treats, Blue Buffalo Chick/turkey and Natural Balance Chicken w/peas LID. Small portions of dry Natural Balance premium available but he wont eat it. All canned foods with added water, and feed free 3-5 times a day to keep hydrated.
No urinalysis to date.
Vaccines have been injectable, FELOCEL Pfizer RCP prior to my taking him. Honestly not sure what third booster was.
2nd Blood panel as my notes show, RB/WB normal, organs good, electrolytes good, kidney high normal, Phosphorus off/up, Amelyse up. I do not have numbers to share.
We keep him well cared for, he has no scabbing, crusting, or external sores. Receives daily steams in shower, eats and keeps hydrated. I have saline drops for nose...tough to administer, not often given.
Currently on 250 mg l-lysine daily and Famciclovir 62.5 mg. I discontinued Doxy due to extreme withdrawal. Vet has Clavamox avail should we see secondary brewing in the meantime.
All records are to be delivered to specialist asap. Waiting to hear if I need to drive them or can be faxed. His file is already pretty large. My vet agrees a new outside opinion is warranted. He has received wonderful care to date which I attribute to his thriving, however we have not found right course to treat. Biggest fear is huge set back or permanent damage to lungs/nose, throat.
On side note...he was with a younger litter prior to me taking him. Three kittens vaccinated on same day, all three immediately sick. Mine also received rabies that day (12/7). Given Clavamox and returned to normal. All three of these kittens (two still with owner) continue with similar symptoms. No other are affected, nor has it spread to others in households.
Thanks for your input, I am most appreciative. Looking to find resolution for this little guy.
Trans-tracheal wash and culture negative for bacterial, fungal but showed signs if a deep lung infection of unkn origin. Bordatella neg.
Throat culture, negative to pathogen?
Viral testing for FIP, FeLV, FIV, ELISA test run and everything is negative to a serious viral nature.
Oral health is excellent, no signs of mouth ulcers, all teeth have/are moving in/out as they should.
We have an allergic child in household and use environmentally friendly product, no dust mites, no smoking, no candles, etc....however have been using 1:32 bleach, bleaching beds/clothes/blankets, sneezing areas etc and watered down borax spray to carpet for extra assurance to eradicate what we are dealing with since inception of this illness...
for Food...Not sure but coughing existed prior to. Was on Wellness canned food prior to recall. Currently on Weruva canned for treats, Blue Buffalo Chick/turkey and Natural Balance Chicken w/peas LID. Small portions of dry Natural Balance premium available but he wont eat it. All canned foods with added water, and feed free 3-5 times a day to keep hydrated.
No urinalysis to date.
Vaccines have been injectable, FELOCEL Pfizer RCP prior to my taking him. Honestly not sure what third booster was.
2nd Blood panel as my notes show, RB/WB normal, organs good, electrolytes good, kidney high normal, Phosphorus off/up, Amelyse up. I do not have numbers to share.
We keep him well cared for, he has no scabbing, crusting, or external sores. Receives daily steams in shower, eats and keeps hydrated. I have saline drops for nose...tough to administer, not often given.
Currently on 250 mg l-lysine daily and Famciclovir 62.5 mg. I discontinued Doxy due to extreme withdrawal. Vet has Clavamox avail should we see secondary brewing in the meantime.
All records are to be delivered to specialist asap. Waiting to hear if I need to drive them or can be faxed. His file is already pretty large. My vet agrees a new outside opinion is warranted. He has received wonderful care to date which I attribute to his thriving, however we have not found right course to treat. Biggest fear is huge set back or permanent damage to lungs/nose, throat.
On side note...he was with a younger litter prior to me taking him. Three kittens vaccinated on same day, all three immediately sick. Mine also received rabies that day (12/7). Given Clavamox and returned to normal. All three of these kittens (two still with owner) continue with similar symptoms. No other are affected, nor has it spread to others in households.
Thanks for your input, I am most appreciative. Looking to find resolution for this little guy.
Re: Kitten with chronic illness
It's unlikely that vaccinations had anything to do with this, unless they were expired, handled improperly, mixed improperly, or something was transmitted between the kittens because someone wasn't diligent enough in hygiene use between kittens. Or, that the brand of vaccines was an off-brand and not effective.
In a shelter environment, incubation period could have something to do with, since it usually takes 7 or so days for development of clinical signs of a virus - so, if the kittens and your kitten had been there at the same time, they could have come down with something at the same time, this is common among shelter kittens. Vaccination at that time, therefore, probably didn't hurt, but also didn't make it better in terms of immunity.
It's truly hard to say or define based on what's been done already. Again, I would just like to reiterate that new cultures and sensitivity tests should be considered because the first tests may not have been specific enough (or the vet might have been looking for something specific when it could have been something else entirely).
Chlamydia and calicivirus are common rule-outs, and unless a specific ELISA or PCR was done, these haven't truly been ruled out.
As for the oral health, can't always see this just upon exam. Xrays are necessary to see roots, destruction, bone formation, sinus problems (the latter accompanied by a scope view if warranted). I'm not saying sinus or teeth problems are present, just saying they should be ruled out in view of the respiratory issues, drainage, etc.
I won't comment on the food choices, so I'll just say please be sure to mention what you've been feeding your kittens from the time of adoption to recently. Most likely not related to food, unless he has a food allergy combined with other issues.
I would cease the borax, it's not only necessary, but potentially toxic to you, your child, and the cats to some degree. Maybe not immediately noticeable, but borax can affect eye, nose, skin, respiratory tract and since the pets are at ground level, they are constantly exposed.
Nothing wrong with the 1:32 bleach mixure, just be sure all surfaces are rinsed thoroughly because if used excessively or not diluted enough, this is as bad as ammonia to pets, causing irritation, mucous membrane irritation, etc. As long as it is very dilute, rinsed after use, no lingering smell or "fume", it's probably ok for basic cleaning, just be careful.
Just want to reduce or eliminate potential irritants as your kitten is so susceptible to air-born particles, smells and scents, aerosols, etc. Keep everything to a bare minimum when possible.
I'm not sure if it is necessary to "nebulize" with the shower every day - sometimes just a few times a week is all that is necessary. If fungal or bacterial in nature, this might actually worsen the problem, but if kitten seems to like it and feels better, then don't stop, or at least, consult with vet to make sure it's ok on a regular basis.
Beyond all the rule-outs I've already mentioned, I would rule out obstructions or foreign body, anywhere from the sinus cavities to the esophagus or surrounding tissues - not likely in the lungs but could be exacerbated by bronchial or lung infection of either bacterial or fungal in nature.
Ask the specialist if he's seen or heard of any new strains of the common URI's going on or seemingly failure in common treatment in these cases. There is always the potential of new strains and not easily identified unless you're specifically looking for something unusual, or if that unusual something appears on a test result. Beyond that, it just seems to appear, in my opinion, there is a potential bacterial/fungal issue somewhere whether upper or lower (or both) respiratory tract and possibly combined with a stricture, obstruction or inflammation. That's only my opinion, hopefully the specialist has a great deal of experience to start at the most obvious based on your kitten's symptoms and health history.
I'm assuming your vet has determined that your kitten's lung and heart development are optimal? (I don't mean just by listening to heart and lung sounds, but also based on xrays, viewing size and shape, nothing abnormal on those views).
Hang in there, and if for some reason your new specialist is also stumped, please ask him/her to possibly consult a specialist in virology at a nearby vet university (or again, in internal medicine) on your behalf. I hope it doesn't have to come to that.
In a shelter environment, incubation period could have something to do with, since it usually takes 7 or so days for development of clinical signs of a virus - so, if the kittens and your kitten had been there at the same time, they could have come down with something at the same time, this is common among shelter kittens. Vaccination at that time, therefore, probably didn't hurt, but also didn't make it better in terms of immunity.
It's truly hard to say or define based on what's been done already. Again, I would just like to reiterate that new cultures and sensitivity tests should be considered because the first tests may not have been specific enough (or the vet might have been looking for something specific when it could have been something else entirely).
Chlamydia and calicivirus are common rule-outs, and unless a specific ELISA or PCR was done, these haven't truly been ruled out.
As for the oral health, can't always see this just upon exam. Xrays are necessary to see roots, destruction, bone formation, sinus problems (the latter accompanied by a scope view if warranted). I'm not saying sinus or teeth problems are present, just saying they should be ruled out in view of the respiratory issues, drainage, etc.
I won't comment on the food choices, so I'll just say please be sure to mention what you've been feeding your kittens from the time of adoption to recently. Most likely not related to food, unless he has a food allergy combined with other issues.
I would cease the borax, it's not only necessary, but potentially toxic to you, your child, and the cats to some degree. Maybe not immediately noticeable, but borax can affect eye, nose, skin, respiratory tract and since the pets are at ground level, they are constantly exposed.
Nothing wrong with the 1:32 bleach mixure, just be sure all surfaces are rinsed thoroughly because if used excessively or not diluted enough, this is as bad as ammonia to pets, causing irritation, mucous membrane irritation, etc. As long as it is very dilute, rinsed after use, no lingering smell or "fume", it's probably ok for basic cleaning, just be careful.
Just want to reduce or eliminate potential irritants as your kitten is so susceptible to air-born particles, smells and scents, aerosols, etc. Keep everything to a bare minimum when possible.
I'm not sure if it is necessary to "nebulize" with the shower every day - sometimes just a few times a week is all that is necessary. If fungal or bacterial in nature, this might actually worsen the problem, but if kitten seems to like it and feels better, then don't stop, or at least, consult with vet to make sure it's ok on a regular basis.
Beyond all the rule-outs I've already mentioned, I would rule out obstructions or foreign body, anywhere from the sinus cavities to the esophagus or surrounding tissues - not likely in the lungs but could be exacerbated by bronchial or lung infection of either bacterial or fungal in nature.
Ask the specialist if he's seen or heard of any new strains of the common URI's going on or seemingly failure in common treatment in these cases. There is always the potential of new strains and not easily identified unless you're specifically looking for something unusual, or if that unusual something appears on a test result. Beyond that, it just seems to appear, in my opinion, there is a potential bacterial/fungal issue somewhere whether upper or lower (or both) respiratory tract and possibly combined with a stricture, obstruction or inflammation. That's only my opinion, hopefully the specialist has a great deal of experience to start at the most obvious based on your kitten's symptoms and health history.
I'm assuming your vet has determined that your kitten's lung and heart development are optimal? (I don't mean just by listening to heart and lung sounds, but also based on xrays, viewing size and shape, nothing abnormal on those views).
Hang in there, and if for some reason your new specialist is also stumped, please ask him/her to possibly consult a specialist in virology at a nearby vet university (or again, in internal medicine) on your behalf. I hope it doesn't have to come to that.
..........Traci
Re: Kitten with chronic illness
Thank you so much! This is a great help to understanding what to expect at the new office. I will be sure to let you all know if/what we find out.
I am pleased to report his spirits and energy remain up this morning so we are at least maintaining at this point.
As for the vaccine info...just knowledge of the only connection between the sick kittens. Also, they came from a home and not shelter. Strange to me that no other animals are being affected and No high fever throughout this ordeal. And finally on my thoughts...Since I've owned him, he was not "sick" until the Clavamox was started (appx. 4 wks after I took him). It seems to me everything escalated since that time.
I will suggest a PCR and new throat culture. There is alot of congestion settling in the throat itself. Nasal swabs were not done, as my vet felt too much room for a cross contamination and misdiagnosis.
Interesting info on oral issues...never knew. Also, Borax is not a regular here, one time deal incase mites were an issue. I do use annually to help reduce allergens and possible flea issues in home since carpets are difficult to control. Other animals here too (Both Healthy).
I truly appreciate your thoughts and recommendations! I have owned, rescued and rehab'd animals in the past. Dealt with many issues, but nothing like this and I am very overwhelmed on how to get this issue under control so he (and we) can begin to enjoy our time together!!
I am pleased to report his spirits and energy remain up this morning so we are at least maintaining at this point.
As for the vaccine info...just knowledge of the only connection between the sick kittens. Also, they came from a home and not shelter. Strange to me that no other animals are being affected and No high fever throughout this ordeal. And finally on my thoughts...Since I've owned him, he was not "sick" until the Clavamox was started (appx. 4 wks after I took him). It seems to me everything escalated since that time.
I will suggest a PCR and new throat culture. There is alot of congestion settling in the throat itself. Nasal swabs were not done, as my vet felt too much room for a cross contamination and misdiagnosis.
Interesting info on oral issues...never knew. Also, Borax is not a regular here, one time deal incase mites were an issue. I do use annually to help reduce allergens and possible flea issues in home since carpets are difficult to control. Other animals here too (Both Healthy).
I truly appreciate your thoughts and recommendations! I have owned, rescued and rehab'd animals in the past. Dealt with many issues, but nothing like this and I am very overwhelmed on how to get this issue under control so he (and we) can begin to enjoy our time together!!
Re: Kitten with chronic illness
While possible, it is relatively rare for cats to have reactions to clavamox. Some cats (again rare), are allergic to penicillin-like drugs and may have serious reactions, but, the symptoms you posted are unlikely to have been caused by the clavamox. Particularly the ear infections. I suspect this was going on and your vet missed it or simply overlooked it.
The most common side effect of clavamox is diarrhea and lowered appetite.
I would think if the ear infections occured near or at the same time as all the other problems, the vet would also have taken exudate from the ears and cultured them to rule out yeast etc vs bacterial infection.
I suspect that there is a multibacterial or fungal problem going on, and the clavamox temporarily addressed a certain bacteria, but because they colonize and because other types of bacteria or fungals could have been present, your kitten didn't respond. This is usually because the antibiotic is not specific to the bacteria, and certainly not specific to fungal. When there is no response or resolution, then you know the antibiotic chosen was not the correct one.
This is similar to chronic cases of herpesvirus, where there is usually a period when symptoms resolve, but in times of stress or immune compromise, it will flare up again. Because this also predisposes to secondary bacterial infections, this is why many vets will prescribe antibiotics, to either prevent them or resolve them, but it doesn't always address the primary herpesvirus.
The most common side effect of clavamox is diarrhea and lowered appetite.
I would think if the ear infections occured near or at the same time as all the other problems, the vet would also have taken exudate from the ears and cultured them to rule out yeast etc vs bacterial infection.
I suspect that there is a multibacterial or fungal problem going on, and the clavamox temporarily addressed a certain bacteria, but because they colonize and because other types of bacteria or fungals could have been present, your kitten didn't respond. This is usually because the antibiotic is not specific to the bacteria, and certainly not specific to fungal. When there is no response or resolution, then you know the antibiotic chosen was not the correct one.
This is similar to chronic cases of herpesvirus, where there is usually a period when symptoms resolve, but in times of stress or immune compromise, it will flare up again. Because this also predisposes to secondary bacterial infections, this is why many vets will prescribe antibiotics, to either prevent them or resolve them, but it doesn't always address the primary herpesvirus.
..........Traci
Re: Kitten with chronic illness
I picked up his records today and have some values. Just for information purposes since I have been posting according to my notes:
Mar 10: Ultrasound/radiograph: mild diffuse bronchial pattern, mild calcification of bronchial lobes,
echo: normal across all valves
Feb 24: Trach wash: Two slides exhibit low numbers of cells and much degenerated material. Many cells have ruptured. Identifiable cells are predom. well differentiated epithelial cells. There are small numbers of neutrophil and macrophages. comment: difficult to determine what types of cells present because they appear ruptured. there are neutrophils and marcophages which can be identified. this suggests inflammation. Organisms are not identified.
FIP 7B elisa <1:40
Basophils 0 Lymphocytes 7296
Eosinophils 456 Bands 0
Monocytes 456 Neutrophils 6992
Blood panel ANTECH Diag. 3/8/11:
Super chems run, off are Phosphorus 9.4 (H), Amylase 1942 (H)
CBC wbc 15.2, rbc 8.47
off: Platelet 194 (L)
2/3: 1st blood panels:
RBC 7.32, WBC 15.89
Off: Mono 1.95 K/uL (H)
Baso .12 " (H)
PLT >119 " (L) 175-600
Mar 10: Ultrasound/radiograph: mild diffuse bronchial pattern, mild calcification of bronchial lobes,
echo: normal across all valves
Feb 24: Trach wash: Two slides exhibit low numbers of cells and much degenerated material. Many cells have ruptured. Identifiable cells are predom. well differentiated epithelial cells. There are small numbers of neutrophil and macrophages. comment: difficult to determine what types of cells present because they appear ruptured. there are neutrophils and marcophages which can be identified. this suggests inflammation. Organisms are not identified.
FIP 7B elisa <1:40
Basophils 0 Lymphocytes 7296
Eosinophils 456 Bands 0
Monocytes 456 Neutrophils 6992
Blood panel ANTECH Diag. 3/8/11:
Super chems run, off are Phosphorus 9.4 (H), Amylase 1942 (H)
CBC wbc 15.2, rbc 8.47
off: Platelet 194 (L)
2/3: 1st blood panels:
RBC 7.32, WBC 15.89
Off: Mono 1.95 K/uL (H)
Baso .12 " (H)
PLT >119 " (L) 175-600
Re: Kitten with chronic illness
The most telling signs in the labwork are monocytes, lymphocytes, basophils and esosinophils, all of which can and most often do, indicate inflammation, or allergic reaction - and all of which can indicate infection of some type.
I would at this point at least, due the absence of other symptoms relating to these enzymes, disregard the mention of amylase and phosphorus. Amylase is not a prognostic factor unless there is a suspicion of kidney or pancreatic disease. Phosphorus can elevate or decrease when the calcium is also out of whack, or relating to kidney issues, among various other disease processes. It too, is not too specific at this point - unless it is in relation to your kitten's diet, (dietary imbalance/formulation of the diet, or there is an excess of vit D in the diet, etc) - Again, may not be significant, but I do recommend you mention to the new specialist what you're feeding the kittens.
The platelet function might be due to his body's defense in fighting infection, antibodies, and his young agev (and lowered immune response).
I'm not sure I understand your term when you mention the tracheal wash - as it relates to the "throat culture". A tracheal wash involves a tube inserted into the trachea/throat, and particles taken from the tube are examined under a slide to differentiate cells and try to identify them. What may be more warranted by the new specialist is a bronchoscopy, which is similar, but the scope can see the bronchial tubes and also obtain a biopsy sample and/or mucous for testing or culture & sensitivity testing. This would probably be best in order to detect other bacteria or fungal, and can also rule out bronchial obstructions (like a small growth that has proliferated bacteria). This too, requires anesthesia.
So, the bronchoscopy could be quite revealing and closer to a truer diagnosis in which to choose and initiate correct treatment. However, the other rule-outs still apply, i.e., inflammation or allergic reaction from anything to food to environmental triggers, asthma, even believe it or not, reaction to kitty litter. If the bronchoscopy doesn't confirm anything, the specialist may still want to opt for a scope view of the sinuses.
I certainly can't speak for the specialist or his plan of action, but if this were my kitten, based on his symptoms and chronicity, and if he is a good anesthesia candidate and having a quick presurgical blood screen, I would opt for a bronchoscopy if advised.
If there is any connection to the other kittens, this might reveal such a connection. In the event it does, the new owner(s) should be advised as much.
I'm keeping your kitten in my thoughts and prayers. I know this is frustrating for you, and it certainly must be uncomfortable for your sweet little guy...hang in there and don't give up, ok?
I would at this point at least, due the absence of other symptoms relating to these enzymes, disregard the mention of amylase and phosphorus. Amylase is not a prognostic factor unless there is a suspicion of kidney or pancreatic disease. Phosphorus can elevate or decrease when the calcium is also out of whack, or relating to kidney issues, among various other disease processes. It too, is not too specific at this point - unless it is in relation to your kitten's diet, (dietary imbalance/formulation of the diet, or there is an excess of vit D in the diet, etc) - Again, may not be significant, but I do recommend you mention to the new specialist what you're feeding the kittens.
The platelet function might be due to his body's defense in fighting infection, antibodies, and his young agev (and lowered immune response).
I'm not sure I understand your term when you mention the tracheal wash - as it relates to the "throat culture". A tracheal wash involves a tube inserted into the trachea/throat, and particles taken from the tube are examined under a slide to differentiate cells and try to identify them. What may be more warranted by the new specialist is a bronchoscopy, which is similar, but the scope can see the bronchial tubes and also obtain a biopsy sample and/or mucous for testing or culture & sensitivity testing. This would probably be best in order to detect other bacteria or fungal, and can also rule out bronchial obstructions (like a small growth that has proliferated bacteria). This too, requires anesthesia.
So, the bronchoscopy could be quite revealing and closer to a truer diagnosis in which to choose and initiate correct treatment. However, the other rule-outs still apply, i.e., inflammation or allergic reaction from anything to food to environmental triggers, asthma, even believe it or not, reaction to kitty litter. If the bronchoscopy doesn't confirm anything, the specialist may still want to opt for a scope view of the sinuses.
I certainly can't speak for the specialist or his plan of action, but if this were my kitten, based on his symptoms and chronicity, and if he is a good anesthesia candidate and having a quick presurgical blood screen, I would opt for a bronchoscopy if advised.
If there is any connection to the other kittens, this might reveal such a connection. In the event it does, the new owner(s) should be advised as much.
I'm keeping your kitten in my thoughts and prayers. I know this is frustrating for you, and it certainly must be uncomfortable for your sweet little guy...hang in there and don't give up, ok?
..........Traci
Re: Kitten with chronic illness
Traci,
Yes, these are the trach wash results. He was put under, had the tube and her op report in in the file. The first page of the ANTECH report states Aerobic culture and MIC. I didnt include but states No growth after 24, 48 hours, final, no aerobic growth present after 72 hours. Page two was indicated above.
I only shared info I have from diagnostic reports in my file. Yes, he did have a throat culture too....I watched her stick the swab down the throat. There is not a lab report in my package so it may be in her SOAP notes.
You mention food more than once, and of course I will discuss his diet, but please send me a PM for off topic opinion if you think there is a red flag here. I am open to thoughts, and felt I needed to remove the Wellness food from his diet (all their diets for safety) after learning of the recall. He did not show signs of having anything wrong with him concerning the health related recall, specifically, Thiamine def. I have fed Wellness here since 2006.
I've added the new info to my list for Monday's appt....Driving the records out today.
My best, Lisa
Yes, these are the trach wash results. He was put under, had the tube and her op report in in the file. The first page of the ANTECH report states Aerobic culture and MIC. I didnt include but states No growth after 24, 48 hours, final, no aerobic growth present after 72 hours. Page two was indicated above.
I only shared info I have from diagnostic reports in my file. Yes, he did have a throat culture too....I watched her stick the swab down the throat. There is not a lab report in my package so it may be in her SOAP notes.
You mention food more than once, and of course I will discuss his diet, but please send me a PM for off topic opinion if you think there is a red flag here. I am open to thoughts, and felt I needed to remove the Wellness food from his diet (all their diets for safety) after learning of the recall. He did not show signs of having anything wrong with him concerning the health related recall, specifically, Thiamine def. I have fed Wellness here since 2006.
I've added the new info to my list for Monday's appt....Driving the records out today.
My best, Lisa
Re: Kitten with chronic illness
Re: the food, it's just my opinion, I don't care for some of the ways certain manufacturers formulate their pet foods, mainly excessive supplementation, or deficiency in vital nutrients or addition of ingredients that have not been tested for safety or efficacy in pets.
If your vets have not expressed concern over the diets, and bloodwork remains fairly consistent (no evidence of thiamine deficiency) then they probably have reason not to mention it further, since it is unlikely to be part of the current health problems. Just wanted to offer that since it was a recalled food, make sure the vets have it recorded in kitten's health records that he had been eating that food.
If your vets have not expressed concern over the diets, and bloodwork remains fairly consistent (no evidence of thiamine deficiency) then they probably have reason not to mention it further, since it is unlikely to be part of the current health problems. Just wanted to offer that since it was a recalled food, make sure the vets have it recorded in kitten's health records that he had been eating that food.
..........Traci