Some tests ARE definitive, but we're not talking about such tests unless either of the scope views detect something like polyps, inflammation, growth, etc.
Exploratory in vet terminology usually involves open (cavity) surgery. That's all I wanted to infer. The scope views generally are not invasive in terms of tissue damage, except that there can be post-anesthesia irritation, particularly in esophagus or nasal passages, etc. This irritation is usually mild and self-limiting (sometimes requiring antibiotics if severe).
I understand the plan, but I do think much was missed in initial diagnostics, which is why and what I went through with you as thorough as I could. Of course I can't speak for, or direct your vet, that's why I simply ask questions to ensure nothing is missed.
I'm just trying to get as much information as you can provide, it's the only way I can help advise. None of what I say is intended to make you feel bad, I understand the diagnostic challenges and the steps necessary to take. I also understand the costs. This is a complicated case, but I continue to believe a diagnosis will be reached in order to treat effectively, which initially may not have been that complicated. I am not sure I agree with the steps or omission in steps thus far, but I'm not the vet, it's not my decision. Again, I just wanted you to be informed, and point out the options you have.
At this point, you still have the option to ask the new vet for a professional consult on your behalf, although I suspect she's dedicated to this case. I just want you to be able to bring that up with her at any point you feel enough is not being done. She's not board-certified, at least that you know of, therefore, you still have that option.
I want just as much, for Squiggy and his brother Lenny to be happy, healthy kittens, trust me. It pains me that Squiggy is so ill and that you've gone through so much and so much cost and still do not have a diagnosis. This is not your fault, please don't think I'm inferring that, you have to be able to trust the vets, I just want to reiterate that third opinion option. I know how it sounds, but it is what I would do if the next step is not revealing.
Kitten with chronic illness
Re: Kitten with chronic illness
..........Traci
Re: Kitten with chronic illness
I truly do appreciate your help. I have said before I am just overwhelmed with this situation not being able to help resolve it so far.
My question for you is do you believe I am wrong to request these tests before going straight to a rhinoscopy? Would the scope provide the same results as the PCR, Throat culture, ELISA?
I guess these are questions I should discuss on my follow up too, but maybe I am off track trying to run more tests to avoid more invasive procedures on this guy. I just feel putting this guy under who already has breathing problems is a recipe for disaster and I am trying to protect him as much as cure him.
I just know we did the trach and received no answers and fear putting more stress on him for a rhinoscopy without knowing answers will come from it either. At least a swab and blood draw is less stressful on him.
I have until 4/26 to make decisions, unless of course if he has another setback.
--Lisa
My question for you is do you believe I am wrong to request these tests before going straight to a rhinoscopy? Would the scope provide the same results as the PCR, Throat culture, ELISA?
I guess these are questions I should discuss on my follow up too, but maybe I am off track trying to run more tests to avoid more invasive procedures on this guy. I just feel putting this guy under who already has breathing problems is a recipe for disaster and I am trying to protect him as much as cure him.
I just know we did the trach and received no answers and fear putting more stress on him for a rhinoscopy without knowing answers will come from it either. At least a swab and blood draw is less stressful on him.
I have until 4/26 to make decisions, unless of course if he has another setback.
--Lisa
You have every right be concerned about anesthesia, in a compromised kitten. However, if the bronchodilators and corticosteroids are doing their job, chances are, the lungs will be in much better shape to withstand anesthesia. Do however, express your concerns to your vet and ask about her experience with rhinoscopies in her practice (how many has she done, have they been significantly diagnostic).
The Elisa/PCR probably is not as important as either the rhinoscopy or bronchoscopy at this point - it is simply a diagnostic that should be done/ruled out anytime there is a respiratory problem and due to the herpesvirus because they sometimes go hand in hand. Either calicivirus, chlamydia or mycoplasma could possibly be contributing to the problem, but there is most likely a deeper concern elsewhere, either as your vet suspects, in the sinuses or nasal cavities, or the esophagus and lungs. A growth, for example, could be present in either area, which can only be detected with a scope view (or MRI - ask her if this might be in the picture at some point, hopefully not due to the costs). Fungal disease, as another example, can sometimes form growths and cause obstructions. Either type of scope can help detect polyps, growths, obstructions, inflammation, foreign bodies, etc. The problem is determining which area is the source. I understand your vet's choice, to perform the rhinoscopy, in the event the source is in the sinuses and draining/migrating into the esophagus and lung areas. Keep in mind, all the setbacks Squiggy has had despite prior treatments. There is most likely an underlying problem somewhere, and the sinuses are a good place to start.
Another problem is the choice to use or not to use antibiotics right now. On one hand, antibiotics can help keep secondary infections at bay, however, it is best to culture suspicious sources to determine the correct antibiotic choice. Prophylactic use also helps prior to some surgical procedures. On the other hand, antibiotics can also alter test results before culturing (timing).
What I would propose is, call your vet and ask for a few minutes of her time to talk about:
Does she feel the rhinoscopy is more important at this point, and will she obtain samples for culturing? Does she feel the source is in the sinus cavities alone? (I get the impression she has a suspicion). Does she feel the source from the sinuses is the same as that of the trachea/esophagus, thereby negating the importance of another tracheal wash for culturing, or, does she also intend to do another tracheal wash at the time of the rhinoscopy (because the first results were not very indicative of specific infection - the latter, kind of concerning, because as I mentioned before, there could still be new bacteria present that wasn't before). If the rhinoscopy is not revealing, what is the next step - should we be consulting a virologist or internal med specialist? What about antibiotics? Prophylactic now, or post-rhinoscopy? (ideally, when obtaining samples for culturing, we want to wait for the results before antibiotic therapy, yet still consider treating if we have knowledge of or suspicion of, some bacterial infection brewing).
I might have missed it somewhere, but were cultures ever done on the other sick kittens? The other vet seems to be implying that a steady course of Baytril has helped significantly, but without culture and sensitivity tests, there's no way to determine if Squiggy has the same thing as the kittens - it could be totally isolated, totally unrelated. Plus, if they are different ages, that should be taken into account. Ask your vet about her opinion on that.
Lastly, whenever I am at a major decision process involving extensive diagnostics, I always find it helpful to be upfront with my vets and ask them specifically, if this were your cat, what would you be doing? I trust my vets explicitly to be honest with me and heed their advice. If you have a good working and trusting relationship with your vet, you should be able to trust her opinions.
Hope this helps?
The Elisa/PCR probably is not as important as either the rhinoscopy or bronchoscopy at this point - it is simply a diagnostic that should be done/ruled out anytime there is a respiratory problem and due to the herpesvirus because they sometimes go hand in hand. Either calicivirus, chlamydia or mycoplasma could possibly be contributing to the problem, but there is most likely a deeper concern elsewhere, either as your vet suspects, in the sinuses or nasal cavities, or the esophagus and lungs. A growth, for example, could be present in either area, which can only be detected with a scope view (or MRI - ask her if this might be in the picture at some point, hopefully not due to the costs). Fungal disease, as another example, can sometimes form growths and cause obstructions. Either type of scope can help detect polyps, growths, obstructions, inflammation, foreign bodies, etc. The problem is determining which area is the source. I understand your vet's choice, to perform the rhinoscopy, in the event the source is in the sinuses and draining/migrating into the esophagus and lung areas. Keep in mind, all the setbacks Squiggy has had despite prior treatments. There is most likely an underlying problem somewhere, and the sinuses are a good place to start.
Another problem is the choice to use or not to use antibiotics right now. On one hand, antibiotics can help keep secondary infections at bay, however, it is best to culture suspicious sources to determine the correct antibiotic choice. Prophylactic use also helps prior to some surgical procedures. On the other hand, antibiotics can also alter test results before culturing (timing).
What I would propose is, call your vet and ask for a few minutes of her time to talk about:
Does she feel the rhinoscopy is more important at this point, and will she obtain samples for culturing? Does she feel the source is in the sinus cavities alone? (I get the impression she has a suspicion). Does she feel the source from the sinuses is the same as that of the trachea/esophagus, thereby negating the importance of another tracheal wash for culturing, or, does she also intend to do another tracheal wash at the time of the rhinoscopy (because the first results were not very indicative of specific infection - the latter, kind of concerning, because as I mentioned before, there could still be new bacteria present that wasn't before). If the rhinoscopy is not revealing, what is the next step - should we be consulting a virologist or internal med specialist? What about antibiotics? Prophylactic now, or post-rhinoscopy? (ideally, when obtaining samples for culturing, we want to wait for the results before antibiotic therapy, yet still consider treating if we have knowledge of or suspicion of, some bacterial infection brewing).
I might have missed it somewhere, but were cultures ever done on the other sick kittens? The other vet seems to be implying that a steady course of Baytril has helped significantly, but without culture and sensitivity tests, there's no way to determine if Squiggy has the same thing as the kittens - it could be totally isolated, totally unrelated. Plus, if they are different ages, that should be taken into account. Ask your vet about her opinion on that.
Lastly, whenever I am at a major decision process involving extensive diagnostics, I always find it helpful to be upfront with my vets and ask them specifically, if this were your cat, what would you be doing? I trust my vets explicitly to be honest with me and heed their advice. If you have a good working and trusting relationship with your vet, you should be able to trust her opinions.
Hope this helps?
..........Traci
Re: Kitten with chronic illness
Thanks Traci! This is great! Very beneficial to the questions I have at hand. I haven't called her yet. Watching what is going on this week. After another horrible two days on Sun & Mon, he is 98% symptom free for tues and wed. Just a little snorty. No cough, no throat issues. My hopes are not high but I am riding this one with happy thoughts. Waiting to see if the meds did just kick in or what. 48 hrs without wheezing and coughing has not happened EVER!
I was concerned on not using antibiotics also, but I think she thought he needed a break, see what transpires and if something else brews. Just my opinion on how she explained things. I was told it was just going to be a process to get him effectively treated with 3 months of ongoing situations.
I really am not sure on what diagnostics outside of x-rays were done on the other two kittens. I was off on the 4wks of Baytril for them, after thinking about it, her kittens were hospitalized for this issue in Feb. So they had close to 8 wks of Baytril. They are two weeks younger than Squiggy. Their issues could be unrelated, but all have pneumonia and chronic URI type issues and same symptoms. Squiggy was with them for 2 wks before coming to live with us.
Will keep you posted. Hoping our good streak continues and he can get some strength up. You have been a great support these last couple weeks and I am most appreciative!
Lisa
I was concerned on not using antibiotics also, but I think she thought he needed a break, see what transpires and if something else brews. Just my opinion on how she explained things. I was told it was just going to be a process to get him effectively treated with 3 months of ongoing situations.
I really am not sure on what diagnostics outside of x-rays were done on the other two kittens. I was off on the 4wks of Baytril for them, after thinking about it, her kittens were hospitalized for this issue in Feb. So they had close to 8 wks of Baytril. They are two weeks younger than Squiggy. Their issues could be unrelated, but all have pneumonia and chronic URI type issues and same symptoms. Squiggy was with them for 2 wks before coming to live with us.
Will keep you posted. Hoping our good streak continues and he can get some strength up. You have been a great support these last couple weeks and I am most appreciative!
Lisa
Re: Kitten with chronic illness
Did you talk with the breeder or her vet, ask if there were any new changes in her environment/cattery right before or during the time the kittens became ill? Did she or her vet ever mention the possibility of molds or some type of spores circulating in the home? This would be one rule-out since it might have some connection. Again, it would have been ideal if cultures had been done on the kittens to determine if the results were similar to Squiggy's - even though his results were not really revealing, unless the vets used the same tests.
..........Traci
Re: Kitten with chronic illness
I've spoken with both the breeder and her vet. The breeder and I speak about once a week to discuss the current status and swap info. There is no prior conditions in the house of this nature. There is anemia on isolated conditions, those animals are spayed/neutered. This was shared by both breeder and vet. This vet has cared for her animals for over 15 yrs.
The only connection we can come up with, which I mentioned before was all three received boosters on same day and came down with a "cold" immediately after. They were given Clavamox and recovered. This was on 12/7. 4-6 wks later all three developed pneumonia. I've had Squiggy since 12/16. He was not sick when I took him, but did report to my vet he coughed on 12/23 at initial check up. It wasn't till January that all the snotty, throat symptoms started.
Next time I speak with her I will ask on the mold issue in the house. I do know she has a new litter and they are all very healthy to date. Not ready for adoption, but she was talking about how well they are. They are separated from the other 2 though for safety.
My best, Lisa
The only connection we can come up with, which I mentioned before was all three received boosters on same day and came down with a "cold" immediately after. They were given Clavamox and recovered. This was on 12/7. 4-6 wks later all three developed pneumonia. I've had Squiggy since 12/16. He was not sick when I took him, but did report to my vet he coughed on 12/23 at initial check up. It wasn't till January that all the snotty, throat symptoms started.
Next time I speak with her I will ask on the mold issue in the house. I do know she has a new litter and they are all very healthy to date. Not ready for adoption, but she was talking about how well they are. They are separated from the other 2 though for safety.
My best, Lisa
Re: Kitten with chronic illness
Could you explain that further?ociboys wrote:There is anemia on isolated conditions, those animals are spayed/neutered.
..........Traci
Re: Kitten with chronic illness
A couple of her adult cats have the blood disorder Anemia and are treated for low iron. It was found years ago after a litter with a mom affected. I believe it is a genetic thing with them. She has informed me that all animals she does breed, has a genetic profiling done out of California which rules out disorders and heart issues? This was done on these parents too. She is CFA registered but not TICA. My understanding is the stud owner is the show lady and she gets top pick of what comes out, the rest are placed for adoption.
They both did come with a health contract and guarantee on defective heart conditions. Unfortunately, for this health issue on the contract, my option is to return him for a replacement. NOT an option for me. The vet bills are only covered for heart related congenital conditions and full refund on cost of the pet. Believe it or not, she did send me a little money to help cover some of the bills. Not much in comparison, but was a nice gesture.
I dont have knowledge on breeding, showing, never have desired to breed or own show cats, so if I am not answering your questions correctly, please advise.
I would be happy to ask her any questions. Her vet concurred it wasn't in this blood line and didnt have any relation to this condition so I didn't push it since his CBC and panels are all fine.
--Lisa
They both did come with a health contract and guarantee on defective heart conditions. Unfortunately, for this health issue on the contract, my option is to return him for a replacement. NOT an option for me. The vet bills are only covered for heart related congenital conditions and full refund on cost of the pet. Believe it or not, she did send me a little money to help cover some of the bills. Not much in comparison, but was a nice gesture.
I dont have knowledge on breeding, showing, never have desired to breed or own show cats, so if I am not answering your questions correctly, please advise.
I would be happy to ask her any questions. Her vet concurred it wasn't in this blood line and didnt have any relation to this condition so I didn't push it since his CBC and panels are all fine.
--Lisa
I have an updated status on Squiggy. He ended his Famciclovir and was reduced on his inhalers around the 15th., he returned to a sickly status and i was in contact with the feline vet. she advised to return to full dose of the inhalers. Two days and he continued to become worse, last Thursday we had a follow up by phone and she advised to start up the Famciclovir with Claritin, and be seen Friday for a work up. We brought him in Friday, additional tests were run, including a culture and sensitivity test.
I received the results today, her report is normal resp. bacterial, normal bacterial flora, no mycoplasmas or other present. Leading her to believe this is pure viral issue. I was advised to continue the Famciclovir 2x day with is 62.5 mg/day with 1x day of Albuteral and Flovent. for the extended time. No antibiotics. We will discontinue the Claritin since he is responding on the Anti-viral again.
In the meantime, she will be researching what long term effects Famciclovir can have on a cat. Apparently a new drug used these days. A Rhinoscopy may be needed in the future, to explore if there is damage done by the whole issue of his illness. Best outcome would be a polyp found but minimal chance that this would be the issue.
She feels his lungs sound much better and are improved from the 4/4 visit, and still thinks most symptoms are coming from the nasal cavity (based on friday's appt).
As always, Hoping for the best and we find this guy to be in good health...soon!
Thanks Traci and Cleo for your continued support during this frustrating time.
Regards, Lisa
I received the results today, her report is normal resp. bacterial, normal bacterial flora, no mycoplasmas or other present. Leading her to believe this is pure viral issue. I was advised to continue the Famciclovir 2x day with is 62.5 mg/day with 1x day of Albuteral and Flovent. for the extended time. No antibiotics. We will discontinue the Claritin since he is responding on the Anti-viral again.
In the meantime, she will be researching what long term effects Famciclovir can have on a cat. Apparently a new drug used these days. A Rhinoscopy may be needed in the future, to explore if there is damage done by the whole issue of his illness. Best outcome would be a polyp found but minimal chance that this would be the issue.
She feels his lungs sound much better and are improved from the 4/4 visit, and still thinks most symptoms are coming from the nasal cavity (based on friday's appt).
As always, Hoping for the best and we find this guy to be in good health...soon!
Thanks Traci and Cleo for your continued support during this frustrating time.
Regards, Lisa
Re: Kitten with chronic illness
Please define "sickly", and as you refer to it with your vet.
I'm getting confused about all the vets. The last one, the feline-only vet, what is her opinion? Has anyone thought to refer you to a specialist yet? (again, virologist, or internal med)
This has gone on for way too long, and not likely just a viral. Also, anti-virals aren't always helpful since many of them don't have a great deal of efficacy behind them (sort of like a 'well it may not help but won't hurt' thing).
What exactly was cultured, from where, and for what?
I'm getting confused about all the vets. The last one, the feline-only vet, what is her opinion? Has anyone thought to refer you to a specialist yet? (again, virologist, or internal med)
This has gone on for way too long, and not likely just a viral. Also, anti-virals aren't always helpful since many of them don't have a great deal of efficacy behind them (sort of like a 'well it may not help but won't hurt' thing).
What exactly was cultured, from where, and for what?
..........Traci