FHV cat with extreme nausea & appetite loss

My cat Sheryl is a six year-old domestic short-hair and has had chronic FHV problems her entire life.  I have tried everything (other than enucleation) to alleviate her pain and symptoms. From my experience, usually with FHV cats are asymptomatic most of the time with occasional flare-ups, Sheryl however, is symptomatic all the time with symptoms including but not limited to: squint eye (due to corneal ulcers), constant congestion, sneezing, poor coat condition, and stomatitis. Due to the stomatitis she has had 6 molariform teeth removed, although I have read a lot lately about full mouth extraction.

I have tried vaccinations, antibiotics, lysine, and a whole litany of other recommendations; only to end up back at point A. Point A has always been symptomatic but living a good quality of life. Unfortunately, lately she has digressed, her coat is ill-kept, her eye needs cleaning everyday or twice a day rather than once a week, she is very lethargic, and her bouts of sneezing have become much more violent.  Friday (2/8/2013), when she started vomiting I took her to the vet.  They administered an anti-nausea medication, and gave me Proviable paste to take home (stomach soothing).  The vet said to let her start out with a little water and work up from there but if she continued to vomit that would be signs of a greater ailment.  That was Friday, and while she drank water, she has not had anything to eat and continues to vomit a clear liquid or nothing at all.  I'm almost positive there is something primary or secondary to the FHV; perhaps FIV or renal failure.  She isn't the same happy cat she used to be, things went downhill quickly within a matter of a few weeks and she looks like she is in a lot of pain.  She isn't noisy other than if she has to vomit, and seems content to lie next to me on the couch.

My next appointment is tomorrow, but I was wondering if anyone had any experience with severe FHV or any of the symptoms? Perhaps some advice might be given about what to ask the vet, what tests might need to be done etc.  I know blood work and possibly a FIV test (or two) are in order but are there other things I should be concerned about? I have done some pretty intense research on different diseases, viruses, and bacterias but forums seem to offer the most sage advice from people with firsthand experience.

Thank you for any constructive input

I'm guessing you had your follow-up appointment today?  How did that go?  If your girl went for almost an entire week without eating, it's no wonder she isn't herself.  Cats really need to eat, and if they don't eat on their own, must be force fed after only a few days.

I don't know about the FHV part, but the vomiting could be from too much acidity from having nothing on her stomach, could be from pancreatitis, could be from Hepatic Lipidosis (from not eating), could be from Kidney Disease, could be from lots of things.  If she seems to be in a lot of pain,that could be indicative of a blockage somewhere, OR pancreatitis, or possibly something else, but those are the two things that come to mind first (for me). 

Did you get a blood test done.  What did the Vet say? 

Thank you for your reply and sorry to keep you waiting. Her follow-up appointment was yesterday and other than administer probiotics not much happened.  The vet said that if she continues to vomit that she will need blood work; I would have preferred if he did that yesterday but we'll see how Sheryl holds up. 

After the first appointment, I did force feed her watered down wet food through a small syringe...no small feat! The vet also did the same thing yesterday.  She is drinking water like a champ which keeps me optimistic but she has no inclination to eat.  I have the most pungent, stinky food imaginable and various other types and I warm it up but she won't even glance at it.

This evening I called the vet to let him know how she was doing. I stated that she wasn't eating at all and he recommended that I buy stinky food and warm it up...  While he was a very pleasant gentleman, I can't help but feel my money has been wasted twice due to lack of initiative to do blood work, I should have been pushy and asked for it.

I don't think it's FIV, or renal failure, and she doesn't seem to be in pain, but your suggestions of it being hepatic lipidosis or pancreatitis are pretty spot on. I might see how syringe feeding goes, it seems that the only treatment for hepatic lipidosis is an aggressive feeding regime.  I'm VERY surprised the vet did not bring that up yesterday.

Thank you for your suggestions and feel free to offer any more if you have experience with this type of thing.

Emily & Sheryl

Ask the vet about using Pepcid to help calm her tummy.  She could be nauseous because of excessive drainage. 

Have you tried Evening Primrose Oil to help with her congestion and/or Claritin?  The dose for EPO is 500mg -1000mg once daily.  Claritin is 1/4 to 1/2 of a 10 mg tablet once daily. 

I know of people on the herpes yahoo group who have had success using Eye See Clearly drops in the eyes.  http://www.allergicpet.com/products/eye_see_clearly.html
 

Is she on a grain-free diet? 

Yes she is on a grain-free diet. Usually I give her dry in the am (about 1/6 cup) and wet in the evening. Thank you for the Pepcid recommendation as well as Claritin, I think I will give both a try if my vet gives it a go ahead!

As for herpes, everyone always says L-lysine but I have never seen any concrete results with that.  Right now her conjunctivitis is being treated with Neomycin, Polymyxin B.  I have also used Tobramycin but I like this combo much better. Not going to lie, the Eye See Clearly is looking promising, thank you!!!!!!!!

I just gave her 4-2cc syringe fulls of stinky wet food mixed with water.  I'm crossing my fingers that it will work within the next day and she will hopefully have an appetite! 

Thank you for your words and help, I truly appreciate it and so does Sheryl
 

Do you steam her in the bathroom frequently to help with the congestion?  When my herpes girl was very congested, I ran a vaporizer 24/7 near where she spent most of her time and I put on a huge pot of water on the stove to simmer.  I placed several drops of eucalyptus oil in the water on the stove as that helps open up nasal passages.  I let it fill the whole house and kept it going as long as I was home for about a week. 

If she has any discolored eye or nasal discharge, you might talk to the vet about doing a culture and sensitivity test on it, if you've not already had one done.  There could be some kind of weird secondary infection going on that responds to antibiotics, but not enough to eradicate the infection so it flares back up.  The culture will tell the vet what kind of infection you're dealing with and the sensitivity test tells the vet which medication most effectively treats the infection.  We finally found out my Hannah had a secondary pseudomonas infection which was causing most of her problems.  We did two 30-day rounds of antiobiotics and got the numbers down to an acceptable range.  She's not had a serious flare up in several years.  She still gets sneezy, snotty, and watery eyes from time to time, but that's associated with weather change and seasonal type allergies.
 

I take Sheryl into the bathroom everyday with me when I shower. Today it is back to the vet; I thought syringe feeding was going well but this morning she vomited again. X-rays and blood work I'm sure, which is somewhat frustrating as I would have liked those on my first appointment rather than my third, but I'm happy that hopefully we'll find out what is happening with Sheryl.

stephanietx, like you, I have always thought that Sheryl's FHV symptoms have always been secondary to something else.  Recently I have moved so this is a new vet, but my previous vet and I had discussed this and she has been on antibiotics more often than not. I will ask the vet about a sensitivity test today.  Thank you and send good thoughts Sheryl's direction

Emily & Sheryl
 

How did the vet visit go?
 

When you syringe feed her, are you going nice and slow?  If you go too fast, that can cause vomiting too.  it's a catch 22 .  Lack of  food can cause vomiting because of over acidity (not to mentioned other worse problems), but feeding them too fast can cause them to throw it right back up again. 

Is she on antibiotics right now?  I know with my Sven , most antibiotics cause him him to throw up, porr guy.  If the Vet suggested anti-biotics, did he tell you not to give them at the same time as the antibiotics?  In otherwords, to wait at least 2 hours between giving probiotocs and antibiotics?  I like to wait at least 6 hours, if possible.

Hope you can get to the bottom of this!

I do feed her slow when I am using the syringe. No antibiotics as there was no infection other than conjunctivitis which is being treated with Neomycin. 

However, she did swallow a fish hook...


This was found Saturday at 1pm.  The vet that had seen me a week ago Friday (2/8) apologized profusely for not doing x-rays and apologized for her partner (who saw me Thursday 2/14) as well; I had asked for x-rays and blood work both times.

In the vet's office I felt harried and rushed.  So I drove to the 24-hour emergency clinic only to wind up going home with Sheryl in tow.  I spent most of the day crying and feeling terrible for Sheryl and the rest of the day researching similar cases. Of course I want to get the surgery but I also want some questions answered before I spend $1500. I made a list of questions and plan on taking them to a NEW recommended vet (with Sheryl) in the morning.  List of questions are as follows feel free to add anything you think I should ask:

What do you think Sheryl's long-term prognosis is given that she is always FHV symptomatic, has frequent/constant conjunctivitis that might require enucleation, will eventually (within a short period of time) require a full-mouth extraction? I feel her FHV is a secondary symptom/problem to something worse, how would we go about diagnosing that?

What will the surgery be like?  "Exploratory" was the word used, so what happens if you get in and she has a perforated bowel, and how does that complicate surgery/recovery time? Are there any special recovery procedures that will need to be followed (i.e. diet, rest time, palliative care etc.)?

Will there be complications from hepatic lipidosis? If so, what can be done to mitigate that or is she too far gone in that aspect?

Here is some information about Sheryl's lifestyle: Sheryl eats a grain-free diet of wet at night and dry in the morning.  She is up-to-date on all of her vaccinations/worming/flea meds and gets a fecal analysis every year. Her dental cleanings are now an annual occurrence but she is still missing 6 teeth from a previous extraction. She has a constant supply of ophthalmic gel to ease the symptoms of conjunctivitis, comes into the bathroom with me everyday when I shower, and has a heating pad she sits on 24/7 because it is the best thing for kitties since the invention of stinky wet food.

She does not have a bad life and she eats better than I do that's for sure.

Once again, thank you for all the advice, it is greatly appreciated.

Emily & Sheryl

An update:  Sheryl got surgery to remove the hook but unfortunately most of her small intestine was perforated so the vet and I discussed best options and decided that putting her to sleep was the best option.

I am heartbroken about my kitty.  There isn't a day that has gone by that I don't think of her or miss her presence.
 

I am so so sorry for your loss. Hugs.

So very, very sorry for the loss of your dear Sheryl. You gave her such love and I am sure you were in shock over the x-ray findings. I truly am sorry for what you are going through right now. I hope you know how much Sheryl loves you still and is grateful for letting her go peacefully. My deepest condolences.

I'm so sorry for your loss. That must have been such a shock to see the X ray.
Rest in peace Sheryl.

I will lock this thread. When you're feeling up to it, please post a tribute thread to Sheryl in the Crossing the Bridge forum.