Pseudomonas aeruginosais for 3 years and Vet suggests to make a hole on my cat's head :(...

My cat, Bill, is diagnosed with pseudomonas aeruginosais since 3 years ago. After his discharge was analyzed by culture, Vet suggests to use Baytril. Half year ago the Vet says Baytril seems not much help to Bill and perhaps it is also because Bill's immune system is too weak to fight the sickness  as well. He explains the strong pseudomonas aeruginosais stays in Bill's nasal for too long now and could ends up eating his soft tissues and bones and suggest to have a better nasal flashing way by making 2 holes in Bill's forehead and put in 2 tubes on each side which allows more effective flashing eg daily instead of putting him temporary to sleep to do so. We were shocked and without much consideration we turned this down as Bill is pretty happy running around everyday, playing and eating as normal except and we just couldn't imagine how he can live it with the 2 tubes on his head plus a cone to avoid him touching the tubes especially it's not an one-off treatment but need to keep the tubes there for weeks until Vet can confirm the pseudomonas aeruginosais inside Bill's nasal is gone. Vet thinks it is a more effective help but there is no guarantee in fully recover from pseudomonas aeruginosais and it can easily come back again and again. 

Bill is a short hair blue cat at 9 years old. He is a very good boy, very behave and adorable but also a poor cat without snacks but only lysine since his bladder was blocked with crystal twice and confirms he can't digest the fats from taking normal cat food or fresh meat, so he is on veterinary diet urinary food since he was a kitten. About 3 years ago, he was found in high fever all the sudden and then his white blood cells number was extremely low. The first Vet couldn't find any solutions but ask us to send Bill to a big clinic for further test & overnight monitoring...That's how we met the existing Vet who has been in really great help in Bill's case and he has very much patience in running a lot of test on Bill even CT scan but didn't find any infection and still can't find what is the reasons Bill has used almost all his white blood cell. About a week or two later, Bill's white blood cell numbers resume to normal himself and he was pretty weak by then and then very soon we found him sneezing with discharge from white turned to green. Vet confirms Bill is with pseudomonas aeruginosa after his discharge was analyzed by culture and showing Baytril is the only available antibiotics could work, so then Bill is on Baytril since then on and off for 2 weeks and upto few months. Bill will get better after few course of Baytril with discharge changed back to white or clear but then will need to use antibiotics again when it turns to green again. Vet did few times nasal flashing on Bill and we keep Bill on a small closed place for steaming treatment with saline water in order to keep his nasal moist and help him to clean his nasal. In the past half year, we decided to stop giving him antibiotics and let him heals himself but pseudomonas aeruginosa is still with him unfortunately and this time the Vet suggests to open 2 holes in his head...My husband and I just can't accept such a surgery which is no guarantee to help Bill or not but we are afraid the pseudomonas aeruginosa attacks him further that could interfere his breathing system and risk his life.

Is there anyone has the experience in a similar situation? I found some pretty old posts in this forum mentioned Zenaquin but i'm not sure if it fits for Bill. 

My understanding is the Zenaquin is the medication of choice for Pseudomonas.  We do have a few members here who have had cats with this issues (NOT needing the tubes in their heads however, as far as I know)  Here is a thread that discusses one or two of them:  http://www.thecatsite.com/t/278001/pseudomonas-aeruginosa

One of our advisors, @stephanietx, is one of the people whose cat had this.  

As far as what's wrong with Bill's ability to digest fat, what exactly was he diagnosed with...malabsorbtion syndrome, or EPI, or what? 

Thank you so much for your reply mrsgreenjeens. After read through your recommended posts, my husband and I decided we will bring Bill to another clinic and seek for help eg with Zenaquin and the gentamicin for the nose which stephanietx has mentioned in some older posts but of course will need to see if the Vet has any other comments based on Bill's latest status. We don't actually want to get Bill do all the possible tests and culture again but if there is a chance for Bill to get better without having the tubes on his heads then we are willing to give it a try.

About digesting fat ability, Vet only say Bill has generic problems for it. oHe is about 13 pounds now and is happy with the royal canin urinary cat food in the past 8 years especially the wet one. We give him the urinary dry food twice a day and added half pack of wet food mixed with water in the evening. He is also having 2 lysine twice a day. He was on some kind of antihistamine type of medication supports for months but doesn't help much.

By the way, we have another 3 years old cat at home with no infection and on normal cat food (by carefully separate their food and eating area each day). She is not very close to Bill but occasionally chasing each others and get into a little fight together like others cat do.

If you take Bill's records to the new Vet, maybe you can avoid having to get a new cutture.

Lactoferrin is another "supplement" similar to L-Lysine that helps with the immune system.  May cats with Feline Herpes take both.  You might ask the new Vet about that as well. 

Joma,

If you're in the US, ask your vet if he has access to VIN (an online vet community), to consult with specialists, or ask him to consult with a reputable specialist on your behalf for new ideas in treatment.  Vets have to be prepared to change treatment if the first chosen one is not working.

I'm wondering if a new culture would be prudent to see if the results have perhaps changed after all this time and perhaps the sensitivity list might include more than just Baytril..  It might be worth it to try, this is where a specialist's opinion and direction can come in handy because if nothing else has sensitivity to the pseudomonas aeruginosa, a specialist might have other ideas to try.  You can't risk further damage to Bill's nasal passages by not being on treatment.

Another option, not as an antibiotic, but rather steroid to combat inflammation if it is present.  But, because you've mentioned Bill's immune system has been low, this would have to be a very cautious decision.  I mention it only because in otherwise healthy cats, a steroid like prednisone could be helpful on a temporary basis while trying the antibiotics.

In the meantime, always keep your litter boxes as clean as possible to prevent transmission to your other cat, since it can be found in feces.  However, this type could possibly be non-contagious to your other kitty, so if your vet never told you that, ask him if it is the type that is or is not potentially contagious to other cats.  Keep both cats indoors only (continued exposure to soil, moist environment, vegetation are methods of re-infection).

thank you very much all for the valuable feedbacks. new vet did culture on bill and confirmed with pseudomonas aeruginosais once again. bill is on cipro tablets for 2 months now together with genoptic eye drops plus lysozyme tablets. all for twice a day. genoptic supposes 3 times a day but since we are all at work, we can only manage 2 times a day. bill seems turning better since 2 weeks ago. we are in asia and the weather is pretty moist down here in past few weeks. we think his conditions may have something to do with the weather. we will send him to revisit doctor again in a month time and bill will complete cipro for almost 3 months by then. hoping he can get better and better each time and eventually get ride of such a trouble bacteria. he is a very good boy but do struggle in eye drops sometimes and if we didn't put the tablet right inside his mouth near his uvula then he will keep throwing it out and give us an angry look with saliva keep runs out from his mouth...but basically he is very behave most of the time.