Chronic Sinusitis Insanity

[reishka]

I need a sanity check. My vet's office has no available appointments today, my long-term usual vet is out until Monday, and the specialist we're seeing is ONLY in on Mondays (and I'm not sure I trust her).

We have a senior-ish kitty, named Nutmeg, who has been with us for about 4 or 5 years. She showed up in our backyard, mangy and thin and with some kind of infection. One day she just came over to me and collapsed in my lap, so we took her to the vet - teeth infections, blood infections, sinus infection, plus the usual ticks, fleas, worms. Scarily thin. Vet said she might not make it, given that she also appeared to be older (in her teens).

But she did. She recovered from all of her issues.. except one. She was perpetually snotty, sneezy, and congested. We spent thousands trying to find out why: what was causing the infection, CT scans, x-rays, a blind biopsy. We tried different medications over the course of a year. Eventually we ended up in the territory where the next tests would be 2k - 3k each, and may not give us a definitive cause, so we decided to stop hunting the cause and focus on treating the symptoms. In the meantime, she was given a diagnosis of chronic rhinitis/sinusitis

For four years, she's been on a low-dose steroid regimine. .08cc of prednisolone, once a day. If she seems to have a flare-up (a few times a year), we give her an extra dose in the morning and then slowly taper her off over the morning dose after a week.

Fast-forward to this past April. We started noticing that she was a little more lethargic (taking more naps) and chalked it up to her getting older. But we also noticed she was eating. We started keeping a record and watched how, over the coming months, she was eating much and much less - to the point where she was eating maybe a quarter tin of wet food a day (roughly 1.25 oz - We take a 5 oz tin and split it into two meals, and she gets 1/4 cup dry food as a snack before we go to bed). So we took her back to the vet.

Vet ran a bunch of bloodwork tests, x-rays, and said she couldn't find anything that would explain the appetite loss. She sent us to another facility for an ultrasound. The ultrasound didn't show anything either, but the vet at the new facility wanted to run a different test to check her liver (the logic being that the low-dose steroid may have damaged her liver over the years and was contributing to the problem). But we would have to take her off of the steroid for at least a week. In the meantime, she prescribed an appetite stimulant.

While she was on the appetite stimulant and the prednisolone, she had a healthy appetite back and gained about half a pound over three weeks. Once the prednisolone was tapered off, she returned to not eating - even with being on the appetite stimulant. I chalk this up to her being completely congested and unable to smell food.

We go in for the liver test, and there appears to be no issues. So this second vet now wants us to stay off of the prenisolne, and get an inhaler instead - the thought is that the prednisolone is affecting her ability to taste/smell, and thus is what is causing Nutmeg to not eat.. But the inhaler would cost too much from a US pharmacy, so she is sending us to a Canadian pharmacy to order it, and it will take 2 - 3 weeks to get here. Meanwhile, this vet puts Nutmeg on meloxicam for a week in the interim - and says that the meloxicam should make it easier for her to breathe, so she should be hungry and we shouldn't need the appetite stimulant, but she gave us another perscription for the stimulant just in case.

She had her first dose of meloxicam on Monday evening. She ate maybe 1/2 of dinner.
Tuesday she did not eat at all.
Wednesday morning we gave Nutmeg the stimulant. She threw it up. We got a new dose and gave her this. She got very drooly. We put food down her - she ate maybe 1/4 of a meal. We gave her the meloxicam before dinner, and then put down dinner. She ate maybe 1/2.
Thursday: She ate maybe 3/4 of breakfast, and 3/4 of dinner
Friday: She was VERY wheezy (sounded like she was breathing through a straw), didn't eat anything
This morning: Gave her another dose of the stimulant. She ate a smoothie kitty treat, but didn't touch dry food breakfast. Tried to smoothie some wet food for her, didn't touch that either.

The meloxicam doesn't seem to be working to control the congestion. We've seen Nutmeg breathing from her mouth - not full-on panting, but she was laying on my chest and was very wheezy. I saw her little cheeks puff in and out as she was breathing. She has NEVER done this on prednisolone. She also doesn't seem to be able to sneeze out any snot that she has - before, it would be kinda gross with her sneezing snot everywhere, but at least she could breathe.

The specialist only works on Mondays. I attempted to call my personal vet - the one that has been treating Nutmeg for four years, and sent us to the specialist. She will not be in until Monday either. My vet's office has no Saturday appointments available. I need a sanity check. Something in my brain is saying that this entire situation is crazy, and I feel like I'm sitting here with a cat that is worse off than when I originally took her to the vet in the first place. I love my personal vet and I trust her judgment, but I don't know this specialist. I'm trying to emotionally detach from the situation and look at it logically, but I'm finding it very difficult when Nutmeg is wheezing, having to be force-fed pills (which no one enjoys), on a medication that has severe warnings, and having to wait 2 - 3 weeks for yet another medication to arrive...

So please, anyone with chronic rhinitis/sinusitis cats, share your experiences. Maybe I am crazy, maybe I'm not. I just need to hear something that isn't my own echo chamber anxious brain.

 

[Furballsmom]

Hi! I don't have experience with this, but I've read that putting a cat with these issues into a bathroom with a steamy shower running for 10-12 minutes a couple times a day can help ease their airways and possibly help her to be able to clear the snot.
Poor baby, poor you!! Is there a university veterinary medical department you could speak with?

 

[Furballsmom]

Also;
Sometimes finger feeding is the only thing that works, either sitting on the floor with them and literally scooping a little food onto your finger, or gently tucking a little bit of food into their cheeks.

Try making this;
tent test for dehydration and home-made pedialyte recipe - The Daily Kitten

Also, try making one of these;
Kitten Glop Recipes - Supplementing Cats and Kittens with nutritious formula you make at home: presented by Bengal Cat breeder Foothill Felines. --This website has a number of kitten glop recipes, with ingredients that you may very well have in your house.

These can be used on their own or combined with food. Also, if you heat the food a little - stir it so there aren't any hot spots from the microwave. Or you could heat some water, about a tablespoon, and add that to canned food. A small glass works to stir it all up.

• Chicken, beef or ham flavored baby food such as Gerber Stage 2 - make sure there is no garlic or onions in the ingredients

• Tuna and/or the juice, a low mercury/low/no sodium brand is called SafeCatch

• Salmon, mackerel

• Sardines (make sure there are no bones)

• boiled cut up chicken or turkey with no seasonings

• canned kitten food any brand - it's usually smelly. See if it's eaten on its own, then maybe mix it in or put on top

• Try mixing in Kitten Milk Replacer - there are recipes on the internet or store bought

• Fish, tuna or BBQ flavored canned wet food (I personally have never seen BBQ flavors, but...)

• Lickable cat treats or pouch treat 'gravy' poured over the food

• kitten glop (recipes in website link above)
• Bonito flakes
• fortiflora
• fish oil
• green beans, asparagus mushed up

• goat milk, or no lactose cow milk
• whole cooked eggs (the white must always be cooked) or raw egg yolk now and then
• broth with no salt and no garlic or onion or seasonings of any kind
• There are also commercial toppers, Applaws is a brand that can work well as a topper
  
• Some good treats would be freeze dried Purebites, Orijen, Meowtinis, Meowables

• There are also Lickimats that you could spread types of soft food onto, even plain unflavored yogurt, and even freeze it. Licking something can help a cat to feel better emotionally The LickiMat - Food Puzzles for Cats
• shredded cheddar cheese
• chamomile tea, made from the little bags only, a couple cooled teaspoons a couple times a day in water or food, can helpcalm a stressed cat

 

[reishka]

Hi! I don't have experience with this, but I've read that putting a cat with these issues into a bathroom with a steamy shower running for 10-12 minutes a couple times a day can help ease their airways and possibly help her to be able to clear the snot.
Poor baby, poor you!! Is there a university veterinary medical department you could speak with?

I'm taking her into the bathroom with me because it did seem to help previously - the steam seems to loosen everything up and is easier to sneeze out. But the past week or two it hasn't been as effective. Combined with her wheezing (it sounds like she's breathing through a straw), I think everything is just too inflamed for her to get a good "deep breath" to shove everything out of her nose. I try to feed her right after the shower, when she's likely to be the lease congested.

As for a university vet department... I don't know! I'll have to look.

The good thing is that she's at least not dehydrated. I see her at the water bowl multiple times a day. We've been trying to entice her with baby food (she loves it, and that's how we would give her the prednisolone - mix a little into meat-only baby food and she'd lick it right up) and puree cat treats, but so far no luck. She has difficulty with a number of foods because she has only 4 teeth left... which makes it all the more frustrating! But I hadn't thought of kitten food, or a few of the other things you suggested. I'll be making a trip to the store and pick all those up. Hopefully something works! Thank you!

 

[PushPurrCatPaws]

reishka -
Did the vet actually take only one week to taper your cat off of oral Pred?! After having been on it for four+ years?!

That is just not a healthy tapering off off a long-term, systemic Pred/ steroid use! Her body has gotten very reliant upon the steroid for her whole system... tapering a cat too quickly off of that can really put the cat into a metabolic emergency. Plus, doing that and then just switching to an inhaled (localized) steroid should ALSO be done in a very slow tapering process. You can't just switch from the systemic steroid, to no steroid, then over to an inhaled steroid without gradually doing a tapering over a many-months time period. A cat takes about 2-3 months to have their body develop a dependence on the things Pred can do to it and for it. For a cat that has used oral Pred for years, you just simply need a very long and gradual reduction of dosing in the hopes that the cat's system can once again take over the "duties" that the Pred was doing for the cat.

Also, about the eating less issues beginning around April, did the vet(s) fully test for: possible diabetes, hyperthyroidism, cushing's disease, or even just GI ulcers? All these can develop from long-term Pred usage.

 

[reishka]

reishka -
Did the vet actually take only one week to taper your cat off of oral Pred?! After having been on it for four+ years?!

That is just not a healthy tapering off off a long-term, systemic Pred/ steroid use! Her body has gotten very reliant upon the steroid for her whole system... tapering a cat too quickly off of that can really put the cat into a metabolic emergency. Plus, doing that and then just switching to an inhaled (localized) steroid should ALSO be done in a very slow tapering process. You can't just switch from the systemic steroid, to no steroid, then over to an inhaled steroid without gradually doing a tapering over a many-months time period. A cat takes about 2-3 months to have their body develop a dependence on the things Pred can do to it and for it. For a cat that has used oral Pred for years, you just simply need a very long and gradual reduction of dosing in the hopes that the cat's system can once again take over the "duties" that the Pred was doing for the cat.

Also, about the eating less issues beginning around April, did the vet(s) fully test for: possible diabetes, hyperthyroidism, cushing's disease, or even just GI ulcers? All these can develop from long-term Pred usage.

The vet that took us off of the prednisolone is the specialist. She took in total about 4 weeks - but only because Nutmeg was on a double-dose at the time. She was taking .8cc in the morning with breakfast, and .8cc in the evening with dinner. The tapering/future medication schedule looks like this:

Week 0: .8cc in morning, .8cc in evening.
Week 1: Reduce morning to .4cc. Keep evening at .8cc. Begin appetite stimulant dosage of 1/4 pill every 72 hours.
Week 2: No morning dose. Keep evening dose at .8cc.
Week 3: Evening dose is .4cc
Week 4: No dose at all
Day 1 of week 5: Liver test (this past Monday). Begin Meloxicam at .7cc
Day 2 of week 5: reduce Meloxicam to .35 and continue for 6 more days. Theoretically should not need the appetite stimulant, but continue dosage if necessary.
Week 6: (next week) No meds, unless appetite stimulant is necessary.
Week 7: If inhaler has arrived, begin with AeroKat chamber, 1 puff, twice a day.

The Meloxicam is meant to be a "holdover" until the inhaler arrives.

As for my vet, we ran a senior profile, chem 27 with SDMA, T4, IDEXX CBC, and a urinalisys. Her glucose is smack-dab in the middle, so no diabetes, and no hyperthyroidism. She didn't see anything that would indicate GI ulcers, but DID send us to the specialist for an ultrasound to rule out that (and other concerns). Ultrasound came back clean. I am unsure if we specifically looked for cushings, but I can certainly ask on Monday.

 

[PushPurrCatPaws]

Well, that's good, although 4 weeks is still a short time compared to her four years of being on Pred, in my opinion (but I'm not a vet). I'm not sure if any of her current symptoms might be from not being on Pred at the moment? My cat uses a low morning dose of Pred along with some Flovent/Aerokat once or twice a day, depending on her asthma/allergies. This is the program our vet and I worked out for my cat. (If I ever wean her off the pred fully I think I'd personally do it over 2-5 months, just to be sure.)

 

[Furballsmom]

Hopefully something works!

 

[reishka]

Well, that's good, although 4 weeks is still a short time compared to her four years of being on Pred, in my opinion (but I'm not a vet). I'm not sure if any of her current symptoms might be from not being on Pred at the moment? My cat uses a low morning dose of Pred along with some Flovent/Aerokat once or twice a day, depending on her asthma/allergies. This is the program our vet and I worked out for my cat. (If I ever wean her off the pred fully I think I'd personally do it over 2-5 months, just to be sure.)

The quick weaning and suddenly changing of her meds by the specialist is one of the reasons I feel like this whole thing is crazy. While on the prednisolone, she was at least eating SOME, even if it was reduced. She didn't have entire days where she refused to eat, like she does now. That, combined with the specialist saying we shouldn't need the appetite stimulant while on the Meloxicam, and we've needed it twice so far because she literally did not eat anything the entire day makes me very unsure about the whole thing. I think I can understand the reason from switching from the prednisolone to the inhaler ("The prednisolone may have affected her ability to smell and taste, so she simply isn't interested in food"), but everything just seems so quick and she seems SO miserable in the meantime. She's never had her cheeks puff out when breathing, and she's never sounded so wheezy, even on her worst days.

I'm definitely calling my vet on Monday and seeing if she wants me to continue with the specialist's plan, or if we want to modify it or do something else. I trust my vet more than I trust this specialist (she seemed to get pretty annoyed with all my questions...). Thank you for affirming that this feels a little too quick (even if that wasn't your intent)

 

[PushPurrCatPaws]

I need a sanity check. My vet's office has no available appointments today, my long-term usual vet is out until Monday, and the specialist we're seeing is ONLY in on Mondays (and I'm not sure I trust her).

We have a senior-ish kitty, named Nutmeg, who has been with us for about 4 or 5 years.
... My vet's office has no Saturday appointments available. I need a sanity check. Something in my brain is saying that this entire situation is crazy, and I feel like I'm sitting here with a cat that is worse off than when I originally took her to the vet in the first place. I love my personal vet and I trust her judgment, but I don't know this specialist. I'm trying to emotionally detach from the situation and look at it logically, but I'm finding it very difficult when Nutmeg is wheezing, having to be force-fed pills (which no one enjoys), on a medication that has severe warnings, and having to wait 2 - 3 weeks for yet another medication to arrive...

So please, anyone with chronic rhinitis/sinusitis cats, share your experiences. Maybe I am crazy, maybe I'm not. I just need to hear something that isn't my own echo chamber anxious brain.

Monday is a bit far away when a kitty is not eating well, for sure. Can you at least email or call the vet's office and have the receptionist or vet tech make sure that your regular vet can call you back at the end of the day today, when the vet's appointments are done with? To check up on anything you can do for Nutmeg for the weekend? You are Nutmeg's advocate, and your thoughts and feelings about how she is doing are IMPORTANT, and maybe discussing whether the meloxicam is working as it should or not, or even if Nutmeg might do well to be on a teensy dose of oral Pred until the inhaled steroid can come, could be options? (My cat does not do well on just inhaled steroids; what works for her is smaller bits of both types... I don't know if your cat will do well on just the inhaled steroid either, although most cats with asthma do fine using only Flovent. It takes some time to train the cat to use the Aerokat in any case, and it can be stressful on both you and the cat. You may have some months or weeks ahead of you where your cat needs steroids and isn't getting an adequate dose? You could consult the vet over the phone until Monday's appointment? I don't know -- just trying to help!)

 

[PushPurrCatPaws]

The quick weaning and suddenly changing of her meds by the specialist is one of the reasons I feel like this whole thing is crazy. ... I think I can understand the reason from switching from the prednisolone to the inhaler ("The prednisolone may have affected her ability to smell and taste, so she simply isn't interested in food"), ...

Personally, my experience with my cat's reactions to the inhaler is that it is the inhaler version that actually upsets her nose, upper GI and tummy more. The inhaled steroid really gets into the mucous membranes in the mouth, throat and nose. On the days when Milly needs two doses of Flovent, she is often fussier with her food, like she feels nauseated.

 

[reishka]

Remember how I said I love my vet? My vet's office called her, and she called me. She's writing me an rx for the inhaler I can get at a local pharm until the Canadian one comes in, and we're going off of the Meloxicam as it doesn't seem to be helping. She isn't super thrilled about how quickly the specialist took her off of the pred, either. There's also the possibility of doing a sub-dermal appetite stimulant so we don't have to keep repeating the stressful pilling, but that won't be in until Monday.

I'm about to go jump in my car and pick up the rx.

 

[Furballsmom]

wow, good on you and your vet!!

 

[PushPurrCatPaws]

Are you in the US? Prepared to fork over $$$ when you don't go the 'Canadian pharmacy route'.

I used a Canadian online pharmacy for a while, but didn't like the inconsistency of some of the Flixotide inhalers I was getting from Turkey (long story). So I decided earlier this year to just fork over the big bucks and get the actual Flovent HFA 110mcg at my local pharmacy (on west coast, USA). They should really lower the price of the drug; it's ridiculous.

Good vibes for you and Nutmeg this weekend!

 

[Furballsmom]

They should really lower the price of the drug; it's ridiculous.

yes it is!!

 

[PushPurrCatPaws]

reishka -
This thread might help, and other threads, too, if you search TCS here...

Inhaler Asthma - Difficulties! Advice Please

 

[reishka]

Monday is a bit far away when a kitty is not eating well, for sure. Can you at least... I don't know -- just trying to help!)

Now that I've talked with my vet I feel a little less spiraling-out-of-control. There were things she liked and things she didn't, but she at least feels that the inhaler is worth a shot, but waiting so long for it to arrive isn't in Nutmeg's best interest, so we're now armed with an inhaler, an AeroKat, and some new food. I think I will return to my regular vet instead of the specialist, unless my regular vet pushes for me to stick with the specialist.

Personally, my experience with my cat's reactions to the inhaler is that it is the inhaler version that actually upsets her nose, upper GI and tummy more. The inhaled steroid really gets into the mucous membranes in the mouth, throat and nose. On the days when Milly needs two doses of Flovent, she is often fussier with her food, like she feels nauseated.

This is definitely something I will keep and mind as we start the treatment. I have a book where I record what times Nutmeg eats, how much, how she seems to be feeling that day, etc, so I will make sure to monitor and make note of any adverse reactions and take it up with my vet.

Are you in the US? Prepared to fork over $$$ when you don't go the 'Canadian pharmacy route'.

I used a Canadian online pharmacy for a while, but didn't like the inconsistency of some of the Flixotide inhalers I was getting from Turkey (long story). So I decided earlier this year to just fork over the big bucks and get the actual Flovent HFA 110mcg at my local pharmacy (on west coast, USA). They should really lower the price of the drug; it's ridiculous.

Good vibes for you and Nutmeg this weekend!

Thank you! Yes, I was aware of the cost -- it was one of the reasons that the specialist told us to order from an online Canadian pharmacy - it is 55$ through the Canadian place, and $280 through the pharmacy I just went to. Luckily we have some spare cash in reserve for things like this (having two special needs kitties means I always keep at least a couple hundred in reserve, just for them, just in case). I'm not thrilled about the cost, but it is thankfully something we can afford.

reishka -
This thread might help, and other threads, too, if you search TCS here...

Inhaler Asthma - Difficulties! Advice Please

Thank you for the link! I'm going to read this next!

 

[cheeser]

I'm so sorry poor Nutmeg isn't feeling well. But I'm glad you were able to get in contact with your regular vet and work something out.

One of our cats has chronic sinus problems that can't be fixed, so I understand all too well how heartbreaking and frustrating it can be when you feel so helpless. *hugs you tight*

Have you tried feeding Nutmeg with a spoon, or out of an elevated dish? When Buddy's sinuses are giving him fits, he seems to eat better if he doesn't have to lower his head. And sometimes thinning his food down a bit with broth seems to help.

I hope Nutmeg is feeling better soon, and please keep us posted re: her progress!

 

[reishka]

1-week update!

OK, so last Saturday my vet decided on a few changes:

• No more metacam (she was really pissed Nutmeg was on it)
• An rx that day for an inhaler
  
• A version of mirtazapine that can be rubbed on the pinna of her ear, instead of by pill

After a week of using the inhaler, she is less wheezy than she was last weekend. She also has much less mucous buildup, and is sneezing less (although this could be attributed to the metacam still being in her system). She has not vomited. We don't see her cheeks puffing out when breathing.

Giving her the inhaler is easier than pilling. We wrap her in a kitty purrito and gently keep the AeroKat to her face using the smallest mask. She seems to tolerate between 10 and 20 breaths, though around 13 - 15 she will get squirrly and pull her head back. If we're lucky we can get a few more breaths after that. We aim to feed her 15 minutes after using the inhaler.

Her appetite is not normal (and I wasn't expecting it to be so quickly). The transdermal mirtazapine is recommended on a daily dose instead of every 72 hours - but we've only applied this once, on Wednesday. The recommendation is to only give her the mirtazapine if she goes 24 hours without eating. Saturday she ate nearly 4 ounces of food, which is the most she has eaten in a day in weeks. We're trying many different foods, adding in kitty-safe chicken broth, a nutrition booster, and L-lysene powder. We don't have enough data to see which foods she likes over others.

As long as there are no continuing adverse effects, we will be making a followup appointment in about 2 months with the specialist to review her progress.

 

[Furballsmom]

Her appetite is not normal (and I wasn't expecting it to be so quickly).

wow, this and everything, oh my gracious, good for you and Nutmeg!!