Worms + Feline Herpes + Chronic Cough + worse after deworming = ??

[martymcjackson]

I'm very concerned about my little recovering-feral kitty (Jackson), and I would appreciate any thoughts from those who have successfully navigated a similar situation!  My little guy is about 10 months old and has been strictly living inside for about 4 months now.  He is gradually becoming more social and allows petting, but will not allow us to pick him up.  He also is totally onto us about his trap that we used for his TNR & subsequent vet visits back when he was still outside living the feral life, so it is virtually impossible at this time to get him into a carrier or trap to facilitate a vet visit.  (He will only enter the trap when both ends are open...as soon as one end is closed, he stays far away, even though we are now keeping it permanently behind the living room couch, covered and lined with blankets, hoping to entice him into seeing it as a nice place to sleep.)

Okay, so he hasn't been to the vet since July (the month before he came inside to live, and the last time we were able to trap him), and at that time they diagnosed him with intestinal worms, probable lungworms, and probable Feline Herpes.  He received a shot of Ivermectin (sp?) for the lungworms, two rounds of Panacur for the intestinal worms, and we have been giving him 500-1000mg of Lysine powder daily for the Herpes.  He seemed to be doing better over the past several months, but over the past several weeks we noticed his occasional cough becoming more frequent and his appetite becoming truly voracious, until... one night a few weeks ago the cough finally culminated in vomiting out a sizable quantity of adult roundworms.  So... we called the vet, who recommended two more rounds of Panacur... caveat being that we can't get a current weight on the cat (although I suspect he is about 11 lbs), so the vet gave us the dosage for 1-10 lbs.  He seemed to feel better for the three days he was taking the Panacur... his desperate appetite settled down and his cough slowed down a little.  But now in the week that has followed, his cough has become more frequent than ever, and he is back to having brownish-red eye discharge like he used to get when he lived outdoors (and which the vet felt was due to the Herpes).

If this was any other cat I've ever had, he would be going to the vet post-haste.  But this cat I can't get to the vet... at least not yet (we're working on it).  Plus, even if we could get him there, they have to fully anesthetize him in order to even examine him, which of course carries its own dangers.  So I guess I'm just wondering if anyone else has had something like this happen, with a cat getting sicker after being wormed?  Is it possible that the chemical load of the Panacur stressed his system and caused a Herpes flare-up?  I know the cough may also be related to the worms not having been treated successfully, especially since his cough always ends in kind of a choking/gagging where it is clear that he is trying to expel either worms or mucus (or both).  I know it is also possible that he may have asthma, or even pneumonia.  I am just concerned and confused about how to best care for my little guy in light of all the challenges.  He is due to start another round of Panacur this weekend, and I feel so hesitant b/c I'm not sure if that medication is just too hard on his system.  I am going to call the vet in the morning, but I also wanted to run this by folks here, in case anyone has some insights from their own experiences.

Also, he has been on a grain-free Wellness + Halo diet for several months now, and had been doing very well on it... I think he still is doing well on it, actually.  No problems with diarrhea through any of these worm issues, which seems kind of amazing.  So that's the one good thing he has going for his poor little health!

Thank you!   [emoji]9829[/emoji]

 

[sillywabbit]

Hi, I faced a similar problem. It's been almost a year so I hope I remember right.
My kitten had to go through a 2nd round of worming after i found worms in his poop. He also had a uri at the time. I remember him being pretty sick and yep, I ended up bringing him in for a 2nd round of antibiotics about 2 weeks after the 2nd deworming. If I remember right, the vet tech said that was kinda normal. What I don't remember is the "why" but I think it had to do with the body dealing with (eek) the dead worms inside. But he was on antibiotics for around 2-3 weeks after the second deworming.

You also should realize that with a heavy worm/egg load that even a 2nd round of meds msy not do the trick or so I was told at the time. Something about the lungs not being able to kill the eggs or something ? You might want to ask the vet about that. And ask how or if he could have reinfected himself.

Can the vet visit? Is there a humane organization around that can help defray your expense? I sure can relate, that's for sure. Why can't the vet give you a short term meds to kinda knock your kitten out just enough to get him in a carrier?

And...I really want to be positive for your sweet lil fur ball but has the vet ruled out heartworm...?

I wish you the best, I really do.

 

[mrsgreenjeens]

Boy, that is  a tough one, when they cannot be handled yet.  Working with the Vet via phone is the only thing I know of, which you are already doing.  I'll see if @catwoman707 might have some suggestions.  She's pretty good at this sort of thing.

 

[catwoman707]

Thanks mrsgreenjeens! I will try my best.

MartyMcJackson, you mention probable lungworm, probable herpes. I can understand the herpes part but can you tell me whay the vet thinks lungworm? Did he test his poop for eggs? Or do a cbc? Or a tracheal wash to test the lung fluid from his throat?

It's the cough that is the main concern here, the herpesvirus we will get to once we distinguish the worms issue.

I need you to describe in fine detail what the worm(s) looked like that he vomited.

The thing is, I hate to say this but it sounds like you are still dealing with both types of worms still present.

If the vomited worms looked like thin spaghetti sort of, that is roundworms.  A cat (usually a young/teenaged cat who was untreated as a small kitten who was flea infested but managed to survive despite anemia)  who has them really badly will take several attempts to be completely rid of them. This is where rescue peeps like myself actually know alot more that the vets do since most common house cats they see regularly will never get worms as badly as a feral cat will, and that it does infact take repeated dosing to cure.

I don't believe that lungworms can be vomited up. However, they will surely cause a cough, The coughing is caused by the worm larvae that are laid in the airway, which in turn causes difficulty breathing and mucus accumulation. If left untreated, complications in the damaged airways can lead to more serious problems such as emphysema, fluid build-up in the lungs, and even pneumonia.

I doubt very much it is that far though, if he really does have lungworm. The cough does sound as the vet's suspicions are likely correct.

You would certainly know if he were to get pneummonia, but let's not go there since we will get him well before that happens.

Anyway, if I know what made the vet suspect lungworm, it will be helpful.

Roundworms don't usually cause diarrhea, they can but it's usually parasitic that causes that.

The panacur will not cause stress to his system, the worms will though. It is irritating and uncomfortable for it to cause wheezing/coughing/choking on mucous.

It's also unhealthy and will wear on his system.

The stress of the worms will cause the herpevirus to surface though. Most definitely.

If he had herpevirus (upper respiratory infection with eyes relations) as a kitten, he has a pretty healthy immune system for him to overcome the cold symptoms without help from antibiotics.

The eyes can be treated with terramycin ointment, as well as Idoxuridine, which not all vets carry, but some do, and it is pure liquid gold for a cat with bad herpes eyes, but the brown/red discharge would be in a much milder case of the virus.

The Ivermectin is an actual pesticide, used for earmites, lice, etc. and it sounds that he will need another, possibly a larger dose. Vets tend to dose this cautiously, with good reason. It is however quite effective.

I have one vet who will see ferals for me, and he gives me a pill that I can give the feral cat before the appt, and they get very drowsey, so we are able to handle them easily, like it or not! It reminds me of Lucy Lu, a very feral tortie girl who I took to the vet after dosing her and held her face in my hands, kissed her face, opened her mouth and examine her teeth, etc and remember the look in her eyes.... She had no choice and I loved being able to maul her...that is until it wore off at home

Okay, I will be watching for your reply to continue.

 

[martymcjackson]

Gosh, thank you so much for taking the time to reply so thoughtfully.  Much appreciated!

The first and only vet who first saw him (and who has since moved out of state, leaving us with a different doctor at the same clinic to deal with by phone... another unfortunate caveat here) wasn't 100% about the lungworm diagnosis.  His lungs were noisy upon examination back in July (which had to be done under full sedation with ketamine), and the vet was aware of other local lungworm cases due to snails/slugs being plentiful in our area.  So she gave him a shot of Ivermectin for lungworm just to be safe, and also a shot of an antibiotic in case it was a bacterial infection.  (His cough did quiet down for several months after that, before roaring back with a vengeance over these past several weeks.)  We had also spotted a roundworm that had made its way out of his rectum back in July while he was still an outdoor cat, so he had his first rounds of Panacur at that time.  The vet had also said it was very possible for roundworms to migrate to the lungs.

We had hoped his worm ordeal was over, but then one of his coughing spells a few weeks ago culminated in the vomiting of roundworms - no doubt in my mind they were roundworms, as they were spaghetti-like and easy to identify.  I'm just not clear if they were ejected from his belly, or from his lungs.  Do you know if it is even possible for a cat to eject roundworms from the lungs in that way?

Now the million dollar question: How on earth were you able to get a sedative pill into a feral cat?!  Our boy will isolate and spit out any pill hidden in his food, and he will reject food that has a pill crushed up in it.  (He'll take the Lysine powder, but only b/c it's fish-flavored... and the Panacur powder only because it is apparently palatable to dogs and cats.)  He will allow me to pet him when he's in the right mood, but touching his face in any way other than gentle petting (for example, my sly attempt earlier tonight to wipe his eye drainage with a cleverly-concealed, damp cotton pad) results in him freaking out and smacking me with claws out.  He is fast fast FAST about it, and he means business.  So... I don't see getting a pill into him, sadly.  Maybe someday, but not quite yet.

I sent an email to the vet's office tonight updating them on his status and asking them if they think the need is starting to outweigh the risk in terms of trapping/anesthetizing him in order to have him examined.  They will probably err on the side of caution to cover themselves for liability, but honestly I am still on the fence b/c it is just so so so traumatic for him, and the risks w/ the ketamine are looming large in my mind.  Do you have a gut instinct of what you would do if this was your cat?

 

[martymcjackson]

PS - We did have fecal testing done after the first round of Panacur in July, and it was negative for worms at that time.  However, I have since learned that fecal testing can't necessarily be trusted as a diagnostic tool, b/c of the life cycles of various worms sometimes causing a false-negative.  Clearly that's what happened with our little guy... we thought the worms were gone, but not so much. 

 

[catwoman707]

What my gut instinct is telling me....(although with your statement about there being some other local lungworm infections it makes me question my gut a bit, but I still tend to think this...)  is that he is overcome with roundworms.

This is how they work-the cat ingests the larvae by either eating a rodent, bird, even water that has larvae, the larvae go to their stomach and develop into eggs, which then travel to the liver, muscle tissue and lungs. The eggs in the lungs will be coughed into the throat, then swallowed, going back into the stomach, where they hatch, mate, and so it goes on again.

Back in July, if you saw a roundworm coming out of his butt, he was INFESTED with them throughout his body.

It takes ALOT of internal worms for a cat to get to the point of actually vomiting them and having any coming out of his back end too.

So, he was treated with panacur, which only kills the adult worms, and I think he was given 2 rounds correct?

This is good, but not nearly enough in a bad infestation as his.

I had one teenaged little girl once who I had to repeat treatment 6 times...yes 6, to finally get her completely rid of them. I would treat her, she would be fine, by the time she was due for the next treatment, 2 weeks later, she was vomiting them again! I couldn't believe how many she had. Poor thing. Don't panic on the number 6, because I had no idea the first couple of treatments that she needed anything different than my standard protocol of deworming kittens, which is 2 treatments, 2 weeks apart. But since she was infested, after the second dose she started vomiting them after about 4 weeks or so, then I began the next 4 treatments, so.....

If you think about it, his initial treatments of the antibiotic shot as well as the ivermectin, he was good for months yes? Which clearly tells me he was getting the correct treatment, but needed additional ones, but now you are back to square one because they have fully infested him once again, as seen in his vomit.

There is only one med that does not need repeating (supposedly) and that is Emodepside ( in Profender) but not all vets use this. (it should be repeated after 3 weeks though) This is a topical which would be so much easier for you, plus I should add that while the majority/most cats do just fine, there have been a few reports that profender may have caused side effects/reactions. Many reported foaming at the mouth, but I know the foaming is due to a cat's sensitive noses and the smell can cause like almost a taste of the med. The foaming is harmless.

So you might want to talk to your vet about this product.

I don't think his panacur dose is large enough. I think it needs to be increased to adult cats over 10 lbs. He was given the dose equal for a small kitten, and he is alot bigger with a bad infestation, so ask about this please.

I also want to mention this, I am only wanting to put all of the facts that I am aware of out there for you, but there is also evidence (although VERY rare) that in badly infested cats you do not want to kill too many roundworms all at once because it can potentially cause a heart blockage. I have found no sure evidence of this however it's something you should be aware of, surely the vet knows this too if it is infact a real consideration for his treatment.

As for pilling the feral I was telling you about? She was in a cage so she could be cornered, and I used elbow high leather gloves If you were to attempt this you would want to protect your arms with sweatshirts, probably 2 of them and some thicker gloves. The cage definitely gave me the advantage over her, I could have never done that if she were free as it means he would not believe he was unable to 'get out of the situation' basically, and you would have a wild maniac shredding you in pieces! lol~

That is why I wanted to mention the profender med, it is put on like flea med topicals are, which you can do at home.

It's not the panacur that will cause his ill behavior it is the worms. Panacur is pretty well tolerated, and especially his dose which is on the lower end.

Let me know

 

[catwoman707]

P.S. I strongly believe the panacur dose needs to be higher, I just re-read what you said about his last round of it, and it hardly touched the worm problem.....

Panacur is a great wormer med but of course needs to be given in the correct dosage for your cats weight.

Also wanted to mention in case you do infact need to get him in a carrier again.

Oh also, unless the trap has been sprayed down with a household cleaner then rinsed off well, it will hold the smell of fera from him being in it prior, so you want to get that smell of of it or he will never forget how scared he was when trapped before.

You can have a larger sized carrier sitting out somewhere, door wide open. Bait it with something he loves, tuna is great, and set it inside. Do not close the door, allow him to eat the tuna with no probs. After this is done a couple times he won't feel any threat to go in.

So if you need him inside for a vet visit, rig a string to the door, set the carrier next to a wall so the door doesn't open further out than lined up to the carrier, run the string through the carrier to the back of it, so that once inside you can pull the string and will have more leverage to keep enough pressure on the door that he is unable to push it back open. (this is why you would run it through to the back rather than not or he can just push his way out the door.)

Also do you know how to fully scruff a cat? You can get a good scruff with your entire hand, the larger the amount of fur/skin you get ahold of, the more he will be forced to submit. However your scruffing doesn't mean you can safely lift him off the floor without help because his claws can still and will get you. The back ones are worse than anything since they have so much force/strength.

If you ever do need to scruff, be sitting on the floor and petting him, then grab a large amount of the back of his neck and immediately push down, this will pin him to the floor. Then another person can come and cover all around with a large thick towel, so as he is gradually lifted they can quickly wrap his legs and entire body. Be SURE your arms are well protected!

You will have to be pretty aggressive with this, not sure if you have it in you to do but if so, this is how to scruff a feral who allows petting.

It's okay if you don't, most people unless they have been forced to learn this prefer NOT to try!

A vet will also do house calls and bring an assistant when seeing feral cats.

 

[martymcjackson]

Thank you again for all of this, @catwoman707!  Your experience and insights about dealing with ferals is invaluable!

We had been thinking about trying Profender even prior to starting this thread, so now with your mention of it and with the vet's approval, we will go forward w/ this instead of continuing the Panacur.  If he is still having evidence of worms and/or no improvement in respiratory symptoms after two rounds, we will either trap him and take him in for a vet visit, or find a vet who is willing to come to our home.  Does this sound like a good plan?

I had to chuckle at your "tie a string to the door and pull from across the room" method of securing the cat in a carrier... that is a most excellent idea that I may just have to try with him!  He has been warming up to his trap (brand new, never used... we had used borrowed ones from a local rescue for previous trappings) that we are keeping behind the couch (with both ends tied open) as a little blanket-lined, blanket-covered cozy cave... I have caught him sleeping in there several times over the past week.  So hopefully by the time we would need to take him in to the vet, he will be willing to start going into the trap with one side closed.  He is so smart and has a very good memory about how one closed end of the trap eventually leads to two closed ends... lol... we will work on it. 

Thank you also for the advice on scruffing as a two-person effort; that advice may come in very handy at some point in the future!  The only time I've scruffed him was when he was about six months old... it was the day he "accidentally" came inside and ended up staying forever.  I had accidentally dosed him with an old tube of canine flea medicine left over from our deceased dog (which my partner had kept for sentimental reasons, unbeknownst to me) when he was still living outside, so when I realized what I was doing (i.e., 'wait a minute... this tube seems a lot bigger than the last one'), we lured him inside to keep an eye on him... where he proceeded to freak out and jump up onto the kitchen counter, where he cowered and hissed for hours, and refused to come down.  Over a period of hours I worked with him, starting with fastening a wet, soapy paper towel onto a wooden spoon to scrub some of the medicine off his neck, and ending with me eventually being able to pet his head, and then reach around to scruff him and pull him down off the counter.  He promptly ran into the living room and hid under a chair for two days, then he came out and never looked back, and has been our inside boy ever since.  He only cried for outside for the first week... now he doesn't even seem interested in going outside... preferring to watch the world outside from his cat tree by the front window. 

It is so sweet to see him slowly warming up to us over these past several months, and we would do anything for him.  He found his way to the right home, and we love him dearly.

Thank you again for all your great info and insights... you have helped to ease my mind and make our care decisions a little easier!

 

[martymcjackson]

PS - the vet also mentioned following up with Revolution as a monthly maintenance treatment and to prevent further problems.  What do you think about that?  I have hesitations about dosing him long-term with anything unless it's absolutely necessary... especially since he doesn't go outside at all anymore.

 

[catwoman707]

Sounds like an excellent plan, I feel pretty confident this will get rid of the worms completely, you will notice his breathing is better, going back to normal, no more coughing, no more ravenous appetite!

He surely needs 2 rounds though, and for his weight.

This takes care of the 'how in the world will you get him into a carrier' problem too!

I also think the revolution is a perfect way to follow up, just to be sure......it would be tragic if there were one tiny little bit of larvae or egg that remained, and in a couple months time to be right back where you are now.Because they have a way of encrypting themselves away and lying dormant, so we want them to be gone forever!

He will be so much happier! You too

I'm so glad I was able to help, please let me know how things are going soon, I will be wondering how it turned out.

Thanks for having such a kind heart and caring for this boy, I love that he is so loved

 

[martymcjackson]

Thanks again.  How long do you think would be an appropriate duration to follow up monthly with the Revolution?  3 months of treatment?  Longer?

 

[catwoman707]

I would say 3 months is fine.

However he can always become re-infested if he is not flea protected. This is the most common way for a cat to get roundworms.

You haven't mentioned whether you have any other pets, so if not then your home should be fairly flea-free for the most part, but even indoor only cats will manage to get fleas as they get inside somehow or another and will find your pet, especially during the colder winter months, or the hotter summer months.

This is your choice to regularly flea treat him or not, but if you decide to do so, I would not continue with revolution after the 3 months, but rather advantage 11, my fave for flea control.

 

[martymcjackson]

@catwoman707, thank you again for all the good info and support.  We finally received the Profender today and managed to apply it successfully.  Is there a way to tell if this medication is working properly?  We had another stool test done after that recent round of Panacur, and again (just like in the summer, after the first round of Panacur) no evidence of infestation could be seen in his stool.  I am not sure whether to think that the vet we are using isn't doing the test properly, or just that we have submitted stool samples twice at just the precise time in the life cycle of the worms in which no eggs would be passing through the stool (??).  In any case... by  now we don't trust the stool testing to be a reliable tool in keeping accurate tabs on his worm situation.  I imagine we want to look for his bloated belly shrinking down in size, his cough subsiding, and ideally we'd like to see dead worms in his stool to reassure us that the med is working.  Other thoughts/advice w/ this?  Thanks again!  [emoji]9829[/emoji]

 

[catwoman707]

You're so welcome, I am glad I was able to help!

I'm not sure whether we already discussed re-treatment with the Profender, I believe so but wanted to be sure. He really needs to be re-treated again at least once 30 days after today, then with Revolution every 30 days for a minimum of 3 months, then of course on to Advantage 11, which is my recommendation for constant and effective flea control, which means worm control as well.

Plus him being indoors only greatly reduces any chance of him becoming reifested.

I was researching Profender a bit more and was suprised to read that successful treatment in kittens required Profender monthly for 6 months. I think this may be because the dose is quite small and may not hit a kitten enough to ensure full treatment of worms. Smaller dose for safety reasons.

Regular/standard worm treatment/control of worms by using profender in adults is every 3 months, but in your kitty's case it needs a repeated treatment in 30 days for sure.

By now your vet surely understands the significant infestation you are dealing with so I am certain he/she will do a follow-up treatment of the Profender.

Yes, what you should see is a reduced tummy, his appetite becoming less ravenous and more normal, the coughing should eventually stop altogether, and you may see worms in his feces, not always but may.

As for the stool testing. This is a fecal float, a solution is added that will cause any loose eggs to float on top. The fact that both times he was tested after the panacur treatment tells me why nothing shows up. The panacur is unable to get rid of all of the larvae/eggs that are deep and dormant, they then are able to mature and develop, which means adult worms once again.

This is why it is absolutely essential he gets retreated in 30 days. I'm almost tempted to say retreated twice, but not so sure about this, if your vet feels it may be needed then I would def. go for that.

I will be watching this thread for an update!!

 

[martymcjackson]

@catwoman707 ~

Okay, it has been just over 3 weeks since the first dose of Profender and here's where things stand:

* His cough improved dramatically over the first week, but he has since started to lose ground, with cough becoming more frequent again (though still not as bad as before)

* His upper respiratory symptoms and discolored eye discharge followed the same trajectory, getting very noticeably better in the first week and then going downhill again.

* He was far less "mucus-y" for the first week, but now is snorting again.

* Same thing with his appetite - less ravenous at first, but now back to constant begging.

* His bloating only improved a tiny bit, and by now he is looking more bloated than ever.

* His stools never changed - they have always been solid, no diarrhea, and this remained consistent.  No worms appeared in his feces.

* I've been noticing that his gums look more pale, which can be a symptom of parasites, yes?

* His fur still looks good, fairly shiny - no changes.

Since it does seem like he is losing ground, do you think it would be okay to give the second round of Profender now, at just over 3 weeks vs waiting a full month?

Thank you again!

 

[catwoman707]

Absolutely, and I actually am thinking that, with your vet's approval of course, that if it is completely safe, he be given it in intervals of not over 2 weeks.

I say this because it clearly is working but quickly becomes overwhelmed again, they are allowed to grow too long to get a handle on it.

All I know of profender dosing is that it is normally repeated when needed after a month.

Is your vet clearly aware of what has happened since his last dose? If not you should call and get a msg to her that it is important you two speak asap, so as to not allow them to reproduce any longer than possible.

Can you tell how soon after the dose that his symptoms returned?

 

[catwoman707]

I found a very informative site about profender and it's studies, whether every 2 weeks is well tolerated.

Very good info- http://www.drugs.com/vet/profender-topical-parasiticide-for-small-cats-can.html

It appears that profender is safe when given at 2 week intervals, which is what I believe your cat will need to get well.

Take a few minutes to carefully read over this info, and talk to your vet about this as well.

Not all vets are educated on profender beyond the standard redosing at 4 week intervals, so be sure and ask her feelings about treating him every 2 weeks.

In one study it was given to kittens at large overdosed amts, repeatedly and it is felt safe when given every 2 weeks.

It's looking like the only solution, constant and repeated doses, the appropriate dose for your cat's weight, every 14 days for possibly even 6 times.

I have a feeling they are really bad in his system. The reduced symptoms shortly after dosing is a tell-all. They keep growing back and taking over though, a month in between doesn't seem to be enough to get rid of them.

 

[martymcjackson]

Thank you so much.  We will definitely talk with the vet today, but... she seemed to only be willing to dose him more frequently with Panacur (vs Profender, as she normally doesn't use it) and only if his stool tested positive, which it never does.

. . . sigh . . . 

Do you have experience using dichotomous earth for parasites?  I am not a huge fan of the stuff, but that might be the one option for us to treat him without a vet's cooperation and without an Rx.  I know the only acknowledged danger w/ dichotomous earth is if it is inhaled, it can cause lung irritation.  But I find it hard to believe that it wouldn't also cause microscopic damage to the GI tract of an animal, and can that possibly be a good thing?

 

[catwoman707]

Diatomaceous earth in my opinion is not going to cut it with your kitty.

I am def. concerned that your kitty having such a heavy infestation may start causing health issues, some can even be irreversible, such as worms eating the tissue in his lungs.

Do you feel that your vet understands the extent of the problem, and is taking his condition as seriously as it needs to be?  Has a vigilant treatment course planned and is concerned that he only temporarily responds to the treatments?

I am hoping that at this point now, she will clearly see the picture, it is bad and needs to be addressed and handled NOW.

He has had a few different treatments, they have only been able to help temporarily, because his infestation is an exception to the norm, or average, and is not being treated as vigilantly as he needs.

I think it's important to be a bit more firm with her, get her to really listen, that it is not cutting it, if she isn't comfortable repeating profender every 2 weeks, then move on to what she is okay with, because if not, the result can and will eventually hurt your cat, and that is just plain wrong and unnecessary. His suffering is also not necessary. He needs repeated treatment a MINIMUM of 2 weeks apart, or they will continue to take over his body. Coughing is a sure sign of a heavily infested cat, and is also a trigger saying, this cat needs much more treating than the norm.

It may very well be she is not experienced with heavily infested cats, and it sounds to me more and more that this is the case.

It's not a personally insult on her, I'm sure she is a fine vet. But this said, it doesn't mean that she 'gets' the seriousness of an infestation to this extent. Which is why she is still erring on the cautious side.

He needs constant attention to this, perhaps it's not a bad idea to get a second opinion due to this issue going on and on, not to mention the cost........I'm sure anyway.....

I wonder if there is a way to get her to order the profender for you, let her know that you plan to dose him every 2 weeks as your decision, but that you really need her onboard with this as well. Perhaps she could ask other vets their views/opinions as well, to convince her it is critically needed. Someone else may have dealt with something like this before, and will help her to feel okay with the decision to dose every 2 weeks.

Or if a different vet would agree and help with this. I am not advising you do this without a vet's knowledge, and it would be best if a vet would agree and work with doing this, rather than your current vet not agreeing. That said, only if you believe this is what is needed too, and you are comfortable with it.

His symptoms alone, and the time frame make it quite clear, it works for the adults, at least some or alot of them, but without a repeat as soon as it's needed for new grown worms, BEFORE they lay too many more eggs, which is not more than 2 weeks later, and treatment repeated every 2 weeks, over and over until finally, the last dose will be given when there are no more signs of worms at all.

This will cover the very last remaining eggs that may be dormant.

Geez, this makes me worry about him!!