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Dr. Barbara
Dr. Barbara, Cat Veterinarian
Category: Cat
Satisfied Customers: 1614
Experience:  Over 30 years experience in veterinary medicine and surgery.
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Hello, my 9 year old cat was diagnosed with

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Hello, my 9 year old cat was diagnosed with severe gastro-inflammatory disease & anaemia which was managed and, it would seem, cured. Innoculations were due but not yet done, the vet though she should wait until better to inoculate her. She has now been diagnosed with Pneumonia which was helped with a course of Veraflox. The coughing all but stopped. However, the Veraflox is now finished but she started having severe coughing spasms again - once or twice a day now with noises of fluid as she coughs. Does she need more veraflox or other medication? We are very worried still & the insurance money has all gone. I would so much appreciate your help, best regards, ***** *****

Submitted: 2 years ago.
Category: Cat
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Customer: replied 2 years ago.

I would like an answer, especially as I have been charged £16 for it.

Debbie

Expert:  Dr. Barbara replied 2 years ago.
Hi Debbie,
My name is ***** ***** I'm a licensed veterinarian with over 30 years experience in general veterinary surgery and medicine.
I'm so sorry to hear that Sindy has been so ill.
Please bear with me, as I have a few questions about Sindy to more accurately help you.
Did Sindy's blood tests show any abnormalities other than anemia? Do you know how anemic she was/is? Did you vet tell you the cause of her anemia?
Was Sindy diagnosed with pneumonia based upon a chest xray? If so, in this xray did her heart look normal? Has your vet mentioned hearing any heart murmurs or arrhythmias.
For how long was Sindy on the Veraflox? Is she currently on any medications?
Thanks in advance for your answers!
Dr. Barbara
Dr. Barbara, Cat Veterinarian
Category: Cat
Satisfied Customers: 1614
Experience: Over 30 years experience in veterinary medicine and surgery.
Dr. Barbara and 2 other Cat Specialists are ready to help you
Customer: replied 2 years ago.

Firstly I would like to apologise profusely for my negative feedback, as I couldn't locate an answer anywhere, & there are so many spoof sites about. I realise now I was mistaken & realise I was too hasty, sorry.

Thankyou, Dr. Barbara for your kind thoughts. My vet said originally her immune system went haywire & they had to suppress it, giving steroids. Also Synolux for severe gastric inflammatory disease. The anaemia improved apparently & her white blood count improved. She appears to have got over the inflammatory disease, though & is in good spirits again.

The vet has not mentioned any heart defects.

The pneumonia was diagnosed on chest X ray results.

The first Veraflox course was 5 days, & the coughing spams almost disappeared along with the fluid-like sounds. Then she relapsed & is on a 10 day course of Veraflox now. At the moment she has a bad coughing spasm once or twice a day with noise of fluid - her whole body seems to spasm. Apparently the pneumonia is only on one side now, so there is improvement.

I may be able to email a detailed copy of blood test results, if that would help.

Also she has to go back to vet in a few more days, whereupon I can get the answers you require.

I feel now that your response has given us extra hope & reassurance, thank you so much Dr. Barbara.

Expert:  Dr. Barbara replied 2 years ago.
Thanks so much for your response. . .I can definitely understand your frustration when you didn't get a response. We veterinarians come online at various times, and I did so yesterday and found your question down our list. . .I am sooooooo sorry!
I certainly understand more about Sindy with your response. She probably ended up with the pneumonia since her immune system was at first causing an auto immune anemia, and then suppressed with the necessary steroids. Five days of an antibiotic for pneumonia was probably not adequate especially in an immune suppressed cat. It is really a good sign that she did respond to the Veraflox as this means she is likely on a very effective antibiotic for the bacterial pneumonia that she has/had, but it just was not a long enough course.
If she is symptomatically improving on this second course of Veraflox, then what is needed is just more time. The rule of thumb for antibiotic treatment is to continue it until 3 days after all symptoms have resolved.
I know that coughs in cats are very violent sounding, but as long as her gums and tongue remain pink (and not purple or blue) then she is getting enough oxygen.
Since she has shown improvement on an xray, I doubt that there is any kitty asthma involved here, and this would be my other major concern since her heart is OK.
How long has she been on this round of Veraflox? Is she eating well?
Customer: replied 2 years ago.

Thank you so much for your compassionate response, I understand more about her condition now.

I've found a test results sheet from 26th June inflammatory disease diagnosis, don't know if it will shed any light, briefly:

"elevated white cell count & normal red count. White cell changes suggest inflammation.

Ultrasound showed normal layering of the stomach & small intestine less clear & stomach wall mildly thickened. Abdominal lymph nodes were enlarged. Endoscopy showed thickening & oedema of he stomach wall & presence of food despite starvation. Small intestine lumpy & nodular."

As I said as far as I know she is over the inflammatory disease though,so this may be defunct information. A scan revealed a lump of fat pressing on her stomach apparently.

I assumed the Synolux was for the above conditions.

However, back to the pneumonia I see you say its a good sign she responded to the veraflox.

Sindy has been on this 2nd course for 5 days now. Her gums & tongue are pink & appetite good. We're feeding her those little Gourmet tins, wondered if she should be on any special diet after her tummy problems.

Thank you so much for your valued response,it has put our minds at rest a lot

Expert:  Dr. Barbara replied 2 years ago.
Hi Debbie,
Thanks so much for the info. The great news about the blood counts is that she is no longer anemic. An elevated WBC does indicate inflammation, but of course that can come from anywhere in the body.
Synolux is a potentiated amoxicillin. . .an antibiotic that is used for many infections. Usually IBD in a cat is from a food allergy(or so we think) and this would not address that. . .BUT she did respond to the Synolux (Augmentin in human medicine), so really it is not important at this time to know exactly what happened gastroenterologically.
I am very pleased to hear that Sindy is eating well and that her tongue and gums are nice and pink. . .what a trooper, and it certainly seems that she is on the road to total health again!
Regarding her diet. . .if what she is eating now is a completely nutritious diet (for cats this would be a mostly meat diet with the necessary vitamins and minerals added), and she is not having any diarrhea or vomiting symptoms, then I think her diet is fine. For how long has she been eating these gourmet tins of food? If for a week or longer, then I wouldn't change a thing.
If Sindy continues to cough less and be healthy in all other ways, then the Veraflox is doing its job. Just remember that she should be on the Veraflox for 3 days after her symptoms have resolved.
Thank you so much for your very kind rating. . .greatly appreciated! I'm so glad that our conversation has soothed your minds. . .brings a smile to my face!
This thread will remain open for a couple of days, so if you have any more questions or concerns about Sindy, just let me know. I'll also put you in for a follow up in about 5 days to touch base and see how Sindy is doing. There is no more charge for this!
Take care, and hope you are all sleeping well tonight,
Dr. Barbara
Customer: replied 2 years ago.

Thank you so much, your responses have been invaluable

Expert:  Dr. Barbara replied 2 years ago.
I'm so glad! I hope that Sindy is continuing to improve, breathe more quietly and having less or no coughing episodes.
Talk with you soon,
Dr. Barbara
Customer: replied 2 years ago.

Hi Barbara, Sindy is coughing, quite moderately now - not so dramatically, only about twice a day. Our vet said yesterday she should stop the Veraflox as she's worried about side effects - possible blindness. She's now been on this lot of Veraflox for 12 days.

Do you agree with that, or- as you said she should continue for 3 days after recovery?

Expert:  Dr. Barbara replied 2 years ago.
Hi Debbie,
With quinolone antibiotics in general there have been reports of retinopathy and blindness in cats. I have never seen this, nor heard about this personally, but the warning is still in our drug books. . .I just looked! Veraflox seems far safer and the report from the International Feline Society study is that 6-10 times the normal dose of Veraflox produced no retinal degeneration (blindness) in cats. The recommendation is to use normal dosing (not higher than normal) and for no longer than 30 days. The recommended dose is 7.5mg/kg or 3.4mg/pound once daily.
My opinion is that blindness and retinopathy are a remote possibility, but still a possibility. On the other hand, the same drug schedule says that treatment should be no longer than 30 days, and for 2-3 days beyond resolution of symptoms.
So, if the Veraflox definitely seems to be helping Sindy, then you may want to take the very, very, very slight risk of blindness and continue it for 2-3 days beyond resolution of her cough.
I hope this is helpful!!!!!!
Dr. Barbara
Customer: replied 2 years ago.

Thank you very much indeed

Expert:  Dr. Barbara replied 2 years ago.
Hi Debbie,
You are very welcome. How is Sindy today?
Dr. Barbara
Customer: replied 2 years ago.

She is still coughing a little, 2 or 3 times a day, but is in good spirits generally. She's had Veraflox for 23 days now, so I'll ask the vet if she could have another week on it.

I appreciate your help, Debbie

Expert:  Dr. Barbara replied 2 years ago.
Hi Debbie,
Thanks so much for the update!
After having pneumonia, it can take awhile for the inflammation of the alveoli and the bronchi to subside. I do think another week of Veraflox is indicated. After that, regardless of the cough, I think it would be great to have a recheck chest xray done just to see where things stand. It may be that Sindy also has asthma. Has she ever coughed much before this pneumonia?
Again, thanks so much for bringing me up to date,
Dr. Barbara
Customer: replied 2 years ago.

Sindy is still coughing, just once or twice a day but still seems bright & happy in herself though. She has never coughed before this bout of pneumonia. I note your comments about asthma, this is a bit worrying - would a chest x ray be able to diagnose asthma?

Many thanks for your continued interest

Expert:  Dr. Barbara replied 2 years ago.
Hi Debbie,
Great news that Sindy is continuing to improve and hopefully she will be completely symptom free by the time she has taken Veraflox for 30 days. She has also responded as most cats do to Veraflox without any signs of retinitis. She has about 8 days more of Veraflox. . .correct?
Asthma can be indicated on an xray. If her heart and lungs look otherwise completely normal, then what is possibly asthma becomes probably asthma, and this along with a positive response to medication becomes a diagnosis of asthma. Hope this makes sense!
The fact that she never coughed before the pneumonia does indicate that she didn't have asthma. Whether she does now have sensitive bronchioles from this bout of pneumonia remains to be seen. . .we just have to see how she does. So far so good!!!!
Dr. Barbara
Customer: replied 2 years ago.

Thank you Barbara. Sindy had 5 days of Veraflox initially, then a break of about 10 days. The 2nd course was 23 days, now finished.

So, I'm wondering whether now we should see how she goes - the coughing seems like a pretty dramatic spasm throughout her body, but is sounding less fluid-like.

Maybe she should have a break from the veraflox now .? Maybe in a couple of weeks time, if she still has the symptoms she could have another short course of Veraflox?

The Xray showed her heart as normal, but with a cloudy area round her chest area, and one side has cleared up apparently.

Many thanks once again for your most valued opinion

Expert:  Dr. Barbara replied 2 years ago.
Hi Debbie,
Was Sindy's xray since the second course of Veraflox? I think that this will make a difference in the decision. If she still has visible pneumonia on the xray, then I think she still needs treatment for pneumonia as there are probably "trapped" bacteria in the mucus in her lungs. If this is the case, then she should probably also be receiving coupage. . .thumping on the affected side of her chest to break up the mucus so that she can cough it up. She probably would benefit too from nebulization. Since most clinics don't have nebulizers, you can do the second best by placing Sindy in a steam filled bathroom for 10 minutes twice daily. Sindy might also benefit from guifenisen. I can't look up a dose right now, but if you'd like to try this, your vet there would need to prescribe it. It can be nebulized or given orally. This all is if she still has pneumonia visible on a follow up xray now or within the past 2-3 days.
Hopefully her lungs are now clear!
Dr. Barbara
Customer: replied 2 years ago.

Sindy's chest Xray was before the 2nd course of veraflox. Will try the steam treatment, though. If the coughing continues for much longer I will arrange for another chest Xray.

Thank you so much, your responses are invaluable.

Expert:  Dr. Barbara replied 2 years ago.
Hi Debbie,
Coughing in cats really always sounds very dramatic, no matter the cause. Sounding less fluidy is promising.
I hope the steam treatments help her respiratory system to heal completely. They should help some at least, and won't be harmful in any way. I think at least one week of "steaming" will let us know if they are beneficial.
I think your plan to wait on the X-Ray is fine.
Customer: replied 2 years ago.

Very many thanks Barbara, this online support system has made such a huge difference.

Expert:  Dr. Barbara replied 2 years ago.
I'm very glad Debbie to have been of help. . .you are welcome.
Please let me know about Sindy's progress please. She's been through so much, but THANK GOODNESS FOR YOU!!!!
Customer: replied 2 years ago.

Thank you for your email Barbara, Sindy's condition is still the same, still coughing several times a day.

Think I will take your advice & book another chest X-ray, - altho' I wondered if it is absolutely essential, as she has the diagnosis - would it change anything?

You mentioned Guifenisen - would it be best to try that? The Veraflox seems to have had an effect but not cured, so wondered if you thought it beneficial to try her on the Guifenisen ?

I know pneumonia is very stubborn.

Have already rated you, but will rate again, thanks Debbie

Expert:  Dr. Barbara replied 2 years ago.
Hi Debbie,
Sad to hear that Sindy has not continued to improve but from what you wrote, I think she is doing well other than the coughing, and I'm glad to hear that.
Guaifenesin would be helpful if Sindy has mucus that when thinned could be brought up out of her lungs. . .and she may have some residual mucus. It certainly shouldn't hurt to try this.
Other causes of coughing should also be considered like: pneumonia or pneumonitis that is caused by a bacteria not sensitive to the Veraflox, fungal pneumonia, early congestive heart failure, asthma or spasming bronchioles/bronchi, allergies, heart worm, lung worms, and cancer. It is possible that her pneumonia "covered up" other problems on the x ray. Also, has she had a heart worm test?
If Sindy was my patient (here!), I'd want to get a follow up x ray, a fecal test, and heart worm test, just to see where things stand and to direct any future treatments. She is still coughing, and this is a new (in the last few months) problem for her, so what is causing this now/still?
Thanks so much for bringing me up to date, and for the second rating. Certainly, if you have more questions, concerns or comments just "fire away"!
Dr. Barbara
Customer: replied 2 years ago.

Thankyou. Our vet is a young-ish local vet under the auspices of a specialist so now you've shed more light on the possible causes, I'll relay your info to the specialist & hopefully get to the bottom of this.

Debbie

Expert:  Dr. Barbara replied 2 years ago.
Sounds like a good plan to me. In my opinion the more minds applied to a case, the better. Please keep me informed. . .I know you will!
Customer: replied 2 years ago.

Thank you Barbara, your advice is like gold dust!

Debbie

Expert:  Dr. Barbara replied 2 years ago.
Thank you Debbie!
I'll be eagerly awaiting your findings with your vet there and yours and hers thoughts.
Barbara
Dr. Barbara, Cat Veterinarian
Category: Cat
Satisfied Customers: 1614
Experience: Over 30 years experience in veterinary medicine and surgery.
Dr. Barbara and 2 other Cat Specialists are ready to help you
Expert:  Dr. Barbara replied 2 years ago.
Hi Debbie,
Thank you so much for your very kind rating. . .greatly appreciated!
Have you decided to pursue with diagnostics the cause of Sindy's continued cough? Have you tried any further treatments? Actually, it has been the weekend, so please let me know how things are going when you get a chance.
Thanks,
Barbara
Customer: replied 2 years ago.

I emailed the specialist with her current condition & passed on the info you gave me about possible causes.

the only symptom now is the coughing and she is very bright & active in herself. she's had no further treatments but will see if she can have more veraflox now she's had a break from it, or the other medication U suggested. Will try to speak to the specialist this week

Kind regards, debbie

Expert:  Dr. Barbara replied 2 years ago.
Hi Debbie,
Will eagerly look forward to hearing from you!
I'm so glad to hear that Sindy is doing so well. If Sindy was my case, I'd want to have a follow up chest film to determine her current situation, and then treat accordingly. No need for further Veraflox if pneumonia has cleared.
Guiafenesin would be used also if she still had visible pneumonia in her chest, to thin out the mucus.
Have a great week and hear from you soon. . .
Barbara
Customer: replied 2 years ago.

Hi Barbara, the specialist vet - who had your suggestions, then contacted our vet here, so Sindy is going to have a dilator - A kind of atomiser gadget which gives a puff of medication.

Would you say this is the best course of action at this stage?

Debbie

Customer: replied 2 years ago.

Sindy Saga update!

Siindy was sick one night so was worried she was reverting to the gastro

inflammatory disease. However, it was a one-off, & so ok. (cross fingers!)

We've been sold a Aerokat aerosol chamber (£90 !!!)

(discovered I could have got one on the internet for £65!

Also VENTOLIN - SALBUTAMOL SULPHATE. Vet said this would open up the airways or something.

However, huge difficulty administering the dose but will persevere.

I thought Ventolin was particularly for asthmatics ?

Perhaps it will help her pneumonia, but as I said before she only coughs a few times a day now ?

Vet doesn't want to repeat X ray just yet.

Best wishes from Debbie

Expert:  Dr. Barbara replied 2 years ago.
Hi Debbie,
Thanks so much for the "Sindy Update". . .I so appreciate being kept in the loop!
The Ventolin is a broncho-dilator, and after the insult to her lungs from the pneumonia, I imagine she does have residual inflammation in her bronchioles. This would lead to spasming of the smooth muscles of the bronchiolar walls, and the Ventolin will relax these muscles, open up her passages and eliminate her cough. . .this is the plan anyway.
The Aerokat is expensive, but once you and Sindy get the hang of it, it should work well. It could also be used to deliver an aerosolized steroid should your vet there feel that is necessary.
I wish you the very best of luck with the Aerokat! Easy for us to say! I'd really like to hear how things are going for you both in the next weeks. . .thanks!
Barbara
Customer: replied 2 years ago.

Hi Barbara, Sindy & I are persevering with the Ventolin dilator & now fairly competent at it. However, Sindy is still coughing once or twice a day.

How long do you think she should have the ventolin for?

Expert:  Dr. Barbara replied 2 years ago.
Hi Debbie,
Now you and Sindy are the experts at this! Congratulations!
I think it would be good to get a follow up xray and to possibly change her to an inhaled or oral steroid. The Ventolin opens the airways temporarily each time, but doesn't actually cure the bronchospasm. The steroid would be aimed at decreasing any residual inflammation Sindy has from her pneumonia (if this is the problem now).
Make sense?
Very nice to hear from you. . .Thanks!
Dr. Barbara
Customer: replied 2 years ago.

Thank you so much, once again, for your valued response- its great to have this level of support.

Sindy's condition remains the same, but the coughing is a bit better. She takes the ventolin inhaler pretty well now , she knows it doesn't hurt.

As we are away in Crete this week, & so vet has given us some Prednidale (?) tablets easeily crushed into food, which our neighbour will do.

We'll have to check the cost of another X ray - so far Sindy has cost £4,300! Insurance limit was £4,000 so now we do have to take vet's bills into consideration.

Anyway, Sindy is in good spirits, good appetite & mischievous as usual.

She has lost her voice though so cannot meeiow which is a shame.

Thanks once again for your help Barbara

Best wishes, Debbie

Expert:  Dr. Barbara replied 2 years ago.
Hi Debbie,
Hope you are enjoying Crete. . .sounds wonderful! Thanks so much for the update about Sindy and about you!
Most of our cats here that are asthmatic, which sure seems to be Sindy's problem now, are treated with prednisolone (prednidale) orally when needed and do very well. If she is asthmatic she should do very little or no coughing now. Cats tolerate steroids much better than dogs (or us for that matter) so we can get their good effects without much worry.
Understand completely about the veterinary bills! She's doing well now, so although a follow up x ray would be nice, it's not imperative at the moment it seems. Being "creative" with recommendations is really our specialty.
Have a glorious time!
Dr. Barbara
Customer: replied 2 years ago.

Hi Barbara, Crete was lovely - only 28 degrees!

We returned to find no change with Sindy - still bright in herself, coughing a little & unable to meeiow .

Do you think she should still have the Ventolin dilator - she hasn't had it for a week while we've been away. ?

However, she had a 10 day course of Prednidale.

Expert:  Dr. Barbara replied 2 years ago.
Welcome home!
I'm actually surprised that Sindy is still coughing. . .was she coughing while on the prednidale?
The goal is to treat her respiratory tract so that she isn't coughing. If she needs her bronchi dilated, then the ventolin is needed. If she has inflamed bronchi, then the prednidale is needed. . .how's that for an answer!!! :-) I think it would be good to ask Sindy's care giver if her coughing was less on the prednidale, or you may just have to try it yourselves and monitor her to see how she does.
Does this make sense to you???
Barbara
Customer: replied 2 years ago.

Yes Barbara your answer makes total sense - she has coughed all along throughout courses of Prednidale. Vet has given us another 5 day course. However, each coughing spasm is shorter now & we only see it once a day - overnight or early morning usually. She's out all day so don't know if she coughs then as well. Certainly seems to have improved though.

Our vet hasn't said Sindy is actually asthmatic, but recommends Ventolin twice daily now.

I'm asking the specialist to re-check all her test results to see if there's something which would indicate why she has this residual cough and has lost her mieeow. Poor poppet!

Many thanks Barbara

Expert:  Dr. Barbara replied 2 years ago.
I'm so glad to hear that her cough has improved so much on the prednidale, and hopefully we'll get it completely resolved. Both ventolin and prednisolone (prednidale)work well for asthmatics (which sure sounds to me like Sindy's situation). In my experience, usually asthmatic cats ultimately don't need long term medication, but I do have owners with asthmatics have some pred on hand to begin if (and when) the coughing recurs.
I'll be interested to hear what the specialist has to say.
Thank you so much for keeping me in the loop!
Barbara
Customer: replied 2 years ago.

Still waiting for vet Claire to ring me with specialist recommendations.

I've not seen Sindy cough for 2 days now.

However, she's been sick twice in the last fortnight - quite a dramatic spasm but its fairly clear liquid & big bits of grass, mainly. She doesn't appear to bring food up.

I was a bit worried in case it was the gastric disease returning

Will contact you when our vet has rang.

Once again thankyou so much for your interest & advice, it has made so much difference & put our minds at rest a lot.

Expert:  Dr. Barbara replied 2 years ago.
I'm really glad that I can be helpful.
What great news about Sindy's lack of cough!!!!!
Since she brought of grass when she vomited, I'm sure that is what stimulated that. A good way to tell if they are eating grass because they are sick (self medicating) or because they just like grass, is looking at her surrounding symptoms. If she continued to eat normally, then she was fine. . .just liking the grass.
Look forward to hearing from you again after you receive the specialist recommendation. . .or before of course if needed!
Barbara
Customer: replied 2 years ago.

Thank you for your response. I have not heard from my vet or the specialist! That seems a bit off as the specialist particularly said he would look into Sindy's case. Will ring them this week.

However, there is no change - happy in herself, still coughing a little, Ventolin twice a day - does she need to be on it as long a she is coughing?

Customer: replied 2 years ago.

Many thanks, Barbara.
My laptop is having a wobbly! So as I'm not sure if this got to you, I'll repeat it:

Havn't heard from my vet or specialist which I thought was a bit off as he particularly said he would look into her case again.

There's no change with Sindy cat - happy in herself, still coughing here & there, can't mieow, and has Ventolin twice a day - I have no idea how long she should be on Ventolin.

Customer: replied 2 years ago.

Hi Sindy has had a check up, and vet said her breathing was good & she seems fine. The coughing seemed to stop, so I discontinued the Ventolin. However, she started coughing a bit again during the past couple of days, so started giving her ventolin again twice a day.

Was this the right thing to do?

Expert:  Dr. Barbara replied 2 years ago.
Hi Debbie,
Good to hear from you!

In my opinion to know whether she needs ventolin now or not depends upon how long she was off ventolin before she started coughing, and if the ventolin has stopped her coughing since reinstituting it.

Look forward to hearing from you!

Barbara
Customer: replied 2 years ago.

thank you Barbara, I'll keep an eye on her.

Customer: replied 2 years ago.

Thankyou Barbara

Sindy was off Ventolin for about a week & stopped coughing. Since she started coughing again - altho just a bit, I give her Ventolin every other day & she seems ok.

Expert:  Dr. Barbara replied 2 years ago.
Hi Debbie,

Your decision to give her Ventolin every other day is fine. Getting it so infrequently may mean that she doesn't need it at all, but if this schedule works for her it is also very safe.
It is such a lovely Christmas present for me to hear that she is doing so well! She (and you!) have been through so much!
Keep in touch, please, but also faithfully follow your doctor's recommended rechecks and follow up blood tests. . .I know you will.

Merry Christmas!
Barbara
Customer: replied 2 years ago.

Thank you so much Barbara. I took Sindy to the vet this week for her innoculations and a check-up and she was pleased with her. If Sindy could talk she would say you are a star, your support has meant a lot.

We miss hearing her mieeeow - she tries though but no sound comes out, so when she tries to mieeow we make the noise for her!

I hope you have a lovely Christmas, best wishes, Debbie

Expert:  Dr. Barbara replied 2 years ago.
Hi Debbie,
It is a wonderful Christmas present to hear that Sindy is doing so well, and that I could be of help!
I wish you all a very Merry Christmas and a very Happy New Year!
Thank you!
Barbara

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