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Dr. Deb
Dr. Deb, Cat Veterinarian
Category: Cat
Satisfied Customers: 9404
Experience:  I have been a practicing veterinarian for over 30 years.
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Feline bacterial pneumonia - recovery

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My cat was diagnosed with bacterial pneumonia five- six weeks ago. For a brief time he was in an oxygen tank (for a few hours on two separate occasions). He then had a bronchial wash and the pneumonia was diagnosed. He's been home on antibiotics for almost six weeks. I also use a nebuliser on him once or twice a day (with saline). However his recovery seems intermittent. It seems like he starts getting better - breathing improves, he runs around more and plays etc - but then seems to get bad again. He seems bad again now and has done for about 3-4 days. More lethargic, noisy breathing and gets out of breath easily. Does this mean the antibiotics are not working?(He is on two types). Or does recovery from
Pneumonia usually progress in this way? Or does it mean he won't recover? It's complicated by the fact that he has asthma (diagnosed last year). Could it be the asthma affecting him? He usually has the aerokat spacer but has not been having this since the pneumonia was diagnosed. He is 14 but is otherwise a happy, healthy cat with a good appetite who goes out every day and is lively etc.
Submitted: 1 year ago.
Category: Cat
Expert:  Dr. Deb replied 1 year ago.
Hello, I'm Dr. Deb and will do my best to help you today.I'm sorry that your cat seems to be having these issues; however, in my experience cats with bacterial pneumonia typically don't show this sort of progression of their symptoms so I might be suspicious at this point that something else may be going on. 1. Has he had a chest x-ray done since his symptoms began?2. Has a cardiac ultrasound been done or discussed with you?3. Has he been tested for heartworm disease?4. Has blood work been done? Since it looks as if you are currently offline, there may be a delay after I receive your answers since I have to type up a response to you and I may be offline at the time you respond. But I'll get back to you as soon as I can since I'm on the computer some part of every day.Thanks for your patience. Deb
Customer: replied 1 year ago.
1. He has not had an x Ray again yet. He was due to have one last week but the vet suggested postponing it for two weeks as he was not yet better and the x Ray carries a risk as he has to be sedated so she said better to wait. He was examined at that point and his heart was normal and also his temperature.2. I am not sure whether a heart ultrasound was done but am fairly sure I was told his heart was ok at the time he had the x Rays and bronchial wash done. Would heartworm show up on an x Ray? Or affect his pulse? Also to add that we are in the UK. Is heartworm prevalent in the uK? 3. I am almost certain that his blood was tested when he had the bronchial wash too. It showed that he had sought anaemia.The bronchial wash showed bacterial pneumonia. It sounds as though you think something else may be going on as well ? Or do you mean it was a misdiagnosis?
Expert:  Dr. Deb replied 1 year ago.
Thanks for the additional information.My concern is that his pattern is not what one would expect for bacterial bronchopneumonia which is why I have to wonder if more is going on with him. Bronchopneumonia is not a very commonly seen condition in a cat for one thing and I wouldn't expect him to feel better and then appear to have a relapse for another; this latter in particular is what makes me not necessarily question the diagnosis but want to make sure that other issues aren't present. Many patients with bacterial pneumonia will need to be treated for at least 6 weeks (if not longer) so the time frame doesn't worry me that much. I asked about blood work since some of these patients will have an elevated white blood cell count with an increased number of band cells, but certainly not all of them do. The mild anemia may reflect chronic disease or some other issue which is unclear to me at this point. For example, if he has other issues going on, then he may be at higher risk for developing pneumonia. Those other issues might include bronchitis, heartworm disease, fungal infections, lungworm, immunosuppression, collapsed lung, toxoplasmosis to name just a few examples.Additionally, there are other conditions which might appear similar to pneumonia including but not limited to congestive heart failure (even in the absence of a heart murmur or arrhythmias), pulmonary fibrosis or pulmonary embolism, bronchitis or asthma. It's quite possible that his asthma is playing a role which might explain his current worsening symptoms. While it may seem contraindicated to use anti-inflammatory doses of steroids in a patient with a bacterial infection, there are those vets who will do so (even if that patient doesn't have asthma issues) since pulmonary inflammation is frequently present; this may be something to consider and discuss with your vet. If this were my case, I'd want to consider additional diagnostics if my patient wasn't responding as expected especially if I had made the diagnosis of pneumonia alone with no other predisposing factors.I don't typically need to sedate any of my patients when having an x-ray done nor do I rarely ever need to sedate them for an ultrasound. I realize that everyone may practice differently but unless the patient is extremely fractious, sedation is seldom needed for these procedures. I'd want to take an x-ray initially to evaluate the lung field and the heart size and to determine if any fluid was present in the chest. Depending on those findings, I might then suggest an ultrasound.But at the very least, repeated x-rays are often done to evaluate response to therapy when pneumonia (or other conditions involving the lungs) is diagnosed. There's a blood test for heartworm disease although it may not be as accurate as we'd like; often this condition can be suspected based on typical radiographic findings. Unfortunately, we don't have good treatments for heartworm disease in cats although steroids are sometimes used to treat the secondary inflammation which is present. I neglected to ask you which antibiotics were prescribed (and assumed the ones chosen were based on sensitivity data from his bronchial wash) but in general the biggest culprits in cat pneumonia will be mycoplasma and bordetella organisms such that doxycycline is prescribed for the former and clavamox for the latter. I might also consider a bronchodilator such as Theophylline as well as continuing the nebulization that you're currently doing (but consider steroids instead of sterile saline).I would also recommend coupage (gentle clapping on the chest to mobilize/loosen secretions) 4 to 6 times daily. This is obviously a complicated case but I hope I've provided additional possible explanations for why he's not steadily improving instead of waxing and waning; I also hope I've provided additional medication options which you might discuss with your vet.Deb
Customer: replied 1 year ago.
Thank you for this. Just to add that he was started on a bronchodilator twice a day at the beginning of this week and I have also been doing coupage on him although usually only twice daily.His antibiotics are metronidazole and Baytril. I think the vet said they couldn't get clear enough indications from the bronchial wash and so were going for antibiotics which would counter a wide a range as possible.You mentioned heartworm but is that active in the UK ?Thank you also for your suggestions that there may be other underlying problems and/or other problems which might present like pneumonia but be something different. What would be the way that the vet would be able to check for these various options. It sounds like I should return to my vet in the next few days and ask for an x Ray without sedation (I know the vet didn't use a sedation when he was first ill as he was too fragile and so will hopefully be prepared to do this again); ask her whether something else might be going on and emphasize that he does not seem to be getting better and is getting worse.
Expert:  Dr. Deb replied 1 year ago.
You're more than welcome although I'm sorry that I was off my computer when you responded back. That's great to hear that a brochodilator was begun since this drug can be of benefit regardless of the underlying pulmonary pathology. And, also glad that you've started coupage. Unfortunately, I live in the States and don't have knowledge of whether heartworm disease is prevalent in the UK or not but from what I've gathered from my research, it's not likely to be a problem there in dogs. If that's the case, then it's even less likely to be a problem in cats. I do agree that Baytril is a pretty broad spectrum antibiotic and a good choice for respiratory issues but I'm not certain that I think Metronidazole would be one I'd use...but this is just my opinion. I still think that Doxycycline would be a better choice in a situation such as this if I was faced with selecting an antibiotic empirically (as opposed to one based on culture and sensitivity results). Some of the conditions I mentioned will be difficult to definitely diagnose but it seems to me a repeat x-ray really needs to be done at this phase. I might also consider an ultrasound just to rule out any issues with the heart since the symptoms for this condition can be so similar to the ones which he has. I might also consider a referral to an internal medicine specialist if there's such an individual or referral hospital close to you. Of course, I can't know for sure if other issues are present but I'm highly suspicious that they might be; at least I'd want to rule out as many other possibilities as I could at this stage since his condition is clearly deteriorating. Deb
Customer: replied 1 year ago.
Thank you very much for such an informative and detailed set of responses.
Expert:  Dr. Deb replied 1 year ago.
You're more than welcome. Best of luck with him. Regards, Deb
Expert:  Dr. Deb replied 1 year ago.
I also hope that you'll keep me posted about him if you have a chance. Even after you've rated (if you do, of course), we can still continue to communicate at no additional charge to you. Kind regards, Deb
Dr. Deb, Cat Veterinarian
Category: Cat
Satisfied Customers: 9404
Experience: I have been a practicing veterinarian for over 30 years.
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Customer: replied 1 year ago.
That's very kind thank you. I am taking him to see my vet again this week and he is going to have an x Ray. I will mention the possibility of trying another antibiotic. I previously asked my vet if there was an alternative to the metronidazole as I was having problems giving those tablets to my cat (since resolved) and she said there was not. I may mention the one you suggested although it's always tricky as I know it must be frustrating for a vet if clients come in with alternative treatment suggestions.
Expert:  Dr. Deb replied 1 year ago.

I just wanted to thank you for the rating and bonus; they're greatly appreciated.

Metronidazole has a very foul taste to it which makes it really difficult to dose in cats unless it's compounded by a special pharmacy into tasty treats or possibly a gel which can be rubbed in the ear. But it sounds like you've worked it out:)

I do understand how it may be difficult to have this sort of conversation with your vet but at this point, they should be suggesting alternative explanations to you...or at least this is the way I see it. And, most savvy owners will research their pet's symptoms so I'm never surprised when alternative suggestions are made. Some I agree with and some I don't but I always explain why.

I'll also look forward to an update in a few days. Kind regards, Deb

Customer: replied 1 year ago.
Hi Deb, I just wanted to give you a brief update. I took him to the vets again and he has lost more weight and his lungs are crackling again. Given that he has been having breathing problems since last June - with the asthma - which have got worse since December we discussed either sending him to a treatment centre for a CT scan and a lung biopsy which may/may not give any definitive answers or secondly doing euthanasia. I was really hoping that this would not be he outcome but given the fact that he is 14 and his breathing has been getting steadily worse over several months I think that this may be the kindest thing to do. I'm going to think it over in the next day or two. Thanks again for your advice.
Expert:  Dr. Deb replied 1 year ago.
I'm so sorry to hear that he's taken a turn for the worse:( I understand the dilemma you face and would also find it difficult to make decisions if he were my cat. I don't like to put too much emphasis on age when making these sorts of decisions but I do recognize that it's a factor. I think a lot also depends on his personality and how much he would tolerate. My heart goes out to you as you're contemplating the next step for him; I certainly wouldn't find fault with whatever you decide to do since I know you'll be doing what you think is best for him. Deb
Customer: replied 1 year ago.
Dr Deb - would it be possible to ask you another paid question? I tried to use your standard link but it said you were offline.
Expert:  Dr. Deb replied 1 year ago.
Yes, you can certainly ask me another paid question although I'm going to be off and on my computer for the next 5-6 hours (or thereabouts) so I may not get to it if I happen to be offline at the time you ask it.

If you do post another question, just put "For Dr. Deb Only" at the beginning of your sentence so other experts won't answer it.

I'll get back to you as soon as I can. Deb

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