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Dr. Deb
Dr. Deb, Cat Veterinarian
Category: Cat
Satisfied Customers: 10921
Experience:  I have been a practicing veterinarian for over 30 years.
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For Dr Deb only Hi Dr Deb I wanted to follow up on our previous communication. My cat was diagnosed with asthma last year and he was mainly well managed with aerokat until December when he started to cough more and have breathing problems. In March he had an x Ray and bronchial wash and was diagnosed with bacterial pneumonia. He seemed to start getting better on metronidazole and Baytril but in the last week or so has been getting worse. He has lost some weight and is coughing and seems to be struggling to breathe at times. His resp rate ranges from about 40-60 but sometimes goes over 60 and sometimes below 40 (although not in the last week).Other than this his QOL is good. He is eating, drinking, goes in the garden everyday, is still affectionate and still plays.The vet - who has been great with him - has now recommended a ct scan of his lung and a biopsy. But she has said that it is not clear whether we will get any concrete answers and therefore no clear prognosis. Although he is 14 he is otherwise in good health and seems younger than 14. He seems resilient but is also quite a nervous cat as when I got him as a kitten he had not had any human contact and it took a while to build up trust with him.I suggested to the vet that euthanasia is an option now and she agreed. In thinking about what to do I'm trying to consider what the possible outcomes might be. Ie if I do go ahead with the tests are there any possible outcomes which could offer him more than a few months of gradually getting worse. Ie I don't want to put him through tests if there are no possible good outcomes. His last lung x Ray and bronchial wash was six weeks ago and it showed that one area was not good but that they were otherwise 'well aerated.'I would really appreciate your thoughts/advice on what might be the sorts of diagnoses/prognoses that the test could offer up and whether it would be cruel of me to go ahead with the tests.
This is obviously a really, really tough situation, isn't it and I feel really bad for you both:(
As you probably already know, the normal, at rest, respiratory rate for a cat is 20-30 breaths/minute so obviously his rate is quite high.
I would imagine with a rate as high as 60 that he's fairly uncomfortable and it must be difficult to see him struggling to breath.
I agree with your vet that a CT scan and biopsy may (or may not) provide specific answers to his underlying issues although this is certainly one way of trying to find out. I still think a repeat x-ray would be in order prior to putting him through such extensive testing especially if you didn't have to sedate him for it.
Comparing what his lungs (and heart) look like now to what they looked like in March might be quite enlightening and help with your struggle to make the right decision about him. In fact, if this were my patient, I would have already repeated an x-ray to determine if there were significant changes.
Without seeing his March x-rays, it's difficult for me to comment on what your vet meant about one area not being "good". But if this is the area which is to be biopsied and is localized to only one area of his lung field, the possibilities might include a collapsed lung lobe, fibrosis, cancer, a cyst, fungal infection (if commonly seen where you live) or aspiration pneumonia (although this seems less likely).
I'm having a hard time understanding why fibrosis or a collapsed lung lobe or even a cyst would cause his significant respiratory issues, though.
I don't think it would necessarily be cruel to put him through additional testing where he'd need to be sedated/anesthetized but I'm certain that your vet has mentioned the risks of such procedures to you.
If he has compromised lung function, then he may react in a negative way to anesthesia; in fact, such procedures may be fatal for him, I'm sad to say.
I don't think there's a right or wrong decision in a situation like this although my instinct and experience tell me that this isn't likely to have a positive outcome...whether you decide to go ahead with a CT scan and biopsy or not...and it pains me to say so. Realistically speaking, he should have gotten better by now if this were just pneumonia, although I would have changed his antibiotic to Doxycycline as I mentioned before.
I would have also given him steroids on the off chance that his asthma is causing some of this respiratory issues although this drug might affect any biopsy results (if done).
Taking into consideration his personality and how much he will tolerate is another factor if he's a nervous cat. Quality of life is what I consider to be more important than quantity of life but this is just my personal opinion.
I'm not sure how much this has helped or not; I don't think this is an easy case and thus making decisions is difficult.
But, if he were my cat, I'd want to try a few more medical options first before I decided to euthanize him (if I decided to forego additional extensive testing); I definitely would take another chest x-ray, too.
Dr. Deb and 2 other Cat Specialists are ready to help you
Customer: replied 2 years ago.
Dear Dr Deb, thank you very much for your considered reply. I am guided especially by your comment based on experience and intuition that there is unlikely to be a good prognosis. I spoke to my vet this morning who said a similar thing - the best outcome would be a different infection in the lungs which would, even then, take several months of pills and treatment to remedy. And even then a positive outcome couldn't be guaranteed given that he has asthma and also given that he has had the problems for so long.I think, on reflection, that I am not going to put him through any more tests. My vet isn't recommending xray because she said it won't tell us enough. And the biopsy and CT scan would require a drive to a special centre almost twenty miles away. He is already panicking every time I put my shoes on (he runs and hides) in fear that he is going to the vets as he has been so many times in the few months. I forgot to mention too that he has previously been in an oxygen chamber twice - when he was first diagnosed with pneumonia. His breathing is becoming more laboured and his coughing is getting worse and I feel that I'd rather not put him through any more, much as I love him and will miss him terribly. It seems like the hope for him ever making a full recovery when he has been having lung problems for almost 18 months now is becoming more and more remote. I understand your recommendation of more tests and hope you don't think that I am not doing what is best for him. I think he's been through enough in the last year or so and don't want to prolong a limited quality of life. I'd rather reflect that he has had a good life and don't want his final months to be a gradual deterioration. Thank you again for your feedback in this question and my previous question.
You're so welcome;I'm glad that I could help and provide another perspective although it sounds very similar to what your vet thought, although I still might disagree about taking another x-ray (especially if this is cancer).
I also wanted to again thank you for the rating since it's most kind.

I really can't disagree with your thoughts and decision about declining additional testing as difficult as it's been to reach this conclusion. The way I see it is that the stress it might induce could cause more harm (since stress exacerbates many conditions), any additional medications could cause him to become even more withdrawn; I'm not sure any potential benefits would outweigh the risks involved.

I'm certain that his life has been filled with much love and affection; I would want his final time with you to reflect this quality of life you have had together.
If he were my cat, I would most likely have made this same decision.

I know you're going to treasure each and every moment you have left with him; he'll never feel so spoiled, I expect:)

I hope you'll keep me posted about him and how he fares; even though you've rated, we can continue to communicate about him at no additional charge to you.

Kindest regards, Deb
Customer: replied 2 years ago.
Thank you for this. Sadly we ended up taking him this morning to say goodbye. His respiratory rate was up to 80 and he was very uncomfortable and I could see that he had had enough. Thank you again for your kind words and wisdom.
Oh, I'm so sorry:(((
I really thought you'd have more time with him; I'm sure you thought so as well.

I sometimes wonder in situations like this if my feline patients are hanging on for us but then when they realize that we've come to terms with their terminal condition, they worsen. The decision is never easy but at least we know it's the right thing to do.

I know there's going to be a huge hole in your heart for a long time to come but I know in time you're going to think of him with tears of joy rather than tears of sadness.

My sincerest condolences to you and your family at this sad time. Kindest regards, Deb
Customer: replied 2 years ago.

Thank you again for your kind words. Sadly, I knew that if I didn't pursue the more tests/treatments option that it would be time to say goodbye but yes I didn't expect it to be the following morning. But it wasn't fair to keep him alive while he was having more and more problems breathing. He had been losing weight, was coughing more and more, and most importantly was struggling to breathe much of the time and was uncomfortable, shifting position very slowly to accommodate the fact that his breathing was so difficult. He was tired of fighting to breathe and was also worn out from repeated vet visits and the various treatments over the last couple of months. He was having more bad days than good days. And I wanted to say goodbye while he still had some nice moments in his day rather than wait for him to waste away until he had no quality of life at all. And I didn't want his last moments to be undergoing an invasive procedure while I wasn't there.

On the morning that we took him in for the euthanasia his breathing was up to 80 and he was not really interacting and seemed very bewildered and uncomfortable and would only eat if food was held right in front of him. I think the only other option would have been back into the oxygen chamber again.

But it was a very tough decision to make and I will miss him very much. Part of me worries that I did it too soon but I have read that a week too soon is better than a moment too late and I am trying to remember that. What you say about our animals hanging on for us makes sense. I think there is much truth in that. He's been like a little shadow following me around and sitting on my desk while I work for the last 14 years and so it's been very hard to say goodbye. But at least he is not suffering any more. Thank you again for your messages. Best wishes.

I completely and totally agree with everything you so eloquently said and feel exactly the same way.

I know you're still grieving and will continue to do so for quite some time. Fourteen years is a long time to have a friend be there for you; I know his sudden absence is hard to accept and that you miss him each and every day.

I like to think of the pets I've lost as running free and healthy with no cares or burdens. I see them getting together as a family and sharing stories about their life with me.
I suspect your boy is doing the same:) Kindest regards, Deb
Customer: replied 2 years ago.
NEW QUESTION _ OPEN NEW CASE FOR DR DEB ONLYHi Dr Deb,You gave me some advice a month ago when I was trying to work out how best to help my cat who was having breathing problems which had been occurring over a year. Sadly, as I said in my last message I had to say goodbye to him as he was getting worse and I wanted to spare him any more invasive testing.Unfortunately my reason for emailing now is for a second opinion on my other cat (14), who is from the same litter as my cat who died. I took her to the vet about two months ago as she had also coughed once or twice and seemed lethargic. The vet heard crackling on her lung and asked me to bring her back in three weeks time. I was due to take her back but got overtaken by events with my cat who died.We took her back two weeks ago and the crackling was still there. We took her again this week and the vet said the lung sounded better but that her breathing (exhale) sounded a bit restricted. I had been keeping a record of her resp rate too. It ranges from 20 (when sleeping) to 40 when awake/alert.Obviously I am worried that she may have what my other cat had - given that they were brother/sister (genetic predisposition?) and also lived together (possible infectious/environmental causes). I asked the vet whether she could also have asthma (which her brother was diagnosed with) and he said it was very unusual for a cat to be diagnosed with asthma at this age and they are usually diagnosed around age 7 or 8. She is 14. But this surprised me as my cat who died was diagnosed with asthma when he was 13 - which of course makes me think that maybe he never had asthma at all and it was something else altogether.The vet wants to try antibiotics first - and if they don't work then to try steroids - and if that doesn't work to run tests. However, given that my other cat had a year of antibiotics / steriods / inhaler etc with a horrible outcome and no clear diagnosis I feel very torn about what to do. He prescribed Ronaxan / Doxycycline which is what I know you suggested for my other cat. However, he seems very uninterested in the fact that my other cat died last month of similar symptoms after a year of various treatments.I have tried - and failed -over the last three days to give my cat this tablet. I've tried putting it straight into her mouth and she gags it up; mixing with water in a syringe - same result - putting directly into food. She just becomes really distressed and foams at the mouth. I don't want to force her especially as she is already distressed at my other cat no longer being around. She is still looking for him and is also seeking our affection much more.Also she is about 1/2 a kilo overweight but is now gradually losing weight as she used to eat my other cat's food but also since he died she is eating less anyway.And so I wanted to ask you- if you were in this situation how would you proceed?
- Would you think that the cats had an infectious/contagious disease? What could this be?
- Could they both have (had) asthma or is it unlikely to be diagnosed so late?
- Is 20-40 normal or is the 40 too high?
- What is the easiest way to give a cat Doxycyclin. The tablet I am supposed to give her half of is very big.At the moment I want to spare my cat any more distress than necessary. Would you think it it ok to wait until she has lost enough weight to make taking an x ray safer? (My vets will only do an x ray under mild sedation). I would like to try and reduce her weight over the next month, monitor her breathing and then if there still seem to be problems then do tests.Would you have any other advice?
Customer: replied 2 years ago.
Hi - I realised I didn't open this question properly. Apologies, I have now done so on a new form.
I see the other question which you've opened and will respond to you there:)