UPDATE 2 POST 47 I'm already at the end of my rope (cat with chronic condition)

[french_fry]

As I’ve mentioned several times on this board, my eight month old kitten was diagnosed with asthma within a couple of weeks of taking her in off the street in August. She is otherwise healthy and perfect but we are at a loss as to how to treat her.

When diagnosed she was in the midst of a daylong period of lethargy, shallow/rapid breathing, etc. that was punctuated with full fledged asthma attacks - neck extended downwards, hacking/wheezing, etc. She was given oxygen, injected steroids and bronchodilators and a sedative at the emergency clinic and bounced back quickly. We were sent home with a daily oral steroid, a daily bronchodilator in tablet form and an emergency albuterol inhaler.

The emergency inhaler had been used two or so times with good results until yesterday, when we came home and found her in the midst of another very severe episode - lethargy, fluttery breathing, frequent hacking/wheezing attacks. We administered the inhaler twice over the period of a couple of hours and it helped a little but didn’t get her back to breathing comfortably. We took her to the emergency vet for another round of oxygen, injected steroids, etc. The vet was not very encouraging - in fact, his exact (and only!) response was, “I have asthma too and usually my inhaler controls it but sometimes I have to go to the emergency room.” I said, “With all due respect, you have health insurance.”

Now our kitten, while breathing much better, is unwilling to take her medications mixed into her food like she has been for the past couple of months. Pilling her or shoving a syringe down her throat brings on a stress asthma attack, which is slightly milder than the full day thing we have to take her to ER over but is still not good for her. Whenever we have to give her the emergency inhaler my BF ends up almost needing stitches even if we try to put her in a towel first.

We just feel so defeated. Our vets are very, “you need to get the medication into her by force and bring her in for oxygen if it causes an attack” which is easy to say when they’re not the ones shelling out $250+ every time (plus the EXTREME stress on the cat) this happens.

We love this cat and 99% of the time she is happy and healthy and perfect…but we can’t go through this cycle every six weeks (or less!)

I’m not sure if this is asking for advice or just venting, but any thoughts are appreciated.

[Simkie]

I had a cat who’s asthma was very well controlled with depo-medrol, which is a long acting steroid. Your kitty sounds more severe than Celia was, but if your vets have not discussed using depo, I’d ask them about it.

Can her daily steroid be compounded into a transdermal prep?

Have you been able to figure out triggers (other than stress)? With mine, switching her to a single ingredient diet pretty much controlled her asthma.

[HeatherCK11]

I’m really sorry you are having to deal with this. It is incredibly rare for a young cat/kitten to be experiencing such severe symptoms.
No doubt your stress levels are high. This is a hard road.
This may be the time to have a sit down with your primary vet and have a very real conversation about finances, prognosis, stress and quality of life.
Big hugs.

[Pancakes]

I agree with the poster that said an 8 month old kitten with asthma this severe is unusual.

Has the cat been dewormed? Lungworms are possible that can cause severe inflammatory responses… Panacur is a cheap option that needs to have been done at least once.

I also agree that having a serious quality of life talk is necessary. This isn’t going to get better. It’s only going to get worse over time. Even if you can find inhalers or steroids to help, this cat will not have a normal lifespan and it sounds like it’s already a burden on you.

[french_fry]

We have not been able to figure out triggers other than stress. Initially we thought stress was the primary trigger (she had her first attack after going to the vet for the first time - we had to give her a liquid antibiotic that night, which was unpleasant, and she had an asthma attack shortly afterwards) but now we are thinking that it is a secondary or separate trigger since her purely stress-related attacks seem to be much less prolonged and severe than the two ER episodes.

Litter definitely seems to be a factor - we had changed her litter the night before she had the first bad attack. We switched her to a dust-free litter a couple of months ago and she had been fine ever since. I stupidly tried switching her to another new litter (that ended up being way dustier than advertised) a couple of weeks ago and she had a mild attack that was quickly controlled with one dose of her rescue inhaler.

That said, there was nothing unusual about her litter (it was clean and the litter that we have been using for months now without issue) on Sunday.

It’s just so weird because based on my research most cats have recurring milder symptoms and she is TOTALLY FINE from day to day and then once every few weeks she has a really bad attack.

We know it is asthma because she was x-rayed and exhibited the unmistakable “donut”-like thickening in the walls of her airways. She was dewormed and deemed totally healthy upon physical examination when we first got her, shortly before she was diagnosed with asthma.

She threw up her breakfast (which had included both of her medications) on Sunday before she had the bad attack so we’re thinking that was obviously a big factor (although the vet was pretty unconcerned.) That said, she has avoided or otherwise missed taking her medication a couple of times in the past and has never had an issue so I don’t think that’s the sole reason she had the attack.

I am very unhappy with my primary care vet re: how this whole situation has been handled so I have been leaning on the emergency clinic for answers, which is really not their job. I set up a consult with a different vet practice I have heard really good things about (and who I questioned at length about their asthma treatment protocol) for later this week and am hopeful that they may be able to give me some answers other than, “well, if the prednisolone and the theophylline aren’t working you’ll have to take her in to the ER.” The new vet clinic has already suggested compounding the steroid into a transdermal prep so at least we won’t have to force one of the two daily meds down her throat.

If she was constantly sickly and had a poor quality of life overall this would be more of a no brainer but she (and we!) are so happy 99% of the time. It’s just these bad episodes that make me question where to go next.

[BCGirl]

Your kitty is very lucky to have you! I agree that a change of vet seems to be in order. Finding a small animal vet that can work through this with you from a more comprehensive and helpful standpoint is key. I can only imagine how terrifying these episodes are, and I know you want to figure out her chronic condition to make her quality of life the best possible.

Even with the definite diagnosis of asthma, it is worth investigating other systemic factors when it is this bad at such a young age. You said a change in kitty litter (the dust) brought on an attack- could it possibly be related to vacuuming/dusting/household cleaning? Or maybe something different with your laundry that she might snuggle into? Also, does she ever get people food as treats, could there be any correlation?

Also, as Simkie said, the single ingredient diet might help, she may have a food allergy or intolerance. Most commercial foods have loads of carbs and fillers in them (even scarily some of the ones recommended by vets) and that could be a factor. My indoor kitty went through a big scare with potential diabetes and a food change brought her blood sugar completely back under control.

I hope you find a vet that can help you work through this. As with human asthma, the goal is to avoid the ER visits through preventative medicine and your current vet doesn’t seem to like that approach. Good luck and jingles and hugs for getting kitty better!

[Alex_and_Bodie_s_Mom]

I third (or fourth) another vet.

My vet is the kind that won’t rest until he figures out what’s going on. He will be on the phone at all hours consulting with specialists around the country, doing research online, figuring out alternative treatments. Different treatments, longer-lasting steroids, steroid injections (if they’re available for cats, and I think they are) – all of these are avenues that need explored.

Also, have you kept a diary of her daily life? I know it can be difficult, but if you can track this for let’s say the six weeks or so between attacks, documenting her daily activities (so far as you know them), what she eats, her cat litter, people who visit, changes in YOU (laundry detergent, perfume/cologne, shampooing carpets, etc.), then you might start to see a pattern. I did this last year with The Mick, and while difficult, I just had a notepad with a magnet on my fridge, and tracked everything that way.

[Beethoven]

I was going to suggest keeping a diary as well. My asthma kitty also has asthma attacks if I give him liquid meds. He doesn’t get too stressed about pills though.

I am glad you are looking into another vet as that sounds like it is very much needed at this point.

Have you done a transtracheal wash? Usually those are done to make a definitive diagnosis of asthma. Although, it sounds like her radiographic changes are pretty significant.

Glad someone else brought up lungworms, glad to hear she has been dewormed. It maybe worthwhile to look up what dewormer was used and if its effective against lungworms in cats. Also an off the wall suggestion would be rule out heartworms. They are very rare in cats but since she is over 6 months old then it is a possibility. They tend to manifest as respiratory issues in cats and also vomiting. They can be harder to rule out in cats as they often have occult infections meaning only 1 sex, so no microfilariae and the snap test only test for females, so male only would not be picked up and cats tend to have a low number of heartworms. There are other blood test that can be done though.

Good luck with your kitty. My boy was diagnosed at 11 months and is now 11 years and has not had any severe attacks which I feel very lucky after hearing your story.

[french_fry]

This is great advice, thanks so much! I could seriously cry with relief that some people out there get where I’m coming from.

I made her clinic fax me her extensive vet records and found that she actually was NOT dewormed. Her fecal came back negative (?) for everything except coccidiosis, which she was given a course of Albon for. I am trying to do some research on lungworm but haven’t found the answers I’m looking for re: if further testing is required. She had the fecal a couple of days before her first asthma attack and the emergency vet didn’t mention anything odd about her chest x-rays other than the “donuts.” I may as well ask about heartworm too.

She is actually eating pretty crappy food, to be honest. We had her on a grain-free Wellness kitten formula which she really wasn’t fond of so when we needed to incorporate her medicine into her food we switched her to Meow Mix Savory Morsels since that’s what she had eaten when our friend found her and she INHALES the stuff. She occasionally gets a handful of Simply Nourish grain-free dry food. We thought that getting her something she likes to eat (and will therefore eat the medicine mixed in) was more important than the fact that the food was sort of subpar.

I think we need to take another look at her food - any specific recommendations?

I will definitely keep a journal.

[BCGirl]

Yikes on the deworming! Fingers crossed it might have something to do with that and hopefully a simple solution! You must be about ready to blow up on them. You can also call the new vet you are planning to see and ask about lungworms and heartworms, they may be able to give you more information.

I totally understand the needing to feed what they will eat especially when medicine is involved. I feed orijins dry food cat and kitten - the fish variety is especially stinky if that is needed to entice her to eat. Just not so nice for the humans to smell! For wet food I feed weruva, which has tons of flavor options, but splash dance is my cats favorite.

I totally understand the frustration, as does everyone on here- it can be really tough to find a great small animal vet. Good luck and I’m keeping my fingers crossed!

[Simkie]

I would look at the meat only canned foods to give her AS LITTLE to react to as possible. No vegetables, no starch…just the meat and vitamins.

My asthma cat ate EVO Venison…hesitant to recommend Natura Pet now that Proctor and Gamble owns them, but it works very well for us (prior to that buy out.)

Another brand is Wild Calling.

Or Hound and Gatos.

Or By Nature.

It looks like Newman’s Own also does this sort of thing.

I’ve fed everything above except the Newman’s Own and have been happy with it (not EVO since the buyout.)

Links above are not recommending that protein source, just showing the brand. You’ll probably want to start with something that is NOT chicken.

My asthma cat went to go live with a friend, so not sure what she’s eating these days. I have an IBD cat on the Wild Calling rabbit, and the rest are on By Nature chicken.

[french_fry]

Thank you so much for these options!

At the risk of sounding dense, is there a reason not to feed chicken (either in general or with asthma cats?)

Her current food has chicken, the dry food has chicken and I actually gave her a tiny bit of poached chicken the night before she had her bad attack so I think I’m desperately seeking a connection here…

The wet food we currently feed her comes in a couple of iterations - I think two out of three are mainly chicken so she’s probably averaging chicken once or twice a day.

FWIW, she’s had some mild, intermittent symptoms of an allergy or skin condition. Occasionally she scratches one ear sort of obsessively - never enough to really leave it raw or draw blood but very occasionally it’s a little scratched up looking. And one day she had a red, itchy belly (she hasn’t grown back all of her hair from her spay so it was really noticeable) that I attributed to unwittingly letting her come into contact with some scented litter. She is on the prednisolone consistently and all of these things cleared up in a day or two so it’s hard to know if the pred is masking something…

[Simkie]

Chicken is just a common allergen, and nearly all cats have been exposed to it at some point in their lives. You’re looking for a novel protein–one that she’s not been on before

I’d get her on venison or rabbit or beef or pork or buffalo and NOT rotate. Give her the same thing every day, no treats. Off the cuff, I’d say six weeks to know if you’ve got a good protein for her or not–hopefully much sooner if she is really reacting to something in the food.

And, yup…those skin issues sure sound like allergy symptoms to me.

[french_fry]

I am so out of my league here! I feel like I’m a “how to inadvertently kill your cat” what not to do PSA.

I will get her on one protein that she hasn’t been on before and definitely mention this to the vet when we go in later this week.

Thanks so much for the help.

[Pancakes]

I think that you’re getting good suggestions. I admit I breezed through your first post and with the additional information you’ve added I have more information for you.

First and foremost, you need to try to have your vet determine if your cat has feline asthma or bronchitis. They are NOT THE SAME. They seem like they are the same, however. I can’t tell you how many of us vets have difficulty determining in cats what the cause of respiratory distress is. It’s NOT EASY. Donuts on an x-ray aren’t pathognomonic for asthma. It’s bronchial inflammation.

http://www.todaysveterinarypractice.com/mags/1403/T1403F02.pdf

Please read this article. Not only is it thorough, it’s a good source (I know the writer personally :D) . Now, it’s a little heavy on the medical jargon and it’s aimed for veterinarians, but it does go through your treatment options.

Now, some things that stand out to me:

1. Your cat was never dewormed. Panacur (fenbendazole) is cheap and easy. You can try to diagnose a lungworm infection by Baermann fecal, but you may miss certain species of lungworms. A vet in your area should know what is most likely. Sometimes you only diagnose them on a BAL (bronchoalveolar lavage) or TTW (transtracheal wash), but who cares… Panacur isn’t going to hurt your cat and it’s dirt cheap. It’s stupid easy so why not.

2. Heartworm test: worth trying, but it may be negative. The traditional “snap” tests only react to the antigen produced by a female. Your cat is young and HW is unlikely, but if your cat has a positive test it is most likely real.

3. Further tests: Transtracheal wash or bronchoalveolar lavage. Both tests require anesthesia to some degree; BAL is deeper and they have to really be under but diagnostically you can get more cells and a better diagnosis that way. Both have the risk of making things worse temporarily, though, and both can be fairly $$.

4. Treatment options: If your cat has never had a course of doxycycline, it may be worth trying. Mycoplasma species can be hard to diagnose unless you get into PCR type of blood tests and doxy seems to have immunomodulatory capabilities. Something to talk about with your new vet.

5. Steroids: As the article says, albuterol is only short-term…but it is not going to work long-term. Look into a fluticasone inhaler (FloVent for the human brand) as these are much much much safer long-term for kitties compared to steroid injections or even prednisolone. They have local effects on the lungs. And most cats are pretty good about taking them. They even have special masks http://www.trudellmed.com/animal-health/aerokat that help deliver the puffs.

6. Consider immunomodulatory medications. If you get a true diagnosis of feline allergic airway disease, maybe it’s time to look into something like cyclosporine (Atopica) to modify your cat’s immune response to the environment. This is kind of down the line…

7. Food: Don’t go crazy. Start with a good novel protein/carb limited ingredient food or a hypoallergenic food to rule out any kind of food sensitivity. Food allergies are rare but if your cat truly has some weird allergy disorder, it’s worth ruling out food allergies too. Natural Balance makes limited ingredient diets (Rabbit/green pea, etc) that are OTC and there are many prescription vet diets out there.

8. Climate control. Use a low-dust litter (Precious Kitty is the vet-made brand) and use a HEPA filter in your house if possible. No scented anythings; no scented candles, air fresheners, sprays, etc. Nothing that might trigger an attack.

That’s all I can think of at the moment. Any good vet worth their while can provide this list to you, and more. IF you can’t find one, you can always try to have your cat seen by a specialists – any vet with DACVIM specialty (internal medicine) is a good one.

[french_fry]

I love you guys! This info is so, so appreciated.

Pancakes, this article is fantastic. I really, really wish I had seen it before I went down the Google rabbit hole because it reflects all of the best information that I’ve found in various sources plus some stuff I didn’t know. I am going to print and make my BF read as well.

re: the diagnosis, I just pulled her records and this is the exact language used:

"Diagnostics: Chest x-rays showed hyper-inflation of lungs and a diffuse bronchointerstitial pattern consistent with asthma. No evidence of heart failure was seen at this time.

…

[Kitten’s] clinical signs are caused by feline allergic bronchitis (feline asthma.)"

So…is that asthma? Bronchitis? Both? Or is your point that there haven’t been diagnostics that could accurately diagnose one or the other at this point?

Our kitten is currently back to getting .1ml prednisolone orally 2x/day and half of a 25mg theophylline pill 1x/day. I don’t think this was meant to be her end-all be-all but our current vet practice has not been responsive when I’ve brought up my concerns about long term oral steroids and queried whether there were other options.

I will discuss Panacur, a heartworm snap and doxy with new vet practice this week.

Our kitten does have an Aerokat for her albuterol rescue inhaler and hates it with a fiery passion. It’s not insurmountable (I’m sure she’d get used to it…eventually) but the Flovent is stupid expensive so I think our vet wanted to try a more conservative treatment to see if we could get her stabilized We will probably end up with a daily inhaler since from what I’ve read it is the safest, most effective long term option. Our vet charges $350 for one inhaler that (I think) is supposed to last a month or two. Hopefully I can find a less expensive source.

[Simkie]

[QUOTE=Pancakes;7828282]

1. Your cat was never dewormed. Panacur (fenbendazole) is cheap and easy. You can try to diagnose a lungworm infection by Baermann fecal, but you may miss certain species of lungworms. A vet in your area should know what is most likely. Sometimes you only diagnose them on a BAL (bronchoalveolar lavage) or TTW (transtracheal wash), but who cares… Panacur isn’t going to hurt your cat and it’s dirt cheap. It’s stupid easy so why not.[/QUOTE]

And available online for cheap, so you don’t even need to deal with the vet who didn’t think of this and worm her

http://www.amazon.com/gp/product/B00061MVMI/ref=oh_aui_detailpage_o05_s00?ie=UTF8&psc=1

(I used this stuff to worm our wandering barn cat.)

[betsyk]

Inhalers… do you have a friend or family member who uses Flovent and would be willing to leave a wee bit in an inhaler for you, from time to time? I never said anything about insurance fraud, I do know that sometimes 30 doses is more like 31 or 32

[Marshfield]

[QUOTE=betsyk;7828406]
Inhalers… do you have a friend or family member who uses Flovent and would be willing to leave a wee bit in an inhaler for you, from time to time? I never said anything about insurance fraud, I do know that sometimes 30 doses is more like 31 or 32 :-)[/QUOTE]

Unfortunately, the flovent would be a daily prevention medication. I have very mild asthma, but even the generic albuterol costs me $30 with good insurance. It seems as though when the propellants in them changed cost went up. I just met someone who is using Flovent successfully for her asthma cat and it IS expensive. Even ordering out of Canada, the Flovent costs her over $75 per month. Ordering it in the US is even more expensive, the $350 the OP was quoted in the US, sadly, is likely quite close to the price without insurance and not a massive mark up on the part of her veterinarian.

[BCGirl]

Pancakes to the rescue! What a ton of information to talk over with your new vet- who I hope is going to be great. I can’t wait to hear how kitty’s appointment goes later this week!