CHRONIC NASAL DISCHARGE

What causes chronic upper respiratory tract disease?

Chronic upper respiratory tract (URT) disease is a relatively common problem in cats, and can have many causes.  The most common form is termed chronic post viral or idiopathic rhinitis.  In this condition viral infection (e.g. cat 'flu - caused by feline herpes virus or feline calicivirus) causes the initial mucosal damage; but the chronic signs relate to secondary bacterial infection of the damaged nasal passages.  This may then lead on to chronic osteomyelitis of the turbinate bones and cartilage (bacterial infection of the fine bones within the nose).

More unusual causes include:-

1 .   Fungal infections including cryptococcosis.

2.    Inflammation which can result from polyps of inflammatory tissue.

3.    Neoplasia (cancer) which can be localised within the nose, or be part of more widespread disease.

4.    Physical damage which can result from foreign objects getting stuck up the nose, facial trauma (e.g. from cat bites or car accidents), or be associated with severe dental disease.

What are the clinical signs of chronic URT disease?

The main signs are nasal discharge and difficulty in breathing i.e. chronic 'snuffles'.  The exact nature of the discharge, whether both sides of the nose are affected, and the presence of other clinical signs are dependent on the exact nature of the disease process occurring within the nose, and on the presence of any other illness the cat may have.

In order to determine the extent and nature of the disease it is important that the cat be given a thorough physical examination by a veterinary surgeon.  Particular points that the vet will look for include:-

1 .   The presence of nasal discharge, and whether it is bilateral (affecting both sides of the nose) or unilateral (affecting only one side of the nose).  Some diseases tend to show unilateral signs (e.g. foreign bodies, or cancer), while others more often cause bilateral signs (e.g. chronic post viral rhinitis, cryptococcosis).  The type of discharge can also be important; whether it is clear, purulent (pus), or blood stained.  Although the presence of a discharge can be helpful in making a diagnosis, it can on occasion be misleading.

2.    Facial swelling may indicate a more serious underlying problem such as cancer or fungal infections arising within the nasal chambers.  Although facial pain is seen rarely, resentment of facial examination is common among cats with URT obstruction, especially those with intranasal foreign bodies, or polyps.

3.    Sneezing, difficulty in breathing, noisy breathing and mouth breathing may all be seen, but their presence is usually of little diagnostic value.

4.    Examination of the eyes may reveal ocular discharge ('runny eyes'). This usually results from tear duct damage associated with previous URT viral disease or post viral conjunctivitis, but occasionally associated with cancer within the nose.  Another legacy of URT viral infection can be the development of chronic inflammation of the cornea (the clear front part of the eye).

5.    Evidence of painful or infected ears may be associated with inflammatory polyps.  Cats with polyps may have problems eating if the polyps are large enough to cause obstruction at the back of the throat, and these cats often have a snoring type of breathing.

6.    Cat's with URT obstruction often have a poor appetite and so experience a degree of weight loss.  Marked weight loss is more suggestive of cancer, fungal disease or severe generalised disease.

7.    The size and shape of the kidneys may be altered if certain cancers are present.

8.    Mild to moderate enlargement of the lymph nodes (glands) at the angle of the jaw is common, resulting from a local inflammatory response.  If the lymph nodes become very large, or if lymph nodes elsewhere in the body are also affected, cancer or fungal infections are most likely to be the cause.

Over-interpretation of clinical signs can be very misleading since different diseases can give rise to similar signs.  However, a few general rules do apply, e.g. facial deformity (changes in face shape) with associated pain, especially if accompanied by a unilateral nose bleeds or marked lymph node swelling is suggestive of more serious underlying problems such as nasal cancer or fungal disease.  Lack of these clinical signs does not rule out these diagnoses as some cases of nasal lymphosarcoma (a common type of cancer) can cause bilateral nasal obstruction and little nasal discharge of any kind.  Although post viral rhinitis usually presents as chronic bilateral purulent discharge, it can also result in unilateral discharge, sometimes blood tinged and occasionally with severe nose bleeds after 'sneezing fits'.

Does the history of the cat make a difference to the likely diagnosis?

Yes.  It is very important to know the answers to a number questions relating to the cat's previous experiences. e.g.

1.    Did the cat have an acute URT infection (cat 'flu) as a kitten?  This is the most common initiating cause of chronic rhinitis.

2.    Is there any history of facial trauma, dental disease or ear infections?

3 .   At what age did the cat first develop the clinical signs?  The age of onset and speed of onset of clinical signs can often be misleading, but can occasionally be of help in the diagnosis.

4.    Has the nasal discharge always been of the same type, consistency and colour, and has it always been unilateral or bilateral?  Are the signs progressing, is the cat systemically ill, and has the cat responded to any previous treatments?  The answers to these questions may help determine the underlying cause of the problems.

My cat had 'flu as a kitten and has had 'snuffles' ever since, although he is well in himself Should 1 ask the vet to find out what is wrong with him?

Arrange for your vet to examine your cat but if chronic post viral rhinitis is believed to be the most likely cause of the patients clinical signs, and the cat is not too distressed by the nasal discharge, it is probably best not to put it through further examinations.  Further investigations are generally best left for cats with severe or progressive clinical signs, or those with evidence of generalised disease.

When considering treating cats with severe chronic URT disease it is helpful, (where possible), to differentiate between the possible underlying causes.  This allows for the correct treatment to be given and the probable outcome to be discussed.  However, since most cases of URT disease will result from chronic post viral damage, it is important to remember that tests may give negative results and the likelihood for full recovery, even with treatment, may be guarded to poor.

What tests can be done to rid the cause of the disease?

1.    Non-invasive tests, such as haematology, biochemistry and tests for FELV and FIV may help to determine the extent of systemic disease.

2.    Nose and throat swabs may be taken to look for the presence of fungi and viruses.

3.    For the best hope of finding a diagnosis it is necessary to give the cat a general anaesthetic in order to perform more extensive investigations.  These include taking radiographs (X-rays) and examining the nose and mouth.  Detailed examination includes looking up the cat's nose, and examining behind it's soft palate (the flap of skin at the back of the throat).  While examining the nose it is possible to take samples to look for bacteria, fungi, evidence of inflammation or cancer cells.  These methods do not allow very good access to the nasal chambers, so it is possible that underlying disease may sometimes be missed.  Deep biopsies of the nasal cavity with special forceps are very helpful in obtaining an accurate diagnosis.

Can chronic URT disease be treated?

Yes, but in only some cases is treatment likely to give a long term cure.  In most cases the clinical signs can merely be controlled, since the chronically damaged bones cannot be repaired.

Antibiotics can be given to reduce secondary bacterial infection.  However to control the clinical signs it is usually necessary to give them for long periods of time or as repeated courses in order to control the clinical signs.  Some cases can be permanently cured with long courses of expensive antibiotics.  In the remaining cases it is generally hoped that with time the cat, and its owners, will learn to live with the cat's disease, without the need for repeated courses of antibiotics.

Other treatments that can be considered include drugs to reduce the thickness of the nasal secretions (mucolytics), or treatments to help the cat breath more easily (anti-congestants or steam inhalation).  If the cat is severely affected by 'snuffles' and is undergoing further investigation, it is possible to therapeutically flush the pus from the nasal passages while the cat is under general anaesthetic.  Although this procedure can occasionally give some degree of short term relief, the clinical signs usually return.  The most essential aspect of treatment is good nursing care; keeping the cat's face clean and clear of discharge, and encouraging it to eat by feeding warmed up food that is strong smelling.

Specific treatments can be given where a specific causes have been found, e.g. polyps can be surgically removed, some cancers can be controlled with chemotherapy, and fungal disease can be cured with anti-fungal drugs.

Glenroi Veterinary Clinic

MOVING HOUSE

Why do cats try to return to their old house?

Cats are very territorial animals and they may have problems accepting a new house as their home.  If the old house is nearby cats may return to their old haunts and try to take up residence with the new people living there.  If the move is further away cats may just wander off and get lost.

What can 1 do to help my cat settle in a new home?

·  Before leaving the old house cats should be fitted with an identity collar, with the owners name and new address.  This should be kept on until cats are fully settled in their new home.  A microchip is a useful extra precaution.

·  Cats should be transported in a safe well secured container such as a cat basket or cat box so there is no danger of escape.

·  On arrival at the new house the cat should be left in its basket until one room has been sorted out and installed with familiar objects.  The cat can then be let out but kept confined to this room and a litter tray provided.  To help the cat to settle it should be fed with its favourite meal.

·  Once the removal men have gone and the house is quiet check that all the doors and windows are closed and allow the cat to explore.

·  Cats should be given lots of extra attention, petting and extra food during the period of settling in. The cat should be fed indoors for at least 7-10 days before being let outside.

·  Once the cat has begun to accept the house then it can be shown the garden.  At first, it should only be let outside before meals so food can be used to lure the cat back inside if it wanders too far.  Cats are much more likely to fight in a new territory so careful observation and curfew attention is vital especially in first few weeks.

·  Initially the cat should be let out alone only for short periods during the day.  It should be hungry so that it will not wander too far and will readily respond to a call when its meal is ready.

·  If possible try to avoid having builders working in the house during the initial settling in period.  Cats hate this and it will inevitably make readjustment more difficult.

How long will it be before I can safely let my cat outside alone?

This is very variable depending on the disposition of the cat and how much time has been spent on making the cat feel at home; some cats take only a few days to settle down whilst others may take three weeks or more.  Outdoor cats with a wide experience of change tend to cope best but even they should be kept in for a week to give them a chance to learn about their new home.

My cat is very nervous.  Are there any special precautions I should take?

It may be wise to board particularly nervous cats in a friendly cattery before the packing up of the old house starts and to keep them there until everything is unpacked and positioned in the new house.

My cat keeps returning to our old house.  What can I do?

This happens because the bond with the new home is not sufficiently established.  Measures must be taken to establish the new home as the source of food and shelter ( in contrast to the old house where these things are denied him).  It may take weeks or months before the cat can safely be let out unattended.

· Keep the cat indoors at the new house for about a month.  Use the guidelines given above to try increase the bond with the new house.  It may help to feed the cat small meals several times a day.

· When the cat is first let out it should be starved for 12 hours so that it is really hungry.  It should be left out for only a short time and then called in and fed.  For the first two weeks it should only be let out once a day and be called in after no longer than 30 minutes and fed immediately.

· Warn the new occupiers of your old house and discourage them from feeding the cat, talking to the cat or otherwise encouraging it.  In some cases active deterrent action can be tried such as turning the cat out and throwing water at it.

· Other neighbours, even those who were previously friendly with the cat, should be asked to behave similarly.

· As a last resort consider boarding the cat for a few weeks in a cattery as far away as possible from either home to try to scramble its memory of its old home and its homing mechanism.

· If all else fails encourage the new owners of your old house or their neighbours to adopt your cat.

My cat never goes outdoors so moving house should be straightforward

Moving house can be just as traumatic for the indoor cat because it involves a complete change of personal territory.  Gradual introduction one room at a time with lots of attention will help to reduce the stress of the upheaval.

THOUSANDS of cats are made strays each year through insufficient thought and care

DON'T LET YOUR CAT BE ONE OF THESE!

Glenroi Veterinary Clinic

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Arthur Webster & Associates Pty Ltd

PO Box 438, PYMBLE NSW 2073 Australia