Nasal Flushing in Cats
This week was extremely busy. We had a few dog bite wounds, sick sugar gliders, a GDV, a leopard gecko that had been regurgitating, a sneezing guinea pig, and that was just half of our Thursday! Aside from those, I actually wanted to write about a common presenting concern: the wheezing cat. When we have a cat owner call in to say that their cat is coughing and wheezing, since the airway is important for life, we want to see them as soon as achievable. Remember that your signalment is important when you are creating your list of differentials! Once we get that cat patient in, we need to determine if their signs are lower airway or upper airway. Part of the physical exam will include auscultation of the chest. One thing that I extrapolated from my days in the large animal medicine service in vet school was to also listen over the trachea at the neck. This is one way to help you decipher lower airway from upper airway. Is the wheezing louder over the trachea than it is over the bifurcation of the bronchi? Then it is most likely referred from the upper airway. Cats are not obligate nasal breathers. But it does take them a lot to be breathing through their mouths! A differential for the wheezing cat is allergic bronchitis or feline asthma. But before you put this coughing cat on steroids, know that feline asthma isn’t all that common, and the upper airway wheezing in cats is very common. There are a lot of resources online for feline asthma. So here are a few links if you need a refresher! Merck Veterinary Manual on Bronchitis Cornell Feline Health Center Case Study: 5-year-old male neuter DSH presenting for coughing Initially when we saw this patient he was being referred to us for bronchoscopy. It was thought he had a feather stuck in his lower airway or potentially feline asthma, depending on who you spoke with. We only have one DVM trained to do bronchoscopy at our hospital. So instead of scheduling on a day this DVM was working, I got the case. The first thing I thought after my physical exam was that the wheezing noises were louder in the upper airway than in the lower airway. X-rays had already been taken a couple days prior at the cat’s rDVM. So, I did a sedated laryngeal and oral cavity assessment. I saw a significant amount of mucous at the caudal aspect of the soft palate and on the arytenoids. I aspirated what I could get and swabbed for a culture. I started the cat on Doxycycline while we waited for the culture results. Surprising to me was that the culture came back negative. I guess that just goes to show you that not every green and yellow clump of mucous needs antibiotics. However, Chlamydophila is difficult to culture, and we still had not ruled this out. So a PCR may have been more fruitful. The cat’s symptoms waxed and waned. Sometimes improving, sometimes not. The owner was using some nasal drops provided to her by a friend and maybe these helped a little. This week, the cat came in for a therapeutic nasal flush. Since it had been months between his visits. I reassessed him. He was reverse sneezing in fits. His lungs auscultated normal and he had pink mucous membranes. We anesthetized and I used proparacaine for local anesthetic in the nostrils. I chose an 8Fr red rubber but could have gone wider for this particular cat. I measured the tip of the catheter to the medial canthus as I didn’t want it going in too far. Sterile saline was used for the flushing. You want to use sterile saline for a few reasons. If you want to culture the sample, you don’t want to be introducing anything into the nose. But also, because you’re flushing retrograde, you don’t want to flush anything into the airway. Yes, we anesthetized and the airway is protected by the ET tube, and our patient is tipped rostrally so it drains cranially and not caudally, but it is better to be cautious. I do have to say, pulling 2 ml of mucous from the back of the cat’s nasal cavity was satisfying and likely the cat will feel better! So what do we do now? You can do cytology, culture, and/or PCR on the sample. The owner declined diagnostics due to cost. So I told the owner she can continue with the nasal drops, or we can do extra-label Cerenia for its anti-inflammatory properties. He should at least feel better! Next steps if it doesn’t resolve would include a CT and/or a rhinoscopy.