Upper respiratory infection - cat

Question
QUESTION: My cat is 11 years old.  In September 2005 he was diagnosed with small cell GI lymphoma.  His chemo protocol was chlorambucil and prednisone.  This cat has had Feline Herpes Virus since he was a kitten.  It was well managed with 500mg of lysine daily until over one year into chemo, when it flared up and was followed by an opportunistic infection that was difficult to clear with several weeks of Clavamox.  The next URI came several months later; Zithromax finally cleared it, again with daily dosing for five weeks.  He's had many Herpes flareups since.  We do not treat with antibiotics unless there is clear evidence of infection, like thick yellow mucus.  His eyes are not affected.  We stoped the prednisone several months ago, but he is still taking chlorambucil 2mg twice a week.

I am concerned about his latest infection.  It has not responded to Amoxicillin, Clavamox nor Zithromax.  He is now on day 6 of clindamycin (one half 75mg in two daily doses).  He seems slightly better: less sneezing and hacking.  However, the mucus is still colored.  People on a couple of internet groups have suggested using a nebulizer, Vitamin E, infant nose drops (Little Noses).
I am at a loss as to what to do at this point, as we seem to be running out of antibiotics.  Any advice would be most appreciated.

ANSWER: Boy this is a hard one Marie. He seems to be developing a resistance to all the antibiotics.
My question is this to you: At his age, is he living the kind of life you think he should? I mean if he is sick almost all the time, is he a happy cat?

I really don't have any answers for you Marie. You might want to have his latest infection cultured to see if there is a better antibiotic for him. He will continue to suffer from these infections and I truly don't see how he is leading a life of quality when he is sick all of the time.
While this is something only you can decide, sometimes we get so caught up in the little things,such as searching for the next antibiotic to try that we need outsiders to remind us that we need to be thinking first of his well being and comfort.

I don't think the nebulizer will hurt anything, they are often recommended for cats with asthma. I don't know anything about the Little Nose drops so be careful about toxic drugs and especially in his weakened state. Vitamin E is a good vitamin but what purpose is it serving in this situation? I personally don't know how it will help.

I wish I could be of more help but it seems you are running into a wall here.
Culturing and going for the weird drugs would be your last resort at this point.
I hope you can find something to help him.


---------- FOLLOW-UP ----------

QUESTION: This is not so much a follow up but a clarification and a thank you.
I appreciate the fact that you reminded me of the importance of quality of life.  I've seen it so often: he's not feeling that much worse than he was one month ago ... but that's what was said a month earlier.  Sometimes it is difficult to be objective when a loved one's health deteriorates gradually.  I know I must look out for this, as I've promised Darcy that I will not let him suffer.
That being said, we did see our vet three weeks ago.  She found that she could hardly feel the ropiness in his intestines when she palpated him.  There's no fever.  He's eating well, he plays, he terrorizes our three other feline roommates.  He purrs and cuddles with me at night. He sneezes several times a day; once in a while he has a coughing fit.  He seems to recover quickly from the discomfort this must bring.  I see very little change in behaviour.
I love this little guy to bits and I will never be ready to lose him, but I don't think that time has come yet.
I have a sterile collecting kit; I am planning to have a culture done to see if we've missed something.  Oh -- and the Little Noses I mentioned is just a plain saline spray.  I used one drop last night, and the result was dramatic -- a lot of mucus came out, and he didn't sneeze once for hours.  
If this infection does not clear up soon the plan is to take him off the chlorambucil and give his immune system a chance to recover.  It's a gamble, but we knew from the start that we might end up having to pull him from all chemo meds.  Some cats have remained in remission for months after stopping chemo, so to me it would be worth a try if all else fails.
Thank you for your prompt response and for the quality of life wake up call.  It is something that cannot be stressed enough -- and something that must be repeated often, as it is quite easy to lose track of the big picture when one desperately doesn't want to see it.
Regards,
Marie

ANSWER: Marie,
I applaud you, I bow to you, I hug you!! Thank you for being one of the rare gems of a pet owner that doesn't yell at me or the vet when this is mentioned.
You are indeed a gem to remember these things and to know the difference.
I would have to say that if the Little Noses are working that well then by all means continue with them. That won't hurt a thing. I personally use a saline lavage if I have a cold also since I cannot take your average 'cold pills.'
If he is as active as you say then I agree with you that it is not time. It is hard for us to know these other things since we are on the other end of a screen as opposed to a vet's exam room. I have had to make the devastating decision my self twice over the last 5 years to put down beloved pets.
So I know it's very, very hard to make that choice.
I have no doubt in my mind that you will make the right one when it's time. I can tell by your reply that you are a very sensitive, responsive and loving pet owner.
Good luck to you and Darcy both and please keep me posted on how he does.
Jana

---------- FOLLOW-UP ----------

QUESTION: Hello Jana,
This is not a question; it is an update.  Shortly after I last wrote Darcy's URI got worse.  He continued to eat well and to cuddle with me, but he stopped playing and was clearly uncomfortable.  We switched vets.  Our new vet and her partner consulted with colleagues and prescribed a combination of doxycyline and Flagyl, along with a probiotic.  Within two days Darcy stopped sneezing; two days later he was breathing normally, running around like a kitten and waking me up at 3am to play.  We had a wonderful summer -- he was well and very happy, and I cherished every single moment.  In September we had a party to celebrate three years into remission: a little miracle in itself.  In late October 08 he suddenly became lethargic, was running a fever and had some difficulty breathing.  I spent hours with our vet researching how best to treat him; we opted for nebulizing with Gentamicin and Mucomyst.  It didn't work.  We stopped the chlorambucil, added immune system boosters, nose drops, vitamins ... It didn't work.  He only got relief from sitting in a large cage with a vaporiser.  I had to keep my promise that I wouldn't let him suffer.  We gave him NSAIDs; he felt better, but not enough - and we couldn't keep him on NSAIDs.  I had a long talk with Darcy, and we decided that it was time to say goodbye.  One more day: NSAIDs, steam.  We cuddled.  I sang to him.  He purred and gave me kisses, and for one hour that day he played a bit, although it cost him -- I think he did it for me.  That evening our vet came to us and helped Darcy cross over.  He died peacefully in my arms while I sang You are my Sunshine to him, badly, choking back tears.  Dear friends provided the funds for a private cremation the next day.  He is sorely missed, my beloved boy.  It is still difficult to go to bed knowing that he isn't following me to cuddle and fall asleep next to me.  But I know I made the right decision.  I did not let him suffer.  I honoured my promise to him.  It helps.

Marie

Answer
Marie,
Even  through my tears I am smiling. As I said before, you are a gem of an owner. You made the right choice and by honouring your promise to him you did prevent him from suffering needlessly.
I can't help but wonder if he didn't develop some sort of fungal infection after all of this treatment. But regardless, no matter what he had you still did the correct thing. The hardest thing, but the right thing.

I am very grateful that you wrote to me and told me this. I appreciate it very much. While it will be very hard without Darcy now, you will smile sooner and your tears will be shorter knowing his is at peace. That was what kept me going after losing my Floyders in 1999 at the age of 19 yrs one month. I cried for months, but I smiled sooner because I knew he was not suffering any longer.

Thank you again for the update.