Nose - Nasal Problems

Nasal odor in Himalayan - nasal passage mass

Question: Dear Doctor-

I have a 12.9 year old male Himalayan who is the absolute light of my life. There are no other animals in the house and he is primarily a house cat but I let him go in the garden and grass with me for a few minutes each day. He always chews on the grass (and promply throws up. He has been a puker all of his life....once every 2 months or so despite Petramalt. A furball is usually expelled) In June, I noticed a foul smell from his nose and he began to get finicky about his wet food and the flavors he always liked, he began to turn away from. There were no other symptoms. I knew he was overdue for a teeth cleaning that I had been putting off because I am scared of losing him to anesthesia. I brought him to the vet on June 1st and gave the above history. The vet told me that Destry had moderate dental disease and that a cleaning was in order and would probably take care of the smell. He also told me that he would put him on an antibiotic that ought to take care of anything else it could be. I recall that he said something like, "It doesn't smell like a tumor."

His teeth cleaning went well and he got a clean bill of health. He said nothing about signs and syptoms to watch for and it wasn't until recently that I remembered him commenting it not smelling like a tumor (do tumors smell?) If i had known that they do, i would have brought him back in immediately. The nasal odor continued however. He also started sneezing about one time per day. No discharge, oozing, draining from eyes, ears, nose or mouth. He never had any change in behavior. He remained finicky about wet food but seemed to be eating okay (especially if he could get it off my plate!) There were no other symptoms.

My mom, who is a physician (internal medicine) returned from being out of town for a long period of time, smelled Destry's nose and said it smelled like a culture in a petry dish and that she was sure something was going on.

I took him immediately to the vet hospital that I used and saw the vet on duty that day. She was so scared of his hissing that she did not even examine him. His weight was down 14 ounces from June 1st. She said it could be one of only two things, an abcessed tooth or a cancerous tumor in the sinuses. She wanted to get x-rays under anesthesia. Two days later we under-went that ordeal. At the outset, I asked her to perform a thorough physical exam while he was under and I asked if she would perform a flushing of his nose to run and culture and sensitivity. She said she would if she got in there and felt it was necessary. She took an oblique view on the left and right and told me that she saw nothing. She said she smelled nothing from his nose. She also said that she smelled my perfume on him and she believed that he was allergic to my perfume and that was the reason for his sneezing. Of course, she never asked how long I have owned the perfume (a few days) to relate the two together. At that point, I got upset and told her that I knew that something was wrong with my cat, his nose smelled and this was not going to be the end of the hunt. She took another view and said she saw a deviation but stated that she did not know enough about a cat's anatomy to know whether it was normal or abnormal. She said it was too close to the brain for her to biopsy. She referred me to a radiation-oncologist who read the films but who would not speak to me, only to the referring vet. After she read the films, her recommendation was to get a CT scan in Phoenix (Tucson doesn't have a CT scanner). I made the five hour round trip with my cat and sure enough, the films show a mass that is more prevalent in the left nasal area than the right but it has broken through the septum to the right side. I was told that it is not deep in the sinus cavity and did not involve the ? bone (seperates brain from sinus). I was told it is in the middle area. Now I am referred back to Tucson for an rhinoscopy.

All this time, (five days) he has been on Clavamox BID. By the time I took him to the CT scan, I am convinced that my cat is dying because now he is acting nasty, won't eat or drink. Thank goodness for the information provided by the vet at the CT scan who told me that the Clavamox can upset their stomachs and decrease appetite.

My problem is with regard to the endoscopy. I called a person who is boarded in Internal Medicine and who does endoscopies. He will not do it until I have a coag profile drawn.....why this wasn't drawn on one of the TWO times my cat has been under anesthesia in the past five days, I don't know. An endoscopy should help us reach a definative diagnosis of infection vs. tumor right? Should it be performed by a specialist? Are there any questions I am not asking that I should be asking?

Prior to me dragging him to the vet, he was happy and active and his normal precious self. Cost is not a problem, I will do whatever needs to be done as long as he is not in pain. What should I be asking about? How are malignant tumors of the sinus treated? What if it is a fungal infection? How is that treated? I am fearful that it is not infection because his WBC is not through the roof and is in fact, low. He is slightly anemic.

Shouldn't we have done an endoscopy in the first place? After the CT scan I really know nothing more than I knew when she said based on my history of nasal odor that it was infection or tumor!!!!! If it is a tumor, what is the prognosis in cats? I am sorry this is so long, i am trying to provide you with every detail because I am unsure of what may be relevant or not. I kept hoping that all this would be is a piece of grass stuck in his nose or some infected aspirate from vomiting or something non-life threatening.

Oh, we are waiting for results on Valley Fever titer and some other fungal infections (Cocci?) What are your thoughts? Thank you very much in advance. Anne

Answer: Annie-

I don't think of nasal tumors as having a particular smell but I am known for having a really poor sense of smell, so I am not sure that they don't. I wonder if your vet was actually saying that he didn't think this was a tumor because the symptoms were what he would expect for a tumor and he used the term "it doesn't smell like a tumor" in that manner.

Dental disease is a fairly common cause of sneezing and nasal passage infection or inflammation in cats and it was reasonable to assume that this was a likely cause for the symptoms observed in Destry. However, it was also very good that you were persistent in insisting on further testing when treating the dental problems did not result in a lessening of clinical signs. Sometimes, you really do have to be a strong advocate for your pets.

It is a good idea to try to get a biopsy of a suspected nasal passage mass. It is recommended that blood clotting tests be run prior to attempting to biopsy the nasal passages. It makes a lot of sense when you think about how easily nosebleeds start and how hard they are to stop, sometimes. I think that the clotting tests were not run during previous visits because it wasn't necessary for the procedures being run that day and someone else was going to do the nasal biopsy. Some veterinarians are very particular about this testing and insist on doing it as close to the surgical procedure as possible to ensure that there is the least possible chance for changes between the time the test is done and the procedure. This is one of the problems associated with the use of multiple specialists.

There are three ways that I know of to try to obtain tissue samples from the nasal passages.

The first technique is forceful flushing of saline through the nasal passages and collection of the saline and any dislodged tumor tissue at the pharynx. This actually has worked really well for us on two or three occasions but is often unsuccessful in aiding a diagnosis.

The second method is to figure out from the MRI scan where the tumor should be and to blindly pass a biopsy needle or big bore catheter to that point and into the tumor. This usually provides for a bigger biopsy sample than endoscopy and can be performed without the specialized equipment. It does require anesthesia but Destry has demonstrated that he is able to process anesthesia so this is not a major concern at this point. It does require blood clotting testing, just like endoscopy. Culture samples can also be obtained in this manner, in some cases. Since this is a blind technique it is really good that the tumor is not located near the cribiform plate that separates the brain from the sinuses, as it should be possible to get a sample without as much risk of perforating this protective barrier for the brain.

The third method is the endoscopy. The major advantage to this is that the specialist gets to see the appearance of the mass and can be relatively certain of getting a sample from the tumor rather than surrounding tissue. The disadvantage is that the biopsy capability for endoscopic instruments small enough for the nasal passages is limited and they biopsy samples are likely to be fairly small. Once in a while this complicates getting an accurate diagnosis of the tumor type.

It is sometimes possible to biopsy a lymph node draining the nasal region to find the tumor type and it is a good idea to biopsy these to see if the tumor has spread to lymph nodes, as well.

Cats usually have a pretty good prognosis with radiation therapy for nasal tumors. This is partly due to the prevalence of nasal lymphoma in cats, which is pretty susceptible to radiation therapy. Around half of the cats treated with radiation for this tumor will survive more than a year after treatment and the two year survival rate is higher than for other nasal passage tumors. For tumors that are not lymphomas, the one year survival rate after radiation therapy is still around 40% but the two year survival rate drops to about 17% (Theon, JAVMA 1994). Chemotherapy does not appear to help a great deal in increasing survival time but it is an option if you wish to pursue every possible angle of attack and would be more important if there was evidence of spread of the tumor beyond the nasal passages.

I do think that it is best to get a tissue sample to determine the tumor type to help make plans for therapy. If your vet is not comfortable getting the sample it would be best to let the specialist do the biopsy. I am not sure that endoscopy is absolutely necessary but since it is an available option in your area and does allow visualization of the mass and nasal passages it seems reasonable to go this way with testing.

Good luck with this.

Mike Richards, DVM 9/28/2001

Nasal polyp possible in diabetic cat

Question: Dear Dr. Mike:

I have a 12 year-old diabetic cat (she gets 1 unit of insulin twice a day) who seems to be having a problem with her right ear. She's constantly scratching it and is constantly shaking her head. She's also been sneezing alot, sounds very congested and has alot of white-colored liquid coming out of her nose. (Her ear also had a hematoma at one time and it was left in the curled position.) I adopted her 3 years ago (the hematoma was repaired before I adopted her) and her ears were filthy to the point of them bleeding (no mites). I had her ears flushed and kept cleaning them until they were crystal clear. Now 3 years later and even though they are crystal clear, she's still scratching, shaking her head and sneezing alot. The vet has taken x-rays (didn't find anything) and has put her on Baytril for as much as up to 28 days thinking it could be a sinus infection. She seems to respond to it, but once she's off the medication, it starts all over again. He now has her on Clavamox pills BID, but she's still very uncomfortable. I also have her on L-Lysine (250 mgs once a day) for over two months now because the vet said that this would boost up her immune system, but that doesn't seem to be working. Could she possibly have a ruptured ear drum that would be causing her to shake her head, sneeze, etc.? Would really appreciate any help you could give me. Thanks, Dr. Mike.

Sincerely, Janice

Answer: Janice-

The first thing that came to mind when reading your note was the possibility of a nasal polyp. These are not uncommon in cats, they don't show up well on X-rays and they cause chronic ear irritation and/or running noses and/or difficulty swallowing in cats. These can be hard to find but an examination under anesthesia that allows retraction of the soft palate and examination of the back of the nasal passages sometimes reveals these polyps. There are other possibilities, such as dental disease, cryptococcus infection (a fungus) and cancers. Some cats who have herpes virus infections early in life have chronically runny noses and many of these cats also seem to have ear irritation, even when there are no other signs of infection. L-lysine can be helpful if chronic herpes virus infection is present but often the current problem is not due to the virus but due to secondary infections with bacteria or fungi. A ruptured ear drum is possible but is usually recognizable in cats on examination, especially if the ear canals are clean, so that would be easy for your vet to rule in or rule out with an examination.

If your vet can't find a problem on examination of the nasal passages with normal tools, such as an otoscope and if your vet doesn't have an endoscope, it is reasonable to ask for referral to a practice that has an endoscope, or an internal medicine specialist -- because they usually have this capability.

Mike Richards, DVM 8/3/2001

Nasal passage infection/inflammation - Pseudomonas aeruginosa

Question: hi dr. mike, i'm having a problem with my kitty... she's about 4 yrs old (pound kitty/spayed/domestic short haired) and she has had a chronic nasal passage infection/inflamation...she's been gagging/coughing for about a year (i adopted her recently, the previous owner had her on several rounds of antibiotics but didn't do any further tests on her). my vet looked in her nasal passage under general anaesthesia and reported that it was clear but had a bacterial infection with mucus and some inflamation...no polyps. he cultured the bacteria and found it to be Pseudomonas aeruginosa. a sensitivity analysis showed it to be reactive to baytril, so a course of 20mg SID of baytril ensued for 20 days. nothing improved, so another 20 days at the same dose was given. there is still coughing, and my vet has suggested 5 mg prednisone BID for 5 days, then a drop to 5 mg prednisone SID for 10 days. i'm wondering if this is necessary (i hate steroids!) and the dose seems quite large for a 10 lb. cat! i think i remember hearing that cats tolerate pred much better than dogs, but my 70 lb. dog is currently on 10mg pred SID and so it seems a bit odd to have my small cat on the same dose!

do you have any suggestions of what to do? another vet suggested a biopsy, but my vet said "of what?" since he had already looked and there only seemed to be healthy tissue.

any advice would be so appreciated!

thank you dr. mike! cheers, sue

Answer: Sue-

Chronic nasal infection/inflammation problems in cats are extremely frustrating to diagnose the cause of and to treat, once a cause or causes are identified.

Probably the most common underlying cause of chronic nasal infections is damage to the nasal turbinates and nasal passages from feline herpesvirus 1 (rhinotracheitis) infection. Once the damage is done, it is very hard to keep secondary invaders out of the nose.

Pseudomonas is a normal inhabitant of cat's respiratory tracts. However, it can still be a problem with it isn't suppressed by the body and it manages to grow wild in the respiratory tract. So treatment is called for. Usually enrofloxacin (Baytril Rx) does work well against Pseudomonas. It is sometimes necessary to use higher than normal dosages to get a good effect, though. The dosage range most effective against Pseudomonas is 11 to 20mg/kg once a day. For a ten pound cat, this is up to 90mg per day. Many cats with Pseudomonas will also respond to azithromycin (Zithromax Rx). This medication is usually used every other day. The dosage is 20mg/cat every 48 hours. It is often necessary to use it for five or six months.

Some vets think that using the intranasal herpes virus vaccinations helps to reduce the clinical signs in cats affected with chronic nasal infections. I am not all that sold on this, but there are vets that think it helps.

Using a decongestant can help. Nasal sprays containing neosynephrine or tolazoline can be helpful. It is pretty hard to use them, sometimes, though. It is important to treat one nostril only, for no more than three days. If longer treatment is necessary, switch nostrils. Chlorpheniramine helps some cats. We use 2mg twice a day for adult cats.

Sometimes antibiotic therapy works best if it is applied directly in the nasal passages, too. Gentocin injection or gentocin eye drops can be dripped into the nostrils to treat the Pseudomonas. Baytril injection and amikacin injection have been used in this manner, too. We have used gentocin ophthalmic drops in this manner in our practice but have not tried using the injectable products.

There are a lot of options for controlling these kinds of infections but often there will be recurrences or long term maintenance therapy may be necessary to keep things under control.

It may be worth considering having someone examine the nasal passages with an endoscope or to consider advanced imaging techniques, such as an MRI or CT scan. Once in a while there is a diagnosis that leads to a real cure, such as a foreign body in the nasal passage or a polyp that is just hard to find.

Good luck with this.

Mike Richards, DVM 4/13/2000

Stuffy nose and sneezing in Himalayan

Q: Dr. Mike,

I have the 14 year old Himalayan with the "stuffy nose". I am concerned because he has now started to actually sneeze some muscous-like white material when he first starts to eat. He seems to clear his nose this way, breathes through his mouth for a few minutes and then is ok.

I had mentioned that the vet had given him a cortisone shot that worked wonders. He was back to his normal self for approximately 2 weeks and then the symptoms came back. Is it possible to have cortisone administered by pill, and is there a danger of continuing to give an additional injection to control the symptoms?

I am very hesitant about proceeding with the xray of his head due to the anethesia being necessary as well as reluctant to continue with any type of surgery both due to the expense as well as the likelihood of any type of long-term benefit. I would really like to have your suggestions before I go back to my own vet.

I'm new to your service, so I'm not sure if you are going to answer this with an email to me directly or if I need to go into your web site to find the answer. Please let me know as soon as possible.

Thank you, Carol

A: Carol-

It is possible to administer corticosteroids orally. Prednisone is the cortisone most commonly used for oral administration in veterinary medicine. Most veterinary pharmacologists would probably recommend oral administration of corticosteroids over injection but many veterinary practitioners favor injectable corticosteroids such as methylprednisilone (DepoMedrol Rx) because the seem to work better clinically. The advantage of oral administration is that the medication dosing can be carefully controlled and if every other day dosing is possible there is much less adrenal suppression (loss of function of the cat's adrenal glands due to administration of the cortisones). The advantage of injectable medications is the possible increase in effectiveness and the reassurance of getting to examine the patient at the time the injections are given.

We usually try oral administration of prednisone when we anticipate that they will need to be used on a continuous basis for long periods of time.

When contemplating lab testing it is a good idea to ask yourself what you anticipate doing with the results. In a situation in which lab testing is being used in an effort to determine if an illness requires extensive surgery, radiation therapy or other costly and invasive procedures there is a good reason to consider whether or not the lab work is necessary if you already know you aren't going to follow through with the necessary procedures because they are too expensive or too invasive or too time-consuming or whatever the objection to them is. We try to make the decision on whether to follow through based on what we think the lab work will tell us about prognosis, the amount of discomfort the pet might be in or to eliminate the possibility that less invasive procedures or alternative treatments might be helpful -- in the cases when there is doubt about this.

Plain X-rays of the head are not too difficult to take, although most patients have to be anesthetized. They are hard to interpret sometimes and we often have to send the films to a radiologist for review. MRI and CT scans show problems in the skull much more clearly but are expensive and do involve longer anesthetic times and often a trip to a specialist or vet school with the equipment.

There is a procedure known as traumatic flushing, in which saline solution is forced through the nostrils in a rapid flush and then captured in the rear of the mouth and examined for evidence of fungal infection, bacterial infection, foreign bodies and cancer. This procedure does involve anesthesia but it is pretty simple to perform and we have occasionally been able to identify a chronic problem with this technique and provide treatment. In fact, on one occasion, the flush was the treatment when a blade of grass was flushed out of the nostril of a cat. If your vet is not familiar with this technique I am pretty sure that it was written up in a Clinics of North America journal several years ago. He or she might subscribe to the journal and have the article.

A lot of chronic upper respiratory infections are caused by herpes virus infections. Usually cats with this problem have had chronic sneezing or nasal exudates all their lives, though. L-lysine and interferon are sometimes helpful in treating the chronic herpes infections and are pretty safe to use. They might be worth considering as supportive treatments, too.

Hope this helps. We do answer all subscriber questions by email and we post many of them on the site as well.

Mike Richards, DVM 4/20/99

Chronic nasal discharge in Cats - possible causes

Q: Dr. Mike,

Just spoke to you briefly when I signed on as a subscriber. Think your web page is a wonderful thing, but I'm new at the Internet and did not browse enough to see if you may have already had an answer to my problem.

Our 14 year old Himalayan, Comfort, has been suffering from what appears to be some type of allergy, or worst case scenario, some type of tumor in his nose. His biggest symptom is a "stuffy head". He breathes fairly well while asleep but during the day he seems to "snort".

This all started about 2 months ago. We are a two cat household and both cats are indoor with only a large outdoor deck where they can smell the good smells of the salt air as we live on the beach at Puget Sound. The other cat is just fine.

Comfort started out with watery eyes, that was a clear discharge, and quickly was ok with some application of eye drops. Then he started a few sneezes and came down with what would appear to be a head cold. His appetite was good, he was active and for all intents and purposes did not appear sick, except for the "snorting".

We took him to the vet and she thought it might be a problem with his teeth as they have never been cleaned and there was a lot of tartar on the one incisor and the gum above it was inflamed and there was a lot of saliva in his mouth that he would try to swallow. She prescribed Baytril and hexarinse for the gums. His mouth is much better and the halitosis is pretty much gone and the gum is only slightly red. We had him on the Baytil for 10 days. That seemed to make the head cold "break" and the congestion became worse. We continued it for another 10 days but then he started to not want to eat and was obviously in discomfort from the stuffy nose.

The next step was to try Cefatabs. Those seemed to upset his stomach and he did not want to eat at all and his bowels became loose. He was originally 11 pounds and then dropped down to 9.2 because he was not eating. We took him back and had x rays and blood drawn. The results were that there did not appear to be any infection and the organs all appeared normal. He was given an injection of cortisone.

That made a tremendous difference. He immediately was able to breath and his appetite came back with a vengeance and he seemed to bound back to normal. For 10 days all was just great. But then this morning he again seems to have a stuffy head. Here in the Northwest, we human allergy sufferers are under seige since the weather is warm and there is lots of pollen in the air. I saw your web page while I was looking up information on cat allergies and thought I'd send my e-mail for your response.

I have tried some aroma therapy with a vaporizer with eucalyptus oil and he does like that and it helps both of us to breathe easier!!! He is a good pill taker but I have stopped both of the Baytril and Cefatabs at this time.

Thank you in advance for any help and suggestions. I look forward to getting the monthly digest.

Carol

A: Carol-

I sent an answer to your second inquiry on this. I am sorry that there was a delay in responding to this one.

The most common cause of chronic nasal exudates in cats is thought to be herpes virus (rhinotracheitis) infection. It can lead to on and off episodes of sneezing and nasal exudate that last throughout a cat's life. This problem is less likely in an older cat in which a nasal exudate has just started, though.

Allergies leading to nasal discharges seem to be relatively rare in cats, but are not out of the question. The response to corticosteroids does make the possibility of an allergy seem more plausible. Unfortunately, cortisones can make alot of problems improve, at least temporarily, though.

In our practice area we do not see a lot of fungal infections of the upper respiratory tract but they are more common in some areas of the country. I am not familiar enough with the North West region to know if they are a problem there. Examination of the nasal exudate for evidence of fungal infection can be helpful in diagnosing this condition, though. Flushing the nasal cavity vigorously and retrieving the flushed material may aid in making a diagnosis. Since cats won't allow this when conscious, it is necessary to use anesthesia for this diagnostic procedure, though.

Bacterial infections of the nasal passages are probably rare but it is always tempting to try antibiotics since they are readily available and since they do sometimes work.

There is a lot of evidence that problems with the teeth can lead to chronic nasal discharges. If any teeth are missing it is a good idea to consider X-rays to make sure a retained tooth root is not contributing to the problem. Otherwise, teeth cleaning and a good oral exam should be done, but your vet has already taken this step.

X-rays are also useful in determining if there is a cancer affecting the nasal passages but skull X-rays are hard to interpret (at least for me) so we usually send them to a radiologist for review after taking them.

Foreign bodies (grass, plant lawns, food, etc.) stuck in the nostrils can lead to chronic nasal exudates. We have seen this a couple of times due to small sticks or blades of grass in cat's nasal passages. I know of a case of a tooth that was pushed into the nasal passage leading to an nasal discharge and we have had a case in which a fistula developed where a tooth was and a dog had food in its nasal passages constantly, leading to chronic nasal discharges. Fixing the fistula resolved the problem.

Realistically, in an older cat, there is a strong probability of a nasal cancer. The best diagnostic test for these is MRI or CT imaging. This is generally expensive and it is somewhat important to decide if you will follow up with radiation therapy, chemotherapy or surgery, depending on what is found, prior to paying for the diagnostic testing. Most of the other causes of chronic nasal exudates can be found through testing other than these sophisticated scanning techniques, although it may take your vet several tries at various diagnostic procedures to find the one that provides an answer.

It is also OK to use decongestants in cats, if they are helpful. Your vet can help determine which one works best for Comfort. Decongestants might lengthen the interval between the need for cortisone injections, which is better for Comfort in the long run.

Hope some of this helps.

Mike Richards, DVM 4/20/99

Nasal discharges - very ill Cat

Q: I have a 12 year old male indoor only cat who recently became very ill. We have had him since he was 6 months old. We moved from RI to VA 6 months ago and this illness is our 1st test of our new vet.

3 weeks ago Boots began sneezing and had some discharge from his nose. A visit to the vet revealed an elevated temp so they put him on Orbax for 10 days. He kept getting worse. The discharge intensified and his nose became an open sore. After 8/10 days they said to stop the medicine and wait 4 days to bring him in for a culture. The discharge worsened and he started to bleed from his nose. He sneezed blood and mucus all over the walls. They xrayed his sinus' and cultured the discahrge. The vet said it was extremely nasty discharge but it would take 5 days to get growth & sensitivity results back. It only showed a staph that was sensitive to Orbax. The xray showed nothing. The vet said it could be fungal so he also started Nizoral. We drew more blood for a fungal test but results won't be back until Tuesday. After 4 days on the Niroral & Orbax, Boots is failing fast. He doesn't eat at all. He drinks if I place a water bowl by him. The glands under his chin are larger than grapes. He just stays in one spot and breaths labored breathing through his mouth. The nose finally has a crust on it, but I believe it is because he no longer cleans his nose. He doesn't groom at all so I have been cleaning him with a damp washcloth. Can you help? What are we missing here? This was frisky, healthy, 14.5 pound cat. A month later he is desperately ill. I hate to see him suffer like this but I feel like something must be able to be done.

I also have 2 other cats, a dog and two young children. I worry about exposing everyone to something contagious. The new vet says not to worry but...

Thank you for your time, Michele

A: Michele-

I am sorry to hear about Boots' problems. I wish that I could help in some way with the diagnostic process but all I can really do is give you some information on the overall picture.

In adult cats the most common cause of new nasal discharges is almost certainly cancer. In many instances or even most instances, the cancer will be very hard to detect with X-rays. Magnetic resonance images (MRI) or computerized tomography (CT scans) are better at detecting cancers but are not widely available and are costly. Endoscopic exam of the nasal passages can also be helpful. A "low tech" diagnostic approach is to flush the nasal passages with saline forcefully to obtain a sample (this is a little more complicated than it sounds but has been described pretty well in the veterinary literature so your vet should be able to find a description of the technique. If I remember correctly a good description of the procedure was in the Waltham Focus a year or so ago). We have been able to get enough tissue for biopsy a couple of times using the saline flush method.

Chronic nasal discharges that have been present nearly lifelong but suddenly get worse are sometimes associated with viral infections such as rhinotracheitis virus.

Bacterial nasal infections sometimes occur, especially if there is a nasal foreign body (something stuck in the nasal passages such as a grass blade or piece of string). Fungal infections also occur but are not really common, either.

There are several specialists in Virginia who may be able to help. Dr. Chiapella, in Manassas, is very good but is currently on vacation. The Virginia-Maryland Regional College of Veterinary Medicine in Blacksburg would be a good choice for advanced diagnostics and many people in the southern portion of Virginia travel to NC State's veterinary school.

I hope that Boots has improved but know from the odds that it is likely he has not. Should cancer be the problem radiation therapy can sometimes provide a few months of relief from the symptoms. It isn't something all pet owners would consider but is an available option for veterinary cancer patients.

Mike Richards, DVM

Drainage from nostril

Q: Dear Dr. Mike:

My cat is 17 years old, one month ago we noticed mucus coming out of her right nostril. We took her to the vet- he prescribed antibiotics. After 10 days she developed a bumb over her eye and mucus was still running out her nose. We took her back to the vet - he took several tests and a biopsy, xrays - test results were inconclusive. xray showed white cloud on right side of nostril. Taking everything into consideration he determined it was a tumor. Don't know if it's malignant or not. Prescribed Prednizone to keep her confortable, we need to make a decision regarding putting her to sleep. We went for a second oponion- We are treating it as a very bad sinus infection, he prescribed Biaxon- We have been giving it to her for ten days now. the mucus is a little less- however no it's accompanied with traces of blood. Can you possibly tell me what to do in this situation. We love her very much and dont want to lose her. Is it in her best interest to let her go to sleep?

She is very listless and tired.

Thank you for your help.

A: There are a number of possible causes of drainage from the nostrils in cats. It is important to consider all of them, so I'll try to provide as complete a list as possible. Since many of the the following causes will be unlikely I'll try to cover the ones that are more likely to apply to an older cat in more detail after the list.

The most common cause of nasal discharge in cats, overall, is viral illness. This can occur at any age. It can be chronic and in some cases even lifelong. The two viruses most likely to be the ineffective agents are rhinotracheitis (feline herpes) and calicivirus. Usually viral infection causes drainage from both nostrils and it is often accompanied by other signs of illness, such as ocular discharges, sneezing, lack of appetite, etc.

I am not sure if feline leukemia virus (FeLV) infection or feline immunodeficiency virus (FIV) infection can cause nasal discharges on their own but they are commonly found in cats with chronic nasal discharges and may exacerbate a viral, bacterial or fungal infection if one is present. FeLV may also predispose to cancer. In any case of chronic nasal discharge it is best to test for these viruses as possible underlying causes of the condition.

Bacterial infections of the nasal passages are supposed to be pretty rare in cats but can occur. They tend to occur bilaterally. It may take extended use of antibiotics to cure these infections. It is best, if possible, to establish that an infection is present and to choose an appropriate antibiotic based on culture and sensitivity testing.

Fungal infections also appear to be pretty rare, although the region of the country the cat resides in may have some impact on exactly how rare. Fungal elements may be found in the exudate from the nose, by flushing the nasal passage and collecting samples for exam or in some cases through serological testing.

Dental infections are a common cause of rhinitis and may be more common than is generally recognized. They are capable of causing unilateral discharge. It can be very hard to determine if a tooth root abscess or other problem is present without X-rays that show tooth root and bone around it well.

Cancer is a common cause of one-sided nasal drainage in middle-aged and older cats. Cats appear to be prone to squamous cell carcinoma and lymphoma cancers of the nasal area and nasal passages. Cancers can be difficult to diagnose since the nasal passages are hard to examine thoroughly, even with endoscopy. Computerized tomography (CT scans) and magnetic resonance imaging (MRI) are supposed to be good ways to visualize cancers in the nasal passages but are rather costly and not generally available. X-rays can be useful if bone destruction or an obvious mass are present but it is very hard to accurately assess the presence of cancer in the nasal passages based on X-rays alone. It is sometimes possible to flush the nasal passages with saline rather forcefully and dislodge enough of a tumor to make a diagnosis. Anesthesia is necessary for this procedure and it is not a sure thing.

Nasal foreign bodies are always possible. Cats sometimes inhale a foreign object, such as a blade of grass or sometimes regurgitate and contaminate the nasal passages with a foreign object in that manner. We have found grass, small sticks and a piece of thread in cats with nasal exudates. Foreign bodies can cause unilateral or bilateral nasal exudates.

Cats sometimes get polyps in their nasal passages or in their pharyngeal region which can lead to nasal exudates.

Trauma can lead to long-term nasal exudates, especially in cases in which the hard palate is fractured through or there is damage to the sinuses. In most cases a history of trauma of this magnitude would be known by the owner, but not always.

Middle ear infections can lead to nasal exudates in some cases. It is always a good idea to check for evidence of otitis media when a cat has a chronic nasal exudate. This is especially true if signs of facial paralysis or Horner's syndrome are present (uneven pupil size, protrusion of one or both third eyelids).

If the discharge appears to be primarily blood it is a good idea to consider the possibility of exposure to rat or mouse poison, other blood clotting disorders and high blood pressure. Hypertension can be associated with feline hyperthyroidism and kidney failure in older cats. Small amounts of blood mixed with mucous are more likely to be the result of another cause of nasal discharge and almost all of them can have look that way.

Those are the possible problems that I can think of. The two most likely causes of a chronic nasal discharge in an elderly cat who has not had the problem life-long are cancer and dental disease. Polyps are also possible but are easier to find with endoscopic exam, which seems like it might have been done in your cat's case since biopsy samples were taken.

Biopsy samples seem to be pretty unreliable in feline nasal tumors, based on a limited number of cases we have sent to oncologists. We have had two patients whose biopsy results indicated non-specific inflammatory changes who actually had cancer which was definitively diagnosed later. I still think it is worth trying to get them and to interpret them, but I think it is unwise to trust a negative result.

I do not know what Biaxon is, so I can't say what it might be helping. Prednisone does sometimes help control inflammation in the nasal passages but if cancer is present radiation therapy is the best option for palliative control of symptoms. It is somewhat expensive and also limited in availability, although most veterinary colleges and several larger veterinary referral centers routinely do radiation therapy for cancers now.

If no one has taken a really good look at your cat's teeth, that would be the first thing I'd recommend. It wouldn't be a bad idea to try antibiotics for an extended period, which may be what is happening if Biaxon is an antibiotic. If this is Biamox I would be worried that it is a version of amoxicillin and not a particularly good choice for therapy of a nasal infection, unless its use is based on sensitivity testing. There should be at least encouraging results after a week or so or another antibiotic may be necessary. Don't put off more definitive diagnosis for too long while trying antibiotics, though. Your vet will have an opinion on how long and what antibiotics to use and it should be respected since he or she can actually examine your cat. After that, your vet appears to have tried hard to come up with a specific diagnosis and to have done the testing most veterinary hospitals can manage "in-house". If you wish to pursue a diagnosis further, then asking for referral to a veterinary teaching hospital or referral center with an internal medicine specialist or oncologist might be the best course of action. Since this is very likely to be cancer it would be best to try to decide in advance how far you are willing to go in treatment. Radiation therapy requires a commitment in time and money that is prohibitive for many people. It lessens the clinical signs, probably prolongs life for most patients but does not often cure the cancer and therefore has to be considered as a way to increase the quality of remaining life rather than as a way to treat cancer if it is present.

There is a time when most clients know that their pet is no longer willing to fight the battle to stay alive. Most people really seem to have a good instinct for when this has happened. If you believe that your cat is at this stage then it is time to consider euthanasia. It is a decision you can't revoke, so just be sure that you are pretty certain it is the right thing to do. If you don't feel that way, there are some other things left to try.

Mike Richards, DVM

Nasal Drip - check eyes

Q: I just noticed tonight that my cat's nose has started dripping. She has no other symptoms other than the drippy nose. She will be laying on my lap and her nose will drip 3 or 4 times, a clear, watery liquid. She has been a house cat for several years, and has had minimal contact with our farm cats. Is there cause for concern other than the annoyance of her dripping all over the place!

A: You might want to look carefully at your cat's eyes. One cause of water dripping from the nose is excessive tear production. This runs down the tear duct into the nose. When tearing is excessive, it can drip out the end of the nose. If the eyes look OK and there are no other symptoms of problems (like sneezing or coughing) then I can't think of any other specific reason for just having a dripping of clear fluid from the nose.

Sometimes in these situations it is worthwhile just to have your vet check your cat, even though the odds are probably pretty good it is a normal, or at least non damaging, event.

Mike Richards, DVM

Last edited 03/04/05