C10001382 / invoice 10000

HISTORY
Presenting for: Betty, a Persian cat, presented for checkup due to ongoing respiratory issues and laboured breathing that has been constant and exhausting for the owner.

Historical Conditions:
- Respiratory PCR in January negative for Mycoplasma, herpes, fleas, Chlamydia, influenza, and bordetella - all neg
- Previous round of Doxycycline with no improvement in nasal discharge
- Previous antiviral treatment (famciclovir) with minimal improvement
- History of roundworm infection shortly after acquisition
- Dental issues present since acquisition at 7 months of age
- O really wants to groom her but she is very naughty

Diet: Appetite is fine, no issues with eating

V/D/C/S:
- Chronic nasal congestion and thick, laboured breathing
- Intermittent sneezing - none in last couple of days but several episodes the day before
- Nasal discharge historically present, nose often feels dry
- No eye discharge currently

Current Meds:
- Saline nasal drops from chemist

Lifestyle Risk Factors: Indoor Persian cat

Other:
- Owner reports cat is happy and not depressed, still enjoys playing
- Breathing is loud enough to disturb sleep
- Very small nasal passages noted
- Weight stable at 2.7kg (consistent with previous weights)
- Normal urination and defecation

EXAM
Wt: 2.7kg
Behavioural: Well-behaved during examination, allowed handling and procedures without significant resistance
Eyes: Some moistness noted, likely from recent eye drop administration
Ears: Examined and cleaned during visit, cat appeared to enjoy the cleaning
Nose: Nares very small / closed
Oral: Significant dental disease present with deciduous canines still retained, halitosis present, teeth in poor condition for age
Respiratory: Laboured breathing audible, sounds more prominent in nasal passages / pharynx,  respiratory effort slightly increased, RR 24
HR 136bpm, no murmurs

ASSESSMENT
Chronic upper respiratory disease - DDx: nasopharyngeal polyps, chronic herpes virus infection. Poor response to previous antivirals and antibiotics suggests possible physical obstruction. Concurrent dental disease may be contributing to overall inflammation in the area.

Retained deciduous dentition - Deciduous canines present alongside adult dentition.

PLAN
Diagnostics:
- Consider anaesthetic examination of nasopharynx and larynx using soft palate retraction and endoscopy to rule out polyps or other physical obstructions, and can extract decid canines and do full oral radiographs at this time
- Blood collection for FIV PCR testing discussed as alternative option

New Meds/Tx:
- Discuss with O - cannot treat physical causes of breathing issues today, and given antivirals haven't worked unlikely to help now, however can Tx 2ndary infection. 
- Clavulox BID for 7 days - risk of vomiting and diarrhoea discussed, probiotic available if GI upset occurs
- Gabapentin 1/2 tablet initially (can increase to whole tablet if needed) to reduce anxiety for grooming and handling

Additional Discussion:
- Sx for stenotic nares recommended as specialist procedure.
- If anaesthetic examination for polyps performed, concurrent removal of retained deciduous canines recommended

- Insurance coverage for specialist procedures to be confirmed by owner - warned will likely not cover dentistry
- Herpes virus may cause chronic inflammatory syndrome and can be difficult to detect on swabs due to intermittent shedding

Client Comms:
- Owner to contact insurance company regarding coverage for specialist consultation and procedures
- Specialist referral can provide detailed estimate for procedures
- Email follow-up to be sent regarding treatment response
- Owner's email updated to david1302085@hotmail.com

Resp PCR negative for all - mycoplasma, herpes, calici, chlamydia, influenze, bordatella. 

O' already awre that negative doesn't rule out as can be intermittent shedding, however good nothing was positive. 

Could consider trial of antivirals anyway to see if we get any improvement as this would suggest perhaps there is a viral component. 
If not viral then supports either allergic or anatomical. 
Could consider pred trial if doesn't respond to Famciclovir. 

Left msg for David to call and discuss

Spoke to David and advised FeLV negative but FIV weekly positive and would need PCR for clarity. 
Already indoor only. Implication is more for other cat but they have already been living together for a few months and they do share food/water/groom each other so exchange may have already happened. O" wasn't too concerned. 
Discussed need to redraw blood and send for PCR. Together we decided to wait 3 months and then test again with PCR - if positive then we will test other cat also. 
Await Resp PCR results.