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Pacific Tide
An informational newsletter
Pacific Veterinary Specialists & Emergency Service
1980 41st Avenue
Capitola, CA 95010
Specialty 831-476-2584 ~Emergency 831-476-0667
April 2013
Volume 4, Issue 1
Pacific Veterinary Specialists Monterey
2 Harris Court Suite A-1
Monterey, CA 93940
Monterey Office 831-717-4834 or Capitola 831-476-2584
www.pacificveterinaryspecialists.com
About our Author
Merrianne Burtch, DVM, DACVIM
Dr. Merrianne Burtch received her Doctorate in Veterinary Medicine from UC Davis in 1993. She completed
an internship at Santa Cruz Veterinary Hospital in
1994. In 1996 she completed an ACVIM approved residency in internal medicine at the same facility, which
included out-rotations at UC Davis. She became board
certified in internal medicine in 1999. Dr. Burtch's special interests include diabetes mellitus, gastroenterology and liver disease. Dr. Burtch is a founding partner
of Pacific Veterinary Specialists and works at both the
Capitola and Monterey locations. Dr. Burtch has always
been an advocate for pets and in April of this year
started a non-profit organization: BirchBark Foundation. She is also the president of the Monterey Bay
Area Veterinary Medical Association. She shares her life
with her husband, two boys aged 23 and 14 as well as
3 cats named Baker, Boris and Natasha and three dogs
named Leta, Q and Stewart.
Merrianne
Burtch, DVM,
DACVIM
(small animal)
Nasal Disease in Cats
Chronic rhinitis in cats can be a
frustrating disease. The most common
reasons for chronic nasal discharge include viral infections, idiopathic
chronic rhino sinusitis (ICRS) and cancer. Less often foreign bodies, polyps,
fungal infections or nasopharyngeal
stenosis are the source of the problem.
Signalment, a careful history, physical
examination and organized sequential
diagnostics are necessary for making a
correct diagnosis in cats with nasal disease. Definitive diagnosis almost always
requires endoscopic evaluation with
biopsies and/or imaging studies.
Signalment is important for the
sake of differentiating etiology. Younger
cats, shelter cats or breeds from a cattery are more likely to have an underlying infection- viral, fungal, bacterial or
less likely parasitic. They are also more
likely to have a nasopharyngeal polyp
or nasopharyngeal stenosis. Older cats
are more likely to have an underlying or
emerging cancer as the source of their
congestion and discharge. However age
does not preclude either diagnosis. Foreign bodies and infections can occur in
cats of any age and history is very helpful in determining whether those possibilities exist.
History helps determine possible
sources of congestion in cats. Recent
boarding or exposure to young kittens
will increase the chance of infection.
Duration and course of clinical signs
should be determined. Cats allowed
outdoors are more likely to have foreign
bodies and increased chance of fungal
2
infection such as Cryptococcus. Obtaining a careful history is valuable and
helps guide diagnostic steps as well as
treatment. Nasal discharge, stertorous
breathing and sneezing are the most
common presenting complaints, but
gagging, epiphora, halitosis and dysphagia can also be present.
Physical examination should include determination of air flow through
the nostrils, facial symmetry, comfort of
palpation of the face and evaluation of
submandibular lymph nodes. Careful
examination of the oral cavity and palate, teeth and ocular retropulsion
should also be done. Type and amount
of nasal discharge is helpful in determining whether secondary bacterial infection is present. Epistaxis increases
the likelihood of foreign body or cancer- but can be evidence of systemic
disease such as coagulopathy and hypertension. Facial deformity or pain
increases the chance of fungal disease or
cancer as a diagnosis.
Normal nasopharynx
Once the history and physical
examination findings determine your
differential diagnoses, your next steps
might include CBC, chemistry, UA,
blood pressure and if high likelihood- a
titer for Cryptococcus.
Culture of the nose is not usually a definitive diagnosis because many bacterial infections are opportunistic rather than the
primary problem. For most cats with
chronic rhinitis endoscopic evaluation
and diagnostic imaging is necessary to
make a definitive diagnosis. Anesthesia
and radiographs of the skull can be done
to look for obvious loss of bony structures in the skull. Is it very important to
note that older cats with cancer will often have mass lesions in the nasopharynx
which cannot be visualized without the
use of a flexible endoscope.
Nasopharynx with mass present
With 180 degree retroflexed to view the
caudal aperture of the nares in the nasopharynx masses that might otherwise be
missed can be identified and biopsies obtained. Often it is the only anatomically
abnormal area in cats with nasal cancer.
Lymphoma and carcinoma are most common cancer in the nose of cats.
Therapy depends on the diagnosis.
Viral infections can resolve with time and
supportive care. The use of famcyclovir
and other anti-virals, antibiotics, antiinflammatory and antifungal medications
are appropriate according to the diagnosis. Some cats with idiopathic chronic
rhino sinusitis may respond to azithromycin or doxycycline as immunemodulating antibiotics. Lymphoma can
be treated with radiation and chemotherapy and should be referred to an oncologist for consultation and treatment options. Prognosis for carcinoma varies depending on the extent and grade of cancer. Radiation, debulking surgery and the
newer chemotherapeutic Palladia are options for treating carcinomas. Because
cats with cancer often become anorexic
some owners will choose the placement
of an esophagostomy or other feeding
tube to maintain calorie intake in cats
with poor appetite. As always our role is
to create a list of differential diagnoses,
then give options to cat owners to obtain
a definitive diagnosis. Obtaining a definitive diagnosis and providing owners with
treatment options gives them the best
opportunity to make informed decisions
for their particular pet.
Here is a link to an on line more extensive
document on chronic rhinitis from
Michigan Veterinary Specialists.
http://www.michvet.com/Client%
20Education%20Handouts/Internal%
20Medicine%20handouts/Chronic%
20Rhinitis%20in%20Cats.pdf
Our Doctors
Internal Medicine
Kelly Akol, DVM, DACVIM (small
animal)
Merrianne Burtch, DVM, DACVIM
(small animal)
Michelle Pressel, DVM, DACVIM
(small animal)
Ryan Garcia, DVM, DACVIM
(small animal)
Surgery
Lisa Metelman, MS, DVM, DACVS
Tom LaHue, DVM, DACVS
Oncology
Radiology (VRS)
Theresa Arteaga, DVM, DACVIM
(Oncology)
Larry Kerr, DVM, DACVR
Mark Lee, DVM, DACVR
Critical Care
Emergency
Colleen Brady, DVM, DACVECC
Lillian Good, DVM, DACVECC
Cardiology
Christian Robison, DVM
Kim Delkener, DVM
Mark Saphir, DVM
Jessica Kurek, DVM
Mandi Kleman, DVM, DACVIM
(Cardiology)
Behavior
Dermatology (August 2013)
Jan Brennan, DVM (practice
limited to behavior)
Katherine Doerr, DVM (board eligible)
About Our Hospitals
PVSES was founded to provide high quality, specialized medical care to companion animal patients. Our practice is
dedicated to serving the veterinary community as a partner in total patient care. We offer comprehensive specialized services including endoscopy, Doppler ultrasound, surgery, 24-hour ICU care, and emergency and critical care.
Our staff is committed to providing compassionate and thorough medical care that meets the needs of the patient,
client, and referring veterinarian. In September 2011 we opened PVSM and offer internal medicine, oncology, and
cardiology Tuesday through Thursday in Monterey. Behavior consultation by appointment is available on Mondays.
Pacific Veterinary Specialists
1980 41st Avenue
Capitola, CA 95010
Phone: 831-476-2584
Fax: 831-476-8499
Emergency: 831-476-0667
E-mail:
[email protected]
Pacific Veterinary Specialists Monterey
2 Harris Court Suite A-1
Monterey, CA 93940
Phone: 831-713-4834
Fax: 831-713-4837
E-mail:
[email protected]
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