Monday, November 30, 2015

Coughing, Vomiting, and Vaseline

Katee, in the video above, has a cough, and her owner is concerned. 

Just like people cats can have a cough that sounds different from one-another. Their cough can be loud or quiet, wheezy or honking, congested (productive) or dry.  The may cough once, a few times or have coughing jags (paroxysmal coughing).  At cat may have a different cough associated with different illnesses as well, so it could manifest differently at different stages of the cat’s life.

One challenge in obtaining history regarding a cough is that clients and veterinarians alike sometimes write it off to normal “hairball' problems. In fact, the cough is often due to respiratory disease including chronic tracheobronchitis. Tracheobronchitis in cats is common and results in recurrent coughing followed by gagging. It is the gag that may trigger vomiting after a bout of coughing, which can confuse the issue. Illuminating this history is difficult and one must first ask the question, then explain the distinction, then mimic or demonstrate with video the difference between vomiting and coughing. If we don't have a high index of suspicion, if we don't have the time to get a good history, and if we don't have the tools to open the client's mind and help them to understand the distinction, then we will not get this history.

Attributing a cough to a hairball is a misnomer with virtually no scientific basis. This notion will likely never be expunged from lay dogma. There is no documentation in the literature of uncomplicated trichobezoars (hairballs) causing coughing in cats. Coughing has been reported in complicated surgical cases of gastric trichobezoars in man, but has not been reported in cats.  Cough attributed to gastroesophageal reflux disease in man is common (over 20% of chronic coughs), but this has not been described in the cat1 (Tatar).  It is possible that an esophageal location of a trichobezoar could compress pulmonary structures and thereby elicit a cough, however, this too has not been reported.

While white petrolatum, Vaseline, is often recommended and administered to cats for treating constipation and/or trichobezoars, giving Laxatone (or any other flavored white petrolatum) orally has never been shown to change the consistency or the slipperiness of the stools or aid in the passage of hair in the stomach.  Theoretically, if you want to lubricate the rectum you could administer Vaseline in that manner, but giving it orally ends with petrolatum simply being incorporated into the stool.

Searching PubMed (Aug. 2012) reveals no published studies in man, or animals, that demonstrate any the effectiveness of these products. While there is not a significant risk (and some cats love this stuff) some reported concerns would include passive steatorrhea and fat soluble vitamin deficiencies. There are over 50 published reports related to the efficacy of liquid paraffin for constipation in man, but none in cats. There is one report of liquid paraffin being superior to lactulose in children. The use of Vaseline in cats may be intended to result in the same effect, but they are very different products.

Mineral oil, of course, should be avoided because it can be easily and silently aspirated. Aspiration of mineral oil does not elicit a cough reflex (like aqueous based products) leading to lipid-like pneumonia.

If constipation is a concern (difficulty passing hard stools, straining) and a stool soften was needed then one could consider canned foods, adding water to the existing diet, water-soluble fibers, PEG3550 (Miralax), and lactulose.

The ongoing recommendation of administering product containing white petrolatum as a means of dealing with constipation or ‘hairball’ is a fallacy that should not be perpetuated.



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