Monday, July 10, 2017

Case Report: Cessna - His tail's not all it's cracked up to be...


This handsome 8 year old came to see us for the first time in May, this year, with a particular tale to tell. His owners had found him on April 18th, with an injured tail and a trail of blood through the house, leading back to their daughter’s bedroom and under her bed, where he loved to sleep. His owners had no idea what could have happened to his tail.

Cessna's damaged tail bone
They rushed him to a veterinary hospital on emergency basis and they repaired the injury by amputating the injured tip of his tail. About a month later, he returned to the hospital, having traumatized it again. He had been wearing an Elizabethan collar all the time and still managed to injure himself.  In addition, he was hiding, no longer social and good natured. It was recommended that the rest of his tail be amputated. Cessna’s family was uncertain that was what they wanted to do, so they brought him to Exclusively Cats Veterinary Hospital for a second opinion.

On May 24th, there was no sign of infection, and the tail tip seemed to be healing well, so we re-bandaged it and attempted to manage his apparent chronic pain with a prescription for Tramadol. At this visit (and previously, at the other veterinary hospital), Cessna was notably quite grumpy and intolerant of much handling.

Cessna's new, short tail
Cessna’s hind end was very sensitive and his owners were not able to look at his tail at home, and was also very difficult to medicate. On May 30th he managed to remove his bandage and get at his tail, again. On June 16th, Cessna’s family found a tick on him and wanted to have us look at him. He had been doing well on the Tramadol, but still seemed bothered by his tail. At least, however, he was not attacking it anymore. On the ride into the hospital, he started attacking his tail again, and urinated and defecated on himself. His family was distraught because they felt that he was miserable and could not live with this issue. They wondered if he needed his entire tail amputated. We took x-rays of the tip of his tail, and it appeared that due to his attacks, he had either exposed a sliver of bone, or some nerve tissue or tendons. At this time, his owners opted to pursue another tail amputation, and another 2 inches of tail needed to be removed. The concern about amputating completely was that if the entire tail was removed and he was still painful, he might start attacking his hindquarters and cause irreparable damage to himself. We applied a pain patch, gave him a mild sedative, an epidural, and a cocktail of other pain medications. He recovered from surgery well, and we sent him home on phenobarbital for pain control, sedation, and suppression of hyperesthesia-like symptoms.
Abnormal bone-like material in one of the tail joints

He went home again, but went into hiding. He started attacking his tail again on the 18th. His appetite decreased and started trying to bite his mom when she medicated him. He hid under the bed and defecated on himself when his family members tried to get him out from under the bed.

Cessna was a little embarrassed by his Thundershirt, at first...

His family was beginning to lose hope. Cessna was miserable, and they wondered if it wouldn’t be kinder to euthanize him. He was no longer the loving cat they had known, and he seemed to be in constant pain and distress for no known reason. We examined his tail again and reviewed the x-rays from the previous hosptal and discovered an abnormal joint much closer to the base of the tail that did not flex as nicely as the rest. We x-rayed the area and discovered a very small round mineralized object located in the joint space between two tail vertebrae. This is likely abnormal bony growth due to arthritis. Because it is located between two vertebrae, it likely sends shooting pain down the length of the spine whenever he moves his tail. Since the pain was radiating down the length of the tail, Cessna was attacking the part of his tail that he could easily reach, and not the area that was causing the pain.

We amputated the tail behind the affected joint, leaving about 3-4 inches of tail for him to wave, and crossed our fingers. He received another pain patch, a local nerve block and was started on a medication regimen of gabapentin for neuropathic pain, phenobarbital again, and Onsior for inflammation. In addition, Cessna started wearing a Thundershirt. He stayed with us at the hospital for 18 days as we balanced his pain medications – little enough that he could walk around, eat, and use the litterbox, but enough that he would ignore his tail. Over the time that he was here, he grew continually more affectionate and well-mannered. He began asking for attention, rather than hiding. He was allowed some exercise time to sit in the office with the doctors while they worked on paperwork, and he sat on the cat tree with Mr. A.

Cessna became more outgoing after a while

At first, the Thundershirt was hard for him, because he wanted to curl up in a ball and not move with it on, but by the time he was discharged, he was jumping up into laps for cuddle time. Our entire staff enjoyed his antics as he became more adventurous and learned how to steal tuna fish from Dr. Demos, or snuck through the door to visit the receptionists. On July 6 th, we took his sutures out and for the rest of the morning, he was angry at his tail again, so we gave him an injection of Simbadol, which is a long-acting pain medication. We suspect that his tail was a little painful again, because we meddled with the tail and scrubbed it to clean the incision area.

On July 7, he went home to his family, and the purrs that rumbled out of his chest were so loud they could be heard across the room! We are hoping that he continues to improve over the next few weeks so that we can stop his medications and continue with just the Thundershirt. We’ll have him wear the Thundershirt for another couple weeks after that before we have his family try to take it off. At that time, we hope that his life can get back to normal – his long tale cut short for good reason!

Environmental enrichment (tuna in a cup) becomes Cessna's preferred method of keeping his tail safe

Friday, April 21, 2017

Case Report: Tangled Newborn Kittens

Being a veterinarian can be very humbling, sometimes, because no matter how long a veterinarian practices, there is still the likelihood that each day, they may see something they have never seen before. Exclusively Cats Veterinary Hospital has been around for 25 years, and Dr. Bailey has been practicing even longer than that, and he observed, "In all my years of practice, I have never seen anything like this before!"

Dr. Brooks was presented with 5 kittens that were two days old, born to a feral mother that had been trapped. The foster owner had not been able to access the kittens well, because the mother cat would not let her near them, and she did not want to disturb the litter because all the kittens seemed to be nursing well and appeared active and content. That morning, the mother cat had moved away from the kittens and it became apparent that something was wrong. One of the kittens was nursing on the mother cat, but the other 5 kittens were together in a pile across the cage, struggling and crying. When she reached into the cage to pick up one of the kittens to check on it, she realized that it somehow seemed to be stuck to the other 5 kittens!

Desperately, the foster owner called veterinary hospital after veterinary hospital, looking for help. Time after time, she was told that there was nothing the hospital could offer, or that they didn't work with neonatal kittens. Finally, when she called Exclusively Cats, we told her to rush the kittens in. When she arrived, Dr. Brooks discovered that the kittens were entangled in their umbilical cords. Often, young cats do not know enough to separate kittens from the placenta effectively, and this can cause complications. Sometimes, kittens may end up missing tails or legs because the mother cat is unaware of what she is doing, and in this case, because she only separated a couple of kittens, the rest became ensnared as they moved around. At first, they were happily nursing, but as time went on, they became even more tangled and eventually, the mother cat abandoned them across the cage, because she couldn't figure out what to do.

Immediately, all of our technicians started dropping what they were doing to come to the aid of the kittens. Some held small feet and tails out of the way of Dr. Brooks' work, while she attempted to disentangle them, others weighed, cleaned, fed and warmed the kittens as they were separated. Two of the kittens had hind limbs that were too badly injured to save, and two kittens had umbilical hernias, so Dr. Bailey also jumped in as we cleaned and prepped four of the kittens for emergency surgery. Two leg amputations and two abdominal surgeries later, all five kittens were warm, fed and snuggling in warmed blankets. They received antibiotics and tube feedings because they would not drink from a bottle and the mother had not allowed them to feed recently. At that age, too, kittens cannot urinate or defecate on their own - the mother must stimulate them to eliminate, and so all the kittens were "pottied" as well.

Once all the kittens were recovered, fed and warmed, we taught the foster mom how to tube feed them, if necessary and sent them home. We hoped that they could be re-introduced to the mother so that they could nurse. The prognosis for the tangled kittens is very grave, as there is a huge risk of infection in kittens so small, and with such daunting beginnings. Fortunately, as soon as they were put back with their mother, she accepted them and they started nursing! this is great news, since they will do better with their mother's milk than with kitten milk replacer.

Overnight, one of the kittens who had an abdominal hernia passed away. Two days later, the foster mom brought in the kittens to weigh them. One of the kittens was euthanized due to a septic infection in the leg that was amputated. All the other kittens gained weight, but the kitten that was not part of the entanglement outweighs the others by about 40 grams! Hopefully, with heavy doses of antibiotics and close observation and care, the rest of the kittens will survive this ordeal!

For continued updates on these kittens as we follow their progress, please follow our Facebook page!