Category: Case Reports

Real life reports of patients that I’ve seen and have something to teach us.

Cats, Strings, & Intestinal Things

cats and string

from kittenwhiskers.com

The country song goes “Mamas don’t let your babies grow up to be cowboys…” and the same thing applies to cats playing with string.  Media is chock full of images of kittens playing with balls or yarn whether it be cartoons, advertisements, or the endless supply of cute videos on YouTube.  But behind all this cuteness lies a deadly risk if a cat eats string, thread, yarn, or dental floss.  These kitties can be fixed but it’s not easy.  This is Mira’s story…

Mira cats and string

Mira

Sometimes you see your cat eat the string and sometimes you don’t.  Often times the first thing you may notice is vomiting.  This was the case with Mira.  At just 2 years old, she’s still an intensely curious cat.  All cats may vomit from time to time – hairballs, catching a mouse, chewing on plants, but never just vomiting out of spite.  When Mira started vomiting multiple times over several hours, her family knew something wasn’t right and brought her in to see us at the Kingston Veterinary Clinic.  The diagnosis was easily found as soon as Dr. Vander Wilp, a colleague of mine, saw the string wrapped over and under her tongue.

When a string gets trapped at this spot, the other end of it starts moving through the stomach and intestines.  Essentially what happens is the string begins to act like a saw cutting through the intestines as it pleats them like an accordion.  Palpating a cat’s abdomen like Mira’s you can feel the intestines bunched up and thickened.  At this point, we weren’t sure how long the string had been present.  What we were all sure of was that Mira needed help in the form of surgery.

Yet, surgery isn’t just a simple snap of the fingers.  Many factors need to be considered.  Due to her vomiting, Mira was dehydrated.  With the risk of the string cutting into the intestines, blood and protein gets lost through these injuries which can complicate healing as well as leaking intestinal contents contributing to infection.  And the biggest mystery, what will you do once you’re there actually seeing the abdominal contents.  Mira’s family elected to go ahead and get her fixed up.

cats and string

Mira’s plicated intestines

Once we had her on some IV fluids and got her a bit better stabilized, I took her into surgery and investigated the damage.  In total, 7 perforations were noted and I discovered the other end of the string was in the colon.  Effectively, it was acting like a drawstring on pair of sweatpants pulling on her intestines at both ends.  Due to the number of perforations and their locations, the best option was to remove a large section of intestine and reattach the good ends.  After releasing the ends of the string through separate incisions in the stomach and end of the small intestine, I removed 32cm of the small intestine and reattached the ends before rinsing her abdomen and closing her up to recover her.

Over the next couple of days, we monitored Mira in the hospital.  Things weren’t going as we had hoped.  She wasn’t eating, kept spiking fevers, and seemed generally quieter than expected.  She only would eat tiny amounts when her family visited.  On the third day post-op, we checked some blood as she still wasn’t doing as we expected and noted several changes in the blood cell count and protein levels that concerned us and raised the suspicion that something had broken down inside.  The results were worse than before the initial surgery.  Despite all the precautions and steps we had taken to help Mira, something was leaking.

After some discussion, her family elected to have us attempt a second surgery as a means of fully discovering the extent of the problems and to fix what we could.  As soon as I got back into her abdomen, I had all the explanation we needed.  Her anastomosis site (the reattached portion) had broken down and a small leak was seen near it.  Given the amount of damage that was found and the previously removed section of intestine, I felt it best to call her family immediately and give them an update.  Assessing the extent of everything internally, I let them know her prognosis was very guarded to poor even with attempting a second repair and advised them that euthanasia was not an unreasonable option.  Her family conferred for a moment and told me to do my best to save her.  Back in surgery, I removed as little intestine as possible that was no longer viable and reattached the new ends.  After a very thorough rinsing of the abdomen and closing her back up, we all hoped for the best.

blood donor cat

Pioneer, the blood donor

Great news the next morning!  Her temperature was normal and she greeted us with alertness and purring unlike any other morning before.  A recheck of her blood now showed dangerously low levels of red blood cells and protein.  Mira needed a transfusion to give her the best chances for survival.  Luckily, one of our staff members volunteered to have her cat donate.  Mira received the much needed blood and was on the complete road to recovery.  By the next day, she was feeling spunky, her blood values had improved, and she was eating everything we gave her.  Mira was going home.

cats and string

Mira getting her transfusion

I like to think of Mira as a little “Mira-cle in May.”  Not all cats get this outcome.  It took the right combination of family commitment, veterinary team care, and a bit of luck.  The important message here is that when your pet seems sick, it’s best to not wait to see if it will pass — at a minimum, please talk with your veterinarian.  Waiting too long could make things worse.

Disclaimer: Blog posts may contain some opinions which are my own and may not reflect those of any current or former employers. Mira’s story is published with permission from her owners and some non-essential details have been omitted for brevity.

Don’t forget to follow along on Instagram @drryanllera , Facebook , or  Twitter for more pet info and interesting daily happenings!

Pets and Ibuprofen Don’t Mix

Otis ibuprofen toxicityThe following is a true story (used with permission) of how easily accessible medications, like ibuprofen, can be harmful to your pet.

Meet Otis.  His story is one that challenges the old adage about curiosity and cats, but he is a curious dog.  Don’t worry, he’s fine now; but he almost wasn’t.  While his person was sleeping one day, Otis took the opportunity to sample some medications that were accidentally within his reach.  Nobody knows his motivation but it’s a good thing his family noticed.  The culprit in this case was ibuprofen.  Yes, many people’s favorite, useful, pain relieving medication really is bad for your pets.

The first sign of trouble was the medication actually being found.  The liquid filled capsules were strewn about on the floor and with no one home other than Otis and his person, it was easy to figure out who the chew marks belonged to.  At this point, many people might be thinking “okay, no big deal.”  And then the vomiting started, which is the first sign of a toxicity issue.  Otis couldn’t hold anything down and the more he threw up, the worse his dehydration got.

otis-blood-resultsBecause ibuprofen toxicity can actually cause kidney failure along with the intestinal upset, his owner brought him to me to check some blood tests and what we found was consistent with ibuprofen ingestion as his kidney values were mildly elevated above normal.  Otis was admitted to the hospital and we started him on intravenous fluids to essentially help dilute the drug in his blood stream and preserve blood flow and pressure supplying the kidneys.  Without this treatment, Otis would surely become more ill.  In addition to the IV fluids, I started him on some medications to help gastrointestinal tract due to the ulcerations that can develop.

During his first couple of days, Otis started to show improvement.  He was happy, eating well, and most importantly – not vomiting!  But when we checked his kidney values, they had gotten slightly worse.  After talking with his family and agreeing that he was clinically stable, we felt it was best that he stay on his IV fluids for a couple more days.  Checking Otis’ kidney values daily for the next few days we noted that they returned to normal with the additional treatment.  After five days in hospital, Otis finally got to go home!

Otis taught us all a valuable lesson; one that he was fortunate to recover from.  While he got into ibuprofen accidentally, many people will try to self medicate their pets with over the counter medications that may not be safe.  This can inadvertently lead to permanent damage, or worse.  Please, for the safety of your pets, don’t rely on Dr. Google or your neighbor to prescribe something for your pets if they become ill; talk to your veterinarian.  Has your pet ever gotten into over the counter medications??

Otis ibuprofen going home

Otis got to go home!

Disclaimer: All blog posts may contain opinions which are my own and may not reflect those of any current or former employers.

Thanks for reading and don’t forget you can subscribe on the right side to get new posts directly to your email!  And I’m now on Instagram @drryanllera and as always on Facebook, Twitter, and Pinterest!

Diabetic Cats – Yes They Can Change!

Sal in hospital

Sal in hospital

The following is a true story (used with permission) of how diabetic cats can change their insulin requirements.

Sal is a 13 year old domestic shorthair cat who was diagnosed with diabetes in 2010.  He had been showing the initial signs of increased urination and having accidents outside the litterbox.  These signs, along with weight loss and increased drinking, are some of the most commonly noted first symptoms of diabetes or an alert to a pet owner that something is wrong.  Some cats may vomit, have a decrease in their appetite, or start to walk in a flat-footed position.  In later stages of not being diagnosed or treated, diabetic cats can have labored breathing and lethargy.

Insulin varieties

Insulin varieties

Back to Sal…  At the time of his diagnosis, he was started on insulin and his diet was changed to a higher protein, lower carbohydrate diet.  He had been doing well for a number of years and was considered to be a well controlled diabetic.  As part of our continuing care of these patients, we recommend doing a glucose curve every 6-12 months as part of their annual examination.  For some cats, we realize that the stress of the clinic setting might be too much for them and encourage home testing (which can be quite easy and most veterinarians will show you how!).  For cats that home testing is difficult either for the patient or the family (not everyone can stand the sight of blood), we do this testing in hospital.  Sal was one of these cats who fit into the latter category.

Hypoglycemia in diabetic cats

Hypoglycemia

Life happens and things don’t always get to go as planned; work or family obligations change, moving might happen, or the budget might be a little tight at times.  That’s okay and can be understandable…it even happens to us as vets too with our own pets and families.  Sal had been delayed in coming in for his annual check up.  His owner brought him in because he was seeming weak and hadn’t been eating well.  I examined him and checked his blood glucose level which was 1.2 (or 21.7 depending on your units)!  The average normal range for a cat is 4.0 – 9.7 (72.6 – 176).

So why did Sal present like this?  His signs were easily attributed to his low blood sugar (hypoglycemia) but his insulin dose had not been increased.  Well, it’s been known for some cats to convert to not needing insulin and their diabetes may be controlled by diet.  This is exactly what happened to Sal.  As he converted, his previously needed insulin dose essentially became that of an overdose.

Normal blood glucose

Normal blood glucose

Rest easy everyone.  Sal is doing fine.  We admitted him to the hospital and put him on intravenous fluids that contained dextrose to help bring his glucose levels up and remove the risk of seizures.  We checked his glucose levels without him getting insulin as well and he never went above the high end of normal so 2 days later he got to go home and now doesn’t need insulin injections!  For now he is doing well, but his family is still going to keep a close eye on him because there may come a time when he might need to start the injections again so he’ll be getting regular checkups from now on.

Disclaimer: All blog posts may contain opinions which are my own and may not reflect those of any current or former employers.

Thanks for reading and don’t forget you can subscribe on the right side to get new posts directly to your email!  And I’m now on Instagram @drryanllera and as always on Facebook, Twitter, and Pinterest!