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 MEET
SOME OF OUR PATIENTS: “Jasper"
Jasper and Biggles didn't have the best start to life. They
had been found at only a few weeks of age fending for themselves.
They were taken to a local cat rescue where both were found
to be suffering from cat ‘flu with high temperatures and runny
eyes and snuffly noses. To add insult to injury, Biggles had
been sexed as a female - by the time he came to the Cat Clinic,
he had miraculously changed into a little boy! However, it was
Jasper who was causing more concern. Certainly his flu symptoms
seemed to be more severe than his brother: he was quieter and
even at this early stage quite a bit smaller than Biggles. Both
kittens were estimated to be about 12 weeks old but whereas
Biggles was a healthy 1.6kg poor Jasper only weighed 1.2kg.
Both were given antibiotics to treat any secondary bacterial
infections (antibiotics are not effective against viruses) and
Biggles quickly responded.
Jasper still remained very quiet, with an occasional sneeze
and quite noisy breathing. Worryingly, there was a distinct
“fishy” smell coming from his mouth and nose. This could mean
a number of things; one of our major concerns was the possibility
of infection with FeLV, Feline Leukaemia Virus. Typical of FeLV
is a lack of response to treatment, and if Jasper had it, there
was a very real chance of his brother having it as it is spread
through very close contact. A quick blood test was performed
which came back as negative, as did a test for Feline Immunodeficiency
Virus. Biochemistry was performed on the rest of the sample
to determine if there was indeed any obvious damage to any of
the major organs (liver and kidneys) but these all came back
as normal. This still left us with the question - just why was
Jasper so sickly and unresponsive to treatment? He was put onto
different medication and his new owner advised to give him steam
bath inhalations daily - just as you would for a child with
a severe cold.
One week later a much happier Jasper came through the door.
He was a lot brighter and his appetite was much better. However,
he still was snuffly and so the treatment was continued for
another week. A new problem had arisen by the next week, he
now seemed unable to keep his food down. In fact, it sounded
like he was regurgitating his dinner - it wasn’t even getting
as far as his stomach to be digested. The vet suspected a megaoesophagus
(see Spice, a previous Cat Of The Month). This is an
extremely rare condition and here was another case within a
few months of Spice’s diagnosis! The owner was advised to put
Jasper on a liquidised diet but this didn’t help - shortly after
eating, the meal was coming back up again. At this point it
was possible to actually feel the enlarged oesophagus through
the fur on Jasper’s throat and so Jasper was admitted for a
more thorough investigation under sedation.
The vet suspected that there was another potentially large
problem: a polyp at the back of the nose. A polyp is a benign
growth made up of inflammatory tissue and skin cells. It is
typified by having a slender stalk from which it grows but they
can become very large. In a young kitten such as Jasper, long-standing
respiratory infections are believed to be linked to growth of
a polyp. This type of polyp starts growing right at the back
of the throat, where the nose opens up into the pharynx. It
will then spread either down the throat or up into the middle
ear (or both if large enough). If it gets into the middle ear
it will start to press on some of the nerves that affect the
face - in Jasper’s case it was affecting the nerves to one of
his eyes causing slightly uneven pupils (Horner’s Syndrome).
A polyp would also explain the noisy breathing and the “fishy”
smell from his nostrils as it was stopping the normal nasal
secretions from draining away down the back of his nose.
He was given a sedative so we could x-ray him. The x-ray films
confirmed there was a soft tissue mass at the back of Jasper's
nose. Jasper was then given a general anaesthetic to allow the
vet to have good look in his mouth - there was a polyp and a
very large one by the look of it. The treatment is to remove
it. Because they grow on a narrow stalk, removal consists of
literally grabbing it with forceps and and twisting till it
comes away. As you can imagine, there isn’t very much room at
the back of a kitten’s throat, and these polyps can bleed from
where they are removed, so it was necessary to place an endotracheal
(breathing) tube into the trachea (windpipe) so no blood would
go down into Jasper’s lungs and he had access to oxygen at all
times. This isn’t the easiest procedure at the best of times
in a kitten, but it was made all the harder this time by having
the polyp blocking much of the entry to the trachea. However,
a tube was successfully put in place and oxygen fed through
it.
Now came the difficult part. Jasper’s head and lower jaw were
held open by the nurse (all the time making sure that the endotracheal
tube wasn’t displaced), whilst forceps were attached by the
vet to the part of the polyp which could be seen. The crucial
part of all this is to use enough force to pull the polyp out,
but not so much that it tears and leaves the vast majority of
it behind. These growths can be friable, (rip easily) adding
to the complications. A good grip was established and steady
traction was applied, all the time using a gentle twisting motion
to remove it. Because of its slender stalk polyps usually comes
away completely with gentle resistance and a very satisfying
“plop”. A gentle pulling motion was exerted in the depths of
Jasper’s throat with no obvious effect and so more force applied,
again to no avail. The good thing was that the polyp appeared
to be quite solid and not as delicate as some but it certainly
was more than happy to remain where it was.
The vet increased the pulling force until, if it wasn’t for
the nurse holding his head, Jasper would have become the first
kitten launched into Outer Space! Eventually, after what seemed
like an age the polyp gave up the fight and flew out of his
mouth. It was a remarkable size - it was a wonder that Jasper
was able to get any food past it as it was large enough to be
lying across the top of both his trachea (windpipe) and oesophagus
(food pipe).
Now came the dangerous part for Jasper - bleeding started from
where we had removed it and so it was necessary to staunch the
flow before any serious complications set in. This was done
quickly and successfully but you couldn’t help feeling sorry
for him as he woke up. Not only would he have a tender throat,
but he must also feel like he had been in a bit of a tug-of-war
what with all the pulling and opening his jaws as wide as possible.
The x-rays also confirmed Jasper's dilated oesophagus. It was
difficult to explain why this might be linked with an obstruction
at the top of the oesophagus rather than the bottom but given
the dramatic nature of the polyp it was felt best to see how
he responded after the polyp had been removed. A painkilling
injection was administered to make Jasper's recovery as smooth
as possible.
The plan was to hospitalise him for a few days to check for
complications and to monitor his regurgitation. He very quickly
came round and was soon yelling for food. Once the vet was happy
that there wasn’t going to be any bleeding from the polyp’s
removal site, Jasper was allowed a very small amount of very
finely mashed food. He fell on this with much enthusiasm; the
polyp had probably been affecting his sense of smell, and seeing
as cats rely on smell to stimulate their appetite, it was probably
the first food he had really enjoyed for a long time. We all
waited for some of it to come back up; after all he still had
the dilated oesophagus, but there was no sign. After a while,
he was given another small finely chopped meal - that quickly
went the way of the first - and stayed down! More food was given
over the next few hours, gradually allowing him to eat a more
normal consistency of wet food with absolutely no regurgitation.
Amazingly enough it seemed that the megaoesophagus had resolved
itself once the polyp had been removed. Jasper was discharged
to a very relieved owner and very lonely brother and was seen
a couple of weeks later to start his vaccinations. He has never
looked back following his surgery, in fact he was with us recently
to have “the unkindest cut” of all for a young male cat! There
had been no more sneezing or snoring, and more importantly,
he is eating a perfectly normal kitten diet and keeping it down.
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