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 MEET
SOME OF OUR PATIENTS: “Kai"
Kai’s owner experienced the one thing every cat owner dreads
- her lilac Burmese boy was seen being hit by a vehicle on the
road outside her house. By the time she had reached the accident
site, he had disappeared. Animals are capable of amazing feats
when badly injured; their first instinct is to get as far away
as possible from the danger area. Unfortunately, this does not
always mean that the injuries are slight - there can be massive
internal injuries that are not immediately apparent. Kai’s owner
searched high and low all morning but there was no sign of him.
Eventually he was discovered back in his own house, hiding under
a bed. He was brought straight down to the clinic for an examination.
Amazingly, we could find no obviously fractured bones or external
wounds but he was breathing much faster and shallower than normal.
When Aileen listened to his chest with a stethoscope, she could
hear air going in and out of the left lung but there were no
sounds coming from the right-hand side of his chest. His stomach
appeared to be much slimmer than normal. Aileen had her suspicions
about these signs and decided that an x-ray was needed. The
x-ray confirmed that Kai had a ruptured diaphragm.
The diaphragm is a sheet of muscle that separates the chest
from the abdomen. When a large object, such as a wheel, hits
a cat, there is a massive increase in pressure within the abdomen
as organs are squeezed together in a confined space. The weakest
place for this pressure to be released is through the thin sheet
of diaphragm muscle which rips apart. The abdominal organs slip
through into the chest. Unfortunately, they then stop the lungs
from inflating properly the cat has small, frequent laboured
breaths. The treatment for a diaphragmatic rupture is surgery;
it’s necessary to open up the abdomen, pull the organs back
through to their rightful place and repair the tear in the diaphragm.
If the diaphragm isn’t repaired, there is a risk of some of
the organs becoming twisted, the lungs are severely compromised
and adhesions can form leading eventually to the death of the
cat.
As well as the damage to the diaphragm and a collapsed lung,
Kai’s liver had several lacerations which were bleeding and
he also had damaged a section of his small intestine. The diaphragm
was repaired and the lung was left to re-inflate. It was necessary
to completely remove the damaged section of intestine and then
rejoin the two ends back together. This in itself is a very
delicate and serious operation as waste products will have to
pass through the joined-up section as it is healing. However,
Kai came through this major surgery quite well.
The plan was to keep Kai in for observation for several days
to make sure all his major injuries were starting to heal OK.
We didn’t want him to eat for a few days post-operatively, to
give the intestine time to start to heal so a liquid nutritional
supplement was given intravenously to maintain him. As the days
went past, it became obvious that we had complications. Kai’s
mucous membranes were still very pale and started to get a yellowy
tinge to them. This indicated that there was some damage to
the liver (which we had seen when we operated) but also that
he wasn’t producing enough red blood cells. Also, his appetite
was nonexistent: we weren’t expecting him to want a four course
meal but by this stage he should be showing some interest in
food. The surgical abdominal wound wasn't closing over properly
and was leaking a watery yellow fluid. We realised we had to
have another look inside him again but we had a very poorly
cat and the anaesthetic itself was a significant risk for him.
Red blood cells carry oxygen all around the body and it was
important to replace Kai’s as soon as possible. Luckily, we
had a donor to hand - Snowy, one of the practice cats. He (willingly!)
donated several mls of his blood which we then transfused into
Kai. Once this was done, he was taken back into theatre for
his exploratory operation. The vet opened up his abdomen and
discovered that whilst his diaphragm repair was looking good,
the intestines required further surgery. This was performed
as quickly as possible because we wanted to wake Kai up as soon
as we could. Because Kai didn’t want to eat we decided to put
a feeding tube directly into his stomach via his nose (nasogastric
feeding tube). This is fairly common practice and allows us
to give the cat liquid food without force feeding. As the tube
was being put in place, Kai was taken off the anaesthetic to
allow him to start to wake up. Unfortunately, at that point,
his heart stopped. The combination of severe internal injuries,
2 major surgical procedures and post-op complications had just
been too much for him. Everyone immediately started doing CPR
(Cardiac Pulmonary Resuscitation). The vet compressed his chest
to get the heart to push blood around the body. The nurses administered
oxygen to the airways and he was given numerous drugs to try
to kick-start his heart again.
Minutes ticked by and we were getting no signs of life from
Kai. We worked on Kai for 15 minutes with nothing. We all took
a step back from him and were about to call it quits when amazingly,
his heart started to beat. A short time later, his breathing
started. We were delighted as his heart became stronger and
regular, and he slowly showed signs of wakening up. This feeling
was very quickly replaced with worry about whether he was going
to make a full recovery, or whether he would be brain-damaged.
However, we hadn’t counted on Kai’s amazing will to live and
by the third day after effectively dying, we were greeted with
a much more normal cat. He was up on his, albeit much skinnier,
legs, eyes and ears functioning normally and, being a Burmese,
demanding to be let out of this horrible kennel!
There was still a concern on how well the bowel was starting
to heal and so he was only allowed very small meals. Everything
seemed to passing through well and so his feeding tube was removed
and after another 48 hours of observation he was discharged
to his much relieved owner. He had to stay on a restricted diet
for another week and was under strict “house arrest”. Two weeks
after his brush with death, he returned for the removal of some
his sutures. We were confronted with a normal, still quite skinny
Burmese; everything sounded and felt to be healing very well
indeed. His right lung had re-inflated and he had started to
put weight on.
 One
month after discharge, the final stitch was removed from a very
normal (or as normal as a Burmese can be) cat. If it's true
about cats having nine lives, Kai seems to have acquired a few
more along the way to have come through such a traumatic event.
If it's possible for humans to have their nine lives too, Kai
has been the cause of his owners, vet and nurses losing several
lives throughout this ordeal!
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