|
 MEET
SOME OF OUR PATIENTS: “Spice"
Siamese cats can be a bit of an acquired taste with their oversized
ears, pointy faces and long spindly legs. Spice was just such
a kitten; in fact he bore a striking resemblance to ET! The
first time we saw him he was just over 4 months old and was
a very cheeky, outgoing chap but physically appeared small and
lightweight for his age. His owner had had him for a short while
and had started to experience problems after feeding. Initially,
Spice was eating kitten food quite happily and it was staying
down where it should do but for the past few days he had started
to vomit most of it back a few hours after feeding. A change
to a lighter diet of chicken and fish still hadn't helped. His
appetite hadn’t suffered and he was very playful but the symptoms
were starting to become a little worrying for us.
A series of diagnostic tests were necessary to find out the
cause of his problem and accordingly, Spice was admitted for
x-rays. X-rays are very good at showing up problems with bones
but not so good at showing up soft tissues such as stomach and
oesophagus (foodpipe). To help matters, a cat is fed a small
amount of wet food containing an "X-ray dye" called barium.
The progress of the barium meal can then be followed at various
stages as it passes through the digestive tract by taking x-rays
at different times. Spice didn't prove to be the most co-operative
of patients for this examination. The patient is best being
unsedated for this type of investigation but an unsedated Spice
was a cat who wasn't going to lie on the x-ray table! The x-rays
made us a bit suspicious that all was not quite right with the
anatomy but in all honesty, the pictures were a bit too blurred
(thanks to our wriggly patient) to be very useful.
Suspecting an anatomical defect, the vet advised Spice’s owner
to put him onto a liquidised diet. Spice’s owner reported that
he had been very much better on the liquid diet, keeping everything
down and managing to put on a bit of weight but when Spice ran
around she could actually hear a "sloshing” noise. As the owner
was going away for a few days, it was decided to continue further
investigation after her break. Unfortunately, on her return,
the owner was confronted with a very sick, sorry- for-himself
kitten. Spice had started to vomit several times a day, was
passing diarrhoea and running a temperature. He had lost weight
and was looking extremely skinny.
A course of antibiotics cleared up the vomiting and small frequent
liquid meals meant he started to put on a little weight and
look decidedly happier. However, at 5 months he still only weighed
1.5kg, nearly half the weight he should be. It was obvious that
things couldn’t continue as they were for much longer.
We needed more investigation but we had gone as far as we could
at The Cat Clinic with our range of diagnostic tools so an appointment
was made at the Royal (Dick) Vet School in Edinburgh. The teaching
universities are fully equipped with up-to-the minute equipment
and are experienced in the many specialised techniques which
it just isn’t possible to encompass in normal small animal practices.
Spice underwent endoscopic examination (a very small camera
is passed down his digestive tract so the vet can actually see
the structures) which revealed a very dilated oesophagus. Another
examination using fluoroscopy was performed. Fluoroscopy is
a technique of taking a series of moving x-ray pictures, unlike
x-rays which can only take a static picture ( a bit like comparing
a video film to an ordinary photograph). This allowed the vets
to actually see the progress of food as it passes down Spice’s
gullet. The results weren’t good news. The fluoroscopy revealed
the whole of his oesophagus was enlarged and, for as long as
3 hours after eating, food was still being retained causing
regurgitation.
The oesophagus is made up of rings of muscle (rather like a
vacuum cleaner hose to look at) and the wave-like contraction
of these muscles passes the food along its length into the stomach.
In Spice’s case, these muscles weren’t working at all, a condition
called megaoesophagus.. Small tissue samples were also taken
from his stomach and these revealed traces of a bacterium called
Helicobacter which causes inflammation of the stomach (gastritis)
in cats. Obviously, this wouldn’t be helping Spice at all as
any food that was reaching his stomach would probably be vomited
back up. Therefore it was necessary to treat both the gastritis
and the megaoesophagus. He was sent home on antibiotics and
medicine to settle his stomach and within a few days his owner
reported a much happier cat whose appetite had greatly improved.
However, this still left the major problem of the enlarged oesophagus,
and sure enough, Spice was still regurgitating food and losing
weight and so a repeat visit to the Vet School was made for
the next stage of his treatment.
A repeat endoscopy revealed that his oesophagus was still very
dilated, although repeat biopsies of his stomach and gut showed
that the Helicobacter had cleared up. An operation was performed
to enlarge the opening out of his stomach and a feeding tube
placed directly into his stomach, the other end passing out
through an incision in his side. The purpose of this was twofold:
firstly to get the correct nutrients into Spice so he could
hope to grow reasonably normally, and secondly, by completely
bypassing the oesophagus, it may get a chance to shrink and
possibly regain some of its muscle tone.
Obviously, any cat is going to find the whole idea of having
a tube sticking out of its side very strange and will try to
remove it, so Spice was dressed in a very “flattering” tunic
made out of elasticated bandage and was sent home wearing an
Elizabethan collar. Due to the small diameter of the tube, Spice
would have to be fed a liquid diet, which the owner administered
with a large syringe several times a day. Almost immediately,
Spice started to gain weight and virtually stopped vomiting.
 The
only drawback was not being able to explain to a very hungry
kitten why he couldn’t eat anything, but Spice, being a typical
cheeky Siamese, still managed to pinch the odd mouthful of food,
unless watched like a hawk! Two weeks after his surgery, he
returned to the Vet School to be reassessed. His weight had
increased from 1.36kg to 1.72kg and he had only vomited once
with no episodes of regurgitation. He was fed a barium meal
and under fluoroscopy. Amazingly, although the oesophagus was
still dilated, there was evidence of some muscle tone. This
time, 5 minutes after eating, all the food had gone into the
stomach.
The vet was worried that it was still too early to allow Spice
to eat normally and so it was decided to leave the feeding tube
in place for a further month. All the options were discussed
with the owner, as there was a very real possibility that Spice’s
condition may never improve, but it was felt by everyone who
had met him, that he deserved every chance, even if it meant
having a permanent feeding tube. A very long (and messy!) month
passed with Spice continuing to gain weight and wreak the normal
havoc that only a kitten of that breed is capable of. The only
abnormal sign that had been noticed was that he would vomit
a very small amount of liquid at 3am every morning - obviously
due to having an empty stomach.
At the Vet School, his weight had increased to 2.10kg and the
results of a further fluoroscopy showed that his oesophagus
appeared, amazingly, to be a more normal diameter and was working
normally at passing food down into his stomach. Also, there
was no evidence of food being retained in the oesophagus, a
considerable improvement from his last visit. It was decided
to try feeding Spice normally. The only condition was that he
had to be held up by his frontlegs immediately after feeding
to encourage the food to go in the right direction, and more
importantly, stay there! All the time he was on liquid medicine
to treat the gastritis.
 Three
weeks later, he again was checked at the Vet School. He had
vomited only once since he started eating normally but wouldn’t
be held upright (typical wriggly Siamese kitten)! His weight
had increased to 2.44kg, and although he was unsurprisingly
quite small for his age, he was looking much more healthy. The
worry was that, although by resting the oesophagus it had returned
to a normal size, as soon as it started to work again, it would
lose its muscle tone and become enlarged and flaccid again.
However, a barium meal and fluoroscopy revealed the oesophagus
was of a normal diameter and working as it should do, albeit
a little slower than normal.
This really was better news than anyone had dared hope for.
In Spice’s case, it seems that by allowing the organ to rest
(and treating the gastritis and narrow outlet), Spice was well
on the way to a good recovery. It is still too early to say
if Spice is fully cured but everyone is cautiously optimistic
about his chances. The owner knows that at the first sign of
vomiting and/or regurgitation, aggressive treatment is needed,
possibly reconsidering the use of the gastrotomy tube. However,
Spice is such a delightful little cat with a great love for
life, that he deserves every chance we can give him.
As a footnote, we have just had him in The Cat Clinic for his
neutering operation; at 9 months he still is a little on the
small side for his age, but his weight is perfect for his size,
and his lungs have certainly not been affected-as anyone who
has ever owned an oriental who’s been deprived of his breakfast
will know!.
ABOVE: Spice (and friend!) relax
in the sunlight. We're glad to report that this photograph is
out of date because he's now coping well minus his vest.
|
