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

Cessna

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 18^th, 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 24^th, 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 16^th, 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 18^th. 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

Feline Immunodeficiency Virus (FIV): Frequently Asked Questions

Blanco, a 15 year old FIV-positive cat

Is this the same virus that causes AIDS in people?

No. The Feline Immunodeficiency Virus (FIV) is also sometimes called the Feline AIDS Virus.  It is likened to the Human Immunodeficiency Virus (HIV) that affects people because of the similarities in the two diseases which result.  Fortunately, most viruses are species specific.  This is the case with HIV and FIV.  The Human Immunodeficiency Virus only affects humans, and the Feline Immunodeficiency Virus only affects cats.

FIV is a type of retrovirus called a "lentivirus" (slow virus) that attacks many of the cells of the
immune system, leaving the cat at risk for diseases that a healthy immune system can usually fight. Once infected, the virus takes up residence in a cat's lymph nodes and infects T-lymphocytes. Sometimes, the lymph nodes can become enlarged tempporarily as the virus spreads to other lymph nodes.

How do cats get FIV?

FIV is transmitted primarily by biting that usually accompanies cat fights.  Other interactions of cats,

such as sharing common food and water bowls or grooming each other, have not been shown to be significant in transmission. FIV affects up to 3% of the healthy cat population in any given area, and is much higher in populations of high-risk or ill cats. In some cases, isolated stray or feral colonies my have up to 100% of the population infected but apparently healthy. Male cats, especially intact males, are at highest risk for disease as they are more likely to fight and spread the virus.

How is it diagnosed?

Evidence of exposure to FIV can be detected by a simple blood test.  A positive test means the cat has been exposed to the virus and will likely be infected for the remainder of its life.  A negative may mean that the cat has not been exposed; however, false negatives occur in two situations:

1.         From the time of initial virus inoculation into the cat, it may take up to two years for the test to turn positive.  Therefore, for up to two years, the test may be negative even though the virus is present in the cat.

2.         When some cats become terminally ill with FIV, the test may again turn negative.  This occurs because antibodies (immune proteins) produced against the virus become attached and bound to the large amount of virus present.  Since the test detects antibodies which are free in circulation, the test may be falsely negative.   This is not the normal occurrence, but it does happen to some cats.

What does a positive test result mean in a kitten?

The vast majority of kittens under 4 months of age who test positive have not been exposed to the virus.  Instead, the test is detecting the immunity (antibodies) that were passed from the mother to the kitten.  These antibodies may persist until the kitten is about 6 months old.  Therefore, the kitten should be retested at about 6 months of age.  If it remains positive, the possibility of true infection is much greater.  If the kitten tests negative, there is nothing to worry about.

How can a kitten become infected?

If a kitten is bitten by an FIV infected cat, it can develop a true infection.  However, the test will usually not turn positive for many months.  If a mother cat is infected with the FIV at the time she is pregnant or nursing, she can pass large quantities of the virus to her kittens.  This means of transmission may result in a positive test result in just a few weeks. 

What type of disease does the FIV cause?

An FIV infected cat will generally go through a prolonged period of normal life with normal risk for health issues (viral dormancy) before it becomes ill.  This incubation period may last 6-8 years or more.  Thus, we generally do not diagnosis an FIV sick cat at an early age.

When illness occurs, we usually see a variety of severe chronic illnesses. This is because the cat's immune system becomes weakened and can no longer fight off the normal bacteria, viruses, fungi and protozoa that a healthy immune system would easily eliminate from the body. The most common illness is a severe infection affecting the gums.  Abscesses from fight wounds that should heal within a week or two may remain active for several months.  Respiratory infections may linger for weeks.  The cat may lose weight and go through periods of not eating well; the hair coat may become unkempt.  The cat may have episodes of treatment-resistant diarrhea.  Ultimately, widespread organ failure occurs, and the cat dies.

What are the signs of an active FIV infection?

IDEXX.com

• Poor coat
• Persistent fever
• Poor appetite
• Poor oral health - gingivitis, stomatitis, dental abscesses
• Chronic, persistent or recurrent infections of the skin, respiratory system or bladder
• Weight loss
• Cancer and blood diseases
• Reproductive failure
• Seizures, behavior changes, neurological disorders

Is there a treatment for it?

There is no treatment that will rid the cat of FIV.  Sometimes, the disease state can be treated and the cat experiences a period of recovery and relatively good health.  However, the virus will still be in the cat and may become active at a later date.  Therefore, the long term prognosis is not good.

What should I do with a cat that is FIV positive but is not ill?

If you have a cat that tests FIV positive but is not ill, it is not necessary to euthanize it immediately.  As long as it does not fight with your other cats or those of your neighbors, transmission is not likely to occur.  However, if it is prone to fight or if another cat often instigates fights with it, transmission is likely.  In fairness to your neighbors, it is generally recommended to prevent an FIV positive cat from roaming the neighborhood. Owners of infected cats must be responsible so that the likelihood of transmission to someone else's cat is minimized. Additionally, living an indoor life will reduce the positive cat's exposure to communicable diseases, parasites and other infectious agents that are common in the outdoor environment.

Wellness visits should be scheduled every 6 months, and you should keep a close eye on your FIV positive cat's weight, since weight loss is often the first sign that a cat is feeling ill.

FIV is not a contraindication for spay and neuter surgeries. 

Cats that are FIV positive should not eat a raw diet or unpasteurized dairy.  Food borne illnesses or parasites that a healthy cat is likely able to fight off are a higher risk for immunosuppressed cats.

There is a growing body of research into anti-viral therapies, but so far, no therapy stands out as a conclusive benefit to the health and longevity of FIV positive cats.

If an FIV positive cat has spent a period of time in your house, you will want to use normal cleaning and disinfecting methods to sanitize the area where the cat lived. FIV does not last long outside the body of a cat, however any secondary infections - bacterial, viral, fungal or protozoal, may linger on food dishes, bedding, litter pans and toys. A dilute bleach solution should be sufficient to clean these items.

For a little more information about one of our patient who is currently a 15 year old FIV survivor, you can read about Blanco on our blog!

Is there a vaccine for FIV?

Unfortunately, there is not a recommended vaccine available for FIV. Vaccination with the currently available FIV vaccine will cause your cat to test positive on an FIV test.

When should FIV testing be performed?

As a general rule, it takes 8-12 weeks for antibodies to appear after infection, so a post-exposure test should be performed a minimum of 60 days after a known exposure, such as a bite wound from an unknown animal. The antibody test is the standard initial screening test, and can be performed in the veterinary office within a few minutes. However, if the test is positive, it is generally recommended to confirm the test using an alternate method. In the past, the Western Blot test has always been the gold standard of confirmation testing, however, PCR tests are extremely sensitive (possibly too sensitive at this time?) and are showing promise as a superior testing method. 

• Sick cats
• Untested cats, or cats with an uncertain history of testing
• Newly adopted cats
• After a possible exposure (escaping out of the house with or without an obvious bite wound, living in a house with cats with unknown FIV status or uncertain testing history)
• After definite exposure (spending time in the vicinity of a positive cat with or without a bite wound) 

Additional Resources:

PetMD
Wikipedia
Oral Health-Retrovirus Connection

Bite Wounds

Please note: Some images of wounds will be presented in this article

We see a significant number of bite wounds, here at Exclusively Cats. Sometimes, the wounds are on indoor/outdoor cats, other times, we find them on stray or feral cats that are brought in for limping. Occasionally, we are called on to treat bite wounds in indoor-only cats - usually after a fight between housemates that got a little out of hand.

Bite wounds often harbor multiple kinds of bacteria

Sometimes, we see the bite wound when it is fresh, and we can prescribe medications and treatments to decrease pain and inflammation, as well as prevent infection. Other times, we see bite wounds after they have become abscesses. An abscess is a pocket of infection that can develop after a wound. This occurs because the canine teeth create small punctures in the skin that do not bleed much. The sharp, conical tooth acts like a needle, injecting bacteria deep into the skin or muscle. Since the wound does not bleed much, the bacteria remain at the bottom of the wound, and when the injury scabs over, a warm, moist area is left behind, which is a great environment for bacterial growth. As the bacteria grow, white blood cells flock to the area to fight the infection. Eventually, there is too much "stuff" (bacteria, diseased tissue, white blood cells and other inflammatory cells) to fit in the puncture wound and the abscess starts to swell. It may be warm to the touch. As it swells, eventually damaged tissue will fail and the abscess will open to the outside and begin to drain. If antibiotics are not started, the wound will scab over again and the process will start anew. 

A bite wound or abscess can happen anywhere on the body, but common locations are on the legs and feet, especially the hind legs, as many cats will get bitten while running away. Other common places to find these wounds are the head and neck, ears, and tail.

If an abscess or bite wound is not obvious due to moist hairs around the wound, or hair loss, you may notice a strong, unpleasant odor - this foul odor is characteristic of  infection. A cat that does not have other obvious signs of a wound may seem painful to the touch, may lick at an area excessively, or may run a fever. Feverish cats often do not have an appetite, so weight loss or disinterest in food can also be signs of a bite wound or abscess. Depending on the location of the wound, you may also note limping, squinting, ear-flicking or the holding of an ear at a strange angle, a reluctance to lie on one side or the other, restlessness, or discomfort when sitting.

Usually, when we are examining a bite wound, we will find a set of 4 wounds (from all four canines), but not all four wounds will be the same severity - some teeth will puncture further than others. Sometimes only one of the four wounds becomes infected. Most of the time, a wound can be flushed and cleaned while the cat is under anesthesia, and then sutured as needed if the wound is large. Warm compresses twice daily will allow the wound to remain open to drain, which will help the wound heal more quickly and prevent the wound from scabbing over and beginning the process all over again. In some cases, the wound is in a location where it can't drain well, and a drain tube will have to be placed. In other cases, the wound has started to heal, but some of the tissue around the wound is too badly infected to recover. In these

This wound required a 12 day stay in the hospital for intensive wound care

cases, the diseased tissue will need to be surgically removed to allow healthy tissue to replace it. This is called "debriding". In extreme cases, there may be enough badly diseased tissue that needs to be removed that the wound cannot be sutured closed and we must use special bandaging techniques to encourage the wound to heal.

An important thing to remember when dealing with bite wounds is that, aside from bacterial infections, other complications can arise from this situation. A cat that has been bitten by another cat will be at high risk for feline-specific viral diseases that can be transmitted through saliva, such as Feline Immunodeficiency Virus (FIV) and Feline Leukemia Virus (FeLV) (although FeLV is more likely to be transmitted by long term contact between two individual cats than a single bite wound, the fact that a cat has obvious contact with other cats outdoors suggests that a bitten cat should be tested for FeLV out of due diligence).  Additionally, a cat that has been bitten by any other mammal - cat, dog, raccoon, fox, bat, etc. runs the risk of rabies exposure. If the animal that bit your cat is known - for example a neighbor's cat or dog, it is a good idea to ask what that pet's vaccination status is. If the animal that bit your cat is unknown, it is recommended to have your cat re-tested for FeLV and FIV about 2 months after the bite wound occurred. In Michigan, if your cat's rabies vaccine is up to date, the bitten cat should be re-vaccinated and observed carefully for 45 days for any signs of illness. If the bitten cat has not been vaccinated for rabies, or the vaccine has lapsed, the situation becomes more complicated, as the choices outlined by the Michigan Department of Community Health are either immediate euthanasia or strict quarantine for 6 months. This is one of the reasons that we emphasize keeping your cat's rabies vaccine current.

Michigan Department of Community Health Rabies Protocol

For more about bite wounds:
Frequently Asked Questions About Bite Wounds
Abscesses From Bite Wounds
Bite Wound Abscesses in Cats

Beware of Cat!: Avoiding the human hospital after visiting the veterinary hospital

When you visit the veterinarian with your cat, and your cat is being a bit feisty and wiggly, a technician may be called into the room to hold your cat for you. You may wonder why that is - it's your cat, your loving companion, after all! You should be the one holding her, right?

Unfortunately, even the sweetest of cats may become unpredictable when frightened, and at that point, she may not care WHO is holding her. She just wants to get away to a safe, dark spot, and hide.

One of the reasons that we bring a technician in to hold a cat is that they have many years of experience holding unruly cats while remaining calm and gentle, but firm. They also have a lot of experience in avoiding getting bitten while still maintaining control of the situation, preventing others from getting bitten as well.

Why do we care so much about bites?

Well, besides the fact that they hurt - A LOT - cat bites have a high likelihood of becoming infected. According to a new study, about 1 in every three people who sought medical care for a cat bite more than 24 hours after the bite ended up being hospitalized for 3 or longer. As many as 72% of the hospitalized patients required surgical intervention for their bite wounds. Several of the patients needed multiple surgeries, and several had complications such as abscesses or lingering joint mobility issues. We don't want your visit with us to end up with a doctor visit for yourself!

At Exclusively Cats Veterinary Hospital, it is our goal to ensure that the safety of both our patients and our clients are of highest priority. For this reason, we hope that you understand when we ask you to sit back in your chair and relax while someone else holds your cat for the veterinarian. It's also one of the reasons why we might ask to take your cat "in the back".

 More information about cat bite related medical problems can be found here.