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

Cuterebra infection: Not really that cute...

Gryffin

Meet Gryffin, a tiny little kitten found wedged between the wall of a gas station and the ice machine. He weighed less than two pounds, and had a wound on his leg. Upon examination by the doctor, it appeared to be a run-of-the mill bite-wound abscess. Once under anesthesia, we were able to take a closer look - clipping up the hair and scrubbing the wound with antiseptic scrub. Bite wound abscesses have a tendency to become infected, so Dr. Brooks removed the scab and flushed the wound. As would be expected, the wound was infected. After cleaning it out, the doctor gently probed the wound and determined that it was clean. We treated Gryffin with pain medication and antibiotics.

But, Gryffin didn't get better. His wound still seemed to bother him, and we examined him again. The wound was free from infection - what could it be? Dr. Brooks commented that it was a remote possibility that it was a Cuterebra breathing pore, but no Cuterebra was found in the wound, and the pores do not scab over while the larvae are inside. It was also an unusual site for a Cuterebra infection, since Cuterebra larvae generally infect the head and neck regions of cats. She decided to satisfy her curiosity non-invasively, by placing the ultrasound probe on Gryffin's leg. This is what she saw:

Ultrasound image of a cuterebra larva

Deep within the wound, far from the scabbed opening, a dead Cuterebra lay - acting essentially like a sliver under the skin, causing irritation and infection and pain. Dr. Brooks was now able to locate the larva and remove it, much to Gryffin's relief! We measured the Cuterebra once it was removed, and determined that it was the biggest one we had ever seen, at 4cm in length.

Cuterebra larva after removal

Cuterebra. It doesn't sound too bad, and usually, they don't cause too much trouble, but Cuterebra larval infection can cause problems for cats.

The Cuterebra larvae are immature bot flies - a large bumblebee sized fly. The adult flies are harmless - in fact, they live for such a short time, they do not even have mouth parts for eating!

Adult Cuterebra

They lay thousands of eggs in the environment (blades of grass, wood chips - areas near rodent burrows) or on other insects (such as mosquitoes), or even directly on the host (such as horses) - usually in clusters of 5-15 eggs. Cats and dogs are not the normal host of the Cuterebra, but can become infected if they spend time in areas where the eggs have been deposited. The eggs tend to hatch quickly when exposed to the warmth of a nearby body. Most of the time, cats will become infected by coming into contact with a newly-hatched Cuterebra larva with the nose or mouth, but the Cuterebra can also enter the body through open wounds.

Once in the body, the larva forms a small cyst under the skin - most commonly near the face and neck. These lumps are usually very easy to distinguish from a cancerous lump by the 2-4mm breathing pore that the larva creates. Often, the larva can be seen moving towards and away from the pore to breathe. These lumps are called "warbles". It is most common to see the warbles in late

August and September. Some years, we see a lot, other years, we see none. In the Waterford area, kittens tend to be most commonly affected, but any cat that goes outside could come into contact with a Cuterebra larva.

Sometimes, a sneezing cat may have a Cuterebra infection in its nose. On some rare occasions, a Cuterebra infection may occur in or near the eye or spinal cord. These situations are very rare. Cats that develop eye infections may or may not have damage to the eye. Neurologic signs of Cuterebra infection may include "head pressing", circling in one direction, or other behavioral changes. Cats that develop spinal cord infections may fully recover once the Cuterebra larva is removed.

The most effective treatment for Cuterebra infection (called "cuterebriasis") is surgical removal of the larva. In some situations, this can be quite complicated, depending on the location of the larva. It is important to be able to remove the entire larva, and not to break the larva while it is inside the cat, or a severe allergic-type reaction can occur (called "anaphylaxis"). 



It is important to remember that you can NOT get a Cuterebra infection from an infected cat, but you may have Cuterebra present in your yard.

Two weeks after removing Gryffin's parasite, he looks great!

In Michigan, late summer and early fall is the time of year that Cuterebra infections become evident. The larvae are very difficult to see until they become large, due to the fur coat your cat wears. Some years, we do not see any cats with Cuterebra infections, other years we see quite a few. This year, we saw a cluster of 4 cats with Cuterebra infection, all in a row at the end of August and early September. Two of the cats had Cuterebra larvae in the neck region, Gryffin had his infection in a hind leg, and one Cuterebra was located up a cat's nose! He had a "chronic upper respiratory infection" that would get only a little better with antibiotics. Some might have written that off as a viral infection (viruses do not respond to antibiotic treatment), but Dr. Brooks took a look up the cat's nose and there was the source of the chronic sneezing! Once the Cuterebra was removed from the cat's nose, he fully recovered.

These days, Gryffin is doing much better, without his creepy-crawly passenger!

EDIT: 11/4/14 Gryffin came in for a recheck and had gained almost a pound since his last visit. His wound is healed and he is looking and feeling great!


For more information:
Article on Cuterebra from the American Association of Veterinary Parasitologists