Case Report: Tangled Newborn Kittens

Being a veterinarian can be very humbling, sometimes, because no matter how long a veterinarian practices, there is still the likelihood that each day, they may see something they have never seen before. Exclusively Cats Veterinary Hospital has been around for 25 years, and Dr. Bailey has been practicing even longer than that, and he observed, "In all my years of practice, I have never seen anything like this before!"

Dr. Brooks was presented with 5 kittens that were two days old, born to a feral mother that had been trapped. The foster owner had not been able to access the kittens well, because the mother cat would not let her near them, and she did not want to disturb the litter because all the kittens seemed to be nursing well and appeared active and content. That morning, the mother cat had moved away from the kittens and it became apparent that something was wrong. One of the kittens was nursing on the mother cat, but the other 5 kittens were together in a pile across the cage, struggling and crying. When she reached into the cage to pick up one of the kittens to check on it, she realized that it somehow seemed to be stuck to the other 5 kittens!

Desperately, the foster owner called veterinary hospital after veterinary hospital, looking for help. Time after time, she was told that there was nothing the hospital could offer, or that they didn't work with neonatal kittens. Finally, when she called Exclusively Cats, we told her to rush the kittens in. When she arrived, Dr. Brooks discovered that the kittens were entangled in their umbilical cords. Often, young cats do not know enough to separate kittens from the placenta effectively, and this can cause complications. Sometimes, kittens may end up missing tails or legs because the mother cat is unaware of what she is doing, and in this case, because she only separated a couple of kittens, the rest became ensnared as they moved around. At first, they were happily nursing, but as time went on, they became even more tangled and eventually, the mother cat abandoned them across the cage, because she couldn't figure out what to do.

Immediately, all of our technicians started dropping what they were doing to come to the aid of the kittens. Some held small feet and tails out of the way of Dr. Brooks' work, while she attempted to disentangle them, others weighed, cleaned, fed and warmed the kittens as they were separated. Two of the kittens had hind limbs that were too badly injured to save, and two kittens had umbilical hernias, so Dr. Bailey also jumped in as we cleaned and prepped four of the kittens for emergency surgery. Two leg amputations and two abdominal surgeries later, all five kittens were warm, fed and snuggling in warmed blankets. They received antibiotics and tube feedings because they would not drink from a bottle and the mother had not allowed them to feed recently. At that age, too, kittens cannot urinate or defecate on their own - the mother must stimulate them to eliminate, and so all the kittens were "pottied" as well.

Once all the kittens were recovered, fed and warmed, we taught the foster mom how to tube feed them, if necessary and sent them home. We hoped that they could be re-introduced to the mother so that they could nurse. The prognosis for the tangled kittens is very grave, as there is a huge risk of infection in kittens so small, and with such daunting beginnings. Fortunately, as soon as they were put back with their mother, she accepted them and they started nursing! this is great news, since they will do better with their mother's milk than with kitten milk replacer.




Overnight, one of the kittens who had an abdominal hernia passed away. Two days later, the foster mom brought in the kittens to weigh them. One of the kittens was euthanized due to a septic infection in the leg that was amputated. All the other kittens gained weight, but the kitten that was not part of the entanglement outweighs the others by about 40 grams! Hopefully, with heavy doses of antibiotics and close observation and care, the rest of the kittens will survive this ordeal!

For continued updates on these kittens as we follow their progress, please follow our Facebook page!

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

Chronic Nasal Discharge in Cats

CHRONIC NASAL DISCHARGE

What is meant by the term "Chronic Nasal Discharge"?

When a cat has a discharge from its nose that lasts more than 2 months, it is considered chronic.  The discharge may be thin and clear like water (serous), thick and yellow or green like pus (purulent), bloody (sanguinous or hemorrhagic), or a combination. Clear fluid or mucousy discharge may be an indication of irritation or viral infection. Thick, yellow fluid or pus may be a sign of a bacterial infection. Reddish fluid can be a sign of intense or chronic irritation, destruction of the nasal mucous membranes or bones (turbinates). Trauma can also cause a bloody nasal discharge.

Foreign bodies only affect one nostril. Fungal infections and tumors may affect one or both nostrils, while viral infections most often affect both, though one side may be worse than the other.

What causes a chronic nasal discharge?

A view into the nasal canal and the papery turbinate bones

Chronic nasal discharge is not a diagnosis; rather, it is a term that describes the signs of disease in the nose and frontal sinuses.  Almost all disease conditions that occur in the nose will cause irritation and inflammation to the lacy bones in the nose, called turbinates.  The presence of disease in the nose is called rhinitis.  The turbinate bones are easily distorted and destroyed.  When that happens, bacteria that normally live in the nose grow rapidly, causing a secondary bacterial infection.

The frontal sinuses are hollow cavities in the skull and are located just above the eyes.  They are connected to the nasal cavity by a small canal.  Most diseases that occur in the nasal cavity have the ability to move through these canals into the frontal sinuses.  When the sinuses become involved and develop inflammation, this is called sinusitis.

Chronic nasal discharge may result from several disorders involving the sinuses and nasal cavity.  These include:

                Chronic viral infection

                Chronic bacterial infection

                Chronic fungal infection

                Dental disease

                Nasal foreign body (e.g. grass seed)

                Nasal tumor

                Inflammatory polyp

                Parasite infection

What tests should be done to make an accurate diagnosis?

There are several diagnostic tests that should be done for a cat with a chronic nasal discharge.  A blood profile will often detect underlying diseases that can contribute to a nasal disease.  Testing for the feline leukemia virus (FeLV) and the feline immunodeficiency virus (FIV) is important because these viruses have the ability to suppress the cat's immune system, making recovery from normally mild infections difficult (or even impossible). 

Nasal x-ray. One side of the nose has poor detail which suggests that the delicate bones of the nasal passages, the turbinate bones, are being destroyed.

It is very important to make radiographs (x-rays) of the skull.  Special positions are necessary to view the nasal cavity and frontal sinuses.  These require sedation or a short-acting anesthetic.  A nasal flush is a diagnostic procedure used to collect material from deep within the nasal cavity.  This material can be studied under the microscope (cytology) and can also be cultured.  Although it is not particularly traumatic to the cat, anesthesia is required, so this procedure is usually done in conjunction with radiographs.  This allows more than one procedure to be done while the cat is under anesthesia.

Anesthesia allows close inspection of the throat, the area above the soft palate, and the nasal canals. This cat had a large buildup of extremely thick mucus above the soft palate.

Some veterinarians have a specialized instrument called an endoscope which allows the veterinarian to actually look inside the nose, as well as to examine the back of the throat and the area around the soft palate.  In order to pass this small flexible tube into the area of interest, anesthesia is required.

There are some diseases that can only be diagnosed with a biopsy of material deep within the nasal cavity.  A biopsy requires recovery of an actual piece of tissue, so surgery is often required for this procedure.

Fungal organisms and a plaque of fungal growth inside the nose of a cat 

Foreign objects within the nasal passage can sometimes be detected with radiographs.  If a foreign body is suspected but not visualized, endoscopy may be helpful, depending on where the foreign body is located.  For some cases, exploratory surgery of the nasal cavity is needed.

As you can see, it may require several days or weeks of testing to determine the cause of a chronic nasal discharge.  When the diagnosis remains elusive, more sophisticated tests may be required.  Veterinarians unable to perform these tests often refer the cat to a specialist.

How is a chronic viral infection treated?

Respiratory viruses, which can infect the nose, may persist and lead to long term viral rhinitis/sinusitis.  No drugs are available to kill these viruses so this type of infection is often incurable but many cats respond to antiviral medications such as Famciclovir.

How is a chronic bacterial infection treated?

Administration of antibiotics alone is usually unsuccessful in curing bacterial infections of the nose and sinuses because the bacteria have become entrapped within the turbinates, and reinfections are frequent.  Although many cats improve while taking antibiotics, cortisone, or antihistamines, they may relapse when these drugs are discontinued.  The use of drugs that stimulate the immune system and the surgical removal of the turbinates have been successful in some cats.  However, others do not respond well.  Overall, the prognosis is guarded.

How is a chronic fungal infection treated?

The most common fungal infection in the nose is caused by Cryptococcus neoformans. Because some of the drugs used to treat this organism are quite expensive and will occasionally cause adverse effects, they are not used unless a firm diagnosis is made.  Fortunately, the newer antifungal drugs have fewer significant side effects and many cats with fungal diseases can be successfully treated.  If the cat is infected with the feline leukemia virus or feline immunodeficiency virus, the outcome will usually be less favorable.

The image below shows a cat named Parker who came to us with a severe swelling in her nose. Microscopic evaluation of samples collected from her nose showed the fungal organism Cryptococcus. Treatment was started and over time, her nose returned to normal.

How is dental disease treated? 

A cat's tooth roots are located very close to the sinus cavity, and if the tooth becomes infected, pus or fluid may drain from the nose. If the infected tooth becomes a severe enough problem, the cat may have facial swelling or swelling of the eye, the tongue may stick out, or the tooth may completely fall out, leaving an opening straight into the sinus cavity.

Disease of this type is treated with a thorough dental cleaning and extraction of the infected teeth, followed by a course of antibiotics. If the disease is bad enough, the cat may be prescribed antibiotics prior to dental care, too.

Read more about what is involved in feline dental care.

How is a nasal foreign body treated?

Nasal mites

When a piece of grass, a seed, parasites or other foreign material lodges in the nasal cavity, the membrane which lines the nose produces large amounts of mucus in response to the irritation.  In addition, affected cats will sneeze violently in an attempt to expel the foreign body. 

If the foreign body cannot be sneezed out, the veterinarian must take steps to remove it.  When a nasal foreign body is suspected but cannot be seen on radiographs or with an endoscope, exploratory surgery may be needed.  If it is found and removed, the prognosis is good.

The following video shows the removal of a Cuterebra larva that was lodged in a cat's nose. He had chronic nasal discharge and excessive sneezing that was not improved with antibiotic treatment. After the Cuterebra was removed, his nasal discharge went away and he stopped sneezing.

How is a tumor treated?

Most nasal tumors are malignant.  Complete surgical removal is very unlikely, so chemotherapy or radiation therapy must be considered.  Unfortunately, many nasal tumors do not respond to either treatment, so the prognosis is poor.  However, when surgery is performed to get tissue for biopsy, most surgeons remove as much of the tumor as possible.  Following this procedure, the cat may be greatly relieved of the nasal discharge and remain improved for several months.  However, in almost all cases, the tumor can be expected to recur. In some cases, however, chemotherapy and/or radiation treatment are successful and the cat will go into remission for as long as several years. It is notable that after a cat has been treated with radiation, the hair at the site of the treatment will likely change color.

This 12 year old cat has been having chronic nasal discharge and sneezing for 2 weeks. He has significant dental disease, but another likelihood at his age is that he may have a tumor. Dr. Brooks' plan for him is to extract his infected teeth and perform a surgical biopsy to determine the extent of his problem.

Several of this cat's teeth have already fallen out and another is almost ready to.

How is an inflammatory polyp treated?

Inflammatory polyps are non-cancerous masses of tissue that are composed of inflammatory cells. Surgery is often successful in removing much of the polyp, but there is a high probability of regrowth if all of the polyp cannot be removed.  Since polyps often begin in the internal ear and grow down the Eustachian tube into the back of the nose, their removal can require extensive surgery that may not be completely successful.  The prognosis for an inflammatory polyp is guarded because the entire polyp cannot be removed in some cases, however, if the entire polyp is successfully removed, the cat will completely recover.

The cat below had an extremely large nasopharyngeal polyp. Once it was removed, her sneezing and nasal discharge resolved completely!

Any time that your cat has discharge from the nose, it is a good idea to have the cat examined by a veterinarian, because the potential causes of chronic nasal discharge are extremely varied, and treatment for chronic nasal discharge is highly dependent on the cause.