Thursday, October 30, 2014

Kitten Head Tilt? Maybe? Upper Respiratory Infection? Maybe? Polyp? (See the video!)




This is Louie the first exam that I saw him. In the first few photos he was about 2 months old. He, like almost every kitten we see came from a barn, or an outside colony, and was saved by a loving family from having to follow in the footsteps of his parents. There is a terrible epidemic of neglect and responsibility among too many people that think that it isn't their obligation to spay and neuter their pets. Of all of the adorable kittens I see I know there are dozens more who grow up feral, abused, or eaten by wildlife. Louie was very, very lucky, he is, as you can see, also adorable!

He had been to the clinic twice before for an upper respiratory infection (URI).URI's are one of the most common ailments that we see in young kittens. Typically they present as a sniffling, sneezing, subdued, lethargic kitten who has stopped eating. Sick kittens usually have both ocular (eye) and nasal discharge that is thick yellow green snot. Sometimes they even arrive open mouthed breathing because the nose is so stuffed. They usually also have a fever. He had been on two rounds of two very good antibiotics and yet his nose remained snotty.

Louie also had a significant head tilt to the right. Because his head tilt was so marked I wanted to see how he navigated. In itself a head tilt isn't indicative nor detrimental on its own, but it can affect the pets ability to ambulate and eat. For Louie it didn't seem to affect him at all. He could walk in a straight line, focus and hit his target, and turn both to the left and the right.

video





Anatomy of a head tilt. The right ear is lower than the left, Louie tilts his head to the right.


The head tilt is consistent through all ranges of head movement, looking up down and even side to side.



At Louie's exam we discussed all of the things I was thinking. I explained that I thought Louie was functioning just fine even with his trademark head tilt. I also mentioned that he still had a little bit of green snotty discharge from the left nostril, but he had no other signs of infection.

Most importantly, his heart and lungs sounded normal. He did however have a very audible consistant stertor, which sort of sounds like a low pitched snore. It occurs when there is a mechanical obstruction at the level of the larynx, or back of the throat. I was very suspiscious of Louie having a naso-pharyngeal polyp. He sounded clear and normal everywhere excecpt the back of his mouth/high trachea, he had no evidence of still having an URI expecpt the left nostril and he was happy active and playful. I suspected that he had a polyp or mas in the back of his soft palate that was occluding air flow therefore making his constant snoring sound and irritating his nose constantly so that it was goopey incessantly.

Here is where I got concerned. If I was right he and the polyp would continue to grow. Polyps can get so large that they cut off your ability to breathe. We usually wait to neuter kittens at about 6 months. That was 4 months from now. I didn't want Louie to wait that long. I was afraid that if we waited we would be risking his life. We vaccinated him that day and he returned two weeks later at barely 3 pounds for his neuter and oral cavity exploratory. I was nervous. I am always nervous. What if I was wrong and there was a problem with anesthesia, he was so little, and he had been through a lot already.

Surgery/Neuter Day;
One back rub before surgery.


As soon as I opened Louie's mouth there it was! Hiding, lurking all pink and tumor-like behind the soft palate, a big giant polyp!

I intubated Louie and then used a soft tipped hook to gently pull the soft palate forward so I could get a better idea of how big and how easily this thing could be removed. Even though Louie was just going under anesthesia pulling and moving the mass caused him to cough and swallow. Removing a polyp is a 2-3 person task, one to hold the head and mouth open, another to hold a light, and me, well I need both hands to try to fit into a tiny kitten mouth..


Here is a video of us trying to get a look at the size and scope of his polyp.

video


Pre-op the mass is in front of the surgical elevator.


The moments of us in awe and utter jubilation that it came out! For as much as this job can be hard, demanding, and gut wrenching, there are moments like these where we all work together and make a huge difference in a patients life.

video



When the polyp was in the back of the throat it was bright pink. Now that it has lost its blood supply it looks white.
The polyp, at almost 2 inches long!
The rest of Louie's procedure; the neuter.
Neuter time

Waking up with the chest elevated.

The polyp is as big as Louie's face!

Looking down Louie's throat, nice, clear open airway!

Louie's endotracheal tube remains in place AND inflated as he wakes up.
 As we watch and wait for Louie to wake up I make sure the the endotracheal tube is in place and still inflated so that any blood that might have occurred as we removed the polyp comes out of his mouth instead of going down his trachea to his lungs.

I hold him with his head down and gently coupage (cup your hands and pat the sides of the thorax to break up and help expel any stuff that doesn't belong in your lungs), as he starts to wake up. We also keep a bulb syringe next to him to suck up any saliva in the back of the mouth.



 Louie wakes up smiling! And breathing quietly for the first time!

Every patient gets a kiss after  surgery, (lol, like it or not...)


Louie woke up a quiet, peaceful kid, still a little bit of a head tilt, but I suspect it will resolve a little...although it is pretty cute.. and his trademark.

For another blog on naso-pharyngeal polyps see Kiki's story.

If you have a pet question, or want to learn more about a pet illness, disease, behavior, etc.. you can ask me on Pawbly.com. If you want to share your pets life please join us in celebrating the amazing tales of our companions at Pawbly. Pawbly is a free on-line community dedicated to helping people learn about how they can take better care of their pets.

You can also find me on Twitter @FreePetAdvice, or Facebook, or at the clinic kissing my patients, at Jarrettsville Vet in Jarrettsville Maryland.

6 comments:

  1. Hello, my 11 year old cat has developed a stertor and upon exam, his soft palate is lower than it should be towards the back of his mouth. They gave him antiobiotics incase it was an infection but in a week it hasnt gotten better. Hea happy and healthy otherwise, still eating, drinking and playing. Does this sound like a polyp? What should the next steps be in terms of investigating? Cost is an issue for me so i want to eliminated unnecessary tests.

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    1. Hello,
      Have you spoken to your vet about the next step that they recommend? Have you asked about the chance of a polyp? In my experience these cats have a very consistent trademark upper respiratory stridor and the trachea and lower airways all auscult normally. For these cases I always recommend a sedation exam and polyp investigation, BUT, polyps tend to be more commonly found in younger cats. An exam to look for a polyp should be quick, cheap and easy. At my clinic it is about $100 to do. Best of luck

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    2. Thanks so much for replying. The clinic is closed on the weekend so i plan to call tomorrow but im not sure what to ask about. The recommended an xray but said that would only show foreign body which he likely wont have.. hes an indoor cat. If they sedate him, would they be able to see a polyp without a scope? Is it possible for him to live with a stertor if we dont find a polyp?

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    3. hello,
      Ask if they would be willing to look for an oropharyngeal polyp? They don't need anything other than sedation and an otoscope or laryngoscope. If possible find a local feline practice.

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  2. Yes, i called today and they are wanting to put him under and look under his soft palate. They are feeling like its more likely squamous cell carcinoma but it could be a polyp or other o obstruction. He has no other symptoms other than a stertor. If he has squamous cell carcinoma, wouldnt he have other symptoms?

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    Replies
    1. Good Luck! I have to admit that I have found dozens of polyps in my career and very few SCC's.. and never under the soft palate.. other clinical signs or symptoms depend on lots of other patient factors. Cancer can do whatever it wants,, we sort of live by this theory. Best of luck! i just sedated a cat today for one.. turns out he just had massive amounts of snot in his nose. Hopefully flushing it out and trying a different antibiotic will cure him!

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