Saturday, July 11, 2015

The Most Common Cat Mass. Abscesses in Felines. How to treat and costs associated with it.

Jerry
I thought that it might be helpful if I started to blog about the most common stuff that I see in practice and I get TONS of questions about assisting people in figuring out what is wrong with their pet. I also get tons of questions about lumps, bumps, and everything in between the tiny unrecognizable specks of pigment and enormous life threatening cancerous leeching lesions. 

We all get bumps. A bump, however, is not a mass. A mass is bigger and more substantial. A bump can be a simple bug bite, a cosmetic lesion, or something similar to a pimple or a wart, and, in general, these can wait until  the weekend is over and then be reported to the vet.

A mass on the other hand is usually not arising from, but rather, underneath the skin. It forms a larger palpable swelling. Masses are often more troublesome to the patient and worrisome to the parent. A mass is a more alarming finding and therefore needs more attention and follow up. It is the size, chronicity and behavior of the mass that helps us identify its cause and subsequent treatment.

When a mass arises suddenly and is painful it is much more likely to be an infection. Jerry came to see me for a large mass in his neck area. He was also not eating, not playing, and seemed very depressed.

Here is my cat pearl (vet lingo for lessons learned in the trenches of practice), for
Cats Masses;

"Every (OK, I should never say every), acutely limping, sick cat that was otherwise healthy yesterday and has swelling and a fever today most likely has an abscess."

Jerry fits the billet perfectly for my primary suspicion in a young healthy cats with acute swelling that are ADR (vet lingo for "ain't doin right"). A cat with a mass, a sudden lameness, and a change in behavior (like not eating and not acting like their normal playful self) almost always has an infection. Jerry has an abscess and a closed, walled off infection is an abscess.

My fingers surround Jerry's mass.
With a tiny amount of pressure the mass reveals itself.
Shaving the area helps identify the size and identity of the infection.
Cats love to abscess.
Here's why;

1. They are very good at getting them. Cats are sharp pointy beings at all ends of the weapons spectrum. Sharp teeth, sharp nails. They are designed to pierce and when they do, they pierce deeply.

2. Cats inherent body armor has adapted to this by healing incredibly quickly after a puncture is delivered.

3. Now if those nails and teeth were sterile we wouldn't have a problem. A puncture with a sterile instrument, say for example a hypodermic needle like I use a million times a day to give vaccines is sterile. That's why a vaccine rarely gives a patient an infection. But, teeth and nails are dirty and those piercing little daggers bury bacteria deep in the tissue as they swipe or bite into their prey or enemy.

4. Tissue is full of life giving magical stuff. Ample blood supply (food), oxygen (life breathing stuff) and warmth is all the bacteria needs to have a new luxury home to settle into.

5. A few days, sometimes even weeks later, that few bacteria now has a whole colony of festering puss living under your cats thick protective skin. Pesto! There is now an abscess!




Infections hurt.
Here's why;

1. That bacteria causes pain by taking up space under the skin and growing. We have all had a splinter in our skin that gets stuck and starts to fester. Ouch!

2. Your body does an amazing job at mounting a response to an invader. It will send all of its immune system warriors to go fight infection, fever results as the immune system kicks into over drive. This is fine for a little while but after that it gets incredibly taxing on the body and we get lethargic, or ADR.

3. Fever causes inappetance as our body puts its efforts into fighting not acquiring or digesting food.

Always pay attention to your cat!

A cat that is looking and acting sick, is sick! I don't care if you can't find the reason, and neither I, nor your sick cat, cares why you cannot get to a vet, your cat is telling you that they are sick. So, go to the vet now!




Jerry had a fever of 103.3 degrees Fahrenheit, (high normal is about 102.5). Of course he doesn't feel good. He has a fever, an infection, and is uncomfortable. 

What we did;

1. Shave the area. I always warn my clients that it will make things look worse, but knowing what we are dealing with allows us to better understand and monitor it.

2. Look for any wounds. Jerry had a small puncture wound at the top of the mass and with gentle pressure it leaked thick blood tinged purulent (puss) material. Not finding a wound does not exclude a mass from being an infection or abscess. (Go back to my point about cats healing so quickly). If I am not sure what lies beneath I use a sterile large bore needle to get an aspirate. You cannot accurately treat something unless you know what it is!

3. Gave subcutaneous fluids to help with both the fever and infection. I find that this helps immensely. Every, (there I go again), pyrexic (fever) pet NEEDS either i.v. or subq fluids! 

4. Gave an injection of an NSAID. This helps break the fever quickly, and helps with both pain and inflammation.

5. Antibiotics are the answer! We started with an injectable, because he wasn't eating antibiotic that lasts 10 days. (Note; after 3 days we changed to a stronger daily antibiotic because the infection was not acquiescing. 

Cost at our clinic; $50 for the examination. $30 antibiotics, $20 NSAID. $25 SQ fluids, daily antibiotic $30.

At home care guidelines; 

1. Keep Jerry inside (flies will lay eggs in any open wound and you get maggots!).

2. Monitor Jerry closely. If your cat is not acting like they are feeling better within 24 hours they return to the vet for a re-check.

3. Provide an e-collar to prevent rubbing, scratching and traumatizing to the infection.

4. If the abscess returns somewhere down the road do a surgical exploratory. It might sound crazy but I have seen infections return months, yes, months, later. I usually recommend that we get more aggressive and go in for a look and try to flush out, or surgically remove the offender. And/Or, place a drain to keep the area open until it looks as if it has completely resolved.

This is Jerry at his two week re-check. The mass is gone, he is acting like his normal self.



A few last side notes;
  • We also boosted Jerry's rabies vaccine. We don't know who caused this and he is an indoor-outdoor cat. Better safe than sorry.
  • I checked Jerry for ear mites and fleas. I have seen some cats cause their own abscesses due to itching. Any scratches by the head especially should be investigated for ear mites, ear infections and fleas. Don't ever treat the clinical sign without identifying and addressing the underlying cause. It would be awful to treat for Jerry's abscess and ignore the reason he got it.
  • Lancing. People love to lance wounds. I am a bit hesitant to recommend this. Remember the body is trying very hard to wall off and fight this wound. Opening the skin up (again) leaves you back at square one of trying to fight infection. If you cannot adequately safely and effectively clean out and treat an abscess adding more holes to the situation leaves more opportunity for more bugs (i.e. infection)  to crawl in and establish residency. The last thing your cat needs is more infection. 
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