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.

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.

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.

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.

Kiki and his Terrible Tussive Tickle

He arrived as they all do.

In a small carrier hidden from view in a dark enclosed plastic box.

Designed to be light weight, these carriers are like a little treasure chest to a veterinarian. You really never know what you are going to find inside. Sometimes the smell gives you a big hint, but I’ll get to that later.

Every vet has learned to take a tiny peek inside these boxes before opening the door, or even contemplate daring to stick your hand in. We have all learned the hard way that there are sometimes ferocious little lions hidden beneath a seemingly gentle puff of orange fluff.

Today's fortune cookie was Kiki.

Kiki is a part of the over 700 cats living in the Animal Rescue Farm just along the Pa-Md border, in a little town called New Freedom. They are the most devoted bunch of amazing, inspiring, compassionate people I have ever met.

To begin, Kiki is a boy, (I know it’s confusing. I can’t really explain why, but that’s a lot of cats they have to manage so some of those cats get some pretty funky, or down right mis-appropriated, names). We have learned to just accept them and go with it.

As I approached his carrier and peeked inside I noticed that he wasn't moving. Kiki just sat in his little plastic cat carrier box hidden quietly in the back. As I opened the door he didn't lift his head, he didn't move, he didn't care about me, or where he was, nor did his internal survival drive tell him to even care about pretty much anything anymore. I could see and hear his rattle and crackle of the all to common ailment of rescue cats “chronic upper respiratory disease”.

How many of these rescues cats do I see? A LOT! You put too many of anything together, and you know what you get? A lot of disease. Send your kids back to school with a whole cackle of other little kids, none of them washing their hands, and be prepared to grab the tissues, because you’ll need them soon.

Kiki had yellow-green snot just caking his nose. Some of it had dried leaving a crust, but more was right behind that cascading down the chute like a slow flow of yellow-green lava. He could barely breathe, and when you can barely breathe you barely move. I lifted his lifeless thin black body out of the carrier. He didn't fight, or protest, or struggle even a little.

I gingerly placed him on the scale. He weighed in at a paltry 5 pounds. That’s was least 2 pounds less then he should have based on his age. When you only weigh 5 pounds those 2 pounds really count.

We quickly made up a very basic treatment plan for him. The good ole basic stand-by treatment plan of fluids, food, and antibiotics. I instructed them to feed him any damned thing he wanted and to try to make it as smelly as possible. Because when you have a whole nasal cavity full of snot it takes a smelly-smelly morsel to convince you to open your mouth and eat.

 We also started him on the antibiotic I call “the big guns”. “The big guns” are those antibiotics that we reserve for the severe cases, the cases that have previously been treated to little or no avail, and they are also expensive. (Funny how life always works that way?) I was going to hit him hard with these drugs and keep him on them for at least a month. My hope was that the previous treatments  were either not the strong enough, or they weren't used long enough. I was covering my bases and stacking the deck.

We put Kiki in a hospital cage with my treatment plan in place and I moved onto the next little plastic chest of mysterious disease.

I told myself coyly that I didn't really need 12 years of college to treat this guy, and I moved onto the next carrier in the processional line.

 Over the next few weeks we cleaned more slung snot from the walls, the doors, and the ceiling than anyone could imagine a 5 pound creature could produce. Kiki sneezed, spit, and re-painted our walls. If any of you are ever thinking of working at a vets office, and need to start at the bottom, (aka kennel), be prepared to not only pick up poop, scoop litter, but also to scrape snot off of walls. After 4 weeks of “the big guns” he still looked puny and miserable.

I called the rescue director and confessed that my hopes had fallen far short for poor Kiki. I asked if I could put him under general anesthesia, look in his mouth, flush his nose, take head x-rays, and pretty much make any stab in the dark that was listed in my text book under ”chronic upper respiratory disease." I heard the pause in her voice, (that little jab of falling short of expectations, I get used to it), and a reluctant “OK”.

 The next day, I said "good morning" to Kiki with a little quiet prayer, crossed my fingers and put him under general anesthesia. We took some x-rays of his head. The x-rays showed the damage to the very fine bony turbinates, years of snot eating your nasal passages, but no tumor. Score 1 for Kiki.

We next flushed his nasal passages, until the snot ran from a thick ropy yellow string to a clear saline. Score 2. He can breathe clearly when he wakes up, at least for a little while, I thought.

We next took a peak behind his soft palate. This is the area where the hard bony roof of your mouth transitions to the soft part then heads down into your larynx.

And there it was an enormous irregular cluster of grape like tissue the size of your thumb!!! I was never so happy to see such a hideous structure. The veterinary treatment for a big wad of tissue growing in the back of your throat? grab, yank, and pull. (And, hope it doesn't grow back). Kiki and that hideously huge throat mass was the center stage curiosity of every staff member in the building. We were all so happy to finally have a clear culprit to assassinate for him and yanking that bugger out was one of the most rewarding moments of my opprobrious career.

 Kiki woke up without any complications and since then he has put on 4 pounds and become the most extroverted, playful, and rambunctious kitty you have ever seen. He decides when it is time to start playing, when you are done playing, and he will slap you if you walk away without his permission. He has become one of our resident cats. And he reminds me everyday why I do what I do.

If you would like more information on this topic; Nasopharyngeal polyps.

Kiki lived with us at Jarrettsville Vet for almost a year. He was then adopted by one of our veterinarians and moved in with his own family. A few months later he developed an inner ear infection that was treated by yet another surgery. He has been happy and well since. He will always be a unique kitty even with with his signature perma-wink and ear bow.

Best wishes Kiki!

If you have any questions about Kiki, polyps, respiratory infection, or anything else pet related please visit me, and the rest of the Pawbly people and ask us! We are here to help you and your pet!.

You can also find me on Twitter! 

A New Lease on Life, Kiki's Story. Nasopharyngeal Polyps in Felines.

He arrived as they all do; in a small cat carrier. He was hidden from view in a dark enclosed plastic box. Designed to be light weight, these carriers are like a little treasure chest to a veterinarian. You really never know what you are going to find inside. Sometimes the smell gives you a big hint, but I’ll get to that later.

Every vet has learned to peek inside the box before you open the door or even dare to stick your hand in. There are sometimes ferocious little lions hidden beneath a puff of orange fluff.

This is Kiki's story. Kiki is a part of the over 700 cats living in the Animal Rescue Farm just along the Pa-Md border, in a little town called New Freedom, Pa. They are the most devoted bunch of amazing, inspiring, compassionate people I have ever met.

To begin, Kiki is a boy. I know it’s confusing. I can’t really explain why, but that’s a lot of cats they have to manage so some of those cats get some pretty funky, or down right mis-appropriated, names. We have learned to just accept them and go with it. But he is whom he is, Kiki. He sat in his little plastic cat carrier box, hidden quietly in the back. I opened the door. He didn’t lift his head, he didn’t move, he didn’t care about me, or where he was, nor did his internal survival drive tell him to even care about pretty much anything anymore. I could see and hear his rattle and crackle of the all to common ailment of rescue cats “chronic upper respiratory disesase”. How many of these rescues cats do I see? A LOT! You put too many of anything together, and you know what you get? A lot of flu. Send your kids back to school and then grab the tissues, because you’ll need them soon. He had yellow-green snot just caking his nose. Some of it had dried leaving a crust but more was coming down the chute, like a slow flow of yellow-green lava. He could barely breathe, and when you can barely breathe you barely move. I lifted his lifeless thin black body out of the carrier. He didn’t fight, or protest, or struggle even a little. I weighed him. 5 pounds, (that’s at least 2 pounds less then he should have weighed). When you only weigh 5 pounds, those 2 pounds really count. That’s 40% of your weight, OMG almost half! We quickly made up a treatment a very basic treatment plan for him. The good ole basic stand-by treatment plan, fluids, food, and antibiotics. Feed him any damned thing he wanted, try to make it as smelly as possible. When you have a whole nasal cavity full of snot it takes a smelly-smelly morsel to convince you to open your mouth and eat.

We also started him on the antibiotic I call “the big guns”. “The big guns” are the expensive guns. Funny how life always works that way? I was going to hit him hard and keep him on them for at least a month. I was going to make sure that the previous attempts that the rescue had made were either not the strong enough meds, or they weren’t used long enough. I was covering my bases and stacking the deck. We put him in a cage with my treatment plan in place and I moved onto the next little plastic chest of mysterious disease. I didn’t really need 12 years of college for this guy, I thought to myself and I moved onto the next carrier in line.

Over the next few weeks we cleaned more slung snot from the walls, the doors, and the ceiling than anyone could imagine a 5 pound creature could produce. He sneezed, spit, and re-painted our walls. In case any of you are ever thinking of working at a vets office, and need to start at the bottom, (aka kennel), be prepared to not only pick up poop, scoop litter, but oh, yes, scrape snot off of walls is also in the job description. After 4 weeks of “the big guns” he still looked puny and miserable. So I called the rescue director and confessed that my hopes had fallen far short for poor Kiki. I asked if I could put him under general anesthesia, look in the mouth, flush the nose, take head x-rays, pretty much make any stab in the dark that was listed in the text book under ”chronic upper respiratory disease” from my old vet school days. I heard the pause in her voice, (that little jab of falling short of expectations, I get used to it, sigh), and a reluctant “ok”.

The next day, I said hello to Kiki, said a little quiet prayer, crossed my fingers and put him under general anesthesia. His head x-rays showed the damage to the very fine bony turbinates, years of snot eating your nasal passages, but no tumor, score 1 for Kiki. We flushed his nasal passages, until the snot ran a clear saline, and I thought “aahh, now maybe you will be able to breathe, well, at least for a little while”. And then we looked behind his soft palate. This is the area where the hard bony roof of your mouth transitions to the soft part then heads down into your larynx. And there it was an enormous irregular cluster of grape like tissue the size of your thumb. I was never so happy to see such a hideous structure. The veterinary treatment for a big wad of tissue growing in the back of your throat? grab, yank, and pull. And, oh yeah, hope it doesn’t grow back. It was the center stage curiosity of every staff member in the building. We were all happy to see the culprit.

Kiki woke up without any complications and since then he has put on 4 pounds and become the most extraverted, playful, and rambunctious kitty you have ever seen. He decides when you are done playing, when it is time to start playing, and he will slap you if you walk away without his permission. He has become one of our resident cats. And he reminds me everyday why I do what I do.

Here are a few video's of our JVC cats having their polyps removed; 

Here is more information on Nasopharyngeal Polyps. 

Kiki is one of the many reminders of why we work so hard on even the most difficult and chronic cases. Kiki was adopted by one of the vets of the clinic and has a family who sees him as the perfect soul he always was.

If you have a pet with this condition and would like to learn more about it (or any other pet related condition) please ask the amazing people at Pawbly.com. It is free for everyone to use. 

If you would like to learn more about us at Jarrettsville Vet Center please find us here at our website, or like our Facebook page.

I am also on YouTube and Twitter @FreePetAdvice.

If you would like more information on this topic; Nasopharyngeal polyps, then please follow the link below:

www.petmd.com/dog/conditions/respiratory/c_dg_nasal_polyps