Drain Placement In A Cat Abscess That Was Not Healing With Antibiotics Alone

Bert is an indoor-outdoor cat. He came home one day with a swelling on his right shoulder about 1 week after his family noted he was limping. The initial exam (about 1 week before the drain was placed), revealed a slight fever, swollen and painful area of the right shoulder. The swelling was explored and a large amount of purulent material was found (puss). Bert was given an injectable antibiotic (Convenia) that lasts about 2 weeks. He was sent home to be monitored.

Diagnosis:
The diagnosis is usually made by patient examination. In most cases, although not all with cats, a wound will be found, or be evident. I have had many patients who do not have an obvious wound because the infection came from a cat fight. Cats are adept at fighting and causing abscess because their sharp claws can puncture the skin, seed bacteria under the skin, and then their skin closes/heals so quickly that it traps the bacteria (infection) under the skin. The bacteria is now in a place that is warm, has food (blood/tissue) and allows it to incubate quickly and effectively. I often see the abscess days to weeks after the inciting fight. Any firm, warm, acute painful swelling, OR, any cat who is acting quiet, lethargic, not eating well and has a fever should be examined for infection.

Treatment:
An exploratory exam, either aspirate, lance, or surgical incision into the swelling usually produces copious amounts of puss. These cases often require multiple treatments. Either longer treatment periods (i.e. antibiotics for weeks), a drain placement, or even exploratory surgery. I have had many feline patients who took many weeks to heal.

Conclusion:
Bert had a drain placed. This allowed flushing of the wound with antibiotic solutions. It also allowed the large pocket to heal and be treated quicker.

Here is Bert's drain placement video;

Here is the invoice for Bert's drain placement surgery;

Related Blogs;

Wound On A Cats Face.

Abscesses In Felines.

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Cat Abscess: What to do when they aren't healing.

This is Chaussette.

She came in to see me because she was "lethargic, not eating, not playful, or acting like herself, and she was much more vocal than normal."

To me these were all very important clues that she was not feeling well, and particularly I thought the vocalization was her very smart way of demanding help and attention. Those cats are very very smart and will tell you there is a problem if you just listen and pay attention.

Always listen to your cat!

So began my exam of Chaussette; Even though her weight was normal, her mucous membranes were normal, she was walking fine, could open her mouth normally, and seemed to look normal, she had a fever (104.8 F, normal high end is 102.5 F) and a large mass on the left side of her neck. The big clue was the big mass on her neck.

She was also an inside cat.

The mass on her neck was painful to the touch and had a tiny area of a scab.

Chaussete had what I find most commonly on cats with no other history of trauma, no access to poisons or toxins, and a hard mass.  With the careful prick of a needle she had puss under that hard mass. She had an abscess. An abscess is an infection that has buried itself under the skin, or within the body. It is significant because it can be harder for the body to fight on its own and remain hidden from our view.

For those of you at home.. If your cat is not acting normally check them over from top to bottom, nose to tail. Let your hands be your eyes. If your cat has a mass it is important to see your vet. I do not ever recommend that you lance or open up the infection on your own. Here's why; It might not be infection. Don't poke without knowing your anatomy and worst possible scenarios.

Even after I was pretty sure it was an abscess I did not lance the wound and I did not open it up. Why? Well, I know people want to pierce an infection to let stuff out,,but,, it might also be allowing stuff in,, and the wound was very large. Too large for me to do much with while she was awake and in obvious discomfort due to a big festering wound on her neck.

Here is where a good discussion with your vet can make a big difference!

Chaussette's options were;

1. Gold Standard; Bloodwork done to assess degree of infection, organ function. Costs range from about $25 (PCV), to $300 USD for full CBC and chemistry. Chaussette was a young healthy cat. This step was not going to change our treatment plan (infection  needs to be addressed). 
2. Silver Standard; Placing a drain under general anethesia. Pre-operative blood work is recommended. General anesthesia cost $100, drain placement $40, pain medications and antibiotics about $40-$60.
3. Bronze; Try an antibiotic to see if that is all that she needs to heal her wound. 

Chaussette's mom wanted to try an antibiotic first. I discussed that it might work, but, I was a bit worried that based on the size of the wound it might not be enough? She elected to try a 7 day injectable antibiotic. I gave it a 50:50 chance. We talked about monitoring at home and the next step should the wound not resolve. 

Chaussette's initial treatment plan included;

1. Examination $50

2. SubQ Fluids $25

3. Injectable Antibiotic $50 (7 day dose).

4. Injectable NSAID $13

About a week later Chaussettes' mom called. She wasn't eating again and the bump was still there.

OK, time for Plan B. (Every prudent vet has a Plan B. Further, every vet talks about Plan B before it is needed!).

Chaussette was given subcuticular (sub q) fluids and injectable non-steroidal anti-inflammatory to help with the fever. We also started her on a different antibiotic. Any cat with a high fever is reluctant, if not down right adamant, about NOT eating. 

Whenever it is possible I provide as much of the immediate treatment plan as possible in the hospital. It might cost a little extra (you can always ask your vet about the cost differences), but, it gets those cats feeling better much quicker, and it can be awfully difficult, as well as down right dangerous, to pill a cat who is cranky because they do not feel good. It is especially difficult in Chaussette's case because her wound is on the side of her  face and it will be hard to not touch it when you are trying to open her mouth to pill her.

I gave Chaussette

The next day Chaussette went under general anesthesia and had a drain placed. The drain is a small flexible piece of rubber tubing that extends from the top of the wound to the bottom. The plastic tube (called a Penrose drain) stays in place with suture at either end. The drain allows us to flush an antibiotic solution under the skin to eradicate and kill the infection that has been hiding out under the skin. I usually put an e-collar, sweater, or bandage very loosely over the surgical area so the cat won't be able to scratch, lick, or pull it out. The worst thing that can happen is that a pet

Cost of treatment plan number 2;
1. Re-check appointment $30
2. Sub Q fluids (to get break her fever and get her comfortable for surgery the next day) $25
3. NSAID $12
4. Injectable Antibiotic, different and (stronger than first) $10 (one day dose).
5. Anesthesia $125
6. Drain Placement $75
7. E-collar $8
8. Daily oral antibiotics, 10 day course $32

The drain was removed about a week later and Chaussette abscess is now finally resolved.

Important tips for drains;

• We use the drain to flush a medical grade surgical solution around the plastic tubing.
• An e-collar is used so that Chaussette won't pull her drain out.
• The drainage should considerably subside over 24-48 hours. It should be gone by day 5.
• The drain must be removed within 2 weeks time or the plastic degrades in the body.
• Drains should only be used when the infection has abscessed and doe snot respond to conventional methods.
• Keep the area clean and dry. These patients MUST be kept inside and under close supervision.

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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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Wounds on a Cats Face. Why Vet Care is Cheap and Effective.

This is Socks, a three year old domestic short haired, neutered barn cat.

I live in Maryland horse country and where I practice medicine it is not uncommon to have your horse barn guarded by rodent loving felines. Socks came to see me to help address a wound. Cats are fairly territorial beasts who cat fight when they are stressed, housed too tightly, protecting food, or generally feeling unsocial. In a county with a lot of horse barns, there are a lot of cats, and, I therefore see a lot of cat wounds. 

There are a few general consistencies with cats and wounds.

1. Cats prefer to fight with WORDS (hissing, spitting, growling, and some high pitched yells that are easily recongized and universally regarded as equivalent to nasty accusations about close family members and inappropraite accusations sure to raise the hair on even the most genteel being) and CLAWS and TEETH.

2. Claws and teeth are designed exquisitely to pierce flesh. The perfect shape and always sharpened to a dangerous point.

3. Those pointy sharp weapons can penetrate deep in an instant. One hit of the target is sure to puncture the skin and almost invariably will leave behind bacteria who are deposited in a warm well supplied host. It is the perfect scenario for infection to flourish.

4. To add insult to this injury, cats have a unique and somewhat disadvantageous preclusion to healing from punctures rapidly.

Let's review the scenario.
Pierce skin, embed bacteria, close skin, envelope infection in the most perfect place for it to proliferate and infect. And, so, not surprisingly, in about a week or two your cat has a big, swollen, infected bump. We call it an abscess. It is painful and it grows until your cats body can either kill it with their own immune system (puss is in reality white blood cells eating up the bacteria), or it ruptures and frees the bacteria to the world.

This is what Sock's wound looked like at the first glance.
Doesn't look so bad does it?
That's because the hair is hiding it.

Here is what I do for cats that arrive at the clinic for a wound examination.

1. You need to get a good look at what you are dealing with. For some cats this requires sedation. At my clinic sedation involves  an intramuscular injection and costs $40.

2. Clip and clean the wound. Hair gets embedded in the oozing wound and delays healing. It also helps get a clearer picture of what the wound looks like, for instance, how deep is it? How large is it? How much tissue is compromised? (See Whiskey's Wound for more information).


3. Flush out the wound. We use the old vet saying often; "The solution to pollution is dilution!" Flush out as much dirt, infection, and clipped hair as possible. We use a medicated cleaner, but betadine (diluted), or soapy water is ok, in almost all cases. (Note; if a body cavity is involved, for instance, into the chest, he abdomen, or the throat/neck area seek veterinary help immediately!)

4. Decide whether to close the wound, or not. There are a few general guidelines for this;

• Don't close in infection. This is a judgement call not to be made by anyone except a veterinarian.
• Don't close in compromised, necrotic, or possible neoplastic (cancer) tissue. These require surgical veterinary excision.
• Understand which wounds need the help of a drain. In general, I place drains if I am concerned about closing in infection, or being able to loose access to flushing out infection.
• If the wound has already begun to heal on its own. This is evident by formation of granulation tissue and the skin around it is looking healthy.

Socks has a good bed of healthy granulation tissue to his wound. He doesn't need surgical exploration at this time.

He does however need;

1. An e-collar to protect the delicate newly healing tissue from being traumatized.

2. An antibiotic to thwart off any residual infection. We gave an injectable antibiotic that lasts about 10 days. This costs about $30.

3. To be kept inside. As the weather is warming flies will search out an open wound and lay eggs in it. This is how maggots develop. These insidious parasites can kill a pet. Never allow a pet with open wounds to be kept outside longer than a few minutes. Flies can find them in seconds.

4. A rabies booster shot. He is due and we don't know the cause of this wound. Play it safe, keep your pets up to date on this disease that kills everyone it meets, and boost the vaccine if your pet has an odd injury that could have been caused by another animal.

Any cat that is lethargic, quiet, not eating well, limping, licking or rubbing any part of their body, has a swelling that appears hot painful or wet, or has an area of wet matted fur should be examined for a wound or abscess.

I know that many people think that "lancing the wound" will help treat the infection. While in many cases relieving the pressure of the infection will relieve some of the pain, it will be dangerous to do (to both you and your cat), and may not resolve draining the infection, nor will it treat the infection in most cases.

Socks exam and treatment was about $100.

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You can find me at the clinic, Jarrettsville Vet, in Jarrettsville Maryland, or on Twitter @FreePetAdvice.