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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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.

If you have a question about your pet you can find a pet community of people who share information and experiences for the simple benefit of helping other pets, all for free, at Pawbly.com.

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

Boo Gets Better

This is Boo.

He came to us a week ago looking pretty sad. He had been found by some very caring kids who knew that he was very sick but didn't really know how to care for him. So they brought him to us. 

He was about one month old. He had so much snot in his nose that he almost couldn't breathe. He also had so much gunk in his eyes that they couldn't open. 

He had what most sick kittens do; an upper respiratory infection. When a kitten gets stuffed up they can't smell their food, and when they can't smell they do not eat.

He also had a very low body temperature. 

But the biggest challenge he was facing was fleas. He had so many fleas that he was anemic. The fleas can, and will literally suck the life out of a pet.  

The best way to treat a young puppy or kitten with fleas is to remove them with a flea comb. Comb the pet and with each pass of the comb rinse it in warm soapy water. When all of the fleas have been removed dry the pet gently with a towel or a blow dryer on low or cool heat. A wet pet will get cold, and an anemic undernourished pet is always tempting hypothermia. Keep them warm and dry and free of parasites.

Kitten care is about a few very basic things;

1. Keep them warm.
2. Keep fleas off.
3. Keep them eating.
4. If you see snot and goop, you have infection, so go to the vet IMMEDIATELY!

Here is Boo about three days later!

And five days later.

Boo is happy, playful, eating like gangbusters, and breathing easy.

He is so comfortable that he actively seeks attention. A very sick pet will just lay there. They do not interact, they do not play, and when they stop eating its time to get medical attention!

This is Boo and Beast. 

Beast came to us from the local Humane Society because there were too many cats an litters for them to be able to care for. They are both recovering from their upper respiratory infections but the companionship does miracles in itself. Kittens need someone to play with and snuggle with. They keep each other warm and are less likely to have behavioral issues down the road. I swear by the two pet principle. Two is better, easy, and more fun, than one.


This is Boo at two weeks. There is no sign of infection anymore.

Cats and kittens are miracles. They have an incredible ability to heal.

Never, ever, underestimate them. But give them a chance by seeking veterinary attention should you see signs of infection.

A special Thank-You to Dr. Hubbard of Jarrettsville Vet for being such a good foster mom to the kittens. It takes a special person to be willing to get up multiple times a night to feed and care for kittens. Those miracles had some helpers and those happy healthy kittens are lucky to have found such devoted feline fanciers!

If you have any questions on pet care you can find me at Pawbly.com. Questions are free to ask, and anyone and everyone is invited to ask or answer. It's all about helping pets.

Or you can find me on Twitter @FreePetAdvice.

Please consider adopting a cat or kitten at your local shelter, and please remember to spay and neuter.

Thanks!

Hit By My Own Car

Being a veterinarian means you wear a lot of hats, everyday.

Most of us vets are what we call "general practitioners."  A quaint little way of saying "jack of all trades, master of none."

Truth be told, I enjoy having a broad spectrum of basic knowledge. But every vet has their own particular strengths, weaknesses and areas of interest. I am lucky to work with 5 other veterinarians who all have their own honed skills and resume of experiences. We often work together collectively and will tackle the cases that require multiple brains with our multiple own perspectives and this ultimately always benefits our patients.

At Jarrettsville Vet I am the surgeon. It suits me just fine. I enjoy the tedious challenge, the never-the-same-problem twice individuality of every case, and the cosmetic aspect. I like to take the puzzle pieces and put them back neatly, and prettily in order, not losing site of function, of course.

Sometimes the surgeries are what we term "routine." A spay, neuter, or a small skin mass removal, these are the daily bread and butter. The surgeries we don't think much about, get too excited about, or fret over.

The once in a while trauma cases, those are the toughies.

Trauma, when I talk about this in veterinary medicine I separate them into two categories;

1. Motor vehicle meets pet. 

OR,

2. Mammal meets mammal. Whether it be BDLD, (our acronym for big dog vs little dog), or wildlife meets pet, or human being is abusive to pet.

Let's discuss category number one today.

Twenty years ago HBC (hit by car) was a more frequent, more likely to be fatal event. 

In my opinion a few things have happened to change the once grim statistics.

• More people spay and neuter, and therefore, fewer pets wander.
• More people use home containment devices (invisible fence, etc) to keep their pet within their own property.
• Almost every municipality have shelters and actively pick up roaming pets.
• Many people will stop and try to help a wandering or injured pet.
• Veterinarians who specialize in surgery and can correct almost every broken bone in the body.

But here's the trauma that I do see happening now more often these days.

Household-induced trauma.Specifically, I see more and more pets being injured by automobiles that belong to the pets own family. These are tough cases on many levels. The family feels guilty, they feel terrible about inflicting pain and suffering on their own pet, and they have to be clear headed enough to be able to make decisions about their pets care.

If there is one wish I could make with today's blog it would be to be diligent and careful and not to assume that your pet understands that a moving car, or lawn mower, or piece of farm equipment, or anything that moves, or has moving parts, is a threat. No matter how slow or how fast it moves your pet is curious and unable to comprehend circumstances, I don't care if they have "been hit before, and you think they have learned their lesson." They haven't and they will be hurt again, or worse yet, maimed or killed.

This is the story of Mac. He was seen lying on the driveway as his family started the car and began to back out. They heard him yelp! and they stopped the car to find they they had run over his tail and ankle.

Abrasion wound to the inside of the ankle.

Mac was brought in immediately after his family injured him. He was examined, x-rays were taken and he was started on pain medications and antibiotics. Luckily nothing was broken. He had a few abrasions, some with open wounds, a moderate amount of soft tissue damage, which included bruising and a few small areas of bleeding. All of his wounds were cleaned and dressed and he was scheduled for surgery the next morning.

The end of the tail is filleted open and there is damage to the fibers that surround the tail vertebrae.

There was some concern that we would have to amputate the end of Mac's tail. We would have had to do this if the end of the tail was necrotic (not viable or dead tissue). Thankfully, Mac's tail tip was still pink and he had feeling when you pinched it.

I have had many discussions over the years about how best to treat tail tip problems. There is a condition in dogs that we call "happy tail." This happens when a dog wags their tail so much, and in close enough proximity to a hard wall, that they break the blood vessels in the end of their tail. Or they hit it hard enough and often enough to cause the skin on the end of the tail to open. It can be a very frustrating ordeal to treat. Try asking a happy dog to stop wagging? Or try affixing anything that can, or will, stay on to the end of a wagging tail..not easy tasks.

Every vet has had to deal with this problem, and just about every one of us has had to amputate a tail or two because we either can't get that tail to heal, or the client loses the ability to try any longer.

The first vet Mac saw on the day of his trauma thought that maybe his tail would need to be amputated. She had forewarned his parents. It has been my experience to always try to keep from amputating a tail because I know how hard it is to manage them long term. If you ever think that this is the easier option please have a long talk with your vet before cutting..any happy dog with happy tail will keep wagging and keep busting open those sutures. Not only do you have to think about dehiscence of a suture, you also have to try to figure out a way to keep it bandaged..

When Mac came in the next day we removed his bandages to see how things were progressing.

The first big clue that Mac needed surgery was the smell that removing the ankle bandage produced. The bouquet of a simmering infection is a definable as the pus that it emits. Sometimes you only smell infection and Mac smelled of infection. Oddly I didn't see a wound that made sense with the putrid pungent aroma I smelled.

I knew right then that Mac would need surgery to find the source of the smell.

Mac's wound was very small..About half an inch long, and there wasn't any signs of bleeding, or the ever easy to identify pus. To an untrained eye (and nose) the ankle wound was small and unimpressive. But when Mac was placed under anesthesia we were able to make a very large pocket of fluid, about 6 inches long with the surgical scrub. The pocket was infection and it lay not beneath the skin where the small wound was obvious, but rather below the layer of muscle that appeared to be wound free.

Half of the drain has been placed. The drain must enter and exit at an area outside of the pocket of infection, but be in communication with it.The drains function is to keep the infection from remaining walled off under the muscle and allow a tunnel for both draining and flushing of an antibiotic solution.

Mac.
Under general anesthesia as we prep his wounds for surgery.

The drain in above and below the infection.

His tail looked jagged and swollen but it was healthy tissue and I thought that a few simple sutures to keep the edges opposed were the first step. The next was just to keep it clean, protected, and watch and wait to see if it would heal on its own.

After surgery. 

Mac's tail stayed bandaged for a week. We checked it daily for the first four days, and then the owners changed it at home for the remainder of the week. The tail healed quickly and looks like brand new.

The ankle was flushed twice daily with a chlorhexidine solution. It is important to remind clients that we are flushing around the drain and not through it. The drain is a flexible latex material that keeps an opening around the infection. We want to keep the entry and exit hole open so that the wound can drain, and so that you can flush a cleaner around the drain and into the infections pocket.

A few last notes on drains;

• Drains need to be removed within 7 to 10 days or the latex starts to break down.
• Be very diligent in keeping your pet away from the drain, and never cut it on your own. Every once in a while the ends get cut, or chewed off and I have to go back into that wound that we have worked so hard to get to heal and fish out a piece of shrunken latex..frustrating and annoying, for everyone.

If you have any questions, or any story to share please share them.

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krista