Seraphina. Lip Avulsion in a Hit By Car Cat. How to, why it is so imperative to do early, and cost of care. Warning surgery photos!

Serafina

This is Serafina. Serafina was brought to me one afternoon by a client who witnessed her, minutes before, dragging herself across the road as numerous other drivers passed her by. That single act by this brave woman to stop her car, pull over, and go out into the road to get to her saved Serafina's life.  

Seraphina was a wisp of a kitten. Barely three pounds in all, mostly fluff and wide green eyes. When she came to me, just a few minutes after being the victim of a hit and run, (although this wasn't witnessed by the finder I deduced it by the severity of her injuries), she was being cradled in a towel. Her face was obviously injured. Her chin had been detached from the bottom row of teeth and lay flapping midway down her mandible. Her pupils were different sizes, (indicating head trauma), and a left back leg just sort of lifelessly dangling. She was adorably and unabashedly obviously cute, but, also crunchy. Crunching is broken bones. She was crunching from the bottom of her sacrum, because her tail was pulled off of her pelvis, which, by the way was broken in multiple places, and there was a long list of worries I had just on my very quick preliminary over view of her. 

The first few hours were about assessment, observation and pain management. She didn't have much going for her. She didn't seem to be able to feel or recognize her broken left leg. We weren't sure that the head trauma wouldn't cause hemorrhage in her brain which could kill her. With little more than a warm bed, food, an opioid to place inside her cheek she was left for 12 hours to see if she would survive overnight. I wouldn't have suspected that she would have survived her injuries. Life is like that. Chance, fate, luck, it is often little more than this. 

It is important to pause the story here. There is a knee jerk reaction to protest the black and whiteness of this particular case at this specific moment in time. There are spectators among the readers who wanted me to start fixing her. On. The. Spot. Life in medicine in the world of severe trauma isn't like this. In many cases we have to wait to collect information before attempting to repair the obvious that is not life threatening. Serafina's injuries; skull fracture, leg fracture, tail avulsion and lip avulsion are not life threatening unless severe hemorrhage or nerve loss is occurring concurrent with them. She also did not have a parent to provide consent to our care so we have to be careful about what we can and cannot do for her. Many (too many I fear) would see this list of injuries, no discernible home to provide financial assistance or care for. The list of all of the "worst case scenarios" is long, ominous, and foreboding. Many just shrug that they are sparing her further suffering and would have put her down right here, right now. My personal plea is to not give up. These are almost always savable. Maybe not "perfect" anatomically, but perfectly happy and functional, able to live a long happy, healthy life.

When she first arrived at the clinic we tried to find her home. We hope each and every time an unknown pet is brought to us that there is some worried parent out searching for them that we can locate and notify for a tear filled reunion. Some small semblance of extending the compassion we inherently feel when we see some little thing so fragile hurting yet alone and at the mercy of the world. We spent days searching to see if she belonged to someone near where she was found. She was so young, only about 3 months old, but she was affectionate and trusting. She knew people and she wasn't afraid of them. She had no microchip, and no person came forward to claim her even after her finder canvassed the area where she had been found. She was one of the too many who gets overlooked, forgotten especially when trauma with a big price tag presents. She is one of too many unwanted, which makes her disposable and easily replaceable. 

The next morning she was still brightly enthusiastic to see her breakfast and made herself very quickly yet sheepishly at home. The first 12 hours are critical. The first two days reveal almost everything you need to know from where you are and how far is needed to get to fly the coop. 

It was two days before I was convinced that she had any nerve function to her broken leg. This was the first hope to save it. She also was beginning to drag herself to the litter box to go to the bathroom. 

For cats, in my opinion, for a trauma patient to be able to survive they need to be able to do the most basic of things, this includes; eat, drink, pee, poop and ambulate. These things must be intact to allow them a reasonable chance at being adopted and cared for adequately to allow them a safe and comfortable life for many years to come. (This is a general rule. Not a hard and fast rule.. ask me about Dora someday).

Within a week Seraphina was beating all the odds. She was alive. She was improving miraculously and at an alarming speed. The injuries that might have been life ending were being crossed out like a bucket list to live.

The last item to resolve, the only one I really felt compelled to correct, the one that would get worse over time, (unlike all the others who were correcting themselves on their own), was her lip. It needed to be reattached to her mandible. It had come in damaged and ripped off the chin of her face, but it was contracting with scar tissue and pulling the chin off of her face at an alarm quick pace daily. Scar tissue is designed by the body to close wounds, pull tissue together, but if the anchor is released the pulling of the tissue can worsen an injury. 

The edge of the front of her lip was being pulled down her chin. Food, hair, and debris was collecting in this pocket. She was uncomfortable with her non-functional chin in the wrong place. 

Lip avulsions happen most commonly, (I have seen it twice, both times with a cat, both times when they had been hit by a car), because the skin of the chin is pulled off the bone of the  mandible when the face is pushed into the ground as the body is pushed forward. Serafina was very, very lucky. Her mandible was not broken, just the skin torn away.

There are reasons I waited a week to do this surgery. She had worse injuries to heal from. Possible internal trauma that would have  made surgery more dangerous and tenuous. The lip had to wait for her to be well enough to survive anesthesia. 

Serafina is lying on her back. Her jaw is clipped,
scrubbed and draped out of the surgery field. 

Serafina went under anesthesia to have the lip replaced and secured to her jaw. This is not a surgery we do every year. Maybe once in a decade. 

Cleaning the tissue, (there was an immense amount of hair, food, debris stuck between her lip and jaw was done under anesthesia. It was the only way it could be done. This is delicate sensitive tissue. You can't clean it well with her awake.

Once the tissue is cleaned it was loosened. We call it undermining. The tissue, her jaw and lower lip was shortening as it was being pulled toward her neck. It is scar tissue contracting. To relieve the tension you have to break down this fibrotic tissue and pull the flap back into place.

Stents (small pieces of surgical i.v. tubing) are used to go through the mandible skin and then looped around her canine teeth. It was the most exciting, aesthetically transforming surgery, (and quickest meets easiest), I have done in a long time. If I could do this surgery every day I would! It was that fulfilling.

A better close up of the closure and stents.

 Waking up her new chin,, just as it is supposed to be.

Serafina was lucky. Incredibly lucky. This case will have a happy ending because someone intervened immediately. She also had her internal organs intact. Bones will heal, especially in young animals. They need time, patience, containment, and monitoring from someone who knows what to look for and what to worry about. 

The cost of the surgery to repair her lip was about $200. It was that quick and easy. Our internal Good Samaritan Fund will cover it.

I have read posts where veterinarians are too afraid, tentative, reluctant to do this surgery. I want to send out a personal plea to all of you looking at a kitten, cat, dog, puppy who has this injury; if the mandible is intact, the canine teeth are anchored, then please try. It is so simple and easy. I'll help in anyway I can.

If you are a pet lover, pet parent, or pet expert I hope that you will join me on Pawbly.com to lend a helping hand for others who need us. If you are interested in more informative cases you can follow me on YouTube, or you can follow our amazing Jarrettsville Vet Facebook page.

Here is another blog about Serafina. The WHY In Who I Am.

Serafina. The WHY In Who I Am.

I have been a veterinarian for about 15 years. The best moments of these years are those I call 'dwelling within my calling'. The cases that remind of the WHY I am here. WHY I worked so doggedly and determinedly hard, for over a decade, just to get into vet school. Never mind the hard work it was to actually get through those 4 years. I was never blessed with blissfully finding, or even fortunately stumbling, upon the road to professional salvation to that destined path toward my perfect future. I could not ever find it among the tangled brush of my day to day life. I suppose I would have been better served by looking toward the horizon in place of the daily clutter that clouds all good decisions. The WHY of me within my little veterinary life exists in the moments of the day that prove to serve my purpose. These minutes of veterinary medicine that mean so much to me are the ones no one else has time for. The cast away felines to be specific. It has become increasingly more imperative for me to look for, recognize, and live within the WHY.

Serafina. Our first meeting.

There are more cats in U.S. homes than dogs. Felines are smaller, require less effort to care for. Less walking with leashes and poop baggies on those cold early mornings. Cats can eliminate in a small box hidden in some remote corner of the home. Cats are just easier; less time, energy and even expense. Cats may be in homes across the USA in greater numbers, but they visit the vet in minuscule proportions when it comes to their canine counterparts. Cats, in our current society, are provided a fraction of the investment in both time and financial resources than their canine cohorts get.

Life is not fair, we all know this, but, life for a cat is exceptionally more complicated, difficult, and cumbersome when compared to a dog.

How many stray dogs do we routinely see roaming my area of the country? Almost none, ever. We are conditioned from the love of our own bedroom occupant pups to stop, call for them, try to recapture them with the leashes we all always have awaiting in our cars. We will take the time to call the authorities as a last act to intervene on their behalf when we see a pup running loose without a leashed parent attached to them. A cat, we all pass by cats trying to survive on the most primitive and basic levels, routinely. Cats get a call to intervene as considered more "pest removal" than missing persons. Cats are omnipresent, replaceable, disposable. It is tragic that so many humans will never know the immense intelligence, kindness, adoring affection and abundant joy that they inherently inhabit. Cats are just as, (if not more so), wonderful than dogs. If you don't know this it is simply because you haven't opened your heart enough to see their magic. Why, (back to the WHY?), why, don't more people extend the same compassion to cats as they do to dogs? I have an answer; it is the failing of humans. Cats make you earn their trust. They take effort. People are inherently impatient and too many have convinced themselves that they are allergic. Milk, milk they will push themselves through tolerating milk in tiny sips, eaten in small icy spoonful quantities of Ben loves Jerry, until the body accepts it as permissible. (Did you know the huge majority of people are born allergic to milk?). Cats, they are wily, coy, cunning, and people dismiss the effort from initial rejection with excuses to dismiss their magic preemptively. "I'm allergic." People you don't know what you are missing.

Cats need help, and I always root for the underdog. It is the badge of honor for considering yourself an advocate. It is also the one species that I can make the most impactful and meaningful difference for. This is important in a profession ripe and replete with immense emotional turmoil. It is important to protect your soul as you try to navigate in the black through the business of hocking your service bespoken wares. I have had to learn this. I have had to figure out how to be a veterinarian who cares and wants to keep trying to care, in a world with tenuous intentions seeming to force you into caring less as the best option to lifelong soul preserving survival.

Serafina, pre-surgical chin repair prep.

Kittens, the ones no one wants, those that everyone else overlooks, the ones with deficiencies, disfigurements, the ones so easily removed as so many others who meet the standard of "perfect" can replace them. Not sure what I am talking about, ask a shelter employee in the middle of March who they feed and care for when there are dozens in need of round the clock feeding every 2 hours. Which ones get the best chance? Which ones do you try to save when you fear that you cannot save them all? You save the ones people will adopt. It is that simple, that linear. There are too many cats. This isn't my opinion, it isn't even my belief, it is the numbers of those who are set to fend for themselves. Those cats who are labeled "feral" are not descendants of cougars or lions, they are the children of humans who gave up on them.

I am going to be honest about my reasons and intentions for defending and publicizing my why. The motivation to intervening on these cases. It is a vulnerability that most won't confess to and never would embrace. It leaves you open to eating your words. Made especially poignant when the world of pets, the business of pet care, and the current environment of hiding that compassion as it leaves you open to dumping (even more) problems on your lap if you admit to caring when no one else either does, or, wants to be financially responsible for, if they do. It's a predicament. Price over empathy. It is a web of disaster I navigate daily. It is the reason many people just close their doors to appearing as if they care about anybody or anything when those lives appear at your doorstep without a checkbook attached to them.

It is also a place of opportunity with little liability. It is where I have found my purpose again and again. These unwanted, unowned, broken, needy felines are the best place to fulfill my WHY.

Serafina is a perfect example. She is the why behind the longing I have to maintain a desire to keep practicing. She is the fuel to burn my continual passion for caring. For reasons beyond her control, she just doesn't have a mom. Well, she has me. That's all either of us need. I am lucky in that way. I have isolated myself so that this is the reality of my veterinary practice. She isn't about being profitable. She is more important to me than that. She is about my safe place.

Serafina was brought into my clinic by a client. This is the only way we will receive them in almost all cases. She has to be assumed to be an owned cat, before she is assumed to be an unwanted cat. Even though the later is far more likely than the former. It may sound that I am pessimistic about so many unwanted cats living among us, but people will feign and deny ownership if a fee for services is looming. We always scan for a microchip when an unknown pet lands at our doorstep. A tiny clue to help find a worried mom. Some small token of adoration the huge majority of pets are denied. In cases of emergencies I have some leverage due to my credentials to provide care to the injured, albeit unknown, pet. Many vets would just send her to the ER, or, the shelter (who without a veterinarian on staff is woefully inept to manage even the mildly sick pets of our community), or, they would just tell the finder to act as the owner and assume financial responsibility for this patient as it is not uncommon for a pet parent to claim the pet "isn't theirs" to avoid having to pay the tab. You can begin to see the landmine of pitfalls we walk among. There is no human equivalent to this. You walk yourself, or someone else, into a human ER, broken and bleeding due to skull, pelvis, leg, and tail fractures and they start helping immediately as someone else starts asking the questions. There is not an internal pause of delay to figure out who is paying first as someone is possibly dying next to them.

In veterinary medicine helping/intervening/providing even basic care isn't so compulsory. In fact it isn't even marginally compulsory. Pets are considered "property". The whole single solitary reason injustice, cruelty, and blind eyes are commonplace. I took Serafina and offered to help her, based on a few things: I knew the person who brought her in. The person who found Serafina, a speck at two pounds, dragging herself across the road, smashed from the waist down, as many other cars passed her by, wasn't lying about her story. This wasn't her cat. Serafina in the first minutes that I examined her had a chance of surviving. It was a slim, tiny chance. But enough for me to know she was best off here, and better off  trying to stay alive instead of giving up on her with a small pink needle of fluid into her vein. This is a little bit of skill and just as much gut. I could eat the cost of her care because I have had cases like hers before. The first time you jump into pro bono is scary. The tenth-plus is not.

Serafina's finder also offered to help. This is a key component. Being a savior for another life is a step into unknown waters. Having someone else to help you through the journey empowers you immeasurably. It helps immensely to not want to feel alone. It's a way to share the load even if the ending is tragic. It takes a village to save both sides. We are all victims to the pressure and chillness of society. I have learned this too. Serafina's finder canvassed the area she was picked up in to see if she had a home. Nothing. Someone knew her, no one would claim her. She also reported her as found to the local authorities. I waited as Serafina got better in my clinic and no one came, or even came to check to see if she was possibly theirs. I was not in the least surprised.

Serafina has been a many months long journey. She has resilience. She is gentle and affectionate, and she is the example to why I am vocal in being proudly compassionate. Even if all I end up is a good story. There enough of the others to need washing and leveraging. I will stick to Serafina for as long as I need to. She completes my why. Fulfills my ever emptying internal soul sucking public pleas for taking everyone else's problems as my own. At least for today she is the WHY. She is the who I am. She is also the reason I don't feel alone, or even oddly vulnerable, lost in a profession with so many others struggling every single day to remember, and maybe even re-embrace their own WHY?

Serafina is a small piece of my tortuous and twisted journey. She is currently residing at my clinic, Jarrettsville Veterinary Center, in bucolic Harford County. She is looking for a home. A home where her love for people can be mirrored by someone's love for her. She deserves this. We all deserve this.

Serafina's recovery story is my next blog.

Thank you to all who help me, the staff, the people who aren't afraid, nor ridiculed, when they care. We take care of each other, two, four legged, furred and skin alike.

For more information on me, the clinic, and our WHY please follow this blog, our Facebook page, and my YouTube channel.