Woody's Honk and Wink. Eyelid agenesis and cleft palate defect in a cat.

This is Woody. He is about 4 months old. He was brought to me last week from the good people at Animal Rescue, Inc. in New Freedom PA.

They originally thought that he might have a nasopharyngeal polyp because he had this constant funny little nasal sound. It sounded a bit like a cross between a stuffy nose and a goose honk. It was a very good guess on their part. They were almost right on the money with their presumption. They were in the right anatomical area, but Woody was missing something, instead of in possession of something extra.

Woody is about as sweet, gentle, loving, affectionate, and adorable as a kitten can be. His story is like so many other kittens at the rescue. Brought in as a baby, raised by volunteers, and now old enough to be looking for a home of his own.

But his path is not so simple and straightforward.

This is Woody.
He is missing the lateral (outside) 2/3rds of his upper eyelid.

Woody was born without complete eyelids.

Sounds crazy, doesn't it?

It is actually a condition called eyelid agenesis.

Eyelid agenesis is very rare in dogs but seen occassionally in cats. In some cases the loss of the lid is mild and only appears to be a cosmetic defect. But for some cats it causes pain, ocular discharge and can even lead to blindness as the hair sweeps over the sensitive cornea with each blink.

This is a picture of my kitty Magpie.
Her eyelids are normal.

I used pictures of my cat Magpie to illustrate what normal looks like. So you will see a picture of Woody and then followed by it will be a picture of either Magpie, or another normal kitten.

This is Woody's right eye.
It too is missing the lateral 2/3rds of the upper eyelid.

Magpie.

Magpie, falling asleep despite my annoying obsessive picture taking.

Woody's eyelid abnormality are what we call an incidental finding. They are not causing him any problems, and although they are not normal, they do not require any intervention on our part, YET.

But the honking sound, that we have to identify.

With a very quick peak, and  a calm gentle tolerant patient we got our first look at the source of the noise.

Woody's mouth.

The above two photos are of the inside of Woody's mouth. What the vet would call an "oral cavity" exam.

Woody is fully awake and this shot is incredibly hard to without drugs.

The right side (it is actually Woody's left side) of the roof of his mouth has a huge open defect.

 This is a sedated kitten before I put the endotracheal tube in their mouth and hook them up to the general anesthesia gas that we use to provide a well controlled plane of anesthesia.The left and right sides of the tissue above the tongue are uniform and symmetrical. The round opening is the soft palate that guides food and water to the back of the mouth. During eating and swallowing the arytenoids shut off the vocal/air tube that goes to the trachea so food doesn't go down the wrong pipe.

The structures of the base of the back of the mouth are specifically designed to direct food, water, and air into the correct tube.

The little pointed tip like structure visible just above the center of the tongue is the epiglottis.
This is looking down into the larynx from the mouth.

Woody is scheduled for surgery in two weeks. I will try to rebuild the soft palate, pharynx, and larynx into a functioning tunnel that will prohibit him from getting food and water pushed up into his nose and segregate these anatomical areas so he won't be prone to regurgitation, oral and nasal cavity aspiration and disease.

Have I ever done this before? No.

Does he need to have this surgery done? Yes.

Am I a little scared? Yes.

I will keep you all posted. Cross your fingers for me.

If the surgery is successful Woody will be looking for a home. If you are interested in adopting him, OR, if you have any pet questions, OR, if you are a surgeon and you would like to assist, (or perform Woody's surgery,,I am happy to pass him off to an expert ;-)), please find me at Pawbly.com. on Twitter @FreePetAdvice, or @pawbly.

Woody had surgery yesterday (September 30, 2013).

He did great!

I closed most of the soft palate defect. I was unable to close it completely for three reasons. First, it is almost impossible to get far enough back in the throat to place sutures and get access to the tissue with the needle. Second, he didn't have a tear for me to correct. He was missing the tissue that was supposed to be there. I couldn't just sew up the two halves of a laceration. I had to use what he was given, and that was not much. He had a hole, and no extra loose ends to collect and package. Third, The tissue swells with trauma, even the precise surgical trauma of a scalpel. I was very concerned that Woody be able to breathe on his own, and if needed I had to be able to replace his endotracheal tube if needed. The tube has to be placed in the very back of the throat. If there is severe or significant swelling you cannot visualize the opening of the trachea from the esophagus.

This is Woody's left eye from above. He is missing the lateral (outside) half of the upper eyelid. This is beginning to cause a few problems. He has hair rubbing on the cornea. Every time he blinks those hairs brush across the cornea, and over time this will cause irritation and could cause eventual scarring. He also has an incomplete blink. There literally isn't enough eyelid to close over the eye. Over time the area that isn't covered by the eyelids will scar and dry out. This will cause an ulcer and this can significantly impact his vision. 

Woody's left eye is worse than the right.

The closure of the cleft palate.

The correction of the left eye.
A conjunctival flap was taken from the bottom lid to create an eyelid and fill the missing gap of tissue.
To be completely honest I have never done this before. If it fails miserably I will let you know..(I always have a plan B ready. I haven't made it yet, but I will if I have to).

LOOK!! the eye closes!

Waking up. 

Thank you to everyone who sent well wishes!

Woody will be back in two weeks for a re-check.

Puppy Mills Cruelty

Puppy Mills

I got a call from Grace at Animal Rescue asking me if I would look at a 7 year old Golden Retriever that they had rescued from a shelter. Animal Rrescue takes in so many dogs abnd cats that they provide spays and neuters to all of the pets that they adopt out at their shelter. When they were preparing to spay this dog they injected her anesthetic and proceeded to try to pass an endotracheal tube into her esophagus to provide her the oxygen and anesthetic gas to keep her under general inhalant anesthesia. For the Veterinarian we approximate what size endotracheal tube to use on the pet based on their size, weight, and breed. I have seen some toy breed dogs take a tube used routinely for cats. And I have had to use a tube three sizes smaller than I estimated on a bulldog.

As a side note: There are a lot of helpful anesthesia tips for brachycephalic dogs. I always have a long discussion with these owners prior to placing these guys under sedation or anesthesia. You should expect to pay more and be asking questions if you are not.

In the process of trying to pass the endotracheal tube the Veterinarian noticed that her vocal cords were abnormal. She also noticed that the size of the lumen (the opening of her airway) was significantly smaller than it should have been. As I have said before your body will respond to an insult (fancy medical term for damage) by scarring. Scarring in a tubular structure is called stricture. A stricture causes the tube to narrow. Her vocal cords were unable to open normally, (they open like drapes around a window) because she had been brutally de-barked.

When Grace called to ask me about this dog she was calling to ask if I could use our laser to try to remove the scar tissue that was like a webbing holding her vocal cords together. It is always very difficult to give an opinion on a case over the phone. I need to see a pet and understand not only the condition about which they have come in, for but also assess the pet, and in many cases the owners ability to follow through with any post operative care. I told Grace that I needed to better understand this dog’s condition by seeing her. I also told Grace that I wasn’t sure what she was talking about when she explained to me that she had a 7 year old dog that had been de-barked at the puppy mill. I had never heard of a de-bark being done by anyone other than a veterinarian. (This is a procedure that used to be done pretty routinely in the “old days,” thankfully it has fallen out of fashion).  Grace sent me a drawing of the dogs larynx as the Vet had described. She also went on to say that the way puppy mills de-barked was to “shove a pipe down their throat, to break the vocal cords.” I wanted to vomit. I couldn’t believe that people could be so cruel. I also couldn’t believe that I had been doing this for as long as I had and never heard of this. (Something about ignorance being bliss ran through my head).  I told her that I was appalled to hear about this girl but I would be happy to see her.

Thankfully she did well under anesthesia and recovered without any problems. It was decided that based on her age, her lack of clinical signs and how well she seemed to be doing that we would take a “watch and wait and see” approach.

My hope is that she will never need another surgery and that she will be with a family that loves her. She may have started out with a terrible cruel person who didn’t care about her, but hopefully she will end up with the exact opposite.

Puppy mills only stay in business because there are people willing to buy a pet from them. If you don’t know the breeder and you haven’t met and visited their facility personally please don’t support them by buying a pet from them. They will only stop abusing when there isn’t someone buying their product.

There is not much information available on de barking, but here is an interesting debate;
http://tinyurl.com/3rdfugb