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. 

If you have a pet question, or are a self-taught, self-learned, pet lover/pet parent who wants to be a part of the best online pet community ever, please join us at Pawbly.com. Pawbly was created to help educate and empower pet people and help pets across the globe. Pawbly is free and open to everyone who cares about improving pets lives.

If you have a pet care related topic you would like me to discuss you cn either ask me a question directly via Pawbly.com, or in person at the veterinary clinic, Jarrettsville Vet, in Jarrettsville Maryland.

I am also available on Twitter @FreePetAdvice.

Foreign Bodies and Feet. When to Intervene.

We get a bunch of phone calls and appointments for limping dogs. Lameness is one of those things that can have a million causes and an equal number of options to fix it. Lameness also comes in many degrees of severity.

As a general rule of thumb there is no rule of thumb for these. A slow progressive lameness can be a bone tumor, a knee injury, or even a tick borne disease. An acute complete lameness could be a fractured bone, blister, or broken toenail. Or, maybe all of these but the other way around.

This is Bridger. He is an athletic German Shorthaired Pointer. I was lucky enough during his exam to have a mom who knew exactly when, and thought she knew how, his lameness occurred; He was running in the woods, she heard him yelp! and then he was limping. That was about 4 days ago.

Over the last four days his foot had become swollen and painful. His family thought the cause was a splinter so they lanced it and bandaged it. But, four days later, and still the foot wasn't getting better.

Here are a few important points to remember when dealing with a wound;

1. Listen to your client. Always give them the benefit of the doubt and then..
2. Pay attention to your patient. Your job is to do not (further) harm and to get them some relief.
3. Have a short term AND long term plan. Discuss all treatment options initially. For me, I usually take a somewhat conservative approach initially. Surgery might be on the menu but for this guy it was not option A. He was acting normally (outside of a wound). As long as I trust my clients ability to follow through with the conservative plan we try, talk, and prepare for Plans B-Z. There ARE ALWAYS options! Bridger's initial consult cost about $100. 

Here are some tips for those of you managing a wound at home;

1. Few  things in life beat the broad spectrum antibiotic powers of plain old soap and water. It cleans (and kills) almost everything. And it is safe. At the first sign of a wound supply copious amounts of soapy water.

2. Bandages.. I have a few good things to say about bandages. BUT, I also have a few bad things to say about them. They close in the bad stuff, like infection and close out the most important stuff, like your ability to see and smell the death, disease, and dirt that lies beneath. The only exception to this is to use a bandage as a way to supply compression to a wound as you drive your pet to the vet. 

And should you choose to not heed my warning, I can state without doubt that bandages placed by good intentioned pet parents cause more problems than they solve.

3. Smell.. a bad smell is infection. Go to the vet.

4. A limping foot is pain.. Go to the vet. They will usually prescribe an NSAID.

5. Red skin happens before purulent (puss) happens.. Go to the vet at red skin and/or puss.

6. What appears to be a small surface wound can be a tiny portal to a huge festering deep wound. Deep wounds may need surgical intervention and exploration. In some cases a drain needs to be placed to assist in flushing out the infection. 

After a day of soaking the foot and antibiotics Bridger's family woke up to this!

When an infection lets loose it can look like an explosion. After recovering from the shock of a blood bathed room they looked at Bridger's foot and saw the culprit. Which was easily removed. A large splinter had been the source of the infection, pain and inflammation. (Thanks to them for sending me photos!)

What did they need to do after the splinter eruption?

Keep soaking the foot every 12 hours for another 2 days. Finish the antibiotic (always finish your antibiotics!), and keep the wound clean and dry. If Bridger goes out on a wet muddy day he needs a bootie. I wouldn't expect that he will need the NSAID any longer. Once the foreign body is out they aren't painful. In fact, if they are I would suspect something else is still going on, so go back to the vet. 

Here's another tip on pain medications. Listen to your pet. Use the pain medication IF you think your pet benefits from it. Do not just keep administering it without asking yourself if the pet needs AND benefits from it. All drugs have potential adverse side effects, these are best avoided by only using when needed and as prescribed. 

Related Blogs;

Dog Fights and Dire Consequences.

How Client Behaviors Dictate Your Pet's Treatment Options.

What Does Lowest Effective Drug Dose Mean?

Five Things I Wish My Clients Understood Better.

Any pet question can be asked for free at Pawbly.com. Pawbly is an open pet centered community dedicated to helping you find better ways to care for your pet. Veterinarians, trainers, behaviorists and all of the rest of the pet loving people of this planet can be found in one place, Pawbly.com. Stop by and say hello, ask, or answer a question, or just pop in to learn more about pet care.

To find me you can got to Twitter @FreePetAdvice, or find me in person at Jarrettsville Veterinary Center in Jarrettsville, Maryland.

A Good Deed and Two Bad Dogs

Anyone of us kids that has ever grown up around another kid knows that sibling rivalry (even if you were an only child but had to go out to recess in school) exists in almost every arena we step foot in. We challenge each other in almost every relationship we have in life. I challenge my husband to do the dishes, he challenges me to not ask him to do the dishes. My puppy Charleston sees that Jekyll has a chewy and he stalks him to snatch it. Its almost unavoidable. We all have items that we covet and if you have another around you that shares the same interest a jealousy can arise, and the bigger, stronger, or bossier will usually challenge, and sometimes succeed.

For dogs this is especially true.

They are pack animals. Their communities have evolved to have an Alpha, or head honcho, dog. Here's the problem...that alpha only gets their alpha status by challenging the old alpha. This can be a BIG problem if you bring one pet into a household that already has a pet who thinks they are 'The Boss'.

Such is the story of Willow.

She is the resident of a retired couple who love her immensely. For many many years, Willow was their only child and they spoiled her willingly. Willow's life was perfect. She was given everything she wanted, she had her parents trained impeccably, and her house was HERS! No question.

Then the unthinkable happened.

Her next door neighbors got very ill and left their dog, (who she liked perfectly fine as long as she remained on her own side of the property line) to her parents. The neighbors dog was a corgi named Margaret. Margaret and Willow were alike in many respects. They were confident, independent, stubborn, opinionated spinsters.

Things seemed OK in the new household until the day they each realized that the other was not leaving..

From that day to today there have been two altercations. Both were precipitated unexpectedly. This has added a significant element of despair to the adults in the household.

On two occasions Willow has arrived at our clinic with two large gashes to her neck.

Many pets are possessive over food, or toys, or a particular item or scenario and when a family realizes that there are issues among the pets they go to great lengths to try to avoid the pieces of the puzzle that might cause a fight or challenge to occur. Over time these pets 'train' their families to reinforce the root of the problem instead of address and overcome it. For Willow's family they were perplexed about what was triggering the fights and they subsequently felt helpless to try to address the situation if they couldn't even begin to understand it.

The following pictures are from the second fight.

Margaret grabbed Willow at the neck, bit down, and pulled back. When she did it pulled the skin away from the underlying muscle, and made a big hole. That hole had an opening of a few inches but tunneled about a foot up to the spine and about 6 inches to the neck. That hole was so big that it required surgery to place a drain and close the wound.

Willow came in for surgery the next day.

The wound is an "L" shaped wound.
On the outside it doesn't look so bad, but there is a large open pocket under that flap.

A very large area of the neck had to be clipped and surgically prepared to place a long drain.

A large hole.

An old wound needs to have its edged "freshened" so that the sutures will hold and the edges will seal.

The entire wound edges have been removed.

The drain is placed and the wound is sutured closed.

The drain extends above and below the parameters of the hole.

A large t-shirt, or sweatshirt is a good way to cover a drain.
The shirt can absorb draining fluid and keep the pet from licking or removing the drain.

At home Willow received an antibiotic solution to be flushed AROUND the drain twice a day. This allowed any bacteria in the hole to be flushed out. She was also placed on an antibiotic and a NSAID for pain and swelling.


Willow returned ten days later to have the drain removed.

Willow healed very well.

I first learned of Willow's first altercation with Margaret from Pawbly.

Here is the question they sent me:

My dog was injured in a scrap with another dog. She is sensitive around her shoulders and I noticed bruising. What can I do to relieve the discoloration and soreness?

 Krista Magnifico, DVM responded ...

Hello Carol,

Thanks for asking your question.

I am sorry to hear that there was an altercation with your dog. Without knowing the extent of the injuries it is difficult to provide advice. Dog attacks and dog bites are some of the worst injuries I have seen. If there are puncture wounds (these can be very hard to see with fur, so look for any wet areas on the fur or places that your dog is licking, these are good clues). At the hospital we give a very thorough look over of any dog that has been attacked or bitten, and in many cases we shave the hair off of any areas that are injured. With hair covering a wound it is harder to treat, monitor, and heal.

If there is no evidence of wounds, but you are seeing bruising we assess the degree and extent of the bruising. Bruising is caused because the blood vessels in the skin have been traumatized and rupture. We have all had bruises. They in general will heal with time. But I have seen some bruising that causes subcutaneous emphysema. This is when the skin gets torn from the underlying tissue. This causes air to be trapped under the skin. It feels like plastic bubble wrap and sounds 'crinkly' when touched. These dogs tend to be very painful because there has been a substantial amount of tissue trauma.

My recommendation is to visit your veterinarian to insure that the tissue damage is not extensive. At my hospital after a thorough examination if there was only pain present I would probably recommend rest and an NSAID. NSAID's are non-steroidal anti-inflammatories. They are very good at controlling pain and reducing inflammation.

I hope that this helps, and I wish your pup a speedy recovery.

Oh, one last thing. In many cases dog fights erupt between pets in the same household. If this is the case I strongly recommend an intervention with a behaviorist. Because where there is one fight there are usually more to follow. Unfortunately I have many clients who have pets who are not friendly to each other. Managing the fits, fights, and wounds is expensive, scary, and stressful. If there are behavioral issues ask for help. Behavioral issues tend to worsen over time and manifest into other areas.

Sincerely,
Krista

Willow arrived at the clinic the next day. Here is what she looked like after we shaved the overlying hair.

A very large bruise (red) and dying tissue (black) at the site of the bite.

One of the most frustrating aspects of being a veterinarian is the behavior issues..Goodness, it seems that every other appointment is itchy pet or bad pet..and then the whole slew of emotional baggage that these problems bring.

Willow, Margaret, and their parents are all in behavior classes and in the long term care of a veterinary behaviorist to help identify the triggers and the issues to avoid any future fights.

If your pets are challenging each other, or injuring each other please see your veterinarian and ask for help.

And remember its never too late to teach an old dog new tricks..Even my husband and "thanks for doing the dishes, honey."

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.

For any pet question you can find me, and many other helpful people with many other skills, at Pawbly

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krista