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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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.

Facial Wounds. How to treat an eye wound as if it's your last good eye.

It might not look like a big deal,
but this wound under the left eye was infected causing Penny
to not eat and be lethargic.
It was also very very painful

This is Penny. She is a mild mannered senior girl who is true to her genetics and therefore is a bit temperamental and unforgiving if you challenge her for food. Then, in typical beagl-obsessive form she remembers she has an opinion and she growls with little forethought to potential consequence.

Such was the scenario last week. Penny growled and her housemate reminded her that she was not as quick as she thought.

Subsequently a swipe and a tooth wound up near her eye. This is not an unusual reason for a vet visit. In the trenches we call it "LDBD' or, little dog vs big dog. Penny's big problem was that she only had one eye, the other had been removed many years before. She, like all dogs who lose one eye was able to get along easily. But, it also meant that her remaining eye needed a little extra TLC to keep it healthy and maintain vision.

Almost every single bite wound ends up as an infection. If your dog gets into a fight and there is an open bleeding wound I recommend that you assume it is going to become infected and ask your vet to provide the following;

• Clean the wound. A dirty wound, say one with gravel, or dirt should be cleaned with copious amounts of water. At the clinic we typically use a large volume syringe to flush the dirt and debris out of the wound. I know many people go directly to the hydrogen peroxide for wounds. It is not my first choice in almost any situation. Water really is the safest and easiest.
• Only a few cleaners are safe for use around the eye. At the clinic we use dilute betadine solution. Betadine should be diluted to a light ice tea color, this is about a one part betadine to four parts water.
• All topical antibiotics for use around the eye should be made for use in this area. Most of the over the counter topical antibiotics are not safe for around the eye.
• An oral  antibiotic is almost always indicated. I prescribed an oral broad spectrum antibiotic with a good skin penetration.for 14 days. 
• Pain management is indicated for at least 3-5 days. I prescribed Penny a NSAID for 7 days. (Please only use a veterinary prescribed analgesic. Many over the counter and human pain medicines are toxic to dogs).
• An e-collars is recommended. If Penny's eye wound hurts she is very likely to rub it. One swipe of her foot and the delicate cornea can be injured. Our whole goal is to protect and minimize any possible damage to her remaining eye.

Penny's treatment plan consisted of antibiotics, pain relief, and protecting the eye. She healed quickly and without incident. Her cost of care was $167 to include all of the previously mentioned goods and services.

I write this blog with  the sole intention of helping people understand and help their pets live longer, happier, and healthier lives. If your pet is in need of help you can find a whole community of caring advocates at Pawbly.com. Pawbly is free for all to use and open to  anyone who cares about improving the lives of animals. 

If you live in the Northern Maryland area you can find me at the clinic trying to save the world in person one wet nose at a time. Jarrettsville Veterinary Center is a full service veterinary hospital with a big heart and an even bigger soul. Come by 7 days a week and say 'hello!'

I am also on Twitter @FreePetAdvice.

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.