This Month at Vetrica

10 April 2004

Latest News

Feedback

It's been a couple of weeks now since the new format was launched for Vetrica OnLine. So far the feedback we've received has been very positive. If you have any comments to make, please do contact us. But development hasn't stopped. Since then we've been working on an online shop. It will take a little time to set-up, but we hope to sell the full range of products online that you can currently purchase in person at the surgery.

New Drugs

Steroid-free Atopy Treatment

This time of year is often when drug companies launch new drugs. Novartis launched a drug called Atopica^® recently. This is a new treatment for atopy, an allergic skin disease that afflicts about half of all Westies (although any breed can get it). We generally use steroid tablets to treat atopy, but they have a lot of side effects, some of which can be quite serious. So a reliable steroid-free treatment for atopy is a great advance. The trial data certainly looks impressive, and the potential for side effects is much less. It's quite a lot more expensive than steroids though (steroids are probably the cheapest drugs there are for any disease). Anyone with a dog currently taking steroids for atopy should seriously consider changing to Atopica^®.

Fast-acting Tick Treatment

Bayer are about to launch a fast-acting tick treatment called Advantix^®. At last it looks as though we will have a product that kills the ticks before you find them yourself. In the past we have always used Frontline^®, but this works very slowly against ticks. Typically it takes 48 hours for the tick to die. Bayer claim that Advantix^® kills ticks within an hour, though they are not claiming that ticks are prevented from embedding their mouthparts first. Only experience will tell if it really is as effective as they say, and is only suitable for use in dogs.

This Month's Interesting Case.

Subject: Tommy, a 3 year old domestic cat.

Problem: RTA (Road Traffic Accident).

Tommy was hit by a car one morning, but before his owner could catch him, he ran off into some dense undergrowth. Unfortunately, despite many hours searching, Tommy could not be found. Tommy's owner alerted us that she'd seen him being run over, but he'd ran away, so we promised to let her know if anyone handed him in.

One week later, we had a call that someone had found an injured cat, more than a mile away from where Tommy was hit by the car. Audrey was immediately dispatched to collect the injured cat. On her return, we thought the cat matched Tommy's description, and immediately called his owner, who arrived sooner afterwards, and confirmed his identity.

As you may imagine, one week after the accident Tommy was in a terrible state. He had a fractured jaw, damage to an eye, and was clearly in great pain. Tommy was clearly unable to eat or drink, and was close to death.

Saving Tommy's life was the immediate task; everything else would have to wait until later. Tommy was quite simply unfit for the anaesthetic required to properly treat his injuries. So we made the decision to fit a naso-oesophageal tube, and provide pain relief before any permanent treatment.

A naso-oesophageal tube is a thin nylon tube that we pass through a nostril into the oesophagus (gullet). This allows us to give food, water and medication without the cat having to chew or swallow. We fed Tommy a proprietory dried food (RCW Concentration Instant Diet), that is a complete, highly digestible diet. This food makes up with water into a liquid that passes easily down the tube.

After only two days, Tommy was much better. He had gained weight, was brighter, and taking an interest in his surroundings. Now he was fit for an anaesthetic, we decided to take a better look at his jaw.

In this photograph, we can see the large hole in Tommy's palate. Note also the displaced maxilla (upper jaw), which you can see by the upper incisor teeth no longer being in a straight line. You can also see that Tommy lost his right upper canine tooth. The feeding tube is visible in Tommy's left nostril.

Under general anaesthetic it became clear that Tommy's injuries were much more severe than we thought at first. He had a fractured mandibular symphysis (which we knew about), but much more serious was a fracture of his hard and soft palates. The mandibular symphysis is equivalent to the chin in humans. Fracture (separation of the two sides) is quite a common injury following a car accident, and is quite easy to deal with. A fractured hard palate is different altogether. The palate has a hard (bony) part at the front, and a soft, fleshy part at the back. The palate separates the nasal and oral cavities, and where there is a hole in the palate, food tends to come down the nose, and can pass into the lungs. Some animals are born with holes in their palates, a so-called cleft palate. Most affected individuals are euthanased at an early age, because treatment is very rarely successful.

Bearing this in mind, we were forced to discuss the option of euthanasia with Tommy's owner. He was likely to need a number of operations, and the chances of a full recovery were small. Fortunately, Tommy's owner was fully committed to him, and willing to take the chance.

We fixed his mandibular symphysis by passing a loop of wire around his lower jaw. The fractured hard palate meant the upper jaw was out of line with the lower one, so when the lower jaw was repaired, it no longer fit properly with the upper one. We dealt with this by shortening Tommy's lower right canine tooth. At least now Tommy was able to open and close his mouth properly.

The palate would have to wait. There was a lot of infection in and around the bone. This had to be got under control before any further surgery could be contemplated. So Tommy stayed with us, being tube fed several times a day for the next week. Fortunately for us, Tommy's such a nice cat that he gave us no problems at all. The hardest part of this was that he kept wanting to roll around when we were feeding him!

One week after admission, and Tommy's mouth was a lot better. You can see how the hole in Tommy's palate has almost completely sealed itself, and the exposed bone has been covered with healthy pink granulation tissue. The feeding tube has been moved to Tommy's right nostril.

After a week, we anaesthetised Tommy again. What a surprise! Not only was the infection clearing up very nicely, but the hole in Tommy's palate was a lot smaller too. Having done so well, in consultation with Tommy's owner, we decided to continue with the current mode of treatment before embarking on any surgery. Tommy was well, gaining weight, and the hole in his mouth was getting smaller. We had absolutely nothing to gain, and everything to lose by rushing into surgery now. So the scene was set for another week of tube feeding.

A week later again, and Tommy was starting to get a bit fed up with his tube. Can't blame him really. For all practical purposes he was better. He was clearly feeling good about himself - he had even taken to trying to jump out of his kennel every time it was opened. Under sedation we could see that the hole in Tommy's mouth was all but gone. A miracle had truly happened, and a large hole in Tommy's mouth had sealed itself. There was still a wound over the palate which was not yet healed, but that was a minor problem.

At this stage we took the tube out, to allow Tommy to feed himself. Three days later, Tommy went home with his delighted owner. Initially, Tommy's appetite was quite poor after the tube was removed. We were a little surprised at this because having been fed through a tube for all that time we expected him to dive straight into his food. A few days pain relief seemed to do the trick.

Six weeks after admission, and Tommy's all better. His mouth has completely healed, and he's had the wire removed from his mandible.

Tommy had the wire around his mandibular symphysis removed last week. He's doing extremely well, and has started going outside by himself. Let's all hope he doesn't get run over again. Next time he won't have as many lives left to lose...

Tommy was lucky. His owner saw him being run over, and even though she couldn't catch him at the time, simply alerting us to the facts of what had happened meant that when he was found, we were able to contact his owner the same day. Without an owner, there is little doubt that Tommy would have been put to sleep. His injuries were so severe, and he was in such poor condition that in the early stages of Tommy's recovery we could not be sure that he would survive.

Yet most cats are rarely as fortunate as Tommy. At Vetrica we regularly have injured cats brought to us by passers-by and car drivers that struck the cat on the road. In most cases we simply have no idea who the cat belongs to. If the injuries aren't too severe, we try to make the cat comfortable, and provide pain relief, but in the absence of an owner, we cannot do much more.

You can help by making sure your cat is identifiable. This is most easily done by having an identity chip fitted. These are quickly and easily fitted by injection under your cats skin in the neck. About the size of a rice grain, they rarely cause the cat any problems. The chip stores a number, which is registered on a central database, which contains your contact details. When injured cats are brought to us, and we find an identity chip, it's simply a matter of looking up the number, and contacting the owner. Important, life-saving decisions can then be made early, and in the best interests of the cat.

Having an identity chip fitted is quick and inexpensive. The current price at Vetrica is available here.

Previous editions of "This Month at Vetrica" are available here.

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