Vomiting – Serious or Watchful Waiting?
Vomiting is nobody’s favorite pastime. Sadly, some cats retch from time-to-time, seemingly whether they need to or not. Finding the cause can be tricky or not. I learned early that even when I was sure I had the right answer, I needed to be ready to be wrong. Unexpected clues – easy to miss – can change treatment plans, like right away.
A cat with a history of hurling sat on my exam table with a complaint of recent vomiting. Her person, Jerri Samuelson, fixed me with a hopeful expression as she stroked “Gucci”, her 2 year old female tortoise shell kitty. “Hi, Ms. Samuelson, I’m Dr. Jeff Nichol. When did this cute girl start vomiting again?” “Well, she’d been doin’ OK but all of a sudden, in the past 3 days, she’s stopped eatin’, then she started pukin’, and now she’s got squirts.” Well, alrighty, then. Routine stuff, I thought. It was a Saturday morning. I’d be off work in an hour and a half, enjoying lunch and then washing and waxing my Triumph. Another day at the office.
My first years in practice had me in the employ of veterinary practice owners. experienced veterinarians. My boss at the Foothill Veterinary Hospital in Sacramento was Dr. Lloyd Beal. The “Chief” as I enjoyed addressing him, was off that day. No problem. I had breezed into the exam room just as confident as any young animal doctor could be. I hadn’t treated every malady of pets yet but I was current in my knowledge and ready for anything. Really? Just 2 years of out of school? Don’t be ridiculous. Of course I was.
What I found on Gucci’s physical exam changed my day and my cocky attitude. Her temperature was 104.2, respirations 60/minute – almost panting, her pulse was 180. Gentle abdominal palpation caused this historically prickly kitty to tense and cry quietly. Her intestines felt odd; there was fluid where it didn’t belong. As I started a mental list of possible causes I quickly realized I didn’t know where to start. I remembered an admonishment from an emergency medicine instructor in veterinary school. “Don’t just do something, stand there.”
Act Fast or Lose
Gucci wasn’t just having another routine bout of vomiting. Her fever spoke loud and clear: major inflammation. It was also clear that it wasn’t too late. Her immune system was fighting hard. A normal or low temperature would have meant that her system was in free-fall. I had time, but only a little. We snapped a couple of abdominal x-rays and found the trouble.
Intestinal loops should appear in sharp focus on x-ray, with a few small gas pockets. Gucci’s were blurred with lots of gas free in her abdomen. I took a small fluid sample, did a quick gram stain on the slide, and had a look under the microscope. Bacteria in prodigious quantities shouted the game plan: exploratory surgery – right now.
Rather than making a quick “exam room” decision I had stuck to my training. The time spent gathering diagnostic information had already paid off. We were facing a leaky gut; septic peritonitis was already underway. Generous doses of antibiotics were added to Gucci’s IV fluids. Several more liters of saline (in glass bottles back then) were warmed for abdominal irrigation. It was going to be a long afternoon. I’d wash and wax the Triumph the next Saturday.
Gucci was a high risk kitty but our heart and respiratory monitors gave comforting reports throughout her anesthesia. My experienced assistant, Hazen, was ready with suction as I carefully opened our 8 pound patient’s abdomen. We were greeted by a veritable sewer. No lecture in veterinary school or text book chapter prepared me for free-floating feces sloshing among angry red loops of bowel. Thinking back on it still horrifies me.
I remember briefly wondering how this cat could possibly survive such severe contamination. Forcing that worry from my racing mind we set to work fast, suctioning and rinsing, using moist lap sponges to pack off intestinal segments, some with holes big enough to pass a 25 cent piece through. Each of Gucci’s ragged intestinal tears had to be trimmed of dead tissue, sutured closed, and then covered with omentum. Mother Nature has mercifully equipped us all with this protective tissue, bless her little heart. I only hoped I could find enough of it to help prevent leaks.
Nip and tuck
Gucci maintained strong vitals as I debrided (trimmed) the edges of her internal wounds and opposed them with strong nylon sutures. A lot could still go wrong; I was counting on her robust immune system for all the help it could muster. On my way out of this tough kitty’s tummy I placed tubes and drains for daily irrigation over the next few days.
Small creatures can lose a lot of heat when their body cavities are open to room air. We’d kept our patient wrapped in a warm water circulating blanket during surgery but she still had me worried. As I placed the last stitch in her skin her subnormal, 92.4 degree temperature had us quickly snuggling her into a thick towel surrounded by warm water bottles. Very slowly her paws started to flex and then her eyes opened. I couldn’t wait to ask her, “What the heck did you eat that poked 8 holes in your guts?”
Instead I called Gucci’s person, Jerri, at her business. Jerri was a hair dresser. Like veterinarians of that era, she worked on Saturdays. She picked up on the first ring. Through the whir of blow dryers and background chattering I explained that surgery had gone well and that her sweet kitty was still under the influence but was sleeping it off. She would not be allowed to drive, operate heavy machinery, or lift heavy objects for several days. We would watch her like a hawk but, of course, there were no guarantees. Infection risk was still high.
We stayed late so Jerri could visit Gucci after she finished the day’s last coloring. She held her swaddled cat tight against her chest and stroked her head as I explained the details of what lay ahead. I remember this odd feeling as we spoke, that Jerri was looking at my hair more than my eyes. Maybe she wanted to trade her work with scissors for mine with a scalpel.
As I escorted our client out the door I explained my puzzlement about the cause of those intestinal wounds. What could her indoor cat have gotten into?
Dental Hygiene at Fault
By day 2 of Gucci’s recovery her temperature had risen to a healthy 101.2 degrees. Her grumbling and complaining, as we gently syringed warm saline through her abdominal tubes, came as no surprise. We’d known this tortoise shell kitty from her previous bouts of barfing. Feline racism is never tolerated but, well, torties are often cranky.
I didn’t shoulder this task alone. Our veterinary nurse Hazen spoke gently to our patient as he offered her a veritable smorgasbord of gastronomic delights, which she delicately sampled one lick at a time. Gucci would never let on that she appreciated his kindness but she recovered nicely and went home in just a few days. Success in plucking her from the precipice was thanks enough.
Multiple intestinal tears in kitties most often result from a “linear foreign body.” If a cat is lucky, this stuff bunches-up and moves along uneventfully but if one end of the string gets caught in a loop of intestine, it doesn’t go anywhere. As the guts’ natural peristaltic movements attempt to push a length-wise string toward the rear end it stays in one place, sawing holes in the moving intestinal walls. Without surgery to repair the damage, leaked bacteria kill these unlucky pets.
Gucci’s family was committed to avoiding a repeat of this harrowing saga so they engaged their sleuthing skills in hunting down the culprit. No linear material was found lying around but a bathroom waste basket had been tossed just a few days earlier. And so I asked, “Jerri, does your family floss regularly?” With her healthy set of choppers I already knew. With its tiny bits of food attached, the used dental floss Gucci discovered was a toy she just couldn’t resist. It almost ended her life.
It was a few months later, with Gucci’s near death experience well behind us. The year was 1977, an era when many young people wore their hair long but mine just grew big. When another of our nurses returned from an appointment at Jerri’s hair salon she recounted how our client had expressed her gratitude for saving her cat but then went on to ask a rather personal question, “Why does Dr. Nichol wear that silly wig?”