Visiting Veterinarian : Pick your problem
By Michelle Gerhard Jasny V.M.D.
Published: August 14, 2008
Jade is a traditionally curious young cat who spends her days exploring the West Tisbury wilderness and sticking her nose into interesting places. When her mom reported she was sneezing, I wasn't concerned. It may be an upper respiratory infection or an allergy, I proposed - or maybe she got something up her nose. I was recently at Children's Hospital in Boston with my daughter. Waiting for the audiologist, we were fascinated by a display, framed under glass, like a work of found art. Hundreds of paper squares, each about an inch in diameter, each holding a small object, labeled and dated, that had been retrieved by the doctors over decades from the noses, ears, and bronchi of dozens of children (and a few adults). Coins, stones, toys, seeds, jewelry, nuts, bolts, buttons, teeth, beads, batteries. You name it; some kid had stuck it up his nose, inhaled it, or put it in his sister's ear. Nasal foreign bodies are not as common in veterinary medicine, but do occur.
How can we tell if Jade's sneezing is just a cold or something more unusual? Signs of upper respiratory infection (URI) include sneezing, runny eyes, nasal discharge, and fever. Rarely serious in an otherwise healthy adult, URI is usually self-limiting, resolving in one to three weeks. Jade had no symptoms except sneezing, but as this persisted, we considered other causes. The primary differentials for chronic feline nasal disease include cancer, rhinitis, and, less frequently, foreign body. There are several parameters we take into consideration when diagnosing. How old is the cat? How suddenly did the signs appear? Is there nasal discharge? What color and consistency? One nostril or both? How about facial distortion? Jade was on the young side for cancer, which tends to occur in much older cats. The onset was fairly sudden. She did not have the bilateral discharge typical of chronic rhinitis. Cats with nasal foreign bodies often present with bouts of intense repeated sneezing, sometimes accompanied by gagging and pawing frantically at the affected side, called a nasal frenzy. Years ago I saw such a sneezing, gagging cat. After several weeks with minimal response to treatment, the owner announced that, during a sneezing fit, the cat expelled a blade of grass from her nostril and was now completely recovered.
Diagnosis can be tricky. Metallic objects, bone, and some types of dense wood will show up on X-ray. Grass, plastic, food, and the like, will not. Few animals let us shove a speculum up there to get a good look, and even if Jade would, her nostril is too small. What we would need is general anesthesia so we could pass a teensy fiberoptic endoscope up the nose or retrograde through the mouth to visualize the nasal passage and remove the object. But many general practices do not have a fiberoptic scope, especially not such a tiny one. What I could do would be sedate her and flush her nasal passages with copious amounts of fluid to see if we can wash out the offending object, I told her mom. Since Jade was feeling fine otherwise, we opted to wait and give Mother Nature a chance.
Soon after, Jade's owner heard a bad bout of sneezing in the bedroom. Going in to check, she found a spray of blood spots on the sheets. In one of the spots was a maggot-like worm. She brought cat, sheet, and worm in to see me. It was evident Jade had experienced a nosebleed from her right nostril. Had this worm come out her nose? It was unlike any nasal parasite that I knew about. We certainly see maggots on animals when flies lay eggs on exposed wounds but no insect I knew of would lay an egg up a cat's nose. We sent the larva to the lab.
While waiting for lab results, I researched nasal foreign bodies and found many fascinating cases. A dog that binged on peanuts, then vomited so explosively that a bunch tried to come out his nose and got lodged. A Great Dane with a broken pencil, thanks to a child. (Ouch!) A rabbit who snorted a feed pellet. A cat with a chunk of Christmas tree branch. (Can't imagine how that one happened.) Bullets, BBs, needles, stones, sticks, grass, tooth fragments. Sometimes a surgeon needed to cut through the bone to remove larger objects. As I shared these tales with friends and clients, people started to tell me stories. Jade's grandmother reported that 50-odd years ago, her little sister stuck a grapefruit seed up her nose. Nobody knew she had done this . . . until five days later when the seed germinated and a curly green tendril grew out of her nostril. A trip to Children's Hospital was needed to remove the sprouted seed.
Jade's worm turned out to be your garden-variety maggot. The parasitologist speculated that Jade had snuffled up organic debris containing a fly egg. Perhaps the egg, like that grapefruit seed, found a nose to be a cozy place to grow, and hatched into a maggot. There was another possibility. Her mom confided that once Jade had eaten a dozen caterpillars, then thrown them all back up. "Maybe she ATE maggots," I postulated, "then vomited, and one went the wrong way and got stuck in her nose. Like the peanut dog. Like laughing children who spew milk out their nostrils. We'll probably never know. Jade received antibiotics for secondary infection. The sneezing seems to be resolving. We hope she will soon be back patrolling the West Tisbury woods. And if you happen to be at Children's Hospital, do me a favor. Go find that display by the audiologist's. See if there is a grapefruit seed, circa 1948.
