Visiting Vet: Bookends

Cats and nature: Sometimes happy, sometimes sad.

Charybdis with the three-inch blade of grass that was pulled out of her nose. — Courtesy Michelle Jasny

I’m going to tell you two stories. The first one is sad. The second is happy. Two cats, two decades apart. Late one evening in 1997, a client called about a young cat, Scylla, who was exhibiting acute respiratory distress. That’s exactly what it sounds like. All of a sudden Scylla was having trouble breathing … coughing, choking, agitated. “Bring her right down,” I said. While awaiting their arrival, I considered the likely diagnoses. Feline asthma. Cardiac disease. Perhaps traumatic injury. I don’t recall all the details, but do remember that as soon as I saw Scylla, I whisked her off to take radiographs to evaluate her heart and lungs. Although some of her symptoms were consistent with feline asthma, she didn’t have the typical expiratory wheeze and dry cough. Instead, her lungs sounded a bit congested, though it was hard to assess completely as she was making lots of gaggy, gurgly noises. I developed the films and popped them up on the viewing screen. A small area around her mainstem bronchus looked a little funky, but nothing definitive. There was nothing to indicate that Scylla had any of the common conditions that cause acute respiratory distress in cats. Her symptoms were unusual and severe. I just didn’t know what was wrong.

These are the cases that haunt veterinarians. A pet in distress and no diagnosis. I tried bronchodilators to open her airways. I tried corticosteroids to reduce inflammation. I called specialists over the phone. “Try anesthetizing her,” they suggested. “It will alleviate her distress while you continue to work up the case, and give those medications time to kick in.” Following their advice, I administered a quick intravenous anesthetic, then looked carefully in her mouth, throat, and as far down her windpipe as I could see. Everything looked normal, so I continued with intubating her with an endotracheal tube in order to maintain her on gas anesthesia and oxygen. Once anesthetized, Scylla breathed more easily. I administered every conceivable useful medication, then, after 20 minutes, allowed her to wake up. As soon as she regained consciousness, the respiratory distress returned … rapidly and dramatically. It was hard to watch, and I soon anesthetized her again.

Her owner and I talked. We couldn’t keep Scylla under anesthesia indefinitely. I didn’t know what was wrong. I could try to stabilize her enough to send her off-Island where specialists could look down deep into her airways with a tiny fiberoptic scope. They could do aggressive diagnostics, advanced imaging, biopsies, bacterial and fungal cultures. They could monitor her in an oxygen cage. After much consideration, however, we concluded that if the intense symptoms recurred when she woke again, we would need to end her suffering. Sadly, that is what happened.

The owner gave permission for a postmortem. I was grateful. I wanted to know the cause of Scylla’s distress. Was there something I could have done differently, some way I could have saved her? I explored the respiratory system, starting with the trachea. Normal. Now down to where the windpipe forks into two bronchi. Right side. Normal. Left side. Normal … no … wait. What’s that? Something blackish. Opening the bronchial tube a bit farther, I grasped the black thing with forceps, and pulled. Out came a huge dead cricket. Poor Scylla. She must have had the cricket in her mouth and somehow inhaled it. The cricket had lodged deep in a small bronchus in her lung, too deep to cough out, thus causing her respiratory distress. First story, a sad one.

Twenty years later, same owner, different cat. Charybdis had recently boarded for several weeks in a kennel. “I noticed her drooling a little the day she got home,” her mom said, “ but that was over a week ago. She’s been completely fine until yesterday, when she was outside and suddenly seemed all weirded out.” The cat had been gagging periodically for a day, was not eating or drinking, and seemed in distress. On physical exam, Charybdis had a slight fever but everything else looked normal. I’ve seen this kind of behavior fairly often in animals who bite and/or swallow bees, yellowjackets, or some such bugs, getting stung inside their mouths or throats. Other diagnoses to consider included foreign body in the nose or throat, retropharyngeal abscess, asthma, even tularemia, or the possibility of an upper respiratory virus acquired while boarding. “I think anti-inflammatories and antibiotics are in order,” I suggested, “and a little tincture of time.”

The next day the owner reported Charybdis was marginally better. She then added another piece of information she thought might be significant. The day before the symptoms began, the lawn of long grass had been mowed for the first time all year. Aha! I seized on this new tidbit. “I bet there’s a blade of grass up her nose!” I replied. I’d seen this before, too. Unfortunately, there’s no quick and easy noninvasive way to confirm or correct this. I could refer her to a specialist who could look way up her nose with a tiny fiberoptic scope. I could anesthetize her, intubate, pack the back of her throat with gauze, then blindly try to flush out any foreign body with copious amounts of saline. Or we could wait and see if Mother Nature would eventually help Charybdis sneeze it out. I voted for the latter. Her mom concurred, and, after confirming with me that it was safe, added the herbal remedy slippery elm.

One week later, Charybdis returned to my office. “I think I see a tiny bit of something coming out her nostril,” her owner said. Sure enough, barely visible, a millimeter or two, something greenish. Taking my trusty hemostat, I grasped the miniscule speck peeking out of Chary’s nose and pulled. Out came a three-inch blade of grass. Hallelujah! It took Charybdis another day or two to completely recover, but she’s now back to her old self. What a strange juxtaposition. “Like bookends,” said the owner. Two cats. Two stories. One sad. One happy.