"No general
anaesthesia," the young man suggested local anaesthesia
as he was worried that his cat might die on the
operating table. His cat was weak as he had been
sneezing blood and had runny noses for the past 2
months. He wanted my second opinion after Vet 1 advised
a CT scan costing $1,500 excluding surgery for 2 lumps
above the right nostril and below the right eye. He
consulted me as his cat had this loud continuous snoring
noise as if the cat had a blocked nose and breathed hard
and loud to get sufficient oxygen to survive. The cat's
gums were cyanotic indicating that he had insufficient
oxygen in his lungs. But the young man did not want any
anaesthesia in case his cat should die at this critical
stage. This was his condition for treatment. Not that he
had any choice as the cat needed treatment for dyspnoea
as well as a large and small swelling on the right side
of the bridge of his nose, below the right eye.
"Local anaesthetic cannot be applied to this area as
there is not much space due to the large size of the
growth," I said. "The cat would feel the pain of
injections of the local anaesthetic and scratch me." I
had a feeling that this cat was suffering from tumour as
he had around 3 grey melanomas in the ear pinnae. Both
ears and melanomas may have spread to this nose area.
The following was briefly how I handled this case with
the least cost as required.
PROCEDURES
1. History & Palpation of the tumour. Firm but no pain.
The cat had 10 days of vibravet 50 mg at 3/4 tablet per
day from Vet 1. Now he had yellow runny nostril on the
right side. "Did he get nose discharge on the left
nostril?" I asked the young man. "No," he said. But I
could see the brownish stain not completely wiped out,
below the left nostril (see picture). His mum later
confirmed that the cat had discharge of both nostrils.
2. Aspiration with 18G needle. The quiet cat was held by
my assistant (without wrapping him in a towel as it
should be done. My right wrist was scratched). I
aspirated 0.02ml of red blood from the bigger of the two
lumps.
3. Incision for biopsy. I used the scalpel to excise the
lump to see what is inside. As I had promised the young
man, I did not use general anaesthesia. The cat raised
his front left paws weakly a few times. I got scratched
once as I took out 2 pieces of the greyish maroon
muscle-like mass below the skin, put in formalin and
sent them to the Laboratory.
4. Anaerobic bacterial cultures and Gram stain were not
done as the cat just had been on 10 days of antibiotics
from Vet 1.
5. I had asked my assistant to clip the hairs of the
forelegs so as to insert the IV catheter easily. This
was done with no problem. Blood test and an IV drip was
done. In the IV saline drip to be given as 500 ml, I put
in baytril antibiotic according to weight, a small 0.2
ml dexamethosone anti-inflammatory and metronidazole
according to weight.
RESULTS
Least veterinary cost is what the young man's father
wanted. With the above procedures, the cost was
"affordable" as it was well below $1,000 since there was
no general anaesthetic and surgery. And no possibility
of death.
24 hours later, the cat had no runny left nostril. I did
not expect such drastic improvement. He went home on Day
3 with Baytril antibiotics. He had no problem with runny
nose and was eating well. Lab reports indicate he had
cancer - malignant cellular infiltrate with a
differential diagnosis including malignant melanoma. I
advised surgical excision but the father wanted to wait
and see.
LAB REPORT. Cat, M, 6 years. Soft tissue lesion, near
muscle. MALIGNANT CELLULAR INFILTRATE. Different
diagnosis includes malignant lymphoma, malignant
melanoma, carcinoma or sarcoma. Immunostains needed to
delineate and type the tumour.
CONCLUSION.
A biopsy is important in growths. A CT scan of $1,500 is
too costly for most cat owners. In chronic sinusitis as
suspected in this case, a gram stain, a fungal and
anaerobic culture would be good but these were not done
as the cat had been on antibiotic in the past 10 days.
There was a budget from the owner.
a diagnosis and a cure. Another round
of antibiotics will not make him happy. Do a biopsy. Lab report says it is
a malignant cellular infiltrate. It is possibly a malignant melanoma
P.S Metronidazole
IV may be effective in this case when combined with
Baytril. As there was no bacterial culture done, it was
hard to say what caused the blood sneezing and nose
discharge. Metronidazole is effective against anaerobic
bacteria (unique anaerobic bactericidal activity). It
seldom cause the pseudomembranous colitis sometimes
associated with the use of clindamycin. Metronidazole is
said to be potentially mutagenic (likely to cause
cancer), but short-term use has not been shown to cause
cancer.
TOA
PAYOH VETS
