The $400 Blade of Grass and Other Surprises

Years ago a senior-aged female indoor-outdoor kitty (let's call her Claire) was brought to the veterinary clinic where I worked because she had recently begun sneezing and gagging. Her breathing was ragged and she was reluctant to eat. She looked absolutely miserable. Her examination suggested a upper respiratory infection possibly with secondary pneumonia. It was clear she had an infection, but her symptoms were strangely severe and sudden. 

Because Claire spent time outside unsupervised, we checked to make sure she hadn't been exposed to two important feline viruses -- feline immunodeficiency virus (FIV) and feline leukemia virus (FeLV) -- which can lower the immune system causing various symptoms of illness including a common cold. Some FeLV+ and/or FIV+ cats live their entire lives without being ravaged by the effects of these contagious viruses, while others succumb to secondary infections or cancer. Fortunately, Claire tested negative for exposure to these viruses.

Next we ran comprehensive blood work on Claire. In cats, organ disease such as kidney or liver failure can compromise the immune system enough to cause symptoms of a cold. Cats often hide early symptoms of organ dysfunction, perhaps just vomiting periodically, and then are presented to their veterinarian "suddenly" very sick when their body can't compensate for the changes any longer. Happily, Claire's blood work showed no evidence of kidney or liver failure. Her electrolytes were mildly abnormal, probably owing to her reluctance to eat and drink. But surprisingly her white blood cell count was not out of whack as expected with an infection of the magnitude suggested clinically.

Desperate for clues, screening chest and abdominal radiographs (a.k.a x-rays) where taken, but they showed nothing beyond some mild aging changes. Claire was now breathing with her mouth open and drooling, a terrible finding in a sick feline. Our options included starting supportive care and antibiotics while adopting a "watch and see" approach, or sedating Claire for a look in the back of her throat. At this point, I feared an obstructive tumor or polyp in the back of her throat or near her vocal cords, but Claire was not allowing a good look. More than anything, Claire's owners wanted an answer. Anesthesia on a sick animal is risky, especially one that appears to be going downhill, but we had exhausted on Claire all other diagnostic methods readily available.

While Claire was sedated, I quickly evaluated her oral cavity (normal), epiglottis and vocal cords (normal) and probed around under her soft palate. Ah-ha! Something unexpected... something green and covered in phlegm was tucked up behind her soft palate. Gently I grasped the green foreign object with forceps and pulled it out. It was instantly obvious to the little crowd of astounded veterinary staff gathered around Claire that a blade of grass--a wide sturdy blade of crab grass--was the culprit. I found no tumors or abscesses or other problems in Claire's throat. She woke up quickly, and her relief at having the offending foreign body removed was immediate and obvious!

This winter, I was plagued by a similarly confounding case. A young spaniel named Trixie* appeared to have stepped on something buried in the snow and was limping on her front leg. A tiny healing scab was found on the bottom of her paw. A radiograph showed nothing but a little gas in the tissue between her toes, consistent with infection trapped under the skin. Antibiotic and anti-inflammatory therapy helped a little, but then Trixie's  foot would blow up with blister-like abscesses and bleed. We cultured the discharge to make sure our antibiotic choice was appropriate (it was), and checked a sample under the microscope to determine if there was a more insidious cause for the unrelenting swelling like cancer (it wasn't). Because Trixie wasn't getting any better, we debated exploratory surgery on her foot and removal of the blisters for testing. Surgery on feet and toes can be awful because there is no loose skin left to close the wound; therefore, diligent aftercare is required on the part of the owners. 

A post-operative photo of Trixie's paw with a
 drain in place. Note the size of the thorn
compared to a penny! Next to the thorn is a fleck
of thorn material similar to what the owners
noticed at home.

One day Trixie's owners noticed a fleck of black foreign material oozing from between her toes and we bit the bullet on surgery. As I cut into the blisters, a small amount of pus and a lot of scar tissue met my scalpel blade. Another fleck of black material oozed out. I dug deeper and suddenly bumped into a firm black object. I grasped a visible portion with a forceps and pulled. And pulled. And pulled! Finally, a thorn the size of a small twig emerged! Trixie is now recuperating from surgery, and our biggest challenge will be keeping her quiet long enough to allow the wound to heal. 

All medical cases are puzzles that beg to be solved. Some are simple wooden cutouts easily fixed, but some are 1000-piece photomosaic jigsaws of dizzying complexity that take a lot of time and persistence to put together. Working through cases like Claire’s and Trixie’s can be frustrating but the results are incredibly satisfying and unforgettable.

* Name changed to protect privacy.