Animal medicine is fun. While we do still catch some of the same things that human doctors get (pun intended) such as being a psychologist and hearing all about family woes, past illnesses, and other pets, there are definite bonuses to being an animal doctor. (Oh, and as previously alluded to in another post, yes, we do get asked to diagnose people illnesses.) One of the bonuses from my perspective is the often unexpected things that these little guys will toss our way.
I have been treating a cat with a pyothorax since last Monday. For those of you non-medical types, pyothorax is the doctor word for pus in the chest. So basically, the cat had an abscess inside his chest. It was lovely. Disgusting, chunky, stinky goo that I tapped from the chest first using a needle then we placed a chest tube so that I could drain it more often and flush it out. (Yes, I do have the usual female veterinarian fascination with abscesses. Not to say that men don't ever have that fascination but it seems to usually be a female thing. I have no explanation for that...)
The most common cause of pyothorax in a cat is a fight wound. This is likely in my little guy since he is a semi-feral kitten that was outdoors and just recently has become tame enough to handle. Pyothorax can go bad (VERY BAD!!!) because cats like to wall things off with fibrin which is a tough, collagen-like material that then stops the lungs and chest from expanding normally. This can be a permanent change leaving a cat that cannot breathe normally for the rest of its life.
Typical treatment of abscesses include flushing and draining, obviously not an easy thing when dealing with the inside of the chest. This is also apparently one of those "in vogue" types of therapies, also. By this I mean that we see therapies and diagnostic modalities go in and out of favor through the years in medicine. Flushing with sterile saline +/- heparin was originally used then became less commonly accepted and is now back in favor. The use of heparin would be to try to break down and prevent the formation of the fibrin. We chose to try this therapy since after removing 160ml of fluid the x-rays looked about the same as before although he was breathing better. This made us worry that he may have had a problem before anyone realized and may have had a lot of fibrin already.
We started antibiotics and flushing/draining the chest. He began to improve almost immediately although he had a raging fever (105.7F) the first night. After that, he began to eat and feel much better quickly. My original plan was to keep him on intravenous antibiotics for a week (so that I could be certain he received a complete dose) and to leave the tube in place for a week (to allow a window for reassessment of the fluid as well as draining the fluid). It would seem that the cat had other plans...
This morning we were unable to get the fluid back that we had put in to flush (a mere 34ml). We took another x-ray (unplanned) and found that the chest looked great. Clinically, the cat looked wonderful. We then discovered that the IV catheter was blown as well meaning we could not give the antibiotics through the vein without placing a new catheter. As so often happens, we then altered our treatment plan entirely based on the whim of a cat. We pulled his chest tube and IV catheter and switched to oral antibiotics. He's a much happier kitty now without the tube and IV lines. I think he was just making the statement that he is ready to go home! So, assuming there are no complications we will send him home. His owners can't pick up until Monday (out of town tomorrow) but I think Socks will be okay with that...or he could just make change in his little world again!
1 day ago