My patients, My life

In this first chapter of A Tale of Two Kitties, I would like to introduce my readers to Dusty the cat. Dusty is a fighter in every sense of the word. His story is one that I hope you will enjoy. It is a tale of the incredible resilience and downright tenacity of a common cat. I hope that Dusty becomes as memorable to you as he is to us at Shepherd Spring Animal Hospital.

This young kitty, Dusty, resides down the coast, in a quaint seaside town called Carabelle.  He is more than familiar with life on the streets and throughout his relatively short life of 3 years he has had to fend for himself, undoubtedly, on many occasions. 

In one of his more recent brushes with the law of natural selection, Dusty found it necessary to mix it up with an equally savvy creature of the street that, unfortunately, bested his own weight by about forty pounds.  Indeed, Dusty made a miscalculation in allowing his mouth to write a check that his scrawny little butt could never cover. He called out a street wise dog over some silly territorial issue that both should have left alone.

A couple of hisses and some initial spitting at this dog signaled that any hope for diplomacy had been flushed down the storm drain that Dusty called home. In an effort to make his first blow his best, Dusty buried ten well sharpened claws into the face of the dog that would not back down. 

The big problem for Dusty was that the dog had procured a vice like grip on this little kitty’s throat at the same time all this facial stabbing was taking place.

It was precisely at this point that both parties rethought the benefits that peaceful negotiation might offer this stalemate. The street dog released his grip on Dusty’s throat in order to make the verbal point that those were, indeed, the longest and sharpest claws in recent memory.

In a reciprocal move toward reconciliation, Dusty kindly resheathed his ten sabers. No doubt this act was encouraged by the fact that breathing was becoming increasingly difficult with his windpipe firmly ensconced in the jaws of an angry dog.

That was all there was to it. Both sides claimed victory (don’t they always?) and retired to lick their wounds.  The dog undoubtedly developed multiple facial abscesses and Dusty’s fate was to meet a veterinarian down the coast named Norm about 2 weeks later.

Several days later Dusty made an appearance at one of his food stops along his route and a kind soul named Mary noticed that he wasn’t himself.  After a couple of days of well intended medical attention to an upper respiratory infection, Mary loaded Dusty in a kitty carrier to transport him to our clinic. 

An hour later, as we sized one another up I pretty much pegged Dusty as a good kitty with a respiratory infection.  He had a nasal discharge and a fever but was still eating as reported by his caregiver Mary. The wounds on his neck from the bite were not evident and I really didn’t have cause to believe that this was not just another street cat with a URI (upper respiratory infection).  There was, however, a strange “rattle” to his respirations.

I explained to Mary my plan to start him on a round of antibiotics and see if that didn’t help before we spent any more money than necessary. She quickly agreed with the plan but said that no human could give Dusty oral medication.  She had claw marks on her hands to make her point.  I fixed her up with at handful of syringes of injectable antibiotics that she was sure she could administer to this needy cat.

We spoke a few days later and she was happy to share that Dusty was better and all things pointed toward a complete recovery.  As the reader could guess, I wouldn’t be telling this story if that was how it ended.

About a week later Mary called and said that Dusty had taken a sudden turn for the worst and that I needed to see him as soon as I could.  We set up an afternoon appointment that same day and soon I was again visiting with this battle torn kitty.  Dusty sat hunkered down on the exam table, mouth open, gasping for every fraction of a breath. His gums had a distinct blue tint to them indicating that his tissues were starved for oxygen. Dusty wasn’t just critical, he had three of his fuzzy paws in the grave and the other paw on a banana peel.  We carefully and quietly carried him back for x-rays. 

It was obvious to me that Dusty had obstructive airway problems.  It is very strange for this to occur in a cat.  Dogs get toys and balls stuck in their larynx or damage their tracheas with collars or choke chains but cats just don’t participate in that sort of nonsense. I was scratching my head to make sense of what I was seeing and hearing.

As soon as the radiograph popped up on the computer screen my jaw dropped.  There was an obvious obstruction in his trachea near the base of his neck.  Without more of an idea what the heck could be the cause of the problem I considered a tumor, some freaky congenital problem and even an aspiration of some foreign body.  The bottom line, however, was that Dusty was barely clinging to life.

As I briefed his caregivers on just how critical this situation was, I wondered how in the world I could ever hope to anesthetize Dusty in order to surgically explore his tracheal obstruction.  If I gave him an anesthetic injection to induce anesthesia he would no longer have the strength to breathe around the problem.  If I placed an endotracheal tube (a plastic tube through which to breath, which is inserted down the trachea during surgical procedures) upon anesthetic induction, there appeared to be a great chance the tube would not be able to pass the obstruction to get air into his lungs. If it were a foreign body in his trachea I would possibly push it into his chest and lose any chance of reaching it surgically in time to save his life.

Mary and her husband blessed my next move whatever it was and said that, no matter what happened, they knew I would do my best.  At that point I had appointments scheduled for the next hour and a half.  I hoped Dusty would settle into his quiet, dark cage and buy some time for me while I attended my appointments.

 Some things just don’t work out.

While examining my next patient, my tech and I made eye contact across the exam table as we both heard a loud thump coming from the cages where Dusty had been placed. I excused myself and we quickly darted to the back to see what we had heard. 

Dusty lay prostrate in the bottom of his cage.  There was not so much as a twitch anywhere on his body as I snatched open his cage door.  He had valiantly hung on as long as he could and with one final muscle spasm Dusty leaped into the “light”.  I stroked his motionless body and silently thought that his suffering was finally over.

As I cradled his lifeless body in my arms, I felt his chest and found a slight fluttering heartbeat.  His heart muscle was still trying to function with the last remnants of oxygen in his bloodstream. It had not yet given up.

I looked at Kathy and stated in a matter of fact tone that we had exactly 2 minutes to get oxygen to this heart and we had already wasted 30 seconds. 

An emergency tracheotomy is the stuff of E.R. shows on television.  In the real world of veterinary medicine, extremely rare is the occasion where such a procedure would be indicated. Today was apparently my day to get to run where few are ever afforded the chance to step.

In a truly, time critical event such as this, the rules for surgery change rather drastically.

First, we don’t need to worry about anesthesia in a patient that, for all intents, is dead. The dead really don’t care what you do, one way or another. Second, no time or need to concern oneself with sterile surgical technique as, again, dead patients don’t get infections that require treatment. Seconds wasted doing a surgical prep would make it all a moot point.

In about 15 seconds, performing like a well rehearsed dance team, we had Dusty tied upside down and stretched out on the surgery table. I wet his neck down with alcohol, grabbed a scalpel blade and a pair of operating scissors. I still had at least 45 seconds I figured. 

I made a one and a half-inch incision down the midline of his neck over where I remembered the obstruction to be on the previous x-ray.  I split the muscles overlying the trachea and with a precious few seconds remaining I was elated to see the problem square in the middle of my surgery site.  The cartilage rings of his trachea had been crushed in an area about ¼ inch long. As healing had occurred, the wounded tissue contracted and slowly collapsed that area of his airway.  I placed my scissors without fanfare just behind the obstruction and with one big snip severed his trachea about ¾ of the way around its circumference.

What happened next makes me smile, even now, weeks later as I write these words. With my fingers, I elevated the

Dusty, the day his sutures were removed.

partially severed windpipe thereby spreading the opening that I had just created.  As the incision widened, I heard the life-giving rush of air being sucked into Dusty’s lungs.  He immediately exhaled, then inhaled again and I knew we had just  saved his bacon. I got downright giddy.

My moment of surgical triumph was interrupted by the realization that the “dead” cat of 2 minutes before was stretched out on my surgery table about to rejoin the conscious world of the living.  The problem with that, of course, was the small fact that he was still in the middle of, what had just become,  a very involved surgical procedure and was decidedly lacking in the anesthesia needed to, at least, keep him in the same room with the surgical team.

I opened the drawer, grabbed a cat sized endotracheal tube and inserted it into the severed end of his trachea and inflated the cuff to form an airtight seal to his lungs.  I then hooked him up to a flow of pure oxygen and turned on the anesthetic machine.  I managed to get him anesthetized before he fully regained consciousness and we started to prepare him for the reconstruction of his damaged airway. 

I left the surgery, washed my hands and walked back into the exam room with my previous patient.  My client, after a careful assessment of my frazzled expression,  asked if I found what made the thump that I had rushed out of the room to investigate.  I told him the story of where I had been for the previous 5 or so minutes and I really think he thought I was kidding.

After I finished with that client, Alison stalled the next one while I went back into surgery, with an attempt at sterile technique this time, and removed the damaged part of Dusty’s trachea and carefully reconstructed the ends back together.

I sent Dusty home the very next day.  I can’t imagine how good he must have felt to be able to breathe again after all that he had endured. He was a totally happy kitty.  Several days later he was back to have an infection at the surgery site treated.  No surprise there owing to our lack of sterile surgical technique on our initial cut down. But, as I pointed out earlier, one has to be alive to be infected. 

His local infection resolved quickly after starting a different antibiotic. Interestingly, he no longer minded having pills poked down his throat. In retrospect, it now seems obvious why he did not want anyone messing around with his throat trying to pill him when he was already having such a tough time getting air.

We removed his sutures a few days later and Dusty has since returned to normal.  As I reflect, it seems plausible that there just might be something to that whole “nine lives” thing.  No doubt Dusty is tough, tough as a nickel steak. His resilience made us look good, and made a bad day into a great day. Thanks Dusty, I am glad we met. May your life be long and your friends be many.  Come see us some time!