Thursday, September 2, 2010

Down in the Mouth

My associate Tina Waltke examined an 8 year old cat with decreased appetite and weight loss. It turns out that the cat has some kind of growth in its mouth, on the right lower side, on the tongue side of the lower back teeth. She admitted the cat to our hospital so that I could biopsy it. I got the biopsy back. I should have results soon. I’m worried, though. Oral things in cats tend to be bad. My first inclination is to think that this is a squamous cell carcinoma, a really devastating oral tumor in cats. But this doesn’t have the classic appearance. Squamous cell carcinomas tend to be pretty invasive, and this one seems more proliferative than invasive. This is a relatively young cat. I really hope it’s something benign, something treatable. If it’s a squamous cell carcinoma, there really is no treatment. It would be the demise of the cat, and in an 8-year old cat, that would be really tragic.

It’s that time of year for the allergics and the asthmatics. Half my cases are allergic skin disease, or allergic lung disease these days. The allergic skin disease is easy enough. The allergic lung disease is a challenge. Any time a coughing cat comes in, it can be a challenge. Here’s why:

The most common reason for a cat to cough is asthma, which is allergic bronchitis. But…it is also possible for a coughing cat to have infectious bronchitis as well. If you take an x-ray, you may see a pattern that fits with bronchitis, but you really cannot tell whether it is allergic or infectious. The way you can truly distinguish is to do a procedure called a tracheal wash, where you sedate the cat, squirt sterile fluid down into the lungs, retrieve the fluid, and send it out for culture and for microscopic examination. If there are a lot of neutrophils in the fluid, it’s probably infectious, because neutrophils are the cells that fight off infection. If you find a lot of eosinophils, then it’s probably allergic, because eosinophils are often seen in allergic reactions. Even better is to do bronchoscopy, where the cat is anesthetized, and a bronchoscope (a long tube with a camera at the end) is inserted down the trachea and into the lungs, allowing you to visualize the air passages and obtains samples. These procedures, however, require anesthesia and can be pretty costly. Instead, it’s reasonable to run a simple blood test called a complete blood count, and if you find a lot of eosinophils circulating in the bloodstream, it supports the idea that this is allergic. Often, though, the complete blood count is normal, and provides no helpful information. So what do we do? How do we treat?

If you treat as if it is infectious (i.e. give antibiotics), and it’s really allergic, the cat won’t get better, but it won’t get worse. If you treat as if it is allergic (i.e. give steroids) and it’s infectious, it could get worse, because steroids suppress the immune system, and infectious things can get worse when you suppress the immune system. What I do is: treat with antibiotics for two or three weeks. If the cat is not significantly improved after three weeks, you probably are dealing with asthma. At that point, I prescribe steroids and watch the cat closely. More often than not, the cat gets dramatically better. I’ve been doing this all throughout August and now again, in September. There must be something in this geographic region that is in bloom that is driving cats crazy.
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