Let’s Chat! Edition #3
Symptoms: labored breathing, hiding, crackly skin
It’s not uncommon for people to ask me questions about their cats (and dogs). I make it clear that I love animals and that I am happy to talk about their pet’s well-being. This is the essence of why I wanted to start a website about cats, to help cat parents care for their best-friends with confidence.
The conversation below has been modified to remove personal information. The cat’s name has been changed, but the general information is unchanged. If you choose to comment, please keep your comments kind. All unkind, rude, or unhelpful comments will not be published.
Here’s how a recent conversation went:
Cat-Daddy: There’s something wrong with Jewel.
Me: What’s going on?
Cat-Daddy: She’s breathing really weird and hiding. I took her to the vet at about 5pm, he said there wasn’t anything he could see. He gave her a steroid shot and told us to bring her back in a couple of days. They were closing, but he gave her a good checkup.
Me: Is she worse? (9pm)
Cat-Daddy: Her breathing is getting worse and she is foaming at the mouth…and her skin, it’s like popcorn, crackly, right where they gave her the shot.
Me: Crackly? Like there is air under her skin? That’s weird, did they do anything else to her? Give her fluids? Did they take her away from you at any time? Usually that subcutaneous emphysema comes from a really big injury of some sort, like punctured lung, or I once saw a rabbit that was picked up by a hawk and its skin was pulled away from its body that had that.
Cat-Daddy: No, she was with us the whole time, except the x-ray, and she only got the steroid shot. I will be so mad if the shot did something to her.
Me: Her skin wasn’t like that when you took her in?
Cat-Daddy: No, not at all.
Me: That’s so weird, that shouldn’t have happened just from a steroid shot.
My mind was racing at this time, “could a steroid shot cause skin separation like this?”, I thought. “Whatever, it doesn’t matter, she is having trouble breathing”. I asked my friend to call me back through face-time so that I could look at her. She was doing very heavy abdominal breathing and had drool all around her mouth. She was clearly in distress. I offered to go by their house to look at her, but ultimately I didn’t think it would do much, and urged them to go to an emergency veterinarian that evening. I know they would have gone to an emergency vet even without this conversation because they are exceptionally concerned kitty parents, but they wanted to get the opinion of someone that might have insight before jumping to conclusions. They had, after all just been to the vet a few hours earlier and were told to return a couple of days later.
My dear friends had to put their sweet fur-baby to sleep that night. In an x-ray that night the vet saw that her skin was full of air, leaking from an unknown area inside of her. The veterinarian gave them the option to open Jewel to try to find and fix the leak, but with her age, the outcome might not be good. Since this happened suddenly without injury, the leak likely emerged from an area of weakness, which would be difficult to repair and could have resulted from a small tumor that was not seen in the x-rays.
While I understand that the original veterinarian took the time to do an x-ray and a physical exam at the end of their work day, I get the feeling that the appointment might have been a little rushed because my friend arrived at closing. A cat that is doing abdominal breathing is always something that needs to monitored carefully. Cats do not breath heavily without reason. My friend was never instructed on the potential severity of the situation. They should have been given the option to go to an emergency veterinarian for monitoring, or told that they should take her to the emergency veterinarian if her condition worsened. Had my friend not taken Jewel in she would likely have died overnight and suffered horribly in the process, suffocating because of the pressure of the air accumulating under her skin. That said, hindsight is always 20/20. There was little the veterinarian could have done beyond taking more time to educate my friend. I do want to defend the veterinarian against my own bias here, my friend says that the veterinarian has been very good to them over the years, and always provides excellent care. The thing to remember is that we are all humans, and even doctors make mistakes.
In these situations one thing I want any pet-parent to know is that you can ask questions. You can be considerate and mindful of your veterinarian’s time and still ask, “what if it gets worse”. While the healthcare professional should have taken the time to say something about it, we are all human, we all get tired and at the end of the day may not be fully focused on what is at hand. You must advocate for your fur-baby’s well being. That one question could have been answered in less than two minutes, and would have reminded the veterinarian that they weren’t looking at a skin rash level problem, but rather a symptom that should be addressed with extra care.
My friend and his wife were kind enough to share the x-rays of their cat with me to share with you. Trigger warning: please be aware that the second image is rather graphic, you may not want to look at if you are sensitive to medical images.
Hindsight is always 20/20, but the first signs of subcutaneous emphysema are showing in the area at the back of the neck (little red arrows) in the first image that was taken just hours before the second image. The air displays dark, just like the air around Jewel’s body. Her skin (the bright white outline) is just staring separating from the internal mass of her body as the air leaked into her body. Had this been noticed, it would have been apparent that there was something severely wrong. The first veterinarian was likely focused on her internal organs and missed the much less obvious air under her skin.
In the second image her skin has filled with substantially more air, and is impossible to miss. It pains me to see these sorts of images as I understand how much distress an animal can be in when in this condition. In my totally non-doctor opinion, noticing the subcutaneous emphysema in the first x-ray would not have saved her life, but she could have been sent to an ER for monitoring.
I am very proud of my friends for taking sweet Jewel’s condition seriously, and taking her to the emergency vet when they noticed her condition worsening. If you do not have someone with animal health experience to call, or maybe the advice someone like me doesn’t feel quite right, get a second opinion. Had my friends not been able to call me, I am sure they would have called an emergency veterinarian to assess the situation.
Everyone has a different perspective on how they should care for pets. I am not here to judge how anyone chooses to approach it. I hope that if you and your cat are facing a health challenge that this conversation gives you some insight into your cat’s experience and how you might handle it.
My best to you and your fuzzy friend.