**Warning: there are actual surgery pictures posted in this blog. content may not be appropriate for all audiences
As a veterinarian, getting to a diagnosis can be much like playing detective. One of our biggest obstacles is that our patients can’t talk to us. So we try to piece together the diagnosis using all the tools available. Today, I’m going to share with you, Rosko’s story and the “tools” we used to diagnose and treat him.
Rosko is a young, friendly cat who lives with his family. Rosko started vomiting multiple times over the last couple days and wasn’t eating as much. His owners were concerned about Rosko so they took him to North Lake Veterinary.
#1 The History: I met Rosko and his family and quizzed them on Rosko’s history. I was told that Rosko was an indoor cat with no known history of getting into anything he shouldn’t eat and who had otherwise been very healthy. I obtained details about his vomiting and other bodily functions.
#2 The Exam: I conducted a full examination on Rosko and by doing so was able to rule out a number of possibilities just from the exam, but I still didn’t have a diagnosis.
#3 The Signalment: this refers to Rosko’s age, sex and breed. In young cats certain differentials (or possible diagnoses) are more common than in older cats and visa versa. Same goes for the sex of a patient- male cats may be more prone to certain problems than females and visa versa.
#4 Diagnostics: As a veterinarian I have access to a number of diagnostics such as blood work, x-rays, ultrasound, urine and stool tests, to help me when I haven’t gotten the diagnosis just from the tools above. By using the history, exam and signalment, I can narrow down my wide array of available diagnostics to pick the tests that may be the most fruitful.
I explained to Rosko’s owner that I understood there was no history of him eating anything but at with his young age and with his symptoms, the first diagnostic I wanted to perform was an x-ray. His owner okayed an x-ray, again re-affirming that she didn’t think he would eat anything but acknowledging that anything was possible.
From the x-rays we could tell that Rosko had eaten a foreign object and we suspected it was a dime. We also could tell from taking multiple x-rays from different angles (different views) that the dime was in his intestine and would need to be removed.
Rosko was scheduled for surgery. Blood was drawn to help find out more about Rosko’s condition before we put him under anesthesia. We want to make sure a pet is as stable as possible before we anesthetize them and blood work helps alert us to any potential complications. (I highly recommend having blood work done before any anesthetic event regardless of the age of the pet). For example, if Rosko’s electrolytes were abnormal we can correct that by giving him certain fluid therapies. If Rosko had a high white blood cell count, that can alert us to an infection and we can start an antibiotic right away. Fortunately Rosko’s blood results looked normal.
Before surgery, an intravenous catheter was placed in Rosko’s arm and he was started on intravenous (IV) fluids to hydrate him fully, help keep his blood pressure up during anesthesia, and allow us access to his vein if we needed to administer further medications.
Rosko’s Exploratory Surgery:
Rosko was anesthetized and his belly was clipped and scrubbed. This is a picture of me draping him to help keep everything sterile. I then made an incision into Rosko’s abdomen and palpated Rosko’s stomach and intestines.
In the middle of his duodenum (part of his intestine) I could feel a hard object. Fortunately there were no perforations and Rosko’s intestine otherwise looked good. By making a small incision into Rosko’s intestine I was able to recover a dime!
I then sutured Rosko’s intestine closed, tested this area to make sure there was no leaking, and returned Rosko’s intestine into his abdomen.
Rosko recovered from anesthesia very well. He went to the emergency hospital to be monitored overnight and then went home the following day. Rosko returned to North Lake Veterinary to have his stitches removed about 2 weeks after his surgery. His owners report he is back to his normal self with no more vomiting!
Morals of the story:
1. Don’t wait to come to the vet if your pet is acting abnormal. If Rosko’s owners hadn’t noticed Rosko’s vomiting and gotten him to the vet, the dime could have perforated through his intestine and a perforated intestine is usually deadly.
2. Expect the unexpected. Pets can be unpredictable. Even a cat, like Rosko, who had never eaten anything abnormal in his life can swallow a dime.
3. Try to keep string, yarn and foreign material away from your cat. But again, even with the best of vigilance they can find things you would never predict.
Thanks to Rosko’s family for letting us share his story!