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Page 1 of 2 Cat Tails
Marmalade's Story
Marmalade is truly that, a sweet orange tabby with a mildly apprehensive personality. He loves laps and can snuggle forever. He just doesn't like it when the snuggle ends. Marmalade is also just a little wary of strangers now, never sure of what is going happen even on a friendly approach. But once he knows you, he is loving, communicative and gentle.
In October 2006, Marmalade was found by his owners in the alleyway, open mouth breathing, stretched out and he had urinated where he lay. He did get up eventually, and made his way home. I saw him a week later, because he was not eating. When I saw him, he was significantly dehydrated, emaciated, and painful around his belly. His right  kidney was around three times its normal size. His nails were all intact, so I guessed that he had not been hit by a car, but may have experienced other trauma or been poisoned. I recommended IV fluids to rehydrate him, and basic diagnostics to figure out what happened - radiographs and bloodwork. This was declined, and he went home with only a dose of subcutaneous fluids in the hope it would help him at least a little bit.
The next day he was brought back in, and started on IV fluids. Radiographs showed a diaphragmatic hernia - a huge tear in the diaphragm, that partition of muscle and connective tissue that separates the chest cavity from the abdominal cavity. It appeared that his liver at least was in his chest cavity, and the right lung was collapsed. His right kidney was enormous, and he still had some blood in his urine.
Surgeons today suggest that repair of a diaphragmatic hernia is not done immediately - that we wait for the patient to stabilise first. This is about a week, and Marmalade's injury had been a week before I saw him. However he was still dehydrated, hungry, mildly cyanotic despite breathing normally, and guarding his bruised belly. We fed him only canned food in multiple small meals, because if the stomach or intestine gets trapped in the chest and its blood supply cut off, the cat could die very quickly. Marmalade responded very well to IV fluids, IV antibiotics, pain control and food. Within a day we were starting to discuss surgery to repair the injury.
I had never done this surgery in a cat before, and it would require a skilled anaesthetist, because as soon as the surgeon cuts into the abdominal cavity, the chest is open and the lungs collapse from the inrushing air. So the cat would need assistance to breathe, and just giving oxygen and noting that his chest wall was moving is not enough (that is a reflex), the anaesthetist would have to literally breathe for the cat, giving gentle positive pressure ventilation so as not to cause additional damage to the lungs. Then after the surgery, the cat would have to be closely monitored on oxygen because his lungs could suffer so much inflammation from being collapsed and re-expanded that he could die from that complication within the first three days. The entrapped abdominal organs would also suffer reperfusion injury, and occasionally the parts that have died from lack of blood supply may have to be removed. So this is a detailed and tricky surgery to attempt. Marmalade's best chance of survival was referral to board-certified veterinary surgeons who do this kind of thing all the time, and in a specialist-equipped referral veterinary hospital.
Marmalade's owner was in another part of the country, and his parents were looking after his cats. We tried to balance communication between everyone, but the one difficulty was becoming apparent - no money available to do the surgery. Marmalade's chances of survival because of sudden decompensation due to organ entrapment, large blood vessel rupture and adhesion formation were somewhat limited, even though by the time he had been with us for four days he looked almost "normal" to the untrained eye. At that point he was eating well, but could not move a few steps without turning a little blue because his squashed lungs could not supply enough oxygen to his body. As young cats do, he was trying to heal. When it became apparent that Marmalade was simply going to be discharged from us and left to take his chances, the option of surrender was offered. Marmalade became my cat.
I did his surgery the next week with the assistance of Caroline, our veterinary technician who is really a fully-qualified veterinarian from the Philippines. She was responsible for the anaesthetic. It was pretty scary stuff but all the preparation I did the week before really helped. I thought my way through every step of the surgery and peri-operative anaesthesia several times. That morning, I placed his x-rays upside down on the x-ray viewer in the OR - because he would be lying on his back. I figured out which side the tear would be on, based on the x-rays, and which side of the table I needed to be to best handle the organs and instruments. We set up surgery, turned on the heated surgery table, warmed countless towels and hot packs; and set out apparently endless surgery packs and drape sets.
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