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Feline Nasopharyngeal Stenosis

Friday: February 16, 2018

This is a more personal post rather than anthropological, but today I was reminded why I love my science education so much. Though it mainly dealt with bones and teeth (human skeletons) with very little focus on soft tissues (living or recently dead people), it gave me a wonderful understanding of anatomy in general and along the way, through interests I gained in my studies, I’ve picked up medical terminology here and there. And all tetrapods have the same basic body plans, and mammals are even more similar, so my knowledge of human anatomy aligns well with, say, cats.

So, when we picked up my Maya cat today from a teaching hospital where the doctors are heavily steeped in teaching science as their focus more so than dealing with the general public, I can say I understood 99% of their jargon (I didn’t see any attempt at all to speak in layman’s terms).

Maya’s always done maybe one or two “reverse sneezes” for years and within the last year she started to do it more often and added some snorty sounds here and there. Changing her position helped, it seemed. In the last couple months, though, she had developed further into pretty much non-stop wet and snorty, whistley, snoring sounds and nothing made the noise stop; she also couldn’t sleep well, purr well, or eat and drink well. We’ve taken her to several docs, and her treatment included steroids, antibiotics, and allergy pills. None of which really seemed to help and some of which had negative side effects (steroids particularly make her dehydrated and she’s always at a risk of that without the help!). Everyone agreed though: something was up with her nose and none of them had the tools to truly diagnose it.

Well, Maya had a scary episode over the weekend which seemed like hyperventilation (rapid fire “reverse sneezing”) followed by puking a lot so we took her to the ER vet (twice). The first time, she had of course stopped and everything checked out well so they sent us home to monitor her expecting it to have been a one time thing. Instead, it was non-stop after I got her home so they then gave her an anti-nausea shot to break the puking cycle, steroids to reduce possible inflammation, and 100ml of fluid to correct her dehydration.

To get a sense of what she was like, this is a less severe cat experiencing what looks to me like exactly the same thing (but without the puke aftermath and not nearly for as long): Cat Reverse Sneeze – skip to about the 40 second mark. I want to be clear though – we brought videos to the vet and they could not diagnose her without actually looking; many issues could cause this type of behavior so if your cat is doing this, don’t automatically assume it is caused by the same thing. Now, I would suggest skipping all the visits with steroids, antibiotics, and allergy medicines from an uncertain vet and go straight to a vet with scoping and imaging. It would have saved us a lot of money and also rectified her issue so much sooner.

Anyway, we dropped her off at the Purdue Small Animal Hospital Wednesday. Her preliminary work showed she has excellent kidneys (yay!) and everything else was a-ok except she doesn’t weigh as much as she should (we’ve noticed) and her globulin and one liver enzyme levels were mildly high, indicating perhaps inflammation. She was also still dehydrated so they gave her some fluids. Her initial x-rays showed her lungs being a little hyper-inflated, meaning she is straining to breathe and she had some gas in her stomach and small intestine (probably from swallowing post-nasal drip, we now think).

Thursday, they put her under and did a CT scan followed by a rhinoscopy to look inside her nose. This was in conjunction with the radiology/oncology department that fitted her in a special mask to be able to do measurements and whatnot should there be a tumor. Phew, there wasn’t!

They noticed her nose was filled up with mucus. She has never had nasal drainage so it must all be creating post-nasal drip. Here’s a before photo which shows the clear snot (with air bubbles) and a mucus booger plugging her airway (when you see her next photo, you’ll see how blatantly problematic that was!). So, they essentially gave her a neti pot cleanse, collecting the goo to ship off for lab work (testing for a bacterial or fungal infection). It is likely that her Saturday event was an attempt to get the booger outta the way (and her physical stress of attempting to do so upset her gag reflux). Her constant dehydration is likely a result from mouth-breathing. Though it is sometimes apparent, it seems she does it more than we assumed!

After the cleanse, she was diagnosed with nasopharyngeal stenosis. You can see that here plain as day. You’re looking at the hole that connects the airway in the nose to the throat (the nasopharynx). It should be “peanut” shaped and be maybe something like a third of the width of this image. All her soft tissue should also be a happy healthy pink, but hers is pale. This is the stenosis diagnosis. Like any tissue in the body, agitation prompts it either to grow or to recede. Her soft tissue had been agitated enough over the years that it began to grow, scarring over (the paleness). This means it is tougher than normal (not as soft and stretchy), and obviously now greatly obstructing the airway.

To compare, I could not find a photo of a healthy cat airway, but here is one for a dog from Vetfolio. The only difference really would be overall size but the proportions are about the same:

So what’s the solution? It isn’t as easy as a polyp which can simply be plucked out, but we are super grateful it isn’t complicated like a tumor crushing her bone. It is in the middle, where it is a chronic condition that will get worse over time. What we can do is have them perform a balloon dilation – they put her under again, wedge a balloon in the hole and stretch it out a bit, then remove it and wake her up. They were going to do that the same day but her body temperature started to fall so they chose instead to wake her up rather than risk anesthesia complications.

The prognosis is good, except for the crucial fact that many cats need to do that two or three times. A) She is an older cat so that worries me (being put under is always a risk, but the older the higher that is), and B) it isn’t a cheap procedure. Cost isn’t prohibitive with how much we love her, but the thing is, the procedures might have to be done literally one month apart. With a couple grand already spent and at a couple grand each for the ballooning, this is not something we can do tomorrow :/

I can report that except a diarrhea run in the middle of our lengthy ride home with a prompt bath when we got back, she’s napping so peacefully right now on her little heated pad with upside-down Sasha. Not a peep is coming out of her nose, and no air is puffing out of her cheeks. She was sneezing a bit and had some clear drainage coming out of her nose but we expect all that to be cleared up within 24 hours. And she now eats like a hauss:)

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