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Colin | 2 weeks ago
Colin To Dr. Krista : May I Pick Your Brains? Dear Dr. Krista, I’m Writing To …

Colin to Dr. Krista : May I pick your Brains?

Dear Dr. Krista,

I’m writing to ask your advice about a stray cat I found last month. See images attached.

But first I want to thank you for the polyp videos you made, which were refreshing, as well as impressive.

One of my strays was snoring, so I was eager to pluck out a polyp hiding behind his soft-palate. (He didn’t have one, but I’m gratefully alerted for the future.)

Last month I found a stunted stray ginger cat outside a 7/11 in North Thailand, where I’m a self-financed Christian missionary.

Can you help me diagnose, and treat the problem?

At first I thought it was simply FVR / Calici and chronic snuffles.
But when I opened her mouth, she had only 4 teeth in her head!

Yes, she had calici tongue-ulcers, but little sneezing, no ocular discharge, and has been eating like a horse from day one. She’s happy and bright in herself, apart from the ugly sore nose.

Her mandibular Ln were big and hard, so I put her on antibiotic tablets, with a little dexamethasone (actually 2.5mg Prednisolone tab. daily.)

Then after a week or so I sedated her, and examined her mouth more closely, no observable polyps (drat!) but one of her molars was loose and covered in calculus, so I pulled that one out, and cleaned up the remaining molar and two premolars, otherwise the poor thing would have zero teeth.

There was of course gingivitis and pharyngitis, but pink, not red like “dragon-mouthed cats” on dcf.

For the last month I’ve given her a course of floxacilin (30 days) with amoxycillin, and tried all sort of creams on her nose and lower eyelids which. as you can see, are raw and sore.

Her Ln are almost normal now, +but that nose is no better+, and she tries to rub as though it is itchy.

(I made up creams mixing; 10% flours of sulphur, betamethasone, ivermectin, and vaseline)

There’s a temporary lessening at best, but no lasting improvement.

So what is your differential for her?

In NZ where I locummed, cat leprosy was common (Mycobacterium from mice and voles) so that was my diagnosis, but the floxacillin has made no impression.

I’ve trimmed her claws and taped her fore paws to stop her making her nose raw.

I’m stuck, and thought of asking you Doc.

I’d guess she’s 3-4 years old, confident, unvaccinated, entire, lived wild all her life eating left over fast food, and possibly DCF from neighbours.

Since October I’ve been feeding her raw chicken frames, tinned sardines, vitamin syrup, and no DCF.
She loves raw chicken :), and eats whatever I put in front of her and still looks for more.

Apart from her nose you would not think she was ill in any way.

Thanks for your advice.

Colin

PS. For some reason, Depo-medrone has been taken off the market here, not even local vets can get hold of it.

Colin Melbourne English missionary in Asia
https://www.born-again-christian.org/news/
https://www.born-again-christian.org/news/ไทยคริสเตียน/
https://www.born-again-christian.info/aboutus.htm
https://www.born-again-christian.com (Asian languages)

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  1. Krista Magnifico

    Hello!
    Thank you for helping this kitty.
    I am happy to help, but a few things are important to remember; I do not know all of the local diseases to your area. We live in very different places and animals get exposed to different diseases in different places.
    Based on the history and response to treatment so far I think the antibiotic was warranted and may need to be provided every so often to manage secondary infections due to severity of the cats condition.
    I also think that there is a chance this could be one of the following:
    Infection (fungal or bacterial)
    Immune mediated (pemphigus/lupus)
    Or cancer (squamous cell, etc)

    To diagnose these you may need biopsy or cytology. I would try to resist treating without some ability to rule something out. (Steroids and fungal infections can make things worse).

    Please keep us posted. Very best of luck.
    Krista.

    1. Colin Post author

      Dear Dr. Krista,

      Thank you for your quick response 🙂

      Yes, I’m aware of the dangers of cortisone therapy, but living in the mountains, I’m limited to kitchen table surgery 🙂

      I do also liaise with a kind local lady-vet, who supplies me with whatever medicines I need.

      She too is stumped, and I’ve been here three decades plus +and never seen anything like it before.+

      I tried mixing miconazole in with the various creams I concocted, like you concerned it could be a fungal disease. But I find flours of sulphur cures both mange and ringworm here, if applied gently and persistently enough.

      Yes, the spectre of Squamous cell carcinoma looms, but she is remarkably bright and active.

      Almost no sneezing or nasal discharge.

      The “Rodent ulcers” that I’ve seen look different, and usually just the lips, and the ulcer has a thickened rolled edge: This one is different.

      +Doc., have YOU seen anything like this before?+

      I should mention, she had a lick granuloma on her hip, but that has healed now, with flea-bathing, and the steroids she’s been on. (I don’t like using fipronil, ie. “Poison your pet to poison its parasites”. Not a sound strategy.)

      Can you ask around for me please if any of your colleagues have seen a nose like that, despite over a month intensive blunderbuss therapy? Feel free to post the images on a specialised dermatology group if you know of one.

      Colin

    2. Colin Post author

      Dear Dr. Krista,

      Thank you for your comments. Your mention of locality sparked a line of new thoughts.

      Most of my vet jobs have been in the tropics (Jamaica, Arabia, Singapore etc) where venomous creatures are commonplace (Toads, insects, scorpions, spiders, centipedes, and snakes).

      I’ve seen Arabian horses lamed by a centipede bite, a rare Arabian Oryx die from a snake bite.

      One characteristic symptom I’ve noticed in cats of spider bites is intense, frantic licking of the cat’s body. It is continuous until the toxin effect subsides after a few hours, so mild sedation is called for. It’s clinically distinct from the CNS effects of agricultural toxins.

      This cat has lived around a 24 hour 7/11 shop, and the bright lights at night attract swarms of termites and beetles: Cats love eating termites, +but so do; scorpions, snakes, spiders, centipedes, and toads+ that live in drains.

      Just this week, my other strays brought two live snakes as “love gifts”, one was a harmless Tree-snake, the other a 60cm Red-necked Keelback (small, but whose venom is nonetheless as deadly as the Banded-Krait’s!) (See attached snap I took of “Chatty” offering a cute-little Keelback present to me.)

      https://thailandsnakes.com/red-necked-keelback-venomous-mildly-dangerous/

      Doctor Krista, It’s possible what we are looking at is a cat recovering from a bite, or sting, on the left nostril by a snake, scorpion, hornet, spider etc.

      I know from personal experience that such wounds provoke Type 4 cell-mediated immune responses, (cf. acute inflammatory antibody responses) and so are very slow to heal. (My neighbour was blinded in one eye by reaction to a Hornet sting.)

      With neoplasia, I’d expect this cat to be inappetent and “ill”, but she’s bright, eating well, and purring loudly by my side as I type. So I’m leaning to the insect, arachnid, snake bite, or sting idea for now.

      It’d be nice to have the luxury of lab-work and histology, if it were available and reliable, but I’m old-school trained, and content diagnosing on sensory data alone.

      I certainly considered your Pemphigus differential, but she would have responded very well to the prednisolone 2.5mg/day according to this paper and others:

      https://www.veterinary-practice.com/article/feline-pemphigus-foliaceus

      Thank you for helping me brainstorm 🙂

      I will update you on her recovery.

      Colin

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Michael | 2 years ago
We Are Reaching Out To Krista Magnifico, As New Fathers To A Seven Month-old Maine Coon …

We are reaching out to Krista Magnifico, as new fathers to a seven month-old Maine Coon named Goliath. We recently found out that Goliath has severe gingivitis and needs several teeth pulled. While doing x-rays, our vet found that Goliath also has “a large mass within the nasopharyngeal region which is most likely a nasopharyngeal polyp.” Every clinic/animal hospital that we have contacted is either well outside our budget, or will not give us an estimate of the cost of this surgery without first paying for an initial consultation, even though we have labs, notes and x-rays from our vet visits–all of which we can readily share. We found your video on youtube describing this surgery and the cost. We would be happy to arrange travel to you, but because we live in Jersey City, we hope that we could organize to do everything in one trip. Would this be feasible? And if so would you be able to share what scheduling availability you have?

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  1. Autumn

    Hello-
    Dr. Magnifico and I just recently just did a polyp search on a 9 month old Maine Coon kitty… It ended up being chronic rhinitis which took multiple rounds of anti inflammatory, antivirals and antibiotics.
    She trust Dr.Berger at Long Island Spay/Neuter… you will have to pay a consult fee no matter where you go, as this gets your foot in the door! Keep us posted-

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