Can't find Dr. Doolittle, and the cat won't talk.
November 19, 2012 5:47 PM   Subscribe

Cat illness - what to do?

A couple of years ago, Louis (pic) a neighborhood cat, possibly anticipating Romney talking points, semi-adopted us (wife+me) - he's a freeloader outdoor cat that comes in to eat and get medical treatment, but does no work around the house, except when he marks the territory as his (and then the work of cleanup falls to us). It is our understanding that he's about 11-12 years old.

March of last year, the lymph nodes under his jaw were swollen - on both sides of the neck, symmetrically. The vet prescribed anti-biotics, and Louis recovered well. He also got a bunch of vaccinations that were considered prudent.

January of this year, we had him operated upon to take out a skin abscess(?) that was not healing for a long time. It was a lump/growth right behind his left front shoulder blade - the lump finally broke through the skin resulting in blood/plasma discharge that Louis would continually lick. When this did not heal after months, we decided to take it out. The abscess/lump was not biopsied to see if it was cancer or whatnot, but he recovered very well, though it was a challenge to keep him indoors for a couple of weeks. When he was brought back to have his stitches taken out, his vaccinations were re-upped.

Last Friday evening he came in for dinner as usual, and we noticed that the left side of his face was significantly swollen - the size of a large golf ball - stretching from under his eye to the neck area. His appetite was not affected, and as usual he ate heartily.

Saturday morning we took him to the vet. The vet examined him - the swelling is a hard mass slightly above and below the jaw, basically hugging the jaw on one side. The vet couldn't tell the origin of the swelling, but speculated it might be a tooth abscess or possibly an infection from a cat fight. However, as long as the swollen mass was hard, he could not operate to "drain" it of puss. He recommended warm compresses and antibiotics on schedule and a return visit Monday (today). The cat also got an immediate anti-biotic shot and had his blood drawn for analysis.

Over the weekend, we kept Louis indoors, but his appetite was uncharacteristically gone - he hardly ate or drank at all - and he was very enervated, sleeping and hardly moving for 20+ hours. He got all his anti-biotics on schedule, and a couple of warm compress treatments, though we stopped the latter as he was very uncooperative with those.

Sunday evening the swelling was significantly down from his face overall, but the hard mass remained, now concentrated and more distinct around his jaw.

Monday morning (today) we took him back to the vet. Upon examination, the vet said that the mass was still hard and therefore he could not operate to "drain" any possible puss. He said the blood lab work came back normal, including normal values of white blood cell count. He said that there are three possibilities:

1)Tooth abscess.

2)Infection from cat-fight.


He wants us to continue with the warm compresses and the anti-biotic regimen, and come back Friday. If by Friday the swelling doesn't go away and the mass doesn't soften, he will have to perform a biopsy on the mass.

Louis seems back to his old self as far as appetite and behavior goes, (though possibly 5% less lively - hard to say).

However, once we got back and started thinking about the whole thing, we were left with questions - hence this post.

Basically, we want to know if having the biopsy is a good course of action come Friday, assuming the swelling does not go down or soften. Putting him under anesthesia is always a risk and we'd like to avoid as much of such an ordeal, as possible, unless there are clear medical benefits or indications.

What will a biopsy tell us?

Of the 3 possibilities outlined, can one diagnose #1 - tooth abscess - without a biopsy? Perhaps through an X-ray (does an X-ray also involve putting him under?)? How does one diagnose a tooth abscess in a cat (the vet looked inside his mouth but couldn't tell anything other than that Louis has the teeth of an elderly cat - and yes, we've been brushing his teeth every couple of days the past few months).

Possibility #2 - infection as a result of a cat fight. What does a biopsy do for us here? Doesn't it make sense to let the antibiotics take their course first and thus eliminate/confirm the "infection" diagnosis through the swelling either disappearing or not? What does a biopsy buy us here? The key, it seems, is to eliminate possibility #1 (tooth abscess) as a source of the infection through some other means (X-ray?) first so that the tooth can be taken care of instead of continuing to cause problems once the antibiotics treatment stops. But either way, shouldn't we give the antibiotics time to work before we do a biopsy should that fail? Also, if it's an infection that causes that much swelling shouldn't the white blood cell count have been elevated?

Possibility #3 - cancer. If it's cancer, presumably the swollen mass itself is not the cancer, because it's highly unlikely to have sprung that big from one day to the next. Therefore presumably it's a swollen lymph node in response to cancer. But if it's a systemic response, then why is it not a bilateral swelling, instead of just on one side? If a biopsy is conducted on the mass - presumably a lymph node, per the reasoning above - would that indicate what kind of cancer it is, or would it merely tell us that it's some kind of cancer and that would be a prelude to a hunting expedition to find where the cancer may be in the body.

As a result of this non-veterinary speculation, our first instinct is to wait on the biopsy - because come Friday, it would be only 1 week from the start of the swelling - until the antibiotics have a chance to work... a full course would be something like 10 days. Also, push to find some non-highly invasive way to try to ascertain if it's indeed a tooth abscess (X-ray?). If we eliminate the possibility of a tooth abscess, and the antibiotics don't work within 10-14 days, perhaps only then put him under for a biopsy? However again, what does a biopsy give us here?

posted by VikingSword to Pets & Animals (11 answers total) 1 user marked this as a favorite
I'm a doctor (not a vet, and not Louis' doctor) but to me it sounds like this is responding significantly to antibiotics and that it swelled up quite suddenly, so that points towards infection. If the mass is cancer-related then it should not decrease in size with the antibiotics and compress treatments, unless there is a localized infection in addition to cancer.

You can get unilateral swelling related to cancer if a cancerous mass is blocking drainage of lymph or venous blood on one side of your body, but again that shouldn't be responding to the treatment.

You can get evidence of a dental (or other) abscess on imaging, but not with an x-ray, only with a CT scan, and that doesn't sound reasonable in this case unless you plan to proceed with surgical incision and drainage, plus, your vet hasn't suggested this. If it's a cutaneous abscess you can usually decide whether to I&D it based on physical exam, which is what the vet seems to be doing.

The way I would look at it is this - you're considering that it's either infection (from whatever source), or cancer. The purpose of the biopsy is to look for cancer. If it's cancer, presumably you are not going to pursue aggressive treatment. He's responding to the treatment you're giving him now, and the only additional thing that could be done would be surgical incision and drainage of the infected area, which it sounds like your vet doesn't think is prudent at this point. So I don't see much of a reason to do the biopsy because it's acting like an infection, and if it's anything other than an infection you're not going to do anything differently about it, except maybe put him on the kitty version of hospice...

All that being said, it can be hard to treat a localized infection like an abscess without doing an I&D procedure because antibiotics can't get into the pus pocket well. However this is a matter to take up with your vet, and if they're saying this doesn't look I&D-able, then I'd take their word for it. YMMV since I am not a vet and this is all as related to human disease!
posted by treehorn+bunny at 6:21 PM on November 19, 2012 [2 favorites]

p.s. if an infection has gotten so bad it's affecting nearby bone, you may be able to see it on x-ray. In humans, that typically takes weeks.
posted by treehorn+bunny at 6:23 PM on November 19, 2012

I came in to say something similar to treehorn bunny.

If kitty seems to be responding to the conservative treatment, keep at it. If he gets worse or stops eating completely you can consider the biopsy.

FYI, my cat did not have to be put under for a chest x-ray. He would have to be put under for a CT from what I understand. But that was prohibitively expensive, so we didn't do that.

Good luck!
posted by misanthropicsarah at 6:47 PM on November 19, 2012

He wants us to continue with the warm compresses and the anti-biotic regimen, and come back Friday. If by Friday the swelling doesn't go away and the mass doesn't soften, he will have to perform a biopsy on the mass.

So. 1. and 2. are infections, and 3. is cancer.
The reason the biopsy is a good idea if the mass hasn't softened by Friday is that
a.) Infections like this localized thing usually do soften up and become lance-able with no treatment (the infection is allowed to progress and that is how they usually act), or
b.) when antibiotics are given the antibiotics begin to help it resolve and it changes in character (usually starts to go away)

If the area is the same by Friday, it means at the least that the antibiotics are NOT working on the supposed infection. Which is possible.
Blood work showing "normal" for a tooth abscess is not that strange. Blood work showing normal for a cat-bite (fight) abscess is a little weird (needs further interpretation). But it could happen.
The part about acting/feeling better and eating/drinking more normally is important. Pets "not acting right" is a huge signifier that they should be seen by a vet.
One thing to know is that obnoxious, serious cancers can show up very quickly (and they can look like an abscess). When they don't soften/change, that is what we think of next.

The biopsy can tell a vet the difference between a cancer and an infection. If what everyone hopes is an infection (as opposed to cancer) doen't react to the antibiotics, then that is the next step
Good luck! He is a handsome kitty!
posted by bebrave! at 6:48 PM on November 19, 2012

PS. about the warm compresses, make sure you wring out the washcloth really well, so it's barely damp at all. You don't actually want the water, just the moist heat. As much as he hates it, it probably feels good too. So keep up with those if you can.
posted by misanthropicsarah at 6:49 PM on November 19, 2012

Other than the fact that it has responded to antibiotics by decreasing in size, I would caution you not to think that cancer can't swell up that fast, because it can, and it does.

The episode with the mass on the cat's back concerns me, and it concerns me about your vet and your vet's up-ness w/r/t cancer in felines. The whole thing you describe sounds very similar to stories I've read about people whose cats had tumors that burst, more or less. These tumors are VAS, Vaccine Associated Sarcoma, and it's super nasty. I could be wrong about this whole thing, but if it wasn't confirmed as an infection issue and the mass wasn't tested, you don't know.

It would concern me if your vet wasn't concerned enough about it to have it tested. This is a cancer that commonly presents in areas that cats get shots - on the haunches and on the back between the shoulder blades. I am willing to be wrong and I WANT to be wrong, but I can't tell you that this isn't a possibility. VAS is aggressive and will spread or come back in the same place.

So, all this said - I would have the following questions:

1. Why hasn't the vet hasn't simply attempted to draw off some fluid from the mass and see what he gets. If he gets pus, it's infection. If he gets clear fluid, you're probably looking at cancer.

2. Does the cat withdraw from you when you try to touch the area? Pain is usually associated with abscess or infection. No pain, again, looks more like cancer.

I might be totally off track but if this were my cat, this is where my mind would be.
posted by Medieval Maven at 6:54 PM on November 19, 2012 [1 favorite]

Louis is an absolutely beautiful free-loader.

I think I'd just go with what your fairly conservative vet is doing, given that the cat seems to be eating and behaving normally. If he gets worse, of course you'll contact the vet and get him in sooner.

Don't forget, there's always a second opinion if you're not comfortable with the way this is going.
posted by BlueHorse at 8:03 PM on November 19, 2012

The compresses really do work so try to talk him into it.
posted by fshgrl at 8:34 PM on November 19, 2012

Response by poster: Thank you everybody for the answers so far. Everyone's been so helpful it's hard to single out any one reply.

Update on Louis. My wife claims that the swelling has gone down slightly more today - I can't tell because I don't know if it's just seeing what I want to see, but if it's down further, the shrinking is slight - it's still a fairly large ball around his jaw. He's eating reasonably well, but his attempts to get out have become much more vigorous and energetic, which makes me think he's feeling a lot better/stronger... keeping him indoors has now entered the chore stage where he's up all night trying every door and window... no sleep for the household; we've had this experience since keeping him in after his surgery early this year - as he gets stronger he tries to get out harder. Yes, he's mostly an outdoor cat used to coming and going as he pleases.

We'll keep monitoring him over the next few days, and then Friday talk to the vet. Hoping desperately that it's just an infection and it'll be soon gone!
posted by VikingSword at 10:43 PM on November 19, 2012

For what it's worth, my spidey senses lean towards tooth infection.
posted by MeiraV at 8:18 AM on November 21, 2012

Response by poster: Update #2. By Thursday night, Louis' swelling was completely gone. So Friday morning we're at the vet's, still with no clarity as to what it was that caused the swelling. The vet wants to clean the cat's teeth in one week, and for that he has to put him under. We're quite queasy about the putting under part, but grateful that the swelling was probably not cancer(?). The idea is that the vet will be able to see more when he's cleaning the cat's teeth, and possibly spot which tooth it was that caused the abscess, if indeed it was a tooth abscess. The vet is leaning against the tooth being responsible, because according to him, the swelling would have been further along the jawline, closer to the front of his mouth, instead of in the back of the jaw. Obviously, we have no idea, but I guess he should have his teeth cleaned from time to time anyway. We are also planning on upping the frequency of brushing his teeth to daily from every other day - though this might be tricky in that he doesn't like the process at all, and might start coming in less frequently, which would defeat the whole scheme.

But for now, the news is good, the swelling gone. He's destroyed the bathroom window screen trying to get out and knocked down and broke sundry stuff, but when we let him out this morning, he was back within hours, looking for a mid-day snack, so all is forgiven apparently. The guy doesn't hold grudges, which is very nice of him.
posted by VikingSword at 5:20 PM on November 24, 2012

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