Tuesday, February 1, 2011

Case of the Week - Trosper

For this case study, I'm going to discuss the rather smelly end of the veterinary profession. We've all cleaned up the final product of our cats' daily business. It's mildly unpleasant, but usually routine. In this case, we'll learn a bit about what can happen when that process no longer goes smoothly.

Trosper is an eight year-old Turkish Angora that first came to the clinic nine months ago in distress. He had been having constipation and had needed multiple enemas in the past. When I examined him at the clinic, he was again severely constipated. In addition, his anal sacs were very full. These scent glands are located right inside the anus and create a very strong smelling liquid secretion that cats use to mark their territory. They typically express regularly with defecation or when a cat is nervous. In some cats, the secretion does not get released and starts to build up inside the sacs. The secretion can thicken and build until the sacs are very distended. When this happens, the cat feels discomfort and irritation, especially during defecation. This can then lead to less frequent defecation and finally constipation. I express these glands by basically doing a rectal exam and squeezing them from the inside.

We expressed Trosper's anal sacs to remove all the built-up secretion and gave him an enema. Unfortunately, the enema was not enough to allow Trosper to defecate because of the severity of his constipation. We had to anesthetize him so that I could manually remove the feces from his colon. I was able to push his feces to the end of his colon so I could then pull it out through his anus. (This might qualify me for the Dirtiest Jobs show)

Trosper had been on Lactulose, a stool softener, and Cisapride, a medication that increases the muscle strength of the colon. When a cat is prone to constipation, I have the owner adjust the dose of the Lactulose so that the stool stays soft but formed and the cat is defecating daily. I had Trosper's owner increase these medications to every 8 hours instead of every 12 hours, and increase the dose of the Lactulose.

Trosper took a few days to recover his appetite completely but has been doing well since. He has come in every four months to have his anal sacs expressed so that they do not build up too much and cause him discomfort. On the last check, the sacs were quite full so we will check him every three months now. He is still on his medications and has been defecating very regularly. We've also been working with his owner to get Trosper to lose weight. In otherwise healthy cats, constipation occurs more commonly if cats are overweight. His weight loss is not going as well as hoped, but he has lost a little. We can also see constipation in cats that have other medical problems that frequently lead to dehydration such as kidney disease or intestinal disease. Cats with recurrent constipation should be tested for underlying disorders.

Constipation can cause serious problems beyond just the pain, so it's important to treat it seriously. Just like in your house, when the plumbing isn't working, nothing else seems that important.

Dr. Judy Karnia

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