Expert: Ali - 6/5/2009

Question
QUESTION: I have a 5 1/2 year old tomcat who has many health issues.  He was run over as a kitten and has a herniated diaphram, which makes it hard for him to breath.  He lives inside and outside, according to his mood.  We live in the country.  Last summer I noticed he was pulling tufts of fur out instead of simply shedding.  This summer he is doing it again, much worse.  The only change I know of is that we kept one of his kittens (2 yrs. old now) who he hates with a passion.  The younger tomcat is willing to be friends, but Sambo isn't.  I am worried, because when I look around, there are piles of black cat fur wherever he's been, and he's beginning to look a little shaggy. He also meows at me a lot, as though he's trying to tell me something.    (By the way, the vet won't 'fix' him, due to his respiratory problems).  Is there something I can do for him?

ANSWER: Wendy,

Sometimes when cats pull their fur out it's about stress, other times it's about allergies and in some cases thyroid issues can play a part in hair loss. I'd recommend having the vet check him over and if nothing's happening then I'd suggest changing his diet to a well balanced, high quality raw diet such as Feline Pride or a high quality canned food made from human grade ingredients such as Wellness or Spot's Stew by Halo to see if his fur starts to grow back. If the cause of his hair loss is allergies then it can take a few months to remedy the situation once he's stopped coming in contact with the specific source of his allergy. As for the herniated diaphram I'm curious - have you sought a second opinion about leaving it as is? I've heard that type of issue can be repaired which would make for a healthier kitty because he could be neutered at the same time...The whole issue with neutering the tom is about more than just population/aggression control - male cats that haven't been neutered are more likely to develop serious issues such as prostate and testicular cancers which can often be fatal and sometimes are hard to detect....If you'd like I can research the issue further and speak to a few vets to get you some info on what could/should be done in this case in terms of your tom's herniated diaphram...

---------- FOLLOW-UP ----------

QUESTION: Yes, I'd very much like to know if he can be helped.  I had heard that cats don't often live through being anesthetized.

Answer
Wendy,

I apologize for the time it's taken me to get back to you, I've spent the last several days doing some more research about herniated diaphragms and the risks associated with repairing them. Most of the information I've been able to find recommends that a cat's diaphragm be repaired at minimum 24 hours after the initial trauma once the cat's had a chance to receive fluids and be treated for pain and shock. Statistically speaking your cat is very fortunate to have survived as long as he has with such a serious injury to his diaphragm. The main reason why many vets opt to wait 24+ hours before performing the surgery if at all possible is because cats tend to respond more favorably when they've been treated for the shock that comes with getting badly hurt, any pain caused by their injuries and of course the calmer the atmosphere before your kitty undergoes his anesthesia the better his outcome will most likely be.

Regardless of the literature I've checked out I'm a bit disturbed by the fact that I haven't seen anything in the last 5-10 years with regards to published papers written by veterinary specialists and professional journals that are published for veterinarians that recommends leaving a cat's herniated diaphragm without even attempting a surgical repair. The main concerns in these published works recommend repair of diaphragmatic hernias whether they're congenital or traumatic in origin as soon as the kitty is stable enough to tolerate the surgery reasonably well.

As I'm sure you're aware cats with diaphragmatic hernias have some pretty obvious breathing problems which can cause/contribute to some significantly more serious health problems for the cat overall because they aren't oxygenating well throughout their entire body - what this means in layman's terms is that because the cat can't breathe well they can't circulate the proper amounts of oxygen to the heart which means that there's a chronic shortage of oxygen in the cat's body. Apparently it's quite common in cats with diaphragmatic hernias to have serious issues such as abdominal organs that have found their way into the chest cavity through the hole in their diaphragm. In some cases this can mean that several major organ systems didn't have enough room to grow, develop and function normally simply because there's really not any spare room for major organs not normally meant to be within the chest cavity.

When major organs such as the stomach, liver or portions of the intestinal tract end up in the chest they can seriously limit the blood supply to the major organs. As I'm sure you've noticed, your cat's ability to breathe properly and move normal amounts of oxygen throughout his system has been compromised, this is a direct result of the damaged caused when being hit by a cat caused his diaphragmatic hernia. The cat's inability to get adequate levels of oxygen throughout his body can cause problems with the cat's ability to thrive - this may be evident to a vet during a routine physical exam because the cat's muscles may have wasted and the cat may be thinner overall than a completely healthy cat without a diaphragmatic hernia.

I've been doing some further research with regards to surgical repairs of herniated diaphragms in cats and so far everything I've managed to read and get my hands on suggests that your kitty's diaphragm should have been repaired ASAP after he was stabilized following his accident. There isn't any material that I've found with regards to cats whose injuries have been left essentially untreated by a vet for as long as your kitty's issues have. From what I understand the fact that your cat has survived just fine up until this point he would most likely be okay going through the surgery to repair his diaphragm provided that he's kept as quiet and calm as possible while he's being anesthetized. If a cat with a herniated diaphragm gets anxious or becomes overly fearful during the induction of anesthesia there can be serious consequences. During any surgery performed under general anesthesia it's pretty standard for most vets to place an endotracheal tube into the cat's airway and place them on a ventilator set to deliver the appropriate dose of anesthesia and assist breathing throughout the surgery. Obviously you're aware that this type of surgery is a big deal, but provided that you choose an experienced, competent, quiet veterinarian with extensive experience repairing defects in cats' diaphragms similar to the one your kitty has the information that I've found so far leads me to believe that your cat has a fairly good chance to survive this surgery. I have yet to see much in the way of literature about cats who have been allowed to continue living with a diaphragmatic hernia that has been diagnosed but not repaired for 5+ years, but in general provided that cats who have this defect as a direct result of traumatic injury like your cat who have the surgery 24+ hours after the original injury have about an 80-88% chance of survival based on the articles I've found in veterinary journals.

If you'd like I can try to help you find a well respected, experienced specialist in your area to perform your cat's diaphragm repair. In the event you'd like to take me up on that offer I'd be happy to help you out, the only thing I'd need from you is the area you're writing from and how far away you're prepared to travel in order to get the best possible care for your precious little man. We'll do our best to find the best possible doctor to repair your kitty's hernia. From what I understand repairing this injury to your cat's diaphragm is very important for his overall health and ensuring that he has as long, healthy a life span as possible. My major concern at this point since your kitty's original injuries weren't really repaired is that the survival rates of 80-90% may turn out to be lower for your cat since so much time has gone by without corrective surgery being performed. I suspect that if your little man is allowed to keep going the way that he is with his herniated diaphragm his ability to get sufficient oxygen throughout his body will reduce over time simply because his lungs have possibly become quite compressed as a direct result of organs normally located in the abdomen making their way up into the chest cavity.

Another serious concern that I have is that since your cat was hit by a car and suffered a diaphragmatic hernia as a direct result of that trauma would be that there might be serious problems with the way his internal organs have grown and developed. I suspect that a competent veterinary specialist would perform comprehensive tests to determine how all of your cat's major organs are functioning, what his ability to oxygenate his body is like and what potential problems might occur without the surgery as well as the possible complications that might happen as a direct result of performing the surgery. If your little man has any major organs sitting inside of his chest cavity there can be problems related to the fact that these organs place serious pressure and stress on your cat's heart and the heart and lungs places substantial pressure and stress on the major organs because there really isn't much room for organs to grow inside of the chest that were originally meant to live inside of the abdomen.

Your situation is unique since your kitty's hernia was never repaired after his original injury as a kitten so I think it's well worth taking the time to do the appropriate research and find a specialist willing to examine your little guy and give you the most current information available when it comes to what's best for him.
Based on the information I've been able to read online in veterinary texts, journals about veterinary medicine and anything else I've been able to get my hands on it's certainly worth seeking the opinion of a specialist in the field of surgery if you are able to afford the financial costs that go along with that kind of advanced care. Given the information I've been able to find I think that it would be in your cat's best interests to go ahead with surgery IF a veterinary specialist agrees. Based on the statistics and information I've been able to find I would be comfortable with the idea of allowing an experienced specialist in veterinary surgery to perform this repair on any of my resident cats. There are certainly other factors that would come into play before I'd agree to immediate surgery - I'd want to be sure that I was comfortable with the veterinarian performing the surgery, their level of knowledge, expertise and experience. I'm also someone that requires veterinarians who come into contact with pets under my care to answer any questions and concerns I might have until I'm completely satisfied that I know what's happening and I'm comfortable with the entire procedure.

In the event that finances are an issue in terms of the care you'd be able to provide for your kitty it's important to be aware that I keep an ever growing list of animal welfare organizations and charities that might be willing to help you out with the overall cost of surgery and any treatment that's necessary beforehand. I only ask for the general area you're writing me from to save us both time and effort - after all it doesn't make much sense to provide you with a substantial amount of useless information that doesn't apply in your area. Essentially knowing what state/province you're writing from allows me to give you information that's more likely to apply in your area. Given the information I've managed to find about repairing a diaphragmatic hernia I suspect that the surgery would help your little guy breathe much easier, have more endurance and stamina and overall feel much happier and healthier if the surgery is successful.

I can't promise that any cat or kitten undergoing surgery of any kind including routine surgery won't have complications related to being under anesthesia. The new anesthetics in use today are much safer than they've ever been, cats are intubated and placed on a ventilator just like people are. In most clinics any pet under anesthesia is monitored closely to ensure that critical functions like breathing and heart rate remain in the normal range. The best way to minimize complications related to anesthesia would be to spend some extra money to have a pre-anesthetic blood profile done before surgery, have the vet place an IV catheter and administer fluids throughout the surgery and check basic functions like blood pressure and heart function. A pre-anesthetic blood profile allows the vet to have an overall picture of how the cat's major organs are functioning, the IV catheter will allow the vet direct access into a vein if it's necessary to administer medication to stabilize basic functions like heart rate and breathing in the event that something goes badly wrong and the IV fluids make the anesthetic easier on the cat's body overall because they're well hydrated. Checking blood pressure and heart rate, placing an IV catheter, administering IV fluids and doing basic blood work really isn't any different from what surgeons and anesthesiologists do with people to ensure that they're healthy enough to undergo surgery.  

When an animal is under anesthesia they're hooked up to machines that measure heart rate and oxygen levels in the blood at a bare minimum, some larger hospitals also monitor blood pressure, the rate that IV fluids are flowing into the pet's vein, body temperature and the color of the patient's gums. These are all functions performed by doctors that treat human patients. In your kitty's case there's a good chance he'll need to have some extra hands on deck if you opt to go ahead with the surgery, this would mean that I'd be most likely to recommend a major veterinary hospital with the most advanced equipment just in case your cat does require critical care before, during or after surgery. From what I understand there's a slightly higher risk of complications under anesthesia in a kitty undergoing a repair of a diaphragmatic hernia, but it's important to remember than placing any human or animal under anesthesia always comes with the risk of death regardless of why they're being anesthetized.