Dr. Cary Craig – Weighing In On CH & Anesthesia!

Cary Craig
Health Science Associate Clinical Professor
Surgical & Radiological Sciences UC Davis Veterinary School

PART 1

     There are no medical contraindications to any anesthetic technique in CH. However, I think there are considerations, particularly with respect to recovery from general anesthesia. My preference would be to use short acting or reversible techniques. Inhalant anesthetics such as isoflurane have the advantage of being very short acting and recovery is rapid once the inhalant is discontinued. My own CH kitties I have induced anesthesia either with propofol (a short acting injectable anesthetic) or isoflurane or sevoflurane by mask. For anesthetic maintenance gas anesthesia is best, maintaining anesthesia with injectable anesthetics for a spay would require doses that would prolong the recovery period. The gas should be delivered by an endotracheal tube rather than a facemask. Anesthetized animals, with or without CH, cannot protect their airways and are at risk for aspiration and/or airway obstruction. I would also recommend the use of an analgesic (pain control medication) and it is best used as a premedication, i.e., given prior to the surgical procedure. Usually this is a narcotic. The doses used for pain control are safe. Occasionally, some cats have some behavioral changes when they are given narcotics which can be sedation, euphoria or dysphoria. These are temporary; they go away as the drug wears off. If the drug effects are unacceptable the narcotic can be reversed.

     To dispel any myths- gas anesthesia is not safer than injectable anesthesia but it does offer a number of advantages in many circumstances. In CH kitties the rapid recovery is the primary advantage. It is not dangerous to use ketamine in CH kitties but I expect recovery from ketamine to be a very unpleasant experience for a kitty that has difficulty with balance and coordinated movement. Ketamine has a fairly long duration which gets very long if it is used intramuscularly as an anesthetic.

 Acceptable medications for CH cats are; Dormitor/Antisedan, Dormitor (medetomidine), is a sedative/analgesic that can provide profound sedation and short term analgesia. It is reversible with Antisedan (atipamizole) which makes it very useful for short procedures. It is not really an anesthetic so I would not recommend it for a spay which is an abdominal surgery. I think it is suitable for castrations in young, healthy animals.

PART 2

Neurologic injury from anesthesia is caused by a period of inadequate oxygen delivery to the brain. The severity of the neurologic damage is proportional to the length of time the brain is oxygen deprived. The part of the brain involved in vision is particularly sensitive to lack of oxygen so blindness is the most common symptom, more severe deficits are certainly possible.

There are basically two reasons why the brain would not get enough oxygen during anesthesia in all patients (normal or otherwise) and with all anesthetics (there are no safe anesthetics, only safe anesthetists):

  1.  Not enough oxygen gets into the blood – this would occur if there is a problem at the breathing level. Almost all anesthetics depress breathing in a dose dependent manner, the deeper the level of anesthesia the more depressed breathing is. A kitty breathing room air (21% oxygen) probably will not get enough oxygen into his/her lungs if breathing is depressed. This is why anesthetized patients should always be provided supplemental oxygen. Another thing that can prevent enough oxygen from reaching the lungs is an obstruction of the airway. Anesthetized kitties cannot protect their own airways reliably and are at an increased risk for airway obstruction. This why a fully anesthetized (as opposed to sedated) kitty should have an endotracheal tube placed. It keeps the airway open and helps prevent any fluid (saliva, blood, mucous, vomit, etc.) from being aspirated into the lungs. One caveat, in the hands of someone not experienced intubating cats, intubation itself can be associated with complications (tube accidentally placed in the esophagus, traumatic intubation, spasm of the larynx)
  2. Not enough blood gets to the brain. Even if there is plenty of oxygen in the blood if blood flow to the brain is inadequate the brain will become hypoxic (oxygen deprived). This can happen if blood pressure gets very low. Most anesthetics decrease blood pressure in a dose dependent manner. It is impossible to predict how much blood pressure will decrease in any given patient by any given dose of any anesthetic. Cats are particularly sensitive to the blood pressure lowering effects of commonly used anesthetics so blood pressure should be routinely measured in cats that are under general anesthesia. That way, a drop in blood pressure will be detected and appropriate action can be taken to restore it to normal.

     I think one of the most common causes for a cat to wake up with neurologic problems is a prolonged period of very low blood pressure. If not enough oxygen gets to the lungs so that there is not enough in the blood the gums and pink skin will turn bluish purple (cyanotic) and if anyone is looking at the cat they should see this. If there is enough oxygen in the blood but not enough is getting to the brain you have no way of knowing this unless you are measuring blood pressure. It can even happen sometimes when blood pressure seems ok – blood flow is extremely important and we infer blood flow from blood pressure. So it is important that the person monitoring the anesthesia can interpret the blood pressure numbers in the context of the cat’s clinical signs of adequate blood flow.

  There are still too many practices that do not routinely measure blood pressure in their anesthetized patients with the assumption that standard drug protocols and dosages won’t cause a problem. But normal doses in normal patients can, and often do, cause problems. If the problems are detected and addressed they are not serious. If not detected there may have serious consequences.

     This is scary stuff but it should not stop client’s from having their cat’s anesthetized for necessary procedures (e.g. spay, neuter). The incidence of cats that aren’t ill dying while anesthetized has been found to be about 0.3% (or 175 out 80,000). That figure goes up substantially if the cat is sick when it is anesthetized. This is much better than 10 or 15 years ago (but still ten times the mortality rate seen in people) and we are working very hard at finding ways to make it even better.

     I think the most important factors in improving the safety of anesthesia are experience with the drugs being used and in anesthetizing the species they are being used in, experience and skill with endotracheal intubation and vigilant monitoring. 

Meet “Bifford”

About “Bifford”

Bifford was born in Chicago, Illinois after his mother was rescued off the streets by a compassionate and patient animal shelter volunteer. Being one of four kittens he was categorized by animal shelter volunteers as “the worst” out of the litter in regards to his cerebellar hypoplasia. When Bifford was a mere 10 days old his mother rejected him thus withholding care and nutrition he so desperately needed when a devoted foster mother assumed responsibility for his around the clock care. When Bifford was transported to Youngstown, Ohio by a local cat shelter a note was enclosed with him:

“Born October 09, 2011, mother rejected at 10 days old. Tipsy [my brother] and I are the largest of the four kittens in our litter and most affected with CH. He will use a litter box 99% o f the time, will cry beside the litter box if he cannot get in or is having trouble. Sometimes falls/flips right out of the litter box and also sometimes lays on side to go [to the bathroom] and I will help hold him up until he finishes. Sometimes will take a nose dive in litter and will need cleaned off/bathed. Sometimes he will accidentally step in his own mess because he is unable to bury his potty. Will eat some from plate but will eat best when fed canned food by hand while holding him up under his belly with my other hand. Will cry for a bedtime bottle around 9-10 PM and gets canned food 3x/day.” 

Bifford was initially adopted in Fall 2012 but was returned after his family moved and could no longer take him with them. Upon being returned back to the shelter he was then adopted in Spring 2013 by a family who vowed to care for him but unfortunately bungled his care. When being returned (again) to the shelter in May 2014, Bifford’s former family admitted that they were unable to effectively care for Bifford and felt that he was “suffering” and wanted him to “die with dignity” to which they would contain him in an empty hot tub with the cover on it in order to “contain the mess”. Bifford was terrified and underweight but otherwise unscathed, though shelter life was no life for him. Living in such close proximity to other cats in a cage free shelter proved the theory of “survival of the fittest” in which Bifford was not as fast as the other cats and was often the subject of many bullies.

I agreed to foster Bifford on Mother’s Day, 2014 in which the situation was only to be “temporary” in order to spring him from the shelter and hopefully nurture him physically and emotionally. The first few nights were proving to be exhausting ones for both Bifford and myself — roaming the house and crying all hours of the night I can only speculate he was terrified being in a strange, new environment (again) and even more terrified that he was going to fall in love with a new family and ultimately get returned back to the shelter. Couple this with the fact that at that time I had no idea how to properly care for a “CH” cat (nor did I know much about them) I feared that I would not be able to arise to the labor of love that was Bifford.

Years have passed since those first few days and I still joke with Bifford that he is a “foster” though I can say without reservation that he is a “foster fail” because he took over my heart in so many ways. Come October 09, 2018 Bifford will be turning 10 years old to which he has a happy, healthy and spoiled lifestyle (what cat do you know that has their own bedroom and TV?!) and ultimately planted the seed of special needs animals advocacy and education due to all of the misconceptions and ill-information circulating about special needs animals.

Please enjoy the website, Bifford’s photos and overall shenanigans and information 🙂

Meet “Bart”

September 2017 — In foster home

August 2017 — First Rescued

Bart– February 2018 

Bart was abandoned at a local veterinary clinic after a good samaritan rescued him and his sibling (the calico pictured above) who both had horribly brutal upper respiratory infections (eyes caked shut, severe nasal discharge, congestion) — Bart’s sister slowly improved but Bart did not. Bart came to the clinic with a broken back leg (the veterinarian suspected something had tried to catch Bart as prey), a hernia and his left eye had ruptured most likely due to having feline herpesvirus.

Feline Viral Rhinotracheitis (FVR) is an infectious disease caused by the feline herpesvirus type-1. Typical symptoms of FVR involve the nose, throat and eyes, sneezing, nasal congestion, inflammation of the tissues that line the eyelids and surround the eyes, discharge from the eyes and nose. The herpesvirus can also cause keratitis, or swelling/infection of the cornea that leads to corneal ulcers. Rare cases include the rupture of the cornea, which unfortunately happened due to the herpesvirus in Bart’s situation.

Bart came to our home and was absolutely terrified. He bordered on the “feral” in which he spent the first month at our home cowering under our bed refusing to come out and hated being handled and held by anyone. It was assumed that Bart would be a “cellar dweller” but at least he had a roof over his head and food in his tiny belly.

By December, 2017 Bart had his left eye (what was left of it) removed, his hernia repaired as well as neutered. Upon waking up from surgery he purred for the very first time– a milestone that made his new parents gush with pride (and possibly a few happy tears!). By spring of 2017 Bart realized he needed to make up for lost time while he was sick as a baby and became an ornery, rambunctious kitten!

Bart still has vision issues (he suffered a corneal ulcer on his right eye as well, luckily it did not rupture and he has some limited vision in it) as well as a habitual “booger nose” and suffers from the occasional flare-ups caused by the herpesvirus but today is a happy, functioning, handsome man!

Bart would have sadly been overlooked in a shelter setting (or even more devastating– euthanized) because of his “special needs” coupled with the fact that he is a black cat to which statistically sit in shelters longer than any other type of cat. By giving this handsome fella a chance the world was able to see what a spunky, resilient kitten he is! Despite almost becoming someone’s snack while in the wild he has made a complete turn around and rules the house! Bart is a typical cat who cuddles, plays and gets into mischief!

Do you have a cat that suffers from herpesvirus? How do you accommodate your home for your special baby?

Meet Maggie Mae!

Maggie Mae– December 2006

 Maggie Mae– July 2007

Maggie Mae with “Cheeto” (foster kitten)– August 2016

Maggie Mae was the product of an Amish puppy mill — full of disease, death and over breeding in cramped, filthy and inhumane conditions in Lancaster, PA and then ultimately sold to PetLand (Harbor Pets) in Boardman, Ohio in October 2006. She was pulled from her mother far too young and was alone, terrified in a dark, metal cage with no blankets, no toys and no human interaction as she was “DEFECTIVE” because she had an inguinal hernia so she was unable to be sold in the pet store so she was being sent back to the amish to ultimately either be over-bred or put down. The store was placing her in a black trash bag in which her “momma” noticed the heinous act they were performing and promptly asked a store employee why they would do such a thing, the employee callously replied, “If they go in a bag back to the breeder and do not make it then that saves them money in not having to put them down. They are the rejects, they are no good.” Her mother was not having any of this and immediately expressed interest in taking the small ball of fur home.

Sadly, puppy mill dogs have a reputation of their own — hereditary issues, ongoing medical problems and deformities due to inbreeding. Maggie Mae was scheduled for her spay July 2007 to which the veterinarian fixed the hernia as well in which after that she was a happy, healthy and vivacious young pug!

Maggie Mae continued from that fateful day to live a happy, spoiled life though the health problems would rear its ugly head–waxing and waning. Today, Maggie Mae celebrated her 12th birthday! She has a few teeth left (having over 20 removed due to her “pug mouth” and periodontal disease) and is now deaf and suffers on rare occasion petit mal seizures stemmed from being informally diagnosed with a tumor in the brain but without the proper (and expensive) diagnostic work it is simply the veterinarian’s professional opinion.

Though Maggie has slowed down, she cannot hear her momma anymore and sleeps more than she once did she was given a chance at life that was originally attempted to be taken away from her due to a medical condition that is easily repaired. Sadly, puppy mill pets are often subjected to these types of injustices every day — unsanitary, inhumane conditions with improper nutrition and often absent veterinary care they are viewed as inanimate objects instead of what they truly are– living, breathing beings with unconditional love and devotion to those who open up their hearts and homes to them.

Puppy mill pets, and pets with hereditary and genetic complications are categorized as “special needs” pets because they are often misunderstood and misinterpreted and badly need someone to be their voice.

Meet Leo!

Leo had an unfortunate disease of Degenerative Myelopathy. It is a progressive disease of the spinal cord and begins with the loss of coordination in the hind limbs. There is currently no cure for this unfortunate disease and no direct way to diagnose it. Veterinarian’s will perform diagnostic testing to rule out other injuries/illnesses by using testing such as radiographs and MRI’s. There’s no way to test if they’ll get it & no cure. Since there is no cure for this disease the only thing a family can do is keep nurturing the dog’s quality of life (good nursing care, physical rehabilitation, pressure sore prevention, monitoring for urinary infections and ways to increase mobility through the use of carts/harnesses). In Leo’s case it basically paralyzed his back end and initially started with him dragging his paw to having trouble even walking around. Leo started showing signs of Degenerative Myelopathy when he was 8 years old and seemed to worsen every six months or so. Leo’s “mom”, Jessica equated Leo early on in the disease to “walking, but walking like Bifford in a wobbly, ridged movement” and then progressed to dragging himself around until they got the wheelchair. Unfortunately Leo passed away 01/2019, a victim to this unfortunate disease. Jessica & Cody, Leo’s parents were kind enough to pass along Leo’s cart to another family who had a boxer, “Rocky” who was also suffering from Degenerative Myelopathy and they hope to continue on this “paying it forward” by educating families on this disease and helping families better understand the disease and care for their pets!

Bifford’s Cabinet Member– Coraline!

Miss. Coraline on the move while hanging with her mom outside!

Meet Coraline! Coraline is a 4 year old domestic long hair from Industry, PA born to a feral mom underneath a porch. Coraline is categorized as a “moderate” cerebellar hypoplasia and living her very best life! Once looking at life outside with her feral mom she was immediately scooped up by Nicole (her forever mom!) and has been the light of her families life and constant source of joy and inspiration ever since! Nicole & Coraline have been (and continue to be) major advocates for cerebellar hypoplasia pets and special needs babies in general and is our Pennsylvania representative on the “Bifford for President” campaign! We LOVE Coraline & Nicole and are thankful to have them as friends and advocates! Want to ask Coraline & Nicole a question? E-Mail us at PresidentBifford@gmail.com

Adoptable: Lilly

ADOPTION FEE : $90.00

Cat Crew, Cedars, PA PO Box 33 Cedars, PA 19423

catcrewinc@gmail.com

Meet Lilly

Lilly is in search of a very special foster or adoptive home!

This unique little lady, who is about six months old, was trapped at a feral cat colony in April 2019. When we realized that she shows signs of cerebellar hypoplasia (CH), which is a neurological condition also known as “Wobbly Cat Syndrome,” we knew that we couldn’t return her to her colony because her wobbliness means she cannot lead a safe life outdoors. She appears to have a fairly mild form of CH, as she wobbles when she walks and loses her balance at times but always gets her pee into the litter box and is always able to eat on her own. She is not bothered by her condition and doesn’t know that she is any different from non-CH cats! 

Lilly is still learning that humans are not scary, which is why she needs a special home willing to continue to work to gain her trust. We have discovered that the biggest way to earn her trust is through PLAY! She absolutely loves wand toys and will happily talk to you while she plays with you. And, if you are not sure you’re ready to adopt her but she has touched your heart, we would be absolutely thrilled to move her to a foster home that has more time to work with her, as her current foster has many other foster cats that also need time and attention.