Elsa is a lovely little cat who presented to us approximately 6 weeks ago following a road traffic accident. At this point, she was in critical condition; she was struggling to breathe and there was blood from her nose and mouth. After serious trauma we were, of course, concerned about a number of internal and external injuries but we first had to ensure her condition was stabilized. Elsa was placed in oxygen, given pain relief and intensive monitoring was started.
Breathing issues post trauma can be related to pain and stress. However, more serious concerns include bleeding/bruising of the lungs (lung contusions) and traumatic diaphragmatic rupture. Cats in respiratory distress can be very susceptible to further stress and deterioration so any further investigations must be done cautiously and safely.
Elsa’s left eye appeared swollen and the pupil was not responding to light. This could be due to swelling from the impact but we could not rule out more permanent damage to the eye or optic nerve. She had corneal ulcers on both eyes and her jaw appeared fractured. Lastly, Elsa’s awareness and reaction to her surroundings seemed inappropriate which raises the suspicion of head trauma. There were no other obvious external wounds, injuries or fractures.
The full effect of lung contusions or neurological damage can be delayed so it would be contraindicated to start any further investigations in case her breathing or neurological status deteriorated. For this reason, we allowed her time to settle and continued monitoring.Within a few hours the bleeding from Elsa’s mouth and nose had completely stopped and her breathing had improved. We continued supportive care overnight including treatment for her eyes.
The next morning, Elsa was brighter and her breathing was stable without supplementary oxygen. We elected to sedate her and perform further investigations to understand the full extent of her injuries. We took x-rays of her abdomen and chest which confirmed her diaphragm was intact and that there were no other serious problems in her chest. However, we were able to confirm that Elsa had multiple jaw fractures. There were a number of options for the jaw including further imaging and surgical correction.
Luckily, the fractures did not create too much of a jaw misalignment and Elsa’s owners chose to try and manage the fractures conservatively. This would involve keeping the jaw as still as possible to allow it to heal naturally. In order to keep the jaw still and provide Elsa with ongoing nutritional support she would need a feeding tube placed directly into her oesophagus. This would allow liquidized food to be given directly down the tube bypassing her mouth. If Elsa failed to cope with the feeding tube or her jaw failed to heal appropriately further imaging and surgical intervention would then be considered.
Elsa stayed in with us over the next few days for continued monitoring, pain relief, eye medications and tube feeding. The swelling around her left eye was gradually improving so we elected to give this more time before reassessing if her vision loss would be permanent or not. Given Elsa was brighter and coping well we elected to send her home. Caring for Elsa wouldn’t be easy; she would require strict house rest, oral pain relief and topical eye medications. The biggest challenge for her owners however would be the care of the feeding tube and administering the liquid feeds. Her owner’s did extremely well with all of her medical care and Elsa was never short of attention and TLC.
Over the next few weeks Elsa made brilliant progress; she came in for repeat dressings around her feeding tube and for her ulcers to be checked. The ulcers healed relatively quickly, the left eye was comfy and the swelling continued to improve. Her jaw seemed to be healing well and before long Elsa started to eat on her own. This was not only a great sign that the jaw was on the mend but that any potential misalignment wasn’t going to impact her ability to eat. To Elsa’s delight we removed her feeding tube and dressings.
Elsa is on the road to full recovery; she has completely finished all of her pain relief and is still continuing to be a happy girl who can eat normally. Unfortunately, Elsa’s vision never returned in her left eye but she is able to shut her eye fully and remains comfy. We elected to keep her indoors for a little longer whilst she becomes accustomed to getting around with some visual impairment but so far it hasn’t affected her quality of life and we don’t suspect it ever will.
Throughout the whole process Elsa has been an absolute pleasure to treat, she is such a sweet girl and is always so well behaved. A very well deserved brave pet with also very patient and dedicated owners!
