Cat’s Skin Tears Off
Sometimes I must treat a patient without knowing the exact diagnosis. Sometimes thongs go upsettingly wrong.
When we started Nicco on the prednisolone and antibiotic, I still did not have a diagnosis why he was jaundiced, anemic, attacking his own blood, and many, many tests had come up negative or inconclusive. With the prednisolone, Nicco ate better, felt better, the anemia started to resolve, the jaundice resolved. We were on to something good!
Then an 8 inch patch of skin from the back of his neck to his shoulder and down his arm just ripped open. No kidding! My assistant was gently holding him, when a crack opening up in his skin over the shoulder on the left, and the skin just slid back 4 inches like cellophane pulling off a loaf of bread. Then another crack opened over his right shoulder. The epithelium- the outer top layer of skin that holds hair, was so thin I could see light through it. And, by the way, Nicco was furious about this whole weeks in the hospital an intravenous thing. He had had enough!!
So, here I am, my beloved patient on the table in front of me, his mom standing there (she had come for a visit and was thinking of taking him home that night). Yours Truli, my assistant, and Nicco’s mom just watched this eruption of the surface of his skin break into cracks, like the 2012 crust heaving and splitting.
“Thank G*d that happened here!” was the first thing anybody said. “If that would’ve happened to me at home, I would have fainted, maybe died.” Me too. (Another one of those things I think, but I can’t say for the sake of professionalism.)
Okay. Now, if you’re a veterinarian, you’re thinking, “this is real bad.” That’s what the dermatopathologist told me, too. I cut a couple of biopsy samples from the edges of the cut skin (figuring, I might as well get a diagnosis.) I reached for the sterile surgical glue, which I had almost zero hope would actually stay in place and gently peeled the skin back over the underlying fat, glued it in place, gave antibiotics, and crossed everybody’s fingers for good luck.
Of course, the next day, the skin had reopened. I reluctantly put Nicco under sedation (I didn’t want to, he had just had massive jaundice and organ dysfunction and the most likely thing causing the skin problem was a drug reaction, but I had to). You just cannot live without good skin; the skin is the largest organ of the body.
I took tiny sutures used to sew the clear cornea on the surface of the eye, and delicately sewed the skin into place. By now, the skin was purplish in color, and I was sure it would just slough off. But I had to try. Nicco wore a little shirt (he despised it.) But he was eating and drinking, and had not broken with a fever. I weaned him down on the prednisolone pending the pathology results because my most likely theory was either the medication caused the skin reaction, or the unknown disease did in the first place.
The dermatopathology revealed microhemorrhages throughout the blood vessel bed underneath the skin, The disconnect n the microvascular supply had caused the skin the thin and whither and eventually rip. That all sounds great, but it really did not tell us why it started in the first place, or how to prevent it from spreading over his whole body. The dermatopathologist felt it was not a drug reaction, and it resembled nothing she had ever seen before; she sent the samples for another opinion. The second cat dermatopathologist concurred with the first and was equally mystified.
Meanwhile, Nicco was at home, and coming to the hospital every 2-3 days for me to check under his shirt and make sure all his skin wasn’t falling off or infected. It tore open a tiny bit after a few days, but we left it alone. He got his shirt off one night and clawed a 2 inch gash, which I surgically glued shut. 3 weeks into this skin tearing part of the saga, I noticed that Nicco still sometimes had fleas on himself.
“You know, fleas may have triggered this problem in the first place. You really MUST get rid of every flea on him and in his room in your house.”
Here’s the deal: I gave him a Capstar prescription flea pill in the hospital which kills every flea on him. Then, when he went home, he went in a tile-floor bedroom, which mom had flea sprayed. I told her,get IGR (Insect Growth Regulator) products, like VetChem brand or Zodiac brand at the pet store. Well, she sprayed under the bed, she upended an upholstered chair and sprayed that, there was no closet, no hiding places for fleas. Yet Nicco still had some fleas.
After 2 weeks of me trying to figure this out, and his mom trying to get the room cleaned, we figured it out!
“What do you mean IGR? I got this stuff at the supermarket. It says it’s for fleas.”
OMG! Did I not say?….Did I not write in a letter?….Did I not provide a handout?….she never really listened before. Then all of a sudden,she clicked on the IGR part and I helped her pick out the right flea spray. No more fleas!!! Yay!
After 23 wek in his shirt, the purple area started to turn pink. The skin thickened up. After a month, we tried without the shirt on. Nicco was fine! The dermatopathologist called to check up on “the case” and see what the autopsy showed.
“He made it; he’s fine!”
“What? That never happens! But I’m happy for him!”
Honestly, I’ll never know for sure what made Nicco sick. A weird toxin in the garage that we couldn’t find? A disease spread by fleas? An immune system dysfunction that righted itself? And feline Fragile Skin Syndrome is a death sentence. But miracles happen, especially when you don’t give up!