An Ounce 0.4 ml of Prevention Is Worth $1,000 of Cure


When I first met Percy*, he was in serious trouble. The 2-year-old cat came to the emergency clinic exhibiting profound weakness. He was having trouble breathing. His gums, eyes, and skin were pale but tinged yellow. He had a mild fever. His coat was unkempt, and occasional bits of flea feces were present in the fur. Despite his symptoms, he was markedly stressed by his presence in the hospital — he hissed, attempted to scratch and bite (although he was too weak to do this effectively), and was visibly agitated.

In this type of situation, I needed to prioritize my actions in a process called triage. Several patients were waiting to be treated. Percy was deemed the most critical, so he jumped the line.

Although Percy had many serious issues, two of them needed to be addressed immediately. First, his respiratory distress could be imminently life-threatening. Second, his agitation was exacerbating his breathing problems. Agitated individuals require more oxygen. If they can’t breathe properly, they may panic and become more agitated. This leads to ever-increasing oxygen demand and a potentially catastrophic feedback cycle.

I put Percy in a special cage that could provide an enriched oxygen environment, administered a sedative to reduce his anxiety and oxygen demand, and avoided handling (and stressing) him until the sedative had taken effect.

Percy’s breathing improved significantly once he was calm, which made it safe for me to work with him. The technicians drew blood and urine for diagnostics and placed an intravenous catheter while I performed an ultrasound (using a special emergency technique called CFAST) of his chest and abdomen. It showed no evidence of abnormal fluid around the heart or in the abdomen. There was no evidence of air between the chest wall and the lungs. In other words, the ultrasound did not reveal a cause for Percy’s symptoms.

X-rays failed to show any abnormalities in the lungs or airways that might cause respiratory distress. Percy was returned to his oxygen-enriched cage while techs ran his blood and urine tests. They soon delivered the answer to the mystery of Percy’s condition: he was extremely anemic. Anemia is a condition in which red blood cells, which carry oxygen, are present in insufficient quantities. It can lead to breathing problems even if the lungs are working fine because the bloodstream simply can’t provide enough oxygen to the tissues in the body, which led to the yellow tinge noted in his gums, eyes, and skin.

Microscopic evaluation of a blood smear revealed Percy was suffering from a condition called feline infectious anemia (FIA), which is caused by an organism called Mycoplasma haemofelis. It is most frequently spread by fleas and can cause serious, acutely life-threatening illness only in rare individuals who are not able to suppress it. Percy was one such individual.

Percy received an injection of dexamethasone sodium phosphate (to reduce the activity of the immune system, which plays a role in acute FIA crises) and was started on an antibiotic (doxycycline) to control the Mycoplasma. He got a dose of Advantage to eliminate the fleas that were likely responsible for trasmitting the disease.

Percy’s condition rapidly stabilized and began to improve. Fortunately, he did not require a blood transfusion, which can be very dangerous, especially in cats. His anemia resolved at a remarkably rapid rate after treatment began and he was home within 36 hours. I expect him to make a full recovery.

Percy’s ordeal had a happy ending. However, it didn’t have to happen in the first place. If he had been on a regular flea preventative at home, he wouldn’t have gotten sick. Cases such as Percy’s are among the many reasons why I recommend consistent high-quality flea prevention in all pets.

*The name of the patient as well as certain identifying details in this story, and in every story I write, has been changed to protect the patient’s identity.

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