Cornell University Hospital for Animals

College of Veterinary Medicine

Companion Animal Hospital
607-253-3060
Client:
KARL KRAUSS
237 A ALLEN ST
ELMIRA, NY 14904

Box 20
Ithaca, NY 14850-6401
Client Discharge Instructions
Referring DVM:
BROADWAY ANIMAL HOSPITAL
PC
EMILY DUGGAN
W(607)734-1272
F(607)734-0101

Patient:
TRUNKS
FELINE
Case # 241008
DOMESTIC SHORTHAIR
14 lb 2 oz
GRAY/WHITE
DOB JUN 01, 2004
CASTRATE

H(607)425-9911

Visit Data
Admit Date:
OCT 27, 2015
Discharge Date:
OCT 29, 2015

Discharge Status: ALIVE

Discharging DVM: Dr Julie Stanton
Service Chief: Dr Meredith Miller

Attending DVM: Dr Julie Stanton

Student: Kristen Hultberg

Patient Care Instructions

DIAGNOSIS
Nasal tumor with erosion into the cranial cavity and left orbit (etiology unknown)
HISTORY
Trunks, an 11 year old male castrated domestic shorthair, was presented to Cornell University Hospital for Animals' Emergency
Service on 10/27/15 for evaluation of chronic upper respiratory disease, lethargy and inappetence. Trunks first began sneezing and
coughing in late August. He was taken to his primary care veterinarian, who prescribed Lysine and Doxycycline for a presumptive
upper respiratory infection. Trunks appetite declined, and it was very difficult to administer his medications. Trunks was referred to
Colonial Veterinary Hospital in early September, and skull radiographs revealed an expansile rostral mandibular lesion and a soft
tissue opacity in the nasal passages. The left mandibular canine tooth was extracted and biopsies were taken showing marked mixed
neutrophilic gingivitis with granulation and squamous hyperplasia. A rhinoscopy was performed, no masses were seen, and a biopsy
was taken of the right and left nasal passages. Histopathology revealed inflammation (neutrophilic predominance with transitional
metaplasia and lack of cilia on the right). There was no evidence of neoplasia or infectious organisms. Trunks was started on a
course of amoxicillin following the tooth extraction, but started eating less and defecating less. He was then diagnosed with
pancreatitis (via positive fPLI) and constipation, and was treated with metronidazole and lactulose. His appetite briefly improved,
then sharply declined. On 10/21/15, Trunks was hospitalized and an esophagostomy tube was placed. He returned home on
10/23/15 and was fed 60-70mL Hill's a/d slurry four times a day. He was also treated with doxycycline, lactulose, and Lysine.
Several years ago, Trunks had an episode where he was acutely non-weight bearing in the hind and was diagnosed with an aortic
thromboembolism. He fully recovered, and an echocardiogram performed at that time showed no evidence of heart disease (report
unavailable). Since that time, he had been a healthy cat with a good appetite. Trunks has periodically received vaccines and has no
other known historical health problems. He lives with one other cat and is indoor only.
VISIT SUMMARY:
On presentation on 10/27/15, Trunks was quiet, alert and responsive. His vital parameters were all within normal limits, and he had
pink mucous membranes. He periodically had increased upper airway noise and a hacking cough. An esophagostomy tube was in
place on the left side of the neck and the incision site was in good condition with no swelling, heat or redness associated with it. His
heart and lung sounds were clear with no evidence of murmurs or arrhythmias on auscultation. He was over conditioned with a body
condition score of 7/9 (1=emaciated, 9=obese). He had severe halitosis and was missing multiple teeth including mandibular incisors
and the left mandibular canine. Every time his mouth was opened, he gagged and hacked. There was evidence of mucoid opaque
discharge bilaterally from the nares with crusting and ulceration of the nasal planum. Bilaterally, his eyes showed visible nictitans and
the left eye was mydriatic with an incomplete direct pupillary light response on that side. He resented abdominal palpation, but it was
soft, with no obvious masses. Trunks' physical exam was otherwise within normal limits. Blood was collected for point-of-care blood
work, which showed hyperproteinemia and hypernatremia but was otherwise unremarkable. Blood was also collected for a complete
blood count and chemistry profile. A brief abdominal ultrasound revealed no free fluid. An FIV/FeLV SNAP test was performed and
was negative. Trunks was fed 65mL Clinicare via his esophagostomy tube and was given an intravenous anti-emetic (Cerenia).
On 10/28, Trunks' care was transferred to the Internal Medicine Service. Trunks was quiet, alert, and responsive. His vital
parameters were within normal limits with a heart rate of 160 beats per minute, respiratory rate of 20 breaths per minute and
temperature of 100.9 degrees F. Trunks' physical exam was unchanged from the previous day. Blood was collected and submitted
for Cryptococcus antigen and a Neurology Service consult was performed. Later that afternoon, Trunks was placed under general
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anesthesia and abdominal ultrasound and CT scan of the skull and thorax were performed. Trunks recovered uneventfully from
anesthesia and was treated in the evening with dexamethasone SP (1 mg/kg), buprenorphine, and IV fluids. He was fed Hills a/d
slurry via esophagostomy tube. Trunks rested comfortably overnight.
On 10/29, Trunks was bright, alert, and responsive. His vital parameters were within normal limits with a heart rate of 160 beats per
minute, respiratory rate of 16 breaths per minute and a temperature of 100.0 degrees F. His physical exam was unchanged from the
previous day. He was fed through his esophagostomy tube every 6 hours and continued on buprenorphine. He was then discharged
to the care of his owner in the afternoon.
DIAGNOSTICS (only abnormal values listed, reference ranges in parenthesis)
COMPLETE BLOOD COUNT
Seg Neutrophils 12.8 thou/uL (2.3-11.6)
Lymphocytes 0.4 thou/uL (0.9-6.0)
Monocytes 0.9 thou/uL (0-0.7)
Total protein 8.7 g/dL (5.9-7.5)
Interpretation: Trunks has a mild stress leukogram, which is likely due to stress of hospitalization. He also has an increase in his total
protein, which is most likely caused by dehydration.
CHEMISTRY PROFILE
Anion gap 26 mEq/L (18-25)
Calcium 11.2 mg/dL (9.1-10.9)
Interpretation: Trunks hypernatremia has resolved. He has mild nonsignificant elevations in his anion gap and calcium levels.
FUNGAL SEROLOGY: CRYPTOCOCCUS Ag
Negative for antigen
Interpretation: Trunks does not have Cryptococcus infection.
NEUROLOGY CONSULT
Mental status: dull, lethargic
Attitude/Posture: Head down, responds to name, increased reactivity/flinch on menace
Conformation/Muscularity: Normal
Gait: Normal
Cranial Nerves: Anisocoria OS>OD, incomplete constriction on direct and consensual PLR OS. Normal nasal sensation, elevated 3rd
eyelid OU, incomplete dilation OD. Exaggerated response to facial sensation on left, normal on right.
Proprioception: Normal
Spinal Reflexes: Normal, can?t assess left front due to catheter and bandage
Nociception: Head pain
Neuroanatomic localization: Midbrain vs, peripheral (sympathetic vs. parasympathetic) vs. ocular
Rule outs: Infection vs inflammation vs. neoplasia vs. other
ABDOMINAL ULTRASOUND
The pancreas contains many, small (up to 3.3 mm diameter), hypoechoic nodules, some of which bulge the contour and result in a
mildly irregular margin. The spleen contains many, small (up to 0.45 cm diameter), hyperechoic nodules, none of which bulge the
contour. The spleen is otherwise normal. Both kidneys have normal size (L: 3.9 x 2.3 cm, R: 4.1 x 2.2 cm) and shape, with mild loss
of corticomedullary
definition, and innumerable, thin, mildly hyperechoic linear striations that radiate out through the medulla and cortex. The liver,
gallbladder, stomach, adrenal glands, medial iliac and jejunal lymph nodes, urinary bladder, peritoneum/mesentery, small intestine,
and colon are normal.
SUMMARY:
1. Many, small, nonspecific nodules, pancreas and spleen
2. Questionable nephropathy
CT SCAN (SKULL AND THORAX)- official report pending
Mass visible in the ethmoid turbinates extending into the left frontal sinus, left retrobulbar space, and sphenoid sinus. Evidence of
lysis of the frontal sinus, cranium, and nasal turbinates with extension of the mass into the cranial cavity.
DISCUSSION
NASAL TUMOR
Trunks' CT scan revealed an extensive mass in the caudal aspect of his nasal cavity. Unfortunately, this mass has caused damage
of the surrounding bony structures and invaded into his cranial cavity (cavity in the skull that contains the brain) and left orbit (cavity
that contains the eye). The mass is likely interfering with the innervation of Trunks' left eye and causing his mydriasis (dilated pupil).
In cats >90% of nasal tumors are malignant, with the most common being lymphoma, squamous cell carcinoma, or nasal
adenocarcinoma. A biopsy would be necessary to provide a definitive diagnosis. However, a biopsy was not performed due to the
close proximity of the mass to the brain. Nasal tumors are typically locally aggressive and, rarely, metastasize (spread) to other
locations in the body. At this time, Trunks has no gross evidence of metastasis. Nasal tumors can be treated with either palliative or
definitive radiation therapy. However, this is unlikely to significantly extend Trunks' lifespan given the extent of the tumor. An
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alternative option is palliative therapy, which consists mainly of pain and anti-inflammatory medications. The goal of palliative therapy
is to allow Trunks to be as comfortable as possible for the remainder of his life.
As Trunks' tumor progresses, it is likely to cause neurologic deficits. Depending on how it grows, clinical signs may include changes
in mentation, seizures, and ataxia (wobbly gait). It will be important to assess Trunks' quality of life daily based on his comfort level
and energy.
MEDICATIONS
Prednisolone 10mg/ml suspension: Give 0.64 ml by mouth every 24 hours. This medication is a steroid. Expected side effects
include increased thirst, urination, and appetite. Concerning side effects include signs of gastrointestinal ulceration such as vomiting,
diarrhea, poor appetite, or black colored stool. Do not combine this medication with any type of nonsteroidal anti-inflammatory
medication (Aspirin, Metacam, etc) as this can worsen side effects. Please consult a veterinarian prior to discontinuing this
medication and do not stop it abruptly. NEXT DOSE DUE 8PM TODAY.
INSTRUCTIONS
1. Please administer medications as described above. If Trunks is experiencing any side effects that you are concerned about,
please call Dr. Stanton at 607-253-3060 or your primary care veterinarian.
2. FEEDING TUBE INSTRUCTIONS:
-Trunk should be eating 1 to 1.5 cans of Hill's A/D per day.
-Mix one can of Hills A/D with 80 ml of water in a blender. Please administer this gruel over 4 meals a day (60 ml of gruel per each
meal)
-Establish a feeding place and stick to it. Cats do best with routine.
-Before feeding please slowly flush the tube with 5ml of water. If Trunks begins coughing or gagging stop immediately. Next
administer Trunks? meal (60 ml of gruel) slowly over 20 minutes.
-After feeding, flush the tube with 10 mL of tap water to clear it of any leftover food.
-Keep the site clean, dry and loosely covered. This is what Kitty Kollar? was designed to address.
-Bandages or coverings should be placed loosely so that the site can breathe, and never let the area stay wet or moist. Do NOT use
Triple Antibiotic ointment ("Neosporin") unless directed by your veterinarian.
-Give Trunk a chance to eat. If he does not eat his entire meal then the remainder may be given by the tube.
-Please seek medical attention if the tube position has changed, it is no longer secure, or it falls out. If the insertion site becomes
excessively irritated, swollen, painful or infected, or there is excessive, foul-smelling material at the site.
3. MONITORING: Please continue to monitor Trunks for signs of systemic illness such as vomiting, diarrhea, or lethargy.
Additionally, please monitor for progression of neurologic signs such as blindness, seizures, head tilt, loss of hearing or difficulty
walking. If you observe any of these clinical signs, please contact your veterinarian.
Thank you for bring Trunks to Cornell. He is such a sweet boy and a joy to work with. If you should have any questions please don?t
hesitate to call 607-253-3060.
CLIENT SIGNATURE:
Please sign below to indicate that you have reviewed the contents of this Discharge Statement and that all of your questions and
concerns regarding your pet's care have been answered.

__________________________________________________________
Owner/Agent Signature
Date
Thank you for bringing your animal to the Cornell University Hospital for Animals. We hope that you have been satisfied with the
service and treatment. If you wish to discuss these matters, contact us at 607-253-3060.

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