Neonate With Pectus Excavatum

Hi there, this is my first time posting, although I run a rescue and have often found invaluable information on this site. I apologize in advance, as it will be a long post.

My current situation is one I've seen addressed here before, and am looking for some personalized advise on.

I rescued a doll face Persian cat that was one day away from giving birth. We knew when she was dumped so late in the pregnancy as a purebred, that there was likely to be an issue. She gave birth to two kittens, one still born, and the other now 23 days old. At 8 days old, she stopped producing milk, and he became a bottle baby. He currently weighs 380 grams.

Yesterday, I brought him to the vet as he was having intermittent heavy breathing, combined with a decrease in appetite, and restlessness. He has times of happiness, playfulness, etc, and times of seemingly extreme distress. My vet saw him, and he was diagnosed with Pectus Excavatum. That said, my vet wasn't extremely familiar with the condition, and was unsure if that was likely causing his issues. At the time, I didn't know anything about the condition or what questions to ask, and today my vet is not in, so I cannot follow up until Monday.

When I got home, I learned more about this condition online, and believe very wholeheartedly that that is exactly what is causing the problem. When he was born, we noticed he was shaped almost like a pancake. It seems like his condition is worsening, which would make sense since he continues to sleep on his stomach.

I am unsure of the severity of the malformation, as well as the shape of his ribs (if the curve inward or go outward). I've read catwoman707's advise on how to tell the shape, however when I flip him and press on his ribs, I am unable to really see any movement.

My question is this:

I have seen before the suggestion of fastening a vest. This concept makes perfect sense to me, and I would be very comfortable trying it. Is this still a viable option at his age? He has no murmur, no noticeable respiratory issues, etc. Through painstaking efforts, I have gotten him to eat and have continued weight gain.

If the vest is a viable option, I have follow up questions regarding how much tension to put on the vest, how long to use it for, what's the ultimate goal, etc.

Of course I would love opinions on what his chances are, how severe it is, etc, but I understand that getting that advise is not necessarily realistic via the web.

Note:

I am happy to share whatever information I can to help anyone better help me.

I can post videos of his breathing and me doing the test on his ribs. I'm not sure if I can post them here, but I can add them to youtube and then post that link.

I discussed with another vet today getting x-rays, but she but she admitted she would have very little value in reading them or advising me. She said she's never personally dealt with this condition before. I would get the x-rays if I could find someone here with experience in reading them. If it would make more sense to get the x-rays after some days with the vest, that's an option too. Of course, money is tight as a rescue, and trying to spend only when it will actually be effective is my goal.

I seriously appreciate anyone who has taken the time to read this. I desperately hope to save this precious little guy, and give him a good quality of life. Reading online, the likelihood of that seemed dismal. Reading here, I feel much more inspired. It's incredible how valuable the first hand experience of fellow rescuers is.

Thank you for caring! I don’t have any personal experience with rescuing such young kittens, but I’d like to direct you toward an article about pectus excavatum that discusses some treatment options: Flat Chested Kitten (fck)

Kittens born with pectus excavatum can live normal lives, live Vegemite in the article I linked you toward.

Hi - thanks so much for coming here! Thank you also for taking in these small lost souls!
Wishing you all the best of luck - I have no info or help other than sending TONS of good wishes to you all. Speaking of, were you able to keep little miss Persian mum?

The best advice is you @- mention the forumists being knowleable about flat chested kittens syndrome. Better @ then pm because more people may read the answers. You tell you saw some good postings...

Good luck!

Thank you for the well wishes and link to the article! I'm nervous for the little guy, but very determined. In case anyone finds this thread with the same problem, I'm going to post a great article I just found detailing medicinal suggestions, physical therapy, and splints. I plan to discuss all of it with my regular vet Monday, as well as get x-rays, as long as they are useful. Even just becoming aware of his problem has allowed me to handle him better (avoiding his ribs), and know when to feed him and when to help him settle down. This has decreased the amount of intense episodes of heavy breathing. My big fear right now is that his ribs curve in, but I really can't tell. When I flip him and push on his ribs, I see no movement, and his ribs really resist my pushing. I'm nervous to squeeze too hard. He also screams at the top of his lungs and really struggles to breathe when he's on his back, making the whole thing stressful. I've tried doing the massages just a little, and it definitely seemed to help calm him down when he was breathing heavy. My feeling is that if his ribs were curved in, it wouldn't ever have a calming effect to be massaged like that, but I'm not sure.

The article states that steroids can help them to breathe easier. Does anyone have any experience with giving steroids to a kitten this young?

Also the member I noticed as being extremely knowledgeable in this is catwoman707 . I shot her a PM but would be happy to have the conversation here instead, I just don't want to put any pressure on in case she's busy.

I actually feel confident in doing the massages, or possibly a splint, and that having a positive outcome for him, since I am currently able to keep feeding him. I just need to make sure of his rib shape, because obviously if it's curved in, it would be devastating to make his condition worse.

Also, in regards to his mom, she's with us and doing very well. It was really sad to separate him from her when she loved him so much, but he wouldn't take to the syringe/bottle at all as long as he was with her, and spent nearly all day trying to nurse from her to no avail, expending all his energy. I think she's recovered finally from the separation, and is going for her spay next. She's a sweetheart, and we love her too.

Attached is a picture of the little star. As I hope you can see, he's pretty stinkin' adorable!

FLAT-CHESTED KITTEN SYNDROME TREATMENT - Maine Coon Cattery DreamCoon

@Sarthur2 catwoman707

Oh my word what a doll baby!!!

Hello there!
You got my attention

If you flip him over holding his scruff and continue holding it as he is laying on your open palm he should relax enough to get a good few sqeezes in so we can determine if the vest will be the right approach.
Fingers crossed as it will fix quite fast due to his very rapid growth/young age.

You will be flipping him and holding his scruff in your left hand (assuming you are right handed) and with your right hand, thumb on one side of the rib cage and first 2 fingers on the other side, ribs are soft and flexible so you should def be able to squeeze your thumb and fingers together and get movement.
As you squeeze in and out, watch the center, you want to see it rise where the ribs join together in the center.

I should add that if ribs seem resistant to moving, try to squeeze together towards the lowest ribs near tummy. Those are the longest so moving might be easier there.

Thanks for the reply. I tried again as suggested, the problem is being on his back is the worst position for him. He screams and breathes -very- heavy, it makes it impossible to see which direction his chest moves in. It doesn't help that his hair is extremely long too. I'm going to bring him to our vet tomorrow morning. I will ask her to check for me, and likely do x-rays as well to be sure. From there I'll be ready to move with confidence on the process of reshaping. He had a bit of a rough night last night, being restless and only eating a few ML of formula. Then this morning he ate very well, and was happy playing, and is now sleeping. I've noticed he always sleeps on his side now too. One problem is since he hates being on his back, it's made it harder to stimulate him to poop. He strains so much it almost seems like really intense contractions, he can't breathe well at all in that position. I've changed to trying to stimulate him while he's in the palm of my hand, with his backside hanging off. It works for peeing, just not yet for the other. He's now going on his third day of not pooping, so I've put pumpkin in his formula this morning, which has always worked fairly quickly for my bottle babies in the past. As long as he is stable and eating, I feel comfortable waiting for the vet to get started with his physical therapy, so that I don't make any mistakes identifying his shape.

Does he relax if he was scruffed and lifted rather than laying on his back in your palm?
A warm wet washcloth smoothed over his long fur will take away the fluffiness so you are able to see better too.
I'm afraid the vet may be discouraging, I've heard it all before, to the point where those I helped were told that the kitten should be euthanized and they believed this to be needed/the only hope. No offense to vets, they simply don't have much if any experience with this.
Until I explain what to do and very fast, within days the ribs are growing in the right way and kitten is doing so much better, that fast.
Also, if he is side sleeping he needs help now, starting ASAP. As his rapid growth will squeeze his chest and lungs/heart fast.
Try doing this when he is on his side asleep, on a hard surface (not on blankets) let the surface he lays on be supporting one side of his ribs, then you can push on the up side of his ribs, see if you are able to see the center come out that way.

Or hold him up over your head with tummy down and squeeze his ribs which keeps him from being on his back even.
Wish we were neighbors, I would be there in a heartbeat to help!

Okay how about this, have him standing up, slide your hand under his chest and squeeze the ribs, feel what it does, goes in or outward.
Your kitten has a pretty good sized issue so time is critical to be honest. He is growing every day and with his breathing and at times no appetite he needs to get started now.
Just need to make sure his chest center comes outward and doesn't curl inward when squeezed.
Most commonly it does come out and makes the vest perfect for reshaping the growth direction.

Add several drops of mineral oil to his bottles for constipation. If no change within a day then using a 1.0 ml no needle syringe you can give him a warm mineral oil enema.

Is side sleeping worse? I could try to encourage him to sleep on his stomach if that would be better. The pumpkin in his formula has started to kick in, and he's started to poop a little bit, which is encouraging. I suspect that his constipation is playing a part in his decreased appetite too. His feedings alternate between being very hungry, and being not at all hungry, which isn't ideal, but he's still gaining 15+grams a day, so he's okay for now in regards to appetite I think, although that can always change.

I'm going to try again soon to check his ribs again soon. He's sensitive to touch and forcing his position, so I have to try to get the right moment. My fear is I vaguely recall my vet saying that they did invert inwards, although I was processing a lot of information at the time, and can't say with absolute certainty. My vet also spoke of the condition as though it wasn't a big deal, so I'm not confident she'd be paying that close attention to whether they were inverted, or just flat. I'm confident that that is what's causing his problem though. I have the first vet appointment at 2 tomorrow, although I was told she gets in earlier to check on her patients and would give a call before then.

As far as vets and their pessimism, I can totally relate. I work with a variety of vets in the area, and have seen the lack of care toward neonates time and time again. This vet has been extremely caring though, and is always optimistic. Last year we had a litter of 4 week olds with panleuk, and she did a lot of research and put a lot of time in with us trying to help them recover. All five made a full recovery. She doesn't have a lot of first hand experience with neonates and the issues we've presented to her, but she does her homework, and I actually believe she'd work on the vest with us too, although I feel like I can handle that once I have a better grasp of the severity of his condition. She would never recommend euthanasia, and I'd never consider it.

If my fear comes true, and his ribs do invert inwards, is there anything I can do? Or is it just hope that he can make it to the age where he can get surgery?

Also, he just had one of his episodes of heavy breathing. He wasn't coming out of it on his own, so I did the massages outlined in the article I posted, and he's breathing normal now. Am I right to believe that the only way the massages would relieve his discomfort is if his ribs are in the correct position? I know I should be able to get a read on him the other way, but his breathing makes it difficult for me to really feel confident about the movement I do see. I do believe his chest is moving outward in the right direction, the movement is just so so slight.

Sorry one last question: Have you had success just doing the massages versus the vest? My feeling is he's almost always on my lap, so I can do the massages throughout the day and have more control over it. But if it's not enough, I can make the vest and monitor him.

I will just randomly reply to your questions/comments.
First of all, no we don't want him laying on his tummy, not at all if there were a choice.
This only continues to prompt his chest to grow in the same shape as they are now.
We want to encourage the shape to change.
I am feeling concern over his breathing episodes though, it only gets more and more restricted daily, not in measurable amts but certainly every few days or so due to his rapid growth.
I understand what you describe about your vet, having a rescue myself for many years and have tried plenty of vets, I know how much they vary and you do find one every so often who may not have experience in all, but have the compassion and drive to learn what they aren't familiar with.
Lucky for you and I we have a vet like this we deal with
Euthanization would not be by choice, if he gets to the point where his breathing episodes increase he will be struggling for enough oxygen to support him, which is torture basically.

As far as massaging, it can help. If you are familiar and have ever dealt with twisted legs in baby kittens, which I have become very good at fixing as well, it's kind of the same idea.
It requires long massages on the leg then at the end of massaging comes gently twisting the leg in the correct position, slightly over extending.
I am hopeful from your saying it seems to come out in the center, even a slight amt is promising.
You can do massage only but I would definitely prefer he got those ribs reshaped faster, and the vest starts to work so fast, almost the first day.
After 3 days his ribs are well on their way to growing correctly.
Then he can just have it on some of the time, then he is done.
Of course every couple of days he's grown, vest snugness needs adjusting.
It does help that he is almost to the age where he is not mostly on his tummy but more on his feet
His struggling with forced positions is due to his breathing, certain positions causing him to have a harder time breathing.
If his center rib area does curve inward like we hope not, massaging and pressure on the sides of his ribs while in your lap, squeeze, release, over and over.
This will still prompt shape change, just not as certain of the outcome whether surgery will still be needed if he makes it that long or not, due to varying degree of invert. SO much safer and simpler with out surgery!

In regards to euthanasia, of course. I just meant I understand some vets have a tendency to be overly pessimistic, and at this stage I would not consider it, as I see how much promise he has.

As for an update, I spent a couple of hours with my vet and the little one today. She has been phenomenal in doing research and consulting with other vets, all of whom have shown a lot of interest in his case. He had x-rays done, which unfortunately show that he has a mild inversion of his ribs. She said when his chest was expanded during inhale, his ribs had no inversion at the end. It only showed during the exhale. So I wonder if there is an opportunity to massage slightly just on the inhale? I imagine a vest isn't an option at the moment. The good news is the flattening overall is very mild.

That said, he has still been symptomatic, which we spent some time exploring. The past two days were noticeably worse than usual, in terms of labored breathing. That's also when his constipation worsened. Originally, he pooped every day. Then he had a day of slight diarrhea (my fault as I had made a brief change to his formula out of necessity), followed by four days of no bowel movements (today being the fourth day). The only exception was a tiny tiny movement yesterday that I found in his bedding, which implies he's been straining. He had an enema today, and had a lot come out. So my hope is that without all the extra pressure on his system, his breathing will be easier. It's only been a couple of hours he's been home, but no heavy breathing yet. If frequent episodes start up again, then I'll know the constipation wasn't the problem.

I agree that being on his feet more should help. He's been completely steadily walking for almost a week now, which is pretty ahead of the curve compared to my past bottle babies, who are usually just wobbling around. I of course hope that he can grow out of it naturally. I also spoke to my vet about following up with more x-rays after about a week to see if he's getting naturally better or worse, because if he loses the inversion then we'd have more options. My vet is going to continue to research and is consulting with another senior vet tomorrow. In the meantime I'm hoping the enema will help, and she prescribed a laxative to use as needed. I'm still unsure if doing massages during inhale is appropriate (when he's not inverted), because I had originally read it was best to do them during exhale, when they're most relaxed.

I will say this: I never realized anything was seriously wrong with him until Saturday, when his labored breathing became really noticeable. I rushed him to the vet the next day. I believe it's possible that the diarrhea and then constipation greatly exacerbated the issue, and maybe without that it would be less serious, and something he'd grow out of. I think time will soon tell on that, so I will update likely tomorrow after I've monitored him a bit.

catwoman707 thank you so much for taking the time to keep reading/replying. I know I've posted a ton and hearing your feedback has been so helpful.

As I was reading your last post I thought, she needs to put him on a very mild laxative for now.....so glad to read on that he is.
At this time I think it's best to start doing the squeezing motion while he is in your lap and as often as possible. It won't restrict his breathing or cause it to cave in more, it is to stimulate growth but not in width so much as depth.
Did you see her doing any bending of his cage manually to determine how the center reacts?

As far as the constipation causing the irregular breathing episodes, I would say more likely the breathing issue has him holding it in because it's uncomfortable to push and causes pressure on his chest and lungs that's causing constipation.

With all due respect to your caring vet, I don't feel any confidence in calling it a mild case, it's more than mild to see the breathing episodes at his age, and will likely get worse soon due to growth.

This shape restricts the lungs but it also restricts the heart which is a muscle, and can cause damage, he may suddenly have a heart murmur, or worse damage depending on how much longer it goes on and how tight it gets.

So if you are able to squeeze his ribs during inhale then go for it. As long and as often as you can. If you can't do it only on inhale do it anyway. Ideally on inhale yes but on exhale it's not like you are holding it squeezed, which is what the vest does.
As I see it and the signs he shows, lack of cooperating with being laid on his back shows he is struggling, the breathing episodes and how much more often it's happening in the past couple of days, he is already quite restricted and has no room for it to become any worse at this point for him to have the best chance of getting through this, and without heart damage.

It really is the only option right now. Keep me updated please! At least a couple times a day if possible!

He's had more breathing episodes tonight, so you're right, it doesn't seem the constipation was the issue.

She determined it was mild based on some measurements that follow some veterinary scale, so I think it's mild from a technical standpoint. That said, I agree it doesn't seem mild in the way it's affecting him, and seeing him in so much pain at times is driving me crazy. I haven't slept more than five hours the past few days, if that.

In practice, massaging on the inhale isn't possible, because its basically just forcing back out his breath, so I have to do it on the exhale. I'm going to spend all night doing it, and I just desperately hope it starts to take effect. I had read it was a dangerous option given his shape, but it feels like make or break time for him.

Seeing the littlest ones in pain is my least favorite part of rescue. I don't think he's beyond repair, but I'm less hopeful than I was before. I will continue to update.

Now when I massage he groans in pain. I don't think I have any options left. Is there any chance he can outgrow this? He still comes out of it, plays, eats, purrs. But the bad spells are pretty bad.

I am feeling to the point of urgency, as it sounds you are as well.
Can you describe what massaging you are doing?
Can you gently squeeze his ribs while in an upright position and hold, and watch for a change in breathing at all?
Start out small, maybe squeeze 1/2" and hold, watch for his reaction, although holding might make him restless too.
If no changes in breathing try a little more, an inch and hold, see if that makes his breathing change.
He is running out of space fast. If his ribs are wide which they likely are, then squeezing may give him more room for lung capacity. If he doesn't change his breathing then we might go the vest route, start off small keeping a hawk's eye on him for the first couple hours, then increase it a bit more and watch again.
He may very well benefit from it, and you will know if his breathing episodes slow or stop while wearing it.

bklyn said:

Now when I massage he groans in pain. I don't think I have any options left. Is there any chance he can outgrow this? He still comes out of it, plays, eats, purrs. But the bad spells are pretty bad.

Click to expand...

Is it possible for you to take a video clip and post?
If not, can you describe what he does?