Congenital Diaphragmatic Hernia

[IronHippo]

I could use some thoughts. We brought Radish (13 month old male) in to the emergency vet tonight because of a sudden urinary issue. We left him there to get cleared out and the vet who performed the procedure just got back to me. He had crystals and will need to be on a urinary care diet from now on, but his kidneys are fine which means we caught it early and I'm glad for that. I definitely was not anticipating him having urinary problems so early in his life and I'm just really confused how he developed crystals so young but that's not what I'm writing this post for.

When the vet did the xray to check on the catheter, she noticed that parts of his organs are where they shouldn't be--she said parts of his intestine and possibly his liver are in his chest cavity and it appears that he has what she called a diaphragm hernia. Because we've had Radish since he was 2 months old and he hasn't had any traumatic incidents since we adopted him, she thinks it is likely a congenital condition.

We wouldn't have known about it if they hadn't done the xray as part of the procedure. I'm just really kind of shocked and a little scared. He's always been as active as I'd think a kitten should be and loves nearly anything and anyone he meets. Even the techs were remarking on how chatty and handsome he is as we were leaving. I'm glad that we at least know about his condition now. We'll probably be finding out more from the clinic's surgeon or the daytime vet tomorrow/later today, but I kind of would like to know if anyone has gone through this with their cat before and how did it turn out. I know he's still young so he should have a really good chance of recovering from surgery if it's needed, but every time I think about his intestines bunched up around his heart I get so worried. Would welcome input if any. Thank you!

 

[Jem]

I did a little reading as I wanted to know if it is similar to a hiatal hernia which humans commonly get (where the stomach pushes up thru the diaphragm causing reflux and digestive issues). And basically it's the same "sort" of issue (but more severe), where there is a tear or rupture of the diaphragm allowing the lower organs to move into the chest cavity. I also read that surgery seems to be the only option, as they need to repair the damaged diaphragm to keep the organs where they should be. Usually when it's congenital, symptoms don't start to show that there is anything wrong until they are 1-2 years old, so the fact that your kitty has not started showing any symptoms (as far as I know), getting this done before his breathing or heart become compromised (which would make going under anesthesia more dangerous) would probably be best (IMO).
It also seems that recovery from this requires crate rest, so that is something you should be prepared for. (getting a dog crate that fits a litter box, a bed, blanket, food, water, without too much extra room to move around too much.)

I don't actually have first hand experience with this in kitties, but wanted to send you good thoughts for a speedy recovery for Radish!!!!

Please keep us updated on what they say.

 

[Furballsmom]

Oh Radish baby!!
I have no experience but I'm sending all sorts of good thoughts

 

[IronHippo]

I did a little reading as I wanted to know if it is similar to a hiatal hernia which humans commonly get (where the stomach pushes up thru the diaphragm causing reflux and digestive issues). And basically it's the same "sort" of issue (but more severe), where there is a tear or rupture of the diaphragm allowing the lower organs to move into the chest cavity. I also read that surgery seems to be the only option, as they need to repair the damaged diaphragm to keep the organs where they should be. Usually when it's congenital, symptoms don't start to show that there is anything wrong until they are 1-2 years old, so the fact that your kitty has not started showing any symptoms (as far as I know), getting this done before his breathing or heart become compromised (which would make going under anesthesia more dangerous) would probably be best (IMO).
It also seems that recovery from this requires crate rest, so that is something you should be prepared for. (getting a dog crate that fits a litter box, a bed, blanket, food, water, without too much extra room to move around too much.)

I don't actually have first hand experience with this in kitties, but wanted to send you good thoughts for a speedy recovery for Radish!!!!

Please keep us updated on what they say.

Thank you so much. I didn't sleep much last night and I was very grateful to see your response this morning. I did some research before I went to sleep and every said surgery too so I'm preparing myself for him needing surgery. I know there will be sticker shock but he's so young...and I think his insurance should cover it, he's been covered since he was a kitten. I hope I'll be able to find some kind of reasonably priced large crate. Thank you for your response!

 

[IronHippo]

Oh Radish baby!!
I have no experience but I'm sending all sorts of good thoughts

Thank you!

 

[Furballsmom]

 

[IronHippo]

Sorry, does anyone have suggestions on what to look for for his bed rest period? I'm looking at dog crates online right now. It looks like I will need a very big one. He had a playpen to keep him confined when he was a kitten that's in storage now but it was one of those collapsible cloth ones and I'm sure he's too big for it now anyway.

 

[Furballsmom]

I think a dog crate, maybe a couple of thermal kitty beds?

You could look at Letgo or Nextdoor, just sanitize it, you should be ok

 

[Jem]

When it comes to the size, you actually don't want it TOO big. Enough floor space for a litter box, a bed/sleeping area (maybe a plush dog cushion instead of a bed that has sides that would need climbing over) and food and water at the complete opposite side of the litter box and just a bit extra so everything is not crowded and she can move about comfortably but again not too much. Crate rest is supposed to try an limit too much movement, so the more room you give the more they will move around.
Having said this, you do want to make sure that the room they have to relax in can accommodate them fully stretched out and that they can stand at full height. You want to make sure her access to the litter box and usage is comfortable as well so a few inches of room around the edge of the box so she can turn about without her head or tail being pressed up against the cage, would probably be good.
So maybe measure your litter box, and whatever pad/cushion you will use then add a few extra square feet (for moving around and dishes) to your measurements and you will hopefully find a suitable dog crate with that approximate square footage. Maybe 10-12 square feet????IDK. (so a 4x3 or 5x2.5) I don't really know what measurements standard crates come in...I never had to buy one myself, because I can just used my dad's (well my dad's dog ), and only ever needed it once.
Also if you can find a cage with 2 doors, it would make your life much easier when it comes to cleaning the litter box and tending to the food and water dishes.
And keep in mind that if you are home and are planning to sit and watch TV or whatever, kitty can come out to snuggle with you, it's just you don't want any jumping, running, or any type of play or extended walking that will put a strain on her body.

 

[Jem]

Wow, I just looked online, and some of these cages are expensive! Maybe scour the local buy and sell websites, someone in your neighborhood/city may be wanting to let one go for cheap! I wonder if your local shelter or vet may be willing to lend you one?

 

[Furballsmom]

Seems like the pet supplies industries are getting a little (--lot!) crazy with their pricing

 

[IronHippo]

Yeah they are expensive In the grand scheme of the total surgery cost, maybe not so expensive...but still an additional cost. Thanks for suggesting checking second hand sales! The locally available used ones are either not big enough or rusted from being outdoors so I think I'm going to go new (it's just about a $15 difference between new and used honestly so with the difference in conditions I might as well go new). I've got an eye on one that is currently in stock at the local Petsmart (Top Paw® Double Door Wire Dog Crate | dog Carriers & Crates | PetSmart) and I think I will be able to set it up so that his litter box is on the outside "attached" to one of the two doors--it's a hooded box so I'm thinking I'll put the openings together so he can climb in and out from that side of the 2 doors and that way he still has a nice amount of room to lie down in the cage itself.

Still waiting to hear back from the daytime vet though. Once I know if he'll need surgery or not I'll go buy the crate.

 

[Furballsmom]

 

[IronHippo]

Thank you for the good vibes Furballsmom and Jem! We just went to visit Radish and they said they will take the catheter out tonight, monitor, and if he is OK then we can bring him home tomorrow!

As for the hernia, they said it's definitely congenital but in Radish's case it isn't a typical diaphragmatic hernia--I forget what she called it (I'll get the name when he's discharged) but in his case his hernia appears to not be life threatening and the type of surgery required to address it might do more harm than good as it could mean introducing things to his system that he just isn't used to handling since he's been "configured" the way he has been from birth. She recommended we just wait and see before considering the surgery step. The important thing is getting him through the urinary issues.

I'm so glad that we know this is an issue for him now; x-rays just aren't something that vets typically do and we never would have known if not for this incident. So silver lining, I guess, and luckily it is likely to be far less of a concern than his poor bladder. Hopefully he can come home tomorrow. He looked miserable; he had a soft cone on and a pink cast on his left front leg for fluids and tubes trailing out of the cage, and the techs said he hasn't been eating and has been growling at them--he even has a bite warning sticker on his cage and records! But the minute he saw us he tried hobbling over and wanted nothing but scratches. He even ate a few pieces of kibble from our hands (they'd laid out a whole buffet of food options for him and they all pretty much looked untouched ).

Thank you so much for your thoughts and comments, Jem and Furballsmom!!

 

[Furballsmom]

in his case his hernia appears to not be life threatening

they'd laid out a whole buffet of food options for him

I hope that your visit inspired him to eat a little more

 

[IronHippo]

I hope that your visit inspired him to eat a little more

Thank you! I hope so too!

 

[IronHippo]

Found this sheet which I think describes what Radish has: https://www.saintfrancis.org/wp-content/uploads/Peritoneopericardial-Diaphragmatic-Hernia.pdf

The vet was saying that it seemed like his sac was very large and because of that it lets things pass through without issues at the moment. So I guess we continue to monitor.

 

[Furballsmom]

How are things today? Is Radish-baby eating?

 

[Jem]

I hope he recovers soon from his urinary issues, and good news on not requiring the surgery for now. Hopefully he never does and his body just accommodates that his insides are a bit "off".
Were you able to bring him home today??
Keep us posted.

 

[IronHippo]

Thank you both for asking! Yes we will be able to bring Radish home today and my husband and I are going together after work! They took the catheter out this morning and he peed by himself in the litter box not too long after. This hospital seems to be very good and they've seen a lot of cat urinary issues, so I'm sure they'll have discharge instructions--if not we'll ask. As for his PPDH, I'll just double check that we should just be monitoring for any signs of lethargy and that otherwise no surgery is required for the time being. I don't know if he's started eating but I'm sure the catheter is part of the reason why he didn't want to eat yesterday. He was still being given liquids to encourage urination when the vet called so at least there's that, but I hope he is eating a little by now.

Will update once we bring him home and we've monitored him for a bit!