• Laboratory testing can form a major part of investigations and typically involve blood and urine testing. 

• Most of our laboratory testing is performed at a commercial veterinary laboratory (QML) offsite as this provides the highest quality of testing. Depending on the test, turnaround times are approximately 24-48 hours. If tests have a longer wait time we will advise you.
   
• Some tests can be performed in the hospital and results obtained that day. These include basic blood and urine testing and electrolyte testing, but more specialised tests are sent to specialised laboratories. 

QUESTIONS AND ANSWERS

• Can a blood test tell me if my cat has cancer?

  • Unfortunately not. Although there are many tests developed in humans to detect specific cancers, these are not really present as screening tests in cats. Blood tests performed will typically give an indication of overall health of a patient, or localise a problem to an organ such as the kidney or liver. 

• Will my cat require any preparation before the test such as fasting or having the test at a certain time? 

  • Some tests require special preparation such as fasting or timing (e.g. phenobarbitone levels or thyroxine hormone levels) however we will advise you if this is required. If you are not sure, just ask us.

• How long will it take for my cat to have a blood test performed?

  • That depends on the type of test and your cat! Some samples can be obtained immediately, however sometimes cats are less anxious if they have a sedative given, this can take a little time (e.g. 1-2 hours). Some tests such as hormone testing are required to have multiple samples taken a few hours apart. If these tests are the ones being performed your cat will stay in the hospital in a comfy kennel with bedding and fresh water (and food depending on the type of test) while the samples are obtained. 

• Will my cat need sedation for a blood sample and what can I expect? 

  • Some cats get anxious on the way into the hospital or when we try to keep them still to obtain a blood sample. We may recommend that your cat has a little sedation prior to blood sampling. This is not because it hurts, but just to keep them calm. 

  • Sometimes this is a capsule that you give them at home prior to travelling or it can be given as an injection once they have arrived at the hospital. These sedatives only last a few hours and your cat should be back to normal by the time they are ready to go home.

  • Elderly cats can sometimes take a little longer to return to normal and may be just a little bit wobbly when they are walking.

  • We recommend that any cat that has been sedated stays indoors for 24 hours afterwards as their reaction times maybe a little slow!

• What happens when my cat has a blood sample taken?

  • Usually the blood is taken from a vein in their leg or their neck.  

  • A small amount of fur is clipped and we apply some local anaesthetic cream to numb the area. This takes about 20 minutes to take affect but we find it very helpful for the cats and they react much less. 

  • The cat is then gently held and a needle  inserted into their vein. This is rarely painful and with the local anaesthetic cream, most cats don't even notice. 

  • Sometimes we even feed cats while we are obtaining a sample as this distracts them from what we are doing!

  • A small amount of blood is collected and put into one or more tubes for analysis.

  • After the needle is removed, we will sometimes place a small bandage to keep pressure on the site, but this can be removed when you take your cat home if we have not already done so. 

• Will my cat feel faint after a blood test?

  • No. If they have been sedated they may still be a little wobbly, but not from the blood sample itself. 

• Are there any risks from having a blood sample?

  • No, for most cats it doesn't hurt and the most common side effect can be a little bit of bruising at the site. This is often more obvious in elderly cats with blood pressure problems. 

• What are the different types of blood tests that can be performed?

  • There are many different types of blood tests. Your veterinarian may order more than one test at a time but we will discuss with you which tests we suggest and why. 

  • Some common blood tests include: 

    • Blood glucose test - helps identify diabetes

    • Full blood count -  assess red and white cell numbers. This helps identify anaemia or signs of infection. 

    • Kidney function tests (e.g. urea, creatinine, SDMA)

    • Liver function tests (e.g. ALT, ALKP, AST, GGT, TBil)

    • Thyroid function tests (e.g. Total T4, TSH)

    • Blood tests to check blood clotting (e.g. ACT, APTT, PT) 

    • Blood tests to check the levels of certain elements and vitamins 

      • Ionized calcium

      • Vitamin B12

• How long do blood test results take?

  • It depends on the test. Tests we assess in the hospital are received on the same day. Most tests submitted to the external lab are received within 36 hours, however more specialised tests can take 10-14 days - particularly if sent interstate or overseas. 
  • We will let you know when you can expect your test result and will call you when we receive them. 

• An ultrasound is used to provide information about internal body systems such as the liver, gastrointestinal and urinary tracts.

• Ultrasound probes send out high-frequency sound waves, directed at the tissue being examined and then record the reflected sound to create an image. 
• Common reasons for ultrasound scanning include investigations of a cat's abdominal organs, chest cavity and musculoskeletal and vascular systems. 

• Our ultrasound is one of the newest available and we have a wide range of the highest quality ultrasound probes to obtain the most detailed and superb images. 
• Our team are highly experienced in performed ultrasounds on cats and have undergone a lot of additional training. 
• Ultrasounds are typically performed with cats sedated to reduce their anxiety and help keep them still. This means that better images are obtained.
   
• The fur over the region being scanned is clipped and a gel applied.
   
• Although an ultrasound can give a large amount of information, additional testing such as biopsy or aspirates (see link) maybe required to obtain a definitive answer. These procedures are performed under heavy sedation or anaesthesia and we will always discuss the requirement for this with you prior to any procedure being performed.

• There is often a large number of ultrasounds performed every day. We will contact you once the is ultrasound performed to discuss results, however can sometimes be a few hours after admission.
   
• For patients having repeat ultrasounds we aim to do this within the repeat consultation appointment, however this may not always be possible.
   
• A written report of the ultrasound will be provided to your veterinarian.

ULTRASOUND QUESTION AND ANSWERS

• Can an ultrasound tell me if my cat has cancer?

  • Ultrasounds can be very good at identifying abnormalities such as lumps and bumps in organs such as the liver, kidneys and intestines. Although some cancers have a typical appearance the ultrasound itself will not tell us the "type" of cancer present and a lump is not always cancer!
  • Only analysis of cell types under the microscope can determine this information.
  • These samples can be obtained using fine needle aspiration or trucut biopsy guided by the ultrasound or sometimes surgery is required. 

• What happens when my cat has an ultrasound?

  • Typically cats will have a sedative prior to ultrasound examination - not because it is painful at all, but to help reduce any anxiety and keep them still. 
  • Cats lie on a large mattress on the ultrasound table - it is very comfortable!
  • The region being examined will have the fur clipped and ultrasound gel applied which allows the ultrasound probe to generate good images. 
  • A variety of different images are obtained and a detailed report is prepared.

• Is an ultrasound for my cat invasive? Are there any risks? 

  • Ultrasound scans for cats are non-invasive and the procedure does not involve the use of ionising radiation such as x-ray but low-power sound waves. There are no known risks.

• Does an ultrasound have any limitations?

  • Ultrasound is a really useful tool for investigating diseases in cats but it is not perfect. Sound waves don't travel well through air or bone, so ultrasound isn't good at imaging body parts that have gas in them or are hidden by bone, such as the lungs or head.

  • We may recommend other tests such as CT or MRI scans or X-rays.

•  When will I get my cat's ultrasound results?

  • We will call you with your cats results after the scan is finished and will discuss if any further procedures will be necessary. 

The benefit of having an ultrasound with us is that if additional testing (e.g. fine needle aspirates)  is required we can typically proceed with this on the same day. 

We have the unique ability to provide specialist feline medicine care together with specialists in the fields of surgery, anaesthesia, cardiology and critical care to provide the best comprehensive care for your cat. 

• Radiography (x-ray) allows evaluation for respiratory (e.g. lungs), gastrointestinal (e.g. foreign bodies) or urinary tract abnormalities (e.g. kidney or bladder stones). It is also used for evaluating bones.
   
• Radiography is performed with the patient sedated or under anaesthesia as it is important for us to keep our staff protected from exposure to x-rays.
   
• For cats with breathing problems, performing investigations such as radiography can cause their breathing effort to deteriorate if they become distressed. We sometimes need to perform investigations very slowly to ensure that they do not become too anxious.
   
• We will contact you once your cat has had their radiography performed to discuss results, however this may be a few hours after admission.

QUESTION AND ANSWER ABOUT RADIOGRAPHY

• What is an x-ray?

  • An x-ray is radiation used to create a picture.  As x-ray beams pass through tissues of the body they are absorbed differently by various structures such as bones and soft tissues. These differences produce an image in shades of grey. X-ray imaging is also known as radiography.

• Why perform an x-ray and not some other sort of test?

  • X-rays can be used to diagnose disease and injury, including:

    • bone conditions e.g. fractures, dislocations, infection, arthritis and bone cancers
    • lung conditions e.g. asthma, pneumonia, cancer
    • congestive heart failure
    • stomach or intestinal obstructions e.g. foreign bodies (objects eaten that get stuck - in cats commonly string, hair ties, bits of plastic toy etc) 
  • Different testing methods such as CT or ultrasound give different types of information and maybe complimented by additional x-rays. Ultrasound is not very good at evaluating bones or gas filled structures so also performing x-rays may help identify a foreign body that is metallic (easily seen on x-rays). We will discuss with you which test would be best and explain why.

• Are there any risks to my cat from the x-rays?

  • Technically, an x-ray machine uses a small amount of radiation to create the image. Some types of x-ray, such as CT scanning use higher doses of radiation than plain x-rays.

  • The amount of radiation used in both x-ray and CT is unlikely to cause any serious problems to your cat. 

  • Generally, the benefit of the x-ray in diagnosing a health condition is greater than the risk of the radiation.

• CT is an advanced imaging tool that allows for incredible detailed studies of the nose, lungs, abdomen and musculoskeletal systems. It can also be used for evaluation of the brain and spinal cord, although typically high field MRI would be recommended for this (see section on MRI).
   
• CT can be performed under anaesthesia or we may use a purpose built chamber that can be used to perform the CT under sedation alone. CT performed without anaesthesia is only used in patients where anaesthesia poses a significant risk as the quality of the images is often not as good due to patient movement. 
   
• CT of the brain or spinal cord maybe recommended as CT scans are faster than MRI studies but they may not identify small abnormalities seen with MRI.
   
• All CT studies performed are submitted electronically to specialist radiologists for a report. These reports are received within 1-10 working days.
   
• Our feline clinicians also give an initial report on the day of the procedure.

QUESTION AND ANSWERS - CT SCAN

• What is a CT scan?

  • A computed tomography (CT) scan uses x-rays and computer technology to create detailed pictures of the body. It is very fast and can image every type of body structure at once, including bone, blood vessels and soft tissue. 

  • CT scanning equipment consists of a large gantry (a supporting structure) with a circular hole. Inside the gantry is a rotating ring that carries the x-ray machine and  x-ray detectors. An attached table slides the cat into the machine. 

  • Multiple x-ray projections are taken in thin slices along your cat's body (like a sliced loaf of bread). The detectors send this information to a special computer that combines them into an image.

  • The CT scan is also known as a computed axial tomography or ‘CAT’ scan (enter joke here!). 

• Is a CT scan invasive?

  • No it isn't. A CT scan is a non-invasive, painless procedure. It is performed with cats under heavy sedation or anaesthesia to keep them still. 

• Why might a CT be recommended for my cat?

  • CT scans are commonly recommended for:

    • Assessment of a body part’s structure or shape
    • Screening for disease particularly cancer 
    • Diagnosis of trauma or injury
    • Diagnosis of vascular disease
    • An aid to planning a difficult surgery
    • To aid interventional procedures such as biopsy or needle aspiration inside the body. 

• What happens when a cat has a CT scan?

  • Generally, the cat is admitted to the hospital either after your initial consultation or on another suitable day.

  • Your cat will likely have a light sedation given and an intravenous catheter placed. Once the catheter is in place your cat will either be anaesthestised or heavily sedated. This is not because the procedure is painful, it is just because we need your cat to be still and the machine makes a lot of noise. 

  • They are moved to the scanner table and our radiographer may use straps and foam pillows to position their body to help them keep still. 
  • The table slides into the circular hole in the machine.
  • Depending on the body part and the condition being investigated, a number of images may be taken as the table moves in and out.
  • The ring inside the gantry moves in a circle around your catas it takes the x-ray images. Each revolution (turning) of the ring takes less than a second and there may be a number of revolutions depending on the examination. This is where ensuring your cat is not moving is very important as movement will blur the images.
  • Depending on the type of medical investigation, the CT scan may take anywhere from a few minutes to half an hour or more.
  • Once the CT is completed we will phone you with the results and discuss if any further procedures are required. 

• Are there any risks associated with the CT scan?

  • The CT scan is a very safe procedure. Very rarely the contrast agent may trigger an allergic reaction in susceptible patients but this is very rare in cats. 

• MRI is an advanced imaging tool that allows detailed pictures of the brain and spinal cord. It is typically used in patients with neurological symptoms.
   
• All MRI scans are performed under general anaesthesia.
   
• We are lucky enough to have access to two types of MRI: high field and low field.
   
• High field MRI provides exceptionally detailed images, however cats must be transported to an external facility at the University of Queensland. Only patients that have a low anaesthesia risk can be examined at this location.
   
• Low field MRI provides good detailed images, however they are not as sharp as the high field MRI. The benefit of low field MRI is that it is onsite at our Underwood hospital and patients that have a higher risk of anaesthesia (e.g. those cats with obvious neurological signs) can have very close monitoring.
   
• We will discuss the advantages and disadvantages of each option with you. 
   
• All MRI studies performed are submitted electronically to specialist radiologists for a report. These reports are received within 1-10 working days.
   
• Our feline clinicians also give an initial report on the day of the procedure.

QUESTIONS AND ANSWERS MRI

• What is an MRI?

  • A magnetic resonance imaging (MRI) scan takes detailed pictures of the inside of the body. It can identify problems in the soft tissues such as the brain that cannot be examined by x-rays or ultrasound.

• What happens when my cat has an MRI?

• • When your cat has an MRI they must be under anaesthesia. This is not because the procedure is painful, but they must lie very still on a table that slides through a tunnel in the middle of the MRI scanner and it is also noisy.

  • The scanner uses strong magnetic fields and radio waves to generate signals from the body. These are picked up by a radio antenna and processed by a computer to create detailed pictures.

    The benefits of an MRI are that it produces very detailed pictures, does not use x-ray radiation and is painless. 

  • Multiple different scans are performed by the machine to give different information about the tissues and once completed our feline veterinarians will contact you to discuss the results and any further testing (e.g. spinal fluid analysis) that might be required. 

  • All our scans are also sent to specialists in diagnostic imaging for a detailed report which arrives within 12-72 hours. 

  • Depending on how unwell your cat is, they can potentially go home 1-2 hours after the scans are completed and they have recovered from their anaesthesia. 

• What is an MRI used for?

  • Our feline team may recommend an MRI to examine the

    • brain and spinal cord

    • bones and joints

• Is an MRI safe for my cat?

  • An MRI is a very safe procedure however it must be performed under anaesthesia and some patients, particularly those with severe neurological signs can be very challenging to keep stable under anaesthesia. We have highly skilled nurses and specialist anaesthestists available to make sure the procedure is as safe as possible.

• How long does an MRI take?

  • An MRI scan can last as long as 2 hours or more.

• When will I get my cats results?

  • Our feline team will give you their report as soon as the scan is finished. We also send our MRI's to a specialist diagnostic imaging team and these detailed reports take 12-72 hours.

• This test is performed in patients with neurological disease. It is used for identifying infectious brain diseases such as fungal disease (e.g. cryptococcus), viral disease (e.g. Feline Infectious Peritonitis), cancer (e.g. lymphoma) and meningitis.
   
• A needle is passed into the fluid filled space around the spinal cord either at the top part of the neck (cisternal) or the lower spine (lumbar).
   
• This procedure is typically performed following MRI or CT studies and is always performed under anaesthesia.
   
• Once the fluid has been obtained it is sent to the laboratory for further testing. Results start to be received after 24 hours.
   
• Overall risks of cerebrospinal fluid testing appear minimal in most cases. Patients with severe brain abnormalities or raised pressure within the brain appear to have the highest risk of complications. Complications may result in further deterioration of neurological signs after the procedure. If your feline clinician is worried about the risk, spinal fluid sampling may not be performed however this will be discussed with you at the time.

QUESTIONS AND ANSWERS : CSF

• What is CSF?

  • Cerebrospinal fluid (CSF) collection is a test to look at the fluid that surrounds the brain and spinal cord.CSF acts as a cushion, protecting the brain and spine from injury. The fluid is normally clear.

• How does CSF help make a diagnosis?

  • CSF can be examined under a microscope to look for organisms causing infection such as bacteria or fungus. The laboratory also looks at the cell types and sometimes can see cancer cells, (although not seeing them doesn't exclude cancer unfortunately). We can also test the CSF for DNA from specific infectious agents such as coronavirus and toxoplasma organisms. 

• How is a CSF performed?

  • There are different ways to get a sample of CSF. Cisternal puncture (spinal tap) is the most common or a lumbar puncture (spinal tap) can be used. Cisternal puncture uses a needle placed below back of the skull. Lumbar puncture is more technically difficult as the space in cats is very small. 

  • Your cat will have an anaesthetic to keep them still and they are positioned on their side. The area is clipped and cleaned and a spinal needle is inserted. Once the needle is in position, the CSF  is collected.

  • The needle is removed and the area is cleaned. Your cat is then woken up from anaesthesia and monitored closely until they have recovered. 

  • In some cases, special x-rays are used to help guide the needle into position. This is called fluoroscopy. or radiography. This is more common with lumbar punctures. 

• Are there risks associated with CSF collection?

  • Yes. This is a specialised procedure and complications are possible as the space is close to the brain stem. Our feline team perform these tests regularly and are very experienced so complications are rare. When they do occur it is typically in cats with severe neurological conditions prior to the procedure. These neurological diseases can result in raised pressures within the skull (raised intracranial pressure) and when CSF is removed, it can cause a shift in pressures that can result in compression of the brain by the base of the skull.
  • Performing advanced imaging prior to the procedure can help us to identify increased risk factors for this procedure and we may recommend the procedure is not performed if we think it maybe too risky.  Fortunately complications associated with CSF collection are rare. 

• How long will it take to obtain results?

  • Cell counts and fluid analysis will take 24 hours. Advanced testing for infectious diseases (PCR) takes 7-10 days. 

• Rhinoscopy is examination of the nasal passages using specialised cameras: a rigid camera for insertion into the nasal passages and a flexible endoscopic camera for examination of the back of the nose and oral cavity.
   
• Rhinoscopy is used to evaluate cats with sneezing, nasal discharge or changes to the bones of the face.

• Rhinoscopy is important in the diagnosis of cats with nasal cancer, fungal disease, foreign bodies and chronic rhinitis.
   
• Rhinoscopy is often combined with a CT scan of the nose as some areas of the nasal chambers and sinuses cannot be reached with the cameras.
   
• All rhinoscopy is performed under anaesthesia.
   
• Most patients will also have nasal biopsies obtained during the procedure and this can result in some bleeding from the nose.
   
• Patients may be required to stay overnight in the hospital depending on the findings during rhinoscopy.
   
• There is often a long list of patients requiring endoscopy on any given day. Typically we will send you an SMS to advise you of the time your cat will have their procedure and your feline clinician will contact you once we have performed the investigation.

QUESTION AND ANSWER: RHINOSCOPY

• What is rhinoscopy?

  • Nasal endoscopy or rhinoscopy is a procedure  used to look at the inside of your cat's nasal cavity and sometimes the sinuses. Our feline veterinarians insert an endoscope (a long tube with a camera and a light) into the back of your cat's nose through their mouth and also up into their nose.  The camera captures video images and projects them onto a screen.

• Why have I had rhinoscopy recommended for my cat?

  • Rhinoscopy is recommended to investigate a cat who has had chronic sneezing and nasal discharge. It is used to identify  rhinosinusitis (nasal and sinus inflammation or infection), nasal polyps, nasal cancer and fungal infections. It is also used to remove foreign objects such as grass, seeds or even insects!

• Does my cat need a CT with their rhinoscopy?

  • CT imaging and rhinoscopy complement each other very well and give us the full clinical picture of what is happening in your cat's nose and sinus cavities. A CT scan gives us detailed anatomic information about the structure of these areas and we cannot reach all of these areas (such as the sinus) in cats due to their size. Sometimes areas of disease are only seen on CT. Rhinoscopy allows your veterinarian to evaluate the nose from the inside and obtain samples for testing. It also allows removal of foreign bodies if they have been identified. We will discuss with you at your cat's appointment whether we think a CT will be beneficial. 

• What happens when my cat has a rhinoscopy?

  • Rhinoscopy is always performed under anaesthesia. This is to keep your cat still and also to protect their lungs from the fluid that is used to flush their nose during the procedure. 
  • Once your cat is under anaesthetic, they are positioned to keep their head still while we examine the inside of their mouth and the back of their throat using soft flexible endoscopy cameras.
  • Images are obtained and any abnormal areas are identified. This is also where many foreign bodies tend to get stuck. 
  • We then change to a rigid camera which is inserted up into their nostrils. We examine the inside of your cat's nose and take biopsies of the nasal tissue for histopathology (looking at the types of cells) and culture (growing bacteria or fungus). 
  • While the rigid camera is inside your cat's nose, there is saline flush running which helps to clear discharge. Cats with very snotty noses often feel better after the procedure as it clears everything out. 

• Is rhinoscopy painful? 

  • Rhinoscopy shouldn't hurt although sometimes there can be some bleeding from the biopsy sites and cats may sneeze a little more. These symptoms usually resolve on their own in one or two days.

• How long does rhinoscopy take?

  • In most cases, rhinoscopy takes about 30-45 minutes to complete. 

• What are the risks of rhinoscopy?

  • In general, rhinoscopy is very safe.  Adverse reactions can occur relating to the anaesthetic (if they have other airway related problems) or if disease has spread from the nose to the brain (e.g. cryptococcus fungal infections). CT can be important in helping to identify these changes. We will discuss with you if we think your cat has any additional risk factors. 

• When do we get the results?

  • Your feline veterinarian will discuss the results with you on the day. Biopsy results are typically received within 72 hours. 

• How long does my cat need to stay for?

  • In cats that are otherwise well, rhinoscopy is generally a day procedure and you cat can go home the same day. 

Frontal Sinus Trephination and Instillation of Pluronic Antibiotic Gel for Pseudomonas Chronic rhinosinusitis. 

At Cat Specialist Services we are trialling a novel treatment for cats suffering from Pseudomonas infection in their nasal cavity and sinus cavity.  

What is Pseudomonas?

• Pseudomonas is a type of bacteria that can be a normal part of the bacteria in a cat's nose. However in cats that have had previous cat flu infections or with other underlying disease causing damage to the delicate structures in the nose, Pseudmonas can take hold and cause significant infections that get deep into the bones of the nose and sinuses. Over years they can cause a lot of damage to normal bone and tissue. As a bacteria, they are also very effective at becoming resistant to standard antibiotics. 

• How is Pseudomonas Chronic rhinosinusitis in cats usually treated?

  • This is an extremely challenging condition to treat and it is important to note that cats will very rarely be cured of the condition as often the changes to the nasal tissues are permanent and recurrence is common. Many treatments are often tried including a variety of antibiotics and anti-inflammatories. Nebulisation can be helpful to break up nasal discharge. Nasal flushing (under anaesthesia) or eye drops can sometimes help alleviate symptoms however symptoms inevitably return. 

• How can you tell if the infection is in the sinus?

  • In many cats with Pseudomonas infection, the infection gets in the sinuses. These are air filled  spaces in the skull behind the eyes and nose. It is very difficult to clear these infections once they are established in that location as normal antibiotics will not penetrate easily into the tissue. 
  • We identify the involvement of the sinuses on a CT scan and this helps to direct which side (they are on the left and right sides) require treatment. 

• What is trephination?

  • Trephination is the technique where we place a small hole through the bone into the sinus. We then flush any material out (there is often pus like material) and help improve the drainage from the sinus into the nasal cavity. We will frequently send off samples to the laboratory to confirm the type of infection and which antibiotic the infection is sensitive to. 

• What is the gel?

  • The pluronic gel is specially engineered to be liquid when cold and when it warms to body temperature it solidfies into a thick paste. It is a carrier for an antibiotic (typically gentamicin) which is effective at killing Pseudomonas. By instilling the antibiotic into the sinus in this way we are hoping that we will be able to destroy more of the Pseudomonas than by giving antibiotic by tablets alone, particularly as the Pseudomonas may be resistant to many of those types of antibiotic. 

• Are there any risks?

  • We have treated a number of cats using this technique now and we have not had any significant complications, however potential risks could include trauma to the eye if there is leakage of material to the space behind the eye (retro-orbit) or possible adverse reactions to the antibiotic itself. 

• Is this procedure painful?

  • Yes it is possible that this procedure would cause some discomfort, however it is likely that your cat already has a significant headache from their sinus infection! We will always give your cat pain relief and most cats that have this procedure performed will stay overnight so that we can give them some strong pain killers. They generally go home the following day with pain medications for the next few days. 
  • Most cats don't show any signs of discomfort and are eating well within a few hours of the procedure. 

• Does it work?

  • We have had good success with the treatments so far, however it is important to note that we are not aiming to cure your cat (although with mild symptoms this could be possible). Our aim is to get the longest time possible in between treatments where your cat is comfortable and their symptoms are mild. 
  • Currently cats seem to require this treatment every 6-12 months. 

• How can I get this treatment for my cat?

  • You would need to organise an appointment with our feline veterinarians. They will assess your cat and discuss the options with you. 

• Bronchoscopy is the use of a small flexible endoscopy camera to evaluate the large and lower airways of a cat. This procedure maybe recommended in cats with chronic cough and breathing abnormalities such as wheezing. It is often combined with a CT scan of the lungs.
   
• All bronchoscopy studies are performed under anaesthesia.
   
• Bronchoscopy is not without potential risk as frequently the investigation is being performed in cats with unhealthy airways.

• Potential complications include leakage of air from the lungs into the chest cavity (pneumothorax), further deterioration in breathing effort or anaesthesia complications. Sometimes although bronchoscopy is the ideal test to obtain a definitive diagnosis, we may not recommend it as the risk maybe too great for your cat. We will always discuss this with you if we are worried.
   
• Bronschoscopy is often combined with a bronchoalveolar lavage (BAL). This is where sterile water is flushed into the lungs and then suctioned back up. We then look at the characteristics of the fluid and assess the different cells that are present, try and grow bacteria or other organisms and run various infectious disease tests on the fluid.
   
• Patients will often stay in the hospital for the night after the bronchoscopy is performed to both continue monitoring of your cat's breathing effort and to start treatment.

QUESTION AND ANSWER: BRONCHOSCOPY

• What is bronchoscopy?

  • Bronchoscopy is a procedure that lets veterinarians examine your cats lungs and airways.  During bronchoscopy, a thin tube (bronchoscope) is passed through your cat's mouth and down their windpipe into their lungs. 

  • Bronchoscopy is most commonly performed using a flexible bronchoscope. 

• Why has my cat been recommended bronchoscopy?

  • Common reasons for needing bronchoscopy are a persistent cough or wheeze, infection or something unusual seen on a chest X-ray or CT scanning. 
  • Bronchoscopy can also be used to obtain samples of mucus or tissue, to remove foreign bodies or other blockages from the airways or lungs or to enable development of a treatment plan. 

• Are there risks?

  • Unfortunately yes, although complications from bronchoscopy are uncommon and usually minor, they can occur. Complications may be more likely if airways are inflamed or damaged by disease. Complications may be related to the procedure itself or to the anaesthesia required for the procedure.

  • Some possible complications include:

    • Airway spasm. A cat's lower airways are very reactive (which is why they are so prone to getting bad asthma) and airways can spasm from the presence of the bronchoscopy or the fluid. Cats are commonly given bronchodilators (airway dilators) medications when their anaesthesia is first started to reduce this occurrence. 

    • Collapsed lung. In rare cases, an airway may be injured during bronchoscopy. If the lung is punctured, air can collect in the space around the lung, which can cause the lung to collapse. Usually this problem is identified quickly and easily treated, but it may require a longer stay in the hospital.

  • It is important to note that although uncommon, these risks are possible and if we are worried that the risk of a complication is to high, we will recommend the procedure is not performed and discuss alternative methods (such as treatment trials) to help your cat. 

• How long does the procedure take?

  • It really depends on the health of your cat's airways as the process can be very slow and meticulous. Mostly bronchoscopy takes around 30-45 minutes. 

• What happens during the procedure?

  • Your cat will be anaesthesized and a tube placed into their trachea to supply oxygen. There is a lot of monitoring equipment that is used and typically two nursing staff monitor your cat's anaesthetic and help with the procedure. Your feline veterinarian will then guide the bronchoscope into the different airways. 
  • Depending on the patient, lungwashes (bronchoalveolar lavage) may be performed following the airway assessment. The patient is then recovered from their anaesthetic and is very closely monitored for the next two hours after their procedure. 

• What is a bronchoalveolar lavage? 

  • This forms another part of the airway examination. Sterile saline is flushed down the bronchoscopy (or a small sterile tube is placed into the airway) and the fluid is then sucked back up. This helps us to retrieve samples of the mucous, cells and possible infectious agents that maybe present. 

• When will we find out the results?

  • Results from the bronchoscopy are obtained the same day and your feline veterinarian will telephone you once the procedure is completed to discuss the results. 
  • Samples submitted to the laboratory taken approximately 24-72 hours and we will call you when we receive them.

• Will my cat be able to go home after the procedure is finished?

  • That really depends on the severity of your cats breathing problems. If the procedure has gone well and your cat is not severely affected then they may be able to go home a few hours after the procedure. If we are concerned that their breathing is not normal then we will discuss ongoing hospitalisation options with you. 

• Gastrointestinal (GI) endoscopy is the use of flexible endoscopic cameras that are guided through the mouth, oesophagus, stomach and the top part of the small intestine. This is known as upper GI endoscopy. Colonoscopy is where the endoscopic cameras are passed up the colon to the junction of where the large intestine joins the small intestine.
   
• Endoscopy and colonoscopy are typically performed in patients with chronic vomiting, weight loss, inappetence or where gastrointestinal abnormalities have been identified on imaging.

• They can be very useful in the diagnosis of feline inflammatory bowel disease, intestinal lymphoma, polyps, gastrointestinal ulceration and other types of intestinal cancer.
   
• Both upper GI endoscopy and colonoscopy must be performed under anaesthesia.
   
• Upper GI endoscopy requires patients to be fasted for 12 hours. Colonoscopy requires fasting for 24 hours. This is to ensure the GI tract is not full of digesta. For patients having colonoscopy, additional enemas maybe performed when the patient is under anaesthesia.
   
• Endoscopy has the advantage of being minimally invasive, however biopsy samples are very small and some regions of the intestinal tract cannot be reached using this method.   Additionally, some diseases only occur in the deeper layer of the intestines and these can only be diagnosed via surgical biopsies. We will discuss the advantages or disadvantages of each technique with you depending on your cat's combination of findings.
   
• Biopsies obtained during the endoscopy are submitted to an external laboratory for processing and results take 3-5 working days to obtain.
   
• Patients will normally be discharged the same day or the following day, depending on each case.
   
• Your feline clinician will contact you to discuss the findings once the procedure is completed.

QUESTION AND ANSWER: ENDOSCOPY

• What is endoscopy?

  • Endoscopy is a medical procedure that allows your feline veterinarian to observe the inside of the gastrointestinal tract without performing major surgery.
  • An endoscope is a long flexible tube with a lens at one end and a video camera at the other. The end with the lens is inserted into the cat and light illuminates the relevant areas and projects it onto the screen. The endoscope can be inserted via the mouth or the anus to assess different regions of the gastrointestinal tract. 

• What is endoscopy used for?

  • Endoscopy of the gastrointestinal tract is used for a few different reasons but most commonly,
    • Taking small samples of tissue for diagnostic purposes (biopsy) e.g. when investigating causes of chronic diarrhoea, chronic vomiting or weight loss
    • Locating and sampling tumours 
    • Locating and removing foreign objects 
    • Dilating strictures (scar tissue) in the oesophagus, duodenum, or colon.

• Is it painful?

  • No, endoscopies are generally painless. Compared with the stress experienced by the body in a full surgical procedure, an endoscopy is simple, low risk, and cost effective. Cats also have a very quick recovery time. 

• Why might a surgery be a better option?

  • A limitation of endoscopy is that we cannot examine the entire gastrointestinal tract. we can only examine the oesophagus, stomach and duodenum (the upper part of the small intestine) and the ileum and colon. 
  • Some cats only have disease in the parts of the intestine that we cannot access endoscopically. Ultrasound or CT imaging help us to determine whether any abnormalities can be accessed endoscopically or not. 
  • When biopsies are obtained endoscopically, we take a sample from the inner layer of the intestine, however sometimes the changes are deeper in the tissue and surgical biopsies (which can take a sample from all the layers) is the best way to obtain the diagnosis. 
  • We will advise you which option we think would be most suitable. 

• What happens on the day of the procedure?

  • Typically your cat is dropped off on the morning of the procedure or they may have been hospitalised overnight (this is more common with colonoscopy as there is more preparation required to empty the intestinal tract).
  • It is important to follow the directions for fasting if your cat has gone home (typically fasting for 12 hours for stomach and upper intestine (upper GI) endoscopy and 24 hours for colonoscopy)
  • Your cat will be anaesthetised. Further preparation of the intestinal tract such as enemas, maybe required if your cat is having a colonoscopy. 
  • The endoscope is then inserted through the mouth or the anus and the intestinal tract is systematically evaluated. Air is pumped into the intestinal tract by the endoscope to allow visualisation (otherwise the intestine collapses over the lens and nothing can be seen).
  • Multiple biopsy samples are obtained (they are very small and disease can be very patchy in location so many samples are taken to increase the odds of diagnosing it).  
  • Any abnormal looking regions or masses will be biopsied, however we also biopsy normal looking tissue, as some diagnoses can only be made based on tissue samples. 
  • Once the endoscopy is complete, the endoscope is removed and your cat is recovered from the anaesthetic. 

• What can I expect with my cat after the endoscopy?

  • Most cats recover without incident from endoscopy. They are monitored for a few hours afterwards and then in most cases will be able to be discharged later that evening. 

• Are complications possible?

  • Complications are possible but very rare. Sometimes if a cat has a pre-existing ulcer within the intestinal tract, the presence of the endoscope and/or the air that is pumped into the tract can cause perforation of the ulcer. This is a very serious complication but can be treated and luckily is extremely rare. For cats that we think have an ulcer present, we take special precautions to reduce this risk. 

• Do I need to do anything special with my cat when they get home?

  • No, it is often best to keep things exactly the same with cats! Although if your cat is an outdoor cat, they should be kept inside for 24 hours following the anaesthetic. 
  • In winter it can be difficult for cats to maintain their body temperature after an anaesthetic so making sure they have somewhere warm is good. 
  • Regarding their food, generally their normal diet will be fine, however if we think your cat should eat something different (e.g. as part of a treatment program) we will discuss this with you. 

• When do we get the results?

  • We will phone you with the initial results as soon as your cat has had their procedure. Biopsy results from the laboratory take an addition 48-72 hours and we will contact you when we have these. 

• Thoracocentesis is a procedure where a small needle is inserted into the chest cavity using ultrasound to guide the needle into the correct location. Thoracocentesis is performed when fluid is present within the chest cavity and as much fluid is removed as possible. 

• This is typically seen in cats with breathing problems and maybe combined with ultrasound of the heart (echocardiography) and xrays or CT scanning.
   
• Thoracocentesis is performed under sedation or under anaethesia. 

• Once samples of the fluid are obtained these are typically submitted to a laboratory for further testing. 

QUESTION AND ANSWER: THORACOCENTESIS

• What is thoracocentesis?

  • Thoracocentesis is a procedure performed to remove air or fluid from around the lungs where it shouldn't normally be.

• How is it performed?

  • Your cat is given a sedation or short anaesthetic to keep them still. This is not a painful procedure, however a needle is inserted into the chest where there are many structures, so keeping them still is very important. 
  • In addition, cat's with fluid or air around their lungs can be highly stressed and anxious due to their breathing difficulties so sedation helps them to relax and keep calm, which reduces the effort they need to breathe. 
  • Once your cat is sedated we typically clip the fur from their chest and use an ultrasound to identify the major area of fluid build up (or radiography for air). 
  • We clean the area and apply a local anaesthetic cream and sometimes an injection of local anaesthetic as well. 
  • We then guide a needle into the fluid pocket using the ultrasound and remove as much fluid (or air) as possible. 

• Is this an emergency?

  • Often yes, although it depends on how quickly the fluid has built up and how much there is. Often a cat will feel better immediately after the fluid has been drained and their breathing effort improves dramatically. 

• Why might a cat get fluid around their lungs?

  • The most common reasons are heart disease, cancer and infections although there are other less common reasons. 
  • Investigating why the fluid has occurred is very important and typically requires an ultrasound of the heart (echocardiogram) to screen for heart disease and analysis of the fluid for cancer cells or other infectious agents such as bacteria. 

• Why might a cat get air leaking around their lungs?

  • Generally this is because of trauma or underlying airway disease such as asthma or cancer or a foreign body. 

• Is there a risk with thoracocentesis?

  • Yes, but unfortunately this is one of those procedures where the risk of the procedure is far outweighed by the life saving benefit of removing the air or fluid. The risk is that the needle can cut the lung causing further air leakage, or cut a blood vessel causing haemorrhage. In the rare event that this occurs the complications are typically mild and self limiting and the complications are less with the patient sedated or under anaesthesia. 

• Is the procedure painful?

  • In humans this procedure is done with a local anaesthetic. In cats, we have them under sedation or anaesthesia to keep them still, not because of the pain of the procedure. The needle size itself is the same size you would have a vaccination with so there shouldn't be any pain after the procedure is completed. 

• Can my cat go home afterwards?

  • It depends on the condition of your cat and how unwell they are. For some cats with chronic heart disease they can go home the same day. For other cats that are sicker they may need to stay in the hospital for longer while we try to investigate what is making them unwell and start treatments such as antibiotics or chemotherapy. 

• Will my cat need this procedure again?

  • Sometimes. It depends on the underlying cause. For example cats with heart disease or with cancer can build up fluid on multiple occasions and feel much better after it is drained. For some cats (e.g. those with terminal cancer) we may even discuss placing a special port that enables easy drainage of the fluid to keep them comfortable. 

  • If we think your cat has a disease where fluid recurrence is likely, then we will teach you how to check their breathing rate at home when they are resting. You can also find a link to these instructions here.

• Sometimes enlarged lymph nodes, abnormal body organs or an abnormal mass lesions are identified during imaging and fine needle aspirate (FNA) are recommended to obtain samples of cells.
   
• The patient is sedated or under anaesthesia, depending on the location of the abnormality.
   
• A small needle is guided into place using ultrasound and samples obtained.
   
• As the needle size is very small, the sample obtained is also very small and there are some diseases that can be difficult to diagnose using this method. Some diseases though such as lymphoma or certain types of infections can be easily diagnosed this way.
   
• Results are typically obtained within 48 hours of submission of the sample to the laboratory.

QUESTIONS AND ANSWERS : FINE NEEDLE ASPIRATES

• What is a fine needle aspirate?

  • Fine needle aspiration is a type of biopsy procedure. During the procedure, a small needle is inserted into the region of concern and a sample is collected onto a microscope or slide or sterile container.  These samples can help make a diagnosis e.g. of infection or cancer. 

• When is a fine needle aspirate used?

  • A fine needle aspiration is most commonly performed on a lump or abnormal appearing organ. These changes maybe identified on physical examination or on an imaging test such as an ultrasound or CT scan.

  • Fine needle aspiration may also be performed on:

    • cysts (fluid-filled lumps)
    • nodules or masses (solid lumps)
    • enlarged lymph nodes

  • Without a biopsy, it's difficult for a veterinarian to know what these abnormal areas contain. 

• How is a fine needle aspiration performed?

  • Your cat is likely to be under sedation or anaesthesia for this process. This is not because it is painful but to keep them still during the procedure. 
  • Their fur is clipped and the area is cleaned. 
  • We will sometimes use a local anaesthetic on the skin. 
  • Ultrasound can be used to help locate the region for fine needle aspiration. 
  • A thin needle is attached to a syringe and inserted through the skin into the abnormal area.
  • A sample is suctioned (aspirated) into the needle and syringe and then placed on a microscope slide and/or sample pot. 
  • Several needle insertions may be required to ensure that the sample is adequate. 

• How long does a fine needle aspirate take?

• • The fine needle aspiration itself is usually a short procedure, less than 10 minutes-20 minutes depending on how many samples are required

•  What should I expect with my cat after their fine needle aspirate? 

  • If your cat has been sedated they may be a little groggy afterwards but this should only last for a few hours. 

  • Rarely there may be a little bruising at the site.

• What complication can occur with fine needle aspirates?

  • Serious complications after fine needle aspiration are rare.

  • Minor bleeding under the skin at the biopsy site can occur. 

  • Sometimes bleeding can occur from tumours or tissues with blood vessels.  

• How reliable are the aspirate results?

  • A fine needle aspirate is an effective tool in evaluating and diagnosing suspect lumps or masses.  It is minimally invasive, however  compared to a surgical or trucut biopsy samples are very small and fine needle aspiration biopsies do require some expertise to perform and interpret.
  • Because an FNA biopsy can only sample a small number of cells from a mass or lump, there is a risk that any abnormal cells may be missed and not detected. 

• What happens to the sample?

  • The samples are either assessed in the hospital or sent to a laboratory. The material is examined used the microscope after it has been prepared and stained so that the cellular material can be examined. 

• How long does it takes to get results?

  • Results are received within 24-48 hours and we will contact you as soon as we have received them.