A Powerful Sneeze

 D. E. Larsen, DVM

“Doctor Larsen, Midnight has a terrible sneeze at times, and she has had this runny nose for nearly a couple of weeks,” Cindy said.

“Let’s get her up on the exam table and look her over,” I said.

“Okay, but you remember that she has a short fuse,” Cindy said. “If things get uncomfortable for her, she can be downright mean.”

“I remember,” I said. “If I remember right, one or two of these scars are from one of Midnight’s earlier visits.” I raised my left hand and forearm to show Cindy the criss-cross maze of scars.

“That’s funny, Doctor Larsen,” Cindy said with a smile. “Why are all your scars on your left hand and arm?”

“That is my holding hand, and it is the one that takes all the abuse,” I said.

We placed Midnight on a towel on the exam table.  Cindy and I spent a couple of minutes petting her to calm her down.

I could see a slight nasal discharge from her right nostril, but I couldn’t induce her to cough with any palpation of the back of her throat or her windpipe.

Holding her head like a baseball and pointing her nose in the air, I opened her mouth as wide as I could and depressed her tongue with a brave move of my index finger. The back of her throat looked pretty normal. Midnight’s temperature was okay, and her lung sounds were normal.

“Everything I see looks okay except for that nasal discharge,” I said. “If she is sneezing hard, there might be a foreign body in her nose. Cats will sometimes get a blade of grass in their nose. That usually happens when they are eating grass, and it gets coughed or gagged up the back of their nose. A lot of cats will allow me to look up their nose with a small otoscope, but I am not sure that Midnight would allow that without some anesthesia.”

“I’m not sure I want her sedated just yet,” Cindy said. “Maybe we should just try some antibiotics for a few days.”

“As long as things stay mild like this, I would be okay with a course of antibiotics,” I said. “Understand, though, if this is a foreign body, antibiotics won’t solve the problem. Things might get better for a short time, but then it will start all over again.”

***

I started Midnight on Amoxicillin for one week, and the nasal discharge cleared up, and the sneezing was not evident. But by the following week, both the discharge and the sneezing returned.

Cindy still wanted to try a stronger antibiotic. Again, after a week of another antibiotic, the nasal discharge and sneezing disappeared. This time it was two weeks before things were back to square one.

“Okay, Cindy, it is time that we get an x-ray,” I said. “We will probably need to sedate Midnight for the x-ray, so we will just keep her under anesthesia until I can get a look at the x-ray. That will only be a couple of minutes, and that way, if we need to do an exam or a culture, we can get it done with one procedure.”

“Will she be able to go home right away?” Cindy asked.

“It is probably going to take her a few hours to be fully awake,” I said. “I am going to give her a little ketamine in the muscle to save both us and Midnight a battle. Intramuscular ketamine makes the recovery time a little longer. Still, she will be ready to go home by the middle of the afternoon.”

I was able to get a dose of ketamine into Midnight’s muscle with only a minor struggle. We watched for her eyes to dilate widely, and then she collapsed. I applied a good dose of ointment to each eye to protect the corneas during anesthesia. The eyes were always wide open when ketamine was used for anesthesia. Then we placed an endotracheal tube and moved Midnight to the x-ray table.

The x-rays clearly showed a soft tissue mass deep in the right nasal passage. It was far enough back that would not be able to get to it with a scope in the front nasal passage. Now I hoped that it was a foreign body and not a tumor.

Nasal cancers, usually nasal adenocarcinoma, were common in dogs. In cats, the most common nasal tumor was lymphoma. Both were bad news in the 1980s.  

With Midnight on her back and the endotracheal tube pushed to the left, I used a small spay hook to pull the soft palpate forward as far as I could. With a small dental mirror that I seldom used, I could see a dark mass filling the posterior nasal passage. At least it was a foreign body.

By now, I had most of the available space filled with instruments. I would have to remove the mirror and attempt to grasp this mass with a blind grab using curved forceps. I made good mental notes of its depth and location before I removed the mirror. Then I pulled the soft palate a little harder and stretched the corner of Midnight’s mouth a little as I inserted the points of the curved forceps into Midnight’s nasopharynx. When I contacted the material, I opened the forceps and grabbed something. I hoped it was the foreign body.

With a deep breath, I pulled on the object. I could feel a movement. I opened the forceps and then pushed the points a little deeper into the mass and grabbed again to get a more substantial grip. I pulled again, and the mass came into view, and then it was out.

I lifted the snarled mass in the grasp of the forceps so I could get a good look. It was a doubled-over leaf from a thistle, stickers and all. I can’t imagine how that must have felt.

There were only a few drops of blood. The antibiotics had at least controlled most of the inflammation around this mass. I swabbed the area and passed a catheter through to the nose to ensure nothing else was packed in there.

When Midnight was recovered, she seemed as if nothing had happened. Of course, she gave no credit to me.

“Can you imagine how this must have felt?” I said to Cindy as I handed her the wad of thistle that was carefully secured in a small baggy.

“Oh, my gosh,” Cindy said. “This was in her nose. I can’t believe it. How did something this big get into that little bitty nose?”

“It didn’t go in the front of her nose,” I said. “She coughed it into the back of the nose. She has to feel better with it out of there, but you couldn’t tell it from looking at her.”

“Do we have to do anything now?” Cindy asked.

“I think another round of antibiotics will be helpful,” I said. “There has to be some raw tissue that was holding this mass. Other than that, I think we are home-free. Don’t be alarmed if you see her sneeze a little in the next few days, but after things are healed in that nasal passage, that should resolve also.”

“Well, I think after this that Midnight’s excursions to the great outdoors are going to be greatly curtailed,” Cindy said as she headed out the door with Midnight in her carrier.

Photo by Dan Galvani Sommawilla on Pexels