SVM Surgeon, Students Repair Unusual Defect to Make Cat’s Adoption Possible

Wrapped in a coat of white fur with a black patch like a bandit’s mask, Maeve is a sweet, slender, one-year-old domestic shorthair. And she’s also tough as nails.

She proved it back in January when she birthed a litter of kittens on the cold, snowy streets of Milwaukee. And she did it while enduring a complicated congenital defect, one that could have easily cut her life short without help from the UW School of Veterinary Medicine (SVM).

Along with her four brand new kittens, Maeve was brought to the Milwaukee Area Domestic Animal Control Commission (MADACC) where observant staff discovered a large gap in the muscle wall near her belly button. This condition, called an umbilical hernia, can be painful and potentially dangerous if left untreated, but it didn’t appear to be life threatening in Maeve’s case. So MADACC settled her into a foster home, and after her litter was weaned, they brought her to the SVM for spay surgery and a hernia repair.

Kendra Hayden was assigned to Maeve as part of the school’s junior surgery program, where third-year students team up with faculty to conduct spay and neuter procedures for dogs and cats from area shelters. When Maeve was shaved during a pre-surgery examination, Hayden noticed something quite startling—each beat of her little heart could be seen pulsing through the skin that stretched over her chest.

“We weren’t expecting that at all,” says Hayden, a member of the Class of 2017. “We thought she had an umbilical hernia but nothing more significant than that.”

To find out exactly what might be troubling Maeve, Hayden turned to Dr. Sara Colopy, clinical instructor of small animal surgery at the SVM. Following a physical examination, Colopy suspected Maeve’s umbilical hernia was actually a more extensive midline abdominal hernia that expanded into her chest through a cleft in her sternum. X-rays confirmed a diagnosis of an incomplete sternal cleft, a birth defect caused by the failure of her breastbone to fuse during development.

“Her sternum has a wishbone shape, and her heart and liver were sitting in the middle of the cleft covered only by skin,” says Colopy. “Normally, these organs are protected by bone and muscle.”

Fortunately, the X-rays also showed that Maeve’s abdominal contents had not herniated into her chest. And an echocardiogram (heart ultrasound), performed by Dr. Rebecca Stepien and Dr. Sonja Tjostheim in the UW Veterinary Care (UWVC) Cardiology Service, revealed that she had no congenital heart defects. In other words, hernia aside, Maeve was a healthy feline and a good candidate for surgery—her only option for a normal cat life.

“Before taking on something like this in a shelter animal, I always ask myself if there’s potential for a 100 percent cure so the animal can be adopted, and if we can ensure 24-hour care after the surgery because shelters often don’t have the resources for this,” says Colopy.

In Maeve’s case, the answer to both questions was yes. Maeve could be housed in UWVC’s Critical Care Unit after the operation, and the school’s Students, Pets, and You (SPAY) Fund would cover the costs of her care. And for the operation itself, Colopy devised a procedure that had an excellent chance of permanently fixing Maeve’s defect. But it had the potential to be a complicated, multi-step surgery.

“Most hernias are umbilical, and they can be quite large,” says Colopy. “But a cleft sternum is rare.” In fact, Colopy found only one published case report of a feline sternal cleft, so the surgery team was in somewhat uncharted territory.

Hayden started things off by conducting the spay procedure with the help of Colopy and junior surgery teammates Stephanie Winske, who administered anesthesia, and Erik Olson. Although the spay went very well, Colopy found another defect during the procedure called a urachal diverticulum. Maeve’s urachus, a small tube that empties urine into the umbilical cord during in utero development, had only partially shut down after she was born, leaving a vestigial tube extending from the bladder. This dead-end vessel is prone to infection, so Colopy removed it.

Image may be NSFW. Clik here to view. Kendra Hayden

Image may be NSFW. Clik here to view. Stephanie Winske

Image may be NSFW. Clik here to view. Erik Olson

The students then settled in for a unique learning experience while Colopy extended the spay incision to the area of Maeve’s hernia to expose her heart and liver. She found that the pericardium—the sack that protects and lubricates the heart—was open and fused to the sternum, tethering the heart close to the hernia. So she cut the attachment, allowing the heart to drop down to a normal, safer location in the chest.

Next, Colopy attached Maeve’s diaphragm to her chest wall (the defect prevented a normal sternum attachment) to keep the abdominal organs from herniating into her chest.  Last, Colopy used delicate incisions to release abdominal and chest muscles from the ribs surrounding the hernia and shifted them over the heart and liver.

“This created a two-layer muscle cover for her heart,” says Colopy. “She had all of her normal muscles, but they were split. This closed the gap.”

To complete the surgery, Colopy and Hayden closed up the lengthy skin incision together. “The surgery went well, and Kendra and the team did a really great job,” says Colopy.

Following several days of recovery in the CCU and junior surgery ward, under the watchful eyes of technicians and students, Maeve was ready to find a permanent residence. She didn’t have to look very far. Pam Gillitzer, one of the CCU technicians who cared for Maeve during her recovery, decided to adopt her.

“Maeve has done fantastic since coming home,” says Gillitzer. “I had her confined for a week after she was discharged, but now she has free roam of the house, and she takes advantage of it.”

According to Gillitzer, Maeve enjoys scrutinizing birds from the porch, playing in empty bathtubs, and harassing her canine housemate, Bounce, a one-year-old Australian Shepherd.

No longer a shelter cat, she’s found herself a place to truly call home.

Nik Hawkins