Brave Bart Undergoes Double Surgery to Beat Cancer

14 May 2013

Bart in hospital
Bart in hospital

Mary Casey and Tony Lowe knew something was amiss when their beloved domestic shorthair cat, Bart, started circling in an unusual manner and occasionally stumbling as he walked. At 12 years of age, Bart had always been in excellent health, and was very popular in their Inner West neighbourhood.

"He loves people. He always sleeps next to the front gate so he can be admired by passers-by," said Tony. In the past, Bart had been known to enjoy visiting surrounding streets, making new friends, but now he was reluctant to leave their front yard.

Tony and Mary first took Bart to their local vet, Sydney Animal Hospitals Inner West, where he was referred for further investigation to the University of Sydney's Veterinary Teaching Hospital.

"Bart was a very interesting case and had a very unusual presentation," said Associate Professor Vanessa Barrs, a specialist in feline medicine from the Faculty of Veterinary Science, who diagnosed Bart.

Dr Anne Fawcett and Dr Angela Phillips from Bart's local vet had noted that he was suffering from high blood pressure, muscle weakness and very low potassium levels in his blood - symptoms that suggested an adrenal gland tumour secreting excess amounts of a hormone called aldosterone. Excess aldosterone production leads to the retention of sodium ions, increasing blood pressure. It also reduces the number of potassium ions in the blood, causing muscle weakness.

This diagnosis, however, did not explain Bart's compulsive circling to the left, which hinted at a neurological defect.

"It's incredibly rare for a cat to have a brain tumour AND an adrenal gland tumour, but I was so suspicious that this was the problem we proceeded with an MRI scan of his brain," said Associate Professor Barrs.

Lifesaving imaging: The CT scan carried out by the Faculty of Veterinary Science team shows Bart's 3cm long adrenal gland tumour - circled in black.
Lifesaving imaging: The CT scan carried out by the Faculty of Veterinary Science team shows Bart's 3cm long adrenal gland tumour - circled in black.

Her hunch was right, with an MRI scan revealing a walnut-sized tumour compressing the left side of Bart's brain. An ultrasound was also carried out to confirm the presence of a three centimetre long adrenal gland tumour.

Dr Mariano Makara, an imaging specialist from the Faculty of Veterinary Science, performed Bart's imaging and said he was surprised at the size of the tumours.

"It's unlikely that he would have survived had they not been taken out," said Dr Makara.

The two tumours were removed by a team of surgeons led by the Faculty of Veterinary Science's Head of Small Animal Surgery,Dr Katja Voss, with the brain tumour being removed first.

"We had to open the skull to get to it, but then it was luckily quite easy to separate the tumour from the brain tissue to remove it. We had to be careful to avoid damage or swelling of the brain tissue, but all went well," said Dr Voss.
Once Bart had recovered from his brain surgery, he underwent a second operation to remove his adrenal gland tumour. This was a trickier procedure, as the tumour was closely associated with the surrounding blood vessels. As a result, it was difficult to separate the tumour from the blood vessels without rupturing them. Bart had significant bleeding after the operation and required two blood transfusions.
"This is not an unexpected complication after this type of surgery," said Dr Voss.
Owner Tony visited Bart at this time and remarked that he was a very sick cat. "He could recognise me but could move very little, and I thought his recovery wasn't a certainty."
Bart stayed in the intensive care unit until he was strong enough to return home. His owners were touched by how well the team at the hospital, led by Associate Professor Julia Beatty, looked after him. "They are exceptional people who do very impressive work," said Tony.

Bart now fully recovered
Bart now fully recovered

Bart has now made a full recovery, and his owners are thrilled to see a bright look on his face again. He no longer makes expeditions to other parts of the neighbourhood, preferring to stay close to home, but he continues to love attention and is able to run around the house with the family's second cat, Repton.
"You wouldn't know from looking at him that he's survived two major operations!" said Tony.
Tony and Mary, who are both archaeology graduates from the University of Sydney (Mary with a PhD), are very grateful to the team of feline medicine, imaging, surgery and anaesthesia specialists at the University of Sydney's Veterinary Teaching Hospital who were instrumental in Bart's recovery.
"They did a great job with Bart and I doubt he could have had better or more professional care. He can jump around and run again, and obviously enjoys himself, and that's a great outcome for him and us."