CONTENTS

SUPPORT GROUP

I have set up a Yahoo group specifically to act as support for breeders dealing with FCK kittens. This is a stressful thing to deal with: you don't know if your kittens will live or die, you are probably getting up at all times of the night to do supplement feeding, you worry all the time about what's going to happen, and you worry also that you might be doing the wrong thing, or not doing enough. It's a time when the support of someone who has been there can be a big help, even just knowing that someone else knows what you're going through can be enough.

The list is open only to those dealing with FCK directly, and membership is moderated to make sure that it remains a genuine support group. If you would like to join the group, please e-mail me using the contact form and I will let you know how to subscribe.

WHERE THIS INFORMATION COMES FROM (back to contents list)

  • This text is placed here to help breeders and owners who may come in contact with this distressing condition. Please note, I am not an expert, nor do I have veterinary training. However, we have recently established a veterinary-based research group, and you can now download our information sheet which can be printed and taken to your vet. More information will be made available as it is researched. We have created a simple questionnaire with the help of an epidemiologist and it would help studies immenselely if you could fill out a form for as many litters as possible, both affected by FCKS and normal. Information about unaffected litters is required to provide control data. This is particularly relevant if you have bred from either male or female cats before and not had FCKS. If you would like to support the work of the group, please visit our website: www.think-project.org where you will find full details of the project, veterinary information about FCKS, how to support us financially, and the questionnaire to fill in.

  • You are welcome to print, download, distribute or reproduce this information, however, you must acknowledge the source (give the URL), the name of the author, and the 'warning' that I am not a Vet to ensure people reading the information are not misled. For information prepared by a vet, please use the veterinary article linked below.

  • I have gathered information from breeders who have experience of FCK to pass on to those who suddenly find themselves confronted with it but have no information on how to deal with it, and I would like to acknowledge all their contributions. Even the tiniest additional piece of information helps. I have been updating it very rapidly recently, and it ought really to be rewritten, but until I can do that I've put it all here because something is better than noghting! This web-page is NOT a criticism of breeders or breeding - no good breeder will knowingly breed kittens who will get FCK. If you have a litter, or a kitten with flat chests, I would be very grateful to receive any and all information on your litter as this will add to the body of data available to help others. The page is very long, because I am trying to pass on as much as possible of what I have learned about this condition. I don't believe you can have too much information about this, but I'm sorry about the length!

FOR VETS (back to contents list)

Most veterinary professionals are wary of information obtained on the internet. For this reason the veterinary surgeon Kit Sturgess has written an article examining thoracic deformities and treatments for them, and lists a bibliography for further reading. Kit's veterinary qualifications are listed in the article. This can be downloaded for printing or reading (as a pdf) by clicking here. If you are not a vet, please be aware that the content of this article necessarily contains images which may be upsetting to you (photographs of dead kittens, and post-mortem examinations). This is necessary for the clinical description and examination of the problem.

You may also find it useful to read an early research article written by Kit and a veterinary research group, which investigated one possible cause for FCKS. This can be downloaded here (click on the filenmames on the list to download them).

FCK = Flat-chested Kitten; FCKS = Flat Chested Kitten Syndrome

NB There have been some breakthrough treatment ideas for this condition. These are discussed below - please let me know if you use these treatments with success (or otherwise). This web page owes a great deal to the sharing of information by breeders worldwide, and if we can find a way of treating kittens with the problem it will be due entirely to the generosity and time of those who have responded to this web page.

INFORMATION DOWNLOADS (back to contents list)

WHAT IS FCK? (back to contents list)


Although the veterinary term 'Pectus Excavatum' is sometimes used for FCK, that is inaccurate. Pectus excavatum refers to the sternum (breastbone) growing pointing inwards into the body: a few FCKs also have pectus excavatum, but many do not and a flat chest is not the same thing as an ingrowing sternum. I am very grateful to one of the breeders who read this page for sending this x-ray of pectus excavatum:

In FCK the underside of the ribcage flattens and sometimes caves in. I believe that the majority of cases of FCK go undiagnosed: when the condition is only mild the kitten does not show any signs of distress or weakening and can thrive as a normal kitten. The ribcage will right itself with time. A mild case of FCKS probably requires no intervention, although supplementing with vitamins and - if the kitten is one of a large litter - with additional milk, is highly advisable to prevent the condition from worsening.

Usually in extreme cases the kitten will start gasping for breath and will die if left. Sometimes the flattening does not cause breathing difficulties and the kitten can survive. Once the ribcage is pulled inwards though, there is a danger of lung damage, and some kittens who appear to do well at first nevertheless die, and autopsy has shown abnormal lung tissue. The two diagrams below were produced in a veterinary study that was commissioned by the Burmese Cat Club (details further on).

In terms of the flattened chest of a FCK, the muscles between the ribs (intercostal muscles) and the muscles of the diaphragm do not contract and relax correctly, so the whole volume of the chest cavity becomes smaller and the lungs are not properly inflated or deflated. Less oxygen is able to get to the muscles and the kitten tries to get the extra oxygen by breathing faster -- i.e. appears to be panting.

HOW CAN I TELL IF MY KITTEN HAS FCK? (back to contents list)


By careful observation, the moment at which the rib-cage flattens can actually be seen to occur. This happens between 2-10 days from birth, and by feeling the 'walls of the chest' with your fingers you can often detect the flattening before you can see it by finding a ridge running longways at the sides of the ribcage.

It's very difficult to explain what a flat chest feels like in words, but if you can get hold of a reasonably fresh banana (yes, a banana) you can feel what a flat ribcage is like: I've cut this one in half so that you can see the shape in cross-section. Hold the banana with the flattest side downwards (usually on the inside of the curve). Hold it as I've illustrated, and draw your hand upwards. You can see that the outside of the skin has two clear ridges at the lower edge, and the bottom is flatter than the sides and top. This is almost exactly what a mildly flat chest feels like (even down to the size) only with a covering of fur

You may feel a slight ridge running along the ribcage in some kittens that does not progress into FCK, so don't panic!

Normally the flat chest is simply that: flat. But if the muscles of the diaphragm are severely affected they will pull the sternum into an abnormal position -- i.e. the sternum will be pulled into the chest cavity, and this in turn will distort the shape of the heart and prevent the lung tissue from developing normally. This pulling in is one reason the condition is sometimes called pectus excavatum, but usually the sternum does not grow inwards, it is pulled in with the ribcage. When this happens recovery is unusual.

This kitten has an inverted sternum - you can clearly see it is dipped into the body instead of curving outward.

There is another condition (independent of FCK) in which the sternum sticks out, and though this apparently has no health implications, it is considered a veterinary fault

The kitten was a single FCK in a healthy litter, and was losing weight and clearly failing until he was put onto supplement feeding with KMR. He is now happy and healthy, though his sternum has not righted itself. He is smaller than his siblings.

(many thanks to his owner for sending his picture and regular updates on his progress)


[if you have photographs that show FCK it may be useful to other people to be able to see them - I would like to put them here if they show the condition.]

There are degrees of flat-chestedness -- sometimes occurring in the same litter. Many slightly flat-chested kittens go unnoticed and recover on their own. Various causes have been put forward for this condition developing: The Burmese Cat Club funded research into Taurine deficiency which, though it only had a very small study group to work with, concluded that it was not relevant. I have scanned the pages, and images of the article can be downloaded here (click on the filenmames on the list to download them). I apologise if this infringes any copyright, but the article was printed some years ago and is difficult to obtain now, and I feel that providing information to save lives must outweigh copyright concerns. Other theories have suggested Potassium deficiency, but treatment with potassium supplements as suggested by Bristol Veterinary College have not shown significant results in treating the condition, and blood samples have not suggested a deficiency. There has been no long-term or serious study into this condition, and for this reason I am assembling data for the future so that if such a study is undertaken a sizeable sample of litters can be studied to gain more information.

Rex kitten with FCK - note also the dip in the spine just below the shoulders

Egyptian Mau with FCK - note splayed elbows pushed out by the sides of the ribcage

WHICH BREEDS ARE AFFECTED? (back to contents list)


Absolutely ALL breeds and types of cat can produce kittens with FCK, including domestic non-pedigree cats. However, some breeds, particularly those with very limited gene pools, seem to be more prone to it - or their breeders are perhaps more open about discussing it. Those breeds that seem to come up most often in communications to me are the Burmese and the Ragdoll - in every country, not just the UK. Recently I have been notified of a number of Bengal litters with the problem.

WILL MY KITTENS DIE? (back to contents list)


There are two major crunch points with FCK kittens - if the kittens survive onset of the condition they may survive, but breeders have seen kittens apparently doing well who die suddenly at 10 days, and others who thrive up to three weeks of age and then, similarly suddenly fade and die. If kittens survive beyond 3 weeks, then the likelihood is that they will not die of FCK, the ribcage may revert to a normal shape if the condition is not too pronounced, or may remain flat into adulthood with no apparent side-effects. A recovered FCK would have every expectation of a normal life, as long as the compression has not affected the development of the heart or lungs. If a kitten runs and plays as normal without getting out of breath or tiring quickly then it is probably OK - your vet may be able to assess the kitten more specifically. Some FCKs grow out of the condition and the ribcage goes to a normal shape in time.

Sadly, if your kitten survives the 10-day and 3-week times this is not a guarantee of future survival. Kittens who are particularly small have often got a compromised heart and they can die at 12-18 weeks, or even later. We all become very attached to these little surivors, and it can be heartbreaking to think you have saved them and then have them die on you just when you think you are out of the woods. There are no guarantees I'm afraid, but if the kitten is a normal size by 16 weeks and seems normal in every way, then it probably is OK.

IS FCKS SEX LINKED? (back to contents list)


Many people who experience isolated instances of FCKS, or have some kittens go flat in a litter but not others, notice that it seems to affect male kittens more often than females, and often it seems to be the largest male, as if his weight is a factor. Certainly a heavy kitten will be putting much more pressure on his chest when he lies on it, and he may go flatter than a lighter kitten with the same condition. Going by cases notified to me there certainly seem to be noticeably more male cases of FCKS than female, and several breeders have asked if it can be sex-linked, since only their males are affected. Possibly there is some relation between male kittens being bigger than females on the whole (breeders have noticed that often it is the kittens who start out being the heaviest and fattest who seem to get FCKS, not the skinny ones, however this is not regular enough to be reliable, and I don't have enough detail on all the cases notified to me to be able to give any statistical data on the possibility). Since both sexes get FCKS the likelihood is that the preponderance of male kittens suffering from it is related to relative size and weight, and that it is not sex-linked. Possibly, if we ever get enough data about the problem, and can raise funds to do a veterinary study, it may be worth examining something like testosterone levels in affected and unaffected kittens.

WHAT CAN I DO ABOUT FCK? (back to contents list)


You can help - read on...
Since putting this information on the web, I have had numerous enquiries from breeders who have had kittens develop this condition. I'm afraid I don't have any perfect answers, but I can pass on what feedback I've had regarding results and possible causes. This is a very sad thing to experience - we all want our babies to be perfect, and having things go wrong is heartbreaking. For most of us, the worst thing about sickness in a kitten is sitting and watching and not being able to do anything to help. Some vets believe that the condition is due to a vitamin deficiency, and the most commonly used vitamin supplement for kittens is Abidec. This is a liquid vitamin supplement for babies and toddlers available from an ordinary chemist (unfortunately it tastes disgusting). If in doubt ask your vet. Remember that these kittens are always very young and small, so any treatment is very difficult. You only need one drop of Abidec per kitten, so don't end up squirting it down their throats so that they choke. I have used Nutri-drops in a very mild case, and that seemed to help - Nutri-drops (available in the UK, and possibly elsewhere under a different name) is mainly glucose and vitamin A, and a cocktail of other vitamins. It will give a kitten energy to suckle more, which is helpful if your kitten fights against a hand-fed milk supplement.

One thing that everyone also recommends is to supplement-feed affected kittens with a very high-quality kitten milk supplement, even if they seem to be feeding OK from the mother. One breeder observed that FCK kittens seem to use far more energy than normal ones just to keep up, and this has been confirmed by Kit Sturgess, so it is reasonable to expect that the kitten would need supplementing.

Cimicat doesn't seem to be much use as it's not very rich, and I would only recommend KMR which is a marvellous creamy-rich milk substitute, and has saved the lives of countless kittens who did not thrive on Cimicat, regardless of whether they had FCK syndrome. In the UK the supplier is KRUUSE UK Ltd, tel 01977 681523. They have always been very helpful and will despatch the powder to you the same day if they can. I'm afraid it's not cheap! Your vet should also be able to get it for you. You can also get it from CANINE CHEMISTS Tel: 0870 225 4777 (thanks to Doris for sending me the details). In the US, KMR is available at the chain PetSmart. The US distributor is PetAg Inc., 255 Keyes Avenue, Hampshire, IL., 60140; 1-800-323-0877 (Many thanks to Don for this information).

The other alternative is evaporated milk (brand name Carnation in the UK) diluted with water (about 1 part Carnation to 3 parts water) with a raw egg yolk beaten in (as long as you are happy that your egg supply is free from Salmonella). This is VERY nutritious if you can't get KMR. I'd supplement often to make sure the kitten is getting enough nutrition, as we still don't know if poor nutrition from a poorly functioning teat could be a causal factor. The exercise of struggling against you (at first) and of suckling from a syringe will also help the lung development, but will also tire the kitten, and you may have to abandon hand-feeding if it is counter-productive because of exhausting the kitten.

TREATMENT (back to contents list)

   

SUMMARY OF TREATMENT PROTOCOL

The more you can understand the condition of your kitten, the better you can help it, so spend time with the kitten observing the condition and how it affects the kitten, what makes it worse, and what makes it better. You can observe by watching and by feeling the kitten while it is lying at rest, feeding or moving around.

Flattening occurrs at any time from 3-10 days after birth, but is more likely to appear sooner than later. Although we do not know absolutely what causes the ribcage to flatten, it has been observed that cases of mild pneumonia can cause the ribcage to flatten to various degrees. In these cases the kitten exhibits abnormal rapid breathing BEFORE the ribcage flattens, and the effort of drawing breath in causes the ribcage to flatten. Note,: not all kittens who get pneumonia go flat. 

For this reason there is no harm in putting a kitten with FCKS on a broad-spectrum antibiotic as soon as the condition is noticed. 

The kitten may also be suffering a nutritional or vitamin deficiency, and therefore frequent administration of a vitamin and energy supplement is recommended. Hand-feeding formulas may supply this need, but it is advisable to supplement with additional vitamins. An ideal source of additional energy (from glucose) and vitamin support is to be found (in the UK) in Nutri-drops, which are obtainable from www.purrsonaltouch.com. If you know of other sources of supply for this supplement, particularly outside the UK, please let me know so that I can put the information here.

Flattening takes place over the course of 2-3 hours. It happens gradually, so the kitten is not normal one minute and flat the next. Observation of the condition developing saw a large healthy kitten with no discernible symptoms become almost completely flat over the course of 2 hours. The kitten was sleeping, and the breeder checked the thorax by feel: as each breath drew the ribcage in slightly more, the development of the condition was very clear. Although light pressure was applied by hand to discourage the ribcage from adopting the unnatural shape the development of the condition was not arrested until it stabilised by itself.

Once the kitten reached a state where the ribcage was horizontal across the underside, the condition ceased to worsen, and the kitten stabilised. The kitten showed no obvious signs of distress during this process, woke and fed normally, and otherwise behaved as the other kittens in the litter did. 

FCKS does not leave the kitten with the ribcage in a fixed position. The thorax is flexing all the time, and the degree of flatness changes during each inhale-exhale breathing cycle. When the kitten breathes in, the sides move outwards and the underside comes up towards the spine, increasing the flatness. On exhalation the sides collapse inwards, and the underside of the chest moves downwards away from the spine. Thus when the lungs are full, the condition is noticeably worse. 

Because the thorax is flexible, it can be pushed into the correct position by squeezing the kitten's sides. The best way of doing this is not to apply continuous pressure, but to apply greater pressure on exhalation when the more natural position is reached, and gentler pressure when the kitten is inhaling and the flattening is most extreme so that you do not prevent the kitten from inhaling. The more active the kitten is, the more extreme the position of the ribcage, so it is better to keep the kitten calm and quiet, particularly during massage. Quite strong pressure may be necessary, and most kittens, far from being distressed by this, seem to enjoy it. A good time to massage is during feeding. This has two purposes: the kitten is relaxed, so the condition is less extreme; the activity ensures the kitten remains alert and suckling when it might otherwise fall asleep, so it suckles for longer. Since kittens with FCKS use more energy than normal kittens, encouraging them to feed longer and waking them for extra feeds is highly desirable. 

You may have to utilise different types of massage. The first and most effective is simply to put thumb and fingers on either side of the body and press on the ridge of the ribs as they stick out. For quite severel affected kittens this seems to cause them no distress. If a kitten fights against this and cries out, a different method is necessary, which involves again using the thumb and fingers on either side of the body, but instead of squeezing, you rub the ribcage gently in a downward position from the spine down, applying inward pressure as you do so, as far as the angle made by the flattened ribs. This seems to be much more comfortable.

Massage should  be maintained for at least as long as a kitten is feeding, and longer if possible. The longer you massage, and the more frequently it is done, the more help it is to the kitten. After massage the chest is noticeably less flat than before, but usually the time between massages allows it to flatten again.

You can observe easily that when a kitten is fighting for a teat or crying for its mother, the chest is much flatter than when it is at rest or feeding unchallenged. If the kitten continues to gain weight this is a good sign. If weight-gain stalls or the kitten begins to lose weight you may be losing the battle If the underside of the ribcage collapses inwards so that pressure on the sides makes the centre of the chest cave in rather than push out, the kitten will almost certainly not survive.

There is a problem in applying a splint, or 'corset' to a kitten with FCKS, since the splint will be fine while the kitten is resting, but as soon as it needs to draw a deeper breath, the corset will restrict the movement of the ribcage, causing a sensation of suffocation, and the kitten will panic. This in turn makes it struggle and cry far more, and feel more restricted. Unless a kitten is happy with the corset during all periods of activity, it must not be left alone. This being the case, the owner may as well massage the kitten as put it into a corset while it is watched. Older kittens seem more amenable to wearing a corset 24 hours a day.

A more useful purpose of the corset is to prevent the kitten resting its weight on the flat underside of the thorax. In doing this, it encourages the flat position and effectively prevents the thorax from rounding out by itself. A tubular corset will allow a kitten to lie on its stomach (which is a natural position) without putting pressure on the flat chest. However if the corset is loose enough to ensure breathing is not inhibited, it will often slide off. There have been numerous ingenious ways tried of keeping a corset in place, however the construction must not prevent natural movement and inhibit the kitten from finding its mother for milk, or rolling upright if it gets tipped over. Since adequate nutrition is so crucial in survival, the kitten needs to be able to feed whenever it is hungry, and not just when the breeder is on hand to help it get to a teat. Encourage the kitten to lie on its side while feeding and sleeping. Kittens normally seem quite amenable to this. Lying on the side will help gravity to do what you would otherwise be doing by squeezing. I have also found that kittens who do not respond well to splinting can be helped by laying other kittens on top of them when they are sleeping, but ONLY if they are sleeping on their side! Be careful as, again, the pressure may not be tolerated by the kitten.

DOGS have problems with a condition similar to FCK, and breeders sometimes call it 'Swimmer Puppy'. It seems to be very similar to kittens (although it may not be the same condition), and a useful website that suggests a way of helping the puppies may offer hope to cat breeders with FCKs.

According to this website, the normal sleeping position for a puppy is on its side, but ones that develop FCK end up sleeping on the chest: this  exacerbates the flatness, as well as keeping the puppy in an unnatural position, which may be bad for lung development. The key to the puppies is to force them to lie on their sides, and the breeders do this by a combination of sitting over the puppies and continually turning them  onto their sides both when resting and when feeding, and also by putting them into a sock stuffed with cotton balls that makes a rounded shape on the underside of the body, thus rolling the puppy onto its side when it is relaxed.

Swimmer Puppies

Kittens, however, spend at least 50% of their time lying on their chests under normal circumstances so, although lying on the side is not abnormal, it is not abnormal for them to lie on their stomachs.

If you are not able to devote this sort of time to your kittens, then please give them to someone who can. It would be terrible to lose one of these brave little lives because your other commitments prevent you from caring for it. Think very carefully about continuing to breed if you cannot take time off to look after kittens if anything goes wrong: breeding is time-consuming and often requires sacrifices, and if your work or life prevents you from being there to support a struggling kitten then breeding may not be the right thing for you.

I am able to report that in late 2004 and early 2005 four breeders with affected kittens had success in taking action on the physical symptom (the flattened ribcage) by 'splinting' the ribcage in a corset (and several breeders have since tried it succesfully). The first two did this with a cardboard toilet roll, cut to shape. This was curled tightly around the body and tied in place so that it pressed on the sides of the ribcage, pushing the flattened underside back outward. The curved underside meant that even lying on its front, the kitten was not putting pressure directly on the ribcage, so its sleeping position was not making the condition worse.

One of the breeders who tried this said the tube did not make the kitten roll over onto its side (see below), but although lying on the side helps, simply lifting the chest off the floor of the bed will relieve the immediate pressure on the flattened area, allowing it to expand out naturally if it is able to do so. It is clear that pushing the sides of the ribcage in can provide immediate relief to a kitten that is having breathing problems. I think this could be a life-saving solution to the condition. We still don't know what causes FCK (and there IS definitely a genetic component, or we would not be able to predict it happening in certain lines), but if this turns out to be an effective treatment we have won a very large battle. The puppy breeders use a sock, but because kittens are so much smaller and more delicate to handle, I think the toilet roll solution is far better.

IMPORTANT
There are warnings to be aware of if splinting:

Not all cases of FCKS are suitable for splinting. To find out if your kitten is suitable, lay it on its side when sleeping or suckling and put gentle pressure on the ridge of the side of the ribcage. You will be able to see if the breathing is easier or impaired when you do this Look particularly at the soft tissue below the ribcage: if the pressure causes this area to be sucked inward more than when there is no pressure applied, you should not splint the kitten. Massage is the only alternative in this case.

Another type of FCKS which is not suitable for splinting is where the corset makes it more difficult for the kitten to breathe, or the distress makes the condition worsen. Some kittens are fine in a splint if they are resting, but cannot expand the ribcage sufficiently to draw breath when they are active. If your kitten falls into this category you cannot splint, but you should be able to massage without difficulty

If the ribcage is beginning to poke inwards, or the sternum (breastbone) is already poking in, pressing on the sides will force the sternum inward rather than outward and kill the kitten - make sure that before you try anything you are CERTAIN that the sternum will move outwards when the ribcage is compressed. Use your fingers to press the sides so that you can see what is happening before you put on a splint/corset, which will hide the thorax so you won't be able to tell what is happening.

If you decide a splint is going to work, just put the roll on loosely and work on making the kitten lie on its side. This will make a difference even without putting pressure on the sides. It is always a good idea to consult your vet about anything like this, and he or she should be able to advise you on whether your kitten has an inverted sternum or not if you are unsure. Many vets are skeptical about information found on the internet: if this is the case, please direct them to this page where they can access the veterinary article for themselves, or else print the article off and take it to them.

Be patient and gentle - tighten the splint gradually in stages (over hours or days) or you could harm the kitten or break ribs by forcing. One breeder of Maine Coons had a kitten who was struggling with breathing, but as soon as she splinted him he could breathe again - this is obviously a type of condition that is different from the ones who are made worse by the splint. She is not the only breeder who has tried this and been successful. Splinting is easier with larger kittens, but the longer you wait before splinting or treating with massage,  the more the ribcage becomes habituated to the abnormal shape, and the harder it is to restore it to the correct shape. Many thanks to this little fellow's mummy, who kindly took these excellent photographs. He's now doing very well and only wore the corset for a week.

Another breeder was kind enough to send me his thoughts and some photos of what he thought about this solution... 'Your pic of a kitten in a cardboard tube would do nothing to keep kitten on its side or put pressure on his sides instead of front of chest. I did something else. The ridge keeps the kitten sleeping on his side and he can not put pressure on his tummy side'. Although some people seem to have been successful with the tube version, we have no way of knowing if the kitten would have survived anyway or not, so it's a good idea to consider everything that may help. The younger a kitten is, the more likely physical therapy intervention will succeed, and the quicker it will show results. However you have to be careful if a kitten seems all right and you remove the corset, in case the chest flattens again. If caught within a few days of developing, a week in a splint seems to be enough to reverse the damage. Older kittens may need a lot longer. You can take the splint off to check the condition and massage the ribcage, though if it is hard to get it on and off in the right position then you may find it easier just to leave it in place.

Feedback from breeders is essential to learn more about FCK and different ideas and experience can refine our ideas and solutions. I am very grateful to Barbara, a Burmese breeder in Germany, who read this information and made a website with very clear and informative pictures showing her kitten and his progress with the splint. She and her vet also thought that the join in the tube should be below the ribcage rather than above the back, to encourage the kitten to lie on its side and her results were really encouraging. Her website is here. http://www.burmesen.com/chester2.htm. Sadly, Chester died after initially improving dramatically, but it is clear that the splinting did relieve his problems while he was alive.

More information from someone who read this page: 'We have an FCK and we printed the information you gave on the internet and brought it to our vet so she could see about the brace. We made a brace/splint only we made it differently. Ours doesn't go over the front legs. To make this brace use a soft curved piece of plastic about 1 1/2 inches wide and about 3-3 1/2  inches long depending on the size of your kitten. We got our plastic from an 8.75 oz Sunny-Delight bottle.  Then took the plastic and covered it with horse wrap, so the plastic would not iritate the kitten. Envelop the 6'' horse wrap around the plastic piece leaving enough of the horse wrap extended to go around twice. Wrap it snuggly yet comfortably around the kitten's chest under the front legs. You should change the horse wrap every 2-3 days, for it loses its stickiness. (it sticks to itself not the kitty) Our baby is doing quite well.'

If splinting is done carefully it could save the life of your kitten(s), but bear in mind that sometimes the FCK seems to be caused by poor lung or heart development (or pneumonia), not the other way around, so even if the ribcage is rounded out again it may not solve the underlying problem, and the kitten may still die. However this is much more hopeful than any of the other things that have been suggested in the past, giving instant relief to a kitten having difficulty breathing. We do know that sometimes the internal damage is caused by the FCK and not the reverse, so please let me know if you are trying splinting, and please do let me know the outcome. The cases I have been told about so far are of single FCK kittens in a litter; it would be very useful to know of a case where this is tried with a whole litter that has gone flat, as the condition tends to be more serious where a whole litter is involved, and the mortality rate is higher.

Vets in Holland seem to have more experience of FCK than those in the UK, including it in their training, and have taken a more pro-active attitude to treatment: they recommend physiotherapy and massage on the thorax every three hours for 24 hours a day or more often if you can do it. This is combined with treatment using anabolic steroids (Bolbane) pioneered by a practice in Zeist which they believe speeds up the changes initiated by the physical therapy. Unfortunately for English speakers the site is only in Dutch, but since the Dutch usually speak very good English, your vet may be able to contact this practice for more information (the vet is called Nico Dijkshoorn). A success story from Holland using this protocol can be read here: http://www.felinefantasy.nl/ , look at: a cat's tale > Smirnoff's Story.

Some vets also recommend making a flat-chested kitten move more by pulling it away from the mother so that it has to work to get to the milk, and also encouraging it to cry, though without distressing it unduly. The thinking behind this is that it will strengthen the muscles used in breathing and this may encourage the ribcage into the correct shape. I do not advocate this approach: as described above, the effort of increasing lung capacity during activity causes the flattening to increase, and also I suspect the extra energy the kitten is forced to expend is not helpful if it is already losing weight because it is not feeding well.

Finally on splinting: some kittens are extremely distressed by splinting, and the distress it causes would be counter-productive in attempting alleviate symptoms. One breeder reported that her kitten was gasping for breath after screaming because it did not like the splint. You need to gauge how the kitten is reacting to make sure that the pressure you are providing is not too great, and also that having a splint on is not going to upset the kitten so much that it expends too much energy fighting or crying, and that it stops feeding because it feels it cannot move. If you cannot splint because it distresses the kitten too much, then use massage and  pressure on the ribcage to keep encouraging it to a normal shape. Do this as often as you can. DON'T do it while the kitten is suckling if it is distressed by it, but most seem to find it pleasurable (!).

SUMMARY OF TREATMENT PROTOCOL:

HILL'S A/D - A WARNING(back to contents list) 


A number of breeders have recently had problems with vets suggesting they feed diluted Hill's a/d diet to immature kittens who are in difficulty. A/d is good for convalescent adults or older kittens, and is very good for weaning, but it is NOT appropriate for the very young (i.e. younger than 3 weeks of age). As far as I know, Hills does not suggest the use of a/d in neonatal kittens. One breeder had to fight with her vet to insist they used only kitten-milk formula when tube-feeding a sickly kitten who was under 2 weeks old, when they wanted to feed a/d. I have heard from two breeders whose kittens died, apparently from constipation, afer being fed a/d under 2 weeks of age. Good kitten formulas are designed precisely for the nutritional needs of a kitten, and KMR in particular is ideal for a weak or sickly kitten. A very young kitten who is not doing well may have digestive problems, and almost certainly has an immature digestive system. Hill's a/d is a high-protein meat-based food, which common sense should tell us is inappropriate for an immature digestive system.

WHY DID THIS HAPPEN? (back to contents list)


Although many people will offer implausible causes for FCK (such as queens lying on heat pads or heated floors during pregnancy) all of these theories have been disproved. It is possible that a mating liable to produce FCK will have that liability increased by external conditions, but it can be clearly seen that some cats will throw FCK and some will not unless mated to another cat which throws the condition. Unfortunately, the genetic picture is not clear - a cat cannot be described as either a carrier or not a carrier. We know that this condition is genetic, but it seems to be polygenic, which makes it much more difficult to locate. I have heard from two breeders who did repeat matings, but only had FCK kittens in one litter.

Some lines throw FCK far more than others, and some studs or queens are well known for it, and so you avoid them in your breeding lines if you can. Virtually all studs in all breeds have thrown one at some time or another (because of the numbers of kittens they sire), so it's unavoidable, and abandoning ALL lines that have thrown FCK would be incredibly damaging to any breed as it would limit the gene pool far too much. It seems that either sire or dam, or both, may carry the genes that trigger the condition, but having it manifest in a litter of kittens can rely on combinations of environment (whether the queen is healthy and produces a lot of milk) and other factors. The main thing to avoid is having a known serious FCK carrier in your pedigrees, but also to avoid having the same cats in the pedigrees too much as well. FCK appears much more often with inbred lines. There is a dramatically increased link of FCKS in litters from related parents, and one of the reasons the condition may be particularly prevalent in Burmese is the extremely limited gene pool of this breed.

There is also no doubt in my mind that sometimes FCK appears without any apparent genetic component. I suspect that it is a condition that manifests as a result of any number of causal factors. This is a bit like a human running a temperature: we get a temperature as a result of a huge number of illnesses, but the temperature is always the same, and it is just a sign that something is wrong, and is caused by an underlying illness. It looks as if single cases of FCK can appear a bit like a temperature - the outward sign of something being wrong, so it can be the result of another problem, as well as a problem in itself.

Unfortunately, some stud owners continue to run studs who have thrown a lot of complete litters of FCK kittens. I have personal experience of a stud owner who said categorically that her cat had not thrown any, only to find after my kittens were born that he had had two complete litters and the stud owner knew about them: I talked to the owner of the queen that had had these kittens, so there was no question of the information being just malicious gossip. This stud was widely used as he was a UK Grand Champion: when 'clean' lines were mated to him the kittens were generally healthy, but kittens bred from those offspring nearly always develop FCK. Fortunately my kittens were all completely healthy, but I knew that they had at least a 50/50 chance of carrying FCK, and so I did not feel I could keep a kitten from the litter to continue my lines. I was very sorry to lose this line, as this unwitting 'test' mating showed that my line was not susceptible to FCK. Unfortunately I could not mate the queen again to get a breeding girl from her, and she had to be neutered. Needless to say, I was more angry than I care to remember!

It seems that there are numerous genetic markers that must be present in order for the condition to arise in unrelated matings: if a cat has many of these markers then most of the offspring will have flat chests. If mated to another cat with a high level of markers, then all kittens in a litter will be flat. Single flat kittens may suggest that one of the parents carries a significant number of markers that were mitigated by the other parent being relatively free of them OR that there is an environmental rather than a genetic reason for the condition developing.

FCK can be affected by the situation of the queen: any adverse event during pregnancy (including poor nutrition) can render a queen liable to produce FCKs if she carries a small number of 'markers', while a better environment may prevent the condition from developing. If you have just one flat-chested kitten in a litter then the causes could be environmental more than genetic (see paragraph below), but maybe using a different stud would be safer for breeding next time. It seems to be rare to get a whole litter of flat chests unless both parents are strong carriers of the genetic cause, so it would be advisable to abandon a breeding line that produced whole FCK litters. Single flat kittens in a litter, though indicating a risk in the lines, may not be such a serious problem and it may be only one parent who is the cause, assuming there is no environmental factor. Many breeders prefer to avoid any incidence of FCK in the lines they are using if they possibly can, even though this may severely limit their gene pool (and there are many dangers for a breed in following this course), but sometimes a kitten will turn up in a line that was thought to be clear. It is a matter for each breeder to weigh up the factors of FCK risk and limiting their gene pool to a dangerous degree, and I'm not going to criticise the decisions individual breeders make.

There may possibly be physical reasons why FCK may occur that have nothing to do with genetics or the bloodlines: if a queen was ill during pregnancy, or had to have antibiotics; if the queen had a fall during pregnancy that might have knocked one of the fetuses. Also, if one kitten is getting less good milk than the others: sometimes a queen has one teat that does not produce as much milk as the others, and the kitten who gets this teat may go flat from vitamin deficiency or lack of good nutrition (if that is one of the causes). Sometimes with very big litters the smallest may be flat, though I have had litters of 8 and 9 with no problems at all (and the queen lay on top of the radiator all through every pregnancy without producing a single flattie), so I'm not sure that is a legitimate cause. Some people will look for any excuse to say it's not their bloodlines, particularly if the cats they breed are very good show quality, or if they are very attached to their bloodlines for other reasons. All you can do is ask the breeder if you are looking for a stud or breeding queen. FCK CANNOT be caused by your queen sleeping on a heat pad or other heated surface while pregnant. I have had 15 Siamese, Burmese and Tonkinese queens over the years who have spent their entire pregnancies (to various studs) stretched out along the tops of radiators or sitting on top of an AGA, and never had a single flat chest. Veterinary studies have now comprehensively RULED OUT sleeping on heated surfaces as a cause of FCK, though originally when the syndrome was first identified it was suggested that it might be one possible cause.

HOW CAN I PREVENT OR AVOID THIS CONDITION? (back to contents list)


First of all, be truthful about it. This is not something you caused, and it does not in any way mean you are a bad breeder, so it's nothing to be ashamed about. Only by discussing it openly will we learn more and will the lines that produce it consistently be prevented from damaging clear bloodlines. Unfortunately I know of several breeders who persist in offering studs for public use who consistently throw this condition, and whose offspring also produce it. Just because a cat is very beautiful or a show winner does not mean he or she has suitable genes to pass on.

Unfortunately we really don't know enough either to avoid the condition entirely or to cure it successfully every time (unless the new ideas I've written about above turn out to be successful): very bad cases where the kitten begins to have trouble breathing are unlikely to be cured, and the kitten usually dies. Mild cases can often recover with no help at all, sometimes remaining slightly flat, and sometimes the ribcage goes back to normal. Either way, you must not breed from that kitten, and it's not advisable to breed from any of the litter mates in case the cause is genetic. I would not advise the the repetition of a cross that had produced an FCK kitten again just in case the combination of the two lines was the cause; maybe another stud would produce a safer outcross.

Main things to avoid to try and prevent the occurrence of FCK:
1. Use of ANY antibiotics or medications during pregnancy or nursing
2. Inbreeding in the pedigrees between the male and female lines
3. A Queen who does not produce a good milk supply (if unavoidable, then supplement, even if the milk is coming OK)
4. Using lines known to have produced FCK kittens - though beware, not all breeders are truthful about this
5. Poor nutrition during pregnancy and nursing: plenty of fresh high-quality food must be available to the queen at all times, and raw meat such as rabbit is an ideal source of good nutrition.

If you are reading this because you have a litter with FCK in it I wish you the best of luck, and I hope that your kittens survive. It is heartbreaking to watch babies die, and everyone who has experienced FCK would offer you their support in dealing with it. Unfortunately nearly every breeder who has been breeding for some time will have experience of FCK, if you haven't, then you're very lucky.

SHOULD I BUY A KITTEN WITH FCKS? (back to contents list)

There are no guarantees that when you buy any kitten it will live a long and healthy life. Of course, it is the hope of every breeder that our kittens will have long lives and will not suffer from any unforseen illnesses, but there are always risks. A kitten with FCKS who lives to 12 or 13 weeks and does not seem otherwise less strong or healthy than its siblings should not necessarily have any less life expectancy than any other kitten, but it would be foolish to assume that there are no more risks with a kitten that has a deformity like this. Many FCKS kittens grow out of the condition, and I have not heard of many who reach 'saleable' age who do not live perfectly normal lives, as long as they are not obviously compromised. If the breeder has told you that the kitten has FCKS then that is a good thing, since they are not trying to pull the wool over your eyes, and you are going into this with your eyes open. NEVER by a kitten with FCKS, or a recovered FCKS kitten or cat for breeding. You are asking for trouble. It is also highly inadvisable to buy or keep a breeding cat from a litter where siblings have had FCKS: breeding is risky enough with the things we don't know about without increasing the risks with something you do know about.

Some guides:

If the kitten -

  • is the same size as its siblings
  • is active and energetic
  • has no detectable signs of illness or deformity (e.g. a heart murmur or kyphosis) other than a flat chest

- then it has every chance of leading a normal life.

If the kitten -

  • is significantly smaller than its siblings
  • does not play as actively as the other kittens
  • has any other condition in addition to the obvious flat chest

- then the chances are that it may not have a long life, and could involve you in vets bills and early heartbreak. However, this is not a reason NOT to take the kitten. Every young animal has a right to love and the warmth of a loving home: with the breeder it may not get the time you could give it (because they probably have several other cats), so even though its life may not be very long, you could give it the special love and attention that will make its life special and happy.

The most immediate problems you should encounter are when it comes to neutering. The heart, though it sounds OK, may be slightly damaged, and that means that spaying/neutering, when the cat needs a general anaesthetic, is a risk time. Talk to your vet about it if you are in doubt, provide him/her with the information leaflets from this website, and take every precaution possible before and during surgery (e.g. risk-minimizing anaesthetics such as Propofol/Rapinovet; full anaesthesia with intubation rather than just 'injection' anaesthetic; pre-operative anti-histamine to guard against vaccine reaction; a veterinary nurse monitoring the heart with a stethoscope throughout the operation (a heart monitor does not pick up on changes in heart sound, only a faltering or erratic beat, by which time the damage has been done). All these things may be more expensive, unless your vet (like mine) does all these things as standard, so be aware of this before you buy the kitten). If the cat comes through neutering fine (and most do), then you should not have any more unusual expenses that you would not have with any other cat.

A 'flattie' is special: it will have had extra special love and attention from its breeder, and will probably be a much more affectionate pet as a result. The breeder may also feel much more attached to the kitten, and will look for a special home for him. If you are prepared to give one of these special kittens a home, then you will be a special owner too.

WHAT CAN I DO TO HELP? (back to contents list)

Please notify me if you are dealing with an FCK litter or kitten. I may not have time to reply if you are just notifying a litter or kitten, but if you ask a question that is not covered here, I will try to answer it. If you have any information you can add to this - anything from your experiences and thoughts on the notes above - then please do e-mail me. I hope this site will provide enough information eventually to give us all a better understanding of this condition and how to deal with it, but this can only be done if I receive information from breeders who are having to deal with it. All information received will be treated with complete confidentiality. Everything shown on this website is provided with the permission of the breeders concerned.

The THINK Project is a research group founded to raise funds and collect data in order to create an academic research post to investigate thoracic deformities in kittens, particularly FCK. The website is: http://www.think-project.org/

Our aims are:

Identifying specific thoracic deformities clearly
Informing the public and vets on identification and treatment
Funding multi-disciplinary approaches to researching the problems
Identifying causes with an aim to prevention and treatment

The organisation was launched formally at the GCCF Supreme Show in the UK in November 2005, and you can support it at any time by joining or making a donation via PayPal. download the THINK project information leaflet here. You can also help by completing our questionnaire (you can find it on the website, which was created with the help of a veterinary epidemiologist. We need information about litters with FCK AND litters that are healthy, so that we have a large body of research and control data. Any data sent to us is treated with full confidentiality, and you do not have to give your name or other details unless you want to.

It is likely that at least £300,000 will be needed to fund this research adequately (salary, overheads, consumables, lab and bench fees etc.), and we cannot expect to find all of this from veterinary sources. Initially we will need funds to gather primary data and organise a program of education through vets surgeries, as well as bringing the scheme to public attention. If you would like to make a donation to the fund it will be possible to do so through PayPal (any currencies) - e-mail address is think.project@gmail.org - or by sending a cheque (GBP only) to the treasurer. All contact details are available on the THINK website: www.think-project.org.

Copyright © 2007 Julia Craig-McFeely
This text may be copied or reproduced without permission in newsletters and other information sheets for cat owners and breeders, as long as it contains the name of the author, the original source (the URL) and also the note (given at the top) which must be shown prominently that the author does not have veterinary qualifications. This is to ensure that users of the information are not misled.

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