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Hypertrophic Cardiomyopathy – A Silent Ambush Killer of Young Cats: A Warning and Words of Advice.

As some of you may know, we recently lost our sweet little 2 yo kitty named Toad. This heart-wrenching loss had my 10yo daughter in tears for weeks. She still draws pictures of him and talks about him like an old friend that she misses. Toad was a very social cat who loved my daughter, hung out in her room, and slept with her every night. One morning, Tony came downstairs and announced that Toad was no longer using his back legs. We rushed him to work, gave him all the pain medications, and determined his back legs would likely never work again and would start to die due to lack of blood flow – they were cold and hard and PAINFUL! This led to a very tearful euthanasia where I had to watch my daughter clutch his sedated (due to the level of pain he was in) body against her chest and sob into his soft fur. And then I gave the final injection.

While Toad probably would have never lived a long kitty life, we possibly could have kept him going much longer than we did had we known what was coming. Toad died of a young cat disease known as “Hypertrophic Cardiomyopathy” (HCM) where the heart muscle becomes TOO thick and, therefore very little blood is pumped each time and the increased turbulence increases the risk for clots. Toad’s presentation is the most common way to discover this disease in young cats – a fatal blood clot to the aorta at the point where it splits off into the hind legs. The clots can partially or fully block blood flow to the back legs. In Toad’s case, the legs were cold and hard, therefore, no blood was getting to them.

So, how can you prevent this tragedy from happening to your family?

  1. Have your new cat/kitten evaluated by a vet for a heart murmur. (Toad never had one, but it’s good to know anyway)
  2. Have your new feline check for a chemical that is released when the heart is stressed. It’s a test called proBNP.
  3. If 1 and 2 are normal, GREAT! Keep an eye on your kitty.
  4. If #1 is not normal, but #2 is normal, keep an eye on your kitty and watch for early signs of heart disease like when they’re completely asleep (and not twitching with a dream or something) count the number of times they breathe in a minute – it should be less than 30 breaths per minute. If it’s more, contact your vet.
  5. If #2 is not normal, think about having an echocardiogram (ultrasound of the heart) or a work up at a cardiologist to determine what the next step is and whether your kitty needs to be on medication.

If you’re rescuing a cat from the shelter or from the streets, there’s not a lot you can do to prevent this condition other than making sure to feed it a commercial cat diet that’s balanced for cats and has the amino acids required to keep the heart healthy – but if genetics are in play, the diet won’t really change the outcome. If you’re purchasing a cat breed (specifically Ragdoll and Maine Coon), make sure you find out if the breed is predisposed to heart conditions and then grill the snot out of the breeder and make sure the parents and grandparents have been tested for heart conditions before purchasing. After this whole ordeal, we got his sister, Popcorn (pictured with him as a kitten) and she’s all okay with no signs of heart disease. Now, I’m trying to encourage people to avoid this horribly traumatic experience themselves by recommending testing for young cats.

After his death, I performed a necropsy to confirm my suspicions and give myself solace for putting him down (sometimes, even when you’re sure, you still doubt “Did I just kill my daughter’s cat for the wrong reason???”). Sure, enough, I found a very large clot wedged in the descending aorta along with branches of the clot going into both femoral arteries, effectively shutting off all blood supply to both legs. I also found his heart, which was greatly enlarged with the left ventricle (the one that makes the big pump to the whole body) grossly thickened to the point where almost no blood could be pumped each time. The only thing I can even remotely think of as far as symptoms that I missed was that he was a very active kitten and eventually got to be a sleepy/cuddly cat while his sister continued her tortuous reign on the outdoor small rodent population. I thought this was just his personality, but, looking back, he was probably tired all the time due to lack of oxygen/blood to his body.

***** Warning! Pictures of Toad’s necropsy (autopsy) to follow ******

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#grosspictures coming!

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STOP SCROLLING IF YOU ARE EASILY GROSSED OUT

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Seriously! STOP! Blood! Gore!

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But it’s a REALLY good visual of how everything failed for poor Toad

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This is a picture of the clot sitting in the fork at the end of the descending aorta. It splits into right and left hind legs.
This is a cross section through the middle of the heart – see how little space there is to fill with blood to be pumped?
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Cats: They’re Sensitive (and they’d like to stay that way)

Cats are funny creatures. So independent and in your face with their needs and desires. They seem so low maintenance. You just get a cat, some food and a litterbox and you’re set! Easiest pet you ever had!

Sweet Toad – the perfect cat – except that he’s a nasty bully to the other cats.

Oops, no! Sure, some cats are ridiculously low maintenance and use their litterbox all the time, eat, drink, don’t vomit on your important documents or pee on your laundry or chew on your electrical cords. But getting one that great from the get go and their staying that way is a gamble much like life insurance (or worse, short term disability insurance).

Spicy Penelope – except to other cats – she’s the target of their aggression

Litterbox habits: This is the number one behavioral complaint we get with cats. Now, I am no behaviorist, but will try to explain what I tell clients when they’re having trouble with urinating or defecating outside the litter box. First thing’s first: as a vet, I definitely want to make sure there’s nothing medical that is causing this issue. Urinary tract infections, cystitis (which can also be behavioral), arthritis, diabetes, kidney disease, crystals or stones, other health issues. So, we will start with bloodwork and urinalysis to rule out the easy ones. For arthritis, we may, next try X-rays or pain medication trial. Once we’ve ruled out medical reasons the cat may be giving you the fluffy finger, we’ll move on to behavior/social/psychological issues.

This is Delphi – she’s 18 and hyperthyroid and pees on our counters and herself – hence the bath.
  1. There’s a rule of thumb that you should have 1 litterbox per cat plus 1. So, if you are like me and have 5 cats, you should have a minimum of 6 litterboxes.
  2. If you have multiple cats, make sure to spread out the litterboxes in case one cat is secretly bullying another cat and chasing them out of the litterbox. I have multiple litterboxes on each level of my house, including the basement. If you have dogs, make sure the cat can get to the litterbox without a dogs nose up their butt waiting for the “fresh from the oven” treats. Consider a baby gate raised to 5-6 inches off the floor to allow the cat to scoot under, but not the dog – or if you have a small dog and young cat, baby gate on the floor.
  3. Some cats like the covered litterboxes, some feel claustrophobic. You’ll have to try different ones. Give different options. Regular open ones, closed ones, tupperware bin with a hole cut in the side, deep ones, shallow ones. Who cares? Cats. They care. A lot.
  4. Clean the boxes VERY regularly. At least once daily. Cats are bourgeoise and don’t want to use a dirty bathroom just like you.
  5. Try different litters. Some like the clumping, some don’t, mine hated the pelleted recycled stuff that was supposed to save the environment. Like many people, cats are more about themselves – tiny, soft, fluffy narcissists. (My cats really LOVE Dr. Elsey “Cat Attract” litter)
  6. Don’t keep the boxes where there’s a lot of noise, or commotion. Or, God forbid, change what’s in the room. My sister’s cat stopped using the litterbox in the laundry room when she got a new washing machine.
  7. A cat’s stress organ is their bladder. So, if something is stressing them out, the bladder will get inflamed and can even make them urinate blood without their having a bacterial urinary tract infection.

Food and water secrets: In general, cats are desert animals and are prone to not drinking enough which can lead to urinary and kidney issues.

  1. Offer water in several forms. Beautiful bowl you tediously picked out online that perfectly matches your décor and your cat’s unique personality? Complete garbage. Try leaving a disgusting dish in your shower to collect water haphazardly – they LOVE it! Leave a faucet dripping, leave a cup of water on the counter – they’ll drink it.. then dump it. Pretend to fix yourself a glass of ice water and look away for a few minutes. Run the shower for just a second and watch them happily clean the droplets off the walls. Cats are bougie, but also sometimes hipster.
  2. If you’re ever in the position to need to try to force feed your sick cat – remember this: whatever food you decide to use, your cat will HATE that food forever! So have an alternate food to offer to see if they will eat on their own and don’t use their regular food if they have special prescription diets that they need. Talk to your vet about options.
  3. Cats DON’T NEED MUCH FOOD. Really, most domestic animals are obese these days, but for the most part, cats only need about 200 kcal per day (average for a 10 lb/4.5kg cat +/- weight for tiny cats or TRUE Maine coons – talk to your vet to get an idea of what your cat should weigh). Look at your bag of cat food and figure out how many kcal/cup of food and calculate from there. Overweight cats lead to unhappy, sedentary, arthritic, diabetic kitties who can’t even groom themselves and have to get shaved or develop sores on their rears from excrement sticking to them.
This is Dan the clinic cat. Dan is 20 lb. Dan has an eating problem and needs to be on a diet.

Social order:

  1. Don’t TOUCH me! For a cat, the only acceptable place to be touched (until consent is fully achieved and a safe word is established) is the top of the head. This is the only place that they cannot groom themselves and will more readily accept touch on this area. So, if you’re first meeting a cat or trying to gain it’s trust, start with a little scratch on top of the head and then move on from there.
  2. Cats are like potato chips, you can’t just stop at one. Buuuuut… maybe you should. Yes, some cats LOVE companions, but for the most part, cats are solitary creatures that really need their own territory. If your cats aren’t getting along, you may need to establish their own territory complete with their own food, water, litter boxes, beds, toys, humans, etc. I recently thought I would be smart and get two kittens from the same litter so they would “love each other” and it totally worked for about a year. Now, they hate each other and break out in full on screaming, hair flying battles. We have 5 cats now and have to rotate who gets to be around humans between the main floor, the basement, and even the outdoors. Only my 18 year old dirty hippie kitty is accepted/picked on equally by the other four.
  3. Kitties seem like couch potatoes once they reach adulthood – happy to eat, drink, and sleep. In reality, cats get really bored really easily and to keep them mentally as well as physically healthy, it’s very important to keep them stimulated in their very controlled environment. My household does not allow for toys on the floor (per poodles), but a cat tree next to a window, a bird feeder to watch, laser pointers, SCRATCHING toys (flood them with scratching toys to keep them from shredding your furniture), toys with moving parts, there’s some mouse toys you can put their regular food in and hide throughout the house instead of in a bowl so they can feel like they’re hunting, there’s compressed catnip in a ball you can hang on the wall and they can rub/lick/play with it. Cats like tunnels, ramps to get to high places. Leave Amazon boxes on the floor for a few days, plastic or paper bags from shopping, kids’ canvas tunnels, tents, etc.
Popcorn, sibling to Toad. Hates Toad. And Penelope.

Dr. Elsey’s Cat attract litter: https://www.drelseys.com/products/cat-attract-litter/

Cat toy: https://www.chewy.com/doc-phoebes-cat-co-indoor-hunting-cat/dp/179101

Cat nip balls: https://www.amazon.com/Potaroma-Silvervine-Catnip-Healthy-Cleaning/dp/B08T7493WJ/ref=sr_1_2_sspa?crid=2MIY8OB36U2B0&keywords=catnip%2Bballs&qid=1663263254&sprefix=catnip%2Bball%2Caps%2C118&sr=8-2-spons&th=1

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Let’s hear it for the clients!

So, I’ve written about some of the more annoying things clients can do or ask of us. To be fair, the majority of our clients are considerate and polite. It’s like always having something funny and typically negative to say about your spouse or kids when you’re telling stories in public – if I spent all of your attentive time talking about how sweet my husband can be or how squishy my kids’ cheeks are, you would quickly grow bored and may have to hold back your gag reflex. So, I decided I’d write about the good guys (and gals) who keep me in this profession – and will try to keep it entertaining.

A frequent flyer, this patient is everyone’s favorite and she knows it! Her owners are pretty cool too!

Mr. Dean:

When I was working at my first job in South Carolina, it was my first time being a small animal vet and there was a huge learning curve. When I first met Mr. Dean, he was an imposing character. Older man, gruff, zero time for formalities or politeness. Not that he was rude, but he surely didn’t take the time for making you feel better about yourself. He was a hunter and had his pack of beagles. One of his beagles he brought to me wasn’t “doin’ too good” and we ended up diagnosing with kidney failure.

Mr. Dean was a very concerned owner. He would come to the office and just talk to me about his dog and his condition often and let me know how he was doing. I told him over and over about the basics of kidney failure and that a low protein diet was important to help his dog’s kidneys, but he continued to tell me how he makes him hand rolled meatballs every night for dinner and he “knows it’s not right, but he just loves them”. Then, he finally got to where his dog would eat biscuits. So, every morning, Mr. Dean and his wife would get up and make biscuits from scratch just to feed to their ailing dog.

This is a picture of Norman – the beagle that wandered into our yard – he has since run away after his neuter

Eventually, his dog got to the point where it was time to make “the decision” and Mr. Dean asked me to come to the house to euthanize his beloved beagle. This gruff, hardened man softened greatly at this point. It was hard to see, but we had been working so closely with his dog that I knew it was time to say goodbye. After his favorite beagle had passed, he gave me a tour of his property and his “hunting kennels”. These were not your typical hunting dog kennels – they were immaculately clean, the dogs were all allowed into the house at some point during the day. This gruff old man who spends his time hunting rabbits and turkey, even had a couple of turkeys that he had taken in as pets. I don’t know much else about him, but if I died and came back as a beagle, I would certainly want to come back as one of his.

There was one guy that I met after helping him deal with his ailing old boxer and then, eventually, euthanizing. In the next few weeks, we were all so happy to see him come in with a new little bulldog type puppy. That little puppy was just a little hopping ray of sunshine! He made us happy, but most importantly, he made his mourning owner happy. Everything was as usual through puppy vaccines, neuter, and into his first year of life. And then, it happened. The owner rushed this young dog into see us because he had been seizing and would not stop. We worked on him for what felt like forever, giving anti-seizure medicine, placing an IV, running blood, had him on monitoring, but we could not get him to stop seizing. I called my boss as I was still a new graduate and asked what else we could do. He told me to try giving tiny amounts of the euthanasia solution (which is just a concentrated anti-seizure medication) until the seizure stopped.

Not the bulldog in the story, just super cute

This was the point where I had to make the decision of whether to allow this dog to continue to seizure or give him euthanasia solution to SEE IF IT WOULD work. This was in the middle of nowhere with no access to emergency veterinary care, I was alone, I was still wet behind the ears, and everyone was looking to me to fix it. I went outside the building and started crying. This was all too much for me. Then I thought of one of the girls working there as an assistant and how I had heard her talk about how weak girls can be in situations of stress. So, I stopped crying and went back into the building and started titrating euthanasia solution (pentobarbital) until the sweetest little bulldog stopped seizing.

It took him almost 12 hours to come back to consciousness, but when he did, he wasn’t the same happy, go lucky sweet puppy. He was angry, charging the cage, growling, snapping. I talked to the owner and said that this can sometimes happen with the post-ictal phase where the brain is recovering and that we would just need to give him more time. He did not recover. Finally, the owner came in to see him to see if the dog would recognize him. He didn’t. Just like with us, he charged the opening of the cage, trying to bite this sweet man who was dealt too many unfair hands. Then the owner made the heart wrenching decision to euthanize. We could not even reach into the cage to get to the injection port in his IV line. We had to just stab the needle through the plastic line and give it that way.

Broken hearts are a commonality in this profession. That owner didn’t deserve that. He was a great owner, always wonderful to us, and was even gracious after the fact, knowing that we had done everything we could.

There have been farm clients that understand that we are hot, tired, likely deprived of calories. I had one client who brought me out a freshly made smoothie in a glass after I had worked on her horse’s lacerations. Numerous clients who have brought out water, soda, coffee, some even offered beer or wine. I had one client invite me in for lunch after working on his horses. I met his family, felt 100% too grungy to be in this nice of a house and around this much money, but it was so nice to feel welcome, especially when being called out for an emergency. Small animal clients who bring us buckets of coffee and doughnuts, buy us pizza, or a sandwich spread, cookies, baked goods for Christmas, even a card sent just saying thank you.

I had one client in Michigan, who, upon hearing that I was leaving, brought in a present of a bottle of wine made from their grapes in their garden (not a vineyard), displayed on a wooden wine bottle holder the owner made from wood from their own trees. The wine bottle was decorated with a picture of the horse that I had helped them with. I still have that bottle on my kitchen counter and am afraid to mess it up by opening it.

There have been so many good clients, it’s hard to tell a full story about each of them. There was the client who was comforting ME while I was euthanizing HER horse. She was very worried about me and having to do the procedure. There was one who gave me a beautiful drawing of their dog I had worked on. There are all of those who have their animal caught and restrained for us when we get there, or let us know ahead of time that their dog or cat has been known to bite – instead of waiting until we have finished listening to their heart and then suddenly have to dodge the teeth coming at our face only to have the owner say “yeah, I thought he might do that” – and ALL the ones that understand that we are slammed with sick patients and don’t grumble at us when we fly into their exam rooms, hair disheveled, 15 minutes late.

Then, there are all the clients who just make our job easier and, dare I say, worth while by the simple act of *drum roll!!!!* following our suggestions. It’s that easy. Sometimes, when I see a client coming in for a recheck, I get excited that they are actually coming back! And then, when I find out they’ve been giving the medications as I said (though I understand some animals are difficult to medicate – but at least they gave it “the old college try”) and using the products I told them would help the most – talk about a heart fluttering moment! I’m not even talking about spending all the money on all the available diagnostics and treatments, just giving a medication every 8 hours like I said, or applying ear medication once EVERY day, or decreasing the number of treats and food given and getting their dog to lose weight.

Some clients have really grown into our lives and become our friends that we think of on a daily basis, even if we moved far far away – Mr. Dean, I still “peench ” them dogs real hard before I give an injection, and you’re right, it seems to help.

Some clients feel the need to connect with us with gifts, which is awesome!

But, as medical professionals, we mostly only get to revisit the cases that are not improving despite the hours of research and brainstorming we have been giving to that animal; who have the call backs from clients complaining or upset; who pour hours of emotional weight onto people; consoling them or talking them through difficult decisions, knowing bad news and preparing to tell the owner who is waiting so hopefully in the room for something “easy” to fix, telling them bad news and just watching as the shock hits them followed by the collapse of their shoulders and welling of tears. ALL DAY. EVERY DAY.

So, being a polite, considerate owner when things are okay for you and your pet, or taking advice on treatment for your animal, or letting us know when something got better (even if we totally expected it to) is all it takes to be a good client in our eyes. Unfortunately, sometimes, we have to put up walls of armor through humor, usually dark humor, so I apologize to those who were offended by my last post, but at the end of the day, we’re all just softies who can’t watch movies where animals get hurt, and who break down crying when we watch a Subaru commercial, but sometimes have to use sarcasm as a way to make it through the day.

Hooray for the clients!!!!

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What’s coming into the clinic?

I’ve decided to compile a collection of expected diagnosis based solely on judging a book by its cover. Basically, what we, as vets see coming in and go ahead and make large assumptions (normally we assume the worst or most obnoxious). So, here are some presentations and the expected problem.

Basset hound/Cocker spaniels: Ears. Always ears. Even if they’re just coming in for a rabies vaccine only and refuse to pay an exam fee, they will want you to check out their ears…. and a nail trim.

Red/white/blue pit bull: skin – allergies and or mange. Dilute colors = skin issues – also nail trim.

Labrador (any age, any color) not eating/vomiting – foreign body – ate toy, golf balls, raw hides, rocks, dry wall, socks, underwear, etc.

Any female dog over the age of 1 year and not spayed – WILL ALWAYS BE PYOMETRA until proven otherwise – and owner will give you a guilt trip about the expense of the emergency surgery “So you’re just going to let my dog die then?!?” even though you told them from the beginning to get the dog spayed “No, sir, I did not tell you to NOT spay your dog” (avoid a $800-$4000 emergency bill)

Puppy (any breed) under 1 year of age presenting with diarrhea, inappetence, and/or vomiting: Parvo until proven otherwise.

English bulldog: this one is wide open but can include some or all of the following: skin issues – (allergies, hair loss, ear infections, skin infections), respiratory failure due to nonexistent nostrils, too long of a soft palate, heart failure, or obesity. Inability to use hind end due to hemivertebrae, spinal bifida, obesity. Eye issues due to entropion (eyelid curling inward causing eyelashes to scrape the eye), cherry eye (gland of third eyelid popping out), dry eye (eye is dry.. and covered in thick green mucus and crust). Infection of skin around butt hole due to tail corkscrewing around and stabbing them in their own butt, also obesity. C-section: they literally cannot have puppies naturally due to large heads, small pelvis, and, well, often obesity (most also have to be artificially inseminated due to their poor conformation). *** hint – if you want an english bulldog, go ahead and save for $1500-2500 PER year in vet bills.

Old chihuahua/toy poodle – coughing – heart failure – will want nail trim – dog will turn blue trying to bite us

Young chihuahua/toy poodle – broken leg from getting sneezed on

Great Dane – vomiting/retching/bloated – GDV or twisted stomach bloated. Get to the emergency clinic NOW – the stomach is likely dying as you drive.

Cat (outdoor) swollen leg/lump/lethargic – cat bite abscess – sometimes caused by just a friendly cat fight gone wrong, but much more often by a neighborhood Tom – they will try to breed anything with a cat shape – male, female, spayed, neutered, it doesn’t matter and the fights that ensue end up with someone getting a serious bite wound. Cats have a particularly nasty bacteria in their mouth similar to the bacteria in a komodo dragon’s mouth and the bite wound will fester and cause fever, lethargy, limping until it breaks open and drains. Antibiotics are very helpful.

Male cat – vocalizing in the litterbox/posturing to urinate, but nothing or very little coming out – blocked urethra – right now emergency! Don’t wait until morning. The urine backs up to the kidneys and causes serious, sometimes irreparable damage.

Same thing goes for castrated, male goats – looks like stretching, urine dribbling, loud vocalization, sometimes looks like constipated – it’s not constipated – get to vet immediately! Some studies have shown that if you wait to castrate until 6 months of age and avoid feeding grain altogether, you can avoid this fatal issue.

Older Dachshund/chihuahua/other tiny breed dogs: “trench mouth” – the teeth are rotting out of mouth – will also want a nail trim.

Dachshund of any age, unable to walk/stumbling: Intervertebral disk disease – the same gene that makes them short legged and long backed also makes their connective tissue crap and they will often “slip a disk” and without surgery +/- major anti-inflammatories, will be paralyzed – will definitely request a nail trim.

Coughing dog anywhere in the southeast – Heartworm until proven otherwise

Dog constipated: diarrhea – almost every time. Diarrhea causes straining, straining looks like constipation. Most owners, including myself don’t necessarily pay attention to their dog every time they go out, but will notice when the dog is going out all the time and straining.

Dog stares off into space, stumbles, or collapses when not walking, urinated on self – marijuana – just admit it and save us all a big “told you so” and, like, $400 in diagnostics. We won’t call the cops.

Any animal with the history of “I think my neighbor poisoned him” = anything except poisoning by the neighbor – just doesn’t happen.

Lump on boxer : mast cell tumor until proven otherwise

Dog with episodes of choking or “something stuck in throat” – allergies with reverse sneezing or kennel cough

Dog with lameness/stiffness/lethargy in certain areas of the country: lyme disease until proven otherwise

Small breed dog with hind limb lameness: luxating patella (knee cap slipping out of place)

Large breed dog with sudden hind limb lameness: ruptured cruciate ligament (like the ACL tear in athletes)

Goldens: especially the super sweet ones that belong to a special needs child: Cancer. Every F***ing time.

German Shepherd: will rush the door viciously barking as soon as you open the exam room door. Everyone in the clinic will hear and will assume you saw the shepherd. Will not let you touch it the whole time without heavy restraint, muzzle, sedation. Absolutely will request nail trim.

Cat with scabs all over body: fleas/flea allergy (even one bite from a flea can trigger the allergy in some cats)

Obese draft/quarter horse/donkey/pony that is stiff, doesn’t want to walk: founder/laminitis

Anything that is scratching and not on veterinary prescribed flea meds: fleas. Always fleas. Especially if the owner preaches essential oils and says there are absolutely not fleas and uses a natural remedy for flea control – fleas all day.

Cat with significant weight loss: and drinking a lot/not eating: kidney failure. Eating a ton/personality change: hyperthyroidism

Anything named “Lucky” or “Miracle” = doomed.

Anything named “Angel” will bite, unprovoked – owner will definitely want a nail trim.

Again, these are things vets just assume when they see it on the schedule. It doesn’t mean every patient every time and we all certainly go into the exam room with an open mind.