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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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“The Good Death”

The weird, complicated process that is ending suffering and why it’s NOT the worst part of my job.

***Since euthanasia can be a really sad subject, the pictures in this blog are animals who were saved from euthanasia***

I was going on my usual neighborhood run with the dogs and was coming up on a neighbor’s house who had a dog that I had treated recently. In my tired, oxygen deprived brain, I was thinking – like I had been for the past several weeks – “I wonder how Axle is doing? I should call them.” Then, I remembered with a sinking sensation: “Axle is gone, stupid, you euthanized him last week.” Then, of course, I spent the last agonizing miles going through all of his labs and imaging in my brain trying to figure out what had been wrong with him and if I had missed anything or if I could have done better somehow. This all got me to thinking though about the oddity that is euthanasia and all the weird components that go into it.

Merlin was brought in for euthanasia after his mother mangled his back leg when he was 3 days old. After a leg amputation that was like surgery on a chicken wing, he grew up and lived another 8.5 years before he succumbed to his joint issues.

The most common assumption about my job that I get is that euthanasias must be the hardest part of the job. For ME, for the vast majority of the cases, euthanasias are (and you’re going to hate me for this) actually one of the easier parts of the job. You don’t have to figure anything out, I have a set way I do it EVERY time, and the only challenge is hitting a vein – which I’ve gotten pretty good at. So, between the 19 year old cat that weighs 3lbs here for euthanasia or the 8 year old english bulldog with all the skin, ear, and eye problems and the owner who refuses to keep up on treatment and wanted to know why you couldn’t just give them antibiotics every 2 weeks? I’ll take that euthanasia, thank you.

Catina was brought in for euthanasia as a feral barn kitten with two ruptured eyes from a viral infection. After months of just sitting and reading a book aloud, her anger, fear, violent hissing/biting when handled went away and she is now the sweetest cat who loves attention

So, what’s wrong with me? Am I souless? Do I not care about the love and devotion people have put into their life time companion? Why do I not break down crying and sobbing with the owners every time I have to stop an animal’s heart with an injection and wonder if, when I die I will be punished or not? So, hear me out.

Penelope was saved from death after being brought in as a frozen kitten found in a ditch. Her heart stopped during revival and had to be resuscitated. Now she’s an ungrateful spicy kitty that is well loved.
  1. The vast majority of euthanasias are a good thing. Animals who have reached their limits of life’s comfort and are mostly miserable everyday. Pets and friends who no longer want to get out of bed, can’t keep food down, get confused about where they are, are becoming skeletal despite a good appetite, have a mass that is taking over their body or has ruptured and is bleeding out. Basically, giving these pets the gift of taking away their pain is almost relieving. It is difficult for the client because they are struggling with the decision to euthanize – something we don’t have to deal with (though would like to) in the human world – and are losing their best friend. But, as an outsider, looking in, all I see is a pet that has run out of options for seeking comfort and I’m just sparing them the agonizing wait of slowly withering into nothing, starving to death, bed sores, fear and anxiety as they slowly suffocate from heart failure, daily pain that prevents them from any normal functions.
  2. Vets, especially the ones who have been practicing awhile, have established deep, dark pits of space where they take hard emotions and bury them down deep. We get all the emotions thrown at us on a daily basis – happy, sad, stress, guilt, anger, frustration, irritation, self loathing, client loathing, patient loathing, public loathing, loathing (generic), annoyance, etc, etc, and if we actually take the time out of our day to process these emotions, we would never get all the patients seen that we are required to see (not to mention the ones that get shoved in when there is no time and the ones we have to send away that hate us and write terrible things about us). Therefore, to survive as a professional and a human, who then has to have functioning relationships with real people away from work, we have gotten super good at flaring with that emotion and then shoving it down into our deep dark caves of oblivion. When you’ve dealt with all that in a day and then you have to euthanize something. This is straightforward. And….
  3. We euthanize animals ALL THE TIME. All day, everyday, with extra ones being added right before holidays for some reason. Eventually, a thick callous is formed and it just becomes another task in our day. If we’ve been working with a patient for a long time, if the need for euthanasia is sudden and traumatic, sure, it’s way harder on us emotionally, we’re not monsters.
  4. If we feel that a euthanasia is NOT warranted, we will talk to the owner and try to convince them that maybe this is a treatable or completely fabricated illness (I had one cat euthanasia on a 4 yo cat who was just prancing around the euth room, purring, rubbing my hands and the complaint was she hadn’t pooped in 4 months. I finally convinced them that if that were the case, she would be dead and that she was very likely pooping in a place they haven’t found). I have stopped euthanasia on animals that were being put down for being “miserably itchy all the time” and had no hair. Turns out, they just needed flea medication. Sometimes, medications haven’t been tried and even chronic diseased patients can get several more months of relief with the introduction of these meds. Sometimes, the owner is just not equipped to care for the patient and another owner can afford and dedicate the time to give the animal a great quality of life. But, I’ll tell you what, broaching the topic is somewhat a delicate thing as the owner has likely already been stewing over this decision and introducing even a tinge of doubt can be traumatic for the owner especially if it comes down to a money issue. At the same time, we can’t afford to rescue every animal ourselves and the animal has to be pretty “sellable” (super sweet, not a sketch ball, not super complicated) to convince other people to adopt (as bad as that sounds.)
  5. Finally, yes, euthanasias affect us. We are not monsters. I can walk into a room, connect with the owners and feel their sadness, feel their depression and their guilt. I make it my priority (after confirming that the animal needs to be euthanized) to make the owner not feel guilt or regret. I talk to them and console and re and reaffirm that this IS the BEST decision they could be making and that it is the RIGHT decision. My job is to the client at this point and once they have rightfully decided to end a patient’s suffering, they need to know that a professional in this field 100% agrees with them. But the WORST euthanasias, by far, besides the obvious when you have worked with a patient for a long time and know the animal and the owner and their full life story, is when there is either an old man, a hardened Clint Eastwood type man, or children in the room. I have a very hard time when that old, withered man who looks like he hasn’t cried since he was a toddler and is ashamed of even that time, has big fat tears welling up and he doesn’t want you to see him. It’s okay, you can cry, I won’t tell anyone. Or children when they seemingly understand what’s going on and then once I say the patient has passed then they get a wild, panicked look in their eyes and ask “You mean he’s DEAD!?!” and then burst into tears or screaming.
Wicket was saved from euthanasia after she was born with no bones in her front legs.

Euthanasia is easily the saddest part of the human/animal bond. Whether it’s saying goodbye to a best friend you’ve had since you were a child, or the only thing left you have to link you to your husband who died last year, or even in an unexpected emergency, it’s never any easier, but it is also a sense of relief. Our job as veterinarians is to make sure you make the best decision for the animal and make sure you feel okay with it. When it’s clear cut, nothing could be easier for me than to decide to end the suffering of the animal and to be it’s advocate when the owner’s mind and heart are understandably muddled with emotion.

Heggie – saved from euthanasia and rehomed with a clinic employee.

That all being said, it still sucks.

Anything but bad luck for Dan, the office cat. Saved from euthanasia after being hit by a car and left at the clinic with a broken tail and jaw. Now demands attention (and food) all day from employees and clients alike.