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Pascal - Saddle clot .. quite urgent

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  • e_m_sullivan
    Pascal, my 12 year old tabby threw a clot (as I now know), 3 days ago, paralyzing his back legs. I got him to the vet within an hour or so - he was diagnosed
    Message 1 of 6 , Jun 1, 2005
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      Pascal, my 12 year old tabby threw a clot (as I now know), 3 days
      ago, paralyzing his back legs. I got him to the vet within an hour
      or so - he was diagnosed quickly and treated with heparin, aspirin
      and pain killers. He has no history of heart disease.

      In the intervening 2 days a pulse and warmth has returned to one
      leg, and a slight pulse to the other. He is eating, the pain
      medication seems to be working, and he is staying at the vets. I am
      spending what time I can with him. He is on no other medication (he
      started bleeding with the Heparin).

      My vet has recommended euthansia tomorrow, saying that they rarely
      recover from this. He has been very good in the past. I have asked
      for a second opinion.

      Some of the posts (Sparky et al), seem to indicate we should give
      him more time, and maybe alternative medication. Money is not an
      object (he is well insured).

      Any advice - if there is a chance I would like to give him one but
      my vet seems quite convinced ?

      Many thanks

      Elaine
    • Lynn
      Hi Elaine, I m so sorry about what happend to Pascal. This hasn t happened to my Teegan yet, but he is also 12 years old and I really worry about what I would
      Message 2 of 6 , Jun 1, 2005
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        Hi Elaine,

        I'm so sorry about what happend to Pascal. This hasn't happened to my
        Teegan yet, but he is also 12 years old and I really worry about what I
        would do if he threw a clot.
        I'm pretty sure my vet would say the same, but that probably comes from
        trying to spare the human companion expense, time and trouble of caring
        for a cat, which must surely be stressful and time consuming. I think
        many vets may not run into many who would go to extremes to care for
        their animal companions.
        I would ask the vet, if the outcome is always so bad, why treat the cat
        at all in the first place? Healing takes time. I can only speak for myself, but
        as long as my cat was not in pain and I could be around or have someone
        else be around to supervise the cat, (or take him to work with me!), there
        would be no rush to make a decision. I'd wait to see if there is a gradual
        improvement. You did say a pulse and warmth has returned to one leg
        already. Three days isn't giving much time to recover. Cats can suprise you.
        Realize of course, that the chances of it happening again are increased, but
        if it happened to my Teegan, I would give him more time to assess how
        much function returned, (if he was eventually able to hop around, urninate, etc.)
        before I made a decision that would be irreversible.

        Best of luck to you and Pasal and {{{ hugs from myself and Teegan!}}}

        Lynn & Teegy

        --- In feline-heart@yahoogroups.com, "e_m_sullivan" <e_m_sullivan@y...> wrote:
        > Pascal, my 12 year old tabby threw a clot (as I now know), 3 days
        > ago, paralyzing his back legs. I got him to the vet within an hour
        > or so - he was diagnosed quickly and treated with heparin, aspirin
        > and pain killers. He has no history of heart disease.
        >
        > In the intervening 2 days a pulse and warmth has returned to one
        > leg, and a slight pulse to the other. He is eating, the pain
        > medication seems to be working, and he is staying at the vets. I am
        > spending what time I can with him. He is on no other medication (he
        > started bleeding with the Heparin).
        >
        > My vet has recommended euthansia tomorrow, saying that they rarely
        > recover from this. He has been very good in the past. I have asked
        > for a second opinion.
        >
        > Some of the posts (Sparky et al), seem to indicate we should give
        > him more time, and maybe alternative medication. Money is not an
        > object (he is well insured).
        >
        > Any advice - if there is a chance I would like to give him one but
        > my vet seems quite convinced ?
        >
        > Many thanks
        >
        > Elaine
      • Susan
        Elaine, Cats can develop collateral circulation after a clot. See: http://maxshouse.com/arterial_thromboembolism.htm NATURAL HISTORY AND PROGNOSIS Short-term
        Message 3 of 6 , Jun 1, 2005
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          Elaine,

          Cats can develop collateral circulation after a clot.
          See:

          http://maxshouse.com/arterial_thromboembolism.htm

          "NATURAL HISTORY AND PROGNOSIS

          Short-term prognosis depends on the nature and
          responsiveness of the cardiomyopathic disorder and
          heart failure state. In cases of saddle embolism,
          motor ability may begin to return in one or both legs
          within 10 to 14 days. By 3 weeks, significant motor
          function (i.e., hock extension and flexion) has often
          returned, typically better in one leg than in the
          other. Motor function may be completely normal by 4 to
          6 weeks, although a conscious proprioceptive deficit
          or conformational abnormality (e.g., extreme hock
          flexion) may persist in one leg Unfortunately, most
          cats experience additional thromboembolic episodes
          within days to months of the initial event, although
          survivals of several years, including repeat embolic
          episodes, have been observed. In one large
          retrospective study, 34 of 92 cats (37 percent)
          survived an initial event of saddle embolism.
          Follow-up information was available for 22 of these 34
          cats, and an average long-term survival of 11.5 months
          was recorded .

          CLINICAL INDICATORS OF A RELATIVELY FAVORABLE
          PROCNOSIS. Thromboembolism is a well-established cause
          of morbidity and mortality and represents a severe
          clinical complication. A more favorable prognosis may
          be suggested by (1) resolution of CHF and/or control
          of serious arrhythmias, (2) lack of LA/LV thrombi or
          spontaneous echo contrast, (3) re-establishment of
          appetite, (4) maintenance of relatively normal BUN/
          creatinine and electrolyte levels, (5) return of limb
          viability and function (e.g., loss of swelling, return
          of normal limb temperature, return of motor ability),
          (6) return of femoral arterial pulses and pink nail
          beds, (7) lack of self-mutilation, and (8) committed
          owner.

          CLINICAL INDICATORS OF GRAVE PROGNOSIS. A number of
          morbid events confer a grave prognosis: (1) refractory
          CHF or development of malignant arrhythmias, (2) acute
          hyperkalemia (from reperfusion of injured muscles),
          (3) declining limb viability (e.g., progressive
          hardening of the gastrocnemius and anterior tibial
          muscle group; failure of these muscles to become soft
          48 to 72 hours after presentation; development of
          distal limb necrosis), (4) clinical evidence of
          multiorgan or multisystemic embolization (e.g.,
          neurologic signs, bloody diarrhea, acute renal
          failure) which usually accompanies extensive
          thromboembolism, (5) history of previous embolic
          episodes, (6) presence or development of LA/LV
          thrombus or spontaneous echo contrast, (7) rising
          BUN/creatinine levels, (8) disseminated intravascular
          coagulation, (9) unresponsive hypothermia, (10) severe
          LA enlargement with arrhythmia and myocardial failure,
          and (11) uncommitted owner with limited financial
          resources,"

          Pascal does need to have an ultrasound so his
          underlying heart disease can be identified and
          treated. From what you have described I think Pascal
          falls in the category of favorable prognosis.

          To find either a cardiologist or internist to do
          Pascal's ultrasound, go to http://acvim.org

          Susan


          --- e_m_sullivan <e_m_sullivan@...> wrote:

          > Pascal, my 12 year old tabby threw a clot (as I now
          > know), 3 days
          > ago, paralyzing his back legs. I got him to the vet
          > within an hour
          > or so - he was diagnosed quickly and treated with
          > heparin, aspirin
          > and pain killers. He has no history of heart
          > disease.
          >
          > In the intervening 2 days a pulse and warmth has
          > returned to one
          > leg, and a slight pulse to the other. He is eating,
          > the pain
          > medication seems to be working, and he is staying at
          > the vets. I am
          > spending what time I can with him. He is on no other
          > medication (he
          > started bleeding with the Heparin).
          >
          > My vet has recommended euthansia tomorrow, saying
          > that they rarely
          > recover from this. He has been very good in the
          > past. I have asked
          > for a second opinion.
          >
          > Some of the posts (Sparky et al), seem to indicate
          > we should give
          > him more time, and maybe alternative medication.
          > Money is not an
          > object (he is well insured).
          >
          > Any advice - if there is a chance I would like to
          > give him one but
          > my vet seems quite convinced ?
          >
          > Many thanks
          >
          > Elaine
          >
          >




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        • Karen
          I d give him a couple weeks or more, sometimes circulation takes that long to return, or longer, and if not, you will definitely know if the tissue is dying by
          Message 4 of 6 , Jun 1, 2005
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            I'd give him a couple weeks or more, sometimes circulation takes that
            long to return, or longer, and if not, you will definitely know if
            the tissue is dying by a couple weeks after throwing the clot, it
            will begin to give off an odor (and swell).. the skin will also turn
            black and hard .. at least that's what happened in my case, to a
            front leg.

            If circulation returns to one leg, perhaps amputation of the other
            leg may be an option.. is he a candidate for surgery? I would not
            rush into euthanasia. Definitely do get more opinions from other
            veterinarians and give him some more time before you make the final
            decision. The fact that they "rarely" recover from this tells you
            that some cats do make it through. Only time will tell.

            If he is not in obvious pain or discomfort then there is no need to
            rush euthanasia. If he is stable, and since money is no object, I
            would also run a echocardiogram of the heart - take him to a heart
            specialist to see what kind of heart condition he has and what his
            prognosis is, what stage disease does he have, etc. It may help you
            understand his condition better and decide future course of treatment
            if he makes it through this crisis.

            It's wonderful he is eating there. That's always a good sign I think.
            Mine didn't eat for the entire week he was there, and for about a
            month after he came home I fed him orally using syringes because he
            did not eat enough on his own. (his hospital stay frightened him
            something terrible) I remember he purred loudly soon as he came home
            although he was so weak he could not even walk a step or two before
            falling down, but he got stronger day by day) Amazingly he recovered
            greatly, not from his clot, the leg still died (and fell off 9 months
            later), but otherwise he pulled through (and lived 15 more months, he
            was nearly 16 when he passed away)

            Your vet should understand if you want to wait longer to decide what
            to do, or if you want to take him elsewhere for a 2nd or 3rd opinion.

            By the way, did the vet put your kitty on BOTH heparin AND aspirin at
            the same time? I thought they would choose one OR the other, as they
            both thin the blood. But perhaps someone else could enlighten me if I
            am wrong. I just never heard of this before. Is anyone's cat on BOTH
            treatments at the same time?? I am thinking this may be why your vet
            discontinued the heparin when the cat started bleeding.. Two blood
            thinners may have been too much.

            Take it day by day and keep us posted. I hope he will come home soon!

            Karen
            http://www.ziggycat.netfirms.com/


            --- In feline-heart@yahoogroups.com, "e_m_sullivan"
            <e_m_sullivan@y...> wrote:
            > Pascal, my 12 year old tabby threw a clot (as I now know), 3 days
            > ago, paralyzing his back legs. I got him to the vet within an hour
            > or so - he was diagnosed quickly and treated with heparin, aspirin
            > and pain killers. He has no history of heart disease.
            >
            > In the intervening 2 days a pulse and warmth has returned to one
            > leg, and a slight pulse to the other. He is eating, the pain
            > medication seems to be working, and he is staying at the vets. I am
            > spending what time I can with him. He is on no other medication (he
            > started bleeding with the Heparin).
            >
            > My vet has recommended euthansia tomorrow, saying that they rarely
            > recover from this. He has been very good in the past. I have asked
            > for a second opinion.
            >
            > Some of the posts (Sparky et al), seem to indicate we should give
            > him more time, and maybe alternative medication. Money is not an
            > object (he is well insured).
            >
            > Any advice - if there is a chance I would like to give him one but
            > my vet seems quite convinced ?
            >
            > Many thanks
            >
            > Elaine
          • ireneboater
            Hi Elaine, So sorry to hear about your kityy, but definately give it time. If you go back in the archives, Scratchy - my kitty - had 2 major saddle thrombosis
            Message 5 of 6 , Jun 1, 2005
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              Hi Elaine,

              So sorry to hear about your kityy, but definately give it time. If
              you go back in the archives, Scratchy - my kitty - had 2 major
              saddle thrombosis and 2 front leg thrombsis. He is doing ok right
              now. Almost 80-90%% himself I'd say. Sleepy most of the time but
              walking eating, pooping, everything!

              I'm lucky to have the time with him. I'll tell you that I have spent
              a lot of money on him but i think the major culprit of that is my
              vet charging me an arm and a leg. The more I learn the more I know
              that I DON"T have to do certain things.

              My cat is on Fragmin 6ml per day (sometimes 2 times a day, other
              people use Lovenex). 1/2 baby aspirin 2x times a week. Enalapril,
              Lasix (he has had 2 bouts of Congestive heart failure) and Atenol.
              He is on a few homopathic meds (nattokinese -- supposedly to help
              bust clots), CoQ10,Taurine, other people use B12- fish oil, vitamine
              E, etc etc.

              Give your cat a chance. The second time Scratchy had his saddle
              thrombosis, it took him a good 2-3 weeks to even start walking
              again. I love my kitty and would only euthenize him I knew that he
              would not recover. I gave him the chance to tell me if he would be
              able to continue. I know I am living with him on borrowed time but I
              know that he is happy and can take care of himself.

              Good luck and let me know if you need any help.

              PS ALL vets tell their pet's owner the same thing. They don't even
              give their cats a chance. "there is a 30% chance of survival, 50%
              chance he will re-clot, most likely you will have to have to take
              drastic measures to take care of you cat, cleaning him when he pees
              on himself, etc etc."

              This is what I heard when I brought Scratchy in Jan 2005. He
              survived and was walking within 2 weeks. Feb 14 he had sudden
              blindness which resolved in 24 hours. March 5th ish another saddle
              thrombosis. It took a little longer to resolve and then I started
              him on the Fragmin (I think asprine itself does nothing). april
              front leg had a clot. I wait hoping that he won't throw another
              clot -- but i know that I am doing all that I can to give him a
              chance. He's not in pain. He eats - but is losing weight but I think
              he looks damn good. (He also had a clot in Nov 04 but I had no idea
              what it was -- it was his front leg).

              Ultimately it's up to you. You will know when and if it is time.
              Many people have had very good experiences but you have to know that
              it may be weeks, months or years with Pascal. For me every moment
              that I have with Scratch is treasured.

              I hope this helped. I wrote a lot when it first happened look in the
              archives or email me if you want more info. The people on this list
              are amazing. Good luck.

              Irene and Scratchy.

              --- In feline-heart@yahoogroups.com, "e_m_sullivan"
              <e_m_sullivan@y...> wrote:
              > Pascal, my 12 year old tabby threw a clot (as I now know),
            • mae liu
              I e-mailed Elaine yesterday. Always forget to write the group address in the to: field. Elaine, don t give up yet especially Pascal is not suffering. Cats
              Message 6 of 6 , Jun 2, 2005
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                I e-mailed Elaine yesterday. Always forget to write the group address in the to: field. Elaine, don't give up yet especially Pascal is not suffering. Cats are amazing animals and they should be given a chance to recover.

                I just want to tell Irene that I started crying when I read your e-mail about Scratchy. It gives me so much hope since Placido's cardiologist didn't say anything encouraging to me. People in this group are so great and compassionate.

                mae, placido and nicky




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