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Re: Pascal - Saddle clot .. quite urgent

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  • 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 1 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 2 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 3 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 4 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 5 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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