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Re: [FH] Pascal - Saddle clot .. quite urgent

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  • Susan
    Elaine, Cats can develop collateral circulation after a clot. See: http://maxshouse.com/arterial_thromboembolism.htm NATURAL HISTORY AND PROGNOSIS Short-term
    Message 1 of 6 , Jun 1, 2005
      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 2 of 6 , Jun 1, 2005
        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 3 of 6 , Jun 1, 2005
          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 4 of 6 , Jun 2, 2005
            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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