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Saddle Thrombosis (Please Help me understand)

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  • mspetite14
    Hi Everyone, I am writing in the hopes that someone may help me understand what happened with my cat Sasha. I am heartbroken that I had to put her to sleep. I
    Message 1 of 8 , Mar 14, 2014

      Hi Everyone,

      I am writing in the hopes that someone may help me understand what happened with my cat Sasha. I am heartbroken that I had to put her to sleep.

      I will try and explain to the best I can what happened. Sasha was a Persian, 13 ½ years old. She was diagnosed with Feline asthma 2 years ago. I treated her asthma with the aerocat and inhale steroids because I didn’t want all the side effects of using oral steroids. She was stable during that time and doing fine. About a month ago I noticed she was more lethargic, not eating as much only about ½ her normal amount, and coughing. I took her to the vet and she did an exam, Chest X-ray and bloodwork. Bloodwork was normal but her Chest X-ray showed a lot of inflammation in the left lung. She told me to go to the ER VET Hospital and get an Ultrasound done. Next day I took her to the Vetinary specialty hospital and we had an ultrasound done.

      The results of the ultrasound were that she had diffuse inflammation in her left lung but no mass. The report states, “an infection of lower airway lung tissue in her left caudal lung lobe.”

      They suspected phenomonia and treated her with Convenia. The ER at the Vet hospital said he was not worried and that she should be fine. He sent her home with me since she was not in any respitory distress nor did she have any fever etc. . Please note they also examined her heart and noted that she had NO heart murmur/arrhythmia at this time.

      Let me say I knew nothing of Convenia when they gave it to her at the Hospital and if I knew what I know now I would NEVER have allowed it. Okay so anyway, I bring Sasha home that night and she goes downhill quickly. By the next day she has a fever and looks very sick! I rush her back to the ER Vet Hospital and they admit her. They put her in oxygen and she stays there for five days. During this time I question why they used Convenia and said that I was angry they did that without asking me first and it is not a drug indicated for pneumonia but for skin infections. They shrug off my concerns and just say it is a safe drug.

      Anyway, she is there 2 days and doing no better so they add the antibiotic Baytril. Within 24 hours her fever breaks and she seems a little better but breathing still labored and in the oxygen cage. Three days later they say she can come home. They give me Baytril and Mirazipine (appetite stimulant) because she was not eating much in hospital and is very thin has lost 3 pounds. So at this point she is down to 6 pounds.

      I bring her home and she seems fragile, gets out of breath quick and her respiration seems fast and labored. I call the hospital and tell them my concerns and they say she has phenomia it will take time for her to feel better. She is not eating much even with the mirazipine and very thin. I begin assist feeding her and add in Cerenia for nausea. I am frantic at this time because I feel like she is not eating and I wonder whether it is phenomonia we are treating or is something else wrong. At this point she is home from the hospital for 4 days. I am back at hospital asking them what to do because she is still not any better nor is she eating much.

      They switch antibiotics to Zithromicin because they say the Baytril may be making her too sick to eat. That night , in the middle of the night I hear a loud bang in the litter room. I run in and there is my Sasha dragging her back legs, panting and crying terrible in pain. I quickly get her carrier and rush her back to the ER hospital where they tell me she had a Saddle Thrombosis. I ask what is that and how this happened?? They said she must have had undetected heart disease. I don’t understand that because Sasha was in their hospital for five days and they said she had no heart murmur so how in the world did she have undetected heart disease. They tell me the news is grim....She will have to be put to sleep because she is in terrible pain and she has very little pulse in her back legs. Prognosis is very bad. I am distraught. They give her a pain killer and give me time to think. I agree to put her to sleep because I don’t want her to suffer anymore than she already has. I am totally a mess at the hospital.

      Now I am left with all these questions.......Why did she throw a clot? Did it have something to do with the Convenia, or did she have heart disease all along and not pneumonia? Was she just getting too many meds on an already weakened system. How or what brought on a clot? I know that nothing can bring her back now but I just would like to understand better what happened. I am heartbroken over this and can’t seem to get any answers from anybody. I have questioned the doctors at the hospital and my vet. They all say the same thing which is she had no heart murmur on physical exam but that she must have had undetected heart issues.

      Any help or insights you can provide would be so much appreciated. I am just so upset about all this and trying to understand what went wrong. I am also blaming myself. I just wish I would have known it was heart disease and I could have treated her for that and she would not be gone now. I just feel horrible that she had to suffer like that it was terrible hearing her crying the whole way to the hospital. It is something I will never forget.

      Tracey

    • Elfinmyst
      Hi Tracey I am so sorry you lost Sasha under such terrible circumstances. I hope I can in some way reassure you that you are not at fault. First of all a lot
      Message 2 of 8 , Mar 14, 2014
        Hi Tracey

        I am so sorry you lost Sasha under such terrible circumstances. I hope I can in some way reassure you that you are not at fault. First of all a lot of cat heart disease is very well hidden and does not always have a murmur. The first sign is sadly, sometimes, sudden cardiac death or a blood clot. People here have faced that and looking back there were no symptoms, nothing to suspect a heart problem. Cats are excellent at adapting to it. My Toby had no murmur at most of his examinations, they were only heard under high stress. 

        Finding inflammation in the lung would definitely indicate asthma of pneumonia and would fit with the symptoms. Convenia is an antibiotic which acts long term. It is usually used for skin disease and a broad spectrum antibiotic. As far as I know, it can cause adverse reactions but I have never heard of a blood clot caused by this drug.  It is not licensed for pneumonia but used off label in the UK. My own vet avoids it as if there is a reaction, you can't just stop it as it works for weeks. Convenia doesn't work for some pneumonia, you need baytril. The fever breaking suggests the baytril did the job. Baytril is also a very strong antibiotic. 

        A saddle thrombosis is a blood clot to the artery to the back legs and is caused by sluggish blood flow through the failing heart so it forms a clot which travels. It is highly likely Sasha had heart disease which was not picked up as they didn't do an ultrasound of the heart, just the lungs. And heart disease doesn't happen in a few days, it takes months or years for the damage of HCM to occur, I would suggest she had it for a while, possibly years and it wasn't picked up as there are often no symptoms at all until heart failure. 

        Sadly this seems a case of the pneumonia being a primary symptom and the vets not realising she had heart disease. Most convenia reactions are pretty quick and one of my cats had the injection with no ill effects at all. You did nothing wrong, you took her to the ER as needed and she was given the drugs for her pneumonia. As the symptoms of heart failure (exercise intolerance, fast breathing) are also the same as pneumonia, sadly no one considered an alternative. If it is a small consolation, the likely scenario was a hidden heart disease she had for some time which could only have been picked up by a heart scan.

        Lyn



      • JOSIE NEWMAN
        hi Tracey I am so, so sorry about Sasha. I know EXACTLY how you feel as saddle thrombosis is what I lost my Jesse to, on Dec. 22, 2011. it is heart-wrenching,
        Message 3 of 8 , Mar 15, 2014
          hi Tracey
           
          I am so, so sorry about Sasha. I know EXACTLY how you feel as saddle thrombosis is what I lost my Jesse to, on Dec. 22, 2011. it is heart-wrenching, no two ways about it. I am still riddled with regret and guilt more than two years later. I kept him in ER for 24 hrs after he threw the clot like sasha, in the middle of the night while in the litter box. in his case, it was only one hind leg, the left one. saddle thrombosis can sometimes resolve but with jesse, his potassium levels were climbing so they suspected he would soon have a heart attack. he was on fentanyl and they were turning him every half hr and he had begun to pant. when he first threw the clot, he was not panting, he was not crying or anything. but it got worse as the 24 hrs progressed. he was more than 19 and already had cancer of the liver and lungs -- it was still a horrible choice to make. at least I already knew he had heart disease, HCM. but I was told it was quite stable and was moving very slowly. the cardiologist said later she thought he threw a clot from the cancer in his lungs to his hind leg but we never did find out bec no autopsy was done. I blame myself partially bec I did notice the 24 hrs prior to his throwing the clot he was somewhat dragging his hind legs when he went to water dish etc. and looked a little shaky and unwell. I knew something was up but chose to ignore it or not take him to ER, and I should have done so around 24 hrs prior to his throwing the clot.
           
          frankly, I would never take another animal to those ER vets you went to. they should certainly have ultrasounded sasha's heart to determine if her heart was involved instead of assuming it was pneumonia based on listening to her heart through a stethoscope. then again, even with cardio on staff where I took jesse, who is the same cardio I now take my Chloie to, she did not previously suspect Jesse's HCM was really, really bad and she is a well-respected cardio.
           
          I found talking to grief counsellors and friends helped me somewhat resolve and work through what I felt. but even then, it is so tough. all the best to you.
           
          Josie and Chloie  
           

          To: feline-heart@yahoogroups.com
          From: mspetite14@...
          Date: Fri, 14 Mar 2014 14:35:09 -0700
          Subject: [FH] Saddle Thrombosis (Please Help me understand)

           

          Hi Everyone,

          I am writing in the hopes that someone may help me understand what happened with my cat Sasha. I am heartbroken that I had to put her to sleep.

          I will try and explain to the best I can what happened. Sasha was a Persian, 13 ½ years old. She was diagnosed with Feline asthma 2 years ago. I treated her asthma with the aerocat and inhale steroids because I didn’t want all the side effects of using oral steroids. She was stable during that time and doing fine. About a month ago I noticed she was more lethargic, not eating as much only about ½ her normal amount, and coughing. I took her to the vet and she did an exam, Chest X-ray and bloodwork. Bloodwork was normal but her Chest X-ray showed a lot of inflammation in the left lung. She told me to go to the ER VET Hospital and get an Ultrasound done. Next day I took her to the Vetinary specialty hospital and we had an ultrasound done.

          The results of the ultrasound were that she had diffuse inflammation in her left lung but no mass. The report states, “an infection of lower airway lung tissue in her left caudal lung lobe.”

          They suspected phenomonia and treated her with Convenia. The ER at the Vet hospital said he was not worried and that she should be fine. He sent her home with me since she was not in any respitory distress nor did she have any fever etc. . Please note they also examined her heart and noted that she had NO heart murmur/arrhythmia at this time.

          Let me say I knew nothing of Convenia when they gave it to her at the Hospital and if I knew what I know now I would NEVER have allowed it. Okay so anyway, I bring Sasha home that night and she goes downhill quickly. By the next day she has a fever and looks very sick! I rush her back to the ER Vet Hospital and they admit her. They put her in oxygen and she stays there for five days. During this time I question why they used Convenia and said that I was angry they did that without asking me first and it is not a drug indicated for pneumonia but for skin infections. They shrug off my concerns and just say it is a safe drug.

          Anyway, she is there 2 days and doing no better so they add the antibiotic Baytril. Within 24 hours her fever breaks and she seems a little better but breathing still labored and in the oxygen cage. Three days later they say she can come home. They give me Baytril and Mirazipine (appetite stimulant) because she was not eating much in hospital and is very thin has lost 3 pounds. So at this point she is down to 6 pounds.

          I bring her home and she seems fragile, gets out of breath quick and her respiration seems fast and labored. I call the hospital and tell them my concerns and they say she has phenomia it will take time for her to feel better. She is not eating much even with the mirazipine and very thin. I begin assist feeding her and add in Cerenia for nausea. I am frantic at this time because I feel like she is not eating and I wonder whether it is phenomonia we are treating or is something else wrong. At this point she is home from the hospital for 4 days. I am back at hospital asking them what to do because she is still not any better nor is she eating much.

          They switch antibiotics to Zithromicin because they say the Baytril may be making her too sick to eat. That night , in the middle of the night I hear a loud bang in the litter room. I run in and there is my Sasha dragging her back legs, panting and crying terrible in pain. I quickly get her carrier and rush her back to the ER hospital where they tell me she had a Saddle Thrombosis. I ask what is that and how this happened?? They said she must have had undetected heart disease. I don’t understand that because Sasha was in their hospital for five days and they said she had no heart murmur so how in the world did she have undetected heart disease. They tell me the news is grim....She will have to be put to sleep because she is in terrible pain and she has very little pulse in her back legs. Prognosis is very bad. I am distraught. They give her a pain killer and give me time to think. I agree to put her to sleep because I don’t want her to suffer anymore than she already has. I am totally a mess at the hospital.

          Now I am left with all these questions.......Why did she throw a clot? Did it have something to do with the Convenia, or did she have heart disease all along and not pneumonia? Was she just getting too many meds on an already weakened system. How or what brought on a clot? I know that nothing can bring her back now but I just would like to understand better what happened. I am heartbroken over this and can’t seem to get any answers from anybody. I have questioned the doctors at the hospital and my vet. They all say the same thing which is she had no heart murmur on physical exam but that she must have had undetected heart issues.

          Any help or insights you can provide would be so much appreciated. I am just so upset about all this and trying to understand what went wrong. I am also blaming myself. I just wish I would have known it was heart disease and I could have treated her for that and she would not be gone now. I just feel horrible that she had to suffer like that it was terrible hearing her crying the whole way to the hospital. It is something I will never forget.

          Tracey


        • Heather Thompson
          I am so very sorry you are going through this. Unfortunately not all Heart problems create a murmur. My boy Munchie has Hypertrophic Cardiomyopathy and has
          Message 4 of 8 , Mar 15, 2014
            I am so very sorry you are going through this.  Unfortunately not all Heart problems create a murmur.  My boy Munchie has Hypertrophic Cardiomyopathy and has no murmur.  His was found while xraying him for joint problems.  Saddle Thrombus is just something that happens even when cats are on medications for heart problems.  This page has a lot of good information about it: http://www.metro-vet.com/resources/reference/distal-aortic-trifurcation-thromboembolism/ 

            Heather
          • Tracey
            Thank you so much to everyone who replied and emailed. I am very grateful and appreciative for your responses. Nothing is going to bring Sasha back but at
            Message 5 of 8 , Mar 16, 2014

              Thank you so much to everyone who replied and emailed.  I am very grateful and appreciative for your responses. 

               

              Nothing is going to bring Sasha back but at least understanding what happened helps me feel a little peace.   The guilt is overwhelming but from everything I read there was really no way of knowing without testing and no one tested because there was no murmur and all indications pointed to the asthma/phenomonia. 

               

              I have been thinking back to the few night she was home with me after being released from the hospital.   I do remember one night where she stumbled and couldn’t seem to walk for a few minutes her hind legs gave out but then within a few minutes she got up and seemed okay.  Then again a day later she was walking and she seemed to hesitate like she couldn’t get her legs to move forward but then she did and again seemed normal.    At the time I thought she was just weak from not eating and being in the hospital for five days with pneumonia.   I did call the vet hospital and asked about it that  day but they reaffirmed that it was probably just that she was weak and to give her time to recover.

               

              Now I think she may have thrown a few small clots that her body was able to process before the “big” one.   So sad.   I just wish I would have known it was her heart problems and maybe I could have prevented this.  

               

              Grief is such a burden.   Thank you all for helping me to understand. 

               

              Tracey

               

               

            • Jordan
              Tracey, I can SO RELATE to what you are going thru. My heart kitty Sheba, who is a himalayan, has unclassified cardiomyopathy (UCM). And is monitored twice
              Message 6 of 8 , Mar 16, 2014

                Tracey,

                I can SO RELATE to what you are going thru.   My heart kitty Sheba, who is a himalayan, has unclassified cardiomyopathy (UCM).   And is monitored twice yearly with her cardiologist.

                But this is ONLY after having lived through what you recently did.    I grew up with a pedigree red persian, Squire, who I did not even know he had heart disease until the day I lost him!!!    I left the house one Sunday morning, kissing him goodbye, and when I arrived home just 3 hours later, I found him on the floor unable to walk.

                I called my father in sheer panic, and we quicky rushed Squire to the vet . . . where they told us the very same thing you heard.   I had to put him down immediately.    We had NO IDEA he even had heart disease.    He was 14 years old, a grand champion show cat and he lived a very good life of unconditional love.    

                I was 18 at the time, and never knew life without him!!!   It was gut wrenching!!

                When Sheba's cardiologist, started her on Plavix, I did not even question it because I NEVER ever wanted to see another kitty go through what my poor Squire did.

                You gave your Sasha a long life of unconditional love and that is the VERY BEST we can do for our fur babies.   I hope you can find some comfort in that.

                Hugs to you,
                Jordan and Sheba
              • Sarah Thompson
                Hi Tracey, I am SO sorry to hear about Sasha. And believe me, I ve been there. One of my most special cats had a congenital heart defect which led to DCM,
                Message 7 of 8 , Mar 16, 2014
                  Hi Tracey,

                  I am SO sorry to hear about Sasha. And believe me, I've been there. One of my most special cats had a congenital heart defect which led to DCM, and threw saddle emboli regularly. The first time, I heard lots of yowling, thought the cats were play-fighting and ignored it for a while until it became worse. I found my beloved Mazel at the foot of the stairs screaming in pain and unable to move his hind end, and with a cold, blue tail. We rushed him to the vet. They put him on heparin, (this was before more modern drugs like Plavix) and oxygen and told us all we could do was wait. A cardiologist did an echo and said "six weeks to six months". They also told us they'd probably have to amputate toes or paws. Maz, however, was not going for this at all. He pulled through, for a while dragged one paw a little, and soon was back to running and jumping like a normal cat.

                  We went through this several times. Once we had to keep him in a cone for months because he had "pins and needles" in one leg and tried to chew it off!

                  We also had to inject heparin 3x a day, and he had to go to the vet weekly for blood tests to monitor his levels. Eventually we switched him to coumadin, but he still had to go to the vet weekly. And he was SO good about it. All the techs adored him!

                  In between all this he would go into pulmonary edema and we'd wake at night to find him gurgling and gasping for breath, and would have to rush him to the vet again. Eventually, we decided it was easier on everyone to just stay home, and we set up an oxygen cage at home and I gave him his meds and sat up with him all night.

                  Another time, we were getting ready to end it after another saddle embolus paralyzed his back legs. The vet said to give him another hour, so we did. When we came back to say goodbye, he pulled himself up on his front legs, dragged himself to the front of the oxygen cage and said "Please don't give up one me". So we didn't. And soon he was able to jump on top of the refrigerator! (And then howl because he couldn't figure out how to get down.)

                  Eventually, his kidneys failed, his heart could no longer pump enough blood and he left us sitting in my lap. (He also was still spunky enough to pull the IV out!) That was FIVE YEARS after they gave him 6 weeks to 6 months!

                  Anyway, saddle emboli are caused by blood that is sitting stagnant, usually in the heart. Because it's not flowing, it clots, and then the clot travels from the heart. The most common place is the "v" where the blood vessels split to go to each hind leg (thus the term saddle). But they can also go to the lungs, brain, kidneys or pretty much anywhere. To my knowledge Convenia has nothing at all to do with it. However, (and I didn't see any of the tests), it's possible the lung inflammation was actually a clot - although usually they look quite different.

                  Sometimes I think I put Maz through too much, so don't feel bad about putting Sasha down. You did what you thought was best and kindest and you know your cat best. And Maz was quite a bit younger and so more resilient. And even if you'd known it was heart disease (we did), it likely would not have changed much, so don't blame yourself. And I know that's easier to type than to do, because I've blamed myself for every cat I've ever had that died, even though I know perfectly well their lifespans are less than ours.

                  Hugs to you!
                  Sarah & kitties
                • Tracey
                  Hi Sarah, Thank you for sharing your story. It is nice to hear a more positive outcome with Saddle Thrombosis. I think if my Sasha had just thrown the
                  Message 8 of 8 , Mar 17, 2014

                    Hi Sarah,

                     

                     

                    Thank you for sharing your story.  It is nice to hear a more “positive outcome”  with Saddle Thrombosis. 

                     

                    I think  if  my Sasha had just thrown the clot without the lung problems I probably would not have put her to sleep even with the hospital telling me too....Knowing me I probably would have tried my best to get her better even against the “odds”.     But I just knew she was already so weak from the phenomena,  and in such pain from the clot  I just couldn’t see putting her thru more. 

                     

                    I am glad to hear your kitty survived 5 years...that is amazing.   You are one excellent cat mom!!

                     

                    Tracey

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