Embrace Pet Insurance Blog

Blood clot in cat: Q&A with Dr. Carleton

Late last year, there were a series of questions posed by Sharon, whose cat Henry had just died of a saddle thrombus unexpectedly. I thought the information was useful and interesting enough to separate it out in it's own post so that no-one misses it.

Question from Sharon:

My beloved cat Henry died unexpectedly 9/21/09. I woke up to his loud cries and leapt to his side. Within a minute he was gone. I think back to a month ago when one morning Henry couldn't stand up and his back right leg was weak. I took him to the vet that morning and he got better within a day. The vet did an x ray of his leg and only saw what looked like a touch of arthritis in his knee. He gave me some pain medicine and we went home. Henry got better immediately. Now I wonder if he actually had a mild attack of ATE, which was followed by a total clot that ended his sweet life. Does anyone have an idea?

Answer from Dr Carleton:

Sharon, I think you are right - partial clot (saddle thrombus) that resolved on its own the first time and then a clot that caused a heart attack, which is why it was so quick. I am so sorry for you Sharon,

Sincerely, Heather...

Question from Sharon:

Thank you for answering. I took him immediately to the vet for an x-ray on his leg the day he had trouble walking. If a clot had already resolved, is it fair to say that it wouldn't have shown up? Also, would a vet know to look further because the symptoms were so sudden? With this disease, would it have helped Henry if we had put him on aspirin or blood thinners, or is the disease a time bomb regardless? I'm not out to blame the vet, just to understand this malady and to know what to look for since I have other cats. Many thanks.

Answer from Dr. Carleton:

Sharon, A clot will never show up on X-ray. The only way you know it is there is by 1) decreased blood pressure in that leg (measured with a doppler and cuff), 2) a cold extremity and discolored pad and 3) clinical signs that range from limping to dragging the leg depending on whether the clot is a partial or complete one. If the clot is affecting both sides, the cat is basically paralyzed in the hind end and is extremely painful.

As anti-coagulant therapy, even with treatment, a cat with a saddle thrombus' median survival time is 2 months to a max of 2 years (uncommon) because of the tendency for them to throw more clots. Sometimes a clot can be so bad that you have to amputate the leg in order to save the cat. However, I hesitate to do this because the long-term survival is poor and it doesn't really seem fair to the cat or owner. Heather

When I'd asked Sharon if I could share her questions, she wrote to me the following: 

Dear Laura. That would be great. Here are two photos of sweet Henry. He came to my house as a stray in 2003 and passed away on 9/21/2009. The vet estimated his age was 12 years or so. Thanks. Sharon

P.S. When I took him to the vet three weeks before he passed away, he was limping badly, but then it went away almost immediately. The vet who looked at him specialized in orthopedics, so I think that was part of the reason they may have overlooked the underlying condition.

Have you had something similar happen to your cat?

Related Posts:
Saddle Thrombus in cats
Causes and signs of saddle thrombus in cats
Cardiomyopathy in cats related to saddle thrombosis
Memories of Dave
Blood clot in cat: Q&A with Dr. Carleton

Q&A: issues with an amputated toe in a dog

One of my more popular posts is on the topic of toe amputations in dogs and cats.

Recently, one of my readers, Heather Z, posted a question about her lab's post-surgical toe issues that I thought was worth separating out as its own post.

Hi. We have a 111 lb black lab and just had his third (III) toe removed on the front right paw in the middle of October. He still walks with a limp and holds it up when he stands. We keep it wrapped in a sock with a cone on his head all day every day because he wants to lick it. When he goes out, we wrap it to keep it dry.

He has been on antibiotics and about the 2nd week it started to pus and the swelling of his fourth (IV) toe was still huge and didn't go away. Brough him in and they upped his antibiotic. Nothing was said if it was infected but that's what I think. We also put a drying solution mixed with water on it twice a day and blow dry it as recommended.

I'm just worried that something else could be wrong with swelling not going down still going on a month. It is a pain. I think we did the right thing but its just hard seeing him like this and there's no improvement with the swelling! Anybody know of this?

I passed the question on to Dr. Heather Carleton, one of Embrace's veterinary advisors and this is what she had to say in response:

My question would be why was it initailly amputated? Was is broken, arthritic, had a tumor, etc? If it was amputated because of a tumor, I would be concerned that there is recurrence. If not, I would have the foot x-rayed and make sure there is no bony involvement with the infection (i.e. with the bone above the ampuatation site). If there is, the area may need to be debrided. If it is just soft tissue that is infected, antibiotics should take care of it.

Heather Z's got back to me with an answer for Dr. Carleton:

We had it amputated because it had a hard tumor growing connected to the bone. We had it sent into the lab and it is benign. He has been on cephalaxin and ciprofloxacin, which did not work, and now we went to clindamycin. I took him in last Thursday and had the desolvable stitches they left in taken out. I started to cut them out and they took the rest out. Our vet says it should clear up and to call and talk to him Monday. Well, that is tomorrow and it is still swollen. He said the next thing will do is move up to a more expensive antibiotic that costs $100 bucks or so.

This is still really frustrating because it is not getting that much better and he still limps. I hope this next option he has in mind works or else the next move will be going somewhere else and getting a second opinion and probably an x-ray and possible debridement as you suggested.

Here's an update from Heather Z.

When I brought him in last Wednesday, the vet thought he was doing much better now that the desolveable stitches had been romoved and the swelling around the scar tissue started to heal better. I just don't get why they left them in there. I heard from other people that desolveable stitches can cause inflammation. I also think when they wrapped his foot postoperately with the sticky wrap they did it too tight and was supposed to remain that way for 7 days. I also talked to other people and they said that they rewrap and change around the 3rd day.

The vet said he looked like he was healing well and the inflammation of his big toe should not be a concern because it is part of his healing process. He is moving around better and the outside toe looks almost back to normal size but the middle toe is still very swollen but may have improved a tad since suture removal. I am supposed to check back with him in two weeks and keep giving him his clindomycin 4 pills twice/day.

So, somewhat better but he still has to have a cone on his head when we are gone and something on his foot so he doesn't lick it like mad. I left the house for an hour and he somehow pulled it off and yanked his booty off and was licking it till it bled. Uh. But that is how it is going so far. It is now one month and 1 day. Buddy is a crazy licker anyway and is always grooming. I just hope things start getting better faster!

Have you found yourself in this situation? Let us know what happened in the comments...

Related Posts:
Toe Amputations for Cats and Dogs
Ask Laura: the impact of toe amputation surgery
Ask Laura: dog weight bearing toe amputation appropriate or not?  
Ask Laura: infected ingrown toe nail on cat  
Ask Laura: to amputate or not to amputate the cat's toe, that is the question
Corns on a greyhound's toe: Dr Riggs discusses

To treat or not to treat Cushing's Disease

Over at Wellsphere, I had a heart-breaking question on one of my Cushing's Disease posts that I thought worth sharing here. The answer is from our esteemed veterinary consultant, Dr. Heather Carleton.

Question:

I have a minature schnauzer, Kizzie. She turned 11 in Feb. She was diagnosed with epilepsy at 3 and enlarged heart. She has been on 3 meds 2 times a day since. She has been to the vet hospital 3 times with pancreatitis and has cost me about $5,000 in medical bills. A couple of months ago she was diagnosed with Cushings.

I love her very much, but am at the breaking point financially with her. She is a member of the family, but for now I have chosen not to treat her with the additional expensive meds that the vet wants to put her on. Do you know the life expectancy of a dog with cushings...with no treatment?

She has just started loosing her fur in the past 2 weeks. She seems tired a lot and a bit weak, but other than that she is in good spirits and is not wimpering or anything like she is in any pain. From what I've read, the best to expect is 20-30 months...with meds...can't find anything out about without meds...If you know, I'd appreciate it!

Answer:

In general, a dog with untreated Cushing's can actually live as long as a treated dog, but will likely have more side effects (over time) from the disease if not treated. Usually treatment for Cushing's is not even recommended unless the dog has clinical signs because treatment does not necessarily change their overall life span - it just keeps them from being polyuric (urinating a lot), polydypsic (drinking a lot), losing their hair, etc.

However, in this case, if the dog is showing signs of weakness, the Cushing's may be having a negative impact on the dog's heart condition, which would be a reason to treat her if financially possible.

Regardless of whether or not this dog is treated, I would monitor her heart disease, especially if weakness persists or she starts coughing.

[from Laura: my heart goes out to you and your dog. Thank you for sharing your real life story]

Note:
As with any of your pet's health conditions, if you are worried about your pet, talk to your veterinarian - the internet is no substitution for an in-person visit.

Related Posts:
Cushing's Disease in Cats and Dogs

Photo courtesy of the Miniature Schnauzer Rescue of Houston - donations welcome

Causes and signs of saddle thrombus in cats

Saddle thrombus is one of the most appalling conditions a cat lover will face - it is extremely unexpected, very distressing, and rarely ends up well. I've had many comments from pet parents about their harrowing experiences of saddle thrombus.

In particular, Linda commented twice on my post on saddle thrombus in cats about her cat Little Bit - the first about Little Bit and the onset of the saddle thrombosis and the second, the sad passing of Little Bit. I'm so sad for Linda's loss and I really appreciate her sharing her story at such a difficult time so others might find some solace.

In Linda's second comment, she had a question about the typical symptoms of heart disease in cats - how could she have known about her cat's heart condition before the saddle thrombus occurred? Linda mirrors the emotions of many of the people whose cats have died as a result of a saddle thrombus - what could they have done to prevent such an awful occurence?

A veterinarian friend of ours answered the question in the comments but I thought it worth highlighting here for all to see.

Dear Linda,

I am so sorry to hear about your cat Litle Bit. I just lost a cat myself and the emptiness that is there afterwards is always unbearable.

I am writing here to answer your questions about HCM (hypertrophic cardiomyopathy) and to let you know that the presentation that you experienced is extremely common.

Unfortunately, cats rarely show signs of heart disease, like coughing or exercise intolerance. HCM can be picked up on auscultation of the heart (although there must be an arrythmia or tachycardia to give you a hint) and by ultrasound. However, 2 year old cats are not routinely ultrasounded unless they are Maine Coon cats which are predisposed to the disease.

With regard to the disease, it only becomes evident clinically when clots that have been sitting in the heart chambers are showered throughout the animals body - ending up in the aorta and sometimes the lungs.

If it gives you any consolation, even if Little Bit had been diagnosed previously, the condition is very hard to treat medically and regardless of the heart medications used, is progressive. If she had survived this episode, within weeks to months she would have been suffering from another one, which no one would wish for their best friend.

I hope this helps a little...

Sincerely, Dr. Heather Carleton

[Note that auscultation means the act of listening for sounds in the body - in this case, noises of the heart]

So sadly, it appears that little can be done to prevent this condition except take your cat for regular check ups.

For more information, check out my post on hypertrophic cardiomyopathy.

Related Posts:
Saddle Thrombus in cats
Causes and signs of saddle thrombus in cats
Cardiomyopathy in cats related to saddle thrombosis
Memories of Dave
Blood clot in cat: Q&A with Dr. Carleton