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Posts Tagged ‘cardiomyopathy’

Sidney, Montana, the summer of 1960. Ike Williams and Jon Wilkins were partners, the owners of Williams & Wilkins Blacksmiths and Mechanics. Their shop was large, chaotic and dirty. It occupied the entire frontage of their property hiding their small, immaculate, frame house. The shop and their considerable skills shielded them from the necessity of acknowledging their relationship, something the community had no real need or desire to hear or talk about. The partners were able to repair and, if necessary, fabricate parts for any type of motorized or pulled agricultural implement. That was what the community considered important. They had lived and worked together in Sidney for twenty-five years before my new bride and I arrived. I was a recent graduate and new associate veterinarian in the only veterinary practice within a fifty-mile radius.

Like an old married couple Ike and Jon finished each other’s thoughts, knew how to avoid conflict, were comfortable in their own skins, and with each other. All necessary accommodations had been made.

They both loved cats. I was never able to determine exactly, or even approximately, how many cats they had. There were shop cats, outside cats and house cats, all well cared for.

From time to time one or both of them would bring in a house or shop male for castration or a female to be spayed. All received annual vaccinations. I guess they had a method for deciding which cats would occupy which spaces. The outside cats were free to reproduce but each new litter of kittens was brought in for vaccinations and caring homes were found for them.

They were both sitting in the waiting room when I returned from doing rectal exams on twenty-five head of half-wild range cattle to check for pregnancy. I rubbed my sore left arm as I greeted them.

“Mr. Williams, Mr. Wilkins, what have you got for me today?”

They stood up as if joined at the hip. Wilkins held a huge tabby in his arms. The cat was whimpering obviously hurting.

“This is Wilma, she’s a house cat. Old Doc spayed her for us several years ago and she’s had all her shots every year. Today when we came in for lunch we found her, crying in pain. She’s paralyzed.”

As he talked tears welled up in Wilkins’ eyes. Ike put his arm over his partner’s shoulders.

“It will be OK Jon. Young Doc is good everyone says so. He’ll take care of Wilma for us, won’t you Doc?”

I held out my hands.

“Here, let me take her. Let’s go into the exam room and see what we can figure out.”

Wilma was too soft, too fat, and too lazy. Both hind limbs were flaccid. She meowed louder with Jon no longer holding her. She was also hyperventilating. I examined her carefully, noting that the white nails on her hind paws were tinged blue and the paws were cold to the touch. I was unable to palpate a pulse in either femoral artery.

“This is not good,” I told them. “I’m pretty certain she has what we call a saddle thrombus. It’s a blood clot blocking the two main arteries to her legs. I’ve never seen a case but I remember the description from vet school. All the signs are there. She is paralyzed in the hind legs, in obvious pain and there is no blood circulating to her hind legs.”

“Is there something you can do to fix her?” asked Ike.

“Well, theoretically I could operate and remove the clot. However, I’ve never done anything even remotely like that before, never actually opened an artery on purpose then tried to suture it closed afterwards. I don’t think we even have any suture material small enough to do that kind of thing. Also we have no idea what causes this and it could come right back. I’m sorry. I hate to say this. My job is to help animals not kill them. In this case I think the best thing I can do to help Wilma is to put her out of her misery.”

They were devastated.

“Are you sure you don’t want to even try?” pleaded Jon. “Cost is not a problem you know. We’ll pay whatever it costs,” he looked to his partner for confirmation. Ike nodded his agreement.

“OK, I’m willing to try anything, but I have to make certain you know this could be a disaster. I’ve never even seen anything like this done. First let me look to see if we have any suture material small enough to close an artery.”

I was apprehensive as I searched through the cabinet of surgical supplies. I found one packet of 4-0 silk, with needle attached. It looked to be several years old. I had no idea where it came from or for what my boss intended for it when he bought it. I came back into the exam room and held up the packet.

“This might work, but it’s old and I’ll need to sterilize it again, I have no idea how long it’s been around, the package says it expired two years ago. You guys are certain you want me to try this? I don’t really know what I’m doing. I’ll have to dissect down to the end of the aorta, that’s the main artery coming from the heart, where it branches to supply blood to both hind legs and the tail. Then I have to find the blockage, try to put a tourniquet around the artery above the obstruction, open the artery, remove the clot and suture the artery closed. Chances are very good Wilma will bleed to death while I’m fumbling around.”

“But she’ll be anesthetized, right Doc? She won’t feel anything? Ike asked.

“That’s correct,” I said. “As soon as I anesthetize her she’ll feel no more pain, until and unless we remove the clot and get everything repaired and let her wake up again. She could still be in a lot of pain after I’m done with the surgery, I don’t know.”

“But you can give her something for post-operative pain, right?” Jon pleaded.

“Sure, sure, we can treat post-op pain.”

“OK Doc. Go for it. Is it OK if we wait here? We already put a sign on the shop door saying we wouldn’t be back until tomorrow.”

“Sure, you’re welcome to wait here. It will take me some time to put a surgical pack together to sterilize with the suture material. I have to think about what I might need by way of instruments. I know we don’t have any specialized vascular surgical instruments or suction so I’ll have to improvise. I’ll let you know before I get started. Let me give her just a touch of tranquilizer to see if we can make her more comfortable. I’m afraid to give her anything like a full dose because her heart rate is so fast. The tranquilizer will slow her heart rate and the high heart rate may be the only thing keeping her alive.”

I got Wilma anesthetized, hooked up an intravenous drip, opened up her abdomen, packed off her abdominal organs and found the distal aorta. When I tried to dissect around the aorta I managed to break off some small branches and the abdomen quickly filled with arterial blood. The turkey baster I added to the pack was not an adequate suction device and Wilma bled out in short order. It was the unmitigated disaster I had feared.

Today we know that saddle thrombus is almost always associated with a disease called dilated cardiomyopathy. This is a condition, probably with genetic predisposition, that is uncommon but not rare in cats. The heart is enlarged and dilated and it doesn’t function properly. Normally blood is always moving inside the heart. This constant motion of the blood, even when the heart is resting between beats, helps prevent clots from forming. Because the heart is dilated and unable to beat strong enough areas of flow stasis develop within the heart chambers. Areas of flow stasis allow clots to develop. When the clot becomes large enough it is eventually washed out of the heart. It flows downstream until it lodges at a location too small for the size of the clot, usually at the terminal trifurcation of the aorta. Modern veterinary surgeons can deal with this, providing the underlying heart disease is treatable. Today, if diagnosed early enough and if the underlying heart disease is controlled, many of these animals can be saved and will go on to live a reasonably normal life. In 1960 my saving Wilma would have been a miracle.

Ike and Jon understood and were even appreciative that I tried.

I felt guilty and depressed, never acclimated to losing an animal, especially through my own clumsiness.

Excerpt from “Animals Don’t Blush”

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