Cassie lounges on the couch My sweet Cassie’s heart is literally too big for her body. I was devastated to learn about this problem at the emergency vet. What a wild ride it is to care for a kitty with so much mystery inside! It was my third visit to a vet since adopting Cassie just a month before. The first was about her back legs not working right. The left splayed out to the side and twisted sometimes. She didn’t always walk cat-fashion on her toes. The day I noticed a limp, I scheduled the appointment. The limp was soon gone and Dr Chan found no injury, adding that she was a confident walker. He thought we could understand Cassie better after she had settled into the routine at her new home. She might be working on adrenaline, panting a little as she explored the examining room. That sign of stress would hopefully die down in a couple of months when he suggested I bring her back. But then I noticed pink pee. Cassie only urinated about once a day, leaving a big grey ball in the sandy clumping litter that she preferred. I couldn’t see the colour of the urine until she peed a little outside of the box. The second time it was pinkish, I thought, That isn’t normal. It must be blood. When I checked the upstairs box, I found a stain on the newspaper just outside the box, a pink drop marking the centre of the stain. Then I recalled two suspicious stains right after I adopted her. On her third night with me, she slept in my room, settling on top of my head on the pillow. The next morning, I found a brownish stain on each pillow that looked like a drop of dried blood. The stains came out with cold water and soap. When I discovered a stinky spot of poo on the rug a couple of days later, I wondered if that explained the stains. But after I saw pink pee in two locations, I connected it with the spots on my pillow and believed my original impression that they were drops of blood. Cassie probably had a urinary infection when she first arrived. She had a history of bladder problems this year, with a number of vet visits before being surrendered. The problems continued during the month in care, but were believed to have resolved. Blood in the urine was serious. I called the vet right away, but as Cassie was still eating and using the litterbox, they didn’t consider it a life-threatening emergency as a blockage would be. I brought her in two days later. There were no clear answers. Dr. Chan wondered if Cassie’s problems were connected to her previously diagnosed back problem. Even though she raced around the house and jumped freely, she might hide pain as cats are wont to do. Squatting could be particularly painful. That would also explain why she tended to get constipated. She might sit there painfully and then stop, waiting until things dried up inside. But X-rays revealed a beautiful spine. Dr. Chan thought that perhaps her injury was not to her bones but neurological, like a pinched nerve that we couldn’t see. He prescribed a pain medication, Gabapentin, that would counteract nerve pain. He also injected Cartrophen, a remedy usually for arthritis that also helps to build the bladder’s inner lining. He didn’t want to prescribe antibiotics as he thought her condition was improving, and bacteria become resistant when antibiotics are overprescribed. I gave Cassie the Gabapentin for a day and a half before giving up on the pain medication. She didn’t love the taste mixed with food, but my concern was more that it made her sleepy. Her normally rambunctious behaviour took a complete turn. At first I thought it was probably good for her to rest, but I didn’t like to see her slow down so much. And the medication didn’t seem to change her urinary problem. The second day there was a huge puddle of pee outside the box. A few days later, Cassie began peeing on the living room carpet in front of me. The problem was getting worse, but I didn’t know what to do. A week after our second vet visit, it was 7 p.m. when Cassie started to pee drops on the living room carpet. At first I scolded her, although I know that never works, and reminded her about the litterbox. Then I brought the box down to where she seemed to want to pee. She would go in the box, pee a couple of drops, then exit the box and pee on the rug. She kept peeing drops, then grooming herself furiously, then peeing more drops on the rug or in the box. Some drops had blood. Nothing she did gave her any relief. I was glad that my favourite cat health links were handy on this website! I read Cornell University’s articles on lower urinary tract infections, and discovered that a serious blockage could present itself in the way Cassie was straining to pee. As my vet was closed, their answering machine recommended the Animal Emergency Clinic of the Fraser Valley in Langley for emergencies. Another vet with excellent reviews was still open briefly. They couldn’t fit me in, but recommended the same emergency clinic. Two recommendations meant that I could trust this service that meant a long drive. The emergency clinic agreed that Cassie should be seen right away. I said it would be about a half hour. My map book showed an easy route, turning left off the Langley Bypass onto 204th Street. It seemed like a surprisingly pleasant drive in light traffic until I looked for the turnoff. It wasn’t there! Now it was raining and getting dark. I turned on a cross street and searched for 204th, thanking God when it finally appeared. Drivers behind me honked when I paused to get my bearings. I was already at 64th Avenue past the clinic's address, but saw neither the clinic nor the Costco that was supposed to be the landmark across the street from it! Turning left, I finally saw the Costco on the north side of 64th Avenue. The bright sign of a veterinary specialty clinic beckoned to me from the south. I pulled into the complex of industrial offices and parked in front of the vet. But it was closed and actually had a different name! I pulled out my phone and called for directions to the emergency clinic, which was at the south end of the complex. I was nearly in tears when I arrived with my sick cat crying in the carrier. Things improved from that point. The staff were professional, while the reception area was warm and inviting. I declined the offer of free speciality coffee but eventually gave in to hot chocolate. It helped with the long wait. They took Cassie in to see her without me at first. They did the same with several other new patients. Then I was called in to see the young vet, Dr. Kari Christianson. Thankfully, there was no blockage, but she explained that lower urinary tract infections can have many causes. We needed to identify the cause to find the best treatment. This involved a number of diagnostic procedures: X-rays, blood work, urine testing, the works. “That sounds like it costs a lot,” I said. “It could be up to about $850,” Dr. Christianson replied. “Wow! That’s a lot, but I suppose it’s needed.” She said they would reduce costs by giving me a lower rate for X-rays, treating it as a second image rather than a first. Dr. Chan had done the same. They would also waive one of the fees that they charged for an emergency visit, as I had recently seen my own vet. I appreciated these considerations. It warmed my heart when they treated other clients with the same kindness. I spoke to whoever was open to talking about their pet. An older man brought his dog in. When doing some home renovations, staples that he had left on the floor seemed to have disappeared after his dog was snuffling the area. He didn’t know for sure, but worried that the dog may have swallowed the staples. When the vet technician came out and asked if he knew for sure that the dog had eaten the staples, the elderly man hesitated. I answered for him that he wasn’t sure. The technician then said that he wouldn’t need to see a vet, as the X-ray had shown nothing. They would only charge for the X-ray. It was good news for that little dog. Another family had accidentally nipped their dog’s ear when grooming him. The technician said she would first check the wound to see if it could be addressed without seeing a vet. This time a vet was required. The family was exiting the examination room after the ear was sutured when I was ready to leave. A shocking visit after 11 p.m. was from two RCMP officers. They had shot a dog, and needed to get documentation from the clinic. I was near the officers at the counter and felt their tension. “How sad,” I said. The men didn’t look at me. I added, “But I suppose it’s in the line of duty, a hard job.” Still nothing. I’d heard of cases where officers weren’t trained well to defuse conflict and used force too quickly, but I didn’t know the circumstances and reminded myself not to judge. I imagine that it was traumatic for them to have killed a dog. Finally two cats arrived separately. I crouched down to admire the calico cat in her carrier. She was swaddled in fabric around her head that was protecting an abscess. When she turned her back to me, I gave her space. The other kitty sat in a soft-sided carrier with a woman who was fully absorbed in her phone. I was glad that some cats were getting the level of care that the dogs were. I had to wait a couple of hours before all the diagnostics were done for Cassie. They wanted her to pee for them. Finally she squeezed out a couple of drops. There was blood in them, as expected, but the sample was too small for a culture to find out what bacteria was at work. Cassie’s bladder looked full in the X-ray, only because inflammation had thickened its muscular wall. It was actually empty. They couldn’t even penetrate the bladder wall with a needle to get an aspirated sample. The most shocking news was about Cassie’s heart. Dr. Christianson had noticed a pronounced heart murmur, a whooshing sound between heartbeats that could mean that the heart wasn't pumping blood as effectively as it should. The X-ray revealed that the heart was enlarged. Dr. Christianson said that a normal heart would fill about one third of the chest cavity. Cassie's heart took up more than half of the space (see the image below). Interestingly, Dr. Christianson offered a rather horrifying explanation for the strange way that Cassie’s back legs function. An enlarged heart can develop a blood clot, which often lodges in the aorta where it splits into the two back legs. Called thrombosis, my mother nearly died from this condition years ago, but recovered. In cats, it causes weakened or even paralyzed back legs. The heart condition might also explain Cassie’s earlier panting in the examination room. Dr. Christianson prescribed an antibiotic called Clavamox for the urinary infection. For pain, I decided to go back to the Gabapentin prescribed earlier. Clearly Cassie needed pain relief, if only from her infection. I was relieved when the emergency fee was under $500. It was midnight when we finally arrived home. We took a better route, down 64th Avenue to 200th Street, to avoid the earlier mixup. The street I'd been looking for on my way there had passed over the road in a bridge. Thankfully, once home, Cassie no longer strained to pee. She lapped up her canned food mixed with pain medication. Giving Cassie her antibiotic pill the next morning was a new challenge. I settled her between my legs where I sat on the floor, as the vet had shown me when giving her first pill. I tried the plastic pill dispenser the clinic gave me, but it was too long to handle while keeping her squiggly mouth in place. I tried pilling Cassie by hand, but she wouldn't stay still. I covered the pill with wet food, as the vet technician suggested, but Cassie ate around the pill, although she got some of the pill's powder. Forcing the pill into Cassie seemed contrary to what I'd learned about animal communication, where it's important that the animal is in charge. Reflecting on that, I was inspired to crush the pill and mix it with food. Cassie gobbled it down completely. First I used a spoon to crush the pill, then a mortar and pestle that I had used for crushing spices. The method worked perfectly. Gabapentin unfortunately has an odd smell. The medication, held in oil, must be shaken vigorously before syringing it out. Even touching the oil when opening the jar leaves an unpleasant odour that has me reaching for paper towelling, water and soap. Cassie doesn’t like the medication mixed with her food as much as she tolerated the Clavamox, but I divided her food so she would be hungry when it was time for her dose. I'm hoping she doesn't need it much longer. The next step in heart treatment is an echocardiogram, an ultrasound of the heart that shows how it is working and where the muscles are thickened or too thin. Then we can learn how best to treat the heart with appropriate medication. Most cats with heart problems are never diagnosed and simply die suddenly. That's probably what happened to my Ebony, who died before her fifth birthday. At least we have the advantage of knowing and can act accordingly. I'm expecting to hear from Dr. Brown, a vet who performs echocardiograms in our area. He sends his report to a cardiologist to interpret the results. Unfortunately we have no veterinary cardiologist in our region after the sole practitioner moved to Italy! Tomorrow we have another visit with our regular vet. Hopefully we’ll get a good urine sample and can learn more about how to keep Cassie infection-free. It's over a week since our emergency visit, and my sweet kitty seems to be feeling much better. When Cassie curled up on the arm of the couch next to me as I watched television last night, I pressed my ear to her fluffy side. There was purring. There was a regular heartbeat that motored along in a quiet rhythm that sounded perfect to me. There was deep breathing as her lungs filled with air and released. There was love and there was deep peace. Who could ask for more? - Irene Plett PS: At Cassie's vet visit yesterday, there was NO HEART MURMUR. She was so relaxed and purring. The vet tried to stress her a bit to see if the murmur would show up, but nothing. It seems the only time there was a heart murmur was at the emergency clinic, where her heart rate was also extremely elevated. It's a good sign, but still leaves a mystery! Not life-threatening, I'm told, so we can wait a bit to learn more and decide the next steps. Topics: cat health, lower urinary tract infections, heart trouble in cats, emergency veterinary treatment, veterinarians Cassie's big heart is the rounded shape near the base of the black (air-filled) lungs.
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