Do cats get PEs?

[streetdoc]

Just curious as my cat (only 7yo) recently died suddenly. Suddenly as in acting completely normal, cried out just once and flopped over. No history of problems, just got her shots 6 months ago, but was probably somewhat stressed by a move a few months ago. I'm really at a loss for why, so I did opt for a necropsy.
I'm an MD and Pulmonary Embolism came to mind, but do cats even get PEs? they sit around 20 hours a day-what would be the risk factors? geez, i'm feeling like a horrible cat mommy...any thoughts? I will hopefully have my answer in a week or two.
thanks

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[StealthDog]

Yes, they do. Embolisms can be septic (i.e. if there is vegitative valvular endocarditis), neoplastic, or thrombotic. My path book on pulmonary thromboembolisms:

"Thromboembolism of the pulmonary arterial tree, often life threatening, occurs in dogs and cats. A wide variety of predisposing conditions that may result in altered blood flow, hypercoagulability, or endothelial damage includes sepsis, immune-mediated hemolytic anemia, protein-losing nephropathy or enteropathy, DIC, cardiac disease, neoplastic disease, hyperadrenocorticism, dirofilariasis [heartworms], amyloidosis, and use of intravenous catheters."

Sorry about your kitty I hope the necropsy reveals the cause.

 

[julieDVM]

They do - but they're not that common - especially in a seemingly healthy cat. In my experience, thromboembolism of the terminal caudal aorta (a saddle thrombus) is more common than a pulmonary embolism (unless you're dealing with sepsis or something infections like that).

I'm sorry about your kitty.

 

[streetdoc]

The more I looked into PE, it seemed that I would have seen signs in the hours leading upto everything.
I'm still at a loss for causes of such sudden happenings.

And on a side note, I'm not even sure if a vet looked at my cat at the emergency vet. I live literally right around the corner and was there within 5 minutes but when she (the vet tech) took her into the back no one but the tech came out to tell me that my cat was dead. I would have thought for $132 i would have at least been able to talk to the vet...then again, maybe the tech was the only one there. I already knew my cat was on the way out, I went to the emergency vet for them to do something! Shouldn't they have at least tried something (it was only 5 mins, she was warm, tail still puffed)? I know a cat is not a human, but in the ED (I'm an emergency medicine resident), if it's been 5 min, we still go through all the basics. I would think with a cat a loss of brain function would not be that big of a deal and that they should have "coded" her instead of just saying, "yeah she's dead." Am I wrong? What are the protocols? Should I have been charged $132 for a vet tech to confirm what I already knew???

Maybe I'm just in the anger phase of grief, but I was not so impressed with the attention my cat received (not to mention I was snotting all over my sleeve before she offered me a tissue)...and to think I specifically selected this apartment because of it's close proximity to the emergency vet "just in case."
I can't help but think that the stars were alligned for things to turn out well (I was home, I was 3 feet away when she flopped over, I had her in the cage, and in the car and was at the vet's all in 5 minutes) but I feel the "emergency vet" let me down.
wow, sorry for the rant-I'm really just hurting I think...
streetdoc

 

[Bill59]

I'm sorry to hear about your kitty. The most common causes of sudden death in cats are hypertrophic cardiomyopathy and heartworms. However, cats are infamous at hiding signs of illness so there's always a chance this was a more chronic process than recognized.

To identify HCM at postmortem it's important to weight the heart because measuring myocardial thickness can be unreliable after death.

As for protocols for resuscitation of DOAs, someone at the emergency clinic would be the best person to address that. Realize the chance of a successful outcome in a patient hitting the door in asystole is extremely low. Although you go through the motions for your patients, in vet. med. the client will have to pay for this. And they often complain about the charge when they later realize the chance of success is so low -- in other words, you're often damned if you do, damned if you don't.

So some hospitals will not automatically code such patients. Rather, each case has to be considered with all the specific details.

 

[banditalfi]

The more I looked into PE, it seemed that I would have seen signs in the hours leading upto everything.
I'm still at a loss for causes of such sudden happenings.

And on a side note, I'm not even sure if a vet looked at my cat at the emergency vet. I live literally right around the corner and was there within 5 minutes but when she (the vet tech) took her into the back no one but the tech came out to tell me that my cat was dead. I would have thought for $132 i would have at least been able to talk to the vet...then again, maybe the tech was the only one there. I already knew my cat was on the way out, I went to the emergency vet for them to do something! Shouldn't they have at least tried something (it was only 5 mins, she was warm, tail still puffed)? I know a cat is not a human, but in the ED (I'm an emergency medicine resident), if it's been 5 min, we still go through all the basics. I would think with a cat a loss of brain function would not be that big of a deal and that they should have "coded" her instead of just saying, "yeah she's dead." Am I wrong? What are the protocols? Should I have been charged $132 for a vet tech to confirm what I already knew???

Maybe I'm just in the anger phase of grief, but I was not so impressed with the attention my cat received (not to mention I was snotting all over my sleeve before she offered me a tissue)...and to think I specifically selected this apartment because of it's close proximity to the emergency vet "just in case."
I can't help but think that the stars were alligned for things to turn out well (I was home, I was 3 feet away when she flopped over, I had her in the cage, and in the car and was at the vet's all in 5 minutes) but I feel the "emergency vet" let me down.
wow, sorry for the rant-I'm really just hurting I think...
streetdoc

I am so sorry you feel your cat didn't get acceptable treatment, but perhaps I might be able to shed some light on what (possibly) went on at the emergency clinic.

I have worked at an emergency animal hospital for several years and occasionally we get a cat that comes in, is rushed to the back, and literally dies before it's put on the table. In this situation, the doctor never looks at the cat (I am not sure if the doctor confirms death, but in these situations I do not think he does). Generally, the head technician - not the DVM - informs the owners and they have the option to either cremate or take the body home with them. They are not charged an emergency or physical exam fee.

In the case that the doctor does examine the animal crashes, first of all the doctor would be out to talk with the owner and explain what happened - we feel it is unprofessional otherwise. Also, in this situation, the owner is charged the physical exam and emergency fees (though at the discretion of the DVM) in addition to the cost of cremation, if the owner chooses.

I hope this helps to clarify some of the costs you inferred and I sincerely hope that you're able to better understand what happened. Also, if you honestly think you were not treated well, I don't think there is anything wrong with writing a letter with some choice words to that effect. I'm sure you've experienced difficult clients in your profession and I can assure you that we have our fair share of them, but at the same time that doesn't mean that you shouldn't let the emergency center know how the practice can be improved.

Edit: Regarding resuscitation, we do offer the option to the owner in either case, though I am sorry to say it is not very successful. Generally with DOAs - though I don't want to say we discourage it - we don't really enjoy doing it. I've never witnessed a DOA surviving (though I am sure there are cases) and then the client would incur the other fees.

 

[streetdoc]

Thanks for the insight, banditalfi!
I had to use emergency clinic once before (back east) and was just so impressed by the treatment I received that this time around I was a bit shocked. Deep down I know she was doa, I know it would not have turned out any differently, and I think I am just feeling like I didn't do enough. Grief is a funny thing...
Emergency clinics are a wonderful resource and I think when I have some time to get over this I will feel differently about my experience (I was just typing at a weak moment).
thanks

 

[hoodle]

Just to add to the comments... I also work at an emergency clinic, and my sister is an emergency room doctor (human). The differences between human and animal emergency medicine are striking. For humans, the default tends to be aggressive treatment - when in doubt, usually, doctors attempt resuscitation. For animals, on the other hand, the default is NOT to resuscitate unless explicitly told to do so by the owners.

As someone said earlier, you're damned if you do, and damned if you don't. Vets have to defend their charges all the time, because most people are shocked at the expense of detailed medical care for their pet animals. As a rule, most clients will NOT be able to afford extensive resuscitation, unless you're practicing in Beverley Hills or the like! This makes emergency practices loathe to initiate aggressive treatment without express consent.

That said, the nurse who triaged you should have taken one look at the dead/dying cat in your arms, and as she rushed to the back room, should have said "your cat looks gravely ill and might already be dead. Would you like us to attempt resuscitation (at your expense)?"

If you were in the waiting room and distraught, the animal should have been brought back and treatments immediately initiated while someone went out to get a history/find out what you want to do. It does sound like you were treated unprofessionally. In the future, though, knowing what you do now about vet emergency medicine, if you're bringing in an critical animal, the most important thing to do is indicate how far you plan to go. You really have to be proactive...

 

[dvm'08]

J It does sound like you were treated unprofessionally.

you dont know this - you have no idea what events actually transpired at the emergency clinic. it is bad practice to pass judgment on your colleagues based on 3rd hand information. bad form.

 

[ri23]

I agree with DVM'08. You should not judge the actions of other veterinarians if you weren't there. Even the OP admits that he was in shock due to grief (and understandably so). I'm sure that the people at the emergency clinic did everything they could for the cat.

 

[tkim]

I agree with DVM'08. You should not judge the actions of other veterinarians if you weren't there. Even the OP admits that he was in shock due to grief (and understandably so). I'm sure that the people at the emergency clinic did everything they could for the cat.

But you weren't there, either, so how can you be sure that they did 'everything they could'? Can you smell the irony in your statement?

The best medical care rendered can be overshadowed by poor communication to the family (or owner). This situation might be a case of this.

Streetdoc's a she.

Sorry about your kitty.

 

[StealthDog]

The best medical care rendered can be overshadowed by poor communication to the family (or owner).

This is a key point. There is a great discussion about this on the VIN ethics board called "Being an EC client" that is worth reading through.

 

[hoodle]

The only reason I said "unprofessionally" was that she sounded like she was confused and frustrated with her experience - as tkim indicated, communication is absolutely essential. Not to say that everyone won't come out of an emotional experience feeling a little confused and dazed, but her initial feeling was frustration... and that suggests she might not have been treated as well as she deserved.

 

[ri23]

But you weren't there, either, so how can you be sure that they did 'everything they could'? Can you smell the irony in your statement?

The best medical care rendered can be overshadowed by poor communication to the family (or owner). This situation might be a case of this.

Streetdoc's a she.

Sorry about your kitty.

While that's true, if I were going to assume something about someone's behavior as a professional I would assume they are doing their job to the best of their ability. If I was going to state otherwise, I would require some sort of proof. Making comments like that could damage a vet's reputation unnecessarily.

I do agree that client communication is essential. There are some amazing doctors, but they can't communicate with their clients and therefore retain very few despite their abilities.

 

[tkim]

While that's true, if I were going to assume something about someone's behavior as a professional I would assume they are doing their job to the best of their ability.

Never assume that, especially in medicine.

 

[streetdoc]

The results are in.
It seems my girl had idiopathic hypertrophic cardiomyopathy. The heart weighed 26.7 g (expected 12-18g). I was told open mouth breathing is sometimes seen and, indeed, I can think back to times when she was stressed (chased down to clip claws, boxed up for the trip to the vet) and she would do some open mouth breathing. I likened it to panting since it was after great exertion...obviously it was more ominous. Even if I had known she had the condition I don't think I would have done anything differently. She didn't seem to suffer at the end and I don't even remember noticing her doing the open mouth breathing those last several days/weeks. Do owners usually put these cats down?
My boy cat has been VERY attached lately (and it is mutual). Any ideas on how to make sure he isn't lonely while I'm at work?
Thanks for all the thoughts, well-wishes, and comments
streetdoc

 

[Bill59]

Do owners usually put these cats down?

The median survival for HCM in cats is around 2 years but that's meaningless much because the range goes from very short to a normal life span. The causes of death are, in order, congestive heart failure, aortic thromboembolism and sudden death. CHF and embolism can be fatal but more commonly result in euthanasia due to disability.

There's no treatment that will alter the underlying course of the disease. However, if CHF develops, that can be managed.

 

[Weazlebub]

The results are in.
It seems my girl had idiopathic hypertrophic cardiomyopathy.

Sorry to hear that. You're description of when it happened reminded me of a lecture I heard by one of the leading small animal cardiology guru's. His own cat died suddenly of what turned out to be HCM. Despite his training and experience he had no idea anything was wrong.