pregnant cat with heart murmur

Re: pregnant cat with heart murmur

David Mills — Sun, 23 Sep 2012 23:28:03 GMT

[quote user="Evelyn Barbour-Hill"]

The job of the veterinary surgeon now is to try and remedy the cat's medical problem,

[/quote]

As long as they pay the bill, eh?

So. We have a cat with a belly full of fluid. Not that common for CHF in cats. So pretty advanced. Uncomfy, built up over a long time. Unnecessary suffering aka cruelty. They come in to see you and you say nothing as this stage? Don't even point out how irresponsible the owners have been simply on this point, never mind historically (loud murmur, intention to allow kittens to be born with genetic defect)? Simply smile and dish out frusemide and a.n.other? Seriously?

I mean, there are lines in the sand and then their are those flailing in the sea. Genuinely surprised.

[quote user="Evelyn Barbour-Hill"]

To "give the owners hell" and threaten them with "I'll report you to the RSPCA" might make you feel good and brave but it will achieve nothing for the cat.

[/quote]

My, how to unpick this ethical muddle. Interesting that you see the two as mutually exclusive. Doing the former is simply a form of influencing the owner, something vets do all the time; it can quite easily go alongside the social obligations vets have towards animal welfare, and in particular pointing out breaches in it. Dog breeds; tail docking; Belgian Blues; history is littered with this isolationism, this refusal to face up to tough conversations and this retreat to 'the animal in front of me'. Is it business? Who knows. Just makes me shake my head in disappointment at the ethical slipperiness of some of our profession. Sad times.

Re: pregnant cat with heart murmur

Evelyn Barbour-Hill — Sun, 23 Sep 2012 22:49:39 GMT

[quote user="David Mills"]

Can't help wondering what Mr Barbour-Hill thinks of the situation now?

The cat sounds like it's suffering. Bad things happen when good people stand by...

[/quote]

He thinks that Mr. Mills is making a lot of prejudiced assumptions about the owners, the cat and the history.

We now know that the pregnancy question is a complete red herring, an irrelevance.

Back in May the cat had a bad heart and the owners decided (for reasons we do not know) not to treat it. We don't even know what advice they were given back then. Possibly it could have been treated more successfully back then, we don't know, we weren't there. The cat was still getting some veterinary supervision, since it had the Delvosteron. Now, not surprisingly, the heart is worse so the owners now know their May decision was wrong. The job of the veterinary surgeon now is to try and remedy the cat's medical problem, or to obtain agreement to euthanasia if that really is the best course. To "give the owners hell" and threaten them with "I'll report you to the RSPCA" might make you feel good and brave but it will achieve nothing for the cat.

That's all I have to say.

Re: pregnant cat with heart murmur

David Mills — Sun, 23 Sep 2012 21:35:25 GMT

Can't help wondering what Mr Barbour-Hill thinks of the situation now?

The cat sounds like it's suffering. Bad things happen when good people stand by...

Re: pregnant cat with heart murmur

Cat Henstridge — Sun, 23 Sep 2012 17:10:10 GMT

[quote user="CatherineThomas"]Before I examined the cat the owner told me that she was pretty sure she was pregnant from all of her previous experience with pregnant cats, and they had decided to let nature takes it's course and not do anything if that was the case.[/quote]

Ha! So they probably wouldn't have spayed it anyway even if she had been normal!

Re: pregnant cat with heart murmur

Hannah Wynne Richards — Sat, 22 Sep 2012 10:29:55 GMT

B****y owners Wouldn't life be simple if we could just get on with treating the animals and just cut them out of all decision making-wishful thinking again

Wynne

Re: pregnant cat with heart murmur

CatherineThomas — Sat, 22 Sep 2012 07:10:51 GMT

Well the cat came in for examination yesterday and the massively enlarged abdomen turned out to be due to ascites. (The scan to prove it to the owner had some pretty pictures of intestines floating around in fluid). The owner wouldn't agree to any further investigation but did agree to starting it on treatment.

Before I examined the cat the owner told me that she was pretty sure she was pregnant from all of her previous experience with pregnant cats, and they had decided to let nature takes it's course and not do anything if that was the case.

Re: pregnant cat with heart murmur

CatherineThomas — Wed, 19 Sep 2012 19:44:49 GMT

[quote user="An On MRCVS"]

I had no idea they spelled apologise like that in the US.

[/quote]

it seems rather mean spirited to tease someone about their spelling using the anon log in.

Re: pregnant cat with heart murmur

CatherineThomas — Wed, 19 Sep 2012 19:43:45 GMT

[quote user="Mark Holmes"]

As far as I can see the bad advice came when she was advised not to spay her cat because of a murmur and then put on delvo..... eh??

I would have spayed it no question.

[/quote]

yes I agree with this. According to the owner it was put on ovarid at first and then they changed it on to delvosterone. Anyway I've left her a message saying that we need to see the cat before we can decide what to do. So hopefully when I go in tomorrow morning there will be an appointment booked.

Re: pregnant cat with heart murmur

An On MRCVS — Wed, 19 Sep 2012 19:35:16 GMT

I had no idea they spelled apologise like that in the US.

Re: pregnant cat with heart murmur

Martin Atkinson — Wed, 19 Sep 2012 19:28:53 GMT

[quote user="Michael Woodhouse"]I do appologise for my US spell checker, trying to find an English one for Chrome)[/quote] I have two: a brain and a dictionary. But I admit they don't always work.

Re: pregnant cat with heart murmur

Michael Woodhouse — Wed, 19 Sep 2012 18:59:51 GMT

[quote user="Mark Holmes"]I would have spayed it no question.[/quote]

Me too.

I've lost count of the animals that have moved to the practice and been told that due to age/murmur/minor biochemical abnormalities he's 'too old' for an anesthetic to sort rotten teeth, festering tumor etc. Not had one fail to do well yet.......

(I do appologise for my US spell checker, trying to find an English one for Chrome)

Re: pregnant cat with heart murmur

Mark Holmes — Wed, 19 Sep 2012 18:01:53 GMT

As far as I can see the bad advice came when she was advised not to spay her cat because of a murmur and then put on delvo..... eh??

I would have spayed it no question.

Re: pregnant cat with heart murmur

Hannah Wynne Richards — Wed, 19 Sep 2012 10:03:31 GMT

When it comes to getting owners to do the right thing-sometimes a carrot approach works-sometimes a stick is necessary

Wynne

Re: pregnant cat with heart murmur

Evelyn Barbour-Hill — Tue, 18 Sep 2012 18:42:10 GMT

[quote user="David Mills"]OP asked for ways to proceed.[/quote]

Actually, she asked for a way to remedy the situation.

[quote user="David Mills"] I gave my view.[/quote]

And your view was criticised. This is upsetting for you?

Re: pregnant cat with heart murmur

David Mills — Tue, 18 Sep 2012 18:15:05 GMT

[quote user="Evelyn Barbour-Hill"]

You know very little about this case, unless you happen to have a great deal more information than the OP has given us. However on the strength of your imaginings and prejudices

[/quote]

Who said anything different? Peculiar point to make, really. OP asked for ways to proceed. I gave my view. I also think that clients need to be aware of their obligations and when they have let their pet down. I believe from the limited info available these people have, twice, one by not investigating what sounds significant, and, two, by letting the cat out. Fwiw I also believe that giving clients too much say in the name of client retention, and subsequently not pillorioring them for cruelty, has led the profession down many a dark alley - dog breeds, anyone?

[quote user="Evelyn Barbour-Hill"]

However on the strength of your imaginings and prejudices

...

I'd say that " give the owners hell for being irresponsible tools" would be fairly described as "a tirade of ill-informed abuse". My apologies, of course, if you are recommending launching it four minutes after shutting the consulting room door rather than immediately.

[/quote]

Hmmm. Anyone see the discord here? Not exactly helping the OP by telling me what I would do and why I'd do it. Still, it's nice to know.

Re: pregnant cat with heart murmur

Evelyn Barbour-Hill — Tue, 18 Sep 2012 17:00:28 GMT

[quote user="David Mills"]

[quote user="Evelyn Barbour-Hill"]

Like what, exactly, would that be supposed to achieve?

...

The cat needs examining. I'm sure it's likely to be examined if the owner knows the veterinary surgeon is going to launch a tirade of ill-informed abuse as soon as they get into the consulting room.

[/quote]

I used to think the same. But, after reading some veterinary ethics and physician agency stuff, I don't anymore. I think there is a point upto which we can collaborate with the owner to conetxtualise treatment to their satisfaction. After that point - and its up to the individual to draw his/her line in the sand - which animal welfare becomes compromised by a choice/s that the owner has/has not made that in order to uphold our oath etc that coercion becomes the only way of safeguarding the animal's interests. At the same time quite how they have endangered or suboptimally treated their pet - to whom they have moral and legal obligations - should be made quite clear, becasue, frankly, who else is going to do it? Clients that have done stupid things that have led to a young cat with a high grade murmur becoming pregnant would fall into that category for me, especially with an avowed uninterest in investigating any further. Are we really that scared of losing clients to compromise on the animal? It bemuses me.

[quote user="Evelyn Barbour-Hill"]

I'm sure it's likely to be examined if the owner knows the veterinary surgeon is going to launch a tirade of ill-informed abuse as soon as they get into the consulting room.

[/quote]

Hmm. Can you please point out where I recommended this chronologically-defined, "abuse". Such a constructive way of debating things, putting words in other peoples' posts.

[/quote]

You know very little about this case, unless you happen to have a great deal more information than the OP has given us. However on the strength of your imaginings and prejudices you are pleased to recommend that the veterinary surgeon should " Having the cat in the consult room, give the owners hell for being irresponsible tools".

Re: pregnant cat with heart murmur

David Mills — Tue, 18 Sep 2012 16:47:49 GMT

[quote user="Evelyn Barbour-Hill"]

Like what, exactly, would that be supposed to achieve?

...

The cat needs examining. I'm sure it's likely to be examined if the owner knows the veterinary surgeon is going to launch a tirade of ill-informed abuse as soon as they get into the consulting room.

[/quote]

[quote user="Evelyn Barbour-Hill"]

I'm sure it's likely to be examined if the owner knows the veterinary surgeon is going to launch a tirade of ill-informed abuse as soon as they get into the consulting room.

[/quote]

Hmm. Can you please point out where I recommended this chronologically-defined, "abuse". Such a constructive way of debating things, putting words in other peoples' posts.

Re: pregnant cat with heart murmur

Chris Geddes — Tue, 18 Sep 2012 16:05:28 GMT

Hi Catherine

Nothing is licensed for termination of pregnancy in cats. Alizin is used a lot - please speak to one of our vet advisors (01359 243 243) for protocols.

Not saying I would necessarily recommend in this case. I would imagine that abortion at this stage is safer than at-term parturition, but your call!

If cat gets through, an option for long term reproduction control is Suprelorin off-label - if you wanted to avoid surgery (which seems wise!) - you might want to discuss with vet advisor too.

Good luck.

Chris

Re: pregnant cat with heart murmur

Mike Martin — Tue, 18 Sep 2012 15:44:33 GMT

A loud murmur in a cat does not necessarily infer heart failure.

The most common cause of murmur in cats is outflow tract obstruction, typically secondary to HCM /HOCM. The murmur will be louder at faster heart rates. The rate in this case was 240/min . So maybe this cat's murmur is not half as loud when the heart is more normal. Additionally pregnancy may affect the loudness/intensity of a murmur. The majority of cats will live many years with mild to moderate HCM and not require treatment. But equally some do need treatment.

We, as vets, can only offer our advice, opinion and recommendations (or options). Ideally this cat does need a physical examination. A serum BNP (correctly obtained and sent to Idexx) is a good option. The undoubted best diagnostic test would be echo (in experienced hands).

If you were to berate this client for not following your recommendation.....then, if the cat has its kittens, and all ends in well, the owner sees no problem - then its you that would look like a 'fool' (so to speak) and thus also a lost client. However do do share everyone's concern, as there is an increase in respiratory effort. These are difficult situations.

Just some thoughts and ideas.

Re: pregnant cat with heart murmur

Martin Atkinson — Tue, 18 Sep 2012 15:02:35 GMT

Do a NTproBNP, if it's less than 270 chances are the cat will not have cardiac failure and will be fine. You can get it done for £31 from Idexx possibly less if you ask nicely! Clearly your hands are tied if the owner won't bring the cat in to be examined but if its that bad its going to go belly up anyway. I can't see the problem with giving Fortekor (or Vetmedin - it works well in cats) if it is indicated, pregnant or not, deformed or dead kittens are the least of its worries!

Re: pregnant cat with heart murmur

Evelyn Barbour-Hill — Tue, 18 Sep 2012 14:15:36 GMT

[quote user="David Mills"]give the owners hell for being irresponsible tools.[/quote]

Like what, exactly, would that be supposed to achieve?

And have they made bad choices repeatedly? According to the original post, just once they decided against further investigation and treatment, a decision they may have made for all sorts of reasons to which we are not privy. Then later on the cat got out...... maybe the owners are telling the truth and it wasn't their fault? You don't know and nor do I.

The cat needs examining. I'm sure it's likely to be examined if the owner knows the veterinary surgeon is going to launch a tirade of ill-informed abuse as soon as they get into the consulting room.

Re: pregnant cat with heart murmur

Hannah Wynne Richards — Tue, 18 Sep 2012 13:55:40 GMT

This time I'm in total agreement with both Michealand David

Wynne

PS Don't swoon from shock everybody

Re: pregnant cat with heart murmur

David Mills — Tue, 18 Sep 2012 13:47:36 GMT

Cat needs at least examining. If owners refuse then call the RSPCA. Having the cat in the consult room, give the owners hell for being irresponsible tools. In these situations, owners have effectively rescinded their choice-making options by making bad choices repeatedly. Poor cat.

High grade HMs are bad in cats, even worse in younger cats. There is a high probability of a genetic/hereditrary basis so having kittens is unethical.

I think you can use alizin in cats, but we normally would pregnant spay. The former would still mean going through labour. If the cat's in CHF then euthanasia is the only option. Don't let them leave the consult room without it, if they do then ring the RSCPA as they leave. If you wanted prevarication and muddling of the waters, ring RCVS first.

Re: pregnant cat with heart murmur

Rob Loxley — Tue, 18 Sep 2012 13:29:50 GMT

[quote user="Michael Woodhouse"]have a belly full of fluid from heart failure[/quote]

good point

Re: pregnant cat with heart murmur

CatherineThomas — Tue, 18 Sep 2012 13:28:29 GMT

Would cabergoline work? what doses would you use? is it safe with heart disease?

I know Alizin isn't licenced in cats but would it work the same as it does in dogs?

Are there any licensed alternatives to cause abortion in cats, I can't think of any?

I agree that we need to examine the cat but the owner wants to know what we can do if she does bring the cat in.