HYPERTROPHIC CARDIOMYOPATHY

I decided to take Sasabe and Tamerlane in for a routine checkup on April 2, 2005.  Sasabe had turned eight in March and Tamerlane was going to turn eight in May, so it seemed like a good idea.  Neither cat had any history of health problems and neither was showing any symptoms.

We were alarmed when, upon Sasabe's exam, the vet picked up a heart murmur.  The first suspect was hyperthyroidism, which commonly causes heart murmurs in cats.  We had planned to do bloodwork on both cats anyway, so we waited for the results before we decided on our next step.

When the results came, everyone was confused:  Sasabe's thyroid was fine, and Tamerlane was hyperthyroid.  Thinking the lab had switched the results, we re-tested Sasabe.  They hadn't switched the results.  Tamerlane started thyroid medication and we scheduled an ultrasound for Sasabe.

The ultrasound gave us the one diagnosis we were hoping to avoid:  hypertrophic cardiomyopathy (aka enlarged heart).  This is a serious condition that can cause sudden death - - in humans as well as in animals.  Some cats, however, live for years before serious problems develop, so we hoped that would be the case for Sasabe.

The ultrasound showed that only the septum of her heart was enlarged.  We started her on Atenolol, a beta blocker, to help prevent arrhythmia, and a small dose of baby aspirin, to help prevent blood clots.

On October 30, 2006, a second ultrasound showed that her heart condition was so mild she didn't need to be on medication.  Ordinarily, we would have been overjoyed by this news, but there was a bigger problem (see below).

BRAIN TUMOR

Sasabe seemed to be a bit withdrawn for a couple of days, so we scheduled an appointment for October 20 to make sure her heart wasn't getting worse.  Two days before the appointment, she threw up a couple of times, then seemed to return to normal.  We kept the appointment anyway and had bloodwork run, just in case.  It was normal.

On the morning of October 24, 2006, I was getting ready for work when I noticed Sasabe stalking Andromeda relentlessly.  That was odd, since Sasabe had never been aggressive with the other cats.  A few minutes later, she stalked Orion, then later, Solentiname.  This was kind of amusing at first -- as though she'd suddenly decided to smack around everyone who had annoyed her over the years.

When we got home from work that evening, she began stalking the other cats again and also proceeded to stalk MacKenzie, our dog who comes inside.  In addition to this unusual behavior, she had an odd, glazed look in her eyes -- almost as though she were drugged.  We began to get concerned, but since nothing else seemed amiss, decided to wait it out.

The next day, the strangeness continued.  The vet speculated that it might be behavioral and advised us to watch her.  The day after that, in addition to the stalking, she began to show some physical problems:  she quit going upstairs, had trouble jumping onto the furniture, and accidentally kicked objects in her path.  She also attempted to jump into the bathtub when the water was running.  Oddly, she began sitting in Chris's lap and allowing him to pet her, which she'd never done before.  We feared she'd had a stroke and scheduled another appointment for October 27.

Her vet agreed that a stroke caused by a blood clot in her brain was a likely possibility, given her heart condition.  The best option was to wait things out and see whether she improved over time, so that's what we determined to do.  The vet advised us to pay a visit to the neurologist if things got worse.

Unfortunately, things did get worse.  She quit eating, so we started syringe-feeding her.  She got more unsteady on her feet.  The behavior peculiarities increased.  When the neurologist was available on Monday the 30th, we took her in.

A second ultrasound showed that her heart was not the problem -- in fact, it had very minor damage.  Tests of her spinal fluid showed no signs of infection.  A CT, however, revealed a tumor in the olfactory region of her brain.  I'd had "What if it's a brain tumor?" in the back of my mind from the start, since that's the classic thing to be afraid of.  I was very saddened to know that this time, my seemingly overblown fear was quite warranted.

The neurologist explained that her best chance of survival was surgery followed by radiation.  That option, apart from being extremely expensive, would have required daily trips to the vet and anesthesia for a period of two weeks, which we agreed would make her life miserable.  There was no guarantee it would buy her any significant time, either, let alone cure the condition.  He also explained that fluid buildup around the tumor, rather than the tumor itself, was causing most of the symptoms.  We opted to try her on prednisone to reduce the fluid buildup, and schedule an appointment with an oncologist to find out whether chemotherapy might be an option.

The prednisone was like a miracle!  The next day she was back to her old self, and the day after that, she even started eating again.  The neurologist had feared that the tumor had destroyed her sense of smell, so that was great news.  She quit stalking the other cats and the dog, ran around and played, came running when I cooked fish for some rehab turtles, and jumped on the bed at night and stomped all over me, like usual.  We were overjoyed, to say the least, to have our Sasabe back (even if she wouldn't sit in Chris's lap anymore).  We waited patiently for her oncology appointment.

Unfortunately, the miracle caused by the prednisone didn't last long.  On the evening of Thursday, November 9, all her symptoms returned.  I felt like I'd been kicked in the stomach.  We were really hoping for some significant time with her.  We increased her dose of prednisone to the maximum and began syringe-feeding her while we waited for it to take effect, but it never did.  Instead, her symptoms worsened.  By the morning of the 11th, it was apparent that it nothing we could do was going to help her, and for the first time since her symptoms started, she looked distressed.  We let her go peacefully.  She was nine and a half years old.

I miss her terribly and can't help thinking that this seems particularly unfair.  It happened so fast, too, that we didn't have time to accept her condition and its inevitable outcome.  I'm so glad we had those eight wonderful days with her thanks to the prednisone, though.  I wouldn't trade those for anything.