Phoebe-the-Cat came in last week with her left paw curled under her sleek black and white frame. It didn’t seem to hurt. It wasn’t orthopedically awry. Every bone and joint felt normal. When coaxed into action, she was unable to bear weight on the paw—it appeared to give way at the wrist. But when the technician picked her up off the floor she astutely noted that the afflicted paw was cooler than the other.
Sure enough, not only was it slightly cooler but the pads on this paw where paler than on her other paw’s pink digits. Interesting…
I immediately suspected something circulatory (duh!) but had never heard of a case where a blood clot had lodged in the front limb affecting just one paw. How very strange!
Cats with blood clots almost always present with an extremely painful condition called a saddle thrombus. In these cases a clot of blood, typically dislodged from the edges of infected, incompetent heart valves (endocarditis) flows downstream to clump at the base of the aorta. Because blood can’t flow normally past the clot the limbs get cold from lack of circulation and the resulting pain is excruciating.
Most of these cats are euthanized. It’s just too painful a condition for most cats to bear while they await the results of treatment (which is often unsuccessful). That, coupled with the need (usually) for uncertain treatment of the underlying heart disease leads most parents to euthanize their babies quickly.
Phoebe’s situation seemed similar in many ways but 1-she did not appear to be painful, just freaked out at the unfathomable lack of function (and probably the curious sensation) of her paw, 2-the affected area was really not that cold (the change was subtle), 3-she had no telltale heart murmur indicating valve disease, and 4-I`d never heard of such a thing. A clot all the way up there? With no history of trauma? How bizarre!
So I drag out the books and put a call in to the internist. No help from the huge tomes on our shelves or my quickie online research. The internist was on a house call (what kind of internist pays house calls?). That was almost stranger than my case.
About once a week our hospital sees a complicated case with mystifyingly bizarre disease manifestations like Phoebe’s. Predictably, we refer these patients to the appropriate specialist. Perhaps 25% of the time, though, their owners are loath to part company with us.
No matter how many times we explain, plead and cajole, they are firmly entrenched in their decision to confine their pet and his or her issues to our completely confounded attentions. What ensues is a lot of book openings and closings, online research in the Byzantine vet journals and numerous phone calls to the specialists they should be seeing instead of us.
Often it’s the money that keeps them in our hospital (specialists are notoriously expensive, as most of you well know). However most of the time it’s sheer stubbornness that keeps them planted firmly in our strip-mall clinic. This was the case with Phoebe’s mom: I trust you to figure it out, Doc. I know you’ll manage to cure her. (Clearly you have more faith in me than I have in myself.)
Eventually I managed to reach the internist. She was as stumped as we were (somehow that always makes me feel better). She had never read of a case of forelimb thrombosis in a cat. Nonetheless, she expressed confidence in the wiliness of feline physiology and its ability to yield results as peculiar as Phoebe’s apparent pathology.
Give her a baby aspirin every three days and see what happens. Okeedokee. And guess what? Phoebe was better the next day. And a little better the day after that. Miss Phoebe was on the mend. Who knows if the aspirin she’ll be on for months was the cause of her turnaround? But who cares? At this low dose she’s unlikely to experience many side effects. And she’s back to her usual self, sauntering around her house with her usual, I-own-this-place queenliness.
Stay tuned. I`ve got two more weird ones from this busy month’s selections coming up for this weekend’s posts.