I think that the majority of patients we see at AMCOP seem to know the importance of the annual exam. They seem pretty good about coming in for their yearly checkup. I imagine that for every one we see there are two or three who don’t come in unless their pet is sick.
Cats are particularly remiss in their annual visits. I think (and I’m pretty sure the statistics back it up) that we only see a small fraction of the cats out there. They live their little cat lives, going years between visits. Which is ok, as long as the cat is healthy, but how do you know? They sleep all the time. Would you notice if the cat starts sleeping 20 hours a day instead of 19?
Part of me feels a little guilty when the cat people actually bring their cat in yearly and I don’t find anything wrong with it, year after year. Am I just taking their money?
But then after all those years of uneventful exams, I start to notice subtle changes. The cat has been losing weight, there is a certain satisfaction in flipping through the chart, page after page to asses the cat’s previous weight, heart rates etc and noticing a trend. I think weight loss in cats is a huge early indicator of disease. Will you notice a half pound weight loss in your cat over a year? How bout half a pound a year over two years? Three? Suddenly the cat has lost a quarter of its body weight over three years, would you notice that?
It’s really nice to catch the insidious diseases like chronic kidney disease, or hyperthyroidism early so that we can have more viable options to manage them. End stage kidneys or advanced heart disease secondary to a raging metabolism arent’ so fun.
OK, enough with the doom and gloom, this is supposed to be a happy story. I saw a cat a few weeks ago named Nieve. She’s this really cool super sweet white cat with mismatched eyes. She has been my patient for two or three years now. I was chatting with the owner and listening to the cats heart when I suddenly had to stop short: the cats heart rate was all over the place.
Was she purring? I removed the stethoscope and just listened. Nope no purr.
Flip through the chart: anything cardiac in her past? Nope.
Her heart beat sounded like a purr but it wasn’t. In my mind, I’m thinking “what the heck” (only in not so nice words). My mouth informs the owner that I hear an irregular heart beat and need to do an ECG to evaluate the flow of electricity through the heart.
We run the ECG and she has atrial fibrillation. I have a vague recollection of a-fib from some ER episodes and vet school. I have rarely seen it in real life and never in a cat.
I inform the owner and double-check: “has she been acting normal?”
“Yep” says the owner.
So the electricity isn’t flowing through Nieve’s heart normally. Since I’ve never seen this and hearts aren’t something you should muck around with too much if you’re unsure of things (especially when it’s an electrical problem), I referred her to Dr. Nitsche, our local boarded Internist for a look-see.
He reported to me that Nieve had no structural heart disease. Meaning he did an echocardiogram of her heart (an ultrasound to see the insides) and she was normal. I suffered another episode of “what the heck” (again, only not so nice).
Seems to me that if a cat heart is diseased enough to have that degree of electrical problem, you should see something on ultrasound. According to Dr. Nitsche, this just randomly happens to some people and cats. Cats are fortunate enough to not suffer strokes as a result of this like people do.
His exact words were: “If you are a cat and you want to pick an arrhythmia, then this about the best one you can pick”. Well, maybe not exactly, but he said something along those lines. You know me and my memory. Anyhow, with treatment, she should live a pretty normal life (aside from having to take pills for the rest of it). Without treatment, she could progress into heart failure as the arrhythmia makes her heart beat too fast and the muscle will wear out.
He put her on a calcium channel blocker (that I avoid using unless a specialist tells me to because I so rarely have reason to use it) called Diltiazem.
Lo and behold, this cat that was acting normal before is suddenly running around, eating better and seems to feel better than she has in a long time. Only they didn’t know she didn’t feel well because it happened gradually and was viewed as “normal”.
So I’m happy to do those boring “normal” annual exams so that every now and then I can uncover something fixable.
Because that’s what it’s all about.