Summary:
I lost my sweet cat Nugget on September 25. After surviving saddle thrombus in July, he was thriving with meds and care, plus he was the happiest boy, but he had a recurrence. While recovering at the vet, about 3.5 hours later he experienced another clot that went into his lungs. My husband, daughter, and I were able to be with him as he passed. It doesn't seem right that the world keeps turning when there is a Nugget-sized hole in my heart.
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| My sweet, sweet baby |
Details:
In July I wrote: "Nugget had saddle thrombus, a serious condition that only about 10% of afflicted cats survive. We are so thankful that he recovered, but I am terrified of reoccurrence. We are doing everything we can to rehabilitate him to regain full use of his hind legs and to treat his heart issues. He now takes 3 medications and 2 were easy to give from the start but learning to get the other one in him was quite an adventure that took me several days to master! He has progressed greatly in the 3 weeks since the acute episode and we have seen little milestones almost daily."
My fear of reoccurrence was based on the high probability of it in cats with his genetic heart condition, hypertrophic cardiomyopathy (HCM). I became an expert on saddle thrombus and HCM: I read veterinary journals and every website I could find online, talked to 8 vets, joined online groups, and listened to vet tech podcasts. One thing I consistently learned was how unpredictable both HCM and saddle thrombus are; some cats would have a second clot within a few hours of their first, others would live weeks, months, and sometimes years. Some cats would go into heart failure relatively soon and others would do well on meds for years. Even though I knew that many cats went from doing great to passing within moments, I was cautiously optimistic because Nugget was doing so well and he was only 5.5 years old. However, I made sure to treasure every day with him because the next was never guaranteed. He had always been spoiled, but in his final 10.5 weeks he was extremely catered to.
I threw myself into his care. I figured out how to get him to take his Clopidogrel, a very bitter pill (the secret was putting it inside a tiny chicken flavored gel capsule). Aside from a couple of days in the beginning when I had to try about 20 ways to effectively administer it, he never missed a dose. He took his Enalapril and baby aspirin easily from the first doses, and lapped up his multi-vitamin and Nattokinase supplements like they were crack. I did progressively more difficult physical therapy exercises with him and his hind legs, which had been temporarily paralyzed, responded well. I also purchased a pet laser to speed healing and nerve regeneration in his legs. I got up extra early so we could do therapy before my runs. We did another round before I left for work, then after work I did another set of therapy, aimed to give his medication at 6:00 p.m. on the dot, and did therapy a final time before bed. Jon did therapy with him 1-2 times a day while I was at work; we worked very hard to help him regain the ability to walk normally and he progressed steadily and was almost back to 100% when he passed. I measured his resting respiratory rate often and was thrilled that after starting on his heart meds it stayed in the low 20s (30+ is cause for concern).
He learned our rehab routines and he was always ready to work with me and practice walking with good form when he heard me get up in the morning or come home. He continued the other things we always did together, including sleeping by my legs or feet most every night and "helping" me with pre-run activation exercises (mostly consisting of rubbing against me and smelling my running shoes that I was getting ready to put on). He was always by the side of one of us; he loved to snuggle Jon and Albani and to just be with all of us.
Nugget and I always had a strong bond, but during his rehab it got even stronger. I was determined to do everything for him and I felt like he trusted me to take care of him. His ears perked up when he heard me come home. I'm sure all of the lickable treats helped him love those times! I never slept soundly after his first clot because I was always checking on him, as if I could keep him safe that way. It was stressful because I was always worried about him and relieved each time I saw him in a normal state.
He was always a very happy boy, but after recovering from his first clot he seemed even happier. Perhaps he knew what a miracle he was and wanted to take advantage of every day. Maybe it is because he was even more spoiled than before! Like all of us do, he may have developed a new appreciation for feeling good after a bout of feeling sub-par.
After losing him, I continue to look for him in his spots. The corner of our bedroom, by the sliding glass door, by my exercise ball, in the random boxes we gave him, by the barstool Albani sets her backpack by, on any new item set on the floor. Then I realize he isn't there and my heart breaks all over again. It all feels like a nightmare and I feel like I'm walking through haze.
I don't want to forgot his ways. I don't want to forget his cute little noises that Albani dubbed "alien noises", the way he ate lickables like they were crack, the way he pawed at the sliding glass door when he wanted to go outside, his passionate purrs, his sweet head tilts, the way I could always tell if it was him or Bandit eating, drinking, walking, or in the litter boxes by their different noises.
I want to remember:
- He was the best snuggler. He loved to be right next to us on the couches and up against our legs in bed. Some evenings Jon spends several hours on the living room loveseat, and Nugget would snuggle up against him the whole time.
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| Snuggle bug |
- He slept with us often. During his last few months when he couldn't jump, we put our chaise lounge up against our high bed so he could climb up and down. I usually brought him to bed when I went to bed and he'd stay until I got up unless he saw a bug, got hungry, or left to use the bathroom.
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| He looked good on our comforter |
- He purred so much! The moment you pet him he started purring with enthusiasm. Only 30 hours after his first saddle thrombus he began purring again, which I took a video of because I was scared to death that might be the last time he purred (link below).
- He loved helping me get ready to run, including rolling around with my smelly running shoes.
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| 4:45 a.m. doesn't have good lighting |
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| These shoes were almost to 1000 miles & stunk |
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| The best way to do clamshells |
- He always seemed happy. Our other cat Bandit has his moments of anger, but Nugget never did. The only times he seemed unhappy his whole life was when he had health issues (aside from his two clot episodes he had a UTI and something that the vet couldn't diagnose that responded well to antibiotics).
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| Smiling in his sleep |
- He was quite the hunter! Even after his first clot he caught mice often when he went outside. He also loved to hunt little frogs and bugs. I have several photos of him with mice he caught recently but I'll forgo posting them since they involve dead mice.
- He and Bandit loved to wrestle. They wrestled almost every evening around 7:00 p.m. After Nugget had his first clot we learned that he must have been the primary initiator because they didn't wrestle for 6+ weeks as he worked to regain his full ability to walk. When they started again we felt like it was a huge milestone!
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| Nightly wrestle mania |
- He loved lickable treats and ate them in such a cute way, lapping them up. In general Bandit is much more food-motivated than Nugget was, but Nugget went much crazier for the lickables. I used them to give his medications and to motivate him during therapy.
- He also loved gravy! Bandit loves it too and we would give them wet food in gravy for treats. Nugget would lick the gravy off his and leave the remaining meat for Bandit.
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| A week or so after his first clot when he was relearning to stand |
- He loved going outside. He'd ask by pawing at the sliding glass door if the cat door wasn't open. Sometimes he'd forget how to use the cat door when it was open and would still paw at the glass door. Him forgetting how to go out and come in was a running joke in our family.
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| A recent outdoor shot |
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| Waiting for the cat door to be opened |
- He loved helping Jon and Albani in the garden. He liked riding on the little cart they use for produce. While he was relearning to walk after his first clot, I took him on a lot of walks in that cart because he loved being outside and looking around. I'm sure the neighbors were talking about me pulling my cat around, in addition to the cat playhouse we got to allow him to be outside without constant supervision!
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| He loved these rides |
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| Always helping |
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| In his playhouse with Bandit watching |
- He loved being near us. Some cats only want attention on their own terms, but Nugget always wanted it. He would always be in the room with us.
- He was so tolerant and trusted anything we did. Once when Albani was young she made a bed for him with several pillows and toys, then tucked him in with a towel, and he slept that way for hours for her. He was fine with his therapy exercises and cold laser treatments (Bandit would not be so cooperative).
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| Cat bed by Albani |
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| Loving on me during cold laser treatment |
- He never once missed his litter box. When he was recovering from his first clot he didn't move around much for about 30 hours. I put down puppy pads with a blanket over them for him to lay on and fully expected he would have accidents. Once he started moving around the first thing he did was rush to his litter box. He was so tidy. When he used the litter box he spent a long time covering it up - some would say using excessive digging. I could always tell by sound which cat was in the box!
- He helped Jon work every day. Jon works from home and Nugget would almost always join him, which I was jealous of!
- A huge blessing was that Jon was home when Nugget had both his episodes. I was out of town when he had the first and at work when he had the second. I'm thankful Jon was able to get him to the vet immediately both times; even though the emergency vet wouldn't treat him the first time, they did give us pain medication which was very important.
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| Helping Jon pack |
- He had his special spots he loved to sleep: a corner of our room, a spot near my exercise ball, under a barstool by where Albani puts her backpack on the ground, at the foot of the stairs, in Jon's spot on the living room loveseat, and on our bed. After his first clot I always found him immediately when I got home from anywhere and right after I woke up every morning. He was almost always in one of these spots, but occasionally would go upstairs to Albani's bedroom.
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| One of the prime spots |
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| Another favorite location |
- Bandit gets ready with me in our bathroom every morning, and Nugget joined us sometimes. I loved when I had both of them in there with me at 4:45 a.m.!
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| The best way to get ready to run |
- When Albani would blow him kisses he would "dodge" them. It was adorable!
- He had a special bond with Albani. We had to introduce Nugget to Bandit very slowly (Bandit is very territorial), and during that time Nugget and Albani spent a lot of time together shut in the master bedroom.
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| We have a 16 x 20 print of this hanging up |
- Bandit is grumpy sometimes, and Nugget was always oblivious to it. Bandit could be hissing and Nugget would just walk happily by.
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| Bandit guarding the house |
- Nugget had a cat tree that he loved to attack a couple of times each day. He was back at it less than 2 days after his first clot. I'd set up a bunch of toys on the second tier and he loved knocking them all down.
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| Well-used cat tree + toys |
- He was a fighter. He had a lot of health problems during his life due to genetic issues; aside from HCM he was also born with hip dysplasia. I know he would have fought and survived his third clot if there was any way he could have.
- He loved boxes. Anytime we had a box to throw away we'd put it on the floor and let him sleep in it and tear it up first. His joy was worth picking up all of the little cardboard pieces he tore off.
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| Mmmmm, cardboard |
- If I left a dresser drawer open he liked to climb in, and this seemed to mostly happen with my running shorts drawer. He also learned how to open our lazy susan cabinet in the kitchen and walk right in.
- He wanted to make friends with everyone. We live in a rural area with some wildlife around. He was a little too friendly with the skunks, and was sprayed twice. He didn't love the resultant bath with baking soda and Dawn, but he didn't learn not to play with skunks.
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| He cared for a stray kitten we fostered |
- He loved to bite things. Often we'd turn around to see him gnawing at a kitchen chair or barstool. What used to be annoying are now treasured teeth marks.
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| Biting on our bucket gardening system |
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| He chewed off the back of these shoes |
- Of his many toys, he loved strings the most. I wish I had a video of him playing with a string. He loved attacking them over and over! During rehab I'd often have Albani play with him with a string while I did flexion and extension exercises with and massage of his hind legs.
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| Not his favorite string, but he liked this toy too |
- He had the cutest high-pitched meows and sounds that he used to talk to us. It was clear that he meowed to communicate with us.
- He would lay on anything new the came into the house.
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| This sign contained Boston smells |
In sum, Nugget was one of the sweetest cats to ever walk the earth! My world is now dimmer because of how much he brightened it. I knew it would be really painful when we lost him, but it was worse than I anticipated. Something about the love for a pet is unmatched, maybe because they love so unconditionally, bring comfort, and just feel like home. They aren't brought down by the things in life that often weigh on humans, and are always there to cheer us up after a bad day. Pets can really become part of us.
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| Little Nugget |
It is so hard when you do everything you can and it's not enough. There are a lot of running parallels here - in fact, perhaps my whole running career! I have given my all for many specific pursuits (PRs, OTQ, wins, records) and more often than not it hasn't been enough. In both cases, trying and failing was surely better than never starting the journey, but with losing Nugget, my best not being enough was a million times more painful than missing a running achievement.
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| Happy St. Pats! |
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| Chiefs cheerleader |
I also wanted to put links to videos of him in one place, so here they are, in no particular order:
Bandit & Nugget 1
I wasn't sure about including this part, and you might want to stop reading here. I don't want to remember it but I also can't forget and writing it felt therapeutic. The story of Nugget's last day and my continued questions:
On Wednesday, September 25 Jon called me around 11:30 a.m. I knew something bad had happened because that's the only reason he'd call me at work. He said something was wrong with Nugget; he'd lost use of his hind legs and was repeatedly vomiting, and I burst into tears. We suspected another clot, and from becoming an expert on saddle thrombus and HCM, I knew his chances of surviving another clot were extremely slim. I told Jon that I'd call the vet and merge the calls so we could both talk to them.
The vet's receptionist told us she knew the vet would want to see Nugget and that we could bring him in immediately. I told Jon I'd meet him at the vet's and ran out of work (I called and cancel my next appointment on the drive). I was terrified Nugget wouldn't survive the drive to the vet's and that I'd never see him again, so I was relieved when I arrived and got to immediately meet Jon and Nugget in the exam room. Nugget had lost use of his hind legs, but his breathing was normal and was doing better than during his first episode per Jon.
The vet confirmed that he had another saddle thrombus, gave him strong pain medication, and said he would put him on an IV with some Heparin. I knew this was a standard course of treatment and while the success rate is not high there are no better options so we moved forward with trying. Doing something felt better than doing nothing. I confirmed that he wasn't in pain or suffering, and the vet assured us that the pain medication was effective.
Nugget had to be sedated to get the IV in, and once it was set we got to see him again. His breathing was normal and he was sleepy. We stayed with him for awhile and I wanted to stay with him all day because I was so afraid we would lose him, but we were really intruding on the vet and his other appointments (they were very gracious to give us time with him both at this point and later; I doubt my sobbing was good for business). Nugget appeared calm and the vet recommended keeping him overnight to ensure the clot broke up, and I knew that cats are usually hospitalized at least 48 hours and up to a week after surviving an acute episode. They told me I could call as many times as I wanted to check on him, we could visit him during business hours, and that they would call me if his condition worsened. I think we left around 1:30.
I called at 2:45 and they reported he was stable and resting well. I told them I was going to bring Albani by to visit him in about an hour; I was still very concerned he wouldn't make it and wanted her to be able to see him again. We were on our way there right after she got off the bus, by 3:25. Around 3:30 a call from the vet came in and my heart dropped because they'd said they'd call if he was declining. The vet said he suspected Nugget had thrown another clot to his lungs because he'd started coughing up blood (from my research I also knew that multiple clots in a row are common). I told him we were already on our way and would be there in 10 minutes. I called Jon and told him to come too. The rest of that drive seemed to take so long and I was terrified he would pass without us there.
When we arrived he was on oxygen and laying calmly. Albani and I were both able to talk to him and pet him. Jon arrived shortly after and was able to do the same. Albani asked the vet if there was still a chance, and he said "a very small chance". I kept telling Nugget that we loved him, that he was the best baby, and that we were there with him. I gave Albani the option of leaving if it was too upsetting but she wanted to stay with him. Seeing him pass was traumatic but I didn't want him to be without us in a strange place. I hope he knew that we were with him and wasn't scared. I was thankful that he didn't struggle or seem in pain, but gradually stopped breathing. Jon was petting him and trying to give him some chest compressions, and the vet probably knew it wouldn't help but let us do what we needed to do.
I have questioned everything about the decisions I made for his treatment and if I should have done something differently. I also wish I hadn’t left the vet’s at all that day; I should have insisted on staying until the end of business hours. I hate that Nugget was without us for a couple of hours in a strange place where he’d only been before when he didn’t feel well. I hope he knew that he was there to get better then come home. I hope he knew that I didn't want to leave him there. I hope he didn’t feel abandoned and alone, and I hope he knew that we were with him at the end. I definitely see why people do planned euthanasia at home and if I ever have to make that difficult choice I would do it that way.
He was on Clopidogrel and baby aspirin to prevent another clot, but it didn't work to prevent these (maybe it prevented other clots before this). I read one veterinary article about combining Clopidogrel and Rivaroxaban (Plavix and Xarelto), and wonder if we should have pushed for those instead since they act on two different mechanisms of clotting. I asked the vet about them and he said that he doesn’t recommend changing a cat’s meds when the cat is doing really well, which Nugget was until he wasn’t.
He was on Enalapril for HCM and while that helped his respiratory rate, it wasn't expected to directly prevent a clot, though indirectly it could by improving his heart condition. He took a multivitamin and Nattokinase supplement, which has been effective in cats with saddle thrombus. I was so particular about his meds and gave the Clopidogrel and Enalapril at the exact same time every evening. He had his 1/2 baby aspirin every 3 days in the morning.
There is some not-yet-published research out of the United Kingdom on using the supplements Nattokinase and Rutin to dissolve clots in cats, but it takes 60 pills total of the current commercially available human supplements. I had these pills on hand and planned to try this if he had a clot when his vet wasn't open because the one emergency vet in our town said they wouldn't do anything besides put him to sleep when he had his first clot (we also have pain meds on hand). I keep thinking I should have tried to feed him the contents of those 60 gel caps; at least I'd have known I'd have tried everything. The rational part of me knows that it is unlikely I could have gotten much of anything down him or kept it in, since cats won't eat when they are unwell and he'd already thrown up multiple times, but I just wish I'd have tried. He took Nattokinase as a supplement very easily under normal circumstances (the gel caps can be opened and the powder mixed into food, and cats tend to like the taste).
I also wonder if we should have tried to let him pass the second clot on his own like he did with his first; did the IV somehow push out the third clot? But time was of the essence and I knew the faster we got the second clot broken up the more chance he'd have to survive and to continue walking. Every veterinary article will tell you to get immediate treatment; the only reason we didn't the first time is because the only vet open wouldn't provide it, no other vets open on Sundays has means to treat him, and the clot had broken up by the time we had care options on Monday morning.
There are so many other things: Should I have taken him to OSU or Mizzu for more specialized assessment and treatment? He hated riding in the car and we were happy with our local cat specialist, and from my research I'd learned that even with more sophisticated testing, recommendations were usually the same (veterinary science is not anywhere near up to par with human medicine). They are currently running genetic tests to see why Clopidogrel prevents some clots in some cats better than others, so some day they might be able to test to see whether or not Clopidogrel will be a life-saving medication for a specific cat. Should I have given him higher doses of Nattokinase daily? Should I have tried to get him into a clinical trial for some of the new meds for heart cats? They are testing Rapamycin to reverse heart disease, but that would have required monthly trips of 5-9 hours of driving and I was scared that stress would be too hard on his heart, so I didn't check to see if he qualified. Should I have talked to more local vets (he saw 3, I talked to 5 others)? I know this is not productive thinking but it's hard not to wonder if I could have changed the outcome somehow.
I read an article that stated that cats with both HCM and saddle thrombus survive an average of 77 days after saddle thrombus (cats without HCM live longer after saddle thrombus), but I kept focusing on the few cats in the groups I was in who'd survived months or years after their thrombus (I do not know whether or not they had HCM or any other conditions). I was terrified of reoccurrence but also couldn't believe that Nugget would have one because he was doing so well. Nugget lived 74 days after his first one. I am so very thankful we had that time with him, and I treasured every moment with him because I knew we might not have him for much longer. I am thankful that he was happy and lived his normal life during that time. I appreciated each day with him and never left the house without giving him love and telling him goodbye. I also told Jon multiple times that I wanted to quit my job and stay home with the cats! Even years more with him wouldn't have been enough, and it's so hard to understand why he couldn't stay with us. I hope that we are reunited with our pets in Heaven, but it's not something we know for certain; I do know that God created animals for a purpose and cares for them. I know He cares for me too, and in times like these that is likely the best thing to focus on.
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| A friend shared this with me |
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