That’s our deaf cat Snowball, shown in better times. He had come to us a few years ago from a ghastly animal hoarder case, the conditions of which had made him chronically sick. Ever since he arrived we have treated him for stomatitis, an oral inflammation disease that is very difficult to overcome. He’s been on steroids, had his teeth removed, and yet his stomatitis would continue to flare up from time to time, leaving his gums bloody and painful. When this happened, he wouldn’t eat and he’d stop grooming himself because his mouth hurt. Our vets in Helena at Montana Veterinary Specialists came up with a special stomatitis drug "cocktail" to help treat this disease, and although it helped, he would still have relapses. It didn’t help that his immune system was suppressed. This left him vulnerable to every bug the other cats might bring into the cat house; things that would be sub-clinical in them would make him sick.
A couple of months ago he spent a week at the vet clinic after a particularly bad stomatitis flare-up. Even then, our vet Brenda Culver said Snowball would stick his paw out of the cage to try and tap people on the head as they walked by. And through all his problems — when he looked awful and felt awful — he continued to be a loving, purring, affectionate guy. When I’d walk into the cat house, he’d look at me and meow. This meant, "Thanks for showing up, now please feed me." Because he was missing all his teeth he ate canned food, so Snowball ate his meals in one of our medical cages to keep the other cats away.
A few weeks ago he started to go downhill again, while he was on the stomatitis cocktail. Frustrated, I had called Brenda to ask what else we could do. She said, "You don’t want to contemplate the alternative." We had discussed his quality of life many times, but we had always concluded that in the face of his enjoyment of eating, his affectionate ways, and his purring, that he still had a reasonably good quality of life.
But he continued to deteriorate, and he looked terrible. Alayne and I, as well as Jodie, talked about whether the time had come to let him go. Then last week, Snowball developed an upper respiratory infection, so I moved him to the isolation cottage and started treating him for that. (In a cat with a suppressed immune system, a simple URI can become deadly.) He hated the oral medication, Amoxicillin, and he was an ace at foaming up and then spitting out the pink fluid. Snowball’s face would be more pink than white after I finished dosing him.
Last weekend he stopped eating, and he became dehydrated. Even after I got the URI under control, he didn’t resume eating. I added fish oil to his food but he wasn’t tempted. I left the food out with him all night, and the next morning, the dish would be sitting there, untouched.
Was he telling us he was ready to go?
If you looked him, you would think so. He seemed miserable.
On Tuesday afternoon, I had finished giving him his medications and stayed to love him up. I figured by then that this would be his last week, and I wanted him to remember me as the guy who loved him, not as the guy who kept squirting medications down his throat. He had been morose, but as I scratched him, he quietly started to purr … and the little rumblings soon began to sound like an engine roaring to life. Then he arched his body, his way of telling me to scratch his back. I was leaning over him, scratching away, when he turned and reached forward to rub his head on my hat brim.
My heart stopped. I thought, this is not a cat who wants to die.
I called Brenda that evening and told her what was going on with Snowball, how he had continued to get worse, how he had stopped eating, and how we had been thinking it was time to euthanize him. But, I told her, "He’s still purring! How can we give up if he’s doing that?" I told her I was just worried that there might be something else going on with him … maybe it wasn’t his immune system, it wasn’t the stomatitis, maybe he was dealing with something we didn’t know about.
Too often we have treated an animal for one chronic disease, only to have them die of something totally different that we had never diagnosed … because the original disease masked the symptoms of the later disease. For example, my most favorite cat in the world, Hoedad — one I brought back to the U.S. from Sri Lanka many years ago — had chronic renal disease, which we treated for a couple of years. But he died, unexpectedly, of lymphoma. We never knew he had it until the very end. That has happened to us so often, and yet we sometimes forget.
And even if there wasn’t another disease at work, I wanted to give Snowball one last chance. We’d hook him up to IVs, Brenda was going to try an experimental viral drug, and we’d see if we could help him turn the corner. If not, at least we know we had tried everything. So that’s why I took Snowball into the clinic yesterday morning. It was going to be our last effort.
When Brenda called late yesterday with her initial report, I almost wanted to cry. Brenda said her husband, Britt Culver, our board-certified internal medicine specialist at the clinic, had found fluid in Snowball’s chest. That led him to do an echocardiogram of Snowball’s heart. He found Snowball was suffering from hypertrophic cardiomyopathy, in which the walls of the heart muscle become thickened and enlarged.
That would explain why he felt and looked so bad, and why he had stopped eating. Britt told me tonight that many congestive heart failure patients become anorexic.
Now, ordinarily, this would be a devastating diagnosis to get. But considering that cardiomyopathy is treatable in the short-term with heart medications — Britt has started Snowball on diuretics and beta-blockers — and considering that we were contemplating euthanasia, this was like someone tossing us a lifeline at the last possible moment.
Don’t get me wrong, there’s no false hope here. Snowball’s prognosis is not good … already having fluid in his chest is a poor indicator. But at least we know what we’re dealing with now, and we have a chance to make him feel better again — at least for a while. We’ll know in another 48 to 72 hours how well the heart medications are helping him.
The lesson we learned … again … is that in the face of chronic disease and a sudden downturn, we should always ask, "What else could be going on?"
Our goal now is to get Snowball to see another Rocky Mountain spring, so he can sit in the open window and soak in the sunshine and feel a warm breeze. Will he make it? I don’t know. But at least we have a better chance today than we did two days ago.
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