A week ago Fluffy died after a life that lasted 3 times longer than veterinarians predicted it might. Until a few days before his death he was happy, comfortable, and affectionate. Although he was uncomfortable briefly at the end, he did not suffer fear or pain, as I had long been concerned he might.
When he was first diagnosed with NM, there was no data on how the previous 4 cats known to have the disease had died. Other cats suffering from a similar illness (hereditary myopathy in Devon Rex) died in the main from choking on their food. The veterinarians who diagnosed him suggested, and for many years I feared, this could be how Fluffy would take his leave. Knowing the alarm this sort of death would cause him, I dreaded that eventuality.
Sad as I am to say goodbye to my dear friend, I am happy to report that it was nothing so panic-provoking that took his life.
Years ago, Fluffy's heart was examined for weakness due to an excessively high heart rate. (His pulse leapt by 80 beats a minute from walking about 10 feet.)
His heart proved to be healthy, but as the surrounding affected muscles lost tone and became weaker, the strain on that muscle increased. His vet, Janice Crook of Mosquito Creek Veterinary in North Vancouver, B.C., suggested putting him on Cardio Plus (now called Feline Cardiac Support) by Standard Process. This nutraceutical* supports and strengthen the heart. In the years that he was on it his cardiac related bloodwork dramatically improved. It seems clear that he lived considerably longer due to a daily concoction of 1 crushed pill in a puddle of raw liver. (Yum!) (He was also taking 2 Hepatic Formula--liver-supporting nutraceuticals--after a few years, when his liver began to show strain, as well.)**
In the end, after nearly ten years, the work required of this small muscle became too much. Over a period of a few days his appetite decreased dramatically and he began showing signs of malaise. Most surprisingly, he was not purring (except occasionally when visited by friends, such as Janice Crook, DVM, and Bree from upstairs) and he did not want to lie in his favourite position, cradled baby-style in my arms. This second seemed suddenly to cause an increased workload for his heart, or perhaps his lungs. His breathing became slightly laboured at this time.
Bloodwork and urinalysis showed him to be in excellent health except for a somewhat stressed heart. (Nevertheless, his cardiac blood values were three times better than when first tested.) A physical exam revealed a galloping heartbeat. He was in heart failure.
At this stage we were faced with a limited number of options.
We could fuss over him, taking his blood pressure (which would require shaving his arm and annoying him greatly, knowing his perspective on such things), doing a heart ultrasound, and so on, but Janice and I agreed that these would be of no real use--expensive, distressing, and in the end providing interesting information, perhaps, but not affecting the actual course of treatment.
We could accept that his time had come and euthanize him, or allow him to end his days naturally. (There are those who argue that the right thing to do is always to allow an animal to die naturally, others who always intervene. And there are those who watch and see and try to decide what makes sense in each changing situation. Janice's advice to me years before was that when her animals begin to have 50-50 good and bad days she starts thinking about euthanasia. Fluffy skipped that step and went straight to 100% lousy.)
Or we could try the one medicine she knew of that might help. Vetmedin could perhaps assist his heart to contract strongly enough to allow a comfortable continuation of his life. The drug itself, she said, didn't have the unwelcome side effects of earlier heart medicines. Most cats in heart failure tended to have tough, thickened hearts. This medicine works better with thinned hearts. (Remember, I was grieving as all this information flowed around me. I am giving you a dumbed down version because it's all I could take in.) In Janice's opinion it seemed likely this was the condition of Fluffy's heart, and that he might respond well to the medicine.
I decided to try the Vetmedin. She said he would feel better in a day or two if it was going to help. He was somewhat revived the next day--purring some and cleaning himself and eating more--but the following day he was depressed and uncomfortable again. That day I called his pals to come say goodbye, and we took him to Janice the following day for a last exam and euthanasia.
I have not written as much in this blog as I had initially intended to. Knowing how very few cats have this disease, I didn't worry too much about getting the information out. But I think there is something to learn from the course of Fluffy's illness and the different steps we took to assist him in living well for the time he had.
In support of his heart, I made a daily practice of seeing that he exercised.
In the early days I took the physiotherapist's advice and turned myself inside out trying to get him to stand on his hind legs and walk around, and drove us both crazy bothering him to do so. Also on her advice I tickled his hind legs and spine to stimulate them, ran a vibrating toothbrush over his body (again to stimulate the muscles to contract), and generally made him feel like running and screaming (well...) every time I came near. In the end I didn't feel convinced this was helping, though perhaps it was, but the stress it all created in him, and therefore in me, the perpetrator, seemed not to be worth the hypothetical gain.
Over time I instead taught him to hop up onto my shoulder to be carried around, and would not take him outside or allow him out on his own until he hopped up. This was to keep his hind legs exercised, and because he had a natural inclination to hop up, anyway, he took to this habit well (with the need for mild encouragement nevertheless still often in place). I learned various ways to encourage him to hop up when he wanted me to lift him. One thing that made it easier for him was to settle him on the floor so that he was balanced over his four legs, rather than flopped over on one side. Or to lift his head slightly so that it suggested an upward movement. To tap my shoulder and say, "Up, up, up!" enthusiastically. And so on.
The other main element of his exercise program was to take him to the end of the yard and plop him down and leave him to make his way home. I put him out a couple of times a day for exercise and personal hygiene purposes.
These two practices were much more natural and pleasant for us both than trying to get him to play when he was tired of it or walk when he had nowhere interesting to go. (With NM walking is better exercise than running because different muscle groups are involved in each, and it is the short muscles used in walking that are affected by the disease and therefore in need of assistance.)
The combination of attention to diet (more on that in a future posting), exercise, water intake and crystal buildup (more later), stress reduction, and the use of nutraceuticals had the effect of lengthening his life by many years. (His first brush with death came when he was 8 months old; the weakness of his system was alerting us to its presence for the first time. At that time the examining veterinarian said, when pressed, that there was clearly something very wrong with him, though she had no idea what, and that if he were her cat, she would put him down.)
Giving Fluffy a long, healthy life was done without a lot of expense, but with a great deal of attention to detail, particularly as he aged. Far from being a burden, this requirement to pay attention led to an increase in affection and calm in all parts of my life, and to a greatly rewarding friendship with a self-assured and contented cat. It also encouraged me to to face issues of death and disability in a direct way. Who could complain about any of that?
Thanks, Fluffy. You are truly missed. Yet more than anything I am grateful for the opportunity to know you.
Cheers, kiddo.
*nutraceuticals are extracts of foods demonstrated to have had a physiological benefit or provide protection against a chronic disease. (See American Nutraceutical Association.)
**see Feline Instincts' Twelve Year Study on Additional Feline Organ Support
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