The prognosis of a cat with hypertrophic cardiomyopathy (HCM) is highly variable. Some cats may develop only mild hypertrophy and suffer little compromise of heart function, while others progress to more severe disease.
Hypertrophic cardiomyopathy by BruceBlaus [CC-BY-3.0], via Wikimedia CommonsHCM may worsen quickly over a period of months, or it may progress slowly over several years. Its severity may not change for many years and then suddenly worsen. Some cats with HCM die very suddenly, even though they had no clinical signs of heart disease. It is the most common cause for spontaneous death in indoor cats.
A cat with mild to moderate disease may enjoy an essentially normal life for a number of years. However, the prognosis is much more guarded once the cat has more severe disease.
The risk of developing congestive heart failure is proportional to disease severity, which is often classified by measuring wall thicknesses and left atrial size. Although congestive heart failure can be treated medically, severe heart failure may become difficult to manage over time as the disease progresses.
The prognosis for a cat with heart failure, unfortunately, is guarded to poor. On average, survival for cats with HCM and heart failure is 12-18 months after diagnosis.
There are three basic causes for diabetes insipidus (DI): a defect in antidiuretic hormone (ADH); a defect in the kidney’s response to ADH; or psychogenic polydipsia.
The diagnosis of DI can be challenging. Tests include:
blood and urine tests – complete panels to rule out diabetes mellitus, kidney and liver disease
a water deprivation test and/or a modified water deprivation test to determine if the symptoms are caused by psychogenic polydipsia, a defect in ADH, or a defect in the kidney’s response to ADH (the animal must be properly hydrated, hospitalised, and screened for kidney disease prior to doing a water deprivation test)
A young cat in good condition with a history of coughing and mixed dyspnoea with increased abdominal effort on expiration is most likely to have feline asthma.
Although chest radiographs are necessary to confirm, harsh lung sounds in all fields and the absence of a heart murmur or gallop rhythm makes the diagnosis of asthma very likely.
A week before the December exams, I found myself making the five-hour train journey south to not-so-sunny Leicestershire for the first time since I left for uni in September.
This wasn’t because I couldn’t stand being away from the horses for a minute longer (though it was starting to get that way), but because I wanted to go back for the funeral of a family friend. These things happen, and I continued to revise for the exams while back at home.
For most of us at vet school, everything we’d done beforehand was aimed at getting in. Studying, sports, work experience. Most of us were good at what we did, going above and beyond our past classmates. To get into vet school, we were pretty much top of the class. To us, anything lower than an A was catastrophic. We had to be the best to have the chance of even getting an interview.
Now, with our first exams looming, for the first time, the possibility of failure had become a very real thing. The sheer amount of information we’ve been cramming into our heads since the start of term couldn’t possibly be remembered, could it? We’d heard the scare stories from the second years:
“Nobody passes all of the December exams.”
“You’re lucky if you get 40%.”
Here, we were on the level playing field of a whole new ball game. I think we’d all tried to mentally prepare ourselves for the worst over the coming week.
Was this just the start of the possibility of failure though? In practice, it is by no means always possible to cure the animal put in front of you. Whether that’s because it’s not possible to provide a diagnosis or treatment because we don’t know enough about the condition, because the disease process is too far along, or because of economical limitation, the fact remains the same. We will have to accept that we cannot do everything for every animal we are presented with in the coming years.
However, just because we may not succeed, we have not necessarily failed.
