Matters of the Heart

I am a fixer. Ask anybody that knows me well and they will confirm this. It doesn’t matter the problem, I will try to fix it. I was on my clinical rotations at Purdue University in 2003 when I ran into Milo, a scrawny little kitten. He had been left on the steps of the teaching hospital overnight. We brought him in and checked him over. We found that he had an abnormal heart sound and sent him over to the Cardiology service for evaluation. An echocardiogram (ultrasound of the heart) showed that he had a severe birth defect of his heart. He was too small to correct it. So the student that adopted him had to medicate him every day to protect his heart. The head of the department signed off on Milo as a teaching case and his medications and later procedures would be pro bono work. I liked the little dude, so I took him home.

 

Milo was very skittish. Everyday, I would have to find him and get this not so small pill into this tiny kitten. His medication was atenolol. This is used to lower his heart rate so as to not put as much stress on his constricted heart chamber. Here was my first lesson with Milo. My other cats were not on medication. I had to learn the trials and tribulations of “pilling” a cat. Nevertheless, I got it accomplished and, after 6 months, Milo was big enough to try to correct his heart.

 

The medical term for his condition is pulmonic stenosis. This is a narrowing of the heart near the valve between the right ventricle and the pulmonic artery that pumps blood to the lungs. Milo was placed under general anesthesia and a catheter was threaded up his artery back to his heart. Using fluoroscopy (an image formed by continuous x-rays like a movie camera) the catheter could be seen inside his heart without doing surgery. At the end of the catheter is a balloon and we would attempt to use the balloon to expand the narrowing of his heart.

 

As part of the teaching aspect of the hospital, I was able to be present for his procedure and help guide the catheter into place. We inflated the balloon but it did not stretch his stricture. The cardiologist threaded in a larger balloon with more pressure and again it did not correct the problem.

 

Milo’s stricture was severe and without open-heart surgery it could not be corrected. There was no way to know this until trying the balloon procedures. At this point, the cardiologist asked me what I wanted to do. We could proceed with open-heart surgery and the many risks that entails, or we could stop.

 

I elected not to do surgery. We woke Milo up, stopped his medications and I brought him home. All the information pointed to the fact that his heart should give out in about six months. I wanted those six months to be stress free for him and let him enjoy life. He had become anxious and miserable about being medicated and I figured he deserved to live his last few months in relative ease.  I knew that at the first sign of heart failure, I would have to humanely euthanize him.

 

Milo recovered well from anesthesia (I also neutered him that day) and he resumed his normal activity with my other pets. At the end of 2003, I moved to Albany, NY and brought Milo with me.

 

He was a shy and anxious cat. He would not interact with me at all and kept his distance from my dogs and other cats. A loner would be the best way to describe him. When I had to travel for training or vacation my office had standing instructions that if he went into heart failure to humanely euthanize him without trying to reach me. I didn’t want him to suffer if I could not be reached.

 

I am typing this in July of 2013. Milo is still with me. He has outlasted my other cats. He likes to curl up with my dog Skeeter daily. Skeeter has mixed feelings on Milo but tolerates him. (See pictures below)

 

Milo is still not medicated. I tried a few times over the years with pills, pills in food, liquids and even transdermal variations of his medications. He might tolerate them for a while but he very quickly becomes miserable and intolerant of them.  He is content with his life, so who am I to try and alter it?

 

Milo has taught me many things about veterinary medicine and life in general. Rules and expectations can be broken. Sometimes the best fix is to do nothing at all and let life take its course.  I am very thankful he is a part of my life.

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