My cat has heart disease. My cat, Orville, who makes me laugh every day (which not even my husband or Garrison Keillor can do) has a problem with one tiny valve in his heart. His huge, perfect heart. And it beats too fast. His Big Heart beats almost twice as fast as it should—as it reasonably can. A heart is only designed to go so fast, to work so hard, and if a heart works too hard, things thicken and harden. Hard hearts don’t beat as well as soft, supple, healthy hearts. Hard hearts don’t, in fact, beat at all.
I found all this out a little over two-and-a-half months ago at our local veterinary medical teaching hospital. Our regular vet had found a Heart Murmur and referred us to a Specialist for a Full Work-up: chest x-ray, EKG, and an echocardiogram. I made an appointment and we saved our money—two car payments-worth. My parents said we were nuts; my mother in fact said “Well, you can always get another cat.” But this was our cat—our Pre-Kid. Orville was our responsibility. We adopted him. We agreed to be responsible for him—for his health, for his well-being. We didn’t say that we would sometimes be responsible. We didn’t say that we would be responsible as long as it didn’t cost too much. I mean, if we didn’t take care of him, who would?
When The Specialist told me that Orville would be on beta blockers for the rest of his life, I tried very hard to understand her. “Why beta blockers?“ I asked. “Isn’t that what people with high blood pressure take? Does he have high blood pressure?”
“We used them to slow down a patient’s heart rate,” she said. “Orville doesn’t have high blood pressure, he has mitral valve dysplasia—he has a misshapen valve. And right now that’s leading to prolapse—the valve isn’t closing properly, so his heart is leaking a little bit. That’s what’s causing the Heart Murmur.”
“Not bad, but a bit. See, blood in the heart is only supposed to move in one direction. The heart pumps and forced blood through the valve and then the valve shuts behind it, like a flap door, keeping the blood from flowing back the way it came. But Orville’s valve isn’t closing properly.”
“So how do we fix it?”
“Well, we can try the beta blockers. His heart is definitely beating too quickly—we can at least take some of the strain off the muscle and see if that helps the valve. Ideally, if we can control this through the medication, the valve won’t thicken and will perhaps have a chance to work more normally than it does now.”
I asked her if we could get the medication in a liquid. We could. The pharmacist would even flavor it. Like liver. My cat would be taking 0.63 cc’s of liver-flavored beta blockers twice a day for the rest of his life. Actually, he wouldn’t be taking them: Expat and I would be administering them. Twice. Daily. And oh, by the way, they would need to see him for another heart monitoring echocardiogram in about two to three months, just to check on the status of things. Just to tell us how much longer his heart might work.
I called Expat on the way home from the teaching hospital and told him the news. We both hoped that the beta blockers would work. Expat said, “He has such a Big Heart. I hope that Big Heart doesn’t kill him.”
And so, every twelve hours for the next three months Expat and I dutifully chased Orville out from under the bed or the sofa or the dining room table, sat on him (well, more like crouched over him, keeping him immobilized with our knees), and squirted 0.63 cc’s of “liver juice” into the corner of his mouth, much to Orville’s dismay. The first week was rough—he hid from us, eyed us warily when he wasn’t hiding from us, and seemed generally edgy and unhappy. By the second week, things had calmed down a bit; Orville no longer glared at us from under the bed as though we were interrogators at Gitmo. By week three, he seemed to resign himself to the fact that this was just how it was going to be: that his loving Pet Parents were just going to periodically sit on him and squirt icky stuff down his throat while telling him that he was a good boy, and the rest of the time he could get away with murder. Not such a bad rap, all things considered.
And all things considered, the medicine seemed to be working—at least, from our very nonexpert vantage points. Expat and I both agreed that his wee heart rate was slower and we chided ourselves for never recognizing his old, rapid rhythm as abnormal. He was just easily excited, we said. He was always hyper, we thought, and hyper cats must have hyper pulses. But once that initial phase of distrust wore off and Orville started sitting on our laps again, we knew how wrong we had been. When he fell asleep on my chest and I felt a slow, relaxed, easy thump as his little ribcage rose and fell, I knew that the butterfly beats of old were wrong. I felt guilty—how could I have missed it? How could I not have known?
Given our dutiful attention to his medication schedule, I expected to get at least some good news when I took him back for his three month check up last week. Maybe the vet would think his heart rate was much better. Maybe his Heart Murmur would be a little less pronounced. Maybe his valve would be okay—maybe it wouldn’t have thickened all that much. I was Thinking Positive.
The Veterinary Resident who did the preliminary exam was a very nice man about my age who seemed a little nervous but who handled Orv with such care that when his eyes widened and he looked up from his stethoscope and my writhing cat and said “I cannot find The Murmur,” I just assumed he hadn’t been pressing the stethoscope to Orville hard enough.
“Do you want me to try holding him for you?”
He tried again. He placed the stethoscope on Orville chest and stared at it, as if willing it to hear the irregularity for him—as if maybe he could look through Orville with his x-ray vision and see The Murmur.
Orville, meanwhile, with his cat’s way of morphing into water when he didn’t want to be held, wasn’t making anyone’s job any easier.
“Look,” I said to The Resident as I dragged Orville for the third time from his carrier—which he despised five minute earlier, but which was now his favorite hiding place—and placed him back on the examining table, “What if his Heart Murmur is gone?”
“Gone? That Murmur was a four on a scale of six. It was very pronounced. A four is a Very Pronounced Murmur. I cannot understand why I cannot hear it. . . Let me listen again.”
After round three, The Resident threw up his hands and announced that he would be back in a few moments with The Attending, who would talk with me further about Orville’s condition, what we needed to do today, and what might be happening with the Very Pronounced Murmur.
“The Murmur is gone!” The Attending looked up from her stethoscope and smiled. “This is wonderful.”
“Can it do that?” I asked.
“Oh, yes. Yes, yes. This is the best case scenario. This is what we hope for when we put a patient on beta blockers.” She smiled and handed Orville back to me, who promptly spilled through my arms and down the front of my shirt, and vanished into his carrier.
“So do you still need to keep him today?”
“We’ll still need to do the echo to see what the heart actually looks like, but we’ll skip all the other stuff today. You can come pick him up in a few hours.”
So I left him there and went to work. Orv was ready later that day. The Attending and The Resident came out together and handed me the carrier.
“He was a model patient,” The Attending told me. “We didn’t even have to tranquilize him to do the echo. And his heart looks wonderful. That valve is closing properly and everything seemed to be flowing beautifully.”
“And his Heart Murmur?”
“Completely.” She smiled. “Of course, he will have to stay on the beta blockers for the rest of his life, but given the success we’ve seen with them, I’m going to say that you don’t need to come in for another check up until next December.”
She shook my free hand. The Resident shook my free hand. “I’m glad you couldn’t hear The Murmur,” I told him.
“Me too.” He smiled. “Merry Christmas.”
“Yeah,” I said. “Merry Christmas.”
I paid the bill and left with Orville. I needed to get him home; it was almost time to give him his medicine.