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Dr L Simmon
Dr L Simmon, Cat Veterinarian
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My cat passed away on Wednesday this week, whilst coming out

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My cat passed away on Wednesday this week, whilst coming out of anaesthetic. He was only 7 years old.
2 weeks ago he was seen by the vet as he'd been having a hacking cough once, or twice a week, and I showed them a video of an episode of this to the vets.
They suspected he had asthma, hence they said they would book him in to do X-rays and take samples. I thought it was asthma too as I'd seen a YouTube video of a cat with the same type of cough.
So this happened on Wednesday, when he was given a General Anaesthetic.
My cat didn't have water or food from about 8pm the previous day. I didn't know when he would be seen on the day of the procedure but it turns out he wasn't put under until around 3pm. Could the fact that he didn't have water/food for around 19 hours put him under more risk?
I understand that they can’t have anything for 12 hours, but had I known that he wouldn’t be seen until 3pm, I would have asked for a reschedule, for when they could do the procedure early morning.
They said that he had respiratory failure followed by a cardiac arrest. They brought him back but he had a spasm and crashed again and he didn't make it.
30/04/2021 09:10
I want to know if they compromised his health by the fact that he hadn't had fluids for around 19 hours, by delaying doing the procedure to 3pm in the afternoon.Other than that, whether or not there were steps they could have taken, other tests, before opting for a general anaesthetic, which put him at greater risk.My concern over the lack of fluids was that maybe the lack of lubrication contributed to him having what they said was a spasm. I understand not having anything for 12 hours, but given his symptoms, were they unduly putting him at risk, by a) giving him a G.A. in the first place and b) his not having had fluids for about 19 hours. He was big, but not overweight. He was a Ragdoll cat and they are known to grow large in size, especially the males. I suppose the bot***** *****ne is, I want to know from them that they did everything correctly in their duty of care, given what they suspected to be the reason for this hacking cough/suspected asthma. Was it the correct course of action for him and could his death have been avoided by their doing other tests ahead of the G.A.
Customer: replied 11 days ago.
I originally submitted this in the wrong area, and a lawyer responded and was unable to help with my query. So I submitted it a second time, but when I view my past questions, it says it is closed. Please don't close this question.

Hello, you are through to Dr Linda, a UK based vet.

I am just typing my reply which will take a few minutes.

I'm so very sorry to hear of the shock passing of Jacob and understand it must be an incredibly difficult time for you. It is only natural to want answers and I think it is important for us all (you and the vets) to understand what exactly happened.

As Jacob was an adult cat, going without food and water for that amount of time would not be considered an issue and should not have affected his prognosis in any way. We ask all patients undergoing anaesthesia to starve from the night before and, on a busy day, this will naturally mean that those patients seen later on will have gone longer without eating or drinking. I do not think this played a part in his passing.

You mention lack of lubrication,  but it would have been the airways the spasmed (constricted) and these would not 'dry out' in the sense you mean, even if dehydrated (which he would not have been in that short space of time).

Before anaesthetic, it can be useful to perform a blood test to check e.g. liver and kidney function, and this would usually be offered when you fill in the consent form. However, given his cause of death, it is unlikely this would have made a difference if done.

A post mortem could help if not carried out, though it may be too late for this. This would provide a definite cause of death and shed more light on what happened.

I would advise you to write down all of your questions and concerned and to organise a face to face meeting with the vet(s) in charge of his care so that they can hopefully provide you with some more specific information.

I would also like to mention that the Blue Cross offer a very good bereavement support service for all owners. It is confidential and free of charge and can be reached here:https://www.bluecross.org.uk/pet-bereavement-and-pet-loss

I do hope this helps and please let me know if there is anything else,

Take care of yourself,

Linda.

Customer: replied 11 days ago.
Okay, thanks Linda, I really appreciate your response and the link to the Blue Cross service. Thank you.
Customer: replied 11 days ago.
I forgot to say that he hadn't emptied his bowels in the morning and I'm worried that if he didn't have a litter tray, he could have been stressed about that too. If he was stressed, with regards ***** ***** or food, could that have hampered him too? (I'm going to ask about where he was kept when I receive a call from the vet, which I requested earlier this morning).
It would be unusual for him to have been kept without a litter tray; certainly in our clinic we will always provide one.However, naturally all cats will be a little stressed as they are out of their comfort zone and in new surroundings, so it is actually rare that they would empty their bowels if in for the day. This would not be expected to have any knock on effect.
Customer: replied 9 days ago.
Hi Linda, I had some feedback from other Ragdoll owners on this. When Jacob had his general anesthetic, he had a lung flush done. I'm told by another Ragdoll owner that this is high risk, and that someone whose cat had to have this done, had it done at Edinburgh vet school by specialists. I wasn't told this procedure was high risk, otherwise I would never have consented without knowing for sure that it was absolutely necessary and that an alternative course of action wasn't available. Another lady whose cat was suspected to have asthma, was allowed to have an inhaler for her cat. Another lady's cat has asthma. Her cat is 13 and is treated with steroids. In this last case, the vet initially thought it was viral so started her with 2 sets of antibiotics. After this the vet said to try her on steroids, which they did and the cough went overnight. So they only give her steroids every 2nd day and I'm told she seems well. So her cat didn't have to go through any of the treatment Jacob underwent.
So my feelings now are, why did they go straight to the extreme of giving Jacob the lung flush, which I now understand to have been high risk, when they could have offered the steroids initially to see if that made a difference? I just wish I could have had a second opinion from another vets, before this all happened, or at least consulted the Ragdoll facebook page, where I received the information above. I should never have allowed them to go ahead with it. Thanks in advance. Regards, Maria
A bronchoalveolar lavage is a relatively standard diagnostic procedure which can enable us to get a diagnosis of certain lower lung diseases.
It is typically performed in primary GP practices and not referral centres.
It is not considered high risk. Any procedure does carry some risk and this should have even discussed beforehand when you signed the consent form.
The benefits are thought to outweigh the risks as it is very important to get the right diagnosis so the best and most appropriate treatment can be started.
Simply giving steroids isn't considered best practice as this will treat some conditions but not others.
Customer: replied 9 days ago.
It seems that there is divided opinion on the risk of this lung flush. If it was your cat, would you have taken this path or would you have taken a different approach, trying something less intrusive first? What would the harm have been to start on steroids first, because the results would have been seen within as little as a week, i.e. whether he'd had any of the coughing episodes. I would have been able to observe him as I have been working from home because of Covid. Even to have him on steroids for 2 - 4 weeks would have been something, before going straight for the G.A. and lung flush. Thanks.
I personally have a scientifically driven mind and would be reluctant to treat my cat without a definitive diagnosis. Hence, I suspect I would have gone ahead with the lavage in your shoes, yes.I appreciate with hindsight it is natural to wish we had been more conservative, but what happened could not have been predicted and is a rare, but very sad, outcome.A steroid trial is an option, yes. However conditions like bacterial or viral infections can worsen with steroids. It also means we are treating a condition without having a diagnosis, so there is risk involved in this too.
Customer: replied 8 days ago.
Ok, thank you for giving me your thoughts on this. I just think if he'd had a short treatment of steroids first, and he'd got better, he might have been in a better position to have gone through the lavage treatment, with less risk of a spasm. Do you think that might have been possible?

With hindsight, yes, perhaps this would have helped.

However, we are only thinking of this because of the outcome we had.

Realistically, the normal thing to do is to get a diagnosis (by performing tests such as a lavage) and then starting treatment.

If, for example, your cat had an infection causing the symptoms and you opted for steroid trial but they worsened and passed away, you would be wishing you had done the lavage first.

Ultimately, we can only make the best decision at the time with the information that we have. I would have suggested a lavage as the next step rather than a steroid trial, as this is considered 'better medicine'.

According to the British Medical Journal:

'BAL or TBLB, when required, should be performed before the initiation of treatment'.

(BAL = BronchoAlveolar Lavage)

Customer: replied 8 days ago.
Thank you, ***** ***** the answer I was looking for, that there is a possibility that giving a treatment of steroids first, it could have helped. I understand it's important to get a definitive diagnosis, but also to make sure the patient is well enough to undergo a G.A. and the lung flush. If that was performed a week or 2 weeks later, it would not have mattered, and meantime, he could have been taking steroids that may have helped him.
Obvioualy, it's because of the outcome of Jacob's treatment, that I'm looking for answers and a path that could have avoided what happened. If it wasn't for the outcome, I wouldn't have been asking for other cat owners' experience with asthma in cats. It's never going to change what happened, but for me, I will be less ready to simply accept a certain course of treatment, without fully understanding all the risks involved, and discussing the possibility of another approach first.

However, in your opening question you say he had a cough a few times a week, rather than an ongoing cough or wheeze. So, in all honesty, a course of steroids would likely not have been considered in the place of a diagnostic test as there would not have been a need to stabilise him, given that his breathing was stable on admission. I hope this makes sense.

Customer: replied 8 days ago.
I've only just seen your last message about the British medical journal. That's fine, but it could still have been done within a week or 2 of a "trial" of steroids. I'm going by the fact that doing such a trial helped the lady that got in touch with me about her cat, as mentioned previously. Her cat is now doing fine, without having undergone the GA and lung flush.
Customer: replied 8 days ago.
Jacob's cough was only once a week, at the most, on occasion was only twice in a 7 day period. I understand what you're saying, though, that that would make him less considered to have been given steroids first, if his breathing was stable. Armed with what I know now, I would have been the one to ask about the possibility of a less invasive treatment initially, even if for a short time, e.g the steroid treatment.
I understand.
I hope this has helped in some way and I absolutely agree that knowledge is power and it is important to understand what happened and what could have been done differently, if anything.
Customer: replied 5 days ago.
Hello Dr Linda, I'm not sure if there is any other help you can offer, but I wanted to just let you know the outcome of the X-rays and lung flush. I picked up a voicemail from the Vet that did the procedure and she told me that the X-rays, they were told everything looked "absolutely" normal, that there was nothing there to explain the cardiac arrest. From the lung flush, they saw white cells, she said "nothing exciting", a few red blood cells as well, suggesting trauma & inflammation those airways. She went on to say both results would be expected of something like asthma, so she suspects it was asthma that was causing his coughing.
To me this goes even further to make me feel that the tests were pretty much done in vain, and Jacob died needlessly. He was put at risk, one that shouldn't have been taken in my opinion, when steroids could have been an option for him. He could have quite happily have lived another few years. Is there anything else you can say or add to this that might help me please?
I'm sorry you feel this way.
I would advise a sit down meeting with the vet so she can hopefully address your concerns in peeosn and discuss why what was done was done.
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