Wednesday, May 23, 2018

Katharine Saw Neurologist Today for the May 14 Incident

Katharine saw the neurologist today for an exam. He manipulated her legs, watched her walk, then tested her facial responses by flicking his fingers and using a long Qtip to touch her face. He saw right sided decreased response in face and legs as we noticed when she had her episode May 14. If it's a seizure, he believes it could be a left side brain tumor (as with humans, the left brain controls the right side of the body, etc.) Tomorrow she returns for the actual MRI and if that is clear, then a spinal tap to look for inflammation/infection. She was NPO this a.m. in case they did the MRI but they couldn't today due to two emergency cases. She'll be NPO tonight again as of ten p.m. So, she's just now, at 1:46 EST, eating for the first time today. Tomorrow, she goes in at 9 a.m. and will be there for the MRI all day. The MRI will take about four hours from start to finish. Then she'll go to recovery and then she will be released about 5 p.m. or later depending on when the MRI actually begins.
The cost: $2000 for the MRI and an additional $500 for the spinal tap. She will be under anesthesia for both. If she has a tumor, surgery will be required. No, I didn't ask for the price. I can imagine that it's twice the cost of the MRI. While concerned about the cost, I'm far more concerned about Katharine. At least we know her heart is in good shape and she can withstand the operation. So, we'll know more tomorrow. For today's exam, I wrote up her medical history, medication list, gave copies of the ER/cardio/vet tests related to the May 14 episode, and copies of past blood work just in case it was useful. Writing up a detailed history and current medication list always helps the new vet or vet specialist get a better picture of the cat's history, especially if there have been any illnesses.

Wednesday, May 16, 2018

Update on Katharine-No Clot, No HCm, and No Reason To Be Sick

Update on Katharine-nothing. Cardio recheck showed nothing. Praise the Lord! There's no murmur presenting at all; no SAM; no thickening; no reason to throw a clot. Unlike with humans, pets do not get clots at all unless there's an injury to the area (the leg) or there's heart disease or cancer or some other disease that would produce hypercoagulation. It's possible she had a clot in the leg. But Dr. D, the cardio, reviewed the video we had of Sunday/Monday and Katharine was not in pain-which a clot in the leg would have produced.
It's possible she had a seizure and the leg was part of the process but not physically affected or somehow had neuropathy due to a seizure or something. (https://www.mayoclinic.org/diseases-conditions/peripheral-neuropathy/symptoms-causes/syc-20352061)

Xrays show no signs of other disease but she will need an MRI and one is scheduled for next week.

At the cardio, they ran a urinalysis and there was no glucose (which was high in the blood but could be due to physical stress of the situation and the visit to the ER. If she was diabetic for example, the glucose would be in the urine as well.) And there's little protein-which could be from using a needle to draw the sample-the sample being mixed with some blood which is protein.

So we are now doing a albumin/creatinine ratio test:
"The urine albumin test or albumin/creatinine ratio (ACR) is used to screen people with chronic conditions, such as diabetes and high blood pressure (hypertension) that put them at an increased risk of developing kidney disease...Virtually no albumin is present in the urine when the kidneys are functioning properly. However, albumin may be detected in the urine even in the early stages of kidney disease...Most of the time, both albumin and creatinine are measured in a random urine sample and an albumin/creatinine ratio (ACR) is calculated. This may be done to more accurately determine how much albumin is escaping from the kidneys into the urine. The concentration (or dilution) of urine varies throughout the day with more or less liquid being released in addition to the body's waste products. Thus, the concentration of albumin in the urine may also vary..."

She's still on gabapentin. She's showing no other signs of recurrence. I have her on Renal K potassium gel and powder since her potassium level was 3.7-something not seen except with Myrna who was on high levels of lasix as well as potassium.

We will continue to monitor.

Monday, May 14, 2018

Katharine Hepburn in the ER at 1 a.m. Due to Lameness and Fainting

I've written about this before: cats (and someone once told me kids) end up in the ER middle of the night, rarely during the day. Katharine Hepburn was in the ER at 1 a.m. last night/this a.m. Around 11:30 p.m. she suddenly seemed to be lame in the rear right leg. She kept hobbling around; then it seemed fine; then she would lay down and hold it up. We watched her for awhile and it was on and off. So, we put her in our room to monitor her. To me, she appeared to walk not on her pads but on her hocks-the part of the leg connected to the pads. Cats will sit on these for sure but when they walk, they should be on only their pads. After about ten minutes in the room, she became disoriented, couldn't stand up, seemed to fall over, etc. It reminded me of what Myrna did back in 2009 when she first ended up in the ER due to HCM. So, we left and by the time we get to the ER it was 1 a.m.
They kept her for two hours. They suggested she had a seizure or threw a clot. They put her on oxygen just in case. They took a CBC/chem panel, an xray, and a heart blood test-the proBNP test (potentially shows signs of heart disease but it can be a false negative and does not say WHAT is wrong which is why an echo is what the cat really needs), and did a Doppler reading on the arteries in the legs. ALL of it came back negative for any particular reason. As far as they know, the heart looked fine in the xray (you can determine size with an xray and see if there is congestion.) The blood work was almost normal but the Lactate (similar to CPK level which is a muscle enzyme) was HIGH. This is what happens when the body has reduced oxygen levels and the muscles kick out something with which to compensate. This is an acid level test which measures lactate acidosis.
Here's an interesting article/paper:
http://www.vetlab.com/Hughes%20IVECCS%20What%20Does%20it%20…
So, clearly something happened to reduce oxygen and cause lameness but what? I called the cardio's office while there and left a message. They called this a.m. and we will see them tomorrow. Katharine has an annual cardio checkup due to a slight murmur and because she's Myrna's sister. This would have been in June or July anyway. The other thing they suggested was to get an MRI so we will make an appointment for a local vet to do an MRI. And we need to retest her lactate level when she's not sick.
They gave her a pain med Gabapentin for three times a day. It's a pain/anti seizure med.
So, that's all we know for now.

Thursday, May 3, 2018

Comments Not Always Welcomed Or Published

A comment was posted to the blog that I've not published. It was a personal attack and therefore, did not add to the conversation about Feline HCM. The comment said that I chose to let Myrna suffer by prolonging her life due to selfishness. This page is meant to encourage you to help your cat deal with HCM, to understand that it may or may not be a death sentence, that death may be months or years away. But that there is no reason to put down a cat just because they are diagnosed with HCM; that there is more they need and more that can be done to help them fight, to slow the progression of the disease, to help the body deal with the disease, etc. All of that is worthwhile. None of it is selfishness. Why end a life before it is necessary? Is it difficult to know when to let go? Yes-and many of us have gone through that. When I say that she died quickly, I mean that in the last few seconds, she had a heart attack and died. That she was not put down six years prior was not an act of selfishness nor did she suffer for six years. On the other hand, I have noted honestly that the last few months were very difficult for her but that we thought she would pull through, not knowing that those difficulties would add up over the last few months and lead to her death. When she had gone through so much before and pulled back-not from death but from being sick-we did not understand that she was no longer bouncing back near the end even as she got over each episode, even as she played energetically the last week before getting sick again. Do I want to do this again? No-because I don't want my other cats to get this horrible disease. But will I if they get sick with this or another disease? Yes-I will fight, read, write, organize, learn and deal and move on and help them and take the best care of them that they need-NOT "Do the best I can do" but do what they need. And that's what I did for Myrna. Her ending went as I had hoped-which is selfish-but I wanted her to be stablized first; I wanted to be with her; I wanted to do all that we could in order to know if it was the end or not. And God chose to end her life quickly with a heart attack, in the ER, with me by her side, after she had been stabilized, and leaving the decision not up to me. A blessing to us both? Not really. A blessing would have been for her to heal and come home. But one shouldn't discount whatever sort of blessing God sends. When to end a sick cat's life is not an easy decision to make. Fighting is hard. We must be their advocates. Why not fight the good fight? Why give up so easily as the commenter would-I'm assuming-based on their comment. Actually, it was a rant. Perhaps they have no heart. Because unless you've been there, taking care of a sick cat, you do not know what is involved, what it means, and how difficult it can be.

Saturday, April 7, 2018

Update On New HCM Drug Therapy Research MYK-461.

A new drug study-released in February 2017 (and posted here last year) is progressing. The research with humans is coming along in stages. The drug may reduce obstruction of the left vent. Eventually, once approved, it may be able to be given to cats and dogs to reduce HCM. There are three tabs of information on the left of this website. One is a list of studies and publications about the medicine being studied. Read through the variou publications. It makes for fascinating reading.


Mavacamten (formerly MYK-461) is an orally administered small molecule designed to reduce left ventricular contractility by allosterically modulating the function of cardiac myosin, the motor protein that drives heart muscle contraction. MyoKardia has evaluated mavacamten in three Phase 1 clinical trials, primarily designed to evaluate safety and tolerability of oral doses of mavacamten, as well as provide pharmacokinetic and pharmacodynamic data. In 2016, the U.S. FDA granted Orphan Drug Designation for mavacamten for the treatment of symptomatic oHCM, a subset of HCM.
MyoKardia is currently studying mavacamten in PIONEER-HCM, a Phase 2 open-label single-arm study to evaluate safety, tolerability and efficacy of MYK-461 in patients with symptomatic oHCM. The primary endpoint of PIONEER is the level of reduction in post-exercise left ventricular outflow tract (LVOT) gradient over 12 weeks of drug treatment. PIONEER is also exploring relationships among reduction in contractility and LVOT gradient, endpoints measuring functional capacity (i.e., exercise) and clinical symptoms in addition to gathering safety and tolerability data on mavacamten in an outpatient setting. In September 2017, MyoKardia presented data from the first cohort of symptomatic oHCM patients in its PIONEER-HCM Phase 2 clinical trial showing statistically significant improvements in reductions to the LVOT gradient and peak VO2, as well as clinically meaningful improvements in NYHA functional class and other parameters. The most recent data presentations from the mavacamten program may be found here.
MyoKardia is developing MYK-491 to treat dilated cardiomyopathy (DCM) by establishing normal contractility in a DCM heart. A Phase 1 clinical trial of MYK-491 in healthy volunteers is currently completing and a Phase 1 trial in patients is beginning in early 2018. 
Other product candidates include HCM-2, which is being developed to lower cardiac muscle contractility in HCM patients; and LUS-1 to counteract muscle disruption resulting in impaired relaxation of the heart.

Wednesday, December 6, 2017

Holiday Dangers for Pets-Food, Flowers, Tinsel, and More






1. Dangerous wrapping—Brightly colored bows and ribbons are a festive and enjoyable part of the holiday season, but remember that ribbon can be extremely dangerous for cats. If ingested, it can cause a cat’s intestines to bunch and get twisted, and in many cases this will need to be remedied with surgery. If left untreated, this can be fatal.
2. Hanging ornaments—From a cat’s perspective, low-hanging ornaments on a tree are just begging to be swatted at and then played with on the floor. If there are any low-hanging ornaments on your client’s tree, be sure that they are made of materials that a cat can’t chew or otherwise destroy and ingest.
3. Poisonous plants—While poinsettias have long been believed to be extremely dangerous for cats, the danger they pose when ingested by a cat (stomach upset) is not as bad as some other common holiday plants, such as mistletoe, pine tree needles, amaryllis lilies, red azaleas and paperwhites. If your client has festive plants, make sure they are somewhere a cat won’t be tempted to chew on them. If you are unsure if a plant is poisonous, or are concerned that your cat may have eaten something dangerous, have your client call you or the ASPCA’s animal poison control center (888-426-4435) for more information.
4. Candles—A cat probably isn’t going to be too intrigued by the candle itself, but a wayward swishing tail can easily knock a candle over, causing a host of problems. Clients should candles out of reach, and make sure they stay vigilant around lit candles. The last thing they need over the holidays is an injured cat or fire damage to their home.
5. Holiday foods—While it may be tempting to give a cat just a nibble of turkey or other holiday food, encourage your clients to resist the urge. Rich foods can upset a cat’s digestive system, which could produce unpleasant effects. Also, cats should never be given any type of bone, as they can splinter and cause internal injuries to a cat.
6. Stress—Cats like routine and predictability, so when their schedules or environments change, they can become upset. If your client is planning on having holiday guests and their cat isn’t used to entertaining, create a safe, quiet space away from the action where the cat can have some peace and quiet. Dr. Brunt, CATalyst Council’s executive director and a feline veterinarian for more than 20 years, adds, "Be sure to have food, water and a litter box available in this secluded area so your cat can be comfortable away from your gathering."
7. Tinsel—Like ribbon, tinsel is almost irresistible to cats and, if ingested, it can require surgery to extract. Which would your client rather live without: tinsel or a night at the veterinary emergency clinic?
8. Cats given as gifts— Every companion animal deserves a home where it will be wanted and well taken care of. Shelters nationwide report an uptick in new arrivals right after the holidays, when people surrender the "gift pet" that they may not have wanted.
9. Christmas tree water—The water that keeps a tree fresh is frequently treated with chemicals that can make cats sick. Be sure that cats can’t access the tree water.

10. Travel dangers—If your client is traveling with their cat during the holidays, be sure that their cat is properly secured in a carrier and that he or she has adequate identification, including a microchip. That way, if they get separated, their cat has a way to be reunited with them. Also, prior to leaving home, encourage your client to find contact information for a veterinarian or an emergency veterinarian in the area they’re visiting, so that, if their cat gets injured or becomes ill, they know where to go to get their cat the care and attention it requires.

Tuesday, November 14, 2017

Kittens-Wean Naturally By Mom and Continue Feeding Past Six Weeks

This is why we didn't let our kittens be adopted until they were 12 weeks old and argued AGAINST them being removed from their mother at 8 wks. (Of course, only two eventually left the house at 12 wks.) I had read many articles about kitten growth and read that 12 weeks should be more standard and that 6 weeks is only based on when kittens begin to start eating and that kittens are not done growing and learning from mom at 6 weeks.

https://www.sciencedaily.com/releases/2017/09/170915165217.htm

"Early weaning increases aggression and stereotypic behavior in cats. Based on the study, the recommended weaning age of 12 weeks should be raised by at least two weeks. Delaying weaning is an easy and cost-efficient way of improving the quality of life of cats."