Wednesday, August 25, 2010

Next Visit to the Cardiologist in January 2010

By January, Myrna had been responding well to her two meds-spironolactone and atenolol.  The lasix had by now been discontinued.  Lasix is usually prescribed when there is fluid buildup and discontinued when the problem clears.  There are side effects from long term use that must be considered which mainly concern the lack of potassium in the body that the kidneys and heart need in order to function. 

She was eating, was energetic, and seemed to be doing well.  But then, everyone came down with a bout of flu in January.  One by one, all five kittens had vomiting and some diarrhea to some degree. So did Myrna.  We knew from the first cat to be sick that the severity of the illness determined if anyone needed to see a vet.  As each one became sick,  we monitored what they ate and how sick they became.  The usual pattern was that one would stop eating a meal and would come to the food and sniff but then run off.  Some time later, one would vomit what they had eaten (if they had) or water and this would occur two or three times over the next couple of hours.  Then they would sleep but be alert and would not present with a fever. (We took their temperatures.)  After awhile and they seemed to stop vomiting, I would administer 2 or 3 ccs of water and make sure they could keep it down.  If they did, I would later mix water and juice from the wet food can and administer 3 ccs of that.  If they kept that down, I would later offer them a small amount of food.  For those who refused the canned cat food, there was the old favorite, tunafish and tuna juice.  That usually would make them eat and they would receive tuna fish until they began eating their regular food again.  The theory is that if cats are nauseous, food will not be appealing.  It must smell strongly enough to entice them and tunafish seems to do the trick.

But Myrna seemed to be a bit slower even after she rebounded from the flu.  She seemed to have a pained look on her face and to be sleeping more and her breathing did not seem to slow down even at rest.  I took her to the vet for x-rays to check for fluid in the lungs.  The x-rays didn't show any fluid but did show that the heart was slightly enlarged.  From previous discussions regarding the disease, any enlargement could indicate that fluid is building up and would soon be in the lungs. So, the cardiologist was called and an appointment made and off we went. Myrna was indeed sick again and was no longer responding well to her meds.  Here are the findings:

Today's echocardiogram revealed that Myrna's hypertrophic cardiomyopathy has progressed significantly since her last evaluation in November.  Specifically, Myrna has undergone progressive thickening of her left ventricular walls (previously .73cm, now .91 cm; normally less than .6 cm) and she has developed severe enlargement of her left atrium.  This progression of heart disease indicates that Myrna is again at high risk for developing congestive heart failure.  Based on this marked progression in her HCM, it is appropriate to restart Myrna's lasix at a low dose.  I also recommend beginning enalapril to help delay the onset of recurrent congestive heart failure.

Her meds were now: lasix 1/4 tab of 12.5 mg q 12; spironolactone 1/4 tab of 25 mg q 12; enalapril 1/2 tab of 2.5 mg tab q 12; atenolol 1/4 tab of 25 mg q 12.

We also had to return to her vet for a blood test to check renal values now that she was also on enalapril.  We saw the vet a week later and her values were normal. This meant that she did not have any negative reaction to the lasix/enalapril and could continue the regimen.  Within a few days, Myrna bounced back and was energetic and on the mend.

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