|Myrna being "cute"-rolling over|
On Wednesday, she went out of the box in front of me and cried prior to going. So, I took her to the regular vet for an urinalysis and since she needed a CBC/chem panel for the cardiologist, we also did a blood draw. The results might show if Myrna is having any kidney/renal issues or is showing any other issues that might cause discomfort and cause her not to use the litterbox.
Before the visit, I made a list of meds and procedures about which I had read in the Yahoo HCM Support Group (find it in Yahoo-it's a good source) to ask the vet about. As always, I also noted if there were any changes in Myrna that I had noticed. I have noticed an increase in hesitation in jumping up onto counters so I wanted to make sure her back legs were in working order since HCM cats can-even though she's on Plavix, a blood thinner-create clots in the heart that can be passed to the valves in the back hind quarters, causing the legs to lose feeling and to not work. I also wanted to know if there was another pain med that might better suit her.
Myrna had her usual every 4 months checkup last Thursday with her cardiologist, Dr. DeSana. As usual, Dr. D was warm, engaging, and allotted plenty of time to review my list. She took x-rays of the heart and lungs and she did a Doppler test on Myrna's hind legs to make sure that the circulation of the blood flowed not just to the back valve but from the valve through the legs to the paws. She showed me what symptoms to look for if there was an issue. The symptoms are that the paw would be cold, and the pink paw pads would be grey to white. If that happened, she would eventually lose use of her legs. She might also be chewing on them. Any of those symptoms would require an immediate visit to Dr. D or the ER or the regular vet.
*By the way-that reminds me-often owners think that if the vet can't see the cat immediately that they have no choice but to wait until the vet is free. Cold feet, loss of circulation, not able to breathe-whether it's a cat or a human-calls for a visit to the ER as fast as possible. The cost of the ER won't be much more than the regular vet (unless you have a free or very cheap vet.) Please-go to the ER and never wait.
Dr. D said that unfortunately, Myrna's heart is slightly increased in size on the left side. That is a natural progression of the disease but it was very disheartening to hear. When I see Myrna at home, the beautiful, engaging, lively, energetic little girl she is, I allow myself to think that she's not that sick. But Dr. D reminded me that Myrna is indeed a sick little girl.
Regarding the elimination issue, I decided that we will continue to manage the issue instead of trying to control it with medication. There are more important things to worry about with Myrna and I want her to continue to be energetic and lively for as long as she can. Granted, the out of box issue could become worse and we may need to do another type of med. But until then, there are more important things.
Some things we reviewed:
1) I've noticed in the Yahoo Support Group that some owners take it upon themselves to change heart medications-decrease or stop-without checking with the vet or without fully understanding that meds take time to work and that symptoms might occur and they might ease up over time. Never stop giving meds without first checking with the vet. However, the first step is to fully understand why a med is given, what symptoms might occur, and how long it might take before things are more normal. We must ask questions of the vets and demand full answers even when the vet may not offer up such information on their own.
2) Also from Yahoo Group-high incident of renal failure in HCM cats. I wanted to know if that would happen with Myrna, how to prevent, and how to reconcile. She said that usually older cats develop renal failure once they have HCM and they believe it's because there were renal issues which had gone undetected prior to HCM. Medications, such as lasix, deplete the body of the much needed potassium the kidneys need, and the other electrolytes the body needs. Another cause is high levels of doses of meds, levels that might not be needed-which is why Dr. D starts her patients on the least amount they need and titrates up as needed. Young cats such as Myrna are less likely to get RF although we must be aware of it and watch for it. Renal failure could occur because vets have not prescribed spironolactone-a diuretic which saves potassium for the body. It could also occur because a CBC/chem panel isn't taken or taken often enough to detect possible loss of potassium and review renal values. So, if we have cats who are six or ten years old and begin to have heart trouble, we must have CBC/chem panels every few months, and be aware of the possibility of renal failure. And all of our heart cats should take spironolactone to reserve potassium levels in the body. If a cat does develop RF, heart meds should be lowered if possible (whatever the cat can tolerate and still help the heart) and extra fluids should be given. Sometimes a special, low phosphorous diet or renal diet is prescribed.
3) From the Yahoo Group-owners whose cats suddenly died. Dr. D said she can't say that Myrna won't suddenly die, that it happens despite the best of meds and care. What owners should do is be more aware of the cat, to be as vigilant to change as possible. If the cat is breathing too quickly and the breathing rate doesn't settle, if the cat seems distressed, if the cat is lethargic and doesn't want to move, if there is anything the cat is doing that indicates it is sick, then the cat needs to go to the ER, the vet, or the cardiologist immediately.
4) From Yahoo Group: metacam given to young kittens may cause renal failure later in adult life-that is usually due to too high a dose over a long period of time as kittens that may cause RF as adults. If a cat had metacam for a long period of time as a kitten, then we must test renal values each year in the adult (over six or so years of age) years and be aware of the possibility of RF as the cat becomes a senior cat (over ten years of age.)
5) Nauseousness can be seen in a cat with an irregular heart beat but that is usually due to the medication the cat is receiving.
6) Meds-carvedilol-a beta blocker like atenolol. She prefers atelenol. Nattokinase-a Japanese natural product unproven to work as a blood thinner. She prefers Plavix which is proven. Aminophylline-a bronchodialator-opens airways in the lungs when there is congestion. She said this is an old method and is now considered a "band-aid" approach to congestion in the lungs and shouldn't be used for congestive heart failure. Also raises heart beat which isn't good for HCM. CHF needs aggressive IV lasix. Aminophylline is best used for cats with asthma.
Notes from Dr. D:
"Today's evaluation revealed that Myrna's cardiovascular status is currently stable. There is no evidence of congestive heart failure on her thoracic radiographs currently. However, Myrna's overall cardiac size is slightly larger than on her recent radiographs, which indicates a progression in her cardiac disease. Based on this finding, I recommend only a slight decrease in her lasix dose. Further, there is no evidence of circulatory compromise to the hind limbs. Her blood pressure was normal (systolic=115mmHg.)"