Saturday, January 19, 2013

Myrna Loy's Heart is More Enlarged

Myrna today breathing much better

Myrna’s recent visit this week to the cardiologist for a check-up brought bad news.  I had noticed some recent changes in her and had ignored them because they were not severe and the appointment was coming up.  What I noticed was quicker breathing that took longer than usual to slow down.  She also had short bursts of playtime followed by the need to just lie still for awhile. She’s had three more “I’m totally exhausted today” days in November, December, and early January, days where she wakes up and spends the day sleeping and looks completely wiped out when awake. On three separate occasions she’s had wheezing, snoring, and a hoarse voice, all short term and only once each that we’ve noticed.

The bad news is that her heart has suddenly grown from October’s test of 1.83 to 2.12, a significant jump. And she has congestion in her lungs.  This accounts for the change in breathing patterns which I shouldn’t have disregarded.  It is just the beginning and doesn’t pose yet a significant risk.  Myrna will now receive ¼ Lasix TID (three times a day).  There are no other changes as of yet. We must keep a close eye on her breathing and activity and she returns to the cardiologist in two weeks.

But the change in her heart is significant and does pose a risk.  The heart muscle is weaker and cannot pump as efficiently. The heart walls are thickening and cannot take in and release blood well.  This can lead to clots or congestive heart failure or arrhythmias. 

The doctor originally said, in 2009 when Myrna was diagnosed at 8 months that she could live 2-5 years.  If she lives to her birthday in March, she will be four years old.  The doctor cannot say how much more time she has since it depends on the rate of progression and ability to manage the disease with the meds and Myrna’s response to therapy. 

I can’t figure out if there’s anything we’ve done or should do: were windows opened too long last week on two separate days when it was about 50 degrees outside but still very cool?  She loved sitting in the windows.  Was a trip to MSU in early December, which took all day, to test for renal function, too stressful?  Something we’re not doing?  Or is it a sudden but natural progression that can’t be stopped? How much more quickly will the numbers grow, making it difficult for the heart to function? 

It’s all speculative.  For now, we monitor and take her back if breathing worsens. 

I was told by her regular vet that her blood work was normal.  I hadn’t yet received my copy in the mail and mine came the day after the cardio visit.  The blood work was normal EXCEPT-her ALT is low 44 (she is usually high indicating dehydration), indicating that she’s well hydrated.  And she is.  Unfortunately, it’s in her lungs.  And her CK value was 1118, sky high. That indicates injury or damage to the heart muscle or perhaps the growth of her heart walls. And her bicarb level was high at 25 which can indicate congestion in the lungs, which she had.   I’ll review the blood results with her cardiologist next visit.

Here are the doctor’s notes:

“Today’s echocardiogram revealed that Myrna Loy has undergone progressive left atrial enlargement due to her hypertrophic cardiomyopathy.  The left atrial dimension is now 2.12 cm (previously 1.84cm.)  In addition, the strength of cardiac contractility is decreasing.  Unfortunately, these progressive changes have resulted in early signs of congestive heart failure on her radiographs.  I recommend a slight increase in the Lasix dose to help resolve the congestion.  We should repeat radiographs in 2-3 weeks to determine if this adjustment has effectively resolved the congestion. 

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