Tuesday, April 21, 2015

Understand Heart Murmurs-All Might Indicate Heart Disease and Only an Echo Will Tell

One thing vets seem to not discuss correctly are heart murmurs. Murmurs can be caused by anything in the heart. Myrna, for example, has SAM-systolic anterior motion murmur. The heart beats by diastole-closing, and systolic-contracting or opening. She has a murmur during contractions of the heart muscle.

Issue: heart murmurs might be an indication of heart disease. An echo is needed to determine if there's heart disease, type, and progression. (There are many things that can be wrong with a heart but most cats with heart disease require meds for the same type of symptoms and outcomes as HCM.) A murmur doesn't mean heart disease is present but you won't know without an echo. It could show up later-as it did with Cooper. He had two echos and then suddenly heart disease appeared. A murmur shouldn't be dismissed. Too many times I've heard that a vet has said the murmur is "soft" or "only" a two or one and the pet owner shouldn't worry. Wose, sometimes if the vet can't hear it, they believe the issue has cleared up.  Any murmur is a reason for an echo, might indicate the presence of heart disease, and just because it can't be heard doesn't mean it's not still there.

Myrna's murmur has always been a two and yet she's had HCM since it was diagnosed at 8 months old, and she was diagnosed with a murmur as young as two weeks old. So, she's proof that a soft #2 murmur does not mean that heart disease doesn't exist.
What to know about your cat's breathing rate:

Count it daily when the cat's at laying down for a few minutes. You want to count a rate that is steady. Cat's breathing rate increases during dreams, when sniffing, when pouncing, looking outside, etc. You want to count the cat when it's not distracted.

Count one up/down chest movement =one count. Number of those in 15 seconds. Times by four for one minute breathe rate. Some vets count in ten seconds and then times by six. Choose your method. 

A cat at rest should be 24 breaths per minute; a cat beginning to have CHF will be about 30 or more. Between 30 and 36, to bring it down-as long as the cat's not in distress-give an extra dose of your diuretic and wait an hour. The cat should improve. Give water by mouth if the cat's not drinking enough (again, water is key to help kidneys in the diuresis process.) If the rate increases or if the cat is stumbling/fainting/in distress/hiding-go to the ER a.s.a.p. If you have injectable lasix on hand, inject .2ml into the cat and wait an hour and follow the above. If the rate is above 36, you may need the ER. 

Now, if your cat is like Myrna, and the norm (after three years) becomes 32, then your window of CHF becomes smaller. When she's 32+ we give extra diuretic, we've done injections, we've gone to the ER. At the ER, they will give oxygen and inject lasix. Oxygen helps the cat to calm down as oxygen (explained in an earlier post) is what the cat is fighting to intake and circulate. Oxygen helps to put breathing back in balance even as the cat is still in CHF.

Too many vets believe a cat in CHF will pant, breathe open mouth. They make the mistake of telling their cat owners to not worry until the cat is panting or breathing open mouth. Reality is that CHF begins the moment miniscule amounts of fluid show up in the lungs/around the lungs and increases the breathing rate. Always watch and measure your HCM cat's breathing rate and take care to lower it a.s.a.p. Never wait until your cat is breathing so hard that it is driven to breathe open mouth. By then it could be too late to overcome CHF even in the ER, let alone at home.

Another thing vets say is "Keep an eye on it" without telling you what "it" is you should be watching-the systems, the reactions to meds, the breathing rate, etc. Always ask "What does that mean" and drill it down: "What might happen?" "Are there any contraindications (complications between meds)?" "What are side effects" "What if the cat licks the (skin) med?"

Just don't believe the vet when they say "Don't worry about CHF" or the breathing rate. It must come down back to normal a.s.a.p. or the cat needs the ER. Again-it's all about the oxygen, not drowning in fluid, etc. things I've posted about earlier.

Things To Know About HCM Cat Care

Reminders-from past posts:

HCM cats cannot have steroids, not even creams. Steroids make the body retain fluid; retention for HCM cats leads to CHF. Even in use against other diseases or cancers,the risks of CHF must be weighed. Basically, which disease treatment wins out?

As your HCM cat gets sick, it won't clean itself. Also happens to any cat when sick. Gently clean the coat with baby wipes-alcohol and fragrance free; or cat wipes from pet stores, online stores. Gently brush the cat. Don't rub the fur as it will create snarls. This happened to Cooper near the end (my fault) and he looked horrible as we had to cut out the snarls. Myrna, on the other hand, (and forgive the morbid humor) will be the cleanest dead cat we've had yet-she constantly grooms.

Don't let your sick cat waste away. Feed it as often as necessary to get it to eat (without gaining weight unless it has room to gain.) Use Mirtazapine-appetite stimulant. If a 1/4 tab isn't enough, try a half every 2-3 days. Feed the cat tuna juice, sugar water, KMR kitten formula by hand-9ml every two hours-if the cat's not eating well enough. The body needs energy to run its systems; you want to avoid the body using up the fat stores and leading to hepatic lipidosis (liver disease-which can occur under many circumstances but not eating is a leading cause.)

While a CKD (kidney disease) cat needs to decrease protein and phos levels, a heart disease cat does not. High levels should be avoided but most commercial cat foods have decent levels. As the need for diuretics increase, as the need to get rid of fluid (CHF) is of utmost importance, concentrating on helping the kidneys improve the diuresis process is key. You can do that by using vitamins and supplements to improve kidney support. If the phos levels in the cat's blood work are increasing, then low phos foods will be needed.

Again, an increase in diuretics to fight CHF requires an increase in potassium supplement levels.

Supplementing Potassium for HCM Cats Necessary with Diuretics-Don't Let Your Vet Tell You Otherwise

For those whose vets don't believe in potassium supplementation:
"Because potassium is crucial to cardiovascular and nerve functions and is lost in diuretic therapy for edema or hypertension, (or for HCM cats heart disease) it must be added as a dietary supplement frequently."

Read more at the link above.  Since HCM cats are on diuretics, and as the need for more increases, so does the need for potassium supplements.  Boosting potassium is key to supporting kidneys to help in the diuresis process.  

Understand What Blood Tests Your HCM Cat Needs and Why

What does a blood test reveal, what's tested, and why.
Your HCM cat should have a blood test every time they visit the vet. You need to check potassium levels, and kidney values, for dehydration, and you can tell if there is an infection or muscle damage, etc. There's a lot one can tell. Always keep notes on vet visits and get copies of notes from the vet and keep copies of blood work.

Monday, April 20, 2015

The More You Know the Better Your Cat Will Be

Reminder: please read the "Notes" at the cat Facebook page and the blog's Medication tab and other tabs for what your cat should be taking and why.

A HCM cat often needs more than just a diuretic. There are drugs to boost the heart or slow it down, and to protect the heart's ability to properly function. And vitamins and supplements are also key, for the heart/body function/kidneys, especially as the need for a diuretic increases. I strongly urge you to administer them to your cats. Your cat's body needs to replenish what the diuretic takes out-electrolytes, especially potassium. The cat needs to be hydrated as diuretics dehydrates-feed mostly wet food not dry; add water to food and water by mouth as needed but especially when pilling.

Keep up the med schedule as prescribed. Don't delay!! This is crucial. Keep a notebook-write down reactions to situations, meds, does the cat seem dazed/slow/unsteady in its gait, etc.-every little blip you see and discuss it with the vet. Could mean a reaction to med, meds need adjusting, could be a new situation occurring in the heart, could be electrolytes are too high/too low, etc.

Know your electrolytes, how they function, how they are interrelated to the body's function: potassium, sodium, chloride, glucose, magnesium, bicarb, phosphorous, calcium. Understand how if they are too high (hyper) or too low (hypo) they can cause issues. You will need to replenish potassium for sure, and give magnesium and bicarb as needed for kidney support, and glucose-as long as the cat's not diabetic-for when it needs energy support in times when it's not eating well enough (a drop of corn syrup or condensed milk in 1/4 cup of water for example.)

A simple CBC/chem panel blood test will show you a range of results for electrolytes and other blood chemistry items being tested.

The different tabs at the blog have links to websites that explain all of these. I recommend reading Wikipedia, Drugs.com, MedlinePlus website, etc. Find a website that is easy to read, that doesn't get you caught up in ads or scrolling through photos of information-which are a waste of time. The more you know, the better your cat will be as you will be able to do more for your cat. Good luck!

Meditations on a Life Blessed with Myrna and Feline HCM-What Does It Mean?

Driving Myrna up to Novi on Saturday reminded me of how blessed or lucky we've been all these years simply getting her to the vet: the storms we got Myrna through without inducing CHF; the storms-both summer wild and winter deep with snow-we were able to avoid having to take her to the vet or cardio or ER at all or were able to put off until things subsided.

I say both blessed and lucky-which can be applied to so many things regarding her care (the doctors who saved her/the cardio and staff; the drugs we found generic and supplements we found that worked that were affordable; my old car that worked when it didn't want to/my husband's car that was newer that I could use in summer because it has AC/when I was able to get a new car that had AC [(joy of all joys-but I digress])-because as a Christian I want to praise God for this blessing called Myrna, to be thankful for all that He made possible for her and with her (this page/the blog/sharing and talking to all of you).

But by no means do I believe God has blessed one cat and not others; that God has provided for one and not others; that one's tragedy is more or less than another's. I don't believe sinners who get sick are punished by God and believers who get sick are blessed by God. I don't believe in seeing someone else's pain or struggle and saying "thank god that's not me" or "well, now I don't feel so bad because their situation is worse."

While there are times when we might focus too inwardly, and there are times when we should look outward and say "thankfully my life isn't like that"-the troubles in our lives, the pain we feel about any situation, is ours. No one else is dealing with it. No one else has your thoughts, complications, situations. Our lives are not single issue even if we tend to concentrate on an issue at it's peak-for example, Myrna's illness as of right now, which to quote WH Auden, seems to have "stop all the clocks".

Even when you go through similar situations, whatever pain you feel is yours and must be dealt with the best you can. No one else will really understand. We can all sympathize when we go through a similar situation but it's never the same. Much like a cake, there's a basic recipe but additional ingredients change the recipe. So, while I thank God, feel thankful, have felt so blessed by this blessing called Myrna, I in no way want to say that YOU are not likewise blessed if you do not feel towards your situation the way I feel towards mine and my belief in God.

Nor do I want to say that your cat is less blessed than mine. I don't know why God gave me Myrna, nor what I was meant to do other than save her life for as long as possible, and write here and at the blog. Not every situation must become a thing; some situations can be a learning experience-such as this one. But where do I go from here? I'm not brainy enough to be a vet let alone a vet tech (who must know as much as a vet by the way but with less schooling I believe.) Besides, I would yell at anyone coming into the vet's office who didn't follow the care and medication guidelines. I doubt I'd have a job for long.