Wednesday, April 16, 2014

Myrna's Stable, All's Well But COLD

Update-Myrna's well, breathing is stable. We have once again-because it's freezing and we have snow-IN THE MIDDLE OF APRIL-turned up the heat, closed the windows (the insulation having unfortunately already been removed so they are a tad drafty.) Keep your HCM cats warm/cool, and don't let the humidity (if and when we have any) get to them. It will impair their breathing, bring on congestion, lead to CHF.

Saturday, March 29, 2014

Cooper Came Home from ER on Friday

Cooper came home this afternoon. They had him on oxygen until this morning because his breathing was so fast. But it turned out that his lungs were finally clear after a night of lasix. He was breathing fast due to anxiety which they didn't realize until the am X-rays . He's now on pimobedan or vetmedin as well as the rest. He looks much better today after a day in the Er than he did last week. He was even relaxed and stretched out in the crate in the car. He breathes fast apparently so we need to learn what is normal and what indicates he needs lasix. I'm starting a Facebook and blog for mbcm. I'll let you know more when they're up and established.

Thursday, March 27, 2014

Cooper Returns to ER with CHF Almost a Week After Leaving Hospital-Turns Out He Has Rare Disease


Myrna and Cooper were to see cardiologist today-a recheck for Cooper after being in the hospital last Friday night for CHF; and a regular checkup for Myrna.   He had slowly bounced back from being in the ER with CHF last Friday.  He came home Saturday looking miserable and slept in the basement.  But Sunday he was more alert and more social, choosing to sleep in our bed.  He continued to be more social, eat more and more often, and take his heart meds as the week went along.  However, his breathing rate ran 10-14 and continued to be around 12-14 by Wednesday night.  By 1 a.m. the breathing rate was 20 in 15 seconds.  He was breathing very fast but not panting, not looking uncomfortable.  I gave him 10mg lasix. By 1:25 a.m. the rate came down to 15 where it remained until morning.  We decided he wasn't getting better because despite 10mg at 1 a.m. and 10mg at 7:30 a.m., he had only urinated once.  So my husband took him to the cardio's office, which is connected to the ER. They put him on oxygen.  When I took Myrna in for the 3 p.m. appointment, I discussed Cooper with the cardiologist.  He unfortunately, has CHF again and will remain overnight in the ER on oxygen and IV lasix.  

Dr. DeSana did a new echo today.  As reported Friday, he has cardiomyopathy but today she was better able to see the heart.  He does NOT have HCM.  He has a rare disease called
 Moderator Band Cardiomyopathy.  There is NO clot nor thickened section of a valve wall. What he has are bands of muscle tissue that connect themselves to sections in a chamber of the heart.  They don't belong there.  They are restricting blood flow and ability of the valve to work. The connective bands make it look as if the chamber is segmented when it's not.  I need to research this more.  But here are some links:

http://www.ncbi.nlm.nih.gov/pubmed/6211423
http://www.ncbi.nlm.nih.gov/pubmed/16861023

He's not in danger of having heart failure any time soon. He has NO clot which is great news. He is at risk-as are all cardio patients-of getting clots, arrhythmias, low or high blood pressure, and congestion, which he is battling now. 

She said his lungs are worse with congestion than Myrna's have ever been.  And she fainted and had trouble breathing, and was in pain and lethargic when she had CHF. Cooper has not fainted, grown weak or lethargic, or looked in great pain and discomfort. We don't know why he has congestion.  It could be that his lungs were not that clear when they released him Saturday. They listened to his lungs but did not take new films. LESSON LEARNED:  if fighting congestion, always get new xrays taken when you think the lungs sound clear to make sure they are clear. 

The problem is that he's not responding well to lasix.  His kidneys are perfect. The blood values are fine; he concentrates urine; his specific gravity is normal.  And strangely enough, he's actually dehydrated!  The only fluid in his body is in his lungs.  But for some reason, the lasix isn't causing the body to send fluid to the kidneys to be excreted as quickly as it should, certainly not as quickly as it works for Myrna.  The vet will now be more aggressive.  He will receive IV lasix tonight in the ER.  

His breathing rate at noon was 72; by 4 p.m. it was down to 42-better.  He was able to come out of oxygen to get an echo without collapsing or without an increase in breathing rate which is good news.

At home, we will use higher doses or dose more often of lasix.  We may need to do injections, supplies we still have for Myrna.  

His condition is very odd.  It's also very rare. It's the first case the cardio has ever seen.  She read about it in vet school but has not treated a case. The cause is unknown.  The research mostly believes that the condition is congenital (unless there's new research) because most cases have occurred in cats that had not had heart echos when the hearts were healthy, prior to being diagnosed. So, researchers assumed the condition was always present when it might not have been.  When he ever does pass away (and he's not expected to any time soon) we will donate his heart to research and the vet may write a paper on it.  

Since the condition is rare, treatment with medications and effects or symptoms of the disease are not well known.   Lasix is needed for sure.  For him, right now, an ACE inhibitor or a beta blocker are not recommended because his heart rate is high, blood pressure is low, and contractility is weak.   She does want to put him on Vetmedin a.k.a. Pimobedan to improve heart contractility.  

She also suggested seeing a holistic vet.  He apparently is very good with difficult cases. I'll look into it.

Cooper will hopefully come home in the morning.  She will call after 9 a.m.  By the way, Cooper looks pissed off in the cage today.  And he hisses whenever the vets or techs open the cage for anything.  He only hisses at home at the other cats, never at us or visitors. (But
 he always hides from visitors.)

 
Cooper

Myrna Has a Cardio Check-up Since Last Month When She Had Congestion, Low BP, High Heart Beat

Let's review Myrna's checkup first: She's great! Clear of congestion she had a month ago when we had to give extra lasix and two shots in February. BUN is up to 41 and creatinine up to 3.6 but the vet's not concerned. It was inevitable that we'd see these go up after five years and a lot of lasix (56mg a day.) But it does not indicate kidney disease/failure. There's more to look at than the BUN/creatinine. She concentrates urine, urinates frequently and large amounts, and all other blood values in the CBC/chem panel blood test are in normal range. Her blood pressure is normal at 128, up from around 90 that she was in Feb. (It had been 90 which is very low in September due to a heart attack and took weeks to come close to normal before it dropped again in February.) Her heart rate, which had been around 160, is now 150 and the vet is happy with that. Her left atrial valve is actually smaller by 2 tenths: 2.45 to no 2.2. Hey, any good change is a GOOD change! We'll take what we are given and rejoice.

Here are the doctor's notes:


"Myrna had a good evaluation today.  Her radiographs did not reveal any congestion in her lungs or evidence of impeding congestive heart failure.  The echocardiogram revealed stable parameters with the exception of her left atrial dimension, which as decreased slightly from 2.45cm to 2.20cm since February. Her blood pressure was 128mmHg today.  I could not be more pleased with today's finding.  I do not recommend any changes in her therapy." 

Wednesday, March 26, 2014

Cooper's HCM Developed Quickly-Believe Weight Loss Last Summer Indicated Onset

Did I mention Cooper's HCM developed quickly? He had an echo two years ago when he first had hypercalcemia and we were worried about the effects on the heart. The echo was clear. He had a stress related murmur that he's had even as a kitten but no sign of disease. Last summer he weighed 12.8 lbs and began to slowly lose weight-an ounce here, 1/2 ounce there but he was eating well enough. By December he wasn't always eating everything offered and by the end of December he weighed 12.1 lbs. We knew that he hadn't been eating well but thought it had to do with the tooth he was losing to resorption. Two months later at the dental surgery, he weighed 11.5. We had not realized that he had drastically lost weight. We now believe the weight loss indicated the onset of heart disease. At no time did he ever present with congestion until last week. It wasn't until he really didn't want to eat last week, and that he looked tired, and that on Thursday seemed to breathe fast, that I knew he needed to see the vet. But even then, I wasn't expecting heart disease. I thought the hypercalcemia was causing issues again.

Cooper Tuesday-Recovering from CHF But Breathing Rate is Still High

Cooper is perking up. He's more alert and eating more. He actually looks healthy again. We are giving tuna juice/kitten formula/homemade chicken broth (not mixed together but choosing 1 or 2 of them each time) by mouth 3-6 ml total with every meal and in between meals. He's eating some wet, and tuna, and kitten dry food at each meal. We feed him twice in the morning, at lunch, when my husband comes home, and in the evening, and at bedtime Not sure if the lasix is working enough. We've given extra at times but his breathing rate hasn't improved. It seemed better by Sunday but yesterday, Tuesday, it was about 14 in 15 seconds so around 60 per minute. If this were Myrna, that would be WAY too high. But he's up and about and the breathing isn't labored and it goes down to 12 and up to 14 when he's moving about. We see the cardiologist tomorrow so we'll see what she says then. It could be that he has no congestion but another issue.