Katharine's HCM Advances, Adds New Drugs

 Katharine saw the cardiologist 9/13/23 and her heart has increased in left atrial from 1.50 September 2022 to 1.76 a year later. If it continues to progress, she'll be at 2 or over 2 by April, and more potential issues might develop. For comparison, Myrna in her first year had a left atrial of 1.83, then 1.69 after a few weeks using COQ10 (see later paragraphs.) It would decrease again to 1.52 the next year and remain low until the disease took over in 2013 (almost four years into the disease) and the left atrial increased to 2.12. At this point, she began to develop a series of serious issues. In 2013 she had a heart attack; in 2014-15 she had increased serious CHF issues. And then she died in 2015 (I can't find what size was her left atrium in order to compare to Katharine but it was 2.20-2.30.)

She had two cases of possible CHF this summer after major storms-late July and late August. I had given her small doses of diuretics which worked almost immediately although she needed two more doses in August. With the heart size increasing, more CHF might occur if I do not stay on top of it and fight it immediately with furosemide (lasix.) She may need a daily dose to ward off CHF. I will continue to monitor and discuss it later with the cardiologist if more CHF occurs.

The cardiologist put her on Plavix-1/4 once a day; and an ACE inhibitor Benazepril-1/4 BID. She is also on Atenolol 1/4 once a day.

Myrna was on Enalapril for an ACE inhibitor. I don't know why Katharine is not. The cardiologist said something about it has a different approach given Katharine's early issues. ACE inhibitors stop the ACE process-the angiotesin converting enzyme-which shuts down the bodies' veins, constricts veins in the case of a heart attack or accident that causes the body to lose blood. When you inhibit the ACE process, you allow veins to be wide opened and fully functioning. This helps lower blood pressure, and increases the flow of oxygen to the blood and therefore to the heart. The ACE process also increases SALT so by stopping the ACE process using an inhibitor, the body's ability to retain salt is reduced, thereby lowering fluid due to less salt, and therefore reducing blood pressure.

I also bought from CHEWY, a bottle of Rx Vitamins 30# COQ10, a supplement that we used with Myrna that improved her heart condition for a few years. Each capsule has 30mg. With Myrna, I'm not sure pet formula COQ10 existed because I bought Nature Made and squirted each capsule into her food. She received 200mg per day. Then later, I put it into the goop mixture I devised of this and other supplements and vitamins to improve her kidney function when the amount of diuretics increased and the load on her kidneys was too much, and her kidney values declined. This pet specific COQ10 is small enough that she can swallow it. I will give it to her daily. It's a lesser amount that what Myrna was taking but then Myrna's heart was far worse at 8 months old than Katharine at 14 years old. 

So, if Katharine's heart is nearing 2.0 this next year, and Myrna had severe issues at 2.12, we must work hard to try to improve Katharine's heart function, keep her overall health stable, and monitor closely for CHF; and be aware that there is a chance we might lose her in the next two years. Given her age at 14 and a half, she has lived a long life and we have had her a very long time. I'm grateful that her other health issues-seizures, IBD-are under control and hopefully remain so. That leaves me time to concentrate on taking care of her heart. But I refuse to make any concessions, to give in the inevitable, and to treat her condition as a given. And I refuse to give up. I cannot plan for how I want her life to end or when. But I will help her fight; I will help her body stay strong in order to fight. 

Please read more at the blog's tabs: Myrna's Story, Meds, About HCM; and do a word and category search for further information.

Apps for Feline HCM

Someone mentioned they use an app to track their cat's progress and breathing. Here are some apps that help with tracking breathing. You can also use the clock/counter/timer on your smart phone, your stove or microwave, a kitchen timer, etc. if watching a watch (very small hands) or your house clock is difficult or not available.

I have NOT used these. These are NOT paid sources. These are NOT things I recommend as products, just things I Googled. You and others might have even more apps to recommend. Please do so here in comments. Thanks.

https://apps.apple.com/us/app/count-my-breaths/id1513102381

https://apps.apple.com/us/app/my-pets-heart2heart/id1564965551

https://www.cavaliermatters.org/unique-hereditary-diseases-index/mvd-heart-disease/mvd-respiratory-app-cardalis/#:~:text=The%20Cardalis%20app%20is%20very,information%20is%20recorded%20and%20charted

https://apps.apple.com/us/app/srr-counter-for-dogs-cats/id1086456790

Cat Medications and Supplements-Where to Buy

Cat Meds:
Cat meds do not need to come from the vet but it does depend on if it is exclusively sold by the vet; or if the vet exclusively has the smaller dose made for pets while the human pharmacy may only have the larger doses for humans. You might need to get some meds from your vet or cardiologist to get started when your cat is first sick (be it HCM or other issues), and then take the time to comparison shop for a more affordable price. When a sick cat needs six or more meds as with HCM, you'll want meds that you can get for a month's worth that are only $10 or less (for example) or whatever is affordable and available.

Most meds a cat needs are human meds and likely can be purchased at the local human pharmacy and for less money than from the vet. Even if the tabs come in only large sizes, check to see if they can be cut down to the dose you need (using a good pill cutter) so that you can buy the cheaper human size and not the more expensive vet size (if applicable.) Ask the pharmacist about the possible various dose sizes and thencomparison shop. There are various variables to consider.

Target, Kroger have had $4.00 meds in the past when we needed so many for Myrna Loy. We now get the various meds from Kroger, and a local compounding pharmacy, and an online pharmacy Wedgewood; and we have used the online pharmacy Road Runner in the past.

Check for hours a pharmacy is opened. You'll want something that is convenient for you to access. You don't want the store to be opened until 10 p.m. but the pharmacy closed by 6 p.m.

Supplements: can often be purchased at pet stores, Amazon, 1800pets, Chewy, etc.-like Laxatone, Lysine, Renal K, cat vitamin paste, immune liquids, taurine, etc.

Vitamins like COQ10, vitamin E, iron, magnesium, potassium for humans, etc. can be purchased at Kroger or Target (comparison shop: Target, Kroger brands, vs Nature Made, Sundown and other brands-look price per pill count, pill size per mg; and specials on price: 2 bottles for one for example) or elsewhere for human supplements and then cut them up or pierce and mix into food (depending on the flavor of the gel cap.) [These supplements are only some a cat might need. See the blog Med tab for what we used for Myrna. Your cat might not need them or might need others. These are suggestions referencing what we used.]

Short Story About a Cat Named Myrna Loy

This is a short story I wrote around 2012 when Myrna was still alive. It was never submitted to be published. It's a very simple story about a process we really used with her. 

A Cat Trains the Owner 

Once again, Jen found it difficult to wake up on time after being up twice last night to help Myrna go to the bathroom. It was like this every night and had been like this for over a year. You’d think by now she’d be used to having her sleep disturbed, followed by the ritual of 5 to 15 minutes of waiting for the girl to go, before finally climbing back to bed and then taking another 15 minutes before she was back to sleep. 

Most nights, the girl got her up just once but lately, it had been twice. If she went by 11 p.m. she would be up again around 2 a.m. and then again around 5 a.m. If she got her to go by midnight or 1 a.m. then the girl would go by 4 or 5 a.m.  It was rare the girl went by herself but she always woke up Jen to say she had gone. 

It was a process that began when Myrna wasn’t using her litter box. They had worked with her using various behavioral techniques and timing when she needed to go. If three hours had passed and Myrna was up and about, they would ask her if she needed the litter box. They would take her, give treats to encourage her to go, and sometimes it worked. Quickly, the girl learned that treat time equaled litter box time and would cry when she needed to go, would also go downstairs to the basement as soon as she heard the treat bag. Sometimes it worked and sometimes it didn’t. But over time, Myrna made the connection, and the trick began to work. She began using the litter box more often.  

But the trick wasn’t meant to be used while Jen was sleeping. All she could do was pray the cat would use the box and not have an accident. But Myrna decided she would only use the litter box if Jen got up in the middle of the night to give Myrna a treat. So, one night, about 3 a.m., Myrna climbed on top of Jen, stood on her chest, leaned in and cried very loudly and incessantly until Jen woke up.  

“What’s wrong?” Jen asked.  Myrna bounced off Jen and jumped to the floor. Jen thought nothing of it and rolled over. Seconds later, Myrna was back, standing and crying again.  

“What? You have a toy?” asked Jen and Myrna bounced off again. Jen went back to sleep but seconds later Myrna was on her again.  

“MEOW, MEOW, MEOW!!!!!” cried Myrna at which point Jen had to get out of bed. She turned on the bedside light and followed Myrna. Myrna went to the litter box, climbed in, and went. Then she hopped out, looked up at Jen and cried, and walked in circles doing the twitchy butt thing she did when she wanted attention. Jen got the hint. She petted her and praised her.  

“Good girl, Myrna! You used your litter box!”  Jen got out a piece of paper and wrote down the time and then went back to bed and turned off the light. Only she hadn’t completed the process by ending the praise with a treat so Myrna climbed up onto her again. 

“MEOW! MEOW! MEOW!”  

“What???!!  What do you need now?” cried Jen. And Myrna cried and walked in circles on the bed.

     Then Jen remembered the usual process: Myrna goes, Myrna is praised and petted, and then treated. But the treats weren’t up here so Jen dutifully went downstairs to the kitchen to get the treats. She gave one to Myrna and praised and petted. And then Myrna sat and looked for another, so Jen gave another, then another, then finally one more before saying,

“That’s it Myrna. Back to bed” at which point both Jen and Myrna went back to bed.  

So, ever since then, this has been the nightly ritual. If Jen could train Myrna to go without a treat or without Jen’s involvement, that would be great. But this helps Myrna, this comforts Myrna, and Myrna hasn’t had an accident day or night in a year. So, what if Jen hasn’t slept more than three months in a year? As for Jen’s husband, Myrna doesn’t bother to wake him.  He would never wake up. He sleeps through everything.

Bette Davis Necropsy Report-Cancer in the Brain

Bette's necropsy report came in two weeks ago and I have only been able to post about it now. A necropsy report-if you've never seen one-drills down into the cellular level of tissues. Samples are taken from all major organs and tissues and any areas noted as a concern or involved in the demise of the animal. They also look at all organs and give a physical description. 

Basically, Bette died of brain cancer. The Nerve Sheath Tumor was gone from her spine. BUT it had spread through the nervous system into her brain. The SYMPTOMS of TRIGEMINAL NERVE damage that we thought we saw: open mouth breathing, excessive drooling, tongue out, difficulty swallowing, combined with her right eye not blinking or closing, and the eye ulcer (from not closing the eye all the way) that hit her two weeks before she died, were signs of brain cancer. 

Likely it was spreading before radiation treatment. Possibly could have been seen if another MRI had been done as she began radiation treatment. Definitely would have been seen if we had been able to convince anyone to do one in the last week or so when she was struggling to breathe and no one would listen (the vet school ER for example.) I would have wanted to do palliative care and to be more aware of her demise and spend the time accordingly (not that I wasn't with her that last week) instead of trying so many things to fix whatever ailed her, only to be ignored by almost anyone I approached. (Her regular vet was wonderful as was her dentist-see previous posts.)

Her increased breathing issues were also related to decreasing brain function. 

She also had ASPIRATION PNEUMONIA. When she went immediately into respiratory distress at 6 p.m. that Thursday night 5/18/23 was because she aspirated food into her lungs. Likely, she regurgitated and inhaled it. Aspiration pneumonia quickly happens when something is inhaled into the lungs and quickly causes respiratory distress and death. 

She had declining cranial responses-the eyes weren't closing, she couldn't move her limbs-over night Thursday and when we put her to sleep Friday, all from brain cancer.

She also had mild HCM-not detected in January-but seen in pathology report in the left vent and in the cells. It was not drastic and is likely radiation/cancer change related. However that works. She wasn't presenting "clinically" meaning there were no outward or vital signs indicating heart disease. 

She also had lymphoma in her cells-cancer-that cats do not recover from.

She had a small tumor/nodule on her thyroid that would have become an issue if the rest of the cancers hadn't happened.

NO MASS in the body; NOTHING wrong with the esophagus or larynx causing breathing issues. The ER doctor that Thursday 5/18 thought something was pressing down on the esophagus causing the breathing issues because the xray showed gas in the opening and at the end but the airway suppressed in the center. The vet school radiologist for the pathology report looked at the xray and said it was normal. The way she was laying for the xray made it look as if it were pushed down; and the pathology did not find a mass in that area. 

There are terms in the necropsy such as:

*heart myofiber disarray and fibrosis

*Lipofuscin granules 

*hepatic parenchyma small nodular aggregates listiocytes

*pancreas nodule of hyperplastic exocrine pancreatic epithelial cells

*proliferations of thryoid epithelial cells

*fibrin hemorrhate viable and degenerate neutrophils

*infiltrates of a momomorphic medium round cell population

etc.

I did complain this week to the owner of the ER about the rudeness of the clerk on that Thursday when she said "The doctor already told you we can't fix this. Whatever's wrong with her we can't fix this." as we are standing there with Bette in severe respiratory distress. I calmly discussed my concerns, as well as shared the necropsy. She apologized and seemed concerned about the interaction and said she'd address it. I can only hope changes are made because they have been a wonderful ER that we have almost exclusively used since 2009 despite being 40+ minutes away. (The cardio is in the same building and can run over to see a sick cat as needed.)

I also calmly complained to the vet school about the over reliance in my view, of the ER staff on VITALS to determine if a patient is fine, while IGNORING how the patient presents with difficulty breathing. I said that the resident in the ER had said that Bette on 5/16 was fine, while they ignored that she looked awful, wasn't breathing well, and made horrible noises. I wanted her admitted so that the hospital staff could see her the next day but was refused. Possibly they could have done an MRI or made further determination that she was failing so that again, we could have done palliative care. I told the manager that she crashed two days later in respiratory distress and died that Friday. So CLEARLY she was NOT FINE on Tuesday. I'm not sure a practice manager can change how vet school students are taught and how the residents handle cases. AND it was just a voice message that I left after getting the manager's number. But I told him that she was a rad/onc patient and the pathology report was on file there. 

We fight the signs of illness as we see them. That's what I encourage you to do-always. Monitor your pets especially those with a chronic condition such as HCM. They need meds, regular schedules; they need monitoring for breathing; they need help eating; they need all symptoms addressed even if in the end they will die of HCM or cancer. And fight-complain-when vets are not helping or solving or searching; or clerks are rude. Fight your panic that prevents you from thinking of what to do. Get organized for pet care-we did even more of this for Bette's care than we already do for the cats. 

What did I learn from Bette's ordeal: 

*to get the MRI earlier than later as soon as it seems necessary; to get it again weeks later if the pet seems worse (as she lost the use of her rear left leg in April maybe? When she first had trouble breathing in May?) 

*to keep oxygen on hand always

*to check the cats' faces for ability to blink-if you get half way to their face and they blink that's a good sign; if you get up to them before they blink, that's not a good sign.

*That I was able to force myself to think as I panicked about her breathing issues and to act quickly, to overcome the panic and to act. I hadn't been in this situation since Myrna died in 2015. It all came back and is now registered in my brain.

*That I did more for Bette than for Baby when she was sick in the ER struggling for a week in 2021 before we had to put her to sleep. We put her to sleep too soon and I'll never know what I could have done. But I panicked. (Baby was breathing on her own unlike Bette who could never have come back home.)

So, there was nothing that we could do to cure Bette while we were doing everything we could think of doing to help her. She was slipping away the moment she got sick in January because that was the first sign. 

Cats Virus Causes Them to Not Eat

UPDATES: So Jimmy wasn't eating last week; Elizabeth began not eating last 6/3 Saturday; and Katharine was a picky eater more than usual last week, also. 

We discovered that all of the meds we normally would use-Cerenia, Mirtazapine, stomach meds, nausea meds-were contraindicated with his Prozac. Either the Prozac made them not work, or the other meds had a possibility of running up a heart rate/blood pressure, or can make a cat weak-depending on interaction. Jimmy saw the vet for sub q fluids Friday and Saturday and a B12 shot Saturday and began to slowly eat on his own Saturday afternoon. He spent Saturday-Sunday slowly eating a couple bites every two hours; then eating more and more often Monday and Tuesday, until he was eating a full meal on his own by Wednesday. He was slow and "out of it" and would disappear for hours until ready to eat Saturday-Tuesday; by Wednesday was hanging out upstairs again. 

His CBC/chem panel blood work showed signs of inflammation and pain: neutrophils and monocytes were increased to HIGH, and the lymphocytes and eosinophils had decreased to LOW. Possible causes: anemic-he had lower red blood cells but normal reticulocytes so not likely; Bone Marrow disease-with low RBC, high others, possible but requires bone marrow testing so NO for now; kidney disease-his SDMA is increasing from 10 to 11 last time, to 12 this time. Combined with the increasing RBC it's possible. Urine test was clear, no protein, no glucose, SPG-specific gravity-was normal at 1.030. So no obvious signs but something to monitor especially as he is 14. As a cat ages, kidney disease can be a problem. His ALT, ALP, etc. were all normal-no liver issues, no dehydration, etc. Other causes with the blood results: gastro issues, pancreas issues. He had an ultrasound Thursday that showed some small intestinal thickening of the walls which indicates possible virus or possible IBD coming on. If he continues to improve-and given that Elizabeth and to some extent, Katharine, were also not eating-the vet thinks it is some sort of virus. We are to monitor, give extra lysine (herpes virus) they already take, and if further "intervention" such as sub q fluids or more B12 or other tests are warranted, we'll go from there. (Other tests-MRI? Other blood work? A steroid-although not Prednasolone because of his pre-diabetic history and Prozac.)

Elizabeth-suddenly wouldn't eat Saturday as much as usual. But given we were busy with Jimmy, we let her do her thing. Then Sunday she wouldn't eat at all. We began hand feeding her Hills AD by syringe every two hours Sunday and into Monday. Elizabeth can take Mirtazapine. She had some Sunday which took hours to kick in and let her eat very little Sunday night. She had it again Monday to no effect. We have been giving her Cerenia (anti-nausea/vomiting med) since Sunday. It might have helped but did not encourage eating. I called the vet Monday and they saw her on Tuesday. They gave sub q fluids, a B12 shot, checked CBC/chem panel, did a urine-all came out normal. Nothing like Jimmy's blood work to indicate any pain or inflammation. 

We continued to hand feed her as needed until she finally began eating a couple bites every two hours Tuesday night and Wednesday. She also had an ultrasound Thursday that showed she also has a small intestine wall thickening that indicates IBD. Again, the vet said that if she's eating on her own enough, to continue to monitor her recovery. Use Forta Flora in her food-and Jimmy's-but any further "intervention"-meds, tests-will be discussed if this happens again.

Katharine-she responds well to Mirtazapine and eats well on it for a few days before needing more. She has not yet seen the vet. BUT again, the vet thinks a virus of some sort hit them. It affected Elizabeth slowly over time when she was showing signs of being a picky eater; hit Jimmy hardest because of the dental procedure and anesthesia which makes the body slower and more apt for things that are working their way through the body, to suddenly emerge. This can happen with HCM-in the form of CHF after surgery/anesthesia-for example. AND it's because they all have chronic health issues of various sorts.

Roxanne? Not sick. Secluded in the a.m. so that she eats and isn't bothered by the others; is also younger and so far healthy with no chronic issues.

Feline Thrombosis/FATE-Feline Arterial Thromboembolism-the Affect of Blood Clots in Cats

When Bette first went lame, many readers thought it could be thrombosis. So, what is thrombosis? Thrombosis is when a clot forms in (typically) the heart and travels and cuts off blood supply to the affected region. It can be to the heart-heart attack, stomach-vomiting (typically a symptom), or front or rear legs (the rear legs are saddle thrombosis or FATE-feline arterial thromboembolism.) Clots can be formed due to injuries or disease but for cats, it's mostly due to heart disease.

We know it was not thrombosis because we eventually learned with an MRI that it was Nerve Sheath Tumor. The tumor damaged the nerves to the rear part of her body, especially the left leg. But it did not affect blood flow in the legs. (A tumor could of course, depending on location on the body.)

A clot that travels in a blood vein will damage the arteries to the legs and arterial blood pressure will not register. Hopefully, the normal blood veins in the leg will continue to work and supply blood to the legs and the leg will be healthy. This may not always be the case. Cats can be paralyzed by loss of blood flow to the legs. In January, Bette's leg weakness went away while on prednisolone. Thrombosis isn't cured with prednisolone. And she maintained normal arterial blood pressure.

A cardiac ultrasound by her cardiologist in January showed no signs of heart disease, or clots having formed in the heart. With thrombosis due to HCM, an ultrasound would show changes to the heart and clots. When the problem of weak legs returned in March, that is when she had an MRI that showed the tumor.

When a clot forms in the legs, this can happen over days even if the onset seems sudden. The PAWS of the affected leg will be pale, not pink (or pale gray), and the paws will feel cool or cold to the touch. This is why you should always check cat's paws for color and feel of temperature so that YOU know when the paw is normal and may not be normal. If you suspect the paws are getting cold, see the vet and cardio as soon as possible.

When the clot settles in the artery of the leg, the cat will be in pain-typically over time-a few hours, a day; may go weak, may not want to move around; may begin to breathe heavily due to the clot having formed in the heart and passed along the body; may begin to breathe heavily due to increasing pain as the clot forms in the legs until the artery is cut off; the cat eventually will likely scream out in pain, and panic, and try to move around, as if to get away from it. The cat will not be able to stand or move the affected leg or legs. The cat will need immediate attention at the ER, the cardiologist office, or from the regular vet (you should discuss with your regular vet if they have experience with thrombosis and what treatments they can offer in the way of emergency care so that you know if they can treat the cat or if the cat needs the ER.)

We went through this with Myrna Loy. She had a heart attack in 2013, and FATE in 2015. With her heart attack, it was difficult to assess what was happening. She had begun to breathe heavily that morning and I gave her extra diuretic. She then hid and I spent a couple of hours trying to get her out from under the bed. I monitored her but saw that her breathing was getting worse. I finally had to chase her out with the vacuum. She ran, then laid down in the hall. I gave more diuretic but that didn't change her breathing. I called the cardiologist and she suggested that Myrna was having a heart attack. I rushed her to the ER which the cardio shares, and she was treated and the ultrasound showed a heart attack. Luckily, she was on Enalapril so the blood veins were kept open in her body so that the heart rate wasn't driven up, damaging the heart even more. She received oxygen, diuretic, other ER drugs, and stayed overnight until stable; was put on a twice weekly dose of aspirin in addition to the Plavix she was already on.

When she had FATE in 2015, she woke up and began to have a difficult day. She seemed uncomfortable; she wasn't eating well; her breathing eventually increased. I remember her paws were cool to the touch, but it was May and the AC was on and she had been on the floor. I ignored a major first sign. I was with her upstairs all night as she didn't want to move, didn't want to be touched, didn't want to eat, and seemed more and more in discomfort. As her breathing increased, I increased the diuretic. Her breathing rate fluctuated. She had just settled down on the bed for awhile, resting, breathing comfortably when she suddenly raised up, seemed to look surprised, and then leapt up from the bed and cried out in pain. She jumped down onto the floor and her rear legs were not moving. I picked her up, placed her back on the floor to make sure, and saw she couldn't use them. I immediately took her to the ER. By the time we arrived, it had resolved itself. She was treated, kept overnight, and saw the cardio the next day. She luckily had lost only the use of the artery. The other blood veins in the legs had taken over and supplied the legs with blood so that she never lost the use of her legs.

There is more information at the blog about what we went through and there is this information from a conference I attended in 2011. You can do word/category searches at the blog to learn more about thrombosis and thromboembolism.

2011 Vet Conference Thrombosis