Myrna Loy's Visit to the Vet and Cardiologist

Last week our HCM cat, Myrna Loy, saw the regular vet for a check-up and vaccines as well as her cardiologist. The news is a mix bag.  

Her blood work is normal and she seems to be doing well on all of her meds. The liver values, which had been elevated in the high but normal range after she began taking Valium last winter, returned to normal after four months even though she's still on Valium.  This means that her body is now tolerating the Valium.  It also means that, while I don't want to increase the amount of it that she receives, we do now have some wiggle room to add another 1/16 during the day if necessary.  But so far, even though we have 75-80% box use with Valium, I do not care to add more meds to her system since she is doing so well otherwise.

Her kidney values are good, strong, and normal.  BUN is 23, Creatinine is 1.8-normal range.Potassium is 4.2 and in normal range. She does receive a potassium supplement. It was 1/2 of a 595 mg tablet a day. But her urine PH is 7.5 so I have decrease the supplement to 1/4 a day to hopefully bring down the PH.  The PH should be around 6.5.  A high PH can lead to bladder irritation, bacteria or a UTI, or crystals, all of which irritate the bladder and make it uncomfortable for her to urinate and use the box.  Her urine sample also showed a high level of protein in it.  I questioned if that meant anything such as proteinuria and if she would need a UPC-urine protein creatinine levels in the urine tests or a GFR-glomerular filtration rate test. The test is used to see how much blood passes through the filters of the kidneys or the glomeruli.  The vet said that if the kidney values-BUN and creatinine-were not good, and if glucose or other items were present in the urine, that these combined with proteinuria would indicate there is a problem with the kidneys and more tests would be needed.  However, none of these problems exist in Myrna's urine or blood work so the high protein level is due to the red blood cells (or white blood cells-sorry, I can't remember which) that were present (0-2 is the notation on the lab result) in the urine sample, most likely due to the needle aspirating the urine from the bladder. 

However, we saw the cardiologist two days later.   Unfortunately, Myrna's heart size has increased from 1.2 to 1.8 in the left atrium.  She is now receiving, in addition to all the other meds, one 81mg. children's aspirin twice a week.  She should receive an aspirin every 72 hours but that creates a rolling dosing schedule. And we need to be cautious about how much she receives because aspirin can be toxic to cats if too high of a dose is given.  It could lead to stomach upsets and vomiting and can also damage her liver and kidneys.  She will need to have her blood rechecked in a month to monitor her liver and kidney values. And if she vomits or doesn't eat or seems to have any stomach issues, we are to suspend dosing.  I'm to call the cardiologist next week to let her know how Myrna seems to be doing after a week of aspirin.   The cardiologist said she is now at a higher risk of getting clots and that clots or thrombosis, are painful and almost always deadly (I do know of cats who survive the ordeal if it is caught promptly but still-they are difficult to combat and take a long time and can do more damage to the body affected and to the heart in general.) She is also at a higher risk for having a heart attack.  She will return to the cardiologist in October.

So, I am back to where I was when this all began December 2009 when she was first diagnosed when I didn't know what to do or what was going on and I had to do research in human and vet science to see what it all meant.  Back then, the uncertainty of her life, if she would develop CHF again or have a sudden heart attack or have an adverse reaction to her meds, kept me on edge.  It was only after months of subsequent good reports from the cardiologist, that I could begin to relax.  Now,  I've spent the last few days trying to spend more time with her and taking more pictures of her.  I also wonder if there is something more I should be doing or if I've been neglectful of her meds. Are they cut precisely?  Are they dosed accurately and on time? Is she eating all of her COQ10 with each meal? Should she receive more? Is there another med to ask the vet about?

If you saw her, you would think she was normal. The cardiologist said that many of the cats she has seen often begin to deteriorate over time, not just due to the heart but also due to the long term use of meds that can lead to kidney damage, which leads to lack of appetite, which leads to lack of proper body function and support, which leads to a decline in health and ability to overcome an illness, which leads to... 

So, all I can do is more research (everyone recommends vetmedin so I'll have to look into it and ask); make sure I cut the pills accurately and dose them on time; make sure I keep her cool in a house without central AC (we have window units and fans); keep her as calm as can be; play often and take many pictures.  And each day I pray for her. 

Here are the cardiologist's notes:

"Today's echocardiogram revealed a progression in the enlargement of Myrna Loy's left atrium.  This chamber is currently moderate-severely enlarged.  The measurement is similar to that documented on her original echocardiogram (my note-back in December 2009 when it was 1.8 then four months later back down to 1.2.) The presence of marked left atrial enlargement indicates an increasing risk for heart failure and blood clot formation.  Fortunately, there is no evidence of current or impending congestive heart failure.  Therefore, no specific changes in Myrna Loy's medications are recommended."

Myrna Loy and toys

Update on Cooper with Hypercalcemia

At the end of July we will retest Cooper's urine and calcium, phosphorous, and PTH levels after having suspended administration of magnesium and potassium supplements.  The idea is that magnesium may be acting as a phosphorous binder and that the fact that he practically has no phosphorous could be due to more than just hypercalcemia.  If neither the PTH nor the phos have increased, then we will suspend administration of the inulin fiber he has been taking for a year now to see if that could be acting as a binder or somehow influencing the outcome of his blood chemistry.  After this time, if the phosphorous is still low, then he will return to MSU for  a fractional excretion of phosphorous from blood and urine tests.

Meanwhile, we are trying to manage the calcium with a high fiber diet by feeding him w/d by Science Diet.  We have been mixing it into his regular Fancy Feast. However, he doesn't always want to eat even his favorite food. The house next door is being worked on and any noise disturbs Cooper and prevents him from eating. I gave him an appetite stimulant this week since he had nearly stopped eating.  It helped on Monday, the first day I gave it to him.  But then his eating slowed down.  I will give him another stimulant tomorrow-it can only be given every 72 hours.  

Cooper is the larger cat up front with Myrna (HCM) and Elizabeth-in the basement

In the discharge papers from MSU, the doctor noted that she would like him to eat 7 oz. of dry food a day and 12 oz. of wet food a day.  Trouble is, he barely eats 1oz of dry and 3 oz of wet.  Some days he will eat 2-3 oz can of food per meal. But today for example, he ate 3 oz of Fancy Feast with canned tuna added over breakfast and lunch and still left some in the bowl.  That's about 2 oz devoured-one oz. per meal.  That's not good at all.  

Update on Katharine Hepburn

Last week I posted that Katharine wasn't eating and had gone to the vet. She had a fever. They gave her sub q fluids and antibiotics and an appetite stimulant.  She ate well as soon as we got home and for the next few days. But since Saturday, her eating has decreased. Unlike last week, she is at least eating something for each meal. I have been giving her water by mouth twice a day.  I'm going to wait to see how well she eats overall before giving her another appetite stimulant. She really isn't a big eater. She always eats a few bites and the leaves. So, maybe she is back to her normal.

Katharine hanging off  of the condo the day after the vet visit.

Her blood work and urine came back the next day and everything is great. She did show some dehydration so the sub q fluids and the water by mouth will hopefully take care of it.  

Cat With a Fever

One of our other cats, Katharine Hepburn, hasn't been eating well and we were afraid that she had swallowed another hairband, one that got away from me and promptly disappeared.  She hasn't been eating well since Sunday a.m. I took her to the vet today and she has a fever of 103.9.  They gave antibiotics, appetite stimulant, sub q fluids; took urine and blood tests. Will know more tomorrow.  But soon after we got home, she wanted to eat, and eat, and eat again.  I've been feeding her since 3:30 in small amounts after the initial late lunch.  She finally settled down for a while around 6 p.m.  

Myrna also went to the vet today for her annual checkup and shots. They also did bloodwork and urine test and we'll know more tomorrow.  She goes Friday to see her cardiologist for the first time since March.  She seems to be doing well.  It's been difficult keeping her cool enough this last week with the high temps and the horrible heat in Michigan.  Our window AC doesn't want to produce as much cooling as it did so we've run fans in the rooms (not in the windows as only heat was blowing in.)  I'm glad for the break but at some point we need to fix the AC just as temps are beginning to rise again.

Katharine is in the window, looking at me from upside down position. Elizabeth Taylor is on the level below.

Maybe I'll spend my days driving with her in the car with the AC on or just sitting in the car in the driveway while it runs the AC. 

Cooper Visits MSU for Parathyroid Scan

Cooper hiding under a towel while at MSU

Cooper at MSU

Last Thursday, Cooper, the cat with hypercalcemia, was again at Michigan State University vet school for more tests. They did a scan and found that the parathyroid has a small nodule. This should be the reason for his hypercalc. He might need an operation (about $4000.) However, the vet, in reading the research studies on hypercalc, said there is no mention of a cat with nearly zero phosphorous, zero PTH hormone, and hypercalcemia. Cats have always presented with high calc, high phos, and high or normal PTH. They know that the hormone tells the body to produce calcium and that a high level of calcium will tell the hormone to rest because it's not needed. Next steps: more fiber, feed fiber food called W/D by Science Diet. Stop magnesium and potassium supplements. Continue water in food and by mouth (we give 3ccs in each three times a day.) Check phos, calc, and PTH in a month. Continue to monitor. Give drugs to help body get rid of calc if diet changes do not work. Possibly have surgery in 6-12 months if there are major changes or if the diet/drugs do not work. Drugs and surgery have their risks as does letting the calcium continue to climb. I'll keep you up to date.