Cats and Kidney Disease-even HCM Cats May Need Treatment

If your cat develops kidney disease-CKD-the cat needs a low protein, low phos diet. The article lists some of those brands. This may also apply to your HCM cat but in a different way. With heart disease, the kidney function declines. With diuretics, the kidneys take on the load of the work. Both issues create some decrease in function. At some point, your HCM cat may need a CK diet.

Both CKD and HCM cats need more potassium supplementation (Renal K, Nature Made, Sundown, etc.) as well as COQ10, vitamin E, vitamin C (made for felines), and iron (use human iron cut into halves or quarters.)

https://www.medicanimal.com/The-truth-about-renal-diets-for-cats/a/ART111494?fbclid=IwAR2TmszV--YG90Pa1AIGHKuJcUbFi3Vhs7dqegpsd-CcGlv3WJYfNKiDDyw

Roxanne Vistis Cardio-Has Slight Changes in Left Vent but Not Yet HCM

Roxanne saw the cardiologist yesterday just because that's what we do. Glad we did. She shows signs of changes in the left vent. No signs of heart disease but those changes often become HCM. The cardio said it could go either way. But no stress or too hot or too cold or too humid environments. And no steroid medications. And she will need annual cardio visits. We found with Cooper that heart disease can suddenly emerge from one year to the next-one year he was fine; the next he was not.

She gets car sick, though, and vomited and had diarrhea in the crate on the way there. But while there, she was very calm. She sat quietly for the exam; her heart beat was steady, not racing due to being in a new place.

No meds are recommended at this time since the heart rate is steady and there are no other signs of actual heart disease. The walls of the heart are not seriously thickened; there's no congestion; etc. She described the walls to be as appearing to be uneven.

So, we will keep an eye on her.

Here are the vet's notes:

"There was no evidence of serious cardiac disease during today's echocardiogram. The only questionable abnormality that was found is that the wall of Roxanne's left ventricle are slightly thickened. This may be completely normal for Roxanne or it could be an early indicator of hypertrophic cardiomyopathy (HCM). There is no need for any type of treatment at this time. She is not considered to be at risk for congestive heart failure or blood clot formation. I advise rechecking her echocardiogram in 1 year. If progressive changes in the heart are seen at that time, Roxanne will be diagnosed with HCM and we will consider beginning cardiac medications. If there is no change in her echocardiogram, we will consider these measurements to be normal for Roxanne."

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." 

Baby It's Hot Outside-Heat, Humidity, Storms, and Reasons and Means to Keep HCM Cats Cool

Not too hot, not too cold. HCM cats must be just right.

It's hot weather season again. Need to make sure our HCM cats are kept cool but not too cold. HCM cats can't handle heat and humidity. In general, the heart is too weak to handle the stress of changes in weather-fighting to keep a body cool or warm; and breathing will become difficult-as it does for humans-in humidity. Opening windows is fine as long as hot or humid air is not coming in. Use fans or AC units. Also pull shades. Dark rooms are often cooler. We don't have AC so we are using a series of window fans and portable and window AC units to keep the house cool and air moving. Myrna and the other cats at this time of the year also live under the furniture and in the shade in the rooms. Our oldest, Baby, has spent most of the last three days in the basement where it feels about 20 degrees cooler. If only I could get Myrna to live in the basement but no, she prefers to be somewhat more social.

If you've been through storms this week, or will be, good luck handling your HCM cat. If possible, close windows and shades, so the cat doesn't see the lightening; maybe move the cat to the basement or first floor where the storm may not be heard as much as upstairs; if possible, distract the cat with treats if the storm is very loud. If a huge storm or tornado is in the area, you might want to place the cat in the cat carrier. It's a contained, controlled environment that you can cover or place in a closet to not only keep the cat safe but try to keep it calm.

 

Myrna (left) and her much larger and older sibling Cooper (not related by blood) doing what they love at night-looking out at bugs and wildlife.

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. 

Update on Myrna and HCM

Forgive me for taking so long to update the blog.  Myrna's doing well and so are the others (we hope) but I've been busy. 

So, on 3/1/12 Myrna had a check-up with her cardiologist Dr. DeSana in Novi.  Myrna's doing well and all seems stable. I did discuss a few things with the vet. But here are her notes first:

"Today's thoracic radiographs did not reveal any significant changes since Myrna Loy's evaluation in December.  There has been no increase in the size of her heart and there is no evidence of current or impending congestive heart failure.  Her cardiovascular disease is currently stable and no changes in her medications are indicated.  Please return (to her regular vet) to perform a chemistry panel (blood work) to assess the status of Myrna's liver function due to the new addition of Valium to her therapeutic protocol to manage her inappropriate urination."

The cardiologist requested a chem panel (blood test) to test Myrna's liver values because Valium is known to cause hepatic (liver) failure in some cats.  So, we must be vigilant about her health.  We did have a CBC/chem panel done later that day at the regular vet office.  The following day the results came back.  Her liver values are higher than before taking Valium but not so high as to warrant taking her off the meds. They were low normal range a few months ago and are now higher in the normal range. This warrants having the blood retested in 6 months if there are no indications sooner that she is unable to tolerate Valium. Symptoms of hepatic failure are vomiting frequently of not only food but of bodily fluids, not eating, and turning yellow-jaundice-on her skin and fur.  All other values, especially kidney values, are in the normal range which is great news.  Potassium is low again at 4.3, although well within the normal range.  But it's down from 4.6 despite taking supplements. That may not be much of a difference but we are trying to make sure she retains potassium levels because the kidneys need potassium-not too much, not too little-and the lasix, as a diuretic, drains the body of extra fluids and along with the fluids, also drains electrolytes (potassium, sodium, phosphorous, chloride, magnesium) which the body needs to function. 

I told the doctor that I had noticed that Myrna's front legs seemed a bit weak. She often seems to wiggle her legs when she walks on them and seems to slide around on our wood stairs and floors more easily than before. She thought it was the Valium, which is a muscle relaxer but that the chem panel would show if anything else is affecting the legs. So, now that we know the CBC/chem panel is good, we can be reassured that the Valium is somewhat relaxing the legs but that no harm has come to her legs and she is not showing any change in blood pressure to her front or hind legs which would indicate possible clots in the leg valves.

Dr. D answered some questions about some things which I've read about in the Yahoo Support group for Feline HCM.  It's a good site for support and information but can also be a site with misinformation so caution and online research are always called for before jumping to conclusions or following some one's advice (even mine.) 

The first item regarded a post about research that shows that fluid around a cat's heart can lead to incorrect echo readings and lead to a misdiagnoses.  She said that she thought what they were referring to (the post had listed a valid research paper but I do not have the link to repost) was that when a cat is sick from an incident or disease other than something affecting the heart, and becomes dehydrated, the heart walls can thicken. If an echo is done, the technician or vet-if not an experienced cardiologist-may misread the exam and state that the cat has HCM.  Once the cat is rehydrated, and recovers from the incident that made it sick in the first place, and a follow-up exam takes place days or weeks later, the cat may seem to have miraculously "recovered" from HCM.   Except cats do not recover or become cured of HCM.  The cat was in fact, misdiagnosed in the first place. 

This misdiagnoses frustrates owners and makes them weary of all future vet appointments or future diagnoses.  What I believe is that owners must be aware that only an experienced cardiologist is able to make a complete and correct diagnoses; that they need to know that even the cardiologist must see blood results and x-rays along with an echo in order to make a complete diagnoses; that vets must take into account what all seems to be wrong with the cat; and that owners and vets/techs must be more aware that severe dehydration will affect the echo.  

Finally, owners need to ask the right questions but need to know what to ask in the first place.  And vets must be more willing and able to answer things not yet asked and to explain everything fully to owners. But often, vets do a poor job of explaining or give such simple answers that it only paints 1/100 of the picture.  We need to ask what types of meds might be possible for a cat with HCM. We need to ask what do the meds do-chemically and physically; how the meds might interact with other meds; and how the meds affect the body. We need to understand what the CBC/chem panel details and how the values are related and what they mean and how heart meds and disease might affect the values. We need to understand how to count breathe rate, why that is important, and what it indicates if it is high.  We need to ask the vet, for example, why he believes that the cat only needs one med when other cats might receive 3 or more. We need to be willing to turn to the internet and research sites such as Drugs.com and Wikipedia and many others for information on drugs, their uses, and how they chemically work (which is important to understand what they do to the body and which parts they affect-like are they filtered through the liver or kidneys; what enzymes do they effect, etc.) And we need to understand that the cat's body isn't just made up of the diseased HCM heart and that only the heart is affected by meds.  The entire body reacts to meds and disease and to the diseased heart.  The entire cat must be treated and understood. 

Next, Dr. D explained the effect of Enalapril on the kidneys. The Yahoo Support group post stated that enalapril decreases blood pressure in the kidneys. To understand what actually happens, we need to understand what Enalapril does. In the case of a heart attack or a drop in blood pressure in the body, the body releases enzymes that in the end make up angiotesin I which circulates in the lungs to meet up with an enzyme called angiotesin converting enzyme to create angiotesin II.  In order to preserve blood flow to the heart, lungs, brain, and kidneys, angiotesin II cuts off all blood supply to the outer limbs and other areas of the body. But this creates a narrow chamber in the body so to speak, in which blood flows.  It's as if the body is now a canal and the water which ran down lakes and streams is now being pumped into the narrow canal. The water will then rise. In the body, the blood pressure rises and the heart pumps faster to handle the increase of blood. The volume of blood or the amount of blood in the body hasn't changed. What has changed is the rate at which it circulates through the body and into the heart. The rate has increased because the route of circulation is smaller. That is why the blood pressure rises. A faster beating heart is soon over worked.  A diseased or weaken heart cannot tolerate the increased rate of circulation and the rise in blood pressure. Relief must be given in the form of an ACE (angiotesin converting enzyme) inhibitor-a medication that prevents the ACE properties of closing off the outer circulatory routes to take effect, thus keeping the normal routes of blood circulation open, keeping blood pressure normal, and allowing the heart to return to normal function.  What happens in the kidneys is that tiny filtration units called glomeruli in the kidneys takes in and passes out the blood supply to be filtered in the kidneys. ACE inhibitors dilate the exiting blood vein but not the entering blood vein, thus creating less blood going in and more blood coming out of the kidneys.  This means less blood pressure in the glomerulus and less filtration of toxins by the kidneys.  Which is why a chem panel blood test is needed a week or two after Enalapril is begun and why a retest is needed every few months if the cat continues the therapy, to test the kidney values-if the kidneys are filtering toxins effectively.  A further tricky danger with Enalapril is that it and Sprironolactone and potassium supplements can lead to high levels of potassium in the body, creating another risk, that of hyperkalemia, leading to abnormal heart beats and other medical issues. 

Myrna Loy

This is by no means a complete explanation of Enalapril or anything else I've listed above.  To learn more, check Drugs.com and Wikipedia and the other links from this blog.

Search the Archives

This is just to remind everyone that the following articles have been published in this blog and the Archives can be searched to find the content:

HCM related issues, meds, how it all began with Myrna Loy, med changes, when Myrna had incidents (and how we caught them and what the vet did to save her), how she responds to meds, inappropriate elimination and HCM, inappropriate elimination and Prozac and Valium (Myrna's on Valium; Jimmy Stewart is on Prozac-he doesn't have HCM), how to be organized (meds in a tray in the cupboard, meds in a tray in the frig), vomiting, hypercalcemia, etc. 

If there is information you'd like to know more about, please let me know.  I'll write more about it or find it for you in the archives.

Thank you for reading the blog and I hope you find it helpful, encouraging. Please share your stories and your knowledge here and on the Facebook page.

Valium for HCM Cats and Inappropriate Elimination

Myrna with her Christmas scarf

Myrna Loy's inappropriate elimination issue isn't under control. We've tried Buprenex, treat time, behavioral training, meds when she had crystals, SO wet food, no other wet food, dry CD, few treats, etc. To no avail. It gets better for days, then she has an incident. For whatever reason, there were two last week, three on Christmas, and two overnight.

She went to the vet and all's well. After more research, discussing it w/our very knowledgeable pharmacist, a human cardiologist, her vet cardio, and her regular vet, we've decided to try Valium which has little interaction with her condition, non negative with her heart meds, and is an anti-anxiety med. She's off Buprenex. We will see how she does on Valium. Started with 1/16 of a 2 mg tab today.  She was a bit buzzed, then a bit confused, and now a bit sleepy.

This may take awhile and behavioral training will still be needed.  The only other option is to take her off Plavix, put her on aspirin, and then begin Prozac. This would be because-per research and FDA warnings-Plavix's blood thinning properties are negated by Prozac (and other drugs such as Prilosec.)  If on Prozac and Plavix, she runs the risk of creating clots that could move to parts of her body and she could have a heart attack.  The blood thinning properties of aspirin are not negated by Prozac but for her condition, aspirin may not be sufficient as a blood thinner.  I'd rather save her life and put up with out of the box issues. Except, lately, it's been too much, too often, and on too many odd places. Hence, the Valium. 

Let me know if your cat's on Valium for any reason and how it is doing.

Myrna's Checkup Thursday Sept. 8, 2011

Update on Ms. Myrna Loy:

Myrna being "cute"-rolling over

Ms. Myrna, as I often call her, is still having, from time to time, an out of the litter box experience.  Buprenex, which we give her to relieve any discomfort she might be feeling (no past UTI or cystitis presented but she has seemed to have pain related to using the box) has helped tremendously.  We have also, since this began back in March, continued to use litterbox break treat time-scheduled visits to the litter box (a.m., afternoon, evening, bedtime) and treats given if she or any of them use the box.  We also toss treats around areas of the house at certain times-a.m., afternoon, evening-areas where she has gone or might go, areas where we want to dissuade her from going. The combination of the behavioral techniques and meds has helped her use her box on a regular basis-about 90% of the time.  So, we are still perplexed as to what to do about the 10% of the time she doesn't use her box.

On Wednesday, she went out of the box in front of me and cried prior to going. So, I took her to the regular vet for an urinalysis and since she needed a CBC/chem panel for the cardiologist, we also did a blood draw. The results might show if Myrna is having any kidney/renal issues or is showing any other issues that might cause discomfort and cause her not to use the litterbox.  

Before the visit, I made a list of meds and procedures about which I had read in the Yahoo HCM Support Group (find it in Yahoo-it's a good source) to ask the vet about.  As always, I also noted if there were any changes in Myrna that I had noticed. I have noticed an increase in hesitation in jumping up onto counters so I wanted to make sure her back legs were in working order since HCM cats can-even though she's on Plavix, a blood thinner-create clots in the heart that can be passed to the valves in the back hind quarters, causing the legs to lose feeling and to not work. I also wanted to know if there was another pain med that might better suit her.

Myrna had her usual every 4 months checkup last Thursday with her cardiologist, Dr. DeSana.   As usual, Dr. D was warm, engaging, and allotted plenty of time to review my list.  She took x-rays of the heart and lungs and she did a Doppler test on Myrna's hind legs to make sure that the circulation of the blood flowed not just to the back valve but from the valve through the legs to the paws.  She showed me what symptoms to look for if there was an issue. The symptoms are that the paw would be cold, and the pink paw pads would be grey to white. If that happened, she would eventually lose use of her legs. She might also be chewing on them.  Any of those symptoms would require an immediate visit to Dr. D or the ER or the regular vet.

*By the way-that reminds me-often owners think that if the vet can't see the cat immediately that they have no choice but to wait until the vet is free. Cold feet, loss of circulation, not able to breathe-whether it's a cat or a human-calls for a visit to the ER as fast as possible. The cost of the ER won't be much more than the regular vet (unless you have a free or very cheap vet.) Please-go to the ER and never wait.

Dr. D said that unfortunately, Myrna's heart is slightly increased in size on the left side.  That is a natural progression of the disease but it was very disheartening to hear.  When I see Myrna at home, the beautiful, engaging, lively, energetic little girl she is, I allow myself to think that she's not that sick. But Dr. D reminded me that Myrna is indeed a sick little girl. 

Regarding the elimination issue, I decided that we will continue to manage the issue instead of trying to control it with medication.  There are more important things to worry about with Myrna and I want her to continue to be energetic and lively for as long as she can. Granted, the out of box issue could become worse and we may need to do another type of med. But until then, there are more important things. 

Some things we reviewed:
1) I've noticed in the Yahoo Support Group that some owners take it upon themselves to change heart medications-decrease or stop-without checking with the vet or without fully understanding that meds take time to work and that symptoms might occur and they might ease up over time. Never stop giving meds without first checking with the vet. However, the first step is to fully understand why a med is given, what symptoms might occur, and how long it might take before things are more normal.  We must ask questions of the vets and demand full answers even when the vet may not offer up such information on their own.
2) Also from Yahoo Group-high incident of renal failure in HCM cats.  I wanted to know if that would happen with Myrna, how to prevent, and how to reconcile. She said that usually older cats develop renal failure once they have HCM and they believe it's because there were renal issues which had gone undetected prior to HCM. Medications, such as lasix, deplete the body of the much needed potassium the kidneys need, and the other electrolytes the body needs.  Another cause is high levels of doses of meds, levels that might not be needed-which is why Dr. D starts her patients on the least amount they need and titrates up as needed. Young cats such as Myrna are less likely to get RF although we must be aware of it and watch for it.  Renal failure could occur because vets have not prescribed spironolactone-a diuretic which saves potassium for the body. It could also occur because a CBC/chem panel isn't taken or taken often enough to detect possible loss of potassium and review renal values. So, if we have cats who are six or ten years old and begin to have heart trouble, we must have CBC/chem panels every few months, and be aware of the possibility of renal failure. And all of our heart cats should take spironolactone to reserve potassium levels in the body.  If a cat does develop RF, heart meds should be lowered if possible (whatever the cat can tolerate and still help the heart) and extra fluids should be given.  Sometimes a special, low phosphorous diet or renal diet is prescribed.
3) From the Yahoo Group-owners whose cats suddenly died.  Dr. D said she can't say that Myrna won't suddenly die, that it happens despite the best of meds and care.  What owners should do is be more aware of the cat, to be as vigilant to change as possible. If the cat is breathing too quickly and the breathing rate doesn't settle, if the cat seems distressed, if the cat is lethargic and doesn't want to move, if there is anything the cat is doing that indicates it is sick, then the cat needs to go to the ER, the vet, or the cardiologist immediately.
4) From Yahoo Group: metacam given to young kittens may cause renal failure later in adult life-that is usually due to too high a dose over a long period of time as kittens that may cause RF as adults.  If a cat had metacam for a long period of time as a kitten, then we must test renal values each year in the adult (over six or so years of age) years and be aware of the possibility of RF as the cat becomes a senior cat (over ten years of age.) 
5) Nauseousness can be seen in a cat with an irregular heart beat but that is usually due to the medication the cat is receiving.
6) Meds-carvedilol-a beta blocker like atenolol. She prefers atelenol. Nattokinase-a Japanese natural product unproven to work as a blood thinner. She prefers Plavix which is proven. Aminophylline-a bronchodialator-opens airways in the lungs when there is congestion. She said this is an old method and is now considered a "band-aid" approach to congestion in the lungs and shouldn't be used for congestive heart failure. Also raises heart beat which isn't good for HCM. CHF needs aggressive IV lasix.  Aminophylline is best used for cats with asthma.

Notes from Dr. D:
"Today's evaluation revealed that Myrna's cardiovascular status is currently stable.  There is no evidence of congestive heart failure on her thoracic radiographs currently.  However, Myrna's overall cardiac size is slightly larger than on her recent radiographs, which indicates a progression in her cardiac disease. Based on this finding, I recommend only a slight decrease in her lasix dose. Further, there is no evidence of circulatory compromise to the hind limbs. Her blood pressure was normal (systolic=115mmHg.)" 

Blood Work from Last Week's Cardiology Visit Comes Back

Myrna Loy's blood work came back from last week's cardiology visit.  Myrna's CK and RBC values are off. The vet thinks because all other values which indicate renal, liver, muscle, and heart function are normal, those values indicate that she is dehydrated.  She gave the o.k. to give her 3 ccs of water with each meal-by mouth and in the food total.  She also said this is probably why she was constipated and having out of the box urine issues in April.  Her meds drain the body of fluid (as they are supposed to for HCM) so it's quite possible for a HCM cat to actually be depleted of water and to need some water in their system.

The regular vet and I should have thought to do a CBC/chem panel in April when she was in for the urine issue. If a cat isn't sick, one does not need a CBC/chem panel. But with proven constipation (the xray showed it at the time) it may have been a good idea to check her values for dehydration. And because we know Myrna's condition, she should have them regularly. Now, regularly for her means once a year unless otherwise called for. It's been a year since she had a full panel (it was a year ago in April that she had her last congestive heart failure incident) and her renal values were last checked last August.  I had the cardiologist do a CBC/chem panel only because it had been a year.  I'm glad I did. Dehydration can be a serious issues. It can lead to many other issues than just with the colon (constipation). It can lead to trouble and failure of renal, liver, heart and other body functions as the body loses electrolytes and other minerals it needs to function, and can lead to loss of blood pressure (less water, less blood flow, less pressure) and to lethargy-in much the same way as dehydration affects humans.

Here's a link from "Pet Well Being" website that explains it:

http://pethealth.petwellbeing.com/wiki/Cat_Dehydration

So, give your cat water on a regular basis in their wet food. Give cats with urinary or bladder issues extra water in their food and by mouth especially in hot weather. Give extra water on a regular basis if your cat gets gassy/constipated from time to time.  Your vet can give you plastic syringes (sans needles) which you can use to put water into the cat's mouth.  Those are very helpful and make the job easier.

Good luck!

Two Vet Conferences re:HCM Coming Soon!

Interested in knowing more about HCM, nutrition for cardiac disease, and other feline heart issues?  Maybe you can tell your vet or vet cardiologist about them so that they can attend. There are two conferences to attend:

The largest, longest is Thursday through Saturday, Sept. 8-11 in Boston. You can attend as a para-professional for $250 and take as many sessions as you'd like.  There will be many interesting heart disease, HCM, and nutrition related subjects that layman should be able to follow.

http://www.catvets.com/uploads/PDF/2011FallConference/Schedule.pdf


The other shorter conference is in St. Louis, July 16-19. Per the search schedule, Monday, July 18 at 8 a.m., Dr. Meg Sleeper will give a discussion regarding nutrition and HCM. There is a $25 fee for attending the conference as a non-practitioner.

https://www.avmaconvention.org/avma11/public/enter.aspx

Today is Myrna's One Year Anniversary for the Disease HCM



Katharine H. to the left; Myrna to the right.



One year ago today, Myrna collapsed at 11:30 p.m. and was rushed to the ER where they found she had congestive heart failure.  They were able to stabilize her and the next day, one year ago tomorrow, she saw her cardiologist, Dr. DeSana, for the first time.  Today, she had a check up with Dr. DeSana and had great results.  The progression of the disease has plateaued.  There were no changes since June when we saw improvement.  The lungs are clear; breath rate normal; heart rate at 130 which is low but steady since April; and temp at 101.4-normal due to the daily dose of lysine she receives (her temp had been abnormally high as of July at nearly 103. Daily lysine for a month brought it down in August to 101.)  I noted that she seemed to sleep more and to be tired more but there's no cardiac reason for that.  The vet suggested she's just getting to be more of an adult and will rest more which is normal.  We will continue to monitor her for activity, breathing, and everything else.

Have I mentioned that it wasn't until June when she showed improvement that I finally was able to relax and not think about/worry about her condition all day, every day? I monitor her daily but I'm not anxious about her.  There's a vast difference.  If I'm more relaxed with and about her, she's more relaxed.

Here are the results:

Today's echocardiogram revealed that Myrna's hypertrophic cardiomyopathy is stable.  There has been no progression in left ventricular thickening or left atrial enlargement since her last echocardiogram in June, 2010.  Further, her radiographs did not reveal any evidence of congestive heart failure.  No changes in Myrna's medications are indicated at this time.

Stress in a Multiple Cat Home

Bette is left, Myrna right. How can they sleep like that?

Stress-a leading factor in causing congestive heart failure in cats with HCM.  Stress-noise, changes, other animals, visitors, work being done on the house-those are the things we think about when we think about stress.  Those are the things we are ever watchful against when protecting our cat who has HCM.  We check her daily for signs of her illness.  We check many times a day to make sure she is breathing easily.  She receives her meds at set times. What we hadn't counted on, and what has recently become an issue, is that living with six other cats, even four of her siblings, can be stressful.  There's a lot of activity in a seven cat household.  There are cats who play roughly.  There are cats who cry when they are upset, can't find a toy, want to be fed, even when they have a toy in their mouth with which they are playing.  There is Baby, the oldest house cat, who swats and hisses at them all for no other reason than they have gotten too close to her, close enough for her to reach them. 

Then there is Myrna's brother, Jimmy Stewart, a handsome grey tabby who unfortunately, has had litter box issues.  He has his own reasons for stress and he has shown it with inappropriate elimination.  He's a very loving, sweet boy but he's physically, emotionally, and mentally sensitive. Smells bother him that don't bother others. Noise bothers him.  He's the first to get sick and gets sicker than any of the others.  Cooper, the oldest male, bully's him.  When he's bullied, he bullies Myrna by attacking her.  What began as typical rough housing, escalated into extreme violent attacks, so much so that we've spent the last two months separating them at night and when we are gone and even short spells during the day.  We don't know what sets him off but it happens a lot around the litter boxes after she's gone in one.  I'm sure that's a clue to his issues but not sure why it affects him.  And yet, when they are in the same room, they are fine and will even curl up and sleep together. Jimmy doesn't attack Myrna every time he sees her. 

He's spent the last few month going out of the box and marking.  His habits have spread to two or three of the other cats.  At one point this summer, it was so bad we were afraid that all seven were having issues.  We read and we tried everything. We put boxes upstairs again after we hadn't needed them for a few months.  We changed litter five times. We changed location of boxes.  We removed liners. We cleaned with three different urine removing cleansers. We cleaned with soap and vinegar. We gave him special play time, special attention. We put food and water down where he kept going. We used different techniques to dissuade him.  All to no avail.  Finally, we spoke to a specialist in early October who suggested that we clean using orange cleansers. I found one at Ace Hardware. I spent two days wiping walls, trim, floors, furniture, and washing anything that could be washed.  I used bleach water on tough urine spots on the wood floors. I even cleaned the basement where the litter boxes are.  We cleaned the boxes with soap and bleach. We used yet another different litter. We plugged in Feliaway. We sprayed with Feliaway. We used treats when we took him downstairs to use the litter boxes to entice him to go.  We have tried to set a schedule for him. Those all seemed to work very quickly and by the end of the week, we had 10 incidents and not 15.  The following week, we began medicating Cooper with a psychotropic because we felt we couldn't medicate Jimmy if the oldest male, Cooper, was being a bully and causing issues. (Just to note-it wasn't an easy decision but Cooper drew blood one Saturday by biting him very hard.  Cooper is a very anxious cat even without six cats in the house.) 

Since then, it's been better but still with issues.  We still have one or two others who either mark or go out of the box.  We know it's not always Jimmy because it happens in places I know he was not in. Other times, we're not sure and he had access to the area so it could have been him.  We see Jimmy use the boxes on his own in the basement but he goes on the pads under the boxes upstairs instead. We can't figure that one out or what to do to entice him to use the boxes upstairs. An old chair I had for 24 years was marked on by Bette Davis when she had a UTI in October but was successfully cleaned.  But it was recently marked more than once by someone and I unfortunately didn't catch it until it was too far gone and we had to toss out the chair.  Sigh. Oh well, time to redecorate the room! We've now decided to medicate Jimmy because he might still be marking and because he's still a bit anxious about something.

So, what does this have to do with Myrna and HCM?  It's not good for her condition to be attacked and to be afraid and fighting off her attacker.  Urine marking and inappropriate elimination can cause stress in other cats because they know urine shouldn't be where it is. It can lead to the others exhibiting such behavior.  The house should smell clean and should be as clean and calm as possible.  Her owner or mother (me) should be as calm as possible.  Time spent cleaning is less time playing with cats. It takes hours to clean up after messes. Then there's the corresponding laundry to do (aside from washing soiled items, there are the rags used to clean the house that must be washed because they can't sit in the dirty laundry basket smelling of urine. Trust me-it stinks!)

I'm hoping that by calming Cooper, calming Jimmy, and keeping the house clean, that it will produce a calming affect on others, and will in the long run, be of benefit to Myrna.  She needs a positive environment. They all do. We all do.

Myrna goes to the cardiologist on Thursday for a checkup. She seems fine. I'll post results after the visit.