Jimmy is Taking Atenolol for Heart Rate (not heart disease.)

Jimmy was given diltiazem (a calcium blocker) last summer by his cardiologist for his heart rate. He was tachycardia with arrhythmia due to his leaky tricuspid valve and left atrial dilation. It worked at first for a few months but then stopped working. His heart rate became more uneven with PVCs (premature ventricular contraction.)

A few months ago she put him on atenolol, a drug I'm used to which many HCM cats are given (as with Myrna.) He has responded well and his heart beat normalized. It has recently returned to some tachy and some arrythmia but the rate is 120-190 (when stressed.) She's happy with these results. He just had a cardio checkup this week.

If your cat is having heart rhythm difficulties, ask for atenolol if the cat is not already receiving it. Atenolol manages the heart rate as a beta blocker, which affects heart muscle, and helps to lower stress and affects blood pressure and improves the overall way a cat feels and interacts with its environment. It's one of many that an HCM cat might need to take daily to manage heart disease.


https://www.drugs.com/search.php?searchterm=atenolol

Updates Katharine and Roxanne and Elizabeth-Gastro, Meds, Weakness, Inappetence and More!

So much has been going on this past month. In early October, blood work was done on Katharine and Roxanne; then Katharine and Elizabeth had their annual updates where more blood work was taken and more issues arose.

Roxanne is still testing high for potassium or HYPERkalemia at 5.3 (with 4.9 being high normal.) What does that mean? We need to consider testing for possible hypoaldosteronism which is rare. It may also indicate Addison's disease or diabetes. And is connected to possible renal failure or decline. For now, monitor. We might consider giving her a diuretic if she continues to test for hyperkalemia. Symptoms may cause muscle weakness, nausea, heart palpitations, irregular heartbeat, and abnormal blood pressure.

If a cat has HYPERaldosteronism which produces HYPOkalemia, that could indicate cancer. And low potassium disrupts the body's function, leads to racing heart, weakness, etc.

She also tested POSITIVE AGAIN FOR FIV virus antibodies. The vet is checking to see if there is a test to test for the actual vaccine so that we can determine if she received the vax as a kitten or if she was exposed to the disease since 2017 (somehow despite no other cat in the house having FIV.) We will monitor her for active disease and try to make sure she does not fight or bite or get bitten by any of our other cats.

Katharine developed weakness and inappetence after taking an ACE inhibitor Benazepril for two weeks-she began in mid September. Mirtazapine did not work to spur her appetite. She began losing weight. While her weight was fine around 9.12 or 9.14, when it fell in early October after one week to 9.7 after we thought she was eating well enough, we had to begin feeding her by hand using the trusty 3ml plastic syringe method. (We give her 9ml of Hill's AD in the morning before breakfast, 9ml if she is not eating dinner, and 9ml at bedtime.) We concluded that somehow the Benazepril was prohibiting the absorption or interaction of the Mirtazapine, although there is no known contra-indication. 

When Katharine had her annual exam October 19, her heart was racing at 260 (normal should be 140 and no lower than 135 and no higher than 200.) Given her heart rate was high, the cardiologist said to give her Atenolol twice a day; given that she was weak, to pull the Benazepril and to check her heart rate in a week. She recommended that we buy and try a mobile EKG Kardia to monitor the heart rate at home. When we tried it, we got a laughingly low rate of 77-which would indicate she was near death. Given that she was up and about, eating, walking, alert, we knew it was wrong. We took her to the vet the next day and compared the in house heart rate reading to the Kardia device and both ran about 177.  This means the Atenolol at BID (twice a day) is working. But she does need an ACE inhibitor if it can be tolerated. We will try Enalpril sometime in the future and monitor.  Follow the link to purchase the device if interested. Follow this YouTube video for more information on how it works. It took until almost the end of October for Katharine to stop appearing weak; and it wasn't until this week 11/5/23 that Mirtazapine began working normally to spur her to eat.

We also noticed her breathing rate had increased. But it was difficult to get a true reading. So, in late September, her cardiologist said that it was ok for her to take furosemide once a day every day of  1/4 of a 12.5mg tablet (3mg approx.) Since the tablets were small and crumbled when cut, we changed over to the 20mg tablet, cut that into quarters, and shave off a bit more to reach the same 3-4mg dose. 

Because she wasn't feeling well at her annual exam, Katharine hasn't yet had her annual rabies shot so we will soon return for that.

She had her PLI/Cobalmine/Folate panel tested for pancreatitis and gastro issues and she has a high folate. These blood tests are to test for metabolic function. Specifically, folate is B12 and indicates malabsortive issues in cats (or humans.) If the cat cannot absorb nutrients, health issues develop. AND the inability points to issues in the gastro metabolic system which could be disease, irritation, infection, etc. This goes along with the gastro scan she had in early October that showed she had a "smouldering" pancreas, an issue developing. She is already on steroids. The vet suggested we had a different probiotic Visbiome  She also received a shot of B12. We can take her monthly to receive them and/or supplement her diet with B12. The vet wants us to give her cobalamine tablets which is B12.  I ordered some from Amazon and am waiting on them to arrive. 

Elizabeth had her annual exam in October and her rabies shot. She is good. She also needs some probiotic and will take Visbiome three times a week and not daily. Her PLI/cobalamine/folate test was also good except the folate was high. She has the same sort of gastro issues as Katharine but does not present with symptoms (although she was sick in June.) 

I think that is up to date on the cats. Jimmy has had a few urine out of the box accidents but we keep at it encouraging him to use the litter box and doing treats and behavioral work. 

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.

Bette Davis Develops New Issues Leg Lameness/Gastro Motility// Update on Cats

 I have been remiss in writing the blog. My last post was 2021 although the Facebook page has been updated as things happened. 

We continued to have issues with Jimmy's eyes and ears but instead of Horners (2021) it was in the summer of 2021, 2022 more of an allergy. He took Tobramycin eye drops, and Quadruple Topical Ointment for his ears. His litter box issues come and go. He might not go out of the box for two months then suddenly go against a chair, or on the floor, or counter, etc. We have increased his Prozac to .42. He has been taking that since about 2011. It is compounded into a liquid by a local compounding pharmacy so that we can titrate the medication as needed. The pill is too difficult-impossible really-to cut into small doses. He does not have HCM but he might have a liver issue developing for which we monitor.

Katharine continues to take Mirtazapine for inappetence -not wanting to eat well. She has lost over a pound of weight since late 2021. She had been just over 11 pounds and is now 9.13. We give her 1/8 every four or so days, monitoring her intake, and weighing her weekly. If she takes more than 1/8, she gets hyper and cannot settle down to eat.  Katharine-a sibling of Myrna Loy (our original HCM cat that died in 2015 of HCM)-now has mild HCM and is taking Atenolol. This was discovered in September by the cardiologist that she has been seeing annually since 2010 because she has a murmur AND because she's Myrna's sibling. All the siblings see the cardio before dental cleanings (anesthesia) and have seen her annually since they turned 10 years old because the heart changes as cats age. Katharine will now see the cardio every 6 months or more as needed and we monitor her breathing rate for signs of CHF. Katharine ALSO has seizures since 2018 and had a new serious one January 2022 which required an extra dose of phenobarbital and would have resulted in a trip to the ER had she passed out or not responded to the extra dose (not grand mal-she never has had grand mal. Her seizures include acting spacey, unable to walk.) She did go to the vet the next day to get updated blood work CBC/chem panel, and had her PLI/cobalamine/folate updated, as well as her vitamin D levels checked (all necessary for any cat and especially any ill cat.) Her pheno dose is now 3/4 tab BID (twice a day.) We also do a blood test for her pheno levels and that tells us if the level is sufficient or not. If not, or if too low, we need to increase the dose.

Roxanne, Elizabeth have had minor issues these past two years but nothing significant. No new meds. Neither has HCM. Elizabeth's last gastro ultrasound did detect splenic myelolipoma  a small mass on her spleen that does not yet appear to be intrusive or cancerous. We will monitor.

Bette Davis: Bette has idiopathic cystitis  for which she takes Valium daily to help her relax, to help her bladder relax. She has been taking this since 2010. She still receives 2mg per day, 1/2 tab BID. She also developed in the summer of 2021 and in 2022 an allergic reaction in the eyes similar to Jimmy's but with the skin around the eyes inflamed. She has been on chlorpheniramine from Kroger 1/4 tab once a day since 2021; and takes the same Tobramycin and Quadruple Ointment as needed, mostly during the summer when the infection is worse. We do not know a cause since only these two cats are effected. She also has chronic pancreatitis but the test results this fall, and the gastro scan in December showed it was not active.

BUT then it was. The new issue for Bette began around Christmas or just before. Some cat began to drop small hard fecal matter on the floor near the litter boxes. And Bette began vomiting almost daily, either after her morning meds or after breakfast, or sometimes after dinner. And she was not eating well. I was using Miralax in her food, and trying to get her to eat without using Mirtazapine. Then this past week, after New Year, she began struggling to defecate. I took her to the vet on Wednesday and the outcome was:

-she has active pancreas flareup that was the cause of the vomiting; not eating; not eating led to...

-dehydration which led to...

-kidney stones in the bladder but she is female and will pass them easily, unlike male cats. And dehydration also led to...

-severe constipation, inability to pass bowel movement which led to...

-impacted anal glands and an infected gland and both had to be expressed. And now she's taking Zenequin antibiotic which led to.

An xray also showed she has rear spine arthritis, a vertebrae is swollen. Not uncommon in older cats but she is the only with it so far. She may need a pain med in the future. Currently we are to monitor her and not let her jump around. She's not able to jump up-something I noticed around Christmas. 

She is to take Cerenia daily, Zenequin, and her Valium and allergy med daily; we are giving Miralax in water by mouth with a 3ml plastic syringe (I give 9ml at a time, 3 times a day.) And we add Miralax to her food but she still isn't eating enough. We are giving her Methigel too. She still has trouble defecating and the fecal matter has been getting stuck in her rectum and we must pull it out. She did have a normal BM this morning without assistance. To help her pass things, we will give her Laxatone. 

BUT then today-Sunday 1/8/23-she developed rear leg weakness. Her paws are warm-not cold which would indicate a blood clot but I will monitor. I will call the vet Monday. She is not able to raise her tail either, which we thought was part of the anal gland issue and might be. But it could indicate more serious nerve damage. It could heal in time or lead to inability to control her urine/defecation. All of this is quite sudden. As far as we know, she had no accidents in the house, hadn't fallen, was doing well until after Christmas.

Atenolol Drug Shortage-You May Need a Compounding Pharmacy

There is a drug shortage for Atenolol, a very important medication. Atenolol is often prescribed for HCM cats. It works to lower the heart rate and blood pressure by working on the heart muscle. It is vitally important that the heart rate and blood pressure come under control for an HCM cat. Most cats with HCM have a high heart rate. A damaged heart should not be overworked and stressed. Lowering the heart rate also helps to lower blood pressure, although Atenolol is only one drug that the cat might need to lower blood pressure. 

Our vet cardio released this statement:

"Some of you may already be aware that there is a nationwide shortage of this medication due to a production issue. Many pharmacies are running low, which is becoming an issue for our cardiac patients who are receiving it.

There are a couple of options:
1) Continue calling around to pharmacies in your area since some pharmacies still have it in stock.
2) Get it compounded at a specialty compounding pharmacy. We prefer to use Wedgewood for our compounding needs. Atenolol can be made into tablets, capsules or liquid suspension. See the link below for more info..."

If you or your vet are unable to find Atenolol locally, here are two reputable pharmacies you can try:

http://www.wedgewoodpetrx.com/search/atenolol.html

https://www.roadrunnerpharmacy.com/

Also, Google "compounding pharmacy" for your area. You may find one locally. Your vet would call in a script for them to fill. 

Myrna's Heart Develops New Complication-AFib

Myrna had her regular check-up with the cardiologist today. She has developed an arrhythmia due to atrial fibrillation.  This is a new complication that will make management of the disease and congestion difficult. And there's very little we can do.  Yet, while this is a new complication, it comes after almost five years of the disease.  Many cats develop it sooner or die of HCM too soon to develop a fib.  And she continues to battle congestion or Congestive Heart Failure.  The cardio reiterated that Myrna is the only patient she and her practice partner Dr. Brown has ever seen with the heart size of Myrna (2.2) that continues to live as long as she does and do as well as she does with the ongoing CHF.  (Good vitamins and supplements, plenty of meds and correct dosing and adherence to the strict schedule, and vigilance on our part as to changes in her physical condition and reactions, and the best damn cardio team all play their part.)

Myrna Loy

She has been suffering with congestion all summer long.  It comes and goes and we deal with it by determining when she needs extra lasix: usually it is when her breathing is above her "normal" breathing rate of  32 a minute (a cat is usually around 24) or when she is breathing hard, making a hard push through the chest cavity.  When she is breathing steadily at 32 and it is not difficult but has a third "bump" in the chest cavity (in, out, BUMP; in, out, BUMP) then we know she needs the inhaler.  That BUMP shows up near the back, near the end of the ribs as she physically makes an effort to exhale.  There have been times when she is breathing above 8 or hard AND has that third BUMP in the breathing process through the chest cavity.  That's when we not only give extra lasix but give a dose of the inhaler as well. And that is the most effective protocol for us to follow.

There are concerns with the inhaler as it can be contraindicated with atenolol, the beta blocker that slows down the heart rate.  The inhaler is inhaled and absorbed into the bloodstream.  If it builds up, it can increase blood pressure and have a negative interaction with atenolol (a process that involves antagonists, beta 1 or 2 receptors, bronchodilators and constrictors,etc.-a process I do not understand well enough to explain.)  We are to give it in the a.m. and p.m. and only in between as needed, which we have been doing.  But the cardio hopes that with cooler weather, the need for it twice a day may decrease.

The arrhythmia was heard via stethoscope and was confirmed via ECG.  The echo showed atrial fibrillation, a process by which too many electrical impulses disturb the heart rate making it erratic.  The heart cannot pump or contract (systole, diastole) correctly.  This allows blood to flow between chambers but without the heart muscle reacting.  This means the unused heart muscle will over time become potentially weak like any muscle that is unused.  This will create a myriad of complications: will make it difficult to fight congestion; will cause a lack of efficient and sufficient circulation of blood and oxygen; will lead to weakness in her body, etc.   From Pet Place website:

"Atrial fibrillation (AF) is a common electrical disturbance or arrhythmia of the heart, marked by rapid randomized contractions of the atrial heart muscle causing a totally irregular, often rapid , ventricular rate. In this arrhythmia the normally coordinated electrical activity in the upper heart chambers, the right atrium and left atrium, is lost. The muscle of these chambers begins to wiggle like a "bag full of worms." Atrial flutter is similar to AF, but the atrial contractions are rapid but regular. Both rhythms are very abnormal and reduce heart function." 

This weakness is already showing up.  She has lately been lacking an ability to jump up and down and to land well enough depending on the angle of the jump.  I was afraid her rear leg pulses were getting weak but they are now strong at 130.  But that is also due to her heart racing at 150-190 (as it was today in the office.)  No, I don't know how a heart cannot contract sufficiently and yet produce a high heart rate.

Because the heart rate is up, and we need to prevent a racing heart, the cardio prescribed additional daily atenolol and she will begin to take it twice a day or BID-1/4 of a tab BID.  Her lasix medication levels will change as well from 15, 13,15,18 mg to 18, 13,15,18mg a day.  (She receives lasix four times a day.)

She also presented with a touch of pleural effusion-fluid around the heart and lungs-in the pericardial-but not enough to aspirate.  But they gave a lasix injection and additional lasix at home may be warranted. But again, this is a troubling sign and due to the new complication.

"Pericardial effusion, sometimes referred to as "fluid around the heart," is the abnormal build-up of excess fluid that develops between the pericardium, the lining of the heart, and the heart itself."

The blood work comes back tomorrow and I'll know more then how her kidney values are doing and if the supplements I've been giving are helping.

She still has a clot in the heart but nothing has broken off that can be seen.  So far, so good.

Here are the cardio's notes: 

The new complication that myrna is presenting us with is an arrhythmia (irregular heartbeat) called atrial fibrillation.  A fib is a persistently irregular heartbeat that results from severe output (amount of blood circulated to the body.) This can result in a relapse of congestive heart failure, generalized weakness, and/or blood clot development.  I am happy to say that it does not appear as though Myrna has experienced a blood clot [Editor's note: In the rear legs. There is one in the heart.].  There were none of the hallmark abnormalities during her examination today and she had normal blood pressure in both of her hind limbs. (130mmHg on the right and 126mmHg on the left.)  [Editor's note: I had been concerned that her rear legs were weak due to low pulses.]  Rather, it appears that her weakness is a result of the new arrhythmia. Unfortunately, the arrhythmia will persists throughout her life-we cannot eliminate it entirely. However, we can improve control of her heart rate by increasing her dose of atenolol.  She is a good candidate for this adjustment because her heart rate is higher today (190/min on the ECG) and her blood pressure is normal.  There is a small amount of fluid accumulation around her heart and lungs today (pericardial and pleural effusion), indicating that we're not keeping up with her congestive heart failure treatment as well as we would like.  We will need to increase her dose of lasix to better manage her heart failure."