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.

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