Feline HCM Cat Care Primer

From a discussion with a reader and a good reminder for us all:

Your cat will need to see a cardiologist and you will depend on the cardio for guidance about most of the regular care of the cat. Shots, other wellness issues-the regular vet. But you'll need to coordinate care between the two. Always have copies of cardio visit sent to vet; and regular vet info sent to cardio. The cardio should be consulted before any annual shots are given to make sure he's up to it. The cardio should be consulted for any contraindications with any other meds the regular vet wants to give. The regular vet needs to know how is the cat doing and what meds the cat is on from the cardio and what issues to look for.

*DO NOT allow your cat to be given steroids at any time-pill, injection, or asthma meds as these cause complications with heart disease cats. They retain fluid and that is not what the cat needs. For all other issues, stick only to antibiotics. If desperately needed for an illness, must consult with cardio first.

Keep copies of all visits and test results. You'll need to refer to them, be up to date, for all visits with any vet. Keep a notebook about how your cat is doing and any issues or concerns you need to address with the vet.

Get organized for cat care. File box, files, pill cutter, pill containers, frig boxes on counter or in frig or pantry to contain meds, supplies, supplements, pills, etc. will make care faster and more organized space wise. Nothing rolling around and bouncing around. And that will keep you calmer. As your needs grow for more things for the cat, so will your need to organize it. Find what works for you.

Did he have an echo? That is the only sure way to tell if and what type of heart disease he has and how it is progressing. He should have one every 3-5 months depending on how he is doing; is he seeing an actual cardiologist? He should as that is the expert. He'll need an echo every time he ends up in the ER.

He should have blood work done every 3 or so months and always before he sees the cardiologist so that the cardio knows how the body is responding to heart meds.

Meds-Atenolol is a beta blocker to lower heart rate and to help lower blood pressure. He should have only about a 1/4 tab a day. Maybe later twice a day as the disease and heart worsen. Too much, and the rate is too low, he will be weak. Plavix-only needs 1/4 pill once a day. Maybe later twice a day. And maybe later also add in aspirin. (Aspirin is difficult as cats do not tolerate it well. But you'll use a buffered 80 mg every three days and no more often than that. It might cause gastro upset but in progressive HCM adding aspirin can be beneficial to preventing clots along with Plavix. We gave it on Wednesdays and Saturdays.) He should also be on Enalapril, an ACE inhibitor. It helps to reduce body's retention of sodium, therefore of water; and it keeps veins opened in case of a heart attack. There are other drugs he may need: Sprionolactone-a mild diuretic that helps save potassium; Isosorbide-to lower blood pressure but it changes the load on the heart (I can't recall exactly how it works, only know that Myrna was on it late in life.) There are other diuretics such as Torsemide to use later if needed.

The major med to use is a diuretic like lasix/furosemide. Talk to your vet now about getting this. A daily maintenance dose of 5mg will keep away congestion. Congestion in the lungs is an inability to breathe and get oxygen to the brain/body, making one weak. It is also painful as it feels as if one is drowning. It's not simply a cold as we think of it for humans. As congestion pops up, he'll need more of a dosage and more often during the day. The amount and number of doses will increase as the need increases.

You are treating not only the heart but the entire body. The heart disease will effect his liver and kidneys. Meds will also. You must be aware of needs for the entire body. He will need a good overall cat vitamin paste. He will need extra potassium when on lasix. We use Renal K gel and powder. As the disease progressed for Myrna, I also used Sundown potassium pills. She was near the end on mega doses of potassium. I also gave her kidney support goop and how I administered it changed over time. First, in her food; then she needed it by mouth via a syringe. I mixed up COQ10, vitamin C, E, Renal K powder, etc. with baby sweet potato (source of potassium) in a small dish, and gave her 3ml 2-3 times a day as the disease progressed. Then I added Nature Made iron pills cut into halves and gave them by mouth about twice a day. Iron is necessary for the production of red cells which the kidneys need. It was complicated because it caused gastro upset and I had to adjust the dose as needed. But her kidney values remained stable for the last year of her life after increasing. You can read more about it at the blog under the Med tab.

As the lasix works to get rid of fluid, the cat will drink a lot of water. The cat will at times become dehydrated. You must keep up the hydration. Lots of water bowls, add water to wet food, more wet food than dry. While the heart does not need liquid, the body does. It seems contrary but water is necessary for the overall health and particularly kidney function. As the lasix works, electrolytes will become depleted. That's why you will need the extra potassium. If the cat is not eating well, he will need some extra glucose. The cat won't need extra sodium and does not really need a salt free diet as the lasix is already getting rid of salt. But do cut back on treats and avoid crackers/chips, and table foods.

There may be times he won't eat and you'll need to feed by hand. That can be discussed later but you can read about it at the blog. I have many tricks and methods to suggest.

Learn to monitor the cat and how it is breathing and walking. If you see the cat lethargic, not interested in getting up or eating, go to the vet or cardio. If the cat has cold paws front OR back, go to the cardio or vet ER immediately. If the cat is lame, dragging a leg or legs, or is falling over, go to the vet ER or cardio immediately. If the cat vomits a lot and doesn't get up, go to the vet ER or regular vet immediately. If the cat is laying down and breathing hard and doesn't get up, the cat could be in CHF-congestive heart failure, or having a heart attack. Go to the vet ER or cardio immediately for care. If the cat isn't eating, but seems fine, skip the vet for now and read in the blog how to feed and what to feed by hand.

Learn to count the breathing to monitor for CHF or other heart issues-one up and down chest movement is one count. How many of those in 15 seconds? 6-10 is fine. 12 or more and the cat may need the ER. A cat's breathing fluctuates during any given time from really slow to really fast. But sustained, heavy breathing-not panting, not opened mouth-is an indication that something is wrong. Count the breaths and if you think it's high, count again after a few minutes of the cat being still. If you have a diuretic that you are giving, and you think it's breathing fast, give an extra 2-5mg of diuretic and see if the cat responds within an hour. If the cat does, then he's in CHF but responding and you can give more 2-5mg of extra lasix in four hours. But if the cat seems really bad off, meds also don't help, then rush him to the vet ER or cardio for oxygen and injected lasix and monitoring.

Find the closest cardio, regular vet, and one or two dependable ER or 24/7 animal hospital to have on hand to go to anytime you need the vet.

You can order a lot of supplements at Amazon, Entirely Pet, 1800PetMeds. Sundown potassium and Nature Made products are at the local stores. But shop for lowest prices-Kroger often has buy one/one free; Target has low prices.

And as for the meds, these should be available at the local human pharmacy. They are often cheaper than those from the vet. Kroger and Target had $4.00 generics and have lower prices on many of the meds you are using. Shop around as things change. Avoid Walgreens/CVS which are expensive.

There is a lot of information at the blog in tabs, categories, and as a word search you might find helpful.

But please do continue to feel free to discuss your cat with me and how you are doing. I'm here to help.

Good luck!

Again Why Homeopathic Meds are NOT Good for Feline HCM-Give What IS Natural to the Body-Vitamins/Minerals

Someone asked about homeopathic medicines for HCM. As I've stated here many times before, I do not agree about using them. You should avoid them. They are mostly ineffective, are very expensive, and some may be dangerous especially St. John's Wort and anything with onions and garlic, and some of those are out there with those ingredients that are deadly to cats. Why are they ineffective? Because you cannot get enough of them into your cat to equal the power of one tablet of a medicine prescribed by the vet. For example, you will never be able to boil enough dandelion tea for a diuretic or feed it to your cat to equal even 5mg of lasix of which your cat may need 2-3 times a day, etc. And as congestion increases as the heart size increases, you'll need more doses at higher dose rates of lasix. We are talking about getting rid of fluid that is drowning your cat's lungs. That is a more immediate, pressing need that lasix/torsemide can affect. 

And while we need to keep the lungs dry, we must keep the body wet or well hydrated-which does seem a contradiction. The medicine lasix and torsemide makes the cat drink which replenishes a lot of lost fluid. And kidneys need a lot of water to process the diuretic. Feeding a cat mostly wet food will help hydrate. Add water to the wet food, also. Replace the water in the bowl twice a day, use bottled or filtered water if your tap water isn't that great tasting (we use both.) 

Instead of wondering what homeopathic plants/meds to use, concentrate on replenishing what IS natural to the body: the electrolytes, vitamins and minerals we all need to function, which are lost when a cat is on heart meds and diuretics. These show up in the blood work that the vet will do from time to time-potassium, chloride, sodium, glucose, magnesium, phosphorous. The cat needs an overall balanced vitamin, potassium supplementation if on lasix, and later-as we do with Myrna now that she's on high levels of diuretic-various vitamins and minerals for kidney support (important for diuretic process) such as magnesium, COQ10, B12, antioxidants such as krill oil, etc. We give about 1ml of glucose a day-more if needed-in the form of corn syrup or sweetened condensed milk mixed with water when we've had to hand feed her, such as this week. It provides energy to the body and helps prevent the body from attacking fat reserves in the liver-hepatic lipidosis. 

Sodium, chloride, and phosphorous one needn't worry about replacing or giving more of unless the cat does stop eating entirely. Then you could try bicarb or add sodium to water and give by mouth but that would be very rare for anyone to need to do. The heart actually beats due to an exchange of sodium, potassium, and calcium ions; sodium regulates water retention and helps the kidneys process waste. If levels of sodium, chloride, and phos are high in the blood work, then measures to reduce them would need to be discussed with the vet. But most cat do NOT need to reduce sodium in their diets. Yes, even HCM cats need their sodium. Just watch the blood work levels. 

One sign of a cat being dehydrated can be hyper levels of waste and sodium, glucose, etc. showing in the blood and urine. Which is also why you do need to have the cat's blood checked every three months if the cat is on a lot of heart meds and diuretics.

Myrna Visits Cardio for Pleural Effusion Fluid Withdrawal for Feline HCM

Posted to Facebook 2/10/15

At cardio-even though she wasn't and then she was better this a.m. and about noon, I brought her in. They took out 6oz which explains the roller coaster breathing rate and difficulty. The torsemide took out the extra fluid that must have existed in addition to the 6oz they withdrew which is why her breathing would go up and down.  

No word on why she was sick Sunday unless kidneys are not well or the effusion

lymphatic fluid was involved. But we could have come in yesterday but definitely today. We are waiting to see blood results. There's no scarring in lungs so this must be due to Rutin supplement!

Torsemide should take care of the fluid but it's not and we need to give more as needed or maybe more regular daily doses.

Myrna came home feeling better, more alert, breathing well. 

Myrna's potassium is up to 3.5 from 3 on 1/22 which is good. Not great news but not really bad is that BUN is up to 37 from 33; creatinine is 2.7 from 2.3 so not bad.

She will get extra 2.5mg of torsemide and extra potassium.

We will schedule a vet visit for every two weeks in case she needs fluids withdrawn.

But the cardio wanted me to understand that Myrna is in the end stages of her disease. You know it's bad when the cardio is using her calm, serious voice and not the one I've heard for over five years that was hopeful, optimistic, and laughing. We had the beginnings of the talk in January. And there have been times in the past-as Myrna developed increased heart size, clots, other incidents-that the serious voice was used. But Myrna always bounced back and surprised us all.

That her kidneys still function must be due to the vitamins and supplements we give. The cardio is surprised that she needs such a high level of torsemide and that her kidneys are still functioning. We will keep up all that we've been doing , pushing extra meds as needed, etc.

Myrna's sixth birthday is March 22. My goal is to celebrate it with her.