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37024Re: [FH] Introduction

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  • Jean
    Jul 2, 2009
      Hi Cheryl,

      (I wrote more of a general response below - I also have an RCM/CHF kitty,
      crisis and diagnosis in November, who's turning 10 this month - but I've
      moved the following two paragraphs to the top since they're more currently
      relevant. The rest is just if it helps you in any way once things are
      stabilized - my Patches had a hard time stabilizing initially as well, he
      was doing fine post-hospitalization and then got really sick and stopped
      eating later that month. I was prepared to let him go three times that
      month, and at that point would NOT have guessed that he'd still be around -
      let alone feeling really well. Each case is different, but in his case he
      had a poor reaction to some of his initial cocktail of heart meds...I don't
      know if that might be going on here, since it sounds like Vizzy's been on
      his meds for longer than Patches had been at the time, but I definitely
      empathize with your situation.)

      How did Vizzy's mobile vet appointment go today? I hope he's eating a bit
      better... The things that are coming to mind are to watch his respiration
      rate closely (which it sounds like you're already doing) and check his
      bloodwork, since he may be having some issues with his relatively-new meds.
      Patches happened to have his liver enzymes shoot through the roof (which we
      don't think was even responsible for most of how poorly he was doing), and
      the kidneys can also be affected by heart meds. Heart trumps kidneys, but
      kidney problems can make kitties feel really badly. It sounds like he's been
      on the plavix for over a month now, and I don't know how long it can take
      for GI side effects to show up (anyone?) - in Patches' case, he suddenly got
      extremely sick, throwing up and miserable all night, and then he flat-out
      stopped eating despite no longer vomiting. A one-dose trial of aspirin four
      months later resulted in nausea and vomiting, and since he'd had a singular
      bout of acid reflux that caused him to stop eating about five years ago
      (successfully treated with kitty-doses of pepcid ac and an appetite
      stimulant for two weeks, and never recurring) and has been on pepcid and
      anti-enemics since the episode in November, we (his parents and his primary
      vet and cardiologist) think he has a sensitive stomach. But GI side effects
      aren't uncommon from plavix or aspirin therapy - so I would be wondering
      about the plavix and his bloodwork. My cardiologist's office reassured me
      that plavix stays in the system for about (at least?) six days when I was
      concerned about taking him off his meds while he was so sick, so it may be
      worth discussing stopping the plavix, at least, for a few days while he
      isn't eating much/at all.

      We also found that kitty doses of pepcid ac (1/4 of a 10 mg tablet, the
      original strength - NOT the now-common 20 mg strength) helped him, and
      others on this list use a syrup of slippery elm bark for nausea. While my
      cousin was providing home hospice care for her older kitty with GI lymphoma,
      his appetite rebounded a bit (albeit temporarily) when she and her vet tried
      pepcid as well. So something for Vizzy's stomach may be worth asking about
      or trying to see if it helps.

      (The more general email follows, which may not be terribly relevant while
      you guys are trying to get through the current situation. But I'm throwing
      it out there in case any of it IS of use to you at some point.)

      I just posted a response to Jan, which will probably cover similar ground
      but may be relevant to you too. I'm sorry you're here, but it's nice to see
      a few other RCM kitties! Like Vizzy, Patches went into CHF and was diagnosed
      with severe RCM in early November of last year. (Looking back there were
      very subtle clues - he wasn't as active, which I attributed to getting a
      little older, and I was suspicious when he stopped finishing his kitty milk
      after begging for it. In the week before going into CHF he left a few
      kernels of food at some of his meals - like, 1-4 - which was very unlike
      him, so I took him for an exam just two days before he went into acute CHF
      and spent the night in the oxygen cage with injection-laxis and
      nitroglycerin in his ear. His respiration rate was slightly high but not
      unusual for a squirmy cat at the vet's, and the gallop heart rhythm that the
      cardiologist heard wasn't a murmur that the examining vet was listening for
      a few days before. (Or that three of them were trying to detect when he went
      in in crisis - one thought he might hear "something," and it's a
      high-quality animal hospital. They just aren't cardiologists, though they
      knew at that point it was heart-related.) He'd had an EKG 11 months
      previously while going under for a tooth extraction and dental, and had a
      chest x-ray and year and a half before to check for pneumonia when he had
      the kitty-flu. So please don't be too hard on yourself - the signs are so
      subtle sometimes, and they're so good at hiding it. But without enough clues
      to indicate the need for specific tests (or even go in for an unscheduled
      checkup - Vizzy happened to lose some weight at a time when it wasn't
      suspicious), there's really no way to know, and cats are notoriously good at
      covering when they aren't feeling 100%. Like you, I was sad to realize that
      Patches was starting to "feel his age" and slow down a bit due to severe
      heart disease and then heart failure. But he really didn't let on.

      While I'm not an exception to the 3-12 month range (we very nearly didn't
      make it out of the first month, due to his adverse reaction to his first
      cocktail of meds and utter refusal to eat or drink after going off of them -
      I wasn't prepared to syringe him all his food and water forever when he
      clearly felt SO poorly if he wasn't going to turn a corner to have a decent
      quality of life. He was one unhappy kitty.), since he did turn that corner
      from not tolerating his meds he's been feeling REALLY good. (And he turns 10
      this month!) Once we got him to start eating again, then dealt with the
      constipation due to the combination of dehydration and reglan, he was
      comfortable, purry, and happy. We added pimobendan slowly - I was very
      reluctant to mess with "stable," but it was generally agreed that his heart
      needed more support. He'd originally been on digoxin, and his dig levels
      were fine - low, even - while he was really sick and the dig wasn't the
      suspected culprit, but we weren't putting him back on anything he'd
      originally been taking when it went downhill. I didn't notice it improving
      his appetite, but by then he had his old (gluttonous) appetite back. I think
      I've read that it can improve appetite (whether by serving as an appetite
      stimulant or helping the cat to feel better/more energetic in general), but
      that isn't showing up on any of my quick searches just now other than
      anecdotally on this list. I have no idea whether or not it might be
      contraindicated by Vizzy's chaotic heart rate, and I would personally be
      wary of starting any new medication while he already isn't feeling well. But
      I'm incredibly grateful, in a way, that Patches did so poorly on his
      first-line meds that he got to try pimobendan - once Vizzy stabilizes, it
      may be worth asking his cardiologist/specialist about whether or not it
      would be appropriate to try for his situation. It's off label, but
      everything anecdotal that I've heard (and in my cardiologist's experience)
      indicates real quality of life improvements. Which, with severe RCM, is what
      I'm really going for.

      Please let us know how things are going - I hope he's just having a bad few
      days, and you're able to get something into him. (Not eating just makes them
      feel worse, ironically.) But I would definitely want to check his bloodwork,
      and would be suspicious of the plavix affecting his stomach - I just have no
      idea how long it can take for that problem to present, since Patches got
      sick and stopped eating barely a week and a half in. I believe that aspirin
      therapy (some fraction of a baby aspirin for cats) is LESS harsh on the
      stomach than plavix, since it's only given twice a week or every three days,
      and while injectable blood thinners (lovenox and fragmin, though as an ICU
      nurse you probably already know that!) have other drawbacks they do get
      around the GI problems. Some on this list use a supplement called
      nattokanise (which, off the top of my head, I may be misspelling - if the
      yahoo search function is working, search "natto," and there's definitely
      information about it in the files section) as a GI-friendly blood thinner if
      they don't like or their babies don't tolerate plavix/aspirin.

      Good luck to both of you. *hugs* Give Vizzy a pet for me.


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