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49690Re: [FH] New member: Help/advice needed

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  • hemizonia
    Feb 15, 2014
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      Hi Sara-
      Whew.  What a dilemma you're in. There's no internal med vets around?  Or closer?  Of course, being on a weekend doesn't help at all.
      I don't know what's available in/near your area, but if there's any sort of 24/7 critical care facility with a staff internal med  vet, you could try getting Cayenne in there.  For myself, I'm a 2-hr drive from UC Davis.  I've tried getting one of my cats in for an appointment asap, couldn't get her in for 10 days, so I drove down there after hours, went in as an emergency, and the oncologist saw my cat the next morning.  You might check around for similar possibilities.
      I'm assuming that Cayenne has had bloodwork and that there's no electrolyte abnormalities?  When his heart rate is low, how does he look?  Color still good?  Any type of respiratory pattern difference (I've found watching for even subtle changes in the normal respiratory pattern is a good indication of possible problems, not just respiratory but also cardiac and even metabolic).
      Has a chest xray been done?  Any murmur?
      An irregular heart beat could be caused by a whole number of various things.  Total heart block would be very serious, but being agitated shouldn't increase the heart rate if this were the problem.  Electrolyte imbalance could cause arrhythmia's.  Atrial arrhythmias could also cause irregularities (like with A-fib, not all the beats are conducted).  Of course, ventricular arrhythmias are the ones potentially life-threatening. 
      There might be a conduction defect between the atria and ventricles.  Or it could be something like mitral valve prolapse (that's why I asked about any murmurs).
      Apparently, during the EKG, no abberancies were seen.  I've known pregnant women who can go into runs of PACs due to the upward pressure from the fetus.  One way they overcame it was to get up and get their heart to speed up a bit. 
      Myself, I have mitral valve prolapse syndrome.  It's some kind of dysautonomia.  Before being on regular meds (ativan to simmer down my sympathetic nervous system), my heart would be extremely irregular and get all the way down to the low 40s. I could overcome it by walking.  The IM doc I went to also has the same condition .... he's got an exercise bike in his office and at home just so when he becomes irregular, he jumps on for a few minutes.  Perhaps Cayenne has something like this.  Once during a conversation with my vet, I mentioned the dysautonomia; he said this happens in animals bitten by certain ticks (if I recall correctly).
      I think the holter monitors they have for dogs and cats is worn like a sweater, so Cayenne would probably be ok with it at home, and you wouldn't have to worry about electrodes coming off.
      I hope you are able to find help for Cayenne.  Definitely sounds like he needs the care of a specialist.  And it's unfathomable to me that vets are not believing you, an MD, when you relate that Cayenne has bradycardia.  Personally, I would find it kind of insulting.
      Please let us all know what happens. 
      mary & Leo
      In a message dated 2/14/2014 9:08:10 P.M. Pacific Standard Time, saraht@... writes:

      Cayenne is my middle kitty, age 8.

      • Cayenne saw his ex-vet last Thursday. She said his h eart was too slow and he had a serious arrhythmia. She had me listen and I heard it too. (I'm an MD.) So the next day we took him to the critical care vet who has treated my senior cat's asthma. He did an EKG and echocardiogram. Of course Cayenne was terrified and so his heart rate went way up which got rid of the arrhythmia.

        Apparently vets have not yet figured out that when cats come to the vet, get held down, shaved, poked, etc, their heart rates go up (apologies to any vets here - I really do want your input!), so I got told that a) his heart was too fast, not too slow and b) I had no idea of what I was talking about and there was no arrhythmia. They put him on medicine (atenolol 6.25 mg) to slow his heart down. I don't actually know if this made things worse or helped or what. I listen to him at home daily. If he's resting, his heart is very slow (60-80) and he has very scary arrhythmias (oh - that means irregu lar heart beats if you don't know) that in people can lead to sudden death. (For vets: bigeminy, trigeminy, and maybe short runs of VTach.) When he gets sick of me messing with him, his heart speeds up (120 on the atenolol) and his rhythm goes back to mostly normal.

        The critical care vet told us we needed to bring him back this week to see the vet internist. So we brought him back today which was her first appointment. The tech (who apparently knows more than people who have been to either vet or medical school) told us we were told to bring him back in THREE MONTHS for a thyroid test - even though his thyroid was 100% normal when they checked it, as were all his other tests. I managed to hold it together and told her my cat had life-threatening heart problems and no, I was not bringing him back in three months and no, I was not leaving until I talked to the vet.

        The vet also didn't believe m e, and told us to go home and continue the medicine. I refused. Then she suggested doing telemetry to check his heart rate overnight. That would have given us an answer since presumably once Cayenne fell asleep, his heart would slow down and his arrhythmia would show up. So we left him. About an hour later, she called back and said they could not get the electrodes to stick to him, that they'd tried glue, staples, shaving him, and everything else and it wasn't going to work. Next week they can order a monitor he can wear (Holter monitor) either at home or at the vet (although if they can't get the electrodes to stick, I don't see how that works either) and he'd be in a cone and stressed, so I don't even know if that would get accurate results. It would take a few days to get the monitor, then a day to do the test, if we're lucky, and then they send it out to get read, so a few more days. So much for advertising "critical care"!

        My saving grace so far is Dr. Kanda, the vet who will be doing Simmy, my senior cat's, radioactive iodine. She is REALLY nice and amazingly generous with her time. In desperation I called her. She actually called around to see if anyone in town had a wearable monitor - but no one does. There are also no cardiologists in the entire state. (Really, medical/vet care MUST be better in Afghanistan than Utah!) I asked her what she thought we should do. On one hand, Cayenne could have had this for months and we just didn't know until he went to the vet. On the other hand she said if it were her cat, she would not take ANY chances and would get him to a cardiologist immediately. She suggested Colorado State U which has a vet school and presumably a cardiologist at least on call. I told her there was a cardiologist in Las Vegas, which is half as far. She even offered to coordinate things so that Simmy gets his treatment while we 9;re out of town, and to board Ben, my newest baby. What a sweet lady! You can tell she's in it because she cares, and not just for money.

        So I guess now we wait until I can talk with a vet in Vegas, and see if she thinks we can wait until the vet is available presumably Tuesday. (My cats ONLY get sick on holidays and weekends.) And then I guess we head to either Vegas or Colorado.

        I am a total wreck. One sick cat I can handle. Two is too much.

      • PS: Somewhere during the hour Cayenne was back in telemetry the vet changed her mind and decided to stop the atenolol even th ough I was "lying" about the slow heart rate.  Go figure.

        To paraphrase "A Fine Frenzy":  Merry Christmas, Happy G-damn Valentine's Day too!

        PS:  I have a LOT of experience with hypertrophic cardiomyopathy and congestive heart failure and would be happy to share what I know with anyone interested, as long as you realize I'm NOT a vet, and it's been a while so things have probably improved a bit.  I did teach my vet some cardiology though.  :-)


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