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Re: [FH] Wow--real info. Need help deciphering.

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  • William Draper
    i ll see what i can do: - heart rate of 200 is the upper end of normal for a cat (mildly stressed) - your cat has a grade 3 out of 6 heart murmur - judging by
    Message 1 of 2 , Apr 4, 2004
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      i'll see what i can do:
      - heart rate of 200 is the upper end of normal for a cat (mildly stressed)
      - your cat has a grade 3 out of 6 heart murmur
      - judging by the ultrasound and doppler report, i think your cat has a mitral valve insufficiency
      - that assessment and recommendation are standard for feline HCM
      - the thiamine is going to be for the hind limb weakness (she seems to think it's a neuropathy)
      - the hind limb weakness may be from a saddle thrombus

      bill
      dvm in 2005
      ----- Original Message -----
      From: Susan Aufieri
      To: feline-heart@yahoogroups.com
      Sent: Friday, April 02, 2004 7:14 PM
      Subject: [FH] Wow--real info. Need help deciphering.


      Abby had an appointment today with the people down the street. The new
      owner of the clinic is certified in ultrasound and is also a cardiology
      doc. She's also done emergency med.

      The doc looked at her xrays from her first visit. Thought her liver
      looked small for her size. I thought, ut oh, *another* issue? Then we
      started the ultra sound. First was the heart ultrasound, more on the
      rest of the ultra sound later.

      I need a bit of clarification and some help on deciphering this. I sort
      of understand this, since my Mom has heart problems for almost 25
      years. But this is kind of new territory in that Mom's problem is
      plumbing, Abby's is enlargement.

      Straight from the sheet (forgive typos, I'm trying to read marginal
      handwriting):

      Auscultation:
      HR 200, sinus grd 3/6 w apical systolic murmur. Eupreic (?). Femorals
      s/s (or is it 5/5?). Plump cardiac silohuette, lungs & vasculatory wm
      (? I'm not quite sure if it's com, rm, rom or mm)

      Gait weak in hind end, almost plantar on hocks.

      ECG: N/A

      Echocardiogram:
      LA/AO = mild to moderate LAE (I think it's LAE)
      LV= septum normal, LV posterior wall mild to moderately hypertrophied,
      LV (can't read the rest, looks like lumen mm)

      Systolic function = good

      RA & RV = wm
      LVOT & RVOT = wm
      Doppler = mr 3+ posterior jet

      Assessment/recommendation:
      Asymetrical HCM with moderate LAE and tachycardia.
      1. Free t4 at this time
      2. Add enalapril 1.25 mg POSID now
      3. In 7 days add atenolol 12.5 mg POSID
      3. Decrease Lasic to 12.5 mg SID 7 days after atenolol starts
      (these steps are to make sure we can figure out what caused what if
      something happens).
      4. CBC profile, Urinary analysis in 4 to 6 weeks
      5. Echo repeat in 6 months
      6. For neuropathy, thiamine start 100 mg 1M initial dose, 100 mg SQ 1D
      x 10 D, then weekly

      I really, really think that this Vet is on the ball. She agreed with me
      that the "IBD" was more syndrome than disease and due to the
      antibiotics. She gave me a "huh" stare when I told her about her former
      vet wanting to do endoscopy. This is more of a let's try simple things
      first, natural things first (like the thiamine shots), work our way up
      to invasive stuff if we have to.

      After the echo, she roamed Abby's abdominal cavity to look at her
      liver, gall bladder, pancreas (scarring) and to find fluid. There was
      no extra fluid. She's got kind of a witty personality. As she roaming
      with the ultrasound she says, "See that cauliflower? That's Abby's
      tummy. She needs food, it's empty." "See that rope? Intestines." "See
      that blob? That's fat and the thing being squished is her liver, which
      is normal. See this blob move by? All these blobs were fat! She
      couldn't see any irritations anywhere. Of course, we can't see inside
      her intestines, but she's not inclined to think it's IBD. I told her
      how I ditched the Purina EN, the OvaBan (she refuses to prescribe it to
      kitties, and if she does it's for no more than 14 days and ONLY as an
      appetite stimulant), ditched the grains (she says "makes cats fat"),
      and got her on some high quality food (The Wellness). I told her about
      her fur growing back after I ditched the grains. Didn't really seem to
      surprise her, she said something to the effect of "grains bad". ;-) I
      also told her about Abby's diarrhea fiasco (owner induced w/new brand
      of catfood at 100% strength. doh!) and how the Phytomucil stopped it
      dead in it's tracks. She was impressed. I think she stored that one
      away.

      So, it was probably THE most informative vet visit I've ever taken an
      animal to. Abby also put on 2/10's of a pound from last Friday.



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      [Non-text portions of this message have been removed]
    • William Draper
      you could notice b/c the thrombus will cause a decreased blood flow to the limb. you will see cyanotic (blue from low oxygen) nail beds if there is a clot.
      Message 2 of 2 , Apr 5, 2004
      • 0 Attachment
        you could notice b/c the thrombus will cause a decreased blood flow to
        the limb. you will see cyanotic (blue from low oxygen) nail beds if
        there is a clot. which pain killers were being used?

        bill
        dvm in 2005

        p.s. 3 hours from the mountains and 2 hours from the beach is perfect for
        me ;)


        On Mon, 5 Apr 2004 06:54:44 -0400, "Susan Aufieri"
        <susanaufieri@...> said:
        > Oh great. So if she throws a clot, I wouldn't notice that it's not her
        > neuropathy (assuming the thiamine doesn't help).
        >
        > I started her on the heart meds Saturday. Forgot to ask the vet if her
        > pain killer would cause problems so she hasn't had any since Friday
        > night. HUGE difference in her. Not eating much (I know, get her to
        > eat), and doing the feline equivalent of swearing when she walks. I
        > hope the thiamine works...
        >
        > Susan
        >
        > ps: too bad. NC is nice, but NH is nicer. Best state to live for 2004
        > ;-)
        >
        >
        > On Apr 4, 2004, at 2:46 PM, William Draper wrote:
        >
        > > LAE = left atrial enlargement. this is a sequela from the left
        > > ventricular
        > > HCM. this enlargement can also cause thrombi to form, as it creates
        > > turbulence in the blood.
        > >
        > > bill
        > > dvm in 2005
        > > ----- Original Message -----
        > > From: "Susan Aufieri" <susanaufieri@...>
        > > To: "William Draper" <wedraper@...>
        > > Sent: Sunday, April 04, 2004 1:58 PM
        > > Subject: Re: [FH] Wow--real info. Need help deciphering.
        > >
        > >
        > > Pretty certain the hind limbs' weakness isn't the thrombus. She's
        > > walked oddly for eons, never been a graceful kitty. :-) It is most
        > > definitely neuropathy, it's gotten worse over the years. Though I did
        > > bring up the fact that I'd read it can be associated with HCM, though
        > > not often (I think I saw that on VIN).
        > >
        > > What is an LAE? I guess it's all the abbreviations that confuse me. My
        > > mom has heart issues, but it's the plumbing parts, not the heart
        > > itself. So I know nothing about these things...
        > >
        > > thanks!
        > >
        > > Susan and lil Miss Queen Abby
        > >
        > > On Apr 4, 2004, at 8:59 AM, William Draper wrote:
        > >
        > >> i'll see what i can do:
        > >> - heart rate of 200 is the upper end of normal for a cat (mildly
        > >> stressed)
        > >> - your cat has a grade 3 out of 6 heart murmur
        > >> - judging by the ultrasound and doppler report, i think your cat has a
        > >> mitral valve insufficiency
        > >> - that assessment and recommendation are standard for feline HCM
        > >> - the thiamine is going to be for the hind limb weakness (she seems to
        > >> think it's a neuropathy)
        > >> - the hind limb weakness may be from a saddle thrombus
        > >>
        > >> bill
        > >> dvm in 2005
        > >> ----- Original Message -----
        > >> From: Susan Aufieri
        > >> To: feline-heart@yahoogroups.com
        > >> Sent: Friday, April 02, 2004 7:14 PM
        > >> Subject: [FH] Wow--real info. Need help deciphering.
        > >>
        > >> Abby had an appointment today with the people down the street. The new
        > >> owner of the clinic is certified in ultrasound and is also a
        > >> cardiology
        > >> doc. She's also done emergency med.
        > >>
        > >> The doc looked at her xrays from her first visit. Thought her liver
        > >> looked small for her size. I thought, ut oh, *another* issue? Then we
        > >> started the ultra sound. First was the heart ultrasound, more on the
        > >> rest of the ultra sound later.
        > >>
        > >> I need a bit of clarification and some help on deciphering this. I
        > >> sort
        > >> of understand this, since my Mom has heart problems for almost 25
        > >> years. But this is kind of new territory in that Mom's problem is
        > >> plumbing, Abby's is enlargement.
        > >>
        > >> Straight from the sheet (forgive typos, I'm trying to read marginal
        > >> handwriting):
        > >>
        > >> Auscultation:
        > >> HR 200, sinus grd 3/6 w apical systolic murmur. Eupreic (?). Femorals
        > >> s/s (or is it 5/5?). Plump cardiac silohuette, lungs & vasculatory wm
        > >> (? I'm not quite sure if it's com, rm, rom or mm)
        > >>
        > >> Gait weak in hind end, almost plantar on hocks.
        > >>
        > >> ECG: N/A
        > >>
        > >> Echocardiogram:
        > >> LA/AO = mild to moderate LAE (I think it's LAE)
        > >> LV= septum normal, LV posterior wall mild to moderately hypertrophied,
        > >> LV (can't read the rest, looks like lumen mm)
        > >>
        > >> Systolic function = good
        > >>
        > >> RA & RV = wm
        > >> LVOT & RVOT = wm
        > >> Doppler = mr 3+ posterior jet
        > >>
        > >> Assessment/recommendation:
        > >> Asymetrical HCM with moderate LAE and tachycardia.
        > >> 1. Free t4 at this time
        > >> 2. Add enalapril 1.25 mg POSID now
        > >> 3. In 7 days add atenolol 12.5 mg POSID
        > >> 3. Decrease Lasic to 12.5 mg SID 7 days after atenolol starts
        > >> (these steps are to make sure we can figure out what caused what if
        > >> something happens).
        > >> 4. CBC profile, Urinary analysis in 4 to 6 weeks
        > >> 5. Echo repeat in 6 months
        > >> 6. For neuropathy, thiamine start 100 mg 1M initial dose, 100 mg SQ 1D
        > >> x 10 D, then weekly
        > >>
        > >> I really, really think that this Vet is on the ball. She agreed with
        > >> me
        > >> that the "IBD" was more syndrome than disease and due to the
        > >> antibiotics. She gave me a "huh" stare when I told her about her
        > >> former
        > >> vet wanting to do endoscopy. This is more of a let's try simple things
        > >> first, natural things first (like the thiamine shots), work our way up
        > >> to invasive stuff if we have to.
        > >>
        > >> After the echo, she roamed Abby's abdominal cavity to look at her
        > >> liver, gall bladder, pancreas (scarring) and to find fluid. There was
        > >> no extra fluid. She's got kind of a witty personality. As she roaming
        > >> with the ultrasound she says, "See that cauliflower? That's Abby's
        > >> tummy. She needs food, it's empty." "See that rope? Intestines." "See
        > >> that blob? That's fat and the thing being squished is her liver, which
        > >> is normal. See this blob move by? All these blobs were fat! She
        > >> couldn't see any irritations anywhere. Of course, we can't see inside
        > >> her intestines, but she's not inclined to think it's IBD. I told her
        > >> how I ditched the Purina EN, the OvaBan (she refuses to prescribe it
        > >> to
        > >> kitties, and if she does it's for no more than 14 days and ONLY as an
        > >> appetite stimulant), ditched the grains (she says "makes cats fat"),
        > >> and got her on some high quality food (The Wellness). I told her about
        > >> her fur growing back after I ditched the grains. Didn't really seem
        > >> to
        > >> surprise her, she said something to the effect of "grains bad". ;-) I
        > >> also told her about Abby's diarrhea fiasco (owner induced w/new brand
        > >> of catfood at 100% strength. doh!) and how the Phytomucil stopped it
        > >> dead in it's tracks. She was impressed. I think she stored that one
        > >> away.
        > >>
        > >> So, it was probably THE most informative vet visit I've ever taken an
        > >> animal to. Abby also put on 2/10's of a pound from last Friday.
        > >>
        > >>
        > >>
        > >> Your reply will go to the author of this message. If you feel your
        > >> reply will benefit the entire group, please change the "To:" line to
        > >> feline-heart@yahoogroups.com
        > >>
        > >>
        > >>
        > >> Yahoo! Groups Links
        > >>
        > >> • To visit your group on the web, go to:
        > >> http://groups.yahoo.com/group/feline-heart/
        > >>
        > >> • To unsubscribe from this group, send an email to:
        > >> feline-heart-unsubscribe@yahoogroups.com
        > >>
        > >> • Your use of Yahoo! Groups is subject to the Yahoo! Terms of
        > >> Service.
        > >>
        > >
        > >
        >
        --
        William Draper
        wedraper@...
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