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Understanding HCM

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  • Facies Family
    My beloved Facie, a doll-faced Persian, died at 14 1/2 on May 9. She was just diagnosed with HCM on April 12. I am grieving and also in shock because the vets
    Message 1 of 2 , May 31, 2004
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      My beloved Facie, a doll-faced Persian, died at 14 1/2
      on May 9. She was just diagnosed with HCM on April 12.
      I am grieving and also in shock because the vets have
      told me her case is mysterious and I'm not getting
      answers to help resolve this loss. I am hoping
      someone, particularly a specialist vet or
      cardiologist, can help me understand this better to
      come to grips with it.

      Facie had annual exams with full blood profiles, plus
      in-between appointments for any minor issues that
      might crop up. She was in prime condition, kidneys et
      al just great, only a bit of arthritis in the shoulder
      that made her limp now and then. She looked so great
      that even the folks at the vet's office thought she
      was only 4 or 5 year old. We had an annual visit May
      '03, everything great. Nov. 29 she had a visit for
      chin acne and vitals checked (weight and heart OK).
      Her appetite is always great, and she keeps herself in
      good trim--between 8-9 pounds since she was young. We
      took her in early for her big exam on Mar. 30 and
      discovered she had lost 6.5 ounces, had a heart rate
      of 210, and a gallop rhythm (irregularly irregular).
      No breathing trouble, she had not seemed
      lethargic--she does sleep more in the winter months,
      but she always got sporty on sunny days in our
      enclosed garden. My husband and I both have home
      offices so we've been able to watch her closely
      through her senior years and she is an affectionate
      mate during the day, perched on our desks or laps. We
      were referred to a cardiologist who made the diagnosis
      of HCM with ultrasound and ECG. He said it was so mild
      (patchy thickening, 35% at most, most of the
      chamber normal) that he felt she had another 2 years
      of quality life with regular treatment. He prescribed
      1/4 tab atenolol per day and bring her for a check-up
      in 4 weeks, when he would consider adding aspirin to
      her regimen. I was due for medical treatment in the US
      which could not be postponed (we are in the UK). I was
      torn about leaving and also about starting her meds
      without being here, but he assured us that beta
      blockers do not have a downside and she did *not* need
      close observation to adjust the dose. My in-laws care
      for her regularly, at our house or theirs, and she has
      an immensely fun time at their house (we're always
      afraid she's going to resent going home when we take
      her down for holidays together), so my husband and I
      decided to take her there during our absence. They are
      also retired and one of them is home 24 hrs a day. We
      sent records to the local vet and set up the contact
      so he would take instructions from the cardiologists,
      and in an emergency, she would be taken to the Bristol
      University feline center, one of the two top feline
      cardio research units in the UK. My husband stayed at
      his parents' for the first 5 days of her atenolol, and
      she seemed great. She was springtime frisky, playing
      and enjoying herself and appetite increasing
      above normal (which happens when she's physically
      really active in the spring and summer). All reports
      from my in-laws were great. They took photos for us,
      and she looks great. Then, 3 weeks to the day from
      starting the meds, she walked across the kitchen and
      collapsed. The local vet diagnosed a saddle thrombosis
      and recommended euthanasia. We had a system in place
      to alert our cardiologist, who was on the phone and
      evaluating her condition. She was not in pain (no
      crying, no indication in vitals that she was in pain)
      and he said to get her to Bristol , 2 hours away. She
      was up and walking before they arrived, and strolled
      out of her carrier in such good shape that the
      specialist there was concerned that it might not have
      been a clot. Ultrasound & ECG, also blood screen for
      enzymes confirmed that it had been, but her body was
      clearing it effectively. Her heart condition had
      actually improved since she started the
      meds too. She was seen by a top feline cardiac
      researcher the next day, and her own cardiologist came
      to see her. He said he was shocked to see her, that
      with her mild HCM he would not have believed a clot
      was possible. I arrived and saw her for an hour each
      day for the next two days--she was clearly dopey from
      the analgesics, but walking, responsive, and eating
      well. The hospital wanted to keep her for observation
      for several days before releasing her. I will hold off
      on detailing the rest of her treatment in intensive
      care, but I will tell you that 84 hours after her
      collapse, she had another embolism and died instantly
      in her sleep. We decided against a post-mortem when
      the vet told us that clots often dissipate before they
      can have a look and leave no evidence. Given that poor
      outlook, we decided against it as it was all too
      traumatic.

      What is most distressing is that all of the vets and
      cardiologists who treated her say they are mystified
      by her first embolism episode, her fast almost
      "miraculous" recovery from it, and her death. They say
      they have never encountered a case where an
      asymptomatic, mild HCM patient turned up
      with a clot this early in the progression of the
      disease. It just seems too coincidental that this
      happens 3 weeks after the atenolol is started, but I
      can't find any data that suggests that it is risky.
      Nor did I before we started the treatment. I wonder if
      positive changes in the morphology of the
      could cause cell damage and thus clots as easily as
      negative changes (thickening)-change is change--but
      I'm not a doctor and this is just an intuitive
      question.

      I was deeply anxious about leaving her and would have
      put my own medical treatment behind her own, but for
      the assurance of the vet who said she did not need
      constant observation. I am not blaming the vet, but
      myself, and finding it hard to live with this. If her
      case is so atypical, I can't help wondering if we did
      something or could have done something different. She
      was not stressed going to or at my in-laws (she is the
      rare cat who likes car trips and doesn't cry in the
      car). I keep thinking I would have seen some sign that
      something was wrong and could have stopped it. Does
      anyone have any knowledge of the disease that it can
      be this capricious and unpredictable? She was healthy
      and beautiful and a wonderful friend for 14 1/2 years
      and her loss is unbearable.





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