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my cat Hotspur (We're new here.)

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  • mahedabel
    Hi, everyone. We are new here but have been in the feline crf group since June or July. I have been reading here for the past week or so, but this is my
    Message 1 of 7 , Dec 2, 2004
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      Hi, everyone. We are new here but have been in the feline crf group
      since June or July. I have been reading here for the past week or
      so, but this is my first post.

      My cat Hotspur is 15 ½ years old. I found him laying behind a
      garbage can at a car wash in Durant, Oklahoma when he was about 3
      weeks old and we have been together ever since. He was diagnosed
      with RCM in 1999 after a heart murmur was discovered at his yearly
      vet checkup. He has been on Atenolol since that time and has had
      regular checkups at the cardiologist. We never really had any
      problems with his RCM until mid-November when his echo showed that
      his heart had become severely enlarged since his checkup in January.
      Prior to that, I was always told that his condition was stable and
      that the Atenolol was doing just what they hoped it would. I have to
      admit, sadly, that until recently I didn't really know anything about
      RCM. I just took him for his checkups and gave him his Atenolol
      faithfully on time, everyday. Until very recently, Hotspur never
      seemed like anything was wrong with him. I guess that's why I didn't
      worry or research his heart condition or do anything except what the
      cardiologist told me to do. I remember, very clearly, our first
      cardiology visit (I was terrified then) when the cardiologist told me
      that Hotspur probably didn't know anything was wrong with him and
      that he probably didn't feel bad. And all of our subsequent visits,
      they said Hotspur was stable and to just keep giving the Atenolol.
      And so my sweet little Hotspie cat and I continued through the years.

      Then in June of this year, also as a result of his yearly vet
      checkup, Hotspur was diagnosed with CRF and off we went to the kidney
      specialist. At that time Hots didn't seem to feel bad either. We
      got a bunch of tests done, ultrasound etc, and it was discovered that
      he had extremely high blood pressure and severe metabolic acidosis,
      too. So he was started on medications for all of that. Then in mid-
      November, I thought he looked like he was breathing a little bit
      heavier than usual and he wasn't eating much so we went to the
      cardiologist and found out his heart has become very enlarged since
      January and he has "slight tricuspid regurgitation". That's what
      the report says. It says a lot of stuff that I'm still in the
      process of understanding. So I guess what I want to know is, does
      anybody have any ideas about what I could do to help Hotspur? He is
      not eating very well without me sitting with him and encouraging him
      (which I don't mind at all but I feel like it's probably not a good
      sign), won't eat the prescribed kidney diet at all. Often I spoon
      feed him small amounts very often throughout the day to make sure he
      gets enough food. I think he eats enough each day although
      definitely not what's best for him. Here are the medications he is
      taking:

      1/2 tab Atenolol twice daily (I think it is 25mg tablets, but I can't
      remember for sure)
      .625mg Norvasc once a day
      3.25mg Citrolith twice daily
      1/4 tab of 10mg Pepcid twice daily
      1/4 tab Spironolactone once a day (can't remember what mg the tabs
      are)
      Aluminum Hydroxide binder in all of his food daily
      1/8 tsp. Metamusil once a day

      I am going to start him on Twinlab Super B Complex this week and am
      also getting some salmon oil to mix in his food to try to inspire him
      to eat the kidney diet or at least something healthier than 9-lives.
      Even though he doesn't eat much some days, he doesn't seem to feel
      bad most of the time. Some days he just sleeps a lot but otherwise
      seems okay. His next kidney doctor appt. is Dec. 9th and the
      cardiologist told me to bring him back for another cardiology checkup
      in May. He has maintained his weight of 7.4 lbs for the past 2
      years.

      I am worried about his heart needing a diuretic and his kidneys
      needing fluid. He doesn't get Sub-Q's. He just drinks water on his
      own and I have noticed that he is drinking more since starting the
      Spironolactone. The cardiologist and the kidney doctor are both
      great and they do discuss Hotspur together to decide what to do. If
      anybody here has any suggestions or advice on how to take better care
      of Hotspur I would appreciate it so much. I'm very sorry this is so
      long and thank you if you managed to read it. Also, he seems to
      feel okay most of the time, but I worry that I might miss something,
      so if you know of any little signs I should look for that could mean
      something bad, please let me know. Hotspur is my little soul mate.

      Thank you very very much!

      Michelle & Hotspur
    • brinkett
      ... January. Hi, I m sorry to hear about Hotspur. Just curious - are you sure it s RCM and not HCM? I ve never heard of a cat with RCM surviving 5 years and
      Message 2 of 7 , Dec 2, 2004
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        > We never really had any
        > problems with his RCM until mid-November when his echo showed that
        > his heart had become severely enlarged since his checkup in
        January.

        Hi, I'm sorry to hear about Hotspur.

        Just curious - are you sure it's RCM and not HCM? I've never heard
        of a cat with RCM surviving 5 years and not being in congestive
        heart failure when diagnosed. Cats with RCM are usually quite ill
        from the word go. Also, cats with RCM usually aren't given atenolol.

        -----

        From vetgo cardiology concepts:

        28 What is feline restrictive/intermediate cardiomyopathy?

        Feline restrictive/intermediate CM refers to that group of primary
        mycardial disorders that are not typical of feline DCM or feline
        HCM. Morphologically the heart is characterized by a normal to
        reduced contractility, no thickening of the IVS or LVFW, and a
        normal left ventricular cavity. The endocardium is usually
        thickened.

        The history and physical examination are identical to those of
        feline HCM. The diagnosis relies on the echocardiographic
        examination. Left atrial enlargement and mitral valve insufficiency
        are common.

        The most effective therapy for this disorder remains unknown. The
        underlying disorder is that of diastolic dysfunction. ACE
        inhibitor therapy is used if contractility is reduced, diltiazem is
        used if contractility is normal (corrected for mitral valve
        insufficiency). Presumably these patients are at risk for
        thromboembolic events, hence prophylaxis is warranted.

        The prognosis is unknown but generally very poor.

        -----

        Sarah.
      • mahedabel
        Hi Sarah, I got all of Hotspur s file from the cardiologist (except there is no paperwork in this file from our first visit in 1999 and I know that s when we
        Message 3 of 7 , Dec 2, 2004
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          Hi Sarah,


          I got all of Hotspur's file from the cardiologist (except there is no
          paperwork in this file from our first visit in 1999 and I know that's
          when we first went because I still have my receipt from paying
          them.) and it all says he has RCM so that's when I started reading
          up on it. And I wondered the same thing that you are wondering, so I
          called the office and the cardiologist said yes, it is RCM that Hots
          has and not HCM and he explained a little about both conditions and
          just sort of confused me more. I've kind of been overwhelmed with
          all of this lately and I think it's affecting my comprehension of
          things at times. So I've been reading about both RCM and HCM and
          trying to compare Hotspur's files to the info I'm finding - not that
          that is going to help, I guess. He seems okay except for the eating
          habits and I keep reading about how the life expectancy after RCM
          diagnosis is what – 12 months at most and probably a lot less? And
          then I wonder, how is he alive and seemingly well all this time if he
          has this and now I pretty much stay terrified that I'm going to go
          home and find him dead. So I called the cardiologist and asked him
          what to be prepared for – basically is my little cat just going to
          suddenly die and he said no, he doesn't expect that Hotspur will
          suddenly just die, but he (Hots) is at a point where he needs a
          diuretic and we have to balance that with the kidney problems. He
          said "It's hard, but it has been done." Then he said to come back
          again in May which is also surprising after all the things I've read
          about RCM. But I think our doctors are all very good and we've seen
          the same cardiologist every time. So I guess Hotspur has RCM. I
          don't know… On the report that the cardiologist sent over to our
          general vet after our last appointment, there is a summary of
          Hotspur's condition. It's at home and I'm at work, but when I get
          home I can type it in a post and if you don't mind, could you read it
          and please tell me what you think? It is a short summary and I would
          sure appreciate it.

          I read about Morag today and I had to go hide in the bathroom to
          cry. She sure was a beautiful girl.

          michelle and hotspur









          --- In feline-heart@yahoogroups.com, "brinkett" <scrubbrush@r...>
          wrote:
          >
          > > We never really had any
          > > problems with his RCM until mid-November when his echo showed
          that
          > > his heart had become severely enlarged since his checkup in
          > January.
          >
          > Hi, I'm sorry to hear about Hotspur.
          >
          > Just curious - are you sure it's RCM and not HCM? I've never heard
          > of a cat with RCM surviving 5 years and not being in congestive
          > heart failure when diagnosed. Cats with RCM are usually quite ill
          > from the word go. Also, cats with RCM usually aren't given
          atenolol.
          >
          > -----
          >
          > From vetgo cardiology concepts:
          >
          > 28 What is feline restrictive/intermediate cardiomyopathy?
          >
          > Feline restrictive/intermediate CM refers to that group of primary
          > mycardial disorders that are not typical of feline DCM or feline
          > HCM. Morphologically the heart is characterized by a normal to
          > reduced contractility, no thickening of the IVS or LVFW, and a
          > normal left ventricular cavity. The endocardium is usually
          > thickened.
          >
          > The history and physical examination are identical to those of
          > feline HCM. The diagnosis relies on the echocardiographic
          > examination. Left atrial enlargement and mitral valve
          insufficiency
          > are common.
          >
          > The most effective therapy for this disorder remains unknown. The
          > underlying disorder is that of diastolic dysfunction. ACE
          > inhibitor therapy is used if contractility is reduced, diltiazem is
          > used if contractility is normal (corrected for mitral valve
          > insufficiency). Presumably these patients are at risk for
          > thromboembolic events, hence prophylaxis is warranted.
          >
          > The prognosis is unknown but generally very poor.
          >
          > -----
          >
          > Sarah.
        • brinkett
          ... Hots ... and ... If Hotspur does indeed have RCM, then he s certainly an atypical case. ... It s usually not more than about 12 months, yes. Cats with RCM
          Message 4 of 7 , Dec 2, 2004
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            > And I wondered the same thing that you are wondering, so I
            > called the office and the cardiologist said yes, it is RCM that
            Hots
            > has and not HCM and he explained a little about both conditions
            and
            > just sort of confused me more.

            If Hotspur does indeed have RCM, then he's certainly an atypical
            case.

            > He seems okay except for the eating
            > habits and I keep reading about how the life expectancy after RCM
            > diagnosis is what – 12 months at most and probably a lot less?

            It's usually not more than about 12 months, yes. Cats with RCM are
            usually in CHF when they're diagnosed and the mean survival time for
            cats in CHF is 18 months. Though these are all statistics. Some
            cats survive longer and some don't survive as long. What surprises
            me about Hotspur's case is that he was asymptomatic for so long.

            > Then he said to come back
            > again in May which is also surprising after all the things I've
            read
            > about RCM.

            Not really. Morag's cardiologist said the same thing, but with the
            understanding that she would be seen when required by our regular
            vet. Frequent ultrasounds are not going to be helpful because there
            won't be any improvement, and the cat's regular vet, in consultation
            with the cardiologist, can handle tweaking the meds when required.

            > On the report that the cardiologist sent over to our
            > general vet after our last appointment, there is a summary of
            > Hotspur's condition. It's at home and I'm at work, but when I get
            > home I can type it in a post and if you don't mind, could you read
            it
            > and please tell me what you think? It is a short summary and I
            would
            > sure appreciate it.

            Sure, I'd be curious to read it since Hotspur isn't the "norm".

            > I read about Morag today and I had to go hide in the bathroom to
            > cry. She sure was a beautiful girl.

            Thank you. She certainly was. I've lost some beautiful cats in my
            time but Morag's death affected me the most. She had such a strong
            personality and spirit and left us much too soon.

            Sarah.
          • diane
            Kearra was dx d with HCM in 1995 and put on Atenolol. At some point after that (few years) her murmur disappeared. IIRC she was taken off Atenolol but kept the
            Message 5 of 7 , Dec 2, 2004
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              Kearra was dx'd with HCM in 1995 and put on Atenolol. At some point
              after that (few years) her murmur disappeared. IIRC she was taken off
              Atenolol but kept the aspirin.

              In 1999 or 2000 she was dx'd with RCM (we kept up with the
              ultrasounds). She was put on Enecard. 3 weeks after her 2001
              ultrasound she threw a clot and went into CHF while at the vets.

              Up until the day she threw the clot, she had no outward signs of heart disease.


              Diane
            • lclarizia@aol.com
              Michelle, I tend to agree with Sarah -- five year survival with RCM would be very unlikely. My own experience -- my Baby Boy was initially diagnosed on August
              Message 6 of 7 , Dec 2, 2004
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                Michelle,

                I tend to agree with Sarah -- five year survival with RCM would be very
                unlikely.

                My own experience -- my Baby Boy was initially diagnosed on August 27th with
                HCM, which made sense given his initial symptoms, the ultrasound and the fact
                that it's the most common form. A repeat ultrasound done in October looked
                more like end-stage RCM to the cardiologist who read it (it was done at my
                vet's, he sent it to the cardiologist). I took him to Tuft's Veterinary Hospital
                in November, and as it turns out, it's DCM -- and it's very obviously DCM, all
                four chambers are markedly dilated.

                The point is that as the heart remodels due to the disease, it can look
                different depending on what stage the disease is at. I was present at the first
                and last ultrasounds, and I can easily see how his diagnosis changed, because
                his heart looked completely different 3 weeks ago than it did in August. The
                skill of the ultrsound operator has a lot to do with it as well.

                How many ultrasounds has Hotspur had? I understand the rationale behind not
                repeating ultrasounds, due to costs, especially when there is obvious
                hypertrophy of the ventricle which tends to indicate definite HCM. Thanks to an
                inheritance from my cat-hating grandmother who died in July (oh, the irony!) I was
                able to do the multiple ultrasounds without too much stress financially, and
                my God, it was definitely worth it.

                Do you know what Hotspur's measurements are? I hope he's feeling better too
                --

                Lisa


                [Non-text portions of this message have been removed]
              • brinkett
                ... point ... off ... That s interesting because one hypothesis is that RCM is end stage HCM. With HCM, the ventricular wall is thickened, but with RCM, it
                Message 7 of 7 , Dec 2, 2004
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                  > Kearra was dx'd with HCM in 1995 and put on Atenolol. At some
                  point
                  > after that (few years) her murmur disappeared. IIRC she was taken
                  off
                  > Atenolol but kept the aspirin.
                  >
                  > In 1999 or 2000 she was dx'd with RCM (we kept up with the
                  > ultrasounds). She was put on Enecard. 3 weeks after her 2001
                  > ultrasound she threw a clot and went into CHF while at the vets.

                  That's interesting because one hypothesis is that RCM is end stage
                  HCM. With HCM, the ventricular wall is thickened, but with RCM, it
                  isn't. So to go from HCM to RCM means that the model of the heart
                  has to have changed drastically.

                  One interesting point - the resolution of ultrasounds is variable.
                  Morag was originally diagnosed with HCM when she had the ultrasound
                  done at the regular vet by a very reputable ultrasound technician.
                  But when we took her to the cardiologist, she was diagnosed with
                  RCM. I asked, why was she diagnosed with HCM just a month ago and
                  now it's RCM? The answer - "here at the university, we have a very
                  high resolution ultrasound machine", i.e. expensive machine.

                  The reason she had been diagnosed with HCM originally is that with
                  RCM, the shape of the ventricle is abnormal. The walls aren't
                  thickened, but there is fibrous material in the ventricle and the
                  wall sometimes protrudes inward. The cardiologist drew me a
                  picture. With the lower resolution machine, where the wall was
                  bulging inward, it was misinterpreted as the wall being thick
                  because the resolution of the machine wasn't high enough to
                  differentiate between wall thickness and wall abnormalities.

                  Sarah.
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