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Re: my cat Hotspur (We're new here.)

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  • 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 1 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 2 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 3 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 4 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 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.

              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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