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Re: Lillie's Progress/Update...Reduced Meds

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  • turkishangoraathumanesociety
    Another update (I left previous posts below, so everyone knows what I am talking about, since its been a while). Lillie just started phase 2 today of further
    Message 1 of 8 , Jan 3, 2006
      Another update (I left previous posts below, so everyone knows what I
      am talking about, since its been a while). Lillie just started phase
      2 today of further reducing her meds. She has a cardiology appt to
      recheck her in mid February, which will be one week after no meds at
      all...unless earlier seems necessary. It's so SCARY...Everytime she
      SLEEPS I feel like something is wrong. She does pretty much sleep all
      day, but she runs around up & down the cat tree at night.
      I'm stressing out over this, I know I should be happy.

      --- In feline-heart@yahoogroups.com, "turkishangoraathumanesociety"
      <turkishangoraathumanesociety@y...> wrote:
      >
      > Knock on wood...so far so good with Lillie's reduction in meds
      after
      > her "resolved" HCM. We'll be on the reduced schedule until Feb,
      then
      > NONE if it goes as planned. She will have another Cardiologist
      visit
      > to make sure all is still well once off (Although, being the
      > worrywort, I will probably take her to her closer Internal Med
      > specialist sometime in the middle, just to be sure). She LOVES to
      > race up and down her cat tree anyway, but it does seem to be a bit
      > more frequent (although she sleeps all day long after her late
      night
      > cat tree gymnastics! :) ).
      >
      > --------------------------------------------------------------------
      > Re: SEVERE Obstructive HCM w/VERY POOR prognosis to
      > *RESOLVED/Excellent* Miracle!
      >
      > --- In feline-heart@yahoogroups.com, "turkishangoraathumanesociety"
      > <turkishangoraathumanesociety@y...> wrote:
      > >
      > > Hey everyone...Sorry it took me so long to respond about
      > Lillie's
      > > appointment. I am taking full time classes, and everything was
      due
      > at
      > > once. I also have to manually type the reports, reading off the
      > paper
      > > copy. The original post is below this update in case someone
      missed
      > > it and doesn't know what I am talking about (Please scroll down
      and
      > > read that first if so, so you can follow). Her original meds are
      > > listed in "database" on the left side of the board, and will
      remain
      > > at the old dosages in the database until we have finished the 4
      > > month "weaning off" process, and her pics are the first album
      > > in "photos" called "A Lillie Photo album". The meds listed in
      the
      > > database are meds she was put on since January of 2004 (5 months
      > > after heart failure) when she was able to make the 3 hour drive
      > (each
      > > way) to the cardiologist. Prior to that, she was being treated
      > > solely by an Internal Med Specialist. During that 5 month period
      > she
      > > was on Cardizem & Lasix, and in Jan 2004 she was weaned off those
      > and
      > > then put on the Atenolol and Enalapril. She had been making
      > strides
      > > that 1st 5 months, but real improvements came when put on the
      > current
      > > meds (and why I am so scared to wean her off of them)
      > > Okay, now for the report: (Again, this is a cat who was
      > considered
      > > to have very little change to live long after her heart failure
      in
      > > Aug 2003)...I fully credit proper care by her Cardiologist 4hrs
      > away,
      > > and check-up visits to her Internal Med Specialist 40 minutes
      away
      > > for this (and of course prayers from the boards during several
      > other
      > > close calls). Once she had unexpected heart failure a general
      dvm
      > > was not in the picture whatsoever, and that is how it will
      > > remain, "resolved" or not. *ANY EXPANATORY NOTES *I* HAVE ADDED
      IN
      > > THE REPORT will show as (ed: xxxxx):
      > >
      > > Patient Summary Oct 2005:
      > > Final diagnosis: Resolving (resolved?) Hypertrophic Cardiomyopathy
      > > Resolution of dynamic outflow tract obstruction
      > > Normal wall measures, normal LA and LV size, normal LV systolic
      > > function
      > >
      > > History and clinical problems:
      > > 3 year old spayed female cat presented for a reevaluation of her
      > > heart function. She developed overt, severe left-sided
      congestive
      > > heart failure in Aug 2003 and was diagnosed with hypertrophic
      > > cardiomyopathy with dynamic outflow tract obstruction. She has
      not
      > > had repeat episodes of congestive heart failure. Since her last
      > visit
      > > here, she has been doing very well at home. The nasal crusting
      > (ed:
      > > Feline herpes a/k/a Feline Viral Rhinotraecheitis) has decreased
      > with
      > > L-Lysine therapy. She is currently on the following medications:
      > > Atenolol (1/4 of a 25mg tablet twice a day)
      > > Enalapril (1/2 of a 2.5mg tablet once a day
      > > Lactulose (1 ml twice a day)
      > > Aspirin ( 1 81mg tablet every third day)
      > > Zeniquin (1/2 of a 25mg tablet once a day, every other week)*
      (ed:
      > > for undetermined bacterial issue causing brown crud at base of
      > front
      > > toes...had been very painful for about a week when originally
      > > occurred...was on pain meds (Buprenex) until it could be tested,
      > > biopsied, treated. Little bits remain over a year later, so med
      > > needs to be continued)*
      > > (ed: L-Lysine one 500mg capsule twice a day)
      > >
      > > Diagnostic Procedures and Physical findings:
      > > Physical Exam: Weight 4.6kg (ed: this is almost a 3 POUND
      increase
      > > since her last visit to cardiologist the previous year. She had
      > been
      > > so skinny and not gaining weight, so I put her on Regular INNOVA
      > > which is high quality and high calorie food) Temperature: 102.6
      > > degreesF Heart rate: 145bpm Respiratory rate:32 Auscultation of
      > the
      > > lungs was within normal limits. A soft gallop was noted on
      > > auscultation of the heart. No heart murmur was detected (ed: this
      > in
      > > contrast to grade 5 in the first few months). Mucus membranes
      were
      > > pink and moist with a capillary refill time of less than two
      > seconds.
      > > All physical exam findings were within normal limits. Systolic
      > blood
      > > pressure 158 mmHg
      > > Echocardiogram: There was no significant hypertrophy or dynamic
      > > obstruction noted on today's examination. Left ventricular
      ejection
      > > fraction is normal. The left atrium and ventricle are in the
      upper
      > > limits of normal for a cat of Lillie's size. Aside from mild
      > > papillary muscle prominence, there is seemingly resolution of her
      > HCM.
      > >
      > > Treatment:
      > > It may be possible to discontinue her meds, but this should be
      done
      > > gradually and she should have one follow up appointment once she
      is
      > > off all meds.
      > > 1. Atenolol: (1/4 of a 25mg tablet twice a day)--can be reduced
      to
      > > 1/4 ONCE daily for 3 months, and then 1/4 EVERY OTHER day for one
      > > month, then discontinued.
      > > 2. Enalapril (1/2 of a 2.5mg tablet once a day)--can be reduced
      to
      > > 1/2 tablet every OTHER day for 3 months, and then 1/4 tablet
      every
      > > other day, then discontinued.
      > > 3. Lactulose (1 ml twice a day)--continue as dir.
      > > 4. L-Lysine (1 500 mg tab twice a day) --continue as directed
      > > 5. Zeniquin (1/2 of a 25mg tablet once a day, every other week)--
      > > continue as dir.
      > > 6. Aspirin ( 1 81mg tablet every third day)-- Aspirin therapy
      can
      > be
      > > discontinued--the risk of blood clots is very low at this time. *
      > (ed:
      > > with my anguish over stopping other meds he said I could give her
      > one
      > > 81 mg tab once a WEEK if it would make me feel better while she
      is
      > > being weaned off others, but doesn't find it necessary...I am
      going
      > > to do the once a week)
      > >
      > > Recommendations and instructions: She appears to be doing well at
      > > today's exam and her disease appears to have resolved. THIS IS
      > > OCCASIONALLY NOTED IN CATS WITH HYPERTROPHIC CARDIOMYOPATHY, and
      > > follows the trend of her prior exams.
      > >
      > > PROGNOSIS: Currently her cardiac prognosis is EXCELLENT
      > >
      > > Next appointment: An echocardiogram should be performed in 9 to
      12
      > > months to evaluate her heart. Presumably she will be off all
      > > medications for her heart at that time.
      > > -----------------------------------------
      > > Info from actual echo photos: (ed: if this means something to
      > someone)
      > > 1 IVSd 4.81 mm
      > > IVSs 7.32 mm
      > > LVIDd 15.69 mm
      > > LVIDs 7.95 mm
      > > LVPWd 4.60 mm
      > > LVPWs 7.32 mm
      > > EDV (Teich) 6.81 ml
      > > ESV (Teich) 1.10 ml
      > > EF (Teich) 83.84%
      > > SV (Teich) 5.71 ml
      > > %FS 49.33%
      > >
      > > 1 L 1.42cm
      > > ----------------------------------------
      > > (ed:)He also mentioned that she gets VERY upset/stressed when
      being
      > > examined, (tries to scratch and bite everyone...which my precious
      > > little baby would NEVER do...I don't know why they would say
      > > that! :) ) so that is very likely the reason why she has been
      > > getting crazy bloodwork in the past, indicating super high
      > > lymphocytes. He even consulted with a pathologist about this, as
      > > there had been concern in the other office about possible cancer
      > > developing. We also need to keep her Feline herpes and paw issue
      > > under control...that, too added to the stress indicated in
      > bloodwork.
      > > ---------------------------------------------------
      > >
      > >
      > >
      > > ORIGINAL POST:
      > > --- In feline-
      heart@yahoogroups.com, "turkishangoraathumanesociety"
      > > <turkishangoraathumanesociety@y...> wrote:
      > > >
      > > > Okay you guys,...I JUST got in the house after a long road trip
      > > today
      > > > for Lillie's appt...Will tell the whole story later, but bottom
      > > line:
      > > > what was called SEVERE OBSTRUCTIVE HCM with a prognosis of VERY
      > > POOR
      > > > kept getting better bit by bit each visit. She just had her
      > > > echocardiogram and he is now calling it: "HCM
      > > > resolved/resolving?....EXCELLENT". More details later...I know
      I
      > > > should be over the moon, but actually to me this news is the
      most
      > > scary
      > > > news ever, because he wants me to start tapering off her meds
      and
      > > after
      > > > a few months STOPPING. This really REALLY gives me anxiety,
      > > because
      > > > her meds are what I feel got her to this point. More detaails
      > > later,
      > > > but I guess we should celebrate...it's just hard when you went
      > > through
      > > > the complete nightmare that was her heart failure and later
      > > scares.
      > > > She has the best Dr there is, so I know I shouldn't worry,
      > > > but....well.... EEEEEEEEEEEEEEEEK! More details tomorrow or
      later
      > > >
      > >
      >
      (Lillie's pics in photo link to the left, 1st album)
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