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Fw: [vettalk] Re: cat was diagnosed with saddleblock yesterday - i need advice

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  • Westgold
    Hi everybody -- my posts to vettalk about clots has yielded some very interesting information. This is one of 3 emails I ll be forwarding now, hopefully there
    Message 1 of 4 , Jun 29, 2009
      Hi everybody -- my posts to vettalk about clots has yielded some very interesting information. This is one of 3 emails I'll be forwarding now, hopefully there will be even more --
      ----- Original Message -----
      From: Mother Stephania
      To: vettalk@yahoogroups.com
      Sent: Monday, June 29, 2009 12:23 AM
      Subject: Re: [vettalk] Re: cat was diagnosed with saddleblock yesterday - i need advice





      Hi Michelle,

      I'm not a vet and have no knowledge on my own. But I had the great honor about three weeks ago of attending a 4 hour "mini-course" on Feline HCM by Dr Mark Kittleson of UC Davis ... whom you probably know is one of the foremost experts on feline HCM. I'm still excited to have heard and met him.

      Dr Kittleson has worked intensely with his own Maine Coon colony since about 1993 and done a lot of research on possible treatments for HCM. I felt a little sorry for him because his bottom line at the talk was that, after years of research, he doesn't know of any treatment that can be proven to be beneficial for the treatment of HCM prior to the onset of congestive heart failure (CHF) ... and after CHF, the only thing he feels makes a major difference is Furosemide (Lasix). I emailed him and asked if there are any other possible drugs being looked at to slow progression of HCM ... and he replied that there aren't any that he is aware of. I asked him if there was any hope for the future and he said the best hope is probably gene therapy, but that is a long way off. He has found in his Maine Coon colony (which are mostly Maine Coon mixes now, no longer purebreds) that there is so much variability in presentation and progression of the disease ... whether given medication or given nothing ... that he got to a point that he doesn't give any medication to his cats prior to CHF. The only exception is giving a Beta-blocker (e.g. Atenolol) to cats with severe SAM (systolic anterior motion of the mitral valve ... which is what usually results in an audible heart murmur).

      With cats that have a thromboembolism (blood clot) ... he suggests that the outcome depends on a variety of factors including whether or not the cat is in CHF (those not in CHF have a good short-term prognosis), if the left atrium is moderately to severely enlarged (which increases the risk of forming additional blood clots), if there are other clots in the heart, etc. Regaining use of the limbs depends on the dissolving of the clot either naturally or with intervention, size of the clot and whether the blood flow was completely blocked, and if so, for how long, etc.

      A year ago, I heard a recording of a talk on Cardiogenic Thromboembolisms (blood clots originating in the heart) by Dr Henry Green III who is a cardiologist at Purdue Univ. I'm going by memory now ... but I recall he said that he usually gives cats 24-48 hours after a thromboembolism to see how they respond before suggesting euthanasia. He feels that cats able to survive it will show some signs by then. He recommends giving pain medication as well. He commented that he has found a low body temperature is not a good sign (i.e. negative prognostic indicator). He generally recommends giving both Low Molecular Weight Heparin (LMWH) and clopidogrel (Plavix) in an attempt to prevent future clots. Since the LMWH is very expensive, if clients can't afford it, then he gives just Plavix. He is currently doing a study comparing the use of aspirin and Plavix. The study is called FATCAT (Feline Arterial Thromboembolism; Clopidogrel vs. Aspirin Trial). Dr Green mentioned the study a year ago ... but at Dr Kittleson's course three weeks ago, he commented that he hadn't heard any results yet from the FATCAT study, and asked if any of the other cardiologists present had heard anything ... they hadn't. I think both Dr Kittleson and Dr Green said that there isn't currently any evidence that aspirin helps prevents clots.

      I haven't heard Dr Kittleson, Dr Green or any other cardiologist talk about CoQ10 ... but, of course, my knowledge is limited.

      I don't know if any of that is helpful ... but wanted to share what (I think) I've learned.

      Stephanie in Montreal ... Definitely NAV




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      Westgold wrote:
      Hi again --- we would appreciate knowing what we can do to help prevent our HCM kitties from developing clots. I have read that any person on a statin or beta blocker should also be on CoQ10 -- does this go for cats too? Most HCM kitties seem to be on atenolol, and many are on all kinds of other meds too. Many of the people on feline-heart have their HCM kitties on CoQ10, and/or nattokinase or other things to help prevent clots. Do these work, and what do you recommend? My HCM kitty has seen two different cardiologists, and both have said that no supplements will help. But CLOTS seem to be a very big problem -- I feel I should give him something just to help prevent clots. What is recommended? thanks!!






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    • Westgold
      ... From: Janet Somers To: vettalk@yahoogroups.com Sent: Sunday, June 28, 2009 10:18 PM Subject: [vettalk] Re: cat was diagnosed with saddleblock yesterday - i
      Message 2 of 4 , Jun 29, 2009
        ----- Original Message -----
        From: Janet Somers
        To: vettalk@yahoogroups.com
        Sent: Sunday, June 28, 2009 10:18 PM
        Subject: [vettalk] Re: cat was diagnosed with saddleblock yesterday - i need advice





        I'm not a vet but I know Plavix is commonly prescribed to cats these days to help prevent clots. The cardiologist I consulted when Freddie had HCM said it's "winning" against aspirin in effectiveness, according to recent research. Apparently aspirin is still being prescribed as a blood thinner (even in cats) but, according to this cardiologist, has been shown not to really be effective, whereas Plavix has shown good results. (Plavix is very expensive, like almost prohibitively expensive, though; and, like aspirin, it can cause GI bleeding.)

        Janet + Charlie, Lilly, Callie, Murray, and angel Freddie

        --- In vettalk@yahoogroups.com, "Westgold" <westgold@...> wrote:
        >
        > Hi again --- we would appreciate knowing what we can do to help prevent our HCM kitties from developing clots. I have read that any person on a statin or beta blocker should also be on CoQ10 -- does this go for cats too? Most HCM kitties seem to be on atenolol, and many are on all kinds of other meds too. Many of the people on feline-heart have their HCM kitties on CoQ10, and/or nattokinase or other things to help prevent clots. Do these work, and what do you recommend? My HCM kitty has seen two different cardiologists, and both have said that no supplements will help. But CLOTS seem to be a very big problem -- I feel I should give him something just to help prevent clots. What is recommended? thanks!!
        > ----- Original Message -----
        > From: Vickie Averhoff
        > To: vettalk@yahoogroups.com
        > Sent: Sunday, June 28, 2009 5:08 PM
        > Subject: [vettalk] Re: cat was diagnosed with saddleblock yesterday - i need advice
        >
        >
        >
        >
        >
        > --- In vettalk@yahoogroups.com, "Westgold" <westgold@> wrote:
        >
        > The vet said she has heart disease and had thrown a clot that was cutting off the blood supply to her rear legs. I believe him and this all makes medical sense. The part I am struggling with is that he strongly recommended euthanizing her right away because she was in extreme pain (he says) from the blood clot and the heart disease would continue to grow worse and eventually she would not be able to breathe.
        >
        > Saddle thrombi are incredibly painful and carry an incredibly poor prognosis in most cases. If this person wants her cat to live, she needs to get her to a vet who will start treating with heparin to dissolve the clot, but even then the prognosis is still poor. If the cat survives the clot she will need treatment for the heart disease, usually Hypertrophic Cardiomyopathy (HCM).
        >
        > Her vet may not be comfortable treating clots (the treatment is pretty intensive), so a referral to a 24 hour care facility is probably indicated.
        >
        > Euthanasia for these cats is a reasonable option if intensive care is not possible.
        >
        > Vickie, DVM
        >
        >
        >
        >
        >
        >
        > ----------------------------------------------------------
        >
        >
        >
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        > Version: 8.5.375 / Virus Database: 270.12.93/2206 - Release Date: 06/27/09 17:55:00
        >






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      • Westgold
        ... From: Mother Stephania To: vettalk@yahoogroups.com Sent: Monday, June 29, 2009 12:15 AM Subject: Re: [vettalk] Re: cat was diagnosed with saddleblock
        Message 3 of 4 , Jun 29, 2009
          ----- Original Message -----
          From: Mother Stephania
          To: vettalk@yahoogroups.com
          Sent: Monday, June 29, 2009 12:15 AM
          Subject: Re: [vettalk] Re: cat was diagnosed with saddleblock yesterday - i need advice





          Hi Janet,

          I agree that any cat with suspected HCM should be checked for hyperthyroidism, particularly an older cat since the average age of onset for hyperthyroidism (I think) is around 12-13.

          Just a footnote on terminology ... Dr Mark Kittleson of UC Davis stated very explicitly that "HCM" is only used for primary hypertrophic cardiomyopathy. It is only considered HCM if all other possible causes for the thickening of the left ventricle have been ruled out. According to his veterinary textbook, "Small Animal Cardiovascular Medicine", Dr Kittleson considers HCM a primary disease. If heart thickening is secondary to Hyperthyroidism (or anything else, like aortic stenosis, systemic arterial hypertension, and acromegaly) ... then he says it should be called " concentric hypertrophy secondary to hyperthyroidism".

          It is probably not important since the important thing is not terminology but rather diagnosis and treatment. Just sharing something I learned as I try to learn proper terminology. As you say, the great part about hypertrophy secondary to hyperthyroidism is that once the thyroid is under control, the thickening of the left ventricle is usually reversed, at least partially, if not fully.

          Stephanie in Montreal, Definitely NAV




          --------------------------------------------------------------------------------


          Janet Somers wrote:
          Hi,

          My Freddie (who died last year from hyperthyroidism and renal failure) had HCM (hypertrophic cardiomyopathy, enlarged heart and/or thickened heart walls, causing potential clot development). The HCM is often a result of hyperthyroidism, so I wonder if this cat has been checked for that. (I assume she has but just in case, I thought it was worth mentioning.)

          Freddie never "threw a clot" but I was constantly in fear of that and his cardiologist wanted him on Plavix (a human blood-thinning drug). I didn't put him on it (the cardiologist gave me the choice) because he already had gut issues and I didn't want to exacerbate them (Plavix, like aspirin, can cause GI bleeding).

          I'm not a vet but I read a lot about saddleback thrombosis at the time of Freddie's illness and have heard of cats getting through it. I even read that often they get it and are barely symptomatic. It sounds like this cat had a bad time of it, though, and I would trust whatever the vet has to say about it. Still, I'd make sure the cat is checked for hyperthyroidism, if she hasn't been already, because that can often be controlled, which often alleviates the HCM.

          Janet + Charlie, Lilly, Callie, Murray, and angel Freddie







          --------------------------------------------------------------------------------



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