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Re: [FH] Prognosis For HCM/RCM

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  • Jim Sinclair
    ... I have done exactly zero amount of research on this, so take this as just a single anecdotal data point: Clipsy s echocardiogram 6 months after her
    Message 1 of 13 , Feb 2, 2012
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      On Thu, Feb 2, 2012 at 1:37 PM, <nyppsi@...> wrote:

      > While it is commonly preached & accepted that HCM is not a reversible or
      > curable affliction, I repeatedly read posts indicating that echocardiograms
      > have, in some cases, shown reductions in the thickness of atrium walls
      > after a period of medication and reduction or elimination of valve leakage.

      I have done exactly zero amount of research on this, so take this as
      just a single anecdotal data point: Clipsy's echocardiogram 6 months
      after her diagnosis showed reduction in thickness, but the
      cardiologist explained that this was due to loss of tissue as part of
      the progression of her disease. About two weeks after that
      echocardiogram, she threw a clot and died.

      Again, I have not studied this at all and what I have to say is mere
      speculation of a layperson: It seems that wall thickness alone is not
      the whole story, in that thickness can decrease even as disease
      progresses?

      > I don't want to view the issue through rose colored glasses, but, on the
      > other hand, I don't want to take the negative fatalistic viewpoint that seems
      > to be the stock-and-trade of veterinary cardiologists. I often wonder if,
      > in some cases, that's their way of generating more echo business ($450.00 a
      > pop in my area).

      On the other hand, when Clipsy was first diagnosed by a vet at the
      local emergency clinic, that vet's viewpoint was about as negative and
      fatalistic as it could get: She said Clipsy was unlikely to survive
      the night and even if she did, she would die in a matter of days or
      weeks at most, and would be gasping for breath and suffering miserably
      the entire time. She therefore recommended immediate euthanasia. If I
      had accepted that recommendation, there wouldn't have been a
      cardiology consult at all, nor an echocardiogram. (The diagnosis in
      the emergency clinic was made based on clinical signs plus an X ray.)
      It seems to require a certain amount of optimism to pursue treatment,
      doesn't it?

      > What is one to believe?

      Before Clipsy died, I was wondering what the purpose was of repeat
      echocardiograms. She was still alive six months after the prediction
      of her imminent death, she was *not* suffering from difficulty
      breathing or any other apparent distress, she was enjoying a good
      quality of life--what would the echocardiogram tell us that we didn't
      already know? We knew she had HCM, and we knew what medications and
      supplements she was taking, and we knew from her behavior and from her
      regular vet's routine physical exams and blood tests that this regimen
      seemed to work for her.

      If she were still alive, or if I ever have another cat diagnosed with
      heart disease, I would/will ask my own veterinarian more questions
      about that. Specifically, I would want to know whether information
      obtained from a new echocardiogram would enable any medication
      adjustments or other interventions to enhance the cat's quality of
      life or to extend survival time with good quality of life. If so, then
      for me, it would be worth it.

      If it's just a matter of the referring vet or the cardiologist wanting
      to track things for statistical purposes--well that is important, in
      that the more patients they follow up on, the more accurate prognoses
      the can give for newly diagnosed cats and the better data they'll have
      about efficacy of different treatment protocols. I would certainly be
      willing to have my cat given a safe and painless test like an
      echocardiogram in order to contribute to the knowledge base about the
      disease.

      But if it's being done for the benefit of veterinary knowledge and not
      for the benefit of my particular cat, then I think the veterinary
      researchers should be footing the bill for it.

      Jim Sinclair  jisincla@...
      www.jimsinclair.org
      http://moosepuppy.petfinder.com
    • joanne marbut
      I understand that you are seeing improvement in your cat s health.  My cat s health has improved greatly after taking COQ10 and vitamins as well as her heart
      Message 2 of 13 , Feb 2, 2012
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        I understand that you are seeing improvement in your cat's health.  My cat's health has improved greatly after taking COQ10 and vitamins as well as her heart meds. Her heart hasn't changed much in three years. She's stable with HCM. And yet, the vet reminds me that she is seriously ill.  And she should. It's easy to think we can remain on this course without interruption until she's 20 years old and dies of old age. But that won't happen.  This disease may take years to progress but at some point, unless something else takes the cat's life, our HCM cat will die of HCM, as will they all.  Anything can happen. She had two fainting spells in the fall that lasted 2-5 minutes each. She has recently had an anxious episode where she was breathing fast and needed my attention and lots of petting before 15 minutes passed and she calmed down (just as I was going to take her to the vet.)  After, she was fine. These are not normal incidents but are for HCM cats
        where anything can happen when the heart isn't perfect.  We must stay the course of action and therapy-the heart meds, the vitamins, supplements, etc. and the blood tests, the xrays, the echos, the vet visits and not become complacent.

        [Non-text portions of this message have been removed]
      • ERIC LEE
        HI,   I asked my vet for antibiotics for my cardiomyopathy baby but I thought I would ask here ... There shouldn t be a problem giving antibiotics to him
        Message 3 of 13 , Feb 2, 2012
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          HI,
           
          I asked my vet for antibiotics for my cardiomyopathy baby but I thought I would ask here ...
          There shouldn't be a problem giving antibiotics to him while he is on Atenolol and baby aspirin right?

          Thank you very much!!





          [Non-text portions of this message have been removed]
        • Westgold
          I personally wouldn t give anything new unless I discussed it with my cardiologist. You never know what kind of interactions or side effects there might be.
          Message 4 of 13 , Feb 2, 2012
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            I personally wouldn't give anything new unless I discussed it with my cardiologist. You never know what kind of interactions or side effects there might be. The littlest thing can upset the careful balance in our kitties, and things can turn on a dime.
            ----- Original Message -----
            From: ERIC LEE
            To: feline-heart@yahoogroups.com
            Sent: Thursday, February 02, 2012 3:53 PM
            Subject: [FH] Antibiotics with Atenolol and baby aspirin





            HI,

            I asked my vet for antibiotics for my cardiomyopathy baby but I thought I would ask here ...
            There shouldn't be a problem giving antibiotics to him while he is on Atenolol and baby aspirin right?

            Thank you very much!!

            [Non-text portions of this message have been removed]





            [Non-text portions of this message have been removed]
          • Toby Jones
            This mirrors my experience.  Very true. ________________________________ From: joanne marbut To: feline-heart@yahoogroups.com
            Message 5 of 13 , Feb 2, 2012
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              This mirrors my experience.  Very true.



              ________________________________
              From: joanne marbut <jomarbut@...>
              To: "feline-heart@yahoogroups.com" <feline-heart@yahoogroups.com>
              Sent: Thursday, February 2, 2012 11:10 AM
              Subject: [FH] Re: Prognosis For HCM/RCM


               
              I understand that you are seeing improvement in your cat's health.  My cat's health has improved greatly after taking COQ10 and vitamins as well as her heart meds. Her heart hasn't changed much in three years. She's stable with HCM. And yet, the vet reminds me that she is seriously ill.  And she should. It's easy to think we can remain on this course without interruption until she's 20 years old and dies of old age. But that won't happen.  This disease may take years to progress but at some point, unless something else takes the cat's life, our HCM cat will die of HCM, as will they all.  Anything can happen. She had two fainting spells in the fall that lasted 2-5 minutes each. She has recently had an anxious episode where she was breathing fast and needed my attention and lots of petting before 15 minutes passed and she calmed down (just as I was going to take her to the vet.)  After, she was fine. These are not normal incidents but are for HCM cats
              where anything can happen when the heart isn't perfect.  We must stay the course of action and therapy-the heart meds, the vitamins, supplements, etc. and the blood tests, the xrays, the echos, the vet visits and not become complacent.

              [Non-text portions of this message have been removed]




              [Non-text portions of this message have been removed]
            • Toby Jones
              I have heard, infrequently, of terminally ill cancer patients given months to live, having their cancer disappear and be healed.  Much more frequently, I have
              Message 6 of 13 , Feb 2, 2012
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                I have heard, infrequently, of terminally ill cancer patients given months to live, having their cancer disappear and be healed.  Much more frequently, I have heard of people succumbing and dying from (terminal) cancer.  Could a cat have a miraculous recovery?  Maybe.  Do the vast vast vast majority die from HCM at some point?  Research I have read would say yes.

                Being in a science field myself, I would assume that echocardiographs have a standard error of measurement (as with every other scientific tool); i.e. two different cardiologists (or even the same cardiologist) could give different readings on a cat, even if there are no real changes.

                I can tell you from my experience that there was nothing that we didn't try for Eli, and yet he still died at only five years of age despite years of medical treatment and weeks at a time of 24/7 vet tech supervision.  That is my reality.  I hoped against hopes, as I would assume everyone does when faced with this condition, but in the end, it did not save him.



                ________________________________
                From: "nyppsi@..." <nyppsi@...>
                To: feline-heart@yahoogroups.com
                Cc: nyppsi@...
                Sent: Thursday, February 2, 2012 10:37 AM
                Subject: [FH] Prognosis For HCM/RCM


                 
                While it is commonly preached & accepted that HCM is not a reversible or
                curable affliction, I repeatedly read posts indicating that echocardiograms
                have, in some cases, shown reductions in the thickness of atrium walls
                after a period of medication and reduction or elimination of valve leakage.

                Cardiologists always seem to tend to take the "worst case" approach,
                conceding only that medications may slow the progress of the condition, but not
                reverse it. I personally have seen what appears to be clear
                echocardiographic evidence that medications (enalapril) have resulted in visible
                improvement of Jesse's condition (HCM/RCM).

                I'm very confused.

                I don't want to view the issue through rose colored glasses, but, on the
                other hand, I don't want to take the negative fatalistic viewpoint that seems
                to be the stock-and-trade of veterinary cardiologists. I often wonder if,
                in some cases, that's their way of generating more echo business ($450.00 a
                pop in my area).


                What is one to believe?

                Dick

                [Non-text portions of this message have been removed]




                [Non-text portions of this message have been removed]
              • Westgold
                Yes, this is the very sad reality. This horrible disease manifests itself differently in each cat. What works for one will not work for another. And even
                Message 7 of 13 , Feb 2, 2012
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                  Yes, this is the very sad reality. This horrible disease manifests itself differently in each cat. What works for one will not work for another. And even those with mild HCM can drop dead without warning. All we can do here is support each other and share our experiences. Every little thing we learn from someone else might come in very handy someday. All we can do is the best we can do. We know you did everything you possibly could for Eli, unfortunately some of them just are not meant to live very long. When I lost my first kitty to HCM at 18 months, someone comforted me with the thought that she was just so wonderful and so beautiful, God just couldn't wait any longer to get her back in His arms. But He has let me have Tigger for over 7 years now, what a blessing!

                  I have mentioned this before on this list -- I think we all need to be prepared for anything that might happen, as this disease can turn on a dime. Keep your carrier right by the door. Have the address and directions to the nearest ER instantly available, and the phone numbers to your own vet and cardiologist, and their hours. Above all, plan ahead. Know how far you will go. Sometimes saving them with heroic efforts is not the right thing, if they will live in pain or continue to have breathing problems, etc. There is a point at which you must be prepared to say "enough". Think about it ahead of time, as you will not be thinking straight once something happens.

                  take care -- Michelle & Tigger Too in Toronto
                  ----- Original Message -----
                  From: Toby Jones
                  To: nyppsi@... ; feline-heart@yahoogroups.com
                  Sent: Thursday, February 02, 2012 5:23 PM
                  Subject: Re: [FH] Prognosis For HCM/RCM



                  I have heard, infrequently, of terminally ill cancer patients given months to live, having their cancer disappear and be healed. Much more frequently, I have heard of people succumbing and dying from (terminal) cancer. Could a cat have a miraculous recovery? Maybe. Do the vast vast vast majority die from HCM at some point? Research I have read would say yes.

                  Being in a science field myself, I would assume that echocardiographs have a standard error of measurement (as with every other scientific tool); i.e. two different cardiologists (or even the same cardiologist) could give different readings on a cat, even if there are no real changes.

                  I can tell you from my experience that there was nothing that we didn't try for Eli, and yet he still died at only five years of age despite years of medical treatment and weeks at a time of 24/7 vet tech supervision. That is my reality. I hoped against hopes, as I would assume everyone does when faced with this condition, but in the end, it did not save him.

                  ________________________________
                  From: "nyppsi@..." <nyppsi@...>
                  To: feline-heart@yahoogroups.com
                  Cc: nyppsi@...
                  Sent: Thursday, February 2, 2012 10:37 AM
                  Subject: [FH] Prognosis For HCM/RCM



                  While it is commonly preached & accepted that HCM is not a reversible or
                  curable affliction, I repeatedly read posts indicating that echocardiograms
                  have, in some cases, shown reductions in the thickness of atrium walls
                  after a period of medication and reduction or elimination of valve leakage.

                  Cardiologists always seem to tend to take the "worst case" approach,
                  conceding only that medications may slow the progress of the condition, but not
                  reverse it. I personally have seen what appears to be clear
                  echocardiographic evidence that medications (enalapril) have resulted in visible
                  improvement of Jesse's condition (HCM/RCM).

                  I'm very confused.

                  I don't want to view the issue through rose colored glasses, but, on the
                  other hand, I don't want to take the negative fatalistic viewpoint that seems
                  to be the stock-and-trade of veterinary cardiologists. I often wonder if,
                  in some cases, that's their way of generating more echo business ($450.00 a
                  pop in my area).

                  What is one to believe?

                  Dick

                  [Non-text portions of this message have been removed]

                  [Non-text portions of this message have been removed]





                  [Non-text portions of this message have been removed]
                • acrocat@rocketmail.com
                  Hi Jim ... End-stage HCM is recognized on echocardiogram by the decrease in heart function and the decrease in movement of the walls, and thickness. It s as
                  Message 8 of 13 , Feb 2, 2012
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                    Hi Jim

                    Just addressing a few things in your post:

                    --- In feline-heart@yahoogroups.com, Jim Sinclair <jisincla@...> wrote:
                    > Again, I have not studied this at all and what I have to say is mere
                    > speculation of a layperson: It seems that wall thickness alone is not
                    > the whole story, in that thickness can decrease even as disease
                    > progresses?

                    End-stage HCM is recognized on echocardiogram by the decrease in heart function and the decrease in movement of the walls, and thickness. It's as if the heart begins to scar down, although that's not exactly what happens. These hearts can resemble HCM hearts, in that the walls measure normal but the heart function is bad.


                    > Before Clipsy died, I was wondering what the purpose was of repeat
                    > echocardiograms. She was still alive six months after the prediction
                    > of her imminent death, she was *not* suffering from difficulty
                    > breathing or any other apparent distress, she was enjoying a good
                    > quality of life--what would the echocardiogram tell us that we didn't
                    > already know? We knew she had HCM, and we knew what medications and
                    > supplements she was taking,

                    I would do echocardiograms repeatedly for my own cat. I would want to know, for example, if the heart started to get this "scarred down" appearance. I would want to know if his heart function was declining, if the pressure in his atrium indicated that a heart failure relapse was imminent, if there was "smoke" in the atrium, if there was a big ugly clot stuck in the atrium (I might euthanize in that case, personally, rather than wring my hands at home waiting for that thing to leave the heart), etc.

                    You can also add on meds in some cases, depending on what you see.

                    If your cat chooses the 'pleural effusion' (rather than edema) form of CHF, you can see if he's building up more effusion, too.

                    If the disease looks end stage, there may not be much to do. If money is an issue, cats can certainly be managed "remotely" based on symptoms, but more info can always help you plan for the disease and perhaps add or change meds.
                  • joanne marbut
                    If the cat has a bacterial infection not related to the heart disease, then yes, the cat can be on antibiotics such as if it had a UTI or a skin infection, a
                    Message 9 of 13 , Feb 2, 2012
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                      If the cat has a bacterial infection not related to the heart disease, then yes, the cat can be on antibiotics such as if it had a UTI or a skin infection, a cut, etc.  But I haven't heard of antibiotics being prescribed for HCM specifically. 

                      [Non-text portions of this message have been removed]
                    • acrocat@rocketmail.com
                      Hi Dick I would love it if there were a drug out there to improve or eliminate HCM in cats. Everyone would. HCM comes with a grave prognosis in humans as
                      Message 10 of 13 , Feb 2, 2012
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                        Hi Dick

                        I would love it if there were a drug out there to improve or eliminate
                        HCM in cats. Everyone would. HCM comes with a grave prognosis in
                        humans as well, so a drug to cure or lessen the severity of HCM would
                        have a huge market.

                        There are two maxims in science which apply to your statement:

                        >I personally have seen what appears to be clear
                        > echocardiographic evidence that medications (enalapril) have resulted
                        in visible
                        > improvement of Jesse's condition (HCM/RCM).

                        The first is:
                        The plural of "anecdote" is not "data." :) That's self-explanatory.

                        The other is, association is not causation. This means that if you eat
                        a banana and then puke, it does not mean that bananas are toxic or that
                        they cause vomiting when ingested by humans. You ate one, and then got
                        sick, but it does not mean that the banana made you sick. Another
                        example would be if you started an exercise program and then had patches
                        of itchy skin on your torso. This does not mean that exercise causes
                        rashes in humans. (It probably means you're irritated by whatever type
                        of fabric you're wearing, or the soap you use for exercise clothes,
                        etc.) Association (bananas and stomach upset, and exercise and rashes)
                        is not causation.

                        So, starting enalapril and seeing a change in echo dimensions does not
                        mean that enalapril cures or mitigates HCM. There are hundreds of
                        thousands of animals and millions and millions of people on enalapril
                        who have not had any cardiac benefits from enalapril. We'd expect this,
                        as it has no direct action on the heart.


                        --- In feline-heart@yahoogroups.com, nyppsi@... wrote:
                        > While it is commonly preached & accepted that HCM is not a reversible
                        or
                        > curable affliction, I repeatedly read posts indicating that
                        echocardiograms
                        > have, in some cases, shown reductions in the thickness of atrium
                        walls
                        > after a period of medication and reduction or elimination of valve
                        leakage.

                        You've also probably read more posts in which someone said their cat had
                        CHF, or a saddle thrombus, or passed away, I'd bet. Many of these cats
                        were on the same meds and supplements--what about them?

                        I'd also note that wall thickness can change with the disease; it is
                        heart function (specifically diastolic--the relaxation--function) that
                        you'd monitor. As I described in a recent post, some cats lose
                        thickness as the disease progresses. It's also possible for the walls
                        to get thicker or thinner for reasons that are entirely and completely
                        mysterious. A cat can be diagnosed with bad HCM and then "plateau" for
                        months or years. Other cats crash within weeks or months. HCM does
                        what it wants--no one can pull it off of whatever track it's on, and
                        believe me people have tried their absolute best.

                        As for valve leakage, I assume you still mean cats. In cats with the
                        obstructive form of HCM (called HOCM, or HCM with SAM), lowering the
                        heart rate can lower the obstruction i.e. the valve is less "leaky."
                        This is because the leakage is more prominent when the heart rate is
                        higher, not because they've been cured by a heart-rate-lowering drug.
                        Of course, if their HCM regresses (again, for reasons that are unclear),
                        the obstruction can lessen as well.

                        > Cardiologists always seem to tend to take the "worst case" approach,
                        > conceding only that medications may slow the progress of the
                        condition, but not
                        > reverse it.

                        Again, humans with HCM have the full force of a pharmaceutical industry
                        which would find a cure for HCM incredibly lucrative behind them, and
                        they aren't getting cured. I'm sorry, there is no medication to reverse
                        HCM. There just isn't.

                        > I don't want to take the negative fatalistic viewpoint that seems
                        > to be the stock-and-trade of veterinary cardiologists. I often wonder
                        if,
                        > in some cases, that's their way of generating more echo business
                        ($450.00 a
                        > pop in my area).

                        I'm glad you don't want to take the view that cardiologists are
                        withholding lifesaving medications for HCM cats out of greed. That
                        would be an unfair and incredibly cynical view.

                        Adriann



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                      • ERIC LEE
                        I am sorry. I worked 12 hours yesterday so I didnt type so well. He ha an upper repiratory so thats why I asked my vet for antibiotics. I am just being very
                        Message 11 of 13 , Feb 3, 2012
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                          I am sorry. I worked 12 hours yesterday so I didnt type so well. He ha an upper repiratory so thats why I asked my vet for antibiotics. I am just being very cautious and worrysome
                           
                           
                          Thank you for all of your replies!!!

                          [Non-text portions of this message have been removed]
                        • acrocat@rocketmail.com
                          Most URIs are caused by viruses and not bacteria, so antibiotics won t help. If he has yellow snotty stuff, then antibiotics would help.
                          Message 12 of 13 , Feb 3, 2012
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                            Most URIs are caused by viruses and not bacteria, so antibiotics won't help. If he has yellow snotty stuff, then antibiotics would help.
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