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Re: [FH] Re: Prognosis For HCM/RCM

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  • Toby Jones
    This mirrors my experience.  Very true. ________________________________ From: joanne marbut To: feline-heart@yahoogroups.com
    Message 1 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.

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    • 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 2 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

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      • 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 3 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]





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        • 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 4 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 5 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. 

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            • 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 6 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 7 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!!!

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                • 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 8 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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