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Re: [FH] Prognosis For HCM/RCM

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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 1 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

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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 2 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 3 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 4 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 5 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 6 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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