Re: Nattokinase questions - esp from users
My 7 year old mixed Maine Coon, Moe, has started back on Lovenox for the second time. He has been on it now for 2 weeks and seems to be handling it well (this time). The first week he was on it we did a morning and evening injection of 7 units under the skin (the bottle says enoxaparin 10mg/0.1 ml/#30 0.1 ml). We started the injections on a Sunday when we were home and could watch him. Monday morning we took him in to have a blood test (according to our invoice it is a PCV + Total Solids STAT) to see if there were any abnormal values. The blood test is relatively inexpensive (~ $37) and we do it with a "nurse only" appointment so avoid the normally high costs of his progress evaluations and tests done with the cardiologist. We did another PCV blood test on Wednesday morning in addition to an ultrasound to see if the Lovenox was working. The blood tests revealed normal values and fortunately, the smoke seems to be better and the clot that was forming is now gone. Looks like Lovenox is working for Moe will he be on Lovenox for the remainder of his life. We will do another full blown follow-up evaluation again in about a week or so. The cardiologist is being EXTREMELY conservative this time for some very specific reasons (which you will see below). In addition to the Lovenox, Moe ges porassium gluconate 3 times daily ( 2 mEQ tablets - 1 1/2 pills morning and evening, 1 pill mid afternoon). He also gets Atenolol (25 mg tablets - 1/4 tablet every 12 hours) and furosemide (12.5 mg tables - 1 tablet - morning, midday, and evening). He is not on Plavix or aspirin (this time) and I honestly don't know if the cardiologist will eventually add back Plavix at some point down the road. I will ask her on Moe's next follow-up.
Our first experience trying Lovenox back in mid February was not so great. Prior to going on Lovenox for the first time, Moe was on approximately the same does of potassium gluconate, furosemide, and atenolol as listed above. In addition, he was getting 1/4 tablet of Plavix (75 mg tablets) every 24 hours, and 1/4 tablet of baby aspirin once a day (Mondays, Wednesday, and Fridays only). Based on his ultrasounds and increasing smoke, the cardiologist decided to add Lovenox to his regimen too. I was concerned because Plavix, aspirin, and Lovenox are all blood thinners but I kept my mouth shut deferring to greater experience.
We started the first doses of Lovenox on the weekend and stayed home to watch how he was doing. He was getting a morning shot and evening shot (same dose as above) only. The first day we didn't notice anything dramatic but did note that Moe seemed to be "ground bound" not wanting to climb up or down on anything. He seemed very quiet and often had a faraway look in his eyes - almost as if he was concentrating intently on something. He seemed lethargic. He did not want to eat and stopped drinking.
By the second day (his third shot given in the morning) he seemed even more lethargic. We gave the fourth shot in the evening before going to bed. In the middle of the night, he started to "dry retch", fell over onto his nose, and was as limp as a rag. We grabbed him and headed to the emergency clinic.
Good thing we did has his blood values had plummeted (full blood test taken before starting Lovenox was totally normal) and Moe was given an emergency blood transfusion and kept in the hospital for 3 days on fluids, etc. Fortunately, Moe was not in congestive heart failure at the time as the furosemide he was taking had emptied his lungs of fluid and his not drinking had made him dehydrated so they were able to slowly add back fluids into his system. The veterinarians said that he would have died had we not brought him in and it was miraculous that he made it even with the blood transfusion because his blood values had plummeted so low. Moe had bled internally in his stomach and the veterinarians gave us no reason as to what triggered the bleeding but I can't help believe it was the cumulative effect of all three thinners given at the same time (aspirin, Lovenox, Plavix). His full panel blood test taken immediately before adding the Lovenox was totally NORMAL.
I'm not sure what happened here. Maybe the cardiologist forgot he was on a triple dose of blood thinners and didn't look back in the file to double check? Maybe Moe's experience was different than all kitties treated in a similar scenario before? Maybe this was the first time a cat was treated there with all 3 meds/doses? We didn't blame the cardiologist and forged ahead. However, we almost lost the beautiful kitty we so dearly love and put him through a hospital stay that was pretty stressful and expensive ($3500). I now make sure during EVERY follow-up visit that the cardiologist READS the list of medicines Moe has been prescribed and is currently on at the time of the vet visit. I insist on written instructions for every med change and we go over it together before I leave the hospital.
Our total vet costs for Moe since January of this year have been $10,000 plus (includes tests, meds, vet consults). We don't regret a penny on this beautiful cat but it has been frustrating that the treatment protocols for HCM seem to be hit and miss. There's not much out there in terms of double blind tests and studies on cats to determine what works best for what set of conditions. I guess every animal is different. Our cardiologist indicated it is difficult to get funding for the studies and many people elect not to invest the money in the testing/treatment of "a cat."
Moe was started back on Lovenox just recently because it appeared the combination of Plavix and aspirin alone weren't working for him to reduce the turbulence and clotting factor. He needed something and we really didn't have any options. NOTE: Before we started Lovenox for the second time, we took him OFF both Plavix and aspirin and put him on sucralfate (100 mg/ml - give 2.5 mls every 8 hours) and omeprazole (20 mg capsules - 1 capsule every 24 hours) for 2 weeks prior to starting the second round of Lovenox. This was to heal any ulcers that may have caused the internal bleeding. He is still currently taking the omeprazole and sulcrafate until the bottles are empty.
I would highly recommend checking your kitties blood a day or so at the most after you start the Lovenox to see if he's doing well. Hind sight is 20-20 and if I had it to do all over again..... A low cost blood test could save you a $3500 hospital stay. It would be worth a discussion with your vet.
Moe seems to be doing quite well now but we are taking it day by day and testing, testing, periodically. Ask lots of questions. Hope this helps. Feel free to email with any additional questions.
On May 1, 2012, at 1:36 PM, olsoncleaning@... wrote:
> My 4yr old boy was diagnosed about a year ago with severe HCM. They put him on atenolol and plavix. They saw clots and the turbulence in this left chamber. On his second echo, the clots and the turbulence were gone. On his third echo, they still don't see any turbulence but do see a clot adhering to the lining of his heart. So, now they're going to put him on lovenox. His HCM has not really progressed, just a slight thickening of the wall, which the cardiologist says is a good thing. The only other thing that's going on with my boy is that he's had diahrrea for several months. My vet is just starting to work on solving that, but I'm a bit concerned that the Plavix might be causing it. I've read that Plavix can cause stomach issues on humans, so you can only imagine what's happening to my little eight pound boy.
> --- In email@example.com, Mary McKee <marylmckee@...> wrote:
>> Since there are no documented studies that have revealed any results yet on Plavix, I, too, would like ttotao hear from any forum members who have a cat on Plavix that was diagnosed via ultrasound/ echocardiogram with "smoke" and if the Plavix seems working for you to reduce the "smoke" or prevent clots. For example, " no clots for 2 years, no noticeable help at all, vets says can't see smoke or clots any more?" I know every animal is individual but sometimes vets don't do a great job of conveying their field experience with these treatment protocols and there isn't much written info out there yet.
>> For the forum members who don't know what "smoke" is, it is the "swirling" that is seen on an echocardiogram by the veterinarian. Apparently as the left atrium of the heart enlarges as the disease progresses, there in increasing risk of turbulence and arterial thrombosis with the increasing heart size. My vet calls it "sticky blood."
>> Here is a good article I found describing the various drugs prescribed by veterinarians to inhibit "the coagulation cascade or platelets" which can lead to feline aortic thromboembolism:
>> Another good article on HCM in general - http://www.newmanveterinary.com/felhcm.html