NEW ECHO or HEMOPET PANEL? WHICH FIRST?
- Hello !
Sorry this is going to be so long - just feel like I need to present it all.
Still here trying to get clearer on the next BEST STEP for Lahri: Thyroid Panel (T4 = 2.8) or Cardiologist Visit (though I have a recent echo eval in hand). Many of you may remember all of this. I apologize for repetition. I tried putting this out there piecemeal, but that didn't work well. Soo, even though some of this has been out there in different forms, I'm putting out the whole picture to see is anything else comes of it. Getting perspective has been very challenging for me, still overwhelmed by many big challenges in the last month. I'm also having difficulty in managing relevant information and well-intentioned comments. My hope is that someone can simply see through this `jungle' of information and confusion complicated lack of confidence in my vets and concern over finances. (Though I have worked with FOUR local vets in the last month, I do not trust even one of them to make decisions about Lahri. Good people, I'm sure, but competency. . . concerns me deeply.)
BRIEF LITTER HISTORY
14 yr. old Lahri lost a brother to HCM and renal disease in `08
I put a sister into her final sleep 12/5/12 under the advice of three vets, one saying her pleural effusion was due to heart disease, the other saying cancer, and the third saying, due to pain, "It is time."
Another sister was diagnosed with CRD 12/23/12.
Diagnosed with mild to moderate HCM 9/08
Diagnosed with Hyperthroidism 3/09
Methimazole treatment quickly cleared evidence of HCM (cardiologist saying repeated in echo: "There's nothing there."
Cardiologist saw Lahri several times until June 2010, noting no change in his condition.
(For financial reasons, we have not returned to the cardiologist - five hours away)
12/27/12 Lahri was echoed at a local veterinary clinic, a new offering in this semi-rural area, but I was not informed the echo would be evaluated by a veterinarian simply certified in sonography.
I do not feel I can trust the evaluation.
After the death of their beloved sister 12/5, brother and sister experienced strenuous bouts of URI, probably the herpes virus, and both are only just now returning to stability. Lahri's recovery was interrupted three days ago when the perimeter of one of his eyes as well as the inner eyelid became red and swollen - Doxycycline seems to be helping quickly.
Though I've not paid great attention to Lahri's breathing rate (BR) in years, I have been doing so since his sister's death. There have been times lately when I've noticed his BR go to 40, 44, and twice even 48 (which I'd never see before) - and while lying down - NOT asleep but lying down.. Granted, I only counted 15 seconds and multiplied by 4, and with him, that does not always compute accurately. Also, L's cardiologist told me years ago he is simply a "fast breather." Due to rates in the 40's, she herself was surprised to discover nothing in the echos that confirmed a related problem. Admittedly, I am still experiencing a lot of anxiety related to his sister's recent death, and reading of so many group members reaching for lasix when their kitty's BR is only in the 30's also gives me pause, despite what I know about Lahri..
SO . . . finally to what looks like the question to ask. Am I wise or foolish to have a thyroid panel done before going to the cardiologist? Were finances not the problem they are, I would have done both by now. I have actually had a couple emails with Dr. Dodds and know Lahri can have the panel done two weeks after all the URI has passed. It is my hope the panel will show his methimazole dosage needs a little tweaking and that doing so will slow some of the BR's I'm seeing and allay my anxiety that something COULD be amiss with his heart. Winning 2-3 months to work on the financial side would be a great gift.
That said, I will add two more pieces for consideration. The veterinarian-sonographer the following in his "General Assessment, Diagnosis, & Therapeutic Recommendations. FOR WHATEVER IT MAY BE WORTH (???) "This is likely a toxic cardiomyopathy. The ventricular septum and free wall values are not necessarily reflective OF the pathology in this patient given the regional hypertrophy. Areas of echogenic changes in the myocardium were noted. This is suggestive of remodeling. Given that the T4 is normal in this patient assessment for systemic hypertension would be warranted. If persistent tachycardia is present and greater than 200 bmy at rest then Atenolol therapy should be considered. Recheck is recommended in 6 months.
Lahri had a BP test a couple weeks ago and despite being freaked, the systolic began at 150 and went to 200. The vet said, "Of course, he was scared" and just said to take the average if I wanted a number: 175. Considering how skittish Lahri is and terrified of even getting into a cat carrier, I'm not concerned about high BP in him. (Should I be?)
Finally, after seeing that 48 the other night, I decided to note L's BR (with some HR's) all day. yesterday. This is what I got.
6:15 a.m. BR 32
6:30 Methimazole 1.25mg
7:00 - 8:00 BR 24-28, 36, 32
9:45 BR 28
10:45 BR 24-26
11:45 BR 32
1:00 pm BR 24 (asleep)
1:45 BR 28-32 HR: 124
3:00 BR 28 HR: 144 (noted: movement of chest very obvious, deep breathing?)
3:20 BR 35 (more alert)
5:00 BR 38 (very alert) HR 132
7:45 BR 26
8:45 BR 28 (alert)
(I stopped trying to the HR's because I have to wait SO LONG for his purring to stop and the numbers are always so good.)
OK - I canNOT see the forest for the trees here. If there's anyone out there who can, I'll very much appreciate whatever you have to say. (Oh, I do not need to hear "Lahri's worth" paying for another echo.)
THANKS SO MUCH . . . and I'm sure this is going to try the patience of some of you. I just cannot wrap my mind around all of this.
mb and lahri
PS For anyone still reading, here are his recent chemistry (12/28/12) values.
ALK. PHOSPHATASE 47 (0-62)
ALT (SGPT) 71 (28-100)
AST (SGOT) 51 (5-55)
CK 675 (64-440) DVM said due to lying down so much during herpes flare-up
GGT 3 (0-6)
ALBUMIN 3.2 (2.3-3.9)
TOTAL PROTEIN 7 (5.9-8.5)
GLOBULIN 3.8 (3.0-5.6)
TOTAL BILIRUBIN 0.1 (0.0-0.4)
DIRECT BILIRUBIN O.1 (0.0-0.2)
BUN 19 (15-34)
CREATININE 1.0 (0.8-2.3)
CHOLESTEROL 162 (82-218)
GLUCOSE 103 (70-150)
CALCIUM 10.1 (8.2-11.8)
PHOSPHORUS 6.0 (3.0-7.0)
TC02 (BICARBONATE) 17 (13-25)
CHLORIDE 115 (111-125)
POTASSIUM 4.5 (3.9-5.3)
SODIUM 151 (147-156)
A/G RATIO 0.8 (0.4-0.8)
B/C RATIO 19.0 (
INDIRECT BILIRUBIN 0.0 (0-0.3)
NA/K RATIO 34
HEMOLYSIS INDEX +++
(Indwex of +++ may decrease ALP by 25-50% and increase AST by 25-50%
LIPEMIA INDEX N
(Index of N, +, ++ exhibilts no significant effect on chemistry values.
ANION GAP 24 (13-27) mEq/L units
T3 (12/18/12) 2.8 (0.8-4.7)
BP: Ave 175 (12/31/12) w/t me to calm him. Tech said started at 150, eventually went to 200. DVM said "take ave
- hi Marybeth,
If it was my kitty, I'd do the Hemopet thyroid panel first. If you're seeing elevated respiration and heart rate it could be from his hyperthyroid, could be hypertension or could be from his recovering from URI and the recent eye problem (possibly pain or discomfort can cause breathing and heart rate to go up). Elevated blood pressure can cause the tachycardia (rapid heart rate), but when you take his heart rate while he's sleeping or at rest and NOT at the vet, his heart rate is good. Anything between about 130 and 150 in considered normal. Our Misty has unidentified rapid heart rate and hers usually is between 160 and 200...more often in the upper end. They've never been able to figure out why, since she's on both Methimazole for hyperthyroid and Amlodipine for high blood pressure. If you do the Hemopet thyroid panel, it need to be done within 4 to 6 hours after you give him his thyroid meds. We always get the full panel done. (Thyroid Profile 5™ PLUS (T4, free T4, T3, free T3, TgAA - PLUS CBC, Differential, Chemistries)
You can get the panel info at the Hemopet site: http://hemopet.org/ Click on the Hemolife button at the top of the page to get to the order form, Sample Instructions, and Sending a Sample info. I always order the test myself. The vet does the sample prep, charges me a minimal draw fee, usually $30, then I send in the payment with the forms to Hemopet myself (fed ex). You must include an ice pack in the shipment....all the info is on the Sample Instuctions page. The full panel #5 is $135 plus whatever your vet charges you for the draw/prep an then the shipping. Still cheaper than the full panel done by the vet, which I have paid over $240 at times.
Lahri's breathing isn't too bad from what you documented here today... 16 to about 24 while SLEEPING is normal, 28 to 32 is acceptable while sleeping or resting. When it gets above 32 to 36-38, if they're moving around, I wouldn't be too concerned about. BUT... up in the 40's I would be concerned about. IF it's up in that range while resting or sleeping, to me that could alert me to something heart or hyperthyroid related. Hyperthyroid makes everything work harder and faster.
If he keeps having decent breaths per minute (anything below 32) while sleeping or resting, those would be acceptable numbers. If it's higher than that, I would consider checking the thyroid. If he was in congestive heart failure/CHF, they'd be MUCH HIGHER than that...in my experience with my heart kitties. In that case, if it's really high, get to the vet for a chest xray to see if there is fluid in the lungs, then giving diuretics would be in order (Lasix, Spironolactone, etc.), or they might draw the fluid out with a needle if it's a lot.
His bloodwork looks really good. His T4 on this regular panel is 2.8, which is mid range and normal, but when my guys have been anything above 2.0, I always get a Free T4 done just to make sure of the results. Often the regular panel isn't accurate. At least it hasn't been with our guys. I always use Dr. Dodds/Hemopet, because they run a full panel, not just one or two things. They so the T3, T4, Free T3 and Free T4, which all of those tests give the whole picture as to what's going on with the thyroid. Just a T4 isn't conclusive of what might be going on. That's just been my experience. Misty will have a normal in range T4 on a regular panel, then we run a Free T4 and it's elevated or too low, then we need to tweak her meds.
Now the elevated blood pressure reading... they are ALWAYS higher at the vet's office, so you can't really have an accurate BP reading at the vet's office. I would, if you can afford it, have a housecall vet come to take his BP once to get a calm, resting baseline to go by. I actually went and bought my own doppler BP unit, so I take Misty's BP myself whenever I need to. Her BP is always less at home that at the vets. The vet will do it and it's up to 200, I take it at home with her resting or sleeping (sometimes she doesn't care and stays asleep when I put the cuff on) and it will be 135. Huge difference from the 200 at the vet.
Before you start any BP meds, I would try to get a reading done at home just to be sure.
I'm sorry you don't have that trust in you vets. I have the same problems here. Tons of vets, not a lot of faith in them. It's sad. Most of the time, I'm really on my own with what I need to do with my guys, and if it wasn't for the sharing info on this group and other groups, I'd be totally in the dark.
I hope any of this helps.
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