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Introducing Daisy - Heart Disease ... ??

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  • June Jeffrey
    Dear Group, My baby Daisy is 19 and has quite a few things going on at present.  For background, she was diagnosed with early cronic renal failure in May
    Message 1 of 6 , Mar 4, 2013
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      Dear Group,


      My baby Daisy is 19 and has quite a few things going on at present.  For background, she was diagnosed with early cronic renal failure in May 2012.  Being managed with renal diet - Royal Canin feline S/O pouches - and since starting these renal values have improved.

      She started having cluster seizures in August 2011 and after tests failed to determine a cause, she was diagnosed as having ideopathic epilepsy.  Epiphen (phenobarbital) was prescribed and brought the seizures under control apart from two breakthrough seizures in November 2012.  It was thought a stressful blood draw contributed to this happening and as the blood test showed the pheno serum concentration was under the theraputic level the pheno dose was slightly increased and is now withing theraputic range.

      On 18th December she started having breathing difficulties which resulted in four vet visits within next three days.   In brief, the first and second visits failed to identify a cause or suitable treatment and by third visit breathing was much worse.  Vet was reluctant to do exray as she felt Daisy would not survive sedation due to seizure possibility and breathing issues and suspected the problem could be a tumour in the lungs/pulminary fibrosis or heart issue but more likely the first two.  On that basis was offered treatment as though it were a tumour/fibrosis (steroid to maximise what lung capacity there was to hopefully improve breathing) or try for exray which might or might not show what the problem was.  Was told not doing anything was not an option so opted for the steroid treatment.  This was a long acting (four week) injection and was told it would take up to four days to start working.  This did bring her respiratory rate down
      after several days.  Vet still felt Daisy would not survive sedation for exray or ultrasound and said prognosis for either tumour or heart problems not good anyway - gave Daisy anything from three days to three months maximim.  I asked about anaemia as PCV had been below normal range in blood tests taken in August 2011 and May 2012 but was told red blood cells were normal so not felt to be a problem.  Asked about giving oral B complex and B12 (Methylcobalamin) supplements but was told oral supplements do not work so would need B12 injections (am in UK so understand only Cyanocobalamin available for injection here).  Also told treatment with ESA's difficult.  Daisy has now started trying to eat cat litter which I understood to be a symptom of anaemia.

      By middle of January, Daisy seemed to be doing better so asked vet to do a full CBC with T4, Folate and Vitamin B12 tests.  Result came back as Daisy having borderline non-regenerative anaemia most likely due to cronic disease -
      PCV 0.270 (0.30 - 0.44),
      Red Blood Cells 5.75 (5.0 - 10.0),
      White Blood Cells 8.3 (5.0 - 18.0),
      Platelets 42 Low (180 - 550) - reason given as sample showed clot) - Lab report stated appeared to be thrombocytopaenia but clumping made this difficult to evaluate. 
      Folate result was high - >24.0  ng/ml  (9.7 - 21.6). 
      Vitamin B12 result was 318.0 pg/ml  (290 - 1500). 
      Was told as B12 in range treatment not needed. 
      No explanation of high Folate but have done some research and understand this can indicate small intestinal bacterial overgrowth. 

      Crea had improved from previous test, no other major significant biochemical abnormalities.  

      Four days after blood test breathing went up again after first steroid injection wore off, so a second steroid injection was offered pending making "difficult" decision.  Four days later noticed Daisy had swollen abodmen and suspected ascities.  Took her to vet as an emergency.  Ascities confirmed and furosemide injection given, with tablets - 0.5mg x 2 daily for four days following on (again pending making "difficult" decision).  Breathing improved dramatically over next couple of days reducing from 40RRR pm to 24-28RRR pm.  Daisy weighed 6lb 10ozs when I took her in with ascities on 24th January and 5lb 12 ozs 3 days later on 27th January after loosing fluid.  Her weight was 5lbs 15ozs on 14th December 2012.  On speaking to vet after the four days and reporting the significant improvement in breathing with the furosemide was given a month's supply.  Weight since 27th January has varied from 5lb 11ozs to 5lb 15ozs. 

      Due to the improvement it appears was made by the furosemide am now wondering if this is a heart issue rather than tumour.  Understand that one cause of ascities is right sided heart failure and am wondering if any other heart medication would help her.  I appreciate the problem is lack of a positive diagnosis.  Vet would need to refer to another practise for an ultrasound and the issue of sedation arises again and whether she would survive this. 

      I wondered if any other listmembers had been in a similar situation?

      Also wondered if anyone has any experience of:
      1)  right sided hear failure?
      2)  ascities and if so what were the causes?

      Additionally, could anyone advise what other heart medications might help Daisy with or without a definate diagnosis?
      Would any heart supplements help - e.g. Coenzyme Q-10?

      Vet mentioned that an echocardiogram would cost around £600.  Wondered if any UK members who have had this procedure for their cat could advise on cost and if sedation was needed?

      Also wondered if any list members have any experience of high Folate in blood test results and if so were they advised what had caused the high Folate, or does anyone have any more information about reasons for high Folate?

      Sorry for the length of this post but felt some background information about Daisy's issues would be useful as part of the overall picture.

      Many thanks in advance for any suggestions/information that can be provided.

      Best wishes,

      June and Daisy.

      [Non-text portions of this message have been removed]
    • June Jeffrey
      Dear Group,   My baby Daisy was 20 in April and I joined the group in March as she had at that time a suspected heart condition.   She already had a number
      Message 2 of 6 , Jul 22 6:56 AM
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        Dear Group,
         
        My baby Daisy was 20 in April and I joined the group in March as she had at that time a suspected heart condition.
         
        She already had a number of health issues; for background, she was diagnosed with early cronic renal failure in May 2012, which is being managed with renal diet - Royal Canin feline S/O pouches - and since starting these renal values have improved.  She previously started having cluster seizures in August 2011 and after tests failed to determine a cause, she was diagnosed as having ideopathic epilepsy.  Epiphen (phenobarbital) was prescribed and brought the seizures under control apart from two breakthrough seizures in November 2012.  It was thought a stressful blood draw contributed to this happening and as the blood test showed the pheno serum concentration was under the theraputic level the pheno dose was slightly increased and is now withing theraputic range.
         
        On 18th December she started having breathing difficulties which resulted in four vet visits within next three days.   In brief, the first and second visits failed to identify a cause or suitable treatment and by third visit breathing was much worse.  Vet was reluctant to do exray as she felt Daisy would not survive sedation due to seizure possibility and breathing issues and suspected the problem could be a tumour in the lungs/pulminary fibrosis or heart issue but more likely the first two.  On that basis was offered treatment as though it were a tumour/fibrosis (steroid to maximise what lung capacity there was to hopefully improve breathing) or try for exray which might or might not show what the problem was.  Was told not doing anything was not an option so opted for the steroid treatment.  This was a long acting (four week) injection and was told it would take up to four days to start working.  This did bring her respiratory rate down
        after several days.  Vet still felt Daisy would not survive sedation for exray or ultrasound and said prognosis for either tumour or heart problems not good anyway - gave Daisy anything from three days to three months maximum.
         
        By middle of January, Daisy seemed to be doing better so asked vet to do a full CBC with T4, Folate and Vitamin B12 tests.  Result came back as Daisy having borderline non-regenerative anaemia most likely due to cronic disease.  Anaemia is now being treated with vitamin B12 injections monthly.
         
        Four days after blood test breathing went up again after first steroid injection wore off, so a second steroid injection was offered pending making "difficult" decision.  Four days later noticed Daisy had swollen abodmen and suspected ascities.  Took her to vet as an emergency.  Ascities confirmed and furosemide injection given, with tablets - 5mg x 2 daily for four days following on (again pending making "difficult" decision).  Breathing improved dramatically over next couple of days reducing from 40RRR pm to 24-28RRR pm.  Daisy weighed 6lb 10ozs when I took her in with ascities on 24th January and 5lb 12 ozs 3 days later on 27th January after loosing fluid.  Her weight was 5lbs 15ozs on 14th December 2012.  On speaking to vet after the four days and reporting the significant improvement in breathing with the furosemide was given a month's supply.  Weight stabilised between 5lb 12ozs to 5lb 15ozs until early March when ascities started to
        build up again.  Vet did not want to increase furosemide and decided to add 3.125mg (1/8 sid)of Co-Amilozid (Moduretic 25) once a day as this works on a different pathway to furosemide and is also potassium saving.  This successfully reversed the fluid build up and weight went back to around 5lb 15 ozs and remained stable.  
         
        Due to the continued improvement vet agreed to refer Daisy to a cardiologist for an echocardiogram.  Report as follows:
         
        "Very mild mitral
        and tricuspid regurgitation but no evidence of atrial dilation at that time. Left
        ventricular walls were of normal thickness except for a substantial segment of
        the free wall (at papillary muscle level) which appeared atrophic and was
        hypomotile. Systolic parameters of left ventricular function were reduced. FS
        averaged 20%. Left ventricular chamber dimensions at diastole were normal (16
        mm RPLA view) with mildly increased systolic dimensions (11.5 mm).
        The right heart appeared
        normal. Aortic and pulmonic outflow velocities were low normal.  Ascites was absent but the
        hepatic veins were moderately dilated.  Normal sinus rhythm was
        present throughout.
        There is evidence of
        myocardial infarction involving the left ventricle - an uncommon finding but one
        which  is more common in older cats. This
        has likely lead to reduced left ventricular systolic function. It would be rare
        for this to lead to ascites but presumably this was the case here. The
        prognosis is guarded particularly if repeat bouts of infarction occur. Some
        affected cats may stabilise quite well for some time however if this does not
        recur. 
         
        As the ascites is currently
        controlled I have not altered medications today. I said that it may be possible
        to reduce the Moduretic to alternate
        day therapy for now. However as you already mentioned, the dose may
        also be increased to bid therapy in the future if necessary.   
         
        If the response to medication becomes poor we
        can try the addition of pimobendan
        bid- please phone to discuss if necessary."
         
        Daisy started to suffer fluid build up again in the abdomen again at the beginning of June.  My vet increased the Co-Amilozide (Moduretic 25) to 1/8th of a tablet twice a day in addition to the 5mg of furosemide x 2 daily.  This has reduced the fluid but at her last check up two weeks ago there was still some fluid present.  Matters were further complicated by Daisy having a series of breakthrough seizures over 36 hours in the middle of June.
         
        My vet did not want to increase either the furosemide or Co-Amilozide due to possible kidney damage so I asked about Vetmedin being added as per the cardiologist's report.  After consulting with him it was agreed Daisy could be prescribed 1/4 of a 1.25mg tablet x 2 daily.  He also agreed she was on the maximum diuretic dose possible for her.  I was however advised it was not known if Vetmedin would make a positive difference but might help with the ascities.  My vet mentioned there was always the possibility it could tip the balance and push Daisy into heart failure.  
         
        I wondered if any other group members had experienced an adverse reaction from Vetmedin? 
         
        Daisy's medication schedule is currently as follows: 
        8am - Furosemide x 5mg and Co-Amilozide  x 3.125mg (given separately crushed into a tablespoon covered with gravy from her favourite food)   
        9.30m - 0.1.5ml Ephiphen solution 4% w/v, Oral Drops usually given in tablespoon of food but sometimes via mouth with syringe
        4pm - Co-Amilozide  x 3.125mg
        9.30pm - 0.1.5ml Ephiphen solution 4% w/v, Oral Drops
        12pm - Furosemide x 5mg
         
        I have not yet started the Vetmedin as Daisy went off her food just before it was prescribed and I did not want to start a new medication at that point.  Also, I have been told it must be given an hour before eating.  I give all the other meds with food to avoid undue stress with pilling and am wondering if I can also do this with the Vetmedin.  I have got pill pockets but she's not keen on them and even a 1/4 of the tablet looks really big compared to the others she is taking.
         
        The current heatwave has not helped and my vet did mention the heat is not good for heart kitties as they can struggle to keep hydrated.  She has her bed in a north facing room with a fan and I have been putting a little extra water into her food and giving her Liquivite liquid cat food for extra fluid and calories. 

        Daisy is my first heart kitty and we would both really appreciate any help and information about Vetmedin and ways to administer it from other group members who have experience with this medication.  

        Thank you for reading and apologies for the length of this post but felt some background information about Daisy's issues would be useful as part of the overall picture.
         
        Many thanks in advance for any suggestions/information that can be provided.
         
        Best wishes,
         
        June and Daisy.

        [Non-text portions of this message have been removed]
      • elfinmyst
        Hi June I`m sorry to hear Daisy is having so many problems and balancing her issues. Steroids are bad for heart cats but with non regenerative anaemia, there
        Message 3 of 6 , Jul 22 9:02 AM
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          Hi June

          I`m sorry to hear Daisy is having so many problems and balancing her
          issues. Steroids are bad for heart cats but with non regenerative anaemia, there
          really is no choice. It's a case of trying to balance needs. My cat also
          has had an infarction and was given no chance to live at all . This was four
          years ago and she was given pimobendan (vetmedin) as a last resort. It was
          a life saver for her and at her follow up scan some of the damage had
          reversed.

          Milli was also given this drug with no ill effects after she had both sided
          heart failure. For my cats it has been a miracle drug.

          Lyn

          _www.myfurkids.co.uk_ (http://www.myfurkids.co.uk/)

          [Non-text portions of this message have been removed]
        • June Jeffrey
          Hi Lyn,   Many thanks for your response.  It s great to hear how well your kitties have done on this medication.   How do you administer the Vetmedin to
          Message 4 of 6 , Jul 22 10:15 AM
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            Hi Lyn,
             
            Many thanks for your response.  It's great to hear how well your kitties have done on this medication.
             
            How do you administer the Vetmedin to your kitties and do you give one hour before food too?
             
            Best wishes,
             
            June and Daisy 


            ________________________________
            From: "elfinmyst@..." <elfinmyst@...>
            To: feline-heart@yahoogroups.com
            Sent: Monday, 22 July 2013, 17:02
            Subject: [FH] Re: Help for Daisy - Introduction - Vetmedin query and dosing with other meds

             

            Hi June

            I`m sorry to hear Daisy is having so many problems and balancing her
            issues. Steroids are bad for heart cats but with non regenerative anaemia, there
            really is no choice. It's a case of trying to balance needs. My cat also
            has had an infarction and was given no chance to live at all . This was four
            years ago and she was given pimobendan (vetmedin) as a last resort. It was
            a life saver for her and at her follow up scan some of the damage had
            reversed.

            Milli was also given this drug with no ill effects after she had both sided
            heart failure. For my cats it has been a miracle drug.

            Lyn

            _www.myfurkids.co.uk_ (http://www.myfurkids.co.uk/)

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




            [Non-text portions of this message have been removed]
          • June Jeffrey
            Hi Mary,   Many thanks for your reply.   I ve now found a PDF Vetmedin Owner booklet which states:   How is Vetmedin® given? Vetmedin® is available as a
            Message 5 of 6 , Jul 22 10:48 AM
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              Hi Mary,
               
              Many thanks for your reply.   I've now found a PDF Vetmedin Owner booklet which states:
               "How is Vetmedin® given?
              Vetmedin® is available as a flavoured tablet or capsule. It should be given by mouth twice a day, approximately one hour before food, ideally 12 hours apart in the morning and at night. Use the dose that your vet recommends." 
              If you woudl like a copy of the booklet let me know and I will attach to a private email.
               
              It would make like easier if it could be given in a little food and I'll certainly try your trick with the pill pockets.
               
              Best wishes to you and to Esther.
               
              June and Daisy
               
               
               
               
               


              ________________________________
              From: Mary Sue Rubin <msrubin@...>
              To: 'June Jeffrey' <smudgeypaws@...>
              Sent: Monday, 22 July 2013, 16:17
              Subject: RE: [FH] Help for Daisy - Introduction - Vetmedin query and dosing with other meds

              Hi June,
               
              I’m so sorry about Daisy and her involved medical issues.
               
              My trick with Vetmedin is to wrap ¼ in as small a piece of pill pocket (salmon is Esther’s favorite) and then roll that in some crumbled dehydrated raw food such Stella and Chewy’s. Dried salmon or other crumbled dried fish also works. Some days that doesn’t work and I have to put the meds in a capsule covered in butter and use a pill gun. Maybe you could break the ¼ into halves so it will be smaller.
               
              I was told to give Vetmedin before or after food, but not until I questioned the vet. So Esther had been getting it with food for about a month and it was working. The Vetmedin literature doesn’t say anything about when to administer it in relation to meals. I try to give it before or after food, but I don’t always do it. At some point I am going to call the company and ask.
               
              Good luck.
               
              Mary Sue
               
               
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              [Non-text portions of this message have been removed]
            • elfinmyst
              Hi I was never told to give it at any time or before food, so Trixi and Milli have theirs with their other pills in chicken. But as it is beef flavoured they
              Message 6 of 6 , Jul 22 11:14 AM
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                Hi

                I was never told to give it at any time or before food, so Trixi and Milli
                have theirs with their other pills in chicken. But as it is beef flavoured
                they love it and just eat it whole.

                Lyn

                _www.myfurkids.co.uk_ (http://www.myfurkids.co.uk/)

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