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RE: [FH] Fw: [FAN-H] Fwd: Fwd: Fwd: hcm

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  • Cindi
    Thank you for sharing this information, an excellent read! I would like comments on a question I have. What advantage is there to scan cats with no
    Message 1 of 4 , Jul 8, 2013
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      Thank you for sharing this information, an excellent read! I would like
      comments on a question I have. What advantage is there to scan cats
      with no indication of HCM given the below comment?

      "However, Dr Kittleson, after many years of managing his Maine Coon
      colony and treating many other cats with HCM ... is convinced that there
      is no medication PRIOR to congestive heart failure that will slow or
      stop the progression of the disease. Cats with no medication will
      sometimes progress quickly or some will not progress for years, if at
      all and remain mild".


      Cindi missing the touch of Ditto
      There she was, elegant, beautiful, swathed in the shiniest of clinging
      silks, a vision of loveliness in coffee and cream --- a Princess from
      Bangkok, an Oriental Goddess, a Queen on her throne --- a Siamese cat!
      from May Eustace's Cats in Clover



      On Mon, Jul 8, 2013 at 9:20 PM, Westgold wrote:

      > This is an excellent article from another group -- ----- Original
      > Message ----- From: Mother Stephania To: Mickey ;
      > Fanciershealth@yahoogroups.com Sent: Monday, July 08, 2013 9:12 PM
      > Subject: [FAN-H] Fwd: Fwd: Fwd: hcm
      >
      >
      > Hi Mickey,
      >
      > I can try to answer some of your questions. I'm not a vet, tech or
      > breeder ... just a simple pet owner. But my hobby for the past 5 years
      > has been listening to recordings of talks from veterinary CE
      > conferences, as well as attending a few and taking webinars. I have
      > had
      > an interest in HCM and in 2009 was given permission to attend the
      > annual
      > meeting of the American College of Veterinary Internal Medicine (the
      > ACVIM Forum) which includes the board certification of cardiologists.
      > I
      > got lucky because that year, there was a 4 hour mini-course on Feline
      > HCM by Dr Mark Kittleson of UC Davis (now emeritus) who is one of the
      > world's leading experts on feline HCM and did much of the foundational
      > work with his Maine Coon colony. He is also a leading cardiologist who
      > has written a well known veterinary textbook on "Small Animal
      > Cardiovascular Medicine". I just exchanged emails with him last week.
      > I
      > don't claim any expertise, but I can try to share what I think I've
      > learned from Dr Kittleson ... and also Dr Kate Meurs who, in
      > cooperation
      > with Dr Kittleson, found the HCM mutations in Maine Coons and
      > Ragdolls.
      >
      > 1. How accurate is ultrasounding (echocardiography) in detecting HCM?
      >
      > Echocardiograms are considered the "gold standard" in diagnosing HCM
      > ...
      > WHEN done by a highly trained professional. Not many primary care vets
      > are skilled enough to be able to diagnose HCM with ultrasound. It is
      > generally recommended that echos be done by a board certified
      > cardiologist. If that is not possible, then a well qualified boarded
      > Internal Medicine specialist or boarded radiologist may be able to do
      > them. The important point is that it requires a lot of skill to do an
      > echocardiogram to look for HCM, so you need to find someone with that
      > skill.
      >
      > Even with the skill, it can be hard to diagnose HCM. Advanced HCM
      > (where
      > there is any part of the left ventrical wall with a thickness of 7mm
      > or
      > greater ... and an enlarged left atrium) ... can generally be
      > diagnosed
      > easily and accurately by a cardiologist. The problem comes with less
      > advanced disease. Dr Kittleson, one of the leading experts who has
      > echoed
      > thousands of cats ... says that he can't diagnose mild HCM. It is
      > difficult, if not impossible to know what is mild HCM and what may be
      > normal for that particular cat. He no longer uses the term "mild" HCM
      > but only refers to "equivocal" HCM ... which, he says, may or may not
      > be
      > HCM ... and he can't tell. In that case, one just needs to do future
      > scans to look for any possible progression.
      >
      > So, HCM ... particularly mild/equivocal HCM ... can be misdiagnosed
      > even
      > by an expert. An experienced cardiologist should be able to diagnose
      > moderate and advanced HCM fairly accurately.
      >
      > You may have heard of the biomarker test (a simple blood test) that
      > looks for NT-proBNP ... marketed by IDEXX as the Cardiopet proBNP
      > test.
      > NT-proBNP is a substance that is given off when the heart muscle is
      > stressed. While some advocate using it as a type of screening test for
      > HCM ... it is usually by those who have connections to IDEXX. Dr
      > Kittleson has done studies with it and feels that NT-proBNP is most
      > accurate in indicating advanced HCM ... when it is likely that other
      > signs would be present as well ... but NT-proBNP is not a good
      > indicator
      > of mild to moderate HCM. It also only indicates some type of stress to
      > the heart ... and not what is causing that stress (HCM or something
      > else). It does seem to be a useful test to help differentiate a heart
      > problem from a lung/pulmonary problem ... but requires blood sent to a
      > lab, which may be more time than a vet has to make treatment
      > decisions.
      > I did hear a year or so ago that IDEXX was going to come out with an
      > in-clinic form of the Cardiopet proBNP test ... but never heard that
      > it
      > is available yet. If you are interested in more info on the NT-proBNP
      > test, I have a couple published articles by Dr Kittleson on it in
      > terms
      > of using it to screen for HCM. He still recommends an
      > ultrasound/echocardiogram as the primary diagnostic test for HCM.
      >
      > 2. How old do cats need to be to be tested?
      >
      > That's a tricky question. In some breeds (like Ragdolls) HCM can be
      > manifest at an early age for some cats, but in other cats in the same
      > or
      > other breeds, it may not develop until middle age or older. Some cats
      > may develop HCM at less than a year old, e.g. 5-6 months. In some
      > breeds/cats it will more often begin to manifest itself by 2 yrs of
      > age
      > ... but others may not develop HCM until 7-8 yrs or older. Some may
      > have
      > a mild form of HCM that is difficult/impossible to diagnose, even with
      > an echocardiogram for most or all of their life. It is an extremely
      > variable disease, both in age of onset and in the degree and speed of
      > advancement. If you are breeding and have a breed in which HCM has
      > been
      > seen in young cats, you may want to do an echocardiogram prior to
      > using
      > the cat in a breeding program.
      >
      > But what is most important to know is that since HCM can develop later
      > in life, a single echocardiogram will not tell you if the cat will
      > ever
      > develop HCM or not. All it can do is tell you whether or not the cat
      > has
      > (or might have with an equivocal result) HCM AT THE MOMENT of the
      > echocardiogram. Cats used in breeding programs need to be echoed every
      > year or two ... during and after their breeding careers. A single
      > clear
      > echo does not mean that the cat cannot develop HCM in the future ...
      > nor
      > whether or not the cat will pass on an HCM causing mutation to
      > offspring.
      >
      > Also of note is that males tend to have more severe HCM and develop it
      > at an earlier age than females. That isn't absolute, but is commonly
      > seen. I asked Dr Kittleson about it and he affirmed it ... but doesn't
      > know why it seems to be more severe in males and develop at a younger
      > age. That might suggest that it is a good idea to do an echocardiogram
      > on males at an earlier age.
      >
      > 3. Are there individual clinics that do this or individual vets? What
      > is
      > the appropriate cost?
      >
      > The best thing to do is probably to ask your vet for a referral to a
      > cardiologist. Many specialty clinics have a cardilogist on staff. You
      > can also look on the ACVIM website for a boarded cardiologist in your
      > area. The cost, I think, tends to differ with the cost of living in
      > various geographical areas. It's been 7-8 years since I had one done
      > on
      > my last cat in Montreal and at that time the initial ultrasound cost
      > about $500, with follow-ups around $300. But prices differ. Also, it
      > is
      > common for breeders, often in conjunction with a cat show, to organize
      > scanning "clinics" with a boarded cardiologist who will reduce the
      > price
      > (I think sometimes to around $150 to $200 per cat) if they can arrange
      > for 20-25 cats to be scanned during the clinic.
      >
      > 4. Can this be bred out of positive cats as PKD can? How do they know
      > that this is always genetic?
      >
      > I'll start with the second question ... is it always genetic. They
      > don't
      > know that it is. The assumption of it being genetic is based on HCM in
      > humans ... where it is almost always a genetic disease ... with
      > different gene mutations occurring in different family lines. HCM is
      > the
      > most common inherited heart disease in humans as well, where it is
      > genetic ... and it is only logical to start with that assumption in
      > cats. It is also quite possible that even with a gene mutation that is
      > inherited, there may be other factors ... in the diet or environment,
      > or
      > other genes ... that will trigger the onset of HCM or effect the
      > severity or rate of progression. Those are still unanswered questions
      > that the experts are working on. So, it could be a mistake to try to
      > dismiss a case of HCM as not being genetic and being caused by
      > something
      > else.
      >
      > It should also be noted that Dr Kittleson and Dr Meurs both make the
      > strong point that they define HCM as a PRIMARY disease ... not as
      > something that is secondary to another condition. It is known that
      > some
      > conditions, notably hyperthyroidism and hypertension can cause a
      > thickening of the heart just like HCM. But in those cases, once the
      > primary disease is treated (hyperthyroidism or hypertension) the heart
      > usually returns to normal. They do not consider that HCM. However, it
      > is
      > possible for a cat to have BOTH HCM and something like
      > hyperthyroidism.
      > Dr Kittleson believes that hyperthyroidism may be one means of
      > activating HCM or causing a mild/equivocal case of HCM that has been
      > stable, to begin to progress ... so, after treating hyperthyroidism,
      > one
      > still needs to monitor the heart to see if it returns to normal or
      > continues to progress.
      >
      > While we don't know if ALL HCM is genetic ... since it seems to be
      > genetic in humans and certainly in Maine Coons and Ragdolls ... there
      > is
      > a possibility of breeding it out IF the specific gene mutation causing
      > it has been found and there is a DNA test for it. At the moment there
      > have only been two mutations found ... one occuring primarily in Maine
      > Coons and one primarily in Ragdolls. Ragdolls have it the best because
      > (last I heard) it appears that nearly all cases of HCM in the breed
      > are
      > caused by that one mutation. There is a genetic test for it and
      > breeders
      > can easily test and use only cats that are negative in their breeding
      > programs. Maine Coons have it harder ... while there is one known
      > mutation which they can (and should) breed away from ... there are
      > also
      > Maine Coons with HCM that do not have the known Maine Coon mutation.
      > That means that there is at least one other mutation in the breed
      > (assuming a genetic cause) which can't be tested for. Same is true for
      > RagaMuffins which have the Ragdoll mutation in the breed ... but
      > nearly
      > all RagaMuffins diagnosed with HCM (thankfully, still not a lot in the
      > breed) do not have the Ragdoll mutation ... so they also have at least
      > one other cause of disease.
      >
      > So, when a mutation is found in the breed and a DNA test created for
      > it
      > ... then it can be bred away from. Most breeds do not yet have
      > mutations
      > found, so it isn't possible to breed away from a specific gene.
      > However,
      > if breeders will be open and honest ... they can share pedigree
      > history
      > and breed away from lines that have had cats die of HCM or
      > "suspicious"
      > deaths.
      >
      > One last comment on HCM. It is important to diagnosis early so that
      > one
      > can avoid using the cat in a breeding program ... and knowing a cat
      > has
      > HCM, one can watch for signs of congestive heart failure or blood
      > clots,
      > etc. However, Dr Kittleson, after many years of managing his Maine
      > Coon
      > colony and treating many other cats with HCM ... is convinced that
      > there
      > is no medication PRIOR to congestive heart failure that will slow or
      > stop the progression of the disease. Cats with no medication will
      > sometimes progress quickly or some will not progress for years, if at
      > all and remain mild. The reality is that with the known gene mutations
      > there is what in genetics is known as "variable expression" and
      > "incomplete penetrance" ... which means that the same mutation in one
      > cat may cause severe disease at an early age, but in another cat, even
      > in the same litter, may only cause mild disease later in life, or not
      > any disease at all ... yet can pass the gene on to offspring that may
      > develop severe HCM. Giving medication prior to congestive heart
      > failure
      > may not hurt (unless pilling a cat daily hurts the human animal bond)
      > and may make the owner feel better to be doing something, but Dr
      > Kittleson has found no scientific evidence that anything will alter
      > the
      > natural course of the disease. Once it progresses to the point of
      > congestive heart failure, then a diaretic like lasix is known to be
      > beneficial.
      >
      > Hope some of that helps answer your questions. If you or others want
      > to
      > learn more about HCM, I always highly recommend the HCM website done
      > by
      > Dr Kittleson, Jody Chinitz and Marcia Munro ... at:
      > http://mysite.verizon.net/jachinitz/hcm/index.html
      >
      > Stephanie in Raleigh
      >
      > ===========================
      > On 08/07/2013 6:46 AM, Mickey wrote:
      >
      >> My email left before I could type
      >> I have a couple of questions regarding this disease that I hope
      > someone can answer for me
      >> Since it is my understanding that using ultrasounding for this
      > disease is the only way right now to detect it, is it 100% correct or
      > can it also be misdiagnosed?
      >> How old do cats need to be to be tested? Are there clinics that do
      > this or individual vets? And what is the approximate cost? Also, can
      > this be bred out of positive cats as PKD can?
      >> And since a genetic marker in Persians hasn't been found how do they
      > know this is always genetic?
      >
      >
      >
      >
      >
      > [Non-text portions of this message have been removed]
      >
      >
      >
      > ------------------------------------
      >
      > Your reply will go to the author of this message. If you feel your
      > reply will benefit the entire group, please change the "To:" line to
      > feline-heart@yahoogroups.comYahoo! Groups Links
      >
      >
      >
    • elfinmyst
      Yes, an excellent artcle. And a good question, Cindi. I would answer that it is important to scan cats with a risk of HCM for several reasons. Heart disease is
      Message 2 of 4 , Jul 9, 2013
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        Yes, an excellent artcle.

        And a good question, Cindi. I would answer that it is important to scan
        cats with a risk of HCM for several reasons. Heart disease is not just HCM, my
        Milli has two holes in her heart and her medication is vital to stop high
        pressure in her aorta. Without a scan we wouldn't have known that. The scan
        can detect valve problems and holes which do respond to treatment.

        Also cats are excellent at hiding heart disease, a cat could be in heart
        failure and the owner not notice it, but the scan would. The cat may be at
        risk of a clot and that could be picked up too on the echo.

        And fnally, my cats with moderate HCM have been given atenolol which has
        stopped their murmurs and prevented obstruction of the blood flow, reducing
        their risk of clots. So whilst medication may possibly not help the heart
        wall thickening, it may help secondary effects of HCM like turbulence in the
        heart and obstruction . But since I also have HCM cats whose wall
        thickening has reduced with medication, I would always ultrasound my cats to catch
        it early. Maisie, my last entire girl had her scan last year and showed the
        mild/equivacol HCM and is being neutered this week.

        Lyn

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

        [Non-text portions of this message have been removed]
      • Diana Fox
        I have to agree with Lyn on this. I think scanning is so, SO important and as Lyn points out-not just for HCM.   You really don t know how-or if- medicines
        Message 3 of 4 , Jul 9, 2013
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          I have to agree with Lyn on this. I think scanning is so, SO important and as Lyn points out-not just for HCM.   You really don't know how-or if- medicines will work until the cat is taking them, but I have seen first hand that medication CAN help in some cases and slow the progression of HCM for a time. Each cat is different and so a medication that works for one might not work for another. Sadly, I see this with the cats from my breeding program.We have a Maine Coon male, a retired stud, who is DNA typed negative and had scanned clear his whole 5 years of breeding. One year after retiring him, we started getting reports of HCM deaths in his kittens(..all from DNA typed negative/clear scanned females). At our boy's 1st scan after the reported HCM kittens, he was diagnosed 'borderline' HCM and put on Atenolol...two sons were scanned around the same time- one diagnosed 'mild HCM' and put on Atenolol, the other 'moderate HCM' and on Atenolol,
          Plavix and baby aspirin. Both boys also had heart murmurs present on those scans. On the two boys next scans, the heart murmurs were gone and there was no increased size of the left ventricle-one boy's was even slightly less thick than before. (The boy with the 'moderate' HCM sadly passed away late last year from the kidney failure which showed on blood work done shortly after his second scan.) Our boy, on the other hand,  progressed to 'Severe HCM' in the 10 months between scans. He is now on Plavix and baby aspirin, along with his Atenolol. The son with the 'mild' HCM just had his 3rd scan and is doing so well that his cardiologist told the owner they could wait two years for his next scan. She has told me tho, that she will continue to scan her boy every year, just to be sure. HCM is such a frustrating, complicated and heart-breaking disease...all we can do for our much loved cats is give them our very best care, follow their
          cardiologist's instructions and pray for the best .
          Diana...in NC, north of Raleigh
          From: "elfinmyst@..." <elfinmyst@...>
          To: feline-heart@yahoogroups.com
          Sent: Tuesday, July 9, 2013 5:14 AM
          Subject: RE: [FH] Fw: [FAN-H] Fwd: Fwd: Fwd: hcm

           
          Yes, an excellent artcle.

          And a good question, Cindi. I would answer that it is important to scan
          cats with a risk of HCM for several reasons. Heart disease is not just HCM, my
          Milli has two holes in her heart and her medication is vital to stop high
          pressure in her aorta. Without a scan we wouldn't have known that. The scan
          can detect valve problems and holes which do respond to treatment.

          Also cats are excellent at hiding heart disease, a cat could be in heart
          failure and the owner not notice it, but the scan would. The cat may be at
          risk of a clot and that could be picked up too on the echo.

          And fnally, my cats with moderate HCM have been given atenolol which has
          stopped their murmurs and prevented obstruction of the blood flow, reducing
          their risk of clots. So whilst medication may possibly not help the heart
          wall thickening, it may help secondary effects of HCM like turbulence in the
          heart and obstruction . But since I also have HCM cats whose wall
          thickening has reduced with medication, I would always ultrasound my cats to catch
          it early. Maisie, my last entire girl had her scan last year and showed the
          mild/equivacol HCM and is being neutered this week.

          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]
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