Thursday, March 2, 2017

New Drug Might Decrease Effects of HCM

New drug might help cats with HCM: "The novel drug, MYK-461, proved effective in a study of five cats with a naturally occurring form of inherited hypertrophic cardiomyopathy (HCM)...eliminated left ventricular obstruction in five cats with HCM...MYK-461 was already shown to stop the thickening of the ventricle walls in mice."

Here's the paper about the new trial drug discovered for the treatment of HCM. Understand the drug treats obstruction, not something all HCM cats have; and it may not decrease the progression of the disease, just some physical issues of the disease. But only time will tell. Keep an eye on this drug. Let me know if you read more about future developments. I'll try to stay aware of it. "Treatment with MYK-461 reduced contractility, eliminated systolic anterior motion of the mitral valve and relieved LVOT pressure gradients in an exposure-dependent manner. Our findings provide proof of principle that acute reduction in contractility with MYK-461 is sufficient to relieve LVOT obstruction. Further, these studies suggest that feline HCM will be a valuable translational model for the study of disease pathology, particularly LVOT obstruction."

Thursday, December 22, 2016

Jimmy Needs Prozac Adjustment

Once again, after about a month with the increased Prozac (I'm assuming because Prozac can cause aggression), Jimmy is once again attacking his sisters. Never sure of the cause but something happens in his head and he gets angry and attacks. This isn't just swiping and hissing but a full on attack. Fur flies, cats cry, and when two are fighting, they all get involved. And it happens in a flash. So, I will dial down the Prozac-this time to .18-and see if he improves. Problem is, with the lower dose, he then begins to have accidents which we've seen since about September (the last one being 11/26 when he went against a window.) Maybe I'll try a week of a low dose and a week of a high dose and alternate. I could tell a change was coming, though. He has always had these maniac/depressive mood swings when on Prozac. He would spend a couple weeks very happy and then begin to slow down and not be active or involved, and would seem lethargic and disinterested in his environment. So, I would adjust the Prozac. Since September, the depressive mood swing has led to attacks against his sisters (because those are the cats he's near) and going out of the box.

Thursday, December 8, 2016

Echos Necessary Before All Surgeries to Detect Heart Health and Avoid Problems

When writing up a medical history list of Bette for the cardio visit, I came across her 2013 dental surgery record. It was written for her and Cooper's dental surgery record which they both had had the same day. I realized in reviewing it that I had not taken either Cooper or Bette to the cardio for a scan prior to surgery. I believe it was because at the time Myrna was so sick, and we were spending so much on her care, and now were faced with $1000 for two dental surgeries, that spending another $600 for cardio echos was going to be out of reach. And yet I wished that I had spent that money.
Cooper had had an echo summer of 2012 and was fine. He had dental surgery a year later in 2013 and afterwards, began to slowly exhibit symptoms of being ill but symptoms I attributed to his reoccurring hypercalcemia (high calcium rate) which we had battled the year before and which had not returned. Blood tests didn't show anything other than a minor increase in calcium. Months later, March of 2014, after another dental surgery, he did not bounce back and we took him to the vet two days later, only to discover he had CHF. We rushed him off to the cardio. He would be on heart meds March-July and die of CHF in July.
If I had taken him to the cardio in June 2013, we may have caught early signs of heart disease. And certainly, he had heart disease by March 2014 which an echo would have caught and we could have avoided dental surgery and the onset of that first CHF-even if the outcome would have been the same in the end.
From now on, every cat gets an echo before surgery.

Bette Davis Visits Cardiologist for a Checkup

Bette Davis yesterday, finally had a cardio check-up with the famous Dr. D that was Myrna's vet cardio. She was the last one Dr. D had not yet met. Bette passed with flying colors: no issues, and she was well behaved.
Going to the vet cardio's office brings back mixed feelings. First, apprehension over what will be found-the same feeling I had when I took Myrna. Then, memories of being there so many times over the six years with Myrna when she was seeing the cardio, coupled with that feeling of "I should be back in three months which was the routine with Myrna but that routine no longer exists." Then sadness because that building houses the ER where she died.
Assuming no one gets sick, I won't return to the cardio's for a few months. Late next summer, Katharine and Roxy will return for annual check-ups: Katharine has a heart murmur and Roxy has an anomaly that needs monitoring.
Despite the mixed memories and feelings, it is always great to see the staff and chat with Dr. D about her life and family; and talk to Julie, the much respected, talented vet tech who worked with Myrna and me for so many years. She recently and unexpectedly lost a pet dog to cancer. She brought him in for a scan; cancer was discovered in the stomach; and she put him down that day. But there was also joy-her son is now two and she showed me photos and a video.

Jimmy Stewart Update Urine and Frucotsamine

Jimmy update: doing well this week on .19 Prozac (up from .17.) The Solequin calming treats may have helped so we'll get more. Urine is free of bacteria, glucose, and crystals which is good. Fructosamine test for blood sugar was in the normal range at 208-although it could be lower. Kidney values-normal but ticking up. Need to keep an eye on him; hydrate more (albumin shows dehydration); and maybe some light kidney support vitamins if I can sneak them into his food.

Saturday, November 26, 2016

Jimmy Accident Out of Box

Tuesday, Jimmy went out of the box against the living room window. Yes-the window, window sill, under the window to the foam insulation, behind that to the screen and sill on the outside; down the wall, under the baseboards, through the cracks between floor boards, down the chest, under the legs, etc. It took an hour to clean with my husband doing the outside work and me cleaning up the mess inside. And we both cleaned and moved the chest (in place because you don't want to inadvertently spread urine.)

Last week, he went against the wall at the top of the landing, a favorite place of Myrna's. That was easy. This was beyond difficult.

After wiping up the urine, I used cleanser, then bleach on the wood, window, screens, floor, chest, etc. Where it might actually bleach out color, I used sparingly. But the wood interior sill wouldn't stop smelling so I kept soaking it in bleach. Finally, I used a wet paste of baking soda and have left it soaking for a few days. I'll eventually wipe it up and vac and sweep and let it dry and make sure the smell is gone.

He has had accidents a few times this summer but on pads around litter boxes for the most part, nothing this horrifying since his issues first began in 2010. When he first began urinating out of the box in 2010, we tried everything-new boxes, new litter, calming sprays, changing placement of boxes, adding boxes, monitoring his use of and the time it took for him to go; monitoring behavioral cues; using behavioral training techniques; finally adding Prozac to the mix. We've titrated up Prozac as needed as time went by, all with success. He began to be normal by 2013, and only had one or two accidents against litter pads in the last two years. Then this summer he went about four times, and has gone three times since fall including this week. That's about seven accidents in six months, more than in the last three years put together.

I took him to the vet yesterday for blood work of CBC/chem panel and fructosamine to test his sugar levels as he is pre-diabetic (discovered a couple years ago.) If there is too much sugar in the urine, the bladder fills quickly and the body wants to "dump" it as soon as possible, and the cat feels it must go immediately. (And if there are reasons why they choose a certain site, it's difficult to discern as to why they chose that spot other than it might be cool or comforting-if they have a UTI for example. But why a window?) The CBC/chem panel shows some dehydration and some ticking up of kidney values. Those can be related but typically seen only in extreme cases of dehydration and a decline in electrolytes. And there are none. And his SDMA kidney value test was normal. We will get the fructosamine results in a few days.

Meanwhile, we are trying a calming treat solliquin the vet suggested. We add it to his food.

The vet also suggested we increase the Prozac. We had in August but by late September, he began showing signs of anger management issues and fighting with his sisters (psychotropics can increase anger as well as increase feelings of happiness.) We decreased the dose. He was fine. But now he's had two accidents. We increased it again to .19 from .17. She suggested we get it over 2.0 and if he gets angry, increase dose to see if he becomes less angry.

What is difficult is that we started from zero in 2010 and built a successful approach that included training, boxes, litter, paying close attention to cues, and meds. There is no other successful med other than Prozac, that if Prozac stops working, there is nothing more effective. In fact, most other meds are less effective for controlling anxiety and litter box use. It was working. But if it is no longer working, and we have done all there is, what more do we do to solve the problem?

Pray of course. Increase Prozac if possible. Clean more thoroughly (the house is clean but I have not washed walls and baseboards in months and probably should since Roxanne has been running around the house and is no longer confined-not that she's had an accident but to make the place smell more neutral.)

I'll ask the vet about any concerns regarding his kidney values. May need to pay attention there. And he needs a urine test and he did not have a bladder on Friday.

Saturday, November 12, 2016

Roxanne Visits Cardio-Has Changes in Left Vent but Not Yet HCM

Roxanne saw the cardiologist yesterday just because that's what we do. Glad we did. She shows signs of changes in the left vent. No signs of heart disease but those changes often become HCM. The cardio said it could go either way. But no stress or too hot or too cold or too humid environments. And no steroid medications. And she will need annual cardio visits. We found with Cooper that heart disease can suddenly emerge from one year to the next-one year he was fine; the next he was not.

She gets car sick, though, and vomited and had diarrhea in the crate on the way there. But while there, she was very calm. She sat quietly for the exam; her heart beat was steady, not racing due to being in a new place.

No meds are recommended at this time since the heart rate is steady and there are no other signs of actual heart disease. The walls of the heart are not seriously thickened; there's no congestion; etc. She described the walls to be as appearing to be uneven.

So, we will keep an eye on her.
Here are the vet's notes:

"There was no evidence of serious cardiac disease during today's echocardiogram. The only questionable abnormality that was found is that the wall of Roxanne's left ventricle are slightly thickened. This may be completely normal for Roxanne or it could be an early indicator of hypertrophic cardiomyopathy (HCM). There is no need for any type of treatment at this time. She is not considered to be at risk for congestive heart failure or blood clot formation. I advise rechecking her echocardiogram in 1 year. If progressive changes in the heart are seen at that time, Roxanne will be diagnosed with HCM and we will consider beginning cardiac medications. If there is no change in her echocardiogram, we will consider these measurements to be normal for Roxanne."