Bette Recovers Ability to Walk/Use Litterbox with Steroids-Must Monitor

Bette again has responded quickly to prednisolone given twice a day (as opposed to once daily) and can now fully walk and go to the bathroom without issue.

But much like HCM, this is a disease that will grow and get worse over time. And much like HCM, we must monitor her daily for signs of the disease and complications, and monitor her ability to walk and use the litter box.

We are not allowed to increase the prednisolone in the future because more than 2ml a day will lead to immune suppression which might occur regardless. Immune suppression can lead to an increase in viruses taking hold (but she's indoors and on lysine for Herpes so that might reduce the probability.) But long term use can also suppress her response to vaccinations which can be a concern although she is an indoor cat. (But the distemper virus is air borne and can be brought indoors on us as well.)

Other long term effects of prednisolone for cats is not the same for dogs (dogs have more possible issues) but it can lead to edema-fluid retention similar to humans, or over eating (and she needs to lose one pound as it is. She's 12.3 and really should be about 11 lbs especially given her mobility issues.)

Here's one of many links you can find online about prednisolone. 

AND as a reminder-STEROIDS CANNOT BE GIVEN TO HCM/heart disease cats (and dogs.) It causes fluid retention, is contraindicated with diuretics. Bette does not have HCM.

Medications she is currently on:
*Valium 1/2 tab of 2mg tab BID (twice a day)-since 2010 for litter box issues.
*Prednisolone-1ml BID-steroid

*Buprenex pain medication - .15 BID-for a few days for her right leg pain to get her past this recent issue. We will do at least once a day going forward to see if she's in a lot of pain and if less of it affects her ability to be comfortable for now. I can increase it as needed. This is a less severe pain medication. The neurologist suggested gabapentin which we have used on other cats for other issues and it is too difficult to control. It makes them loopy even at very low doses.
*Cisapride-once a day for now-a medication to help her expel fecal matter. Works internally not at the rectum but might help here body prep the matter to push it out. We can do it BID but for now just once in the a.m. to get her past her recent issue. She has had normal bowel movements since Saturday. Is that the prednisolone or the cisapride?

*Cerenia four times a week to control pancreatitis.
*Chlorpheniramine-anti histamine for her eye/skin inflammation she began to have in 2021. Four times a week.
*Gels: lysine, Methigel (urine), Laxatone (to help her gastro mobility) four times a week

Bette Davis Develops Nerve Sheath Tumor Rear Along Spine

Bette Davis was seen in January for rear leg lameness, immobility of the tail, and difficulty going to the bathroom. I posted about it at that time. She was treated with antibiotics and prednisolone. By the end of January, she had finished the course and had fully recovered her mobility and ability to go to the bathroom. But two weeks later in February, she developed bathroom issues so was put on prednisolone 1ml once a day. That worked fine until March when March 6 she suddenly showed signs of rear leg lameness again. We had an appointment for Wednesday March 8 by which time she had gotten weaker, had again developed bathroom issues-inability to urinate or defecate fully. This time we opted for an MRI because she could have spinal cord or vertebrae injuries or lymphoma-although her gastro scan did not show signs in her organs of lymphoma (although it can appear elsewhere.) Both respond to prednisolone to reduce inflammation. 

Today, March 9, was the MRI. Unfortunately, she has cancer but one we did not think about-Nerve Sheath Tumor. It is growing along the nerve on the left side of the spine but growing into the right side of her rear limb which is why she is weak in the rear legs but has significant discomfort in the right rear leg. It has also made her numb in the rear end and rectum area, making it difficult to urinate and defecate. 

The solution short term is to increase the prednisolone to 1ml BID for the rest of her life. She cannot increase the amount of the prednisolone even as she might grow weaker and have more difficulties going to the bathroom because then immune suppression issues will develop, leading to other various health issues that are even more serious. 

Radiation is a possibility but expensive: the vet estimated $7-10k. We have been referred to Oncology at the state vet school and might hear from them next week. At the consultation, we will learn more. How will we pay for it? From savings, investment account from which we can borrow without penalty, CareCredit, credit cards. But how often will she need treatment? And we have four others, three of whom are her siblings and the same age with their own issues (Katharine has HCM now.)

There is no surgery possible as far as we know for her tumor.

Diapers and rear leg lameness might also be in the future. There are plenty of cats on social media that do both and seem to live happy lives. BUT with her nerve cancer, pain will be an issue and pain meds will be needed in the future. BUT it is likely not life threatening the vet said and she could live a normal rest of her life existence. But then again, he gave her a year before her life was impacted and that is when people tend to put cats to sleep. 

We prefer not to do that especially after we lost Baby by putting her to sleep without fighting for her life (in 2021 she had been in the ER for a week dying of acute pancreatitis and I failed to bring her home to either try to get her to recover or let her die at home.) I don't want to run the risk of letting Bette go too soon just because taking care of her isn't easy, just because she can't easily move around if she can manage. I must decide how I want things to end for her so that I'm prepared. I was so prepared for Myrna's death in 2015 after six years and nine months of facing the fact. But I was so caught off guard with Cooper (who lived five months after being diagnosed with heart disease) and Baby that I still feel a lot of shame and heartbreak.

Here is one link to one explanation. You can Google for others if interested. 

"...Nerve sheath tumors (NSTs)...are benign or malignant mesenchymal tumors and they originate from periaxonal Schwann cells (schwannoma) and fibroblasts (neurofibroma/neurofibrosarcoma). Due to its mesenchymal origin the terminology for NSTs is diverse and a wide range of names has been used in the literature, e.g., neurinoma, schwannoma, neurofibroma, neuro(fibro)sarcoma, neurilemmoma, neurogenic sarcoma, and neurofibromatosis. Currently the most widely used name is nerve sheath tumor...NSTs may occur in every large or small nerve in the body...grow outside the dura mater (extradural) they may extend along the pathways of the nerve roots into the intervertebral foramen. Once inside the spinal canal they may develop an intradural-extramedullary component or even an intradural-intramedullary component (Figure 1). Clinical signs include severe, unexplained, and intractable pain, thoracic or pelvic limb lameness, monoparesis, ataxia and proprioceptive deficits. Early diagnosis and an aggressive surgical protocol maximize the possibility for complete tumor resection sparing the limb. NSTs have a high rate of recurrence, and the overall prognosis is considered poor..."

Types of Tests for Heart Disease

https://todaysveterinarypractice.com/cardiology/cardiac-blood-tests-in-cats/

This site lists various tests like xrays and ultrasounds for detecting heart disease and lays out pros and cons.

Pro BNP Test to Detect Heart Disease-When Is It Necessary

https://thehormonelab.com/handbook/other-endocrine/probnp-canine-cardiac-marker

When at the vet, should you get a blood test to test for heart disease in a cat (or dog) if you do not know if a cat has HCM? The ProBnP test looks at and measures a protein that is released when there is damage to the heart. This is a test that would need to be repeated any time you thought the cat had HCM or issues with the heart. I would recommend that you save the money and see a cardiologist instead. Of course, the ultrasound is more expensive and may take time to get an appointment.  AND it also would need to be repeated if you suspected the cat had heart issues later on. AND if the cat is positive with ProBnP, you still need to see the cardiologist immediately. 

Only a cardiac ultrasound can tell you if the cat has any heart issues. Of course, even the ultrasound would need to be repeated if you suspected the cat had heart issues. 

If your cat is presenting with signs of HCM-such as CHF (congestive heart failure)-and XRAYS show the cat is congested, skip the Pro BnP test, treat the CHF with diuretics, treat any other symptoms (rapid heart rate, a need for oxygen, rear leg lameness [likely a clot or injury] etc.) THEN make an appointment to see a cardiologist as soon as possible to get an ultrasound-the ONLY true test for heart disease that will also tell you exactly what is wrong with the heart, and guide the vet as to treatment. 

Seeing a cardiologist early-as a young cat-gives you a good baseline reading of the heart. Seeing a cardiologist annually if the cat has a heart murmur will allow you to know what is the cause of the murmur, if it needs treatment, and catch if HCM does develop. Other issues with the heart may arise-as the cat ages because the heart ages there may be heart disease; or if the cat gets CKD-kidney disease-which damages the heart; or if they have thyroid disease or other diseases or cancer, all which stress or damage the heart in their way. A cardiac ultrasound in all of these cases will be the only way to see what is wrong with the heart. No need for the ProBnP.

Genetic Testing for HCM-Not Always Necessary

This is general information and not really helpful for those with HCM cats. But apply it to your other cats; tell your friends, etc.

I believe your cat doesn't need a DNA test to see if they might get HCM. They could still possibly get it even though they do not have the gene. But it is a good starting point for breeders since many top breeds of cats are prone to HCM.

Also-testing and being positive with a gene tells you nothing-you still must wait to see IF the disease will occur in your cat and to what extent. For that you need to see a cardiologist at least annually and then wait for it to appear.

I recommend that all cats see a cardiologist when a kitten, or when you first get one home; then again when they are four, then age six or so, and then annually once they are ten because the heart ages and issues can arise. Also see the cardiologist if your cat has a detectable murmur, or if they need surgery, or they need dental cleaning/surgery, if they need anesthesia for anything such as an MRI. If you do not, the anesthesia will likely cause CHF-the first sudden sign of HCM that typically hits a cat. (It's likely HCM or CHF signs were appearing at home but owners missed them.)

https://basepaws.com/blogs/news/genetic-markers-for-feline-hypertrophic-cardiomyopathy

Breathing Rate Apps-For Pets and Humans

Someone said they use a breathing app to count breathing rates. I found there are quite a few different apps out there that might help you count and track the rate. You can also use the clock/timer on your phone. I simply watch my second hand on my watch-something anyone over 45ish likely still uses. (Or older??)

One thing I may not have mentioned-when counting the breathing rate you are ALSO looking for the difference between a fast rate and a fast rate that includes a PUSHING out by the chest (and for a cat it's really the entire chest/abdomen area that moves.) A PUSH indicates the body is having a difficult time getting oxygen into the lungs; it's trying to get oxygen and cannot. That indicates there is CHF and the cat needs the vet/ER vet now (although surprisingly when Katharine got sick a few months ago, it wasn't CHF but simply a respiratory infection that caused the PUSH which we had not seen in our non HCM cats before.) You'd want to give a diuretic but also leave for the ER and oxygen.

Here are a few. I'm sure there are more. Find these apps at Apple or Google or wherever you go for apps. I have no information on costs or ease of use but a pet owner said they use SRR and like it.

RRate, SRR Counter for Dogs and Cats, Medtimer, TapRate, Respi-Rate, Breath Counter.

Breathing Rates-How to Count; Why it Matters; Bette Update

Let's talk breathing rate. It's important that you monitor your cat's breathing rate many times a day. An HCM cat may be fine one minute, and then suddenly go into CHF. How do you know? Count the breathing rate. I tell you to count in 15 seconds because it's easier to watch the cat and your watch. But the breathing rate is really counted as a "minute". So, take 15 seconds and times it by four for a minute rate. But 15 seconds is a good way to start. How many up and down chest movements in 15 seconds? One up and down is ONE COUNT. 6 at rest is great. The cat is fine. 8 at rest and the cat may be heading into CHF. 10 or more and the cat likely has CHF and needs another dose of diuretic if you have it, or a trip to the vet or ER vet. What I like to do is count the rate; let the cat sit for a minute; then count again. Is the rate increasing? Slowing? Staying the same? Try again. Then decide.

Normal cats have a fluctuating rate while at rest, watching birds, listening to noise, preparing to eat, etc. But normal cats can have a sustained rate and tolerate it because it will decline. But HCM cats don't have that luxury because it likely indicates CHF. What is CHF? Congestive heart failure-when the heart is too enlarged to take IN all of the blood/fluid circulating and the rest falls into the lungs. This is PULMONARY EDEMA and can only be gotten rid of with a DIURETIC like furosemide. The other issue can be PLEURAL EFFUSION when fluid builds up AROUND the lungs. This can only be gotten rid of with a needle extraction by the vet AND a diuretic.

Both conditions of CHF will also need oxygen from the vet. WHY? Because fluid in the lungs prevents the blood that passes from the heart INTO the lungs from getting oxygen from the lungs and moving on to the brain, organs, body, etc. This leads to a decrease in organ function, a decrease in the body's ability to handle the disease or to properly function.

CHF is also a DROWNING IN THE LUNGS, when a cat cannot breathe, not simply a cold or simple congestion as humans can get. (Humans can die of CHF but often humans think of CHF in cats/dogs as a cold. It is not.)

If you have diuretic on hand, if the cat is on a regular dose (typically it calls for a maintenance dose of 2.5-5mg twice or more a day as needed for example) you should give the cat another dose if you suspect CHF. 2.5-5 is a good start. Wait about 20 minutes for it to kick in and continue to monitor. Don't hesitate to go to the vet/ER vet for oxygen and injected diuretic if the cat does not improve. Time is of the essence.

AND since it's winter and recently severely cold, remember to keep your cats inside; keep them warm, not hot; keep them out of opened windows even if it is warm where you are. Too much cold or humidity (and windows get a lot of cold air blasting through, or the sun overheating them) can bring on CHF. Stress-noise, car rides, visitors, construction noise-can cause stress. Try to keep them calm and remove them from the stress if possible (another room?) or monitor as always.

If your cat is not already on diuretics, ask the vet why and ask for a prescription so that you have them on hand when the time comes. You want to stay AHEAD of the issue, not try to fight it AFTER it has arrived. Katharine-our latest HCM-is not on them yet but I do have new pills on hand just in case.

Good luck!

Bette: tail straight up, jumping up and running around since her post Christmas/January illness. We are titrating down the steroid and will continue to monitor in case it returns.