HCM Cats Need to Drink a lot of Water

Your HCM cat on diuretics will need to drink a lot of water, and will want to drink a lot of water. You should provide more than one bowl, and maybe one large bowl where they normally drink and a smaller one where they spend a lot of time (bedroom for example.) Your cat on diuretics will be urinating often. You should increase the litter boxes and think about adding one where it's most convenient such as a bedroom. The boxes will need to be scooped often so that the cat is comfortable using the box. If the cat is not drinking enough, try bottled water (gallon jugs are less expensive than individual bottles) for a fresher taste. If the cat isn't drinking enough, gently give the cat 3-6ml of water by mouth every 3 hours over the course of a day; add water to the wet food for an additional source.

Cat Care-Take Notes, Get Notes, Share Notes with All Vets

Cat care-always take notes at the vet; always get copies of results and findings and blood work; keep a file-you'll need one in which to keep records, in order by date. Your regular vet may be the primary for now but you'll need to always consult with the vet cardiologist for any other meds not prescribed by the cardio or for the heart or any procedures the regular vet suggests (for example, HCM cats cannot usually survive surgery and should NEVER take steroid based medications or inhalers for example). 

But as the heart disease progresses, you may find that you'll need to see the cardiologist more often, at which point, the cardio becomes the primary care vet (although they typically don't do vaccines.) The cardio will check pulse, breathing, heart rate, look at eyes and ears and mouth-they look for any signs of any other disease and dehydration and any other heart related issues that show up in other parts of the body (lack of oxygen, blood, poor circulation, etc.) 

AND always make sure the cardio gets the regular vet's paperwork; and that the regular vet gets sent copies from the cardio or any other vet your cat sees. If your cat goes to the ER, have them send copies to both the cardio and the regular vet and give you copies as well. Vets should consult each other when seeing your cat if they have any questions about care. It helps them review for continued care, to review for any complications or to figure out next steps. It helps to keep track of when were last blood tests and results, if certain procedures or tests were done and when. 

We always made sure Myrna's cardio and vet had the same records. And having them yourself, just helps you learn more. And the more you know, the better the care will be that you give.

Feeding a Sick Cat or a Cat That Won't Eat Enough-Some Helpful Guides

Trouble feeding the cat? If you are having trouble feeding your cat or it won't eat enough, one method (of many I've posted about before) is to use kitten formula. You can buy it dry or in cans. You mix the dry with water per instructions. You can syringe feed it by mouth. It has many nutrients that your cat needs. It's a good supplement. Add some corn syrup to boost the energy (1/8 tsp per 3oz fluid.) 

You could also try adding this mixture to the wet food if the cat is eating something.

To determine if the cat is eating enough, consuming enough calories, measure the amount served vs. the amount left over. Determine the calories for each typical serving. Measure what is not eaten and determine the calories of what is left over. We did this with Cooper in 2014 when his weight suddenly dropped (due to heart disease.) Cooper pushed his food around and it always seemed that he ate well but was losing weight. But once I measured what was served vs. what was left on the plate, I realized that he ate only 1/4 of his food. That led to us doing multiple feedings so that he ate every 2 hours (of course I was home so it was simple to do.) But we were able to sustain his weight.

A normal cat should consume about 240 calories a day. When you determine what little your cat may be eating, that 240 number will seem like a daunting task. But if you add up every little calories-and you'll need to write it all down to track it-you will eventually get there. Some days with Cooper, we were lucky to hit 200 but most days we hit 220.

Every 3ml syringe of sweet potato or condensed milk or tuna juice has about 15 calories. Every tablespoon of wet food may only have about 20-30 calories. Every 15 treats may be another 25 or so calories.

Links are below to help you determine calories per serving, and help you figure out measurements. Good luck!

Here's the link for wet food 5 oz cans.

http://www.petobesityprevention.org/…/Cat_Canned_Pouch_Food…

Measurement guide:

https://www.exploratorium.edu/coo…/convert/measurements.html

Dry food calories per cup are listed below. 

www.petobesityprevention.org

PETOBESITYPREVENTION.ORG

COQ10 Necessary for Heart Health but Use with Caution

COQ10-Necessary but Use Cautiously and Watch for Interactions with Other Meds

A question came up about COQ10. This is a substance found in the body and necessary for heart function. It is believed one should take a supplement in order to provide the heart with more of the substance to improve heart function, and because some meds may interfere with the body's use of COQ10. 

We gave it to Myrna beginning in 2010 and within weeks, her heart size deceased by some tenths and she seemed healthier in general. I would pierce and squeeze and mix a 100mg into her food once a day. As of 2014, I added it to her kidney support vitamin mixture. 

I don't know if it ever interfered with her meds. Her blood sugar was normal. Her blood pressure was only influenced by her heart attack in 2013 (three years after being on COQ10 and Plavix at the same time.) I believe Pepcid which she was on since September, may have interfered with Plavix (which unfortunately we had to give due to the stomach acid I was not able to control with other things such as bicarb/club soda or vinegar) because of the numerous clots she experienced this past year. 

Some articles such as this Mayo Clinic article states that COQ10 may interfere with every medication on earth. And yet articles such as the Wikipedia post state that there is a need for supplementation of COQ10. I believe in giving it and highly recommend it. We use Nature Made. 

Begin with 50-100mg per day and watch your cat for any negative interactions which you may see in blood work or in heart rate or blood pressure. Always proceed with caution with anything that you give. After all, even electrolytes-natural and necessary for any body-can be too high or too low and cause negative interactions or changes in the body. 

Wikipedia link

Mayo Clinic link

Cats on Heart Meds Need Potassium and Iron Supplements

If you read the other Facebook page "Cats with HCM" you'll be more up to date than this page.  Since Cooper died August, 2014, there isn't much to post although I post from time to time information that might be useful.

For example, our HCM cat Myrna at "Cats with HCM" has been on iron supplements since April to improve kidney function because her diuretic needs to be increased due to congestion and her BUN and creatinine were creeping up.  Her kidney function has improved dramatically as shown in the kidney values so I highly recommend that you give your cat iron if it is on high levels of diuretic and/or the BUN and creatinine are creeping up.  We give Nature Made and use the 65mg tabs and give three 1/2 tabs a day.  Start with one 1/2 tab and increase to two 1/2 tabs and up to three a day if needed. It may lead to dark stool which is normal or diarrhea.  If the diarrhea isn't severe (more than once or twice a day) and doesn't prevent the cat from feeling well, then continue the iron.  But if you are concerned, cut back to one or two 1/2 tabs.   Why? Because iron makes red blood cells which the kidneys need to better process the diuretic to help the med get rid of congestion.  The body needs it to make oxygen which keeps the cat breathing well, keeps up the blood pressure (to normal levels), which keeps muscles strong and nerves in the body (heart, kidney, etc.) functioning better.  Even if the cat has "normal" iron blood levels, this is essential and we have seen great success with Myrna.


Don't forget to give a potassium supplement if the cat's on a diuretic even if the potassium blood level is "normal".  If it's below 5 on the blood test, give it. We use Sundown 595mg and break them in half.  How much depends on how low is the potassium.  Myrna from the other page, began with two tabs a day but is now taking 3000mg of potassium a day (per the label not the actual amount.)

Feline Moderator Band Cardiomyopathy Use of Rutin and Torsemide and the Need for Increased Potassium

If your cat has Moderator Bands, and/or pleural effusion-which requires constant needle aspiration to withdraw fluid from around the lungs, there are two things you should try: switch from lasix to torsemide. It's stronger, works faster on pleural effusion than lasix and theoretically requires less mg per volume than lasix. Extra potassium is needed as torsemide can deplete potassium and other electrolytes. Potassium is necessary for kidney function. Use Gerber baby food sweet potato (highest food source for potassium) and Tumil-K and Sundown Potassium (or another regular source but we use and like this product.) The other thing is rutin. Ask your vet if white fluid comes out when fluid is withdrawn from around the lungs with the needle. This is lymphatic fluid and can cause scar tissue or fibrosis to form in the lungs, creating pockets for fluid to sit (and impossible to withdraw) and the fibrosis makes breathing painful and difficult. We are using rutin from Whole Foods. We give 750mg daily-divided up over four times a day. We have used this for a month and so far, scar tissue hasn't formed.

The Necropsy on Cooper's Feline Moderator Band Cardiomyopathy Heart

We received the necropsy in September of Cooper's (who died August 2014) kidneys and heart we donated for research to MSU.

From the notes:

"...within the left ventricle of the heart there are excessive amounts of loose fibrous connective tissue lined by endothelium that span the interventricular septum to the left ventricular free wall and papillary muscles.  Subgrossly, sections of kidney have mild undulation of the capsular surface, with mild interstitial fibrosis of the subjacent cortical parenchyma.  Glomeruli have mild diffuse membranous glomerulonephropathy and there is multifocal thickening of basement membranes of Bowman's capsule, proximal convoluted tubules, and vessels. Proximal tubular epithelial cells are swollen with finely vacuolated cytoplasm and occasionally faded nuclei. There are mild, multifocal lymphoplasmacytic interstitial infiltrates.  Gross examination of the heart finds excessive number of small, fine moderator bands towards the apex of the heart, extending from papillary muscles to the interventricular septum. There is an increased amount of white fibrous connective tissue along the endocardial surface of the left ventricle. Excessive moderator bands are considered under the heading of cardiomyopathies although it is considered a congenital defect that manifests later in life.  In this case, these moderator bands are visible grossly and histologically within the distal apex of the left ventricle.  The kidney lesions  suggest a mild nephritis of some chronicity, and these changes, in conjunction with reduced cardiac output and therapies to enhance diuresis in the animal, likely contributed to the reported azotemia prior to death."


Definitions: I tried to find definitions and explanations for what the notes mean.  These are not the best but this is what the above refers to.  Basically, damage was done to the kidneys, preventing them from processing the diuretic properly. The diuresis process could not keep congestion from the lungs.  In addition, of course, were the complications of the heart disease.  We believe he needed more potassium and supplements for kidney support while in the ER and every day.  There had been a slight improvement in his kidney values prior to his death but we only had had a month when we were giving extra supplements.  Given more time, I think we could have helped his kidneys improve their function and the diuresis process.  We see it working currently for Myrna, who, despite now on Torsemide, has normal kidney values (see  blog "Cat Living with Hypertrophic Cardiomyopathy", January 2015 posts):

Left ventricle-The left ventricle is one of four chambers of the heart. It is located in the bottom left portion of the heart below the left atrium, separated by the mitral valve. The thickest of all the chambers, the left ventricle pumps oxygenated blood to tissues all over the body. After flowing into the left atrium and through the mitral valve, blood enters the left ventricle before it is pumped out through the aortic valve into the aortic arch and onward to the rest of the body.

fibrous connective tissue- bands of tissue in the heart that normally serve a purpose

endothelium-thin layer of simple squamous cells that lines the interior surface of blood vessels and lymphatic vessels forming an interface between circulating blood or lymph in the lumen and the rest of the vessel wall.

interventricular septum-is the stout wall separating the lower chambers (the ventricles) of the heart from one another.

left ventricular free wall-The left ventricle free wall is composed of the area of the left ventricular wall not in contact with the interventricular septum and is not part of the apex.
papillary muscles-muscles located in the ventricles of the heart. They attach to the cusps of the atrioventricular valves (a.k.a. the mitral and tricuspid valves) via the chordae tendineae and contract to prevent inversion or prolapse of these valves on systole (or ventricular contraction).

undulation-marks that appear on the surface of the kidneys that appear to be up and down

capsular surface-thin membranous sheath that covers the outer surface of each kidney. The capsule is composed of tough fibres, chiefly collagen and elastin (fibrous proteins), that help to support the kidney mass and protect the vital tissue from injury.

interstitial fibrosis- characterized by the destruction of renal tubules and interstitial capillaries as well as by the accumulation of extracellular matrix proteins. The severity of tubulointerstitial fibrosis has long been considered as a crucial determinant of progressive renal injury in both human and experimental glomerulonephritis.

subjacent cortical parenchyma-The parenchyma are the functional parts of an organ in the body. This is in contrast to the stroma, which refers to the structural tissue of organs, namely, the connective tissues.

glomeruli- A tuft of capillaries situated within a Bowman's capsule at the end of a renal tubule in the vertebrate kidney that filters wasteproducts from the blood and thus initiates urine formation.

glomerulonephropathy-any noninflammatory disease of the renal glomeruli.

Bowman's capsule-a cup-like sac at the beginning of the tubular component of a nephron in the mammalian kidney that performs the first step in the filtration of blood to form urine.

proximal convoluted tubules and vessels-is the portion of the duct system of the nephron of the kidney which leads from Bowman's capsule to the loop of Henle.

Proximal tubular epithelial cells-Epithelium is one of the four basic types of animal tissue

vacuolated cytoplasm-A membrane bound organelle in the cytoplasm of most cells, especially plant cells, containing water and dissolved substances suchas salts, sugars, enzymes, and amino acids.

faded nuclei-nucleus or nuculeus, meaning kernel) is a membrane-enclosedorganelle found in eukaryotic cells. It contains most of the cell's genetic material, organized as multiple long linearDNA molecules in complex with a large variety of proteins, such as histones, to form chromosomes. The genes within these chromosomes are the cell's nuclear genome. The function of the nucleus is to maintain the integrity of these genes and to control the activities of the cell by regulating gene expression—the nucleus is, therefore, the control center of the cell. 

lymphoplasmacytic interstitial infiltrates-of, relating to, or consisting of lymphocytes and plasma cells.  Interstitial Infiltrates occur within the connective tissue surrounding the air spaces.


papillary muscles- muscles located in the ventricles of the heart. They attach to the cusps of the atrioventricular valves (a.k.a. the mitral and tricuspid valves) via the chordae tendineae and contract to prevent inversion or prolapse of these valves on systole (or ventricular contraction).

interventricular septum-stout wall separating the lower chambers (the ventricles) of the heart from one another.

endocardial surface of the left ventricle-endocardium is the innermost layer of tissue that lines the chambers of the heart. Its cells are embryologically and biologicallysimilar to the endothelial cells that line blood vessels. The endocardium also provides protection to the valves and heart chamber