Overall Primer on Cats and HCM

From a discussion with a reader and a good reminder for us all:

Your cat will need to see a cardiologist and you will depend on the cardio for guidance about most of the regular care of the cat. Shots, other wellness issues-the regular vet. But you'll need to coordinate care between the two. Always have copies of cardio visit sent to vet; and regular vet info sent to cardio. The cardio should be consulted before any annual shots are given to make sure he's up to it. The cardio should be consulted for any contraindications with any other meds the regular vet wants to give. The regular vet needs to know how is the cat doing and what meds the cat is on from the cardio and what issues to look for.

*DO NOT allow your cat to be given steroids at any time-pill, injection, or asthma meds as these cause complications with heart disease cats. They retain fluid and that is not what the cat needs. For all other issues, stick only to antibiotics. If desperately needed for an illness, must consult with cardio first.

Keep copies of all visits and test results. You'll need to refer to them, be up to date, for all visits with any vet. Keep a notebook about how your cat is doing and any issues or concerns you need to address with the vet.

Get organized for cat care. File box, files, pill cutter, pill containers, frig boxes on counter or in frig or pantry to contain meds, supplies, supplements, pills, etc. will make care faster and more organized space wise. Nothing rolling around and bouncing around. And that will keep you calmer. As your needs grow for more things for the cat, so will your need to organize it. Find what works for you.

Did he have an echo? That is the only sure way to tell if and what type of heart disease he has and how it is progressing. He should have one every 3-5 months depending on how he is doing; is he seeing an actual cardiologist? He should as that is the expert. He'll need an echo every time he ends up in the ER.

He should have blood work done every 3 or so months and always before he sees the cardiologist so that the cardio knows how the body is responding to heart meds.

Meds-Atenolol is a beta blocker to lower heart rate and to help lower blood pressure. He should have only about a 1/4 tab a day. Maybe later twice a day as the disease and heart worsen. Too much, and the rate is too low, he will be weak. Plavix-only needs 1/4 pill once a day. Maybe later twice a day. And maybe later also add in aspirin. (Aspirin is difficult as cats do not tolerate it well. But you'll use a buffered 80 mg every three days and no more often than that. It might cause gastro upset but in progressive HCM adding aspirin can be beneficial to preventing clots along with Plavix. We gave it on Wednesdays and Saturdays.) He should also be on Enalapril, an ACE inhibitor. It helps to reduce body's retention of sodium, therefore of water; and it keeps veins opened in case of a heart attack. There are other drugs he may need: Sprionolactone-a mild diuretic that helps save potassium; Isosorbide-to lower blood pressure but it changes the load on the heart (I can't recall exactly how it works, only know that Myrna was on it late in life.) There are other diuretics such as Torsemide to use later if needed.

The major med to use is a diuretic like lasix/furosemide. Talk to your vet now about getting this. A daily maintenance dose of 5mg will keep away congestion. Congestion in the lungs is an inability to breathe and get oxygen to the brain/body, making one weak. It is also painful as it feels as if one is drowning. It's not simply a cold as we think of it for humans. As congestion pops up, he'll need more of a dosage and more often during the day. The amount and number of doses will increase as the need increases.

You are treating not only the heart but the entire body. The heart disease will effect his liver and kidneys. Meds will also. You must be aware of needs for the entire body. He will need a good overall cat vitamin paste. He will need extra potassium when on lasix. We use Renal K gel and powder. As the disease progressed for Myrna, I also used Sundown potassium pills. She was near the end on mega doses of potassium. I also gave her kidney support goop and how I administered it changed over time. First, in her food; then she needed it by mouth via a syringe. I mixed up COQ10, vitamin C, E, Renal K powder, etc. with baby sweet potato (source of potassium) in a small dish, and gave her 3ml 2-3 times a day as the disease progressed. Then I added Nature Made iron pills cut into halves and gave them by mouth about twice a day. Iron is necessary for the production of red cells which the kidneys need. It was complicated because it caused gastro upset and I had to adjust the dose as needed. But her kidney values remained stable for the last year of her life after increasing. You can read more about it at the blog under the Med tab.

As the lasix works to get rid of fluid, the cat will drink a lot of water. The cat will at times become dehydrated. You must keep up the hydration. Lots of water bowls, add water to wet food, more wet food than dry. While the heart does not need liquid, the body does. It seems contrary but water is necessary for the overall health and particularly kidney function. As the lasix works, electrolytes will become depleted. That's why you will need the extra potassium. If the cat is not eating well, he will need some extra glucose. The cat won't need extra sodium and does not really need a salt free diet as the lasix is already getting rid of salt. But do cut back on treats and avoid crackers/chips, and table foods.

There may be times he won't eat and you'll need to feed by hand. That can be discussed later but you can read about it at the blog. I have many tricks and methods to suggest.

Learn to monitor the cat and how it is breathing and walking. If you see the cat lethargic, not interested in getting up or eating, go to the vet or cardio. If the cat has cold paws front OR back, go to the cardio or vet ER immediately. If the cat is lame, dragging a leg or legs, or is falling over, go to the vet ER or cardio immediately. If the cat vomits a lot and doesn't get up, go to the vet ER or regular vet immediately. If the cat is laying down and breathing hard and doesn't get up, the cat could be in CHF-congestive heart failure, or having a heart attack. Go to the vet ER or cardio immediately for care. If the cat isn't eating, but seems fine, skip the vet for now and read in the blog how to feed and what to feed by hand.

Learn to count the breathing to monitor for CHF or other heart issues-one up and down chest movement is one count. How many of those in 15 seconds? 6-10 is fine. 12 or more and the cat may need the ER. A cat's breathing fluctuates during any given time from really slow to really fast. But sustained, heavy breathing-not panting, not opened mouth-is an indication that something is wrong. Count the breaths and if you think it's high, count again after a few minutes of the cat being still. If you have a diuretic that you are giving, and you think it's breathing fast, give an extra 2-5mg of diuretic and see if the cat responds within an hour. If the cat does, then he's in CHF but responding and you can give more 2-5mg of extra lasix in four hours. But if the cat seems really bad off, meds also don't help, then rush him to the vet ER or cardio for oxygen and injected lasix and monitoring.

Find the closest cardio, regular vet, and one or two dependable ER or 24/7 animal hospital to have on hand to go to anytime you need the vet.

You can order a lot of supplements at Amazon, Entirely Pet, 1800PetMeds. Sundown potassium and Nature Made products are at the local stores. But shop for lowest prices-Kroger often has buy one/one free; Target has low prices.

And as for the meds, these should be available at the local human pharmacy. They are often cheaper than those from the vet. Kroger and Target had $4.00 generics and have lower prices on many of the meds you are using. Shop around as things change. Avoid Walgreens/CVS which are expensive.

There is a lot of information at the blog in tabs, categories, and as a word search you might find helpful.

But please do continue to feel free to discuss your cat with me and how you are doing. I'm here to help.

Good luck!

Steroids for IBD-Katharine Doing Better

Katharine seems to be doing better on a longer course of steroids. We did ten days of two; then five of one; then every other day of one; now every other day of 1/2 for five days; then we will do 1/4 every three days until the supply runs out. Meanwhile, despite less steroids, she is eating well. The first time this summer when we did steroids for IBD, she didn't eat as much as soon as we stopped giving the med twice a day; and then stopped altogether when we finished the course. And she's gained weight-back on a diet! She's 11.6 up from 10 lbs in June.

Baby Develops UTI; Katharine Update

Baby-who was perfectly fine this weekend and earlier this week-suddenly developed a UTI. Now on antibiotics and was on a touch more pain med than what she receives daily. She typically receives .15 Buprenex to prevent inflammation and the sudden onset of cystitis. She went to the vet yesterday and three hours after a course of antibiotics, she was already improving. It began Tuesday night when she had trouble passing urine and a bowel movement. Not sure which came first but she tried to do both for a few hours. I gave her more pain med at bedtime (she receives .15 BID-twice a day) and this calmed her down and made things less urgent. But she was still having trouble passing either. I got up with her twice in the middle of the night and scooped the litter box which had many dime size amounts of urine and some fecal matter. Eventually, she produced a half dollar size urine but paper thin in the litter. Today, she is back to large balls of litter (we use clumping litter.) She is on antibiotics for a week. Will retest urine in two.

The vet gave sub q fluids-necessary to help hydrate the body, fill the bladder to help flush out bacteria and crystals (if present); did a CBC/chem panel-all is well; and gave the antibiotics Zeniquin and a probiotic pill Proviable.

Katharine is doing well on steroids for IBD and is eating well on her own. We'll see how she does as we titrate down the dose.

Vitamin D for a Sick Cat; Too Much May Be Toxic-Proceed With Caution

The vet recommended a vitamin D blood test (last week during the scan) and the result came back that the level is very low. She recommends a supplement. PROBLEMS: too much and it's toxic. Giving too much of a supplement and causing toxicity would be easy since cats do not need that much vitamin D to increase their levels unless they were not eating or absorbing nutrients. In Katharine's case, she has IBD so her body was not absorbing nutrients effectively. She also was not eating well and not at all a few days prior to the test (although we were hand feeding her.) So, her level may have been temporarily low anyway. We will try it for a few days-next week as the vet needs to order it. I will give very little and we will retest her level in a month. She's eating better on her own so I'm expecting the level to improve.

Here's an article about vitamin D and cats. 

Katharine Struggles to Eat on Liquid Phenobarbital-Trip to Vet for Scan and Meds

Katharine update since 7/11: she had been eating well enough once I cut a small amount off of the phenobarbital pill half that she received in the morning. She ate well enough for a week. We had to hand feed in the evening but she did eat some in the evening. She had not lost weight during this time. But then 7/13, we switched to liquid pheno. Since I couldn't accurately cut the pills in half (not scored, easily fell apart) I never knew how much more or less of 7.5mg per dose she actually received. The liquid version was supposed to help us figure this out, titrate down as needed, and track efficacy. But she immediately lost her appetite. The script was 7.5mg/1ml-one dose was one ML liquid pheno. To decrease the dose, I began giving her .95, then .90, then .85, then .80. She would not eat. We had to keep hand feeding her. The goal was 150 calories a day which was difficult to do just because it required multiple feedings of 21 ml or more per feeding. Each ml was approx. one calorie.

Her gastro scan was already scheduled and that was this past Thursday. She's fine. No liver damage or disease; still no pancreatitis. But her small intestine, the mucosa, is a bit more thickened since May's scan. They suspect IBD-irritable bowel syndrome-because all blood work is normal, and there are no signs of disease or cancer. She is to ONLY eat hypo food-rabbit, venison, duck-and NO fish based foods. She is on steroids for a few weeks (which are tapered down over time.) She received a B12 shot and will receive them every 2 weeks until late August. (They sent the supplies home, expecting me to administer the shot since I learned how to give shots sub q when I had to inject lasix into Myrna. I declined to do this with KH and will take her back to the vet for each shot. I'm not up to it frankly and since it's not life saving such as lasix, it's not something I MUST do.) While she could take by mouth, vitamin B12, since she has IBD, she may not absorb the needed amount, so hence the shots. They also tested her vitamin D levels which-just like with humans-if low, creates all sorts of issues (I have been low on iron and vitamin D and both caused the same symptoms for me: muscle aches and weakness, inability to breathe/move, feeling as if a major disease is attacking your nerves, etc. I take supplements for both.)

I also switched back to pheno pills in case the liquid version has put off her appetite. By shaving a bit off the end, she returned to eating-but after beginning steroids (which can increase appetite) and receiving the B12 shot. She's not eating enough and we continue to hand feed as necessary. She has lost 3 oz. since last week and is down to a bony 10 lbs. So, we must make sure she reaches her caloric daily goals. We will try the pills for a few days, then switch back to the liquid version and see how she responds. If she looses her appetite again, then I'll have the pharmacy redo the formula.

Cure for Cat Car Sickness/Vomiting in the Car

Solution to no vomiting on the way to the vet: I finally hit on a plan to prevent Roxanne from vomiting in the car on the way to the vet. And I don't know why I didn't think of part of the solution beforehand. She vomits in the car regardless of duration of trip or if I give her Cerenia before we leave. So, it occurred to me today that perhaps if she ate very little in the morning and didn't eat at all for two hours before departure, that she wouldn't have food in her stomach to vomit. AND since giving Katharine Pepcid to stop stomach acid, I thought I would give it to Rox to see if that helped. Perhaps nerves creates acid; perhaps acid creates nausea; and nausea leads to vomiting. I gave Pepcid yesterday and this morning and 1/8 more before we left. I gave Cerenia before we left. And it worked. She only vomited up some foam. But she was calm on the way there and while there.

She saw the cardiologist today and all is well. No disease signs at all. So, she does not need to return annually. I will take her back if she needs dental or other surgery (which I hope we avoid) or if there are signs or other illnesses that require a full check-up.

Katharine's Appetite Improves with Less Phenobarbital

Today Katharine ate on her own all day long. And she has eaten nothing but AD in a bowl. And she demanded food every hour. By 3 p.m. she had had 115 calories. We weighed her last night and she's at 10.4, up one ounce from 7/3. So,no weight loss which is good. And maybe she only needs about 165 calories a day. She hasn't eaten since 3 and may need hand feeding a bit or maybe she'll eat again on her own. But titrating down the pheno seems to help her eat.

We had her pheno compounded but I think the vet got the script wrong. I'll call the pharmacist tomorrow first. We want to titrate down one dose and make the evening dose a regular 7.5mg dose. She receives a total of 15mg a day. The script compounded says 7.5mg/1ml-7.5mg is in one ML of concentration. That means one dose is 1ml which is a lot to syringe up and try to give her. That also means the TOTAL for the day is 2ml. If it were 15mg/1ml then I could easily give .5ml per dose and titrate down as needed. I need to use a syringe with hundredths measurements which I have but which is hard to read accurately and we are aiming for accuracy. We need to give the exact dose each time so that we can see how it affects her appetite as well as monitor for efficacy for seizure control. This should be more accurate than trying to cut pills that are not scored and that shatter easily.

However, the really confusing part is the script label says to give .9ml per dose. That would only be 13mg total instead of 15mg (.9+.9=1.80ml instead of 2ml.) That would really decrease her pheno which might be dangerous.