Katharine's Health History Since November and Possible Causes

Presents with:

• Inability to eat enough on her own.

• Physical weakness, inability to climb without stumbling.

• Sometimes shaky after taking Mirtazapine-drug interaction? Low glucose/pot; hyper/hypo? 

• Exhibits leg and facial twitching.

• Mirtazapine no longer has the anxious/eating affect; does not cause her to want to eat; not acting long term for three days.

• Mirtazapine didn’t work well with Benazepril or Gaba or Cerenia to help her eat. Was made weak         on benazepril; improved after ceasing.

• Became weak on gabapentin. Improved after ceasing.

Contraindications that may cause issues for Katharine:

• Gabapentin is contraindicated to Mirtazapine. Made her weak, not eat?

• Gaba is contra to phenobarbital. Made her weak? (Side effect for humans-weak, disorientated, etc.)

• Mirt is an antidepressant. Made her weak?

• Mirt-processed in liver/renal. Can cause ALT elevations, hepatic injury. She has had increased levels this past year.

• Mirtazapine and Cerenia do not work well together for her. Cannot be given the same day.

• Antihistamines contra to phenobarbital.

• Steroids interact with phenobarbital.

• Chronic use of Mirtazapine drives up phenobarbital levels-we saw this in her blood count in December. We saw a decline when we ceased Mirtazapine in January after a month of not taking it. 

History October-December 2023:

September

• Weight September at home-10.2 ½ 

• 9/13/23 cardio exam showed heart disease increased to 1.76. Put on Benezapril and Plavix. 

• But that made her weak immediately. She stopped eating as much. 

October

• Not eating became worse in October. Weight down 10/4/23 to 9.12 at vet.

• By 10/9/23 noticed that Mirtazapine is not making her eat as much, does not have the same effect. 

• Feeding more AD by hand 10/16/23 at 6-9 ml twice a day. 

• Cardio said to cut Benz to once a day 10/16/23. 

• 10/19/23 Mirt began not working well at all. Effect lasted about two hours. 

• She was appearing weaker, unable to stand straight and walk, and seemed tired and uncomfortable. 

• 10/20/23 cardio said to give her Atenolol BID and stop Benz. 

• Began feeding AD three times a day at 9 ml. each time. 

• Tried Cerenia and Mirt together not working well. Better when we alternate days. 

• She has trouble climbing and stumbles on stairs, and struggles with cat tree. 

• Begins to exhibit shakiness and twitching in body and head. Front legs begin to slide around when she sits and stands. 

• 10/22/23. Eating very little on her own at this point. 

• Finally by 10/26/23 she responds well to Mirt and eats well on own. Hand feed evenings only. 

• 10/27/23 weight is 9.12. 

• 10/30-31 eats on own, hand feed 9ml AD evening only.

November

• By 11/3/23 Mirt is working as normal-she eats all day long, and appears to eat all week well enough. Continue hand feeding AD evening.

• 11/11/23 weight still 9.12.  Continues through the month. 

• She is stable enough physically but not strong. 

December

• 12/3/23 wonder if lack of strength is reaction to arthritis and if should start gabapentin as previously discussed. 

• Began gaba 12/3/23 at .1ml of 50mg/ml strength. She appears to walk stronger and to stand straighter with it after receiving it in the morning. She begins to spend each day playing with catnip toys and rolling around. 

• But slowly over time, this decreases. By 12/13/23 she is appearing weak, tired, run down again. Not eating as much. Stops playing with toys, not as vocal or alert. Mirtazapine isn't working with gaba.

• Stopped gaba 12/15/23. 

• 12/16/23 weight down to 9.9. 

• 12/17/23 too weak to climb cat tree. Can’t climb shorter towers. Is very weak. Won’t eat. Not vocal. Shaky. Twitching more. Checked heart rate-150; BR seemed normal. 

• 12/19 Added corn syrup to AD to combat weakness and twitching-thought low on glucose. Increased potassium a bit more (Renal K gel.) Adding glucose seemed to backfire (sign of pancreatitis?) She was even weaker and would not eat anything. 

• Reviewed Dr. Miller’s October scan report and read about pancreatitis. Discovered it could be her liver and/or pancreatitis that is flaring up. 

• 12/20/23 began ½ Cerenia each day. 

• Asked for Hills ID from Cat Clinic and began hand feeding her that 9ml three times a day. Also fed her tunajuice 9ml three times a day. Tried to get her to eat tunafish. 

• Added taurine pills. 

• By 12/21/23 began to nibble on tunafish on her own. Continued hand feeding ID and tunajuice. 

• *Noticed her face and eyes twitching as if she can’t close them and the lids are blinking rapidly. Her front legs twitch under her for a few minutes. 

• 12/23/23-12/27/23 each day wakes up perky, walking fast down the hall, eating food overnight, very vocal, able to climb pet stairs, regular stairs, and cat condo. Then after her morning meds, quiets down; after hand feeding quiets more; after eating breakfast-which she is eating more of on her own, she quiets even more. Appears weaker and more tired by the evening. Continue to hand feed ID and tunafish juice and tuna that she eats on her own. She began eating dry food and dry treats during this week, also. Has more twitching in the evening. Breathing rate appears higher in the evening-CHF or heart or response to weakness and not eating or to being hand fed?

• Is receiving Forta Flora. Did not eat the Visibiome probiotic or Biome food.

Weight 12/22/23 at home 9.5

• Saw Dr. Miller 12/28 ultrasound gastro scan; pheno too high at 37; decreased pheno to ½ tab.

-Is mirtazapine driving up pheno level? Studies shows it can.

• Continued hand feeding ID four times a day, letting her eat what she would. 

• Continued to be weak.

January

• 1/1 Still hand feeding ID; she’s not eating well enough on her own. 

• Continues to do well in the a.m. when she wakes, and to decline in energy as the day progresses.

• 1/3-used ear drops and eye drops-ears full of black wax. Used ten days until 1/14.

• 1/4 began 75mg magnesium and 25mg potassium extra daily in a.m.

• 1/5 her weight at home is 9.3 ½.

• 1/5 began baytril. Perked her up a bit.

• 1/7 began cypro ¼ and she began to eat some on her own. Ate Fancy Feast and tuna.

• 1/8-1/10 She continues to be hand fed but begins to eat more on her own. More perky and alert also. Eats Fancy Feast and tuna.

• 1/10 weight at home is 9.5 

• 1/11 Sees cardio, heart is fine, not related to issues of inappetence. She does not eat when she gets home. Declines to eat on her own. We increase feeding PO of ID. 

• 1/11-14 We hand feed ID and offer tuna but not Fancy Feast. 

• 1/15 She perks up and begins to eat some Fancy Feast on her own and we feed ID.

• 1/16 Not eating well on her own, only a few bites of dry food and tuna. We continue to hand feed.

• 1/17 sees vet for tests: PLI, cbc/chem, bile acids, pheno. Pheno level down to 14 now that she's off mirtazapine-need to increase pheno again. RBC low, liver values high, kidney values creeping up, etc. 
•  She seems to do well with Hills ID and tuna; then begins to eat more food on her own of Fancy Feast and dry gastro fiber food; then goes into a decline. 
• Week of January 23 she was eating well on her own, stronger, playing with toys, able to climb and walk well. Seemed stable and that our schedule and process was working.
• Then she seizured Saturday January 27. Took her to the ER.

Possible causes of issues:

Her calcium is high.  Hypercalcemia can cause tremors and twitching. Inappetence. Increased thirst and urination.  Overall weakness. (Kidney stones, blockages.)

*These symptoms are also pancreatitis, heart disease, medications, high pheno, low pot, dehydration, lower calories/nutrition. 

-Caused by CKD, cancer, other issues, taking too much calc, parathyroid-leads to too much PTH. Addison’s disease-hypoaldost and low glucorticoids produced-lethargy, not eating (how to test?), caused by dehydration. (Aldosteronism)

It’s a loss of calcium in the bones, goes to blood stream, excreted by kidneys, lands in organs through blood. 

Test: Pth, PTHrp; aldosterone level, glucorticoids?

Steroids and furosemide help body not absorb calc. Helps kidneys excrete calc into urine. 

*Test urine for calcium? Would be high if more is excreted into urine?

Fiber-gastro response food helps to fight calcium buildup, and renal CD diet. 

Addisons: auto immune disorder, with low corticoids, with inappetence, weight loss, lethargy, dehydration; also shock, low blood pressure. Poses like IBD and CKD. 

-does she have abnormally small adrenal glands?

-needs mineralcorticoids and steroids.

Cushings: hyperadrenocorticism, with increased thirst and urination, poses as CKD, muscle wasting, enlarged liver BUT increased appetite. Similar signs to diabetes.

Hyperaldosteronism: adrenal disorder. Caused by tumor in adrenal gland. Also idiopathic. Causes CKD. Or is misdiagnosed as CKD. With muscle weakness, lethargy, HIGH BLOOD PRESSURE (as with CKD, heart disease), loss of appetite.

-test with test to MSU.

High anioin gap-is metabolic acidosis. This test is an indicator of your pet’s acid:base balance, its blood pH and its bicarbonate buffer blood reserves. It is critical that the acidity (pH) of your dog or cat’s body be kept within a very tight range by the continual presence of carbonate (=bicarbonate=HCO3-) in its blood and your pet’s kidney’s ability to discharge excess chloride into its urine while conserving bicarbonate.

-caused by CKD, diabetes, When your pet’s blood sugar levels are not under control, the end result is metabolic acidosis – in this case lactic acidosis and ketoacidosis – as those products build up in your pet’s blood stream. A similar effect occurs in starvation, a cause of ketoacidosis as well. Also, lack of blood flow and oxygen to the body-heart disease, etc. Also-kidney, urine stones, blockages, A deficiency in aldosterone, as occurs in Addison’s disease can also cause a mild increased in your pet’s anion gap.

Ketoacidosis is a metabolic state caused by uncontrolled production of ketone bodies that cause a metabolic acidosis. While ketosis refers to any elevation of blood ketones, ketoacidosis is a specific pathologic condition that results in changes in blood pH and requires medical attention. The most common cause of ketoacidosis is diabetic ketoacidosis but can also be caused by alcohol, medications, toxins, and rarely, starvation.

High ALP- The main use of ALP is as a sensitive indicator of cholestasis in the dog (it will increase before bilirubin), however it is non-specific because corticosteroids (exogenous or endogenous “stress”) induces production of this enzyme, with subsequent increases in serum or plasma activity. In the cat however, ALP is a specific indicator of liver disease, whereas in large animals, the enzyme is less useful as it is insensitive, cholestatic disorders are infrequent, and reference intervals are quite broad.

The major isoforms that can be measured in animals are liver-ALP (L-ALP), corticosteroid-ALP (C-ALP; only in dogs), bone-ALP (B-ALP) and intestinal-ALP (I-ALP), but there are others including leukocyte-ALP and placental-ALP.

• Although alkaline phosphatase is considered a “liver enzyme,” it is produced by other cells, too.

• Alkaline phosphatase levels can be affected by many things, including certain medications and a variety of illnesses.

Certain medications, such as steroids, can cause this level to increase. Additionally, a variety of medical conditions can affect the ALKP level.

Most of the conditions that affect this enzyme cause the blood level to become elevated. The following are a few conditions that cause an elevated ALKP level:

• Pancreatitis (inflammation of the pancreas)

• Gall bladder disease

• Hepatitis (inflammation of the liver)

• Liver failure

• Cancer affecting the liver or bones

• Hyperadrenocorticism (Cushing’s disease)

• Diabetes

• Toxic injury to the liver

High albumin- Albumin is a major protein in a cat’s body that originates in the liver. 

Diseases indicated by low levels of albumin are as follows:

• Chronic liver disease

• Inflammatory Bowel Disease

• Pancreatitis

• Pyothorax (an infection in a cat’s chest cavity)

Unlike low levels of albumin, high albumin in cats has been found to be much less of a cause for concern. This is because, while low levels of albumin indicate loss, high levels indicate overproduction.

The most common high albumin cause is dehydration in your cat or a diet that is abnormally high in protein. While both dehydration and improper nutrition are a cause for concern, both can be easily fixed, and neither indicates underlying disease on their own.

High calcium can drive down PTH-high calc tells body PTH isn’t needed unless there’s a disease of the parathyroid. 

- High calc binds to phos, lowering phos.

-Magnesium acts as a phos binder if given more than body needs-good if need to drive down phos. 

*She has low phos-anemia? 

-low phos means low bicarb, danger to kidneys/indicates CKD

- high glucose levels might also be interfering with this phosphorous levels. Poorly controlled blood sugar levels or diabetes, might not allow the body to absorb phosphorous. 

-low phos indicates diabetes and hepatic acidosis; can be due to not eating well, too much calc or magnesium.

Katharine Has Multiple Organ Issues

Katharine is currently in the ER as I write. (1/28/24). She has developed CKD, liver disease, pancreatitis, and IBD, and of course heart disease. IBD/pancreatitis has been chronic for the last few years and worsened this fall. Liver disease is more recent although one value has been high for the past year. CKD was first thought to be a result of heart disease but has suddenly worsened with the onset of severe liver/IBD/Pancreatitis. In the ER she has low temperature, low heart rate, low glucose, and high liver and kidney values. She may need to be transferred to the vet hospital if she cannot be stabilized to come home.  She had a major seizure yesterday afternoon-not grand mal as everyone thinks is normal. Her seizures have never been more than her spacing out and falling over, unable to walk. When she had break out spaciness in 2021, additional phenobarbital always corrected them. Then she had a larger one and didn't respond to more phenobarbital, so an ER visit with oxygen and fluids was required. We increased her phenobarbital afterwards and she has been seizure free for two and a half years. Yesterday, she seemed fine. She ate, walked, was vocal, etc. But as she drank from the water bowl, she began to space out for a few minutes (from video footage.) I was in the other room when I heard a noise. When I found her, she was on the floor struggling to get up and water was everywhere. I gave her extra phenobarbital twice and she did not respond and began open mouth, fast breathing which she had never done before. I took her to the ER and they put her on oxygen, ran tests. All we know so far, is what I described. 

I was thinking back to Myrna Loy, our first cat with HCM, and for whom this blog and Facebook page were created. As much as I struggled to take care of her for 6 years and 9 months, I now look back and see that it was EASY compared to the cat issues I have dealt with in the last few years-Baby and Bette and now Katharine-because she responded to everything I tried. The only thing that never worked was rutin for the accumulation of lymphatic fluid called chylothorax.  She was so sick those last few months, and I was concentrating on fighting those issues that I did not try many rutin options. But still, she had CKD but it was mild until the very end but never in failure even as she died-two days before her values were good. 

But Baby and Bette and now Katharine-it's been a juggling nightmare with competing issues. For Katharine we respond to what we see in test results and exams and at home: is she eating, not eating? We need to hand feed her how much? What can she eat that the liver and pancreas will tolerate? She needs some fat for her body and medicines and vitamins; but she needs little fat for the liver and pancreas. Which appetite stimulant works and which one upsets the pancreas and liver?  Does she have IBD and needs an antibiotic? She needs to watch her sugar for the pancreas (it's not as if she eats sweets) and watch her sodium for her heart and watch her calcium because it is creeping up, and take a potassium supplementation in a pill and Renal K powder and Renal K gel so that it is normal instead of below normal because her kidneys and heart need a good strong level. She drinks a lot-so her urine appears dilute; but her specific gravity is low and her SDMA is high indicating declining kidney function. Myrna's urine was dilute from taking high levels of diuretics and we worked hard to keep her hydrated with water by mouth and in food, and with meds and making sure she drank enough. But her SDMA was normal until the end, and her specific gravity was normal until the end. Katharine has tremors and shakiness-neurological, pharmaceutical, disease related? 

And of course she seemed normal on Saturday before the seizure. She had eaten, been vocal, was moving around. I thought she had spent the week improving and was more stable. She had been eating more and we had been hand feeding less. She was mobile more. Had been engaged in toys more. And was climbing cat trees again. But the seizure hit her hard. And they think it hit because the liver-which processes phenobarbital-is acting up and may not have processed the phenobarbital well. (They did begin an additional seizure medication topiramate. But it is contraindicated with liver and CKD and causes anemia so may not be well tolerated in the long term.) But other things are going on that are causing low body temperature and low glucose and higher kidney and liver values. 

But what exactly? And what would be the point of an MRI, CT, or biopsy-requiring anesthesia which she cannot tolerate due to heart disease, and may not tolerate due to her current health issues-to discover other causes if she is dying of a disease or cancer that cannot be cured or fought because she cannot undergo anesthesia for treatments, treatments which may not prolong her life, and face having anesthesia causing heart failure, which then leads to her death of heart failure. If she did not have heart disease, I would go forward with an MRI and biopsy if needed. I would fight. And I will fight. But our options are few. We had a plan. We had a schedule. It was working. She was stable. And then she wasn't. That is what is hard for me to fathom. We work with what we know but then the body actually has something lying beneath the surface that throws a wrench into our process and into her health. 

Updates Katharine and Roxanne and Elizabeth-Gastro, Meds, Weakness, Inappetence and More!

So much has been going on this past month. In early October, blood work was done on Katharine and Roxanne; then Katharine and Elizabeth had their annual updates where more blood work was taken and more issues arose.

Roxanne is still testing high for potassium or HYPERkalemia at 5.3 (with 4.9 being high normal.) What does that mean? We need to consider testing for possible hypoaldosteronism which is rare. It may also indicate Addison's disease or diabetes. And is connected to possible renal failure or decline. For now, monitor. We might consider giving her a diuretic if she continues to test for hyperkalemia. Symptoms may cause muscle weakness, nausea, heart palpitations, irregular heartbeat, and abnormal blood pressure.

If a cat has HYPERaldosteronism which produces HYPOkalemia, that could indicate cancer. And low potassium disrupts the body's function, leads to racing heart, weakness, etc.

She also tested POSITIVE AGAIN FOR FIV virus antibodies. The vet is checking to see if there is a test to test for the actual vaccine so that we can determine if she received the vax as a kitten or if she was exposed to the disease since 2017 (somehow despite no other cat in the house having FIV.) We will monitor her for active disease and try to make sure she does not fight or bite or get bitten by any of our other cats.

Katharine developed weakness and inappetence after taking an ACE inhibitor Benazepril for two weeks-she began in mid September. Mirtazapine did not work to spur her appetite. She began losing weight. While her weight was fine around 9.12 or 9.14, when it fell in early October after one week to 9.7 after we thought she was eating well enough, we had to begin feeding her by hand using the trusty 3ml plastic syringe method. (We give her 9ml of Hill's AD in the morning before breakfast, 9ml if she is not eating dinner, and 9ml at bedtime.) We concluded that somehow the Benazepril was prohibiting the absorption or interaction of the Mirtazapine, although there is no known contra-indication. 

When Katharine had her annual exam October 19, her heart was racing at 260 (normal should be 140 and no lower than 135 and no higher than 200.) Given her heart rate was high, the cardiologist said to give her Atenolol twice a day; given that she was weak, to pull the Benazepril and to check her heart rate in a week. She recommended that we buy and try a mobile EKG Kardia to monitor the heart rate at home. When we tried it, we got a laughingly low rate of 77-which would indicate she was near death. Given that she was up and about, eating, walking, alert, we knew it was wrong. We took her to the vet the next day and compared the in house heart rate reading to the Kardia device and both ran about 177.  This means the Atenolol at BID (twice a day) is working. But she does need an ACE inhibitor if it can be tolerated. We will try Enalpril sometime in the future and monitor.  Follow the link to purchase the device if interested. Follow this YouTube video for more information on how it works. It took until almost the end of October for Katharine to stop appearing weak; and it wasn't until this week 11/5/23 that Mirtazapine began working normally to spur her to eat.

We also noticed her breathing rate had increased. But it was difficult to get a true reading. So, in late September, her cardiologist said that it was ok for her to take furosemide once a day every day of  1/4 of a 12.5mg tablet (3mg approx.) Since the tablets were small and crumbled when cut, we changed over to the 20mg tablet, cut that into quarters, and shave off a bit more to reach the same 3-4mg dose. 

Because she wasn't feeling well at her annual exam, Katharine hasn't yet had her annual rabies shot so we will soon return for that.

She had her PLI/Cobalmine/Folate panel tested for pancreatitis and gastro issues and she has a high folate. These blood tests are to test for metabolic function. Specifically, folate is B12 and indicates malabsortive issues in cats (or humans.) If the cat cannot absorb nutrients, health issues develop. AND the inability points to issues in the gastro metabolic system which could be disease, irritation, infection, etc. This goes along with the gastro scan she had in early October that showed she had a "smouldering" pancreas, an issue developing. She is already on steroids. The vet suggested we had a different probiotic Visbiome  She also received a shot of B12. We can take her monthly to receive them and/or supplement her diet with B12. The vet wants us to give her cobalamine tablets which is B12.  I ordered some from Amazon and am waiting on them to arrive. 

Elizabeth had her annual exam in October and her rabies shot. She is good. She also needs some probiotic and will take Visbiome three times a week and not daily. Her PLI/cobalamine/folate test was also good except the folate was high. She has the same sort of gastro issues as Katharine but does not present with symptoms (although she was sick in June.) 

I think that is up to date on the cats. Jimmy has had a few urine out of the box accidents but we keep at it encouraging him to use the litter box and doing treats and behavioral work. 

Roxanne and Katharine Updates-Xrays, Gastro Scans, CHF, Furosemide and More!

Updates:
Roxanne is still testing for FIV. Vet did Western Blot Test yesterday-Thursday 10/5. Did a urine test because urine wasn't available at her checkup last week. We rechecked for potassium because it was abnormally high at her checkup. And she got her first gastro ultrasound just because she's nine, never had one, senior years will begin to show changes, high potassium could be a sign of adrenal gland issues (although that would appear in other blood work and has not.)

Ultrasound showed normal adrenal glands so we will hold off doing any further blood work (there's an $800 gland panel) and we won't test aldosterone levels (high pot might mean HYPOaldosteronism and Addisons Disease) unless potassium remains high for the next couple of months or she gets sick and has other issues. Baby had HYPERaldosteronism with low potassium (can be signs of Cushings) and developed high blood pressure which was primarily caused by CKD (which showed up in urine Specific Gravity and SDMA, BUN, and creatinine tests.) [Baby's hyperaldosterone remained stable from 2018-2020 and was not a cause of her death in 2021.] We will check iron levels in the future if RBC and such hematocrit values change because iron can be a reason for blood values being off.

Ultrasound showed prominent pancreas but no inflammation; normal adrenal glands; but cysts on the liver-this can be normal in cats and becomes a problem if there are too many or they become enlarged. We will monitor for vomiting, diarrhea, poor appetite (symptoms of so many issues), RBC (red blood cell count), liver values. She also has mild kidney changes normal for her age. Again-we will monitor kidney values, BUN, creatinine, potassium, phos, SDMA, and urine.

Katharine-I have been concerned that she has had numerous possible CHF episodes since July, and four these past two weeks. Her xrays yesterday showed some hazing around the heart related to HCM but none in the lungs to indicate CHF. But her cardiologist said that it was fine to put her on 3mg furosemide once a day since she has possibly had CHF episodes because her breathing rate declined within an hour of being given furosemide. Given my experience with HCM, I know when I see fast breathing rate at 40 bpm or more that is sustained and unchanging and must be immediately treated.

Her ultrasound showed "smouldering pancreas" with cysts but no issues or concerns. She is already on a steroid for IBD but cannot increase the amount for the pancreas due to HCM. She otherwise has a normal gastro system and organs. She has some slight scarring on kidneys due to normal aging process but her SDMA and BUN, creatinine, potassium, and phosphorous are all normal. But we will continue to monitor those for signs of CKD, especially important to monitor since she has HCM. I must make sure she gets enough potassium to support her kidneys while on diuretics now as a daily dose and not just an emergency dose.

So, we await blood tests for Roxanne.

Katharine and Elizabeth go to the vet for annual checkups in two weeks (poor Katharine-she's been at the vet and cardio four times these last four weeks and one more to go.)

Katharine's HCM Advances, Adds New Drugs

Katharine saw the cardiologist 9/13/23 and her heart has increased in left atrial from 1.50 September 2022 to 1.76 a year later. If it continues to progress, she'll be at 2 or over 2 by April, and more potential issues might develop. For comparison, Myrna in her first year had a left atrial of 1.83, then 1.69 after a few weeks using COQ10 (see later paragraphs.) It would decrease again to 1.52 the next year and remain low until the disease took over in 2013 (almost four years into the disease) and the left atrial increased to 2.12. At this point, she began to develop a series of serious issues. In 2013 she had a heart attack; in 2014-15 she had increased serious CHF issues. And then she died in 2015 (I can't find what size was her left atrium in order to compare to Katharine but it was 2.20-2.30.)

She had two cases of possible CHF this summer after major storms-late July and late August. I had given her small doses of diuretics which worked almost immediately although she needed two more doses in August. With the heart size increasing, more CHF might occur if I do not stay on top of it and fight it immediately with furosemide (lasix.) She may need a daily dose to ward off CHF. I will continue to monitor and discuss it later with the cardiologist if more CHF occurs.

The cardiologist put her on Plavix-1/4 once a day; and an ACE inhibitor Benazepril-1/4 BID. She is also on Atenolol 1/4 once a day.

Myrna was on Enalapril for an ACE inhibitor. I don't know why Katharine is not. The cardiologist said something about it has a different approach given Katharine's early issues. ACE inhibitors stop the ACE process-the angiotesin converting enzyme-which shuts down the bodies' veins, constricts veins in the case of a heart attack or accident that causes the body to lose blood. When you inhibit the ACE process, you allow veins to be wide opened and fully functioning. This helps lower blood pressure, and increases the flow of oxygen to the blood and therefore to the heart. The ACE process also increases SALT so by stopping the ACE process using an inhibitor, the body's ability to retain salt is reduced, thereby lowering fluid due to less salt, and therefore reducing blood pressure.

I also bought from CHEWY, a bottle of Rx Vitamins 30# COQ10, a supplement that we used with Myrna that improved her heart condition for a few years. Each capsule has 30mg. With Myrna, I'm not sure pet formula COQ10 existed because I bought Nature Made and squirted each capsule into her food. She received 200mg per day. Then later, I put it into the goop mixture I devised of this and other supplements and vitamins to improve her kidney function when the amount of diuretics increased and the load on her kidneys was too much, and her kidney values declined. This pet specific COQ10 is small enough that she can swallow it. I will give it to her daily. It's a lesser amount that what Myrna was taking but then Myrna's heart was far worse at 8 months old than Katharine at 14 years old. 

So, if Katharine's heart is nearing 2.0 this next year, and Myrna had severe issues at 2.12, we must work hard to try to improve Katharine's heart function, keep her overall health stable, and monitor closely for CHF; and be aware that there is a chance we might lose her in the next two years. Given her age at 14 and a half, she has lived a long life and we have had her a very long time. I'm grateful that her other health issues-seizures, IBD-are under control and hopefully remain so. That leaves me time to concentrate on taking care of her heart. But I refuse to make any concessions, to give in the inevitable, and to treat her condition as a given. And I refuse to give up. I cannot plan for how I want her life to end or when. But I will help her fight; I will help her body stay strong in order to fight. 

Please read more at the blog's tabs: Myrna's Story, Meds, About HCM; and do a word and category search for further information.

Apps to Use for Feline HCM

Someone mentioned they use an app to track their cat's progress and breathing. Here are some apps that help with tracking breathing. You can also use the clock/counter/timer on your smart phone, your stove or microwave, a kitchen timer, etc. if watching a watch (very small hands) or your house clock is difficult or not available.

I have NOT used these. These are NOT paid sources. These are NOT things I recommend as products, just things I Googled. You and others might have even more apps to recommend. Please do so here in comments. Thanks.

https://apps.apple.com/us/app/count-my-breaths/id1513102381

https://apps.apple.com/us/app/my-pets-heart2heart/id1564965551

https://www.cavaliermatters.org/unique-hereditary-diseases-index/mvd-heart-disease/mvd-respiratory-app-cardalis/#:~:text=The%20Cardalis%20app%20is%20very,information%20is%20recorded%20and%20charted

https://apps.apple.com/us/app/srr-counter-for-dogs-cats/id1086456790

Cat Medications and Supplements-Where to Buy

Cat Meds:
Cat meds do not need to come from the vet but it does depend on if it is exclusively sold by the vet; or if the vet exclusively has the smaller dose made for pets while the human pharmacy may only have the larger doses for humans. You might need to get some meds from your vet or cardiologist to get started when your cat is first sick (be it HCM or other issues), and then take the time to comparison shop for a more affordable price. When a sick cat needs six or more meds as with HCM, you'll want meds that you can get for a month's worth that are only $10 or less (for example) or whatever is affordable and available.

Most meds a cat needs are human meds and likely can be purchased at the local human pharmacy and for less money than from the vet. Even if the tabs come in only large sizes, check to see if they can be cut down to the dose you need (using a good pill cutter) so that you can buy the cheaper human size and not the more expensive vet size (if applicable.) Ask the pharmacist about the possible various dose sizes and thencomparison shop. There are various variables to consider.

Target, Kroger have had $4.00 meds in the past when we needed so many for Myrna Loy. We now get the various meds from Kroger, and a local compounding pharmacy, and an online pharmacy Wedgewood; and we have used the online pharmacy Road Runner in the past.

Check for hours a pharmacy is opened. You'll want something that is convenient for you to access. You don't want the store to be opened until 10 p.m. but the pharmacy closed by 6 p.m.

Supplements: can often be purchased at pet stores, Amazon, 1800pets, Chewy, etc.-like Laxatone, Lysine, Renal K, cat vitamin paste, immune liquids, taurine, etc.

Vitamins like COQ10, vitamin E, iron, magnesium, potassium for humans, etc. can be purchased at Kroger or Target (comparison shop: Target, Kroger brands, vs Nature Made, Sundown and other brands-look price per pill count, pill size per mg; and specials on price: 2 bottles for one for example) or elsewhere for human supplements and then cut them up or pierce and mix into food (depending on the flavor of the gel cap.) [These supplements are only some a cat might need. See the blog Med tab for what we used for Myrna. Your cat might not need them or might need others. These are suggestions referencing what we used.]