Ultrasound. He showed me how the little valve kind of bows back in. It's not
huge but definite.

He definitely just called it the mitral insufficiency and that the leaking
back in which some how causes the enlargement. He didn't say anything about
ventricular hypertrophy.

He said it wasn't reversable but it was manageable. My regular vet called
and tomorrow I go get and start her on lasix and a beta blocker (don't
remember which one right now) and we will wean her down on the prednisone,
but keep her on it since it has helped get rid of the cough. She may be on a
small dose of that indefinitely but most of this is all "see how she does".
Right now it will be one dose a day of the lasix and the other heart med. I
hope it stays there. Of course, the main thing is diet management and try to
get the extra weight off. Of course, it is a no guarantee situation. My vet
has seen one case where the client opted to do nothing and the cat has lived
years. She also said let's put the blood test for thyroid off a week to let
Pearl recover, which I agree with because between yesterday and today she is
VERY worn out and I am quite worried about how stressed she was. Plus it's
so dang hot and my car does not cool down fast so just the trip between was
tough. I guess I just need to do what I can and hope for the best. Besides
the cough she hasn't really presented any other symptoms. I really hope she
likes the g/d and we can get her to lose weight. Since she isn't a really
picky eater, there is at least a chance of that. Also, we can try the other
brands like Waltham and IVD if she doesn't like the science diet. They seem
most worried about the salt content. She did say that I can grind all these
into a fine powder and mix it into a little a/d. I think that will work. She
is gagging a bit with the pill wrapped in a/d, but she is eating it. So I
think powderized might go down without trouble mixed in that for a little
treat. I'm just feeling like she is going to drop over any minute which is
probably irrational. Asthma just seemed like a more manageable ailment than
this. And not really as scary. There was stuff you could DO to help. This
seems so, well, less definite in proportion to what you can do to what will
reallly happen. Probably desceptive but there you go. That's how I feel. I
sure hope it isn't caused by thyroid. I  just don't know how many
medications I can get down her, nor am I at all ready for multiple problems
to balance when the one seems so huge. I'm so depressed.

Well, I can't say if it's the same thing as what Pearl has, but it
certainly sounds like congestive heart failure.

A brief digression. The efficiency of the heart depends on three things:
    "preload", or the resistance to getting blood back into the heart,
    heart rate and stroke volume: how often the heart beats efficiently
     and how much blood moves with each beat
    "afterload", or resistance by the outgoing blood vessels to blood
     being pumped into them.

In heart failure, which doesn't mean the heart has totally failed, we
try to improve the overall efficiency. "Water pills", or diuretics like
furosemide (Lasix) get rid of excess fluid that would otherwise have to
go through the heart -- in other words, preload reduction.

The next major category of drug, and the second of two in traditional
(pre-1990 or so) therapy was a drug that strengthened the actual heart
muscular pumping. Technically called positive inotropic agents, the most
typical drug in this class is digoxin, a synthetic derivative of
digitalis, which is one of the oldest effective herbals -- it comes from
the foxglove plant. We synthesize it so we don't have the variation in
strength from leaf to leaf -- digitalis alkaloids are extremely valuable
drugs, but unless very carefully dosed can turn toxic.

You'll notice I didn't speak of a specific method of reducing afterload.
Weight reduction is one potential area, but, in general, this means
reducing blood pressure. Some diuretics (e.g., thiazides) help with high
blood pressure, but they are not the ones that cause the most fluid
loss.

In humans, one of the major advances in treating heart failure is
somewhat counterintuitive: giving a class of drugs called beta-blockers.
The counterintuitive part is that they may reduce the pumping activity
of the heart, but the good part is they relax the blood vessels,
decreasing afterload. They are also effective for lowering blood
pressure.

Basic therapy, then, in addition to weight loss and careful exercise, is
founded on individual drugs or combinations.  There are others that may
be added to these three classes. Luckily, given the challenge of
pilling, at least for humans, there are combination pills that contain
at least two of these drugs.

Drug therapy can reverse heart failure if used early enough in the
process. I was heading for heart failure when the drug therapy became
much more aggressive, because I had stopped trying to argue directly
with my then-HMO, and got myself into a long-term cardiac research
program at the National Institutes of Health Clinical Center: an
institution whose findings are not something with which an HMO doc will
argue. I went from a pumping measurement (ejection fraction) of 35-40%,
on the border of heart failure, back to 65% (start of conditioned
athlete) in about 5 years.  In that time, my heart not only shrunk back
from the enlargement, but did an "auto-bypass", in which normally
microscopic vessels enlarged to carry blood where it was needed -- and
my bypass had blocked up.

The good news here is that these drug therapies should be effective in
four-legged people. The combinations are important; my beloved dog of
the fifties only had digoxin available. Still, he lived several years
after first being given a death sentence for kidney failue, dying of
heart disease at 9 -- reasonably old for a dog of the time.

Does HRFL take meds?