Well, I took Alex for his checkup last Wednesday. Earlier in the day, in
preparation for the checkup, I checked his blood glucose and discovered it
was only 54. I phoned the vet's office right away to report that the cat was
hypoglycemic. (His blood glucose had been stable for nearly a year and a
half in the 90 to 110 range, and I had been testing it only sporadically
since it had been so stable for such a long time). The vet tech told me to
encourage him to eat (he has actually been eating a lot) and to bring him in
for his scheduled appointment later that afternoon.

The result of the checkup was that his blood pressure was good at 140. He
had lost 5 or 6 ounces in the last five months, despite eating a lot. The
doctor discovered that his grade 2 heart murmur (present at least since Alex
was 2 years old - he is now nearly 17 years old) had graduated to a gallop,
and she was quite concerned. She had no immediate explanation for the
hypoglycemia. She is testing his thyroid, kidney values (he has chronic,
moderate-to-severe kidney failure), and checking his urine to see if he is
dumping glucose in his urine. At this point, I would have been panicking had
I not read Phil's response to Matt (regarding Phantom) that hyperthyroidism
can give the false impression of heart disease, which resolves when the
hyperthyroidism is controlled. The vet is suggesting another echocardiogram
if thyroid function turns out to be normal. I am thinking very hard about
whether I want to do that or not. Alex has already had two echocardiograms
in his life (the most recent one was about a year and a half ago). At that
time, it was decided that his heart murmur was stable and he didn't need
medication. Previously, he had been on diltiazem without side effects. I
told the vet that if his thyroid function turns out to be normal, my
inclination would be to put him back on diltiazem empirically rather than
dealing with the trauma and expense of yet another echocardiogram. Is there
a downside to this approach? Are there various heart problems the
echocardiogram would be likely to detect that would be treated using a
different medication (i.e., not diltiazem) ? I guess I'm wondering about the
realistic yield of doing (yet another) echocardiogram on a 17-year-old cat
with numerous comorbidities. Phil (or anyone), what are your thoughts on
this?

(I should be getting the results of the urinalysis, thyroid testing, and
kidney panel either tomorrow or Tuesday).
Best regards,
---Cindy S.