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Cat Forum / Health and Behavior / May 2005TK's heart murmur. Bad to worse.
-----BEGIN PGP SIGNED MESSAGE----- Well, I have a diagnosis on TK's condition. I've known for a couple of days but couldn't bring myself to post an update. At an age of about 2 y.o., TK has moderate Hypertrophic Cardiomyopathy. I watched the echocardiogram being done and it was obvious even to my untrained eye. Prognosis: He could die tonight or he might live up to another 6 years. Treatment: He's getting an aspirin (81 mg) twice a week. Although the vet admitted that if you had 100 cats that you knew would die of a blood clot within a year and gave them all aspirin, 95 would still die. And he's getting 30 mg of Diltiazem ER daily, mostly to lower his heart rate but there are other potentially positive effects. And he should lose 3 lbs to bring his weight down to about 11 lbs. Cause: This is the tough part. One of the first questions that I asked the vet was "Could I have done something to cause this...chemical, environmental.... ?" He shook his head and said "No" but then in further discussion 2 points jumped out at me. 1) He pointed at the chart of cat weight conditions (the one that every vets office has on the wall) and indicating the picture of the slightly underweight cat said that "You rarely see heart problems in a cat like that". 2) He also said that "You rarely see heart disease in an outdoor cat" Well, TK isn't obese, but he is overweight. He was about 10 3/4 lbs last year when we took him in. And he was an outdoor cat. So here's my take on the situation: Last year I adopted a wild cat with the intent of treating the bite wound on his butt, and giving him a good home where he would be well loved and well fed. And what did I really do? Take a cat that was perfectly happy living outdoors and visiting us for food and a little play. Then I locked him in the house, cut his balls off, made him fat and lazy, and gave him heart disease. All the while thinking how much I LOVE the little guy and how I want the best for him. I feel like such an a.shole, right now. > -----BEGIN PGP SIGNED MESSAGE----- > > Well, I have a diagnosis on TK's condition. I've known > for a couple of days but couldn't bring myself to post > an update. <snip> Don't kick yourself. HCM is commonly genetic as well. Many, many cats live YEARS with it. You did a good thing, taking him off the streets. -L. > -----BEGIN PGP SIGNED MESSAGE----- > [quoted text clipped - 10 lines] > you knew would die of a blood clot within a year and gave > them all aspirin, 95 would still die. Speak to a cardiologist about Nattokinase- its a new fibrinolytic enzyme that comes from the vegetable cheese natto. It not only dissolves clots, but might even prevent them. > And he's getting 30 mg of Diltiazem ER daily, mostly to lower > his heart rate but there are other potentially positive > effects. Did your vet tell you long-term use of Diltiazem has *reversed* myocardial hypertrophy in many cats with HCM? Diltiazem also has antiplatelet activity in cats. Here's a direct quote from Mark Kittleson: "It appears that the incidence of systemic arterial thromboembolism in cats with hypertrophic cardiomyopathy has decreased since the advent of using diltiazem." > And he should lose 3 lbs to bring his weight down to about > 11 lbs. [quoted text clipped - 3 lines] > and said "No" but then in further discussion 2 points jumped > out at me. > 1) He pointed at the chart of cat weight conditions (the one > that every vets office has on the wall) and indicating the > picture of the slightly underweight cat said that "You rarely > see heart problems in a cat like that". and > 2) He also said that "You rarely see heart disease in an > outdoor cat" Your vet must know something Mark Kittleson, John Bonagura, and Philip Fox don't know- and they're feline cardiologists and the three leading authorities in feline hypertrophic cardiomyopathy. HCM is a *genetic*- not an acquired disease- although hyperthyroidism causes myocardial hypertrophy that might be similar to HCM. http://maxshouse.com/hypertrophic_cardiomyopathy.htm > Well, TK isn't obese, but he is overweight. He was about > 10 3/4 lbs last year when we took him in. And he was an [quoted text clipped - 12 lines] > > I feel like such an a.shole, right now. Your vet is the a.shole, not you, for laying a guilt trip on you. You had *absolutely* nothing to do with TK's HCM- do you understand that? *NOTHING*. TK would probably be dead by now if not for you- and he probably would have fathered many kittens who would have developed HCM later in life. You not only saved TK's life, you did a great thing for the feline species and all of Catdom! Dump your vet. Go to http://www.acvim.org/Kittleson/search.htm and do a search for an internal medicine Diplomate/Cardiologist in your area-- American College of Veterinary Internal Medicine Diplomates are about the best there is. If you can't find an ACVIM specialist in your area, my second choice would be an ABVP Diplomate/Feline Specialist (American Board of Veterinary Practitioners). Go to http://www.abvp.com/diplosearch1.htm http://www.abvp.com/ With the proper treatment, cats with HCM can live near-normal lifespans. Lose the vet and guilt and keep the faith! Best of luck, Phil -----BEGIN PGP SIGNED MESSAGE----- Thanks, Phil. I appreciate the slap in the face to bring me back to reality. I've got to get through the shock, denial, panic, and guilt phases and move through acceptance, and action. In all fairness to the vet, he went out of his way to stress the fact that genetics are the major factor. But in discussing things, I latched on to two sentences that pointed some of the responsibility in my direction. He was just covering all the angles that he's seen as related to HCM.....at my request. He never really said anything like "You did this to your cat". I had decided that the best thing thing to do, since the follow-up vet visit showed that the murmur was still there and seemed to have moved from from a 2-3 to a solid 3, was to bring TK up to Tufts U. and have a specialist in feline cardiology do the echo. He was very good. Asked the right questions in the pre-exam interview, explained what he was seeing as he did the ultrasound quite clearly, and took the time to detail his findings and thoughts in the post exam consultation. So I really have no complaints with him. After I got home, I was searching for more information to try to get a better understanding of TK's condition and was surprised to see the cardiologist's name either referenced in, or as a co-author of, many papers on feline heart disorders. You may know a lot more about the guy than I do. His name is Dr. John E. Rush. From: "Phil P." <phil@maxshouse.com> >Speak to a cardiologist about Nattokinase- its a new fibrinolytic enzyme >that comes from the vegetable cheese natto. It not only dissolves clots, >but might even prevent them. No, I don't think he mentioned it. As a clot preventative, we discussed aspirin (recommended), Coumadin (risky, as Dr. Rush put it "We have a name for that around here.....rat poison"), and Heperin (2 injections a day, not indicated at this time). >Did your vet tell you long-term use of Diltiazem has *reversed* myocardial >hypertrophy in many cats with HCM? Yes. >With the proper treatment, cats with HCM can live near-normal lifespans. I'm hopeful. And since we were lucky enough to catch the problem before he developed outward symptoms, the prognosis is certainly better. I'm just glad that instead of just bringing him to the vet's and getting his booster shot, we opted to get him a full checkup even though the annual was not due until August. >Lose the vet and guilt and keep the faith! I'll work on the guilt, try to keep the faith, but for now, I'd tend to keep the cardiologist. My wife and I just love this little guy so much that the thought that we might have hurt him in even the slightest way is just sickening. >Best of luck, > >Phil Thanks. And as always, your thoughts and observations are greatly appreciated. > -----BEGIN PGP SIGNED MESSAGE----- > > Thanks, Phil. I appreciate the slap in the face to > bring me back to reality. Sorry, I didn't mean to be harsh- its just that I think I know enough about you to *know* how much you love your cat and how well you care for him. I was pissed at your vet because I got the impression he somehow made you feel TK's HCM was your fault- which is absolutely impossible. > I've got to get through the shock, denial, panic, and > guilt phases and move through acceptance, and action. [quoted text clipped - 5 lines] > related to HCM.....at my request. He never really said > anything like "You did this to your cat". Now you tell me! ;-) . Everything you mentioned applies to almost everyone's cat in this newsgroup! If there's was any truth to it, we'd have an HCM epidemic. > I had decided that the best thing thing to do, since the > follow-up vet visit showed that the murmur was still [quoted text clipped - 6 lines] > detail his findings and thoughts in the post exam > consultation. Did he give you the measurements of TK's heart? If you have a print out, look at the measurements (mm) next to "IVS" (interventricular septum) and "LVPW" (left ventricular posterior wall). These measurements tell you the degree of hypertrophy. Cats aren't considered HCM unless the IVS or LVPW or both are at least 6 mm. Let me know what the measurements are. So I really have no complaints with him. > After I got home, I was searching for more information > to try to get a better understanding of TK's condition [quoted text clipped - 3 lines] > a lot more about the guy than I do. His name is > Dr. John E. Rush. As a matter of fact, I do! He's an ACVIM Diplomate- board certified cardiologist. TK is in good hands. > From: "Phil P." <phil@maxshouse.com> > [quoted text clipped - 7 lines] > here.....rat poison"), and Heperin (2 injections a day, not > indicated at this time). Coumadin (warfarin) is very tricky stuff when used in cats. You must use *both* warfarin *and* heparin in cats for the first few days because warfarin also has *pro*coagulant effects that occur *before* the anticoagulant effects start. Also, the anticoagulant properties of warfarin seriously increases the risk of spontaneous hemorrhaging- especially in cats because they love to run, jump and climb. Some cats must be caged or confined to reduce the risks of slight injuries that can cause hemorrhaging. A thrombus usually forms in the left atrium *if* the atrium becomes enlarged. When the LA becomes enlarged, blood flow slows down (like a river slows down when passes through wider areas) and blood factors start to clump together and forms a thrombus. The fact Dr. Rush feels anticoagulant therapy isn't necessary is a pretty good indication that the LA isn't enlarged significantly! ;-))) Diltiazem also has antiplatelet activity in cats and improves LA hemodynamics (speeds up blood flow). So, the combination of the antiplatelet properties of diltiazem and the antiplatelet activity of aspirin should drastically reduce the risk of thromboembolism. > >Did your vet tell you long-term use of Diltiazem has *reversed* myocardial > >hypertrophy in many cats with HCM? [quoted text clipped - 6 lines] > problem before he developed outward symptoms, the > prognosis is certainly better. Oh, hell yeah!! You caught it early enough for treatment to really work! The diltiazem has a better chance of reversing myocardial hyperthrophy if the walls aren't very thick-- which in turn reduces the risk of LA enlargement and thromboembolism. I'm just glad that instead of > just bringing him to the vet's and getting his booster shot, > we opted to get him a full checkup even though the annual > was not due until August. I'm glad you did, too! > >Lose the vet and guilt and keep the faith! > > I'll work on the guilt, try to keep the faith, but for now, Good man! > I'd tend to keep the cardiologist. Now that you clarified the situation and I now know who your cardiologist is- I wholeheartedly agree. > My wife and I just love this little guy so much that the > thought that we might have hurt him in even the slightest > way is just sickening. How do you think he'd feel if he knew you were blaming yourself for something you had absolutely no control over? He'd probably hit you with a left paw! ;-) > Thanks. And as always, your thoughts and observations > are greatly appreciated. Keep the faith- I really mean it. Best of luck, Phil. -----BEGIN PGP SIGNED MESSAGE----- From: "Phil P." <phil@maxshouse.com> >Sorry, I didn't mean to be harsh No apology needed. I've always appreciated your "No BS" approach. > I >was pissed at your vet because I got the impression he somehow made you feel >TK's HCM was your fault- which is absolutely impossible. Well. in a way, he did. But not by any direct statement. To clarify things, it's always seemed to me that people in the medical profession, and especially vets, tend to tone down their thoughts in the area of blame. So just because someone does not say "it's YOUR fault", it does not mean that it's NOT your fault or even that they are not thinking that "it's your fault". So sometimes one has to read between the lines to get a true picture of the situation. Unfortunately, that leaves a lot of room for misinterpretation. Which, it seems that I did. After all, you can't pick up a newspaper without reading how weight and exercise relate to heart disease in humans. So I tended to extrapolate, but without the knowledge base to differentiate between the various types of heart disease. I just hope like hell that there really is nothing that I did to hurt TK. > Everything you mentioned applies to almost >everyone's cat in this newsgroup! If there's was any truth to it, we'd have >an HCM epidemic. Damn good point! >Did he give you the measurements of TK's heart? No. Our regular vet got the full report on Thursday. We have an appointment with her next Thurs. to discuss the report, a weight loss plan, and get another blood workup. Everything looked fine in the blood test last week except his white count which was a little below normal (3300 with a normal range from 3500 - 16k). We're also goiing to do the ELISA tests for FeLV and FIV since he has not been tested since the day we first brought him in with the bite wound on his butt (another thing to be nervous about). > If you have a print out, >look at the measurements (mm) next to "IVS" (interventricular septum) and >"LVPW" (left ventricular posterior wall). These measurements tell you the >degree of hypertrophy. Cats aren't considered HCM unless the IVS or LVPW or >both are at least 6 mm. Let me know what the measurements are. I'll get a copy of the echo report and post the "IVS" and "LVPW". > He's an ACVIM Diplomate- board certified >cardiologist. TK is in good hands. Glad to hear that you think that. >Coumadin (warfarin) is very tricky stuff when used in cats. I could tell he didn't like using the stuff. If we find that we need a heavy duty anticoagulant, I would lean toward that heparin if it's an option. Even if it is 2 injections a day and $250 a month. If you met TK, you'd know that the 2 injections a day would be a big problem with this cat. >A thrombus usually forms in the left atrium *if* the atrium becomes >enlarged. When the LA becomes enlarged, blood flow slows down (like a river >slows down when passes through wider areas) and blood factors start to clump >together and forms a thrombus. The Doppler showed a bit of turbulence. It looked like a lot, to me, but I have nothing to base "a lot" on. >Diltiazem also has antiplatelet activity in cats and improves LA >hemodynamics (speeds up blood flow). So, the combination of the >antiplatelet properties of diltiazem and the antiplatelet activity of >aspirin should drastically reduce the risk of thromboembolism. Hopefully, that's enough. For now at least. >> My wife and I just love this little guy so much that the >> thought that we might have hurt him in even the slightest >> way is just sickening. >How do you think he'd feel if he knew you were blaming yourself for >something you had absolutely no control over? He'd probably hit you with a >left paw! ;-) He does that, anyway. :) >Keep the faith- I really mean it. > >Best of luck, > >Phil. Thanks again. snip > So here's my take on the situation: > Last year I adopted a wild cat with the intent of treating [quoted text clipped - 8 lines] > > I feel like such an a.shole, right now. Some wives feel like you do about their husbands ... and for the same reasons. ;-) > > So here's my take on the situation: > > play. Then I locked him in the house, cut his balls off, What you need is a uctimmy. (That's like on Lassie, whenever things got foggy for the little fella, Timmy's mom would sit him and explain to him she'd say... You see Timmy, anyone can count the seeds in an apple, but no-one can count the trees in a seed. > -----BEGIN PGP SIGNED MESSAGE----- > [quoted text clipped - 42 lines] > > I feel like such an a.shole, right now. I think that is a LOAD of twaddle. There is no way any studies have been done to support this theory. Vets only see X number of cats. I know SEVERAL cats of people owned in the UK that have CM and believe me they go in and out. B.S. B.S. B.S.! Think about what is NOT truly known about heart disease in humans. There are conflicting studies all the time. I also do NOT believe the 3 extra pounds are the culprits. He is not some 18lb. overweight cat. Look Grant wasn't supposed to die at 8 from stomach cancer either. He never DID have a great immune system. My point is, TK has a loving home with vet care. Would the doctor REALLY have any idea how many strays die of CM? What kinds of statistics and records can he give you on this? Just be there for TK. Love him up. It sucks that you have to face this again when some people never do, but did it ever occur to you that since you HAVE had a cat with this before maybe it is overall some greater plan that you recognized some problems right away? That you will know what to look for? That TK is with you for a reason???? Just do your best, man. You'll waste your life AND his if you sit around worrying about what ifs. Give that cat a hug for me. -----BEGIN PGP SIGNED MESSAGE----- >From: Karen <kchuplis@alltel.net> >I think that is a LOAD of twaddle. In all fairness, it may be more my "twaddle" than the vet's. >Think about what is NOT truly known about heart disease >in humans. There are conflicting studies all the time. That is so irritating, too. Read one study an it proves something IS. Read another and it proves that it ISN'T. > It sucks that you have to face this again when some people >never do, but did it ever occur to you that since you HAVE had a cat with >this before maybe it is overall some greater plan that you recognized some >problems right away? That you will know what to look for? That TK is with >you for a reason???? A very good point! I think you read my little story about why we refer to TK as our "gift from God". Maybe we had it backwards. Maybe we're supposed to be TK's "gift from God". I just hope that there's nothing WE did to hurt him. >Just do your best, man. Right now, that's all we can do. >You'll waste your life AND his >if you sit around worrying about what ifs. No, I'm an engineer. I run around in a hyperactive state trying to solve problems.....while worrying about what ifs. >Give that cat a hug for me. Will do. And thank you. >So here's my take on the situation: >Last year I adopted a wild cat with the intent of treating [quoted text clipped - 8 lines] > >I feel like such an a.shole, right now. At least you can be sure no one will track you down without an armload of subpoenas and signed warrants and advanced cryptanalysis skills. That's worth something. But seriously, you have done nothing wrong. Tomcats lead short, brutal lives. Maybe your cat will lead a short, happy life in your house. You apply your best judgement, act accordingly, and accept that you cannot forecast or control the result with any degree of precision, because the mathematics of nature don't allow it. Charlie It's sad that TK has such a condition. That kind of thing has to be genetic. I can't believe that it has anything to do with being an indoor or outdoor cat. Many in this group have indoor cats and, neutered, too, and they don't have this condition. It's so wonderful that you are giving TK a home and good care. Best of luck with all this, -- Barb Of course I don't look busy, I did it right the first time. > So here's my take on the situation: > Last year I adopted a wild cat with the intent of treating [quoted text clipped - 8 lines] > > I feel like such an a.shole, right now. Don't feel bad at all!! Without you, TK would have died outside. Read Phil P's post. As far as I know, HCM is genetic. Most of the cats I've known with it dropped dead as kittens/ very young adults. TK is lucky, and very lucky to have you. You are a wonderful cat daddy! A weight gain of a few pounds is not going to cause a cat to suddenly develop HCM. Should he lose some weight? Probably, but that's not going to cure it either. Your vet is a dick for making you feel like it's your fault. I may be wrong, but aren't you in Newburyport? There's a feline-only practice in Salem, MA. I don't know much about them, but from what I've heard feline-only vets are usually much more in tune with cat healthcare. And yes, I've seen heart problems in underweight cats. Dash did not develop a murmur until she was severely underweight from her multitude of health problems.  Signature-Kelly -----BEGIN PGP SIGNED MESSAGE----- From: "KellyH" <Kelly@farringtonsNOSPAM.net> >A weight gain of a few >pounds is not going to cause a cat to suddenly develop HCM. I sure hope you're right. >Your vet is >a dick for making you feel like it's your fault. He never said it was my fault. I just wonder, based on some of the things he said, if it COULD be my fault. Just the slightest possibility that I could have hurt him is an awful thought. >I may be wrong, but aren't you in Newburyport? Nope, the other side of the state. Springfield. >There's a feline-only >practice in Salem, MA. I don't know much about them, but from what I've >heard feline-only vets are usually much more in tune with cat healthcare. We took TK up to Tufts U. for his ultrasound. I wanted a cardiac specialist to check him out. I was very pleased with the work they did there. Just not pleased with the result. > -----BEGIN PGP SIGNED MESSAGE----- > [quoted text clipped - 3 lines] > At an age of about 2 y.o., TK has moderate Hypertrophic > Cardiomyopathy. He's so young! How heartbreaking. I watched the echocardiogram being > done and it was obvious even to my untrained eye. > Prognosis: He could die tonight or he might live up to [quoted text clipped - 19 lines] > 2) He also said that "You rarely see heart disease in an > outdoor cat" Sorry, but I think this is because they generally do not live long enough to present, having been hit by cars, poisoned by sociopaths, or eaten by coyotes. > Well, TK isn't obese, but he is overweight. He was about > 10 3/4 lbs last year when we took him in. And he was an [quoted text clipped - 12 lines] > > I feel like such an a.shole, right now. I know you love your cat, but I think you are dead wrong. Many, if not most heart problems that present in youth are a result of a congenital predispostion, in both cats and humans. -----BEGIN PGP SIGNED MESSAGE----- From: "Mary" <marys@catlover.com> >He's so young! How heartbreaking. That's an understatement. My wife and I both feel like our entire world has crumbled. TK's become such an important part of our life. > -----BEGIN PGP SIGNED MESSAGE----- > [quoted text clipped - 5 lines] > My wife and I both feel like our entire world has crumbled. > TK's become such an important part of our life. Just don't blame yourself. I am glad Phil verified what I had heard about this type of heart disease being hereditary in young cats. It is horrible enough without you blaming yourself. You have been nothing but wonderful for TK. > So here's my take on the situation: > Last year I adopted a wild cat with the intent of treating [quoted text clipped - 6 lines] > All the while thinking how much I LOVE the little guy and > how I want the best for him. I'm sorry to hear about your kitty, but this is NOT your fault. Here's my take. You provided a good home for a cat that most likely could have ended up with a lot worse than a bite wound on his butt, plus he would have contributed to pet overpopulation. Mostly likely his condition is probably genetic and I don't think it's anything you did. Much as we'd like to think they do, vets don't know everything. Oh jeez!!!! My heart breaks for you. My Randall was overweight. And when I took Randi to the vet before I got Cali, they said he was too fat and had a very slight heart murmur! I just adopted two more kittens today. You are not an a.shole!!! I feel so bad for you. Life really does suck. Carol :(\ > -----BEGIN PGP SIGNED MESSAGE----- > [quoted text clipped - 52 lines] > =ljgE > -----END PGP SIGNATURE----- -----BEGIN PGP SIGNED MESSAGE----- >From: "ElvisRocks" <elvisrocks1@comcast.net> >Oh jeez!!!! My heart breaks for you. My Randall was overweight. And when >I took Randi to the [quoted text clipped - 3 lines] >You are not an a.shole!!! I feel so bad for you. Life really does suck. >Carol :(\ I'll tell you, Carol, my wife and I are both total wrecks over this. I keep getting a picture, in my head, of the time I woke up in the middle of the night with Fission panting next to the bed. But we've caught this early with TK, so we're hopeful. I just feel so bad for our "big ol' buddy". I wanted the "best" for him and now all he gets is the "best we can do". But he's still here, he's still looking good, still a "wildcat". So we take it one day at a time. Four cats, now!?!? WoW!! When do we see the pictures? :) |
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