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View Full Version : Re: TK's HCM checkup at Tufts...Phil P


Phil P.
October 30th 06, 06:20 AM
"Nomen Nescio" > wrote in message
...
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>
> TK went for his yearly Echo, etc., at Tufts this week.
> Some good news, and, as I see it, a disturbing development.
> The Good:
> TK has turned out to be the one in a thousand cats that has
> seen MAJOR reversal in his HCM. Reversal to the point where
> it is almost nonexistent.
> Mitral regurge.....undetectable in all but his most excited state.
> Wall thicknesses......damn near normal
> Atrium.......near normal
> I don't have the full report, yet, or I'd post the numbers.
> But his overall condition is excellent.
> Dr Rush said that if this was the first time he'd seen TK, he would
> tell me that I could discontinue the (twice a week) aspirin, but under
> the circumstances he was reluctant to suggest changing anything.
> So since his kidney values are all good, we're continuing the aspirin
> and monitoring kidney function regularly.
> Overall, the news couldn't be much better.


That's great news! I'd bet the diltiazem had a lot to do with the reversal.
Diltiazem has reduced hypertrophy and left atrial dimensions in a number of
cats with HCM.



>
> Now the disturbing development (and it may keep me from going
> back to Tufts):
> Dr. Rush and another cardiologist were looking at the echo. Pointing,
> running playbacks, and talking VERY quietly among themselves.
> This was before I knew the results and it was making me VERY
> uptight. As my wife later described it, there was a "feeling of urgency
> in the room". Looking back, I would describe it as a "feeling of
excitement".
> You kinda had to be there, but it was very unnerving for me.
> So Dr. Rush told us how well TK was doing......and then:
> He wanted to sedate TK to take some readings when he was in
> a less excited state (TK was very excited about the whole event.
> squirming, bitching, etc.....He was not a happy cat)
> I was reluctant to sedate him.
> Then came the offer that really disturbed me.
> "We'd like to use him in a couple of studies we're doing. We want
> to sedate him for some more tests, do some x-rays, and draw some
> blood for (someone else) who is doing a genetic study of HCM. If
> you consent to this, there will be no charge for today's visit or any
> follow-up care" Uh-Oh. .......Houston, we have a problem.
> TK has just gone from "patient" to "data point".


TK is a Maine Coon or MC mix right? Rush was probably referring to Mark
Kittleson's study at UC Davis. He was the first to identify the gene
mutation that causes HCM in MCs. He's studying the gene mutation and
inheritability factor in other breeds too, now. They probably want to find
out if TK's reversal has a genetic basis.

>
> While I would like to help in research that might do some good
> for other cats, I have several reservations.
> a) TK is NOT a good subject for a study. He may live in a
> house, but he is not a "housecat". He's still at least 75% wild
> and is very distrusting of humans (especially men, which may
> say something about his life before we found him). He trusts
> me, he trusts my wife, but nobody else.
> b) I don't want to subject him to "tests" that he does not need
> and that increase his risks (ex. X-rays)
> c) "Safe" anesthetics have almost killed me twice. (Do you know
> anyone who has been on the edge of cardiac arrest from a drop
> of Novocaine in the eye?....You do now!)
> d) TK can't give his "consent" for the tests.
> e) He may be an important "data point" to Dr Rush, but to me
> he's my "buddy".
> (This kinda goes back to Philosophy 101. Would you kill one
> person if it would cure cancer for all mankind?... What if that person
> were someone you loved?)
>
> Anyway, I thought about it for a VERY short time and then declined.
> Dr Rush was visibly "displeased" with my decision.I think he thought
> I would jump at saving $300 on the day's visit since most of the time
> (as my wife describes it) I "look like I should be standing on the street
> corner with a tin cup in my hand". (A bit of advice, guys. You may want
> to think twice about marrying a fashion model if you're really fond
> of your 10 y.o. jeans)
>
> But anyway, the mood in the room REALLY went downhill from there.
> I stood firm. TK was NOT going to be part of their study. I did finally
> agree to let them draw a small blood sample for genetic testing.
> That turned out to be a big mistake even though it seemed like a fairly
> benign proceedure.
> An assistant prepared the needle and Dr Rush grabbed TK and held
> him in position to draw blood from his jugular. TK struggled, Dr Rush
> held him tighter, assistant poked, Tk struggled, assistant poked
again.....
> Four times and no blood sample. Then TK pulled back, shook his
> head, and missed the point of the needle with his eye by what looked
> like millimeters. That was enough! So I said "I don't think this is
working
> very well".
> Dr Rush snapped at me: "If your going to say things like that when
> TRAINED PROFESSIONALS are doing their job, you'll have to
> LEAVE THE ROOM."
> "No, were done", I said in as non-belligerent a tone as I could muster.
> "He's just too excitable today"
> "You want to stop?"......"Yes"
> So that was it for the blood draw.
> Admittedly, I might have been a little more diplomatic about stopping
> things, especially since two students were in the room. But I wanted it
> stopped, immediately, and didn't have the time to choose my words
> as carefully as I would have liked.
> The visit was wrapped up with a level of tension that was so thick
> you could cut it with a knife.
> Went out to the counter to pay the bill and get the basic report. Written
> on the bottom under "follow up visit" we were "advised that TK will
> need to be sedated" for the next echo.
> Dammit!
> If TK continues to do well, I've got a year to decide how to handle
> this. But my gut feeling says DON'T take him back to Tufts now that
> he is considered an important data point in a research project.
>
> This turned into a longer rant than I intended, but I'm really torn as
> to how I should handle this. Obviously, my concern is to get TK
> to best care possible for TK.
>
> I see two choices:
> Don't go back to Tufts.
> (Where do I take him?)
> or
> Go back to Tufts and make it real clear that I am here for TK's
> benefit and I don't give a flying f**k about his research.
> (That should go over real big)

When you cool down a bit, give Rush a call and ask him what exactly is
involved in the study and what's the purpose of the study. If you really
don't like the answers, just say no thank you. Rush is a very good
cardiologist- I doubt you'll find a better one anywhere near you. If you
say no, I doubt he'll let your decision affect TK's treatment.

You know TK better than anyone. If you don't think TK could handle it or if
you feel the study would put TK in any jeopardy, then its an absolute no. I
would make it very clear that you do not want any invasive procedures done
or anyone but vets handling him- that means only vets or anesthesiologists
would draw blood- no techs or especially students. Also, if the study
required more trips to the hospital- I would say no. I wouldn't stress out a
cat that has a heart problem with any more trips than necessary.

Imagine if they found the gene to "turn on" to reverse HCM in cats!- "the TK
gene" - that's something to think about and a hell of legacy for TK.

Thanks for the update- I love to hear good news!

Phil