"Nomen Nescio" ] wrote in message
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From: "Phil P."

That's not good-- that's great!

I would have been thrilled with the report had it not
been for the 4 - 6 murmur and the skipped beat. They
did an EKG because of the skipped beat and said
things looked pretty normal. The report says "NSR
with a rate of 200 bpm and a LV enlargement pattern
(R wave)"

If he was very excited, the murmur would be more pronounced. Also, don't
forget, the grading system is rather subjective.

TK was VERY upset about the whole ordeal. Plus he
had a few different people handling him. They were
running a bit behind at Tufts so we had to wait a while,
also. First a 4th year student checked him out, then
he was back in the carrier, then a cardiologist (resident)
checked him out and did some instruction with the 4th yr
student, then back in the carrier, then into the ultrasound
room, then he was held down on the table for Dr Rush to
do the ultrasound (and gave the 4th yr student a nip to
express his displeasure with the whole thing which then
got him "the hood"), then back in the carrier, then out again
for the ekg, then back in, then out again for Dr Rush to
check something else with the ultrasound (some type of
aortic velocity profile (doppler). Add in a 1 3/4 hour drive
in Thanksgiving traffic to get there and 2 1/2 hours to get
back and the poor little guy had a rough day.


I'd say that would do it! Did he say where the murmur is (e.g., mitral)?
Tell your wife you want a Littmann 4000 electronic stethoscope for
Christmas. The new ones come with sound analysis software so you can see
what you're hearing through the steth on your computer monitor-- you can
save the file to disk and send it to Dr. Rush as a record of TK's heart
sounds when he's calm at home. I tried to order the software for my 9000
but they said it won't work- I don't see why it wouldn't- both units record
and send the recording to a computer. I think they're just trying to sell
me a new 4000!



The doppler showed "The aortic velocity is still increased
at 2.7 m/s with dagger profile and E-A reversal is still
noted". I'm not quite sure what that means, but Dr Rush
said it's somewhat expected with TK's condition.


E:A reversal is a LV relaxation abnormality- its the reversal of early and
late filling waves. Dr. Martin can explain it much better than me- he's a
vet and also trained in ultrasonography. (I'm glad he's back!)

Aortic velocities of 2 to 4.5 m/sec.are usually characteristic of the
obstructive form of HCM. Did Dr. Rush say TK has the obstructive form of
HCM?




When was the last time you had his T4 concentration checked?
Hyperthyroidism would explain the murmur and the weight loss. Was his
blood
pressure checked?

They didn't check his bp this time. I would have liked
to have it done but I didn't even think of it in the middle
of all the activity.
After TK's echo in May he had to get a recheck on a
low white count in a blood test about a month earlier.
I asked his regular vet about doing a thyroid check
and she said it didn't need to be done because of his
young age (we guess he's about 2 1/2 yo, now). She
said increased T4 is not an issue in cats under 6 yo
and in 17 yrs as a vet, she's never seen hyperthyroidism
in a cat under 8 yo. Dr Rush never mentioned
hyperthyroidism as a possible cause, either. Although
I never explicitly asked about it.
If you know of an exception to the "no hyperthyroidism
in young cats" rule, though, I'll bring him to the vet and
get him tested.


The youngest I've heard of is 4 but never 2 1/2. I forgot TK is that young.
HCM in a cat his age is rare. For HCM to occur in a cat his age, I think its
probably congenital. Familial HCM has been documented in several breeds,
so, I don't see why it can't haapen in DSHs.


I hate having to disagree with vet's, but
it wouldn't be the first time.


No, I think he's right.



I think the weight loss can be attributed to your suggestions
as to how to keep him on a proper diet, the shift to canned
food, and my suspicion that the scale at Tufts may be a bit
out of calibration. They even put him on the scale twice
because the number seemed low. But he seems to be in
"great shape". He's getting a little bit more food, now, so
we'll see if his weight stabilizes. Since Thanksgiving, his
weight has not changed (I wish I could say the same thing
about myself ).

He shouldn't lose more than a pound/4 weeks. Fancy Feast averages about 80
kcal/3 oz. can- the seafood varieties average about 60. 10 g of m/d = about
40 kcals. 280 kcals a day is about right for a 13-14 lb cat. How much does
he weigh?



TK's a lucky cat to have so many good people looking
after him.


I think you lucked out with Dr. Rush- and TK lucked out with *you*!

Btw, did you ever get around to reading the articles I sent you by Dr. Rush?



As always, Thank's for your concern, help, and advice.
Any suggestions are greatly appreciated.


I think you're on the right road.

Best of luck,

Phil