Veterinary Cardiologist advice in NYC // Dr. P. Fox at AMC v specialist

My name is Heather and I live in Brooklyn, NY and work in Manhattan,
NY. My cat, Mack C., is 18 months old and such a joy. Last Saturday,
I took him to the vet because for a few days his left eye was almost
constantly running clear fluid. Mind you, this was our first visit to
this vet because we moved from Manhattan to Brooklyn in August of
2006. His last visit to his old vet was in March of 2006.

I want to warn that I am very long winded so be prepared, but I do
appreciate you reading!!

During the visit I was informed that Mack C. has herpes. He is now on
a daily dose of 500mg of L-lysine. In order to prevent any secondary
infection, the vet also gave me ointment (it's at home so I don't know
the identifiable name) to put on Mack C.'s left eye twice daily until
the eye is seemingly better for two full days.

I was also informed that Mack C. has medial patellar luxation, which
the vet told me is rare in cats but common in some small breed dogs.
Although he did not give me a grade of severity of MPL, I am less
concerned about this because Mack C. is 100% an indoor cat and
therefore won't be doing the kind of jumping an outdoor cat may do.

Lastly, and the worst diagnosis of all, the vet informed me that Mack
C. has a heart murmur. He told me that it was rather apparent and
that it was something my original vet would not be likely to miss.
This would mean that the heart murmur developed in the past year and
is most likely the cause of hypertrophic cardiomyopathy. There is a
second vet in the office and he stopped her as she walked by to have a
listen to Mack C.'s little heart. Without him saying anything to the
other vet, she said, "Oh wow," and then took a better listen and
offered the same diagnosis.

I have spent hours since this past weekend researching these
conditions, focusing most intently on the latter (HCM), since it
offers the grimmest prognosis. My vet said that Mack C. needs to get
an echocardiogram in order to properly diagnose whether or not it is
HCM and if it is, the severity of his condition. He is showing no
clinical sings with the exception of the heart murmur.

My vet told me that they can either refer me to a clinic to do the
echocardiogram or have a specialist come into his vet office in
Williamsburg. He told me that the approximate cost of the test would
be about $300. I'm assuming that does not include any standard fees
such as just coming into the office and also being examined by the
specialist. I am more than willing to pay this amount, but in my
research it seems to be recommended that I go to a veterinary
cardiologist. I'm assuming that the person the vet would bring in is
not a cardiologist as there are seemingly only three board certified
cardiologists in New York City and I doubt they travel to Brooklyn vet
offices.

So I called the Animal Medical Center located in midtown Manhattan to
inquire about fees for the test. This is where Dr. Philip Fox and Dr.
Betsy Bond both practice at least a portion of their time. Dr. Fox
apparently has a very good reputation and I feel lucky to be so close
to this resource. They told me that it is $152 for the initial visit
to see a cardiologist. In addition, the echocardiogram will cost
somewhere from $380 to $420.

This is quite a bit more than what my vet estimated it would be to
bring someone into his office. However, I'm willing to pay it if the
experience of members of this list is that I go to see a cardiologist
for the most accurate echo I can get. Will it make a difference in
treatment? Is going to visit a cardiologist of this stature not
necessary unless Mack C.'s case has made a turn for the worse? Is
there something that Dr. Fox would be able to tell me about Mack C.'s
specific case that a specialist would not? I should have the money to
take Mack C. to the less expensive echo within two weeks. It will
take an additional week or two to save enough money to take him to see
Dr. Fox. Could this be crucial time?

I just want to make sure I am doing all I can to give Mack C. not only
a longer life span but a high quality of life. I am still devastated
about the potential diagnosis, but at this point I am doing all I can
to gear myself towards his health rather than my emotions. Thank you
all for your advice as I will take all into consideration!

Pictures of the lovely boy are at:
http://www.thebighustle.com/mack1.jpg
http://www.thebighustle.com/mack2.jpg

All the best,
Heather

Heather, Have you got a second opinion. Just because he is a good vet does
not mean he is correct. Not saying he is not. Before you go thru massive
testing. Treat it like you should do when you get a major health problem.

I can't give you any medical advice on this subject. I do not want to steer
you the wrong way. Others probably will throw there 2 cents in. But I am
sending some prayer and purrs for such handsome furball

"zinzee" wrote in message
ups.com...
My name is Heather and I live in Brooklyn, NY and work in Manhattan,
NY. My cat, Mack C., is 18 months old and such a joy. Last Saturday,
I took him to the vet because for a few days his left eye was almost
constantly running clear fluid. Mind you, this was our first visit to
this vet because we moved from Manhattan to Brooklyn in August of
2006. His last visit to his old vet was in March of 2006.

I want to warn that I am very long winded so be prepared, but I do
appreciate you reading!!

During the visit I was informed that Mack C. has herpes. He is now on
a daily dose of 500mg of L-lysine. In order to prevent any secondary
infection, the vet also gave me ointment (it's at home so I don't know
the identifiable name) to put on Mack C.'s left eye twice daily until
the eye is seemingly better for two full days.

I was also informed that Mack C. has medial patellar luxation, which
the vet told me is rare in cats but common in some small breed dogs.
Although he did not give me a grade of severity of MPL, I am less
concerned about this because Mack C. is 100% an indoor cat and
therefore won't be doing the kind of jumping an outdoor cat may do.

Lastly, and the worst diagnosis of all, the vet informed me that Mack
C. has a heart murmur. He told me that it was rather apparent and
that it was something my original vet would not be likely to miss.
This would mean that the heart murmur developed in the past year and
is most likely the cause of hypertrophic cardiomyopathy. There is a
second vet in the office and he stopped her as she walked by to have a
listen to Mack C.'s little heart. Without him saying anything to the
other vet, she said, "Oh wow," and then took a better listen and
offered the same diagnosis.

I have spent hours since this past weekend researching these
conditions, focusing most intently on the latter (HCM), since it
offers the grimmest prognosis. My vet said that Mack C. needs to get
an echocardiogram in order to properly diagnose whether or not it is
HCM and if it is, the severity of his condition. He is showing no
clinical sings with the exception of the heart murmur.

My vet told me that they can either refer me to a clinic to do the
echocardiogram or have a specialist come into his vet office in
Williamsburg. He told me that the approximate cost of the test would
be about $300. I'm assuming that does not include any standard fees
such as just coming into the office and also being examined by the
specialist. I am more than willing to pay this amount, but in my
research it seems to be recommended that I go to a veterinary
cardiologist. I'm assuming that the person the vet would bring in is
not a cardiologist as there are seemingly only three board certified
cardiologists in New York City and I doubt they travel to Brooklyn vet
offices.

So I called the Animal Medical Center located in midtown Manhattan to
inquire about fees for the test. This is where Dr. Philip Fox and Dr.
Betsy Bond both practice at least a portion of their time. Dr. Fox
apparently has a very good reputation and I feel lucky to be so close
to this resource. They told me that it is $152 for the initial visit
to see a cardiologist. In addition, the echocardiogram will cost
somewhere from $380 to $420.

This is quite a bit more than what my vet estimated it would be to
bring someone into his office. However, I'm willing to pay it if the
experience of members of this list is that I go to see a cardiologist
for the most accurate echo I can get. Will it make a difference in
treatment? Is going to visit a cardiologist of this stature not
necessary unless Mack C.'s case has made a turn for the worse? Is
there something that Dr. Fox would be able to tell me about Mack C.'s
specific case that a specialist would not? I should have the money to
take Mack C. to the less expensive echo within two weeks. It will
take an additional week or two to save enough money to take him to see
Dr. Fox. Could this be crucial time?

I just want to make sure I am doing all I can to give Mack C. not only
a longer life span but a high quality of life. I am still devastated
about the potential diagnosis, but at this point I am doing all I can
to gear myself towards his health rather than my emotions. Thank you
all for your advice as I will take all into consideration!

Pictures of the lovely boy are at:
http://www.thebighustle.com/mack1.jpg
http://www.thebighustle.com/mack2.jpg

All the best,
Heather

"zinzee" wrote in message
ups.com...

Lastly, and the worst diagnosis of all, the vet informed me that Mack
C. has a heart murmur. He told me that it was rather apparent and
that it was something my original vet would not be likely to miss.
This would mean that the heart murmur developed in the past year and
is most likely the cause of hypertrophic cardiomyopathy. There is a
second vet in the office and he stopped her as she walked by to have a
listen to Mack C.'s little heart. Without him saying anything to the
other vet, she said, "Oh wow," and then took a better listen and
offered the same diagnosis.

I have spent hours since this past weekend researching these
conditions, focusing most intently on the latter (HCM), since it
offers the grimmest prognosis. My vet said that Mack C. needs to get
an echocardiogram in order to properly diagnose whether or not it is
HCM and if it is, the severity of his condition. He is showing no
clinical sings with the exception of the heart murmur.
------------
Oh, wow! Mack C is one hunk of gorgeous feline! (I have three black and
white cats, so I may be just a tad prejudiced). One of my cats, Alex, has
had a low level heart murmur for years. The vet told me these were very
common in cats. She advised me to have an echocardiogram. Initially, I
misunderstood the importance of this because in humans, low level heart
murmurs are usually benign conditions. So, I didn't do it right away. After
a couple of years, I read on a different cat newsgroup that a cat with a
heart murmur is prone to blood clots (which if located in the spine could
result in paralysis of the lower half of the body), so I took Alex back to
the vet right away and discussed the situation in more depth.

The vet explained that (unlike humans) cats with heart murmurs usually do
have cardiomyopathy, and they should be put on medication to avoid the
potential for a crisis, but that the medication would not prevent
progression of the heart disease. So, we had the echocardiogram done (which
cost a little more than $100 in my neck of the woods). The result was that
the cat was diagnosed with cardiomyopathy. He was placed on daily diltiazem
(which is very inexpensive and also used for humans) and aspirin twice
weekly. Sometimes he wasn't getting the medication, though, because he was
so difficult to pill, and I thought it may be more dangerous if he were
getting the medication sporadically than not at all. At some point, our old
vet had moved to a different practice a larger distance away, but still
worked part-time at the same practice doing echocardiograms. Our new vet
suggested another echocardiogram since Alex hadn't had one in several years.
She disagreed with what the first vet and said the diltiazem *did* prevent
progression of the cardiomyopathy. I felt horribly guilty. But then, the
echocardiogram showed that the cardiomyopathy had not progressed despite the
fact that Alex wasn't getting the medication consistently. The new vet
consulted with our old vet, and they mutually agreed that the best course of
action IN OUR SITUATION was to discontinue the medication entirely. So, to
answer your questions (IMHO):

1. Yes, an echocardiogram is important to determine the baseline degree of
cardiac hypertrophy. Get a follow-up a few years later.
2. The prices that you are quoting seem outrageous to me (and the practice
we use is very expensive) but it may be because of where you're currently
living.
3. Don't panic about Mack C. In all likelihood, the outcome will be that you
will need to give him some inexpensive medication and he will live a nice
long life (Alex is now 16 years old and going strong. He also beat
diabetes). Even though Alex is not currently on medication, I am not
suggesting that Mack C or any other cat should not be. We got lucky with
Alex, but if your vet says Mack C needs medication, then he should
definitely have it. It's very inexpensive.

Good luck.
Best regards,
---Cindy S.

Hi Heather,

The first thing I wanted to say is that HCM is not the grimmest of
scenarios when it comes to heart trouble. DCM is... Dilated
Cardiomyopathy. Hypertrophic Cardiomyopathy, if this is what your cat
has, can actually be managed quite well with medication and your cat
could live for years and years with the condition.

My cat, Sylvester, is a huge 19 lb male. He was diagnosed with HCM when
he was somewhere around 5 years old (my memory is failing me for exact
age). He is now 17 years old and is spunky as ever. He was on meds
(Atenolol) and baby aspirin for about 2 years, but his ultrasounds (or
ECGs?) showed no further progression of his disease after this time
period and the meds were making him sick (he has IBS) so I took him off
all the meds and he's been fine ever since. He still has a moderate
murmur, but he's had that for about 12 years now...or maybe longer. I
have him checked every year to see if his murmur has gotten worse (so
far it hasn't).

Go to the best cardiologist you can and get Mack C properly diagosed,
treated, and monitored. You might be pleasantly surprised that he's
still around to pester you when he's an old man.

Good luck,
Jennifer

zinzee wrote:
My name is Heather and I live in Brooklyn, NY and work in Manhattan,
NY. My cat, Mack C., is 18 months old and such a joy. Last Saturday,
I took him to the vet because for a few days his left eye was almost
constantly running clear fluid. Mind you, this was our first visit to
this vet because we moved from Manhattan to Brooklyn in August of
2006. His last visit to his old vet was in March of 2006.

I want to warn that I am very long winded so be prepared, but I do
appreciate you reading!!

During the visit I was informed that Mack C. has herpes. He is now on
a daily dose of 500mg of L-lysine. In order to prevent any secondary
infection, the vet also gave me ointment (it's at home so I don't know
the identifiable name) to put on Mack C.'s left eye twice daily until
the eye is seemingly better for two full days.

I was also informed that Mack C. has medial patellar luxation, which
the vet told me is rare in cats but common in some small breed dogs.
Although he did not give me a grade of severity of MPL, I am less
concerned about this because Mack C. is 100% an indoor cat and
therefore won't be doing the kind of jumping an outdoor cat may do.

Lastly, and the worst diagnosis of all, the vet informed me that Mack
C. has a heart murmur. He told me that it was rather apparent and
that it was something my original vet would not be likely to miss.
This would mean that the heart murmur developed in the past year and
is most likely the cause of hypertrophic cardiomyopathy. There is a
second vet in the office and he stopped her as she walked by to have a
listen to Mack C.'s little heart. Without him saying anything to the
other vet, she said, "Oh wow," and then took a better listen and
offered the same diagnosis.

I have spent hours since this past weekend researching these
conditions, focusing most intently on the latter (HCM), since it
offers the grimmest prognosis. My vet said that Mack C. needs to get
an echocardiogram in order to properly diagnose whether or not it is
HCM and if it is, the severity of his condition. He is showing no
clinical sings with the exception of the heart murmur.

My vet told me that they can either refer me to a clinic to do the
echocardiogram or have a specialist come into his vet office in
Williamsburg. He told me that the approximate cost of the test would
be about $300. I'm assuming that does not include any standard fees
such as just coming into the office and also being examined by the
specialist. I am more than willing to pay this amount, but in my
research it seems to be recommended that I go to a veterinary
cardiologist. I'm assuming that the person the vet would bring in is
not a cardiologist as there are seemingly only three board certified
cardiologists in New York City and I doubt they travel to Brooklyn vet
offices.

So I called the Animal Medical Center located in midtown Manhattan to
inquire about fees for the test. This is where Dr. Philip Fox and Dr.
Betsy Bond both practice at least a portion of their time. Dr. Fox
apparently has a very good reputation and I feel lucky to be so close
to this resource. They told me that it is $152 for the initial visit
to see a cardiologist. In addition, the echocardiogram will cost
somewhere from $380 to $420.

This is quite a bit more than what my vet estimated it would be to
bring someone into his office. However, I'm willing to pay it if the
experience of members of this list is that I go to see a cardiologist
for the most accurate echo I can get. Will it make a difference in
treatment? Is going to visit a cardiologist of this stature not
necessary unless Mack C.'s case has made a turn for the worse? Is
there something that Dr. Fox would be able to tell me about Mack C.'s
specific case that a specialist would not? I should have the money to
take Mack C. to the less expensive echo within two weeks. It will
take an additional week or two to save enough money to take him to see
Dr. Fox. Could this be crucial time?

I just want to make sure I am doing all I can to give Mack C. not only
a longer life span but a high quality of life. I am still devastated
about the potential diagnosis, but at this point I am doing all I can
to gear myself towards his health rather than my emotions. Thank you
all for your advice as I will take all into consideration!

Pictures of the lovely boy are at:
http://www.thebighustle.com/mack1.jpg
http://www.thebighustle.com/mack2.jpg

All the best,
Heather

On Mar 1, 4:11 pm, "Matthew" wrote:
Heather, Have you got a second opinion. Just because he is a good vet does
not mean he is correct. Not saying he is not. Before you go thru massive
testing. Treat it like you should do when you get a major health problem.

I can't give you any medical advice on this subject. I do not want to steer
you the wrong way. Others probably will throw there 2 cents in. But I am
sending some prayer and purrs for such handsome furball


Matthew, I have definitely considered getting a second opinion.
Although, having the second vet in that particular office hear the
heart murmur without any coaching somewhat served as a second opinion
in my mind.

The other evening I thought I could hear the swooshing sound the vet
was referencing. I must say it's hard to really investigate at home
because he has always had a huge purr, even since being a kitten.
Nearly every time I touch him, he starts in. If he's in a funky mood,
he generally doesn't let me get my ear to his chest without a little
paw and claw action.

I really appreciate you sending out well wishes for Mack C.

All the best,
Heather