TK's heart murmur. Bad to worse.

Nomen Nescio wrote:
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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.

"Nomen Nescio" ] wrote in message
...
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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.

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.
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".

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
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 ASSHOLE, right now.

Your vet is the asshole, 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

Nomen Nescio wrote:
snip
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 ASSHOLE, right now.

Some wives feel like you do about their husbands ... and for the same
reasons. ;-)

Nomen Nescio wrote:

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.

in article , Nomen Nescio at
] wrote on 5/20/05 1:50AM:

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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 ASSHOLE, 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.

On Fri, 20 May 2005 08:50:04 +0200 (CEST), Nomen Nescio
] wrote:


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 ASSHOLE, 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

"Nomen Nescio" ] wrote
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 ASSHOLE, 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.

--
-Kelly

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.

"Nomen Nescio" ] wrote in message
...
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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.

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
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"

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
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 ASSHOLE, 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.

"Nomen Nescio" ] wrote in message
...
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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 ****ed 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.
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".


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
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.


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
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.

As a matter of fact, I do! He's an ACVIM Diplomate- board certified
cardiologist. TK is in good hands.


From: "Phil P."

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).

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?

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.


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.