Hello from Tokyo!
My 6-year-old cat, Nelson was diagnosed with HCM last October and the vet said he wouldn't survive longer than 2 months. Fortunately, he reacted well to the medication (Tenormin, furosemide, dipyridamole and transdermal nitroglycerin　upon episode), and is still around.
He is quite happy and though has to stay in an oxygen box
(I have rented a portable oxygen box for small animals) to spare his heart, when coming out, enjoys trotting about in the room, playing with his partner cat, nibbling some food etc. All in all. he has been OK
apart from occasional lung oedema.
However, he has become to breathe quite heavily these days sometimes
even in his oxygen box. I'm so worried and start searching the net again
and happened to find some statement that a combined therapy
of a beta blocker and a calcium channel blocker may be more effective than just using a beta blocker.
http://www.vin.com/proceedings/Proceedi ... &O=Generic
Also I read elsewhere that diltiazem (calcium channel blocker, i think) results in almost complete resolution of HCM though very rarely.
Both articles say that these data are reported/ well documented in the literature, but have no links to the actual documents.
And I'm wondering if anyone knows about these therapies (1. combined use of B and Calcium inhibitors, 2. Use of diltiazem resulting in
total resolution of HCM)... Or any information about the latest therapy
for HCM would really help.
In Japan (I'm Japanese), veterinary medicine is not
so advanced compared to in the U.S. and the documents in Japanese
are way behind the American standard (or so they say).
But for me, without a specialist knowledge and a good command of English, it is almost impossible to locate necessary information.
Please help Nelson and me.
Atsuko
Cat HCM treatment
Re: Cat HCM treatment
Poor Baby....I cannot offer advice...hopefully Traci or davet will be by later this evening and can give you more information....
I just wanted to let you know I read it and pray that some sort of more effective treatment can be found...
I just wanted to let you know I read it and pray that some sort of more effective treatment can be found...
Re: Cat HCM treatment
Dear Tambrey
Thank you very much for your kind words! Not everyone around me
understands what Nelson crysis means to me so I 'm very happy to receive your message.
atsuko
Thank you very much for your kind words! Not everyone around me
understands what Nelson crysis means to me so I 'm very happy to receive your message.
atsuko
Re: Cat HCM treatment
Actually, some of the most foremost veterinary researchers are from Japan, it is incumbent upon your vet to seek a qualified, board-certified feline vet specialist to address kitty's condition. Tell your vet you want a referral to a board-certified veterinary cardiologist, perhaps at a veterinary university near you, your kitty should get an ECG and cardiac ultrasound done to determine optimal heart function and the specialist will then determine what medications are most effective for your kitty's particular needs. It is also very important to monitor blood pressure and rule out hypertension, and rule out secondary health conditions, such as kidney disease, thyroid disfunction, etc, because sometimes, a major condition like heart disease can be compromised or exacerbated by another health condition.
What do you mean your kitty is in an oxygen cage? How often is he in this cage? Is your vet regularly examining your kitty, and testing blood to determine medication effectiveness? What if the doseages need to be adjusted, is he monitoring that??? Oxygen is not a cure-all for breathing distressed patients, you need to talk to a certified veterinary cardiologist to determine the correct medications specific to your kitty's needs. Whenever there is breathing distress, or a heavy workload on the heart, or any other obvious sign of distress, a veterinary visit immediately is warranted to evaluate the heart function, determine what medications are useful for addressing the symptoms, and checking other health factors to reduce the signs of stress, distress, etc. If fluid has accumulated, there are medications that can be prescribed to reduce the fluid load, mainly diuretics, but they MUST be monitored and not used long term unless the condition warrants it.
What do you mean by "lung edema"? Is there fluid in the lungs? Did your vet rule out pneumonia or aspiration or other fluid accumulation? Did he rule out accompanying bacterial infections?
PLEASE, talk to your vet TODAY, and demand a consult/referral to a feline cardiologist IMMEDIATELY!! The cardiologist most likley is up-to-date on diagnostics and treatment, and has resources available to consult with other professionals when necessary.
What do you mean your kitty is in an oxygen cage? How often is he in this cage? Is your vet regularly examining your kitty, and testing blood to determine medication effectiveness? What if the doseages need to be adjusted, is he monitoring that??? Oxygen is not a cure-all for breathing distressed patients, you need to talk to a certified veterinary cardiologist to determine the correct medications specific to your kitty's needs. Whenever there is breathing distress, or a heavy workload on the heart, or any other obvious sign of distress, a veterinary visit immediately is warranted to evaluate the heart function, determine what medications are useful for addressing the symptoms, and checking other health factors to reduce the signs of stress, distress, etc. If fluid has accumulated, there are medications that can be prescribed to reduce the fluid load, mainly diuretics, but they MUST be monitored and not used long term unless the condition warrants it.
What do you mean by "lung edema"? Is there fluid in the lungs? Did your vet rule out pneumonia or aspiration or other fluid accumulation? Did he rule out accompanying bacterial infections?
PLEASE, talk to your vet TODAY, and demand a consult/referral to a feline cardiologist IMMEDIATELY!! The cardiologist most likley is up-to-date on diagnostics and treatment, and has resources available to consult with other professionals when necessary.
..........Traci
Re: Cat HCM treatment
Dear Traci
Thank you for your advice.
I went to the vet last night and talked about
what we could do for Nelson. She is now considering
using diltiazem or ACE inhibitor based on the information
I found on the internet. I know it sounds ridiculous but
we haven't got many choices now.
My vet doesn't have Echo equipment (ultrasound?) but
she has a visiting doctor who carries about it once a week.
He is a cardiologist and Nelson got a diagnosis
from him. At that time, he said Nelson was in a very severe
condition and almost nothing could be done apart from
slowing down cardiac movement and getting rid of
lung fluid (yes, I meand to say lung fluid).
>Is your vet regularly examining your kitty, and testing blood to >determine medication effectiveness? What if the doseages need to be >adjusted, is he monitoring that???
When the medication started and during the first 2 months,
we visited the vet every week and then every 2 weeks
for blood test and X-ray (no blood pressure monitoring because of
lack of equipment).
The dose hasn't been changed much since his
condition has been quite stable.
Diuretics cause kidney failure and this is the main
reason for the blood test as we must make sure BUN is not too high.
Carbon pill has been added to his medication to keep the
damage to the kidney to the minimum. I switched the food
to kidney care ones.
We still go there every 3 weeks. I was alarmed
last time because his heart appeared much bigger than
the one taken in May (these days the vet takes X rays
only when Nelson had an episode, which is rare.).
I don't think I can take him to a univerisyt for ECG because there are only a few universities with veterinary cardiologists
and are always very busy even with a referral. It's a long
way and Nelson wouldn't be able to bear the journey and
waiting and tests in a strange environment.
>What do you mean your kitty is in an oxygen cage? How often is he in >this cage?
The vet suggested that to rest his heart, it is the best thing
to keep him in a high concentration oxygen environment.
So I rented one and since then he spends almost all day in there.
As I work at home, when he likes to come out for loo or food, or when
he just gets bored, I let him out for 30 min-1 hour.
The O2 level is 35-40%.
>Is there fluid in the lungs? Did your vet rule out pneumonia or >aspiration or other fluid accumulation? Did he rule out accompanying >bacterial infections?
Yes, there is sometimes fluid in the lungs and if it's not too severe,
I am told by the vet to give him extra diuretic (furosemide) and put nitroglycerin inside his ears. When this doesn't work, I can contact her anytime even at night. In our case, it is no good to go to the vet at the time he breathes heavily as there is no monitoring equipment
other than X ray and blood analyser.
The university hospitals are way too far and wouldn't accept emergency patients.
There is no symptom that he's got pneumonia, aspiration, etc.
I have searched for relevant info in Japanese first
and asked advice from several other Japanese vets.
What I could find out is that HCM is uncurable and prognosis is bad.
The visiting cardiologist at my vet says the same thing.
So I desperately started to search in English and found more
promissing information like those I asked about in the first post.
And one of them led me here so I decided to join and ask for help.
If you happen to know anything about therapies for HCM or
have any idea where to find references, please let me know.
Then perhaps I could write to the author to ask for advice.
My vet is willing to lend me Nelson's record and I can translate
it into English.
Thank you again for your time and consideration.
atsuko
Thank you for your advice.
I went to the vet last night and talked about
what we could do for Nelson. She is now considering
using diltiazem or ACE inhibitor based on the information
I found on the internet. I know it sounds ridiculous but
we haven't got many choices now.
My vet doesn't have Echo equipment (ultrasound?) but
she has a visiting doctor who carries about it once a week.
He is a cardiologist and Nelson got a diagnosis
from him. At that time, he said Nelson was in a very severe
condition and almost nothing could be done apart from
slowing down cardiac movement and getting rid of
lung fluid (yes, I meand to say lung fluid).
>Is your vet regularly examining your kitty, and testing blood to >determine medication effectiveness? What if the doseages need to be >adjusted, is he monitoring that???
When the medication started and during the first 2 months,
we visited the vet every week and then every 2 weeks
for blood test and X-ray (no blood pressure monitoring because of
lack of equipment).
The dose hasn't been changed much since his
condition has been quite stable.
Diuretics cause kidney failure and this is the main
reason for the blood test as we must make sure BUN is not too high.
Carbon pill has been added to his medication to keep the
damage to the kidney to the minimum. I switched the food
to kidney care ones.
We still go there every 3 weeks. I was alarmed
last time because his heart appeared much bigger than
the one taken in May (these days the vet takes X rays
only when Nelson had an episode, which is rare.).
I don't think I can take him to a univerisyt for ECG because there are only a few universities with veterinary cardiologists
and are always very busy even with a referral. It's a long
way and Nelson wouldn't be able to bear the journey and
waiting and tests in a strange environment.
>What do you mean your kitty is in an oxygen cage? How often is he in >this cage?
The vet suggested that to rest his heart, it is the best thing
to keep him in a high concentration oxygen environment.
So I rented one and since then he spends almost all day in there.
As I work at home, when he likes to come out for loo or food, or when
he just gets bored, I let him out for 30 min-1 hour.
The O2 level is 35-40%.
>Is there fluid in the lungs? Did your vet rule out pneumonia or >aspiration or other fluid accumulation? Did he rule out accompanying >bacterial infections?
Yes, there is sometimes fluid in the lungs and if it's not too severe,
I am told by the vet to give him extra diuretic (furosemide) and put nitroglycerin inside his ears. When this doesn't work, I can contact her anytime even at night. In our case, it is no good to go to the vet at the time he breathes heavily as there is no monitoring equipment
other than X ray and blood analyser.
The university hospitals are way too far and wouldn't accept emergency patients.
There is no symptom that he's got pneumonia, aspiration, etc.
I have searched for relevant info in Japanese first
and asked advice from several other Japanese vets.
What I could find out is that HCM is uncurable and prognosis is bad.
The visiting cardiologist at my vet says the same thing.
So I desperately started to search in English and found more
promissing information like those I asked about in the first post.
And one of them led me here so I decided to join and ask for help.
If you happen to know anything about therapies for HCM or
have any idea where to find references, please let me know.
Then perhaps I could write to the author to ask for advice.
My vet is willing to lend me Nelson's record and I can translate
it into English.
Thank you again for your time and consideration.
atsuko
Re: Cat HCM treatment
Atsuko,
I'm so sorry to hear that Nelson is not feeling well. You are doing alot by with Nelson's care. My Smokey had severe HCM and his prognosis was poor when he was diagnosed. I can say he went on to live 3 years and 3 months. Unfortunately, he lost his battle but not because of his heart disease but because of cancer..
Traci helped me so much with my Smokey. She is a Godsend and is exactly right in the info she provided you in the post. (Thank you Traci, I will never forget). I understand you are concerned about going to a university to have him evaluated, but if there is anyway you can manage it, please do it. If you are afraid of the stress on Nelson, it may be possible for your vet to sent Nelson's medical records to a cardiologist at a university setting for evaluaton. This may be a long shot, but it may be worth looking to see if there are any Japanese board certified vets in the US (maybe in California) who can evaluate Nelson's medical records. Your vet sounds very supportive but it would be wonderful is he could work together with a knowledgeable cardiologist in pescribing the best treatment for Nelson.
There is a group on yahoo called feline-heart. It is a great place for info on heart disease for cats, and you can get alot of support there. The people on that group share their experiences but please remember that every kitty's condition is different and it is most important to work with your vet.
Keep us updated on how Nelson is doing. Hugs to you Atsuko...I know it's hard..hang in there.
Lisa
I'm so sorry to hear that Nelson is not feeling well. You are doing alot by with Nelson's care. My Smokey had severe HCM and his prognosis was poor when he was diagnosed. I can say he went on to live 3 years and 3 months. Unfortunately, he lost his battle but not because of his heart disease but because of cancer..
Traci helped me so much with my Smokey. She is a Godsend and is exactly right in the info she provided you in the post. (Thank you Traci, I will never forget). I understand you are concerned about going to a university to have him evaluated, but if there is anyway you can manage it, please do it. If you are afraid of the stress on Nelson, it may be possible for your vet to sent Nelson's medical records to a cardiologist at a university setting for evaluaton. This may be a long shot, but it may be worth looking to see if there are any Japanese board certified vets in the US (maybe in California) who can evaluate Nelson's medical records. Your vet sounds very supportive but it would be wonderful is he could work together with a knowledgeable cardiologist in pescribing the best treatment for Nelson.
There is a group on yahoo called feline-heart. It is a great place for info on heart disease for cats, and you can get alot of support there. The people on that group share their experiences but please remember that every kitty's condition is different and it is most important to work with your vet.
Keep us updated on how Nelson is doing. Hugs to you Atsuko...I know it's hard..hang in there.
Lisa
Lisa, Angel Smokey and little Caz
This is an american board certified vet in internal medicine and cardiology in Japan...
Dr. Yoko Oguchi Fujii Azabu University Sagaminhara-shi KANAGAWA
This is an american board certified vet in internal medicine in Japan...Internal medicine MDs frequently treat cardiac patients..
Dr. Tetsuya Kobayashi Kobayashi Animal Hospital Warabi Saitama
Dr. Yoko Oguchi Fujii Azabu University Sagaminhara-shi KANAGAWA
This is an american board certified vet in internal medicine in Japan...Internal medicine MDs frequently treat cardiac patients..
Dr. Tetsuya Kobayashi Kobayashi Animal Hospital Warabi Saitama
Lisa, Angel Smokey and little Caz
Re: Cat HCM treatment
Lisa is right on, Atsuko, your vet needs to consult with a certified feline cardiologist. She has resources available to do this. All she needs to do is contact the cardiologist and fax or discuss Nelson's health records, bloodwork, etc. She could also ask the visiting cardiologist or another cardiologist to make an extra visit for Nelson, surely she has other patients with heart conditions who would benefit from the cardiologist's visit more often. She can contact the nearest veterinary teaching university for additional resources as well, she may or may not be able to consult with specialists in the US, but it's worth a shot to try. She can consult either via phone, teleconference, etc. Please don't depend on personally writing to veterinary authors, since they are not in direct contact with you or Nelson, cannot examine him, are not there to evaluate his condition, etc. Also, what you read on the net regarding these studies, and vet's locations, etc, many times, those vets move on to other positions or other locations, etc, information is not always current.
Having said that however, your vet can certainly read up on HCM through university resources, and gather additional information from her peers and associates. Her closest university or a university with known specialists is her best bet since they probably work with the most experienced teachers, and can provide her contact information for specialists. Ask her if she can get a consult from a US specialist if possible.
I'm concerned about the use of an oxygen cage and Nelson's confinement. If fluid is present, that fluid needs to be addressed appropriately with the proper medications. Those medications would probably be much more beneficial for him than constant use of oxygen. You do know don't you, that there is always a risk for too much oxygen saturation?! The fluid may also be indicative of congestive heart failure, which needs to be addressed. Your vet also must determine if the effusion may be caused by something else like a lung infection, bacterial infection, and differentiate that against congestive heart failure. Hyper or hypotension needs to also be ruled out (check blood pressure regularly and thyroid function testing, since sometimes, heart disease is complicated by hyperthyroidism). If your vet doesn't have proper blood pressure monitors, ask her to ask an associate or another vet to borrow one, or she really should invest in this equipment for her patients.
The key in treating HCM is followup ECG's and xrays, distinguishing HCM from signs of congestive heart failure, finding the correct combination of medications to improve blood flow and lessen the heart's workload (without risking kidney damage) address plueral effusion and resolve with correct medication, and manage the condition with regular followups so the vet can determine if medication doses are effective or need to be adjusted or ceased or alternated. It doesn't sound like she knows exactly what combination of medications to use, so this is when it is imperative to consult with a specialist with knowledge of HCM and current therapies, according to Nelson's individual condition and needs. Please, do whatever it takes to get your vet to consult on your behalf with a specialist, and ASAP. The congestion, fluid accumulation, breathing distress and heart enlargement are concerning and your vet may not be experienced to treat this effectively, or at least manage it appropriately. A specialist can and should be able to help. The oxygen cage also needs to be addressed because I don't think this is necessary....oxygen is usually used in emergency cases of extreme need and on a temporary basis. I really do think an ECG is in order here, in order for the specialist to re-evaluate total heart function and to determine which medications are going to best benefit Nelson.
Don't wait on this, demand from your vet that she consults with a specialist immediately.
Having said that however, your vet can certainly read up on HCM through university resources, and gather additional information from her peers and associates. Her closest university or a university with known specialists is her best bet since they probably work with the most experienced teachers, and can provide her contact information for specialists. Ask her if she can get a consult from a US specialist if possible.
I'm concerned about the use of an oxygen cage and Nelson's confinement. If fluid is present, that fluid needs to be addressed appropriately with the proper medications. Those medications would probably be much more beneficial for him than constant use of oxygen. You do know don't you, that there is always a risk for too much oxygen saturation?! The fluid may also be indicative of congestive heart failure, which needs to be addressed. Your vet also must determine if the effusion may be caused by something else like a lung infection, bacterial infection, and differentiate that against congestive heart failure. Hyper or hypotension needs to also be ruled out (check blood pressure regularly and thyroid function testing, since sometimes, heart disease is complicated by hyperthyroidism). If your vet doesn't have proper blood pressure monitors, ask her to ask an associate or another vet to borrow one, or she really should invest in this equipment for her patients.
The key in treating HCM is followup ECG's and xrays, distinguishing HCM from signs of congestive heart failure, finding the correct combination of medications to improve blood flow and lessen the heart's workload (without risking kidney damage) address plueral effusion and resolve with correct medication, and manage the condition with regular followups so the vet can determine if medication doses are effective or need to be adjusted or ceased or alternated. It doesn't sound like she knows exactly what combination of medications to use, so this is when it is imperative to consult with a specialist with knowledge of HCM and current therapies, according to Nelson's individual condition and needs. Please, do whatever it takes to get your vet to consult on your behalf with a specialist, and ASAP. The congestion, fluid accumulation, breathing distress and heart enlargement are concerning and your vet may not be experienced to treat this effectively, or at least manage it appropriately. A specialist can and should be able to help. The oxygen cage also needs to be addressed because I don't think this is necessary....oxygen is usually used in emergency cases of extreme need and on a temporary basis. I really do think an ECG is in order here, in order for the specialist to re-evaluate total heart function and to determine which medications are going to best benefit Nelson.
Don't wait on this, demand from your vet that she consults with a specialist immediately.
..........Traci
Re: Cat HCM treatment
Dear Lisa and Traci
Thank you very much for your replies!! And I'm sorry I couldn't write back any earlier.
First, Thank you, Lisa, for your info about Japanese cardiologists! I think my vet is from Azabu University, so I'll ask her to contact Dr. Fujii. I'm going to talk with the vet later today. And Thank you for telling me about Feline Heart. I'll definitely check it. the problem is writing in English takes me ages and I'm afraid I may not be able to keep up with replies...but will try when Nelson is sleeping.
So sorry to hear about your kitty...3 years and 3 months...you must have done so much for him. He was very lucky to have you as Mum.
Thank you very much for your support.
And thank you so much for your advice, Traci!
My vet is rather old and she is a very experienced and skilled doctor. But she tends to depend on her past experiences (do you call it evidence based treatment?) and is reluctant to apply new therapies when the condition is stable, because the new therapies may deteriorate it.
Still, she is very supportive and if I insist, she would consult the university. As Lisa gave me a specialist's name, and I think my vet's university is the same Uni, she is likely to agree to help with the consultation. And about monitoring, I asked around and found another veterinary clinic which has an ECG monitor near my house. If things go well (I mean the two clinics discuss the matter and agree to cooperate), I'll take Nelson there for ECG and blood pressure monitoring and, with those outcomes, I'll go to my vet for medication etc. so that she could decide things.
She is really a very trustworthy person and has been successfully controlling Nelson's condition at least for 9 months (the visiting doctor is always amazed by it) and I'm too afraid to switch the clinics entirely.
Yes, I heard about oxygen saturation problem. But Nelson seems to be very comfortable in the oxygen cage, and when he feels breathing distress, he goes in there himself or shows the sign he wants to go in.
Actually, the visiting cardiologist said we should keep him out of it when he is breathing normally. But my vet says as far as Nelson feels comfortable, it'd be better to let him in. I contacted the manufacturer of the O2 cage and asked about the oxygen saturation thing but from their experience, there has been no problem reported with 30%-40% O2 gas.
Having said that, I appreciate your concern and will ask my vet to discuss it with the university doctor.
I'm glad I posted the question here. I was so depressed that I was told there is nothing I can do for Nelson but there seems to be a lot. I'll write again when things are settled. Thank you very very much!!
atsuko
Thank you very much for your replies!! And I'm sorry I couldn't write back any earlier.
First, Thank you, Lisa, for your info about Japanese cardiologists! I think my vet is from Azabu University, so I'll ask her to contact Dr. Fujii. I'm going to talk with the vet later today. And Thank you for telling me about Feline Heart. I'll definitely check it. the problem is writing in English takes me ages and I'm afraid I may not be able to keep up with replies...but will try when Nelson is sleeping.
So sorry to hear about your kitty...3 years and 3 months...you must have done so much for him. He was very lucky to have you as Mum.
Thank you very much for your support.
And thank you so much for your advice, Traci!
My vet is rather old and she is a very experienced and skilled doctor. But she tends to depend on her past experiences (do you call it evidence based treatment?) and is reluctant to apply new therapies when the condition is stable, because the new therapies may deteriorate it.
Still, she is very supportive and if I insist, she would consult the university. As Lisa gave me a specialist's name, and I think my vet's university is the same Uni, she is likely to agree to help with the consultation. And about monitoring, I asked around and found another veterinary clinic which has an ECG monitor near my house. If things go well (I mean the two clinics discuss the matter and agree to cooperate), I'll take Nelson there for ECG and blood pressure monitoring and, with those outcomes, I'll go to my vet for medication etc. so that she could decide things.
She is really a very trustworthy person and has been successfully controlling Nelson's condition at least for 9 months (the visiting doctor is always amazed by it) and I'm too afraid to switch the clinics entirely.
Yes, I heard about oxygen saturation problem. But Nelson seems to be very comfortable in the oxygen cage, and when he feels breathing distress, he goes in there himself or shows the sign he wants to go in.
Actually, the visiting cardiologist said we should keep him out of it when he is breathing normally. But my vet says as far as Nelson feels comfortable, it'd be better to let him in. I contacted the manufacturer of the O2 cage and asked about the oxygen saturation thing but from their experience, there has been no problem reported with 30%-40% O2 gas.
Having said that, I appreciate your concern and will ask my vet to discuss it with the university doctor.
I'm glad I posted the question here. I was so depressed that I was told there is nothing I can do for Nelson but there seems to be a lot. I'll write again when things are settled. Thank you very very much!!
atsuko