Feline Hypertrophic Cardiomyopathy / Hypothyroidism / Allergies – 08/12/2010 – 09/06/2011

It is time for a full Skip update.  This last appointment has been trying for us, but mostly Skip.  Oddly enough, it was a combination of things and not just HCM that got us.

Since I last left you it’s been a year and 3 cardiologist appointments.  The first two appointments had no changes and therefore, I didn’t feel the need to write anything.  Skip’s labs were fine, meds stayed the same, and he acted perfectly normal.

This last appointment was a bit of a downer, but only slightly.  Basically, it has been 2 years since Skip was first diagnosed with Hypertrophic Cardiomyopathy (HCM) and I feel lucky for every moment that I spend with him.  HCM can be a killer because it is usually found so late.  We were lucky.

This last cardiologist appointment started like the rest.  I took Skip to his regular vet for his yearly regular checkup and labs for the cardiologist.  Skip’s furry uncles (Oreo and Mason) were visiting at the time.

At his regular vet, the vet noticed that his tartar build up on his teeth was getting bad again (My boy absolutely hates to have his teeth cleaned at home).  It needed to be removed.  I told them, that I would schedule an appointment after getting approval from the cardiologist.

You see, getting Skip’s teeth cleaned isn’t as easy as it is for a normal cat.  With HCM, putting Skip under is more risky. The regular vet is awesome about being aware of Skip’s HCM and she does her best to make sure that he isn’t under any longer than he needs to be.

A couple of weeks later, I took Skip to his scheduled cardiologist appointment.  After they spent a couple of hours looking him over, I got the news I had been dreading since learning about HCM.  Skip had a teeny tiny amount of fluid in his lungs.  This is the first sign of congestive heart failure (CHF).

She said what was happening is that the heart is working harder than it needs to.  The capillaries are under stress and they leak fluid into the lungs for relief of the pressure.

The cardiologist said that it wasn’t enough for Skip to notice, but that she needed to make some changes in Skip’s meds.  She increased the evening enalpril to 3/4 of a tablet and added 1/4 tablet of furosemide.  The enalpril will help Skip’s heart to not work as hard and the furosemide will help remove the fluid from Skip’s lungs.

She needed to see him back in a couple of weeks to make sure that the fluid was gone from his lungs and do some labs to make sure that everything looks good with the addition of the new medicine.  Until the recheck, the teeth cleaning was not approved.  His lungs needed to be clear first.

I was disappointed.  I didn’t want to hear that the HCM had progressed at all.  But…as the cardiologist told me, this is just a little blip.  We’ve been lucky for 2 years and since we are on top of it, we were able to catch the CHF early.

I made up two weeks of Skippy pills.  I use the #3 pill capsules, and added the furosemide to the evening pill since I actually have room in that one.  The morning pill is very full.

Shortly after the cardiologist appointment, Skippy’s furry uncles returned for a longer visit.  It’s always a fun week when they visit.  While I think Skip gets a bit more stressed when they visit, I do think he enjoys having them around some of the time.  I figured that this would be a good test of the furosemide.

Once the two weeks were up, I took Skip back to the cardiologist.  They took a look at his heart and lungs plus took the labs.  The good news is that the fluid in his lungs was gone.  After getting the labs back, they said that Skip’s potassium was low.  The cardiologist was expecting this.  I guess the potassium is expelled along with the fluid, so they wanted to put him on half a 550 mg potassium tablet.  They want to see him again in 4 months to make sure that he is stabilized and the HCM has not progressed further. He was approved for his teeth cleaning as well.

Whew!  I was relieved.  It’s never a good thing to hear about fluid in anyone’s lungs let alone your beloved pet.  I called the regular vet and made his teeth cleaning appointment.  I made it such that we would be able to watch him over the 3-day Labor Day holiday weekend.  My other thought on doing it so soon was that as of right now is we know where his heart and lungs are at.

So, two days later, I loaded Skip up and took him to his regular vet for his teeth cleaning.  Poor guy had two vet appointments in one week. His vet did the teeth cleaning and called me once he was done.  They said he had a lot of tartar build up, but they got it all and he was doing just fine.  Because they only had him under for the minimum amount of time, I got to pick him up early.  This was nice because it gets him out of a stressful situation.  I guess he really didn’t like the dog that was next to him. 😉

Now Skip plus anesthesia is a funny thing when he gets home.  He gets ravenous while still loopy, he can’t walk a straight line, and he won’t lay still.  His poppa and I kept a close eye on him on Thursday.  I kept feeding him a little bit of canned food at a time and kept the hard food from him for a day.  His teeth/gums were tender on that first day, so I wanted him to just eat the canned food.  No sense in having the big chicken become afraid of hard food. LOL

On Friday, we gave him his hard food, but kept up with feeding him the canned food.  All day long.  Morning, noon, evening, and night.  Skip was in heaven. 🙂  So, everything goes normal on Friday, and Skip and I head to bed.

Saturday we get up at 7:30 am for Skip’s heart meds.  I put him on the counter and what do I see while still groggy?  Skip with a swollen right eye that he is keeping closed.  Well, swelling this time of year is nothing.  Skip has allergies and allergies can equal swelling.  So, I gave him 1/2 a tablet of antihistamine, but made a note to check him later on in the morning.

Well, I lost track of time, and at noon ran in to check him.  Yep, I still had a one-eyed bandit.  I had a decision to make…this was a holiday weekend which means if it’s something serious and I don’t take him in, we may be taking a trip to the emergency clinic which equals more cost.  But what if it’s not something serious? Am I a helicopter mom with my kitty?

I made a quick decision.  Something was wrong and I knew it in my gut.  Mommy’s know their babies best and should always trust their gut.  I called the vet and they said to bring him up.  It’s a good thing I did.  Skip had a scratch that was pretty big on his eye.  They gave us some antibiotics and eye pain meds to take home.  Plus his regular vet wanted to see him again on Tuesday to make sure his eye healed correctly.

I have to say it was nice to see the other doctor in the practice.  She’s the one who initially found the HCM and to whom I will always be indebted to.  We always see the other vet because of the urine sample.

Skip was miserable on Saturday.  Between his teeth and his eye, he just wasn’t feeling good.  I did cut back on the canned food on Saturday as well which probably added to his discomfort.  He needed to start eating his hard food again whether he wanted to or not.  He would go into the kitchen and eat apiece of hard food. Then would come out and look at me with only one eye open.  It was like he was saying, “Please mother feel sorry for me and give me the canned food.”  I didn’t relent and he went back to eating the hard food.

Skip was better on Sunday.  There was drainage from both eyes which we thought was odd.  And then on Monday Skip was playing with his toys again and acting normal.

On Tuesday, much to Skip’s protests we headed back up to his regular vet.  Hooray!  Skip’s eye was healed.  We were to continue the antibiotics in both eyes for the rest of the week, but Skip didn’t need eye surgery to fix his scratch.  The reason for the antibiotics in both eyes was just in case his allergies were starting an infection in the other eye.

During this whole week, I spent my evenings making up 428 pill capsules which will get us to December.  428!  That is a lot of pill capsules!  The problem is that the potassium pills are HUGE.  I have to cut the pill into eighths.  I called the cardiologist and asked if I could give him a quarter in the morning and a quarter in the evening.  She said that it would be fine to split it.

So the makeup of the pill capsules is as follows:

Morning Pill #1:
– 1/4 Plavix
– 1/2 Thyroid tablet
– 3/4 Enalpril

Morning Pill #2:
– 2/8 of a Potassium pill (It is actually cut into eighths)

Evening Pill #1
– 1/2 Thyroid tablet
– 3/4 Enalpril
– 1/4 Furosemide

Evening Pill #2:
– 2/8 of a Potassium pill (It is actually cut into eighths)

Once Sunday gets here, we’ll be down to two pill capsules in the morning and two pill capsules in the evening.  It’ll be nice to be back to normal. 🙂

To sum it up, after two years Skip’s HCM progressed a bit and we countered with upping one med and adding two new ones.  Here’s hoping for two more years of the same-o, same-o. 🙂

Feline Hypertrophic Cardiomyopathy / Hypothyroidism / Allergies – 07/15/2010 – 08/12/2010

The saga continues. 🙂  This episode will contain Skip’s latest vet appointment plus his latest cardiologist appointment.  We are now at a little over a year from when he was first diagnosed with Feline Hypertrophic Cardiomyopathy (HCM).

It was getting close to Skip’s cardiologist appointment, so I made an appointment to get his lab tests done as well as his regular yearly checkup.  I finally remembered to close off the area where his litter box is, so that he’d have a full bladder for the urine sample. 🙂

At the appointment, nothing new was found.  His teeth looked good and everything else was fine.  He was his usual happy go lucky self during the appointment.  He was a little mad at mommy once we got home due to the drawing of the blood and urine, but he quickly got over that.

The vet’s office called the following Monday and the lab tests came back just peachy. 🙂  His Thyroid T4 was at 1.5, so no worries there. We are all set for his August 3rd appointment…or are we?

On July 26th, I received a voicemail message stating that Skip’s cardiologist was no longer with the practice and Skip’s appointment was cancelled.  Huh? What?  You’re kidding?  Where’d she go? These were just a few of the questions that went through my head.

I immediately called the Care Center.  When I talked with the front desk, they stated that the cardiologist was still with the practice.  Huh?  What?  I told her what was in the voicemail that I received and she said she’d check to see if the appointment was still there.  It wasn’t.  She was confused, but sent me to cardiology voicemail.

I left a message asking where they were referring people.  I received no response, so I called again the next day asking the same question.  I had also been doing some research and had decided that if I couldn’t find his cardiologist that going back to my old stomping grounds while taking Skip to the Purdue Vet Clinic would work.  I left a message including Purdue’s information and my phone number, but there was still no response.

During this time, I had been in contact with Skip’s regular vet.  I told them what was going on to which they responded with…What?  Since I was receiving no response from the Care Center, I asked if the regular vet would mind referring Skip over to the Purdue Vet Clinic.  They said that they would take care of faxing all of the information over to Purdue.

Meanwhile, I called the Care Center and asked for 3 copies of Skip’s records and what the cost was for them.  Luckily, they provide them at no cost, so I e-mailed boyfriend and asked if he’d pick them up on his way home from work.  I have to say, when they provide records, they provide them all.  I even received cds with the results of tests like ultrasounds and echos.  I was impressed that it was all for free.  Of course I guess that’s the high cost of paying so much for the tests.

A little while later that day, I received a call from Skip’s regular vet that they had found Skip’s cardiologist and that she was still in the area; just with a different practice.  I found out later that the cardiologist had just received the fax from Skip’s primary vet with the lab tests prior to giving her notice.  She remembered it when she walked out the door and made a point to call them and let them know where she was going.  Just as an FYI, it was the Care Center that would not allow her to give a two weeks notice like she wanted.

I told my primary vet that I would call over to the new location and see what’s up.  The new place said that they would begin scheduling appointments later on in the week for the following week and took down my name and number.  They were really nice on the phone and did call me back.  I made the appointment for the first appointment of the following Thursday.

I’d like to get up on a soap box and say that the Care Center handled the whole process of the cardiologist leaving poorly.  There were some extenuating circumstances that I won’t go into that seem to have made some hard feelings.  When I called, they had not even informed their front desk that the cardiologist had left.  I also found out later that the Care Center is referring people to a cardiologist in Columbus instead of Skip’s cardiologist.  I guess there were some hard feelings when notice was given by the cardiologist.  It tells me that the Care Center was not interested in Skip getting the needed care, but rather the money from that care.  If they cared about the pets, they would have put aside their differences and given me the needed information.  Skip’s cardiologist is the only one in Cincinnati, so it’s not like the Care Center could provide me with an alternative solution.  So, my impression of the Care Center has gone down a notch. I am climbing down off my soap box now.

So, whew! There for a week, I was stressing as to how to get my baby checked out.  HCM is already a stressful condition whenever you have to go in for a checkup, so the added stress was not needed.

The day of Skip’s appointment arrived, and I drove up to the cardiologist’s new location which is a lot closer.  I will not currently comment on the new vet’s office as they are starting the process to remodel and were clearly getting everything put into place at their new location.  I will however say that the staff thus far has been extremely nice and willing to work with us parents who have furry kids with a disease of some type.

It took awhile to get called back to the room due to computer issues.  Once we got back there, I found a familiar face.  One of the cardiologists’ techs came with her.  She told me that she was switching over to Oncology, but was helping out on Thursdays to get used to the new building.

I handed over all of the records that I got from the Care Center along with the disks…oh and Skip too.  We went through the sheet I was supposed to fill out, but the front desk forgot to give me…remember a new location and department for them, so no biggie.

One thing I had noticed was that expelling air when purring looked like it took effort.  She noted that and I said that’s all I’ve got.  She went through the cost sheet.  I just told her that as long as they do what is needed to check Skip out and the price is roughly the same, I’m good.  It’s all expensive, so what’s a difference of $20?  I don’t remember what the difference was, but it was inline with what I expected, so I was ok.

Then the waiting…it takes them roughly a couple of hours to check him out.  I worked while I waited a nice perk from work.  The vet tech came out and asked for Skip’s carrier.  I gave it to her and asked if she just wanted to bring him out.  She said he was a little cranky and might be happier in the carrier. 🙂 I think actually as soon as he saw Mommy that he would have been fine.

I was called back to talk with the cardiologist.  It was really nice to see her.  She said Skip’s HCM is unchanged!!!  Woohoo!!  That’s good news in my world.  She said the left ventricle is still a tad enlarged, but unchanged from our last visit and that we were going to continue the same treatment as before.

The cardiologist told me that she saw no fluid in the lungs and his echo was fine.  She said that most cats give a lot of effort to expel air when purring and that is perfectly normal.  Skip has lost a little weight, so that probably contributed to me actually noticing it.  Plus when ever we get near his checkup, I get nervous and more observant.

I asked about the grumpiness I heard about, and she said that she can do anything with him she wants except take an x-ray of his chest.  She has to lay him on his side to do so, and he fights her on it.  I told her that only Mommy is allowed to put him on his side, so I wasn’t surprised.  I told her that I do that all the time at home without any argument from Skip.  That’s because he fully trusts me though.

Poppa says there is a double standard in our house.  Poppa can’t hardly move Skip one iota when holding him unless he wants to hear from Skip whereas I move Skip however I want him without much complaint.  🙂  I just tell Poppa that I have 6 extra years with Skip.

I asked if he growled and hissed.  She said yeah and he was going to take a nip from her.  I laughed (probably shouldn’t have but hey my calm boy was sticking up for himself), and said that the command is “Skip! No Bite, Be Nice” in an extremely serious tone that says I’m not happy with your behavior right now. She kind of gave me a look like “You’re kidding right? How often does this happen?”  I said that sometimes Skip shows his displeasure by using his teeth, but never breaks the skin.  Then she saw I was perfectly serious and said that she would keep that in mind the next time and to remind them.

Skip and I checked out and headed home.  We’ll go back in 6 months and do it all again as this is our life now.  I’m just happy that Skip is getting to live a full life. 🙂  If anything significant happens before 6 months I’ll post an update; otherwise the next update will be in 6 months.

I pondered about this part over and over, but I have to help the others in Cincinnati who need to take their pets to a cardiologist and there is no sense in driving all the way to Columbus.  So, here’s the info: Dr. Kathy Wright (I don’t know all the acronyms after her name) is now with MedVet which is off the Red Bank Expressway in Cincinnati.  The MedVet website is http://www.medvet-cves.com/ .  They haven’t updated the website, but trust me she is at the Cincinnati location.