Hugo update, concerning news from the vet

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Tiina and Hugo

Tiina and Hugo

Member Since 2016
Hi everyone! I wanted to do an update on my boy, Hugo, who is still doing the sugardance. His numbers have been quite high recently and I have been trying to adjust his dose. Just this morning I went back up to 2.25u.

So yesterday was quite stressful for us. As you might remember, Hugo has also asthma in addition to diabetes. Recently he has been coughing despite of getting his twice a day puffs from his inhaler, so I have been worried if there might something else going on. The last two times he had a check-up they heard a heart murmur while listening with the stethoscope. And I have been planning a dental, but the vet wouldn't agree to do it unless he has an echocardiogram. His vet did the echo on him yesterday and it revealed he has a leaky aortic valve and a partially thickened left ventricle. They diagnosed him with hypertrophic cardiomyopathy. He was prescribed a medication for hypertension, but nothing else. I started giving it today, it's one pill per day, called Nelio. They also did an xray of the lungs, but they looked clear. After hearing the diagnosis, I am now really concerned. Do any of you have any experience with HCM? Isn't there anything to stop the illness from progressing and him going into heart failure? I feel like all the work I have done to treat his diabetes and then this is thrown at us. :banghead::( I didn't get any kind of a document of the results, and I don't remember if the vet said if his atrium was enlarged yet or not. I think she said it looked okay. But Hugo is still coughing for example when he purrs. But he is not out of breath, lethargic or doesn't have a bad appetite.
 
So, HCM is reasonably common, unfortunately. Go and hang out with Maine Coon people. Getting him on Nelio/fortekor sounds good, and also maybe on small doses of aspirin if there seems to be a risk of clotting and thrombi. How high is his tension? heart enlargement can be due to hypertension, but given the leaky aortic valve, doesn't seem to be the case here.

My darling Tounsi died of FATE (Feline Aortic Thromboembolism) nearly a year ago, certainly due to undiagnosed and untreated HCM. It's definitely a good thing that you have spotted it and Hugo is getting treatment! I would ask about the clotting risk and blood thinners, though, particularly if you start spotting weird paw mouvements (front or hind -- video link in spreadsheet shared here https://www.facebook.com/TounsiCat/posts/1156486484464981 )

So sorry about the diagnosis, and fingers crossed that you get this other condition under control too!
 
Stephanie & Quintus said:
So, HCM is reasonably common, unfortunately. Go and hang out with Maine Coon people. Getting him on Nelio/fortekor sounds good, and also maybe on small doses of aspirin if there seems to be a risk of clotting and thrombi. How high is his tension? heart enlargement can be due to hypertension, but given the leaky aortic valve, doesn't seem to be the case here.

My darling Tounsi died of FATE (Feline Aortic Thromboembolism) nearly a year ago, certainly due to undiagnosed and untreated HCM. It's definitely a good thing that you have spotted it and Hugo is getting treatment! I would ask about the clotting risk and blood thinners, though, particularly if you start spotting weird paw mouvements (front or hind -- video link in spreadsheet shared here https://www.facebook.com/TounsiCat/posts/1156486484464981 )

So sorry about the diagnosis, and fingers crossed that you get this other condition under control too!
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Thank you for your reply. I'm so sorry to hear about Tounsi's passing and the battle with FATE and HCM. I had a look of Tounsi's facebook page and what a beautiful cat yours was.

I didn't get any info to take home with after the visit, but I just tried to send a message to the vet and asked for more information. I remember the nurse saying that she took five readings of Hugo's blood pressure and only one was above the critical limit of 180 or something. But Hugo was very stressed at the vet after the one hour ultrasound and there were dogs barking outside the room, which he is afraid of. Hugo doesn't have these strange paw movements you mentioned about, but a in 2015 he seemed to injure his leg and seemed to drag it, but the xrays did not show an injury. It became better on its own. I don't know if it could be linked or not.

Now that you mentioned the blood thinners, I don't see why they couldn't prescribe that to Hugo already. I was told to book a new time to see a nurse to take his blood pressure two weeks after starting the Nelio and then book a new echo in June. As serious as this illness is, it feels like I was just left to wait for it progress.
 
All I can offer is support. My Martini also has asthma and we recently brought in a live Christmas tree, it was VERY fresh unlike the ones in years past.
She started coughing more right away, have you brought in any new 'smells' lately? Are you puffing the max 220mg X2 twice daily?
:bighug:
 
Tiina and Hugo said:
in 2015 he seemed to injure his leg and seemed to drag it, but the xrays did not show an injury. It became better on its own. I don't know if it could be linked or not
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I would at least entertain that possibility -- though if there has been nothing since then, maybe not.

Tiina and Hugo said:
she took five readings of Hugo's blood pressure and only one was above the critical limit of 180 or something
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Normal BP for a cat is 160-180. Quintus was at 260 (which made him blind). He's now on amlodipine and down to 180. Sounds like his BP is not sky high and not a cause of immediate worry.

Tiina and Hugo said:
I was told to book a new time to see a nurse to take his blood pressure two weeks after starting the Nelio and then book a new echo in June. As serious as this illness is, it feels like I was just left to wait for it progress.
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HCM is a disease that progresses slowly. Nelio/fortekor are the main thing you can give the cat to help with the illness. Checking again in a couple of weeks makes perfect sense to me. Ask them about the risk of thrombi and utility of aspirin at this stage when you next go. Did they manage to give you an idea how advanced his HCM was? (I suspect not hugely if they said "come back in June". There is really not much you can do besides the meds they gave you. Aspirin will help reduce the risk of a nasty side effect of the condition, but that's all.)

In the meantime, do relax and enjoy your kitty. Hugs!
 
Woah! I've read Aspirin is poisonous/very toxic to cats. Be careful, read up please!!!
 
There's a number of sites that come up with googling aspirin and cats. Most do not recommend aspirin for cats.
I think it would be wise to check with the vet before giving it in any case, but it's up to the owner certainly.
 
Yes, I did read the links you posted, thank you Stephanie! and I also read many other links with differing opinions. I would not give aspirin even with a vet approval, but that's just me. Everyone must make up their own minds on how to treat their kitties.
Take care.
 
@Tiina and Hugo you might want to check out these:

- https://www.medvetforpets.com/feline-hypertrophic-cardiomyopathy-hcm/ -- seems like a good summary on HCM, particularly talks about the distinction between mild and advanced HCM
- https://www.cathealth.com/cardiovascular/hypertrophic-cardiomyopathy-hcm-in-cats-cathealthcom -- some interesting info on treatment
- http://www.acvim.org/Portals/0/PDF/...ardio Hypertrophic cardiomyopathy in cats.pdf -- american vet school fact sheet

Based on cursory reading it seems the risk for clotting (and therefore usefulness of blood thinners) is mainly when the condition is advanced.
 
I am so sorry you and Hugo are dealing with a second issue.
Yum had a murmur and I took her to a cardiologist for an echocardiogram. He said it was just due to her heart dropping in her chest due to age. We were lucky.
Her BP was high though and he prescribed enalapril or something like that. I took her to her vet for another reading and it was still high. Then I took her to her vet a second time, where they measured it while I was brushing her and talking to her. It was low normal. It's hard to get a good BP reading at the vet's office.
 
I'm sorry about the HCM diagnosis. It does sound like you caught it early, though.

I would be hesitant to go the anticoagulant route without your vet encouraging you to do so. You need to know if there is an indication of whether the valve is causing a turbulence in blood flow that indicates if a blood thinner is needed. However, anticoagulation may be a reasonable preventative measure. This link discusses options regarding anticoagulants and thromboembolism specifically in cats with aortic valve issues related to HCM.

One thing to watch for -- ACE inhibitors, such as benzepril (Nelio) can cause a loss of appetite or GI issues. When Gabby was prescribed benzepril, her appetite was awful. We switched her to telmesartan which had recently been given an indication for hypertension in cats and it didn't affect her appetite.
 
Stephanie & Quintus said:
Did they manage to give you an idea how advanced his HCM was?
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They didn't, but I just asked the vet in an email for a summary of the results and she promised me one for next week. I guess she is so busy that didn't have time to write it yesterday. But this is the exact question I asked her and I also asked about the blood thinners. I hope she remembers to answer me and doesn't forget because Christmas is on its way. o_O
 
Martini & Sandy said:
All I can offer is support. My Martini also has asthma and we recently brought in a live Christmas tree, it was VERY fresh unlike the ones in years past.
She started coughing more right away, have you brought in any new 'smells' lately? Are you puffing the max 220mg X2 twice daily?
:bighug:
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Hi! Thank you for the support, it means a lot to me. Feeling like a lone warrior fighting for my cat to get the best care possible and having to go online to read about this instead of my vet telling me more is quite frustrating. I'm so thankful for this group.

Hugo has had asthma ever since he was little, so for about nine years. He gets the strongest Flixotide, but the vet wants him to change to Seretide 25/250 mg Evohaler. I haven't picked it up from the pharmacy yet, so he is still on his Flixotide. No new smells here, but Finland is cold in the winter and the indoor air gets dry. It could play a role in this, but I'm starting to think if the heart illness is to blame for the recent coughing. His chest xray was clear.
 
Martini & Sandy said:
There's a number of sites that come up with googling aspirin and cats. Most do not recommend aspirin for cats.
I think it would be wise to check with the vet before giving it in any case, but it's up to the owner certainly.
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I won't give any aspirin without the vet telling me to do so. :bookworm: I'm just reading that HCM cats need a blood thinner and my Hugo didn't get one. But I hope the vet will adress this issue when she answers my email.
 
MJW said:
I am so sorry you and Hugo are dealing with a second issue.
Yum had a murmur and I took her to a cardiologist for an echocardiogram. He said it was just due to her heart dropping in her chest due to age. We were lucky.
Her BP was high though and he prescribed enalapril or something like that. I took her to her vet for another reading and it was still high. Then I took her to her vet a second time, where they measured it while I was brushing her and talking to her. It was low normal. It's hard to get a good BP reading at the vet's office.
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I'm happy her reading is normal now :) I would assume Hugo was terrified at the vet after being pinned down for the ultrasound. Too bad they don't make those home blood pressure meters for cats!
 
Sienne and Gabby (GA) said:
I'm sorry about the HCM diagnosis. It does sound like you caught it early, though.

I would be hesitant to go the anticoagulant route without your vet encouraging you to do so. You need to know if there is an indication of whether the valve is causing a turbulence in blood flow that indicates if a blood thinner is needed. However, anticoagulation may be a reasonable preventative measure. This link discusses options regarding anticoagulants and thromboembolism specifically in cats with aortic valve issues related to HCM.

One thing to watch for -- ACE inhibitors, such as benzepril (Nelio) can cause a loss of appetite or GI issues. When Gabby was prescribed benzepril, her appetite was awful. We switched her to telmesartan which had recently been given an indication for hypertension in cats and it didn't affect her appetite.
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Thank you for the link, it seems like a good read :)

Today after getting his first pill of Nelio, Hugo seems to have an okay appetite. He still has his on/off diarrhea issues even without the new drug, so I hope it doesn't make things worse. It's good to know to watch out for these things, thank you. :bighug:
 
HCM caught early is a good thing and they can live a happy life for a long time with proper treatment. Doodles HCM was advanced and already in heart failure when diagnosed and we were lucky enough to have him for another year with treatment. The ACE inhibitor he took was Enalapril...there are a few options like the one Hugo is taking. I would get into the habit of taking Hugo's resting heart rate...when he's sleeping. If it starts to go more then 35-40 breaths per minute it could be an early warning of heart failure starting. Lots of vines and prayers.
 
(((Tiina)))

I’m so very sorry to hear of this diagnosis but it sounds like you caught it early. There are many others more experienced with HCM than I am. There used to be a fantastic HCM Group...very knowledgeable...in yahoo groups.

I see his labs were done last June. Have they done any since? My only thought is to recheck his thyroid. I have had it happen in two of my cats and also a friend’s cat where the kitties were hyperT and showed HCM. Once the thyroid was brought into normal ranges, the heart reverted to normal.

A long shot since his tT4 was very normal in June. But just a thought for next time you do labs.

Many hugs and vines.
 
Sorry about the diagnosis and one more thing on your plate. I am glad Sienne weighed in as well as Karen. @Barbara & Uncle is on sometimes and she also went through heart issues. Melissa isn't on here any more, but her Tarragon had HCM, well controlled, for at least 4 years. I also lost a civie to thromboembolism, two days before his follow on echo:( - so good on you catching it early. :bighug:

Stephanie & Quintus said:
So, HCM is reasonably common, unfortunately. Go and hang out with Maine Coon people.
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Or hang out with people that have cats with acromegaly. The excess growth hormone also causes organ growth - hence HCM is common. Neko was both acro and Maine Coon cross. She had her first echocardiogram that showed very minimal enlargement in spring 2013. Cardio vet didn't do anything to treat. Just told me to have the vet keep an eye on the location and level of the heart murmur. November 2015 her heart still had no change on echo - May 2016, big change. I don't know if it was the timing or not, but she had started regular fluids for her kidneys three weeks before hand. We stopped fluids, got her on a few heart meds, and her heart went down in size. But after that, she was on Plavix (clopidogrel) once a day, not aspirin. She was also on benazapril (as Fortekor), but she had already been on that a couple of years for her proteinuria, so we just stayed on it. It had no impact on her appetite. But I have heard good things from others on telmesartan.

Neko had a few dentals after her first echo, but we had to cancel the one after May 2016 when first signs of CHF showed up. She also had a second degree heart block so anesthesia was too risky. I don't think it was the heart that took her in the end, but it definitely made balancing kidney issues tricky. Periodic checks of their RR (resting respiration rate) is a great idea. Neko normal was low 20's. We tried restarting fluids, much less and less often, and her heart rate snuck up to 26, which told me something was off and it was. Her cardio vet told me anything under 30 was fine, but know thy cat.

Stephanie & Quintus said:
Normal BP for a cat is 160-180.
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Actually, normal blood pressure goes down to 120. Most vets will accept 160-180 in the vet clinic, to account for white coat syndrome elevating the numbers. Neko had it bad - her BG never was elevated, but BP was. As a follow on to Neko's proteinuria, we tried getting her BP. First time in the vets office we had a delayed appointment due to an emergency, barky dogs in the waiting room, rookie techs - by which time both Neko and I stressed - her BP was 220. Vetty called it a fail and said try again. Next time was the acupuncture vet, smaller quieter clinic, but a darn puppy jumped her kennel in the waiting room. BP = 185. OK, third time was the dental vet. Neko was by herself in the back cat area that had Feliway going = BP = 142. Much better! After that her BP was only taken by techs at the specialty clinic and usually in the 140-150 range.
 
Tiina and Hugo said:
Been crying my eyes out here, reading about the sad stories online how this can kill in an instant.
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Aw... I would put HCM on the other side of the scale, as something that evolves slowly. FATE can kill fast, but that is only likely to happen with advanced HCM, which I'm ready to bet Hugo doesn't have yet. Crying is normal, the grieving process doesn't start when our kitties die, but when we are faced with the fact that they will, and take small steps towards accepting the inevitable.

Tiina and Hugo said:
I'm just reading that HCM cats need a blood thinner and my Hugo didn't get one.
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I wouldn't be alarmed by the fact he didn't get one (sorry if my initial post is the one that got you worried). Definitely raise the issue with your vet, but as @Sienne and Gabby (GA) notes it's only useful to prevent clots, and clots are likely to happen in certain cardiac configurations (blood pooling in heart chambers where it shouldn't).

Wendy&Neko said:
Actually, normal blood pressure goes down to 120. Most vets will accept 160-180 in the vet clinic, to account for white coat syndrome elevating the numbers. Neko had it bad - her BG never was elevated, but BP was. As a follow on to Neko's proteinuria, we tried getting her BP. First time in the vets office we had a delayed appointment due to an emergency, barky dogs in the waiting room, rookie techs - by which time both Neko and I stressed - her BP was 220. Vetty called it a fail and said try again. Next time was the acupuncture vet, smaller quieter clinic, but a darn puppy jumped her kennel in the waiting room. BP = 185. OK, third time was the dental vet. Neko was by herself in the back cat area that had Feliway going = BP = 142. Much better! After that her BP was only taken by techs at the specialty clinic and usually in the 140-150 range.
Click to expand...

Super interesting, thanks!
 
Hi Tiina! So very sorry about Hugo and glad it was caught early. Also, glad that Karen, Sienne, and Wendy weighed in having had experience with HCM. And it looks like new comer , Stephanie, has some experience too. @Stephanie & Quintus , welcome to the board.

I hope the med is helpful and glad that you were given some things to watch for such as interference with appy.

I hope you are well otherwise. :bighug::bighug::bighug::bighug::bighug:
 
Sorry to hear about the HCM. It's rotten bad luck, but from what I'm reading here, it progresses slowly, so that's the good news. Hugs and healing vines.
:bighug::bighug::bighug:

PS: Hugo has the biggest ears I've seen in quite a long while. What a cutie!
 
Doodles & Karen said:
HCM caught early is a good thing and they can live a happy life for a long time with proper treatment. Doodles HCM was advanced and already in heart failure when diagnosed and we were lucky enough to have him for another year with treatment. The ACE inhibitor he took was Enalapril...there are a few options like the one Hugo is taking. I would get into the habit of taking Hugo's resting heart rate...when he's sleeping. If it starts to go more then 35-40 breaths per minute it could be an early warning of heart failure starting. Lots of vines and prayers.
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Hi Karen, thank you for your reply. I tried taking Hugo's resting heart rate tonight and I got 18-20. So it seems okay. But today he got two coughing fits when he was purring, I don't understand what could be causing it :confused:
 
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Marje and Gracie said:
(((Tiina)))

I’m so very sorry to hear of this diagnosis but it sounds like you caught it early. There are many others more experienced with HCM than I am. There used to be a fantastic HCM Group...very knowledgeable...in yahoo groups.

I see his labs were done last June. Have they done any since? My only thought is to recheck his thyroid. I have had it happen in two of my cats and also a friend’s cat where the kitties were hyperT and showed HCM. Once the thyroid was brought into normal ranges, the heart reverted to normal.

A long shot since his tT4 was very normal in June. But just a thought for next time you do labs.

Many hugs and vines.
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Hi Marje, it's good to talk to you all again, but I wish I would have had better news. :( Hugo hasn't had labs done since June, and then his T4 was 23,6 nmol/l. I will ask then to do it next time.
 
Thank you everyone for your valuable advice and input, and sorry I haven't replied earlier. We travelled to my parents house for Christmas. Hugo did well in the car, but has been sleeping all evening since. I really hope the holidays are peaceful with him. We had a Burmese cat who died when Hugo was just a kitten. Suddenly he howled in pain and lost use of his back legs. He was euthanized on Boxing Day 2010. In hindsight I now believe he might have had HCM too, but I didn't even know such an illness existed. But maybe that was a blood clot caused by HCM that killed him. It was very traumatizing and now knowing that it might happen to Hugo too makes me really sad and scared.

What @Stephanie & Quintus said about the grieving process is true, I spent the two days just crying of the thought of losing him. After the diagnosis of diabetes, I felt like maybe this is something that can be controlled and it won't shorten his life, so I really dedicated my time in learning everything I can from this page. It feels somehow better, because I can see the insulin help him when I get a lower bg reading. With HCM I don't know anything, just that it's there and I can't control it. It's so frustrating! :banghead:

Thank you @Wendy&Neko for all the information and telling us your personal experiences. I'm at loss about what to do with Hugo's dental now. He has some bad teeth, and he hasn't had one during all this time with diabetes, but if there are huge risks with anesthesia, I don't know if it's a good idea to do. I just want to wrap him up in cotton wool, but I know I can't.
 
Tiina, keep thinking good thoughts, like I am for Hugo. Imagine Hugo 3 years from now, doing fine. Keep changing your mindset, if you can.
:bighug::bighug::bighug::bighug::bighug::bighug:
 
Tiina and Hugo said:
I'm at loss about what to do with Hugo's dental now. He has some bad teeth, and he hasn't had one during all this time with diabetes, but if there are huge risks with anesthesia, I don't know if it's a good idea to do. I just want to wrap him up in cotton wool, but I know I can't.
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Between an echocardiogram and an EKG, the vet should be able to say if Hugo's heart is OK for anesthesia and surgery. Neko had an echo before her second SRT (November 2015) and the cardio vet gave me the OK for it.
 
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