11/19 Clyde - Update

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fun2doimpossible

fun2doimpossible

Member Since 2013
Last condo: http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=128564

I got the blood work back on Clyde. It's not good. He is still in remission but the elevated BG levels are being caused by heart disease. The vet was saying that a cat without heart disease the normal range of whatever they were looking for was under 100 and borderline was around 200. Clyde was 475. I'm sorry at this point much of the conversation was a blur so I don't remember what they actually tested just the numbers.

For now, they put him on a transdermal Lasix to help prevent fluid buildup in his lungs.

The vet is saying before we could look at any other treatments he should see a specialist and get an electrocardiogram done to help better determine the underlying cause and which medications may be needed. Without treatment, feline heart disease can be a time bomb, since clots can form in his blood stream which could cause either a stroke or paralysis.

I asked how long does a cat with heart disease typically live. Depending on how the cat responds to medication and it can be anywhere from one month to three years. Afterwards, I consulted Google to try and learn more about this and found that in clinical settings with aggressive treatment the average cat lives approximately six months from diagnosis.

He's 14 and I've decided not to see a specialist and get an electrocardiogram done because after all of the reading I've done, I'm not sure it will extend his life in a quality manner. If I thought it would, I would do it.

I left a message asking that my vet call me sometime today when she has time to talk, so I can talk to her about Clyde's treatment and to get guidance on when to help him cross over. I don't want to see him in pain and suffer any more then necessary.
 
So sorry to read this. Once you process the shock and talk with your vet, you may have a clearer handle on Clyde's condition. I lost a cat to hypertropic cardiomyopathy many years ago. I understand the shock. One step at a time.

Mega vines.

Marilyn and Polly
 
I'm sorry that you received bad news about Clyde's heart. I know that you don't know me but there is a yahoo feline heart group and may I suggest that you post there. When both my cats had heart murmurs I joined. I was lucky that the US showed in both cases that they were not significant. However so many posts that I've read over the years where the cats were treated with medication and they did live 1-3 years and more, often against the odds given to them as well. Just a thought. :YMHUG:
 
I am so sorry to read this about Clyde :sad:

My Smokey had heart disease and in the end it is what we lost her to because it advanced much faster than the docs expected and we were unable to do any aggressive treatment of her kidney disease (no were we able to sedate her for a CT on a mass in her lungs). She got a WONDERFUL cardiologist when she had advanced into the later stages. Best doctor we met in all her care and I am glad we got to meet him. He was a specialist in a University hospital 4hrs from us. When she passed away we got a wonderful card from him and his office. He'd only found out by word of mouth, by he was thoughtful enough to send a card.

Anyway, what getting the test can do.. It will give the doctors an idea of what stage the heart disease is in and you can get meds besides Lasix prescribed to treat the disease. Lasix just manages the symptoms and is very hard on the kidneys. Other meds can help the heart not have to work so hard, and so it slows the deterioration of that muscle. When my Smokey's heart disease was discovered they decided it was mild enough that they didn't prescribe the meds. She went from mild to severe in just a few months because we didn't treat it. She was on a billion meds, had a billion conditions and I think our vets just felt they didn't want to prescribe another med. I was always scared about clots. Luckily she never developed one.

My best to you on whatever path you take with Clyde. Will you be looking at insulin to control the blood sugars that are getting high because of the heart disease? Or does the vet think Clyde is getting low enough in the day to not start insulin just yet?
 
Thank you all for your support.

The good news with the BG is that no sugar was detected in his urine and right now, the vet thinks, based on the blood work I don't need to start insulin again just yet. It will be something that we will need to watch going forward. Because I know it's elevated and dropping low usually around noon/midnight, I'm not sure how to best monitor it at home to see when it looks like he might need insulin again.

I did take him back to the vet last night where they gave him another shot of Lasix before they gave me the transdermal Lasix. Last night, I don't think he ate anything for breakfast. I put 6oz of wet food down for both cats to eat. I saw Max eating and ended up throwing out 3oz of food when it was time for dinner. Clyde didn't even protest when I dropped him into the carrier, or attempt to escape after I clipped the lid on through the front door of the carrier. After I picked up the carrier, I realized I never closed the front door on the carrier. Normally he would have bolted out the door and hid somewhere in the house. He was actually quiet on the vet ride there when he usually is crying the entire time.

I think his behavior last night is weighing heavily on my mind and influencing my decision. I will be at home most of tonight and will be able to watch him to see what his behavior is like. I think he did eat something for dinner last night, either that or Max ate a lot more then normal. :smile: If he is actually eating, I think I will have the electrocardiogram done on him because further treatment may actually help him. Otherwise, I'm not sure how much any treatment will actually benefit him.

I've been such a mess over the last couple of days, it's not funny. I did talk to the vet today and got some more information and scheduled his annual exam on Dec 9.

Tiffmaxee, thank you for the information on the Yahoo group. I will look for them.

Will
 
Elise, thank you for the link unfortunately it is coming back with page not found.

I don't think Clyde ate breakfast today. There was about 3 oz of food left in the dish when I got home from work today, which is about half the food I put down this morning and I did see Max eat breakfast. That means as a best case scenario, Clyde would have eaten about 1.5-2oz of food over the last 24 hours. Normally he eats close to 6oz of food a day.

I'm torn between my original decision not to have him see a cardiologist and having him see one to have the electrocardiogram done. If I have it done and whatever is found properly treated, is it likely that his appetite will return?
 
Elise...thank you and no worries.

I called the vet this morning to let them know I changed my mind about having Clyde seen by the cardiologist. I left a message and they will call me back when they find out when he can be seen. It's a traveling cardiologist that will come to my local animal hospital. It will be better for Clyde that way. I don't want to put him through an hour car ride to go to the emergency clinic to have it done.

I saw him eat this morning and the more I thought about it, I think if I didn't do it I would end up always wondering if it was something that could have been easily treatable to help him maintain a high quality of life.
 
FWIW I think that is a wise move. How is Clyde acting?? Eating is great. Is he acting normal in any other ways? I hope the cardiologist gives me hope. In the meantime even if you don't join the yahoo group they have articles to read. I'd encourage you to join though even if you don't post there because you can read current and past posts to know what to ask for once you get a definite diagnosis.
 
Clyde's appetite is down considerably. He would typically eat about 6oz of wet LC food a day. (3 in the morning & 3 at night). Since the vet visit, he's been eating but leaving a lot of food in the dish. I think I threw out 1.5-2oz last night when I got home from work and this morning.

I know he ate something this morning because I took him to the food and watched him at least a couple of bites. :smile:

He's always been content to just lay there and do nothing, that part hasn't changed. It's more of where I'm finding him laying around that has changed. For example, he was laying on the floor next to the bed, or on the stairs. If anything, I'd have to characterize him as being more mellow since the vet visit.

He's decided he doesn't like his ears touched with the vinyl glove I use for the Lasix. He didn't have any issues when I pricked it for a sample to check his BG.
 
I heard from the vet. Clyde is all set to have an electrocardiogram done on Monday at 6pm EST. Hopefully the results will be encouraging.
 
will, i'm so sorry for the diagnosis. that's not good news. I don't know much about heart disease in cats, but my dad had heart disease and they said what they do with meds is to actually "re-sculpt" the heart muscle. And it was true that he did really well with the medicines that they gave him. Cats & people are not the same, but they do have a surprising number of things in common related to diabetes, so perhaps some of it is similar in heart disease as well.

I think you're wise to get more information. When we don't know enough, I think the human tendency is to go to the worst possible scenario. Hopefully a little more info will help guide you. You love Clyde. You'll know the right path to take is.

When I was struggling with punkin's decline, someone told me to think of 5 things that made punkin unique. That was very easy to do - he was such an extraordinary cat. They said when those 5 things are gone, you'll know it's time. And it was true - that was a good measure and it was easy for me to know when it was time to call the vet.

I hope you don't have to face that for a long time, still. Sending you and Clyde a couple of big hugs.

julie
 
I have had echocardiograms done on two cats. The first showed nothing on X-rays and showed marginal changes on his echocardiogram, so we didn't treat. Turns out that was a mistake, he did have HCM and I lost him to a saddle thrombosis less than a year later. Neko also had a heart murmur so we had a echo. Hypertrophic cardiomyopathy (enlarged heart) is common in acrocats, and also to some extents Maine Coons, which she has in her heritage. The echocardiogram told me Neko's heart murmur is not due to HCM - it was a great relief. It was well worth the cost to get it done.

Melissa's Tarragon also has HCM and he was diagnosed August of 2012. You might want to PM her - he seems quite well managed on medication.

Wishing you the best of luck and hoping for a manageable outcome. :YMHUG:
 
Will

I am so glad you will see the cardiologist. I'm not sure how your vet diagnosed heart disease without an echo. I'm going to search your previous posts to see if I can find the info.

I also had a kitty with very mild HCM. His disease was never a factor in his death. I read all the horror stories, too, but I joined the yahoo HCM group and discovered alot more info. For instance, there are varying degrees of HCM and cats can have mild forms. My kitty did and he lived 7 years after his dx with only one med and no progression in his disease. He actually passed from genetic polycystic kidney disease.

You can't tell about heart disease from an X-ray. My Tobey was xrayed before a dental to check his lungs as he had URI as a kitten and they felt his heart was enlarged so wouldn't do the dental. I took him to a cardiologist the same day and the echo showed his heart was normal. There are different types of heart disease so best to see the specialist first. There are also many meds that cats tolerate very well.

Does Clyde have hyperthyroidism that isn't medicated or under control? HyperT cats will often show changes in the heart but it normally resolves once the hyperT is under control.

I would ask the cardiologist about increased BG due to heart disease. I have never heard of that and I cannot think of a reason why that would be the case but I never say never. I don't know why Clyde isn't showing sugar in his urine....timing of the test perhaps but if a BG is high, no matter the cause, sugar dumps into the urine. I'm going to check with a more experienced member but I would be testing him at home with regular spot checks so we can see what he's doing.

Sending prayers.
 
The group Marje mentions is the one that I gave you the link. I hope the US shows that this is treatable and not as grim as your vet thinks. My vet felt Max's murmur was worse in April so sent me to a cardiiologist. He was right that it sounded worse but his condition turned out to be benign and does not require treatment nor will it need to be followed. The cardiologist said that under stress it will sound louder. You will find out what you are dealing with and decide what to do from there.
 
Thank you for your support. It means a lot.

Clyde is sitting and laying around like he usually does. He never was a very active cat. Any cat toy I brought home he would run and hide from it, even the stuff with catnip in it. :smile: He's a big cat and weighed 19.2 pounds at the vet's on Monday. If you looked at him, you'd never guess anything was wrong with him.

I just hope after all of this he eats more. I wanted to try and get him to eat less to try and loose a bit of weight, but not like this. (I think he was eating some of Max's food.)

On Monday, the vet did a full set of blood work on him. His BG was elevated but his fructosamine was normal. The vet had seen an enlarged heart and fluid on the X-rays and as part of the blood work measured an heart enzyme (sorry Monday and Tuesday was a bit of a blur with all of this). The blood work showed his thyroid was normal so she doesn't believe he has hyperthyroidism.

Between the two of them, she diagnosed he had heart disease but can't make a determination as to what type or how to best treat it without the echocardiogram.

When is the best time to be testing his BG to find signs that he might be dropping out of remission? With the testing I've done so far (and is what prompted the vet visit in the first place), is the BG is peaking right before mealtime and dropping to it's lowest point at about +6. (They are still on the same schedule when Clyde was getting insulin. I would test right before they got fed and they get fed at 6am & 6pm).
 
Could you find out the heart enzyme the vet tested? There is a new blood test for cardiomyopathy called Plasma BNP but I haven't seen anyone have the test done yet. Note to self, might get that done on Neko.

As for testing, the higher blood glucose levels are probably right before food. Feeding will stimulate the pancreas to bring down the blood sugar.
 
Will

Have you tested since 11/17 because I'm not seeing anything on the SS for us to look at. So the heart enzyme was elevated?

If you are up for it, I'd gather as much of the info as you have (like the heart enzyme measured and the level) and post on the HCM yahoo group. In fact, I'd call my vet's office and ask them to fax over his complete lab work. I always do this with my cats....you paid for it, you should have a copy.
 
I have not tested since 11/17 :sad: I've been a complete mess this week. Google is a wonderful tool, but it is also very scary when it comes to looking information about something. Let's just say Google in this case wasn't helping the situation. :-D It's been a lot to take in this week. I'm trying to get everything together and will be posting to the Yahoo group.

Wendy, based on the paperwork I have, it was the NT-pro-BNP enzyme. After reading the link it looks like it was that test. Normal is under 100 pmol/L, borderline was 100-270 pmol/L and above 270 is abnormal levels. Clyde was 475.
 
He was at 485 tonight, which is way to high for me. Looking at the water dish, it looks like someone was drinking a lot today. At least he's going back to the vet's office on Monday. :smile: I have until then to find a pharmacy that will break a pack a pens because it wouldn't surprise me if he goes back on the juice in the very near future. I doubt a 1+ old vial of Lantus is still any good that I had when he was first diagnosed.
 
IMHO, I'd be starting insulin sooner rather than later. As in tomorrow if you get some more spot checks tonight and he is still high. I would....I'd be aggressive. I would not wait until Monday. Can you call her tomorrow?
 
I just read on the heart board that the BNP test is unreliable. I thought I had read it but just checked to confirm. I hope the US yields a good report. It is the gold standard.
 
I meant to add this about the BNP: Tobey just saw the cardiologist and I asked him about blood tests for HCM. He told me the only one that he feels is reliable is the one developed for Maine Coons. Of course, that's just one specialist.
 
Marje and Gracie said:
IMHO, I'd be starting insulin sooner rather than later. As in tomorrow if you get some more spot checks tonight and he is still high. I would....I'd be aggressive. I would not wait until Monday. Can you call her tomorrow?
Click to expand...

At +4 he's at 285. The vet is closed until Monday and I have no way to get a prescription for fresh insulin. I have a opened 1+ year old vial on Lantus in the fridge. It still looks clear but I don't know how good it still is after all of this time. It's been on it's side in the box the entire time.

Does anyone have any experience with insulin that old? Is it still safe to use? If it is still safe, his numbers at at the point where I would give him a shot. Based on the formula and his I would start him at 1u since my vet says his ideal weight is 12 pounds.
 
I've had two cats with heart disease. My Linus had cardiomiopathy, lived to be 18, and died of COPD and not the heart condition. He lived 5 more years after his heart diagnosis. My Snugs was diagnosed with a heart condition 2 years ago. The cardiologist said he would start showing signs of congestive heart failure within a year. He is now 2 years past diagnosis and, so far, he has no symptoms of CHF. (Knock on wood.)

I would encourage you to take Clyde to a cardiologist. There are medications that can help his condition and significantly extend his life expectancy.
 
Hard to say on the insulin, Will. You never know. You haven't lost anything if you try.

I'd probably start him at 0.25u. We can always go up quickly if need be.
 
while it's true the only way we'd know if a vial that was opened over a year ago is any good is to try it...
it's now early sunday morning. your vet can write a script and you'll be able to pick up fresh insulin on monday. that's a little over a day away.

strictly offering an opinion because i have no basis of fact. i've not heard of any caregivers injecting their cats with insulin that had been opened over a year ago and sat in the fridge ever since...

i don't think waiting one more day will make that much of a difference. while it's hard to see those high numbers, the idea of injecting my cat with insulin that might not be any good or possibly contaminated with bacterial growth... i dunno. it doesn't sound like a good idea... sounds kind of yucky to me.

at this point monday is so close... waiting another day just sounds so much better.



jmo.



ETA: unless clyde is throwing ketones...
throwing ketones creates an urgency to start back on insulin immediately.
 
This morning for AMBG he's down to 139. With the spot checks I've been doing he's been bouncing all over the place this weekend.
 
good to see his BGs down a bit.

Will, you mentioned that you feed him twice a day. If his pancreas is struggling, it might ease the load if you split those 2 meals into more - say 4-6 smaller meals. Not more food, just spread out throughout the day.

If you remember back when you were doing the OTJ trial, the suggestion is that if you see a blue ambg or pmbg, you feed a small meal and then recheck in 3-4 hours to see if Clyde is able to pull the Bgs back into normal range.

Just thinking you might go this direction today and see if his pancreas can cope with smaller volumes at a time.

I hope tomorrow's vet visit goes well. Been thinking of you guys. :YMHUG:
 
i've not heard of any caregivers injecting their cats with insulin that had been opened over a year ago and sat in the fridge ever since...
Click to expand...

I appreciate Jill's thoughts on this and would go with her suggestion. My recommendation was based on the number of us who have "R" insulin in the frig that is well over a year old and still use it. I know lantus is not R but my R has the same expiration time frame as the lantus and it's still going strong. I had inquired about the need to toss it and was told by a more experienced member that it would ok to continue to use.

My apologies, Will, for a poor suggestion.
 
Currently, I'm putting food down twice a day. While they both come out and eat right when I put the food down, they never eat all of it at once. They seem to graze on it throughout the day. Right now, nine hours after I fed them this morning there is still food in the dish from this morning. I can try feeding them like that in a more structured manner, but I'm not sure how much difference it will actually make.

Marje, there isn't any reason to apologize. You gave me your opinion based on the best knowledge you had at the time. :smile: It's one of those things where the manufacturer says 28 days, I've seen people say 6 months, and article that said 9 months, so it wasn't unreasonable to think that it could still be viable. Since it didn't appear to be a common practice, I rather err on the side of caution with everything else is going on so I don't accidently make something worse. :smile:

Jill I have not tested for ketones but his blood work was normal on Monday. The limited testing I've done, he's BG is all over the place. He's spiking really high and then dropping 6+ hours later down into the blue range.

The good news is in a about 27 hours or so, Clyde will be back at the vet's office for the electrocardiogram. No matter what happens, I will push to have the vet write a new script to get him back on Lantus and since it's a 12 hour cycle work to get his first does Tues at 6am so he's on his old schedule.
 
Marje and Gracie said:
i've not heard of any caregivers injecting their cats with insulin that had been opened over a year ago and sat in the fridge ever since...
Click to expand...

I appreciate Jill's thoughts on this and would go with her suggestion. My recommendation was based on the number of us who have "R" insulin in the frig that is well over a year old and still use it. I know lantus is not R but my R has the same expiration time frame as the lantus and it's still going strong. I had inquired about the need to toss it and was told by a more experienced member that it would ok to continue to use.
Click to expand...
marje:

i believe i was the "experienced member" you asked. :-D
my response was based on the fact the vial of R i had been using at the time was still going strong a year later (after occasional use).

here's the difference... you and i were talking about a vial of R. the subject here is a vial of Lantus.

the chances of contamination increase every time the rubber stopper is pierced by a syringe needle. a vial of Lantus is pierced at least 60 times a month. i seriously doubt your (or my) very occasional use of a vial R had been pierced anywhere near 60 times in the 1+ years it's been in use. the less times pierced = less chances of contamination. that is my reasoning behind the comments i made to you then and Will now.

hope that helps...



fun2doimpossible said:
Jill I have not tested for ketones but his blood work was normal on Monday. The limited testing I've done, he's BG is all over the place. He's spiking really high and then dropping 6+ hours later down into the blue range.
Click to expand...
Will:
eh, since developing ketones is not dependent upon high BG numbers... getting in the habit of checking for ketones when anything unusual is going on is a good habit to get into.
the recipe for ketones = an insufficient supply of insulin + infection OR other systemic stresses + decreased appetite.



happy to hear clyde will be going back for further diagnostics.
good luck!
 
Marje, there isn't any reason to apologize.
Click to expand...

Thank you, Will. I don't like to give misinformation or take a chance something I say will harm someone's baby.

i believe i was the "experienced member" you asked.
Click to expand...
:lol: :lol: you could be right, Jill, but I was thinking it was Libby and I didn't figure Will knew who Libby was.

hope that helps...
Click to expand...
It does and it makes sense. Besides R, I was also thinking along the lines of a few people who have used their vial of lantus for 6-9 months. But there are too many unknowns and you are right, it's not worth it for one more day.
 
Just wanted to post a quick update from Clyde's vet trip this evening. The good news, as heart disease goes, it is relatively mild.

The cardiologist isn't sure that the heart disease is causing the high BG levels. The vet gave him a shot of a long lasting antibiotic in case there is an infection.

The vet is going to put him back on Lantus to try and get his blood sugar under control. Neither Walmart or Rite-aid will break a pack of Lantus Solarstar pens. She's going to call one of the independent pharmacies they use to compound drugs to see if they will break a pack of pens. If not, my cheapest option will be a vial and use the AAA prescription card at Walmart. She is also checking with them to see if they can compound the heart medication they would like him on into some type of tasty treat. Clyde doesn't like pills or liquids. It is actually easier to give him a shot of insulin then to try and pill him. :-D

I was a little surprised at how much it went up since I got the vial last year.

She did offer to put him on Prozinc instead since it is cheaper. At this point, I told her I'd prefer to stay with Lantus simply because I'm familiar with how it works.
 
Great news!! What med did she put him on for his heart and for what specifically? An arrhythmia?

Watch him closely with the long lasting a/b. It is most likely convenia. The problem with it is once it is in, it is in; any side effects can last as long as the a/b. Why did she give it to him if she can't identify infection? Convenia is more for skin infections; if she's going to just give an a/b, I would ask her why not a broad spectrum like clavamox? of course, now it is too late but something to remember to discuss with her in the future.

Be sure if they compound the heart meds, that they do not add any sweeteners including artificial ones like maltodextrin. I learned this the hard way.
 
What medication for the heart? I'm glad it is a mild condition. They are using convenia for more than skin infections these days and I think often go to it when they aren't sure if there is an infection and where. I've herd that Target will break a 5 pack of pens and Laura just got one from there the other day.
 
Accoring to the paperwork it was convenia. She did it at the recommendation of the cardiologist. He didn't think the heart issue was causing the BG issue and she didn't see anything obvious from his blood work that would cause it.

If I am reading the report correctly he was diagnosed with concentric hypertrophy consistent with hypertrophic cardiomyopathy. The recommendation if we can get him to take the medication is .5 tablet of a 25mg tablet atenolol and .5 tablet of 5mg tablet of benazepril every 24 hours.

Unfortunately I don't have a Target near me to try and get the Lantus pens from. :sad:
 
I don't think there is a rhyme or reason to who will break up a box of pens. Sometimes large chain stores will do it, sometimes not. sometimes the small local stores will do it, but not all of them. Pharmacies that supply nursing homes and hospitals are possibilities because often people just need one when they are in a facility. I could buy one pen at a time from a Sav-On Pharmacy inside an Albertson's chain grocery store. That's a northwest chain, but Sav-On is national, I believe.

Hoping that Clyde responds well to the new meds and insulin.
 
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