@Barbara & Uncle
I'm very sorry I didn't get back here....it needed up being so busy.....we had to cram a lot in two days and we were up really late. Doesn't matter for us but I feel really bad about not getting the info to you.
Before I post the info on pyelonephritis (kidney infection), I wanted to give you just a bit of info on left anterior fascicular blocks as my Tobey has that as well....and a premature ventricular contraction (arrhythmia).
Tobey was discovered as having PVCs under anesthesia so I took him to the most excellent and incredibld cardiologist, Dr. Church (also was Doodle's cardiologist) for an echocardiogram. He had absolutely no sign of any structural heart disease other than a congenital leaky valve (which is actually extremely common in cats and people). Long story short, it appears Tobey only throws the PVCs and thus has the arrhythmia when he's under a lot of stress. My vet runs an EKG strip for 5-8 minutes every six months and it's perfectly normal on the rhythm but it does always show the left anterior fascicular block.
If you go back to Anatomy and Physiology 101
the heart has bundle branches, of which the left anterior fascicular, is one. These are nerve bundles which, at one time, were through to be the sole initiator of the heart pumping action....the stimulus would come through the nerves from the brain to tell the heart to pump. Dr. Church explained to me that recent findings (and he did not give me citations but I trust him) indicate that the heart can pump on its own whether the bundle branches are firing or not. In some cases (e.g. Uncle) a left anterior fascicular block might be associated with structural heart defect. However, in Tobey's case, his is not. So my point is, that while it sounds really scary, I would probably let that be the least of my worries and let the RCM and the arrhythmia be of more concern. It sounds like he is throwing fairly frequent PVCs so they wil want to get that under control. The other thing is that bundle branch blocks can be transient.
I have only used enalapril and had no issues with it and saw no side effects so I'll leave the rest of the med issue to Wendy but I just wanted to explain a little more about the left anterior fascicular block.
On the pyelonephritis, here are a couple of links, that you can share with your vet, discussing the need for certain antibiotics and length of treatment. Interestingly, Helen, on Tanya's,s aid it is not uncommon for vets to be unaware of this or the need to do ultrasounds. X-rays are not sufficient and even with a urine culture and sensitivity, it might not grow bacteria if the infection is in the kidneys (this is what happened with my CKD kitty).
Pyelonephritis in small animals (Baytril and Zeniquin are fluoroquinolones).
From Management and Treatment of CKD in Cats:
Patients with CKD are vulnerable to bacterial lower urinary tract infections with up to a quarter of patients suffering from this at some point in the course of their illness. Current recommendations are that these should be treated if the patient shows clinical signs (systemic and/or lower urinary), if pyuria is present, where ultrasound evidence of pyelonephritis is present and/or if renal function has recently deteriorated. An appropriate antibiotic should be chosen on the basis of culture and sensitivity testing. Typically a prolonged course of treatment (eg, four to six weeks) is needed to eliminate the infection. Repeat urine culture is recommended during the treatment period and seven to 10 days after treatment has concluded to confirm treatment success. If recurrent or refractory infections are encountered, ultrasound of the kidneys and bladder is indicated to look for evidence of a nidus or other explanation.
There are a few more links but I think these two are best. One thing that's important to note is that fluoroquinolones, like
Baytril and Zeniquin (scroll down the link to see Baytril) don't come without risk. They must be properly dosed or they can potentially cause retinal damage. However, with correct dosing, it's rare for there to be any issues. I've had to use Baytril for six weeks at a time on my CKD kitty that was prone to kidney infections and he did just fine. Of course, I don't know anything about contraindications with heart meds and so this would be very important to discuss with the cardiologist.
Lastly...has either vet checked his blood pressure?
