HELP: Monkey: Restrictive cardiomyopathy, dont eat low carb food

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PH&MonkeyPenPenFaFaTiger

PH&MonkeyPenPenFaFaTiger

Member Since 2020
Last post of Monkey: https://www.felinediabetes.com/FDMB/threads/monkeys-tumor-breathing-and-lost-of-weight.251081/

Bad news for Monkey: Restrictive cardiomyopathy phenotype, stage B2-C

The reports are attached. I will talk to the vet tomorrow.

My question is: What should I do? where can I seek help? Is there any group that is specialized in this?

Also, there is something I want to get off my chest. Monkey needs 4.75 U Lantus now, higher than his highest when he was diagnosed, 3.25 U. After I take care of him for few months, his lowest was 0.25 Lantus. After letting my family inject insulin for him, they inject 2 HOURS AFTER eating, for FOUR MONTHS, which I believe cause disaster for his BG. And diabetes does significantly increase the risk of heart disease.

@Bron and Sheba (GA)
 

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Peter I am so sorry Monkey now has issues with his heart. I read the report and I see there have been recommendations made for treatment.
I know absolutely nothing about heart issues in cats so I will tag @Marje and Gracie to see if she can help.
@Wendy&Neko may also be able to give you some information but she may not be around for a few days.

Are you able to get any mid cycle tests in for Monkey?
 
PH&MonkeyPenPenFaFaTiger said:
Last post of Monkey: https://www.felinediabetes.com/FDMB/threads/monkeys-tumor-breathing-and-lost-of-weight.251081/

Bad news for Monkey: Restrictive cardiomyopathy phenotype, stage B2-C

The reports are attached. I will talk to the vet tomorrow.

My question is: What should I do? where can I seek help? Is there any group that is specialized in this?

Also, there is something I want to get off my chest. Monkey needs 4.75 U Lantus now, higher than his highest when he was diagnosed, 3.25 U. After I take care of him for few months, his lowest was 0.25 Lantus. After letting my family inject insulin for him, they inject 2 HOURS AFTER eating, for FOUR MONTHS, which I believe cause disaster for his BG. And diabetes does significantly increase the risk of heart disease.

@Bron and Sheba (GA)
Click to expand...
I’m so sorry, Peter. I don’t really know anything about restrictive cardiomyopathy except it’s caused by scar tissue but I don’t know what causes the scar tissue. It is also marked by fluid in the chest which explains why Monkey was breathing like he was in the video when I suggested you take him to the ER. I found this group in io.groups. I did not see any FB groups.

I hope you can find a good cardiologist that can help you manage this disease.
 
Peter, I did a bit of research and did not come up with much. It's all very technical and written for doctors, I'll send you the links.
I do not like giving people bad news when I'm not a doctor, I can only tell you what happened to us. And because this happened to us does not mean it will happen to you and Monkey. This happened more than ten years ago and I can't find the paperwork, I can't remember what type of cardiomyopathy our cats had.
We adopted two cats who should have been spayed and neutered, they were not. Now we had six cats all under the age of three who should have been healthy. After the momma cat died suddenly our vet had the other five given ultrasounds and they all had cardiomyopathy. Whatever type they had there was nothing we could do, the only medication back then was ASA. Those cats are all gone now but only two of the six died from cardiomyopathy. Our two diabetics Nigel and Noah lived the longest, both at least ten good years and it was neither cardiomyopathy or diabetes that took them from us.
What I don't understand is how a cat with a congenital heart issue can have scarring, maybe it develops over time. It's also not the same as in humans where the most study has been done because cats are a lot less stressed than humans.
Peter my friend, you need to know Monkey might have the same good life as some of our cats with the same thing. I cannot promise you anything but you know you are a good cat papa so for now just keep Monkey calm and give him lots of love. This is not your fault because you let someone else take care of Monkey, he was probably born this way.
https://www.theveterinarynurse.com/...new-feline-cardiomyopathy-consensus-statement
this is the one much easier to understand. Restrictive Cardiomyopathy (RCM) starts at the bottom of page one.
https://www.vet.upenn.edu/docs/defa...erstanding-feline-cardiomyopathy.pdf?sfvrsn=0
Everyone here loves you Peter.
Dickson
 
I too do not have any familiarity with restrictive cardiomyopathy. Neko had HCM, hypertrophic cardiomyopathy (enlarged heart), not RCM. @Noah & me (GA) , I suspect yours had HCM too cause it can run in families. Neko too was on chlopidogril (Plavix), Pimomedin (Vetmedin) and benazapril. She was on benazapril for her kidneys before hand. The Vetmedin she got was powder form in a capsule. We gave half AM and half PM. Originally the vet said to mix with water and give that way, but it must have been bitter because she foamed at the mouth. So I just put it in a smaller capsule and popped it that way. I actually managed to fit a couple other pills in that same capsule.

Heart conditions can cause insulin resistance, not unusual to have to go up in dose. I think it was @Susan&Felix(GA) who also had to deal with RCM.
 
Bron and Sheba (GA) said:
Peter I am so sorry Monkey now has issues with his heart. I read the report and I see there have been recommendations made for treatment.
I know absolutely nothing about heart issues in cats so I will tag @Marje and Gracie to see if she can help.
@Wendy&Neko may also be able to give you some information but she may not be around for a few days.

Are you able to get any mid cycle tests in for Monkey?
Click to expand...

Yes, I will monitor more closely, there will be more than mid-cycle monitoring, I updated his spreadsheet
 
Noah & me (GA) said:
Peter, I did a bit of research and did not come up with much. It's all very technical and written for doctors, I'll send you the links.
I do not like giving people bad news when I'm not a doctor, I can only tell you what happened to us. And because this happened to us does not mean it will happen to you and Monkey. This happened more than ten years ago and I can't find the paperwork, I can't remember what type of cardiomyopathy our cats had.
We adopted two cats who should have been spayed and neutered, they were not. Now we had six cats all under the age of three who should have been healthy. After the momma cat died suddenly our vet had the other five given ultrasounds and they all had cardiomyopathy. Whatever type they had there was nothing we could do, the only medication back then was ASA. Those cats are all gone now but only two of the six died from cardiomyopathy. Our two diabetics Nigel and Noah lived the longest, both at least ten good years and it was neither cardiomyopathy or diabetes that took them from us.
What I don't understand is how a cat with a congenital heart issue can have scarring, maybe it develops over time. It's also not the same as in humans where the most study has been done because cats are a lot less stressed than humans.
Peter my friend, you need to know Monkey might have the same good life as some of our cats with the same thing. I cannot promise you anything but you know you are a good cat papa so for now just keep Monkey calm and give him lots of love. This is not your fault because you let someone else take care of Monkey, he was probably born this way.
https://www.theveterinarynurse.com/...new-feline-cardiomyopathy-consensus-statement
this is the one much easier to understand. Restrictive Cardiomyopathy (RCM) starts at the bottom of page one.
https://www.vet.upenn.edu/docs/defa...erstanding-feline-cardiomyopathy.pdf?sfvrsn=0
Everyone here loves you Peter.
Dickson
Click to expand...

Hi Noah, it is uplifting to see some cats can survive 10 years and still live a good life with cardiomyopathy. But of course, I understand Monkey is unique.

I was absolutely devasted by Monkey's bad news. The guilt is the worst in my life, I have never felt that level of guilt. It feels I can never get over it. This is not something I can accept. Having the cats was my parent's decision, not mine, and I am not ready to be responsible for any form of life. My own life has enough "issues", which cause me to neglect to monitor my Mom who is giving care to Monkey. I cannot accept things end up in this way. I have been thinking of hundreds of reasons "why my faults are not that serious and should be forgivable".

One of the things that come into my mind is you said " I'm 64 and have had enough loss for both of us but I realized long ago that guilt and shame are a waste of emotional energy" and you got PTSD after the departure of your eight cats in three years.

Maybe I need to get some perspectives. I really appreciate you people here talking with me to keep me sane. Thank you for the love, I love you all too.
 
PH&MonkeyPenPenFaFaTiger said:
Yes, I will monitor more closely, there will be more than mid-cycle monitoring, I updated his spreadsheet
Click to expand...
Peter, you haven’t filled in the dose you have been giving the last several days. Was it 4.75 units each time?
He has dropped low 4 times in the last few day down to 41, 22, 45, 32. All those BGs should have triggered a reduction in dose. The 22 is very low.
Please reduce the dose down to 4.5 units immediately.
You may even need to reduce further
 
Bron and Sheba (GA) said:
Peter, you haven’t filled in the dose you have been giving the last several days. Was it 4.75 units each time?
He has dropped low 4 times in the last few day down to 41, 22, 45, 32. All those BGs should have triggered a reduction in dose. The 22 is very low.
Please reduce the dose down to 4.5 units immediately.
You may even need to reduce further
Click to expand...

The one day 11/08/2021, that drop to 41, 22, is due to Monkey did not eat enough things due to he could not eat before 6 hours of ultrasound. (my Mom did not know that she may should at least reduce the insulin if Monkey is not eating enough.) On the second day 13/8, Monkey was start losing appetite and eat less.

There is a new situation today. Monkey did not eat either Dr. Lisa's raw food or Feline Natural Can food. I am not sure it is because of the heart medicine or antibotics injection he is getting, the vet said it should be unrelated. Luckily Monkey is eating this liquid food. https://ohmycats.sg/products/kenko-pouch-kidney-care-aging-40g?variant=39297925906632

However, it contains 30% crabs... which can be a problem, so let me reduce his insulin to 4.5 U?
 
Marje and Gracie said:
I’m so sorry, Peter. I don’t really know anything about restrictive cardiomyopathy except it’s caused by scar tissue but I don’t know what causes the scar tissue. It is also marked by fluid in the chest which explains why Monkey was breathing like he was in the video when I suggested you take him to the ER. I found this group in io.groups. I did not see any FB groups.

I hope you can find a good cardiologist that can help you manage this disease.
Click to expand...

Thanks, I am asking that group for help. I am also finding a cardiologist, but it is hard in HK to find an affordable and available one.
 
PH&MonkeyPenPenFaFaTiger said:
The guilt is the worst in my life...This is not something I can accept...I am not ready to be responsible for any form of life....My own life has enough "issues", which cause me to neglect to monitor my Mom who is giving care to Monkey.
Click to expand...

We need to talk Peter. I have plenty of issues too, a lot of us do. That's why a lot of people end up with a cat, they give you unconditional love some people have never had before. Whatever has happened in the past will bother me the rest of my life but that doesn't mean I'm not responsible for another life. This is when Monkey needs you, you don't have to be strong, you just have to take care of him. Every word I wrote in the Grief forum that you quoted is true but those cats are gone now; the five we have now are getting older every minute, they all have health issues and one day they'll be gone but they need me right now. You are qualified to do that. Remember that you're still grieving for PenPen which makes this news especially bad but you have no reason to carry all this guilt around with you. Monkey was born with cardiomyopathy, that's not anyone's fault.
Peter, there's a reason I call you my friend. You're easy to care about and a good cat papa but life doesn't always work out the way we thought it would. When we lost all those cats my heart was broken and the house was empty but eventually other cats came into our lives. Life got better again.
I know you're far away, I know Hong Kong is expensive, I don't know what your life has been like. It will get better Peter but right now stop feeling guilt, it's you and Monkey and he needs you. We are all here for you Peter.
 
Noah & me (GA) said:
We need to talk Peter. I have plenty of issues too, a lot of us do. That's why a lot of people end up with a cat, they give you unconditional love some people have never had before. Whatever has happened in the past will bother me the rest of my life but that doesn't mean I'm not responsible for another life. This is when Monkey needs you, you don't have to be strong, you just have to take care of him. Every word I wrote in the Grief forum that you quoted is true but those cats are gone now; the five we have now are getting older every minute, they all have health issues and one day they'll be gone but they need me right now. You are qualified to do that. Remember that you're still grieving for PenPen which makes this news especially bad but you have no reason to carry all this guilt around with you. Monkey was born with cardiomyopathy, that's not anyone's fault.
Peter, there's a reason I call you my friend. You're easy to care about and a good cat papa but life doesn't always work out the way we thought it would. When we lost all those cats my heart was broken and the house was empty but eventually, other cats came into our lives. Life got better again.
I know you're far away, I know Hong Kong is expensive, I don't know what your life has been like. It will get better Peter but right now stop feeling guilt, it's you and Monkey and he needs you. We are all here for you Peter.
Click to expand...

Your comforting words make me feel better. Short question: my logic is that diabetes is positively related to the risk of heart disease, and I (or my family) did not take good care of Monkey and make his BG more unstable. I read from CDC "Over time, high blood sugar can damage blood vessels and the nerves that control your heart. People with diabetes are also more likely to have other conditions that raise the risk for heart disease:"

So his cardiomyopathy is at least part of my fault. Do you agree with me?


It would be very nice if I can firmly believe in Monkey was born with cardiomyopathy, it is not my fault. But I just cannot convince myself. In my opinion, the disease of Monkey are mostly man-made, the reason I say that is because last year Monkey recovered from life-threatening diabetes last year, just under like 3 months of my intensive care, making him wet-food diet, then his appearance such as his coat, and his social behavior, were at his peak at the age of 13! Therefore his previous disease is caused by a not-good-enough-care.

Hong Kong... it is getting worse significantly in terms of the mental health of people due to political issues. Too bad. Fortunately, I am financially good.

I call you my friend Noah. Btw, may I ask what do you mean by I am easy to care about? I am curious and I would love to know how other people see me:rolleyes:. I am aware that some people here have their issues, also I found that the most loving and caring people I have encountered have deep issues. I guess because love is like a double edge sword.

Guilt is a waste of energy, yes rationally I agree with that. There seems to be an illusion to me that I need to have grief for Monkey in order to maintain "the Peter who loves Monkey" otherwise I will become emotionally numb and selfish. I know that for the sake of Monkey I need to just focus on him, maximizing my problem-solving capacities. But now every time I see Monkey, I have intense shame and guilt that make it a lot harder for me to face the problem. In addition, I am not living with Monkey now, but I will visit him more frequently.
 
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The cardiomyopathy is not your fault. It's not caused by diabetes, the wrong dose of insulin or the wrong food, he was born that way. You're only finding out now as Monkey gets older, no one would go looking for a rare condition in a healthy cat or even a diabetic cat. There is no test for kittens, no vaccine.
What do I mean when I say easy to care about? Because you let us into your life when things were both good and bad. Sharing personal stories with strangers isn't always easy, you trusted us so we trusted and cared about you.
How do I see you? You're another human being who has just lost one cat, now another cat is not well. It's as simple as that. You don't need to prove to anyone that you love Monkey.
 
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PH&MonkeyPenPenFaFaTiger said:
I read from CDC "Over time, high blood sugar can damage blood vessels and the nerves that control your heart. People with diabetes are also more likely to have other conditions that raise the risk for heart disease:"

So his cardiomyopathy is at least part of my fault. Do you agree with me?
Click to expand...
Peter, when I read that your family gave insulin two hours after eating, my first thought was, "Thank goodness Monkey is on Lantus. It lasts longer and he may have been still covered by the previous injection as it can overlap."
Hugs,
PS, I have a cat named Monkey, too. Actually Monkeydo is his full name. He is Sister's brother.
 
PH&MonkeyPenPenFaFaTiger said:
The one day 11/08/2021, that drop to 41, 22, is due to Monkey did not eat enough things due to he could not eat before 6 hours of ultrasound. (my Mom did not know that she may should at least reduce the insulin if Monkey is not eating enough.) On the second day 13/8, Monkey was start losing appetite and eat less.

There is a new situation today. Monkey did not eat either Dr. Lisa's raw food or Feline Natural Can food. I am not sure it is because of the heart medicine or antibotics injection he is getting, the vet said it should be unrelated. Luckily Monkey is eating this liquid food. https://ohmycats.sg/products/kenko-pouch-kidney-care-aging-40g?variant=39297925906632

However, it contains 30% crabs... which can be a problem, so let me reduce his insulin to 4.5 U?
Click to expand...

bad news... since Monkey is only eating the liquid food that has 30% carb, his mid cycle bg goes to 27.... i really want him to eat his 0% carb food... let me see
 
Ann & Sister said:
Peter, when I read that your family gave insulin two hours after eating, my first thought was, "Thank goodness Monkey is on Lantus. It lasts longer and he may have been still covered by the previous injection as it can overlap."
Hugs,
PS, I have a cat named Monkey, too. Actually Monkeydo is his full name. He is Sister's brother.
Click to expand...

True, on the positive side it is Lantus:cool:
 
PH&MonkeyPenPenFaFaTiger said:
a world number, sorry, i just updated the spreadsheet, would you like to have a look
Click to expand...
I can see now. When did Monkey start having the liquid food?
Do you think he could be nauseated and might need an antinausea medication or do you think it is because he can’t eat the normal food because of his heart condition? I would wait and see if the numbers go back down for a day or two before increasing the dose.
 
Bron and Sheba (GA) said:
I can see now. When did Monkey start having the liquid food?
Do you think he could be nauseated and might need an antinausea medication or do you think it is because he can’t eat the normal food because of his heart condition? I would wait and see if the numbers go back down for a day or two before increasing the dose.
Click to expand...

good news, monkey eat the normal meat again...

he started only eating liquid food since yesterday, i suspected
that it is because the heart pills and antibiotic prescribed by the vet.
 
Bron and Sheba (GA) said:
I can see now. When did Monkey start having the liquid food?
Do you think he could be nauseated and might need an antinausea
Bron and Sheba (GA) said:
I can see now. When did Monkey start having the liquid food?
Do you think he could be nauseated and might need an antinausea medication or do you think it is because he can’t eat the normal food because of his heart condition? I would wait and see if the numbers go back down for a day or two before increasing the dose.
Click to expand...

medication or do you think it is because he can’t eat the normal food because of his heart condition? I would wait and see if the numbers go back down for a day or two before increasing the dose.
Click to expand...

i have no idea if Monkey have neusea, i have checked the symptoms online. I just dont know if it is because of his heart.
what is clear is that Monkey is sleeping a lot, when he wakes up he just go to eat, drink, toliet, then go back to sleep.

Antineusea... i think i may need that. Let me do more research

one person who had a cat that successfully live for 4 years of good life after diagnosis of severe RCM told me that environment is critical and advise me to keep the temperate cool and dry to reduce the workload of heart of kitties. In hk it is humid and warm, so i will dedicate a space to Monkey that have air conditioning 24/7.

Strange that I only see one person mention about that. I don't know if it will work but i will still do it. I find that when Monkey was asleep, his breathing looks completely normal. When he is awake, then his breathing become like the last video i posted.
 
Bron and Sheba (GA) said:
That’s good news Peter. You may be right… it could have been because he started the medications
Click to expand...

nice that monkey just have a full meal of non carb.
he is drinking a LOT of water... i susoect it may be hyperthyroid, going to take him to bloodtest soon.

he is sleeping or sitting most of the time with his eyes semi closed most of the time. Emotionally i feel so much pain, i dont know if his quality of life is ok
 
My Starla (Mommy misses you bunches, baby girl) had thoracentesis done 3 times to help her breathing when she had lung cancer. A needle is put into the pleural space to extract the fluid.
Just throwing that out there in case Monkey's breathing becomes very harsh and he is struggling.
That said, perhaps the meds you have started will assist with that.
Hugs,
 
update:

Monkey's breathing always return to normal when he falls asleep. But when he is awake, sometimes his breathing is slightly labored, sometimes is more relaxed and normal. i wonder why is that? His breathing rate is about 18-22 now
 
PH&MonkeyPenPenFaFaTiger said:
update:

Monkey's breathing always return to normal when he falls asleep. But when he is awake, sometimes his breathing is slightly labored, sometimes is more relaxed and normal. i wonder why is that? His breathing rate is about 18-22 now
Click to expand...
I am going to take a wild guess here and say that it MAY be related to how Monkey is positioned. When laying on his side asleep, there may be more pressure on the heart (labored breathing) and when sitting upright, awake, there is less or reduced pressure which is the "relaxed/normal" breathing you are seeing.
Just guessing,
Hugs,
 
BAD news, Monkey does not eat anything except the 30% carb liquid food. I still have him to eat the liquid food. Now he does not even eat his favorite food, which is shrimp.

so should i drastically increase his insulin dosage? i am going to record his BG every 2 hours. HELP
 
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PH&MonkeyPenPenFaFaTiger said:
BAD news, Monkey does not eat anything except the 30% carb liquid food. I still have him to eat the liquid food. Now he does not even eat his favorite food, which is shrimp.
so should i drastically increase his insulin dosage? i am going to record his BG every 2 hours. HELP
Click to expand...

I would think that increasing insulin drastically is not a good idea. What do you believe it will achieve?
@Marje and Gracie
@PerfumedCatMom
@Bron and Sheba (GA)
@tiffmaxee

I see your SS has not been updated since October 2020.
In order for the team to give you outstanding advice on dosing, they will need to know Monkey's BG numbers.
Hugs,
 
Bron and Sheba (GA) said:
How is Monkey today? Is he eating any normal food? Can you mix up (blitz) any low-carb food and make it into liquid…do you think he would eat that?
Click to expand...

At last, his BG is pretty low today for all time, lower than 200, his BG even drop to dangerously low today. The PMPS 2 hours ago is about 80-100.
Since there will be a large adjustment in his food, I will shoot one 1U of lantus. Luckily a find low-carb liquid food that Monkey likes, not exactly normal food with complete nutrition but I will explain more in my next post
 
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