Experience of HCM and congestive heart failure

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SyrF_85
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Experience of HCM and congestive heart failure

Post by SyrF_85 » Fri May 01, 2020 11:31 am

Hello, I would like to share some tips about HCM and congestive heart failure. Alongside all the usual treatments and regular monitoring via a heart specialist (and, for example, spacing out medications and giving them at the same time every day, deciding the optimum daily amount of food and weighing this out at consistent mealtimes and ensuring food is given with medications to prevent stomach upset [unless otherwise specified], having a chart that shows what should be given when, and when feeding should be done, keeping the cat stress-free, etc.), I believe there are a lot of things vets are unaware of/don't have time to share and/or research/are sadly ignorant of, and this has caused me a great deal of pain as I don't believe my cat was ready to go. My 6-year-old cat went into congestive heart failure from HCM and was given weeks to live. He was still alive 6 months later, with no difference in appetite (apart from two episodes of a lack of appetite which did not last long) and the same energy he had when he was a kitten, which I attribute to the supplements he was receiving. The specialist even said at his last appointment that the fluid was going down and that there was very little fibrosis that is normally caused by heart enlargement. His heart rate had also gone down from dangerous to within the normal range. Due to coronavirus, he could no longer have his monthly scans. During that time he developed a clot despite being on clopidogrel (which doesn't work in certain gene carriers) which resulted in a saddle thrombus. I believe that if he could have had his scan and we'd seen the clot forming in his heart (I was already aware of the stale blood in his heart but it had not yet formed a clot before the lockdown), I could have tried some further supplementation, for example with nattokinase and an experimental treatment with leeches which has had a 90% success rate, but it wasn't to be.

The tips I wanted to share are first to do with eating. There are many very interesting articles and sites about the effect of omega 3 on appetite. On the two occasions my cat lost his appetite, it was because I had cut out his fish food. I would recommend a fish oil tablet or a very high quality fish food with oily fish like mackerel and/or sardine and making sure that you give enough to provide omega 3 content equal to 40 mg/kg body weight eicosapentaenoic acid (EPA) and 25 mg/kg docosahexaenoic acid (DHA). Like I said, there are some very interesting sites that explain the scientific mechanism behind this. There has also been a lot of research into the effect that omega 3 has on reducing heart scarring from enlargement, especially sardine, and omega 3 in blood thinning and helping to prevent clots. (This can increase the risk of bleeding, but unless there is a risk of your cat being attacked or run over, I believe clots to be a higher risk factor.) To find out how much EPA and DHA is in fish food, you can look at the quantity of fish in the cat food pouch/tin, and then search online for EPA/DHA content of fish types generally, and work out exactly how much food to give to match the required doses. It's not good for cats to have too much fish, and some fish can be high in salt, so it's best to limit it to just enough to give the recommended doses, or alternatively, just give the fish oil tablets. (I wanted to give my cat oily fish so that he also received the other benefits I mentioned.) I found an excellent cat food that had only sardine and mackerel (with no fish derivatives) and fish broth, with no added salt, and which had 75% fish content. I also bought krill oil tablets for at the start of the not-eating episodes when my cat wouldn't even eat the fish. It's important to note that even if they say, for example, give one tablet daily, you may have to give more to meet the doses specified above. Just check that if there are any other ingredients, giving more tablets wouldn't push those out of the safe range. You can find out the safe ranges of most things by searching online. Importantly, it can take up to 4 weeks for the levels of anti-inflammatory cytokines resulting from omega 3 supplementation to reach an effective level in the body, so don't give up and think it isn't working (in my cat, I started to see the effects within 2 weeks). (As a side note, I initially gave my cat all his medicines in a palatable putty, even though he took pills well, because I didn't want him to know anything was wrong. This was packed with salt and made him literally weak for the 4 days at the start of his heart failure that I did this, but this abated when I gave the pills manually.)

My second tip is that if it can be helped, NSAIDs, for example meloxicom, should be avoided. These have been shown to increase the risk of clots. On the second, recent, episode of my cat not eating, I took him to the vets because I didn't know what to do (this was before I had properly twigged about the omega 3), and they gave him an injected dose of meloxicom 'just in case' (how I wish I had known about the risk of NSAIDs and said 'no thanks'). Also, I have read some research that suggests that (avoidable) intravenous medications can place strain on the heart - I believe that an oral dose would have been less harmful.

My third tip relates to HCM. My cat was a British Shorthair. These cats are big cobby-type cats and have a lot of muscle and are genetically meant to be bigger than ordinary cats. Despite my cat being 5 kg (the average British Shorthair male is usually greater than 7 kg), my vets convinced me to try and get his weight down to 4.5 kg. They also said to just drop his food until he started to lose weight. First, I believe he was stressed from being so thin and hungry all the time, after having got down to 4.7 kg. Second, no-one told me (and I wish I had looked it up) that if you are going to put a cat on a diet, it has to be on diet food. If you just reduce the normal food, the levels of vital nutrients like taurine are no longer guaranteed as you are feeding less than the recommended amount. A diet food has extra nutrients to make sure your cat is getting enough of these at a reduced amount. In cats with HCM, the most important things you can do are maintain your cat's ideal body weight, keep them stress-free and ensure that they are getting enough exercise and eating a very high-quality high-protein diet (with supplementation).

My fourth tip is to do all the research you can into everything and always push your vets about everything. My experience is that they like to believe that they know everything (I don't mean that in a nasty way - I just think that they often underestimate the intelligence and research skills of their clients, and their clients' intimate knowledge about their pet's behaviours, and believe that formal veterinary training is the only thing that qualifies knowledge about a pet's health), and that you are being annoying if you question anything, but I have learned that being submissive has resulted in things being missed/wasted opportunities. For example, after first being diagnosed with very bad HCM at 1 year and having a couple of scans that revealed that this had actually abated over a couple years on atenolol, my vets didn't tell me that I should be having 6 month scans with a heart specialist (indeed, I don't think they even had a visiting heart specialist for some time). When I realised that this was necessary at his being aged about 5, at the appointment, the specialist didn't do a scan because my cat was stressed. At the next scan, following a vaccine appointment, during which the vet said my cat's heart sounded good, the specialist listened and was concerned and did a scan and found that my cat had a massively enlarged heart and it was unlikely that he would make it past a couple of weeks. I wonder if the extent of this could have been reduced had he had a scan at the previous appointment. I also wish that I had been more assertive in asking about things like his blood pressure, checking his muscle form for cachexia and checking his electrolyte levels, and asking if things like digoxin would help with his irregular heartbeat, during his monthly scans while being in heart failure, but the specialist seemed to want to be in charge and I didn't question that. One vet told me to put my cat on kidney food for the reduced salt, but from my research I believe that only moderate salt restriction is required, and there are many very high-quality foods with no added salt (although salt is naturally present in meat in fish), and as my cat was young and didn't have kidney failure, it seemed to me that the benefits of a high-quality protein would help to strengthen my cat's heart muscle. I also became complacent when my cat was doing well, and, for example, didn't research the risk of the 'smoke' (stale blood) in my cat's heart. My specialist said this could result in a dislodged clot, but I didn't look up how horrific this is for pet and owner (my cat suffered a saddle thrombus), or look into any further supplementation, focusing instead on energy and eating, and feeling so happy that outwardly he was doing so well.

My final tip, which lots of people have given, is to spend all the time you can with your pet if you know their end is coming. My boy was only 6 when he died, and was still so active, and we had so much fun together all the time. I photographed him and videoed him. I came up with a daily routine so we could fit in all his favourite things. And after he has passed, what has helped me more than anything is to write down every last memory I have of him in a book. Scientists believe that one of the causes of emotional pain in grieving is the process of the brain trying to consolidate memories of the loved one (in addition to erasing the physical emotional connections in the brain from the attachment and trying to configure the new reality without the loved one). Writing down the memories can also help with remembering the pet in a positive light rather than focusing all your attention on trying to imagine/experience your life with the loved one still in it and thus combat the difficulty this presents the brain when it is trying to configure the new reality and reduce the pain that comes from the bargaining stage of grief in which you truly believe that if you had done things differently your loved one will somehow come back. I didn't write down my memories with other pets I've lost in the past, and have found the grieving process easier this time around. I would also recommend looking up caregiver's grief, because as silly as it sounds, having structured your day around looking after your cat, and probably focused all your energies on that, and wanted that to go on forever, and with so many medicines to give and signs to look out for, this is an added facet to the grief process.

Finally, I have some supplements that I bought for my cat that I have not used and wondered if anyone would like these? Most are still sealed and some are opened. These comprise Thorne Bio-Cardio Cardiovascular Support capsules (1 bottle sealed and 1 opened), animigo krill oil softgels (3 bottles sealed, 1 opened), Life Extension Cat Mix (2 tubs, both sealed), and an opened tub of AniForte taurine powder (even if your cat does not have DCM - most often caused by lack of taurine - studies have found that taurine supplementation can strengthen the heart during heart failure, and you cannot give too much of this - any excess is just peed out without side effects). I would also recommend a high-quality vegan (so that it is lactose-free) probiotic, although unfortunately I don't have any of these left to give (please note that the cheaper ones of these must be refrigerated after opening - the more expensive don't have to be). There is an expensive one that can be bought from a well-known high-street supplement store for humans that contains many of the strains that have been studied in the context of heart failure. There are lots of published studies on the heart-gut axis that describe the mechanisms for the benefits. I'm not sure if you can post addresses in posts on this forum, but if anyone would like the supplements, please let me know and let me know how we could go about getting these to you. With the Life Extension and Bio-Cardio, I would recommend discussing their use with your vet before administering as there is a potential for interaction between some of the ingredients and prescription drugs used in heart failure. I gave a mix of these supplements twice a day, according to the recommended doses and my research (please let me know if you would like to see my feeding/medicine chart for ideas about anything), diluted with water, using a 1 ml syringe as my cat would not eat his food when I tried to administer them sprinkled on his food.

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SyrF_85
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Re: Experience of HCM and congestive heart failure

Post by SyrF_85 » Fri May 01, 2020 11:53 am

I forgot to include one other very important thing. I kept a daily diary of my cat's eating and behaviour and everything I did relating to him, like changing the time I gave him his food/what I gave him/the times I gave him his medicines and how I administered them, and if anything stressful happened that day like his visits to the vets/bonfire night and fireworks or anything unusual like when he was given NSAIDs. This way, for example, on the instance when I was giving him the putty with his pills, and when I removed fish from his diet, I was able to look back through the diary and piece together exactly why he was lethargic/wasn't eating, and make changes to rectify those things. Without the diary, I would have been unable to remember what had happened and therefore unable to research/work out how to fix things. It has also helped me piece together what I believe was his untimely ending, and thus helped me come to peace with his passing. I also experienced that any fix I made took a little while to reveal itself; for example, reversing a change I made to the time of giving a certain medication (the change had resulted in a lack of energy), didn't improve things straight away. Generally, it would take the day of the fix and the first day after that, as things normalised, before on the day after that things would be back to normal.

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Re: Experience of HCM and congestive heart failure

Post by Catfan5 » Sat May 02, 2020 10:17 am

Hi Sarah, thank you for sharing your experience and so sorry for your loss. My cat, also a bsh, had both hcm and chf, in between those his heart seemed to improve. The thickening became thinner and all seemed well until he had to start taking steroids for ibd. The vet didn’t tell me it could affect the heart of a cat with hcm. But he needed to take it along with diet changes. I totally agree with you about vets, one of ours especially. They are like gp’s, know a lot about about most things but they don’t specialise. They need to listen to the the pet owners a bit more. Long story..I can’t fault our specialist vet, she’s been amazing and would fit Harry in any time I was worried. He had a scan during lock down while we waited outside, watching through the window so we could communicate. He also took clopidogrel, vetmedin and Torasemide. He didn’t have a special diet, just grain free, reasonable quality wet. We knew he was on borrowed time so let him eat what he enjoyed toward the end. You did the very best for your boy. Even with a scan there probably nothing more you could have done for him than you were already doing.
Harry was less than 2yo when diagnosed and died from a saddle thrombus last Wednesday aged 12. Very heartbreaking. X

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Re: Experience of HCM and congestive heart failure

Post by SyrF_85 » Tue May 05, 2020 6:02 pm

Hi Catfan, thank you and I'm so sorry for your loss too. Isn't saddle thrombus the cruelest thing? Nature makes other things bearable, like a feeling of euphoria when a cat is starving, but a saddle thrombus seems to me the most painful and confusing way for a cat to go. I wish it had been anything but that. Is that Harry in your profile? He was gorgeous and such a friendly-looking little man. I'm going to update my profile with a pic of my boy, Benny. I'm sorry about the steroids and Harry's heart. I hope there will be more effective therapies for pets in the future, especially for HCM. I think my mistake with the whole experience was that I never really accepted that this was the end and deep down I thought I could bring him out of heart failure. I hope you're okay and time is helping to ease the pain.

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SyrF_85
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Re: Experience of HCM and congestive heart failure

Post by SyrF_85 » Tue May 05, 2020 6:19 pm

(He is in his 'sister' Saffie's box in the pic :-))

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SyrF_85
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Re: Experience of HCM and congestive heart failure

Post by SyrF_85 » Tue May 05, 2020 6:21 pm

(They had/have lovely places to sleep too, but naturally prefer the humble cardboard box :-))

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Re: Experience of HCM and congestive heart failure

Post by Catfan5 » Tue May 12, 2020 8:34 am

Hi, yes, saddle thrombus is horrible, sudden and distressing not only for the cat but also for the owner to witness. I’m so thankful he was in the house when it happened as he loved to go out on nice days, just into the garden. I didn’t have the car that day and called the vet in a panic who very kindly sent someone to collect him within minutes. Sadly I couldn’t go with him due to lockdown. Is that Benny in your avatar? He looked lovely, that face :) That’s Harry’s brother Alfie in my avatar who also had hcm and ibd but died from lymphoma in 2018. They looked very alike and were absolutely gorgeous. We miss them so much, even our other cats do in their own way.

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Re: Experience of HCM and congestive heart failure

Post by SyrF_85 » Tue May 12, 2020 6:24 pm

It's so sad you couldn't go with him, I'm so sorry about that. My Benny was in the front garden when he had his saddle thrombus. I keep wondering if I had looked out sooner if there would have been a chance he could have survived it but the vet nurse said in 17 years she's never seen a clot dissolve in a cat with any thrombus. Yes, that's him in the avatar :-) One of my older cats has been very nervous since Benny died and I think she's scared that someone is going to take her away too. Alfie was gorgeous too, I'm so sorry you lost him as well. You must miss them so much. I'm hoping there is some truth in the idea that you see the people and animals you love again one day when you pass. Xxx

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Re: Experience of HCM and congestive heart failure

Post by Linah4 » Sun Oct 18, 2020 8:24 am

Hello, I've been doing some research on blood clots in cats but firstly I want to say I'm sorry for your loss - saddle thromus (and any blood clot) is so devastating and stressful. My late girl suffered a saddle thrombus in 2016 and she miraculously dissolved the blood clot on her own, while we helped her with pain meds Gabapentin and Buprenorphine. At the time, her chest xrays looked fine and the vet presumed it was a blood clot based on other tests. I made the mistake of not following up and earlier this year, she started having complications. We did tests and xrays found she had an enlarged heart, among multiple other conditions. I was sure she was also beginning to suffer another clot so I started researching treatments since the only thing my vet was offering was euthanasia as she didn't want to prolong her suffering. To be fair, my girl also had signs of cancer in her xrays so there was a lot more going on.

I came across a website/support community https://ten-lives.com which had different treatment options and was a huge help for me. It's interesting you mentioned Nattokinase since that was one of the treatments (with a lot of success stories) and something I actually tried. I believe it was working as she began regaining mobility in her hind leg that she was limping on and eventually stopped walking on completely. Unfortunately though, all of the other conditions were just too much for her little body to handle.

These are some really great tips, thank you so much for sharing. You should share your story with the community above, I'm super curious about the leech treatment you mentioned as well, I have never heard of that, do you mind sharing more information? Again I'm so sorry for your loss, this condition is so horrible :(

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