Hypertrophic Cardiomyopathy and Congestive Heart Failure

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sarie
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Hypertrophic Cardiomyopathy and Congestive Heart Failure

Post by sarie »

Hey guys, I have another thread about Cat Asthma back when I thought that's what it was but I wanted to start a new more relevant one in the hope of attracting some more advice.

My beautiful 5 year old half Maine Coon boy Harvey has been showing signs of breathing problems recently and last week was diagnosed with a squeaky heart. The vet wanted him to lose a little weight before they conducted further investigations but unfortunately fate had other ideas and on Tuesday night Harvey's heart started to fail. I rushed him to the emergency vet who diagnosed acute congestive heart failure with fluid in his lungs. He was put into an oxygen tent and given diuretics to dry out his lungs. He's still at the vets now, they're keeping him until the weekend to do more tests and observe him. X-rays revealed a thickening of the heart wall on the left side (HCM) but he's hidden it so well I had no idea until he went into heart failure.

I'm absolutely heart broken. He's just the most life-loving, characterful little cat and so young and otherwise healthy :( the vet hasn't given a prognosis yet but I understand it's not good once they go into acute CHF. He will be prescribed heart meds and diuretics when I collect him but can anyone give me more advice on how long I'm likely to have him for? And what I can do to make his life more enjoyable :(
I read that a low sodium diet is recommended too - can anyone give me any advice on low sodium foods? He currently eats Orijen dry and occasionally eats the Bozita wet I put down but usually ignores it and just eats the dry because he's a precocious little sod :)

It's going to take a while to sink in. Please, give your cats extra kisses and cuddles from me tonight; you never know how long you're going to get with them :( x
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Re: Hypertrophic Cardiomyopathy and Congestive Heart Failure

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Email sent to you.
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Re: Hypertrophic Cardiomyopathy and Congestive Heart Failure

Post by sarie »

FYI if any of you have any run-ins with this awful disease, there are so many lovely people out there and so much advice and information. Thank you so much Beanie.
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Re: Hypertrophic Cardiomyopathy and Congestive Heart Failure

Post by Diana »

I dont have experience but hopefully someone can advise on the best food for your boy.
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Re: Hypertrophic Cardiomyopathy and Congestive Heart Failure

Post by sarie »

Thanks Diana. After discussing with my vet she advised that going too low sodium at this point wouldn't be good for him and the time will come for this when his heart failure becomes more severe but for now I've started to wean him off the dried food as this isn't good for his kidneys as he's taking diuretics daily for the rest of his life.

I've got him some Lily's Kitchen Fish Dinner as this only contains 0.5% sodium DMA wheras the Bozita wet food he had was over 1% so was a little on the high side for a kitty with heart problems.

An update on Harvey though... now taking Lasix (furosemide) and Semintra (ARB) daily to control his heart failure and prevent fliud from building up on his lungs. I'm waiting for a referral to a cardio so I can get a better idea of just how severe his HCM is but no doubt I'll need to introduce more drugs into his daily regime in order to manage the disease and slow down the progression.

I'm coming to terms with the fact that he's a seriously poorly cat now but it's very difficult to swallow at times. He's only 5 years old and such a sensitive, beautifully natured little cat - it really seems so unfair for him to be so poorly. His prognosis at the moment is anything from 3 months to 3 years depending on how progressed his HCM is and how well he responds to treatment. He's at risk from a fatal blood clot that could strike at any time and he's also at risk of sudden death as well as refactory congestive heart failure.
I cried for days when I first found out how serious his condition is but there are only so many tears we can shed for our kitties and I've found new comfort in researching his condition and trying to find ways to help him live a good quality of life for as long as possible.

He's adapting well to everything and I've found good ways to get his meds into him stress free but he's sleeping a lot more lately as the meds lower his blood pressure to ease the strain on his little heart. He's been much better over the last few days as his body has adapted to the drugs so he's starting to behave a little more like himself but he now has to remain indoor only as he can't be subject to the stresses and strains of an outdoor existence. He's become very clingy and is sticking to me like glue when I'm home.
I feel grateful that I found out about his condition before he became any worse but given that his heart had already started to fail his prognosis is far worse than it would have been had I discovered his condition before heart failure set in.

All I can do now is enjoy every minute I spend with him and build happy memories. I'm thankful that I've been given the gift of knowing that I'm going to lose him young (as awful as that sounds) so I can fill every moment with love and pleasure and take the time to enjoy him. I know not everyone is so lucky as to know that they're going to lose their little ones before their time and the shock of a sudden loss at a young age must be hard to bear. I know I'm still going to be completely destroyed when his time comes (I'm welling up a bit now just talking about it) but I will make what's left of his life as special as possible. I fear everytime I go home that I may find him dead so I say goodbye to him every time I leave the house. It's sometimes easy to take them for granted, particularly when they're young and you just assume you've got another 10+ years with them but something like this serves as a reminder that life often has other plans and it's important to enjoy every second you have with them and never, ever take your time with them for granted.

Harvey is taking full advantage of all the extra fusses though, he's not daft :)
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Re: Hypertrophic Cardiomyopathy and Congestive Heart Failure

Post by Diana »

Hi Sarie

I hope Harvey certainly has a few years left in him, but if not...as you have told me you have lots of memories and he has live a lovely life with you. But all not is done yet, I am hoping you can control this so he can stick around and pester you with love.
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Re: Hypertrophic Cardiomyopathy and Congestive Heart Failure

Post by Crewella »

((((Sarie)))), I'm so sorry about poor Harvey, but you're absolutely right to take the view that you have - just love and enjoy him, and focus your attention on the positive things and learning as much as you can about his condition. It's not easy, good on you, but you don't know how long you have him for, and it would be such a shame to fritter that time away being sad.

Please add a fuss from me to the extra fusses he's due :)
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Re: Hypertrophic Cardiomyopathy and Congestive Heart Failure

Post by sarie »

Thank you both so much :) I've been giving him lots of extra fusses so I'll pass on some extra ones from you :)

I'm trying very hard not to be sad and doing quite well at the moment, I think I got a lot of it out of my system during the few days following his diagnosis; he's so loving recently it's hard to be sad around him anyway :)
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Re: Hypertrophic Cardiomyopathy and Congestive Heart Failure

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So Harv is a bit up and down recently. I've managed to come up with a few successful techniques to get his medications into him and it's all becoming fairly routine now but I can tell the medications aren't making him feel too well and, as with all heart patients, he's having good days and bad days.
It takes anything from 5 minutes to an hour twice daily now to get him all medicated as if he's feeling particularly grotty then he won't eat the treats I hide his pills in so I have to coax him to eat. Usually some really gentle fuss and a few headbutts (from me to him!) coax a purr out of him and that's enough to get him to consider eating a treat or two.. just enough to get the pills into him.

Monday and Tuesday were bad days, he just looked unwell. His fur wasn't well kept and his eyes were glazed and he just walked around stiffly and didn't interact much and slept constantly. Yesterday he was a little more his normal self though and this morning he seemed brighter but was very clingy, usually a sign he's not feeling wonderful.

I feel so awful seeing him having such a hard time - the medications are keeping him alive but they've really reduced his quality of life. He's seeing the cardiologist on October 22nd and I'm just counting down to that visit as we'll get a clearer picture of what's going on and hopefully the cardiologist will have some ideas of a compatible medication regime that won't make him feel too rubbish.
The problem is that each drug has side effects and when combined they have additional side effects. He then takes drugs to counter those side effects which in turn have their own side effects.. it's a horrible cycle.

He's not meant to be going outside at all due to his condition but he's so miserable all the time that going out is the only pleasure he gets really so I'm letting him out for an hour each evening, late on when most of the area is quiet and the neighbours and their dogs and kids have all gone inside. This has been working pretty well for the most part but unfortunately Harv got into a fight on Tuesday and came in with a small but quite nasty wound under his eye. It looks like another cat has hooked him and pulled a small lump of flesh/meat out. I initially thought it was a glob of blood and tried to clean it up but when I went to clean it I realised it was actually flesh poking out :( It's only tiny, about the size of a pinhead but it's not pleasant. It appears to be his only injury so I've been cleaning it daily and it's all dried up now so hopefully he'll heal up and the little lump of flesh will just drop off like a scab but I feel so sorry for him; he can't even enjoy going outside without having hassle! Worst thing is that this abuse is happening in his own garden most of the time.. I've tried chasing the other cat out but it seems hell bent on claiming my garden as its territory!

Anyway.. I guess long term this'll get fixed as I'm going to get a run built on the back of the house for the cats but I'm having the house re-rendered in November so I can't build anything until that's done.

Here's a shot of Harvey the other morning refusing to get out of bed as he was feeling a bit rubbish. I had to get up for work but I really wanted to stay in bed with him all day :)

http://i.imgur.com/VnP5awe.jpg" onclick="window.open(this.href);return false;
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Re: Hypertrophic Cardiomyopathy and Congestive Heart Failure

Post by Crewella »

Beautiful boy, fusses from me, and roll on the 22nd. xx
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Re: Hypertrophic Cardiomyopathy and Congestive Heart Failure

Post by SarahT1 [PLLE] »

He's so lovely, Sarie. What a horrible situation for you both. He has you to love and care for him so something is in his side. Hugs to you. X
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Re: Hypertrophic Cardiomyopathy and Congestive Heart Failure

Post by bobbys girl »

Poor Harvey. I really do feel for you both. I'm sending (hugs), fusses and lots of good vibes. I really wish I could do more.
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Re: Hypertrophic Cardiomyopathy and Congestive Heart Failure

Post by sarie »

Thanks guys :) Unfortunately Harvey had another bout of congestive heart failure last night :( I got home and he seemed a little short of breath so I gave him his diuretics and monitored him but within about 15 minutes it was clear he was struggling to breathe and I could hear the fluid on his lungs.
At about 8.30pm I rushed him to the emergency vets (second time in a month) as it was clear that my help alone wasn't going to be enough. Worst 20 minutes of my life.. I hate how far the emergency vets are from my house. He was given an injection of fast acting diuretic and I stayed with him in the consultation room for about an hour and a half and at around 10.30pm the vet was happy that we'd stabilised him. I could either leave him there for observation and collect him at 8am or take him home and monitor him myself. Given his condition is worsened by stress I chose to take him home and thankfully by the time we arrived back at the house at around 11pm his breathing was almost normal, although a little fast.
Unfortunately the diuretics make him wee a lot though so the poor little guy had been sat in a carrier absolutely flooded with urine on the way back from the vets so it took me about 30 minutes to clean him up and clean up the house after he trampled wee all over the place in his attempts to make a swift exit from the carrier when we got home!

I ate a packet of crisps for dinner and went to bed at about midnight then got up at 6am for work; not the best really but thank god it's Friday! I didn't want to go into work Today after all that but I had no choice (work commitments) - I hate leaving him alone these days though as he's really not in great shape. The vet said unfortunately his condition makes him a ticking time bomb :( He was in good shape when I left this morning though, he had some breakfast, took his regular meds and his breathing was back within normal ranges so I'm happy his emergency is over.

He's on preventative drugs though so it looks like they haven't been working so I guess we're going to have to look at altering the doses. Feeling pretty stressed and upset about it all Today, the poor little guy can't catch a break :(
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Re: Hypertrophic Cardiomyopathy and Congestive Heart Failure

Post by bobbys girl »

Oh sarie, what an awful situation you are in. I will be thinking of you and your boy today. (Hugs) to you any gentle fusses to Harvey. xx
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Re: Hypertrophic Cardiomyopathy and Congestive Heart Failure

Post by Crewella »

Poor Harvey, and you (((hugs)))

Thinking of you here too. xx
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Re: Hypertrophic Cardiomyopathy and Congestive Heart Failure

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Thank you both :) It's been a very long day here waiting to get back to him so I'm just about to scuttle off home now and see if he's OK. He's in for a long weekend of fusses :) I feel so bad for him though, poor little guy, he doesn't know what's happening or that any of what I'm having to put him through is for his own good. Thankfully he doesn't seem to be holding any grudges but it just seems very unfair for him to be as poorly as he is :(
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Re: Hypertrophic Cardiomyopathy and Congestive Heart Failure

Post by bobbys girl »

Hope you have a good weekend with your boy and there are no more trips to the emergency vets. (hugs) and fusses.
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Re: Hypertrophic Cardiomyopathy and Congestive Heart Failure

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Thank you :) The weekend went OK, he was a bit touch and go on Sunday but he seems stable again for now so hopefully he can hang in there until his cardio visit next week. I'm really stressed about him seeing the cardiologist though. I desperately want him to have his visit as hopefully the cardiologist will get to the bottom of the root cause and be able to put him on the right medications to extend his quality life for as long as possible, especially as right now his quality of life seems to be very up and down - but at the same time the cardio will require him to stay at the vets all day and he'll likely be sedated again at some point during investigations too. Given the problems with his heart he's at very high risk of dying under any kind of sedation so that alone is really worrying for me.

I know I should also trust the vets and my vet has been fantastic up until now so I do trust her (mostly) but I am a little worried about just how much they know what they're doing. Two things that could kill him while he's there (other than sedation) are if for some reason they decide he needs fluids.. IV fluids could push him straight into severe heart failure. The other is steroids.. if they give him any steroids for any reason he could also go into heart failure and die very quickly.
I need to be totally clear that they put this on his notes on his cage because I know one of the vets I spoke to last week suggested that possibly he has a touch of asthma in addition to his heart problem and they could look at starting him on a course of steroids to treat it. I was horrified as, for a cat with HCM and CHF, steroids are as good as a bullet to the head.. I couldn't believe what I was hearing. I had to try to calmly point out that perhaps steroids weren't the best idea until we understood his heart condition more, and they agreed, but the very fact they'd even suggest it worried me.

He will be with the cardiologist that day and not the normal vets so I'm hoping that means he's in better hands as the cardiologist will surely know all of these things but I'm just so worried about handing Harvey over for a day without really knowing if they're going to be able to keep him safe and well while he's out of my care :(
The worst thing in all of this is that he's only 5 years old... I've spent the last few years imagining him going through life with me - one day meeting my children (although he might be glad to miss that) and coming to terms with the fact that his time is limited and he's going to die young is really cutting me up inside. My parents said I'm going through a period of mourning at the moment as I come to terms with him having a terminal condition and that it's natural, but sometimes I feel a bit ridiculous for getting so upset about it as at least I'm lucky enough to know and be able to spend some special time with him. But at the same time I do find myself just breaking down in tears occasionally and without warning and I fear the inevitable loss of him even more.

I've joined the yahoo groups for support with his condition and the people on there are fantastic and their help has been amazing as they're all so knowledgeable but at the same time it's a reminder of how poorly he really is as around once every couple of weeks one of the regulars there will post up to say their little one has lost their fight. It brings home just how inevitable it all is and how no matter what I do there's absolutely nothing I can do to change the final outcome of all of this.
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Re: Hypertrophic Cardiomyopathy and Congestive Heart Failure

Post by Crewella »

I really wish I could say something to help, but all I can do is send my thoughts and best wishes. Give him a gentle fuss from me. xx
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Re: Hypertrophic Cardiomyopathy and Congestive Heart Failure

Post by rayvenspel »

I'm so saddened to read that you're going through this Sarie. Last September I lost my beautiful boy Toosmo to CHF at just 2 years old. I completely understand what you're going through, trying to ensure that a cat has a completely stress free existence is darn near impossible- there are so many external factors we can't control! Cherish each and every day you have left with beautiful Harvey. It sounds like you are such a wonderful loving owner, despite this terrible condition he is blessed to have you. xx
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Re: Hypertrophic Cardiomyopathy and Congestive Heart Failure

Post by Diana »

Sarie I have been following this thread. Your Harvey is hanging in there, such a brave little guy. I have no experience with the condition however I know how hard it can be knowing he is on borrowed time. The bright side, as awful as it is....you know that you may lose him young so you have lots of time to really fuss with him and spoil the little man rotten. My Shelly, we all knew that time was coming and I had already started the mourning process, but cause we knew we made sure she was always close by getting lots of love.

Saying this, that appt may give you great hope and medications can be used so he can enjoy life better for how ever long he has. These days may be good and bad but know that you are doing all you can to give him a good life!
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Re: Hypertrophic Cardiomyopathy and Congestive Heart Failure

Post by sarie »

Oh rayvenspel I'm so sorry to hear about Toosmo, thank you so much for your kind words. It really is so tough to keep them stress free and CHF comes on so suddenly sometimes, it can be so cruelly unpredictable. Last time it happened the vet asked what had stressed him but it's impossible to know sometimes as, like you say, there are so many external factors that could cause stress.
I'm doing my very best with him and trying to avoid being upset when I'm in the house with him as that was what brought on his first bout of CHF. I feel blessed that I still have him, despite how poorly he is, and I cherish every headbutt and purr I get from him at the moment.

I was so sad following Shelly's thread Diana, but as you say it can be a gift to know in advance that they're on borrowed time as then you can really make sure you cherish every moment with them and make sure they know they're loved. I know that you gave Shelly so much time and love in her final days, she was so lucky to have you.

Thank you both so much.

Harvey has had a better couple of days as I've been very closely monitoring his Furosemide intake to try to keep CHF at bay. His breathing rate was a little high on Wednesday night so I gave him an extra few mg and that seemed to settle his breathing back down again overnight - so much so that he started chirping in the night and being naughty, jumping on the headboard of my bed and trying to knock pictures off the walls. He hasn't behaved like that in months so it's really nice to see him having a good day. He was better last night and this morning too, I got headbutts from him in bed this morning and he played with the tap in the bathroom - he's obsessed with water.
I'm really hopeful that he continues to feel better as he's had a really rough time of it recently and has been really under the weather. The longer I can maintain this quality of life for him the better as I really want him to enjoy every bit of time he has left on this earth :) I'll try to get some pictures and videos of him up on here at some point :)
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Re: Hypertrophic Cardiomyopathy and Congestive Heart Failure

Post by bobbys girl »

So nice to hear he feels well enough to be naughty! :D
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Re: Hypertrophic Cardiomyopathy and Congestive Heart Failure

Post by Crewella »

It is lovely to hear he's feeling better. :)
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Re: Hypertrophic Cardiomyopathy and Congestive Heart Failure

Post by sarie »

So an update.. Harvey is with the Cardiologist today and there's good news and bad news but it's mostly good news! :)

Harvey doesn't have Hypertrophic Cardiomyopathy or Congestive Heart Failure, despite all the indications that he does! The Cardiologist says that the vets he's seen so far were completely right to assume this condition as he has all the symptoms and his response to treatments given were also a good indicator of the condition. However, he said in all his years of working he has come across one other cat who has given all the signs and symptoms of this condition but didn't have it - Harvey makes two.
His heart isn't normal, there are abnormalities but the abnormalities are so minor that there's no way they could be causing congestive heart failure or the pleural effusion (fluid in his lungs) he's been suffering with. The heart problems he has are still fairly minor and they may or may not worsen into something that requires treatment but for now he won't require treatment for them but they need to be monitored annually.

What he does have is some kind of chronic lung condition or disease. He's responding to diuretics which would suggest some kind of fluid accumulation in the lungs and this showed up on his initial x-rays. The x-rays also show some whitening of the lungs and the cardiologist said the x-rays he has for Harvey don't really tally up with a diagnosis of Asthma, although given his history of coughing there's a possibility that he does have Asthma too but it's not what's directly causing all his acute symptoms and pleural effusion. What it looks like at this stage is that perhaps he's had Asthma ongoing and this has led to some other type of infection that is causing his acute symptoms - they don't really know at this stage.

His bloodwork is completely normal, although he's showing symptoms of mild anemia but the vet said it's still just on the right side of the normal range so it could be that this is normal for him.

The bad news is that we still don't know what the problem is and the whitening of his lungs isn't fantastic as it suggests something unpleasant is going on. As a result he's now being referred to the Dick Vet School in Edinburgh for more extensive tests on his lungs to try to come up with a diagnosis as whatever is going on is quite unusual. Trust Harvey to be one of those 1 in 1000 rare cases...

The good news in all of this is that because his heart is functioning normally he no longer has to take an ARB or blood thinner so that's two medications that were making him poorly that we can drop. He does need to stay on the diuretics for now as he's responding to those so there may be fluid buildup that is responding to that treatment but the cardiologist is hopeful that once we know what the root cause is then the diuretics will be replaced with a more suitable treatment.
The other good news is that the risk of him dropping dead has now reduced significantly! He is not at risk of blood clots and he's not at risk of stroke or heart attack and stress is no longer a severe risk to him either :) !!

I cannot begin to express how relieved I am about all of this. The cardiologist did say not to get my hopes up too much quite yet because the lung condition he has could be life shortening too as we don't know what it is yet, but he said that lung conditions are usually far more treatable and prognosis is much better than a heart condition and the suspected heart failure was the reason for his initial poor prognosis. If he has no heart failure (which he doesn't) then prognosis is significantly better.

I'm not sure whether to laugh or cry.. this last 7 weeks has been beyond traumatic and it feels like a huge weight has been lifted from my shoulders. Poor Harvey still has a long road ahead of him and some very unpleasant tests to undergo but it's looking like there's hope for him yet! He's being referred as an urgent case so they're hopeful he'll go in sometime next week.. I'll find out this evening hopefully. Harvey has always been awkward.. it would appear he's awkward in his health conditions too. The cardiologist is quite fascinated by his case... ! He's still at the vets right now recovering from his sedation but once he gets home I'll be fussing him uncontrollably :D !
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Re: Hypertrophic Cardiomyopathy and Congestive Heart Failure

Post by bobbys girl »

I hope you will give him a big fuss from all of us too :D :D

It is really good news and I am so pleased for you both. Now we have to pray that his lung problem can be identified and, more importantly, treated.

Big (hugs) to you and fusses to the little man.
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Re: Hypertrophic Cardiomyopathy and Congestive Heart Failure

Post by Crewella »

Phew, I can imagine how relieved you are and am so pleased that his prognosis seems so much better! :)

All paws here crossed that you can now get to the bottom of what's causing the problem.

Hugs and fusses from me too. xx
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Re: Hypertrophic Cardiomyopathy and Congestive Heart Failure

Post by meriad »

I can only imagine the relief and fingers crossed that referral comes through very soon; have you heard back from them?

More fusses for Harvey from me x
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Re: Hypertrophic Cardiomyopathy and Congestive Heart Failure

Post by sarie »

Thank you all :) The news that he doesn't have a terminal heart condition is still sinking in... he's still a very poorly boy at the moment and he gave me a fright this morning as I found him collapsed on the bedroom floor and he was very unresponsive and having a hard time catching his breath but after I sat with him for a few minutes and talked to him he started to purr really gently. After a couple more minutes his breathing started to slow and I gave him some diuretic and within an hour he was back on his feet and behaving normally again.
I'll be so very glad when we get to the bottom of all of this and get him feeling better again as he's clearly still feeling pretty rotten.

His referral has come through and he's going in on Tuesday morning for some extensive tests - I'm really worried for him as he's got to go through a lot for his diagnosis as no vet so far can work out what it is. He's got to have a CT scan, endoscopy, biopsy and a fluid wash and further bloodwork apparently, poor little guy :(

I still can't quite believe he's such a rare case; everyone was convinced he had a heart condition - three vets confirmed it. The confusion partly lay in the fact that he does have some signs of mild early stage heart disease that showed up on his initial echo but because they didn't have the equipment to do the indepth scans that the cardiologist did they didn't realise it was only very mild so they linked the pulmonary edema, heart enlargement and the fact he responded so well to conventional CHF treatments and diagnosed CHF.

I guess the University are looking forward to using him as a case study - I'm just looking forward to them putting all of their great minds together to fix him.

You've all been so wonderful and so supportive, I don't know what I'd have done without all your support through this :)
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meriad
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Re: Hypertrophic Cardiomyopathy and Congestive Heart Failure

Post by meriad »

Roll on Tuesday!!! yes it wont' be an easy day for either Harvey nor you, but hopefully you'll get all the answers you need and know what to do for / with Harvey

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