8/11 Uncle AMPS 169, +2 188, PMPS 150, +2 157, +6 198

http://www.felinediabetes.com/FDMB/...ps-352-3-292-pmps-148-2-119-4-92-6-98.182073/

I did end up giving Uncle the .33u for both shots today. If it doesn't seem like enough, of course I will bump it up to .5u.
Uncle has been hiding/sleeping in the closet since a couple of days after he started the antibiotics. I don't know if he's not feeling well because I mistakenly gave him double doses for the first 6 days, just the antibiotics in general making him feel lousy, if it's his heart or what. He is still peeing and pooping. Not much purring, a little preening and no playing (which he hasn't done in a long time). I'm REALLY nervous to start all of the heart meds because I don't know how they will interact with whatever is going on. I know he needs them and I want to start but I am feeling a lot of trepidation. I just don't want to hurt him.

 

Are you giving probiotics to help with possible tummy upset?

Are there particular heart meds you are concerned about? Neko's IM vet said "heart trumps everything". Getting it working better made a difference for her. The Plavix and Pimomedin (Vetmedin) might have had a temporary couple day BG influence or not, hard to say. It definitely didn't last longer than that. And the Vetmedin perked her up. Did the vet say there were any side effects to be concerned about?

 

Hi Wendy, you are the perfect person to weigh in.
Thank you for the heart trumps everything" perspective. I have the Enalapril and the Vetmedin here (got them from the vet's office) and the compounded Sotilol just came today. I called the compounding pharmacy before they sent it and they were great. Took a lot of time making sure there were no sugars, artificial sweeteners or maltodextrin in it. So I feel okay about that. I need to fill the Plavix prescription at my pharmacy and will do so tomorrow.
I guess I am a little afraid of the Vetmedin. I know it can be very beneficial for most cats but there seems to be some warnings about using it on cats with certain conditions. I hope you can help me sort things out. By reading Uncle's cardio report it states that besides severe RCM and "Moderately Frequent Multifocal Ventricular Premature Complexes" and has Sinus Rhythm with "Left Anterior Fascicle Blockage" that is frequently associated with "left ventricular hypertrophy (usually Hypertrophic Cardiomyopathy)".
I have been trying to read up on Vetmedin and I think I read it may not be good to give it to cats with RCM or HCM and for sure cats that have Left Ventricular Outflow Tract. Anyway, this may be a case of a little info being worse than none. I probably should just trust the advice of the cardiologist.
I did ask my vet if I should be concerned with any side effects and she said no she didn't think so.
I am never sure if I should/can give probiotics at the same time as antibiotics. I have heard differing opinions when I have asked about it for myself. I do have some fermented goats milk that I was going start giving him.

 

I have heard you want to give probiotics separated by a couple hours away from the ABs. The goats milk might be a good trial.

As for Vetmedin, Neko had HCM. I hadn't read it was contraindicated with that. Neko's cardio vet had done a number of trials with Vetmedin and cats, so I felt comfortable with what he suggested.

 

OK, it may not be. My head has been spinning and my vet really like the cardiologist. I'm sure I will be able to ask him questions at some point if I am still worried. Thanks for the advice regarding the antibiotics. That will be easy for me to do since they are only to be given once a day.
I have some Fortastor here I could give Uncle.

 

I've found with my cats it really helps to give a probiotic while they are taking antibiotics. I hope you can balance everything out with all the meds soon and get Uncle feeling better. Sending prayers.

 

So sorry to hear Uncle isn't feeling good. How is his eating? How much longer on the AB? Hope he perks up.

 

Sending positive energy your way. It's so hard dealing with multiple health issues and the meds that go with. I'm glad you have experienced people like Wendy here to help.

 

Thank you Carla! I woke up feeling a little more calm about everything today. All of the support here really makes a difference.
I am SO VERY GRATEFUL .
Started Uncle on the Sotalol this morning. Put it in his breakfast and he didn't seem to notice -YAY
I will start putting a half capsule of Florastor in his +6 meals, thereby keeping it well away from the antibiotic which I'm giving him at PMPS +2. At +4 I will see how he takes to the Vetmedin and once I see how that goes I'll work in the Enalapril and Plavix. Hoping he'll just eat the Vetmedin (it's a chewable) and I won't have to hide it in food or pill him for that one. We shall see...
Thanks again for your positive thoughts and prayers

 

@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:

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?

 

How is Uncle doing today, Barbara?
Sending