Fred to go on 4 drugs for hypertrophic cardiomyopathy

So I spoke to the vet today and he told me the cardiologist's report:

Hypertrophic Cardiomyopathy with Chronic Valvular disease; The collapsed lung on the right was due to the flud from the other one. He also has 'smoke' left atrial spontaneous contrast which is a pre-thrombotic state indicating possible microclots that could turn into clots and go to the legs.

He is prescribing the following:

Furosemide (Lasic)--1/4 tablet twice a day
ACE-inhibitor enalapril--1/2 table once a day
Diltiazem--calcium channel antagonist--1/4 table twice a day
Anti-thrombotic (Plavix)--1/4 twice a day

He said the Lasix and enalapril would be bad for the kidneys but they were very low doses.

I asked if I could crush these up or give these in liquids and he said the compounding liquid form was 'significantly' more expensive (how much more?) and I could crush them up....What should I do? If I put these in food will he eat them? Shall I get those pill squooshy treat things? After reading Dr. Lisa's pill article, I'm afraid to just shove a pill in his mouth.

Also he is providing me with 3 of these and giving me 1 prescription for the pharmacy for the Plavix. I am wondering if he is against the liquid form because it means he doesn't sell them to me?

He said I am to start these tomorrow, Friday, and then bring him in on Monday or Tuesday. I guess this is to do what, new bloodwork and see how he's doing with the kidneys?

Meanwhile, Fred is pretty good today, was giving himself a bath, which he doesn't do much in past year, licking me too, purring, and resting. He seems pretty good right now, although the vet said that he could get a clot at any time.

Would appreciate any feedback on these drugs or how to give them, or anything. I've been reading up a bit on it all.

thanks for all your kind thoughts. At the moment, since Fred is doing well, I'm feeling good. Of course the minute he takes a turn for the worse, I'll be freaking out.

thanks
Martica

 

There is a very good Yahoo Group for Feline heart problems: http://pets.groups.yahoo.com/group/feline-heart/

You're on the CRF-FD group already, so you're familiar with Yahoo groups, please check it out. Very knowledgeable members on there and others who have had similar terrifying experiences. I think you would get a lot of support and info there!

Hope Fred feels better with his medicine cocktail!

 

Will Fred eat pill pockets? Waldo takes all the same meds except the Diltiazem. I break off enough of a pill pocket just to cover the pill and give him the leftover as a treat. Waldo swallows them whole! We've been doing this for 2 months and he eats everyone without fail. It's pretty amazing. (antijinx)

It's worth a try. We WERE using that sandwich American cheese stuff but Waldo got tired of that. Pill pockets are they way to go.

Good luck my prayers go with you...

Jeanne

 

Hi thanks Vicky, I just joined that heart yahoo group yesterday. It's sad that I'm I 3 cat-disease groups now! But on the bright side, I have my fred at 19 1/2.

Jeanne, yes, that's what I meant to say Pill Pockets. I have some of those and was putting the pepsid a/c in there at first, but now I crush it and mix it with his food. So yes, maybe I'll try that too--or is the liquid stuff better? The thing is, Fred has about 2 teeth left, although I guess he could swallow whole.

what is this american cheese sandwich you talk about---just wrap the pill in a piece of a slice? Do cats like cheese? Fred has never had it except maybe when he was young.

I have a feeling he's going to be getting a lot of new treats in the weeks and hopefully months coming up.

 

Crossing all paws for Fred.. and wrapping you in cyber hugs.

I am afraid you wont be able to crush in food the diltiazem or the enalapril. Merlyn was on benazapril but same family. both taste NASTY.. I had them compounded and they tasted worse. Merlyn told my Animal Communicator friend Jean that the liquid made the nasty taste last longer and messed with the taste of his food, at least with the pill it was done and gone. But he did froth at the mouth when I pilled him.

What I ended up doing is putting all his meds in one capsule. You can get empty ones online or a health food store might have them. Size 3 worked mostly but it was a bit tight, might need size 2. (smaller the number the bigger the capsule) This way, I only had to do it once in the evening and once in the morning.

 

My kitty takes enelapril 2.5 mg which is a pretty small pill. I just throw it on top of his food and watch him scarf it all down.
I noticed that you are giving "1/2" pill, but didn't state the dose. I found them unusually hard to cut, and have had to insist that I get 2.5 mg tablets instead of 1/2 of the 5mg which they have tried to give me. The cost is the same and its not very expensive. Cutting pills before my morning coffee was a challenge ;-) If they won't get you the smaller pills they are available at online pet pharmacies.

As for having meds compounded, it is really expensive. If you have to go that route try to double the quantity, because mine charged about $40 just as the compounding fee, plus the drug.

Cody has been on the enelapril and several others about 6 months and has been fine, good in fact. He actually takes aspirin, which is toxic to cats because it takes them days to metabolize it. He gets it 2x/week to thin his blood. maybe I should ask about plavix. Although he almost seems better on the days I give it ..

 

Gosh, I don't really think I could shove a pill in Fred's mouth. I've never ever been good at opening kitty mouths and I'm terrified of that esophagus issue. I one time had a medical procedure and was given antibiotics and took a capsule with no water. It burned my esophagus and was one of the most painful things I've ever experienced. And it lasted for a while and I couldn't eat or drink as I recall.

Yes, apparently my dose is going to be smaller because of the kidney, he didn't tell me the mg, just 1/2 or 1/4, what I wrote.

Actually I have a pill chopper/crusher I got from the drugstore. It was like 2 bucks and it has a compartment that opens up, you place the pill there and close the lid that has a blade on it and it cuts it in half. Then yu do it again (althought he smaller, the harder, but still, it's not like getting a knife and trying to cut it on a counter, which I used to try before I got this thing. This gizmo is GREAT. and then it has another area where you put your pill piece in and screw the lid back on and it crushes to powder as it screws. All very very easy.

OK, well, we'll see. I have a whole new learning curve ahead.

 

Thank you for the cyberhugs--blow a few cyberkisses to Fred while you're at it, please! cat_pet_icon

 

I used to have my HCM kitty's diltiazem compounded into liquid form (dental problems, pilling was hard). I do NOT recommend it. We got by doing it for about a year, until he was stable enough to have his bad teeth removed, but it was not a pleasant time for either of us. The pharmacy would dose it up with triple fish to try and disguise the taste but it was just awful (I tried a tiny bit myself, it made my mouth go numb almost instantly and I couldn't stop gagging, which is a similar reaction that the cat had). It's not very tasty if it's a cut pill either (ugh don't crush it, it would be nasty!), but there aren't a lot of choices with this medication because kitties require small "human" doses.

Currently I get his diltiazem made into once a day suspended release stuff they put in a quick dissolve capsule at the pharmacy. Not sure how common that is, not all of the pharmacies here have the ability to do it. Every cat is different of course, and it is more expensive (similar to liquid compounding), but switching to suspended release did a world of good for him. Less peaks and valleys. If you live in a world where money grows on trees like I do (hahahaha), it's worth at least talking with your vet about.

Pilling does get better! My kitty and I had a real tough time with it at first, but the secret is to feed a little bit of tasty wet food (or tuna or whatever) as a treat right afterwords. Makes the experience more positive for the cat and helps avoid the esophagus problems you are concerned about.

The other medications I don't have experience with compounding into liquid, so I can't be much help with that.

 

Martica,
Plavics is what tastes nasty. Waldo bit into once and that put an end to wrapping in cheese.

Waldo loves his pill pockets so much he inhales them. Usually swallowing whole. I give 1/4 plavics tablet covered in just enough pill pocket to hide the smell. I take a small portion, roll it into a ball, till it's real soft, then smash it flat between my fingers, then wrap around the pill. Give this a try.

The secret is to use only enough pill pocket so that they dont HAVE to chew it. It works.

Good luck as always ...prayers,
Jeanne

 

Maggie was one ditalizam for her HCM. We had it compounded as a transdermal gel that got rubbed on the inside of her ear. It came in something that looked like a syringe without a needle, so the dosing wasn't a problem. I had to use latex gloves to put it on (so I didn't absorb the med) and had to clean the residue off her ear at least once a week. Some think that isn't as an effective way of giving meds, but she was hell to pill and the med tasted awful. So I choose the transdermal route to avoid stress on her (and me). It is expensive.

 

When it comes to food, is Fred a finicky eater, or a gobbler? My guy eats any pill whole if it is in his food, and then he tries to eat the glass bowl. He never leaves a crumb and he eats it fast, so i know he's gotten them. Is this worth a shot?

 

Hi Martica

I got your PM with your other questions and will respond to that too. I'll just respond to this stuff first.

Let me say first that I"m going to be blunt-er than usual. I don't like to be blunt, I prefer to speak more theoretically because I am not a vet and dont' know the full clinical history and have never even met the patients, but here goes. I will preface by saying that I'm not speaking in my professional capacity but rather from my perspective of a decently well-read and terribly opinionated person ;-)

Unless your kitty has had a very recent T4 and a very recent blood pressure, this diagnosis is far from certain. I hope they did both at your last visit. As you've read, HCM is characterized by the thickening of one of the heart's chambers. This thickening also occurs with uncontrolled hypertension and hyperthyroidism so these MUST BE RULED OUT in older cats before a diagnosis is made.

I dont' know what to make of the chronic valvular disease diagnosis. Old cats tend to get some fibrosis and stiffening of the mitral valve which can make it leak a little, but CVD as a term is reserved for a different type of disease that dogs get. I would just interpret this to mean that he's got old, stiffer valves.

This is serious :sad: It's called aortic thrombo-embolism. Occasionally the clot will go to the right front leg (dunno why they prefer the right), but most often to the rear legs. It can get stuck in the "fork" where the aorta divides off to go down both legs and cut off circulation. It is very, very painful so a cat should be taken to the hospital immediately for treatment. For future reference to anyone reading this ... even if euthanasia is considered, make them give your kitty pain meds the second they get their hands on him. Pain meds first, thinking about treatments later.

Back to being blunt. I don't know why these drugs would both be started at once in a cat with significant kidney disease. As your vet mentioned, they can both be hard on the kidneys. The Lasix is essential -- he needs this to breathe ! and can't be helped. Enalapril is a "support" drug and many animals with CHF don't go on it because of kidney issues. You might considering calling your vet to ask him about holding off on the enalapril until you at least re-test the kidneys after starting the Lasix.

I am astonished to see how many cats in this thread were put on diltiazem. I am not sure why any cat without an arrhythmia would go on diltiazem. The facts: there was a single study done in 1991 that looked at a group of 17 cats with HCM and CHF divided into three groups, each of which were given either diltiazem, propanolol (another drug that slows heart rate), or verapmil (another heart drug). The diltiazem cats did better than the propanolol cats (or the propanolol cats did worse than the diltiazem cats, depending on your perspective). THat's it, basically. There was no control group, so did propanolol just worsen the prognosis and diltiazem merely didnt' worsen it? Who knows. But for about 10 years after that, HCM cats were put on diltiazem with no one noticing any difference in outcomes and with many cardiologists dropping is as a treatment. There have not been any other studies that proved anything positive about diltiazem.

Another thing that sticks in my craw about diltiazem is that it seems like many cats are on the diltiazem HCl twice a day and this is a drug that lasts 6-8 hours (so should be TID). There is a sustained release formula though which can be dosed BID.

Coming back to you and Fred, Martica ... I confess that I am a total and complete marshmallow in terms of giving meds to my own cats. I only undertake the struggle if the medication is truly necessary. If giving the diltiazem is a struggle, I'd speak to the vet about why he prescribed it and why it is essential. He'd have to make a case for every pill he rx'd, if this were my cat. (And it shouldn't be challenging, obviously--I'm sure you can clearly explain every bit of a nutritional plan you rx, so should every MD/DVM over treatment plans they create.)

This is good.

These drugs are dirt-cheap--probably less than $20 for two months worth, so the suspension would be more expensive by comparison. There is a pediatric form of Lasix that is a liquid, though, and it's also dirt-cheap. Compounding might cost you $30 month/each or thereabouts. The Lasix pills are tiny and can probably easily be hidden in food. I've seen a few cats stop eating favorite foods because they get a taste of the medicine, though, so I'm always wary of that. If Fred likes pill pockets, you can cut the pill into two or three pieces and use a shred of pill pocket to cover each sliver, and feed them that way. If he likes them, feed them quickly one after the other so he'll eat them quickly. Having another animal (do you have another cat or dog?) standing by also helps them eat them fast :mrgreen:

I don't think so. You can get them all through a human pharmacy though.

Most of the vets I work with will refuse to have certain drugs compounded into liquids (tablets and capsules are ok) because the liquids are suspensions, meaning that the medicine can clump together. If you do this with a drug that can cause low blood pressure or heart rate, for example, or with something potentially toxic like phenobarbitol, you run the risk of someone accidentally giving their animal a fatal or near-fatal dose. Unlikely, but too scary to risk.

Yup.

I'm glad to hear that he's feeling better and you are enjoying time together. THat's what's most important.

Jess

 

HI Jess
Thanks so much---so Fred DOES have a gallop rhythm, does that count as an arrythmia--and therefore warrant the diltiazem?

Thanks everyone for the helping pill-giving suggestion, those are subtle little tips--feed fast, give only enough pill pocket to cover and smoosh it, etc--that are what I need to make this work.

I'm a little scared to give Fred these meds, and am going to see if I can't ask the vet at least to hold off on the enalopril/Ace inhibitor... yikes. poor freddy. He's still doing good, although I think a little constipated from perhaps being dehydrated a bit.

my big question--if I put tuna juice in water (withut the tuna) is that high in phosphorus? I have to figure out more ways to get him to drink more.

am about to go to vet and pick ;up meds

 

Hi Martica

It's technically a gallop sound, not a rhythm -- that'a a common misnomer. So he does not have an arrhythmia because he has a gallop sound. As far as the tuna juice, it might be sodium-packed which is a big no-no. I don't know the phos content. I think it's just packed in water? You could look at the gov't website with all the nutritional info I guess?

 

Drinking more: ideas
add water to his food until it is a soupy consistency. I add 1/4 cup to 1 5.5 ounce can, BID

Get him a pet fish in a gallon bowl which he can drink from. Keep the water spotless, use filtered water. Keep the fish awhile before you give it to him to see if it's reasonably healthy

get one of those flowing water electric bowls. some cats really love those. again keep the bowl and water and filter spotless.

Use a water filter that removes the smelly chlorine

get a 5ml medicine syringe (lg). Fill it with warm/tepid water. slowly squirt it onto his upper gums above the front teeth. repeat 3-4 x= 20ml water.

That's all I can think of at the moment--- Good luck

 

HI Nancy
Those are all helpful thanks--esp. the measurements for the syringe.

I just got the water fountain, the Drinkwell. I'm not sure he LOVES it, but he has been drinking from it. I tasted the water, I put distilled in there. It does taste pretty good.

 

How did yall put your pictures in your signatures? I've been trying to read the FAQs and cannot for the life of me figure it out. I'd like yall to see how beautiful Fred is, even in his diapers!

 

Ya'll ? !!!!
you must be from my part of the country! Welcome

This is a copy of my post in the tech forum that might help you , from one computer challenged bean to another. The name/date of the post is below if you want to read all the other explanations, which I'm sure are better than mine:

Re: Help with signatures/links/images/avatars here!
by Nancy and Cody » Wed Jan 06, 2010 7:42 pm

Ok, so last night I spent forever trying to figure the avatar out, but today I got it. Heres what happened and heres what I did in order
FYI I have a MAC book which is brand new to me so... plus I'm "not of the Twitter generation"

went to my pictures (iphoto) and found one I liked that the subject was kind of square
photoshopped and brightened it a bit
then
I found the above chats and went to shrinkpictures.com
clicked make avatar
then in this exact order 1 2 3
1 click choose picture- brings up my photos and I find the one I brightened- click it
2 type" 90" in where it asks for size
3 click resize and wait

then choose the 1 of 3 you like best
click download below that one
save it to your desktop

open user control panel in the FDMB
select profile tab
select edit avatar
shrink the open window enough to expose the avatar on your desktop
drag it onto the box that says upload from your machine, wait till you see a plus sign appear(+), and drop that baby
click submit and hold your breath

arent they cute!

Last night when I hit resize the picture came up black everytime
today I choose a different picture and ta da!

Hope this helps

 

Thank you Nancy, it worked! There's my baby!
Gave him his first dose of all 4 meds today. Had a depressing visit with the vet. But Fred is doing pretty good so far. Not drinking much though.

 

Good thoughts are on the way to both of you.