Hugo update, lab results (HCM) and mysterious coughing

Hi everyone! So last time I wrote here about my Hugo getting diagnosed with Hypertrophic Cardiomyopathy, HCM. Since the diagnosis, he has had a bloodwork done. Last week he also had an abdominal ultrasound done. I uploaded the results to the labs section on his spreadsheet, but basically his overall proteins were too high and globulin too. Also his cholesterol and triglycerides were too high. Does anyone know why this could be?

The vet wanted to see if everything was as it's supposed to be in his stomach so she did an ultrasound. It revealed that his pancreas is enlarged and also that the wall of the small intestine is thickened in some part. The vet suspects a chronic pancreatis and IBD. Hugo doesn't seem to be in pain and is eating and drinking. The only symptom he has is that he coughs whenever he purrs a lot. So when I pet him, he has a coughing fit. He does have asthma and we even tried to change his inhaled meds to another brand, but it didn't help. The vet prescribed him Doxycycline antibiotics for a possible URI and also he had to start another medication for his hypertension. So he is now getting the Nelio and Amlodipin. The vet doesn't want to put him on steroids for the IBD because of the diabetes.

So now we are just monitoring him on how he is getting on and he will have a blood pressure check up in two weeks and a new echocardiogram in June. Initially we wanted to take him for a dental right now, but the vet wants to wait to see how the heart situation progresses in six months. So she wants to avoid anesthesia. This is why we can't do a biopsy of the small intestine to see if it is really IBD. The vet said they can't rule out lymphoma without a biopsy. So how does this all sound to you? The coughing worries me a lot, but he also had a chest xray done and it showed the lungs were clear. Why would a cat cough when he purrs? Could it be the leaky aortic valve? The partial thickening of the heart muscle? I really appreciate if anyone has heard of something like this before.

http://www.felinediabetes.com/FDMB/...erning-news-from-the-vet.188014/#post-2087803

 

I'm tagging @Wendy&Neko as she has a lot of experience with HCM and @tiffmaxee for the IBD/pancreatitis.

 

The coughing is from the heart. Did you see a cardiologist? Were you given vetmedin or any heart medications?

 

The vet is specialized in doing these echocardiograms and in cardiology, but she isn't a cardiologist....I think. No other medications were given than Nelio (fortekor) and Amlodipin. The vet said since Hugo doesn't have fluid around his heart or in his lungs, so he doesn't need anything for that yet, and no anti-clotting medication either. The vet only said that his echocardiogram showed that the heart appears to be of normal size, but the wall of the ventricle is partially thickened and his aortic valve is leaking back blood. The left atrium is also normal size and she didn't think he was in congestive heart failure yet.

 

I don't have any suggestions, just sending prayers for you and Hugo.

 

Thank you Carla

 

I suggest seeing a cardiologist if there's one relatively nearby. With humans, a valve problem often requires something to prevent clots from forming especially if the valve is flapping around (the turbulence can cause clots to form).

Frankly, if steroids are really needed, you can work the insulin dose around the steroid. The ultrasound is a good first step. You may want to see if you can find some novel proteins, such as rabbit, venison, etc. rather than the usual food. It may help with the IBD. ZiwiPeak is a good brand if it's available in Finland.

 

I was going to say the same thing as Sienne - while steroids aren't ideal, if they really are the best tool for the job, insulin can be worked around them. We've had a few asthmatic kitties here who have needed steroids.

I agree that if you can find a cardiologist, I would have things checked out to try and find the source of the coughing - it certainly could be either heart or asthma...or, of course, something else like a URI, too.

 

I asked about the medication to prevent clots and she said because the left atrium is not affected so he doesn't need it yet. Should I insist he gets this medication? I googled about the cardiologist in my city, but there is only one who comes here in one day per month. But there is the problem of money...Another echocardiogram

I have seen Ziwipeak in some of the pet stores, I could try if he likes it. Thank you

 

What puzzles me about the coughing is that he will start to cough if he scratches his neck and only when he purrs out of happiness. So he can play and chase the other cats and no cough. When he coughs I have given him a puff of Ventolin to breath from his Aerokat, it seems to help. It's very cold in Finland now so it could worsen his asthma, but he will be 10-yrs-old in a week and he has had asthma all his life and didn't experience this during the previous winters.

 

I don't have any asthma experience myself, but I've read in other condos that it can change over time. So it's just something to consider. You could try adding "asthma ?" to the subject line to see if anyone with first-hand experience can offer ideas. It is odd that he coughs when scratching his neck and purring...maybe the dry air is bothering his throat???

 

Fortekor and amlodipin sound good to me. Coughing is a sign of heart disease (can't remember the link though). Clotting happens when blood tends to pool in certain heart chambers, based on what your vet says, the incoming ones, which kind of makes sense -- the ventricules shoot the blood out, seems like a less likely place to have pooling. For clotting prevention you'll be giving aspirin or some similar blood thinner. But if the architecture of his heart issue doesn't make clotting a possibility, not very useful? You might want to ask your vet to explain in more detail how clotting happens and why the current situation doesn't warrant that we expect it.

disclosure: not a cardiologist (!) but had one cat with a heart condition (on fortekor for it) and another who had undiagnosed HCM (sadly died from FATE); also am a human with a couple of unhappy valves.

Are Orientals susceptible to HCM?

 

Hi sorry to hear about Hugo's diagnose, we are sending you lots of

The coughing since is when he purrs sounds to me more like he's having a problem with his upper respiratory system, nose or troat did the vet checked his tonsils?

 

It could be possible that dry air would worsen his asthma, but when it is so clearly triggered by the purring...I don't know.

 

I have thought HCM was more common in Maine Coons and Sphynxes, but not so in the Oriental breed. They suffer from asthma most often.

I have the report that the vet wrote about Hugo's heart, but it's in Finnish so not very helpful. But she writes that she believes the valve problem might have been something he was born with and it has caused his HCM. But no other vets heard his murmur during the numerous times he has been to vets for his asthma, so it seems odd. I would like to take him to the visiting cardiologist to get a second opinion, but it's pretty costly. I have been looking at videos on Youtube of cats with HCM and how they cough and breathe with their mouths open. Hugo breaths normally, or at least it seems like it to me. I have counted his breaths when he sleeps and it's around 20 in a minute. But the coughing after purring is just not normal. Could a cat with HCM cough only with a purr and otherwise breath normally?

 

The vet didn't look in his throat, just felt with her hand around his neck if there was anything that felt abnormal. She couldn't feel anything strange. I keep thinking if it could be polyps in his nose or something in his voice box irritating the throat when he purrs Do tonsils cause this?

 

If that is the case, then Hugo and I have something in common. I had a valve problem, which made my ventricle thicken, before surgery. I actually thought of that when reading your post and wondered how HCM had been diagnosed. As I understand it HCM is an enlargening of the heart due to a weakness in the muscle. An enlargement of one chamber due to a faulty valve would IMHO be something else.

I need to lay my hands on it again, but I found a study that showed a very weak correlation between abnormalities heard upon auscultation and actually cardiomyopathy. Some cats had murmurs and no heart issues, and vice versa. Again, coming back to my (human) case, I have a murmur which is audible in certain situations/positions and not others. Just throwing this out there.

It's possible the coughing is due to something else... or not.

:-| not sure if this is very helpful!

 

Hi Tiina and Hugo
First,Hugo is too cute

If it's asthma we're dealing with just a suggestion perhaps add a humidifier so the air isn't too dry. We also recently purchased a air purifier and there are no more scented candles, smelly diffusers, etc in my house. I also eliminated Feliway diffusers too since it disperses on oily substances into the air. All seems to help tremendously...even for the Bean

Beenie would cough when she purred and unfortunately it was most likely due to her heart. I had to avoid making her purr which was tough. Hope Hugo feels better and you get to the bottom of it.

 

Yes swelled tonsils because of an infection for example could cause the coughing when he purrs or miaus a little loud

 

@Stephanie & Quintus Everything is helpful! Imagine me going through these things alone in my head and not having anyone to throw any ideas at me. I value everyone's opinion and experiences, since you have been through these things, or at least know what it's like to fear for your ill cat. I'm absolutely heartbroken and probably in denial of the seriousness of his condition.

So your cat has hypertension too? What is causing it? Can their diabetes cause it?

 

Thank you, yes I am now having to avoid making him purr, which is awful because I want him to be happy. Did your Beenie have HCM? did she cough other than when she purred? Breath abnormally? I'm sorry for your loss It feels so unfair that cats get these illnesses.

 

If his HCM is not advanced chances are the murmur was not noticeable until recently, diagnosis is usually made with an ecocardiogram where they measure the thickness of the heart walls and the dimensions of the ventricles and an electrocardiogram after one study where abnormalities are detected most vets repeat the study a few months later to confirm and see if the problem has advanced and adjust medication

For what I've learned most of the HCM cases are congenital

 

Can you describe what the cough sounds like? Is it like trying to get rid of a hairball? Or? Coughs in a heart kitty are concerning.

You should check to see if the cardiologist vet is willing to read the echo done by someone else. That will be cheaper that getting a new echo done. The cardio vet may or may not also want an EKG done. When Neko had just HCM, she did have anesthesia, but when her heart rythym deteriorated (detected by EKG), she no longer could have anesthesia.

I would only give medication on advice of the vet. You don't want to play around with the heart. The usual medication given is Plavix, or clopidogrel. Neko had HCM for a couple of years, before she had to start a blood thinner. Thinners can be hard on kidneys. Thankfully Hugo's kidney bloodwork looks pretty good.

I would be cautious around what type of steroids you give if you go that way. Neko could not take prednisolone because of her heart, but she could take budesonide. It helped the thickening of her colon walls, without impacting her BG, and was safe for her heart. I also could not get a proper diagnosis of lymphoma vs. IBD because Neko couldn't have the surgery. How is Hugo's appetite and weight?

 

Just wanted to say hi there stranger
You've been on my mind recently. I'm sorry about Hugo's cough and heart troubles, no advice from me, just a stack load of vines.

Bfg sends Hugo some head bumps too.

 

Hi Tiina, I am so sorry that you are going through this with Hugo. Not having any HCM experience, I can't comment but wanted to give you some hugs. I would be insistent with the cardiologist to read the echo that was just done so, getting that appointment sooner that later might be in your favor for him/ her to oblige you.

Hugs

 

Hi Tina, More vines for Hugo and hugs for you. Looks like you've gotten many good suggestions. I hope Hugo's cough will go away as the milder weather arrives.

 

Tina -- die the coughing start around the same time you began giving Hugo the Fortekor? Fortekor is an ACE inhibitor. A relatively common side effect in humans and dogs is cough. It doesn't seem to be as common in cats but if you noticed Hugo started to cough when he took Fortekor, I wouldn't rule it out.

 

Oh definitely! Didn’t mean to imply this should be self-medicated. Just giving an example of the kind of med they would give (low-dose aspirin would be a common choice here)

 

So, different cats. Quintus has hypertension. Amlodipin, working well. Just realising now: his ventricule (need to check which) is enlarged, cardiologist at teaching hospital said due to hypertension. So he has no heart meds. Any suspicion how long the hypertension has been going on? In Quintus’s case, suspect it is secondary to CRF.

 

Hi Tiina,

I have also been thinking of you and Hugo lately. Especially when I wear my pretty scarf.

All the things that I would have asked or suggested have already been said, so I'll just send you vines and prayers and, of course,s.

Please, do keep us posted.

 

The cough sounds almost like he is purring so much that it makes him cough, for some reason that it sort of overwhelms his airways. I really don't understand it. I could try to take a video if I can, put I wouldn't know how to post it anywhere unless some of you are on facebook or instagram. Will have to think about that.

Hugo's appetite is good and he has been able to keep his weight. I have noticed him drinking a bit more now, but like you said his labs were quite good, except for the high proteins and triglycerides and cholesterol. I am not totally opposed to steroids, because it seems to be out of the question that his diabetes would ever improve in anyway anymore. It's more about keeping it under control now. So if he needs steroids, It's okay, I guess.

 

It has been worsening gradually over the past six months or so, but since he has asthma he has coughed sometimes before that too, but I always just blamed the asthma for it. Now it seems like it can't be just that, because it's daily. He started taking the Nelio (fortekor) in December, and I haven't really noticed his cough changing because of it.

 

I have no idea how long the hypertension has been going on, but probably for a while now. It also seems like the meds aren't really doing much. Last time his bp was just as high as before the meds. Hugo doesn't have a kidney problem, so it really puzzles me why he has hypertension. But I can't help but think if it really is that high at home, because Hugo is stressed at the vet. It's not easy to get the right picture when I can't measure it at home. But now I am giving the Amlodipin in the morning and fortekor in the evening, just hoping they help him.

 

And thank you everyone for the well wishes for my Hugo I am really sad about his heart issue along with all these other things he has going on. All I ever wanted was his diabetes to be regulated and possibly to reach even a short period of remission, just for him to get a break from it all. But it seems like it's all just piling up now and his list of diagnosis just keeps on growing. It quite frankly sucks and I don't want to lose him. Thanks for thinking about him

 

Sending more prayers.

 

HTTP://photos.google.com — you already have an account for the spreadsheet. Sharing photos works similarly. PM me for help if needed.

 

How much is he on? Do you know what his BP readings are/were? Do you think the vet might lend you the material over the weekend and show you how to use it so you could measure at home?

Quintus is on 1.25 a day, BP was 270, down to 170, which is normalish

 

I am sorry that you are dealing with multiple issues with Hugo. It is hard.
Yum's mother started coughing when she jumped down from furniture. An x-ray showed she had a chemodectoma---an extremely, extremely rare (in cats), probably benign tumor on her heart. Her heart was still functioning well, but the mass was so large it was displacing her trachea and pressing on it when she jumped. Just another data point for people with coughing cats. Did not end well.

 

I would also be cautious about using Prednisolone because it can have weakening effects on the heart. I think Wendy’s suggestion of using budesonide is much better if there isn’t potential for IBD. Current research is now that it’s not a question of if IBD will become lymphoma but when. I wish I had gone the route Wendy did with treating IBD/lymphoma more conservatively.

It is actually rare for a cat with heart disease to cough and most coughing in cats is more due to a respiratory issue. But it’s important to keep ahead of it and have it checked out. It’s good your vet did X-rays to look at his lungs and chest and check for fluids.

What can happen is that the coughing can put stress on an already weakened heart and cause heart failure.

Many vines for sweet Hugo and hugs for you, Tiina.

 

It's quite possible that you can continue to balance his various problems for some time to come. Cats with asthma very often get URIs, because their inflamed lungs create a good petri dish for bacteria. I suspect the antibiotics will deal with the coughing. Hugo's only nine years old, so relatively strong. Don't give up the ship!
Hugs.

 

Sending more vines, prayers and s.

 

Tiina, sending many hugs and prayers your way.

When you go in for his on test do they have a quiet room you can sit in with Hugo?? So he can be calm. Sitting in a busy waiting room is probably stressful, and would likely result in a higher no.

 

I have a Bengal who is in the early stages of HCM (Bengals are very prone to it). I agree 110% with those who have suggested you try to get the cardiologist to look at the echo Hugo has already had done, if you can't get another one done yet.

I have a lung condition and certain things make me cough - cold air, laughing, yelling, etc. Hugo's cough when he purrs could be a similar issue caused by his asthma. I would definitely investigate it further.

(((Hugs))) for you, vines for Hugo!

 

I like Gill's idea of the quiet room when you go for a BP test. The first attempt at getting Neko's BP we had a wait in a noisy room, due to an emergency. Neko's BP was a fail, nominally 220+. At the dental vet, in a quiet room by herself and with Feliway, it was 140. After that, I always sprayed Feliway in the carrier and gave her Rescue Remedy in the morning before going to the vet.

Good to hear he's eating well an maintaining his weight. Those are good signs.

 

I have a likely answer to your coughing problem, as my cat has the same issue. The cough caused by purring may be from laryngeal paralysis. Its uncommon in cats, and for whatever reason breathing difficulty in response to purring seems pop up anecdotally with occassional confirmed diagnosis, but doesnt make it into veterinary literature. We are currently at the stage of empirically teating my boy Bentley with pred to try to reduce airway inflammation, as this is the progression of a likely partial paralysis he has had as long as I've had him (squeaky raspy non-meow is an indicator). But it can also show up suddenly from issues such as swelling of nearby vessels and glands. There is some evidence that diabetic neuropathy can cause this paralysis in dogs, but no data for cats as yet, since its so uncommon to begin with. That little piece of info was what actually brought me here to research the possibility of diabetes and learn about home glucose checking, Bentley starts with a purr that is a little more whistly than usual that progresses to coughing and labored breathing with strong abdominal involvement if we arent careful. Unfortunately the startle of coughing (or "honking" as it sometime sounds) isnt enough to break his purr reflex, we have to give him a little shock with a spray bottle, running water, or a look at his dreaded carrier; these things stop the purr dead, and the breathing difficulty with it. If you do get a confirmational diagnosis on this, and peripheral neuropathy or unusual swelling near the laryngeal nerve isnt to blame, unfortunately the only solution seems to be surgery to tuck the laryngeal folds away from the airway.