Oliver's Xray results show enlarged organs and asthma

Because of Oliver testing positive for acro and IAA, we had Xrays done, full body to check out his organs. The Xrays were sent to radiologist for interpretation.
Vet left voice message stating it's a good thing we had them checked because the findings show enlarged heart and should get a cardio u/s, plus she mentioned he has asthma, chronic asthma. As well, the liver & kidneys are slightly enlarged so an abdomen u/s would be a good idea.

I am going to the vet tomorrow to talk about, and get copy of, the findings, so I wanted to know what questions I should be asking and what sort of treatment I should request for the asthma. I don't want to go with whatever she says because I don't think she has much experience so I don't have complete confidence in her. I had to force her to arrange for the acro testing, had to provide her with the details and tell her where to send the draws. I just don't know how much she really knows.

I am thinking that the Xrays just confirmed organ enlargement which is not a great surprise - that's the reason I requested the Xrays in the first place, to see if there was any enlargement yet.

The asthma is my main concern I think so I'd like to know what's the best recommendations for treatment and what questions I should be asking.

Man, I know squat about asthma except that it's a breathing thing and that really worries me. If I need to get him on meds right away, I'd like to know how to determine that state.

 

I've not had any experience with feline asthma myself, so I've no idea what the criteria would be for starting treatment. I do know that a lot of the asthma cats successfully use inhalers to improve breathing. Mostly it's been references to using something like a FloVent 110mcg inhaler in conjunction with an AeroKat chamber/mask.

While albuterol and flovent are steroids, my understanding is that they have only a marginal effect (if that) on BG levels. Though, even if they had a major impact on BG levels, I'd still opt for the easy breathing

Also, at one point, ISTR a posting by either Ginger&Calliope or Hillary&Maui who were waiting for some inhalers to arrive from Australia and were wondering if someone had one they could loan until theirs arrived. I would assume that there was a reason that they were ordering from Australia -- either a problem with getting a script or some serious price break. You might try PMing them and asking their reasons.

 

Sending many cyber hugs for Oliver..

The only thing I can mention is that steroids are, I believe, contraindicated with heart conditions. I do not know if that would also apply to the Aerokat. Breathing obviously is important, but I would have his heart checked before starting him on any steroids for the asthma. Jess might be able to advise more specifically about the heart/steroid issue.

 

Thanks to you for the replies; it looks like lots more info is needed before taking action.
Maybe I need to find out more on the heart if just a size issue and why.
The vet was talking away and saying more than I could write down, but she may have mentioned cardiomyopathy, amongst other words I have not heard.
I'll go to the vet office right when opening, on the way to work and see if she is there yet, which is in a couple hours from now.

 

> The vet was talking away and saying more than I could write down

What I often do in these situations is to write down a list of the questions that I have, and make sure I go over them with the vet before I leave the appointment.

Also, for anything that's potentially going to have a big impact on my cat's life, I try to bring someone else to the appointment with me. Their entire purpose is to sit there and take notes, because I know that, no matter how much I think I'll remember everything later on, I really *won't* remember everything. I'm going to be in shock for some things and just having a hard time processing all the information, much less put it into it's proper context.

By having a notetaker, I can concentrate on the important things the vet is saying, while the notetaker can get as much info written down as s/he can. When I have time later, I can review the notes at leisure and absorb everything that was said. It also means that the appointment time is very well spent: my vet can maximise the amount of information they give me, instead of giving me the two-minute-review-for-dummies version, or not having time to cover stuff that will leave important holes in my knowledge. It also minimises the amount of repetition s/he has to do with me on subsequent phone calls / emails / appointments.

I don't do it for every visit, just on things that I expect will have major impacts, but this might be a good situation for you to try the same thing. It really sounds silly, but the first time I did it, I came out of the appointment absolutely *positive* that I knew and understood everything that was said and, on reviewing the notes the next day, I could see how much I had missed.

Anyway, just a thought. Good luck to you and to Oliver!

-- Jean and her Gwyn

 

Thanks so much Jean! I left a bit out of my post, like the vet had left a voice message, and she talks fast and even after playing back the message, I did not get it all.
I think she's OK and will be a good learner, but I don't believe she has alot of experience, after all, my two are her first FD kitties and naturally, her first encounter with acro and IAA.
That's why I need the info from this site, to know what is NOT acceptable, and what meds if any that I should request. For example, when Shadoe had p-titis, I was sent home and told to try a diff food .. for a cat that had not eaten in over a day? So no, I have limited confidence in this vet as far as experience goes.

Not only do I take notes, but I also request explanations on things which I write down, and request hard copy of all reports, tests, and complete breakdowns for all payments for services provided. I don't have any person that I can take with me, so I am alone on this area and have learned to adapt. I keep a binder of everything which goes with me for most vet visits. About the only thing I don't have in their binders, they each have their own, is the vet office notes!

I will get more info today to post here before making any decisions.

 

Hi there! I'm new to posting but have "cruised" the boards for some time. I may have some input for you with your diabetic/asthmatic kitty.
Up until last week, when we had to put him to sleep for an inoperable nasal tumor, our boy Sam was diabetic, asthmatic and had HCM (hypertrophic cardiomyopathy) the most common heart condition in cats. We managed him extremely well with his inhalers.
As posted previously by another member, we used flovent (advair/ fluticasone) 110mcg/actuation (we gave 2 puffs, every 12 hours) as a daily maintenance drug with an aerocat chamber. We also used Albuterol for acute attacks. For over 2 years on this regime we never had any issues with regulating his diabetes. Yes, it has minute amounts of steroids in it, but not enough to effect a cat, and breathing for these guys is obviously the best choice. Also the stress of not being able to breathe and having attacks can make diabetes hard to regulate in some cases due to constant stress in cats.
The only issue I would be concerned with is using too much of the Albuterol, because they can acquire a resistance to it and you will not have that as an option for acute attacks.
We ordered (because actually cheaper than cost for me, I am a vet. tech.) from CanadaPharmacy.com. We got the lifetime shipping option at $50 and that saved a bit over the years and the generic that works just fine. They take a few weeks to get meds to you so make sure you order with plenty of meds still left.
About the heart 'issue' I would be inclined to say it is HCM, due to it being so common in cats. Most go unnoticed by owners until an issued arises, so great job on taking care of your little guy. HCM is a disease and I could talk more about it with you if your vet is still not making much sense of it all. I don't want to get into it here unless you ask. I have already rambled so much. Good luck with you kitty!

Also I am looking to donate my diabetes/asthma supplies to a needy family, how would I go about finding them? Thank you!


-Adrienne

 

(((Gayle)))
Sorry, I know nothing about asthma and HCM, but I know that this is a well respected website resource for feline asthma:

http://www.fritzthebrave.com/

 

Linda,
Thanks so much for the site; I have bookmarked it and will look when I get back from the vet later.

Adrienne,
That would be awesome if I could ask you some questions on the topic. Adding acromegaly and IAA into the mix does not make me feel very good at all, so any and all sources of info will be more than welcome.

 

hi there Adrienne,

you can actually post in the Supply Closet forum. You'll find it in the main menu of the board.

 

Just a question (for someone like Jess or Jojo)...any chance that it's not asthma, but just a thickening of the airways due to the acro? The radiologist may not be aware that acro can cause that.

 

Hi Gayle

If your kitty isn't having symptoms of asthma, I would still buy the AeroKat and albuterol to have on hand. Albuterol is the 'rescue' inhaler meant to stop an acute attack, so if (heaven forbid) he wakes you up at night coughing you can help him out till he can get back to the vet. Just curious, has he lived in a heartworm endemic area? Also, if he's not having symptoms, it may be that he never will. The radiographs don't always correlate with symptoms, or even illness. I have seen pretty good-looking x-rays on cats that come to the emergency service with a bad asthma attack, and pretty ugly x-rays in cats who apparently have not yet been informed of their lung status ;-)

Until he has an echocardiogram done, I would personally not start oral steroids, especially for a cat that is not in distress. (Inhaled steroid--Flovent--is ok for cats with heart disease.) I have seen many, many cats with underlying heart disease (sometimes even mild disease) go into congestive heart failure from steroids. Now Oliver may or may not have heart disease -- sometimes in cats the heart looks big on x-rays because there is fat around the heart sac (this is the case with Jojo's SettleDown), which can be normal, or it just looks big because of the position, the cat's chest conformation, and the x-ray. Acrocats do seem to be more likely to develop hypertrophic cardiomyopathy, though, so he should definitely have an echocardiogram by a specialist (a cardiologist if there is one in your area).

Heather, you asked about thickening of the airway. I assume you mean changes to the trachea (windpipe)? IIRC, some acrocats get 'noisy' breathing which is upper-airway (throat/nose). That would probably not show on x-rays unless it was very dramatic because the thickening would be on both sides of the windpipe (I assume), and there is probably a component of changes to the nasal pathway too (and head/ entire neck isn't included in regular chest xrays). Just like some cats with HCM have normal x-rays because the area inside the heart is thickened and doesn't change the silhouette you see on x-rays. (Does that make sense?)

 

Jess, I was wondering about that because some acrocats can't be intubated with a normal size tube (have to use a kitten-sized one). I remember my doctor saying that the trachea swells when you have asthma, so I thought that the radiologist might have thought thickening was actually swelling? Please keep in mind that I've never taken a "real" biology class and know almost nothing on "innards".

 

I think for the noisy breathing, Carolyn gives her cats L-Lysine crushed up in their food. (I think Carolyn with one N -- but might be CarolyNN)

L-Lysine is available at health food stores.

 

OK here are the findings and conclusion from the report.
I am pretty sure it's in English but maybe his space bar was broken!

Findings:
Orthogonal cervicothoracoabdominal and orthogonal abdominal images (6/11/10) are provided (4 images total). The cardiac silhouette measures enlarged; the lobar vasculature and caudal vena cava are within normal limits for size. Diffusely increased bronchial markings for the age of the patient are noted; there is no evidence of thoracic lymphadenopathy. Visible tracheal diameter is unremarkable.
The liver and kidneys are enlarged; the spleen is unremarkable in appearance and the urinary bladder is moderately distended. There is no evidence of sublumbar lymphadenopathy. Mildly delayed colonic transit time si suggested by the appearance of the feces; the stomach and small intestine are unremarkable for size and content on submitted images.

CONCLUSION
Cardiomegaly is suggested; echocardiography could be considered to rule out HCM. Mild feline asthma, possibly low-grade and/or chronic, is suggested.
Hepatomegaly and renomegaly, possibly secondary to historical diabetes; abdominal ultrasound would provide more thorough evaluation.

just to add a bit more ...
Oliver doesn't really purr; it's more like a wheezing snorty noise but he does this when you have been patting and given him some good eats. At times when you would expect purrs, I get snorts.
He does not seem ever to have issues breathing but sneezes alot - I had thought maybe he has allergies or something. It's intermittent.

I should note the HISTORY provided to this radiologist, Jamie Williams,MS, DVM, DACVR
Consult Type: FILMINTERP, SIG: DOB: 20030612, Age: 7Y, Sex: N, Wt: 8.3kg. Breed: short hair. Species: Feline, Images: 3, Case Details: Scan rads, diabetic with probable acromegaly and immune insulin resistance.

 

I forgot to add one thing - Jess asked where he has been - I adopted him just this March and he was staying at Casco Bay Animal Hospital in Portland, ME.
I have his paper files from the owners with all the stickers for his vaccinations back to 2003 - I assume he was owned from a kitten age and tended by the same vet office. There are oodles of shot stickers in the file for the RV FELV FVRCP etc.

 

Gayle:

I can't offer any insight into HCM or the asthma. But, have you thought about bringing a tape recorder to the vet when you're getting inundated with info? You won't have to be writing so fast and furious. The little digital ones are very good.

 

Hey Gayle - I can help with the feline asthma.

I'm using the stuff for Sydney.

There is a yahoo group, called Feline asthma relief (FAR) - you may want to join. Kat is the moderator for it.

Anyhow, inhaled steroids, like Jess said, are ok to use. It's the injectible that you have to worry about.

The aerokat is the unit that holds the inhaler and it comes with 2 sizes of masks to fit the face.

http://www.trudellmed.com/Animal_Health ... at_fac.asp

This company makes it and average price is about US$60-70. Believe that is what I paid a few months ago.

In addition, like Jess said, albuterol is the emergency inhaler and in the US is sold as one of the generics for US$10. So, it's cheap. There is only one strength to this, I believe. You will need a script, unless you buy it online.

The flovent (flixotide) comes in 3 strengths - 50/110/220 - or in flixotide terms 50/125/250.

Depending on the severity of the asthma, people start at the 110 or 220. I started at 110 and have moved up to 220. I give Sydney 2 puffs BID.

Here is the best place to buy it from a cost aspect that is:

http://www.4cnrs-asthma-allergy.com/flovent.html

No script needed. Now, I believe FAR is working out a deal with four corners to get the price even lower, as this is where we go for it - so it's another reason to sign up on FAR, to get that information.

And here is the inhaled meds 101 primer that I'm glad was sent to me, as there was info that I didn't know about:

 

The recorder, that's a good idea; I have one around here someplace, I'll have to dig it out.

 

I also have an asthmatic diabetic kitty and am a part of the yahoo group Hilary suggested you join. We also get our meds from 4-corners. They are cheaper than any Canadian pharmacy and shipping is included in all of their pricing. I often get my shipment in 1 week (though sometimes it can take 2 weeks). Please come join us on the yahoo group Feline Asthma Relief!

 

we have a little digial voice recorder. jojo suggested getting one for the consult with meowzi's oncologist, and we now use it for almost every vet appointment. just a couple of months ago, i listened back to the recording of meowzi's cardiology appointment from june '09 to confirm what i thought i remembered (the recording told me i'd remembered wrongly ohmygod_smile )

 

Gayle,
All I can think over and over in my mind is how lucky Oliver is to have found you.
He truly is a beautiful and wonderful man.
I just culd not picture him being with anyone but you.
His life began when you became his Mama.
:YMHUG: :YMHUG:

 

Hi Heather

The trachea branches off to let air go into the lungs, and it is within the lungs that the radiologist sees a pattern. There is no way to know based on an x-ray alone, but tentative diagnoses can be made based on the pattern seen in the lungs -- its location, opacity, markings within it, symptoms, signalment (age, breed, species) etc. The radiologist is presuming asthma based on his age and the appearance of the lung pattern.

Gayle, snorting is 'upper airway', so nose and throat, not from the lungs, so it sounds like your kitty is not symptomatic for asthma. In that case, you can have an inhaler and albuterol on hand to be an extra-prepared mom, but the truth is that he may never show any signs of asthma and indeed might not have asthma at all. There is no reason to treat the findings of a radiologist's report, we just look at the big picture and keep it in mind.

Do keep us posted on the cardiology findings, if you can.

 

Thanks so much, Jess, I think I will look into getting the inhaler and albuterol so that I am prepared, just in case.

When I talked to the vet about it all,she seemed to think that we could revisit the situation when I take Oliver in for a teeth cleaning in the Fall, unless something comes up before then. I'll keep a close eye on him till then

I will definitely any cardiology happenings.