Extremely elevated BNP - heart disease?

[RussellsMom]

Here's the report from the cardiologist:

Cardiac Evaluation Report

Exam Date: 04-02-2024

Patient Details

Name Russell
Species Feline
Breed Domestic Short Hair
Age 13 years
Sex Male Neutered

Diagnosis

Hypertrophic cardiomyopathy (thick heart muscle disease)
Rule out contributing hyperthyroidism (grey-zone T4 on recent lab work)
Normal left atrium
Moderate left ventricular hypertrophy (heart muscle thickening) with normal heart muscle function
Trace mitral, tricuspid, and aortic valve regurgitation - likely normal age-related changes

Other medical problems:

Stress / sometimes fractious at the vet - did well today with gabapentin
Reduced jumping, discomfort at times - rule out arthritis
Moderate periodontal (dental) disease
Overweight

Medications

No cardiac medications are recommended at this time.

For future veterinary visits, keep on hand gabapentin 100 mg capsules: Give 1 capsule 2 - 3 hours prior to arrival at clinic. (In some cases to mitigate added stress if he worsens over time, you can also give 1 capsule the night prior in addition to 1 capsule the day of his visit). You can give the entire capsule, or open it and sprinkle the contents on 1 tablespoon of wet food.

Begin fish oil supplements (omega-3 fatty acids) at approximately EPA ~275 mg and DHA ~175 mg total per day. Start at 1/2 the dose for one week, then increase to the full dose if tolerating well. Please avoid Cod liver oil, flax seed oil, or products with xylitol, Vit A and/or D. Welactin and Nordic Naturals are reputable brands.

Other Guidelines

See www.cvcavets.com for more information about hypertrophic cardiomyopathy.

Diet and Activity

Russell is currently 17.6 lbs and his ideal weight is closer to ~14 lbs. Some tips to help are:

Feed 25% less food per day

Give fewer treats per day

Gradually switch to a low calorie food

If these changes do not help, please contact your primary care vet to discuss prescription diet food. A cardiac-specific diet is not necessary at this time.

End Pet Obesity: Find If Your Pet Is Overweight | Hill's Pet
For more information about nutrition and heart disease in pets go to: HeartSmart | Cummings School of Veterinary Medicine Continue to allow normal activity.

Monitoring:

Russell is currently at low risk for signs of heart failure (fluid in or around the lungs). Signs of worsening heart disease include:

Hiding
Decreased appetite
Difficulty breathing and/or coughing
Decreased interest in, or tiring with play
Weakness and/or collapse
Signs of a clot (always an emergency): suddenly not using one or more legs with signs of pain (meowing/ yowling, uncomfortable) or disorientation.

If you are concerned about the above symptoms, contact a veterinarian. If symptoms are severe, seek emergency care.

Anesthesia/Fluid/Steroid Risk (for your veterinarian):

Russell is currently at low risk for cardiac-related complications.

For anesthesia, we recommend: conservative rate of IV fluids (2-4 ml/kg/hr, or as clinically indicated), caution with drugs that have profound effects on blood pressure and heart rate (i.e. dexmedetomidine, high dose ketamine, telazol, high dose acepromazine, or atropine [other than for bradycardia]). For further questions, consider consultation with an anesthesiologist.

Ok for carefully monitored fluid therapy or steroids as required. Avoid long acting corticosteroids.

Recheck Plan

Please recheck with regular vet in the next 1 - 2 months for a recheck T4 and free T4 to rule out developing hyperthyroidism (which could contribute to cardiac changes). Please forward these results when available.

Please recheck with regular vet every 6 months for wellness care as directed, with close auscultation, blood pressure (Doppler method preferred), and complete labs (CBC, chemistry profile, urinalysis, thyroid level). Please forward these results when available.

Please recheck with cardiologist in 6 months for a follow up consultation, physical exam, blood pressure, and echocardiogram. Please contact us or schedule an earlier appointment if Russell has any signs of worsening heart disease or if recommended by regular vet.

 

[fionasmom]

So glad to read that this went well, with a competent doctor and a good report for Russell.

 

[FeebysOwner]

I think overall, it sounds pretty good for Russell. I will say that a 25% reduction in food right off the bat is a bit much. Getting a cat to lose weight is not a sprint, it is a marathon - the slower the better. Cuting back on his food too much at one time can make him feel hungry and that has impacts both physically and mentally. One of the primary keys of getting a cat to lose weight is getting them to mentally adapt to a lesser amount of food over time.

I don't know how much he eats in a day, either volume or calorically, but the ideal reduction starts with 5-10% at first. After he has adjusted to that degree of reduction you can do another 5-10%, and repeat this process every few weeks. But, he also should be weighed throughout to ensure he isn't losing too much weight. His weight should be checked before each reduction is done, so you have a gauge on how well the process is going. It is best a cat does not lose more than a pound in a month, ideally a little less than that. So, if you are looking at a 4 pound reduction, it really shouldn't happen faster than 4-6 months, the latter - or longer - being preferred.

 

[mrsgreenjeens]

I'm so happy to read your update. Sounds pretty good to me, and now also know you can give him the Gabapentin before his next Vet visit, no matter which Vet he is seeing. Should make the visits much easier on everyone, especially Russell

 

[RussellsMom]

Thank you, all - yes, it's good to know about the gabapentin. I was nervous while he was on it, but I think he handled it fine.

I agree with a slow weight loss plan, FeebysOwner. Oddly, Russell's not really a chow hound - he's kind of a delicate eater. He eats max two 3 oz cans of Fancy Feast throughout the day, but usually not even that much. He doesn't scarf - he eats very calmly. For "treats" we give him a few pieces of Hills sensitive skin and stomach kibble here and there throughout the day. It's not massive amounts of food. He eats zero people food, and until Tuesday, when I gave him the gabapentin, he'd never had any treats or extras (I used a little pinch of Greenies pill pockets to cover the gaba. That made me nervous too, because I didn't know if he'd throw the treats up, having never given them to him before.) Perhaps we're in denial about how many kibbles we "treat" him with. We're both at home all day, so maybe it's adding up. We're going to try to scale back a bit on the kibble and see if that helps his legs. I don't really perceive him as overweight - that's him in my avatar, at 17 pounds, looking to me sort of petite. He's always had a large primordial pouch. But I would love it if he could jump up to the table or the counters again, and maybe losing a pound or two could help.

He seems himself yesterday and today, just maybe a tad less active and still limping/having trouble jumping. His front paws don't look quite right to me since that bad vet visit, like he's walking slightly more on the "wrist" than usual. I'm trying not to overthink it - he is certainly better than he was last Monday, and hopefully will get better day by day. We're going to try cosequin - maybe just a tiny sprinkle to start with to see if he'll eat it and that it doesn't upset his stomach, before we start the loading dose and then taper to the maintenance dose. And we would like to try the fish oil, both for his joints and for his heart. If anyone has experience with that, I'd love to hear.

The cardiac report is quite good - better than we were expecting, given the high BNP - and I am feeling sort of cautiously relieved, if I can put it like that. I'm still very anxious about his health and happiness - probably more because of the Monday blood draw, where they hurt his legs and spirit, than the Tuesday echocardiogram, where they were so gentle with him and the report was pretty good. As long as he continues to recover from his upsetting experience, I expect I'll begin to relax a bit more every day. Thank you all so much for your support and kind words - it helps so much to have you here!

 

[iPappy]

I use Nordic Naturals, and I love the brand. These fish oils are very good for cardiac function, as well as skin, coat, joints, etc. I'm also glad they mentioned to avoid cod liver and flax seed oils, as cod liver is very high in vitamins A and D, and flax seed oils are not as appropriate for cats as fish oils are.
What types of Fancy Feast does he like? The pate styles are more low carb from what I understand, vs. the gravy types that are higher in carbs.
What about portioning out his kibble treats for the next day, the night before? You could measure out his portion, and you'll both be able to know how much he's actually getting. Those little treats do add up over time. (I should know, I've had a few too many snacks lately and suddenly realized I'm no longer fastening my belt on the same hole I used to! )

 

[RussellsMom]

Thanks for the fish oil recommendation! As for FF, Russell's unimpressed by the pate styles: it's gravy lovers all the way. Maybe that's the problem! Maybe I can experiment a bit with gradually adding some pates into his gravy lovers to lower the carb content.

 

[mrsgreenjeens]

Maybe I can experiment a bit with gradually adding some pates into his gravy lovers to lower the carb content.

Excellent idea!

 

[iPappy]

Thanks for the fish oil recommendation! As for FF, Russell's unimpressed by the pate styles: it's gravy lovers all the way. Maybe that's the problem! Maybe I can experiment a bit with gradually adding some pates into his gravy lovers to lower the carb content.

Has he tried the fish oil? If he likes it a lot, it might be easier to mix the two foods with the oil to mask the different flavor.
I think FF makes a "chunky" version that is sort of in between those two textures. If he's a no go on the pate, maybe you could wean him onto those and slowly onto the pates?

 

[RussellsMom]

Hi all - I'm not sure if I should start a new thread with this, but Russell's limping has gotten worse. He was perfectly fine before the vet visit where we STUPIDLY let them take him to the back without us for a routine blood draw. He came back absolutely full of rage and unable to walk properly or jump at all for days.

It's two weeks since then and he can jump onto sofas and chairs (with hesitation), but his walking is worse and he's depressed. His right front paw is somewhat bent, like he's walking flatter on it (not on the tiny tip-toes that cats usually walk on). When he's sitting up or standing, the right front paw trembles and even buckles a little, and when he sits he frequently holds his paw up. When he's lying down, he curls that paw under him in an unnatural way. There are no evident injuries to the paw pads or claws.

He's eating fine and litter box activity is normal, but he is very changed from how he was before that damn vet visit. He's quiet and depressed - he's usually a very chirpy chatterbox. He's had one or two make-out sessions with his blankets and pillows, which makes me happy because I assume an unwell or hurting cat wouldn't do that. But other than that, things are different. He's not playing with his toys; he won't sit on my lap; he's not exploring the house and yard; he barely tolerates my brushing him, which normally he loves so much; he doesn't really want to go outside, which is normally his favorite thing, even though the weather has become very pleasant. He's sleeping way more than usual and doesn't chirp and flip over when I interrupt his sleep with petting. He cries and sometimes even growls when I try to pick him up - absolutely never happened before.

Also, his largest burn scar (he was severely burned when we found him 12 years ago), which is normally just a smooth, hairless patch of white skin, has become very inflamed and raw. It's bleeding and oozing, which has never happened before since he healed up 12 years ago. It's not just a little spot - it's a dramatic-looking 2-inch sore.

Both the limping and the sore developed immediately after that vet visit. I suspect maybe he jumped off the exam table in his effort to get away from them. Either that or - can't bear to think about it - they manipulated him so strongly that they injured him. Both possibilities are tearing me up. I can't bear the thought that I took him to those people and I let him out of my sight. I never let him out of my sight, but I did this time. I just trusted it would be fine.

Maybe the skin inflammation could be because of stress. Nothing environmental has changed for him, other than two stressful (one terrible) vet visits in two weeks. The only other thing I can think of about the skin is that we gave him two pill pockets, which he'd never had before. But that feels like a stretch to me, considering the extent of the inflamed area.

I'm so beside myself, I can't think clearly about what to do. The thought of taking him in to another vet is so awful. But he's clearly been hurt in some way. I don't know what to do. Anyone with similar experiences or advice, please share.

 

[FeebysOwner]

My cat, back almost 2 years ago, went to a feline only vet for the first time as I was contemplating changing vets. She was thorough, but I noticed afterward Feeby was favoring one of her front legs. She had limped in the past with that same leg, but it had disappeared some time before the visit. The initial limp was from arthritis, and after giving her joint supplements, the limp went away.

Anyway, I think that between the existing arthritis and something that occurred during the exam, she was somehow injured. It was just a bit later that she was seen by an internal med vet (for other reasons) who called in an orthopedic vet on their staff that said she had a hyperextended wrist, and that it could take quite a while to heal. The only recommendation was to give her gabapentin for any pain she might feel from using it. They said she would self-limit her activities when/if was bothersome, so no mobility restriction was suggested, as it is often a bigger problem than the injury itself.

I don't remember how long it took to heal, but I let her do her thing, and only shortly gave her gabapentin because she was not willing to take it and would spit it out. Did the vet cause the hyperextended wrist? I will never know, and in the big scheme of things it doesn't really matter. Btw, the entire exam was done in my presence, so if something did happen, me being there didn't stop it. If Russell's injury (I am NOT talking about the open sore) is anything like Feeby's, there isn't really much to do but let time heal it.

However, this open sore is another matter. Is the issue with his leg in the same area as this scar from his previous burn? If so, there may be irritation in that area that has caused him to lick it as cats do to soothe themselves - to the point of making it an open sore. If not, then I don't see a correlation. Nonetheless, the sore that has developed needs to be looked at and treated.

 

[RussellsMom]

Thanks so much for sharing your story, FeebysOwner - it does help a lot. I've been leaning towards thinking it might be a hyperextended wrist and scaring myself with thoughts that it might require surgery (surgery = scary, but especially so with the recent HCM diagnosis. Plus I don't think Russell is the type of guy who would tolerate a long, confined and/or splinted recovery period well).

Russell has had very minor limping (barely noticeable) in the past, which we've assumed is arthritic. As I mentioned in an earlier post, he was never a really big jumper because of his burns, but he's gone from easily jumping onto 35" high kitchen counters and lounging on the 30" dining table when we ate dinner to only being able to jump up onto 20" beds and sofas in the past few years. He's doing those 20" jumps at the moment, but he thinks long and hard about it and feint-jumps a few times beforehand. Walking flat on the wrist, the front leg buckling, depression, and crying when I touch him are new since the bad vet appointment, though.

Reading your story makes me hope ("hope" is an odd word in these circumstances, but I hope you know what I mean) that maybe it's "just" arthritis, exacerbated by his recent experience. We're waiting for the OK from the cardiologist first, but we're eager to try Cosequin and fish oil to see if it helps with that, so maybe those things plus time will help. It is wonderful to hear that Feeby's wrist healed up in time.

I don't feel like the open sore and the limp are directly related, but I suppose it's possible. The limp is in his right front leg. The scar/sore is directly over his right back hip, about an inch down the right flank from the spine and extended about 2 inches across the flank towards his tail. He is licking it more than he does when he normally washes, and he complains when I touch the area even slightly.

Sometimes in the summer if I'm not diligent enough with his sun umbrella (I follow him around with an umbrella on sunny days because of his burn scars), he gets a little irritated on that particular bald patch, but nothing even remotely as pronounced as this. We always have the vet look at any irritation whenever we go in and they've all said it doesn't look at all like skin cancer to them. They're not dermatological specialists, though. We were planning on making an appointment with a dermatologist this year just to make sure he's 100%, but I'm scared to stress him out further at the moment. It's scary - the sore is something that I would normally take him to the vet for; on the other hand, I'm thinking the sore could have been caused by all this recent stress.

 

[FeebysOwner]

I don't think the two are related. Nor can I imagine what any vet could do that would cause an issue with his scar tissue. And, if he has never over licked that spot before due to stress, then I am not sure about that either.

But I thought you were able to give him gabapentin to take the edge off for vet visits. That being the case, unless you know how to properly treat that sore, you don't have much choice than to have it looked at. If nothing else call a vet that you are at least remotely comfortable with, send them a pic of that place and see what they say. Frankly, right now I'd be more worried about that than his jumping ability.

 

[RussellsMom]

Just a quick update: Russell's inflamed scar has gotten better. He definitely was overgrooming that spot after his two stressful vet visits. It's not perfect at the moment, but it's not open and weeping like it was last week. We're pretty sure it was exacerbated by stress, so even though we made an appointment (with a vet Russell did well with in the past but who moved quite a ways away some years ago), we ended up canceling it. I feel like the last thing he needs at the moment is another trip to the vet, gabapentin or no.

That said, he still seems traumatized to me. He's different from how he was before the bad vet visit. It's been almost exactly three weeks and he's just not the same. His fur hasn't lain flat since then - it's coarse, spiked and tufty all over. His affect has changed: he's normally a very relaxed, sociable, happy, funny guy. Now he's tense, low, and unrelaxed. He's eating fine (in fact, he's asking for food more than usual, which concerns me a bit - comfort eating?), and he occasionally does some of the things he normally does (victory lap after pooping; kneading his blanket), but he doesn't sit on my lap, enjoy being massaged, knead his blanket for very long, explore the yard, or want to lounge outside on his usual chair. Those might sound like minor things on paper, but to me they're very markedly different from how he normally is. He's not playing with his toys, which he usually loves, and he's very quiet, which isn't normal. His face is very serious and unrelaxed looking, not his usual smile - his normally relaxed, blissful, content look. When we go out, he sits close to the door and constantly looks behind him, jumping at every noise.

My husband thinks he'll return to normal soon, but I'm heartbroken that after three weeks he's still so affected. As I know you can all relate, my whole life for the past 12 years has revolved around making sure Russell's healthy, safe, and happy. And we've been really successful at keeping him well and happy until that stupid vet visit. I guess I'm just venting at this point, but if anyone has any stories to share of cats who have weeks or months later shaken off a traumatic experience, please do share and help raise my spirits. Any advice about how to help Russell relax back into his normally lovely and protected life, please also share. Thanks