Extremely elevated BNP - heart disease?

[RussellsMom]

Thanks, mrsgreenjeans. I'll try leaving the new carrier out, though he always bolted at the sight of the old one. My husband will drive, so I can sit it in the back seat with Russell. I thought I'd keep my hand in the carrier and pet him and sweet talk him throughout the drive, unless he signals that's not working.

In other circumstances, I might be willing to give the Feliway a go, but some people have reported that it has the opposite effect on their cats, and I don't want to risk that at this point.

By the way, Russell has been a bit more himself since late last night. He brought me his pink mouse (he carries it, yowling, and deposits it near me - a nightly ritual); he's eating fine; we had a purr-filled Furminating session last night. Litter box habits all normal. His jumping is still not where it was and he seems extra-jumpy (startling at every sound). So just as he seems to be getting back to normal, we have to take him in again!

 

[RussellsMom]

Thanks, FeebysOwner - Believe it or not, I'm cool with Rescue Remedy! I'm not sure I have the non-human one in my cabinet, but I will certainly ask the cardiology office about it and give it a try. Thanks, both, for reminding me.

 

[IndyJones]

fionasmom, if you're still reading: You mentioned that Jamie still has no symptoms 6 years after diagnosis with HCM. Has he been on any medications or other treatment for HCM all these years? I have read a lot of material today that indicates that many (most?) cats with subclinical HCM do not ever show symptoms, which is great.

If anyone else reading has a cat diagnosed with heart disease and could post what treatments, if any, they use, I'd really appreciate hearing about your experiences.

Hyperthyroidism and heart disease...

This is my page chronicaling Kabuto's heart disease not sure if its helpful or not.

My advice is enjoy what time you have left with your boy.

 

[RussellsMom]

Oh IndyJones, After my thread about Danno closed, I hadn't been following up on others' posts - I'm so, so sorry about lovely Kabuto.

I'm trying hard not to speculate about Russell at the moment. He's been nothing but hale and hearty (knock wood) in all his 12 years with us - just some surface dermatological issues and an ealier luxating patella, really - nothing that's particularly concerning health-wise. I do feel like he's still ruffled by his excessive stress at the vet on Monday, but otherwise he seems fine as usual: eating fine, drinking fine, using his litter box fine, behaviors generally pretty normal.

It's true I'm spending all my time reading and researching about cat heart health, and I can't help worrying terribly, but we won't know anything until the echocardiogram on Tuesday. Whether it's something, or nothing, or treatable, or not - I have no idea. He isn't showing any symptoms of anything at all. If we hadn't had the BNP, we'd all be carrying on as normal at the moment, and Mommy and Daddy wouldn't be worried about a thing.

In the meantime, a chink broke into my drug-paranoia, and I called the vet for a prescription of 50 mg gabapentin mini tablets. Historically, Russell would rather take your arm off than be given a pill (a few aborted attempts at giving him antibiotics in the past for a rash - the rash went away on its own, luckily), but I'm so scared, if he does have a heart condition, that the extreme stress of another vet visit could make it worse.

Does the following plan sound reasonable to you all?: Since he hasn't really taken this drug before (only once many years ago in combination with other drugs, so hard to tell its effect), to give him 50 mg the day before the vet visit to see how he does/if 50 mg sufficiently relaxes him? That's what the vet suggested, but I'm having even worse trust issues than before with them!

Thanks

 

[IndyJones]

Kabuto had that exact test (bnp) done after the vet found he had a washing machine murmer (her description but acurate)

Kabuto was used to traveling and the vet. I think your plan sounds reasonable. Your cat sounds still early if it is infact heart disease but be aware, it is unfortunatly terminal. Medication can manage it but not cure it. Thats why I say enjoy your boy while you can.

 

[mrsgreenjeens]

As to your plan to try to Gabapentin, was this the cardiologist you spoke with, or the other Vet? I would speak with the cardiologist and run it past them since you said in an earlier post that they didn't want him to be given anything.

 

[RussellsMom]

Oh, yes, thank you - I forgot to clarify. I called the cardiologist's office to ask about Rescue Remedy and mentioned that the person we'd spoken to yesterday said not to give him gabapentin or anything else. The person who answered the phone today was very surprised and said sometimes their phone is answered by an answering service not directly connected to their office. They do in fact recommend gabapentin for nervous pets - that's why we called our regular vet to get the prescription (they're literally just around the corner from us).

The fact that the answering service gave us incorrect information about gabapentin upsets me mostly because what she said about having seen numbers twice as high as Russell's and it turning out not to be heart disease might then be inaccurate, too.

I'm so scared that the stress of another vet could hurt him. I'd never considered heart disease before - he usually gets really upset at the vet and then comes home and shakes it off, no problem. This time was different. His stress was through the roof. His ears and toes were bright, lurid red. He was hyperventilating (breathing was fine later at home - this was before I had any idea of heart disease, so I didn't make any connection there).

I've read that for some cats, the adrenaline of the vet visit can override the sedative effects of the gabapentin. He could go into heart failure from the stress!?

His home life is so peaceful and regular and stress-free. I feel like I might have given him a heart attack on Monday and now I'm in danger of giving him another one.

 

[mrsgreenjeens]

Personally, I think because of the way he was probably manhandled the other day, possibly even to the point where he was physically hurt, is why he was so upset. From what you described when you brought him home, he didn't have a heart attack. Typically their breathing will be severely impacted, as will their appetites, etc. Yes, he didn't act normal, but you didn't mentioned anything that sounded like a heart attack to me . I think you need to step back and take some deep breaths, and stay off Google for awhile. At this point, there really isn't anything you can do until you find out WHAT, if anything, you are actually dealing with. Hopefully it's nothing, but you won't know until after the cardiology appointment. Yes, it's scary, but right now you are driving yourself nuts with research that really might only lead you down a rabbit hole. AND, as mentioned previously, cats are very good at picking up on human emotions, so that won't help him either.

I read that you can actually sprinkle the Gaba in a bit of food to get him to take it rather than try to pill him. And since it is also a pain med, you might get a duo reaction...less pain and slight sedation.

Did your new carrier arrive? Make a big deal about it like it's a new toy, then set it out with the comfy blankets inside and let it alone. I'll bet he goes inside. We leave ours out all the time, as I said, but we typically leave them in our walk in closet so the entire world doesn't have to see them

 

[RussellsMom]

You are so sweet and so right, thank you! He still doesn't seem himself to me, but he did "make out" with his pillow tonight, and his jumping is a bit better, and eating etc. all seems normal. But I am going through waves of panic followed by waves of relative calm.

The carrier did arrive. It's one of the screw-together types (he's a big boy, at 17 lbs, so I thought it would be safer than our old latch-top carrier), so I'll put it together tomorrow and put some blankets and toys in it and leave it out as you suggest. Will let you know how it goes!

I've spent much of the evening reading about cats' experiences with gabapentin, to get me more used to the idea of giving it to him. We got the tablets rather than the capsules, so we can't sprinkle them. Does anyone know if they can be crushed? The tablets are very small, though, so I might be able to sneak one past him.

I would love to hear suggestions about when and how much gabapentin to try. I'm considering not giving it the night before but just giving him one 50mg tablet 3 hours before the vet appointment - a kind of average of the methods I've managed to read about here. But any and all suggestions are very welcome - thanks!

 

[RussellsMom]

Hi all - I'm eager to try the gabapentin, in the hope that it will help calm Russell for his scan on Tuesday, but all the studies I can find about gabapentin safety in cats have been about "healthy cats" - no mention of cats with heart disease. We're of course operating on the conjecture that he has heart disease, to be as safe as possible.

Does anyone have experience using gabapentin specifically with cats who have heart disease? I'd love to hear your experiences.

Thanks so much

 

[fionasmom]

Jamie's cardiologist gave gabapentin to me in order to sedate him before a visit. I did not have any problems with it. I would give it according to the instructions specifically given by your vet.

 

[RussellsMom]

Thanks, fionasmom!

 

[RussellsMom]

fionasmom, what dosage did you give Jamie? Thanks

 

[fionasmom]

Jamie's prescription was 100 mg the morning of the visit. He has never been given torbutol; in fact, it is years since I have seen that offered to any of my pets.

 

[RussellsMom]

Russell's echocardiogram is tomorrow morning at 9:30. We're going to try sprinkling about 100mg gaba into his food around 7 a.m. in the hope it calms him and allows them to get good images.

Generally he's more or less back to his usual self since his distress at the vet last Monday (just in time to take him in again!). He seems a little quiet to me, but I'm not even sure of that - I'm so stressed and am looking for symptoms everywhere. Eating, drinking, litter box, moving around, enjoying company, all seem normal. He's even run around a few times - a few times in the yard (fenced and supervised, don't worry!) and once after using his litter box - all normal behaviors for him.

I feel like he's sleeping more than usual today, but it's cold and rainy here, so it might be nothing. And he's definitely less purry than usual - he's usually a total purr-machine, but since Monday he's seemed more tense and edgy to me.

I've been checking his resting respiratory rate since we got the elevated BNP and it's always between 20 and 24. Active respiratory rate is not much above that. He snores a bit, but he's always done that, even when he was a kitten.

I'm very nervous about tomorrow. Thanks, all, for all the advice and support - it really helps me so much. Please send Russell good luck wishes!

 

[mrsgreenjeens]

We'll be anxiously awaiting the results of the visit. Good luck!!!!!

 

[RussellsMom]

Hi all - We’re back from the cardiologist. Russell was great late last night and this morning – even running around the yard – so I was sorry to have to take him in for another vet visit just when he’s feeling himself again. He easily took two 50 mg mini-tabs of gabapentin in pill pockets at 7 am – I never would have believed he’d have eaten them without spitting them out, but he did, no problem at all.

By 8:30 he was super relaxed – I had to pour him into his new carrier. He was quite calm the whole car ride and traffic was good so it only took us about half an hour. We kept the car warm and quiet and put a towel over the carrier.

The cardiology office was just great – they made excellent use of fear-free methods and were so sweet and gentle with Russell. We were with him the whole time. He was alert and a bit scared, I could see, but his body was fairly relaxed so they were able to get really good scan images.

Shortish version: they found a small amount of thickening in the left ventricle, consistent with early HCM, but we need to rule out hyperthyroid with a free T4 at some point in the next month or so. They tried to do a blood sample after the echo, but his stress was starting to poke through the gabapentin and he started growling, so they stopped. Why regular vets don’t order free T4 during routine panels, I’ll never know. It seems folks are always having to go for a second blood test.

His blood pressure and respiratory rate are great, and his heartbeat is regular. The cardiologist couldn’t detect a murmur and said that sometimes vets hear murmurs or what sound like murmurs when cats are really stressed, but she couldn’t detect one in Russell. His heart looked quite good to her on the scan and she didn’t think Russell needs any medications or lifestyle changes at this point. We’re to come back for another scan in 6 months.

If it’s hyperthyroid, she said sometimes the changes to the heart can be reversed with treatment. If it’s HCM, it’s progressive, but its progression really varies from cat to cat, and we might need to add medications later. She did warn us of the dangers of heart failure and blood clots, and told us what signs to look out for. She said many times that she felt that Russell was at a low risk for those events at the moment.

Before she even did the scan, she said that the high BNP (1236; normal range 0-100) didn’t necessarily concern her in itself. She said some cats have only slightly elevated BNP and severe heart disease; some have very high numbers and are asymptomatic like Russell. I found that reassuring.

She recommended supplementing with fish oil, and she wants him to lose a few pounds, mostly to help with arthritis.

The gabapentin really kicked in when we got home. Russell was staggering around like he was drunk and he was voraciously hungry. He’s been sleeping deeply most of the day. At about 5 p.m. (10 hours after dosing), he and I went for a stroll around the fenced yard and he wasn’t as wobbly, but then he came in and curled up in his heated cat bed again.

My husband is elated by the news. I’m relieved, but still finding things to be stressed about! For one, he hasn’t peed yet today. His litter habits are always 100% regular, so I’m worrying about it. I’ll be happier when I feel the gabapentin has fully worn off and he’s fully himself – hopefully that’s all it is.

I’m attaching the full report if anyone’s interested in the details either for Russell or for their own cats – there might be information there that’s helpful. All shared experiences and observations are very welcome – thank you so much!

 

[RussellsMom]

I tried to attach his report but couldn't figure out how to do it. Will try again later.

 

[FeebysOwner]

Thanks for the update. That seems to be pretty good news!! I am glad that Russell was relaxed enough to get through most of the visit without issue.

I am curious about one thing - Russell's previous blood work, did it contain a T-4 (not the free T-4)? It is usually a standard part of a senior blood panel. If so, and his number was well within range, most vets would not run a free T-4. Those are not generally done concurrently with a T-4 and only run secondarily if the T-4 is high but within range. It isn't usual to run it otherwise. In my layperson's opinion, and based on my own cat, to have heart issues resulting from hyperthyroidism, any T-4 test he would have had done would have been high enough to be categorized as hyperthyroidism. Not trying to disagree with the cardiologist, but rather to let you know it is not typical to automatically run a free T-4 and heart issues don't generally come into play unless the T-4 is high to begin with.

Give him some time to get over the visit, and let his body fully eliminate the gabapentin. I think he will be fine and peeing very soon! Don't let it stress you out at this point!

Not sure why you can't attach the report. If you have it as a file on your computer, you should be able to click on the "Attach File' option in a post and either save it or 'drag' it into the post. Hopefully, it will work next time you try!

 

[RussellsMom]

Thank you! And Russell had a nice long whizz in his box, so Mom's a bit more relaxed at the moment.

The T4 is in what the cardiologist called the "grey zone" - the regular vet didn't mention it. I'll try to attach his bloodwork here. It might look a bit odd because I've done some creative cutting and pasting to remove personal addresses and such and had to resort to screenshots, for some reason: