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Phil P. / TK's Ultrasound report



 
 
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  #1  
Old June 3rd 05, 05:00 AM
Phil P.
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Default Phil P. / TK's Ultrasound report


"Nomen Nescio" ] wrote in message
...
-----BEGIN PGP SIGNED MESSAGE-----

Well, I got some good news today. TK tests negative
for FeLV and FIV. I'll get the results of his bloodwork
retest on Fri. The last test showed "some lymphopenia
and slight neutropenia."

Ok, you had asked:

Did he give you the measurements of TK's heart? If you have a print out,
look at the measurements (mm) next to "IVS" (interventricular septum) and
"LVPW" (left ventricular posterior wall). These measurements tell you the
degree of hypertrophy. Cats aren't considered HCM unless the IVS or LVPW

or
both are at least 6 mm. Let me know what the measurements are.


I've got the report in front of me and have no idea what it all
means except that several dimensions are WAY out of the
normal range.

I've got 2 "IVS" dimensions, diastole & systole.



Diastolic measurements are more important.



- From Report:

wIVSd = 0.69 (3.75 SD) IVS thickness (diastole) markedly increased




6.9 mm diastolic IVS isn't good- but its not very bad either.



wIVSs = 0.97 (2.23 SD) IVS thickness (systole) mild-moderately

increased.


There's no "LVPW" dimensions listed
There is, however, "LVW" diastole & systole

wLVWd = 0.66 (2.58 SD) LVW thickness (diastole) moderately increased.




6.6 mm diastolic LVW isn't good- but its not very bad either.




wLVWs = 1.07 (2.46 SD) LVW thickness (systole) mild-moderately increased.

The numbers that REALLY worry me a

wWTd = 1.35 (4.91 SD) Combined IVS and LVW thickness (diastole) extremely
increased.

w MAd = 6.37 (4.02 SD) LV myocardial area (diastole) extremely increased.


I've known cats with thicker (8 mm) walls live a few years after diagnosis-
The cats had to have been HCM for a few years prior to diagnosis to develop
that much hypertrophy.

Wall thickness is important- but there're other factors that must also be
taken into consideration. For example, a 7 mm IVS or LVW in a small cat is
disastrous, but it might not be so bad in a larger cat. The size of the LV
is important, too. The thicker the IVS and/or LVW the smaller the LV (both
walls encroach on the left ventricle). The degree of IVS & LVW hypertrophy
doesn't seem severe enough to severely reduce the luminal dimension of the
LV. Maybe in textbooks it is- but not in real life.

This may be a long shot: Have you had TK's blood pressure checked?
Hypertension can cause myocardial hypertrophy that often reverses with
treatment of hypertension.

I've know many cats with more severe HCM than TK that lived a few to several
years post diagnosis with proper treatment. A few cats even had a partial
reduction in IVS & LVW hypertrophy and left atrium size with treatment. In
fact, a few years ago, a poster had a cat with HCM that lived 10 years post
diagnosis! I'm not trying to sugar-coat bad news- I'm just telling you what
I've seen in my experience.

I think you caught it early enough for TK to respond to treatment.

Never underestimate the Cat's fantastic ability to adapt and survive and the
Cat's amazing resilience!

Keep the faith!

Best of luck,

Phil


  #2  
Old June 3rd 05, 10:01 PM
Phil P.
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"Nomen Nescio" ] wrote in message
...
-----BEGIN PGP SIGNED MESSAGE-----

Thank's Phil. My wife and I can't tell you how much we
appreciate the time you're taking to help us understand
TK's condition, and your words of encouragement.



I know what you're going though. I lost a dearly loved cat to DCM many
years ago before the cat's obligate taurine requirement was known. A
10-cent taurine supplement would have saved his life. A few years later, I
lost another dearly-loved cat because an incompetent vet misdiagnosed HCM
for bronchitis. Since then, I question and second guess everything- even
clean bills of health!



This may be a long shot: Have you had TK's blood pressure checked?


Yes. Dr. Rush did the BP after the echo. Checked it on the left
rear leg using a stethoscope amplified through a speaker and
the inflated cuff. Quite an elaborate procedure compared to
human BP.


Not really- its a little tricky but just takes a little practice. The
transducer probe is just used in place of the diaphram of a stethoscope. I
have a Parks 812 and 915-BL Doppler with infant probes a few different size
cuffs. Cuff fit and placement are crucial. If the cuff is too big the
measurement will be falsely low. If the cuff is too tight the reading will
be falsely high. The units are also great for detecting a thrombus by
listening to the blood flow in the hind legs.


It was 130/80 which he said was normal.



Actually I was kinda hoping it would be high-- because hypertension is a
cause of HCM and can be treated- which often resolves the HCM.



I'm going to scan the report and e-mail it to you. I hate to be
a pain in the ass about this.



I wouldn't think much of you if you *weren't*! ;-)


But, honestly, I'd inconvenience
a LOT of people if I thought it would give me even the
slightest chance of understanding and treating TK's condition
a little bit better.



To me, everything else is an inconvenience when I'm trying to help a cat.
You should see what I put vets and labs through!


But if you're too busy to be bothered with it,
I understand.


Don't worry about it- I'll make the time.


So I'll scan and send it this evening. It should come out to
about 250k/2 pages. I'll have to send it in multiple parts
so it may take a while for the complete report to appear
and combine.


I'll be looking for it.



Thanks again for your invaluable assistance. You've really
helped us a lot with getting a handle on what we're dealing
with, here.


I used to panic when a cat was diagnosed with HCM until I saw them live for
many years post diagnosis. The key to HCM is early detection and treatment.
I think you caught TK's HCM early enough for treatment to make a very big
difference in his lifespan. I've seen cats with much more severe
hypertrophy live many years with proper treatment- and I know you'll go the
distance- and then some- for TK.

Keep the faith!

Phil



  #3  
Old June 6th 05, 10:16 AM
Phil P.
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"Nomen Nescio" ] wrote in message
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-----BEGIN PGP SIGNED MESSAGE-----

Thank's Phil, I sent the report out Fri night,
I've mentioned it here before, but I can be reached
by E-mail at mrwizard(at)nym(dot)alias(dot)net
The server at MIT was having problems over the past
year but mail has been going through fine for several
weeks, now.


I can't make out the entire report- some parts are cut off. Would you mind
re-scanning and sending it to me again? I don't want to give you an opinion
based on incomplete data.

What I could make out seems encouraging! The left ventricular chamber size
isn't increased and the left atrium is only mildly increased. When the IVS
and LVW are thickened they encroach on the LV and decrease the inside of the
ventricle
(blood holding capacity). This doesn't seem to be happening.

The left atrium is only slightly enlarged- but probably not enough to slow
blood flow down enough for a thrombus to form. The LA enlargement is
probably caused by high left ventricular filling pressure- but I'm not sure
why.

Since you started diltiazem therapy very early, I think it will slow and
probably stop further hypertrophy if not actually reduce the hypertrophy and
the size of the left atrium.

Cats start having problems when the heart can't supply the body's need for
O2'd blood. From what I can piece together from the report, this doesn't
seem to be happening either.

That's about all I can get out of from what I can read.


From: "Phil P."
I know what you're going though. I lost a dearly loved cat to DCM many
years ago before the cat's obligate taurine requirement was known. A
10-cent taurine supplement would have saved his life.


It must have been both heartbreaking and infuriating to find
that out.


It sure was.



A few years later, I
lost another dearly-loved cat because an incompetent vet misdiagnosed HCM
for bronchitis. Since then, I question and second guess everything- even
clean bills of health!


That's my greatest fear with TK....that someone may be missing
or misinterpreting something.



I can't figure out what's causing this- other than a congenital defect
because he's so young- way younger than most cats that develop HCM..




To me, everything else is an inconvenience when I'm trying to help a cat.
You should see what I put vets and labs through!


I kinda knew that, already! That attitude and your level of
technical knowledge (which, I dare say, seems to surpass
many vets that I've encountered) is the very reason that
I'm asking you for help.


I'm kinda stumped. The only thing I come up with for cat this young with
HCM is a congential defect. Do you know if any of his siblings have similar
problems or if either of his parents have HCM in their lines?



I really can't thank you enough.


I just wish I could be more helpful.

Keep the faith,

Phil


  #4  
Old June 6th 05, 11:37 PM
Phil P.
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"Nomen Nescio" ] wrote in message
...
-----BEGIN PGP SIGNED MESSAGE-----

From: "Phil P."

I can't make out the entire report- some parts are cut off. Would you

mind
re-scanning and sending it to me again? I don't want to give you an

opinion
based on incomplete data.


Thanks again, Phil. We really appreciate your help.
I trimmed down some of the report to cut back the file size.
But all that I cut was blank page, fax headers, Tufts header,
and addresses. You should have recieved 2 pages in
separate e-mails of 1 page each.

E-mail 1:
Page 1 starts with an identifying header that I added,
"TK's Echocardiogram Report pg 1 of 2"
and contains History, Physical, Echo (with scales, dimensions,
and description),



The ends of the sentences on Pg 1 are chopped off.


and ends with a line followed by
"John E,Rush DVM, MS,Dip ACVIM Cardiology, ACVECC"

E-mail 2:

Page 2 starts with "Tk's Echocardiogram Report pg 2 of 2"
The data starts with Weight (and a bunch of dimensions
that I don't understand). then Doppler, Miscellaneous,
Assessment, Recommend.

If you recieved all that, then you've got the entire report that
was Faxed to TK's regular vet.
If not, please let me know what you're missing and I'll re-send
it.


Please do. If you can set the size, use 600 x 800.



What I could make out seems encouraging! The left ventricular chamber

size
isn't increased and the left atrium is only mildly increased. When the

IVS
and LVW are thickened they encroach on the LV and decrease the inside of

the
ventricle
(blood holding capacity). This doesn't seem to be happening.

The left atrium is only slightly enlarged- but probably not enough to

slow
blood flow down enough for a thrombus to form. The LA enlargement is
probably caused by high left ventricular filling pressure- but I'm not

sure
why.


Well, that's some good news about a bad situation.
But it's the "WHY?" that keeps eating at me.
MY understanding is that the heart takes in blood on the
right side, pumps it through the lungs and back to the left
side of the heart which then pumps it through the arteries,
veins, etc.
My medical knowledge is somewhat limited, but as an
engineer, I do know pumps, and fluid flow through pipes.
Your comment about "high left ventricular filling pressure"
is interesting. I'm assuming that you're saying that the
left ventricle may be forced to increase pressure to a
higher than normal level. If so, that says to me that there
could be a restriction in the downstream "piping"
system.


My first thought was (congenital) subaortic stenosis- but the echo was
negative.

One thing that jumps out at me is TK's roundworm problem.
I've read that they can move through the circulatory system
and get into the lungs and liver. Could this have possibly
caused a restriction and forced the heart to work harder
at a higher pressure?


Actually, I meant I don't know what's causing the hyperthrophy. I know
what's causing the increased pressure-- Hypertrophy decreases LV flexibility
and relaxation. So, higher (diastolic) pressures are needed to fill the LV.
Congenital subaortic stenosis can cause LV hypertrophy and higher pressures-
but from what I could read of the report it didn't mention stenosis.



He was wormed in the Spring of
'04 and subsequently tested negative. But this Spring he
tested positive, again, and was wormed last month. The
vet suggested a "chronic roundworm" problem may
exist since he's an indoor cat. Which means the worms
have probably been in his system for the past year.
The vet said that "Revolution" might clear up the
roundworm problem if it reappears. But that was before
the HCM diagnosis so I don't know if we could use it
on him, now.
Six months earlier there was NO trace of a heart murmur.
I know he could have been developing HCM prior to
that and the murmur didn't appear until the HCM had
developed to a certain point. But to go from no trace
of a murmur to a level 3 in 6 months seems awfully
quick.


It does- that's why I considered a congenital or heritable defect.
Sometimes congenital/heritable defects take a few months to present
themselves.


Another thing that I'll throw out as info. is that fact that
TK has some powerful "kitty breath". He's been checked
a couple of times for mouth, tooth, throat, infections and
looks fine. And while NO cat that I've ever met has
minty fresh breath, his seems a little on the strong side.



His breath doesn't have an odor of ammonia, does it?

Something else that just came to me as I'm writing
this. We had a problem with our heating system
this winter where the boiler got clogged with soot
and started forcing fumes into the basement. We have
a CO detector in the basement and it never read
anything other that "0" until the day the boiler clogged
and I had a guy in to clean and re-tune it within
hours of noticing the smell and a slight reading on
the CO meter. But there could possibly have been
very small, undetectable, amounts of of CO getting
into the house and basement for several months and
TK has a favorite chair that he sleeps on in the basement.
Could the HCM possibly be connected to trace
amounts of CO in the air over several months?



I never heard of CO2 as a cause of HCM. Although the heart would have to
pump harder and faster to pump more oxygen-carrying RBCs to the system and
get rid of the CO2.


I'm kinda stumped. The only thing I come up with for cat this young with
HCM is a congential defect. Do you know if any of his siblings have

similar
problems or if either of his parents have HCM in their lines?


Well, we THINK he's young. He appeared in our backyard
in the early fall of '03, looking small, thin, and hungry. So we put some
food out for him and he kept coming back every day or 2 and
it wasn't until the end of Nov. when he started to trust us. We
thought he was female for a few months..then we notice that
he seemed to have suddenly grown balls around the beginning
of Dec. '03. Based on that, we're guessing that he was born
in the spring of '03 and someone dumped him at the golf
course down the road (sadly, a favorite dumping ground for
unwanted pets) sometime around the middle or end of summer.
But we really know nothing about his heritage. He may have
been a stray, or a feral, or just another piece of refuse that
some asshole dumped. But we do know that he's got a lot
of "wild" instincts and behaviors.



Its also possible that he had a murmur and the first vet missed it.
Purring can interfere with hearing heart sounds. I've caught several
murmurs that vets missed- and I'm not even a vet. I have an electronic
stethoscope that amplifies and records heart sounds- which I can play back
at the vet's office. It's a little expensive (~$500) but it would help you
monitor TK's heart between check-ups. You can also send the recording to
your computer where you can email it to your vet between exams.



I just wish I could be more helpful.


You've been VERY helpful. I have a MUCH better feel
for what I'm dealing with, here, thanks to you. You've given
me a lot of insight and information, and one tiny bit of
that information may turn out to be a crucial element in
helping TK have a longer and better life. But no matter
how things turn out, I will always appreciate your concern
and the time you've taken to help.
You're one of "the good ones", Phil.


Thanks.

I know its expensive, but you might want to repeat the echo in 3 months to
see if TK is responding to therapy and see if there's and increase or
decrease in hypertrophy and changes in the LV and LA sizes.

Keep the faith.

Phil




  #5  
Old June 7th 05, 03:29 AM
Brad
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Kudo's to you Phil P.....I know you aren't looking for them but I am
sending them over anyway......It appears from reading your posts that
you aren't a vet but extremely knowledgeable is this self study or are
you are retired vet...??......hope you don't mind my asking......

Brad

LIFE'S JOURNEY IS NOT TO ARRIVE AT THE GRAVE SAFELY IN A
WELL-PRESERVED BODY, BUT RATHER TO SKID IN SIDEWAYS, TOTALLY WORN OUT,
SHOUTING... " HOLY @#$%... WHAT A RIDE!"

  #6  
Old June 7th 05, 07:23 AM
Phil P.
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"Brad" wrote in message
news


Kudo's to you Phil P.....I know you aren't looking for them but I am
sending them over anyway......It appears from reading your posts that
you aren't a vet but extremely knowledgeable is this self study or are
you are retired vet...??.....



I've done a lot of research and I've also learned a lot from working with
many vets and many, many cats for many years.



.hope you don't mind my asking......


Not at all.


  #7  
Old June 8th 05, 02:35 AM
Annie Wxill
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"Nomen Nescio" ] wrote in message
...
.... I can't say that I've ever, in my life, wanted to fix a problem
as much as I want to give TK a long, healthy, happy life.
The poor little guy was given such a ****ty start in life and
(as silly as it sounds) I promised him a year ago that
"life will be good from now on".



Nomen,
Best wishes for you to find the source and solution to TK's problems.
I hope he has that long, happy life you have planned. Even then, we never
have our kitties long enough.
I would say that whatever the outcome, that you are keeping your promise by
giving him such loving care.
Annie


  #8  
Old June 10th 05, 03:48 AM
Phil P.
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"Nomen Nescio" ] wrote in message
...
-----BEGIN PGP SIGNED MESSAGE-----

Hi Phil, I was just wondering if the re-scanned report
came through OK and readable.
And a couple of questions:
Under the section "Physical", the report says
"JVD-1/3-1/2 way up the neck".....What does that mean?


JVD = Jugular venous distension. Its a technique for assessing venous
pressure and righ-sided heart failure. You block (occlude) the jugular and
see how far up the neck the distention or pulsations goes. Normal jugular
pulsations travel about 1/3 of the way up the neck. So, TK's is about
normal.

Here's a picture that shows you what I mean.

http://www.maxshouse.com/Cardiology/...distention.jpg


Under the section "Echo", after the dimension there's
always another number like (4.91 SD)....What's the
significance of that number and what does "SD" mean.


SD = Standard Deviation. Its a complicated (at least for me) measure of
variation between the average measurements of a group of cats. The closer
the measurement to the mean of the group the lower the SD. The higher the
measurement compared to mean group measurement the higher the SD. The
actual measurements are more important - to me.


Do you happen to know of any web sites or books that
define and explain all the abbreviations that vets use.


http://www.library.uiuc.edu/vex/vetd...breviation.htm






But to go from no trace
of a murmur to a level 3 in 6 months seems awfully
quick.


It does- that's why I considered a congenital or heritable defect.
Sometimes congenital/heritable defects take a few months to present
themselves.


But is that something that would be undetectable when a cat
is between 1 and 1 1/2 yrs old and appear at an age of 1 1/2 -
2 yrs.


Not necessarily. HCM can present at any age.


In the 1st 5 months he was with us, his heart was checked
by 4 different vets including the pre-neuter exam. Nobody
noticed anything.


A lot of vets dismiss murmurs in young cats and dogs as physiological- from
excitement and stress.


I assume that stenosis could have a cumulative effect with every
heartbeat and eventually the enlarging of the heart walls would
cause the turbulence and the murmur. But from what you're saying,
it sounds like the stenosis should have been obvious during the
ultrasound.


No no no. aortic stenosis was just a guess- the echo ruled it out.


It seems that the more I learn about what is going on, the less
I know about the "why". And I'm quickly running out of guesses.
Yet I know that nothing "just happens". There's always a cause
and effect.



Most of the time the cause of HCM is never found.


Please let me know it the report came through OK.
And Thanks Again.



This one was a lot easier to read. I don't know how much more I can add-
the report doesn't look that bad. I've seen cats live many years with much
worse echoes than TK's.

You might want to join my Yahoo Group-
http://groups.yahoo.com/group/Feline..._and_Behavior/

RPCH+B has been going down the tubes lately.

Keep me posted on his progress.

Keep the faith!

Phil


 




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