In August of 2003, our cat, Morag (Burmese, 8 years old at diagnosis), was diagnosed with severe HCM. She was already in congestive heart failure. The only symptom had been labored breathing, and we had initially put that down to the hot and humid weather at the time. She was placed on Lasix, Diltiazem, Fortekor, and Aspirin. The Aspirin was later discontinued because her stomach didn't tolerate it well.
Our first problem was giving Morag her medication. She has never liked being pilled, and now we were faced with giving her several pills every day for the rest of her life. It didn't start out well, and after a few frustrating days we were ready to throw in the towel. Pill times were frightening because they stressed her out, which isn't good for a heart kitty! Around that time, I found the feline-heart Yahoo! group and poured out our story, and this is when we discovered the magic of compounding medication.
Members on the group recommended that Morag see a cardiologist, and so our vet arranged an appointment with a cardiologist at the University of Guelph Small Animal Clinic for mid-September. We took Morag to her cardiologist appointment with hope in our hearts that a treatment plan could be worked out that would see her happy and healthy for as long as possible, but unfortunately there was to be more bad news. The initial diagnosis of severe HCM was not correct. Morag has restrictive cardiomyopathy (RCM), which is not well understood and has a poor prognosis. She was removed from Diltiazem, since the cardiologist felt it would not help her, and her Fortekor and Lasix doses were increased. We left the clinic with a much clearer idea of what to expect. For that we were thankful, even though it wasn't what we had wanted to hear. I've always believed that the truth is better than false hope, though there are days when I'd take the false hope!
The rest of 2003 was spent in a constant battle to keep fluid out of Morag's chest. We generally managed to go two weeks at a time, two and a half if we were lucky, before having to take her into the vet due to a fluid induced crisis. Each episode resulted in her medication doses being upped a bit, and in the back of our minds, we knew there were limits and that eventually we'd hit the ceiling.
In the beginning of January of 2004, we almost lost her. She went into full blown respiratory distress. The vet wasn't optimistic, and we discussed euthanasia seriously for the first time. However, we decided to go ahead and treat the fluid and see what the next 24 hours would bring. The next morning, I was up early, anxious for the clinic to open so I could find out if Morag was still with us. She was! One thing we've learned about her is that she's a fighter. She had recovered so well overnight that the vet tech who opened the clinic and was unaware of the previous night's events couldn't understand why everyone was phoning to find out how Morag was. I dropped into the clinic before going to work and was amazed at how much better she was. Thank god for Lasix!
Since then, we have pretty much remained on the roller coaster ride of good and bad periods. Unfortunately, Morag's kidneys do not tolerate Lasix well, so we have had the additional problem of balancing her kidney function against fluid accumulation. She can't take the maximum allowable Lasix dose for her weight because she becomes depressed and nauseous and stops eating. Because of this, in March she was placed on a second diuretic, called Spironolactone, in addition to the Lasix that she can tolerate. So Morag is currently on 2.5mg of Fortekor (Benazepril) twice a day, 10mg of Lasix twice a day, and 12.5mg of Spironolactone once a day.
In April, she started to experience "wobbly" periods. She becomes weak and collapses, which is very frightening for us. We believe that she may be throwing small blood clots. Because of this, our vet put her back on Aspirin, but once again she couldn't tolerate it and so we made the difficult decision to remove her from the Aspirin, even though we know she may throw a fatal clot at any time. We decided that we'd rather see her content for a shorter period than miserable for a longer period. She has also started to develop fluid outside the lungs (pulmonary effusion), whereas previously she had only developed fluid inside (pulmonary edema), so this is another sign that things are worsening and that we are in the end stages. We have joked with the vet that she is working her way through her nine lives, and there aren't many left at this point.
As I write this in early May, she is at the vet due to fluid on her chest, after having a fairly good period of about five weeks (a record for us). The vets have told us that intravenous Lasix is clearing the fluid so we'll be picking her up from the clinic later this afternoon. She is still happy, eating, purring, and doesn't allow the other cats to boss her around. We will continue to support her as long as she wants to continue. When she does start to falter, my hope for her is that one day we'll discover that she isn't sleeping, but has quietly slipped away.
-- Sarah
Morag passed away on July 17, 2004. She was nine years old.