Steroids And Heart Conditions?

UnderneathTheStars

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I called the cardiologist who treats Mousse's severe HCM today

Plavix (blood Thinner) And Nose Bleeds

and he wants to prescribe dexamethasone for Mousse's nasal and oral inflammation for 7 days to see if it helps. He said there is a chance that it could exacerbate her HCM but that the risks for her are very small. He's a board-certified cardiologist. However, I did a google search and it seems like the risks are high for an HCM cat. People on some Facebook groups said you should never do steroids for a cat with a heart condition.

I don't know what to do. I'm so conflicted.
 
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babiesmom5

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There are steroids...and then there are steroids. Dexamethasone is a "short acting" steroid, (as opposed to Depo-Medrol, a long acting steroid).

My senior cat with HCM did have a few injections of Dexamethasone later in her life with no ill effects with approval of her cardiologist.

I would rely upon advice of your board certified cardiologist over some Facebook groups. This is just my opinion.
 
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UnderneathTheStars

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There are steroids...and then there are steroids. Dexamethasone is a "short acting" steroid, (as opposed to Depo-Medrol, a long acting steroid).

My senior cat with HCM did have a few injections of Dexamethasone later in her life with no ill effects with approval of her cardiologist.

I would rely upon advice of your board certified cardiologist over some Facebook groups. This is just my opinion.

Thank you! I didn't know there was a big difference between types of steroids. Was your cat classified as mild, moderate, or severe HCM?

I called the specialists back because I was so worried and they explained that most of the ill effects to the heart and the immune system happen with large doses for long periods of time. The dose they prescribed (which I'll pick up in a few minutes) is small and for only a week or so. It's 5 days and then 5 days of tapering. The specialist said he isn't too worried despite the fact that her HCM is classified as severe because it's such a short treatment and because her last two scans have showed no progression in the HCM and no fluid in the lungs/chest.

I wonder if you could help me understand steroids more, though. I don't really understand what the goal is. If the inflammation goes away while on the steroids won't it just return once the 10 day treatment is over?
 

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I don't know how much I can offer regarding the various steroids, but there are basically two kinds that I know of:
  • Anti-inflammatory, used to reduce swelling and irritation
  • Anabolic, used to develop muscles and strength
Mousse's would be anti-inflammatory, and I am guessing they think the nasal/oral inflammation is from allergies, or some sort of bronchial irritation? It would depend on the source of the allergy/irritation as to whether or not it might return after completion of treatment. If they are not sure of the specific cause, the vet probably wants to see how Mousse responds to the steroid and if it does actually eradicate it.

Either way, you might want to ask the vet about natural anti-inflammatory treatments you could use long term. If the vet thinks the nasal/oral inflammation is related to Mousse's immune system, there are immune enhancing treatments as well that you ask about and whether that is a possibility in her situation.
 
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UnderneathTheStars

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I don't know how much I can offer regarding the various steroids, but there are basically two kinds that I know of:
  • Anti-inflammatory, used to reduce swelling and irritation
  • Anabolic, used to develop muscles and strength
Mousse's would be anti-inflammatory, and I am guessing they think the nasal/oral inflammation is from allergies, or some sort of bronchial irritation? It would depend on the source of the allergy/irritation as to whether or not it might return after completion of treatment. If they are not sure of the specific cause, the vet probably wants to see how Mousse responds to the steroid and if it does actually eradicate it.

Either way, you might want to ask the vet about natural anti-inflammatory treatments you could use long term. If the vet thinks the nasal/oral inflammation is related to Mousse's immune system, there are immune enhancing treatments as well that you ask about and whether that is a possibility in her situation.
I picked up the medication today and it's as follows;

.25mg once a day for 5 days and then .125mg (half of .25mg) once a day for 7 days.

The internal medicine specialist says that the sinus and nasal inflammation is likely due to the fact that her previous owner never treated the bacterial sinus infection AND she had calicivirus and upper respiratory infections over and over while being bred. Over time, it caused permanent damage to her nasal passages :(

As for the tongue ulcer that refuses to heal, the internal medicine specialist thinks it is eosinophilic granuloma but can't be 100% because he would need to use anesthesia to take a tongue scraping.

It's hard because I feel like these are the only things impacting her quality of life. The nasal problems cause pain, bloody noses, and congestion. The tongue ulcer causes drooling and sometimes a bit of blood. Otherwise, she's healthy. I'm giving myself until Monday morning to make the decision. I'm so distraught..
 

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Only you can make the decision, but if the steroids can get her help/relief with the nasal issue, then I am guessing they could move forward with a tongue scaping?

B babiesmom5 said her HCM cat had no adverse affect from the steroids - I sure wish others (if there are any) would come along and join chorus with her to help you feel a bit better about moving forward.
 
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UnderneathTheStars

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Only you can make the decision, but if the steroids can get her help/relief with the nasal issue, then I am guessing they could move forward with a tongue scaping?

B babiesmom5 said her HCM cat had no adverse affect from the steroids - I sure wish others (if there are any) would come along and join chorus with her to help you feel a bit better about moving forward.
Even if the steroids take care of the issue the anesthesia necessary for the tongue scraping is too risky due to her heart condition. Unless it somehow changes, but HCM doesn't usually get better it only remains stable or progresses as far as I know. In her case, it has remained stable!

I gave her the first dose this morning. I wanted to wait until Monday so that I could rush her to the office if anything happens. Like a complete psycho, I made a last minute 8:30am appointment to see my general practitioner this morning before I gave breakfast/medication. She is in contact with the specialists. She listened to Mousse's lungs and said they were clear. Heart murmur sounds haven't changed and overall body condition, breathing rate, etc are excellent. She said that with the low dose and short duration, she also agrees that the risk is minimal.

Because I'm so nervous, we came up with a game plan of what to do in case things go wrong. If she does get fluid in the chest, the vet will be on-call for me and all I have to do is ring her up and head right to the clinic where we will evaluate and possibly do a diuretic injection. Again, the risk is small and this plan is just to give me peace of mind.

After, I came home and she took her medication and ate all her breakfast. Then, she wrestled with my other cat for a bit, groomed herself, and is now napping. She has no idea anything is different but I'm sitting here catastrophizing.
 

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Even if the steroids take care of the issue the anesthesia necessary for the tongue scraping is too risky due to her heart condition. Unless it somehow changes, but HCM doesn't usually get better it only remains stable or progresses as far as I know. In her case, it has remained stable!
Oh, I was hoping that getting rid of the nasal issue might help strengthen her system enough to allow the tongue scraping. :disappointed:

She has no idea anything is different but I'm sitting here catastrophizing.
Isn't that the way it works!!

Keep us posted on Mousse!
 
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UnderneathTheStars

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Update: Second dose today!

Yesterday was really nice. Mousse didn't have a bloody nose and she was very alert and playful.

This morning I woke up and she hadn't had a bloody nose yet and very minimal nasal secretions (and they were clear)!!! She had drooled a little bit but not as much as usual. Also, her tongue seems to be looking a bit less raw.

Just for context, usually I wake up and her nose is crusted with thick secretions and blood. Most mornings her chin is caked with drool as well and then she usually has secretions from her nose throughout the day and if she sneezes too much, bright red blood that only stops if I do cold compresses. When these things happen she feels miserable and I end up having to give her pain killers which make her drowsy and she isn't able to do much.

Yesterday, I didn't have to give a pain killer at all and none today so far. Breathing rate was 21 breaths per minute last night and 20 this morning. :)
 
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UnderneathTheStars

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Update: Fourth dose today!

We are almost done with the full 0.25mg doses and after tomorrow we go down to 0.125mg for 7 days. Has someone replaced my cat with a kitten? I have a hard time recognizing the fact that she is ill. She has the same great appetite but all she wants to do is play and cuddle. I can tell she's feeling much better. She hasn't drooled or sneezed blood in days. I took a quick look in her mouth today and for the first time in the 11 months I've had her, I saw nice pink gums and a healing ulcer on her tongue. I almost cried.

I know it's just the steroids and that when I take her off of them, this stuff will likely return. At least, that's what I assume. I'm trying not to be too optimistic but she's such a happy baby right now that it's hard not to do. Her breathing rate is still steadily between 20 - 23 breaths per minute while resting. Lungs are clear and she's actually breathing easier now that the nasal passages aren't so swollen.

Does anyone know if there's a possibility her problems will go into "remission" once the steroids are tapered off? I really don't want to keep her on them long term due to her heart. We are seeing the cardiologist and general practitioner the day after her final dose.
 

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That is all good news! Thanks for the update! Sorry, I can't offer anything regarding whether or not her issues will return once the steroids are out of her system - but, certainly pursue that with her vets when you see them.
 
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