Monday, April 21, 2014

Cooper to Receive Injections of Lasix

Because Cooper's congestion is difficult to manage, Cooper's cardiologist wants Cooper to receive one daily lasix injection of .3ml and three doses of lasix pills-12.5 to 18mg each dose-a day. The amount of the pills will depend on how congested he seems.

Sunday, April 20, 2014

Happy Easter!

Cooper Develops Eye Infection, Stresses at Vet's, Ramps Up Congestion and Breathing, Takes All Saturday to Fight

Cooper developed an eye infection this week. First, it seemed he was closing his right eye, almost winking. Then it seemed to be less round as the left. Then he began to wake up from a nap with it closed. We kept looking at it. No discharge, no blood inside the eye, not bloodshot. But he did have one large scratch on the outside of the left eye which we assumed was from another cat. There was one tiny mark under the right eye but not near the eye. Then Friday, there was discharge in the morning from the right eye. Off to the vet. Conjunctivitis. No internal injury to the eye. Antibiotic drops. Eye's responding well.

BUT congestion was heard. And the visit caused stress and increased his breathing rate. At the vet's and later at home it ramped up to 20/15 seconds. It was 17-20 all Saturday. We kept pushing 18 mg of lasix every 6 hrs. We finally did an injection of .15ml lasix at 6 p.m. His breathing rate by 10 p.m. was 13 while sleeping but then ramped up to 17 by 1 a.m. But this morning, while wide awake, his rate is down to 10. We will continue 18 mg today and if still steady, lower a later dose to 15 then maybe 12.5mg. And tomorrow begin with 18mg and then again 15, 12 and see how he does.

Theoretically, he shouldn't be on so much lasix due to his size, that the disease is new to him and shouldn't be causing so many issues with congestion, and that such high doses can cause injury to the kidneys. You want to start low, hope the lasix works well at low doses, and titrate up as needed for an issue, solve the issue, titrate down, and later titrate up as the disease progresses-hopefully years away. But he's not like Myrna-who responds well to small increases, had a normal breathing rate for years until last year when 8/15 became her norm. His norm shouldn't be 12 or 15 in 15 seconds at rest. He's comfortable now and the most we can do is monitor. The breathing was not as deep, noisy, or as troubling as it has been the last two times he landed in the ER. But fast and congested isn't good and must be fought. 
Cooper being petted

Wednesday, April 16, 2014

Cooper's Congestion Seems to Have Disappeared, Breathing Improved

Update on Cooper's lasix: on Friday we did 18 mg twice and 12.5 twice. The vet had at some point said to give 18mg for the first two doses and then 12.5 for the next dose; then we had discussed giving four doses of lasix. So, having already given 18 in the a.m., on Saturday and Sunday I gave 18mg in the a.m., then 12.5, then 12.5, then 18 at bedtime. On Sunday, he had constipation which I assume is from the lasix causing dehydration. I switched his fiber from the inulin he has been taking for two years to the Miralax type that we give Baby. And we added more water to his food. On Monday, I gave him 18 mg lasix and then three doses during the day and evening of 12.5 tabs. On Tuesday, we did four doses of 12.5 tabs. By Sunday, his breathing was down from 20 to 12-15. By Monday it was 9-12 and remains. So, not only do we need to remain vigilant about his breathing but be aggressive with high doses of lasix for about three days before titrating down.

Friday, April 11, 2014

Cooper is Congested Again; Increase Lasix Dosage/Schedule

Cooper has had to receive an extra 5mg of lasix three different times this week.  His breathing rate is a rollercoaster ride during the day.  He will seem normal one moment and breathing at a high but steady rate of around 40-48 breaths a minute.  Then he will wake up, or walk around, or get nervous about a noise that is outside and his rate will skyrocket to about 80 breaths a minute.  When sleeping, his breathing rate has fallen to a comfortable 24-30.  But a few times this week, mostly late in the afternoon or late in the evening, sometimes first thing in the morning, his breathing rate will present at 80 breaths a minute and remain.  He seems to work hard to push air in and out of his body.  If it's near lasix dosing time when his breathing rate climbs, we give the dose and wait to see what becomes of his breathing.  Usually, it falls after about an hour, sometimes less.   If the rate seems to increase in between doses, and has not decreased after 20 minutes while he rests, that is when we have given the extra lasix.

Last night, I made a video of Cooper breathing and sent it to the cardiologist.  She asked for xrays.  We took him to the regular vet today; they took xrays of his chest which showed only mild congestion.  The xrays were emailed to the cardiologist who said to increase his lasix to get rid of the congestion.  I requested that he receive lasix QID (four times a day) and not TID (three) and she agreed.  So, we will do lasix QID at the 12.5 dose and see how he responds.  We will decrease it over time to 10mg QID  once his breathing rate slows to a normal 24-30 rate per minute.

We don't know why he keeps getting congested.  He sees the cardiologist in May.

The really good news is that he has gained 5 oz in a week and apparently very little of that is due to congestion. He weighs 11.8, up from 11.3.  He's eating little at a time but more often and we continue to give liquid food by mouth three times a day of 3-6ml of tuna juice, cat sip, or chicken broth.
Cooper, breathing hard but being goofy

Wednesday, April 2, 2014

Change Yet Again in Lasix for Cooper

Cooper is slowly bouncing back from last Thursday's ER visit and overnight stay due to CHF (congestive heart failure or congestion in the lungs.)  Cooper's breathing was up 15-20 breaths in 15 seconds on Sunday so we gave him 5mg extra of lasix at 2 p.m.   It seemed up again by 8 p.m. so we gave 5mg once more.  I emailed the doctor on Monday and told her that I was concerned that he needed lasix more often during the day and not just three times.  He was receiving 10mg of lasix at 7:30 a.m., at 2:30 p.m., and at 11 p.m.   It was clear that the 2-11 p.m. stretch might be too long and that he just wasn't yet over becoming congested.

The cardiologist had us revert back to using the 12.25mg pills for three times a day and to see how that works.  Well, so far, she was right (well she is always right!)  It seems the simple addition of 2.25mg three times a day has so far worked to lower his breathing rate. It is now down to 10 breaths in 15 seconds.

For clarity and reference-normal at rest breathing rate is 6 in 15 or 24 in one minute.  Normal when awake and maybe active can be 24-30.  A healthy cat's breathing will fluctuate during the day.  Sleeping, walking, jumping, sniffing, eating, watching birds out of the window-all will trigger various levels of breathing, from 6-10 breaths in 15 seconds.  The difference is that a normal cat, at rest, will breath about 6 breaths in 15 seconds and when they breathe heavier, the breathing will soon settle to a lower, slower, steadier rate.

But a cat that is sick, especially one with congestive heart failure, and even later as heart disease progresses, will breathe a sustained high rate that will not settle.  When the rate does not settle, that is when the cat must see the vet or vet ER immediately.  The cat could have congestion-the lungs or chest cavity filled with fluid. The cat may be unable to produce and breathe in oxygen, to exchange oxygen and carbon dioxide.  The cat will need to be placed in an oxygen cage and given lasix.  There could be other health issues that cause heavy breathing rate-a heart attack, a clot in the heart, or other disease complications, all of which require emergency care.

For those whose cats may already be taking lasix, if a higher, sustained rate of breathing is noticed, an extra dose of lasix of 5mg every 4-6 hours may be enough to combat the onset of the congestion.  One must wait 2-4 hours for a response but might see a slowing of breathing rate within an hour.  If one is injecting lasix or has the supplies to do so for emergencies as we do for our HCM cat, an injection of .15ml every 6-8 hrs might be enough.  Response time is about an hour and breathing may begin to decrease within 30 minutes. However, if the need for extra lasix continues in one day, or multiple days, or the breathing does not decrease, a visit to the vet cardiolgist or ER is necessary.   And before giving extra lasix, if possible, one should consult with the vet cardiologist.
Cooper about four years ago in healthier times