Friday, May 30, 2014

Cats with Heart Disease Cannot Breathe Hot Humid Air

Summer is here even if not officially and we must prevent our cats from breathing hot, humid, muggy, stale air in order to prevent congestion. The air in your home affects how they breathe and if they become congested and how well they deal with congestion. Give your cats good air to breathe indoors: get rid of humidity in the house with dehumidifiers (stand alone units or attached to the automatic A/C unit) Keep the temps inside cool, not hot nor too cold. Run fans-maybe buy some of the "whisper quiet" fans. Run stand alone room units that exhaust through window screens (no need to remove the screen) or buy those you insert into an open window. If you have an automatic A/C in your home, set it for 70-74 degrees or whatever works to keep the air cool but not cold, and not hot and stale. And don't let the cat stay in the sun for too long. Even heat can trigger stress and stress triggers congestion. And keep them indoors as much as possible. Good luck!

Torsemide Works Well for a Cat While Other Cat Needs More Lasix

Cooper is doing well after a week of torsemide. At the request of the cardiologist, we decreased his med to 2mg four times a day (QID). Breathing rate is about an 8/15. Myrna has needed 5mg extra of lasix at some point during the day for some of the last few days (but not all.) Her breathing rate has been 10-12/15 and that's when she received extra lasix. She's stressed by the air conditioners and the fans going, storms we've had. When it's cool during the a.m. and evening, I turn the fans off and give her a break.

Cats Are Like Babies-They Cannot Sustain Injury or Illness On Their Own Without Medical Care

The other day I picked up something someone was giving away for free.  They had a kitten with them which they had recently acquired. The kitten was 8 weeks old and the cutest little thing. It had just hurt its front leg a couple hours before I came over.  The daughter was carrying the thing because it could not walk. I looked and saw the paw was swollen at the joint and asked if that was the hurt leg and it was.  I felt the head and it felt very warm. I suggested the ER and soon because the leg was noticeably swollen and the body felt very warm and feverish (but because it was begin carried it could have picked up body heat.)  We had a discussion about cats in general because they have six and I have seven.  I mentioned that I was used to dealing with a variety of issues. They had a friend coming over in a few hours who is a vet tech who was going to look at it.  Then she said she'll take it to the vet tomorrow if the friend says it needs the vet. 

At this point, there was little I could say.  Pointing out that the leg was swollen and the kitten possibly feverish and needing the ER wasn't enough to compel the lady to leave NOW for the ER.  I didn't think it would work to tell her that by the time she takes it in-say she calls in the a.m. and they say they'll see her at 1 p.m.-the poor kitten would have been suffering, in pain, unable to walk, and possibly feverish for 24 hrs. What person in their right mind lets an animal suffer for 24 hrs?

And it bothered me all the rest of the day.  And then it dawned on me-would she  let her baby do the same thing? Would she be so calm, so seemingly unconcerned and lacking in a sense of urgency to get care for a baby if a baby were just as sick? Probably not.  And that's what I should have asked: how long would you let a baby go with an injured, swollen limb, possibly feverish? 24 hrs? 12 hrs? 5?  

Because cats are like babies, and I don't mean because we treat them as our children.  They are physically too small to handle what most adults or even children can handle.  Constant vomiting and diarrhea-what might be a normal course of illness in a child will weaken and debilitate a cat.  A child can take all sorts of meds for such an illness but not a cat.  Lethargy, an unwillingness to eat or drink are normal for a sick person. They have reserves in large bodies before needing to see a doctor.  But not a cat.  One day without food and water and the cat will not rebound on its own without vet care and may have its life in danger.  A broken, sprained, swollen and painful limb injury? Who in their right mind would let a child sit around without seeing a doctor?  Almost no one I'm sure.  A cat would need care immediately as well.

And yet we treat our pets as if they are full grown adults, able to withstand not eating and drinking; withstand fevers; withstand constant vomiting and diarrhea; and withstand the inability to breathe.  Some HCM owners ignore their cat's pain, crying out, inability to breathe, panting, breathing fast, discomfort, hiding, lack of drinking and eating, etc.  And why? Because they think the cat can deal with it, that it will pass, that surly it can't be that serious, and that maybe the cat doesn't need the vet or that it can wait a day or two until the vet is available.  And of course, there is the cost of care to consider.

But put it in perspective:  the next time your cat is sick, think of it as you would a baby, a child under the age of one. Just how long would you let a baby be in pain, unable to breathe, have a swollen leg, have a fever before seeking medical care?  Five minutes? 30 minutes? One hour?  If we are not going to let a baby suffer without care then we can't let the cat suffer.  Because a cat's body is just about as small, weighs almost the same as a newborn, and cannot sustain illness or injury and rebound on its own anymore than can a baby. 

Monday, May 26, 2014

Feline Heart Meds Website Information'S%20NEW%20IN%20MANAGEMENT%20OF%20CHF.html

Saturday, May 24, 2014

Torsemide and Feline Moderator Band Cardiomyopathy

Cooper's doing better. Breathing rate 10-11. Used the litterbox three times. No gurgles. Handling all that diuretic well. Even ate. His next dose will be 1/4 Torsemide at 8 p.m. and we'll give another 1/4 about 11:30 p.m. We'll see how he does tomorrow but for now we will give 1/2 dose in the morning and take it from there. Thanks for your prayers! What a pain is congestion to get under control. Of all the issues we've ever had with Myrna, she eventually stabilized, and we've had some scary moments with her. But his problem beats all of it. We can't get him to be stable for very long.

Torsemide for Cats May Not Be Working for Cooper Today

Torsemide may not work for Cooper. He was fine yesterday at 8/15 but this a.m. he was at 12/15. Gave 1/4 Torsemide as directed at 8 a.m. but breathing increased. Was at 15/15 by 1. We have another dose before 2 p.m. but then I heard gurgles so we injected him with .3ml lasix. Cardio's on vacation but is able to text. She said the Tor dose and injection together should be fine and to wait to see how quickly it acts. It's been an hour and although he's used the litter box, I'm not sure it's easing the breathing. He may need the ER. Will let you know.

Friday, May 23, 2014

Feline Moderator Band Use of Lasix: Cooper Back to Cardiologist for Oxygen and Lasix Due to Congestion

Cooper has been struggling all week with congestion and we've struggled to figure out the correct dose of lasix needed, timing of doses, and when he needed an injection to overcome the congestion.  We communicated daily and sometimes often during the day with the cardiologist to get input.  We had a protocol, a method, a process to follow. We knew what to do when, how quickly to respond to an increase in breathing, and how quickly to text the cardiologist to alert her of a new issue.  And still, we all struggled to meet his needs. 

Katharine Hepburn had an appointment for Thursday due to a gallop murmur (and an earlier post noted the cardiologist heard a mild murmur and saw no signs of heart disease) and Cooper already had the same appointment made in March because this was to be a checkup.  But he had just been to the ER a couple weeks prior and everyone expected that he would recover and not need to be seen at this time.  But we kept the appointment just in case.  Despite recovering from the ER, despite trying a new drug (spironolactone/hydrochlorothiazide) and having it upset his system (nausea, diarrhea) and dropping the drug and bouncing back quickly from it, and despite an even breathing process, and despite controlling for heat, cold, and not allowing him to be in the sun for prolonged periods or in any open window at any time, he still developed congestion.  And we couldn't get rid of it.

So, Thursday, Katharine, Cooper, and I went to the cardiologist.  They took xrays which showed congestion in the right lung and only slight congestion in the left. They were going to give him a lasix injection but then he suddenly couldn't breathe well and was making gurgling, panic noises.

They put him in the oxygen cage and gave him lasix IV injections.  They kept him from 1:30 until 6:30. He quickly responded to the use of oxygen and lasix which was an excellent sign.  They weaned him off oxygen and his breathing rate dropped to 8/15, and we finally went home at 7 p.m.  As of today, his breathing is still at 8. 

The cardiologist has taken him off of lasix and given him a new loop diuretic to try.  We will begin using it today. He will get the med twice a day and three times if needed.  We will know after a day or two if the med is working to decrease congestion and we will know in 3-5 days if the med does or does not upset his stomach.  In between doses, we can give injections as needed, which we would more likely consult with the cardio about the dose before giving an injection.  The new drug is called Torsemide. It stays in the body and works in the body longer than furosemide (lasix.)  In human patients it is shown to have a greater decrease in recurrence in congestion.  But it can also deplete the body of electrolytes via extraction of fluid,  leading to many adverse side effects.  It can also deplete the kidneys of potassium and can cause stress on the kidneys. We will give 1/4 of a 10mg pill.  He will go from 80 to 100 mg of lasix to 5mg of Torsemide a day.
Cooper at the cardiologist

She also suggested we use a potassium supplement called Tumil-K (we will use Sundown potassium, and Gerber baby sweet potatoes also as a potassium source.)

The cardio and I had separately come to the conclusion that trips to the vet were becoming stressful for Cooper and counterproductive-although he needed oxygen and IV lasix this time-and that going forward, Cooper will see the cardio or vet only when necessary and not for checkups. 

By the way, they know when he's feeling better when he hisses and growls at them!

Here are her notes:
"Despite continued increases in his cardiac medication doses, Cooper has again relapsed into congestive heart failure. He is receiving extraordinary doses of lasix to try to maintain his comfort in breathing and we are having continued relapses in symptoms.  Unfortunately, he did not tolerate hydrochlorothiazide well and that mediation had to be discontinued.  I would now like to switch his lasix to a much more potent diuretic called torsemide.  Torsemide functions very similarly to lasix.  The risks of this medication include kidney failure and electrolyte depletion. The major benefit would be more steady control of Cooper's symptoms.  Today's laboratory results indicate that Cooper is an acceptable candidate for this medication.  To help prevent excessive potassium depletion, I would like you to begin supplementation with Tumil-K (potassium supplement.)

Friday, May 16, 2014

Cooper Makes Miraculous Recovery from Major CHF but Cardio Not Hopeful of Survival of Next Incident Like This One

Cooper went to the ER Sunday night at 6 p.m., May 11 with major CHF. He had been fine all week, dealing well with once a day diarrhea from the Clavamox antibiotic he had been taking for the lesions on his skin from the daily injections of lasix we had been giving him (successfully for two weeks before lesions appeared.)  He was fine Saturday and breathing well and slow and steady. He seemed fine Sunday and spent some time in the sun in the laundry room.  He ate well Sunday in the morning and the afternoon. But then he vomited sometime after 4 p.m. and by 4:30 my husband noticed that his breathing effort had increased.  By 5 p.m. I could hear him gurgling when I picked him up.  So, Cooper and I drove to the Animal Emergency in Novi.  On the way there, he began breathing through open mouth and was crying a lot. Then he had a bout of diarrhea in the crate.  But then he began to cry even more and more urgently. As we arrived, he began screaming as if someone had pulled his tale.

I rushed him in, they took him to the back, the vet tech took down my description of what happened, they pulled his cardio file (the cardiologist office is connected).  They gave oxygen and began lasix treatment.

The ER vet came to talk to me.  She said usually they are reluctant to give a lot of lasix.(This vet wasn't the one who worked with Cooper the last time he had CHF.) Typical dose is 2mg per kilo and he was at home already receiving 4mg per kilo (he had been receiving 18mg, 12mg, a .15ml shot or 18mg pill, and another 18mg at home.) They were going to be cautious until they could talk to his cardiologist whom they had called.

Then at one point, he had so much fluid coming out of his mouth and nose, that the only way to get rid of it and help him breathe was to hold him upside down, head pointing downward, and to let the fluid flow out of him which a huge amount did.

Because he was unstable and stressed, they were not able to insert IVs or do blood work at this time.
Cooper in healthier times.

They heard back from the cardio who instructed them to give larger amounts of lasix intramuscularly for a few hours.  Finally, his breathing came down from 100 to 60.

By 10 p.m. he was calmer, breathing more easily, and they were able to put in a catheter for further IV lasix and other IV drugs.  They were finally able to take blood tests.  His blood oxygen level was good (means that his body-despite the CHF-was producing oxygen.)  They did continue oxygen therapy for the rest of the night, lowering the amount slowly, weaning him off of it until they were sure he could breathe on his own without going into breathing difficulty.  By 9 a.m. Monday he was removed from the oxygen cage, continued to be monitored, weaned off of other drugs, and continued to improve.

Also, later that evening, they gave Buprenex for pain, Dobutamine a drug to help improve contractility of the heart (works much like Vetmedin a.k.a. Pimobendan but is not a drug used outside of emergencies. It's given over a short period of time because the body tends to resist it after about 48 hours.)  The improved contractility of the heart meant better blood flow to the kidneys, aiding the lasix and providing support to the kidneys.  They also used heparin an anticoagulant.

Monday, I spoke to the cardiologist who seemed surprised and happy with his results. His BUN was up to 40 (from a normal of 27 but not in the 100s which would indicate kidney damage/disease); creatinine was  1.4-just 1/10 over normal.  His breathing rate was 32 per minute and he was still slightly congested but breathing well on his own.  She did an echo and did NOT find a clot in the heart.  There had been speculation that a clot may have formed and traveled to the stomach leading to the vomiting and the screaming he exhibited in the car.  But the cardio thought that instead of a clot, he was screaming due to panicking over not being able to breathe.  And the vomiting may have been a sign of the CHF getting worse, as the body shifts blood away from the gastro system to the heart/lungs system and brain and kidneys.  This might have caused some damage, something that can only be seen in the future.  A lack of appetite or nauseousness might mean that the gastro system is weakened.

When I met with the cardio in the afternoon before I collected Cooper, she was much less enthusiastic about his recovery.  She did not think he would recover from another incident such as this one as it was too traumatic and difficult for him; and believes the high dose of lasix may prove to be too taxing on the kidneys. She suggested that if this happens again, we euthanize him but wanted to know our wishes. I said we always opt to fight and if his breathing rate responds as quickly to lasix as it did, if he does not appear to be crashing, we would expect the ER to do as they did before we made such a decision.

She gave Cooper a new drug. He will stop taking Spironolactone and will take a combo pill of Spironolactone and Hydrocholorothiazide.  The new med has diuretic properties which use different aspects of the kidneys to extract fluid from the body.  This aids the lasix without taxing the kidneys.

Here are her notes from Monday, May 12:

"Cooper has sustained a serious relapse of congestive heart failure.  Moderator band cardiomyopathy is proving to be a much more aggressive condition than the more common forms of cardiomyopathies in cats.  We are fortunate that Cooper responded very well to the treatments provided overnight but you should still expect a difficult recovery at home.  I am hopeful that Cooper's vocalization in the car yesterday was due to distress related to his heart failure rather than a blood clot event.  If he exhibits vomiting or seems painful at home we will be concerned that he may have sustained a blood clot. There is no clear evidence of a clot during his examination at this time. Cooper's laboratory testing demonstrated a general good tolerance of treatments provided overnight, although I suspect we will see a rise in his kidney values in the near future as he cannot receive dobutamine at home (this medication improved contractility of the heart and ultimately, improved blood flow to the kidneys.) His potassium level was mildly decreased when checked this morning.  Cooper has proven that he requires more aggressive diuretic doses. He has also proven that his body can handle these aggressive doses. Nonetheless, we have reached the point at which there is very high risk for compromised kidney function and serious electrolyte depletion. I am adding a third diuretic (hydrochlorothiazide) today."

(Update Friday May 16: due to a lack of appetite and other possible side effects like nausea, she has pulled the drug. We are to continue with regular Spironolactone and see if he improves.)

Cooper in ER Sunday May 11 with Severe CHF

Here are the Facebook page posts from May 11 to May 16 in order to catch up the blog.  I will create another blog post to go over the ER and cardio notes.

Sunday, May 11:  "In ER with Cooper. (6 p.m.) He has severe CHF. Vomiting also. Restricted breathing so badly that he's breathing open mouth which he's not done before, not even Myrna. Not sure what triggered it. He may have been in the laundry room sun for too long. Sun means heat. Could be a stressor and stressors bring on congestion. Please pray for his recovery.

Coopers breathing improved from 100 to 60 bpm by the time I left at 10 pm. They were first giving intramuscular lasix then by IV. They gave buprenex for pain; nitro as a vasodilator; and other meds. He had blood and fluid coming through the nose from the lungs.  In order to decrease the fluid he was expelling and to help the lasix work faster, they picked him up and turned him over, head pointing downward. Fluid poured out of him as if from a pitcher-I was told. I've never heard of such a thing before. They never used it on Myrna."

Monday, May 12: "Good news this morning! Prayers are answered. This latest battle has been won or at least congestion has retreated. His breathing rate is 32. They did not use nitro as it wasn't needed. He responded well to the dupo drug (I'll need to get the spelling later.) It helps contractility of the heart, much like and stronger than Pimobendan, improves blood flow to the body. This helped save kidneys that were hit with lasix. They are weaning him off of that. It's not a drug for home use. Only used via IV push and for less than 48 hrs or else the body fails to react to it. He's been on it less than 12 hrs at this point. Kidney values up slightly. Creatinine up 1.4-I think and it was only 1/10 above normal. BUN is up to 40 (norm I believe is 32) when last it was 27 but his BUN was 40 when he entered the ER (so it was taxing at home on lasix pills?) but cardio vet isn't concerned and is happy that it's not much worse. She expected it to be in 100s by now. He's off oxygen. They will continue to monitor this a.m. to make sure he can breathe off oxygen. He had 1/2 liter overnight because his pulse ox-oxygen in blood (a more complex explanation will come later) was excellent. And 1/2 liter is next to nothing in oxygen support. He finally urinated what they described as a HUGE amount at 8 a.m. after holding it in for a very long time they surmise. Cardio will do echo and xrays this afternoon and I will collect him and meet with her then and do further updates. Cardio said it is possible a clot is in the heart and a piece traveled to gastro causing vomiting at home, the violent vomiting in the car, and the screaming. Also, she has seen cats scream in the ER when the breathing is so difficult that they panic and can't get a breath and don't know what to do. Oxygen therapy and pain meds eventually calm them and it did for Cooper. So, either a clot-which we are still praying it's not but the reality is he's susceptible-or it was a panic attack. Thank you all for your prayers.

Cooper's home; Cooper's resting. We were home by 4:30 p.m. but due to storms here in MI and due to the evening usual rituals, I've not had a chance to post. I will tomorrow write up everything else discussed today with the cardio. Thank you all again for your prayers. Remember-stress leads to congestion and to CHF and stress triggers can be caused by anything: heat, sun, cold, cold/damp/humid air from opened windows, storms, noise, visitors, other pets, and kids. Decrease the stress, be vigilant about counting breathing rates, and be vigilant for sudden changes, be vigilant for signs a cat's not well. Keep up with meds and med schedules and accurate dosing. Do all that you can and more. And pray. And enjoy them. Take the photos and video while they are with you. Capture those oh so cute and silly moments. And maybe blog about them. Or post to your Facebook page more often. Good luck!"

Tuesday, May 13: "Cooper's o.k. but not eating today. Breathing steadily at 8 so far. I hand fed him at 11 a.m. peanut butter and tunafish and gave 18ml of KMR by mouth (KMR is kitten formula.)"

Wednesday, May 14: "Cooper is eating on his own today. Slight diarrhea last night after all the KMR but eating solids on his own today. Breathing seems ok."

Friday, May 16:  "Cooper stopped eating last night and had diarrhea again. His breathing is still stable and seems to be at 8/15. We are hand feeding him water, club soda (bicarb-good for kidneys and boosts oxygen in blood cells) and the baby sweet potatoes I bought yesterday. He is urinating a good size so I believe his kidneys are holding up."

Potassium Necessary for Cats Taking Lasix

Aside from giving your cat potassium supplements-either by pill (we use Sundown Potassium tablets cut into chunks which can easily be given by mouth; we give four times a day to Cooper and to Myrna) or by powder (for pets or for humans. Just make sure it's safe for cats) you can also give your cat a variety of foods to boost potassium.  These foods can be mixed into the cat food, fed by hand or with a syringe, or if you're lucky, the cat will eat something out of a bowl. Here are some suggestions:

Baked potato with skin, avocados, cantaloup, eggs, chicken, applesauce, lima beans, tofu, bananas, peanut butter, and sweet potatoes.

I prepare bananas by breaking them into chunks, lying them in a freezer bag and freezing them, then taking out a chunk each day to thaw. Then I mix that into the cat food.  Myrna Loy, our HCM cat, loves peanut butter. She will lick it off the plate. Cooper will not and spits it out if hand fed.

But I recently thought to check out baby food and voila! Sweet potatoes and bananas come in easy to use jars or plastic containers. And applesauce comes in easy to use single lunch packs (and in baby food but I've chosen to buy the lunch packs so that I can eat the applesauce as well.)  These liquid versions are easily mixed into cat food and both Cooper and Myrna will eat it.  And Cooper doesn't mind being fed sweet potatoes by mouth using a syringe.

Many of these foods also are a good source of proteins, sugars, and fiber.  While cats with heart disease need to watch sodium levels, since the foods are fed in small amounts, sodium will not usually be of concern. But do compare labels.  And some cats may need to watch protein or sugar intake for other health reasons.

Not sure if they will want to try avocados.  Myrna did eat the small chunks of baked potato I mixed into her food. No one is interested in cantaloup.

Tuesday, May 6, 2014

Cooper Needs Eye Drops Again

We ended eye drops in Cooper's eyes on Thursday because the 14 treatment (for conjunctivitis) ended. He seems to be closing it again so the vet said it was fine to do another week of drops.

Friday, May 2, 2014

Cooper Develops Lesions from Injections of Lasix

Update on Cooper: he's getting a skin infection from the injections of lasix, just what Myrna Loy got last June/July (see the Cat Living with HCM FB pg and blog posts for last summer.) Luckily, for him, we're aware of what they are and are acting quickly before they develop into large, ugly infected lesions. With Myrna, we didn't know what the dry patches were and then they developed large bloody, pussy bumps (as ugly as it sounds-there are photos at the FB and blog.) We believe it might be because we ran out of the Chlorhexadine pads we wiped the skin with before injecting. We continued to inject despite not having the pads. Now he's off injections for a week until the lesions heal; on Clavamox for a week but at a low dose of 62.5 mg and not the 125mg that Myrna took last summer (which created diarrhea, made her very nauseous, and after a week, we had to stop.) And once healed, we'll try again. Meanwhile, he's on 18mg of lasix QID (four times a day.) We're monitoring his breathing and it's difficult to know when he's congested and breathing fast and when he's just breathing fast. His breathing rate is between 10-15 when it should be 6-10.
Cooper in the water pipes in the basement