Wikipedia-Start Here to Learn More About Kidney Function

http://en.wikipedia.org/wiki/Kidney

Supplements to Use to Improve Kidney Function

We mix krill oil, COQ10, vitamin E oil, and vitamin C powder, and about 1/2 ml of water, and some Gerber Baby's First Foods Sweet Potato into a small bowl.  I syringe it into a 3ml syringe and give it by mouth to Myrna (and was to Cooper.) It did help to improve Cooper's kidney values somewhat. We will see in September if they are improving Myrna's values or not.

 We give almost 1 ml of apple cider vinegar by mouth to combat stomach acid and to help the kidneys by preventing metabolicacidosis. I mix one part vinegar and one part water or more water as needed so that the cat can tolerate it.

 I ordered this from Amazon.

 I ordered this from Amazon.

 Nature Made and Sundown supplements seem to work well for Myrna. I give her 1/2 iron three times a week.  The Sundown Potassium is inexpensive but works well. I give 1/3 of a pill to her four times a day.

 I give 1/2 a B12 twice a week.  I give 1/4 of a magnesium three times a week.

Feline Heart Patients-Heart Size Might Matter and Potassium Support in the ER May Be Key

Coopers heart left atrial went from 1.9 in May to 2.3 with Friday's echo. That's a large jump in a short time. In comparison, in March, Myrna's left atrial was 2.2. I do not have any notes on what it was in June although I do know the cardio said it was stable. She sees the cardio again in September and we'll see how things are then.

Coopers potassium level in July was 3.6-low but decent. It was about the same Friday but tanked hours later in the ER to 2.4. Perhaps a lack of potassium support in the ER (doesn't seem to be noted in chart records which I obtained unless I missed it) and not having had his daily doses of potassium pills and sweet potatoes since Thursday is the key to why the kidneys could not function well enough to get rid of congestion on Saturday. Yet he was still urinating large amounts in the ER. But something was causing the fluid to not leave his lungs. Low blood pressure-which is why he was on dopbutamine-is also a clue. I'm not sure I can solve the puzzle. Vets assume the kidneys hit a tolerance to diuretics and can do no more. But potassium support in the ER seems necessary if potassium declines.

Support Kidney Function When on Heart Meds

There is much that needs to be done to support kidney function for cats with either CKD or those on heart meds. Why wait until kidney values begin to decline? We didn't act until Cooper's values were too high. Myrna's (our HCM cat) values were high normal. So, we began giving her the same supplements. We won't know until she sees the cardio for a checkup in September if her values have improved. But Cooper's had in just a month, just not enough or other things were wrong with the kidney process.

We have always been told to support potassium levels. We gave them both Sundown potassium-a third or a half of a tab twice a day for Cooper, four chunks a day for Myrna; Cooper had Tumil K twice a day (and now she will finish the pills.) By giving the following oils, we are giving omegas and antioxidants and whatever else comes from the mix of these oils: a gel cap of Krill oil 300mg (this replaces the usually recommended cod liver oil which is no longer pure and cod is almost extinct from over fishing), COQ10 100mg, and 1/2 of 100IU vitamin E, mixed with 1ml of water. I give this orally via a syringe because neither was eating all of their food if the oil was mixed in. I put a smidge of Halo xtra C vitamin C powder (made for cats) in their food. They take 1/2 of a B12 (for energy), 1/4 magnesium (needed electrolyte and muscle/nerve help), 1/4 iron (helps to make blood cells for kidneys)-every other day (it had been every day but I was worried about hypervitaminosis but perhaps more doses could be given.) If the phosphorous level begins to creep up and is above a 4, give a phos binder. Cooper was on a phosphorous binder which binds with iron and causes constipation so I had just decreased his iron to a weekly amount.

In addition, we need to decrease protein intake a tad if kidney values are creeping up and decrease it a lot if kidney values are high. Protein in food should be 6-9% for cats needing to lower protein. Watch those treats-they have about 30% protein. With Myrna, we mix lower protein foods with her regular food and I am breaking up treats when she gets them. She gets a lot due to her litter box encouragement process. (She needs us to take her to the box, encourage her to go, and treat and praise her, and when she goes, treat and praise her again. Helps her go in the box and not have accidents.)

Some Science Diet canned cat food sold at the pet store has 6-9%. It was hard to find an over the counter, low phos cat food because the stores did not carry all of the types flavors in a brand that are produced. Fancy Feast makes pouches of broth with fish. If you buy the "Classic", it is broth. There is another version with milk which I would not use. The broth had very low protein due to it being mostly water. But when poured over his food, this broth enticed Cooper to eat. Tuna fish in a can is low in phos but may not be the best thing to give due to pollution and such. But sometimes, that was all he would eat. Or if we put some on top of his food, he would eat everything.

And finally, water. To support kidneys, the cat must take in water. If your cat gets sick and stops taking in enough water, the cat will become dehydrated and kidney function can be impaired. If the cat stops drinking enough, you can gently give liquids in a syringe or eye dropper by mouth, about 6-9mls every couple of hours.

Feline Moderator Band Cardiomyopathy-A Difficult and Often Quickly Ends a Life

From Facebook post August9:

What I want owners of cats with FMBCM to know is that the disease may end a life quickly. It's a very difficult disease due to the bands. But it is worth fighting to keep the cats healthy and alive. Torsemide is an option. Giving supplements to support the kidneys is a must: B12, magnesium, potassium, Gerber baby sweet potato added to food as a potassium source, Tumil K or Sundown Potassium; vitamin E oil mixed with 100mg of COQ10, and Krill Oil and some water-given by mouth. These improved his kidney values enough. 

But in the end, nothing was enough. Only God knows why we are given cats with a disease, why some do well and others do not, and why they are taken from us. Sometimes there are no answers there is just a responsibility and a job we need to do to help them

A Collection of Posts re: When Our Feline Moderator Band Cardiomyopathy Cat Died in August

(August 8, 2014)  Cooper had to go to the ER just after midnight.  Cooper is responding well to oxygen and lasix. Cardiologist will see him later and we will know more about his condition then. He has Feline Moderator Band cardiomyopathy. Similar to Myrna's HCM-different physically-but produces similar symptoms and he takes almost the same meds.

(August 9, 2014)  [When he left the cardiologist office, the cardiologist said he was stable, a bit congested but she expected him to respond well to Torsemide and to recover in the next few days at home. But he never really came home again except for a couple of minutes before we were off to the local ER again.)  Tried to bring Cooper home but he began not to breathe on the way home. He was stable and clear when released. But he began breathing fast in the car ride home. He was drooling, open mouth and rapid breathing. He's at the local ER because he is in too serious a condition to make an hour return trip. The cardio had expected him to recover at home this weekend and to maybe bounce back some. But not practically crash the minute he left the vet's.

Update: at 10 p.m. he was breathing 36 per minute but with effort and is unable to breathe outside of oxygen tent. Cardio called and instructed them on lasix injections and a protocol (We have the BEST cardio!) But there is the concern that he's not bouncing back and had such a sudden recurrence shortly after leaving the ER earlier today after having been in there for 14 hours and doing well at discharge. We are praying for his recovery.

Remember the holistic medicine discussion about a couple months ago? I don't believe in replacing effective heart meds with plants and powders. It takes too much plant and powder to decrease symptoms, improve the heart. And they are costly. BUT I do believe in supplements to support the heart and the body. We do need vitamins and minerals, especially our cats that are on diuretics and heart meds. So, the only good news about Cooper today was that due to the supplements I give him, his kidney values have improved. Good, because after two days of high doses of diuretics, his kidneys will take a hit. I give him Krill oil 300mg, COQ10 100mg, and 1/2 of 100IU vitamin E, mixed with 1ml of water. I give this orally via a syringe. I put a smidge of Halo xtra C vitamin C powder (made for cats) in their food. They take 1/2 of a B12, 1/4 magnesium, 1/4 iron-every other day and once a day, and never all on the same day or time. We've done this for a month (but he's on a phosphorous binder and it binds with iron and causes constipation which is why he gets only a small amount.) A month ago BUN was 115, now 105. Creatinine was 6.6, now 6.0. Phos was 9.6, now 6.6. He has been urinating larger amounts lately which is a good sign of kidneys concentrating urine-producing it. Great! Now if only he could breathe.

Update Cooper: still in ER, being weaned off meds and oxygen. Will be a few more hours before he's ready to leave and then he'll come home and we'll monitor and see how he does. But he's breathing well on his own. The cardio is reviewing via email the xrays (modern technology!) and talking to the ER as needed. The new a.m. doc was surprised that Cooper is normally on a high level of diuretics-a combination of torsemide and spironolactone (the actual diuretic is torsemide with spironolactone playing a minor supporting role while it also preserves potassium.) They have been treating his congestion with low levels of lasix injections so I've asked the cardio to review his diuretic ER needs. They need to not only treat what they see but maintain a therapeutic dose to stay ahead of, to prevent congestion-something the ER doesn't normally do because they treat only what they see. So, if he's free of congestion now, they think he doesn't need more lasix. But he does. So, I'm running over his torsemide and regular meds.

Cooper still has a foggy X-ray. Lasix injection at noon and four, new X-ray at four to see how he is and then home. If he crashes, off to Novi. But we'll know the time between being almost clear at four and the next CHF incident, which will tell us if he's able to overcome congestion or not; if we are aggressive at home can we help him or not; or is he unable to recover.

At 12, the ER vet gave a lasix injection,expecting Cooper to respond well and to be able to come home at four. He had been on dobutamine which helps the heart pump blood better, allowing the blood to go to the kidneys better, allowing the kidneys to use the lasix to work better as a diuretic. He was weaned from this by noon.

At four, the xrays showed he was again in CHF because he was no longer on dobutamine. In consultation with the cardio, we could keep him on dobutamine for 48 hrs (max one time dose is 48 hrs and then the body hits a tolerance) and he would get lasix (dobutamine is only an IV drip drug and not one given at home). But she thought this wouldn't work well in the long run, that it showed his kidneys-while he was concentrating urine and going huge amounts-was in some way compromised enough that after the dobutamine, he would again not be able to process lasix or torsemide and would again go into CHF. This meant that it was time to put him to sleep.

We went to the ER at 5p.m. and spent time with him. They brought him into a room where he walked around, cried, wanted to be petted, wanted out. After about ten minutes, he began breathing hard. After a few more minutes, we knew it was time.  He was put to sleep at 6 p.m. The vet gave a sedative which Cooper fought and cried over.. Then there was another sedative that made him vomit up white foam and which made him more anxious. Then the vet gave the drug that stopped the heart. 

We chose to donate his heart and kidneys for research to Michigan State University vet school. We have a clay paw print. We chose to bury him.

We can't believe he's gone so quickly when he was just fine the other day. We can't believe he didn't bounce back and come home for a bit longer. We don't understand why and yet I know why but then don't know why. His heart is larger than it was in May. His kidney values were bad but had improved and he had in the last two weeks due to supplements, gone back to urinating large amounts. The ER vet was surprised he was on such large doses of diuretic and yet doing so well. The cardio said he's lived longer with kidney values and a bad heart of his sort than she has seen in her practice. He was the rare cat to take and to need a powerful diuretic torsemide. But as "fine" as he was, he's needed extra torsemide and a couple lasix injections at home since his last CHF in May. So, it wasn't all perfectly working. We struggled since early July to get enough food and nourishment into him and he had lost a pound since May. And still he held on and even fought our attempts to put him to sleep. 

Feeding a Sick Cat That Won't Eat

From July 9 Facebook post about trying to get Cooper to eat when he wasn't eating:

Has anyone fed sweetened condensed milk to a cat reluctant to eat or that needed nutritional support? I gave some to Cooper and he liked it. (DO NOT feed sweetened condensed milk or any form of milk to kittens under the age of about six months at all and never to kittens to replace a missing nursing mother or aid the nursing mother. Use kitten formula KMR from pet stores. Milk products might be tolerated by those six months and older but only if they need nutritional support. A cat of a year or older shouldn't have milk on a regular basis due to stomach/diarrhea issues.) The math: one serving is 2 tablespoons. In 2tb are 110 calories, 55 mg of sodium, about 140mg of potassium, 20g of sugar, and some iron, calcium, and vitamins-if I calculated correctly. I mixed 1tb scm with 2tb of water. So, per 3ml syringe serving, the amounts above are greatly reduced if 3ml is one serving. If your cat isn't diabetic, and doesn't need to avoid the sugar for any other reason, it's a good energy source. Sodium might be a bit much but it comes out to 7mg in a 3ml serving (the syringe size we use.) There are six calories in a 3ml syringe. We are counting every calories Cooper is eating. Since his kidney values are now high, we tried reducing the Torsemide and found we could not. He needed extra and it came out to 2.5 QID regardless. He was fine before he went to the vet Saturday for a blood draw and once we found his values were high, and we reduced his Torsemide, he began to stop eating as much and then wouldn't eat on Monday. We had to cut back the Torsemide but again, later, had to give more. Tuesday he got the appetite stimulant Mirtazapine which helped. He's eating small amounts but is not ravenous. His breathing rate was up this morning to 12 and then 10 after his 7:30 Torsemide dose. It was still 10 at 11:30 so I moved up his lunch med to that time and gave him 2.5 and not 1.25 Torsemide. He was breathing well at 8 by 2 p.m. I created a chart to track fluids we give by mouth, calories given, calories eaten. Daily goal is 90 cals a meal. Yesterday, he ate a total of 135 calories by the end of the day. Today, after lunch, he's about 135 calories, slight improvement. He's not drinking enough on his own so our goal is 72ml of fluids by mouth to support his kidneys. And that is water, club soda, KMR, sweetened condensed milk, and sweet potato liquid baby food that is included in the total. We are surprised and perplexed by the sudden increase in kidney values and sudden decrease in eating. He was fine until Monday. But that is how it goes, says the vet. One day the cat is fine, with 69% of kidney function lost but no outward sign of it and then the next day the cat hits the 70% loss and then all manner of issues and symptoms appear.

Cooper Doing Well on Torsemide

The cardio vet office was closed all last week because the entire office-two cardios and three techs, went to a conference. I was full of trepidation, fearing something would happen with my two cardio patients but we survived the week. Cooper's doing well on torsemide.   Breathing steadily at 8. 

Myrna's needed extra lasix almost every day this week, due I believe to the noise from the a/c and fans. 

She has also begun to have accidents out of the box, so far on the pads near boxes. It could be due to the extra lasix and the extra need to go. Urgency can make them uncomfortable. Usually it requires an adjustment with potassium (she may be too alkali) or a Valium adjustment, and may need Methigel, an acidifier. For the days I do this, she uses the box. When I skip one of these adjustments, she goes out of the box. She sees the cardio Thursday and at that time we'll do a urine test. I doubt she has a UTI because the classical symptoms are not there: going very frequently and very small amounts. But I will keep an eye on her and if I suspect she has a UTI, she'll go to the vet.

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. 

Feline Heart Meds Website Information

http://www.fvmace.org/FVMA_83rd_Annual_Conference/Proceedings/WHAT'S%20NEW%20IN%20MANAGEMENT%20OF%20CHF.html

http://bigheartsfund.org/resources/cardiac-medications/

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.

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.)

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.

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.

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

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.

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

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.

Cooper

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

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

Notes on Cooper's Vet Visit for Moderator Band Cardiomyopathy

Here are the notes from Friday's cardiology echo:

Note-he has a thickened left vent wall asymmetrically thickened.

"Cooper's recurrent respiratory symptoms are due to a relapse of congestive heart failure. This rapid recurrence of heart failure is particularly concerning given the fact that Cooper has been receiving doses of cardiac medications that are typically very effective in initial management of the condition.  This raises concerns that Cooper's heart disease is more aggressive than the average patient.  A repeat echocardiogram was performed and the images were clearer because Cooper's heart rate was not as rapid as during his initial echocardiogram last week.  The echocardiogram revealed numerous moderator bands in his left ventricle and mild weakening of cardiac muscle strength (contraction).  The area that I was previously concerned may be a clot within the left ventricle is actually a network of moderator bands.  These echocardiographic findings are more typical of moderator band cardiomyopathy rather than hypertrophic cardiomyopathy.  Moderator band cardiomyopathy is a rare condition and there is little information regarding its natural history.  There is no known cause of the condition.   Cooper was hospitalized and was treated with oxygen therapy, lasix injections and oral medications (spironolacone, vetmedin, and plavix) to manage his heart disease and stabilize his heart failure.  Repeat radiographs this morning revealed almost complete improvement of the congestion in his lungs.  I expect his congestion to fully resolve after the last injection of lasix that he received today at noon.  He has proven that he requires higher than typical doses of diuretic to manage his heart failure.  This comes with a risk of dehydration and adverse effects on the kidneys.  Considering he has such a rare cardiac condition that has already proven to be somewhat resistant to traditional pharmacologic therapy, I feel that Cooper is a prime candidate for consultation on alternative treatments

Cooper

. (Holistic-there is a local vet she recommended.)