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.
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.)
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.)
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