Oxygen Therapy-When in CHF and at the Vet-How to Restore Oxygen Levels and Why

When your cat is in CHF-congestive heart failure-or has any other illness or issue, the cat likely will need oxygen therapy. When in CHF, oxygen and injected lasix at the vet/vet ER works fast to restore the cat. HCM depletes oxygen over time especially with CHF (read previous posts for explanations.) A body depleted of oxygen isn't just weak but isn't functioning well at all. Read this link for more information on the necessity of oxygen therapy.

https://bluepearlvet.com/library-articles/cardiology/oxygen-delivery-methods/

Lethargy Causes and Solutions

Let's review possible causes of lethargy, when it is common and when it is not common and the cat should see the vet.

Lethargy can be due to the difficulty of HCM-difficulty getting oxygen to the body from the lungs into the blood stream when the heart cannot pump enough blood due to swelling and heart failure.

Lethargy is also due to a lack of electrolytes-a lack of potassium, sodium, glucose, magnesium, potassium, calcium, phosphate, chloride, and bicarb-caused by the necessary use of diuretics which, when pulling fluid from the body, takes the electrolytes with the fluid. Low electrolytes leads to low heart rate, low blood pressure, a lack of what makes the heart beat and the kidneys work, etc. This makes one feel weak and faint. A cat owner can supplement electrolytes by giving the cat a potassium supplement (Renal K powder or gel, or human potassium pills such as Nature Made or Sundown), or some mashed banana or sweet potato-or baby food banana or sweet potato-and by giving sweetened condensed milk or corn syrup 1/8 tsp cut with 2 oz of water, added to food or fed by mouth a couple times a day. Sodium should not be given unless a cat has been vomiting or had diarrhea a few times a day for more than two days.

Lethargy is due to dehydration, caused by the necessity of diuretics. Dehydration lowers the heart rate and blood pressure, making one feel weak and faint. A cat owner can give water by mouth using a 3ml syringe (gently give 9mls or more this way), by adding it to wet food, and by providing many bowls of fresh water to encourage intake of fluid.

Lethargy can be caused by the use of medications for heart disease. These meds lower the heart rate and blood pressure in order to help the heart and may make one feel weak and faint. The cat may need time to get used to the meds but a cat owner can discuss the possibility of adjusting meds with the vet.

Lethargy can be caused by any number of issues or complications of heart disease, especially CHF-congestive heart failure-or the buildup of fluid in or around the lungs, making breathing difficult and painful.

Lethargy can be caused by any procedure or vet visit that has worn the cat out. The cat may take a day or two to recover but should be eating enough and using the litter box.

Lethargy can be caused by a lack of intake of food-a lack of nutrients and electrolytes found in foods. If a cat is not eating enough, hand feeding may be necessary. Hills AD is a good choice. It's high in calories and blends well with little water, and can easily be syringed up into a 3ml syringe and fed by mouth to the cat. Stimulants can also be used. Cyproheptadine, an antihistamine, increases appetite but does not wind up a cat. 1/4 tab once a day may be enough to help the cat eat enough. Mirtazapine is another stimulant which I use when the cat is terribly ill and cypro is not strong enough to spur eating. 1/4 of a tab once or twice a day may be needed. Further hand feeding may be necessary if the cat is very run down. Try using baby sweet potato for potassium, corn syrup in water for glucose, protein from tuna juice or homemade beef/chicken broth (plain-no salt or spices) or peanut butter are good protein choices. These should be fed a few times a day, giving the cat about 9-15mls at each feeding.

Whenever your HCM cat is lethargic, note it in your notebook; track what the cat eats, if the cat is moving about; track when the cat had meds and if you hand fed. Then if the cat is not improved after a day, take the cat to the vet and review your notes with the vet. Have the cat examined and blood work drawn to test for electrolyte levels, dehydration, kidney and liver values, and overall health.

Fluid In the Cat's Heart-Pericardial Effusion

What about fluid in the heart? That is known as pericardial effusion, caused by pericarditis, which is an inflammation of the pericardium, a double-layered membrane sac that surrounds the heart. This is NOT the same as CHF but it can lead to CHF. Pericardial effusion affects the right side of the heart more, compressing and restricting, and damaging the heart. The lower heart rate means the heart cannot be strong enough to pump fluid in and out, leading to the fluid backing into the lungs causing CHF. Fluid retention throughout the body typically follows ascites, swelling of the limbs, and weakness or collapse. While PE is possible, it is not always present or the cause of CHF in a typical pet.

Symptoms include those for any HCM issue or other disease:

Lethargy
Vomiting
Anorexia
Pale gums
Abdominal distention
Exercise intolerance
Fainting or collapse
Respiratory distress
Increased breathing rate and/or increased heart beat rat

Fluid IN the Lungs, Fluid Around the Lungs, and Chylothorax

Let's discuss congestion or CHF a bit more. Fluid in the body is comprised of fluid-water from food and drinking, things digested that the body breaks down, and blood. HCM, which is the enlarging of the heart valves, can lead to fluid build up in the lungs, known as CHF-congestive heart failure. The heart is unable to handle the fluid in the body, is unable to pump it out or take it all into the valves. The leftover fluid then backs up into the lungs. This is called pulmonary edema. When the drainage system in the body goes awry-various reason due to heart disease:

Increased hydrostatic pressure as a result of congestive heart failure (CHF)
Hypoalbuminemia (low levels of protein in the blood)
Changes in blood vessels-hey become "leaky"
Obstruction of lymphatic drainage/abnormal lymphatic function
Chylothorax (accumulation of chyle, a lymphatic fluid that originates in the intestines and has a high concentration of fat).
Diaphragmatic hernia
Hemothorax (bleeding into the pleural space)
Pulmonary thromboembolism (a blood clot in the lungs)
Bacterial, viral or fungal infection of the lungs
Cancer

-fluid can gather outside the lungs in the area between the lungs and chest, called the pleural sac, leading to pleural effusion. Regardless where is the fluid in or around the lungs, a diuretic is necessary to get rid of congestion. BUT fluid in the pleural sac can be drained if the diuretic is not working effectively. However, the necessity to drain the lungs often damages the lungs over time, creating pockets from the needle where fluid can gather and not be reached by draining, making breathing difficult and CHF still likely. Increasing the diuretic dosage is often necessary to further fight CHF.

It is possible for HCM cats, with advanced heart disease, to have the thoracic system fail and allow the buildup of chylothorax, a fatty white fluid that builds up in the pleural sac, causing CHF. This is an added complication and almost impossible to fight. It must be drained with a needle. Myrna developed this the last year of her life and lived 8 months with it. We had fluid drained every other week, increased the lasix, changed the diuretic to a harder one called Torsemide, and tried a supplement called Rutin which is supposed to help. Either she needed more or it wasn't working but it did not seem to end the chylothorax. A low fat diet is recommended also for this condition but I'm not sure what foods are low in fat; we didn't try that with Myrna. Chylothorax further damages the lungs because it is a caustic substance. You can read more here: https://vcahospitals.com/know-your-pet/chylothorax-in-cats
Chylothorax and the necessity to constantly drain the lungs due to pleural effusion, can lead to death-damage to the lungs and increased CHF; and because it is a sign of the heart system failing. Myrna lived eight months with pleural effusion/chylothorax which surprised her cardiologist and the vet hospital where we took her for her necropsy (animal autopsy.)

Overall Primer on Cats and HCM

From a discussion with a reader and a good reminder for us all:

Your cat will need to see a cardiologist and you will depend on the cardio for guidance about most of the regular care of the cat. Shots, other wellness issues-the regular vet. But you'll need to coordinate care between the two. Always have copies of cardio visit sent to vet; and regular vet info sent to cardio. The cardio should be consulted before any annual shots are given to make sure he's up to it. The cardio should be consulted for any contraindications with any other meds the regular vet wants to give. The regular vet needs to know how is the cat doing and what meds the cat is on from the cardio and what issues to look for.

*DO NOT allow your cat to be given steroids at any time-pill, injection, or asthma meds as these cause complications with heart disease cats. They retain fluid and that is not what the cat needs. For all other issues, stick only to antibiotics. If desperately needed for an illness, must consult with cardio first.

Keep copies of all visits and test results. You'll need to refer to them, be up to date, for all visits with any vet. Keep a notebook about how your cat is doing and any issues or concerns you need to address with the vet.

Get organized for cat care. File box, files, pill cutter, pill containers, frig boxes on counter or in frig or pantry to contain meds, supplies, supplements, pills, etc. will make care faster and more organized space wise. Nothing rolling around and bouncing around. And that will keep you calmer. As your needs grow for more things for the cat, so will your need to organize it. Find what works for you.

Did he have an echo? That is the only sure way to tell if and what type of heart disease he has and how it is progressing. He should have one every 3-5 months depending on how he is doing; is he seeing an actual cardiologist? He should as that is the expert. He'll need an echo every time he ends up in the ER.

He should have blood work done every 3 or so months and always before he sees the cardiologist so that the cardio knows how the body is responding to heart meds.

Meds-Atenolol is a beta blocker to lower heart rate and to help lower blood pressure. He should have only about a 1/4 tab a day. Maybe later twice a day as the disease and heart worsen. Too much, and the rate is too low, he will be weak. Plavix-only needs 1/4 pill once a day. Maybe later twice a day. And maybe later also add in aspirin. (Aspirin is difficult as cats do not tolerate it well. But you'll use a buffered 80 mg every three days and no more often than that. It might cause gastro upset but in progressive HCM adding aspirin can be beneficial to preventing clots along with Plavix. We gave it on Wednesdays and Saturdays.) He should also be on Enalapril, an ACE inhibitor. It helps to reduce body's retention of sodium, therefore of water; and it keeps veins opened in case of a heart attack. There are other drugs he may need: Sprionolactone-a mild diuretic that helps save potassium; Isosorbide-to lower blood pressure but it changes the load on the heart (I can't recall exactly how it works, only know that Myrna was on it late in life.) There are other diuretics such as Torsemide to use later if needed.

The major med to use is a diuretic like lasix/furosemide. Talk to your vet now about getting this. A daily maintenance dose of 5mg will keep away congestion. Congestion in the lungs is an inability to breathe and get oxygen to the brain/body, making one weak. It is also painful as it feels as if one is drowning. It's not simply a cold as we think of it for humans. As congestion pops up, he'll need more of a dosage and more often during the day. The amount and number of doses will increase as the need increases.

You are treating not only the heart but the entire body. The heart disease will effect his liver and kidneys. Meds will also. You must be aware of needs for the entire body. He will need a good overall cat vitamin paste. He will need extra potassium when on lasix. We use Renal K gel and powder. As the disease progressed for Myrna, I also used Sundown potassium pills. She was near the end on mega doses of potassium. I also gave her kidney support goop and how I administered it changed over time. First, in her food; then she needed it by mouth via a syringe. I mixed up COQ10, vitamin C, E, Renal K powder, etc. with baby sweet potato (source of potassium) in a small dish, and gave her 3ml 2-3 times a day as the disease progressed. Then I added Nature Made iron pills cut into halves and gave them by mouth about twice a day. Iron is necessary for the production of red cells which the kidneys need. It was complicated because it caused gastro upset and I had to adjust the dose as needed. But her kidney values remained stable for the last year of her life after increasing. You can read more about it at the blog under the Med tab.

As the lasix works to get rid of fluid, the cat will drink a lot of water. The cat will at times become dehydrated. You must keep up the hydration. Lots of water bowls, add water to wet food, more wet food than dry. While the heart does not need liquid, the body does. It seems contrary but water is necessary for the overall health and particularly kidney function. As the lasix works, electrolytes will become depleted. That's why you will need the extra potassium. If the cat is not eating well, he will need some extra glucose. The cat won't need extra sodium and does not really need a salt free diet as the lasix is already getting rid of salt. But do cut back on treats and avoid crackers/chips, and table foods.

There may be times he won't eat and you'll need to feed by hand. That can be discussed later but you can read about it at the blog. I have many tricks and methods to suggest.

Learn to monitor the cat and how it is breathing and walking. If you see the cat lethargic, not interested in getting up or eating, go to the vet or cardio. If the cat has cold paws front OR back, go to the cardio or vet ER immediately. If the cat is lame, dragging a leg or legs, or is falling over, go to the vet ER or cardio immediately. If the cat vomits a lot and doesn't get up, go to the vet ER or regular vet immediately. If the cat is laying down and breathing hard and doesn't get up, the cat could be in CHF-congestive heart failure, or having a heart attack. Go to the vet ER or cardio immediately for care. If the cat isn't eating, but seems fine, skip the vet for now and read in the blog how to feed and what to feed by hand.

Learn to count the breathing to monitor for CHF or other heart issues-one up and down chest movement is one count. How many of those in 15 seconds? 6-10 is fine. 12 or more and the cat may need the ER. A cat's breathing fluctuates during any given time from really slow to really fast. But sustained, heavy breathing-not panting, not opened mouth-is an indication that something is wrong. Count the breaths and if you think it's high, count again after a few minutes of the cat being still. If you have a diuretic that you are giving, and you think it's breathing fast, give an extra 2-5mg of diuretic and see if the cat responds within an hour. If the cat does, then he's in CHF but responding and you can give more 2-5mg of extra lasix in four hours. But if the cat seems really bad off, meds also don't help, then rush him to the vet ER or cardio for oxygen and injected lasix and monitoring.

Find the closest cardio, regular vet, and one or two dependable ER or 24/7 animal hospital to have on hand to go to anytime you need the vet.

You can order a lot of supplements at Amazon, Entirely Pet, 1800PetMeds. Sundown potassium and Nature Made products are at the local stores. But shop for lowest prices-Kroger often has buy one/one free; Target has low prices.

And as for the meds, these should be available at the local human pharmacy. They are often cheaper than those from the vet. Kroger and Target had $4.00 generics and have lower prices on many of the meds you are using. Shop around as things change. Avoid Walgreens/CVS which are expensive.

There is a lot of information at the blog in tabs, categories, and as a word search you might find helpful.

But please do continue to feel free to discuss your cat with me and how you are doing. I'm here to help.

Good luck!

Steroids for IBD-Katharine Doing Better

Katharine seems to be doing better on a longer course of steroids. We did ten days of two; then five of one; then every other day of one; now every other day of 1/2 for five days; then we will do 1/4 every three days until the supply runs out. Meanwhile, despite less steroids, she is eating well. The first time this summer when we did steroids for IBD, she didn't eat as much as soon as we stopped giving the med twice a day; and then stopped altogether when we finished the course. And she's gained weight-back on a diet! She's 11.6 up from 10 lbs in June.

Baby Develops UTI; Katharine Update

Baby-who was perfectly fine this weekend and earlier this week-suddenly developed a UTI. Now on antibiotics and was on a touch more pain med than what she receives daily. She typically receives .15 Buprenex to prevent inflammation and the sudden onset of cystitis. She went to the vet yesterday and three hours after a course of antibiotics, she was already improving. It began Tuesday night when she had trouble passing urine and a bowel movement. Not sure which came first but she tried to do both for a few hours. I gave her more pain med at bedtime (she receives .15 BID-twice a day) and this calmed her down and made things less urgent. But she was still having trouble passing either. I got up with her twice in the middle of the night and scooped the litter box which had many dime size amounts of urine and some fecal matter. Eventually, she produced a half dollar size urine but paper thin in the litter. Today, she is back to large balls of litter (we use clumping litter.) She is on antibiotics for a week. Will retest urine in two.

The vet gave sub q fluids-necessary to help hydrate the body, fill the bladder to help flush out bacteria and crystals (if present); did a CBC/chem panel-all is well; and gave the antibiotics Zeniquin and a probiotic pill Proviable.

Katharine is doing well on steroids for IBD and is eating well on her own. We'll see how she does as we titrate down the dose.

Vitamin D for a Sick Cat; Too Much May Be Toxic-Proceed With Caution

The vet recommended a vitamin D blood test (last week during the scan) and the result came back that the level is very low. She recommends a supplement. PROBLEMS: too much and it's toxic. Giving too much of a supplement and causing toxicity would be easy since cats do not need that much vitamin D to increase their levels unless they were not eating or absorbing nutrients. In Katharine's case, she has IBD so her body was not absorbing nutrients effectively. She also was not eating well and not at all a few days prior to the test (although we were hand feeding her.) So, her level may have been temporarily low anyway. We will try it for a few days-next week as the vet needs to order it. I will give very little and we will retest her level in a month. She's eating better on her own so I'm expecting the level to improve.

Here's an article about vitamin D and cats. 

Katharine Struggles to Eat on Liquid Phenobarbital-Trip to Vet for Scan and Meds

Katharine update since 7/11: she had been eating well enough once I cut a small amount off of the phenobarbital pill half that she received in the morning. She ate well enough for a week. We had to hand feed in the evening but she did eat some in the evening. She had not lost weight during this time. But then 7/13, we switched to liquid pheno. Since I couldn't accurately cut the pills in half (not scored, easily fell apart) I never knew how much more or less of 7.5mg per dose she actually received. The liquid version was supposed to help us figure this out, titrate down as needed, and track efficacy. But she immediately lost her appetite. The script was 7.5mg/1ml-one dose was one ML liquid pheno. To decrease the dose, I began giving her .95, then .90, then .85, then .80. She would not eat. We had to keep hand feeding her. The goal was 150 calories a day which was difficult to do just because it required multiple feedings of 21 ml or more per feeding. Each ml was approx. one calorie.

Her gastro scan was already scheduled and that was this past Thursday. She's fine. No liver damage or disease; still no pancreatitis. But her small intestine, the mucosa, is a bit more thickened since May's scan. They suspect IBD-irritable bowel syndrome-because all blood work is normal, and there are no signs of disease or cancer. She is to ONLY eat hypo food-rabbit, venison, duck-and NO fish based foods. She is on steroids for a few weeks (which are tapered down over time.) She received a B12 shot and will receive them every 2 weeks until late August. (They sent the supplies home, expecting me to administer the shot since I learned how to give shots sub q when I had to inject lasix into Myrna. I declined to do this with KH and will take her back to the vet for each shot. I'm not up to it frankly and since it's not life saving such as lasix, it's not something I MUST do.) While she could take by mouth, vitamin B12, since she has IBD, she may not absorb the needed amount, so hence the shots. They also tested her vitamin D levels which-just like with humans-if low, creates all sorts of issues (I have been low on iron and vitamin D and both caused the same symptoms for me: muscle aches and weakness, inability to breathe/move, feeling as if a major disease is attacking your nerves, etc. I take supplements for both.)

I also switched back to pheno pills in case the liquid version has put off her appetite. By shaving a bit off the end, she returned to eating-but after beginning steroids (which can increase appetite) and receiving the B12 shot. She's not eating enough and we continue to hand feed as necessary. She has lost 3 oz. since last week and is down to a bony 10 lbs. So, we must make sure she reaches her caloric daily goals. We will try the pills for a few days, then switch back to the liquid version and see how she responds. If she looses her appetite again, then I'll have the pharmacy redo the formula.

Cure for Cat Car Sickness/Vomiting in the Car

Solution to no vomiting on the way to the vet: I finally hit on a plan to prevent Roxanne from vomiting in the car on the way to the vet. And I don't know why I didn't think of part of the solution beforehand. She vomits in the car regardless of duration of trip or if I give her Cerenia before we leave. So, it occurred to me today that perhaps if she ate very little in the morning and didn't eat at all for two hours before departure, that she wouldn't have food in her stomach to vomit. AND since giving Katharine Pepcid to stop stomach acid, I thought I would give it to Rox to see if that helped. Perhaps nerves creates acid; perhaps acid creates nausea; and nausea leads to vomiting. I gave Pepcid yesterday and this morning and 1/8 more before we left. I gave Cerenia before we left. And it worked. She only vomited up some foam. But she was calm on the way there and while there.

She saw the cardiologist today and all is well. No disease signs at all. So, she does not need to return annually. I will take her back if she needs dental or other surgery (which I hope we avoid) or if there are signs or other illnesses that require a full check-up.

Katharine's Appetite Improves with Less Phenobarbital

Today Katharine ate on her own all day long. And she has eaten nothing but AD in a bowl. And she demanded food every hour. By 3 p.m. she had had 115 calories. We weighed her last night and she's at 10.4, up one ounce from 7/3. So,no weight loss which is good. And maybe she only needs about 165 calories a day. She hasn't eaten since 3 and may need hand feeding a bit or maybe she'll eat again on her own. But titrating down the pheno seems to help her eat.

We had her pheno compounded but I think the vet got the script wrong. I'll call the pharmacist tomorrow first. We want to titrate down one dose and make the evening dose a regular 7.5mg dose. She receives a total of 15mg a day. The script compounded says 7.5mg/1ml-7.5mg is in one ML of concentration. That means one dose is 1ml which is a lot to syringe up and try to give her. That also means the TOTAL for the day is 2ml. If it were 15mg/1ml then I could easily give .5ml per dose and titrate down as needed. I need to use a syringe with hundredths measurements which I have but which is hard to read accurately and we are aiming for accuracy. We need to give the exact dose each time so that we can see how it affects her appetite as well as monitor for efficacy for seizure control. This should be more accurate than trying to cut pills that are not scored and that shatter easily.

However, the really confusing part is the script label says to give .9ml per dose. That would only be 13mg total instead of 15mg (.9+.9=1.80ml instead of 2ml.) That would really decrease her pheno which might be dangerous.

Hand Feeding Technique

Katharine isn't eating enough on her own so we are still hand feeding her. Saturday and today, she ate well throughout the morning and afternoon but then slowed down and then wouldn't eat at all. We are counting calories and on her own, she'll consume 100 in eight hours. She needs another 65-80 or more. So, we are supplementing.

Here are photos that somewhat show my towel technique to calm and contain her while I hand feed her. The towel is draped over her chest, under the neck, and the ends wrapped snuggly over her back. I hold the ends at her neck as if I'm holding her at the scruff. I hold the towel in one hand and syringe feed with the other. (No photo yet for that.)

Phenobarbital Adjusted to Help Cat Eat

Katharine is finally eating on her own. Not much but it is a start. She ate 1 tb of tuna and 1 tb of Hill's Venison for about 20 calories. And I had given her about 5ml of AD earlier. So, she's had 25 cals. this a.m. We will hand feed as necessary to get her up to 160-180 calories a day. But we will offer food every hour and a half to try to get her to eat on her own.

What might be helping-aside from finally getting up to about 165 calories yesterday which made her feel better-is that I shaved a corner off of Katharine's phenobarbital this a.m. And we decreased it a touch last night.

How did we know she wanted to eat on her own? After I had prepared breakfast for all of the cats, Katharine and the rest came into the kitchen, crying for food. Katharine has only sniffed the food for the last couple of days and acted as if she wanted to eat but never ate, and never cried for food. But today, when she cried for the food, we hoped that she would actually eat and she did. She took almost 15 minutes to eat but she ate almost all of it.

We weighed her last night and she weighs as much as she did Tuesday-10.3. So, no weight loss since Tuesday despite hand feeding, and despite not getting more into her than maybe 50 or so calories per day the first couple of days.

I will try to take photos of my feeding technique and post. She originally kept moving her head and refusing to take the food. And as it was liquid (AD with water), it flew everywhere. I tried draping a hand towel over her front like a bib but she was too difficult to hold that way. Finally, I wrapped her up in the kitchen hand towel and held the towel securely, tightly (but not too tightly) at the neck. This seemed to calm her. Maybe it felt as if I had grabbed her at the scruff of the neck as if she were a kitten. And the towel contained her body. She stopped shaking the food off and with minimal head movement, took in the food. This allowed us to feed her 18 or more mls (of 3ml syringe) at a time and allowed us to get 99% of it in instead of 40%.

I think I'll have the phenobarbital compounded so that I can better regulate how much she actually receives. The pills are not scored so are hard to accurately cut. Shaving off the corner of one dose, and the corner of another only helps if the halves are the same size but they are not. The pills cut unevenly. And maybe we'll add Kepra. I'll have to talk to the vet on Monday.

Phenobarbital and Kepra for Katharine

We will slightly decrease Katharine's phenobarbital in hope that it will be enough to restore her appetite. We can only wean over a matter of weeks, not days, unlike with steroids. Meanwhile, we might add Kepra, another seizure med, other wise known as Levetiracetam (the pronunciation of which sounds as if someone is HAVING a seizure.)

Today, we successfully fed her an entire can of AD by mouth, a total of approximately 186ml of water and AD. She finally perked up by 6 p.m. I'm assuming that it was about that time that she had had enough calories to make her feel better. We will need to push more food faster so that she feels better sooner. We are waiting for her to eat on her own. I do not want to try stimulants yet until she is eating on her own. The mirtazapine did not work for her the other day when she was not eating on her own.

Katharine-NO Pancreatitis but Still Struggling

Update on Katharine: NO pancreatitis. PPL came in at .09. Reference range is 0-3.5 for normal pancreas. Reference range increases up to 5.4 for severity. Despite calls to the neurologist from the vet and myself, they have yet to respond. So, we continue to give the med that may be causing her to be sick-phenobarbital. It is a drug that cannot be stopped. It must be weaned. But it also needs to be replaced with something else to keep seizures at bay.

We are hand feeding her. 3ml of baby food sweet potato now once a day just in case she might get diarrhea. It's also a good source of potassium-much needed since she's not eating; much needed by the body as it regulates the heart beat (ions of sodium, calcium, potassium cause the heart to beat;) and potassium is much needed for the kidneys to function.

We are also hand feeding her 186ml of a 5.5 oz can of AD (162.5ml) mixed with 24ml of water, using a 3ml syringe. That comes out to 62 syringes of food. If we do ten feedings of six syringes, we can get about 186 calories into her. So far, she's keeping it down. The Pepcid has taken care of the stomach acid we saw Tuesday and Wednesday.

She is not yet eating on her own but is sniffing food. We gave her tuna today and elevated it by using a large bowl inverted to create a stand. Elevating the food helps because a cat that is sick or has stomach acid will experience it more if they bend over to eat their food. Elevating it allows the food to be more a standing height for the cat, hopefully avoiding any stomach acid or reflux.

Here is an article from IDEXX about pancreatitis. It's a very good discussion paper.

http://www.idexx.de/pdf/de_de/smallanimal/education/client-education/feline_pancreatitis_roundtable_discussion_us.pdf

Katharine Not Eating-Due to Phenobarbital?

A cat that is not eating well enough or at all is creating a dangerous situation, a domino effect where the body lacks nutrients and fluids and goes into steep decline. Too many people think that it is ok to not let a cat eat enough or to skip a few days due to the false belief that the cat is just being finicky. A cat can be finicky but if a cat cries for food but won't eat; sniffs the food but won't eat; does not come for food at meal times; even takes a bite or two and leaves and never eats again that day, then it is a cat that is likely ill-not finicky. The lack of eating must be addressed immediately with the use of supplementation (feeding protein and liquids by mouth) and with medication to stimulate the appetite (Mirtazapine for example.)

Katharine has slowed down eating this month while on phenobarbital. She stopped eating on Monday. I gave food by mouth: tuna juice, juice from the can of cat food, and kitten formula (a great alternative because it has all the nutrients a cat needs.) Unfortunately, she vomited it up Monday night and this morning. She is down a pound in a month.

She had the weight to lose but the real concern is that if she loses too much, does not get any nutrients, hepatic lipidosis-an acidic condition of the liver that involves the release of bad enzymes-could be the result.

When a cat starves, the body begins to shut down and in a matter of hours and days, not months. Cats are not like dogs that will eat anything until they are too sick to want to eat. Cats tend to stop eating as soon as they do not feel well even if the illness is only slight. When a cat doesn't eat, the domino effect begins as the body begins to fall apart.
A lack of nutrients means a lack of electrolytes; lack of electrolytes means low blood pressure, which means a run down condition, which means a lack of oxygen that won't be circulated to the heart and kidneys and organs and brain, etc. all that need oxygen and electrolytes and nutrients in order to fully function.

Feeding her by mouth with a 3ml syringe, a mixture of potassium (baby food sweet potato), glucose (corn syrup), and some salt with tuna juice/juice from canned food; and the kitten formula kept her hydrated enough that she had pink, wet gums. She failed the skin tent test as her skin did not fall but stayed aloft when pulled which meant she was dehydrated. When feeding a cat by mouth, you must make sure not to force feed the cat. Doing so, only makes the the cat upset and creates acid in the gastric system which then makes the situation worse.

She received sub q fluids, a shot of Cerenia (to calm the stomach after vomiting; a good overall restoration medication to help the cat feel well enough to eat;) a shot of B12 (to help them feel better)-all of which are to help her feel better in hopes that she recovers enough to eat.

The CBC/chem panel showed no signs of liver or kidney issues; no infection or inflammation. They sent to IDEXX, the lab company, the PPL-the test for pancreatitis. We will schedule a gastric system scan. She had one in May that was normal so it's good that we have a baseline with which to compare.

She has been sleeping since being home. We have fed her by mouth twice and we aren't sure half of it go into her. She is spitting it out which she had not done before.

We will continue to feed by mouth every three hours during the day and evening; try to get her to eat on her own; and wait to hear from her neurologist, which should be Thursday, as to what to do with the phenobarbital-if that is what is causing the not eating. Also, on Thursday, we will get the PPL results.

Vets, Money, and Our Pets-How Far Can We Be Prepared for Pet Healthcare?

Regarding the post about the vet who saved a dog that was experiencing a difficult delivery-after another corporate vet service denied surgery because the owners could not afford it. That story-while not HCM specific-does address issues we all have or will face: the ability to provide healthcare to our pets; the denial of care based on affordability; the stress and strain of owning a sick pet; and the difficulties of dealing with vets who want money more than they want to help a pet.

Providing care for an HCM cat is expensive. We would spend $150 a month on medications and supplements for Myrna (some supplements were used by the other cats); save $300 a month for future ER visits-which she would have once or twice a year; and spend $350 per cardio visit which she would have four times a year. And we had at the time, six other cats that needed annual visits and periodic visits for other issues. We did not take vacations; we did not buy a lot for ourselves. Our budget was tight.

In the comments in the other story, those who are vets said: "Irresponsible owners! Should have saved for possible healthcare of pregnant dog! Should have spayed! Should have been better prepared! We can't treat without money!"

Who gets a cat and thinks about healthcare? Hardly anyone. But per the vets' comments, when we get a pet, we need to think about and plan for their healthcare expenses. We know they need annual shots. But no one expects a cat will get a disease and will need $600 a month in vet care (spent as well as saved) any more than we expect them to get injured (in the home), or get seizures, or suddenly develop high ALT values. We knew the cats needed rabies shots; we had experience with bladder and UTI issues from the two other cats so knew those things could occur. And we had gone through an expensive attempt to treat what we thought was pancreatitis that turned out to be pancreatic cancer and had to put down an older cat. So, we were experienced with various healthcare issues. We understood healthcare was a necessity. This wasn't new for us. But we never expected HCM. As much as we thought we were mentally and monetarily prepared, we were not. But still, is that our "fault" for not being prepared for HCM? Or just circumstances?

So, yes, an owner needs to think about and plan for healthcare and save for the future needs. Insurance is one option but none cover AFTER the cat gets HCM and most have limited coverage for diseases; and when you have more than one cat, paying for health insurance can be cost prohibitive. (But do look into getting insurance.) From the pancreatitis/cancer issue, we already had signed up for Care Credit which was a blessing for emergencies even if expensive to repay. (Six months no interest means that you repay every $1000 you borrow at $200 or so a month. Myrna's ER visits would be on average $1200.) So, we had access to money for emergency needs. But we never expected a cat to get a chronic, expensive disease such as HCM. When we think about disease, and when vets discuss disease, it's usually end of life issues for the senior cat, kidney disease, heart worm, etc. But no one tells you your cat could get heart disease and that it would be emotionally taxiing and expensive.

One reason why we are not told to be prepared for serious health issues may be because too many vets believe that chronically ill, seriously ill cats should be put down. They dismiss the necessity of care. We have-or we will-all experience this. Too many vets have told you the readers, that it's a waste of time to treat HCM because it is a life threatening and life ending disease and to put the cat down. Can't we say that about any issue? Even our own? Aren't we all going to die one day? Why do we treat anything then? But you-and I-forged ahead, saving the cat even if for "only" six more years. We were told it would be a waste of time and money to save Myrna's sibling Clarkie when he was two weeks old and appeared to be dying, "failing". "Normal"-said the vet. "Happens. Put it down. Hard to save. Would need constant care and around the clock feeding and meds." We insisted. He recovered and is now a healthy nine year old cat whose owner still posts photos to Facebook so that we can keep in touch. Too many vets seem to value money over the care of a pet and do not value the life of the pet over the money. We have in the US a law that says all emergency human patients must be stabilized and treated before asking for payment and cannot be denied if they cannot pay. We need such a law for pets.

So, the vet who refused to do surgery on that poor struggling dog in labor did so because they are owned by a corporation. The corporation refused service because the owners did not have enough money. They allowed a dog to suffer and a puppy to die. But even individual practices may choose to refuse care. In this case, putting down a pet is the only thing recommended, which is what the corporate vet practice told the owners. But who wants to put down a dog because of LABOR problems? Who thinks of that as a life ending issue? Cancer, yes. Severe blood loss due to injury, understandable. But labor?

Should the owners have been better prepared? Sure, for the delivery for sure. Had they talked to anyone about possible issues? Maybe they had and that's how they knew to bring the dog to the ER in the first place. Did they think to save for the delivery issues? Maybe they did and that's why they had some money (let's say they had $1000 and the surgery was $2000.) When the kittens were about to be born in our house, I read up on it. I asked our vet tech how to prepare for the birth. I learned from her about labor distress which is how I knew to bring in the mother when she couldn't expel a kitten after an hour (she had given birth to four by then. The next three would be in the ER.)

But what if while pregnant the dog had run into something and become impaled; or broken a leg; or developed kidney disease? Just how prepared are we to be? Just how far down the road, and the expense, are we to think? And who can think that far? At some point, we do all that we can do and the rest you can't do because you haven't experienced it and no one has told you to be THAT prepared. Until it happens, you don't know what to expect. Which is why when I thought Baby had heart disease, I redid the budget for the next two months and gave her a a couple hundred dollars more for vet care because we had gone through this with Myrna. And so I knew what to expect (but thankfully, Baby is fine.)

So, I'm prepared for pancreatic cancer, end of life issues, HCM, UTI, and now seizures. And there are a few hundred more possibilities that are unknown. How can I be more prepared? I can read up on them, research them, etc.

But when you Google cat health issues, there are a variety of things and all with the same, bland, general descriptions and "Here are some symptoms"-which tend to be the same for all diseases (lack of appetite, lethargy, etc.) So, being prepared is difficult to do until something specifically happens. Then you can Google for specifics.

So, yes, get health insurance if you can; set aside funds to save for healthcare for your pet. And take the cat to the vet on a regular basis. Do not dismiss symptoms such as weakness, lethargy, not eating, or low energy, or odd movements, or runny nose or goopy eyes, or cold feet, or dragging of the legs, or breathing heavily. A cat specifically, sleeping all day, or hiding, or not eating is not normal. Those are often signs of illness. Don't let a cat go more than one meal without eating; and do not let a cat suffer with a fever. And those are only SOME of the things for which one needs to watch when it comes to our cats, especially our HCM cats.

And stand up to vets and demand better care. Find a vet with whom you can talk and feel that you are also heard. You need a partner, not an adversary, when it comes to pet care, especially with HCM. And if you can, donate to vets or programs who help cats in need.

At some point, you will find yourself struggling during a new situation with your HCM cat, or any cat; struggling with payment; struggling with a vet. It will be like starting over. But we do it because we must. We do it out of love. We do it because we value the pet over money and time and ourselves.