Saturday, December 8, 2018

Oxygen Therapy-Necessity and Process for Cat in CHF

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.



Friday, December 7, 2018

Fluid In the 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 rate

Review CHF and Fluid IN Lungs and Fluid Around Lungs; and What is 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.)

Wednesday, November 14, 2018

Feline HCM Cat Care Primer

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!

Thursday, September 20, 2018

Steroids for IBD-Katharine Improving

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.

Thursday, August 23, 2018

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.