Wednesday, August 25, 2010

And Then Came the House Painters

In April, Myrna saw her vet for a checkup.  She was doing very well.  Heartbeat was good.  Lungs were clear.  Energy, play, breathing rate, eating, all good and normal.  And then the house painters arrived.

Apparently, cats are normally in a constant state of apprehension.  They are always watching, waiting, listening, ready to run, hide, and defend themselves if necessary.  We may not see the apprehension in cats, we may not notice a change in behavior unless it is extreme.  When cats are apprehensive, their heart beats faster, they may breathe harder, and unless the situation changes, their anxiety grows.  In normal cats, there is no health risk. In HCM cats, growing anxiety can be a health risk and can easily lead to congestive heart failure.  And we found this out the hard way.

The house painters began work late in April.  The first few days were spent scrapping the paint off of the house.  I was home and I understood the noise would bother them so I tried to make it easier for them to see what the noise was and who was outside.  I thought if they could see the workers, see from where the noise was coming, they wouldn't be bothered and Myrna would not be bothered.  So, I opened the shades (not the windows due to the debris) so that the cats could look out.  They spent hours running from window to window, looking up at the debris falling down, at the men on ladders or running upstairs to look out of the windows at the men up on the ladders. Myrna was anxious but seemed to breathe normally and would sit and rest and would sleep.  But still, she didn't like the noise.  That was Tuesday and Wednesday.  My husband had gone to Chicago and I was to leave Thursday to spend the day with him. 

On Thursday, friends came over in the evening to feed and care for the cats.  I had again left shades open so that the cats could see the workers but this meant that during the day when the workers were here, I wasn't and the cats were alone.  When we returned in the evening, Myrna seemed fine. 

Friday morning, about 10 a.m. the workers arrived and I opened shades and everyone ran around watching the workers.  Myrna was anxious running from window to window and walking around and pacing.   Suddenly, sometime just after 12, she climbed onto the ottoman next to my desk and looked up at me.  I looked down at her and said hello and asked if she was alright.  The look she gave me said "No" and then she raised her paw and just as she had in November, raised her paw very slowly and began to fall over.  In order to tell if she was sick or just moving slowly, I put her on the floor to see if she could walk.  She fell over again.  I yelled for my husband to get the cat carrier and I scooped her up and ran to the phone and called her cardiologist who said to bring her in as soon as I could.  I hung up the phone, put her in the carrier, grabbed my purse, and we were in the car and out the door less than five minutes after she collapsed.  Since it had just occurred, I thought we could make it to Novi and we did not have to go to the local ER. Had we not known how long she had been down or if it had been in the evening, I would have gone to the local ER.

I arrived, they took her in back, and after a few minutes, the doctor came out.  As before when she was initially sick, Myrna arrived at the vets and acted as if she was fine.  They said she was walking around, curious about things, and complaining about being examined.  But she was sick.  Myrna's heart beat was fast and her lungs showed signs of some fluid.  The doctor guessed that congestive heart failure was about to take place and wanted her to remain with them for the day so that she could be monitored.  Apparently, when congestion is noticed and the heartbeat is irregular, those are signs that congestive heart failure is about to take place.  It may take a couple of hours as it did with Myrna but it was better for her that it happened when at the vet under the doctor's care than if we had returned home only to have her collapse and need to go to the ER again.  I left her and returned home.  It turned out that she would indeed get congestion and that she would need oxygen for the next few hours until her breathing rate returned to normal. They gave her more lasix and her regular meds.  They called later in the day and asked that she remain overnight and said if she was doing well the next day, she could come home.  

We called later in the evening and she was doing better. They had decreased the oxygen that she needed because her body was breathing better and she was getting more oxygen naturally.  She was taking her meds well but was known as the Bolter because she kept trying to bolt from her cage whenever it was opened.  So much for being sick-anything to get away. But she wasn't eating for them.  I asked if we could bring her food and they said yes. I took a can of her regular food and some tunafish and juice.  When we arrived, she was so happy to see us.  When Myrna is happy, she twitches her tail which she did this time.  We were allowed to pet her in the cage but not remove her.  I brought her food bowls and prepared her regular food and the tuna for her.  She ate the tuna with much joy and much tail twitching.  We couldn't stay long but I was thankful for being able to visit with her and for the opportunity to feed her. The next day, they called to say Myrna could come home.  She did and eventually recovered.  Her breathing returned to normal as did her energy level. 

The medication schedule was changed.  Lasix would be for now, 1/2 tab q 12; atenolol was decreased to 1/4 once a day, down from q 12; and plavix 1/4 tab once a day and was switched to an a.m. dosing. We were now giving five meds in the a.m. and three in the evening.

Here are the doctor's findings:

Today's evaluation and radiographs revealed that Myrna is again lapsing into congestive heart failure.  The stimulus for this relapse is likely the stress that is associated with the work being done at the house.  Throughout her hospitalization, Myrna received oxygen therapy and lasix injections to clear the congestive heart failure.  Myrna's breathing patterns improved significantly and she was transferred out of her oxygen cage at 4 a.m.  Myrna has developed mildly elevated kidney values, likely due to the increased lasix doses she received last evening. 
A week later, her renal values were rechecked by the vet and were normal. X-rays appeared normal.  She no longer showed signs of congestion.

Lesson learned:

Cats with hypertrophic cardiomyopathy need protection from anything that would cause anxiety or stress, things normal cats can handle.  I need to mitigate all situations that could be stressful for Myrna.  I had to figure out what could bother her.  I had to think ahead and plan ahead. As the work on the house continued and other workers arrived to fix the chimney, I made sure to keep the shades pulled.  Myrna cannot see the noise or she gets anxious.  As the workers moved around the house, I kept the cats closed off from those areas of the house.  I found that if she was appearing anxious, that food could be used as a tool to relieve stress.  I would get the cat treat bag and toss the treat across the floor which would cause her to run after it.  It broke her concentration on the outside noise and provided her with something she enjoyed.  We had many storms in May and June and the most I could do was to close the blinds and allow her to hide.  When a couple storms raged, I put food downstairs in the basement which brought all the cats downstairs for awhile.  During one storm, I even camped out with my laptop and the cats in the basement for a couple of hours until the worse part of the storm had blown over.  She was sick in April because she was aware of the noise.  She became sicker probably because I was gone on Thursday and she was alone with the noise.  We have now come to understand that she puts up with noise we make if she knows we are making the noise.  But if there is a strange noise and we are inside with her, she gets anxious.  If there is a strange noise and we are not around, she becomes even more anxious.  And of course, anything could cause stress.  They were all sick again in May.  We had company stay with us a few days and visitors on and off for a few hours.  With anything new, we try to introduce her quietly or put her in the bedroom away from the noise (and always with a companion cat.)  Our goal now is to always think of her and to protect her from noises and other stresses.

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