Thursday, July 14, 2011

Myrna's Results and Notes from Hospital Stay This Week

So, to recap, Myrna had congestive heart failure coming on this Monday and we made a quick trip to the ER where she stayed overnight until she was transferred Tuesday to the cardiologist. The condition was stopped; no damage or changes to the heart occurred; she bounced back Tuesday and was herself by Wednesday.  How did the attack come on so quickly? There are a few things that may have contributed to the attack in the preceding week and on Monday. I'll review what happened.

Last week Myrna Loy seemed a bit anxious. She needed a lot of petting, spent a lot of time rolling around getting our attention, playing what we call "cute".  At night, she would wake me up crying and then jump on me in bed demanding that I pet her. She slept on me a lot. I was giving her Buprenex .15 (which is all that she'll tolerate) a pain med that is allowed by her cardiologist. We administer it due to going out of the box. So, she was anxious despite the medication which should have calmed her. She was also not always eating all of her food. She often ran off at meal times and had to be brought up or coaxed up and then coaxed again to eat. She usually eats without any issues unless she doesn't like the flavor we offer. But this time, when she didn't want to eat, she didn't eat anything despite trying different flavors. But she wasn't starving. She ate some dry, she ate here and there. And sometimes at night she'd eat everything.

We've had a lot of hot weather and our house has no AC. I run the box in the bedroom which actually cools the upstairs and the living room; we run fans; and I open windows in the a.m. and close others as the house gets warmer as the day progresses. It's cool enough. The cats did lay around all day in the heat. We did our best to keep them cool. But it was probably not enough.  The vet said they have had four patients with heat related CHF in the last week.  And we were gone most of Saturday which meant the AC wasn't on and the windows were closed. She was in the darkest, coolest part of the house but still, it may not have been enough. She looked pretty exhausted Sunday.

She seemed fine Monday. Ate well. Received Buprenex at 8:30 a.m. Then a huge storm blew through around 11 a.m. Usually I take her to the basement and toss dry food or treats around to get her attention off of the storm. But that day, I was busy cleaning the house and was eager to finish before the storm got worse and cut off the electric (which never happened.) So, I wasn't thinking about her. I had become complacent about the disease and the effect on her heart because she has been so stable for over a year.

The storm blew through for about an hour and then it cleared up. We had lunch late-I fed them around 3. By 3:30 I was eating and Myrna was pacing the living room. By 3:45 she was demanding to be petted and was clearly anxious. She jumped into my lap and I kept petting her for about ten minutes. She even curled up on my lap before getting on to the couch and curling up to rest. When she stretched out, I could see that her chest was rising and falling rapidly, too rapidly for me to count. I watched for a few minutes to see if it would settle but it never did. So, by then it was about 4:20. I went upstairs to change clothes and grab things to go.  She was still breathing hard when we got to the local ER.
Here are the notes:

Myrna in the cardiologist ER
"Attitude:QAR, temp 102.4 (normal is 101.5 for her), pulse 170, resp 100 (normal is 35-40), MM pink
EENT: mucous membranes pink and slightly tacky, CRT 1.5, no ocular or nasal discharge
S/I: Possibly 5% dehydrated
H/L (heart and lungs): Difficult to hear clearly over increased respiratory sounds and rate; grade 3/4 systolic heart murmur possibly present, tachypnea, slightly harsh lung sounds.
Lateral/VD chest x-rays: mild patchy interstitial pattern in right caudal lung fields, enlarged heart.
Assessment: mild CHF."

They had her on oxygen and IV lasik all night.
They fed her but she wouldn't eat.
Her respiratory rate rose to 120 by 6 p.m. By 10 p.m. it was 100. By 12 a.m. it was 80. By 1 a.m. the temp was down to normal at 101.8 but the respiratory was high again at 100. During the night they gave spironolactone, enalapril, and lasik but not atelenol which is NOT given when a cat is in cardiac failure or congestive heart failure. Finally by 6 a.m. Tuesday, the respiratory rate was down to 40 and she was taken off of oxygen.

I checked her out at 8 a.m. and drove to NoviCHF before it could get worse. There was no damage to her heart and no change in the numbers from previous visits!  All great news.  The renal values were slightly elevated but not to the extent that we have to worry. We will retest in September during her check-up.

We discussed the possible causes-heat and stress most likely. I realized I must remain vigilant and be again more proactive during storms and must be more cognizant of what the temperature is in the room.  He said that if I had brought her in when she was anxious or tired last week they may not have been able to see something about to start. Often, these things cannot be seen until something is about to begin.

So, keep her cool, keep her calm.  We are watching her closely. She had to rest a couple of days and we were not to encourage play. The meds were the same but the lasik was increased. Here are the notes:

"The thoracic radiographs from the emergency hospital do not reveal obvious pulmonary congestion.  However, Myrna Loy's  clinical signs were suggestive of early CHF. Following overnight diuretic therapy, Myrna Loy appears to be very comfortable and her respiratory rate and effort are normal.  The echocardiogram did not reveal any significant structural changes in the left atrium or left ventricle when compared to May.  Laboratory testing today revealed that Myrna Loy has good electrolyte balance and reasonably good renal function (BUN=38; creat=1.9.)  Recommend increasing lasik to 5 mg TID (a quarter of a tablet three times a day-up from 1/6 of a tablet 3 times a day.)  All other meds as previously directed."

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