Friday, February 24, 2012

Update on Myrna and Valium

Myrna-left, Jimmy Stewart-right, and Bette Davis-bending over, center

Myrna is holding at 1/2 or 1mg of Valium a day and doing very well. Incidences are down to one or two a week and declining I believe. She wakes me sometime around from 6-7 a.m. to let me know she needs to go and we do treats. She cries in the basement (for whatever reason) when she's ready to go about 3 hrs later. I also take her to the boxes before and after each meal or after her long afternoon nap. We try to get her to go before bedtime. She will sometimes go on her own to the box and go. She has her quirks for sure and not sure why but working with her needs and not ignoring them is paying off for now. I don't know how long she can be on Valium, if it will interfere with her heart meds longterm but for now things are going well.

She has a cardio checkup next Thursday and I will post more then. We have some concerns-I need to ask about a previous post regarding a study of echos and fluid volum and correct reading of echos; need to ask if her front legs are slightly wobbly or am I just seeing things; and the effect of Enalapril on the kidneys:

The Yahoo Support group for HCM has had a previous discussion regarding Enalapril and that it lowers the blood to the kidneys. What I understand is that it doesn't but how it works can be misleading. Enalapril is an ACE or angiotesin inhibitor. When the patient has a heart attack, it prevents the blood vessels to the rest of the body from closing off. If closed, blood circulates from the heart to the head and kidneys basically but not the outer limbs. While it might work to preserve blood to the main three organs, it also drives up fluid volume and causes the heart to pump faster to handle the volume of blood in a shorter distance.  If you open up the blood veins in the rest of the body, the fluid flows more freely and the heart pumps less hard.  This does not mean that there's less blood to the kidneys unless there is a wound and blood is coming out of the patient or the blood cells have been damage by, for example, toxins (because toxins and other things can kill blood cells, decreasing blood volume.)  However, the ACE inhibitor does effect the blood level in the kidney's glomerulus (tiny filters) which means less filtration.  Less filtration might allow a buildup of toxins which will damage the kidneys. Combining this drug with lasix, as many HCM patients are on both, might mean less blood pressure to the kidneys or glomerulus as lasix decreases fluid in the body-but not BLOOD-just over all fluid levels in the body which effects overall blood pressure. 

So, we'll see how she is doing next Thursday and I'll post an update after that visit.

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