Sunday, March 17, 2013

Myrna Visit to Cardio March 2013

On Thursday, March 14, Myrna had a check-up with her cardiologist. 

As recommended, I covered the carrier hoping it would calm her so that we wouldn’t have a repeat of anxious heavy breathing that we had the previous week at the regular vet’s.   It worked.   She was far calmer than at any previous visit.   Even when she came out of her crate, she quietly stood to be examined and then lay down while the cardiologist and I discussed her case. 

Myrna sleeping on a quilt
As with every visit, I always go over with the cardiologist, my notes on how is Myrna doing.  I noted that I thought gel caps, which I've been using for almost a month now with her meds, may cause her to have an upset stomach because she will at times in the morning, after receiving her meds, smack her lips which is a sign of nausea or burping.   I will keep an eye on that reaction and if it continues go without the gel caps and see if the lip smacking diminishes.    It could be unrelated but it’s the only new thing introduced recently to her routine.   

I also noted her slow days, when she is full of energy, if she’s using the litter box regularly and that at times it seems that she’s not.  I’m not sure if she’s going elsewhere-and I’ve looked and cleaned but haven’t been able to find something-or if she’s just at times going every 6 hrs and at other times every 3 hours.  She can certainly get me up twice in the middle of the night to tell me she needs to use the litter box.  She just doesn’t always tell me during the day that she needs to go.  No, she doesn’t have CRF and no signs-after all the tests in December-are yet present.  It’s the Valium and the lasix and whatever else. 

That she tells us she needs to use the litter box is the process we began last December 2011 so that we know she will use her litter box when she needs to go.   This process was created because she wasn’t using her litter box.  While eventually put on Valium in January 2012, at the same time we used behavioral techniques to get her to let us know when she needs the box.  During the day, she will sometimes go without telling us.  Just not in the middle of the night when I’m trying to sleep. But I want to be there for her so what do I care if I’m walking in my sleep during the day?

Unfortunately, her heart has grown again since the January visit from 2.12 to 2.30.    That's two tenths in two months.  We’ve decided since her heart has grown and since she’s not able to handle the normal stressors she once could, that we will decrease all her vet visits to every four months or as necessary.  The next cardio visit will be in July and I will schedule her annual check-up and her urine/blood draw to precede that visit in July.

From the doctor's notes:

"Today's echocardiogram revealed continued enlargement of the left atrium (currently 2.3 cm; 2.1 in 1/13 and 1.8 in 10/12.)  This progressive cardiac enlargement accounts for the difficulties we've been experiencing in managing her congestive heart failure symptoms.  Please monitor her very closely at home for any symptoms of recurrent heart failure (lethargy, hiding, rapid or labored breathing) which shoudl prompt a recheck exam..."

Despite the growth in heart size, her breathing and heart rate were normal; there was no congestion noted, and she was great at the vet as always-always very good and calm for the echo.  She’s always been calm for the echo but she used to either purr or growl at the cardiologist when being examined. 

We discussed the type of CHF Myrna is susceptible to getting.  She has had pulmonary edema.  Know the difference between it and pleural effusion?

Did you know there’s a difference between pulmonary edema and pleural effusion but that they both lead to CHF? 

They both lead to CHF but are treated differently.  If your vet withdraws fluid from the lungs, your cat has pleural effusion-fluid buildup around the lungs that can be removed with a needle.  Meds and oxygen might be given as needed.   If your cat has pulmonary edema, as Myrna has had, the vet cannot use a needle and only lasix and oxygen and other meds to stabilize the heart will be used.

(Paraphrased from Pet Med and Wikipedia)

Pulmonary edema-fluid buildup in the lungs.  It leads to impaired gas exchange and may cause respiratory failure. Treatment is focused on three aspects: improving respiratory function, treating the underlying cause, and avoiding damage to the lung. Pulmonary edema, especially in the acute setting, can lead to respiratory failure, cardiac arrest due to hypoxia and death. Low oxygen saturation and disturbed arterial blood gas readings support the proposed diagnosisEchos may strengthen the diagnosis by demonstrating impaired left ventricular function, high central venous pressures and high pulmonary artery pressures. The causes of pulmonary edema can be divided into cardiogenic and non-cardiogenic. By convention cardiogenic refers to left ventricular causes. Non-cardiogenic are varied and can include hypertensive due to a combination of increased pressures in the right ventricle and pulmonary circulation and also increased systemic vascular resistance and left ventricle contractility increasing the hydrostatic pressure within the pulmonary capillaries leading to extravasation of fluid and edema.   Patient is given oxygen and diuretics and other heart meds to manage any heart conditions and to stabilize the heart.

Pleural effusion-fluid buildup around the lungs in the pleural cavity, easier to aspirate-withdraw with a needle. This procedure is done every few weeks. The cat will feel better for 2-3 weeks before beginning to feel poorly again, at which point, the cat needs to see the vet again.    Symptoms might include coughing, difficult breathing, increased rate of breathing, cat cannot sit comfortably, and may or may not have open mouth breathing.  Might also have a lack of energy and a lack of appetite. 

Frankly, Myrna exhibited these symptoms when she had her first CHF and yet she had pulmonary edema.    Regardless, if your cat seems uncomfortable, or slow, or tired, those could be signs that CHF or some level of congestion is beginning which needs to be addressed as soon as possible. 

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