Thursday, September 12, 2013

Once Again Unto the Breach-Myrna Develops Congestion, High Breathing Rate, Goes to the ER

(Short version of the "Breach" speech from Shakespeare's Henry V:)
Once more unto the breach, dear friends, once more...
But when the blast of war blows in our ears,
Then imitate the action of the tiger;
Stiffen the sinews, summon up the blood,
Disguise fair nature with hard-favour'd rage...
Hold hard the breath and bend up every spirit
To his full height...

 show us here
The mettle of your pasture; let us swear
That you are worth your breeding; which I doubt not;
For there is none of you so mean and base,
That hath not noble lustre in your eyes...

The game's afoot:
Follow your spirit...

I mean for this to encourage you as the pet owner of an HCM cat to gather your courage and to carry on the fight as we are doing.

Myrna had to go to the ER Wednesday night.  I do believe I waited too long.  But how do you tell when you should go when all could possibly be normal but different?  You add up the "normal but different" and see to what extreme your cat's behavior is different.  

She was breathing 10-12 breaths per 15 seconds, which, for her, should have been 8-10. (Normal is around 6 for healthy cats.)   She wasn't urinating as frequently although she had a huge bladder when she did go.  But she went at 6 a.m. and again at noon but never after that.  She was eating well enough but not finishing her food.  She had been hiding away in the bedroom under the bed but did come down for lunch.    We did treat time and I tried to get her to use the box and I could feel a large bladder but still, she wouldn't go. Later,  I found her in the hall laying still with eyes opened just staring but responsive but she wouldn't eat a treat.  I picked her up and took her to the box but still she didn't go.   She then disappeared under the bed.  I really should have taken her to the ER then.  At 6:30 my husband gave her the evening meds and she returned to hide under the bed.  By 8:30, we had trouble getting her to come out from under the bed for more meds and dinner.  She still had not used the litter box since noon.  With the not going, and not eating treats, and hiding, and the breathing, I finally decided  to take her to the ER.  At 8:30, I sent a text to the vet telling her I was concerned and she agreed Myrna should see the ER. 

At the ER, they took xrays that should mild congestion in the lungs, and did blood work.  The blood work showed high BUN (35, up from 30) and creatinine (2.7 up from 1.7) indicating possible loss of kidney function and onset of kidney disease.  But still, we needed to control her congestion.  They gave her a large lasix injection which still has not brought down her breathing rate (still at 10-12  breaths per 15 seconds at home; was higher at ER but not at home.) They did drain a large volume of urine out of her because she still refused to go.   She did use the litter box at home at 3 a.m. and finally again at 10 a.m.   

She will see the cardiologist on Friday since her breathing is still high.  The cardiologist will do an echo to determine if CHF is onset or if a heart attack or other issue occurred yesterday (which can have mild symptoms.)   The ER vet said xrays lag behind CHF unless a cat is in CHF. Sort of like knowing a dam has broken and water will soon flood the valley but hasn't yet-xrays can't show what's not there. But an echo can show increasing blood veins and heart function pointing to CHF.  

They changed her lasix to 12.5 mg tablets and she will take them four times a day. (A month ago we were at 30mg a day, then 35, then this week 40 so you can see the need for increasing amounts goes along with the increasing heart size/congestion/breathing concern.)

Must say we had excellent care at the ER. I dislike our local ER since they were sold last year to a new service. Since Myrna's cardio is connected to the Novi AEC, it's best to take her there in case she needs hospitalization overnight and needs to see the cardio the next day. Plus, they know her, have her info on file, even access to the cardio files, can call the cardio, all of which they did.  I've had the cardio's cell phone number since June and this was the first time I used it.   I had called the ER to tell them we were coming in and the cardio called them as well to advise them what to do. Even though it was late, 10:30 by the time we arrived, the cardio didn't mind taking calls from the ER vet to consult about Myrna once tests were run.   And luckily, it was a slow night at the ER.   

That she's producing urine and concentrating it enough, is the opposite of kidney failure. But she's not going. And Myrna's always the opposite in so many ways from other cats' reactions to meds and HCM so producing urine and NOT going could be a sign for her of kidney disease.   But they did say if she's not feeling well due to congestion, she could just not care to go.  But Myrna's always gone, even when initially sick albeit she always had a much smaller heart size back then.   There's no real way to mitigate the situation other than to get more water in her to help her kidneys and see if she'll eat a low protein diet (when kidneys are not well, too much protein for kidneys to process taxes the kidneys even more.) And we need to somehow lower her sodium which keeps going up and therefore increases water retention-which yes, is what she needs for kidneys but not for HCM. This has always been a balancing act but things are never really well balanced.   But we are working on it. 

So, as of Thursday a.m., she is still breathing 12 per 15 seconds but she's not hiding and is more social.  She's calm, she's eating more, but still there's that breathing issue.   She is unfortunately, on the decline.  We were here in June but not this badly.  Eventually, in July, she bounced back when we injected lasix. But that led to the skin lesions.  So, now we are trying to fight congestion with pills.  We may need to return to injecting as long as the lesions don't return.  To keep them from returning, we  could inject lasix just once or twice a week (she's allergic to plastic so maybe allergic to the plastic syringes touching her body daily or the lasix or the entire process.)   Unfortunately, to combat the lesions and to heal the skin, we used antibiotics, two of which caused watery stool and upset the gastro system (although by creating watery stool, that meant that fluid was going to her colon and not to her lungs, the only good byproduct of the antibiotic.)  So, if lesions come again, is there another antibiotic to heal lesions and not upset the gastro? 

Possible reason Myrna Loy can't breathe-buried under Katharine Hepburn
Stay tuned.

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