Friday, January 10, 2014

Myrna Had a Cardiology Check-up Thursday; Much Has Improved

Myrna saw the cardiologist Thursday and there was plenty of good news and only one slight problem.  First, we stopped at the regular vet for a blood draw for a full CBC/chem panel blood test that they send out to IDEXX.  While I don’t have the full report yet, her regular vet did call today to say that things look perfect and that her potassium level was up to 4.9 from 3.7 in September!  (Daily I give her a dime size chunk of banana-potassium source- mashed into her food in the morning; two potassium tablets divided into four pieces-one chunk per meal and one at bedtime; and a vitamin paste that has potassium.) They will fax results to the cardiologist.  I also had them do a urinalysis. 

When a cat is ill, and when a pet is receiving meds for an illness or for any reason, a blood test must be done from time to time to check the blood chemistry values.  As I’ve discussed before, kidney and liver function are affected by medications and diseases, especially heart disease.  You need to make sure the kidney and liver are functioning properly and you need to make sure the overall health of the cat is good.  Issues will show up in the blood test.   You can see if a patient has enough electrolytes: sodium, glucose, chloride, potassium, phosphorous, bicarb; you can tell if they are dehydrated: electrolytes will be low, blood count might be high, kidney values will be off; you can tell kidney function: BUN, creatinine, bicarb, potassium, phos, protein; or liver function: ALT, AST, phos, albumin, bilirubin, protein; and you can tell if a cat is hyper- or hypo-of an element such as hypercalcemia-too much calcium; hypokalemia-too low potassium.

A urinalysis is necessary to test kidney function in a cat that is taking meds because meds are processed in the kidneys and can adversely affect kidney function.  A disease may also affect kidney function.  So, an HCM cat on meds must have a urinalysis from time to time.  The test will show if there is glucose, protein, or red blood cells in the urine.   It will show pH levels which are important to know (6-6.5 is best) and will show if there is an infection, UTI, or any inflammation as well as disease of the kidney.   A vet can compare those results with the blood work to note any issues in function.   For example, too much protein in the urine can mean that protein is leaking out of the blood through the kidneys and not being properly processed in the body.   That can indicate kidney damage.  But some protein in the urine could also be something that occurs without kidney damage.  A look at the protein levels in the blood work will tell more.  If the protein is in normal range in the blood work, then protein in the urine shouldn’t be too much of a concern as of yet.  Glucose in the urine is a concern because that could be an indicator of diabetes.  But compared to the blood work, if the blood value is normal, then glucose in the kidneys could be a sign of stress.  Red blood cells found in urine could be a sign of an issue or could be from the needle used when the bladder was aspirated-urine withdrawn.  White blood count in the urine could indicate infection but if low and all other blood work is fine and body temp is normal, then that could just be an anomaly. 

The slight problem was that her breathing rate was high at 60 (should be about 24 at rest and only about 30 if at play or stressed.)   This could be caused by a week of noise from snow blowers and street plows due to the heavy snow fall as well as the stress from the vet visits and being out of the house since 1 p.m. (the cardio visit was at 3 p.m.)  She had some minor pockets of pleural effusion-congestion around the outside of the lungs-but not enough in one spot to be aspirated (withdrawn.)  She did have enough of the type of congestion she usually gets when congested, which is pulmonary edema.  They gave her a 5mg shot of lasix and instructed me to continue with her regular lasix dosages Thursday night; to give her 3 mg more of a lasix pill if needed; and to text the vet before bedtime to let her know if Myrna’s breathing rate had improved and to also let her know the next day.   By the evening, Myrna’s rate was 40 and by this morning it was 32 which for her is normal due to her heart condition. 

The really good news is that Myrna’s blood pressure and heart rate are normal again. The blood pressure had been very low at 90 after the heart attack in September and was 97 by October and was now normal at 118 (normal should be 118 to 124.)  Her heart rate, which had jumped to over 200 with the heart attack in September, and was 176 in October, is now also in the normal range and is at 144 (normal can be as low as 130 but at rest shouldn’t be more than 160. For an HCM cat, 140 is optimal but may be lower if on atenolol-which is what happened originally to Myrna. Her heart rate was once as low as 120 but she was never weak nor at that time, had a low blood pressure.  If the cat tolerates it well-which Myrna did-then there’s no concern for weakness or the heart rate leading to low blood pressure.)

I asked and she still cannot yet have her annual shots. The only one she really needs is the distemper.  There is no cure for distemper if she was to get it and it is a fatal disease.   There’s no way to prevent her exposure.  We could track it into the house on our shoes; it’s airborne; the other cats could pick it up when we take them out.   She cannot have her shot because she’s congested but also because of the immune response that would kick in and cause stress on the body.  Stress-while a natural reaction-could lead to congestion for her.   We will discuss it again at the next visit in March.  If Myrna does not have congestion, then maybe she can have the shot.

So, overall, a very good visit and a very good prognosis.   Here are the doctor’s notes:
Myrna napping in her favorite box

“Myrna’s heart rate has slowed again (144 min) indicating that she is getting more benefit out of her beta blocker (atenolol.)  The echocardiogram did not reveal any significant changes with regard to the left atrial enlargement or left ventricular thickening.  The mild thinning of the left ventricular wall that occurred following her heart attack has not progressed.  A small amount of pleural effusion was visible today and there was mild congestion (pulmonary edema) on her radiographs.  Based on your reports of her stats at home, I do not believe that she has chronic congestion in her lungs.  Rather, I think she is more stressed than usual today, and this is having some negative cardiovascular consequences.  We gave her 5mg Lasix IM (injection) today to help manage the mild congestion that was visible today.” 

1 comment:

  1. So happy to hear this great news! I have to learn how to test my kitty's heart rate. I will follow your lead. :o)