Saturday, February 22, 2014

Myrna Gets Congestion Again This Week; We See the Vet Friday

February 1, Myrna had congestion that developed in the morning out of the blue. We fought it with extra lasix and an injection of lasix.  Monday, February 17, Myrna developed congestion again and in the late afternoon into the evening and we gave her more lasix and did another injection.  And then once again, for no reason, except that perhaps Thursday's rolling thunderstorm that happened in the morning and afternoon (while it snowed no less) acted as a trigger, Myrna developed congestion Thursday February 22.  It came on suddenly in the afternoon.  Her breathing rate crept up from 8 to 10 and by the evening was at 12 (in 15 seconds.)  By 8 p.m. it was around 12-14 and eventually seemed to remain at 14 (normal is 6.)  Despite extra 5mg of lasix a couple of times, we had to give an injection around 10 p.m. of .15ml lasix and then 10mg of lasix at 1 a.m.  The breathing rate only came down to about 12 by then.  Between 6:30 p.m. and 1 a.m. she had received a total of 41mg of lasix when she would normally have had back in January 46mg total in a day and as of early February (after the first bout of congestion) she would have received 52mg in a day.  Her total for Thursday was 73mg.

And still, despite all of the lasix, she only urinated every 3-5 hours, her normal time frame, and her normal amount.  This is important to note because how much she urinates determines how quickly the lasix works to get rid of the extra fluid and the congestion.  How well she produces urine and how quickly also indicates how well the kidneys are functioning.   It wasn't until after the injection, that she finally began using the litter box more often.  From 11 p.m. until 6 a.m., she used the litter box about four times.  By the morning, Friday, she was better but still breathing around 10 at rest.

We already had an appointment for Friday to see the cardiologist after Monday's congestion.  Xrays showed she still had congestion-pulmonary edema.  The pleural effusion she had in January (along with pulmonary edema) was not present.  For whatever reason, her blood pressure has dropped again to 93 which made getting a blood sample from her difficult.  Her heart rate is only up slightly, from 140 to 160.  The heart is in stable condition, unchanged from January.  While her cardio function is stable, the cardiovascular system is having trouble.  The rollercoaster congestion, brought on by unknown triggers, requires more and more lasix to beat.  The congestion wears her down, becomes uncomfortable, and impairs normal body function of breathing and getting oxygen to her body.  The drop in blood pressure means the lack of oxygenated blood to the organs.  This makes her easily tired and somewhat weak.   This would explain why she was quiet all this week, even though she was always up and about.  She was never truly lethargic, just tired.

We are to keep her quiet.  She will receive 15mg lasix qid (four times a day.)  I am to tell the vet how well she is doing Saturday and Sunday and Monday. The emphasis will be on pushing lasix to bring down the congestion and get her to a more stable condition.

We discussed how difficult it is to decide when to give more lasix.  It's one thing to count breathing rate and to determine that it's up and she needs more lasix.  But I don't always know how long to wait. When the rate is up but she doesn't appear to be in pain or discomfort, I have no problem waiting before giving more lasix a few hours later.  Lasix pills can take up to four hours to work.  An injection takes about an hour.  When she begins to breathe even faster or if she looks really uncomfortable, my reaction is to give more lasix.  But if given too much, the amount can lead to kidney damage or a reduction in function. But getting rid of congestion is key.  But retaining kidney function is important.

The vet said:  "If she's struggling and she's due for lasix, give her an injection of .15ml.  If she's struggling and not due for a dose, give an injection of .15ml.   If she's wishy-washy-breathing rate up but not very high and she's comfortable, give her 15mg lasix."

Her blood work unfortunately shows a decline in kidney function.  We will push 15mg qid today and cut back as needed once the congestion seems to be going away and see how she does going forward.  The BUN is 35 and high is 36. The creatinine is 2.7 and the norm is 2.4.  Phos is fine, though. Potassium is 3.9-low but fine.   She is not in kidney failure since she's producing so much urine each time. But that she needs higher doses of lasix before she finally urinates indicates that the kidneys are tolerating the lasix in general but that kidney function is showing some decline. That's troubling.

Unless she gets sick again, she will see the vet in late March which was a regularly scheduled appointment.  

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