Friday, May 23, 2014

Cooper Back to Cardiologist for More Oxygen and IV Lasik

Cooper has been struggling all week with congestion and we've struggled to figure out the correct dose of lasix needed, timing of doses, and when he needed an injection to overcome the congestion.  We communicated daily and sometimes often during the day with the cardiologist to get input.  We had a protocol, a method, a process to follow. We knew what to do when, how quickly to respond to an increase in breathing, and how quickly to text the cardiologist to alert her of a new issue.  And still, we all struggled to meet his needs.

Katharine Hepburn had an appointment for Thursday due to a gallop murmur (and an earlier post noted the cardiologist heard a mild murmur and saw no signs of heart disease) and Cooper already had the same appointment made in March because this was to be a checkup.  But he had just been to the ER a couple weeks prior and everyone expected that he would recover and not need to be seen at this time.  But we kept the appointment just in case.  Despite recovering from the ER, despite trying a new drug (spironolactone/hydrochlorothiazide) and having it upset his system (nausea, diarrhea) and dropping the drug and bouncing back quickly from it, and despite an even breathing process, and despite controlling for heat, cold, and not allowing him to be in the sun for prolonged periods or in any open window at any time, he still developed congestion.  And we couldn't get rid of it.

So, Thursday, Katharine, Cooper, and I went to the cardiologist.  They took xrays which showed congestion in the right lung and only slight congestion in the left. They were going to give him a lasix injection but then he suddenly couldn't breathe well and was making gurgling, panic noises.

They put him in the oxygen cage and gave him lasix IV injections.  They kept him from 1:30 until 6:30. He quickly responded to the use of oxygen and lasix which was an excellent sign.  They weaned him off oxygen and his breathing rate dropped to 8/15, and we finally went home at 7 p.m.  As of today, his breathing is still at 8.

The cardiologist has taken him off of lasix and given him a new loop diuretic to try.  We will begin using it today. He will get the med twice a day and three times if needed.  We will know after a day or two if the med is working to decrease congestion and we will know in 3-5 days if the med does or does not upset his stomach.  In between doses, we can give injections as needed, which we would more likely consult with the cardio about the dose before giving an injection.  The new drug is called Torsemide. It stays in the body and works in the body longer than furosemide (lasix.)  In human patients it is shown to have a greater decrease in recurrence in congestion.  But it can also deplete the body of electrolytes via extraction of fluid,  leading to many adverse side effects.  It can also deplete the kidneys of potassium and can cause stress on the kidneys. We will give 1/4 of a 10mg pill.  He will go from 80 to 100 mg of lasix to 5mg of Torsemide a day.
Cooper at the cardiologist

She also suggested we use a potassium supplement called Tumil-K (we will use Sundown potassium, and Gerber baby sweet potatoes also as a potassium source.)

The cardio and I had separately come to the conclusion that trips to the vet were becoming stressful for Cooper and counterproductive-although he needed oxygen and IV lasix this time-and that going forward, Cooper will see the cardio or vet only when necessary and not for checkups.

By the way, they know when he's feeling better when he hisses and growls at them!

Here are her notes:
"Despite continued increases in his cardiac medication doses, Cooper has again relapsed into congestive heart failure. He is receiving extraordinary doses of lasix to try to maintain his comfort in breathing and we are having continued relapses in symptoms.  Unfortunately, he did not tolerate hydrochlorothiazide well and that mediation had to be discontinued.  I would now like to switch his lasix to a much more potent diuretic called torsemide.  Torsemide functions very similarly to lasix.  The risks of this medication include kidney failure and electrolyte depletion. The major benefit would be more steady control of Cooper's symptoms.  Today's laboratory results indicate that Cooper is an acceptable candidate for this medication.  To help prevent excessive potassium depletion, I would like you to begin supplementation with Tumil-K (potassium supplement.)

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