(August 9, 2014) [When he left the cardiologist office, the cardiologist said he was stable, a bit congested but she expected him to respond well to Torsemide and to recover in the next few days at home. But he never really came home again except for a couple of minutes before we were off to the local ER again.) Tried to bring Cooper home but he began not to breathe on the way home. He was stable and clear when released. But he began breathing fast in the car ride home. He was drooling, open mouth and rapid breathing. He's at the local ER because he is in too serious a condition to make an hour return trip. The cardio had expected him to recover at home this weekend and to maybe bounce back some. But not practically crash the minute he left the vet's.
Update: at 10 p.m. he was breathing 36 per minute but with effort and is unable to breathe outside of oxygen tent. Cardio called and instructed them on lasix injections and a protocol (We have the BEST cardio!) But there is the concern that he's not bouncing back and had such a sudden recurrence shortly after leaving the ER earlier today after having been in there for 14 hours and doing well at discharge. We are praying for his recovery.
Remember the holistic medicine discussion about a couple months ago? I don't believe in replacing effective heart meds with plants and powders. It takes too much plant and powder to decrease symptoms, improve the heart. And they are costly. BUT I do believe in supplements to support the heart and the body. We do need vitamins and minerals, especially our cats that are on diuretics and heart meds. So, the only good news about Cooper today was that due to the supplements I give him, his kidney values have improved. Good, because after two days of high doses of diuretics, his kidneys will take a hit. I give him Krill oil 300mg, COQ10 100mg, and 1/2 of 100IU vitamin E, mixed with 1ml of water. I give this orally via a syringe. I put a smidge of Halo xtra C vitamin C powder (made for cats) in their food. They take 1/2 of a B12, 1/4 magnesium, 1/4 iron-every other day and once a day, and never all on the same day or time. We've done this for a month (but he's on a phosphorous binder and it binds with iron and causes constipation which is why he gets only a small amount.) A month ago BUN was 115, now 105. Creatinine was 6.6, now 6.0. Phos was 9.6, now 6.6. He has been urinating larger amounts lately which is a good sign of kidneys concentrating urine-producing it. Great! Now if only he could breathe.
Update Cooper: still in ER, being weaned off meds and oxygen. Will be a few more hours before he's ready to leave and then he'll come home and we'll monitor and see how he does. But he's breathing well on his own. The cardio is reviewing via email the xrays (modern technology!) and talking to the ER as needed. The new a.m. doc was surprised that Cooper is normally on a high level of diuretics-a combination of torsemide and spironolactone (the actual diuretic is torsemide with spironolactone playing a minor supporting role while it also preserves potassium.) They have been treating his congestion with low levels of lasix injections so I've asked the cardio to review his diuretic ER needs. They need to not only treat what they see but maintain a therapeutic dose to stay ahead of, to prevent congestion-something the ER doesn't normally do because they treat only what they see. So, if he's free of congestion now, they think he doesn't need more lasix. But he does. So, I'm running over his torsemide and regular meds.
Cooper still has a foggy X-ray. Lasix injection at noon and four, new X-ray at four to see how he is and then home. If he crashes, off to Novi. But we'll know the time between being almost clear at four and the next CHF incident, which will tell us if he's able to overcome congestion or not; if we are aggressive at home can we help him or not; or is he unable to recover.
At 12, the ER vet gave a lasix injection,expecting Cooper to respond well and to be able to come home at four. He had been on dobutamine which helps the heart pump blood better, allowing the blood to go to the kidneys better, allowing the kidneys to use the lasix to work better as a diuretic. He was weaned from this by noon.
At four, the xrays showed he was again in CHF because he was no longer on dobutamine. In consultation with the cardio, we could keep him on dobutamine for 48 hrs (max one time dose is 48 hrs and then the body hits a tolerance) and he would get lasix (dobutamine is only an IV drip drug and not one given at home). But she thought this wouldn't work well in the long run, that it showed his kidneys-while he was concentrating urine and going huge amounts-was in some way compromised enough that after the dobutamine, he would again not be able to process lasix or torsemide and would again go into CHF. This meant that it was time to put him to sleep.
We went to the ER at 5p.m. and spent time with him. They brought him into a room where he walked around, cried, wanted to be petted, wanted out. After about ten minutes, he began breathing hard. After a few more minutes, we knew it was time.
The vet gave a sedative which Cooper fought and cried over.. Then there was another sedative that made him vomit up white foam and which made him more anxious. Then the vet gave the drug that stopped the heart.
We chose to donate his heart and kidneys for research to Michigan State University vet school. We have a clay paw print. We chose to bury him.
We can't believe he's gone so quickly when he was just fine the other day. We can't believe he didn't bounce back and come home for a bit longer. We don't understand why and yet I know why but then don't know why. His heart is larger than it was in May. His kidney values were bad but had improved and he had in the last two weeks due to supplements, gone back to urinating large amounts. The ER vet was surprised he was on such large doses of diuretic and yet doing so well. The cardio said he's lived longer with kidney values and a bad heart of his sort than she has seen in her practice. He was the rare cat to take and to need a powerful diuretic torsemide. But as "fine" as he was, he's needed extra torsemide and a couple lasix injections at home since his last CHF in May. So, it wasn't all perfectly working. We struggled since early July to get enough food and nourishment into him and he had lost a pound since May. And still he held on and even fought our attempts to put him to sleep.