Thursday, January 8, 2015

Update on Myrna Loy Feline HCM and CHF January 2015

Posted to Facebook January 4, 2015

If your HCM cat is on Flovent, discuss with your vet about moving to albuterol. Flovent is for asthma but is a steroid which HCM cats cannot have because it increases fluid retention, the opposite of what we want for our HCM cats.

Posted to Facebook January 5, 2015

Myrna at cardio and having more fluid drained. We spent last night fighting congestion as she was restless, crying, likely due to pain from fluid. There was a snow storm last night and I was grateful she didn't need to go to the ER. Blood work normal so will increase torsemide.

Posted to Facebook January 8, 2015 

So it's cold in almost every state in the US. Wherever you are, keep your HCM cat warm. Turn up the heat. Put blankets on floors under their beds, and on the furniture, even the bed, places where they like to sleep. Drape blankets over chairs to make tents (will keep in heat) and put rugs or towels underneath the chair for them to lay on. A diseased heart shouldn't work harder to keep a body warm. And keep them indoors, which should be done at all times.

Posted to Facebook January 8, 2015

To update you on Myrna, this chylothorax  is what the vet said she had on Monday: lymphatic fluid in the pleural cavity of her lungs, unlike the previous fluid they withdrew before Christmas. Yes, a new complication. We need to prevent the accumulation of lymphatic fluid in the pleural cavity because it can lead to scarring-fibrosis-which would create another complication by making breathing difficult and not allowing space for oxygen. There's a supplement we can try called rutin which we bought at Whole Foods (but there are many sources online and at other local stores.)  And I found a Canadian study such as this one that describes how it works and why it is necessary.   They are round large tabs, and I'll cut into halves. She gets four halves or more a day. I'll start with four and increase as I can. I say halves only because I think the size is too big as a whole to give so I'll cut it in half. Each whole tab is 250mg and we'll give a total of 500mg a day or more. 

Rutin is a natural substance found in buckwheat and citrus fruit, thought to change the triglycerides in the lymphatic fluid so that it flows more easily through the thoracic duct and does not back into the pleural cavity AND will change the makeup of the fluid so that it does not cause fibrosis-or scarring-in the pleural cavity, which would exacerbate her already difficult breathing process.

She was receiving lasix 25mg four times a day, then torsemide 5mg once a day and 2.5 once a day. And now she will take torsemide 5mg in the a.m,, 2.5mg in the afternoon, and 5mg at bedtime.  

To protect her kidney function and electrolyte balance, we are increasing the doses of potassium supplements and the vitamin mixture for kidney support that I mix of vitamin E, C, COQ10, krill oil, and sweet potato (with the occasional glucose or apple cider vinegar mixed in for added benefit of electrolytes and (glucose) and kidney and stomach (vinegar.) (See med tab notes.) 

From the cardio's notes January 5, 2015:  "We drained 2.5oz of fluid out of the right side of Myrna's chest...The character of her fluid is chylous...Myrna's pleural effusion will become pocketed, which will make it more difficult to drain her.  There is minimal evidence of pocketing at this time...BUN 39 (from 34), creatinine 2.8 (from 2.7)..."

Myrna Loy at Christmas 2014 with a new mouse toy

Posted to Facebook January 22, 2015

Myrna had less than 2 oz of fluid removed today. The cardio said she may not have had to come in, that meds may have continued to work well enough.  She was breathing better but since the cardio was off Friday, and since we had to fight yesterday to get her breathing rate low by giving extra meds, I wanted to make sure she was doing well.   And I'm glad we did.   Her potassium is low at 3.0, down from 3.2 from two weeks ago.  We need to push more potassium, possibly begin Tumil-k  (a potassium source for cats.) (We added instead Renal-K gel and powder.) But now we have two examples to go by to compare against in the future when deciding when or if to take her to the cardio for needle aspiration of fluid: when she's not breathing well, is in pain and won't settle, not responding well to meds; and when she's not breathing well but responding to meds-eventually-but not in pain and not crying.

Cardio's notes January 22, 2015: "We drained 1.7 oz fluid out of the right side of Myrna's chest...kidney values are somehow lower today than they were January 5, 2015:  BUN 33 (39 1/5/15) and creatinine 2.3 (2.8 1/15/15)..."

Posted to Facebook January 26, 2015

On Sunday night, we had to give extra torsemide and extra lasix to Myrna because her breathing rate was up to 10/15 (normal for your cat should be 6/15 at rest, for Myrna it should be 8/15 at rest or 32 per minute.) It took two extra 2.5mg doses over five hours before the rate came down to an uneasy 9/15. She did well overnight, continued to drink a lot and use the box frequently, and of course, wake me to tell me about it. This a.m. she was fine and then the breathing became more labored even as it seemed to still be 9/15. So I gave 3mg lasix, 1.25 Torsemide and two hours later she was an easy 8/15. The cardiologist thinks her lung walls may be irritated due to the pleural effusion in the pleural cavity. All I know is that when I give meds and if she responds, there must be some congestion that is making breathing difficult. I think the cardio means that some congestion may not be easily tolerated if the pleural cavity is irritated and that she may not need more meds when she seems to have breathing difficulty. All I know is that I must work on what I see-high, labored breathing rate which calls for more meds (and I still give a touch of lasix with Torsemide just in case the fluid is in the lungs and not around them.) Then I wait to see if she responds. If she does not improve, then at some point she needs the cardio. So far, she's better still tonight. And with each additional Torsemide, I've been giving potassium supplement. We've increased her potassium-and I must still update the Med list-to about 1000mg of Tumil K (approx 485mg each), and two 595mg Sundown potassium, and Gerber baby sweet potatoes of 6ml daily. With a level of only 3.0 in the blood stream as of last week, she's in no danger of getting hyperkalemia.

Posted to Facebook January 30, 2015
We have given Myrna extra Torsemide, lasix, and potassium today because her breathing rate is up again to 9-10/15. She's responding but not using her litter box as much, not going as often as she had I think because as her potassium level declines, the kidneys have trouble processing the med because they need potassium in order to work, so this means she goes less often. But it also means the med isn't working as well as it should, which leads to the increase of breathing rate. We need to give some water by mouth if we think she's not drinking enough. The kidneys also need water in order to process the med and kick out the fluid in the pleural cavity.

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