Saturday, January 31, 2015

Updates to December 2014 Care of Myrna for Feline HCM, CHF, Torsemide, Pleural Effusion

Posted to Facebook December 7, 2014

Need to do proper updates but haven't the time. Myrna saw cardio last Monday for check up since last CHF. She has some congestion around lungs and heart-pleural effusion. Now on 20mg lasix qid-4x day. Giving shots as needed because she has many lesions from the week of once a day injections we had been doing-injection replaced one regular dose. Now also on antibiotic to clear those. She has "black smoke" or thick blood in the heart and a new clot potentially forming. Due to increase of heart size now 2.7 left vent. Must watch for leg or other clots and pain. If develops, must give buprenex that we use on other cats-as a pain reliever-and go to ER. Good news-kidney values improved from ER:BUN down from. 53 to 34 and creatinine from I think 2,9 to 2.7. Or something close. Shows vitamin and supplements I give must be effective or her numbers would climb due to increase of lasix.

Doctor's notes: "Myrna's left atrium continues to become larger and larger. It measures 2.74cm (from 2.6 September). ...poorly organized clot in left atrium...spontaenous contrast (...smoke in left atrium)...accumulation around her lungs (pleural effusion) and heart (pericardial effusion) as a result of ongoing CHF...."

Posted to Facebook December 16, 2014 

Myrna's having difficulty with congestion again. Sunday gave extra dose lasix. Last Wednesday gave a shot as a regular dose. Monday breathing rate was a hard 8/15 with shuddering. The hard push was on exhale meaning she was having trouble exhaling. A hard, or deep, or shallow, or difficult body movements during exhale and/or inhale are signs of not just congestion but of the lungs lacking room to take in or push out oxygen. It means that things are worse, more complicated than having congestion. What you must do, as we have with Myrna-providing you can do injections-is first give extra lasix by mouth: five or more mg then wait an hour to see if breathing rate slows, is more comfortable or normal looking when inhale/exhale occurs; is cat alert or in pain; is cat drinking and urinating in response to lasix. If not using the box, and breathing hasn't eased, then inject lasix (a premixed bottled solution from vet) of .3-.4ml.  Myrna had two injections Monday of .25-.3 as well as pills. Normal daily dose is 80mg. Monday was 100mg counting injections. Today rate was ok but she wouldn't eat or drink and then vomited, all by around noon. I tried mirtazapine for appetite but she vomited . I tried liquid protein and she vomited. (all at same time.) I injected .4ml around one pm. She has finally eaten something, used the box, and breathing rate is 9/15. But she has a long way to go yet. We may need to go to the vet for X-rays and blood work tomorrow or the ER today or tomorrow depending on response, recovery, ability to drink (more critical at this time with all the lasix demanding the kidneys work with the lasix.)

It's very important-I've stressed it before and will continue-that we monitor and stay on top of the breathing rate of our cats. Do NOT let it go unattended. Do NOT wait hours before giving extra lasix, or calling a vet to ask about amounts to give or inject if unsure, or going to the ER . Time is of the essence. Count the breathing rate, look at the chest movements-is there exertion made when breathing, notice the discomfort level of the cat, if cat is alert or pained in the eyes, etc. Then notice if the cat is drinking-constantly and a lot-necessary for lasix to work and kidneys to function. Is the cat urinating enough in response to lasix-a sign it's working and kidneys are functioning. Or is there a problem? Then you must get blood tested ASAP to check kidney values and the health of the cat. Know how your cat is when well vs. when having issues breathing. Fight the first sign of congestion with extra lasix . Monitor progress . Give more lasix as needed. And if results are not seen in a couple hours, or it gets worse , then head to the ER immediately.

Myrna seemed fine at dinner at eight (not a movie that she, the actress was in, but a good one to see-I digress)and her breathing rate seemed 8/15 but at nine p.m. she was anxious and vocal. I sat with her and her breathing rate was 15/15. I waited for it to settle after she was quiet but it didn't and neither did she. We gave .4ml injection at 9:30 pm and I then brought her to the ER without waiting for lasix to kick in. A 15/15 rate combined with anxiousness is too much and indicates a problem.

Posted to Facebook December 17, 2014

Myrna doing very well in the ER. Breathing rate is 44 a minute. Injection at home helped .

Myrna to stay overnight. Should be home by noon or I'll get her then. Then see if she needs to see cardio.

(Later that day:) She will come home around noon. Her breathing spiked middle of the night and they don't know why. Cardio wants her on torsemide but I'm weary.  She will now be on lasix 20 mg four times a day. Cooper, who died in August, was on 25 QID and it wasn't working so went in torsemide and then a month later his values tanked and a month after he died.  (His potassium dropped significantly and his kidney values skyrocketed off the chart and he only lived three months while on Torsemide.)  The disease is progressing as indicated by heart size which is why she's having difficulties. She's been on the same, slightly less advanced, decline, following in the paw prints of Cooper since fall, which is why I'm weary of taking the torsemide step.

(Later that day:) Well don't play the (funeral) dirge yet. Lungs are clear, doing well two hours off oxygen, eating in the ER, demanding attention, vocal, and head butting. I will get her at 2 p.m. and they will give more lasix and we will see how she does at home.

Posted to Facebook December 18, 2014

Discharge papers from ER were not correct. The cardio wanted her on 25mg lasix and not 20. We only did 20 which may be why she was a bit run down last night and breathing a touch high. We will now do 25-20-25-20 lasix doses a day. Today we did 20, will do 25 at 12:30 pm then 20 and then 25- or more as needed. I will make a post holiday appointment but if she's fine in January, will push it back to February.

Posted to Facebook December 22, 2014

Myrna had to see the cardio today because she was breathing about 40 a minute but hard push on exhale. While she has had mild pleural effusion these last few months, she actually had a lot if it around her lungs today. 90 mg of lasix wasn't keeping up with it and because it was around the lungs, lasix actually takes more time to attack it. That's why injections and pills seemed not to help her today. The cardio aspirated-needle withdrawal of fluid-and removed 3 oz. I believe she said. We will begin torsemide tomorrow. But she has a clot forming in the aorta-I think that was it-in a narrow spot which is bad news.

(That evening:) Myrna's back and buoyant! Trotted over to me to tell me she's home; short trip; and feels better. Yes, I speak "Myrna".

Posted to Facebook December 28, 2014

Myrna's doing well since Tuesday, taking daily Torsemide-another type of diuretic. No more lasix on a regular basis. Torsemide is 5mg tab in the a.m. and 2.5mg BID-later in the day and at bedtime. We've had to give extra lasix 5mg Wednesday, Friday, and Saturday when the breathing rate went up to 40. We can only go by what we see is the breathing rate to determine when she might need extra lasix. She had xrays and blood work Friday as a follow-up to Monday's cardio visit and to see how her kidneys are responding to the torsemide. The xrays were almost clear with a tiny amount of pleural effusion (fluid around the lungs-not enough to withdraw with a needle.) Kidney values were great: BUN 35, down from 39 (ER visit 12/16); creatinine is 2.4, down from 2.5 (12/16). Potassium is 3.9, down from 4.4 but still ok. We are giving supplements-vitamine E, C, krill oil, COQ10, and sweet potato twice a day now (approximately 2-3ml per dose of the mixture.) These we use to support kidney function and keep up potassium levels-levels that are necessary for good kidney functioning. Kidney function must be supported due to high levels of lasix, and other heart meds, and now torsemide. The kidneys must maintain the ability to process the diuresis property of the meds which gets rid of congestion. And then there's the million other things the kidneys do that must also be maintained and supported. We are concerned about the use of torsemide. Cooper-our cat that died of sudden heart disease in August-was on torsemide for a month when his kidney values began to go very high which led to kidney damage and the inability to fight congestion. We will monitor Myrna with frequent blood tests but really, we must try to ward off any decline in kidney function with the vitamins and supplements and just assume there's more of a risk with torsemide and push more supplements.

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