Wednesday, February 25, 2015

Myrna Has Her Two Week Cardio Visit to Remove Fluid Build-up-and Jimmy Stewart Tags Along for the Visit to the ER

Jimmy Stewart saw the vet on Friday for swollen chin acne.  We spent the weekend cleaning his sores.  He seemed otherwise fine until Sunday when he wasn't urinating the volume that he would usually.  And then late in the day he began to sit in the box.  We took him out and then he went back in.  He wasn't cleaning his genitals; he wasn't going frequently; he wasn't going tiny amounts.  So, I didn't think he had a UTI. But that didn't mean he couldn't suddenly have a blockage.  The antibiotic shot wasn't suppose to make him sick and he hadn't had any gastro upsets or diarrhea.  Since I was taking Myrna to see the cardiologist Monday and the regular vet can never see last minute patients on Mondays, I decided to take him to the ER in Novi that is in the same building as Myrna Loy's cardio.

Jimmy Stewart at ER
Xrays didn't show stones, most of which would show up on an xray. Urinalysis didn't reveal crystals-another cause of blockages-nor any bacteria.  Xrays did reveal that his colon system was full of bile that hadn't been expelled yet.  Exam didn't reveal that it was impacted but his anal glands were impacted.  The vet expressed them.  She hypothesized that packed glands may have made him feel unable to pass fecal matter and being uncomfortable made him lay in the litter box-which cats are known to do when trying to go and are unable to or when upset enough that the box is a safe place.  Blood work didn't reveal anything other than slight dehydration which would also lead to less water in the colon, lead to constipation.  His urine pH was 8.5.  With a lack of water and a high pH, he is susceptible to forming stones and getting a blockage.  I am to give him daily doses of Methigel-DL methionine, an acidifier-which should lower his pH.  They gave him sub-q fluids to rehydrate.   So, we are to give water by mouth, add fiber to his food, give Methigel, clean his chin acne, and continue to monitor.  

He came home smelling of vanilla which must be from the shampoo they used to clean him after expressing his glands.  His siblings didn't care for it.  "You stink!" they seemed to hiss.  He has been content to spend last night and all today upstairs in bed.  He could have come downstairs but never did until this evening. He has used the litter box twice during the day, going large amounts. He continues to eat very well.  

Myrna Loy
Myrna Loy is now seeing the cardio every two weeks since Christmas to have fluid withdrawn. We have regular two week appointments set up through April for now.  And we will go in sooner if needed.  Myrna had more fluid withdrawn from her pleural effusion.  She had 7 oz. last time and 8 oz. this time, despite high levels of torsemide and despite me giving her extra torsemide this past week as needed to lower her breathing rate.  The ONE good news: her afib-atrial fibrillation, has disappeared.  The cardio has never seen that before.  But that's how it goes with Myrna-she's always presenting with something other cats don't present with to the cardio. 

Her heart rate is steady at 160. 

Her weight is down now to 9.4 lbs, down from 9.8 just a few months ago and around 10 lbs a year ago.  While we wanted her weight to come down for her heart, she's now at the place where we want her to be.  To help her kidneys and her body function, she actually can't get below 9 lbs.  It's a bad sign when cats lose weight which they do because they don't feel like eating which can have many causes. But the result is a lack of water which leads to dehydration, which itself leads to a myriad of issues because of a lack of electrolytes.  And a lack of eating means a lack of protein which causes the body to waste away, and a lack of vitamins and minerals to supply the body with what it needs for energy which would allow the body to function from brain to heart to kidneys, etc.  We have had to give mirtazapine, an appetite stimulant, about once a week which helps her eat enough.  We will have to make sure she eats well every day and give more mirtazapine if needed. 

Her potassium is down to 3.2 from two weeks ago at 3.5.  Potassium is needed for kidney function and a decline in potassium means a decline in kidney function. So, we must increase her potassium levels by increasing the amount of supplements and sweet potato baby food we give her.  The BUN is 37 the same as two weeks ago; creatinine is 2.9, up from 2.7 two weeks ago.  Those are the kidney values that are analyzed the most for kidney function. An increase in values means a decrease in function which is crucial when you are asking the kidneys to process the diuretic medication for the diuresis process of removing extra fluid from the body.  

So, she's ok, stable enough, eating well enough, and for about three days a week still plays with toys and runs around before she runs out of energy.

Here are the vet's notes: "We removed 130ml of chylous effusion from the right side of Myrna's chest today.  Only a small pocket of fluid remained after the procedure was performed. Myrna's kidney values are stable compared to her last visit earlier this month. However, her potassium level is on the decline again. Myrna's is developing pleural effusion at a more rapid rate despite our incredibly aggressive medical efforts.  I see no benefit to increasing her torsemide dose further. Rather, it is very likely that this will be a detriment to her health.  Sadly, we have maxed out on all of her cardiac medications.  We are left with no other great options other than to periodically drain her pleural effusion as her symptoms dictate." 

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