Then all day Sunday she seemed fine until after 7 p.m. She had her meds and seemed fine but by 8:30 p.m. was breathing rapidly. I gave her an extra 1/2 (2.5mg) of Torsemide (her diuretic). She received another extra half after midnight. Then she had another extra half in the morning. Her breathing rate would get as high as 56 breaths per minute and after meds kicked in, would come down to 40. But then it would eventually go up again. She wasn't drinking as much or using the box as much which interrupts the diuresis process (the kidneys need water in order to better process the diuretic meds.) Since she was breathing better Monday morning, I didn't rush her in and our appointment was at 1:30 which meant we left at 12:30. I gave her the afternoon meds before we left so that she had received her regular dose of 2.5mg Torsemide by the time we arrived at the cardio and it helped to reduce any congestion she may have had prior.
Good news: kidney values continue to improve due to the increase of various potassium sources and the now three times a day of her kidney vitamin mixture (vitamin C, E, COQ10, krill oil, baby food sweet potato, occasional apple cider, glucose as needed when run down.) Potassium is 3.5 up from 3.4 (3/9/15) and from 3.2 in February. BUN is down which means improved-from 36 to 27!! Creatinine from 2.9 down to 2.6!!
She actually had very little fluid, miniscule, not enough to remove and that could be due to diuretic increase. But she was still breathing fast. This unfortunately could be due to the sudden changes within the heart as the disease progresses. She has a left atrial wall that is thicker-from 2.6 in September to 2.8 now; a clot that has grown, and another section of the left ventricle that has thinned (due to taking on too much oxygen during the process of blood going from the right side of the heart into the lungs to get oxygen and then exiting out the left to the rest of the body), while another section of the left ventricle has decreased contractions.
Thick/thin walls means the heart has an increased inability to contract well enough to remove and circulate fluid. While the kidneys are holding up and handling diuresis, the heart has gone yet another step towards being unable to do its share of the work-to properly pump fluid out and around the body and to contract well enough to fight CHF. This will lead to more CHF; to low blood pressure due to lack of circulation-making her more tired; low blood pressure will decrease the amount of blood going to the kidneys and will interfere with the ability to work due. It's like playing Jenga-as the pieces come undone, eventually things will collapse.
It's all the natural part of the progression of the disease and yet it's rare for a cat to make it this far as most die of the disease due to kidney failure, clots, CHF, heart attacks, etc. long before their hearts grow to be the size of hers. Her cardio has only seen three cats with this and two came to her late in their disease so she has never seen a cat progress from the beginning to the end of the disease. Myrna has defied the disease for so long; she has had so many issues that other cats had earlier on in their disease progression-like afib-which Myrna only recently got.
She's still not comfortable today, already having received an extra 1/2 of Torsemide. Her breathing rate is 36 bpm.
Her Torsemide is increased to 5mg q 6 hours (every six hours.)
Here are the doctors notes:
"Myrna has a small pocket of pleural effusion. The volume of fluid is so small that the thoracocentesis procedure is high risk with low likelihood of significant benefit. I have no doubt that she had a larger volume of pleural effusion yesterday to account for the symptoms that you noticed. The extra torsemide doses that you gave yesterday are slowly resolving the pleural effusion. Myrna continues to have a increased respiratory rate and effort but I expect to see improvement in her breathing over the course of the next 23 hours as Torsemide continues to exert its effects. Her renal values and electrolyte levels are stable BUN 27, creatinine 2.6, potassium 3.5 The echocardiogram demonstrated mild progression in left atrial enlargement (2.82 from 2.60 in September) thinning of one of the walls of her left ventricle and decreasing movement of the other left ventricular wall. The clot within her left atrium is growing larger. I am sorry to say that we are losing ground."