So, let's review where Myrna is in the process of heart failure:
After five and a half years since she was 8 months old, after multiple vitamin paste, lysine, COQ10, vitamin mixture for kidney support (vitamin E, C, COQ10, club soda, krill oil), high levels of potassium for kidney support (for years 1200mg a day now 5000mg a day), SEVEN different heart meds that kept her going, improved body and heart and kidney function; two clots, black sludge blood (don't ask, never understood that one), one heart attack; one major CHF hospitalization at the start at eight months old and three CHF hospitalizations 2010-2012; asthma; constant CHF (which is very rare and unusual) since 2014; development of afib; first pulmonary edema and now pleural effusion with chylorthorax-lymphatic fluid that is caustic and causes scarring in the pleural cavity-creating pockets of fluid impossible to tap with a needle to withdraw; with a very large heart that would have killed most cats before now (left vent 2.8 when a normal heart is something like 1.3); and thinning walls in one of the other chambers (both creating a lack of strength of pumping-blood, fluid, oxygen, getting rid of excess fluid); after years of NOT having negative reactions to meds, to procedures, to most things the cardiologist expected her to experience because MOST cats do; and after years of her developing reactions or needing something else (like Valium for litter box use) that the cardiologist had NEVER seen in cats; or the early occasional fainting, or her blips and pauses and dazed looks at times that I noted and kept track and discussed with her vet-after years of researching, writing, reading, discussing with the vet, signing up for online journals, even attending one vet conference (St. Louis in 2011 to attend the cardio sessions); after being the longest living cat patient with the largest heart and multiple issues since she was a kitten that the cardio has ever had (not counting those who began with mild HCM and lived years with no issues, or came to her as senior cats who suddenly got HCM)-Myrna's heart is on the brink of failure and her lungs are not able to remain clear enough to allow her to breathe.
Understand-being able to "breathe" isn't the issue. It's not getting enough oxygen; as well as too much fluid remaining in the lungs causes discomfort and she has to push hard on inhale and exhale to try to circulate oxygenated air in and out of the lungs. That difficulty creates pain as well. You will see it when your cat breathes fast and the chest moves rapidly; and/or pushes out hard as if you are seeing a large BUMP process.
Blood circulates from the heart-through the right atrium to the right vent to the pulmonary artery gathering oxygen from the lungs, and then into the left atrium and out to the left vent now with oxygen to take to the body, brain, organs, etc. If the lungs are full of fluid, enough oxygen cannot get picked up in the blood and go to the rest of the body. There will be too much carbon (the body needs more O and less C.) She will continue to grow weaker, her organs will begin to fail due to lack of oxygen. This weakness due to oxygen means she won't eat or drink-causing further reasons for weakness; a lack of fluid will cause the kidneys to fail; will cause the diuretic to fail since there's no water in the kidneys and the kidneys are failing. No water in the body leads to dehydration further causing weakness and organ/body failure as there are no electrolytes when you don't eat or drink. You and your cat need electrolytes as you do oxygen.
We are not eager to pull the plug. But this moment isn't like any of the others we've faced. She is no longer bouncing back. She has moments of energy-she was even last week playing with a toy. She was last week interacting with us (see video of me singing). She has been eating very well and gained weight since last month. But a month ago she went three weeks without needing fluid removed and then suddenly two weeks ago she needed tapping. But then nothing until she needed tapping again a week later. But last week, she needed extra diuretic the evening of her tapping and more and more as each day went by. She ONLY had 2 oz of fluid removed and yet her breathing is 36 and difficult still (even if it doesn't look as bad as it did Saturday before the ER.) We have had so many times when she was ill and in the ER or dealing with an issue that made her weak and sick from which she bounced back and recovered and was free of fluid and free of pain and complications. But not this time. A miracle would be that pleural effusion clears up, that the pockets go away, that pulmonary edema would be easier for the diuretic to clear up. And another miracle would be that her heart doesn't grow more, that a clot that is in the heart now doesn't break off causing another heart attack or worse-blood clots to the legs or brain. We will continue to pray for miracles, recovery, for the joy that has been Myrna to be seen again. After five and a half years of fighting, it's difficult to give up.
But at the same time we need to plan-if given the chance to plan ahead-for her demise. I discussed with the vet that we avoid what happened to Cooper in August-a violent end at the ER (another ER not Myrna's ER) as they put him to sleep. We want her to go quietly, not go into CHF, spew fluid, vomit from the meds, etc.
|Myrna April 19, 2015|