Wednesday, May 6, 2015

Myrna Had Sudden Saddle Thrombosis and Struggles to Recover

Myrna wasn't doing well late Sunday night, May3, 2015.   Wouldn't eat past 9 p.m.  Vomited Monday a.m. after a.m. meds.  Vomited late in the afternoon. Vomited again after evening meds.  Wouldn't eat even with Mirtazapine.  Vomited up any fluid.  A lot of extra Pepcid and then Cerenia helped calm her and she finally ate at 9 p.m.   The problem was a lack of being able to keep down her meds meant she didn't have enough Torsemide diuretic in her so her breathing rate increased.  We finally gave a lasix injection of .45ml (about 20mg) because the breathing rate was up to 40, and I didn't want her vomiting up meds again.

She continued resting until about 11:30 p.m. when she became restless. Then suddenly, she jumped up as if startled, jumped off the bed, landed on the floor and couldn't use her hind legs.  I picked her up to see if she was alright: paws were warm, pads and toenail beds were pink. I put her down again and she still couldn't walk. I took her to the ER.   They did a blood test to test the lymphatic fluid to test the damage done to the legs due to lack of blood circulation and found that there was none.  She was also no longer lame and was calm.  

The trouble I had was with the ER vet who wanted to discuss end of life plans. I wanted to know what was wrong and to get her stable and breathing well. The vet also didn't see that congestion in the lungs was indeed CHF; nor would accept my information about Myrna's heart and that she has clots because the vet didn't have access to her chart-which I surmised meant that she only believed in the chart.  And she questioned why we injected lasix-"It's out of the norm. Does the vet know about this?"  She seemed to accuse me of doing something unethical/illegal.  She also claimed that Myrna was stable when she came in. Um...did you hear the part about not able to walk? And the BR that I noted that was up which needed that abnormal and wonderful thing called lasix injection? 

We saw the cardio on Tuesday for a regular visit and updated her.  Myrna was not congested enough nor had enough fluid in the pleural cavity to tap so that was good news.  She called what happened Monday night saddle thrombosis based on my description.  She said what may have happened is that a series of clots or a shower of them,  have broken from the heart and gone through the body.  One may have caused the stomach acid/vomiting issue; one caused the saddle thrombosis and sat long enough to lead to sudden pain and lameness but then moved and didn't cause damage.  It may be lingering elsewhere or may have disintegrated   She understood the need for lasix injection.  She wanted to solve the stomach upset issue. We did review end of life plans as well.   We need to combat stomach acid-which makes her vomit.  She needs more Pepcid; and maybe she has motion sickness-which causes vomiting-means she needs Cerenia; if we can get her to keep down potassium-which she vomited due to upset stomach-then we can improve kidney values which are up to BUN 52 and creatinine 37-which might be the cause or contributing to vomit/stomach acid. It's a cycle of connected cause/effect that might be difficult to solve. Vomiting leads to little digested diuretic which leads to CHF which causes discomfort which also-like stomach issues-leads to not eating. Empty stomach continues acid cycle.

Until Myrna begins eating enough on her own, we will need to feed her fluid food every hour or two.  We have been giving her sweet potato baby food, baby meat foods mixed with water, condensed milk mixed in water, and tuna juice.  Since she might vomit we are doing 6ml total at a time and will do more if she doesn't vomit.  We must not let her body begin to waste away or develop hepatic liver disease-when the body begins to use up the fat (found in the liver and body) to fuel the body. 

The cardio said to give Buprenex as pain reliever-about .1ml-which we have for Lizzie and Baby for bladder cystitis. But we did that and it back fired Tuesday night and sent her into zoned out land from 10 p.m. until after 3 a.m. She's much too sensitive to it so we can't use that again. 

Today, Wednesday, she's not eating well despite 1/2 tab Mirtazapine yesterday and today. Usually, one 1/2 works for two weeks. She hasn't vomited since Monday morning. She's kept down fluids, food, and meds. We have been trying to give by mouth 3ml every hour or 1 1/2 hours (except 1 a.m. to 6 a.m.) of at least two items if not more of each item: tuna juice, sweet potato, sweetened condensed milk and water, baby food beef mixed with water. She has taken a bite here and there of her food which is a scoop of Fancy Feast and a scoop of tuna, and some treats. Sometimes she eats 10-15 treats at a time; sometimes just one or two. Luckily, she's drinking a ton of water on her own and using the box regularly.

But out of approx. 250 or so calories a day a cat needs, she's only had maybe 60. Sweetened condensed milk might give the body energy to use instead of it going for the fat in the body.  We need to push more calories and maybe try a new stimulant.

As of 7 p.m., she finally ate a whole plate of food and a bit more at 9 p.m.  We will continue to monitor.  We understand we need to evaluate why she's not able to eat enough despite the stimulant Mirtazapine and if she has come much closer to the end than three weeks ago. The saddle thrombosis and possible clot to the stomach have really decreased her energy. 

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