Thursday, January 8, 2015

Update on Myrna Loy January 2015

Much has gone on since the last post in October. I've kept up the Facebook posts but not the blog. I'll catch up soon.  But the recent updates: Myrna has developed new complications,  chylothorax fluid in her pleural cavity, the area surrounding the lungs. She developed slight pleural effusion-fluid around the lungs-in September (along with her common condition pulmonary edema, fluid inside the lungs) but developed a sudden amount of pleural effusion in December just before Christmas.  Once it was drained, she was switched from lasix to torsemide. She was receiving lasix 25mg four times a day, then torsemide 5mg once a day and 2.5 once a day. But then the first week of January 2015, she developed chylothorax fluid-lymphatic fluid that should drain from the intestinal tract to the vena cava but overflows (due to heart disease or other complications) into the pleural cavity. Once drained, she was put on torsemide 5mg in the a.m,, 2.5mg in the afternoon, and 5mg at bedtime.  

We need to prevent the accumulation of lymphatic fluid in the pleural cavity because it can lead to scarring-fibrosis. There's a supplement we can try called rutin. I found Canadian studies about rutin such as this one:

So we are trying rutin for Myrna's lymphatic fluid. She receives 500mg of rutin, a natural substance found in buckwheat and citrus fruit, thought to change the triglycerides in the lymphatic fluid so that it flows more easily to the vena cava and does not back into the pleural cavity AND will change the makeup of the fluid so that it does not cause fibrosis-or scarring-in the pleural cavity, which would exacerbate her already difficult breathing process.  Found some at Whole Foods. Round large tabs, and I'll cut into halves. She gets four halves or more a day. I'll start with four and increase as I can. I say halves only because I think the size is too big as a whole to give so I'll cut it in half. Each whole tab is 250mg and we'll give a total of 500mg a day or more.

To protect her kidney function and electrolyte balance, we are increasing the doses of potassium supplements and the vitamin mixture for kidney support that I mix of vitamin E, C, COQ10, krill oil, and sweet potato (with the occasional glucose or apple cider vinegar mixed in for added benefit of electrolytes and (glucose) and kidney and stomach (vinegar.) (See med tab notes.) 
Myrna Loy at Christmas 2014 with a new mouse toy

Sunday, October 26, 2014

Feline Urine Specific Gravity, and Update on Myrna Loy's Bloodwork

Myrna hasn't been feeling well enough, had trouble eating (the spoiled sweet potatoes being the possible reason), is having trouble chewing again (although not as badly as last month), and had enough energy but just wasn't as up as usual. I had her blood rechecked. A month ago in September, her BUN and creatinine had ticked up and her urine specific gravity was low. This time, good news: potassium is 4.3; BUN is 31, down from 41; creatinine is almost normal at 2.8, down from 3.5; urine specific gravity is up at 1.020, up from 1.004. USG-urine specific gravity-is complex and is associated with how well the kidneys are processing waste; if the cat's hydrated or dehydrated; if there's kidney damage, etc. Read the link below.

As usual, Miss Myrna presented with something unusual: hypothyroid, which is suddenly down to 0.6, down from a norm of 1.2. Just something to keep an eye on but could be the reason she's a tad run down (along with spoiled food, heart meds, heart disease.)

From IRIS website about urine specific gravity

Thursday, October 2, 2014

Feline HCM-Update on Myrna Loy (and Elizabeth Taylor, too)

For whatever reason, Myrna Loy has had a surge of energy since Sunday.  A month ago, she saw the cardiologist for a check-up, had an increase in atenolol due to a higher heart rate, and still had good kidney blood values.  A week later, she struggles to chew, isn't eating much, and sees the vet.  We found that kidney values had increased and combined with not eating, meant that she was low on energy.  She began antibiotics in case she had an inflammation in her mouth and she developed diarrhea due to the antibiotics.  This led to an increase decline of appetite and energy.  I then cut the antibiotic into four  of 1/2ml-from two doses of 1ml-which decreased the severity of the diarrhea.  I also continued the liquid supplement mixture (omega 3, baby food sweet potato, krill oil, etc.) and gave KMR mixed with corn syrup by mouth when she would not eat (this was a form of protein and energy for her.)  Last week, Elizabeth Taylor was hospitalized with a severe bladder inflammation. So, last week was a hectic week with one cat very sick, and another having trouble eating enough on her own and being somewhat run down.

Then suddenly Sunday 9/28/14, Myrna pops up perky, energetic, alert, engaged, playful, and hungry.  She had slowly been eating somewhat better by the end of that week preceding but she has been eating very well on her own since Sunday even though she was still on antibiotics (which thankfully ended 101/1/14.)  She played all day Sunday and barely slept until the early evening. She brought me her potato toy, her mouse, played with the ribbon toy, and played fetch with my husband.  She has played with the mouse almost every day since and has brought it to bed at nap time.  She has been cuddly at night, curled up in my lap for hours.  And last night, 10/1/14, she brought the mouse to bed at bedtime and I tossed it back to her and she jumped for it.  I continued to toss it and she continued to jump up on the bed to try to catch it and often she caught it with both paws-something she's not done in years.  
Myrna and Elizabeth

Elizabeth has finally finished her course of Clavamox antibiotic which has been difficult for her to take. It has caused great foaming of the mouth and much running away.  She really does not want to eat strictly Hills CD as prescribed but we are working on it.  I'm not as concerned about her lack of eating as I am with Myrna.  Why?  Because Elizabeth will eat something per meal, is drinking a lot on her own, and doesn't take heart meds that lead to dehydration and can, for a variety of reasons, damage her kidneys.  She's not starving at all. And she could lose some weight being almost twelve pounds.  Myrna, on the other hand, needs to eat and drink; must keep up her energy, support her kidneys so that they react properly to the heart meds.  And Elizabeth seems to continue to recover, is using her litter box faithfully, and does not seem to be in any pain or discomfort when urinating. 

Tuesday, September 23, 2014

Feline UTI vs. Idiopathic Cystitis-What's the Difference?

There is a difference between a cat urinating frequently due to taking lasix and one that urinates frequently because of an infection or other kidney/bladder health issue. There's also a difference between a cat that drinks a lot due to a kidney/bladder issue and one that is on lasix.  How do we tell the difference?  

A cat on lasix will  drink a lot of water and quite often, which is what we want to see.  The meds drive the cat to drink.  Drinking helps support kidney function; helps hydrate the body as the lasix withdraws fluids-which can lead to severe dehydration, which we want to avoid for numerous other health reasons.  And the frequent drinking combined with the diuresis process from the lasix, will drive the cat to want to urinate often, sometimes large amounts, possibly every 2-4 hours.  The cat will be comfortable using the box. But sometimes they may go out of the box as the urge to go so frequently may overwhelm them. Valium or Buprenex may work to ease their discomfort (search Valium to read why Myrna takes it for this very reason.) 

If the cat's NOT on lasix, then you can assume there's an issue with the kidney/bladder.  You may see the cat drink a lot of water and quite often as the body seeks a way to support kidney function and/or to help flush out any bacteria/crystals/inflammation in the kidney/bladder.  You will see the cat urinate a few times a day if an issue is just beginning or every few minutes with increasingly small amounts of urine when a flare-up is hitting.  Often, blood is in the urine.  The cat may also choose to go out of the box on paper, rugs, cold floors, blankets, etc. as the box may be uncomfortable to use.  You may see the cat sit in the box for a minute or longer trying to expel urine. You may see the cat push urine out, as if straining to excrete urine.   The cat must see the vet or ER vet as soon as possible.  

The typical protocol is for the vet to collect a urine sample by needle withdrawal so that the sample is clean.  They will check for bacteria or crystals, and check the WBC (white blood cell count).  A flare-up can occur if crystals formed in the bladder, irritating the bladder.  Crystals can also lead to a very painful blockage in the urethra.  This blockage is more dangerous for male cats than for female cats.  If your male cat urinates out of the box, it must see the vet or ER vet immediately to see if there is an infection or blockage.  Because a blockage can allow bacteria to enter the kidneys and cause other physical issues, often male cats will die from blockages if treatment is not sought early.   If the WBC count is high, that indicates an infection.  Often with only crystals in the urine, the WBC will be low.  With an UTI or actual bacterial infection, the WBC will be elevated.  The cat may also have a fever and will probably be in a lot of pain.  IV fluids or sub q fluids should be given to help flush out the bladder.  If there is an infection, pain meds and antibiotics such as Clavamox will be prescribed.  Without an infection, usually the vet will give pain meds and suggest that the cat only eat SO or CD wet and dry foods, foods that promote bladder health and fight the formation of crystals and help fight formation of bacteria.  The cat could also take Methigel, a urine acidifier which helps change the pH of the bladder to help prevent crystals and bacteria.  For other kidney/renal/bladder issues, there are other brands of foods for these specific issues. Ask the vet which prescription cat foods might work best.  Other tests that may be needed would be xrays to check for stones and an ultrasound to image the kidneys and bladder to look for other physical causes such as blockages, cancers, and for idiopathic cystitis.   Idiopathic cystitis is caused by a thickened, inflamed, irritated bladder, usually without bacteria or crystals present.  Pain meds to relieve the pain and the swelling and the irritation will be needed and probably a psychotropic to keep the cat calm, not only as it heals but going forward for the rest of its life.  This is what Elizabeth has had since a kitten but hasn't had a flare-up in over two years.  But this is what MSU believes is what she now has and not a UTI. 

We had been told by the ER on Sunday that Elizabeth had a UTI, that bacteria presented in the urine sample and that the WBC was elevated.  Except, it turns out, they captured the sample from the exam table and probably picked up bacteria there.  AND the WBC wasn't that elevated to point to an infection-the WBC should have been much higher had she had this bad of a flare-up due to bacteria.  So, after two days of urinating small bloody samples, and still doing so today, and because her regular vet couldn't see her (nor did they seem too concerned that she wasn't responding-they suggested we come back on Thursday when they do ultrasounds-THURSDAY???!!!), and because the ER didn't (in my estimation) handle this matter fully, I took her to Michigan State Vet Hospital. 

After four doses of Clavamox 62.5mg on Sunday, and more antibiotics Monday, she continued to urinate tiny amounts of bloody urine. It was unusual that she was not responding to meds.  We gave her plenty of Buprenex to relieve the pain and the fever but it didn't seem to help.  We also gave her 12ml of water by mouth every couple of hours.  We had a blanket and some washable rugs on the floor for her to use. When cats have UTIs or any flare-up that makes urinating painful, they will often choose soft fabrics and cold floors which feel more comfortable, which is what she did.  That's why we also kept her isolated in a bedroom and constantly scooped the litter boxes.  

At MSU, they are keeping her overnight for treatment.  They gave pain meds and IV fluids.  They cultured the urine; they did blood work; they did an ultrasound of the bladder.  They reviewed the xrays from the ER and the ER records.  The vet called to say Elizabeth is resting well with pain meds and IV fluids. She doesn't have a UTI. No bacteria in the urine sample they withdrew with a needle. The WBC in that specimen was low, too low for an actual UTI flare-up. Hence, lack of response to antibiotics. They will finish tests tomorrow; try pain meds for home and a psychotropic. They hope she will come home tomorrow if she responds to treatment.

Sunday, September 21, 2014

Cat Issues Abound on a Sunday-Myrna and Elizabeth

Myrna ok today. Not eating well. She sits at the bowl and eats for five minutes but nothing is really gone, just pushed around. She will eat dry food and dry treats. Has diarrhea due to antibiotic. I'm giving her yogurt, Forta Flora to help combat it; cutting out oily supplements; cannot really decrease water due to possible dehydration due to diarrhea; and will need to give water and liquid protein (tuna juice, KMR, corn syrup-just a touch of this) by mouth to support her general nourishment, electrolytes and kidneys and hydration levels.

Elizabeth presented us with a present first thing this morning-going out of the box followed by constant urination of dime size and smaller amounts every few minutes. Luckily, this time, all in a box. I secluded her in the bedroom; gave endless mls of water by mouth, two doses of buprenex of .2ml and then .15ml; and Clavamox 62.5mg pills (which are left over from this summer)-two of those between 9:30 a.m. and 1 p.m. She presented with blood in urine around noon. My husband took her to the ER because you can't wait 24 plus hours before the vet sees a cat that is urinating with blood. An infection can grow and infect the kidneys, not to mention who wants a cat urinating every few minutes around the house? Vet found bacteria and blood; will give us more Clavamox and Buprenex.
Myrna Loy

Elizabeth Taylor

Saturday, September 20, 2014

Myrna Responds to Clindamycin

Update-they gave Clindamycin oral liquid antibiotic to Myrna. I gave it to her last night for the first dose. She will receive it twice a day. She was still very active last night and "high" on Mirtazapine so she ate well in the evening and has, for the last two days while on Mirtazapine, been very aggressive about getting at our food on our plates. She hasn't been this aggressive in about fouryears, ever since she discovered toaster waffles. This morning, she was perky and alert, not at all run down as she has been the last two mornings before taking Mirtazapine. She ate well but is having difficulty chewing. So, perhaps she does have an infection or abscess in the mouth we cannot see and unfortunately will never be able to xray due to anesthesia which she cannot-and most HCM cats cannot-undergo. BUT it's clear the antibiotic is helping. Not sure if it will cause gastro issues as Clavamox has in the past but we'll see. When I pilled her, the roof of her mouth did feel differently, more open. So, perhaps she's not nauseous from poor kidney values. But her kidney values did increase slightly and enough to be concerned. I will give her supplements for kidney support again. Perhaps not eating well enough the last few days did drive up kidney values. We will retest in a couple weeks or so providing she continues to eat. Not sure how long she can be on an antibiotic or if it will be something we do ten days on, ten days or so off, and then wait to see if she returns to not eating and then try them again.

Myrna Develops Difficulty Eating and Has Poor Kidney Values-A Week Ago Values Were Fine

(Thursday, September 18, 2014)  Myrna isn't eating today and looks uncomfortable. She's needed extra 5mg lasix once a day since Monday and last night, we injected .25ml because breathing rate kept increasing. Rate decreased to 8 and seems good this a.m. But still it's something else. She's not eaten well enough all week and has trouble chewing. Have appointment with regular vet this afternoon and might see cardio tomorrow.

(Later in the day)  Myrna at vet today. Took xrays, CBC/chem panel with pancreatitis test, UA, blood pressure (100-102) and heart rate (162.) Both vet and cardio happy with bp and heart rate-sort of low bp but she handles it well and it's due to meds; sort of high heart rate but high due to vet visit and so assumed to be more normal at home and at rest, and it's lower than it was last week at the cardio visit. Cardio believes she's handling the increase in atenolol (now BID) to lower the heart rate. Xrays showed very slight congestion which we knew but no harsh sounds in lungs and no heavy pockets of congestion-good news. Her mouth, teeth, gums all seemed normal. Problem may be due to nausea, stomach acid or stomach upset. She responded well to Cerenia-a stomach calming med late in the afternoon; and ate very well beginning a minute after I gave her 1/8 of Mirtazapine.  Will suspend all unnecessary supplements for a few days. Will know blood and UA results tomorrow.

(Friday, September 19, 2014) The vet called with blood results for Myrna.  It's troubling.  In one week Myrna's BUN up to 41 from about 30 or so-but had been normal; creatinine from 2.7 to 3.2 or more-can't remember exactly. They think decline in kidney function is due to increase in lasix and the shot we gave Wednesday night caused the kidneys to hit their limit which does not bode well for her future ability to take more lasix if needed.  She needed mirtazapine yesterday and today to eat. She may need to take Pepcid. Now taking Cerenia. Concerned with difficulty eating so will give an antibiotic in case she has a tooth abscess that can't be seen . Not eating much last couple days and not eating at all Thursday until late in day after the blood work,  may have also driven up kidney values due to some dehydration-which is why you must give cats liquid food and water by mouth when they are not eating or even eating well enough. Will decrease lasix cautiously.  Currently on 18, 13, 15, 18mg per day; will cut back to 15, 13, 15, 18mg per day.   This puts her between a rock and a very difficult place: the afib in the heart which is a recent development will make it difficult for the heart to beat well enough to handle pumping and blood flow and congestion; a decline in kidney function will make it difficult for kidneys to process the diuretic process demanded of lasix.  The demand on both the heart and the kidneys will increase and yet the function will decrease.