Friday, August 28, 2015

Possible Cause of Death-Respiratory Acidosis

From reading, I have a theory about what led to Myrna's death. It's much like stacking dominoes-as one thing declined, so other processes in the body followed. But it's not a process that I believe I could have prevented. And she was on oxygen in the ER and was not improving. The chemical process may have been caused by hypochloremia-low chloride-caused by vomiting, diarrhea-which leads to hypercapnia (respiratory acidosis) which is too much carbon dioxide in the blood. Or somehow, on it's own, hypercapnia developed in the blood. Respiratory acidosis develops when there is decreased ventilation-inability to get enough oxygen-which leads to an increase in carbon dioxide in the blood. Because the body cannot expel carbon dioxide due to congestion/lung damage/heart condition, more CO2 than O builds up. This becomes hypercapnia and leads to increased breathing rate as the body struggles to produce oxygen. The heart beats faster, this leads to blood pressure increasing, and the inability to breathe, to produce oxygen is exacerbated by damaged lungs and increased heart size and congestion. Her heart had been stable the day before and she only had three oz of fluid removed. And yet, we know congestion was returning rapidly since 5 oz had been removed the day before.

Wednesday, August 26, 2015

The Importance of Sodium and Chloride

Near the end, Myrna was suddenly low on sodium and chloride due to chronic diarrhea, and the vomiting that would occur from time to time for whatever number of reasons. In July, it became so chronic that she couldn't hold anything down. When her blood work showed she was low on sodium-and I read that being low on sodium can contribute TO vomiting and diarrhea-I gave her some salt in the food I was feeding her by mouth. This improved her condition within a couple of hours. 

While HCM cats do not need added sodium, in this rare instance it was what she needed. But why? Here's a website called Pet Education. Com to tell you why. I've referred to this site before. It's a really good, basic site. Bookmark it and search for additional information. "Sodium and chloride help maintain the balance between fluids inside and outside individual cells of the body...Sodium aids in the transfer of nutrients to cells and the removal of waste products. Chloride helps maintain the proper acid/alkali balance in the body. Chloride is also necessary for the production of hydrochloric acid (HCl) in the stomach which helps in the digestion of protein..."

For more information, read this website: "In addition to its functions as an electrolyte, chloride combines with hydrogen in the stomach to make hydrochloric acid, a powerful digestive enzyme that is responsible for the break down of proteins, absorption of other metallic minerals, and activation of intrinsic factor, which in turn absorbs vitamin B12. Chloride is specially transported into the gastric lumen, in exchange for another negatively charged electrolyte (bicarbonate), in order to maintain electrical neutrality across the stomach membrane. After utilization in hydrochloric acid, some chloride is reabsorbed by the intestine, back into the blood stream where it is required for maintenance of extracellular fluid volume. Chloride is both actively and passively absorbed by the body, depending on the current metabolic demands.  A constant exchange of chloride and bicarbonate, between red blood cells and the plasma helps to govern the pH balance and transport of carbon dioxide, a waste product of respiration, from the body. With sodium and potassium, chloride works in the nervous system to aid in the transport of electrical impulses throughout the body, as movement of negatively charged chloride into the cell propagates the nervous electrical potential."

Thursday, August 20, 2015

Preliminary Report on Myrna Loy's Necropsy (Animal Autopsy)

Gross Description

6 years

Necropsy Preliminary Report
A 6 year old spayed DSH died on 8/19/15. The cat had a history of clotting secondary to heart disease. Owner isconcerned about gastric and renal disease. A 4.45 kg female spayed cat is necropsied on 8/19/15. Autolysis is mild. There are adequate visceral fat stores and the body condition score is 6/9. The eyes are mildly sunken into the orbits, and mucous membranes are pale pink. The thoracic cavity and pericardial sac respectively contain 15-20 ml of red, clear, slightly opaque fluid, and 5 ml of dark red clear fluid. The parietal surfaces of the pericardial sac and pleura are multifocally and loosely adhered to the thoracic wall by numerous fibrinous adhesions. The edges of the cranioventral lung lobes are collapsed and plumb colored. All lung lobes float in formalin. The heart is enlarged weighing 20.1 g (0.45% of total body weight), and the right ventricular free wall and left ventricular free wall respectively measure 0.1 cm (RVF) and 0.8 cm (LVF). The left atrioventricular valvular leaflets contain numerous, 0.2-0.3 mm in diameter, tan, firm, smooth nodules. Lining the endocardial surface of the left ventricle are ~10, thin, white-pink, string-like bands of connective tissue (moderator bands) bridging the ventricular septum and the left ventricular free wall. The liver has slightly round edges and a prominent reticulated pattern. The cortex of both kidneys is slightly granular. There are no additional remarkable gross lesions.

Left ventricular concentric hypertrophy
Left atrioventricular endocardiosis
Excessive moderator bands
Liver: Mild hepatomegaly and centrilobular congestion

Pericardial sac: Pericardial effusion
Lung: locally extensive atelectasis and mild fibrinous pleuritis

The heart was overall large and the left ventricle was markedly thickened, consistent with hypertrophic cardiomyopathy which is a condition in which the muscle of the heart thickens (especially on the left side) and compromises the contractility and blood-pumping efficiency of the heart. Left sided heart failure often presents clinically with a thoracic/pleural effusion, as seen in this case; however, the slight milky consistency suggest a chylous/lymph component which can occur if there is damage to the thoracic duct. In addition, the large liver and centrilobular congestion are common changes seen in right sided heart failure. There was also evidence of endocardiosis of the mitral valve, and excessive moderator bands, but the significance of these changes in relation to the enlarged heart is unknown.  Endocardiosis is a common age related degenerative of the valvular leaflets. If severe, these lesions can cause leaky valves and eventually heart failure, but the changes were mild in this case. Excessive moderator bands have been observed in normal cats and in cats with hypertrophic cardiomyopathy, but the significance is unknown.

A final report is pending histopathologic examination of all the major organ systems. 

Miss Myrna Loy Passed Away Wednesday, August 19,2015

I regret to inform you that Myrna Loy, the blog and Facebook page mascot, our heart patient cat with HCM (hypertrophicardiomyopathy) died this morning at 1:30 in the ER, in Novi, with me in the procedure room with her. She quickly went into arrest in the ER after having fluid removed and after being on oxygen and breathing better, but then having congestion quickly return, and she couldn't be resuscitated. It wasn't violent; she didn't have to be subjected to the meds that put animals to sleep (that caused Coopers death last year to be violent). She was six years, 4 months, and 27 days old. She had lived with the disease five years and nine months since first being diagnosed with heart disease after her first attack of CHF (congestive heart failure) at 8 months old. She was a joy and we will miss her.

Myrna Struggles in the ER

In ER with Myrna. BR 50 plus and up to 60 after trying to feed PO and meds. She's been uncomfortable all day despite Valium. Lasix injections and torsemide not working well enough.

Note from vet tech-"Myrna expressed her anal glands" to display her unhappiness at being I the ER. She has never done that, 

Myrna to have right side tapped but not left due to enlarged left atrium. Vet called cardio and they talked. Will sedate slightly. Leave on oxygen a bit more. Test pulse ox-oxygen in blood which tells how well oxygen is being picked up in pulmonary vein/artery and circulating in body.not even at home! BR here is 56.

Myrna Begins to Struggle with More Congestion

Facebook post August 17, 2015

Myrna is going through difficult phase today. Breathing rate was up Sunday and didn't respond to more torsemide. Rate was 60 at six am. Gave meds and .4ml lasix injection. Vomited meds at 7:30 am. BR did come down to 48. Was down to 44 at 10:30 am. Gave more meds at 9 and she vomited those in 15 minutes. Gave more at 11:30am today which she's keeping down so far.   I think a clot moved in her today and may be causing stomach problems since she's vomiting. She was eating until one am this morning. She digested all her food since she did not vomit up any. She is drinking a lot and keeping it down and urinating enough. I'm not sure if and when she may need to see the cardio. If she keeps down her meds; if she responds to meds and injection she can remain at home. Otherwise she may need to be tapped to have fluid removed from her lungs and to make her more comfortable. Fluid needs to decrease to make her more comfortable. If she can keep down the Valium then she can rest a bit. But fluid removal is key. But the tapping process is difficult for her due to sedation so that's why I'm hesitant.

Myrna saw the cardio this afternoon.  They removed 5 oz of fluid, the most ever from her.  Her body is learning to tolerate more fluid in the pleural effusion as her breathing rate was still a decent 44. But that doesn't mean she was comfortable or able to breathe well enough. They will drain and then we will leave. Will do blood and X-rays.

The cardio found that the left leg has no pulse because it was killed off by a clot that occurred in the last two months. I have no idea as to when that occurred. We've had no signs. She was appearing to be unsteady on her legs last week so I gave her more potassium supplement PO (by mouth).  So , I don't know if it was in the last week or before. However, the other blood veins around the leg are supplying enough blood to keep the leg viable. 

Facebook post Tuesday, August 18, 2015

Myrna is still struggling to breathe. Rate is 48 and only goes down to 44 after Torsemide.  The cardio doesn't yet want to see her to try to withdraw fluid but I don't know.  I can't see us spending the next few hours injecting lasix continuously and then struggle to get her to keep down her meds. She vomited last night, and almost again today. She is again low on sodium (141) but-unlike last time, when she was breathing fine but was just very sick-she is too congested so I can't supplement.
However, kidney values in blood work looks good: potassium 4.1, creat 2.8 (high but stable, the same in July) ,and BUN is 34 (down from July 36.)
She hasn't eaten since 1 a.m .Monday. I gave Mirtazpine today, extra Pepcid and Cerenia last night. Until she keeps down things, I can't yet begin feeding her by mouth. She is drinking well enough. I will start with some tuna juice soon and see how it goes.

Thursday, August 13, 2015

Herpes Virus Hits Jimmy Stewart-Baby Thyroid Level Decent but Goes for Ultrasound-Myrna Update

Facebook post August 13, 2015
Baby had a blood recheck last Friday and results came back and the vet called me Tuesday to say she's fine. Thyroid is 2.6 which is down from 2.8 in June which is good. She is scheduled to go for an ultrasound for the GI tract next week. She's swollen and I was afraid she was retaining fluid and was suffering liver or kidney damage. No, (thank goodness) she's just fat and gained a pound since June. This, despite not eating. So, what does she eat if she's not eating? 

Jimmy vomited last night and now has goopy runny eyes. Chances are that the herpes virus they are prone to has hit him. And this, after he spent the last two nights upstairs with us and Baby and Myrna. I hope they do not get sick. I don't think either of them are a carrier because he was the first to contract it as a kitten and it spread to all the siblings but at the time, not the older two cats (Baby and Cooper.) They are all on daily lysine doses but the virus raises its ugly head from time to time. Signs are running eyes, red eyes, vomiting, fever, etc. Solution: extra lysine doses for all of them and antibiotics when needed. He's on twice a day Clavamox.

Myrna isn't eating well again and I have given her 1/2 Mirtazapine.  She's eating some treats but not enough on her own the last two days.  Since Jimmy's sick, I don't want her to stop eating if she's also sick. 

Facebook post August 10, 2015
Myrna's been well this past week, still eating, still breathing fine. She had a vomiting episode Friday night so we waited for half of an hour then redosed Torsemide, Valium, and Pepcid. Then I redosed the rest of the 6 p.m. meds a couple hours later after making sure she wasn't going to vomit again. It may have been caused by anything but I don't think it was too serious as she had been eating before and did eat after the episode. While she hasn't been active since I last noted her activity August 4, she isn't worn out.

Facebook post August 4, 2015
Myrna's been eating very well the last two days and today for the first time in maybe two weeks, has played more than once with her catnip toys. She even tossed around her catnip potato toy and chased after it. Thank the Lord for another day, and for the moments of energy.