Monday, July 14, 2014

Organized for Cat Care

I strive to be better organized for cat care because there is just so much stuff we use. We were getting too many items on the counter for the cats and it was becoming a jumbled mess. So, I bought a stand and a round turn table. It still takes up the same amount of territory but now on two levels, the pills and syringes are on the turntable for easy access, and it just looks and feels more organized. Both items from Bed Bath & Beyond. These are the items we use throughout the day: the meds, syringes for meds, syringes and eye dropper for fluids, the toothbrush, the measuring spoon, dry food, bowls of fluids, and containers of dry food, and supplements that are added to the food at meal times.

Saturday, June 14, 2014

Feline HCM Cardiologist Checkup Reveals Stable Condition but with Congestion-Need to Increase Lasix

Myrna Loy
Myrna had a checkup with the cardiologist on Thursday.  She has been battling congestion for a month, with almost a daily need for 3-5mg of extra lasix, sometime from the afternoon to evening. I think the a/c units and fans are too noisy for her and she can no longer tolerate a lot of noise.  Her breathing also increased during storms earlier in May.  She has been run down this past week, typically in the morning and then bouncing back to energetic life by the late afternoon.  

The cardiologist said her heart seemed steady and stable with a slight change and increase in size (keeping in mind how enlarged her heart is and how damaged it is.)  The clot in the heart may be decreasing!  She has slight fluid in the lung and the cardio wasn't sure if that was congestion or pneumonia.   Myrna had a higher than normal temp at 103.5-but she always had a high temp of 102.9 to 103 when at the vet, induced by stress. Her temperature at home-if it is accurate-is always around 101.9 to 102.   But she has been run down this week so that is why the cardio thought it could be pneumonia-although no other typical symptoms (coughing and not eating, etc.) were presenting.

However, the blood work did not show any signs of illness-electrolytes were normal; white blood cell count normal, etc.  Potassium is 3.8-low normal-but decent given the amount of lasix she is taking (56mg a day.)  And that level is after we give her a potassium supplement of 595mg a day and give her Gerbers First Foods Sweet Potatoes or real banana in her food at least twice a day (excellent sources of potassium and they blend well with wet food.)    Her kidney values are good.  The BUN is normal at 34 and creatinine is 2.7-again 1/10 up from last time, slightly above normal but decent.   Her albumin is slightly high which usually indicates dehydration which is normal considering the amount of lasix she takes. BUT she is also congested so being dehydrated and congested at the same time is possible and to me confusing. 

 Her urinalysis was perfect but her pH is 6.5-all normal but when she gets to be 6.5 or greater, that is when she begins to go out of the box which she had done a couple of times lately.  The pH can go up due to dehydration. I give her Methigel-an acidifier-to bring down the pH level and it seems to work. And she takes a small amount of Max cat food (with acidifier) and S/O in her food to help obtain a balanced pH.   

The cardiologist wanted to increase her lasix to combat congestion and we hypothesized that perhaps she needs more at bedtime to combat any overnight development of congestion which could be the reason that she is run down in the morning. That 11 p.m. to 8 a.m. stretch is the longest she goes without getting additional lasix (and that is IF I'm able to get her by 8 a.m. to dose her.)  We decided to give her 5mg more at the 11 p.m. dose for a total of 18mg at 11 p.m.   That will increase her daily total to 61mg. 

She has had-which I was unaware of-weak rear leg pulses for sometime.  But the cardiologist isn't concerned and the pulses are not interfering with Myrna's ability to jump or walk and are due not to clots but to the obstruction in the mitral valve or SAM (systolic anterior motion of the mitral valve-when part of the septum blocks flow of blood during systolic motion-when the heart valve opens and pushes out fluid:  From Medicine.Net "Systolic: The blood pressure when the heart is contracting. It is specifically the maximum arterial pressure during contraction of the left ventricle of the heart. The time at which ventricular contraction occurs is called systole."  When the heart has trouble contracting, not enough blood flows through the body at a fast enough rate, therefore, pulses are weak.

Blood pressure was down to around 100, down from 130 in March.  Heart rate is 160 which is o.k. I think it's a bit too high but the cardiologist said it was fine. 

Here are her notes: Today’s thoracic radiographs revealed a focal area of congestion in her right middle lung field.  Because pneumonia has been comfortably ruled out based on the bloodwork results, we know that this congestion is a result of recurrent congestive heart failure.  We can increase her evening dose of Lasix to address this congestion and to hopefully improve her energy level when she wakes in the morning.  The laboratory testing did not reveal any new concerns.  Her electrolytes and BUN are normal.  Her creatinine is 2.7 which has not changed compared to her last evaluation. 


Monday, June 9, 2014

We Survived the First Week of June With the Cardiologist Office Closed-but Myrna is Urinating Out of the Box

The cardio vet office was closed all last week because the entire office-two cardios and three techs, went to a conference. I was full of trepidation, fearing something would happen with my two cardio patients but we survived the week. Cooper's doing well on torsemide. Myrna's needed extra lasix almost every day this week, due I believe to the noise from the a/c and fans. She has also begun to have accidents out of the box, so far on the pads near boxes. It could be due to the extra lasix and the extra need to go. Urgency can make them uncomfortable. Usually it requires an adjustment with potassium (she may be too alkali) or a Valium adjustment, and may need Methigel, an acidifier. For the days I do this, she uses the box. When I skip one of these adjustments, she goes out of the box. She sees the cardio Thursday and at that time we'll do a urine test. I doubt she has a UTI because the classical symptoms are not there: going very frequently and very small amounts. But I will keep an eye on her and if I suspect she has a UTI, she'll go to the vet.

Friday, May 30, 2014

Cats with Heart Disease Cannot Breathe Hot Humid Air

Summer is here even if not officially and we must prevent our cats from breathing hot, humid, muggy, stale air in order to prevent congestion. The air in your home affects how they breathe and if they become congested and how well they deal with congestion. Give your cats good air to breathe indoors: get rid of humidity in the house with dehumidifiers (stand alone units or attached to the automatic A/C unit) Keep the temps inside cool, not hot nor too cold. Run fans-maybe buy some of the "whisper quiet" fans. Run stand alone room units that exhaust through window screens (no need to remove the screen) or buy those you insert into an open window. If you have an automatic A/C in your home, set it for 70-74 degrees or whatever works to keep the air cool but not cold, and not hot and stale. And don't let the cat stay in the sun for too long. Even heat can trigger stress and stress triggers congestion. And keep them indoors as much as possible. Good luck!

Torsemide Works for Cat While Lasix Is Needed for Other Cat

Cooper is doing well after a week of torsemide 2mg four times a day (QID). Breathing rate is about an 8/15. Myrna has needed 5mg extra of lasix at some point during the day for some of the last few days (but not all.) Her breathing rate has been 10-12/15 and that's when she received extra lasix. She's stressed by the air conditioners and the fans going, storms we've had. When it's cool during the a.m. and evening, I turn the fans off and give her a break.

Cats Are Like Babies-They Cannot Sustain Injury or Illness On Their Own Without Medical Care

The other day I picked up something someone was giving away for free.  They had a kitten with them which they had recently acquired. The kitten was 8 weeks old and the cutest little thing. It had just hurt its front leg a couple hours before I came over.  The daughter was carrying the thing because it could not walk. I looked and saw the paw was swollen at the joint and asked if that was the hurt leg and it was.  I felt the head and it felt very warm. I suggested the ER and soon because the leg was noticeably swollen and the body felt very warm and feverish (but because it was begin carried it could have picked up body heat.)  We had a discussion about cats in general because they have six and I have seven.  I mentioned that I was used to dealing with a variety of issues. They had a friend coming over in a few hours who is a vet tech who was going to look at it.  Then she said she'll take it to the vet tomorrow if the friend says it needs the vet.

At this point, there was little I could say.  Pointing out that the leg was swollen and the kitten possibly feverish and needing the ER wasn't enough to compel the lady to leave NOW for the ER.  I didn't think it would work to tell her that by the time she takes it in-say she calls in the a.m. and they say they'll see her at 1 p.m.-the poor kitten would have been suffering, in pain, unable to walk, and possibly feverish for 24 hrs. What person in their right mind lets an animal suffer for 24 hrs?

And it bothered me all the rest of the day.  And then it dawned on me-would she  let her baby do the same thing? Would she be so calm, so seemingly unconcerned and lacking in a sense of urgency to get care for a baby if a baby were just as sick? Probably not.  And that's what I should have asked: how long would you let a baby go with an injured, swollen limb, possibly feverish? 24 hrs? 12 hrs? 5?  

Because cats are like babies, and I don't mean because we treat them as our children.  They are physically too small to handle what most adults or even children can handle.  Constant vomiting and diarrhea-what might be a normal course of illness in a child will weaken and debilitate a cat.  A child can take all sorts of meds for such an illness but not a cat.  Lethargy, an unwillingness to eat or drink are normal for a sick person. They have reserves in large bodies before needing to see a doctor.  But not a cat.  One day without food and water and the cat will not rebound on its own without vet care and may have its life in danger.  A broken, sprained, swollen and painful limb injury? Who in their right mind would let a child sit around without seeing a doctor?  Almost no one I'm sure.  A cat would need care immediately as well.

And yet we treat our pets as if they are full grown adults, able to withstand not eating and drinking; withstand fevers; withstand constant vomiting and diarrhea; and withstand the inability to breathe.  Some HCM owners ignore their cat's pain, crying out, inability to breathe, panting, breathing fast, discomfort, hiding, lack of drinking and eating, etc.  And why? Because they think the cat can deal with it, that it will pass, that surly it can't be that serious, and that maybe the cat doesn't need the vet or that it can wait a day or two until the vet is available.  And of course, there is the cost of care to consider.

But put it in perspective:  the next time your cat is sick, think of it as you would a baby, a child under the age of one. Just how long would you let a baby be in pain, unable to breathe, have a swollen leg, have a fever before seeking medical care?  Five minutes? 30 minutes? One hour?  If we are not going to let a baby suffer without care then we can't let the cat suffer.  Because a cat's body is just about as small, weighs almost the same as a newborn, and cannot sustain illness or injury and rebound on its own anymore than can a baby. 

Monday, May 26, 2014

Feline HCM and Heart Medications Websites That Describe Meds

Websites Discussing Heart Medications:  

FVMA Conference Discussion
http://www.fvmace.org/FVMA_83rd_Annual_Conference/Proceedings/WHAT'S%20NEW%20IN%20MANAGEMENT%20OF%20CHF.html

Big Hearts
http://bigheartsfund.org/resources/cardiac-medications/