Monday, February 26, 2024
Update Katharine Necropsy-Discussed with Pathology; Doing Tox Screen
Saturday, February 24, 2024
Katharine's Vet Gives Me the Cause of Her Death
Friday, February 23, 2024
Katharine Died February 4, 2024
I hadn't realized that I had not posted her death. She died of respiratory failure. She had fluid in her lungs and however that worked, her heart stopped. We were going to give her oxygen and take her to the ER but she died before we could leave the house.
Katharine Hepburn |
We took her body for a necropsy later in the day. We received the report today, February 23, 2024. The report is inconclusive. Many things were wrong but nothing to account for the pleural effusion. No heart attack. No brain tumor. No accounting for weakness or neurological issues she had been having. No real reason for liver failure. Or why her heart stopped. She had 30ml of fluid in the pleural cavity-two tablespoons. That would have made breathing hard. But not enough to stop breathing-or so vets believe.
We are going to request a tox screen as the pathologist suggested. And I'll speak to them next week about any other tests.
NECROPSY
Monday, January 29, 2024
Katharine's Health History Since November and Possible Causes
- Chronic use of Mirtazapine drives up phenobarbital levels-we saw this in her blood count in December. We saw a decline when we ceased Mirtazapine in January after a month of not taking it.
- 1/17 sees vet for tests: PLI, cbc/chem, bile acids, pheno. Pheno level down to 14 now that she's off mirtazapine-need to increase pheno again. RBC low, liver values high, kidney values creeping up, etc.
- She seems to do well with Hills ID and tuna; then begins to eat more food on her own of Fancy Feast and dry gastro fiber food; then goes into a decline.
- Week of January 23 she was eating well on her own, stronger, playing with toys, able to climb and walk well. Seemed stable and that our schedule and process was working.
- Then she seizured Saturday January 27. Took her to the ER.
Sunday, January 28, 2024
Katharine Has Multiple Organ Issues
Katharine is currently in the ER as I write. (1/28/24). She has developed CKD, liver disease, pancreatitis, and IBD, and of course heart disease. IBD/pancreatitis has been chronic for the last few years and worsened this fall. Liver disease is more recent although one value has been high for the past year. CKD was first thought to be a result of heart disease but has suddenly worsened with the onset of severe liver/IBD/Pancreatitis. In the ER she has low temperature, low heart rate, low glucose, and high liver and kidney values. She may need to be transferred to the vet hospital if she cannot be stabilized to come home. She had a major seizure yesterday afternoon-not grand mal as everyone thinks is normal. Her seizures have never been more than her spacing out and falling over, unable to walk. When she had break out spaciness in 2021, additional phenobarbital always corrected them. Then she had a larger one and didn't respond to more phenobarbital, so an ER visit with oxygen and fluids was required. We increased her phenobarbital afterwards and she has been seizure free for two and a half years. Yesterday, she seemed fine. She ate, walked, was vocal, etc. But as she drank from the water bowl, she began to space out for a few minutes (from video footage.) I was in the other room when I heard a noise. When I found her, she was on the floor struggling to get up and water was everywhere. I gave her extra phenobarbital twice and she did not respond and began open mouth, fast breathing which she had never done before. I took her to the ER and they put her on oxygen, ran tests. All we know so far, is what I described.
I was thinking back to Myrna Loy, our first cat with HCM, and for whom this blog and Facebook page were created. As much as I struggled to take care of her for 6 years and 9 months, I now look back and see that it was EASY compared to the cat issues I have dealt with in the last few years-Baby and Bette and now Katharine-because she responded to everything I tried. The only thing that never worked was rutin for the accumulation of lymphatic fluid called chylothorax. She was so sick those last few months, and I was concentrating on fighting those issues that I did not try many rutin options. But still, she had CKD but it was mild until the very end but never in failure even as she died-two days before her values were good.
But Baby and Bette and now Katharine-it's been a juggling nightmare with competing issues. For Katharine we respond to what we see in test results and exams and at home: is she eating, not eating? We need to hand feed her how much? What can she eat that the liver and pancreas will tolerate? She needs some fat for her body and medicines and vitamins; but she needs little fat for the liver and pancreas. Which appetite stimulant works and which one upsets the pancreas and liver? Does she have IBD and needs an antibiotic? She needs to watch her sugar for the pancreas (it's not as if she eats sweets) and watch her sodium for her heart and watch her calcium because it is creeping up, and take a potassium supplementation in a pill and Renal K powder and Renal K gel so that it is normal instead of below normal because her kidneys and heart need a good strong level. She drinks a lot-so her urine appears dilute; but her specific gravity is low and her SDMA is high indicating declining kidney function. Myrna's urine was dilute from taking high levels of diuretics and we worked hard to keep her hydrated with water by mouth and in food, and with meds and making sure she drank enough. But her SDMA was normal until the end, and her specific gravity was normal until the end. Katharine has tremors and shakiness-neurological, pharmaceutical, disease related?
And of course she seemed normal on Saturday before the seizure. She had eaten, been vocal, was moving around. I thought she had spent the week improving and was more stable. She had been eating more and we had been hand feeding less. She was mobile more. Had been engaged in toys more. And was climbing cat trees again. But the seizure hit her hard. And they think it hit because the liver-which processes phenobarbital-is acting up and may not have processed the phenobarbital well. (They did begin an additional seizure medication topiramate. But it is contraindicated with liver and CKD and causes anemia so may not be well tolerated in the long term.) But other things are going on that are causing low body temperature and low glucose and higher kidney and liver values.
But what exactly? And what would be the point of an MRI, CT, or biopsy-requiring anesthesia which she cannot tolerate due to heart disease, and may not tolerate due to her current health issues-to discover other causes if she is dying of a disease or cancer that cannot be cured or fought because she cannot undergo anesthesia for treatments, treatments which may not prolong her life, and face having anesthesia causing heart failure, which then leads to her death of heart failure. If she did not have heart disease, I would go forward with an MRI and biopsy if needed. I would fight. And I will fight. But our options are few. We had a plan. We had a schedule. It was working. She was stable. And then she wasn't. That is what is hard for me to fathom. We work with what we know but then the body actually has something lying beneath the surface that throws a wrench into our process and into her health.
Tuesday, November 7, 2023
Updates Katharine and Roxanne and Elizabeth-Gastro, Meds, Weakness, Inappetence and More!
So much has been going on this past month. In early October, blood work was done on Katharine and Roxanne; then Katharine and Elizabeth had their annual updates where more blood work was taken and more issues arose.
Roxanne is still testing high for potassium or HYPERkalemia at 5.3 (with 4.9 being high normal.) What does that mean? We need to consider testing for possible hypoaldosteronism which is rare. It may also indicate Addison's disease or diabetes. And is connected to possible renal failure or decline. For now, monitor. We might consider giving her a diuretic if she continues to test for hyperkalemia. Symptoms may cause muscle weakness, nausea, heart palpitations, irregular heartbeat, and abnormal blood pressure.
If a cat has HYPERaldosteronism which produces HYPOkalemia, that could indicate cancer. And low potassium disrupts the body's function, leads to racing heart, weakness, etc.
She also tested POSITIVE AGAIN FOR FIV virus antibodies. The vet is checking to see if there is a test to test for the actual vaccine so that we can determine if she received the vax as a kitten or if she was exposed to the disease since 2017 (somehow despite no other cat in the house having FIV.) We will monitor her for active disease and try to make sure she does not fight or bite or get bitten by any of our other cats.
Katharine developed weakness and inappetence after taking an ACE inhibitor Benazepril for two weeks-she began in mid September. Mirtazapine did not work to spur her appetite. She began losing weight. While her weight was fine around 9.12 or 9.14, when it fell in early October after one week to 9.7 after we thought she was eating well enough, we had to begin feeding her by hand using the trusty 3ml plastic syringe method. (We give her 9ml of Hill's AD in the morning before breakfast, 9ml if she is not eating dinner, and 9ml at bedtime.) We concluded that somehow the Benazepril was prohibiting the absorption or interaction of the Mirtazapine, although there is no known contra-indication.
When Katharine had her annual exam October 19, her heart was racing at 260 (normal should be 140 and no lower than 135 and no higher than 200.) Given her heart rate was high, the cardiologist said to give her Atenolol twice a day; given that she was weak, to pull the Benazepril and to check her heart rate in a week. She recommended that we buy and try a mobile EKG Kardia to monitor the heart rate at home. When we tried it, we got a laughingly low rate of 77-which would indicate she was near death. Given that she was up and about, eating, walking, alert, we knew it was wrong. We took her to the vet the next day and compared the in house heart rate reading to the Kardia device and both ran about 177. This means the Atenolol at BID (twice a day) is working. But she does need an ACE inhibitor if it can be tolerated. We will try Enalpril sometime in the future and monitor. Follow the link to purchase the device if interested. Follow this YouTube video for more information on how it works. It took until almost the end of October for Katharine to stop appearing weak; and it wasn't until this week 11/5/23 that Mirtazapine began working normally to spur her to eat.
We also noticed her breathing rate had increased. But it was difficult to get a true reading. So, in late September, her cardiologist said that it was ok for her to take furosemide once a day every day of 1/4 of a 12.5mg tablet (3mg approx.) Since the tablets were small and crumbled when cut, we changed over to the 20mg tablet, cut that into quarters, and shave off a bit more to reach the same 3-4mg dose.
Because she wasn't feeling well at her annual exam, Katharine hasn't yet had her annual rabies shot so we will soon return for that.
She had her PLI/Cobalmine/Folate panel tested for pancreatitis and gastro issues and she has a high folate. These blood tests are to test for metabolic function. Specifically, folate is B12 and indicates malabsortive issues in cats (or humans.) If the cat cannot absorb nutrients, health issues develop. AND the inability points to issues in the gastro metabolic system which could be disease, irritation, infection, etc. This goes along with the gastro scan she had in early October that showed she had a "smouldering" pancreas, an issue developing. She is already on steroids. The vet suggested we had a different probiotic Visbiome She also received a shot of B12. We can take her monthly to receive them and/or supplement her diet with B12. The vet wants us to give her cobalamine tablets which is B12. I ordered some from Amazon and am waiting on them to arrive.
Elizabeth had her annual exam in October and her rabies shot. She is good. She also needs some probiotic and will take Visbiome three times a week and not daily. Her PLI/cobalamine/folate test was also good except the folate was high. She has the same sort of gastro issues as Katharine but does not present with symptoms (although she was sick in June.)
I think that is up to date on the cats. Jimmy has had a few urine out of the box accidents but we keep at it encouraging him to use the litter box and doing treats and behavioral work.
Friday, October 6, 2023
Updates Roxanne and Katharine-CHF, Furosemide, Gastro Scans and More!
Updates:
Roxanne is still testing for FIV. Vet did Western Blot Test yesterday-Thursday 10/5. Did a urine test because urine wasn't available at her checkup last week. We rechecked for potassium because it was abnormally high at her checkup. And she got her first gastro ultrasound just because she's nine, never had one, senior years will begin to show changes, high potassium could be a sign of adrenal gland issues (although that would appear in other blood work and has not.)
Ultrasound showed normal adrenal glands so we will hold off doing any further blood work (there's an $800 gland panel) and we won't test aldosterone levels (high pot might mean HYPOaldosteronism and Addisons Disease) unless potassium remains high for the next couple of months or she gets sick and has other issues. Baby had HYPERaldosteronism with low potassium (can be signs of Cushings) and developed high blood pressure which was primarily caused by CKD (which showed up in urine Specific Gravity and SDMA, BUN, and creatinine tests.) [Baby's hyperaldosterone remained stable from 2018-2020 and was not a cause of her death in 2021.] We will check iron levels in the future if RBC and such hematocrit values change because iron can be a reason for blood values being off.
Ultrasound showed prominent pancreas but no inflammation; normal adrenal glands; but cysts on the liver-this can be normal in cats and becomes a problem if there are too many or they become enlarged. We will monitor for vomiting, diarrhea, poor appetite (symptoms of so many issues), RBC (red blood cell count), liver values. She also has mild kidney changes normal for her age. Again-we will monitor kidney values, BUN, creatinine, potassium, phos, SDMA, and urine.
Katharine-I have been concerned that she has had numerous possible CHF episodes since July, and four these past two weeks. Her xrays yesterday showed some hazing around the heart related to HCM but none in the lungs to indicate CHF. But her cardiologist said that it was fine to put her on 3mg furosemide once a day since she has possibly had CHF episodes because her breathing rate declined within an hour of being given furosemide. Given my experience with HCM, I know when I see fast breathing rate at 40 bpm or more that is sustained and unchanging and must be immediately treated.
Her ultrasound showed "smouldering pancreas" with cysts but no issues or concerns. She is already on a steroid for IBD but cannot increase the amount for the pancreas due to HCM. She otherwise has a normal gastro system and organs. She has some slight scarring on kidneys due to normal aging process but her SDMA and BUN, creatinine, potassium, and phosphorous are all normal. But we will continue to monitor those for signs of CKD, especially important to monitor since she has HCM. I must make sure she gets enough potassium to support her kidneys while on diuretics now as a daily dose and not just an emergency dose.
So, we await blood tests for Roxanne.
Katharine and Elizabeth go to the vet for annual checkups in two weeks (poor Katharine-she's been at the vet and cardio four times these last four weeks and one more to go.)