Myrna Visits Cardio April 6 Due to Needing Extra Torsemide Almost Daily

After last week's cardio visit where no fluid was removed from Myrna but additional complications with her heart were noted, she needed one or two extra doses of torsemide a day of 2.5mg all this past week.  Her breathing rate on average was at 36 and then ramped up as high to 56 when she needed extra Torsemide.   But then suddenly, she was much better late Sunday night and all Monday morning. But still we went to the scheduled appointment.

This time, fluid of about 2 oz was withdrawn.  But there's an added complication-in one week she has suddenly developed fibrosis or pockets of scars in the pleural cavity, making it difficult to withdraw all the fluid in the cavity.  This will also create an additional issue going forward of not being able to expand the airway if the condition worsens.  It means an additional reason for her breathing rate to increase-which may or may not include pleural effusion.  And it will mean a lack of oxygen circulating as the airway cannot expand enough.  Rutin-a supplement meant to decrease the scarring capabilities of the lymphatic fluid found in the pleural cavity-may have staved it off but now we will need to give more to her to try to slow down the progression of scarring. We were giving two rutin and now will give three or more a day. 

Since we increased the Torsemide to 5mg QID we must increase her potassium. Her potassium was lower this week and BUN and creatinine were higher this week but still o.k.  Potassium 3.1 down from 3.5; BUN is 36 up from 27; and creatinine is 2.9 up from 2.6.  

So, a new complication, more things to watch for, and more pills to give.  

She had to be slightly sedated for withdrawing fluid and had a slight setback from it-she was dazed and slow Monday night, not eating well Tuesday and resting all day through Wednesday.  But she's better today. 

Here are the doctor's notes:  "We drained 2.3oz of fluid out of Myrna's chest.  She still has a couple of small pockets of fluid remaining but both are too small to safely drain. This pocketing off of fluid is what I have been worried about considering the quality of her pleural effusion (chylothorax.)  This will make it so that we cannot drain all of the fluid out of her chest and we will not be able to completely normalize her breathing pattern.  TI may also result in the need for additional "pokes" to target the areas of accumulation.  She is growing less tolerant of the procedure and she'll

Myrna Loy April 9, 2015

 now require sedation each time it is performed.  her kidney values are rising (create 2.9, BUN 36) and her potassium is decreasing (3.1). "

Myrna Loy's Feline HCM Takes a New Step with a New Complication March 30

Myrna's March 30 visit to the cardio was suppose to be another easy visit. Prior to Sunday, she had been eating very well, breathing extremely well-always around 32 breaths per minute. I thought for sure they would not have fluid to remove and it would be a short, sweet visit like last week.  Except suddenly at 2 a.m. Saturday/Sunday she had what seemed like an anxiety attack. She was restless, trying to hide, trying to climb up on things as if to get away, kept walking around on the bed, kneading on me.  It began slowly but then grew into the trying to hide. I picked her up to comfort her and petted her and she eventually calmed down and went under the blanket that's over the chair to make the cat tent.

Then all day Sunday she seemed fine until after 7 p.m. She had her meds and seemed fine but by 8:30 p.m. was breathing rapidly. I gave her an extra 1/2 (2.5mg) of Torsemide (her diuretic).  She received another extra half after midnight.  Then she had another extra half in the morning.  Her breathing rate would get as high as 56 breaths per minute and after meds kicked in, would come down to 40.  But then it would eventually go up again.  She wasn't drinking as much or using the box as much which interrupts the diuresis process (the kidneys need water in order to better process the diuretic meds.) Since she was breathing better Monday morning, I didn't rush her in and our appointment was at 1:30 which meant we left at 12:30.  I gave her the afternoon meds before we left so that she had received her regular dose of 2.5mg Torsemide by the time we arrived at the cardio and it helped to reduce any congestion she may have had prior.

Good news: kidney values continue to improve due to the increase of various potassium sources and the now three times a day of her kidney vitamin mixture (vitamin C, E, COQ10, krill oil, baby food sweet potato, occasional apple cider, glucose as needed when run down.)  Potassium is 3.5 up from 3.4 (3/9/15) and from 3.2 in February.   BUN is down which means improved-from 36 to 27!!  Creatinine from 2.9 down to 2.6!!

She actually had very little fluid, miniscule, not enough to remove and that could be due to diuretic increase. But she was still breathing fast.  This unfortunately could be due to the sudden changes within the heart as the disease progresses.  She has a left atrial wall that is thicker-from 2.6 in September to 2.8 now; a clot that has grown, and another section of the left ventricle that has thinned (due to taking on too much oxygen during the process of blood going from the right side of the heart into the lungs to get oxygen and then exiting out the left to the rest of the body), while another section of the left ventricle has decreased contractions.

Thick/thin walls means the heart has an increased inability to contract well enough to remove and circulate fluid. While the kidneys are holding up and handling diuresis, the heart has gone yet another step towards being unable to do its share of the work-to properly pump fluid out and around the body and to contract well enough to fight CHF.  This will lead to more CHF; to low blood pressure due to lack of circulation-making her more tired; low blood pressure will decrease the amount of blood going to the kidneys and will interfere with the ability to work due.  It's like playing Jenga-as the pieces come undone, eventually things will collapse.

It's all the natural part of the progression of the disease and yet it's rare for a cat to make it this far as most die of the disease due to kidney failure, clots, CHF, heart attacks, etc. long before their hearts grow to be the size of hers. Her cardio has only seen three cats with this and two came to her late in their disease so she has never seen a cat progress from the beginning to the end of the disease.  Myrna has defied the disease for so long; she has had so many issues that other cats had earlier on in their disease progression-like afib-which Myrna only recently got.

She's still not comfortable today, already having received an extra 1/2 of Torsemide. Her breathing rate is 36 bpm.

Her Torsemide is increased to 5mg q 6 hours (every six hours.)

Here are the doctors notes:

"Myrna has a small pocket of pleural effusion. The volume of fluid is so small that the thoracocentesis procedure is high risk with low likelihood of significant benefit. I have no doubt that she had a larger volume of pleural effusion yesterday to account for the symptoms that you noticed. The extra torsemide doses that you gave yesterday are slowly resolving the pleural effusion. Myrna continues to have a increased respiratory rate and effort but I expect to see improvement in her breathing over the course of the next 23 hours as Torsemide continues to exert its effects. Her renal values and electrolyte levels are stable BUN 27, creatinine 2.6, potassium 3.5 The echocardiogram demonstrated mild progression in left atrial enlargement (2.82 from 2.60 in September) thinning of one of the walls of her left ventricle and decreasing movement of the other left ventricular wall. The clot within her left atrium is growing larger. I am sorry to say that we are losing ground."

Myrna Has Her Two Week Cardio Visit to Remove Fluid Build-up-and Jimmy Stewart Tags Along for the Visit to the ER

Jimmy Stewart saw the vet on Friday for swollen chin acne.  We spent the weekend cleaning his sores.  He seemed otherwise fine until Sunday when he wasn't urinating the volume that he would usually.  And then late in the day he began to sit in the box.  We took him out and then he went back in.  He wasn't cleaning his genitals; he wasn't going frequently; he wasn't going tiny amounts.  So, I didn't think he had a UTI. But that didn't mean he couldn't suddenly have a blockage.  The antibiotic shot wasn't suppose to make him sick and he hadn't had any gastro upsets or diarrhea.  Since I was taking Myrna to see the cardiologist Monday and the regular vet can never see last minute patients on Mondays, I decided to take him to the ER in Novi that is in the same building as Myrna Loy's cardio.

Jimmy Stewart at ER

Xrays didn't show stones, most of which would show up on an xray. Urinalysis didn't reveal crystals-another cause of blockages-nor any bacteria.  Xrays did reveal that his colon system was full of bile that hadn't been expelled yet.  Exam didn't reveal that it was impacted but his anal glands were impacted.  The vet expressed them.  She hypothesized that packed glands may have made him feel unable to pass fecal matter and being uncomfortable made him lay in the litter box-which cats are known to do when trying to go and are unable to or when upset enough that the box is a safe place.  Blood work didn't reveal anything other than slight dehydration which would also lead to less water in the colon, lead to constipation.  His urine pH was 8.5.  With a lack of water and a high pH, he is susceptible to forming stones and getting a blockage.  I am to give him daily doses of Methigel-DL methionine, an acidifier-which should lower his pH.  They gave him sub-q fluids to rehydrate.   So, we are to give water by mouth, add fiber to his food, give Methigel, clean his chin acne, and continue to monitor.  

He came home smelling of vanilla which must be from the shampoo they used to clean him after expressing his glands.  His siblings didn't care for it.  "You stink!" they seemed to hiss.  He has been content to spend last night and all today upstairs in bed.  He could have come downstairs but never did until this evening. He has used the litter box twice during the day, going large amounts. He continues to eat very well.  

Myrna Loy

Myrna Loy is now seeing the cardio every two weeks since Christmas to have fluid withdrawn. We have regular two week appointments set up through April for now.  And we will go in sooner if needed.  Myrna had more fluid withdrawn from her pleural effusion.  She had 7 oz. last time and 8 oz. this time, despite high levels of torsemide and despite me giving her extra torsemide this past week as needed to lower her breathing rate.  The ONE good news: her afib-atrial fibrillation, has disappeared.  The cardio has never seen that before.  But that's how it goes with Myrna-she's always presenting with something other cats don't present with to the cardio. 

Her heart rate is steady at 160. 

Her weight is down now to 9.4 lbs, down from 9.8 just a few months ago and around 10 lbs a year ago.  While we wanted her weight to come down for her heart, she's now at the place where we want her to be.  To help her kidneys and her body function, she actually can't get below 9 lbs.  It's a bad sign when cats lose weight which they do because they don't feel like eating which can have many causes. But the result is a lack of water which leads to dehydration, which itself leads to a myriad of issues because of a lack of electrolytes.  And a lack of eating means a lack of protein which causes the body to waste away, and a lack of vitamins and minerals to supply the body with what it needs for energy which would allow the body to function from brain to heart to kidneys, etc.  We have had to give mirtazapine, an appetite stimulant, about once a week which helps her eat enough.  We will have to make sure she eats well every day and give more mirtazapine if needed. 

Her potassium is down to 3.2 from two weeks ago at 3.5.  Potassium is needed for kidney function and a decline in potassium means a decline in kidney function. So, we must increase her potassium levels by increasing the amount of supplements and sweet potato baby food we give her.  The BUN is 37 the same as two weeks ago; creatinine is 2.9, up from 2.7 two weeks ago.  Those are the kidney values that are analyzed the most for kidney function. An increase in values means a decrease in function which is crucial when you are asking the kidneys to process the diuretic medication for the diuresis process of removing extra fluid from the body.  

So, she's ok, stable enough, eating well enough, and for about three days a week still plays with toys and runs around before she runs out of energy.

Here are the vet's notes: "We removed 130ml of chylous effusion from the right side of Myrna's chest today.  Only a small pocket of fluid remained after the procedure was performed. Myrna's kidney values are stable compared to her last visit earlier this month. However, her potassium level is on the decline again. Myrna's is developing pleural effusion at a more rapid rate despite our incredibly aggressive medical efforts.  I see no benefit to increasing her torsemide dose further. Rather, it is very likely that this will be a detriment to her health.  Sadly, we have maxed out on all of her cardiac medications.  We are left with no other great options other than to periodically drain her pleural effusion as her symptoms dictate." 

Myrna Visits Cardio for Pleural Effusion Fluid Withdrawal for Feline HCM

Posted to Facebook 2/10/15

At cardio-even though she wasn't and then she was better this a.m. and about noon, I brought her in. They took out 6oz which explains the roller coaster breathing rate and difficulty. The torsemide took out the extra fluid that must have existed in addition to the 6oz they withdrew which is why her breathing would go up and down.  

No word on why she was sick Sunday unless kidneys are not well or the effusion

lymphatic fluid was involved. But we could have come in yesterday but definitely today. We are waiting to see blood results. There's no scarring in lungs so this must be due to Rutin supplement!

Torsemide should take care of the fluid but it's not and we need to give more as needed or maybe more regular daily doses.

Myrna came home feeling better, more alert, breathing well. 

Myrna's potassium is up to 3.5 from 3 on 1/22 which is good. Not great news but not really bad is that BUN is up to 37 from 33; creatinine is 2.7 from 2.3 so not bad.

She will get extra 2.5mg of torsemide and extra potassium.

We will schedule a vet visit for every two weeks in case she needs fluids withdrawn.

But the cardio wanted me to understand that Myrna is in the end stages of her disease. You know it's bad when the cardio is using her calm, serious voice and not the one I've heard for over five years that was hopeful, optimistic, and laughing. We had the beginnings of the talk in January. And there have been times in the past-as Myrna developed increased heart size, clots, other incidents-that the serious voice was used. But Myrna always bounced back and surprised us all.

That her kidneys still function must be due to the vitamins and supplements we give. The cardio is surprised that she needs such a high level of torsemide and that her kidneys are still functioning. We will keep up all that we've been doing , pushing extra meds as needed, etc.

Myrna's sixth birthday is March 22. My goal is to celebrate it with her.

Updates to January 2015 Care of Myrna's Feline HCM

Posted to Facebook January 4, 2015

If your HCM cat is on Flovent, discuss with your vet about moving to albuterol. Flovent is for asthma but is a steroid which HCM cats cannot have because it increases fluid retention, the oppposite of what we want for our HCM cats.

Posted to Facebook January 5, 2015

Myrna at cardio and having more fluid drained. We spent last night fighting congestion as she was restless, crying, likely due to pain from fluid. There was a snow storm last night and I was grateful she didn't need to go to the ER.  Blood work normal so will increase torsemide.

Myrna very happy to be home (we were home by two p.m. EST) and bouncing around.

Doctor's notes: "We drained 2.5oz of fluid out of the right side of Myrna's chest...character of the fluid is chylous...pleural effusion (in time may become) pocketed, which will make it more difficult to drain her...kidney values are back up (BUN 30, creatinine 2.8)..."

Posted to Facebook January, 8, 2015

So it's cold in almost every state in the US. Wherever you are, keep your HCM cat warm. Turn up the heat. Put blankets on floors under their beds, and on the furniture, even the bed, places where they like to sleep. Drape blankets over chairs to make tents (will keep in heat) and put rugs or towels underneath the chair for them to lay on. A diseased heart shouldn't work harder to keep a body warm. And keep them indoors, which should be done at all times.

To update you on Myrna, this is what the vet said she had on Monday: lymphatic fluid in the pleural cavity of her lungs, unlike the previous fluid they withdrew before Christmas. Yes, a new complication.

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. And I found Canadian studies such as this one that describes how rutin works and why it is necessary.

We are trying rutin for Myrna's lymphatic fluid. 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.

Posted to Facebook January 22, 2015

Myrna had less than 2 oz of fluid removed today. The cardio said she may not have had to come in, that meds may have continued to work well enough. She was breathing better but since the cardio was off Friday, and since we had to fight yesterday to get her breathing rate low by giving extra meds, I wanted to make sure she was doing well. And I'm glad we did. Her potassium is low at 3.0 from two weeks ago around 3.2 so now we need to push more potassium, possibly begin Tumil-k (a potassium source for cats.) But now we have two examples to go by to compare against in the future when deciding when to take her to the cardio for needle aspiration of fluid: when she's not breathing well, is in pain and won't settle, not responding well to meds; and when she's not breathing well but responding to meds-eventually-but not in pain and not crying.

Doctor's notes: "We drained 1.7oz of fluid...kidney values improved (BUN 33 from 1/5/15 @39; creatinine 2.3 from 1/5/15 @2.8)...potassium is hovering lower (3.0 down from earlier in January 3.2)...begin Tumil-k to better support her potassium..."

Posted to Facebook January 26, 2015

On Sunday night, we had to give extra torsemide and extra lasix to Myrna because her breathing rate was up to 10/15 (normal for your cat should be 6/15 at rest, for Myrna it should be 8/15 at rest or 32 per minute.) It took two extra 2.5mg doses over five hours before the rate came down to an uneasy 9/15. She did well overnight, continued to drink a lot and use the box frequently, and of course, wake me to tell me about it. This a.m. she was fine and then the breathing became more labored even as it seemed to still be 9/15. So I gave 3mg lasix, 1.25 Torsemide and two hours later she was an easy 8/15. The cardiologist thinks her lung walls may be irritated due to the pleural effusion in the pleural cavity. All I know is that when I give meds and if she responds, there must be some congestion that is making breathing difficult. I think the cardio means that some congestion may not be easily tolerated if the pleural cavity is irritated and that she may not need more meds when she seems to have breathing difficulty. All I know is that I must work on what I see-high, labored breathing rate which calls for more meds (and I still give a touch of lasix with Torsemide just in case the fluid is in the lungs and not around them.) Then I wait to see if she responds. If she does not improve, then at some point she needs the cardio. So far, she's better still tonight. And with each additional Torsemide, I've been giving potassium supplement. We've increased her potassium-and I must still update the Med list-to about 1000mg of Tumil K (approx 485mg each), and two 595mg Sundown potassium, and Gerber baby sweet potatoes of 6ml daily. With a level of only 3.0 in the blood stream as of last week, she's in no danger of getting hyperkalemia.

Posted to Facebook January 29, 2015

We have given Myrna extra Torsemide, lasix, and potassium today because her breathing rate is up again to 9-10/15. She's responding but not using her litter box as much, not going as often as she had I think because as her potassium level declines, the kidneys have trouble processing the med because they need potassium in order to work, so this means she goes less often. But it also means the med isn't working as well as it should, which leads to the increase of breathing rate. We need to give some water by mouth if we think she's not drinking enough. The kidneys also need water in order to process the med and kick out the fluid in the pleural cavity.

Breathing Issues with Feline HCM for Myrna Loy

I am getting caught up on the blog so current posts will have past dates at the top referring to information found on the same date at the Facebook page or information from a certain time that hasn't been posted yet to either Facebook or the blog.  

Posted to Facebook January 29, 2015: 

We have given Myrna extra Torsemide, lasix, and potassium today because her breathing rate is up again to 9-10/15.   She's responding but not using her litter box as much, not going as often as she had I think because as her potassium level declines, the kidneys have trouble processing the med because they need potassium in order to work, so this means she goes less often. But it also means the med isn't working as well as it should, which leads to the increase of breathing rate.  We need to give some water by mouth if we think she's not drinking enough.  The kidneys also need water in order to process the med and kick out the fluid in the pleural cavity. 

Posted to Facebook January 26, 2015:

On Sunday night, we had to give extra torsemide and extra lasix to Myrna because her breathing rate was up to 10/15 (normal for your cat should be 6/15 at rest, for Myrna it should be 8/15 at rest or 32 per minute.) It took two extra 2.5mg doses over five hours before the rate came down to an uneasy 9/15. She did well overnight, continued to drink a lot and use the box frequently, and of course, wake me to tell me about it. This a.m. she was fine and then the breathing became more labored even as it seemed to still be 9/15. So I gave 3mg lasix, 1.25 Torsemide and two hours later she was an easy 8/15. The cardiologist thinks her lung walls may be irritated due to the pleural effusion in the pleural cavity. All I know is that when I give meds and if she responds, there must be some congestion that is making breathing difficult. I think the cardio means that some congestion may not be easily tolerated if the pleural cavity is irritated and that she may not need more meds when she seems to have breathing difficulty. All I know is that I must work on what I see-high, labored breathing rate which calls for more meds (and I still give a touch of lasix with Torsemide just in case the fluid is in the lungs and not around them.) Then I wait to see if she responds. If she does not improve, then at some point she needs the cardio. So far, she's better still tonight. And with each additional Torsemide, I've been giving potassium supplement. We've increased her potassium-and I must still update the Med list-to about 1000mg of Tumil K (approx 485mg each), and two 595mg Sundown potassium, and Gerber baby sweet potatoes of 6ml daily. With a level of only 3.0 in the blood stream as of last week, she's in no danger of getting hyperkalemia.

Posted to Facebook January 22, 2015

Myrna had less than 2 oz of fluid removed today. The cardio said she may not have had to come in, that meds may have continued to work well enough. She was breathing better but since the cardio was off Friday, and since we had to fight yesterday to get her breathing rate low by giving extra meds, I wanted to make sure she was doing well. And I'm glad we did. Her potassium is low at 3.0 from two weeks ago around 3.2 so now we need to push more potassium, possibly begin Tumil-k (a potassium source for cats.) But now we have two examples to go by to compare against in the future when deciding when to take her to the cardio for needle aspiration of fluid: when she's not breathing well, is in pain and won't settle, not responding well to meds; and when she's not breathing well but responding to meds-eventually-but not in pain and not crying. BUN is good at 33 down from 39 on 1/5 and creatinine is good at 2.3 down from 2.8 on 1/5 but potassium is low at 3, down from 3.4 on 1/5.  Myrna's heart size left atrium is 2.7 from 2.6 in December.

Update on Myrna Loy Feline HCM and CHF January 2015

Posted to Facebook January 4, 2015

If your HCM cat is on Flovent, discuss with your vet about moving to albuterol. Flovent is for asthma but is a steroid which HCM cats cannot have because it increases fluid retention, the opposite of what we want for our HCM cats.

Posted to Facebook January 5, 2015

Myrna at cardio and having more fluid drained. We spent last night fighting congestion as she was restless, crying, likely due to pain from fluid. There was a snow storm last night and I was grateful she didn't need to go to the ER. Blood work normal so will increase torsemide.

Posted to Facebook January 8, 2015 

So it's cold in almost every state in the US. Wherever you are, keep your HCM cat warm. Turn up the heat. Put blankets on floors under their beds, and on the furniture, even the bed, places where they like to sleep. Drape blankets over chairs to make tents (will keep in heat) and put rugs or towels underneath the chair for them to lay on. A diseased heart shouldn't work harder to keep a body warm. And keep them indoors, which should be done at all times.

Posted to Facebook January 8, 2015

To update you on Myrna, this chylothorax  is what the vet said she had on Monday: lymphatic fluid in the pleural cavity of her lungs, unlike the previous fluid they withdrew before Christmas. Yes, a new complication. We need to prevent the accumulation of lymphatic fluid in the pleural cavity because it can lead to scarring-fibrosis-which would create another complication by making breathing difficult and not allowing space for oxygen. There's a supplement we can try called rutin which we bought at Whole Foods (but there are many sources online and at other local stores.)  And I found a Canadian study such as this one that describes how it works and why it is necessary.   They are 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. 

Rutin is a natural substance found in buckwheat and citrus fruit, thought to change the triglycerides in the lymphatic fluid so that it flows more easily through the thoracic duct 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.

She was receiving lasix 25mg four times a day, then torsemide 5mg once a day and 2.5 once a day. And now she will take torsemide 5mg in the a.m,, 2.5mg in the afternoon, and 5mg at bedtime.  

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.) 

From the cardio's notes January 5, 2015:  "We drained 2.5oz of fluid out of the right side of Myrna's chest...The character of her fluid is chylous...Myrna's pleural effusion will become pocketed, which will make it more difficult to drain her.  There is minimal evidence of pocketing at this time...BUN 39 (from 34), creatinine 2.8 (from 2.7)..."

Myrna Loy at Christmas 2014 with a new mouse toy

Posted to Facebook January 22, 2015

Myrna had less than 2 oz of fluid removed today. The cardio said she may not have had to come in, that meds may have continued to work well enough.  She was breathing better but since the cardio was off Friday, and since we had to fight yesterday to get her breathing rate low by giving extra meds, I wanted to make sure she was doing well.   And I'm glad we did.   Her potassium is low at 3.0, down from 3.2 from two weeks ago.  We need to push more potassium, possibly begin Tumil-k  (a potassium source for cats.) (We added instead Renal-K gel and powder.) But now we have two examples to go by to compare against in the future when deciding when or if to take her to the cardio for needle aspiration of fluid: when she's not breathing well, is in pain and won't settle, not responding well to meds; and when she's not breathing well but responding to meds-eventually-but not in pain and not crying.

Cardio's notes January 22, 2015: "We drained 1.7 oz fluid out of the right side of Myrna's chest...kidney values are somehow lower today than they were January 5, 2015:  BUN 33 (39 1/5/15) and creatinine 2.3 (2.8 1/15/15)..."

Posted to Facebook January 26, 2015

On Sunday night, we had to give extra torsemide and extra lasix to Myrna because her breathing rate was up to 10/15 (normal for your cat should be 6/15 at rest, for Myrna it should be 8/15 at rest or 32 per minute.) It took two extra 2.5mg doses over five hours before the rate came down to an uneasy 9/15. She did well overnight, continued to drink a lot and use the box frequently, and of course, wake me to tell me about it. This a.m. she was fine and then the breathing became more labored even as it seemed to still be 9/15. So I gave 3mg lasix, 1.25 Torsemide and two hours later she was an easy 8/15. The cardiologist thinks her lung walls may be irritated due to the pleural effusion in the pleural cavity. All I know is that when I give meds and if she responds, there must be some congestion that is making breathing difficult. I think the cardio means that some congestion may not be easily tolerated if the pleural cavity is irritated and that she may not need more meds when she seems to have breathing difficulty. All I know is that I must work on what I see-high, labored breathing rate which calls for more meds (and I still give a touch of lasix with Torsemide just in case the fluid is in the lungs and not around them.) Then I wait to see if she responds. If she does not improve, then at some point she needs the cardio. So far, she's better still tonight. And with each additional Torsemide, I've been giving potassium supplement. We've increased her potassium-and I must still update the Med list-to about 1000mg of Tumil K (approx 485mg each), and two 595mg Sundown potassium, and Gerber baby sweet potatoes of 6ml daily. With a level of only 3.0 in the blood stream as of last week, she's in no danger of getting hyperkalemia.


Posted to Facebook January 30, 2015

We have given Myrna extra Torsemide, lasix, and potassium today because her breathing rate is up again to 9-10/15. She's responding but not using her litter box as much, not going as often as she had I think because as her potassium level declines, the kidneys have trouble processing the med because they need potassium in order to work, so this means she goes less often. But it also means the med isn't working as well as it should, which leads to the increase of breathing rate. We need to give some water by mouth if we think she's not drinking enough. The kidneys also need water in order to process the med and kick out the fluid in the pleural cavity.

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.

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.

Cooper Back to Cardiologist for More Oxygen and IV Lasik

Cooper has been struggling all week with congestion and we've struggled to figure out the correct dose of lasix needed, timing of doses, and when he needed an injection to overcome the congestion.  We communicated daily and sometimes often during the day with the cardiologist to get input.  We had a protocol, a method, a process to follow. We knew what to do when, how quickly to respond to an increase in breathing, and how quickly to text the cardiologist to alert her of a new issue.  And still, we all struggled to meet his needs.

Katharine Hepburn had an appointment for Thursday due to a gallop murmur (and an earlier post noted the cardiologist heard a mild murmur and saw no signs of heart disease) and Cooper already had the same appointment made in March because this was to be a checkup.  But he had just been to the ER a couple weeks prior and everyone expected that he would recover and not need to be seen at this time.  But we kept the appointment just in case.  Despite recovering from the ER, despite trying a new drug (spironolactone/hydrochlorothiazide) and having it upset his system (nausea, diarrhea) and dropping the drug and bouncing back quickly from it, and despite an even breathing process, and despite controlling for heat, cold, and not allowing him to be in the sun for prolonged periods or in any open window at any time, he still developed congestion.  And we couldn't get rid of it.

So, Thursday, Katharine, Cooper, and I went to the cardiologist.  They took xrays which showed congestion in the right lung and only slight congestion in the left. They were going to give him a lasix injection but then he suddenly couldn't breathe well and was making gurgling, panic noises.

They put him in the oxygen cage and gave him lasix IV injections.  They kept him from 1:30 until 6:30. He quickly responded to the use of oxygen and lasix which was an excellent sign.  They weaned him off oxygen and his breathing rate dropped to 8/15, and we finally went home at 7 p.m.  As of today, his breathing is still at 8.

The cardiologist has taken him off of lasix and given him a new loop diuretic to try.  We will begin using it today. He will get the med twice a day and three times if needed.  We will know after a day or two if the med is working to decrease congestion and we will know in 3-5 days if the med does or does not upset his stomach.  In between doses, we can give injections as needed, which we would more likely consult with the cardio about the dose before giving an injection.  The new drug is called Torsemide. It stays in the body and works in the body longer than furosemide (lasix.)  In human patients it is shown to have a greater decrease in recurrence in congestion.  But it can also deplete the body of electrolytes via extraction of fluid,  leading to many adverse side effects.  It can also deplete the kidneys of potassium and can cause stress on the kidneys. We will give 1/4 of a 10mg pill.  He will go from 80 to 100 mg of lasix to 5mg of Torsemide a day.

Cooper at the cardiologist

She also suggested we use a potassium supplement called Tumil-K (we will use Sundown potassium, and Gerber baby sweet potatoes also as a potassium source.)

The cardio and I had separately come to the conclusion that trips to the vet were becoming stressful for Cooper and counterproductive-although he needed oxygen and IV lasix this time-and that going forward, Cooper will see the cardio or vet only when necessary and not for checkups.

By the way, they know when he's feeling better when he hisses and growls at them!

Here are her notes:
"Despite continued increases in his cardiac medication doses, Cooper has again relapsed into congestive heart failure. He is receiving extraordinary doses of lasix to try to maintain his comfort in breathing and we are having continued relapses in symptoms.  Unfortunately, he did not tolerate hydrochlorothiazide well and that mediation had to be discontinued.  I would now like to switch his lasix to a much more potent diuretic called torsemide.  Torsemide functions very similarly to lasix.  The risks of this medication include kidney failure and electrolyte depletion. The major benefit would be more steady control of Cooper's symptoms.  Today's laboratory results indicate that Cooper is an acceptable candidate for this medication.  To help prevent excessive potassium depletion, I would like you to begin supplementation with Tumil-K (potassium supplement.)