? 3/8 Yum ER high respiratory rate Congestive Heart Failure

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MJW

MJW

Member Since 2017
Previous http://www.felinediabetes.com/FDMB/...ilure-seizure-home.191878/page-2#post-2145849

Yum was diagnosed with a kidney infection last week. Her creatinine was 6; her phosphorus 13;her HCT 28.
She was on IV fluids at our local vet and then at an ICU for 5 to 7 days.
I brought her home Tuesday. Her creatinine was 3.2;her phosphorus 9.7; her HCT 19.
I am giving her 20mg enrofloxacin once a day and 30mg amoxicillin twice a day.
I am giving her 100ml subQ once a day.

A few weekends ago Yum had an isolated episode of elevated respiratory rate, peaking at 50, mostly in the 40's.
The vet x-rayed her a few days later and found nothing wrong. Her heart rate was not elevated during the event. My response was to back off her cabergoline dose to every other day.

Last night (her second night home from the ICU), she had another episode of elevated respiratory rate.
She was uncomfortable and she wanted to cuddle. Her BG had spiked to 390. I first noticed her breathing when her rr was 60. Then it went to 70. Then it went to 80 and we headed to the ER. It had fallen to 60 when they examined her. Her heart rate was very high, maybe they said 260. They couldn't find anything new wrong. Her EKG was normal. Her kidney numbers were fantastic. Her creatinine was 2.3;her phosphorus 5.4; her HCT 20.7. They gave her a shot of butorphanol to relax her and we drove home. She played like a wild kitten for a while before finally sleeping.

This evening her BG shot up to 434 and her rr rose again to 70. It's about 66 now. I believe she is having episodes of severe pain. The ultrasound of her kidneys indicated severe narrowing of one ureter. I suppose it could be from inflammation due to the infection. I sure hope it's not a stone: she drinks so much water. She did go pee near the beginning of this episode. She needs some kind of medication for short term pain. Has anyone dealt with this before? Her rr started today at 54 but it was mostly at 44. She ate and she acted fairly normal. We were both a bit tired after last night's ER visit.

What can I do for her? Is it normal for her to have this episodic pain with a kidney infection? They didn't feel she was stable enough for a 2nd ultrasound. I guess I have to specifically request something for her evident pain. My vet mentioned gabapentin today, when I was thinking maybe she has arthritis pain. But now I realize this is severe and episodic pain, undoubtedly related to her kidney disease. I got out a heating pad earlier when I was thinking it was arthritis pain. I put it on her back and it didn't accomplish anything, or maybe it triggered this event. I could try putting it on her stomach. I don't want to take her to the ER again for another shot of butorphanol. I need to get her through this episode and I need a solution for the next one. I thought her IM vet associated with the ER (which is the ICU where she had stayed) would contact me today. But she did not.
 
Oh poor Yum! :bighug:

I did not realize she wasn't on pain meds already? :eek:

My vet said kidney infections are extremely painful, she had one herself and said it was the worst pain she's ever had in her life. Asia decidedly had pain, her numbers went higher and I had to increase her regular bupe dose for a good couple of weeks. I was giving her .1 mL bupe every 8 hours with the kidney pain. .1 mL was too much before that episode and made her saucer eyed. I've never used gaba, but a bunch of people here have.

I don't know if/how the pain correlates to the breathing? Asia had funny breathing like that, but I never linked it to pain, it seemed to happen after giving her fluids. I had the snap bnp test (for heart disease) done and it came back positive.

Hope you can get pain meds right away. :bighug::bighug::bighug:
 
I took her to the ER last night because I thought the elevated respiratory rate was due to anemia, but it was not. It has to be due to pain.
 
Stacy & Asia said:
Oh poor Yum! :bighug:

I did not realize she wasn't on pain meds already? :eek:

My vet said kidney infections are extremely painful, she had one herself and said it was the worst pain she's ever had in her life. Asia decidedly had pain, her numbers went higher and I had to increase her regular bupe dose for a good couple of weeks. I was giving her .1 mL bupe every 8 hours with the kidney pain. .1 mL was too much before that episode and made her saucer eyed. I've never used gaba, but a bunch of people here have.

I don't know if/how the pain correlates to the breathing? Asia had funny breathing like that, but I never linked it to pain, it seemed to happen after giving her fluids. I had the snap bnp test (for heart disease) done and it came back positive.

Hope you can get pain meds right away. :bighug::bighug::bighug:
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Wow. Your vet did this automatically? How come they didn't give her pain medication? How come the IM didn't get back to me re the ER visit of last night. I asked the ER for pain meds for her last night but all they did was give her the 1 shot of the sedative which is normally given for breathing problems. She is suffering. If it doesn't pass we will have to go to the ER again. Which is hard on her of course.
 
I have her on a heating pad, which is what they recommend for people. What is the full word for bupe?
 
I wish you were close to me! I have so much gabapentin I could give you! Maybe you could just go to the Er and they could give you some?
 
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MJW said:
Wow. Your vet did this automatically? How come they didn't give her pain medication? How come the IM didn't get back to me re the ER visit of last night. I asked the ER for pain meds for her last night but all they did was give her the 1 shot of the sedative which is normally given for breathing problems. She is suffering. If it doesn't pass we will have to go to the ER again. Which is hard on her of course.
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Well Asia was already on a lower dose of bupe for arthritis and vet said kidney infection was painful and I asked if I could increase and she said of course. The vet I had before this one didn't think pancreatitis was painful, but Asia getting better regulation after having pain meds changed his mind about that (I marked a row in my SS when she started bupe in 2017, it's a rather a dramatic difference).

Any change you could contact the ER and ask for pain meds to go pick up and give to Yum yourself rather than bringing her in?
 
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I don't know why they wouldn't send her home with pain meds. I think some vets are old and have very outdated notions of pain. When Asia was spayed, they gave whatever for pain or sedation while she was having the surgery but sent her home with no pain meds. Vet said "they don't feel pain like we do" :eek: :banghead: That was many, many years ago. They wouldn't do that these days.
 
Kidney infections are painful for humans - my back and abdomen hurt and burned for 3 days until the ab's got it somewhat under control. It was indeed in 'rounds', not bad all the time, very bad at other times. I agree pain medication would help as long as it's none of the types that will affect the kidneys...I don't know what those are so can't say 'don't use ***'.

HUGS!!
 
More vines for Yum. I don't have experience with kidney issues, so I will just keep thinking good thoughts that Yum will be free of pain once she gets on one of the pain remedies. I hope her kidney infection will clear up very soon.
:bighug::bighug::bighug:
 
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I believe there are other ways to administer bupe besides the inside of the cheek if Yum won't allow that (Bronx fought me hard with that). I heard applying a bupe cream form to the ears is another way, hopefully others will chime in.
 
I hope you can get some pain medication for Yum. You can get bupe compounded into a transdermal gel to rub inside the ear. Sending prayers.
 
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MJW said:
Wow. Your vet did this automatically? How come they didn't give her pain medication? How come the IM didn't get back to me re the ER visit of last night. I asked the ER for pain meds for her last night but all they did was give her the 1 shot of the sedative which is normally given for breathing problems. She is suffering. If it doesn't pass we will have to go to the ER again. Which is hard on her of course.[/QUOTE

If it can wait until tomorrow morning, can't you get the needed pain medication from your regular vet? And be sure to get a couple week's worth - based on what Stacy has said.
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Evening MJW.
That all sounds really uncomfy. I've had a kidney infection and it is painful so your gut instinct is likely right.

My Tyler had bupe a short while ago when the pancreatitis hit. It was given into the side of his mouth and he didn't care much until he started to feel a bit better.

I really do hope you can get Yum some pain meds and that also this is not a stone.

From my dim memory I seem to think that a bit of warmth was a relief.

Anyway. :bighug:.
 
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They said I could come by myself and get some meds for Yum.
When I got there (5.5 miles), they said they could not prescribe narcotics like bupe without Yum present.
I made it known I was unhappy and it wasn't good to drag a suffering cat there again, but I drove back home and picked up Yum.
When I got there again, the previous night's ER vet had called the IM and she said she wasn't comfortable prescribing a narcotic (bupe) for Yum (with no explanation).
She also said I had missed an appointment with her today, but that was news to me.
All this was told to me by a 2nd ER vet because the other one was too busy to see me tonight (she walked by me several times with eyes averted).
I wanted bupe because I wanted something fast and short acting and I had used it on another cat for a UTI, but it was off the table.
It came down to another shot of butorphanol or gabapentin. I can't give the butorphanol at home and Yum was kind of wild on it last night so I nixed it.
They gave her gabapentin and sent me home with a couple more doses. With the gabapentin she is collapsed face down on the cushion, refusing food (food which contains her 2nd amoxicillin dose for the evening). Her respiratory rate has varied between 72 and 50 over the last hour. Not sure of a downward trend yet.
Clearly I have bungled everything this evening.
Is the fast breathing due to pain or is my theory totally wrong? How long does it take gabapentin to address pain?
I have had her to the vet 3 times now for breathing too fast with no diagnosis and no good treatment. She is suffering.
They only charged me for the medicine.
 
Oh, poor Yum and poor you! Girlie is on Phenobarbitone for her idiopathic epilepsy, so that might influence things, but I know that with that - and when we tried just a tiny dose of Gabapentin for pain in addition - she went gaga (as in in la la land just lying there). We nixed the Gabapentin for that reason, but - unfortunately - that leaves us with few options for arthritic pain.

I so, so hope that you're able to get some bupe - perhaps that would work better? What dose of Gabapentin are you giving?

I really feel for you: this sounds scary and also exhausting. Is there another ER vet or good vet nearby you might go to instead?
 
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MJW, I’m so sad and angry to read of your terrible ER experience, this is the same place that ODed her on insulin, yes? :mad: I simply cannot believe they led you to think they would give you the pain meds you asked for if you brought Yum in and then changed their mind after you whisked her back there in her state! Maybe you can get bupe from your regular vet today, since they know you and have a relationship with you? I hope so, and I hope they wouldn’t make you drag Yum in for that either.

It’s a controlled substance, and they aren’t likely to give you 2 weeks worth at once, I’m assuming you are in the states. I have to go in every week for a refill and that’s annoying, but it is what it is. Most vets will prefill single dose oral syringes for you and give you several days to a week’s worth.

And for what it’s worth, IMO you didn’t bungle everything last night...those vets did! :banghead:

:bighug::bighug::bighug::bighug::bighug::bighug:
 
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I hope you're able to get some good pain medication soon and that it's exactly what Yum needs to relax and get back on the road to recuperating. We all want her to be feeling better as soon as possible! Vines, vines, and more vines!
 
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Wow. Those ER docs are the ones who bungled big time. You have cause to complain to the highest level person you can get a hold of there. It's inexcusable to first tell you to go in alone, then make you go back and get Yum, and then not give you the meds you asked for because they weren't 'comfortable' about it. You and Yum weren't comfortable either but they don't seem to care.

I hate the current paranoia about addiction that prevents people and pets from getting effective pain relief.
 
I woke up at 3:30 AM and her respiratory rate is over 100.
I took her back to ER.
She has congestive heart failure. In the ICU. 10% chance of making it.
The 100 ml subQ fluids must have been too much. I don't know why they didn't tell me Wednesday night her high respiratory rate could have been due to her heart.
Maybe the gabapentin pushed her over the edge. That is my fault for asking for it.
It's hard to balance congestive heart failure and bad kidneys. They've given her lasix to put her heart first at the moment.
She was alert in an oxygen cage when I left. Prayers for my Yum. She could not be more loved.
 
I'm so sorry and sending mega vines and prayers she can pull through. Heart does trump kidneys and no, I don't think the gabapentin pushed her over but the fluids may have. Have they mentioned doing a chest tap? Doodles took 60mg of Lasik a day for almost a year with CHF but he was young at 9yrs old so his kidneys tolerated it. Lots of :bighug::bighug::bighug::bighug::bighug::bighug: for you and love for Yum.
 
MJW said:
I woke up at 3:30 AM and her respiratory rate is over 100.
I took her back to ER.
She has congestive heart failure. In the ICU. 10% chance of making it.
The 100 ml subQ fluids must have been too much. I don't know why they didn't tell me Wednesday night her high respiratory rate could have been due to her heart.
Maybe the gabapentin pushed her over the edge. That is my fault for asking for it.
It's hard to balance congestive heart failure and bad kidneys. They've given her lasix to put her heart first at the moment.
She was alert in an oxygen cage when I left. Prayers for my Yum. She could not be more loved.
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I am so so sorry to hear this! Please don't blame yourself, you were doing what you thought was right in helping Yum! Continued prayers for you and her!
 
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MJW said:
They said I could come by myself and get some meds for Yum.
When I got there (5.5 miles), they said they could not prescribe narcotics like bupe without Yum present.
I made it known I was unhappy and it wasn't good to drag a suffering cat there again, but I drove back home and picked up Yum.
When I got there again, the previous night's ER vet had called the IM and she said she wasn't comfortable prescribing a narcotic (bupe) for Yum (with no explanation).
She also said I had missed an appointment with her today, but that was news to me.
All this was told to me by a 2nd ER vet because the other one was too busy to see me tonight (she walked by me several times with eyes averted).
I wanted bupe because I wanted something fast and short acting and I had used it on another cat for a UTI, but it was off the table.
It came down to another shot of butorphanol or gabapentin. I can't give the butorphanol at home and Yum was kind of wild on it last night so I nixed it.
They gave her gabapentin and sent me home with a couple more doses. With the gabapentin she is collapsed face down on the cushion, refusing food (food which contains her 2nd amoxicillin dose for the evening). Her respiratory rate has varied between 72 and 50 over the last hour. Not sure of a downward trend yet.
Clearly I have bungled everything this evening.
Is the fast breathing due to pain or is my theory totally wrong? How long does it take gabapentin to address pain?
I have had her to the vet 3 times now for breathing too fast with no diagnosis and no good treatment. She is suffering.
They only charged me for the medicine.
Click to expand...

Gabapentin acts by stopping the firing of nerves that are continuously sending pain signals- good for arthritis and such. They gave her far too big a dose of gabapentin. - it's biggest disadvantage is that it puts the patient into a deep sleep and then when that same patient awakes, the patient keeps falling asleep. It has very heavy soporific effects.

Do you not have a regular veterinarian who knows you and therefore knows that you are not a drug addict?
 
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I am so very sorry to be reading what transpired last night. Poor Yum and you. Sending mega vines for a full recovery. I do not understand why they did not tell you about her heart Wednesday night. They have some explaining to do.

Meantime, lots and lots of hugs and vines for Yum. :bighug::bighug::bighug::bighug::bighug::bighug::bighug:
 
Yum, you can do this, you’re a fighter, please get well! :bighug::bighug::bighug:

MJW I’m so sorry this is happening, sending all of our love to you! :bighug::bighug::bighug::bighug:
 
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I am remembering that Yum had been given Convenia before all heck broke loose. It keeps nagging at me as to whether it played a role her decline. Has there been any mention of it by the ER docs as to whether it played a role in things? Just a thought.
 
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:bighug::bighug::bighug::bighug::bighug::bighug:

Even a little fluids can be too much for the heart. Neko ended up in ICU in oxygen after 50 ml every other day. That was her second heart failure. Vetmedin really helped her the first time, Lasix the second. Again, I don't think it's anything you did. An acro thing. :( Sending the strongest of vines that Yum is in that 10%.
 
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