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

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Thinking of you and sending vines for Yum to pull through.

Don’t blame yourself. Do know that blaming oneself is a normal reaction to grief — it helps shield us from pain. But it doesn’t help anything.

:bighug:
 
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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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The gabapentin wouldn't harm her heart, so cross that off your list of worries.
@Wendy&Neko knows some about this balance.
Yes, the fluids probably were too much, but how could you know that? All that Lasik does is cause her to pee out the fluids so that her heart is relieved a bit. Do you have a vet licensed to treat heart problems in your area? I ask because there are some important diagnostic tests such a vet can do. Without those diagnostic techniques, it's hard to know what other medicines might help Yum.

It's good that the oxygen helped her so much.

Prayers Purrs Hugs:bighug::bighug::bighug::bighug:
 
One more note, the heart stress can really make the BG skyrocket, which is what you saw. When Neko was in failure, she went from 80's to 400's in two hours. Once she was tapped and in oxygen, she came right down again to green. Be cautious what you dose. Don't try to beat down the high numbers with the Lantus dose. Numbers may come down on their own. I ended up skipping a couple shots when Neko was in critical care.

:bighug::bighug::bighug:
 
QUOTE="Bobbie And Bubba, post: 2147126, member: 12895"]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.[/QUOTE]
The same thought crossed my mind.

@MJW I am so sorry that you and Yum are going through such a hard time. I am sending mega vines and prayers for a full and speedy recovery for Yum, and mega (((hugs))) for you. And please, do not blame yourself, you did what you had been led to believe was the best for her, exactly as any of us would have done for our beloved kitties. :bighug::bighug::bighug:

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Bobbie And Bubba said:
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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No mention of the convenia. She tolerated it in the past.
 
MJW said:
No mention of the convenia. She tolerated it in the past.
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It might be worth mentioning as the seizure I believe occurred after the convenia shot and that is one of the side effects of having a reaction to convenia. It could be a combo of that shot and heart issues.
 
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Yum has HCM, hypertrophic cardiomyopathy.
They've started some heart meds.
The lasix and oxygen therapy have dropped her heart rate from 100 to 50. High but improved.
Tomorrow we will see what the lasix has done to her kidneys. The vet says she will never be able to have fluid therapy again.
She'll have to drink the water she gets.
Her blood sugar has come down to the 300's from the 500's, which means she is under less physical stress.
She is eating the microwaved radcat raw chicken I took in, which is far better for her FD and CKD than what they had her on before.
The critical care doctor is very sharp and clear and competent in my opinion at this point.
Thank you all for caring.
I hope these notes might help educate others who run into similar problems in the future.
 
Bobbie And Bubba said:
It might be worth mentioning as the seizure I believe occurred after the convenia shot and that is one of the side effects of having a reaction to convenia. It could be a combo of that shot and heart issues.
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That's interesting. One of the ER vets said something about vascular incidents due to kidney infection or kidney disease. They're not sure if it was a stroke or a seizure. No signs of neurological deficits.
 
Her current heart medication is pimobendan. I think it's a vasodilator. They will consider benazopro (?) in the future, which is hard on the kidneys.
 
I think the vet might have implied that Yum's huge thirst when her BG numbers were high might have contributed to the development/worsening of her HCM.
Another reason to get those high numbers down as fast as possible. The vet was thinking her huge thirst was due to her kidneys but it reached its peak in January when she was in all black BGs.
 
More prayers to you and Yum , that this resolves well and quickly :bighug::bighug: You both have been thru enough :bighug::bighug::bighug:
 
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Those high numbers probably also contributed to her getting a kidney infection.
 
MJW said:
Her current heart medication is pimobendan. I think it's a vasodilator. They will consider benazopro (?) in the future, which is hard on the kidneys.
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I hope her kidney's can tolerate the Lasix. Are they planning to keep her on a low dose? Pimobendan is Vetmedin which Neko took. Doodles took Enalapril instead of Benazepril but both are an ACE Inhibitor. Sending loads of vines and prayers Yum can come home soon. :bighug::bighug::bighug::bighug:
 
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Neko was on Vetmedin or pimomedin. It did wonders for her heart but doesn't work for all heart conditions. Glad the doc thinks she can take it. Neko was also on benazapril, it's impact on kidney values wasn't that much.
 
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Sounds like you have some good direction now. I know there are a lot of concurrent issues going on here but with good medical advice and monitoring heart conditions are manageable. I'm truly sorry you both are going through this. I love that you never give up hope and keep moving forward. This is an emotionally trying situation and I greatly admire you! Still praying for you both. Get well kisses and hugs and scritches Yum!!!!!
 
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Her creatinine held stable at 2.7 over the past 24 hours, in spite of the lasix drip. Her respiratory rate (still in the oxygen cage) has come down to 40 this morning from 50 last night (and 100 at home the night before). They will start cutting back her lasix drip and repeat her X-rays today to check the fluids in the lungs. They didn't include her BG numbers in their morning report.
It's a full service 24 hour facility, with specialists in every field. She had a cardiologist consult yesterday. I will take more food in for her and visit later today, after she has her X-rays.
Thanks @Wendy&Neko and @Sienne and Gabby (GA) and others on the information about Vetmedin and benazepril. The vet mentioned it could be hard on kidneys; good to know it didn't cause Neko major problems. Yum is not on it yet.
Her cardiologist wanted to put her on enalapril last August/September when he thought she had high blood pressure. When I rechecked her blood pressure and found it to be normal, I stopped it after 1 dose. Her BP was normal while she was hospitalized last week, and normal when I had it checked a month ago. I guess vasodilators are used for HCM independently of high blood pressure.
 
Just read the article Sienne linked. Neko's cardio vet had studied pimomedin in cats. One other thing, did the vet mention Plavix/clopidogrel? It is often given to HCM cats to pr vent strokes. Neko was on that too. Some of these meds can be compounded and even compounded together. I just stuffed things into gel caps. Pimomedin can be bitter and caused foaming.

Good to hear you have all th specialists in one building,. Made things easier for me too.:bighug:
 
I am just catching up here. First I'm glad to hear there is a plan in place. A couple of things stood out for me at the earlier posts. With ckd subq fluids are important but with heart disease it's a very tricky balance. A lot of vets automatically start at 100 cc. To say Yum could never ever have I believe was probably not the best thing to say. It would have to be a very reduced amount if Yum really needs it.

As far as pain med bupre. My vet call a script into Diamondback and I received a months worth at a time. So you can get a supply. When Smokey was dx with chf, hcm, MI all heart diseases he was on vetmedin, spironolactone, benazepril which I had compounded into 1 flavored liquid. He also got lasix and aspirin. At his 3 month recheck his echo had improved so much the cardiologist was surprised. Smokey was also asthmatic. It was a fine balancing act.

Yum can do well and now you know there will be some things you will make sure every time you walk into a vets office you remind them "no fluids, convenia, metcam etc" unless it's the last resort.

Good luck, will keep following.
 
My read of the information on pimobendan is that it was developed as an inotrope. With CHF, one of the causes can be that there has been damage of some sort to the heart muscle that prevents adequate contraction thereby causing fluid to back up. It sounds like the vasodilation properties are a secondary benefit.

Enalapril and benazepril are both ACE (angiotensin-converting enzyme) inhibitors. They are typically used to address issues with high blood pressure. In CHF management, there is always a balancing act between heart and kidneys.
 
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As Karen said previously , heart trumps kidneys in this dance. If the cardio vet said no fluids, I wouldn't go near them. We tried starting Neko back on just the littlest bit of fluids and her heart told us no in short order. It's something I still regret doing.

Neko's benazapril was for her proteinuria, she didn't have high blood pressure.
 
Doodles & Karen said:
I hope her kidney's can tolerate the Lasix. Are they planning to keep her on a low dose? Pimobendan is Vetmedin which Neko took. Doodles took Enalapril instead of Benazepril but both are an ACE Inhibitor. Sending loads of vines and prayers Yum can come home soon. :bighug::bighug::bighug::bighug:
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MJW said:
Yum has HCM, hypertrophic cardiomyopathy.
They've started some heart meds.
The lasix and oxygen therapy have dropped her heart rate from 100 to 50. High but improved.
Tomorrow we will see what the lasix has done to her kidneys. The vet says she will never be able to have fluid therapy again.
She'll have to drink the water she gets.
Her blood sugar has come down to the 300's from the 500's, which means she is under less physical stress.
She is eating the microwaved radcat raw chicken I took in, which is far better for her FD and CKD than what they had her on before.
The critical care doctor is very sharp and clear and competent in my opinion at this point.
Thank you all for caring.
I hope these notes might help educate others who run into similar problems in the future.
Click to expand...

From this I see she's doing much better now. I wouldn't worry too much about the kidneys. Once the infection resolves, I think her kidney troubles will be manageable.

Prayers, hugs, purrs:bighug::bighug::bighug::bighug::cat::bighug::bighug::bighug::bighug:
 
So Yum doesn't have profound hypertrophic cardiomyopathy (HCM). It's severe unclassified cardiomyopathy (UCM). The lead vet misspoke in her late Friday evening update. I learned the final diagnosis when I visited Yum and the 2nd critical care vet yesterday afternoon.
It's unclassified (UCM) because it's a mixture of things (maybe; confusing). I got the echo report. Hmmm. Can't copy and paste.
There is marked left atrial dilation (severely enlarged), with relatively decreased systolic function, with dysynchonous contraction of the left ventricle. Her long term grade 3 heart murmur is most likely caused by mitral regurgitation and LVOT turbulence. Left ventricular wall thickness is normal.
All the BP measurements I have seen before this incident were normal (no high blood pressure).
The report recommended the pimobendan and possibly benazepril. (I don't think the report author had knowledge of her normal BP.)
Since @Wendy&Neko mentioned Plavix in this thread, I asked about it yesterday. They have now added Plavix to her meds. I hope I didn't interfere there in the wrong direction. I will add DHA or other omega fatty acids back into her diet when she comes home. I know they are also blood thinners. One vet okayed that on the phone last night, but I will ask again before I do it.

She still has some fluid in her lungs, but they have taken her out of the oxygen cage. They have stopped the IV furosemide and put her on 8 mg 3 x a day. Her maintenance dose at home will be 8 mg 2 x a day to start.
Her creatinine has risen from 2.7 to 3.5, which is very upsetting, although she was at 3.2 when I took her home last Tuesday. They think it will come back down as we decrease her lasix. Her HCT has come up from 20% to 23%, but probably only because she is dehydrated.
Her K was low so they added a supplement.
Her respiratory rate is 30 to 40. Her heart rate is 160 to 180. Her BG is in the 200's to 300's on 1 unit of Lantus 2 times a day.
She is eating well, devouring the microwaved Radcat raw chicken I take in to the hospital. She wouldn't purr for me yesterday, but she did vocalize. There was another cat in the 2 cubicle oxygen chamber, so there might have been some "stranger danger". Yum was far more active than the other cat. Maybe he was the one with the profound HCM.
They think I might be able to bring her home on Monday. She's going to need a lot of meds and many rechecks. We mastered constant ear pokes. I guess we will master pills too.

Thanks for all the information and support everyone has shared here.
 
There's so much to digest in that report. The takeaway seems to be that whatever Yum has is manageable. She gets to come home soon. And if you've mastered feline diabetes, you can handle just about anything. Wishing you the best of luck as you get the hang of the new routine, and hoping for a speedy recovery for sweet Yum!
 
MJW said:
They have stopped the IV furosemide and put her on 8 mg 3 x a day. Her maintenance dose at home will be 8 mg 2 x a day to start.
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Will you be given pill form of Lasix? Doodles started with injections of Lasix and it would spike his BG like crazy (starting on his SS on March 28, 2016 and beyond there are quite a few notes). He also had IAA @72% and the recheck was 84%. We the switched to a chewable form compounded from Diamondback drugs. We often had to dose 3 times a day for 3 days to knock down recurring fluid. He also started on about 8mg a day but quickly needed 30mg BID and at times upto 90mg a day. Lasix does have a moderate interaction with Lantus/Levemir causing increased BG levels. Just something to be aware of https://www.drugs.com/drug-interactions/lantus-with-lasix-1344-803-1146-676.html :bighug::bighug::bighug::bighug:
 
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Doodles & Karen said:
Will you be given pill form of Lasix? Doodles started with injections of Lasix and it would spike his BG like crazy (starting on his SS on March 28, 2016 and beyond there are quite a few notes). He also had IAA @72% and the recheck was 84%. We the switched to a chewable form compounded from Diamondback drugs. We often had to dose 3 times a day for 3 days to knock down recurring fluid. He also started on about 8mg a day but quickly needed 30mg BID and at times upto 90mg a day. Lasix does have a moderate interaction with Lantus/Levemir causing increased BG levels. Just something to be aware of https://www.drugs.com/drug-interactions/lantus-with-lasix-1344-803-1146-676.html :bighug::bighug::bighug::bighug:
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Oh dear. Thanks for this information. I will start discussing medicine formulations when I visit her today. I could easily crush pills and mix w food if they're not too big and bitter. I used to take lasix occasionally and 6mg was enough to make me run to the bathroom. These doses seem so huge. Pet meds don't come with the interaction information that accompanies human meds. They expect us to take responsibility. When I mix them into her food, I have to leave out the SEB that has controlled her gag vomiting. It's all very complicated. I need a chart. I need to master squirting liquid meds into her mouth. Some meds need food others are an hour before or 2 hours after.
 
MJW said:
These doses seem so huge
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Doodles was a big boy 17/18 lbs. His cardiologist was suspicious that he became Lasix resistance as his kidney values remained healthy even at those huge doses. His QOL did greatly improve on the heart meds for almost a year until they stopped working. Doodles also developed asthma toward the end which is why I had to let him go. He couldn't take steroids because his heart was too weak and he was ultimately going to choke to death/ suffer. We treated him with hydrocodone as a cough suppressant for a few weeks but it was used as an end of life drug.
 
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I know you have a lot to remember, especially while worrying about Yum. One thing I always found helpful while giving a lot of pills is empty gelatin capsules, you can put several pills in a capsule (depending on size of each pill and capsule) and always put the bad tasting pills in a capsule. Just a thought, since she will be taking a few pills. Hopefully, this will be your last emergency for some time to come. Head bumps to Yum and loving and healing wishes to both of you.
 
If there's a way to put a few pills into a gelcap that will reduce the amount of pilling. If you're going to get meds compounded into a chew, make sure there's no corn syrup being used or it will spike numbers.

Usually it's not a matter of Lasix resistance per se. It depends on where fluids build up. Lasix doesn't do as well if fluid is in the abdomen. In addition, IV Lasix is more effective than a pill but most places won't send a human/cat home if an IV drug is needed.

It sounds like they are using Plavix as a preventative given the mitral valve regurgitation. The "turbulence" can cause clots to form.

Setting up a chart is a great Idea. I did this with Gabby when she was first diagnosed given all of the complications that were going on.
 
Yum is home. She was so excited and happy. Me too.
She was also very hungry. Woohoo.
Now she's a bit tired.

Her BG has been in the 500's at the ICU and now for me. Maybe it's because of the interaction of Lantus and Lasix. I can reduce her lasix by 1/3 on Friday. 500's are depressing though.
Her creatinine came down to 3.2 today from 3.5 yesterday.

The meds are going to be difficult.

She gets amoxicillin as a liquid twice a day. I mix it into a small bit of food and sweat bullets until she eats it all.
She gets enrofloxacin twice a day as a pill. It was a struggle.
She gets lasix 3 times a day as a liquid. That will be a struggle.
She gets a giant pimobendan chew (sure) twice a day. I ground that up and gave it to her in the bit of food with the amoxicillin, finger crossed. I had to sprinkle on a lot of that awful fortiflora stuff.
She gets plavix once a day as a 1/4 pill. It was a struggle.
She gets cerenia as a 1/4 pill once a day. It will be a struggle.
She gets RenaPlus 1t gel twice a day. I think I can mix it in her food or put it on her paw. Shouldn't be too hard.
They want me to give her pepcid AC but I will try to use the slippery elm bark unless I have to move on.

She is crashed now, either because of the meds ore because of the big pill fight. I suppose it will get better. I remember when I thought I could never home test her.
At least her respiratory rate is normal. 25.
 
I’m so glad Yum is home with you!!! :bighug::bighug::bighug::bighug:

You will figure the meds out. They have been a problem here too, but we manage. I put kraft cheese slice around the pill like a pill pocket and much to my surprise, Asia eats them! I also got a food she liked but doesn’t normally eat (for her it was tiki cat velvet mousse, it’s like baby food) and I was able to mix some nasty tasting stuff in there (vit b complex) and she would eat it. I agree with Amy too, if there are meds you can combine, put them together in a gelcap and then it’s pilling once instead of 3 or 4 times.

Don’t worry too much about the BGs, she will get back on track, Yum is amazing!

Yum is home! Yum is home! :cat:
 
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