Help with diabetic cat with congestive heart failure

CRL

CRL

Active Member
Hi everyone. It has been awhile since I have been on here. Simon aka Zhoomboy is 14.5 years of age and just came home on Thursday night from the ER where they removed a lot of fluid from his chest. He has a small amount of fluid in a sac around his heart remaining. His heart is enlarged and there were many lymphocytes in the fluid sample. The xray also showed signs of asthma. Zhoom also has IBD which is very well managed. Via the cytology report and chest xray, they have decided to treat Simon for Congestive Heart Failure (CHF). This feels like a lot for one tiny little body. They prescribed furosemide (a diuretic) to prevent the fluid from accumulating again in his chest until I can either make a decision to euthanize or take him to a cardiologist. I have not given him the diuretic, on the advice from an online triage vet, since Zhoomboy is remaining stabilized at this time. I am monitoring his respiratory rate which has been mostly in the 48 - 50 bpm range, which the ER vet says in fine for now. If it starts to go up and stay up, I was advised by the online triage vet to give the diuretic. It is so hard when you go through the ER because any questions you have cannot be answered unless you bring the animal back through ER which = stress! My at home vet, who is Zhoom's primary vet, is out of town and not really available much anymore. I need to find him a new vet to help me navigate this complex and fragile health situation. I have had so many differing opinions about his condition. One ER vet thought it best to euthanize hime even though he is running up the stairs, eating, scratching his scratcher and seemingly still having a pretty good life. The online triage vet said that it is very important to go to the cardiologist because CHF cannot be diagnosed by an xray, he needs an echocardiogram for a true diagnosis. It could turn out to be something else and it seems that at this moment I need more information. The online vet also said that many cats can live for many more months to years depending on the severity and progression of their disease. My at home vet is warning me (from afar via text) that if I decide to treat Simon it is going to be very difficult. Does anyone have any experience with heart disease, particularly CHF, in a diabetic cat. What is your experience or any words of wisdom? How did your cat do on the medications etc. Needless to say, I am feeling quite heartbroken at the moment and also have a fair amount of anxiety, because his condition could become incredibly terrible in a short period of time. At least that is what I have been hearing. I just can't imagine euthanizing hime right now with the way he is acting. I am really in need of support as I move through this transition with my sweet Zhoom. Thank you everyone for listening.
 
I have very limited experience with cats with HF but lots of experience with humans. Humans can survive for a long time -- years -- with HF as long as it's well managed. Diurectics, like furosemide (Lasix) are essential. You'll also want a diet that is low in sodium. Given that diabetes is hard on the kidneys as are diuretics, you'll also want to use a food that is low in phosphorus. And, just to complicate things more, you need a low carbohydrate food (under 10%). This is a food chart that lists nutritional properties. It's possible, since you're feeding a raw diet, that you're already in good shape on the food front.

I'd encourage you to track down a veterinary cardiologist. The treatment methods for humans have dramatically improved over the last several years and I would not be surprised if it's the same for cats. If you're anywhere near a vet school, I'd see about a consultation there or even seeing if it's possible to talk to a specialist. If there's not anywhere that's an option, Cornell University's vet school has a phone consult service for cats.
 
Thank you. I actually live a half an hour from Cornell. I took him through the ER there. I am hoping they have a cardiology appointment soon. I will call them first thing in the morning. And thank you for the food chart. I will certainly take a look at that. I appreciate your support.
 
If you look at my signature, you'll see that Neko had diabetes, CKD, HCM, CHF, and small cell lymphoma. She did have an echocardiogram when she was diagnosed with HCM. The CHF came a couple years later when we were treating her kidney disease with fluids. At that point I was referred to an internal medicine vet, who really helped me manage the multiple conditions. You might want to see if you get an IM vet too. There was also a cardiology vet on staff who helped with the heart part, including another echo. The small cell lymphoma diagnosis came the same time as the CHF diagnosis.

Neko did not get furosemide, other than bolus amounts at the vet, the first time she was diagnosed with CHF. That's because of her kidney disease. Treating heart and kidneys are often at odds with each other. Fluids helps one, hurts the other. Thankfully the Vetmedin (pimobenden) helped her heart enough that she got over the CHF then. Flash forward 6 months, we were trying to add just a bit of fluids to help her deteriorating kidneys, a lot less fluids than before. That caused the second CHF episode, diagnosed via x-ray. We did add a small dose of daily furosemide at that point.

I was told that for Neko, her RR, if truly resting, should not be above 30. I found with time that 26 was her upper limit. This may be one of those things that differs by cat.
 
Yes, they told me the RHR should be 30 or below ideally. At the ER they determined that 60 was stable enough to let him go home. At that time though they thought it was lymphoma and I didn't want to treat it. I just wanted to spend as many precious days as I was given with my Zhoom. Now they don't know that it is lymphoma and decided to change the diagnosis to CHF. Which changes things for me, as it seems that he could potentially live many more months if not years if it can be managed. I hope I can get a cardiology appointment soon. Otherwise I will have to take him back into the ER and he will have to get cardio care as an inpatient, which is crazy expensive and so stressful for us to be separated. Ugh. This is really hard.
 
Small cell lymphoma is a very low moving disease and on a good chemo protocol the majority go into remission. I'm on my third SCL kitty, Neko was number 2. It's wasn't a big deal treating it and CHF. Both conditions can cause nausea which is how I discovered something was wrong.
 
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