GA Mister in critical condition, congestive heart failure

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MisterBillie

MisterBillie

Member Since 2022
Mister has Hypersomatotropism (HST), aka acromegaly. He has been in diabetic remission/OTJ for the past a year now after getting SRT done. He has been doing very well the past year.

Just yesterday (a Saturday afternoon) I let him outside for a brief supervised walk around the house. He laid in the sun for about 30 minutes and suddenly became super lethargic and started breathing super rapidly. Usually I can woo him inside by shaking his treat bad, but this time I had to carry him inside and he laid on the floor breathing rapidly with his mouth open and drooled a little bit on the floor.

Eventually over the course of 30 minutes, his breathing recovered but has remained super lethargic since then.

Fast forward to today, a Sunday, and he is still super lethargic, not eating very well, not responding to treats unless I put it right near his nose, and appears to have slightly labored breathing. In hindsight, I have also noticed bloating around his stomach of the past days even before this incident.

I took him to UMN VMC this evening just now, the same place he had his SRT done. The doctor did an ultrasound and she had this to say after doing an ultrasound and triage:

- Atrium "very very" enlarged. Biatrial enlargement. She said it's the end stage for the disease. "Reduced contractility", which leads to him feeling crummy and lethargic because he's not able to get the blood out to his body.
- Options they presented are limited:

Option A:
- Stay at hospital tonight and see the cardio team tomorrow where they can do a full echocardiogram and full cardiac ultrasound.
- Would need to make sure kidneys are okay before they can give him medication that they need to give him to pull the fluid out of his lungs. Apparently the medication they give is super hard on the kidneys.

Option B:
- Humane euthanasia

The state he's in now, she is saying they couldn't ever recommend sending him home.

I opted to try to save, so Option A. Please keep Mister in your prayers. If any cat can pull this off, it's Mister.

Tagging @FrostD this was one of the several individuals who helped me through the SRT stuff. FrostD and anyone else reading this thread, feel free to give it to me straight. Did I make the right decision?
 
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Hi, I’m sorry no one got to you sooner.
I’m so sorry you and Mister are going through this.:bighug:
I don’t think @FrostD is around much at the moment but I’ll try and help you.

I would definitely try option A.
Getting rid of some of the fluid build up can make a difference. I have seen it make a difference in several cats.
I’ll tag @Wendy&Neko but she won’t be around for several hours.
Please let us know how things go and we will keep mister in our prayers and hope the news is good.
 
Were they able to stabilize him and make him comfortable overnight — put him in an oxygen chamber, give him something to take the edge off, whatever?

If so, and presuming he wasn’t struggling, then I likely would have made the same choice. It sounds like the ER vet was confident of the diagnosis and perhaps even prognosis(?), but I’d want to do the additional tests with the Cardio specialists to confirm as well as hear their opinions and recommendations before making any “final” decisions. It is their expertise, after all. And you can’t undo option B, so it’s understandable to want to be absolutely certain that you have the best info possible when making a decision. And sometimes when things happen so seemingly abruptly, we need time to “process” as well.

With Tubby (my acro/SRT kitty), the docs never all agreed whether he heart problems or not. Because everything was enlarged in him, the measurements weren’t those of a normal cat. And that threw some vets off. I just followed what the cardio folks advised, but even they admitted that acro cats could be challenging.

I hope all goes well tomorrow. I’ll be thinking of you and sending positive vibes. Please let us know what happens.
 
:bighug::bighug::bighug: I would and did make the option A choice. Option A got me over 6 more months with Neko. Neko also was larger, partly due to Maine Coon heritage too, so her cardio vet thought her being a bit out of "normal" size was normal for her. I was somewhat lucky in that I had a base line echo done when a murmur was detected (thank you to her vet!), so we could see what happened as heart heart issues progressed.

Neko's first heart failure was also the same time she was diagnosed with small cell lymphoma, and she had stage 3 kidney disease by that point. She was never one to do things by half measures. :rolleyes: She also had an EKG and from then forward she could not have anaesthesia ever again. And I had to stop fluids for her kidneys. Anyway, at first diagnosis she went on Vetmedin and Plavix for her heart. She was not put on Lasix, which is the drug that removes fluid and this is hard on the kidneys. She will note from my signature that she got over this episode. One thing they should be telling you about is how to count his resting respiration rate (RR). It's the number of complete in and out breaths per minute. I used the timer on my phone. Normal is 20-30 per minute, but for Neko, 26 and above was too high for her. She also had bradycardia (slower heart rate). I used the RR as an indicator when she needed to see the vet again.

Long story, but months later the IM vet wanted me to add a very small amount of fluids for her worsening kidneys. Her heart did not agree with that. The heart rules all and gets to decide. She did go into CHF a second time because of it, and the RR told me about it. She had fluid removed, and under sedation not anaesthesia. There was an issue with the fluid removal and some leaked into her lungs. Which resulted in a sudden trip back to the ER and a couple nights in an oxygen cage. She had a couple bolus shots of Lasix at this episode. But still came home for a while afterwards.

Hoping for all the best for you and Billie today.
 
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Thanks for all the kind words so far.

@Wendy&Neko I think you mean "Option A". I knew what you meant, just pointing it out in case others didn't spot the typo. Thanks to you and others sharing their story.

The cardiologist just called back moments ago and said a ton of things, I remember like 10% of it given my current level of sleep deprivation. Luckily they will be sending an email summary of what was said. I basically blacked out and remember almost nothing, here are some vague tidbits I remember:

- He mentioned that Mister's HST/Acro was the cause of this, and has resulted in a thickening of the walls of the heart. He has atrial fibrillation.
- He seemed to be more optimistic than the overnight ER doctor was. The overnight doc was leaning towards it being unlikely Mister will ever leave the hospital and euthanasia being probably the best option. The cardiologist is saying we could get Mister on a cocktail of drugs and potentially improve his quality of life and bring him home, and he confirmed this is the option he would do if it were his furbaby. Mister did respond to the treatments they did overnight at least somewhat positively it sounded like. So, the cardiologist is saying there's a chance Mister can come home tonight pending his vital signs look good after they remove oxygen later today, which seemed like an impossibility according to the ER doc just hours earlier.

The cardiologist mentioned there are three different drugs. One of them is to be taken once every 2 days. One or two of them is to be taken twice daily. I inquired with the question of "can we have them compounded at Wedgewood", and he said possibly two of them, but the third one is very foul tasting. The bad tasting one is one that Mister might have a chance at improving to the point where he may not need to take it if he keeps improving over the coming months.

He did mention that the prognosis with cats with underlying diseases (not necessarily HST/acro) have a survival rate in this situation in the order of months to a year, but that is the average and some cats can exceed that. And historically, Mister is a fighter and a outlier.

Will do a follow up post once they send the email summary, this post is essentially a brain dump.
 
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Ooops, sorry, will fix the option references above.:oops:

Our acros are tough critters, but heart issues are one of the more common side effects. This sounds like much better news. Keep fighting Mister!

Let us know the drug names when you hear them. The Vetmedin/pimobenden caused Neko to foam so it went in a gelcap. It's likely the bitter one. It was twice daily. Along with the Plavix/clopidogrel.
 
Wendy&Neko said:
Let us know the drug names when you hear them. The Vetmedin/pimobenden caused Neko to foam so it went in a gelcap. It's likely the bitter one. It was twice daily. Along with the Plavix/clopidogrel.
Click to expand...
  1. Clopidogrel 75mg tablets (1/4 tablet every 24hrs).
  2. Furosemide 20mg tablets (1/2 tablet three times per day for three days. After three days, reduce frequency to two times a day).
  3. Digoxin 0.125mg tablets (1/4 tablet by mouth every 48hrs (every other day), will require recheck by vet in a week).
  4. Xarelto 10mh tablets (1/4 tablet every 24hrs)
They also recommend a low sodium diet. I wonder if his current food (Weruva BFF Pate) qualifies as low sodium? Will have to do some research, they want the food to have:
  • <100mg of sodium per 100 Kcal
  • high amount of digestible protein (minimum of 6.5g/100kcal)
  • if possible, contains omega-3 fatty acids.
Here are some examples foods they list that would be appropriate:
  • Royal Canine Calorie control higher fiber control (prescription diet)
  • Hills m/d (prescription diet): Wet only
  • lams Healthy Naturals Diet: Weight management with chicken
  • Purina Pro Plan Adult Weight management Turkey and Rice: Wet only
 
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I have to figure out how to pill a cat tonight, needs a 1/2 tablet of the Furosemide. I've never done this before
 
Furosemide = Lasix, the one harder on the kidneys. Any signs of kidney issues on recent labs? Good to hear you can taper it down.

Weruva website has breakdown of nutrition information, including %sodium, for their products. I dLooks like are higher sodium that the m/d. I didn't check the rest. I didn't feat any of the ones suggested above to Neko. You can add omega-3 in the form of fish oil (Nordic Naturals has a cat product) if the food doesn't have it already.

Let me dig for a pilling video. I don't suppose you have a pill shooter, or at least pill pockets?
 
Pilling Your Cat

If the med is bitter, a gel cap is a life saver. I used size 5 for the Plavix - the cardio vet actually gave me a handful of them until I got more for myself (see Amazon). Bigger pills need smaller numbers and are also good for more than one med. I used size 4 for Neko's heart cocktail.

Current kitty and Neko in her good days would take pills in a pill pocket. When Neko went off her food, I had to regain my pilling game and needed a piller/pill shooter with her. Churu has come out since then. Some people put the pill (if small) in half a pill pocket, put it in the mouth followed immediately by Churu. Always follow a pill by water or some food. You don't want the pill stuck going down.

Another thing you might want to get at some point is a pill cutter. I got mine from a local pharmacy.
 
A favour to ask, could you take down the 911 now. Thankfully it sounds like the emergency isn't like it was. Plus you have people responding.
 
Mister ended up gobbling down a Greenies Salmon pill pouch with half a furosemide pill in the middle. What a relief!

He is home now and still very lethargic. His back legs seem to be showing signs of instability, this is a new symptom as of today, this has me extremely worried because it's a symptom of Arterial Thromboembolism (aka Saddle Thrombosis) . But yet he can work himself up to jump up on couches if he focuses and works himself up to it. Maybe he is regaining his strength still from the overnight stay at the vet.

He just drank a bunch of water and is eating a little bit of food here and there, but not as much as normal.
 
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- He's still extremely lethargic. He is showing signs of difficulty walking. A couple times, his back legs seemed unstable until he gathered himself and focused, where he was able to jump up on the couch.
- I can get him to eat and drink, but he's only eating in small amounts.
- He is eating the pills once loaded in a pill pouch treat, so that is good.
- He hasn't defecated yet since being home.
 
Update:

Mister has been on the meds now for a few days and is not getting better. With each day, he's getting slightly worse. The hind limb instability is still present and now his front limbs are experiencing the same thing. I had to hold him up in the litter box for him to do his business because he wasn't able to balance and keep himself up.

Extreme fatigue, he's really only able to move a few feet at a time and where he'll then sit for a few hours.

I'm adding back the 911 tag to the thread title.

I had him rechecked at a more local vet yesterday and the digoxin levels were what they want to see I guess, so I guess the medication just isn't cutting it?

Does anybody else have any solutions, otherwise it's looking like I might need to do in home euthanasia. Throw any ideas at me here, even a hail mary.

I mean presumably the medications should have already put him on a track for improvement day over day, right? Or should I give it a little bit longer before deciding on euthanasia?
 
Did the vet test his potassium levels? That can also give the leg wobbles. Check pictures later on in this page: https://felinecrf.org/potassium.htm

Did the cardio vet mention giving Vetmedin/pimobendan? It was a wonder drug for Neko (and others here) but can't be given in all heart cases.

Are you giving him extra fluids with his meals? Maybe even offering chicken broth? Liquids will help him poop. So will Miralax if you aren't giving it now.

Are you testing his RR or resting respiration rate regularly? What is it?
 
@Bron and Sheba (GA)

UMN VMC Cardiology recommends to see primary Care vet if symptoms get worse, which I did so yesterday.

They did a full chem panel to check Liver, kidney, and electrolytes. The results were about the same as they were on Sunday. There were two values that were slightly better than before.

@Wendy&Neko The vet never mentioned anything regarding your first two sentences with the potassium and Vetmedin/pimobendan. I will call UMN VMC Cardiology tomorrow to ask them about that.

Regarding hydration, I add water to his wet food, and I've been feeding him weruva gravies the last few days which have even more water than the pates.

As far as breaths per minute, every time I've checked it's 30 or upper 20s.
 
I don't have the results of the lab work that was done yesterday, but here is a snippet of the results from Sunday/Monday:

Chem8+ Bloodwork: This is a quick blood test that evaluates kidney values and electrolytes and was
performed by the Emergency Service to quickly evaluate electrolyte, kidney and glucose values.
RESULTS: Azotemia (creatinine 3.0 mg/dL, BUN 30 mg/dL); remainder is within normal limits including
glucose levels(108 mg/dL)

Total T4: This test evaluates thyroid hormone in the body.
RESULTS: Within normal limits

As mentioned above, the chem panel they did yesterday they said was about the same as this one, but there were two values better on the more recent one. One of those values was the creatinene.
 
More snippets:

Echocardiogram: An echocardiogram is an ultrasound of the heart. It allows us to critically evaluate the heart, including quantification of wall thickness, chamber size, valve function, blood flow, and contractility
RESULTS: The echocardiogram shows bi-atrial enlargement with reduced left ventricular systolic function secondary to atrial fibrillation. There is thrombogenic material within the left auricle and there is spontaneous echo contrast within both the right and left atrial.


Electrocardiogram (EKG): This test records the electrical activity of the heart and can evaluate for any arrhythmias.
RESULTS: Arrhythmia characterized by atrial fibrillation with occasional ventricular premature complexes (VPCs) and ventricular couplets.
 
His front legs are now weaker than his back legs, this is a big change, the front legs have been fine up until today compared to the back legs.

He basically is now collapsed in one spot again probably for the next few hours. He's even having trouble shifting his legs in the resting position. His leg issues look nothing like the potassium link that I believe Wendy put in a post above. I think it's due to blood clots? Aka saddle thrombus?

This is really difficult. What would you guys do?
 
Oh my goodness. I am so sorry. These echocardiograms have been done by a veterinary cardiologist?
I cannot recommend that he be started on Pimobendan (Vetmedin) more strongly. It will help the heart be able to pump. It has saved my Ginger’s life. She has very severe atrial enlargement. She’s had almost two years since her pleural effusions and open mouth breathing episodes. In fact, she’s now on Pimobendan three times a day (which is off label but using it in cats at all is off label.). If there’s arrhythmia involved then there are additional drugs needed like Benazepril, I believe.
 
My experience with saddle thromobosis (aka thromboembolism), and what I read on Google, is that it is back legs. The Felinecrf link I have you also talked about low potassium affecting the front. Potassium should be a number on the chem panel, below the BUN and creatinine. Might also be called "K".

Neko did Vetmedin twice a day and also did benazapril - which she was on already for her proteinuria.
 
@Suzanne & Darcy Yes, UMN VMC Cardiology put him on these meds:

-Clopidogrel 75mg tablets (1/4 tablet every 24hrs).
-Furosemide 20mg tablets (1/2 tablet three times per day for three days. After three days, reduce frequency to two times a day).
-Digoxin 0.125mg tablets (1/4 tablet by mouth every 48hrs (every other day), will require recheck by vet in a week).
-Xarelto 10mh tablets (1/4 tablet every 24hrs)

So far they've had seemingly no effect. Which of these meds would be swapped out with the one you're suggesting?
 
Okay. If you think he has a saddle thrombus or any blood clot, he should be started on a high dose of Nattokinase as soon as possible. Many cats on the FB group that I belong to have had theor clots dissolved with Nattokinase. Blood thinners like Clopidogrel or Xarelto (and Ginger takes both) work to prevent clots bit cannot dissolve them. Information os on Facebook at the Cats With Blood Clots group
https://www.facebook.com/groups/961846647630769/
 
Suzanne & Darcy said:
Are his back legs moving? Are they cold or warm to the touch? Can he walk? Is he in any pain?
Click to expand...
He can move them but it's very difficult for him to do so it seems, it's a big struggle. When he tries to walk, which is very rare, they're very unbalanced. He can occasionally work himself up to jump on the couch, but then he'll immediately collapse on the blanket and not be able to lay in a normal position and his legs will just kind of be in a weird position.

They are not pulled to the touch.

His front legs like I mentioned are now becoming an issue which is new as of today. Occasionally his front legs are acting like T-Rex arms and not fully extending
 
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MisterBillie said:
@Bron and Sheba (GA)

UMN VMC Cardiology recommends to see primary Care vet if symptoms get worse, which I did so yesterday.

They did a full chem panel to check Liver, kidney, and electrolytes. The results were about the same as they were on Sunday. There were two values that were slightly better than before.

@Wendy&Neko The vet never mentioned anything regarding your first two sentences with the potassium and Vetmedin/pimobendan. I will call UMN VMC Cardiology tomorrow to ask them about that.

Regarding hydration, I add water to his wet food, and I've been feeding him weruva gravies the last few days which have even more water than the pates.

As far as breaths per minute, every time I've checked it's 30 or upper 20s.
Click to expand...
That’s not a bad breaths per minute. Under 40 is important. In the 20s is good
 
Breaths per minutes should be under 30 I was told. Maybe that was for Neko who had bradycardia (slow heart rate). For her, 26 and above was an indicator something was wrong.
 
MisterBillie said:
@Suzanne & Darcy Yes, UMN VMC Cardiology put him on these meds:

-Clopidogrel 75mg tablets (1/4 tablet every 24hrs).
-Furosemide 20mg tablets (1/2 tablet three times per day for three days. After three days, reduce frequency to two times a day).
-Digoxin 0.125mg tablets (1/4 tablet by mouth every 48hrs (every other day), will require recheck by vet in a week).
-Xarelto 10mh tablets (1/4 tablet every 24hrs)

So far they've had seemingly no effect. Which of these meds would be swapped out with the one you're suggesting?
Click to expand...
I would not say swapped out. Pimobendan is a drug in a class all by itself. You can at least discuss it with them.
 
MisterBillie said:
He can move them but it's very difficult for him to do so it seems, it's a big struggle. When he tries to walk, which is very rare, they're very unbalanced. He can occasionally work himself up to jump on the couch, but then he'll immediately collapse on the blanket and not be able to lay in a normal position and his legs will just kind of be in a weird position.

They are not pulled to the touch.

His front legs like I mentioned are now becoming an issue which is new as of today. Occasionally his front legs are acting like T-Rex arms and not fully extending
Click to expand...
I do know that saddle thrombus affects the back legs, but there are other places where clots can go to affect the front limbs. Recently, I have seen this happening in people’s cats on the blood clots group and the Special Hearts group. I pray he doesn’t have an actual clot thrown.
 
Well, he's on medication that the cardiologist said is going to dissolve the clots that he has. So at some point, a clot will be thrown, right? We just have to pray that the thrown clot doesn't lodge somewhere before it dissolves enough to not be a threat of being stuck.

I will call the cardiologist tomorrow and petition that we start Vetmedin. Not sure about Nattokinase though, can anyone else vouch for that?

In the meantime, should I be shifting mister around and helping his legs get circulation, or would that only hurt things with the clots? It seems like when he's laying down he gets stuck in a weird position and doesn't have the energy to get out of it and his legs might lose circulation.
 
Is there anyone in Minnesota that has Vetmedin/Pimobenden right now? Will pay $100 cash just for a lead if it pans through and can get it tonight
 
I was able to get a hold of the cardiologist because he happens to be on-call tonight. He is saying that Vetmedin may be contraindication with other meds he is taking, and the the dixogen is a better option supposedly.

So frustrating. The current meds clearly aren't working.
 
Good you were able to get ahold of the cardio vet re Vetmedin. There are some heart conditions it is contra indicated. I didn't know about the medications. I wonder which one.
MisterBillie said:
So at some point, a clot will be thrown, right?
Click to expand...
Not certain. Neko was on Plavix/chlopidogrel to prevent clots - she never had a clot. Kitty that did have saddle thromboses was two days before his echocardiogram. So not on Plavix. :( Did the cardio vet say he saw clots? I didn't see that above.
 
@Wendy&NekoThe below info was in the visit summary.

Arterial Thromboembolism (ATE):
Arterial thromboembolism is a devastating complication of heart disease in cats. The underlying cause is associated with heart disease, which induces blood stasis and results in thrombus formation. Blood stasis, along with damaged endothelium and a hypercoagulable state, causes clot formation in the left atrium. Portions of the thrombus can break off and mobilize to distant sites, with the most common site being where the aorta (major artery in the body) splits to send branches to the hind limbs. Lack of blood flow leads to the development of clinical signs, including pain, inability to use one or both hind limbs, and cold extremities.
Although treatment can be attempted, both the short- and long-term prognosis is generally poor. The standard treatment to prevent clot formation is with antithrombotic medications, such as Plavix (clopidogrel) or aspirin.

IIRC, and it's hard to do that now because of sleep deprevation, but he has clots but they're not lodged in anything.
 
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Suzanne & Darcy said:
Oh my goodness. I am so sorry. These echocardiograms have been done by a veterinary cardiologist?
I cannot recommend that he be started on Pimobendan (Vetmedin) more strongly. It will help the heart be able to pump. It has saved my Ginger’s life. She has very severe atrial enlargement. She’s had almost two years since her pleural effusions and open mouth breathing episodes. In fact, she’s now on Pimobendan three times a day (which is off label but using it in cats at all is off label.). If there’s arrhythmia involved then there are additional drugs needed like Benazepril, I believe.
Click to expand...
What was the dosing for the Vetmedin/Pimobendan exactly?
 
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