? 2/24-Flame-AMPS=345,+10=244, PMPS=242+2.5=236,+4.25=211--dosecrease, Flat so far - good or bad?

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Donna and Flame

Donna and Flame

Member Since 2009
Hi everybody,

I am a nervous wreck. I hate having to leave him at the vet. They couldn't tell me when the cardiologist was coming in today. They said he usually calls when he is on his way. His breathing sounded a bit better this morning until I tried to give him his Flovent and then he got upset and started wheezing again. I didn't push it and left him alone. I bought the Flovent and Albuterol to the vet's office and left it with them just in case.

He ate Ok this morning, but I brought food with him to the vet in case he had to be there for a good part of the day.

As you can see, his AMPS was high this morning. The pred is rearing it's ugly head.

I am terrified at what the vet that admitted him said this morning. She listened to his heart with the stethescope and said his heart did not sound normal, she said she heart a gallop. I've just looked that up and it is a sign of cardiomyopathy. My worst fear.

@Doodles & Karen he has been at the vet so many times in the past couple months and as recently as last week and the vet NEVER said she heard this before today. I've known he had a heart murmur but my vet always told me it was mild and not to worry too much about it right now. Could this type of arrythmia be brought on by stress? His breathing got worse at the vet too, which I attributed to stress. He was OK till we took him out of the carrier and they started handling him.

HOW could all of this happen so fast?!?! I understand the FD being brought on by the steroids, but the asthma seemed to come out of nowhere and now the kidneys and potentially now his heart. It all seems to be happening so fast. It's like his body is just shutting down and breaking down.

I am so depressed right now. I've been trying SO hard to help him to feel better and regain a good quality of life so that he could once again be his happy little self, but I feel like we're losing that battle and my heart is breaking.
I'm trying to work today, but I can't hold back the tears. I love this little boy with all that I am.

I will keep you all posted today when I hear from the vet's office. Please keep Flamie in your prayers today. Thank you all so much for being here for us. I could never get thru all of this without my FDMB family to hold my hand.

I am keeping all of you in my prayers as well and sending peaceful, healing vines to all who need them today.
:bighug::bighug::bighug:
 
Donna and Flame said:
I am terrified at what the vet that admitted him said this morning. She listened to his heart with the stethescope and said his heart did not sound normal, she said she heart a gallop. I've just looked that up and it is a sign of cardiomyopathy. My worst fear.

@Doodles & Karen he has been at the vet so many times in the past couple months and as recently as last week and the vet NEVER said she heard this before today
Click to expand...
HCM cannot be heard through a stethoscope, it can only be confirmed on the Echo which he's getting today. If it is HCM, you're catching it early because Flame is still here and there are meds to treat it but cannot be cured. I'm keeping continuous vines and prayers flowing for sweet Flame and many :bighug::bighug::bighug:for you.

For your information Doodles is on a high dose of Lasik (furosemide) 30mg twice a day and Enalapril 2.5mg twice a day for almost a year now. However Doodles kidneys are still hanging in there (how... no body knows but are declining). The cardiologist will know the best med combination if needed balancing heart (if there are issues) and his kidneys.
 
@Doodles & Karen thank you for giving me hope. I worry because Flame's kidneys are already an issue. Trying to remain calm and hopeful.
Thank you for the vines and prayers and the hugs!! They are very much appreciated and gratefully received!! :bighug::bighug::bighug:
 
I have been thinking about you and Flame all night and morning. Glad he is there, and i am sure between the stress of breathing and the new place my heart would be galloping too. Prayers and hugs coming both for you and Flame. You are doing a great job for your boy!! Cry if you need to cry I know it helps me. :bighug::bighug: :bighug: :bighug: :bighug:
 
Sending plane loads of beautiful vines for Flame's echo. I know too well how nervous you are feeling today.:bighug::bighug::bighug::bighug::bighug::bighug: At least my cardiologist did the echo while I was there and I didn't have the wait on top of it all. You must be a bundle of nerves today.

Melissa's Tarragon, who also has asthma, got his HCM diagnosis something like 3-4 years ago. HCM, which Neko also had though mild for a couple years, can be managed. It's CHF or congestive heart failure that is more tricky to balance with a kidney kitty. Neko had had CKD for a couple of years before her CHF diagnosis. For her, it meant no subq fluids could be given as they ended up in her chest. Her first episode of heart failure went away on it's own, the second did not. Neko took an itty bit of Lasix every other day for her last month. But her primary heart drugs were Plavix to prevent clots and Vetmedin to help the heart. She also had a second degree heart block.
 
My sweet boy is home. I wish I had better news. I was hoping for them to find nothing on the Echo, but that was not the case. In my emotional state (I was pretty emotional today), I forgot to ask for a copy of the report but I can call and get it. However, here is what my dear Dr. Losso told me re: the cardiologist's report. (Apparently, she was in with him during the Echo too.... I love my vet!!)

  • DX= Restrictive Cardiomyopathy - she said this is a category that they put cats in when they are not sure what category to put them in. He doesn't have HCM or CHF
  • There was no fluid in his chest, around his lungs or heart
  • Some dilation of left atrium seen - with quite a bit of enlargement
  • Mild enlargement of the right atrium
  • No thickening of the left ventricle
  • Some mitral regurgitation / some tricuspid regurgitation
  • No masses or tumors seen in chest/lungs
  • Definitely inflammatory lung disease (asthma/allergic bronchitis)
  • Blood pressure - normal

Recommendations:
  1. Start Vetmedic 1/2 pill twice a day (the ones they have are large capsule sized beef flavored chewables that I will likely have to crush in baby food b/c the half pill is too big to hide in liverwurst unless I can cut in 1/4)
  2. Low dose Lasix - My vet would like to wait until after we re-do blood work next week to start Lasix - cardiologist advised to check kidney values
  3. Pred - continue 2.5 mg once a day until breathing stabilizes
  4. Zyrtec - can take up to 5 mg per day
  5. Famotadine - 1/4 tab once a day - if he is having an off day and not eating, she said I could give another 1/4 tab
  6. Fluids - this is the big question - kidneys need fluid - she recommended no more than 50 ml at once and start with twice a week - watch him for any signs of increased RR, rapid breathing, loss of appetite
  7. Flovent inhaler - as tolerated - right now not going to force as he gets really upset and this brings on an episode and he struggles to breathe
  8. Albuterol inhaler - as tolerated - right now not going to force as he gets really upset and this brings on an episode and he struggles to breathe, but he may need it, so not sure what to do here
I've done a lot of crying and soul searching today. I realize this is not completely up to me. It is up to Flame too. I will be here and continue to do everything I can for him as long as he continues to want to fight.

He was hungry when he came home, so I let him eat. He's been nibbling since 5:30 pm when we got home. He is also wheezing quite a bit. This pred can not work fast enough for me!! I am debating asking for a shot of steroids to help kick start him because this wheezing is not good.

In this mixed bag of health issues, the FD is actually the least of my concerns because out of all of this, it is probably the 'easiest' (I use that term loosely) to manage. Having said that, I am not sure if I should do the dosecrease tonite or wait till tomorrow AM.
I am awfully spent today - physically and emotionally, so I'm not sure I'm up for a PJ party although I don't think he'll give me one with the pred on board.
I can bump him up to 2.5 tonite I think.... What say you oh wise ones?!?!

If anyone here has experience managing any/all of these diseases, please lend your input and expertise because I sure need some.

Sending our love to all of you and thanking everyone who reached out with a prayer, a hug, a word of encouragement. You have no idea how much it means to us!! :bighug::bighug::bighug:
 
Donna, I'm sorry you have more issues you need to deal with. I hope once you get things started you can find a good balance for everything. I know it's hard, but Flame doesn't know anything is different. He is his same loving self. Take time to love on him and take it one day at a time. I learned when my civvie Callie had stomach cancer to just focus on the day at hand and not think about what may happen in the future. I don't think Flame will come down a lot tonight if you increase his dose, but if you need a break, I don't think it's an issue if you wait until tomorrow morning to increase. Sending prayers. :bighug::bighug::bighug::bighug::bighug::bighug::bighug:
 
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(((Donna))) I know exactly how your feeling, and sorry the news wasn't better. The good thing is that there is no CHF present and hopefully the Vetmedin will keep the RCM from progressing too quickly. It's a big balancing act with giving fluids and having pred in the picture too. Wendy has the most experience with kidneys & heart. I hope the Pred starts working fast and gets his breathing back on track quickly. Give Flame lots of extra kisses and scritches. It will help his body if his bg's are mostly under the renal threshold but if you've had enough for today wait to increase until tomorrow morning. :bighug::bighug::bighug::bighug::bighug::bighug:
 
(((((((Donna))))))) ((((((((Flame))))))))) so sorry you have more issues to deal with. I have thought of you often today. Praying things would go well. Remember to breathe. You have to take care of you too so you can take care of Flame. I am so sending you healing and breathing vines. He has the best momma ever. One moment at a time sweet lady. One foot.
 
{{{Donna}}}

It's not good news, but it's not the worst news, either. You know what you're dealing with now and you have a plan. Hang in there.

I also don't think it will hurt if you wait till tomorrow to increase and try to get a good night's sleep tonight. If you aren't sure you'll be able to sleep, then an increase tonight might be a good idea. Listen to your bod on this one. Remember, you have to stay healthy to help Flame fight as long as he wants to.
:bighug::bighug::bighug::bighug::bighug::bighug::bighug:
 
I'm not sure if it was the right thing to do since his PMPS was only 242, but his appy since he came home has been good which is a good thing. I have a lot of stuff to do tomorrow, but I didn't want him to stay stuck any longer and I think he'll feel a little better if his numbers start to come down. I am also not thinking straight today, so maybe this wasn't such a good idea, but it's done. I'll get a +2 or +3 and see where he's at and then I guess I'll know if I should sleep on the couch tonite.
 
Sorry about the diagnosis, but it did sound a bit too familiar :bighug:. @jayla-n-Drevon has similar familiarity with balancing kidneys and heart in her civie. She also found out the hard way that pred is not a good match for heart conditions. Pred can weaken muscles, the heart is one big muscle. But YEAH for no fluid in the chest!!! I am a little surprised on the Lasix, we held off on that until there were fluids in the chest.

I also want to stress that you get into the habit of taking the RR every day. Try keeping it in a log so you can immediately notice any trends. The Vetmedin really helped Neko. Her appy got better and RR improved within a few days of starting Vetmedin. Hers was in a capsule and bitter so I had to take half the capsule and put in into a smaller gelcap. Also, be very careful with fluids. We did 50 ml every other day, and it was too much. When Neko's normal RR of low 20's went up to 26, which is still normal, I immediately stopped fluids and that's when vetty found fluid on her lungs.

I know you love your vet, but ask her how comfortable she is balancing the multiple conditions. When we got to this point, I started seeing an internal medicine vet who was better at the balancing act, plus he would consult the cardiologist in the same clinic.

Good luck with the increase. I hope Flame just gives you a chance for a peaceful night cuddling him.
 
Hi @Wendy&Neko
Aside from the cardio issue and the kidneys, his breathing is the biggest issue right now and since I haven't been able to get him to reliably take the inhaler for now, Pred is the only option we have to see if we can get his breathing stable again. When his breathing was stable, he took the inhaler just fine - of course he was still on low dose pred at that point as well. But, right now, he struggling so much that putting that mask on him is just too much for him. I managed to get about 3 breaths of Albuterol into him a while ago after his shot but now he's starting to wheeze again, so I may have to try that again tonite so he can rest. When he can't breathe, he can't rest.

I will start trying to get his RR if I can catch him while he's sleeping. I'm starting the Vetmedin tomorrow AM and hope I can get him to take it. I may have to break out the darn baby food again. She only recommended 50 Ml fluids twice a week at this point. I'm nervous about that. Trying to balance the kidney issues and the cardiac issues is a very new thing for me and I don't know what else to do.

When vet found fluid on her lungs, what did they do?
My vet did tell me tonite that Flame is her only patient (at least right now) that has all these issues at once. I will ask her about an internal med specialist.

I also have to work and keep my job, so any vet I see has to have hours where I can make it without taking time from work - evenings, weekends.

I'm now second guessing myself on the increase tonite. I really am not thinking straight. I was just trying to finish up a spreadsheet for work and I thought I was closing an email I had open, so when the message came up "Do you want to save your changes?" I said NO and it was actually the SS I closed and lost my changes!! I quit for tonite!! Was trying to be good and make up the time I had to take off today to get him to vet and pick him up, but I obviously should NOT be doing work any more!!

And, how how I wish he'd let me cuddle him. He really doesn't want that any more. I try and he stays for a few minutes and then goes back to his little bed. Another reason I'm questioning his QOL right now. He's not acting like my Flame any more. He used to be my "Velcro" kitty - on my lap all the time, laying with me on the couch, in bed... where I was, he was. Not any more and it makes me so very sad.

BBL with a +2 or +3 (depending on if he's resting at +2).

Thanks everyone!!
 
Hi,
I remember how I felt when I took Rico to the ER-
I am so sorry that you are going thru this ....:bighug:
The good news is that so many kittys bounce back.:cat:

Rico was taken off the pred sooner than we planned but his heart just could not take it. He is doing quite well on budesonide and as Wendy mentioned the vetmedin really makes a difference.
Rico also get a small lasix dose 2x a day.
It did take a few weeks for him to recover from the heart episode. I honestly thought he may not make it but when he did bounce back he really has done well. Sending prayers....:bighug::bighug::bighug:
 
Donna, Doodles was in really bad shape last year. Once we started the heart meds and found the right dose he improved significantly. It was a real game changer for him especially his appy. Hope you get some rest :bighug::bighug::bighug::bighug:
 
Doodles & Karen said:
Donna, Doodles was in really bad shape last year. Once we started the heart meds and found the right dose he improved significantly. It was a real game changer for him especially his appy. Hope you get some rest :bighug::bighug::bighug::bighug:
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Hi Karen,
That's great to hear. But what about Flame's breathing? That has me more concerned than anything right now. He's wheezing bad again now. The Albuterol seemed to help for a while earlier, but he's struggling again. How do you deal with this with Doodles? It's awful. If it was just the heart or kidneys and the FD... but the breathing thing is horrible. The poor guy tries to eat and can't cause he is struggling to breathe. He just tried to drink some water and he was only able to drink a little. I can't stand to see him struggle like this. I am praying I can get his breathing stable and then I can deal with the rest.
 
jayla-n-Drevon said:
Hi,
I remember how I felt when I took Rico to the ER-
I am so sorry that you are going thru this ....:bighug:
The good news is that so many kittys bounce back.:cat:

Rico was taken off the pred sooner than we planned but his heart just could not take it. He is doing quite well on budesonide and as Wendy mentioned the vetmedin really makes a difference.
Rico also get a small lasix dose 2x a day.
It did take a few weeks for him to recover from the heart episode. I honestly thought he may not make it but when he did bounce back he really has done well. Sending prayers....:bighug::bighug::bighug:
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Hi,
How much pred was he on and for how long? What was he on the pred for? What was his diagnosis? Was he DX with HCM or CHF? Did he also have CKD and FD at the same time? Anything you can tell me is appreciated.

Thanks so much!! :bighug::bighug::bighug:
 
So, he's really flat so far. Does that mean I'm in for a good nite or a bad nite? He has almost 4 hours till nadir. I can't stay up, that's for sure. I may try to sleep on the couch, but then my alarm clock is upstairs and I'd have to reset it for 6:45 AM so I'm up in time for TFS in the AM. Trying not to disrupt my sleep too much cause I have a hard time going back to sleep once I'm up.
 
Tricia Cinco(GA) & Harvey said:
I think he's going to stay pretty flat. One more test should tell you for sure. I hope you can get some sleep tonight.

:bighug::bighug::bighug:
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When should I test next? I'm really tired. I might be able to make it up to +3.5 or +4 but then I'll need to crash. I'm also concerned because he was eating well before when we first got home and now he doesn't want to eat - he's congested again. So, if I did need to get him to eat, I'm not sure I can. The only think I know for sure he'll always eat is baby food and that doesn't have enough carbs to make a difference.
PLEASE Flamie, give mama a break tonite!!
 
Oh also, I emailed my vet earlier and asked about a possible URI and AB's again. Asthmatic cats are supposedly prone to URI's.
She doesn't feel its a URI but is willing to try AB's.

I also floated the idea of giving him a steroid injection to jump start him - this has been the method we've used in the past - 1 injection followed by oral pred. She seemed to feel OK about it and told me to skip AM pred if I'm going to bring him in. But, I'm not sure if I should do this given his recent cardiac DX. But, then I think about it and I have a feeling these cardiac issues have been there for a while and didn't just start overnight and he's tolerated the shot well in the past.

What do you think?
 
Donna and Flame said:
When vet found fluid on her lungs, what did they do?
My vet did tell me tonite that Flame is her only patient (at least right now) that has all these issues at once. I will ask her about an internal med specialist.
Click to expand...
The first time they just put her on the Vetmedin and Plavix, we stopped giving fluids, and they were reabsorbed over time. The second time, she needed a chest tap. As for your vet, I'm not saying to to an IM, just make sure your vet is comfortable handling it all. Neko's vet threw up her hands and the IM vetty is pretty close by so I went there.

By the way, I think it's a good plan on the increase. For the sake of his kidneys, you'd like him to be spending most of his time under renal threshold.

Both Jayla's Rico (not FD) and Neko were CKD when they were diagnosed first with IBD/lymphoma then later heart conditions. Pred is the gold standard treatment for IBD/lymphoma. In Neko's case the IM vet suspected a heart condition (cardio vetty appointment was a couple days later), so they prescribed budesonide instead of pred, which works reasonably well with gut inflammation. I agree you need to balance pred because of his breathing. :bighug: It may be you need a much lower dose than we needed for IBD.
 
Donna and Flame said:
Hi,
How much pred was he on and for how long? What was he on the pred for? What was his diagnosis? Was he DX with HCM or CHF? Did he also have CKD and FD at the same time? Anything you can tell me is appreciated.

Thanks so much!! :bighug::bighug::bighug:
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Hi ;)
Rico does not have FD-
He had been DX with early CKD 6 years ago and has been given SQ for those 6 years to slow the progression of it-
I know there are studies (now) that say not to give SQ until creatinine is worse than his was but my doc encouraged me to start early and for in his situation I truly believe it sort of "preserved" his kidneys although I have no medical science to back that just my gut.
Rico has never had perfect poo but it was acceptable. After his dental last May he began having water poo that got worse and then the water urgency poo was next. The thought without any invasive testing or sedation was IBD. (He had extensive blood tests)
We started him on 2.5mg of pred and it got a little better but not great.
He had no history of any heart issues ever including our visit to a feline specialist in July.
I was still giving SQ at this time but smaller amounts as he was on pred and 17 years old at the time.

I then talked with my regular doc and after much research I found that the reason most people fail at treating IBD with pred is starting at too low of a dose and not holding the dose long enough.
We upped the dose to 5mg 2x a day and in about 4-5 days he was taken to the ER for breathing issues.
The ER Dr was convinced he would not be ok-
She said if he was not improved in the morning she was suggesting to PTS-
He was ok and we went right to the cardiologist.
She put us on vetmedin and lasix if rr over 40 and we began switching to budesonide while weaning off pred-(we ended up taking him off pred sooner than later as his rr was going to high)
She said if he absolutely needed fluids to give VERY small amount and she said the prognosis was not good 2-6 weeks.
Fast forward-
Because the budesonide holds water it seems to be helping his kidneys as he has not had ANY since he was in ER-
He is now 18 and just had a blood panel that was nearly perfect.
He is a bit chubby from the budesonide but all in all he is doing really good. He does get adequan about every 5 days and that has him running the stairs and feeling spunky!
We no longer take him to his cardio because of the stress factor but my doc comes to the house for blood etc... he did X-rays about 4 months ago and his heart looked about the same, possibly a bit more normal.
 
Fell asleep on the couch for a while, but got up and got a test in at about +4.25. He was 211 so I think I'm OK to go to bed. Also just tried to get another few puffs of Albuterol into him cause he was wheezing bad still. Managed to get a few breaths into him, so maybe he can rest for a while.

Any opinions on the steroid shot tomorrow?

Thanks for everything today everyone!! Night night.... :bighug::bighug::bighug:
 
I don't know if it will help or not, but I wonder if elevating his food dish would make it easier to breathe while he's eating? Sending prayers. :bighug::bighug::bighug:
 
carfurby said:
I don't know if it will help or not, but I wonder if elevating his food dish would make it easier to breathe while he's eating? Sending prayers. :bighug::bighug::bighug:
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Hi Carla,
I already have his food bowls on an overturned cardboard box with a placemat on top, so it's elevated by about 3 inches off the ground. Flame is a pretty short kitty. Thanks for the suggestion!
 
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