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

Discussion in 'Lantus / Basaglar (glargine) and Levemir (detemir)' started by MJW, Mar 8, 2018.

  1. MJW

    MJW Well-Known Member

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    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.
     
  2. Stacy & Asia

    Stacy & Asia Well-Known Member

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    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:
     
  3. MJW

    MJW Well-Known Member

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    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.
     
  4. MJW

    MJW Well-Known Member

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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.
     
  5. Sean & Rufus

    Sean & Rufus Well-Known Member

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    Oh, poor Yum! Really hoping she gets through his nasty kidney issues quickly!
     
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  6. MJW

    MJW Well-Known Member

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    I have her on a heating pad, which is what they recommend for people. What is the full word for bupe?
     
  7. Sean & Rufus

    Sean & Rufus Well-Known Member

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    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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  8. Sean & Rufus

    Sean & Rufus Well-Known Member

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    buprenorphine
     
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  9. Chubba (GA)

    Chubba (GA) Well-Known Member

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    Sending more healing vines, prayers, and :bighug:
     
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  10. Stacy & Asia

    Stacy & Asia Well-Known Member

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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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  11. Stacy & Asia

    Stacy & Asia Well-Known Member

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    Buprenex, it's administered orally, but you shoot it inside their cheek as it works best absorbed in the mucosa.
     
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  12. Bobbie And Bubba

    Bobbie And Bubba Well-Known Member

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    Oh poor Yum! I hope they will just let you go there and pick some pain meds up since she was just there. Insist on it. :bighug::bighug::bighug::bighug:
     
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  13. Stacy & Asia

    Stacy & Asia Well-Known Member

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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.
     
  14. Squeaky and KT (GA)

    Squeaky and KT (GA) Well-Known Member

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    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!!
     
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  15. Wendy&Neko

    Wendy&Neko Well-Known Member

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    It's a bit ECID what works with pain meds. I tried gabapentin with Neko and it didn't do much. Buprenorphine (drug name, Buprenex is brand) was a game changer. And she was on bupe in spite of CKD.

    Sending tons of vines for Yum and these for you. :bighug::bighug::bighug:
     
  16. Ella & Rusty & Stu(GA)

    Ella & Rusty & Stu(GA) Well-Known Member

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    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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  17. Bronx's dad

    Bronx's dad Well-Known Member

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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.
     
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  18. carfurby

    carfurby Well-Known Member

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    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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  19. Dyana

    Dyana Well-Known Member

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    Sending healing vines to Yum.
     
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  20. Kathy and TiTi

    Kathy and TiTi Well-Known Member

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    Last edited: Mar 8, 2018
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  21. PussCatPrince - GA

    PussCatPrince - GA Well-Known Member

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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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  22. MJW

    MJW Well-Known Member

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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.
     
  23. MJW

    MJW Well-Known Member

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    Wow. And her BG has spiked to 523.
     
  24. Girlie's mom

    Girlie's mom Well-Known Member

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    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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  25. LizzieInTexas

    LizzieInTexas Well-Known Member

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    Poor Yum. I am mad at the ER/vets. Stupid. I hope she is doing better this morning. Big hugs :bighug::bighug:
     
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  26. Stacy & Asia

    Stacy & Asia Well-Known Member

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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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  27. AZJenks

    AZJenks Well-Known Member

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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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  28. Camille and Cyclone

    Camille and Cyclone Member

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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.
     
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  29. MJW

    MJW Well-Known Member

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    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.
     
  30. Doodles & Karen

    Doodles & Karen Well-Known Member

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    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.
     
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  31. Sean & Rufus

    Sean & Rufus Well-Known Member

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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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  32. Dyana

    Dyana Well-Known Member

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    Prayers for Yum.
     
  33. Kathy and TiTi

    Kathy and TiTi Well-Known Member

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    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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  34. Tracey&Jones

    Tracey&Jones Well-Known Member

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    Prayers and healing vines for Yum.
     
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  35. HWright

    HWright Well-Known Member

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    ❤️❤️❤️❤️❤️❤️❤️Yum, please make it through this, you can and you have a world full of love and vines for you and your mom ❤️❤️❤️❤️❤️❤️❤️❤️❤️❤️❤️❤️❤️❤️❤️
     
  36. Bobbie And Bubba

    Bobbie And Bubba Well-Known Member

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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:
     
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  37. Amy&TrixieCat

    Amy&TrixieCat Well-Known Member

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    Endless hugs and prayers from us :bighug::bighug::bighug:...
     
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  38. Camille and Cyclone

    Camille and Cyclone Member

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    Sending hopeful thoughts for poor Yum and for you. The ER has a lot to answer for.
     
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  39. Red & Rover (GA)

    Red & Rover (GA) Well-Known Member

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    Sending vines for both of you.

    And please document everything you can. The vets have messed up and should be held accountable.
     
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  40. Stacy & Asia

    Stacy & Asia Well-Known Member

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    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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  41. Pamela & Amethyst

    Pamela & Amethyst Well-Known Member

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    LOve light and healing:bighug::bighug::bighug:
     
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  42. Mandy & Rex

    Mandy & Rex Well-Known Member

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    :bighug::bighug::bighug::bighug::bighug:
     
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  43. Bronx's dad

    Bronx's dad Well-Known Member

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    Prayers for Yum :bighug::bighug::bighug:
     
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  44. Shoeskitty-GA

    Shoeskitty-GA Well-Known Member

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    Sending prayers and hugs!
     
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  45. Sharon14

    Sharon14 Well-Known Member

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    Prayers and vines for Yum:bighug:
     
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  46. Dimmu & KL

    Dimmu & KL Member

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    Tons and tons and tons of healing vines for Yum.:bighug:
     
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  47. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Well-Known Member

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    Lasix can do wonders. My thoughts are with you and Yum.
     
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  48. Jill & Alex (GA)

    Jill & Alex (GA) Senior Member Moderator

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    Holding you close in thought and prayer...
    :bighug::bighug::bighug::bighug::bighug:
     
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  49. Bobbie And Bubba

    Bobbie And Bubba Well-Known Member

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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.
     
    Last edited: Mar 9, 2018
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  50. Wendy&Neko

    Wendy&Neko Well-Known Member

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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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  51. Alicia & Maggie (GA)

    Alicia & Maggie (GA) Well-Known Member

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    I'm sorry you and Yum are going through this. Sending you tons of peace vines, and sending Yum tons and tons of healing vines. :bighug:
     
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  52. Stephanie & Quintus

    Stephanie & Quintus Well-Known Member

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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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  53. Kathy and TiTi

    Kathy and TiTi Well-Known Member

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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:
     
  54. Wendy&Neko

    Wendy&Neko Well-Known Member

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    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:
     
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  55. Squalliesmom

    Squalliesmom Well-Known Member

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    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:

    vines.jpg angel2.png vines.jpg
     
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  56. Chubba (GA)

    Chubba (GA) Well-Known Member

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    I’m so sorry you and Yum are in this situation. Sending prayers and healing vines for Yum.
     
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  57. LizzieInTexas

    LizzieInTexas Well-Known Member

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    :bighug: many vines and prayers :bighug:
     
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  58. HWright

    HWright Well-Known Member

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    ❤️❤️❤️❤️❤️Sending heaps more Healing vines and love for you and your sweet Yum, MJW . ❤️❤️❤️❤️

    ❤️(Bobbie and Lucy, same crossed through my mind, too) ❤️
     
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  59. Kris & Teasel

    Kris & Teasel Well-Known Member

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    :bighug::bighug::bighug:
     
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  60. MJW

    MJW Well-Known Member

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    No mention of the convenia. She tolerated it in the past.
     
  61. Bobbie And Bubba

    Bobbie And Bubba Well-Known Member

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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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  62. MJW

    MJW Well-Known Member

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    Mar 29, 2017
    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.
     
  63. MJW

    MJW Well-Known Member

    Joined:
    Mar 29, 2017
    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.
     
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  64. Sean & Rufus

    Sean & Rufus Well-Known Member

    Joined:
    Jan 10, 2018
    I sure hope Yum's next birthday isn't as "eventful" as this year's! Continued praying for Yum and you
     
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  65. MJW

    MJW Well-Known Member

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    Mar 29, 2017
    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.
     
  66. MJW

    MJW Well-Known Member

    Joined:
    Mar 29, 2017
    Me too.
     
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  67. MJW

    MJW Well-Known Member

    Joined:
    Mar 29, 2017
    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.
     
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  68. Tracey&Jones

    Tracey&Jones Well-Known Member

    Joined:
    Dec 12, 2016
    Sending continued healing vines that Yum responds well to treatment and can make it home soon!
     
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  69. Beth 73

    Beth 73 Well-Known Member

    Joined:
    Aug 2, 2016
    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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  70. MJW

    MJW Well-Known Member

    Joined:
    Mar 29, 2017
    Those high numbers probably also contributed to her getting a kidney infection.
     
  71. Stacy & Asia

    Stacy & Asia Well-Known Member

    Joined:
    Oct 2, 2017
    Thanks for the updates, so she’s doing considerably better? I’m glad her numbers came down a bit. I hope Yum turns a corner and is back home with you soon. :bighug::bighug::bighug::bighug::bighug:
     
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  72. carfurby

    carfurby Well-Known Member

    Joined:
    Feb 19, 2012
    Sending more prayers. :bighug::bighug::bighug:
     
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  73. Stephanie & Quintus

    Stephanie & Quintus Well-Known Member

    Joined:
    Dec 9, 2017
    First thing I did upon waking up is check in on your thread. Glad things are improving and under control. :bighug::bighug:
     
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  74. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Well-Known Member

    Joined:
    Dec 28, 2009
    I wasn't familiar with pimobendan/Vetmedin. This link has some very promising information. (The other medication you mentioned is benazepril/Lotensin.)
     
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  75. Doodles & Karen

    Doodles & Karen Well-Known Member

    Joined:
    Jun 2, 2015
    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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  76. Wendy&Neko

    Wendy&Neko Well-Known Member

    Joined:
    Feb 28, 2012
    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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  77. AZJenks

    AZJenks Well-Known Member

    Joined:
    Feb 3, 2014
    Wishing Yum a speedy recovery now that it seems like they have everything sorted out.
     
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  78. Ter and Sally

    Ter and Sally Member

    Joined:
    Jan 9, 2018
    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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  79. MJW

    MJW Well-Known Member

    Joined:
    Mar 29, 2017
    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.
     
  80. Wendy&Neko

    Wendy&Neko Well-Known Member

    Joined:
    Feb 28, 2012
    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:
     
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  81. Olive & Paula

    Olive & Paula Well-Known Member

    Joined:
    Sep 6, 2015
    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.
     
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  82. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Well-Known Member

    Joined:
    Dec 28, 2009
    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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  83. Wendy&Neko

    Wendy&Neko Well-Known Member

    Joined:
    Feb 28, 2012
    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.
     
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  84. Kathy and TiTi

    Kathy and TiTi Well-Known Member

    Joined:
    Feb 12, 2016
    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:
     
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  85. PussCatPrince - GA

    PussCatPrince - GA Well-Known Member

    Joined:
    Nov 25, 2017
    Goodness.
    just caught up with this news.

    I do hope that Yum is on a good road to recovery.
     
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  86. MJW

    MJW Well-Known Member

    Joined:
    Mar 29, 2017
    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.
     
  87. AZJenks

    AZJenks Well-Known Member

    Joined:
    Feb 3, 2014
    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!
     
  88. Doodles & Karen

    Doodles & Karen Well-Known Member

    Joined:
    Jun 2, 2015
    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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  89. MJW

    MJW Well-Known Member

    Joined:
    Mar 29, 2017
    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.
     
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  90. MJW

    MJW Well-Known Member

    Joined:
    Mar 29, 2017
    Good.

    Great to read her echo could improve.
     
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  91. Doodles & Karen

    Doodles & Karen Well-Known Member

    Joined:
    Jun 2, 2015
    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.
     
    Last edited: Mar 11, 2018
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  92. Teresa & Buddy

    Teresa & Buddy Well-Known Member

    Joined:
    Jan 2, 2017
    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.
     
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  93. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Well-Known Member

    Joined:
    Dec 28, 2009
    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.
     
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  94. MJW

    MJW Well-Known Member

    Joined:
    Mar 29, 2017
    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.
     
  95. Amy&TrixieCat

    Amy&TrixieCat Well-Known Member

    Joined:
    Feb 14, 2011
    I'm not familiar with the potential interactions with all the various meds she's on, but is it possible to combine some of them into a single gelcap, to reduce the number of times you have to pill her?

    I'm so glad she's home...continued prayers for her!
     
  96. Ter and Sally

    Ter and Sally Member

    Joined:
    Jan 9, 2018
    What's your respiratory rate?? Sounds like you're got it all thought through though. Nice to be home. You've both been through a lot.
     
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  97. Stacy & Asia

    Stacy & Asia Well-Known Member

    Joined:
    Oct 2, 2017
    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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  98. carfurby

    carfurby Well-Known Member

    Joined:
    Feb 19, 2012
    I'm glad Yum is home. I'm sure that will help her. You'll get the meds sorted out. Sending prayers.
     
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  99. Beth 73

    Beth 73 Well-Known Member

    Joined:
    Aug 2, 2016
    Yum is home where she should be :bighug::bighug:and on the road to FULL recovery !!!! Sending prayers and hugs :bighug::bighug::bighug::bighug:
     
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  100. Sean & Rufus

    Sean & Rufus Well-Known Member

    Joined:
    Jan 10, 2018
    So happy for you and Yum!
     
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  101. HWright

    HWright Well-Known Member

    Joined:
    Jun 19, 2016
    Woo hoo that Yum is home! ❤️❤️❤️❤️❤️❤️❤️❤️❤️❤️❤️❤️❤️❤️❤️❤️❤️
     
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