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Old 08-15-2013, 12:19 PM
 
112 posts, read 299,445 times
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Hello. I didn't even know there was a pet site on city-data, but I was googling for info about congestive heart failure in cats and I found an old forum on the dogs page. It was the best thing I've found yet, so I figured I'd try a post for anything new. My first post here might be a little long, I'm sorry, I'm at my wits ends it seems If I should put this in a different forum let me know.

My 8 year old baby Bailey was taken to his vet last friday for something now very trivial - we thought he was getting a little sore on his lip. By Friday though it was practically invisible & we felt kinda dumb bringing him in but figured we'd get a checkup and see what it could be. At the vet he examined the sore but was more concerned about his "gurgling" purring noise & heavily congested chest. He asked us lots of questions about this - but we'd noticed nothing at home, seemed to just be something maybe from being nervous at the vet or a cold developing. He got off the table and pranced around the office rubbing on the vet and acting fine. In the car he was fine, just plopped down and laid there like usual. We took the scenic route home and when we were 2 mins away I moved him a bit and the panting started. It continued even after we got him home. He just sat there panting. We called his vet back and he told us to take him to the ER. He was admitted Friday with congestive heart failure. They put him in an oxygen tank and gave him meds to get the fluid in his lungs out. Apparenlty he must of alreayd had really bad heart disease. (he had a slight heart murmur we'd known about, and he got super sick about a year ago and lost a lot of weight, we came home one day and we was panting and seemingly on deaths door - he got fluids and pulled out of that and just all of a sudden one day was fine again. we never went to the cardiologist because we were tired of all the tests and getting no answers and he got better! in hindsight, it probably was his heart.)

Saturday was awful. He looked terrible and we really restled with if he was going to make it. And if we should put him down. But he improved slightly by night. By Sunday, he seemed much better - night and day. They started weaning him off the meds & the oxygen. He was so responsive to us! Purring, kneading, flipping his tail, even standing up. We couldn't put him down now. Monday, he was so much better they brought him out to see us and we were able to take him home with a bag of meds.

Since he's been home though - it's been a mess. I had this image in my head he'd come home, tired, and weak, but slowly eat, get better, be comfortable and happy at home for whatever little time he had left. Instead, he won't eat AT ALL. We were given Lasik, Enalapril, and Potassiom Gluconate (they said he was low from getting so many heavy meds all weekend and little food). We've been giving him this Vitamin supplement gel from petco so he gets something with his meds but obviously that's not enough to sustain him. Tuesday morning I got him to voluntarily take a few licks of the gravy from his can of chicken food & a little tuna juice, but then he got a chunk he had to chew a bit and was done. Since then, nothing.

Last night I syring fed him a little food with his meds. 2 hours later he threw up (digested, but still). This morning we woke up and brought him inside and he drink some water and then immediately threw it up. We waited a half hour, syringe fed him 1/3 of what we fed him last night. He was ok. Drank water. Ok. again 2 hours after feeding - threw up. Then he got up and went in the litter box and pooped (pretty runny, but decent). And here we are.

His potassium has a side effect of stomach aches and it's supposed to be taken with food to help that. BUT HE WON'T EAT. So could giving it with him be making him even less inclined to eat and feeling worse?! He was supposed to start tapering off that tonight, I'm going to check with the vet if we should taper or just stop it. Maybe that could help? Or is his systems just shutting down? Is this the point we should be considering euthanasia?

It cost us over 3k at the ICU this weekend and of course lots of turmoil to all. Our goal was just to get him home to be happy and comfortable. But he doens't seem to be. At the same time, to go through all that and put him down a week later? Not even? How do you know?

He walks a bit, then lays a while... he never seems to be truely sleeping, probably cuz he doens't feel well. Can't seem to get comfortable sometimes. He still jumps in the window and on the bed. He uses the litter box. He purrs and flips his tail when i pet him and talk to him, but he hasn't kneaded since he was in the ICU actually. He seems disoriented a bit, like he wants water but can't always see it or something.

Any advice? Did anyone ever bring a cat home from this event? How long is recovery? What should we expect?

Sorry so long... but now that it's all out there, if you have anything, I'd appreciate any support at all.
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Old 08-15-2013, 03:19 PM
 
Location: Pittsburgh area
9,912 posts, read 24,543,247 times
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So sorry to hear you are going through this. Clearly you may have to prepare yourself for what might be the eventual decision, but I don't think you are at the time for giving up just yet.

We did not experience an event with a trip to the ER like you have. But CHF is one of the things Amber was suffering with at the end, and we actually think it was the main factor in her quick passing at home after a few months of treatment for chronic kidney disease. She was diagnosed with the CHF after we were not seeing improvement in her behavior/eating with sub-q fluid treatment for the kidney disease which had been diagnosed just a couple weeks before. Her not being able to process the fluid well was the tip off.

One of the things I seem to remember the vet telling me is that cats are particularly uninterested in eating when they are having trouble breathing. In our case that meant we needed to give the initial doses of Lasix (3x a day at that point) time to work. I actually went home from work in the middle of the day to try to space out the 3x a day dosing properly. That was not fun, I was still not very good at pilling at that point. She had stopped taking Pill Pockets months before (she was on meds for hyperthyroid for over 3 years with Pill Pockets, then suddenly stopped perhaps in conjunction with a change in the pill manufacturer).

So I could believe that the not eating is due to him still not being able to breathe well. Is this something that you notice? I remember Amber sometimes moving around a little and stopping, much more than usual, and I think this had to do with catching her breath sometimes.

If he is throwing up even when you get food down him you might want to inquire about an anti-nausea med. You didn't mention one and there are a few possibilities. Call your vet and mention what is happening and see what they might suggest for this. Cerenia is one that they use; we tried this on Amber at one point.

If you have a vet especially open to trying things you could see if they are interested in letting you try pimobendan (Vetmedin) which is commonly used in dogs for CHF but not so much tested in cats. It is not labeled for cat use at this time, but here is one note about some research: http://winnfelinehealth.blogspot.com...t-disease.html and some other info http://vetmedicine.about.com/od/dise...Pimobendan.htm There are some conditions where it definitely shouldn't be used so that has to be treated carefully. I never reached this point with my vet. I was focused on all the kidney stuff, and the CHF and quick passing caught me by surprise; I thought I'd be dealing with kidney stuff for many months, perhaps into next year or longer.

Is the potassium you're using the Renal K+ powder from the vet? This I found worked better, I initially bought some potassium gluconate tablets from a regular store (much cheaper) but they were too bulky to easily give with the other pills, which I was giving in a single very small gel capsule. The Renal K+ has some animal digest and such in it I think (has a strong stinky cat food smell), makes it tasty and you just mix it in the food. If you have to syringe the food, at least it is in there. Probably getting some food is more important than the potassium supplement if it came to choosing, but you should be able to get both as long as he can keep food down (back to the anti-nausea med).

Try some meat baby food if you have to. I'm trying to think of the progression, but at one point very early on she just flipped a switch to not eating and it went like 3 days which was worrying the hell out of me. Finally on that evening I got the baby food, and sat next to her, and darned if she didn't eat half the jar for me in one go, licked off a regular spoon. The spoon feeding mostly didn't last too long, but it was good for a while. Chicken was the food I went for first, has the most calories, but later ham was I think the bigger hit. These are Gerber 2nd foods in glass jars, nothing in there but meat, water, salt basically. Big thing is no onion/garlic. It would help if you could get some taurine powder into that if he's going to eat it longer term, but not critical at beginning if you're just trying it to see.

It's a roller coaster but I think there could be a decent chance that you can stabilize him for a while and have him be a little more comfortable, long as you can get some food in him. A feeding tube can be an option too if necessary. (FWIW I did a lot of syringe feeding over several weeks and we didn't talk of tubes at all, except I once mentioned it to the tech who said they have done some in the past.) I don't know, I mean, every case is going to be different. And how long you get to have, nobody could really say. But hang in there and work at it a little more. Please keep posting to this thread with more questions or updates, and/or feel free to direct message me (but I read the forums pretty closely usually, several times a day).

NOTE: a few edits if anyone happened to read within 10 minutes after I first posted.

Last edited by greg42; 08-15-2013 at 03:35 PM..
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Old 08-15-2013, 03:28 PM
 
Location: Philaburbia
41,737 posts, read 74,703,059 times
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I'm so sorry you and your cat are going through this. Poor baby. Give him a pet for me.
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Old 08-15-2013, 04:48 PM
 
Location: Manhattan, Ks
1,280 posts, read 6,963,651 times
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I'm so sorry for what you and your kitty are going through.

Though he isn't in crisis anymore it sounds like you have a little bit to go to get him back to a good quality of life. Does that sound accurate? I think you do have a chance to get him back to an acceptable quality of life, there are several other medications that could be beneficial.

I love the idea of adding Pimo. We definitely use it in cats and I've seen some amazing results. Spironolactone is another medication that is sometimes used to great effect. It would be helpful to know exactly what is going on in your cat's heart. Have you been able to get an echocardiogram done on him? Would you be able to? That would give you the best chance to tailor his treatment regimen to his exact heart problem. You can certainly treat successfully without it and many have done it but the echo is more efficient than the trial and error method.

I know these things are expensive. It's up to you to decide your personal limits when it comes to finances and his quality of life. I wish you both all the best!
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Old 08-15-2013, 06:21 PM
 
Location: Montreal, Quebec
15,082 posts, read 14,255,367 times
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I'm SO sorry to hear this. It's commendable that you're trying so hard and refuse to give up, but I think you know what you have to do. You have to be really honest with yourself to gauge his quality of life. Syringes, tube feedings, vomiting, being unable to breathe, meds, meds and more meds...well, I wouldn't want to put myself or a loved one through that, but that's just me.
My heart is breaking for you.
Good luck.
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Old 08-15-2013, 06:43 PM
 
Location: Pittsburgh area
9,912 posts, read 24,543,247 times
Reputation: 5162
Quote:
Originally Posted by weltschmerz View Post
I'm SO sorry to hear this. It's commendable that you're trying so hard and refuse to give up, but I think you know what you have to do. You have to be really honest with yourself to gauge his quality of life. Syringes, tube feedings, vomiting, being unable to breathe, meds, meds and more meds...well, I wouldn't want to put myself or a loved one through that, but that's just me.
My heart is breaking for you.
Good luck.
I guess it's not surprising to see someone say this. I definitely questioned it a fair bit. Just medications, that didn't bug me. Amber had been on twice-daily meds for over 3 years, a not-uncommon routine for hyperthyroid, which is otherwise not a disease of significant discomfort. Her visible signs of not feeling as well were new to me when the kidney disease and the CHF were evident.

The thing that tested me on the quality of life the most was syringe assisted feeding, aka force feeding if you insist. But I never would have done it if I thought we would be syringe feeding her forever. If she hadn't suffered from the clot (most likely) that took her life quickly at home, I would have looked into perhaps a feeding tube. I had read up on tubes and the quality of life might surprise you. It certainly would have been better than the restraining necessary for syringe to the mouth. But it would also be a significant expense, I think several hundred dollars perhaps, which wouldn't make sense if there's not a good medium to long-term prognosis. With CHF, sadly, there may well not be. But it's impossible to say for sure.

What I definitely witnessed personally though was a cat who didn't eat because of a breathing problem. In CHF the breathing problem is because of the fluid buildup and/or weakened heart. Fluid buildup can go down with meds. It's possible this could still work for Bailey and that he would eat on his own some more. The outlook for CHF is perhaps not one of years, but a cat can bounce back from an acute attack like this. We're only a few days into it really. More conversations with the vet would help sort through this I think, perhaps the vet's thinking would be different than mine. I can only know what is written by the OP and what I went through with my own cat.

Just wanted to let you know some of what goes into my thinking that it's not quite yet time for the tough decision. I do not want to give any false hope, that would be one of the worst things to do, but I do not think it has been used up quite yet.
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Old 08-15-2013, 07:08 PM
 
Location: Montreal, Quebec
15,082 posts, read 14,255,367 times
Reputation: 9789
Quote:
I guess it's not surprising to see someone say this. I definitely questioned it
a fair bit. Just medications, that didn't bug me. Amber had been on
twice-daily meds for over 3 years, a not-uncommon routine for hyperthyroid,
which is otherwise not a disease of significant discomfort. Her visible signs
of not feeling as well were new to me when the kidney disease and the CHF were
evident.
That's why I said the OP has to be brutally honest with herself to gauge his quality of life. If he seems to be relatively happy, then by all means, continue to try.
I believe I mentioned that I'm a nurse. I've seen patients with no hope and suffering terribly, but the families would insist we take every measure possible to prolong the misery. We're obligated to do so, but just looking in these poor souls' eyes tells you they're more than ready to let go. I'm drawing from those experiences.
I've even had patients, in a moment of lucidity, clasp my hand and say "Please let me die, Miss."
It's heartbreaking to bombard them with even more chemo and more tube feedings or whatever because the family isn't willing to let go.

Last edited by weltschmerz; 08-15-2013 at 07:44 PM..
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Old 08-15-2013, 07:43 PM
 
Location: Pittsburgh area
9,912 posts, read 24,543,247 times
Reputation: 5162
Quote:
Originally Posted by weltschmerz View Post
That's why I said the OP has to be brutally honest with herself to gauge his quality of life. If he seems to be relatively happy, then by all means, continue to try.
I believe I mentioned that I'm a nurse. I've seen patients with no hope and suffering terribly, but the families would insist we take every measure possible to prolong the misery. We're obligated to do so, but just looking in these poor souls' eyes tells you they're more than ready to let go. I'm drawing from those experiences.
Yeah I definitely get that. I wouldn't want it either.

It's tougher to tell with a cat. I dug into that a lot, how to tell, because I've made a euthanasia decision before with a cat and later, after learning more, was left feeling like it could have been too soon or at least that we hadn't done all we could before getting to that point. With Amber, I was expecting the decision again, but it never came. Anyway, the impression I came away with is even a cat who is mostly lying around can still have some quality of life. If the cat still recognizes you, is attentive when you give attention, is not soiling itself (still goes to litter box), etc. Not eating on own is certainly a consideration in the mix but not the only one, and in this case it's not yet clear that the not eating isn't temporary.

Anyway, trying not to get too sidetracked here but these bits may still actually help in the OP's (and any subsequent readers') thought process.

In some ways the bigger issue IMO can be just how overwhelming it all is to the cat's caretaker(s). It's exhausting, frustrating, very emotional. Hang in there JLB.
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Old 08-15-2013, 09:52 PM
 
Location: southern kansas
9,127 posts, read 9,253,496 times
Reputation: 21292
Quote:
Originally Posted by kansas sky View Post
I'm so sorry for what you and your kitty are going through.

Though he isn't in crisis anymore it sounds like you have a little bit to go to get him back to a good quality of life. Does that sound accurate? I think you do have a chance to get him back to an acceptable quality of life, there are several other medications that could be beneficial.

I love the idea of adding Pimo. We definitely use it in cats and I've seen some amazing results. Spironolactone is another medication that is sometimes used to great effect. It would be helpful to know exactly what is going on in your cat's heart. Have you been able to get an echocardiogram done on him? Would you be able to? That would give you the best chance to tailor his treatment regimen to his exact heart problem. You can certainly treat successfully without it and many have done it but the echo is more efficient than the trial and error method.

I know these things are expensive. It's up to you to decide your personal limits when it comes to finances and his quality of life. I wish you both all the best!
Yes, a specific diagnosis of the heart problem would be good to know. My Yorkshire Terrier Midget was diagnosed with CHF in 2009 at the age of 11. His problem was a leaking heart valve and the resulting fluid build up in the lungs & abdomen. He was put on Lasix, Spironolactone and another I don't recall right now. At the time of his diagnosis, my vet said he had a year to a year and a half at most, then would probably experience kidney failure and/or heart failure. In Midget's case we successfully controlled the CHF for 3 full years, and he had a pretty good quality of life. The last 6 months or so he developed a cough and wasn't very active (slept a lot of the time). In the end he died of acute kidney failure. In his case his heart problem was controllable over a long period of time. Had it been a different heart condition, that might not have been the case.
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Old 08-16-2013, 07:47 AM
 
112 posts, read 299,445 times
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I sincerely appreciate all the thoughts & experiences.

He saw a cardiologist while in the ICU, she said he has Hypertrophic Cardiomyopathy (I guess this means his heart muscles have thickened, and some may have weakened) - this one was "(SEVERE)" written next to it. She also said he has scarring on his muscles of the heart which is likely progressive. As well as the congestive heart failure.

I know they were very clear that 1.5-2 years is an amount we'd be lucky to get. But I also got the impression he'd at least improve once home. That's the part that's bothering me so much, he seemed better in the hospital on Monday! Since coming home he seems to be deterioring. He's gotten weaker. He's throwing up. The throwing up really concerns me. Twice now, he's drank water, then turned around & threw it up. We syringe feed him very little & then a couple hours later he's throwing up. I'm going to ask about the neauseas meds today. I think he's interested in sticking around, he still responds when I pet him and talk to him, when our kitten starts bouncing around, he comes in to watch him, he still claims my husbands side of the bed for himself... but otherwise he's mostly just laying around, too weak to do much.

If this continues, I will put him to sleep. I spent all that money and went through all that turmoil to bring him home so he could be comfortable and enjoy his end time at home. If this is all it's going to be, I'll do what I have to do. I want to give him a little bit of a chance though. Ideally I wanted him to improve, enjoy some time here, then die peacefully in his sleep. Even now, I keep thinking we'll just go to sleep & that will be it. But I know I run the risk that won't happen that way too :/
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