Need Advice Please On Pericarditis...And Possible Intestinal Bleed (I've been seeing the vet already

lunariris

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Ok. So, I've been taking my cat to the vet for my concerns the last few weeks, but, I feel like they are missing something. Bare with me, please, it's long.
 

A little background on my boy: I have an 11-year-old, I've had since he was 4 weeks old, found on the side of the road, who's generally 19.5-20 lbs., who has been suspected of having food allergies for the past few years. We haven't pin-pointed what the specific allergy is, but has been doing good on Good Life dry with Friskies wet (we used Purina for almost a decade and all of a sudden he had problems with their "new, improved" formula. We went through Iams diets, Natural Balance Duck and Green Peas-which he wouldn't eat, Hill's Science Diet, to name a few). He was overgrooming his stomach and the fur on his ears were thinning. They all grew back shiny and he was doing much better this last year.... diagnosed with a heart murmur just a few years ago. He had an echocardiogram and his heart appeared normal. He had dental to remove a tooth and all seemed to go back to normal. His son who's 10, has had a heart murmur his whole life, and we're told it's congenital, and he's been good so far. 

He's had his shots and been tested negative for Felv/FIV.

Flash-forward to this last December.

On Christmas Eve, I found something that looked like a little blood and maybe wood-pine(?) in stool while scooping the litter. I thought it was odd, and then thought about how I'd just switched their litter to 100% pine pellets a few weeks prior. I thought maybe someone actually ate one of the pine pellets. (The particular litter box I was scooping hadn't yet been transitioned to the pine pellets, as I still had several bags of clay litter left and wanted to switch them slowly.) Then later that night, I'm watching movies with everyone, when my boy, Koga, comes in and lies by me, but seems 'off'. Instead of just lying by me, he droops his head a little, looks at me like he's a little tired, and then leans into me. He lies down but seems out of it. I think maybe he has a cold. Then I watch him get up half-way through the movie and go to the litter box. I follow him. He had some slightly bloody diarrhea. I'm concerned, but realize the vets are closed on Christmas, and the nearest ER one is an hour away. I keep a close eye on him until bed time. 

I check on him at Christmas. He was ok in the morning, but once it got later at night, I see him have diarrhea when he's walking across the room to the litter box....NOT normal. I follow behind with cleaner, and then wipe him with a wet cloth. He gives me a grateful, but tired look, like, "Thanks for cleaning me off, I'm going to go take a nap". ...And he does. He goes away from the other cats (not like him, he loves to sleep with his son and with everyone else) and goes where it's out of everyone's view and sleeps. I call every local vet first thing in the morning...no one's open but ER office an hour away that's $250 to walk in the door, and I'm supposed to work from morning until night... I go home to check on him before evening shift, and he's ok, but still tired.  I ask over a dozen co-workers to cover my shift in the morning. One person agrees, which gets me a few-hour window. 

The vets open in the morning, I call as soon as they open, no one answers. THREE phone calls later, nothing. I drive over without an appointment and ask if there's any way I can have him seen. They have us wait almost 2 hours, but we get in. By this time, his nose is dry and warm, and his third eyelid is showing on one side. He's at 18.8 lbs (remember his normal is 19.5-20 lbs). He has an x-ray and bloodwork done. Bloodwork comes back normal... X-ray comes back that he's eating but is gassy and maybe that's what's causing his discomfort. However, the x-ray shows his heart's enlarged and noted his murmur is still evident. A fecal test shows there is blood in his stool, and it is diarrhea, not much else abnormal. He's given a pain injection to help him eat comfortably, an antibiotic injection in case of infection, and I'm told to give him 1/4 tablet of baby 81 mg aspirin once every 3 days. We go home. 

He was great the first few days, super happy to be home and purring while he ate. He threw all his body weight into my legs and head-butted me when we got home. He was thrilled. He head-butted and licked his son on the forehead, and nuzzled a few of the other cats too, happy just to be home. He ate and slept with everyone like normal. However, I still noticed diarrhea in the boxes here and there, still with some blood, but not much now. I call and ask if I should be concerned, but am told it can take a few days to weeks for him to get back to normal.

Then a couple of days ago, there was noticeable blood again. And last night I notice his third eyelid has reappeared across his eye. He's giving me that tired look again. I hear his breathing sounds funny when he's purring.

I call and get him an appointment again this morning. 
 

The poor guy had another x-ray done. He's now at 17.5 lbs...he's lost 2.5 lbs in just a few weeks...
And his x-ray shows his heart is even more enlarged than last week...and now there's fluid (pericarditis), and his respiratory system is affected.  

I hadn't started his aspirin because I was afraid to give him blood thinners while he's been bleeding in his stool. She told me to start him on the aspirin as the blood in his stool shouldn't be made worse and it should clear up on its' own with the antibiotics and some time (....but what if it doesn't??) He's given another pain injection and antibiotic injection, another antibiotic for tomorrow, two other meds, and told to start aspirin. I'm referred to a cardiologist for him. The closest one is the ER place an hour away...and their cardiologist is only available one or two days a week. The other options are closer to 2-3 hours away. I called today when we got home. They can get him in Monday afternoon. So we are going Monday...but I'm afraid to wait. 

What if it's not his heart but it's secondary to internal bleeding...what if he has an intestinal tear?? How can they diagnose that? No one's given me a straight answer without exploratory surgery...
And what's the prognosis of pericarditis? Can he make it through this? I'm so upset I can't think straight. What if we're missing something? He's only 11. Has anyone else been through something like this and have any advice? I'm not looking for vet advice, but just someone who understands the situation and can give me clues as to what I'm looking at and if my boy is likely to survive this.  Any help is much appreciated. Thank you.

(about a month after he was saved, he was about half this size when we got him)

(healthy, handsome Koga)
 

cat-tech

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Can you see a new vet, and try to get them to refer you to a cardiologist sooner?   Why the vet prescribed aspirin, and with pain medications, is beyond me.  Not knowing the type/name of the pain medication, and what those two other injections were, I would really really hesitate to give that aspirin.  Pain meds, yes, as long as it's a low dose.

Did the current vet mention congestive heart failure, or, hypertrophic cardiomyopathy?  With fluid accumulating, you'd want to perhaps start Lasix (a diuretic) - then get the echocardiogram done, and let the cardiologist take it from there.

You can't wait until Monday, I strongly recommend seeing another vet, let them recommend the other cardiologist, and making the drive to another cardiologist.  Tomorrow's Thurs, you don't want to get stuck with an emergency this weekend, so do everything you can to get seen by a new vet and a cardiologist asap.  Again, I *wish* I knew why he was prescribed aspirin instead of lasix, and not knowing what pain meds were given, they could be contraindicated with aspirin.

(the diarrhea could be unrelated - and if it is not black, it's not internal bleeding - (blood work would show that) - ask the new vet for a low-residue food on a temporary basis, and possibly probiotics)
 
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lunariris

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Thank you. She gave him an injection of Lasix in the office. She prescribed Furosemide 12.5 mg 1/2 pill 2x/day, Enapril 5 mg 1/2 pill 2x/day, cerenia for pain (injection in office and pill to take home), and then 1/4 aspirin 81 mg once every 3 days. He had Cerenia and Simbadol last time he went. I'll look up his medicines for possible interactions and call a few more vets. Fingers crossed.
 
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cat-tech

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Ugh, hope you can find a vet with a cardiologist - I'm guessing his heart murmur is up a grade or two and has hypertension related to congestive heart failure or cardiomyopathy - If the murmur were a high grade, she may be concerned about blood not properly flowing and a potential risk of saddle thrombus - not trying to scare you, but a cardiologist is in Koga's best interests asap.  I think an echo done before aspirin therapy would be best and so the cardiologist can determine which medications are most appropriate at this point.
 
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lunariris

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Wasn't going to respond again, but thought it might help someone with a similar issue.

....I lost my boy. :(

We had him in the ER last Wednesday, the day after the last post...my abdominal concerns were again ignored because he was already terminal and in heart failure from HCM with a faulty atrial valve. However, I insisted they Ultrasound his abdomen and they said they'd have to keep him overnight for the person qualified to do it in the morning. I said that was fine, we ran him to the ER because he was solely passing blood...no stool. He was also coughing a little.
They called the next day with awful news. My boy didn't have months to live...what they found in his abdomen was metastasized colon cancer, which might have caused his HCM to go into failure rapidly. Their prognosis was then weeks to live for him, but they couldn't be sure.
I'm still processing it, and he's gone.
He lost 5 lbs in less than a month, and his blood work went from 'normal' to off the wall high WBC etc within less than 2 weeks. I don't understand.
Surgery or chemo might have saved him, but they said they wouldn't be able to guarantee anything positive, because he was likely to die during treatment with his heart. They said it was rather uncommon to have both terminal illnesses at the same time. Now I'm left wondering where it all went wrong.

After the ER visit he did fantastic with different heart meds and pain killers, but went downhill fast over the weekend. He still couldn't go to the bathroom, and his breathing got bad, fast. He still wanted to fight and eat, but it broke my heart. They said if he couldn't go his tumor could rupture and kill him, and he showed signs of fluid in his lungs. I gave him his pain meds, asked them to sedate him first, and they sent my baby over rainbow bridge....It feels so unreal. I don't understand how he progressed so fast. They said the HCM could have led to failure at any time, but how did he end up with colon cancer? He seemed ok before Christmas...
 
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