Anyone have experience with HCM/CHF and kidney issues?

ReadsWithCats

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Hello, it's been a bit as I've been so wrapped up in caring for Thomas. Every time I think we are stable something else seems to pop up. I really tried to keep this short. If anyone reads, I will truly appreciate it. Thomas is my baby and I'm desperately searching for answers to see if I can help give him some more comfortable days!!

We are dealing with HOCM, CHF, and now elevated kidney values. Thomas is happy most of the time still except seems to have stomach discomfort off and on. Has nausea and lack of appetite off and on as well as constipation.
We've tried tapering the diuretics but got increased breathing after a few days.

Current meds: Atenolol, Torsemide, Spironolactone, and Xarelto. (Cerenia and miralax temporarily)

History:
My boy, Thomas, is 2.5. He was healthy (we thought) until Thanksgiving when we were told he had an enlarged heart, just a few days after and he was in heart failure. Started on Plavix & Lasix

Saw cardiologist December 12 and diagnosed with HOCM and CHF. Changed meds to: Atenolol, Torsemide, Spironolactone, Benazepril, and Xarelto. Initially had lots of nausea from meds so did a week of cerenia and mirataz to maintain eating.

At the two week check (12/27) labs were still elevated, stopped Benazepril because he was having some side effects to that, vet also hoping kidney values would normalize if stopped.

Another two weeks (1/11) he started experiencing some possible nausea and lack of appetite. Back for another Chest XR and labs. No fluid seen at this time, but kidney values still elevated. Saw large amount of stool on the xray. He had an enema, vet suggested miralax.

After the enema and a daily dose of cerenia, he did great for about a week except around the time he needs to use the bathroom. Ate normally again and seemed very happy during this time. Almost like his old self.

Cardiologist suggested attempt smaller Torsemide dose in case nausea/inappetence is kidney related. Cerenia daily for at least a week. I started cutting back Torsemide just 5 days ago but over weekend we saw increased breathing. He had an episode yesterday where he seemed nauseous - just wanted to keep drinking water and refused food. Elevated breathing. It was Sunday so neither the cardiologist or regular vet was in. I gave 6.25mg Lasix and then he slept for a few hours. Woke up, breathing slower, ate normally. Not sure if stomach or fluid in lungs?

His breathing also increases at times when is stomach is bothering him though. Pooped Friday night and not again until Monday around noon so almost 60 hours! Otherwise he has been going about once every 36 hours or so.
Miralax doesn't seem to be helping frequency or consistency of stool.

I'll attach the 12/27 and 1/11 labs. I would be so appreciative of any help, advice, etc. This has been such a whirlwind, my heart is breaking over and over. If it is kidney related I gather there isn't much we can do...I just want more happy days with him.

We see our regular vet who coordinates with the cardiologist who is 4 hours away.
 

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silent meowlook

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I am so sorry you are going through this with poor Thomas. It sounds like you are doing everything you could possibly do for him. You have a cardiologist and that is so important.
I don’t know if you have looked into any dietary changes due to the high cholesterol. He should most likely be on a high fiber low fat diet and maybe some fish oil high in omega 3 fatty acids. But, of course always discuss any changes with your cardiologist.

It does look like his kidney value, creatinine is elevated but doing fluids to help could send him into heart failure. I don’t know if micro dosing of fluids could help or hurt. Discuss with your vet of course.

The only real suggestion would be to get a decent stethoscope and have your vet teach you how to listen to signs of fluid build up. Also learn to know what his heart and lungs sound like normally for him so you can better determine what is going on with him.

I am so sorry you both are going through this.
 

mrsgreenjeens

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What is he eating? Is it wet or dry food? If dry, perhaps you can get him to eat wet food? It would help with constipation issues. Also, how much Miralax are you giving, and how often? One of mine has constipation issues and I give him 1/4 teaspoon twice daily, every single day (always dissolved in water first) and sometimes I also have him OTC Laxatone. Constipation can cause nausea, but I don't know if this is the issue with Thomas or not, poor guy.

As far as his heart and kidney. treating those two together can definitely get tricky, so you need to work with your Vet on that. As noted above, too many fluids (sub-q) for treating kidney disease can cause heart issues, so keep that in mind.

Wishing you the best :hugs:
 
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ReadsWithCats

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What is he eating? Is it wet or dry food? If dry, perhaps you can get him to eat wet food? It would help with constipation issues. Also, how much Miralax are you giving, and how often? One of mine has constipation issues and I give him 1/4 teaspoon twice daily, every single day (always dissolved in water first) and sometimes I also have him OTC Laxatone. Constipation can cause nausea, but I don't know if this is the issue with Thomas or not, poor guy.

As far as his heart and kidney. treating those two together can definitely get tricky, so you need to work with your Vet on that. As noted above, too many fluids (sub-q) for treating kidney disease can cause heart issues, so keep that in mind.

Wishing you the best :hugs:
Prior to getting sick in November, he ate mostly wet food with a small sprinkle of dry food around lunch and before bed as a treat. After becoming sick, he no longer wants the dry food so we've been doing wet only. He currently eats Fancy Feast but I'm trying to transition to something healthier/lower sodium/lower phosphorus if he will accept. We have water bowls and a fountain which I see him at regularly since starting the diuretic.

We've been doing 1/8 tsp Miralax once daily but the vet recommended changing to up to 1/4 tsp 2x daily until he is going regularly. Is your kitty a heart kitty? I've read that long term miralax on diuretics can worsen dehydration which concerns me as that's already a struggle.

So far, there hasn't been any treatment or fluids directed at the kidneys. The cardiologist had us order compounded liquid torsemide as the dosing can be more accurately tapered back. (The tablets are so small it is impossible to cut them smaller than 1/4 which limited the dosing amounts). We are going to attempt tapering again starting Monday.

We took him to the vet yesterday (Friday) for another enema as he had not pooped since Monday and was getting very uncomfortable. I started increasing the Miralax yesterday so hoping that helps. She showed me how to do the enema so we can attempt them at home if needed instead of a scary stressful vet trip.
 
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ReadsWithCats

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I am so sorry you are going through this with poor Thomas. It sounds like you are doing everything you could possibly do for him. You have a cardiologist and that is so important.
I don’t know if you have looked into any dietary changes due to the high cholesterol. He should most likely be on a high fiber low fat diet and maybe some fish oil high in omega 3 fatty acids. But, of course always discuss any changes with your cardiologist.

It does look like his kidney value, creatinine is elevated but doing fluids to help could send him into heart failure. I don’t know if micro dosing of fluids could help or hurt. Discuss with your vet of course.

The only real suggestion would be to get a decent stethoscope and have your vet teach you how to listen to signs of fluid build up. Also learn to know what his heart and lungs sound like normally for him so you can better determine what is going on with him.

I am so sorry you both are going through this.
When we discussed diet with the cardiologist she said her opinion is feed him what he will eat. Personally, I've been trying to find a healthier (less sodium/phosphorus/fat) wet food that he will accept. He wasn't picky prior to getting sick, but he sure is now.

I also asked her about fish oil and she was kind of dismissive as to it's effectiveness. She said something along the lines of it won't hurt but she doesn't believe it would help. I tried finding a trusted brand on my own but I'm not sure what is safe.

I've recently seen about microdosing so have it in my notes to ask. I think cardiologist wants to see how he responds to tapering the diuretic and go from there. We have blood work scheduled in two weeks with regular vet

That's a good idea about the stethoscope. I actually have one I had purchased for our asthma cat. I tried listening to him a few times but he freaks out when he sees the stethoscope. Maybe vet flashbacks lol.

Thank you. It's all just been so stressful. I hate not being able to really help him. Most days, he still seems mostly like his normal self but when he's uncomfortable or has a sick moment I feel awful.
 

silent meowlook

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Hi. If he freaks out with the stethoscope, don’t do it. The last thing in the world you want to do is cause more stress. Your vet is right, if he is being picky about eating, then the best thing to do is feed him what he will eat.
 

mrsgreenjeens

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As far as the miralax and diuretics, I would just make sure the cardiologist is aware of the dosage of miralax he is getting. You might even call them and ask if increasing to 1/4 teas. twice daily will be ok since he is on diuretics, unless he is the one who said to increase it.
 
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