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Cat in advanced congestive heart failure: advice appreciated

Discussion in 'Cat Health' started by growlithe66, Sep 30, 2016.

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  1. growlithe66

    growlithe66 Thread Starter TCS Member Young Cat

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    Hi all,

    I hope this post is in the right section, and sorry for the long read. I have 3 cats that I love dearly. Our newest, Toffee, was adopted about 4 months ago. He's a 5 year old extremely lovable DSH. We took him out vet right after adopting to get him all checked out and treat his chin acne, and put him on c/d food for his history of urinary issues. Heart sounded good, no issues. Up until this incident he was perfectly normal- no lethargy, good appetite, no coughing etc.

    Well, about two weeks ago I noticed him breathing odd and instantly brought him into the hospital I work at. The Dr. heard a murmur and we did x-rays, and turns out that he is in congestive heart failure. He was given several doses of injectable lasix and once his respiration rate was low enough, we took him home. We performed a cardiac echo the next morning and sent results to a specialist who confirmed he has hypertrophic cardiomyopathy, and is in advanced stage heart failure. He was put on furosemide and had recheck x-rays done days later. We were very pleased to see that his lungs and heart looked much more clear, and he seemed much more comfortable. Still we were given a prognosis of 4-6 months max. To add, I have worked alongside this doctor for over a year and I trust her judgment and guidance 100%. She is a great friend and is the kind of doctor that treats you with compassion, but also does not give you false hope.

    He has been doing okay at home now on multiple meds- furosemide, enalapril, vetmedin and more recently plavix. He also takes a cardiac supplement. He was doing pretty good for a week or so, but recently he seems to be going downhill. He spends a lot of time lying down. He will get up, walk a short distance, then lie back down. He doesn't seem uncomfortable at all, but just seems tired. He is still eating good and purring, cuddling etc. but his behavior is noticeably more lethargic. Last night his breathing became labored, the first time since this all happened, and we had to give him another dose of furosemide. It feels like he is starting to decline pretty rapidly.

    This is extremely traumatic for us because it came completely out of the blue. He never showed any symptoms of his HCM and so by the time he started breathing odd and we took him for x-rays, he was already in basically end stage heart failure. It has been like a nightmare for us knowing that we have only had a few months with him, but will lose him soon. We will not allow him to suffer at all, but I am very heartbroken and I don't know how much time he has left. He seems to teeter between good and bad. I constantly monitor his respiratory rate and check his gums for color. I worry about him every single minute. It is just terrible watching a cat that once played, ran around etc. slowly become more and more lethargic.

    Does anybody have any advice, experiences to share, or wisdom about this? My boyfriend and I are heartbroken about losing our sweet kitty. Any advice at all is very appreciated. Thank you.
     

  2. Kieka

    Kieka Snowshoe Servant Staff Member Forum Helper

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    It sounds like you are doing everything you can and fully on top of his medical care. 

    I've been the route of cancer and knowing that any day could be my cats last. From that experience, I say to cherish the time you have and spoil him. No regrets. Buy his favorite food, buy his favorite toys, make him comfortable and get in all the loving you can. Also, pictures. Don't forget the value of having as many pictures as you can to remember him with. Try not to get too hyper aware of his symptoms to the point that you can't enjoy your time with him but it is good to have it in the back of your mind. There will come the time that you will have to make the choice but you will know when it's his time. 
     

  3. moorspede

    moorspede TCS Member Top Cat

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    No wisdom or advice here just sympathy for you and Toffee.
     

  4. growlithe66

    growlithe66 Thread Starter TCS Member Young Cat

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    Thanks for the words of advice Kieka. I am cherishing my time left with him, but I wish the constant worry didn't make it so hard. He's got all his favorite toys and treats, I may go out and get him some fresh catnip later at a local pet store downtown. He is such a sweet boy.
     

  5. Columbine

    Columbine TCS Member Staff Member Advisor

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    Hi @growlithe66. Welcome to TCS :wavey I'm so sorry it's not under happier circumstances :hugs:

    I lost a cat to chef a few years ago, and am now dealing with end stage chf with my greyhound. You are most definitely not alone - there are a fair number of members who've dealt with or are currently dealing with chf here.

    It sounds like, on the whole, your boy is coping pretty well so far. The lethargy is just a part of the condition, and so long as his breathing is ok and he's eating well I don't think you have a huge amount to worry about. Just try to be as normal as possible with him, and enjoy on the time you still have together.

    Teetering between good and bad seems to be one of the hallmarks of this disease. Staying as calm as possible, and focusing on the present is the only way to stay sane. You may find that you have to increase the furosemide as time goes on, or even that you need to add in a steroid (such as prednisone). All cats present differently, so my experience will naturally differ from yours in these matters. My boy had major breathing issues towards the end, very similar to asthma attacks, and we ended up using an AeroKat aerosol chamber with inhaled steroids to help him breathe more easily. This isn't appropriate in all cases, but it made a world of difference to Cali :rbheart:

    As the disease progresses, you may well find that his appetite decreases. This is for several reasons: firstly, chf itself impacts on appetite; secondly, vetmedin decrease appetite; and thirdly, he may start to find that putting his head down to eat makes breathing too difficult. The answer for all three of these issues is to find the yummiest food you can, warm it if necessary (warming the food makes it that bit smellier and more tempting to a sick cat), and hold the plate up so that he can keep his head in the most comfortable position. Hand feeding can work wonders too, and is something I've had to become very used to over the past few years (my greyhound does seem to keep on going, and despite being old and frail, is most definitely enjoying life :) ).

    Don't focus on how your boy USED to be. All that will do is cause you distress, and that will filter down back to him. Think of it like this - you wouldn't look at your parents or grandparents and mourn the fact that they no longer had the energy and joie de vivre of a teenager! Your boy is slowing down does NOT mean that he's no longer enjoying life. It sounds to me that he's still taking pleasure in the little things, and you should too :hugs:

    Lastly, remember that this is NOT an instant death sentence. Enjoy the months you have left, don't stress too much about the monitoring - unless your vet says otherwise, 2 or 3 times a day should be plenty - and trust that you'll know when the time has come. You CAN do this - it will hurt like hell when the time comes, but you have these months left. Don't waste them with worrying about the future. Treasure the present. :hugs::vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes:
    Thread: Qbert has CHF
     

  6. growlithe66

    growlithe66 Thread Starter TCS Member Young Cat

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    Columbine, thank you very much for all of your advice and kind words. I will definitely try the feeding tips if he begins to lose his appetite. Thank you for reminding me to just focus on now with him, so that we can fully enjoy our remaining time.
     

  7. Geoffrey

    Geoffrey TCS Member Alpha Cat

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    I am a human doctor, not a vet but I am used to treating hypertrophic cardiopathy in humans.  Management of HCM in cats is somewhat different, but the principles of treatment are the same as

    the muscles of Toffee's heart have become damaged and cannot pump the blood around the body.  This tends to cause a backup of fluid in the in the lungs and the tissues of the body. 

    Referring to Toffee's treatment by your vet:

    1.  Lasix forces the kidneys to work harder and the fluid that has accumulated is passed as urine.  Hence Lasix is a major treatment of this illness. 

    2. Pimobendan, (or Vetmedin) increases the strength of the cardiac muscle in cats (and humans). 

    3. Enalaprim is an Angiotensin Converting Enzyme (ACE) inhibitor that improves heart muscle function in humans and cats, however the exact mechanism of action is not really known..

    4. Plavix is an anticoagulant and is used in humans to reduce blood clotting.  In feline diseases it is effective in reducing the risk of blood clotting in the atria (the first chamber of the heart before blood passes into the ventricles) of the heart and thus prevents saddle emboli where a fragment of blood clot flies off into the blood stream and lodges in the bifurcation of the aorta (the main artery of the body) into the femoral arteries( the arteries to the legs)  resulting in blockage of the arteries to both legs with dire results. 

    Applying the above to Toffee, you can see that your vet is giving Toffee the very best treatment possible. 

    I must, because it is so important and with all respect, question Columbine's advice to use steroids where there is heart failure.  I have little experience in treating cats, and I am not a vet - so any advice that I give should be checked with your vet - but I understand that the use of corticosteroids (prednisone, "steroids") in heart failure can be dangerous as it 's use makes heart failure worse.  (the numbers of cats referred to in her paper are small, but see Stephanie A. Smith, et alii,  Intern J Appl Res Vet Med • Vol. 2, No. 3, 2004). 

    I do hope that Toffee improves,

    With all best wishes,

    Geoffrey
     
    Last edited: Sep 30, 2016
    jcat and basschick purraised this.

  8. Columbine

    Columbine TCS Member Staff Member Advisor

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    Having re-read my post, I can see that I was a little unclear. With the steroid, I was simply stating what my boy needed towards the end of his life. My greyhound is NOT on steroids, nor does it seem likely that he will be.

    Cali developed asthmatic symptoms as a a complication of his chf. The steroids were given in that context (as a result of complications of chf, not the heart disease itself).

    I would also say that I was in no way advising/suggesting that @growlithe66 use steroids for her cat. As I originally said, all cats are different and present with differing symptoms, and what is appropriate for one may well not be appropriate for another. I just know that, in Cali's case, the introduction of inhaled steroids made an enormous difference to his particular symptoms ;)
     
    Last edited: Oct 1, 2016

  9. growlithe66

    growlithe66 Thread Starter TCS Member Young Cat

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    No worries, I understood your post. Thank you for the additional insight, Geoffrey. It is much appreciated!

    As an update, Toffee has been having good days lately but two nights now his breathing has become quite labored at night. Each time I have had to give him a second dose of furosemide, and I am going to talk to his doctor when I get to work tonight. I realize that it is very un-ideal to just be doing this, but the first night we brought him home we had to do it (by doctor's instructions) and I haven't known what else to do. I am going to ask her today if we might need to increase his regular furosemide dosage. She will probably want a kidney panel done for him soon to see how his kidneys are reacting to all this. I will have to consider that carefully because he gets extremely stressed out at the vet, and I'm scared to put him under undue stress. Hopefully she can give me advice on what to do if he gets a labored breathing crisis at night again.
     

  10. Columbine

    Columbine TCS Member Staff Member Advisor

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    I'm sorry to hear your that Toffee's not doing so well at night :( For what it's worth, pretty much the first thing my vets have done for laboured breathing is give an extra furosemide dose (usually by injection), and we actually have an emergency dose of Pixie's diuretic on hand for use if his breathing gets markedly worse. We have spironolactone for him, because he reacts so badly to furosemide (which is normally the primary diuretic used in chf patients). From what I've read, though, the two are sometimes used in tandem for CHF, so that might be something to discuss with your vet, especially if Toffee is already on a high furosemide dose relative to his size. Because the two medications act slightly differently, a combination of the two can sometimes be the best choice. As I said, though, that's definitely a question for your vet ;)

    If Toffee gets really stressed out by the vet, you could discuss the possibility of home visits as an alternative. If that isn't possible, do consider careful timing of your appointments. Cali was always pretty ok with the vet herself, but found the waiting room incredibly stressful - especially if there were noisy dogs about. To get around this, we'd try to book the first appointment of the day, or the first appointment after their lunch break (my vets have a morning surgery, and an afternoon surgery. The intervening time is spent on operations and inpatients ;) ). Just this reduced the stress enormously, as there was almost no waiting time, and what wait there was was in a quiet, almost empty waiting room. It certainly made a huge difference in Cali's case.

    I really hope Toffee stabilises soon :cross::vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes::vibes:
     
    Last edited: Oct 3, 2016

  11. stephenq

    stephenq TCS Member Veteran

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    Usually with CHF and as a result of HCM respiration rate is directly tied to how well they are doing (my cat had both).  If you time your cats respiration rate while resting (sleeping is ideal) it should be 20 per min or less.  Once you get around 40+ a minute you're in trouble.  What you can do is ask your vet for some inject able lasix pre-dosed and keep it in reserve, its extremely easy to give and your vet can show you how.  This isn't a long term solution but can turn a growing emergency around or buy you enough time to get to the vet.  One side effect of lasix is kidney failure, so cats with CHF have to be well monitored.  But if his meds are all at the right doses and he's loosing thge energy and spirit of life then you sadly need to start watching him with the idea of seeing when its most humane to let him go.  I'm so sorry.
     
    Last edited: Oct 3, 2016
    Columbine purraised this.

  12. growlithe66

    growlithe66 Thread Starter TCS Member Young Cat

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    Thank you for the advice, StephenQ. Yes, we're thinking his time is probably coming soon :( I just spoke with the vet a while ago and we are going to up his dosage of furosemide just for now, and will probably be making a decision very soon about putting him down. We know it will be soon but we just want to spend as long as comfortably possible with him until then, without him suffering at all.
     

  13. growlithe66

    growlithe66 Thread Starter TCS Member Young Cat

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    A final update: in the last few days Toffee was deteriorating extremely rapidly. Even with the increased diuretic he was having a lot of trouble. Today we brought him to the vet and he was peacefully euthanized. He will be cremated with all of his treats and toys.

    Thank you all for the advice and support, it helped us a lot.
     

  14. Columbine

    Columbine TCS Member Staff Member Advisor

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    I'm so sorry @growlithe66 :alright: Even when you've had time to prepare, this is always the worst decision to have to make :( My heart goes out to you :hugs:




    :rbheart: Rest in peace, Toffee, you gorgeous boy :rbheart:
    :angel::heart3::purple Butterfly::heart2::paw::heart3::Blue Dragonfly::heart2::rbheart::heart2::Blue Dragonfly::heart3::paw::heart2::purple Butterfly::heart3::angel:
     
    Last edited: Oct 5, 2016

  15. Kieka

    Kieka Snowshoe Servant Staff Member Forum Helper

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    I'm so sorry for your loss. Rest in peace Toffee. [​IMG][​IMG]
     

  16. mani

    mani fervent feline fan Staff Member Moderator

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    @growlithe66 the team at TCS offer our condolences.  Toffee had only a short time with you but he was deeply loved and had wonderful care. [​IMG]

    We will close this thread now, out of respect for your boy, but you are very welcome to open a new one in his memory, in our Crossing the Bridge forum.
    RIP lovely Toffee
      [​IMG]   [​IMG]   [​IMG]   [​IMG]   [​IMG]  ​
     
    Last edited: Oct 5, 2016

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