Stomach Acid Or Chf?

[spac]

I am getting very worried about my 13 y/o cat. On the 11th, she saw a different/new vet, who did not notice thick intestines, but noted a heart murmur. She was diagnosed on the 15th by my regular vet with thick intestines, likely to be lymphosarcoma or IBD. There was no indication of heart problems. Her blood work (chemistry and CBC) are within normal except elevated calcium at around 11.2 and a slightly elevated RDW. The calcium level is why they think she has cancer.

She had been coughing on and off for a week prior to the 11th, but has a history of upper respiratory infections. I don't recall hearing her making any noises prior to the 11th. I gave her sub-q fluids around the 12th and I think I noticed she was making gurgling/rattling noises within hours afterwards. She received 100 ml and she was 7.5 lbs. at the time.

Since the 15th, she is making more and more gurgling and rattling noises. Her respiratory and heart rate have increased. She has been gagging. She doesn't really eat, but when she does, she sometimes spits up clear liquid with a little bit of food. Her gurgling and gagging are at the worst during this time.

She now seems to be constipated. I saw her straining to have a bowel movement three times within 24 hrs, with nothing coming out. She is not sleeping well.

I was able to talk to a tech on the 22nd, who had talked to the vet, but wasn't really helpful. The vet prescribed Lactulose for the constipation, which they're not sure is really constipation or if there's something else going on.
They also want me to do fluids (LRS) everyday at 100 ml each time.
They really didn't have anything to say about the gurgling other than I can give her Pepcid AC (2.5 mg once or twice daily). I can't tell if it helps or not. I'm not sure how long it takes to kick in.
She still isn't eating well even with Cerenia and Cyproheptadine (appetite stimulant). She was eating better a few days ago, but now she's not.

Now that I'm thinking about it, I'm not sure the fluids are helping or not. I'm paranoid that maybe the gurgling and gagging aren't intestinal issues. I'm concerned that maybe she has CHF and the fluids are making it worse. I'm almost certain that she didn't make the gurgling noises until after she first had fluids. But if she's dehydrated... Up until today, I had been doing 50 ml every two days or so. She seemed to absorb the fluids rather quickly. The fluid pouch seemed like it completely disappeared within an hour.

The vet's office is closed until the 26th as I'm sure they all are now. I don't know what to do.

What do you all make of this? Does it sound like stomach acid or CHF? Both?


Ok, just after I finished typing all that, she came out of her box and I got her to at least lick some broth from a chunky can of cat food. She did so with little problems. She seems quieter now, so maybe the Pepcid AC did work. If it did, it took 3 1/2 hrs to really kick in. Anyway... I ordered some CatSure and that should be here on the 23rd. I'm also using Nutrical.

And... I just remembered that she had surgery back in April 2017 and she was hooked up to an EKG. If something was going on, isn't it likely the vet would've picked up on it? I know an EKG can't diagnose everything, but since it didn't pick up on anything in April, how likely is it that she has CHF now?

This is just very frustrating and upsetting. I wish I could do more.

 

[Mamanyt1953]

I wish I could tell you more, I really do! The fact that she is interested in eating, even a little, is heartening! If necessary, Walmart will be open, and you can get pedialyte there, as well as powdered KMR, which will help keep her hydrated and nourished until after the Holiday weekend. You can also mix either with a pate cat food, as well. Get an eyedropper to administer it with, or ask the pharmacist if you can get a 5 cc syringe with no needle. It could be both, it could be either...heck, it could be neither. She may be starting a URI on top of everything else!

CHF can crop up fairly quickly. Also, ideopathic hypercalcemia is fairly common in cats, so with any luck you aren't dealing with a cancer of some sort. Fingers crossed for you both on that one! I'm concerned that two vets made two different findings without either noting what the first did. If there is a veterinary school at a university in your area, I would highly recommend taking her there. It won't be cheap, but it will be thorough and cutting edge!

I'm lighting a candle for BOTH of you! Please keep me updated on how your girl is doing! I'll fret.

 

[spac]

Well... I'm inclined to think it's not CHF based on what I'm seeing. She tried to eat this morning, but started gagging and regurgitated bits of food with clear liquid. I'm thinking she has dysphagia of some sort. She was making a lot of gurgling sounds and had her mouth open a bit to breathe. I gave her a Pepcid AC (2.5 mg) and after 30-60 minutes, she's quieted down.

I was totally getting stressed out and noticed that I was open mouth breathing myself. So I'm hoping that her open mouth breathing was from either stress, discomfort, or stomach acid and not something more serious.

I'm hesitant to feed her anything solid except her pills (I follow with a syringe of water). I guess I could force feed her CatSure along with Nutrical. I'll call the vet first thing on the 26th and see if I can do a drop off so they can observe her behavior. Assuming this isn't CHF, I guess this means we need to try steroids (Prednisolone).

So would an x-ray and/or EKG give any indication that her heart is in good enough condition to try steroids?

 

[Mamanyt1953]

I would think so. If she has CHF, the cloudy liquid around the heart would show up, as well, so you could rule that out. I just wish I had the experience in this to be of real help to you! I'll be checking in tomorrow, just to make sure all is at least remaining stable over the holiday!

 

[sockerkatt]

I recently lost my cat to heart disease and to me it sounds like it's the heart.
I think she might have fluid in her lungs, that's why she's coughing, gurgling and throwing up liquid. open mouth breathing is alarming as well. does her purr sound "wet"?

 

[Mamanyt1953]

Let me know how she is, when you get online again!

 

[spac]

So Monday, the 25th, she just slept in her box all day. When she woke up at 11 pm, she seemed really bad. She was very dehydrated so I gave her 100 ml of fluids, her B12 injection, a Pepcid AC (2.5 mg), and witheld her other medications (Lactulose, antibiotic, and Cyproheptadine). I force fed her some CatSure and Nutrical. I wasn't sure she was going to be alive when I woke up.

On Tuesday, the 26th, I took her to the vet and they did x-rays. They said she has fluid of an unknown origin in her lungs. They said her colon was empty and told me to discontinue the Lactulose and Cyproheptadine. I'm supposed to continue the antibiotic.

They prescribed Lasix at 6.25 mg twice daily for three days. I'm supposed to give her 100 ml of fluids (Lactated Ringer's) once a day.

We go back in three days if she's not doing better or in six days if there's an improvement.

They have me giving her Cerenia at 6 mg every other day. I'm supposed to do Pepcid AC at 2.5 mg once daily. However, they said I can give it twice a day if I think it helps. Without it, she gags and regurgitates her food. She also has more breathing difficulty without it. The vet has no idea as to why that is. That kind of makes me wonder if she has something going on in her throat area.

All this on top of these thick intestines and high calcium. Although the vet did say that the intestines feel better. But the cat isn't eating so I don't know what that means. I'm supposed to force feed her and I HATE that. Especially with the breathing issues.

I'm wondering if somehow she ended up with aspiration pneumonia. Or maybe it is CHF. I'm not sure how that plays into the intestinal issues. This is just very upsetting. I'm pretty darn certain that she didn't start making the gurgling noises until after first receiving fluids, so that would indicate CHF.

Since we got back from the vet, she's been a little restless. I question whether this is bad or good. My mom thinks it's good, but I'm totally paranoid.

Overall, she does seem a little better today. She did go downstairs by herself in the evening. She does seem to be breathing a little easier. But she still makes heavy breathing noises through her nose, it sounds like nasal congestion. She seems hungry, but acts like she can't smell it.

Any thoughts? Any ideas (tests) I can ask my vet about?

I have more thoughts and questions, but I need to go to bed. I'm exhausted.

 

[Mamanyt1953]

If she can't smell the food, she isn't going to be inclined to eat it. Um...did they test for nasal polyps? Just a thought...although there are other things going on that have nothing to do with that. As for force-feeding, a 5 cc syringe can be your best friend. Be sure to insert the tip inside the cheek, and introduce the food slowly. That will almost guarantee no aspiration between the two of them.

I have a candle lit for the two of you!

 

[spac]

The vet wants me to feed her 300 kcals (about two cans of Friskies) per day into small feedings. The discharge instructions say to feed her every six hours. That doesn't seem practical. It seems like it should be every four hours with smaller amounts being given. It also seems like I should start out slow so as not to upset her stomach and cause vomiting (she is on Cerenia and Pepcid AC).

Does anyone have thoughts on this? As it is, I'm having trouble getting just one can in her. I had to go somewhere for six hours Wednesday, so I was only able to get in two or three feedings of about 10 ml each time. I'm not sure how much of a can that was. Then I do have to sleep. I also have to be careful about when I feed her. If it's almost time for a Pepcid AC, then I need to wait until 30 minutes after she's had it. Otherwise, she starts regurgitating and gagging. Then she struggles to breathe.

I don't know what they expect me to do.

 

[Mamanyt1953]

Every four hours sounds better to me, but I'm not a vet. Just do the best you can. I'm thinking (and the hours to vary according to your own schedule) something like 8-12-4-8-12. That gives you five feedings to get two cans down her, and lets you sleep through the night, as well. It will definitely take a day or two to get ANY routine that you find best implimented. Just...the best you can.

 

[spac]

Thanks.

I decided to keep her drop-off appointment with the vet on the 29th. They're supposed to force feed and medicate her so they can see how she gags when she's force fed. She also started holding her pills and water (via syringe) in her mouth instead of swallowing them. I've tried touching her nose, blowing on her nose, and opening her mouth and touching her tongue and she still doesn't want to swallow. She's stubborn!

But I'm really concerned there is something going on in her throat. She doesn't want to swallow the pills or water. She will swallow the food, but sometimes she gags and it sounds like her throat has gurgly sounds in it. She tried to meow a few times, but nothing came out. That's not unusual for her, but I felt that she was actually trying to make a sound and couldn't make one.

She also kind of sneezed and sniffled and there was a mild discharge from her nose - it was kind of yellow-ish. I'm wondering if she has pneumonia. She's 13 and has been infected with the feline herpesvirus and calicivirus her entire life. She doesn't have a fever, but has a low temperature. It was 99 degrees the other day.

She's been on Doxycycline for about 12 days, although she missed two days earlier this week when she was having bad gagging issues. She's now 6 lbs. and is getting 20 mg once daily.

Could this be pneumonia? I'm just looking and hoping for an explanation that doesn't involve her heart or cancer.

 

[Mamanyt1953]

It could be pneumonia...you probably know by now. What did the vet say?

 

[spac]

When I dropped her off on the 29th, I asked them to try force feeding and pilling her so they could see what I was talking about (the regurgitation and gagging). I got a call from a tech not long after I got home and they said she vomited up the food and pill (I never made her vomit). The other doctor there looked at her and said there is nothing more they could do without knowing what's going on. They referred me to the ER to get chest and abdominal ultrasounds.

The ultrasound of the abdomen was normal for a cat of her age. There was no thickened intestines and no signs of cancer. But they found several large masses deep in her neck, right up against the larynx. There was at least one nodule in her lungs. The specialist was certain that she had cancer that spread to her lungs. There was also signs of pulmonary disease. The report mentions B-lines and disffuse pulmonary infiltrates.

The ER doctor didn't want her to suffer and gently suggested euthanasia several times. I said that she had fight in her and that it wasn't my decision - it was hers. She would let me know when she was ready. It's just like with people. Some people are diagnosed with terminal cancer and just kind of give up (they're ready to go) and others fight to the end because they aren't ready to go. The doctor sent me home with a low dose of prednislone and mirtazapine (appetite stimulant - he doesn't like Cyproheptadine). He said not to use Lactulose for constipation - use Miralax. He also said she should be taking Cerenia everyday, not every other day. He also had me switch from Pepcid AC to Prilosec.

She seemed ok when she got home. She was interested in eating (this was before the medication), but just licked the food a little. She was fine (considering she was having trouble breathing) until I gave her the first medication (Prilosec). I waited a bit and gave her the other two (prednisolone and mirtazapine). After all this, she really struggled to breathe. She started behaving oddly. She was vocalizing and seeking out humans. She did not want to be alone, she wanted to sit on someone's lap. She actually wanted to sit on my mom's lap even though she usually prefers me (I think she sensed I was stressed). My mom and I were super tired so my mom went to bed and I slept on the floor so my baby wouldn't be alone. I drifted off to sleep and awoke to her sleeping on my legs (she never does that). I had to get up as my back was killing me. She got distressed again. I finally got her settled in a chair and I went to bed.

When I awoke the next morning, she had been sleeping on my mom's lap for hours. I tried to give her Cerenia and she spit it back up. I got it down again, but she was having problems breathing. I tried giving her a Pepcid AC as that's usually the most helpful and she spit that back up too. She started gagging violently and had phlegm/mucus in her mouth and was drooling it out. She did not want to swallow. She really struggled to breathe and layed down which suggested she was tired and/or weak. She seemed distressed. I decided that it was "time" whether she was ready or not. I'm not sure if getting the Pepcid AC in her would've helped or not. I had been thinking of waiting until Tuesday to have her PTS, but I felt she was suffering, especially after those first three pills.

I don't know if it was the right decision, but I don't regret it. I've had to make these decisions before several times, but this time it was so unreal. I don't understand it and that bothers me. I just wish I could've spent more time with her over the past year, particularly since June. I've been so busy and tired that I think I either pushed her to the side or ignored her. I'm upset with myself for that. I knew that everything after April was a gift (that's when the tumor on her paw was removed) but I didn't have time to cherish it. I hate that.

I suspect that she had those masses in her neck back in April. Her calcium was high then. Immediately following her surgery, she stopped eating dry food. I find it hard to believe that these masses aren't related to that. I actually wonder how long she had them. I find it interesting because when she was younger, I thought she might've had polyps in her throat region. Maybe there was something to my gut feeling, I guess I'll never know.

 

[Mamanyt1953]

Rest you gentle, Sweet Furry Friend, dream you deep. Your pawprints are on someone's heart forever.

I am so sorry. I think that she did tell you it was time when she slept on your legs (which you said she does not do). She was saying goodbye to you. And you did, indeed, make the right decision. To go gently, with less suffering, is always the right decision for a loved one.

 

[mservant]

These decisions are never easy, and advice and timing for anything especially difficult at this time of year. I do agree with Mamanyt1953, your cat let you know, and hopefully your listening to her helps you cope with your loss S spac .
The TCS team would like you to know that we are so very sorry for your loss. Threads are locked after someone has suffered such a loss, as a sign of respect. We invite you to place a tribute at http://www.thecatsite.com/f/19/crossing-the-bridge as an enduring testimony to your friend.