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18839Re: [FH] New Member worried about CHF- any advice?

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  • lclarizia@aol.com
    Feb 27, 2005
      Hi Tami and Shadow,

      Welcome to the list, though I am sorry you had to join us!

      > Here is why I am worried: I think that his breathing is a little more
      > rapid
      > today than it has been and I weighed him last night at 11 pm and he was 11
      > pounds 7 1/2 ounces and then I weighed him at 4:00 today and he was 11
      > pounds 11
      > 1/2 ounces. Do you think that he is starting to get more fluid back in his
      > lungs? If so, can I just increase the amount of lasix?

      Unless you have a precision scale and know its level of precision (i.e. +/- 1
      ounces), I wouldn't go by weight as an indicator, and even if you do have a
      precision scale, 4 ounces is not a great deal as water is pretty heavy (1 pint
      of water weighs one lb), plus you have to factor in things like what's been
      eaten and what's been excreted.

      You can, as a general rule, increase his lasix if you think he's starting to
      build up fluid again. My cat, Baby Boy has DCM with extremely refractory CHF
      (he's had eight or nine chest taps total) and I increase his lasix when I
      think he might be starting something. You don't want to go too far over his
      regular dose without seeking veterinary advice, although my vet told me the top
      dose I could give him in injectable form (which I have on hand for emergencies,
      works faster than his usual oral dose) is 25 mg or 0.5 ml of a 50 mg/ml

      Rapid breathing can be a sign, and it's unfortunate but some cats experience
      episodes where they clear, refill, clear, refill ad nauseum over a few days
      (like my cat). However, it's hard to define "rapid breathing" in terms of a
      symptom of pulmonary edema/pleural effusion as some cats are all over the map
      with their breathing without filling up and others can increase slightly and be
      absolutely loaded with fluid. Then, there are cats whose symptoms change over
      time -- Baby Boy initially breathed fast and breathed hard, then he had a
      "normal" breath rate but was breathing hard.

      Did the vet say whether he had pulmonary edema, pleural effusion, or both?

      > Also, I looked up on the internet that their respirations are supposed to be
      > 15 to 30 breaths for a normal cat. I watched him and twice today it was 32
      > breaths, which I am sure is fine and twice it was 44 breaths though.

      If you look long enough, you'll see different ranges for "normal" breath
      rates, though I haven't seen any that exceed about forty. However, it's normal
      for a cat to occasionally exceed the average "normal" rate, just as we
      occasionally do. I doubt the 44 was anything serious, assuming it was brief -- he
      could have just been sniffing something in the air -- Baby Boy does this sometimes.

      Pattern is really more important than rate, as some cats normally breath very
      fast, others very slow, although anything much more than 40 is something to
      watch. You should make note of how Shadow breaths when you know he's not
      loaded with fluid. How many breaths per minute, does he occasionally exceed this
      and when, how does he look when he breaths -- how much movement is there in the
      stomach, chest and flanks. If you know what his normal breath rates and
      patterns are when he's clear, it's easier to judge if he might be filling up.

      As for other advice -- the gold standard, as it were, for treating CHF in
      heart kitties seems to be a combination of diuretics (lasix, spironolactone, or
      both together) and an ACE-inhibitor, like enalapril. Long-term diuretic
      therapy activates something called the renin-angiotensin-aldosterone system (RAAS)
      which, while benefiting the action of the heart in the short term, causes
      long-term damage. ACE-inhibitors work to prevent this, and also decrease blood
      pressure which is key as CHF is caused by a differential blood pressure in the
      lungs (from the blood "backing up" due to the inefficient heart) and the rest of
      the body -- to relieve pressure, blood vessels in the lungs allow fluid to
      escape from the blood which ends up as pulmonary edema and/or pleural effusion.

      It was believed that the combination of diuretics and ACE inhibitors might be
      dangerous for the kidneys )because in theory, the kidneys would be working
      harder because of the diuretic but getting less blood because of the ACE
      inhibitor) but this seems to not be a problem in cats with no history of kidney
      disease. Still, to be on the safe side, blood values are often checked to make
      sure of this because cats can have occult or hidden kidney problems.

      Many of us have our kitties on various supplements. In humans, a combination
      of coenzyme-q10 and L-carnitine is reported to be helpful for managing CHF,
      and I think it's helped my little guy. There are also various non-allopathic
      nutraceuticals or herbs used as diuretics, such as dandelion, but their action,
      as far as I have been able to tell, is not as strong as conventional
      diuretics like lasix, and might be more appropriate as an adjunct to lasix rather than
      a replacement.

      I hope this helps -- you must be under so much stress now. Layoffs are no
      fun, my company just had a round and the whole research staff, of which I was
      one, were laid off so I'm job-hunting too. Thank God for severance pay. I hope
      Shadow is feeling better soon!


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