Loading ...
Sorry, an error occurred while loading the content.

48922Re: [FH] Introducing Idgie (tachycardia?)

Expand Messages
  • Cindi
    Sep 9, 2013
    • 0 Attachment
      You are doing a great job with her being 20 years old.  It was a U.S. veterinary consultant that spoke about Saline Vs. LRS for CRF cats so would have felt bad if I didn't mention it.  I'm glad you were already aware.

      Cindi missing the touch of Ditto
      There she was, elegant, beautiful, swathed in the shiniest of clinging silks, a vision of loveliness in coffee and cream --- a Princess from Bangkok, an Oriental Goddess, a Queen on her throne --- a Siamese cat!
      from May Eustace's Cats in Clover

      On Mon, Sep 9, 2013 at 12:24 PM, Barbara Piderit wrote:

       Hi, Cindi,

      We live in western Switzerland and I've been told that LRS is not available here.  I think the next best thing is something called plasmalyte and my sense is there're several different versions of that.  I am a faithful reader of Helen Fitsimmons' Tanya's CRF site and have a copy in book form and consider it my Bible, so I understand where your query is coming from.

      Anyway, Idgie first needed sub-q fluids 3-1/2 years ago, for a period of ten days or so, when she was suffering from acute pancreatitis.  About 15 months later, she was diagnosed with toxoplasmosis, which caused a panc flare; we again gave her sub-qs for a period of 15 days or so, concurrent with the antibiotic necessary to kill the toxo.  Both times, the vet prescribed a 0.9% solution of sodium chloride.  Currently, Idgie has been getting 50ml sub-qs SID (same solution) for just about a year now and the vet is convinced that that's largely, but not only, responsible for her stable state.

      Our vet (she is a keeper, the survivor of a series of 5 veterinarians, including two of her colleagues) and I have had the LRS vs NaCl conversation several times, the last time about a year ago.  This is the preferred fluid for hydration purposes here and, I think, on the continent.  Our compromise last year was that I would give Idgie NaCl daily for two months, until the next full checkup was due, when we would see if there were any changes in Idgie's bloodwork.  That took us to November 2012, which was the official beginning of Idgie's long, stable period.

      Idgie's last full bloodwork was done at the Tierspital (small animal clinic affiliated with the veterinary university in Berne) on July 24, 2013, including ionized calcium and PTH which our vet cannot do or have done by the lab she normally uses .  All values on that full blood chemistry and CBC were within their lab's norms, including Na+, except BUN ( 16.08 (6.46-12.20 )) and creatinine  ( 273.00 (52-138 )), which is great for a CRF/CRD cat and has allowed me to put my concerns about elevated calcium and secondary hyperparathyroidism aside, if not away.  Also, neither the vet hospital in Berne nor the veterinary ophthalmologist made any comment about or suggestion to change Idgie's fluids so I have to accept my vet's word that NaCl is the preferred fluid here and continue to give it to Idgie.  Until something changes for the worse, I feel like I have to go with the NaCl flow.

      Head butts,

      Barbara & Idgie


      De : Cindi <dittykat@...>
      À : asterixetideefixe@...
      Cc : feline-heart@yahoogroups.com
      Envoyé le : Lundi 9 septembre 2013 13h24
      Objet : RE: [FH] Introducing Idgie (tachycardia?)

      I am here to learn about heart disease but I know CRF well.  Is there a
      reason you are giving her sodium chloride fluids instead of LRS?  Sodium
      chloride is not the preferred fluid for CRF cats since it is more acidic
      than LRS.  I would think  with more sodium is not good for a heart kitty

      Cindi missing the touch  of Ditto
      There she was, elegant, beautiful, swathed in the shiniest of clinging
      silks, a vision of loveliness in coffee and cream --- a Princess from
      Bangkok, an Oriental Goddess, a Queen on her throne --- a Siamese cat!
      from May Eustace's Cats in Clover

      On Mon, Sep 9, 2013 at 4:31 AM, asterixetideefixe@...wrote:

      Dear Listmates,

      We’re new here, but have been following the feline CRF/CRD,
      pancreatitis, assisted feeding and anemia support lists for several
      years already.  Forgive me, but this may be a very long post.

      My Idgie – her call name comes from her registered name, Idéefixe, and
      the Idgie Threadgood character in Fannie Flagg’s Fried Green Tomatoes …
      -- is a 20yo bluepoint Birman granny girl currently weighing

      Idgie is an acute pancreatitis survivor, has overcome toxoplasmosis,
      multiple urinary infections, and lives comfortably with early Iris Stage
      III kidney disease.  She’s also a healthy feline corona virus carrier,
      and probably has been for the better part of the last 15 years.

      Her daily meds schedule follows:

      50ml NaCl sub-qs SID,

      one Aktivait Cat (vitamin supplement for aging kitties’ brains) SID,

      500mg methylcobalamin (Vitacost capsules) SID,

      5mg Ranitidine/Zantac BID and, now,

      0,625mg of amlodipine besylate BID.

      Her diet now consists exclusively of pouched Royal Canin Renal with
      chicken, to which I add a small amount of MiraLax to stave off
      constipation.  We occasionally resort to 1mg Ondansetron BID for nausea,
      but haven’t needed that for over a month.  While she doesn’t volunteer,
      she accepts my ministrations without more than the occasional grumble.

      Our – Idgie, our preferred vet and my -- overall approach to Idgie’s
      care is preventive and our medication philosophy is “less is more”.
      Over the past 3-1/2 years, we have seen the vet for a check up – blood
      chemistry and CBC, urinalysis and, if necessary, culture and sensitivity
      – every three to four months unless something untoward happened before
      the end of that time period.  Part of those exams also consisted of the
      vet’s listening to Idgie’s heart.  The vet has never before indicated
      concern about an accelerated heart rate and has never heard evidence of
      a heart murmur. I give Idgie “only” 50ml of sub-q fluids per day and
      she’s never demonstrated difficulty absorbing that amount.

      I’ve been blending and syringe feeding her the equivalent of one pouch
      of RC renal  with Miralax since mid-July.  Idgie and her son, Angel Jazz,
      had always lost weight in summer.  I began daily assisted feeding this
      summer because we were leaving on our annual summer cruise on the lake –
      my “sailorette” has been in, on and around boats since she was 14 weeks
      old – and, for it to be a stress-free break for me, preferred to add
      regular assisted feeding to our regime than to be constantly worrying
      about how much she was or wasn’t eating.  We’re back home now;  she
      shows no indications of nausea and eats, especially at night, but only
      very small amounts – not enough to maintain her weight so, for the time
      being at least, I’m continuing to assist feed.  I wonder if she forgets
      to eat due to her cognitive dysfunction syndrome (CDS).

      I will whisper here that she hasn’t had a panc flare in over a year and
      hasn’t had an UTI since late  last winter – shhh!  Her CRD has been
      happily stable since early November 2012.

      BUT, we had a rough summer in that the quality of her night howling (due
      to CDS) changed, accompanied by anxiety she doesn’t usually exhibit.  It
      was a job, but I managed to find a vet with a blood pressure cuff:
      those first readings, on July 9, averaged 218.2 (241/167, 228/146,
      211/156, 236/147, 208/147, 208/131, 196/141).  (I have no record of the
      heart rate.)  She was prescribed 0.625mg amlodipine BID.

      A week later, on July 17, her BP averaged 159.75 (214/165 (186), 179/106
      (124), 147/110 (122), 156/112 (128), 151/104 (117), 153/99 (116)); her
      heart rate averaged 122.75.  The howling returned to “normal” and the
      anxious behavior disappeared.

      On July 24, her BP averaged 133.7 (104/89/94 (72) (was asleep),
      105/186/98 (116) (was still asleep),  130/82/119 (155), 149/103/127
      (115), 129/106/111 (219), 131/93/108 (219), 158/108/128 (219),
      146/122/138 (97?)) and heart rate averaged 153.5, which, I understand,
      is “about normal”.

      On July 30 we saw a feline ophthalmologist who recommended that we
      double the dose of amlodipine to 0.625mg BID:  that day her BP averaged
      140.5 (138/96/115 (-), 125/93/107(-), 140/71/105 (-), 142/92/108 (242),
      166/73/112 (253), 145/199/112 (263), 141/95/110 (263), 137/103/115
      (242)) and her heart rate averaged 252.6.

      On September 2, at our own vet’s, her BP averaged 140 (164/102/122
      (253), 145/111/124 (242), 146/112/124 (231), 153/111/113 (231),
      132/105/118 (242), 132/104/116 (253), 128/108/114 (253), 136/98/110
      (242)) and her heart rate averaged 243.8.

      We had assumed the spike in blood pressure was due to Idgie’s CRF but
      doubt is now niggling at the edges of  my consciousness.  My concern, and
      reason for being here, is the tachycardia.  The vet and I are not
      terribly keen on introducing an ACE inhibitor into the mix because we
      each feel that that might destabilize the wonderful CRF plateau Idgie’s
      been on for almost a year.  (Her total protein is elevated but within
      our lab’s norms.)  But I worry that this accelerated heartbeat will
      eventually take its toll on my grand old granny girl’s aging heart,
      possibly causing HCM and/or other complications.

      At our September 2 vet appointment, the vet agreed to do some research
      on the tachycardia and, possibly, to consult a cardiology specialist.  I
      agreed to get a stethoscope and listen to Idgie’s heartbeat in an
      attempt to determine if the tachycardia is white-coat-syndrome related
      (although it was not present until July 24.  It took me the better part
      of a week  to borrow a stethoscope – I expect to receive my own in the
      course of the coming week – and, so far – I count the dub sounds of the
      dub-uh, dub-uh that I hear – I count 108bpm when Idgie’s just waking up
      and up to 200bmp when she’s been active or is hollering.  Now that I
      have the apparatus, I will try to listen to and count her heart beats in
      a more systematic way but perhaps there is an element of
      white-coat-syndrome here?

      My questions for the list are:  what, in your experience, besides
      advancing CRF, could be causing Idgie’s tachycardia? and what, if
      anything, can be done to slow it down to normal without jeopardizing her
      otherwise stable condition?

      Thank you for reading what has indeed become a very long post.  All
      feedback would be very much appreciated.

      Head butts,

      Barbara &  Idgie

    • Show all 6 messages in this topic