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Re: [FH] Wolfgang CHF/Lasix only?

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  • Susan
    I read a lot of human cardiology articles for med students and that is how I came to understand the rationale for the drugs our cats are on. I also realized
    Message 1 of 7 , Sep 27, 2006
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      I read a lot of human cardiology articles for med students and that is how I came to understand the rationale for the drugs our cats are on. I also realized that veterinary cardiology trails human. If we wait for trials we'll all be dead. However there have been lots of trials for humans and there have been animal trials to benefit humans. So we extrapolate from those..

      The way I have come to understand it is in an emergency the body has responses that help the animal to survive. One is SNS (sympathetic nervous system) also known as fight or flight. This is what increases heart rate to outrun of outfight a predator. Good in the short term but chronically activated as it is with a failing heart very bad because it causes continuing damage to the heart. Beta-blockers (atenolol) block the SNS chemicals that raises the heart rate.

      The other is RAAS (renin-angiotensin-aldosterone system). I think if you were bleeding this system is what kicks in to help you survive. Good if you might bleed to death, really bad if it is chronically activated. ACE-I inhibit the RAAS.

      Both these systems are called the neurohormonal response to a failing heart. This is what vets are trying to modulate at the same time they are trying to keep the lungs clear.

      Sue at MAGDRL <susan@...> wrote:
      Renalie,

      Maybe you should consider switching cardiologists? From what I've learned
      (see Susan's note) it's not at all good to give them diuretics without
      medication to control the heart - either a beta-blocker or an ace-inhibitor.
      The fluid builds up because the two halves of the heart are working at
      different rates. The fluid backs up and the body compensates by leaching it
      into the lungs (usually). The diuretics help to get the fluid out of the
      lungs.

      When you use one of the heart meds (above) it reduces the difference in the
      rates of the two halves of the heart so that not as much fluid builds up to
      begin with. Then you don't have to use so much in the way of diuretics.

      The max dose of diuretics is related to weight. At just over 14 pounds, my
      Pepper is getting 60mg per day of furosemide (lasix) along with 12.5mg
      spironolactone. When we raised her dosage, her kidney values went up for a
      week or so and then came back down. The body can adjust.

      I don't understand his take on supplements but then again, it's typical.
      They study medications and not supplements. Therefore they don't always get
      the whole picture. L-carnitine and CoQ10 *DO* help a LOT!!! Taurine helps
      more with some types of heart disease than others but it sure can't hurt.
      Giving taurine to a cat that has CRF shouldn't make any difference relative
      to the CRF.

      My family wanted me to put my Pepper to sleep back when she was first
      diagnosed in November 2004. I'm sure glad that I didn't listen. Actually,
      it made me very angry with them since they felt I'd lost my mind and treated
      me accordingly. We've had almost 2 years so far with some ups & downs but
      mostly good times. The past couple of days, she's flying up her 5' cat tree
      with no issues.

      IMO - I would switch cardiologists since I don't think this one is doing the
      best for your Wolfgang. Remember that no medical practitioner is infallable
      and you are the voice for Wolfgang. Don't just blindly trust them if you
      don't think they're doing the right thing. Obviously, what they're doing
      isn't working for Wolfgang.

      My best to both of you.


      Sue






      ----- Original Message -----
      From: "renalie_ren_wren"
      To:
      Sent: Wednesday, September 27, 2006 2:41 PM
      Subject: [FH] Wolfgang CHF/Lasix only?


      > Hi there. My cat Wolfgang has had a bad month. I haven't posted in a
      while, so here is
      > some background.
      >
      > Wolfgang went into CHF in January. He was diagnosed with HCM secondary to
      Hyper T.
      > He also had rising creatine levels.
      >
      > Wolfgang was treated with radioactive iodine in March, which cured his
      Hyper T.
      >
      > In July, an echo showed no improvement to his heart, so the HCM diagnosis
      was not
      > secondary to Hyper T. The radioactive iodine, did help this disease from
      progressing.
      >
      > Wolfgang was on .05 ml Lasix. It is in liquid form of 10 mg/ml. He was
      also prescribed
      > 5mg aspirin, one every three days.
      >
      > I asked a lot of questions (after joining this group) about supplements,
      and other heart
      > medicines. His cardiologist told me that what we are doing is working, so
      he didn't want
      > to change anything. He told me the Q 10 and L-Carnitine "wont hurt", but
      not to give
      > Taurine, because of his CRF and protein.
      >
      > Last month I caught Wolfgang in the early stages of CHF. His breathing
      was at 40 resps a
      > minute, but not labored. I took him in, and an x-ray showed fluid in his
      lungs. His
      > cardiologist told me to double his dose of Lasix now. .05 2x a day. He
      was due for a two
      > week check-up to see how his kidneys were handling this much Lasix.
      >
      > Two weeks later (the day he was scheduled for a check-up), Wolfgang went
      into CHF
      > again. This time very labored and uneven. His regular cardiologist was
      busy with a
      > surgery, so I was temporarily assigned a different one. I go to the
      University of Minnesota,
      > where there isn't a shortage of cardiology students and residents.
      >
      > They could not hear Wolfgangs usual grade 3 left murmur, because of an
      arrhythmia.
      > They did an echo which showed a slight (1mm) progression of thickening
      heart walls, but
      > that was it. An x-ray showed fluid in his lungs. They drew blood to
      check Creatinine, and
      > the good news was even after two weeks of doubling the Lasix, his Creat
      went down since
      > July! Three cheers! His Creat was at 2.9 (.5-2.1). I was told that we
      had "wiggle room" to
      > up the Lasix even more. This new cardiologist told me that she was going
      to discuss
      > giving an ACE inhibitor (enalapril) with his regular cardiologist.
      >
      > His regular cardiologist rushed over after surgery to see what was going
      on with Wolfgang.
      > They had finally stabilized him with Lasix and oxygen. I was told I could
      take him home
      > but to increase his lasix for the next three days. .08 ml 3x a day, and
      then go to .08 ml
      > 2x a day. He was also (on my recommendation) prescribed Renacare
      potassium
      > supplement 2x a day. They wanted to follow up in a week to make sure his
      x-rays were
      > clear, and check blood for Creat again.
      >
      > That was last Thursday. His check-up didn't go as well as I had hoped.
      There was still
      > some fluid in his lungs, and now his Creat is up to 3.4 (.5-2.1). They
      gave him another
      > injection of lasix, told me to not change anything, and sent me on my way.
      >
      > This weekend was awful. Wolfgang had resps in the 50s, with uneven
      labored breathing.
      > The cardiology dept. is closed on weekends, so I gave him an extra .05 ml
      lasix.
      >
      > He is slowly doing better. I spoke to his cardiologist on Monday. He
      told me I did the
      > right thing, and I can give him extra lasix if I feel fit. I brought up
      the ACE inhibitor again,
      > and my cardiologist said no. He said he doesn't see enough evidense that
      they work, and
      > he doesn't want to risk further renal failure.
      >
      > Wolfgang is doing better today, but is still not recovered. I just don't
      know what to do.
      > My family thinks I should PTS. I have asked his vet and cardiologist, and
      they think he will
      > recover.
      >
      > I have taken this week off from both school and work. I am willing to
      lose my job to stay
      > with him, and make sure he is eating and drinking.
      >
      > I just don't know what to do now. I called his vet and cardiologist today
      ( I wanted to know
      > what the maximum dose of lasix I could give him) but have not heard back.
      >
      > I would be so very grateful for any input on this situation. Wolfgang
      will be 13 November
      > 2nd.
      >
      > Is just giving him Lasix enough? Am I at the max already?
      >
      > Please help.......
      >
      > ~Renalie
      >
      >
      >




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