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Re: [FH] Madeline -- Heart issues/hyperthyroid/possible inflammatory bowel...

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  • Westgold
    hi -- I m sorry to hear about your little kitty. This is a most thorough examination she had. DO NOT LET ANYBODY GIVE HER STEROIDS FOR ANY REASON. There is
    Message 1 of 5 , Jun 4, 2010
      hi -- I'm sorry to hear about your little kitty. This is a most thorough examination she had. DO NOT LET ANYBODY GIVE HER STEROIDS FOR ANY REASON. There is always an alternative. Steriods could send her over the edge immediately. Steriods should NEVER EVER be given to a kitty with HCM. The other meds seem standard. But please do not listen to any timeline you are given. I hate it when vets give timelines. They can't possibly know. We have kitties on this list alive and kicking YEARS after their vets said they'd be gone.

      Since Madeline has several things wrong with her, you'll have to work closely with the cardiologist to carefully coordinate all her meds, etc. You may be able to get some of them compounded into a liquid form that can be mixed with the food, so you don't have to give her too many pills. But once that is worked out, she could keep going for years. Just keep an eye on her values regularly. The most urgent problem with now is probably the extra fluid, but the lasix will help with that. You have to keep an eye on her breathing rate -- *resting* breaths per minute should be around 23-27. If they go to over 40, or there is open-mouthed or deep labored breathing, that's an emergency and she needs to be taken in immediately so they can clear the fluid from her lungs manually. Sometimes the lasix by itself isn't enough. Others can give you more info on that, my heart kitty hasn't had any fluid problems yet.

      Please keep us postedm, and let us know if there's anything else we can do to help. Among us, we've been through just about everything!

      take care -- Michelle & Tigger Too in Toronto



      [Non-text portions of this message have been removed]
    • Cathryn
      Hi Michelle, Thanks so much for this note. Great to hear your experiences and I hear what you are saying about the steroids. That would have been bad. So I
      Message 2 of 5 , Jun 4, 2010
        Hi Michelle,

        Thanks so much for this note. Great to hear your experiences and I hear what
        you are saying about the steroids. That would have been bad. So I was
        reading up on Lasix and came across this page that said the following about
        furosemide. Madeline was prescribed furosemide and benazepril at the same
        time. This says to wait before adding in the benazepril. The cardiologist
        isn't in today tho' I gather he'd say it's okay. (Sometimes reading up on
        this can make one nervous for sure!)

        What do you think?

        Thanks.

        Cathryn.


        From: http://www.marvistavet.com/html/body_furosemide.html

        INTERACTIONS WITH OTHER DRUGS

        One of the most common drug interactions to be aware of is the interaction
        between furosemide and vasodilating heart medications (especially the
        Angiotensin Converting Enzyme inhibitors such as
        enalapril<http://www.marvistavet.com/html/body_enalapril.html>,
        benazepril <http://www.marvistavet.com/html/body_benazepril.html>, and
        lisinopril). Furosemide will decrease circulating blood volume as it causes
        a depletion in body water. This means that the kidney (and most other
        organs) will have a reduced blood flow to them. The patient�s kidney and
        electrolyte balance must stabilize before a vasodilator is added in. If the
        vasodilator is added too soon, it too will reduce blood flow to the kidney
        and the kidney will fail, possibly permanently. *These medications are
        frequently used together in heart failure patients. To avoid problems, the
        patient should be assessed biochemically with a blood test prior to the
        addition of the vasodilator. If all is normal, the vasodilator may be
        started and renal blood parameters should be rechecked 3-5 days later. If
        they are still normal, then the above kidney issues should not be a problem;
        however, should another heart failure crisis arise and large doses of
        injectable lasix be required to resolve it, kidney values should again be
        checked 3-5 days later.*

        The airway dilator theophylline may be able to reach higher blood levels
        when used in conjunction with furosemide. This means that the theophylline
        dose may need to be reduced.

        Furosemide is often used concurrently with digitalis derivatives. If
        furosemide leads to a significant drop in blood potassium levels, this can
        increase the risk of heart rhythms disturbances and other signs of digitalis
        toxicity.

        Furosemide is often used in combination with
        prednisone<http://www.marvistavet.com/html/body_prednisone.html>to
        reduce serum calcium levels. It is possible for this combination of
        medication to lead to a reduction in potassium level significant enough to
        require potassium supplementation.

        Aminoglycoside antibiotics (amikacin, gentamicin etc.) have properties that
        make them toxic to the ear and to the kidney. These properties increase with
        concomitant use of furosemide.

        CONCERNS AND CAUTIONS

        Obviously it is best not to use this medication in a dehydrated patient if
        water is being restricted.

        Weakness or lethargy could be an indicator that blood potassium has dropped
        too low. Be sure to inform your veterinarian if your pet seems listless.

        Because of the increased calcium excretion brought on by furosemide (i.e. an
        increase in urinary calcium levels), there could be a problem using this
        medication in patients with a history of calcium oxalate bladder
        stone<http://www.marvistavet.com/html/canine_oxalate_bladder_stones.html>formation.

        *It is extremely difficult to overdose with this medication. Toxic doses
        reported are over 100 times a typical oral dose of medication. It is
        important to realize that in the treatment of heart failure (this drug�s
        primary use), a crisis can arise at any time. Often giving an extra dose of
        oral medication can be a life saving procedure. Be sure you understand what
        signs you are to watch for to determine if an extra dose or two should be
        administered and when you should definitely rush to the vet�s office.*

        The loss of water-soluble vitamins or urine can be a problem for patients
        receiving diuretics. Prescription diets for heart and kidney disease are
        vitamin-fortified with these extra losses in mind. Patients that refuse to
        eat such prescription diets should probably receive a vitamin supplement.




        On Fri, Jun 4, 2010 at 2:04 PM, Westgold <westgold@...> wrote:

        > *hi -- I'm sorry to hear about your little kitty. This is a
        > most thorough examination she had. DO NOT LET ANYBODY GIVE HER STEROIDS FOR
        > ANY REASON. There is always an alternative. Steriods could send her over
        > the edge immediately. Steriods should NEVER EVER be given to a kitty with
        > HCM. The other meds seem standard. But please do not listen to any
        > timeline you are given. I hate it when vets give timelines. They can't
        > possibly know. We have kitties on this list alive and kicking YEARS after
        > their vets said they'd be gone. *
        > **
        > *Since Madeline has several things wrong with her, you'll have to work
        > closely with the cardiologist to carefully coordinate all her meds, etc.
        > You may be able to get some of them compounded into a liquid form that can
        > be mixed with the food, so you don't have to give her too many pills. But
        > once that is worked out, she could keep going for years. Just keep an eye
        > on her values regularly. The most urgent problem with now is probably the
        > extra fluid, but the lasix will help with that. You have to keep an eye on
        > her breathing rate -- *resting* breaths per minute should be around 23-27.
        > If they go to over 40, or there is open-mouthed or deep labored breathing,
        > that's an emergency and she needs to be taken in immediately so they can
        > clear the fluid from her lungs manually. Sometimes the lasix by itself
        > isn't enough. Others can give you more info on that, my heart kitty hasn't
        > had any fluid problems yet.*
        > **
        > *Please keep us postedm, and let us know if there's anything else we can
        > do to help. Among us, we've been through just about everything!*
        > **
        > *take care -- Michelle & Tigger Too in Toronto*
        > **
        > **
        >


        [Non-text portions of this message have been removed]
      • Westgold
        oh, yeah -- there s a lot of really scary stuff out there! And the more research you do, the scarier it gets!! But your best friend right now is Madeline s
        Message 3 of 5 , Jun 4, 2010
          oh, yeah -- there's a lot of really scary stuff out there! And the more research you do, the scarier it gets!! But your best friend right now is Madeline's cardiologist.

          Why don't you ask on the list -- if others were given lasix & benazepril at the same time, and if it was ok, etc. She may also need potassium supplements, as the lasix washes it away. This is why you need to work closely with your cardiologist, to keep on top of everything. Tigger has mild HCM, and is just on atenolol (over 5 years now). So I don't have experience with anything else.

          Cathryn, all we can do is what we can do, and hope and pray for the best. Madeline is so blessed to have someone as caring as you to take care of her. Just do what you can do, and leave the rest to God. HCM is horrible, and it can turn on a dime. Even if you do everything right, we still have to be prepared that they could go at any minute. My vet has the philosophy that kitties are "here for a good time, not a long time -- so have a good time, the sun don't shine everyday". He's right. We need to enjoy every precious minute we have with our little ones.

          take care -- Michelle & Tigger Too in Toronto
          ----- Original Message -----
          From: Cathryn
          To: Westgold ; feline-heart@yahoogroups.com
          Sent: Friday, June 04, 2010 2:15 PM
          Subject: Re: [FH] Madeline -- Heart issues/hyperthyroid/possible inflammatory bowel...


          Hi Michelle,

          Thanks so much for this note. Great to hear your experiences and I hear what you are saying about the steroids. That would have been bad. So I was reading up on Lasix and came across this page that said the following about furosemide. Madeline was prescribed furosemide and benazepril at the same time. This says to wait before adding in the benazepril. The cardiologist isn't in today tho' I gather he'd say it's okay. (Sometimes reading up on this can make one nervous for sure!)

          What do you think?

          Thanks.

          Cathryn.


          From: http://www.marvistavet.com/html/body_furosemide.html

          INTERACTIONS WITH OTHER DRUGS

          One of the most common drug interactions to be aware of is the interaction between furosemide and vasodilating heart medications (especially the Angiotensin Converting Enzyme inhibitors such as enalapril, benazepril, and lisinopril). Furosemide will decrease circulating blood volume as it causes a depletion in body water. This means that the kidney (and most other organs) will have a reduced blood flow to them. The patient�s kidney and electrolyte balance must stabilize before a vasodilator is added in. If the vasodilator is added too soon, it too will reduce blood flow to the kidney and the kidney will fail, possibly permanently. These medications are frequently used together in heart failure patients. To avoid problems, the patient should be assessed biochemically with a blood test prior to the addition of the vasodilator. If all is normal, the vasodilator may be started and renal blood parameters should be rechecked 3-5 days later. If they are still normal, then the above kidney issues should not be a problem; however, should another heart failure crisis arise and large doses of injectable lasix be required to resolve it, kidney values should again be checked 3-5 days later.

          The airway dilator theophylline may be able to reach higher blood levels when used in conjunction with furosemide. This means that the theophylline dose may need to be reduced.

          Furosemide is often used concurrently with digitalis derivatives. If furosemide leads to a significant drop in blood potassium levels, this can increase the risk of heart rhythms disturbances and other signs of digitalis toxicity.

          Furosemide is often used in combination with prednisone to reduce serum calcium levels. It is possible for this combination of medication to lead to a reduction in potassium level significant enough to require potassium supplementation.

          Aminoglycoside antibiotics (amikacin, gentamicin etc.) have properties that make them toxic to the ear and to the kidney. These properties increase with concomitant use of furosemide.

          CONCERNS AND CAUTIONS

          Obviously it is best not to use this medication in a dehydrated patient if water is being restricted.

          Weakness or lethargy could be an indicator that blood potassium has dropped too low. Be sure to inform your veterinarian if your pet seems listless.

          Because of the increased calcium excretion brought on by furosemide (i.e. an increase in urinary calcium levels), there could be a problem using this medication in patients with a history of calcium oxalate bladder stone formation.

          It is extremely difficult to overdose with this medication. Toxic doses reported are over 100 times a typical oral dose of medication. It is important to realize that in the treatment of heart failure (this drug�s primary use), a crisis can arise at any time. Often giving an extra dose of oral medication can be a life saving procedure. Be sure you understand what signs you are to watch for to determine if an extra dose or two should be administered and when you should definitely rush to the vet�s office.

          The loss of water-soluble vitamins or urine can be a problem for patients receiving diuretics. Prescription diets for heart and kidney disease are vitamin-fortified with these extra losses in mind. Patients that refuse to eat such prescription diets should probably receive a vitamin supplement.




          [Non-text portions of this message have been removed]
        • Cathryn
          Hi Michelle, Yes I m posting to the list as well. The cardiologist is not reachable right now unfortunately but one of the other doctors is trying to reach
          Message 4 of 5 , Jun 4, 2010
            Hi Michelle,

            Yes I'm posting to the list as well.

            The cardiologist is not reachable right now unfortunately but one of the
            other doctors is trying to reach him.

            You have a good attitude about it. Thank you!!

            I just found out that Madeline's hyperthyroid T4 # is now at 6 which is way
            higher than we anticipated.

            Thank you --

            Cathryn.

            On Fri, Jun 4, 2010 at 2:28 PM, Westgold <westgold@...> wrote:

            > *oh, yeah -- there's a lot of really scary stuff out there! And the more
            > research you do, the scarier it gets!! But your best friend right now is
            > Madeline's cardiologist. *
            >
            > *Why don't you ask on the list -- if others were given lasix & benazepril
            > at the same time, and if it was ok, etc. She may also need potassium
            > supplements, as the lasix washes it away. This is why you need to work
            > closely with your cardiologist, to keep on top of everything. Tigger has
            > mild HCM, and is just on atenolol (over 5 years now). So I don't have
            > experience with anything else. *
            > ****
            > *Cathryn, all we can do is what we can do, and hope and pray for the
            > best. Madeline is so blessed to have someone as caring as you to take care
            > of her. Just do what you can do, and leave the rest to God. HCM is
            > horrible, and it can turn on a dime. Even if you do everything right, we
            > still have to be prepared that they could go at any minute. My vet has the
            > philosophy that kitties are "here for a good time, not a long time -- so
            > have a good time, the sun don't shine everyday". He's right. We need to
            > enjoy every precious minute we have with our little ones. *
            > **
            > *take care -- Michelle & Tigger Too in Toronto*
            >
            > ----- Original Message -----
            > *From:* Cathryn <cathryn.be@...>
            > *To:* Westgold <westgold@...> ; feline-heart@yahoogroups.com
            > *Sent:* Friday, June 04, 2010 2:15 PM
            > *Subject:* Re: [FH] Madeline -- Heart issues/hyperthyroid/possible
            > inflammatory bowel...
            >
            > Hi Michelle,
            >
            > Thanks so much for this note. Great to hear your experiences and I hear
            > what you are saying about the steroids. That would have been bad. So I was
            > reading up on Lasix and came across this page that said the following about
            > furosemide. Madeline was prescribed furosemide and benazepril at the same
            > time. This says to wait before adding in the benazepril. The cardiologist
            > isn't in today tho' I gather he'd say it's okay. (Sometimes reading up on
            > this can make one nervous for sure!)
            >
            > What do you think?
            >
            > Thanks.
            >
            > Cathryn.
            >
            >
            > From: http://www.marvistavet.com/html/body_furosemide.html
            >
            > INTERACTIONS WITH OTHER DRUGS
            >
            > One of the most common drug interactions to be aware of is the interaction
            > between furosemide and vasodilating heart medications (especially the
            > Angiotensin Converting Enzyme inhibitors such as enalapril<http://www.marvistavet.com/html/body_enalapril.html>,
            > benazepril <http://www.marvistavet.com/html/body_benazepril.html>, and
            > lisinopril). Furosemide will decrease circulating blood volume as it causes
            > a depletion in body water. This means that the kidney (and most other
            > organs) will have a reduced blood flow to them. The patient�s kidney and
            > electrolyte balance must stabilize before a vasodilator is added in. If the
            > vasodilator is added too soon, it too will reduce blood flow to the kidney
            > and the kidney will fail, possibly permanently. *These medications are
            > frequently used together in heart failure patients. To avoid problems, the
            > patient should be assessed biochemically with a blood test prior to the
            > addition of the vasodilator. If all is normal, the vasodilator may be
            > started and renal blood parameters should be rechecked 3-5 days later. If
            > they are still normal, then the above kidney issues should not be a problem;
            > however, should another heart failure crisis arise and large doses of
            > injectable lasix be required to resolve it, kidney values should again be
            > checked 3-5 days later.*
            >
            > The airway dilator theophylline may be able to reach higher blood levels
            > when used in conjunction with furosemide. This means that the theophylline
            > dose may need to be reduced.
            >
            > Furosemide is often used concurrently with digitalis derivatives. If
            > furosemide leads to a significant drop in blood potassium levels, this can
            > increase the risk of heart rhythms disturbances and other signs of digitalis
            > toxicity.
            >
            > Furosemide is often used in combination with prednisone<http://www.marvistavet.com/html/body_prednisone.html>to reduce serum calcium levels. It is possible for this combination of
            > medication to lead to a reduction in potassium level significant enough to
            > require potassium supplementation.
            >
            > Aminoglycoside antibiotics (amikacin, gentamicin etc.) have properties that
            > make them toxic to the ear and to the kidney. These properties increase with
            > concomitant use of furosemide.
            >
            > CONCERNS AND CAUTIONS
            >
            > Obviously it is best not to use this medication in a dehydrated patient if
            > water is being restricted.
            >
            > Weakness or lethargy could be an indicator that blood potassium has dropped
            > too low. Be sure to inform your veterinarian if your pet seems listless.
            >
            > Because of the increased calcium excretion brought on by furosemide (i.e.
            > an increase in urinary calcium levels), there could be a problem using this
            > medication in patients with a history of calcium oxalate bladder stone<http://www.marvistavet.com/html/canine_oxalate_bladder_stones.html>formation.
            >
            > *It is extremely difficult to overdose with this medication. Toxic doses
            > reported are over 100 times a typical oral dose of medication. It is
            > important to realize that in the treatment of heart failure (this drug�s
            > primary use), a crisis can arise at any time. Often giving an extra dose of
            > oral medication can be a life saving procedure. Be sure you understand what
            > signs you are to watch for to determine if an extra dose or two should be
            > administered and when you should definitely rush to the vet�s office.*
            >
            > The loss of water-soluble vitamins or urine can be a problem for patients
            > receiving diuretics. Prescription diets for heart and kidney disease are
            > vitamin-fortified with these extra losses in mind. Patients that refuse to
            > eat such prescription diets should probably receive a vitamin supplement.
            >
            >


            [Non-text portions of this message have been removed]
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