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Asthma flare-ups with advanced heart disease.

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  • Patricia Crawford
    Just wondering if anyone could share any experience or insights on dealing wtih asthma attacks and advanced heart disease. Bastet has been having a flare-up of
    Message 1 of 13 , May 4 2:01 PM
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      Just wondering if anyone could share any experience or insights on dealing
      wtih asthma attacks and advanced heart disease.
      Bastet has been having a flare-up of asthma. Her flovent has been doubled, though the risk of the inhaled corticosteroid, though a risk is far less a risk that putting her on pred.
      however, her attacks of coughing have been so bad, her
      cardiologist has ok'd Albuterol at one puff per day, after evaluating all her x-rays and doing another cardiac ultrasound yesterday. She had so many attacks yesterday, she was ok'd for a second dose within three hours if required. Fortunately I didn't have to use it and hopefully we can settle the asthma attacks. The worst attacks have occurred after returning from the vet, so I'm thinking they are precipitated by stress or exposure to the outdoor air just getting her to the vet -- evidently our pollen counts are high right now, but her asthma has been well controlled for three years. The coughing started in mid-March, very infrequent but became severe in late April, the worst it's ever been.
      I'm allowed to use the
      Albuterol as required in order to get me to the ER, where she would be hospitalized to deal with the resultant heart failure.
      Bastet has congenital heart disease: a stage 6 heart murmur, caused by high VSD (ventricular septal defect) and aortic insufficiency. She has always had intermittent arrhythmia. Her pulmonary vessels always appear over-circulated on x-rays, but she has had no evidence of congestive heart failure since 2009.
      Her ultrasound
      yesterday showed no evidence of failure or change in the vessels. There were mild changes related to the progression of her heart disease (the backflow/overload) through the VSD. An opaque area in front of her heart is likely a benign fluid-filled cyst that does not interfere with her heart function. So basically there is no absolute reason not to use Albuterol, and if I have to use it more than once in a 24 hour period, which could could increase her heart rate and could worsen the backflow situation and put her into failure. But evidently that could be dealt with in the ER/with hospitalization and treatment for the failure. It's more important that she be able to breath. Nonetheless I've been up most of the last two nights checking her and counting her breaths, and am exhausted and anxious.
      Pat


      [Non-text portions of this message have been removed]
    • acrocat@rocketmail.com
      Hi Tammy Pacing can be a sign of discomfort or disorientation. I wouldn t think of a stroke as a first rule-out. He s not on anything but enalapril and
      Message 2 of 13 , May 4 8:08 PM
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        Hi Tammy

        Pacing can be a sign of discomfort or disorientation. I wouldn't think of a stroke as a first rule-out. He's not on anything but enalapril and tumil-k (potassium)? And he just got 1/2 baby aspirin? (Dose is ok, as long as you don't repeat in the next few days.) He's not on insulin for diabetes?

        If he's pacing and won't stop (not even to eat), and you can't distract him, I would take him to the vet or ER tonight. In some animals this can be a pre- or post-seizure activity and certainly a major change in mental state is always a cause for concern. If he just seems restless, but is still interacting with you and eating, using his litter box, etc., I'd talk to your vet tomorrow and take him in then if he's still not back to normal. It could be something as simple as a belly ache/gas pain. Make sure to have his blood pressure and his thyroid checked if they haven't been checked quite recently.

        Please keep us posted.
        Adriann
      • acrocat@rocketmail.com
        Hi Pat I m so sorry to hear about Bastet. When did you increase her Flovent? I m surprised the cardiologist is so set against the albuterol. There are risks,
        Message 3 of 13 , May 4 8:23 PM
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          Hi Pat

          I'm so sorry to hear about Bastet. When did you increase her Flovent? I'm surprised the cardiologist is so set against the albuterol. There are risks, but she needs to be able to breathe. Inhaled steroid can only get so far as the airway is open, if that makes sense. If the situation is bad, it can help to have a bronchodilator on board which opens up the airway in order to let the steroid in. Do you have the AeroKat? Can you see that she's taking full breaths?

          I would ask tomorrow about an antihistamine, which frankly doesn't often help allergic cats but since Bastet's choices are limited, it's worth a try.

          If Bastet continues with these very frequent attacks I would personally consider using an oral steroid. I know there are risks with systemic steroids, and I actually know cats who have had trouble with them, but the oral steroids are the most benign (if only because they don't last that long in the system) and it sounds like you're watching her like a hawk. Frequent asthma attacks are a serious quality of life concern to me (my kitty has asthma too). It may be that you can take advantage of a short course of steroids to tamp down the inflammation, then continue with your increased dose of Flovent. I'd discuss this with your vet if Bastet continues to have such trouble.

          Please keep us posted. Fingers crossed over here for a quiet night for you both.
          Adriann
        • Patricia Crawford
          Hi Adriann, I increased the Flovent last Saturday, and i got the Albuterol then as well and had to use it on Tuesday night. After her heart ultrasound and
          Message 4 of 13 , May 5 7:18 PM
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            Hi Adriann, I increased the Flovent last Saturday, and i got the Albuterol then as well and had to use it on Tuesday night. After her heart ultrasound and comparing it to the previous one, he thinks anything more than one puff within 24 hours could cause her heart to beat faster and put her into heart failure in her particular situation. What I would have to do is to give her Albuterol in order to get her to the ER, where they could then treat the subsequent failure in a hospital situation.
            It's hard to know what precipitated this flare-up. She was particularly resistant to the flovent with the previous cannister. She tends to hold her breath or take mini-breaths or knock the Aerokat off her nose. Though I get it back on her face pretty quickly and make sure she takes six full breaths, she may not have gotten the full dose she needed. She's done this for the last two years, and it hasn't been a problem, so I always assumed she was getting enough. But it could be any other number of reasons for this flare-up.
            Her last big episode was early Wed. morning at 1 a.m. I called the ER to see if i could give a second puff of the Albuterol within a three hour period, or if I should run her over to get oxygen. the ER vet actually called her internist in the middle of the night, and ok'd the second dose of Albuterol, which I didn't have to use in the end. She hasn't had a bad coughing spell since (nearly two days). However, she's gone for two to three days and then it acts up again, so I'm being very cautiously optimistic.
            I'll ask about an anti-histamine. I was told cypro is also an anti-inflammatory and that I could double her daily dose.
            Pat


            [Non-text portions of this message have been removed]
          • mistaful_1
            Message 5 of 13 , May 7 5:54 AM
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              Hello all:
              >

              > I ended up taking Slickster to the vets again. It turns our his blood pressure is high.. The vet has prescribed Amlodipine .5ml per day. Also he is to get 1.5 tabs of Fortikor per day.
              >
              > We think he is acting this way (pacing) because of a headache. I have to admit there is a lot of action in the home lately, we sold our home in 3 days of listing it and moving in 2 weeks. So there is a lot of boxes and action in the home. The other reason we came up with is the weather, it has been cold and rainy in Southern Ontario for a few weeks, it could be that too???
              >
              > Or it is just the progression of his enlarged heart..
              >
              > Yesterday was a good day,(warm an sunny) he did less pacing even scratched the carpet and purred for me!!! Today (more rain) pacing and restless...
              >
              > Tammy & Slickster
            • mistaful_1
              Hello All: Yesterday I ended ended up getting Slickster some Tramadol for pain, and it did help lots. He is purring a meowing more... However he paced ALL
              Message 6 of 13 , May 8 4:08 AM
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                Hello All:

                Yesterday I ended ended up getting Slickster some Tramadol for pain, and it did help lots. He is purring a meowing more...
                However he paced ALL night, he would not settle down for bed at all!!!
                I will try to get him to nap during the day, looks like I have my work cut out for me.
                Hopefully tomorrow I will have more answers when he goes for his re-check..

                Sleepy Tammy & Slickster
                --- In feline-heart@yahoogroups.com, "mistaful_1" <mistaful_1@...> wrote:
                >
                > Hello all:
                > >
                >
                > > I ended up taking Slickster to the vets again. It turns our his blood pressure is high.. The vet has prescribed Amlodipine .5ml per day. Also he is to get 1.5 tabs of Fortikor per day.
                > >
                > > We think he is acting this way (pacing) because of a headache. I have to admit there is a lot of action in the home lately, we sold our home in 3 days of listing it and moving in 2 weeks. So there is a lot of boxes and action in the home. The other reason we came up with is the weather, it has been cold and rainy in Southern Ontario for a few weeks, it could be that too???
                > >
                > > Or it is just the progression of his enlarged heart..
                > >
                > > Yesterday was a good day,(warm an sunny) he did less pacing even scratched the carpet and purred for me!!! Today (more rain) pacing and restless...
                > >
                > > Tammy & Slickster
                >
              • Carol
                Hi Tammy, Maybe you can ask your vet tomorrow if Slickster can have buprenex. That s what we give Misty for pain when she needs it. The only side effect she
                Message 7 of 13 , May 8 8:02 PM
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                  Hi Tammy,

                  Maybe you can ask your vet tomorrow if Slickster can have buprenex. That's what we give Misty for pain when she needs it. The only side effect she gets is it makes her get a little constipated, so we have to make sure she gets enough water in her food. It also makes her sleepy. We give Misty injectable. It's really easy to do, just a tiny little subQ shot under the skin.

                  Carol and Angel Snowball *5/10/91 to 1/1/10*
                  and the gang
                  http://carolandsteveskitties.shutterfly.com/



                  -----Original Message-----




                  Yesterday I ended ended up getting Slickster some Tramadol for pain, and it did help lots. He is purring a meowing more...
                  However he paced ALL night, he would not settle down for bed at all!!!




                  [Non-text portions of this message have been removed]
                • D
                  Hi there, what dosage of flovent is your kitty on? My heart kitty takes 250mcg twice daily, and that controls her asthma quite well. They used to have her on
                  Message 8 of 13 , May 9 7:52 AM
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                    Hi there, what dosage of flovent is your kitty on? My heart kitty takes 250mcg twice daily, and that controls her asthma quite well. They used to have her on a lower dose, but it just wouldn't control her asthma. Since upping to the higher dose, she hasn't really had any asthma problems. I also have an albuterol inhaler for emergencies.

                    Also, I have always been told to make sure my kitty takes 10 full breaths of the puff. Also make sure you take the cannister completely out to shake it, to make sure they are getting a good puff.

                    --- In feline-heart@yahoogroups.com, Patricia Crawford <pwcrawford@...> wrote:
                    >
                    > Hi Adriann, I increased the Flovent last Saturday, and i got the Albuterol then as well and had to use it on Tuesday night. After her heart ultrasound and comparing it to the previous one, he thinks anything more than one puff within 24 hours could cause her heart to beat faster and put her into heart failure in her particular situation. What I would have to do is to give her Albuterol in order to get her to the ER, where they could then treat the subsequent failure in a hospital situation.
                    > It's hard to know what precipitated this flare-up. She was particularly resistant to the flovent with the previous cannister. She tends to hold her breath or take mini-breaths or knock the Aerokat off her nose. Though I get it back on her face pretty quickly and make sure she takes six full breaths, she may not have gotten the full dose she needed. She's done this for the last two years, and it hasn't been a problem, so I always assumed she was getting enough. But it could be any other number of reasons for this flare-up.
                    > Her last big episode was early Wed. morning at 1 a.m. I called the ER to see if i could give a second puff of the Albuterol within a three hour period, or if I should run her over to get oxygen. the ER vet actually called her internist in the middle of the night, and ok'd the second dose of Albuterol, which I didn't have to use in the end. She hasn't had a bad coughing spell since (nearly two days). However, she's gone for two to three days and then it acts up again, so I'm being very cautiously optimistic.
                    > I'll ask about an anti-histamine. I was told cypro is also an anti-inflammatory and that I could double her daily dose.
                    > Pat
                    >
                    >
                    > [Non-text portions of this message have been removed]
                    >
                  • mistaful_1
                    Hi all: I had Slicky to the vets yesterday for a blood pressure re-check. The last time he was there his numbers were 190/92 yesterday he was 164/89 this is
                    Message 9 of 13 , May 10 4:13 AM
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                      Hi all:
                      I had Slicky to the vets yesterday for a blood pressure re-check.
                      The last time he was there his numbers were 190/92 yesterday he was 164/89 this is still too high. My vet has suggested that I up his meds to 2 times per day and to re-check next week and to watch for any changes in his behavour.
                      I can tell he is feeling better he has stopped pacing and is much more affectionate so I think we are on the right track!!!

                      Thank again
                      Tammy & Slickster
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