Re: some questions and nyc cardiologist rec?
- Hi Adriann,
Sorry for the late response, a lot happened, I had to take Ziggy back to the vet again because of gradual increase in bpm after wheezing. His radiographs show improvement from the day he was discharged with minimal fluids present, but right lung looks overall hazy and this time we still could not tell whether it's the lower airway disease flaring up or the beginning of chf. We will be getting his re-echo done early next week to get a clearer idea.
>He didn't. I don't think neither us or the vet thought of that. I know the ER clinician said she snuck a peek with the echocardio but didn't give any definitive statement on it. We should have, seeing how much more meds he has to take and we are not even sure what's going on.
> Did he have an echo at this time? An ultrasound probe will tell you if there is pleural effusion or not. It is distinct on ultrasound.
>Ziggy's 9-10 yrs old, his kidney is normal according to his bloodwork few months before his 1st chf. His renal values remain normal after starting Lasix and after 2 chf episode(now it's 3). We just got his new chem screen results back and everything came back down within normal limits :D!! Even his sodium level when before it's a bit high.
> > 1. What are the questions I should be asking at kidney recheck? How do I help maintain kidney health?
> How old is he? Were his kidneys normal (shown by normal urine specific gravity and blood work) to begin with? It is important to remember that Lasix is NOT toxic to kidneys. It is not toxic to kidneys, it does not kill kidney cells or anything like that. Lasix causes a "pre-renal" azotemia. Azotemia means elevated BUN and creatinine. Pre-renal means that it's not the kidney's fault. So his kidneys are working well, but the Lasix has dried him out and caused a pre-renal azotemia.
>I was thinking, if there is no x-ray to confirm clearing of all fluids, how will we be able to adjust his meds basing it only on renal values? (Or I am just in denial and dislike the idea of having him stay on this higher dose of lasix, which looking back at all the questions is really the case. (Ziggy's 6.2kg)
> For cats on Lasix, the most important thing they can do is continue to eat well and stay hydrated through food and water.
> > 2. How does rechecking renal values help without rechecking x-rays?
> I am not completely sure I understood your question here, so I'm sorry if I'm off on the wrong tack. You're checking renal values to make sure he is tolerating his meds. If he is, you can have them adjusted by the cardiologist when you see her, based on how well his CHF is controlled. So if he's not having trouble breathing and his potassium/renal values aren't crazy, waiting for the cardiologist is ok.
>Yes they are. Ziggy can be confusing when he is so playful to the point where he knows no restraint until it gets really bad. If he does stop with certain routine, that means something is very wrong. We were lucky we were able to find out about his chf quite early for the last two episode. It's just that he is such a difficult/non-typical case to manage(so we've been told over and over), we are still trying to find the best way to keep him stabilized. There's always the complication of suspected asthma and other underlying lung disease.
> It's possible that a little fluid is left with a normal breathing rate. The trouble with cats (more so than dogs, again) is that they are masters of self-restraint. A dog who is building up fluid can't help himself from racing to the door when you get home, and then you notice that he's out of breath and coughing. A cat, on the other hand, will restrict her own activity so that she doesn't get winded. You might not notice that she hasn't had the zoomies in a while, or she may be sort of a couch potato to begin with. Sometimes cats come into the hospital with a massive amount of pleural effusion, and the family only noticed a problem the night before. Now 1/3 liter of fluid didn't pour into that cat's chest the night before, for sure. She was building it up but being quiet about it. Her respiratory rate *would* have gone up before the night before, however, which is why you are checking at home.
>When a HCM cat has heart murmur, does that automatically mean they have the obstructive type? Or some cats may have it without murmur? Ziggy has level 2-3 murmur before and went up to 4, according to specialist report, after he was diagnosed with HCM.
> > 4. Atenolol
> > I was wondering if any of you currently use Atenolol for your cat and your experience with it.
> This is used primarily for cats with the obstructive form of HCM (these cats have murmurs, other HCM cats don't) when the obstruction is significant. There is no evidence that it helps cats with HOCM, however.
>Dr. Sophy Jesty sounds great and quite convenient for us to travel to. And you are right, her appointments are very limited, she is only at Fifth Ave. Vet Specialist 3 days a month. The earliest is not available until 2/11. I was told she is now teaching in Colorado.
> It's up to you if you feel you need a second opinion. Unfortunately, Dr. Petrie only does mobile practice now and doesn't meet with clients except at the Animal Specialty Center in Westchester. I'm not sure if he meets with clients there, either, or just does the echo. The best cardiologist in NYC (IMO of course) is Dr. Sophy Jesty at Fifth Ave Vet Specialists. She's board certified and experienced, and clients like her. There are a few others in the city, but one isn't board certified and another (I've heard, I don't know for myself) may not have the best bedside manner. Unless you're already seeing her, of course :) She's only part time now so her appointments aren't always easy to get.
>Yes, his CBC was run by an outside lab this time but I'm not sure of the ones taken by the specialists. I was told that Ziggy is mildly anemic(I think based on the HCT count: 28.5(his mcv is also a bit low at 36) but his number has stayed the same at every CBC we ran after chf so vets said we are ok not to do anything at this time.
> The BUN and creat aren't unusual for a cat being treated with Lasix in hospital--I wouldn't worry if it were my own cat, to be honest. The PCV is on the low side, though. This is unrelated to heart disease and might be a problem with the test. Did he have a CBC run at an outside lab? Do you have those results? If so, what is the HCT? (HCT and PCV are almost the same thing.)
> Hope this helps.Greatly. I feel so much calmer & clear headed after reading your response and the other's. Thanks.