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RCM and Kidney failure

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  • bspringsted425
    Hi everyone. It s been a while since I posted here because things were looking good with Wendy for a few months. Now things are looking bad again though. We
    Message 1 of 3 , Mar 24, 2014
      Hi everyone. It's been a while since I posted here because things were looking good with Wendy for a few months. Now things are looking bad again though.

      We have a vet appointment tomorrow morning but I'm always curious to hear personal experiences. Wendy was diagnosed with RCM back in August when she went into CHF. We were told the medicines she was taking could cause kidney failure but until now we had been lucky to avoid that. As of a few days ago she started showing signs of kidney failure. I initially thought the heart disease was just progressing and her kidneys didn't cross my mind at first, but after doing some research today she has most of the classic symptoms of kidney failure so I'm very prepared for the vet to tell me thats what this is when we see him tomorrow.

      I know that treating kidney failure along with heart disease is hard to do, but has anyone had any success with it? I have a feeling that we might be at the end here and I'm trying to prepare myself to say goodbye to Wendy, but I'd like to hear anyone's experience with both diseases.
    • Elfinmyst
      Hi I had this with Milli. She had a severe heart problem and went into kidney failure at christmas. We had her treated for a week on a drip successfully and
      Message 2 of 3 , Mar 24, 2014
        Hi

        I had this with Milli. She had a severe heart problem and went into kidney failure at christmas. We had her treated for a week on a drip successfully and the kidney failure was acute. I will be honest, we lost her to heart failure the day she was due home. Fluids are risky in a heart cat but I don't regret what we tried to do, we gave her a chance. Milli was only 7. 
        Please read Tanya's wonderful kidney disease site, it gave me all of the information I needed . There are two main types of kidney failure. Acute is what Milli had and was a result of her drugs, it happened suddenly overnight.
        Chronic is much slower and can be controlled. A lot of people here deal with both issues, there are options to reduce the lasix and add spironolactone or even give sub q fluids. 
        I was told it depends on the cat. Milli had mid level reading but was bright and alert.
        Sauce was miserable and unhappy and stopped eating, we had tried fluids, it failed and we let her go peacefully. Talk to your vet, but read Tanya's site, it's invaluable. 
        Lyn  (search for Tanya feline kidney)
      • hemizonia
        Hi- Years ago, I had a cat named Weena (after the young woman in the Time Machine. ). She was a milk chocolate tortie point siamese. I learned so much from
        Message 3 of 3 , Mar 26, 2014
          Hi-
           
          Years ago, I had a cat named Weena (after the young woman in the "Time Machine.").  She was a milk chocolate tortie point siamese.  I learned so much from her.
           
          When Weena was 8, she somehow got into a bit of antifreeze (thanks to stupid significant other who is now EX-).  She did recover, although she lost one entire kidney (it atrophied, just shriveled right up).  Her other kidney was badly damaged.  With diet, she did well, her creatinine in the mid-2s.  Then when she was 12, her kidney #s started going up.  Doc wanted me to give her subq fluids.  Prior to doing so, Weena had a cardiac ultrasound done.  It was normal.  So I began giving her 75 ml subq fluids every other day.  She was always such a snuggler, but she fought fiercely soon after a few doses.  I didn't understand why.  She was so compliant, so sweet.  3 months later, I realized she was trying to tell me something.  The fluid challenge caused a latent genetic defect to manifest in her heart.  By the end of December 2000, she was in critical CHF and was rushed to the ER where the doc told me she would not last the night.  I told them to treat her, no matter what.  She was not ready to give up.
           
          The next morning, she was sitting up, wanting food.  I got her to a cardiologist right away.  He said that she had left ventricular non-compliance, meaning that the left side of her heart could not expand and adjust to fluids (that's the side that pumps to the body ... the right side pumps to the lungs).  She also had secondary pulmonary hypertension due to the "back flow" into her lungs.  He told me that it was going to be very difficult to treat both heart and kidneys.  That's when I looked him straight in the eyes and told him that I would not turn my back on Weena.  Tell me what to do and how to do it.  And so he did.
           
          With RCM, the heart can not adjust to changes in circulating volume.  When you give subq fluids, the fluid is absorbed into the circulation at a rate dependent upon the degree of dehydration present.  If the cat is more dehydrated, fluid enters the circulation faster.  It doesn't matter that the change is towards a more normal state.  It's the absorption rate that matters.
           
          I found that small doses several times a day did the trick.  Weena could tolerate only 25 ml per fluid dose; I used smaller gauge needles to keep the flow slow and drops countable.  I would sing out the number of drops to her as I held her.  She no longer fought getting fluid.  Her cardiologist said that small amount would hardly be enough to help the kidneys.  But I gave that dose 2 or 3 times a day.  I counted drops; the volume was too small and she was too sensitive to go by the lines on a fluid bag.  Once I mis-counted and gave 26 ml.  She started going into CHF.  Having a home office helped; I could monitor her fluid pouch.  When I couldn't feel fluid any more, I'd wait an hour for any that I couldn't feel to be absorbed, and give another dose.  Doing it this way, she maintained a more even state of hydration; fluid wasn't sucked into her system so quickly.
           
          With the ok of her doc, I started giving Weena Q-10, 50 mg per day.  Her episodes of CHF became less frequent and less severe.  I tested the boundaries very cautiously, 1 ml at a time.  She was able to tolerate 30 ml.  Doesn't sound like much, but if you think about it, that's a 20% increase.
           
          Weena needed to be on atenolol ... her cardiologist said to maintain her heart rate between 100 and 120 ... slow for a cat.  But she needed that slower rate for her stiff left ventricle to fill.  Weena was also on lasix, but because of her kidneys, she couldn't take it every day.  Instead, we used spironolactone/HCTZ as a maintenance diuretic.  She got a dose of lasix about twice a week, and whenever she looked like she was going into CHF.
           
          I consulted with an holistic vet about her kidneys.  He recommended a whole list of supplements to put her on.  These were mostly anti-oxidants, but also several supplements that might stimulate kidney regeneration.  Now you're never going to be able to grow more kidney cells.  However, you might be able to cause existing cells to become larger, effectively increasing the filtration area.  There's also ways to help clear creatinine and BUN through the GI tract.  No, you won't see a creatinine go from say, 5 down to normal or anything dramatic like that.  But it will help.
           
          Many, if not most, of the adverse effects seen with CRF are due to oxidative stress.  The metabolic wastes retained in the body from poorly functioning kidneys are potent oxidizing agents.  For example, the normal life span of an RBC is about a month.  With kidney issues, the life span can drop to only 2 weeks.  The anti-oxidants help reduce the effect upon the body due to CRF.  If you are interested, go to PubMed online and enter search terms like "oxidative stress," "kidney failure", etc.  You'll be surprised at all the clinical studies out there supporting the use of anti-oxidants in CRF.
           
          I had oxygen at home for Weena.  She took great delight in sleeping under a blanket ... perfect for dosing her with oxygen.  I'd sneak the tubing in under the blanket with her, flow pointed at her nose.  She got oxygen several times a day for an hour or so.  I had spoken to the cardiologist about this.  Oxygen is one of the best drugs for reducing pulmonary hypertension which can not be treated by giving the usual anti-hypertensive medication.  When the BP within the lungs is high, fluid can "leak" into the air sacs, causing pulmonary edema and CHF.  Giving the oxygen a few times a day seemed to simmer things down just enough to make a difference.
           
          I was able to balance both heart and kidneys for 2 years.  What took Weena in the end was related to her heart problem, but it wasn't CHF.  She threw a shower of tiny blood clots.  While in my arms, she suddenly began to seizure.  I rushed her to the vet.  She was awake, alert, but groggy.  She spent the night in the ER for oxygen, treatment and observation.  She was able to come home the following day.  We thought the situation was over.
           
          After 3 days, I noticed that her once nicely pink mouth was pale.  I took her to the vet.  Within 3 days, her HCT had dropped from 35 to 17.  She had immune-mediated hemolytic anemia.  What happened was that all those tiny clots lodged throughout her body and caused needle-point areas of dead cells.  Her immune system went haywire trying to clean things up.  She was destroying her own RBCs.
           
          Anemia doesn't go well with a bad heart.  Causes oxygen deficit (giving oxygen doesn't help ... there's not enough RBCs to carry the oxygen).  Weena got a transfusion .... not whole blood ... that would be too great a volume for her heart to handle.  She got packed cells, which are just the RBCs.  That brought her HCT up close to 25, and she did much better.  But 3 days later, she was back down to 17.  It seemed that is where her immune system would tolerate the number of RBCs.
           
          Weena survived for 6 weeks following the clotting incident.  The doctors think she might have gone into DIC (disseminated intravascular clotting) because of the immune system malfunction.  Now there is treatment for DIC; in 2002 there wasn't, or at least, not for Weena.
           
          I strongly urge you to get Wendy on some kind of anti-coagulant.  I know that Weena would surely be gone by now, but I feel that had she gotten an anti-coagulant, she would have lived longer.  When she passed away, she was within 1/2 lb of her life-long body weight.  She had been happy, quietly active, and no one would have guessed by looking at her that she was anything else than a healthy, happy cat.
           
          If you would like a list of Weena's supplements, I can send those to you.  Show them to your vet.  I can also give you the contact info for the holistic vet, if you'd like a telephone consultation with him.  Or visit a holistic vet in your area.
           
          In the Feline Heart files, there should be a guide on how to do a respiratory assessment without using a stethescope.  I wrote that for myself so I could monitor Weena better.  I've shown the guide to several vets, and all agreed that it was valid.  My vet once accused me of having "x-ray eyes" because I knew so well when trouble was coming.  If you can't find the guide in the files, let me know and I will send it to you.  Changes in cardiac/CHF status are reflected in how the lungs are working; signs can be quite subtle and still tell you what's happening.  I know I saved Weena from a full-blown CHF episode many times simply by watching how she was breathing.  A dose of lasix, a bit of oxygen, and all was good again.
           
          It takes a lot of monitoring and attention, but treating heart and kidneys can be done.
           
          mary & angel Weena (September 2, 2002, 14 years old)
           
           
           
          In a message dated 3/24/2014 12:04:27 P.M. Pacific Daylight Time, bspringsted425@... writes:
           

          Hi everyone. It's been a while since I posted here because things were looking good with Wendy for a few months. Now things are looking bad again though.

          We have a vet appointment tomorrow morning but I'm always curious to hear personal experiences. Wendy was diagnosed with RCM back in August when she went into CHF. We were told the medicines she was taking could cause kidney failure but until now we had been lucky to avoid that. As of a few days ago she started showing signs of kidney failure. I initially thought the heart disease was just progressing and her kidneys didn't cross my mind at first, but after doing some research today she has most of the classic symptoms of kidney failure so I'm very prepared for the vet to tell me thats what this is when we see him tomorrow.

          I know that treating kidney failure along with heart disease is hard to do, but has anyone had any success with it? I have a feeling that we might be at the end here and I'm trying to prepare myself to say goodbye to Wendy, but I'd like to hear anyone's experience with both diseases.

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