My boy William has Late Stage Congestive Heart Failure/Heart Disease

I posted last night as part of another CHF thread, but it felt like I was hijacking another person's (albeit old) thread, so I am starting a new one. 

A few weeks ago I left for an appointment, and fed my outside boy William and his feral wife Ace before I left. When I came home an hour and a half later, Ace was at the door. I opened it and William bolted in and laid down in the next room. I thought he was spooked by something. Long story short, about two hours later I heard a meow and saw William at my feet in yet another room, laying on his side. Then he tried to jump up on my chair and when he fell down I realized he was in bad shape and his back legs were not working. 

My husband and I took him to our regular vet's ER, where he was diagnosed with saddle thrombus and CHF. A blood clot in his heart and lungs had broken loose and traveled to his spine, blocking blood flow to his legs. We were referred to several cardiologists only to find there was a national convention and nobody was in town. We went to a specialty center who had vets with cardiology training but were not cardiologists. They did an ultrasound and diagnosed him with final stage heart disease/CHF and gave him days/weeks and not months, to live. We were sent home with prescriptions and told to make him comfortable and feed him anything he would eat. 

In the next day or two William regained use of his legs except one is a little bit limpy. We had let him outside and he was languishing under the deck, waiting to die. We pulled him out and brought him inside and started actively treating him. Over the last few weeks we have settled into a routine where every day I chase him around and he gets as many meds as I can push into him plus 35ML of prescription A/D. I let him outside but he no longer lives out there and he mostly comes when we call him. Yes I am in agony when he is not inside. He is only getting half of his thyroid prescription and half of his lasix- however he has lost a lot of weight so this may be now closer to a correct dose. 

I called to schedule him with a regular visiting cardiologist and my doc said maybe go to Blue Pearl and get in thru the ER. I went ahead and talked to them yesterday bc in the morning William seemed a little stiff and not very happy. But then during the day he got a lot better, even like his old self. 

Last night I posted on TSC bc I started to rethink if I should take him. I have trepidations about ERs plus he is already diagnosed as being in his final days. My main concern was his lack of eating, because he cannot subsist on 32 ml of AD daily. 

To make a long story short, I  woke up this morning, got completely ready, came downstairs and William was eating crunchies just fine. He changed almost like a light switch, altho we saw good improvement later yesterday too and more eating. So-  I decided not to take him. I would have had to go thru the ER. I would not have seen the cardiologist. William would have only been referred to her via the ER. I decided to wait another day and see how he is doing. She will be there tomorrow too.

When I called them, I told them I had a flat tire but wanted to know when the cardiologist would be there again in case I can get a ride or come another day.  They lectured me first that I have no appointment so why am I even calling. Second, that if he is in critical condition he must go to ER and it would be wrong for me not to stabilize him. I said he has meds and a diagnosis of late stage heart failure and our main concern is that he is not eating. She said "we can take care of that".  I said thank you for all the information, he has been to 2nearby  ERs and he has meds and we are an hour away and were coming for the cardiologist ER consult primarily, but I will still try to get there, get a ride if I can. 

As far as the 2 ERs, one was at his local vet and the other at VSC in Buffalo Grove. He has already had an ultrasound and xray and been diagnosed. Before I took him to the second ER, I called them to discuss what could be done for him, and they told me they could put him on IV to dissolve the blood clot. This was actually not true, but I am thankful they did not try to do anything that would not be good for him. So in speaking to this latest ER, I realized whoever I was talking to had no idea what they were talking about, and in fact normal stabilizing, i.e. fluids, could kill him. 

With late stage heart failure I am also very worried Wiliiam might have a heart attack during the hour long drive to the center as he HATES going to the vet and usually does a lot of open mouthed panting.  

Finally, I can't bear the thought of my boy sitting in another ER especially when we have already been told by another specialty center, albeit an internist who specializes in cardiology but is not a cardiologist, that he is in final stages and has days and weeks left, not months.

This is the first time I've ever done this, but my gut is saying don't do it, especially when he seems to finally be responding to his meds and getting a routine going with his new "normal". 

If there is anything William needs that he is not getting, I would love to hear from anyone as far as treating a CHF kitty. He is on plavix, lasix, methimazole (thyroid meds), pepsid, and they also gave me blood pressure medicine but the regular doctor said his blood pressure was not bad at the regular vet and it might have just been his upset at being in the hospital. Plus I am giving him 35ml of A/D daily. 

Also I picked up a bag of fluids after consulting with his regular vet as far as giving him a tiny amount, 35ml only if he is dehydrated, which so far he doesn't seem at all dehydrated. I'd appreciate any info in this area too. 

Sorry I am babbling, but I always second guess myself. I have gone the extra mile so many times for my cats. This time it just seemed like I was doing it more for me and not him. I hate not knowing exactly what is happening to him and I want to fix whatever might be wrong. But I just can't bring myself to go to ER an hour away for a more definitive description of where things stand with William who has already been diagnosed. So we will wait until the nearby cardiologist can see him, if he is alive by then. Nothing will cure him, I guess that is my biggest deciding factor. :-( I just don't want his end days to be hard on him. 

I think you're doing the right thing by waiting to see a more local cardiologist; stress is the last thing William needs. As you said, you already have a diagnosis and there's no cure. He's eating and taking most of his meds right now. Even a cardiologist won't be able to say precisely how long he has left - we went down that road, too, and Jamie lived 13 months longer than expected, with a pretty good quality of life interspersed with short-term crises.

It's going to be a roller coaster ride either way. All you can do is keep him as comfortable as possible and enjoy the time you have left together.

Thank you jcat, I thought the same thing. He is outside now enjoying a cool rainy day. When I called the ER I got a bad vibe from them too. I almost hung up before talking, I was so on the fence about telling them I wasn't going. But then what they said made me glad I had done it. They were very clear I would not see the Cardiologist. I just didn't like the way it was going. If I could get an appointment right now, a normal cardiologist appointment, I would do it, but this other way is simply not right, and I just do not trust my boy in the hands of ER staff being poked and prodded. I can take him locally for a blood test and to get his current values, weight, blood pressure, thyroid, pulse etc. 

I really appreciate your insight and experience. If he passes away today or tomorrow or the next day, I am certain it will not be bc we didn't go today. 

For what it's worth, I'd have made the same decision too. The focus should be on quality of life for the time he has left. Hanging around an ER would only make him feel worse.

Cali got in such a state once after waiting forever at the vets that we had to rush him back that night for oxygen. Calm environment is key. We used to try and book in for the first appointment of the surgery (either early morning or first after lunch) to ensure we wouldn't have a long wait. The vets were pretty good about it.

If William does start to pant regularly, it might be worth knowing that asthma meds with an aerokat made a huge difference to Cali...he went from death's door to almost his old self, and it gave him an extra couple of months of reasonable-good quality life.

Whatever happens between here and the end, know that you're giving William the best possible care, and he knows it.

I cared for my CHF kitty a couple years ago.  She was already hyperthyroid as William is, but the trouble was her new diagnosis we were focused on was kidney disease.  We were less focused on the CHF, although that in the end we think is what she died from, some kind of heart attack, clot or similar.

Amber was never on Plavix but she did take Lasix (and methimazole, of course).  Balancing the fluid treatment needed to help her CKD with the need to remove fluid because of the CHF was, well, I don't think we did it well actually.  So if you do anything with fluid, be really careful in amounts I think.  

Anyway, long story short, one thing you can check on is whether he would be a candidate for use of Vetmedin.  This is a drug labeled for use in dogs so far but is seeing increased use in cats with CHF and having good results.  Reports are of improved quality of life, etc.  If I went through this with another cat I definitely would inquire about it.  Other than that, I think you're making the right call trying to keep his stress down.  Definitely no need to go to ER vet unless he is in crisis, and it doesn't sound like he is.  If you need another vet opinion (and it's not wrong to get one, certainly), particularly from a cardiologist, that might make sense.

Apart from that, things are just as you say.  You keep him comfortable for whatever time he has left.  If he still eats, still gets to the litter box, still gets around and enjoys your company and such, that is good.  My vet had warned me that the CHF was an "any time" sort of thing, and in the end he was right.  She lived a couple months after the diagnosis, and it wasn't all the best quality time either.

Keep an eye on his breathing, that can be the thing that causes him not to eat and would be related to the fluid buildup in this case most likely.

This post is a little disjointed but I hope maybe something in there helps.  Hang in there, it's a tough thing to go through.

This info is really very helpful! William is doing even better, he is eating his wet food now too, so almost normal! I know he won't be cured but I'm happy to see him feeling so much better. I'm going to call our regular vet and see about staying with the regular cardiologist. I hope they help make it happen.

I am just updating on my boy William. He is still alive and doing well. When we saw the cardiologist, she prescribed Vetmedin which did not work for William. I learned it has  a caffeine-like effect, causing the heart to pump more vigorously which can cause anxiety in some animals. We elected not to use that for William as he was diagnosed as late stage anyhow, and the medicine said it was not recommended for late stage CHF (some controversy of increasing severity of damage). 

What we did use for William was a) Benazapril (ACE inhibitor) to help his blood vessels stretch open and carry more blood; b) furosemide (Lasix) a diuretic, to cause more peeing and help eliminate fluid buildup caused by inability of the heart to pump sufficiently; c) Clopidogrel (Plavix) which is a blood thinner that helps to keep clots from forming when heart does not pump blood vigorously enough; d) methimazole for his long standing hyperthyroid; and e) 5 mg pepsid daily so that all these meds did not hurt his stomach. 

I started by crushing all his meds and mixing them into a 6-12 ml syringe with watered down AD (which is basically Ensure for animals). William HATED THIS and after a short while he did everything to avoid his daily syringe. Since he has lived most of his life outdoors (he was feral and his outdoor wife is still outside and feral and cries for him) we had a hard time getting him to come in for his syringe of meds. 

Ultimately we ended up doing what another family did for their kitty and which I thought was not ever in the realm of my wildest dreams. We went to a compounding pharmacy, bought 60 #1 white gel capsules, and then took all the meds and loaded them into one standard size (for an adult!) capsule. (IMPORTANT- This is where it is useful to do things like buy 20 mg tablets of pepsid so that you only need to put 1/4 into the gel cap. Same with clopidogrel, make sure they give you the pill that can be cut into quarters for your pet's dose so the pill size is the smallest possible for the correct dose- as opposed to 1/2 a 10 mg pepsid, for example which is a physically larger pill). 

Originally I was still crushing the pills and putting the powder into the capsule, but found I could actually just stuff the pills themselves into the capsule which was much better for getting the actual amounts and not leaving a film on the crusher or particles that belonged inside our cat and not on the counter. 

The capsule, since it is large can be easily pushed to back of mouth by approaching kitty from behind, holding his head up and back, and hooking pill with your right pointer finger from side of mouth into back and then pushing it. I also used a water chaser before and after. And if you can catch your kitty quickly, it also helps to coat the pill in butter spray as it slides back easier and kitty cannot use the barbs on tongue to push it back out as easily because it is no longer the way gel caps get sticky when wet. It just slides. 

We still needed to give William a second pill, i.e. his methimazone at night along with more lasix but we did not do that at first, as this medicating was a tremendous adjustment in his life and he does not like to be given pills! And as a result, over time and in about this last month, as his heart pumped less, he accumulated fluid buildup in his stomach. His tummy swelled out like a little balloon that was going to burst. He never panted or coughed, but we could see something was wrong and that he had to lay in awkward positions to be at ease. We took him to the vet. Rather than draining the fluid from his tummy she gave him an injection of lasix because he was not yet in respiratory distress (had this been the case, he would have been drained). And she told us he had to get one full lasix in the AM and another half at night. 

This is the regimen we are now doing. It is easier this time because, since his original diagnosis we have slowly been keeping him more and more inside, and he has shifted to the routine of coming in at night and then going back outside after he gets his morning meds. Then he comes in at night and gets the evening meds and we usually keep him inside after that depending on the weather and what time of night he comes in (if early we let him back out and then in again right before bed, or overnight outside and he comes in early morning). His wife Ace is always calling for him and waiting for him so this is a sad outcome of his illness. But he has a lot of kitties inside who love him. Ace his wife is the one who is suffering without him :-(. 

For his evening pill we use a much smaller #3 capsule and put one methimazole and 1/2 lasix in there. That pill is way easier and last night butter spray made it easiest I've ever given him.

Some kitties may take their pills using thin lunchmeat like low sodium chicken. I also recommend Natural Balance perfect bites chicken or salmon flavor. Be sure to feel the bag that they are fresh. They should be soft and maleable and they are like pill pockets except your kitty will not get tired of them so quickly like they often do with pill pockets.

William has lost a lot of weight over time with his disease, but this seems very common in both animals and humans. He still eats plenty. For anyone else who has cats on this regimen, I have noticed that William definitely needs food within either right away or minimum 1/2 hour after his morning pill with all the meds in it. And also I was giving him 35ml of "slushy" AD/water by syringe initially, just to make sure he was getting enough fluid and nutrients and keeping his appetite up. I still do that whenever I notice he is not eating quite enough along with making sure his tummy is not retaining fluid. My vet recommended it to keep organ functions stable. I discussed with her that I am balancing the fluid retention and AD in a way to make sure the latter does not aggravate his fluid retention and she agrees. 

So this is the long saga. When he was first diagnosed in late May, I was told that he had late stage extensive heart disease and CHF, multiple clots, he had gone through a saddle thrombus, and that he had days or weeks to live. Now it is almost 7 months later and he is still with us. He is slowly fading, but his life is happy and he absolutely wants to be part of everything. The little bugger drives me crazy because he still RUNS away when it is pill time. He will push himself and be panting when I corner him. I try everything not to have to do this but it still occasionally happens and makes me cry from anxiety that he will throw a clot and just keel right over. But we are talking quality of life and I cannot confine him to that extent- saving his health and destroying his happiness. 

My husband and I have to be in Naples FL in late January and if he is still with us, I am extremely concerned that he will be thrown off his routine and kick the bucket. I have no choice however. Also my family just asked us to come east for Xmas. Not sure we can do that but will try. Either that or fly them to Chicago. We deferred all our usual summer trips this year to be with our little boy. I guess we will just keep taking one step at a time. 

Anyhow I hope this update helps anyone with a CHF cat. My strongest advice is just bite the bullet. Unless your kitty inhales meds hidden in treats or lunchmeat (never use their regular food) just use the big gel capsule- don't give up even tho it seems horrific, it is easiest on everyone. Butter spray the capsule just before you give it, and make sure to syringe a tiny bit of water to hydrade kitty's mouth before and again after, to help wash it down after. 

That's a wonderful update.  I'm so glad to hear that William is still with you!  I don't blame you for being worried about him if you go on a trip.  Like you said, one step at a time.

Keep loving on that little boy.      He's a lucky little cat to have someone like you taking such good care of him.

Here are his pictures, all of them taken from June on through the present. He has lost about a third of his weight all told, and he is very thin now, but is still maintaining. He is the black kitty and that is his wife, Ace who is the brown tabby and who loves him so very much!! She is grooming him in the picture of them together. He used to groom her, but she took over once he got sick. At first he tried to be by himself, but now he understands that she wants to be with him as much as possible. 

I also took a picture of me making the capsules. Now I use a pill holder and sort them all out, but at first I just did them like that. Anyhow it may help a kitty in the future ;-). 

And last is William getting his pettings from me at night (this was during the blackhawks stanley cup playoffs ha ha me wearing my hawks shirt!) He hates his pills so much, but he wants to come in and get his petting and have us dote on him- which we do. 

what a beautiful boy, and you and your husband are beautiful people for taking such good care of him. He is lucky to have you in his life. It is so sweet that Ace has stepped up to care for him too. 

My William passed away on January 11th, almost 7 months from his diagnosis. I am putting this account of what happened on this thread so that anybody who has a kitty with CHF and is actively treating it, may know what to expect in the later stages of this disease as well as paying attention to the meds and monitoring responses to any adjustments. William was late stage when he died, but anyone with a newly diagnosed kitty needs to know that at his diagnosis he was given days or weeks to live by a specialty center and his regular vet did not hold out much hope either. This turned out to be NOT TRUE, he lived a great life and 7 more months of true happiness. If your cat takes meds fairly easily, don't give up on them and see my earlier post about gel caps.

Also, Other threads have mentioned oxygen therapy and I might have tried that if I had thought to get some in advance, if there was a chance that it would have stabilized him. In cases of saddle thrombus, blood clots can often be dissolved fairly rapidly with plavix (blood thinner), so long as your kitty can breathe and the thrombus is new, you buy them that extra time just by giving them the blood thinner and have a very good chance that they will be walking again within 24 hours. 

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I just did a thread edit to add what another poster said as far as treating oxygen therapy/breathing problems. They recommended aerokat commonly used for feline asthma. If I had a newly diagnosed CHF cat and/or had to do this over,  I would stock up on that ahead of time and have it handy, even if you just need to use it so your cat is comfortable on a trip to the vet. http://www.vetrxdirect.com/product/...UWW_ljxT76-C5etzC0MgzjdOPWk0pNwb7QaAmh98P8HAQ

Here is what happened:

He was inside, under the glass dining room table when it happened. John had fed him MINUTES earlier and left for work and saw him there under the table, laying on his back- he might have just even had it happen right then. I think the cleaning people freaked him out big time. Anyhow what happened was he got a saddle thrombus again, a blood clot which broke loose from his lungs and lodged in his spine, completely paralyzing his back legs. The cleaning lady pushed her vacuum at him (she reenacted this for me bc she did not speak english) and he dragged himself by his front paws up the cat stairs in our living room and started crying at the top of his lungs, which brought me downstairs. I got blood thinner pill in him to try and break up the clot, and took him to the vet. There they put him on thermal mat and gave him more pills ie vet medin and lasix to get his heart beating and fluids out of him, plus some sedation, heated blankets, and oxygen with the intention of stabilizing him for me to then  get him to his cardiologist in Northfield per their direction. However, after over 2 hours they still could not stabilize him, he could not breathe on his own without the oxygen mask,  and his body temperature at 95 was precipitously low and not warming up. I asked about bringing oxygen home and see if we could give the plavix and other meds time to work. They said they didn’t have oxygen to take home like that. They then called and consulted with his cardiologist who said in this situation the prognosis is never good. So I had to let them euthanize him. I was there with him and he was trying to rally, kind of like any heart failure person who is trying to live, totally aware, but their body can’t sustain them L. I should have brought his body home to Ace but I was in total shock because I had taken him to the same vet 4 days earlier and got a wonderful report, so I was completely expecting that he would recover from the thrombus like last time.

 

I think what happened was that, he had been experiencing right ventricle failure, a symptom of which is accumulating belly fluid (versus left ventricle which is chest fluid pushing on lungs).  The docs insisted I give him more thyroid suppression meds, ie. his normal dose but he had lost a lot of weight. This caused him to accumulate more belly fluid, to where we had to have him physically drained. At that point they DID cut his thyroid in half, but they also upped his heartbeat medicine via a pill called Vetmedin which makes the heart beat more vigorously, and they also upped his lasix for fluid elimination. I believe these actions caused blood clots, which were sitting there all along in his other (left) ventricle (which was also documented originally as being in failure) to dislodge, as the vet medin pills sometimes do that and are not recommended for late stage failure- they are not even approved for use in cats but are commonly used. Bottom line, he was in late stage heart failure and on his last legs after surviving 7 months. When I took him there 4 days earlier, we did not xray him or do blood test, bc heart failure can be so delicate that the upset like what happened with cleaning people can push a patient over the edge.  I had told the doctor at that time I wanted to be sure as we would be leaving town and she had said you can come back closer to when you go, if there are any symptoms.

 

I am ETERNALLY GRATEFUL that if it had to happen, it was this way, with me right there, because we are leaving January 26^th  for Florida and it would have surely happened then otherwise- one little cat fracas and he would have had the thrombus with nobody there to help- and it is extremely painful. Also William being an indoor-outdoor cat, I would have been torn apart trying to find him outside in sub zero weather. He was so loving to have made the decision to stay inside the night prior. 

 

Ace, his feral outdoor wife, is extremely depressed and anxious but she is eating every day and coming for food. She cries for him. I will try and put some of his ashes out there in case she can smell that it is him. I asked them to shave some of his fur off for Ace, but didn’t think to just bring him home. She isn’t really paying attention to his fur. I am pretty sure she knows, however. The night before it happened, she was crying for him and came into the house almost to the Christmas tree where he was laying by the window. He did not get up for her and she cried for him and then went back outside. I thought it was strange he did not get up (nor the evening before) but it was so arctic outside I thought that was maybe why, that he was letting us all know he was bedded down for the night. He did get up for his pill after a few minutes though, and went outside and looked around for her, but did not go into their house. He came back in after about a minute. That was his last outside.

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Oh my goodness Barb, I am so, so sorry You gave him a wonderful life, and he knew he was loved. I have tears in my eyes as I type this. My heart goes out to you, and to his lovely wife Ace too. He was a truly special boy.

Rest in peace, William, you gorgeous boy
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I'm so very sorry for your loss! Poor William, but I'm so glad he had you with him.

On behalf of the TCS Team, we offer our condolences on the loss of your sweet boy.  We'll lock the thread now out of respect for your loss.  Please consider posting a tribute to William in our Crossing the Bridge forum.