Qbert has CHF

[geojlc]

Thank you for the encouragement.  I love that your greyhound came home with more toys!  :-)  

 

[geojlc]

Tomorrow is Qbert's appointment, but he has started to perk up a lot the last few days.  I don't know if it's the new antibiotics or the diuretic finally starting to do something, but he has been up more, eating better, playing occasionally, and snuggling more.  He's not struggling to breathe as much and generally acting like he feels at least some better.  He still gets tired a lot sooner, but I'll take tired & feeling better any day!

Hopefully the X-rays tomorrow show improvements as well.  

 

[Columbine]

Everything crossed for tomorrow :cross: It's so good to hear that Qbert is feeling better. I really hope his x-rays reflect this positive change

 

[geojlc]

Well, the news from the vet is mixed.

The good news is that his blood pressure is back up closer to normal.  I learned that normal cat BP is 120ish.  2 weeks ago, Qbert's blood pressure was 75, and 1 week ago it was 80.  This week it was 100.  The other good news is that his bloodwork came back pretty good, with only 1 value slightly elevated.

The not so great news is that his X-rays continue to show progression of the CHF.  The radiologist reports that his heart looks bigger, and that congestion seems to have gotten worse in his right rear lung area.  But, at the same time, the radiologist seemed surprised that Qbert had been perking up recently.

My vet & talked about several options.  Qbert is currently near the ceiling of treatment options, so there isn't much she wants to do to change that.  We decided to do another x-ray next week (around the 14 day mark of the antibiotic) to see if there is any improvement.  If there is not, we'll back off X-ray based decisions and move toward making decisions based mostly on how Qbert is acting/feeling.  As long as he isn't in breathing distress and is continuing to stay perked up, we'll keep going as is.  

This is both easier and harder.  It's easier because I won't be anxiously waiting for the next X-ray to see where we are.  But it's harder because there is no way of knowing how long we'll be in this phase.  It's still holding pattern, but, like when our Lilly hospiced in renal failure for 5 months, it will become the new normal around the house until it suddenly isn't...  However, he has so far not really reacted to things the way anyone has expected, so maybe he'll go a while.  :-)  Who knows.  

In other news, the vet reported that he's doing well during his extended stay.  They are generally keeping him in the treatment area so that they can watch him better during the day.  He's calm and hanging out at the front of the kennel watching while he's awake.  I'm feeling much better about my decision to board him at the vet.  They all adore him and are giving him lots of love

 

[Columbine]

It sounds to me that the vet's results are pretty positive. I know it won't feel that way to you, but the CHF showing visible signs of progression on the x-rays is just part of the disease. I think its a good plan to back off the testing and treat Qubert according to observational data - that's what we did with Cali and are doing with Pixie. Testing can help you feel more in control of the situation, but it isn't going to change anything. The big thing is quality of life, and no veterinary testing can determine that for you.

Its great that his blood pressure has stabilised, and that his bloodwork is ok. I'm really pleased he's happy when inpaitent too. It sounds like he'll do great being boarded there while you're away. It sounds like a really great bunch of people too, and that always helps.

Forget about wondering how long this will go on for. Especially after my experience with Cali, I was devastated to hear about Pixie. At first I wanted to know specifics (how long will he last etc), but we've settled into a routine. The best advice I can give is don't think about the future. Just take things day by day - stay in the moment with Qbert. If you spend too much time worrying about the future you won't be able to enjoy the time you have. When its time, its time. For now, enjoy the good days.

 

[geojlc]

We are home with our Qbert.  He scared us while were gone by going into breathing distress on Friday afternoon.  The vet's office wasn't comfortable leaving him un-monitored overnight and over the weekend, so we decided to transfer him to the nearby (and highly recommended) 24/7 critical care facility.  He spent a night on oxygen and then improved back to previous breathing levels.  He was really well taken care of and really happy to see us when we picked him up this afternoon.  

They had some suggestions to talk about with my vet at our appointment tomorrow.  They also changed his clavamox (antibiotic) to one that is similar but only once a day and easier on his stomach.  

I am so glad to have him home.  Qbert rested for a while, moving around to be near where I was working on unpacking but otherwise not doing much.  Then he did a couple racing laps around the house and is now baffing himself on the desk next to me.  

Now to go to another appointment tomorrow and make some more going forward plans.

 

[Columbine]

I'm so glad Qbert's doing well now. Racing around the house is JUST the kind of thing I like to hear

I know how scary respiratory distress is - oxygen can make such a huge difference when it occurs. So glad he came through it well.

It must be so good to be back with him now :9:

 

[geojlc]

Even better, the x-rays today showed a really big improvement!  The vet had to make sure the techs x-rayed the right cat!  :-D   

The vet is going to consult with the cardiologist and we'll make plans for going forward.  I know that Qbert isn't magically better, but I'm so grateful that we'll get to have some more good times with him.  

Next up is working on figuring out giving the long term meds in a way that won't turn into a fight every time.  My vet & I talked about some options, and I might look at trying to put everything in a single capsule so there is only 1 pill to take at any given time.  

 

[Columbine]

That really is fantastic news

If Qbert hates pills, you might find he tolerates liquid meds better. Cali HATE taking pills, but didn't fight me with syringing liquids into his mouth. Just something to bear in mind.

 

[geojlc]

Well, things got complicated again.  

Tuesday morning we celebrated really good looking X-rays, but by that night I was worrying about him not eating--refusing both breakfast & dinner that day.  When he only ate a few bites plus gravy on Wednesday morning, I took him back in to the vet.  She thought (and I very much agree) that all the meds, especially the antibiotics, were upsetting his stomach & messing with his GI tract.  Especially since he wasn't eating enough to get the fortiflora (pro-biotic) into him.  She said she wanted to give him a cerenia (anti-nausea) injection and that she hoped that would get him eating again.  I asked if we could keep him there and have the techs get a meal into him.  She agreed with that idea and that it would take a couple hours.  When I called back after 3 hours, they said he hadn't eaten yet but that he could go home.  I was tired and just wanted to go home for the day.

(as a grump note, I was hoping they would get food into him, not just put food in front of him & hope he ate it...  But I didn't specify that, so I didn't complain)

I added his mirtazipine (appetite stimulant) as soon as we got home, but he still refused dinner.  When he refused breakfast again Thurs morning (yesterday), I took him back to the vet and explicitly told them I was worried because it had been 2 days with no more than a couple bites and that the cerenia & mirtazipine still hadn't helped, and that I wanted them to syringe feed him & get calories in.  Happily, they were happy to do that, and the vet came out to tell me she had finally been able to get in touch with the cardiologist for a consult.  They decided to pull back on the meds and discontinue the antibiotics.  Since his lungs were looking a lot better, getting Qbert's stomach feeling better and him eating again was more important than finishing the antibiotic course.

The vet says that it can take a week (give or take) for Qbert to feel better from antibiotic upset and for his GI tract and hunger meter to reset.  

So, it looks like Qbert will be spending his daytimes at the vet getting several syringe fed meals and then coming home at night.  I was going to try to learn how to do the feedings, but the report yesterday was that he didn't take to the feedings all that well.  I just know that he came home and gave me an unusual 'leave me alone' mrow when I tried to pick him up.  I decided at that point that I wanted to minimize the unhappy making things that I have to do to Qbert so that he doesn't associate me so much with discomfort and disliked activities.  I would rather pay to let someone else have that honor...

I'm hoping that this med change and feeding will give him time and space to break the 'I'm not feeling good so I won't eat/not eating doesn't make me feel good' cycle.  I'm hoping that he is able to perk up and find his happy (or at least his comfortable) place again.  I hope that this isn't him telling me he's done, although I will honor that if he doesn't perk up after the changes & a reasonable amount of time.  I hate seeing him unhappy, and where he is this moment isn't quality of life.  But we did make a change that has a good chance of helping him feel better.  So I will continue to hope.

 

[Columbine]

I'm so sorry to hear this news. It's so frustrating, worrying and upsetting when they won't eat. I so hope that pulling back on some of these meds will be enough to bring Qbert around. Syringe feeding isn't easy, but once you've found the knack it becomes much easier. I haven't resorted to that since I was a kid though - with Cali I'd just put bite by bite into his mouth on the bad days. Once it was in, he'd usually be a god boy and swallow it for me...or at least lick gravy or chicken juices with a little meat in. Pixie is the same - I often have to get meals into him by physically placing it in his mouth, smearing it on his tongue so it doesn't fall straight out again. Its gross and messy, but it often works. Maybe worth a try before you next go to the vet's office.

You are both in my thoughts. Please let me know what happens.

 

[geojlc]

Thank you so much.  The good thoughts and ability to talk about this craziness with someone else who has experience it helps a lot!  

I just talked to the vet tech.  She said they got a good breakfast mixed with probiotic into him earlier and that it went much better than yesterday.  She is going to try offering his next meal to him on a plate before moving to syringe feeding.  

This morning before we went to the vet, I did get him to lick gravy off his lips and then take a couple bites on his own before refusing anymore.  I'll try more of that tonight.  (I tried a couple times to open his mouth & put food in, but he started reacting like it was pill time and actively worked on spitting the food out...)

The vet said they are also adding in a small amount of daily pepcid ac to help with possible stomach acid build up from changing kidney function (this last bloodwork panel showed that all 3 kidney values have inched up just barely into not normal.  It's something we are going to keep monitoring).  She said that should also help him feel better and make eating easier.  

The good news is that the tech commented that she was happy to note that Qbert's breathing is a lot calmer today than it was last week when he was boarding.  They are very happy to see that part! 

Here's to my baby feeling better soon.

 

[Columbine]

I'm so glad that Qbert's breathing is a little calmer and that he's showing a little more interest in food.

CHF really is a roller coaster at times. I'm glad that I'm able to be of some help.

Here's to Qbert feeling better soon

 

[geojlc]

Qbert ate breakfast! It was only around a tablespoon of food made soupy, but be he ate it enthusiastically and then ate a bit of gravy out of another small serving immediately afterward. I wanted to run around the house crowing "he's eating, he's eating, he's eating!"

Now he's back in the blanket fort I made him last night when we blocked off his favorite hidey hole, and I'm feeling much more hopeful. Come on buddy, you can do it!

 

[Columbine]

I know that euphoric 'he's eating' feeling all too well. I really hope the volume and quantity of meds was what was causing him to lose interest in food. Keep going, Qubert!

 

[geojlc]

Qbert is continuing his upward trend.  He's now eating from the free range kibble bowl between meals, and is eating bigger portions of wet food before walking away.  (much to the dismay of the other cats who were more than happy to finish Qbert's bowl off when he was done.  :-)

Even better, he actually jumped up in my arms for snuggles earlier today.  His formal name is Qbert Calcifer Snugglehunter because (before he got sick) he loved hunting snuggles and jumping up into my arms for them.  He hasn't felt up to snugglehunting in several weeks and I was afraid I wouldn't get anymore.  

I feel like we have maybe turned a corner and gotten closer to a place where we can work on managing his chf & HCM rather than just reacting and trying to keep one step ahead.  Next up is his appointment on Tues for bloodwork to see how his kidneys (and liver and electrolytes and all the stuff) are reacting

I know he's not magically better and that things could change again, suddenly even, but I'm grateful for all the good days and snuggles I can get!

IMG_3443.JPG

• geojlc
• Aug 30, 2015

 

[Columbine]

That is SUCH great news. It's always such an amazing feeling when they re-find their appetites - I don't think Ive ever been so happy to see an animal eating as when Cali got his appetite back to the point where he was mugging mum for her meals again! Of course, it wasn't for ever, but that made it mean all the more. Make the most of Qbert Calcifer Snugglehunter (who is truly stunning, btw) feeling more like his old self again. Get all the snuggles you can! :rub:

 

[geojlc]

Well.  It's been a roller coaster of a week.  At our appointment last Tuesday, the vet said Qbert's lungs and heart sounded really good and that we might actually be able to call him stable!  Then, Wednesday, I noticed him breathing hard again.  I took him back in, and another X-ray and found the beginnings of fluid at the edges of his lungs.  Also the blood vessels going from his heart to his lungs were looking enlarged, probably with more fluid backing up.  We put him back on antibiotics hoping that they might help the same way they did last time.

The rest of the week was full of rough breathing and monitoring and continuing to encourage him to eat.

At the vet this morning, we had a difficult conversation about odds and chances.  His lungs sound the same as last Wed.  The bloodwork from last week is showing that his kidney values are still inching up (not to failure levels yet, but definitely above normal and starting to get to problematic levels).  He is having a lot more labored breathing at home, even if it isn't distressed enough to rate an ER visit.  

The vet thinks, given his trends and patterns over the last month and a half, that Qbert isn't likely to get to a stable and manageable point.  The most likely scenario is a roller coaster much like the last couple weeks, where rads and bloodwork and home observations look good for a few days or maybe a week, and then he swings down again.  Those roller coasters are hard on all of us.

We decided that it's time to stop trying to get him to a stable point and to start hospice care.   We're starting this week by pulling back meds to just the ones that are keeping him comfortable and safe (vetmedin, furosemide, plavix, and some pepcid AC to help with stomach acid build up).  We're also moving the meds around a little to make it so there's only 3 pill sessions a day instead of 4.  Then it's observing good vs bad days and trying to make decisions.  The vet gave some suggestions for rating days and using those ratings to help understand when the bad days are outnumbering the good days. 

The good thing about all of this is that it doesn't seem like Qbert is in pain.  He's mostly tired, with occasional discomfort from labored breathing.  He also doesn't seem to be afraid.  I'll take small blessings, wherever I find them.

We don't know how long the hospice portion will last.  Unless things change a lot this week, I suspect sooner than later.  I don't want to force him to wait until he's miserable all the time, or until there is nothing left but the tired.   This choice hurts, but the care is also exhausting.  I'm tired right along with Qbert.

Thank you all again.  It has been really helpful to talk with other people who have gone through this.  It helped to have a place to say "this week was awesome!" or "wow, I hate dealing with this" and be understood

 

[AbbysMom]

I'm so sorry to read you have reached this point with Qbert. Anyone that has dealt with this disease will easily understand your decision, as hard as it may be.

I hope the rest of your time together is peaceful. :heart2:

 

[Columbine]

I'm so, so sorry that you've reached this stage of care with Qbert. I hope he has a peaceful and happy time from this point. I know just how hard this decision is. My heart goes out to you both. Remember - we're still here if you need support/reassurance or just want to vent!