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MJ
January 8th 10, 08:51 AM
This whole situation is in the past, but I'm still looking for
answers.

I'm interested in knowing why giving a 12 y/o, indoor only cat 100 mL
of Sub-Q fluids twice a week would cause him to become sluggish and
stop playing (his playing involved running around the house). About a
month prior, all blood work and urinary results were normal. An x-ray
was done at my request just to confirm everything was ok since there
was a history of stones, and the x-ray looked good. The vet did say my
cat had a grade 2 (out of 6) heart murmur. In the past, the vets (two
of them) had always diagnosed it as either a grade 2 or sometimes a
grade 3. They both said further testing wasn't necessary at that time.

The fluids were given maybe a total of six times to try to flush a
stone out of the ureter (the tube that connects the kidney to the
bladder). The sluggishness started after about the second or third
time. I complained so much about the sluggishness that the vet
relunctantly told me to stop giving the fluids. After my cat stopped
getting fluids, his sluggishness improved only a little. He would
play, but if his playing involved running, he would become tired very
easily and stop. His appetite and thirst seemed normal. He also seemed
to be using the litterbox normally, with no obvious increase or
decrease in urine production.

A little over three months later, my cat was taken to the vet for
lethargy and loss of appetite. X-rays were taken that showed fluid
around the heart. I was immediately sent to the internal medicine vet
who did an ultrasound. A diagnosis of right-sided heart failure was
made. Based on the poor to grave prognosis from the internal medicine
vet and the regular vet, as well as my own gut instincts, I chose to
euthanize my cat. After doing weeks of researching these medical
problems, I still stand by my decision.

Did the Sub-Q fluids cause the heart failure? I know it's possible my
cat could have had some sort of undiagnosed heart problem (like
cardiomyopathy), but he was acting perfectly normal until he started
receiving the fluids. So, even if he did have an undiagnosed heart
problem, it sounds like the fluids still caused the actual heart
failure.

Does anyone have any thoughts on this? I'm having a great deal of
difficulty finding anything about Sub-Q fluids causing heart failure.
The only website I can find that discusses this is one that is created
by cat owners who don't seem to have any veterinary training. I tried
to ask the internal medicine vet about what caused the heart failure,
but was only given the runaround, which I'm sure they do for legal
reasons. He did say the heart murmur should have had further testing
years ago.

Allan Smith
January 8th 10, 02:45 PM
MJ,

A stable, low-grade heart murmur is not indicative of any particular
cardiovascular condition, and, in and of itself, does not contrindicate
sub-cu fluids, though increased caution and observation is indicated, along
with close monitoring for any changes in the level or nature of the murmur.

I'd guess they were using Ringer's Lactate. It is certainly possible that it
could exacerbate an existing congestive cardiac condition while being
administered [1], but it is unlikely to cause one. Since congestive heart
failure is treated with, among other things, diuretics, an excess of fluid
volume could have increased the congestion, and due to increased pressure,
accelerated muscle damge due to constriction of the blood supply. That is
particularly true if kidney function was impaired and fluid clearance
decreased. But whether that did or did not happen can't be definatively
determined.

Of more importance to the behavior changes, what was the outcome of the
stone? An obstructed ureter can cause kidney pain, and it can be second only
to giving birth. One of my sisters had one and she will tell you in a
heartbeat the pain was only slightly less than having her first child, and
worse than having the second and third.

You also didn't mention the breed, some are more prone to congestive heart
problems than others.

If the cat was born before the late 80's, your cat's cardiomyopathy could
have been exacerbated by a lack of taurine in the diet. Taruine is an amino
acid that carnivores cannot synthesize as omnivores do. They must get it
from their diet, and if that diet does not contain organ meat, or is not
supplemented with taurine, it can lead to vision problems progressing to
permanent blindness, and condition called feline dialated cardiomyopathy,
but that is reversible with taurine supplementation.

All commercial cat foods that have the AAFCO approval label are required to
have taurine added (I think that happened in the late 80's). If you were
feeding a cat food with taurine added (it will apper near the end of the
ingredients list), taurine shouldn't be a factor. However, non-certified
foods and homemade foods may be deficient in taurine. Dog food is certainly
inadequate, as dogs are omnivores and can synthesize taurine.

All this said, I have to agree with the IMV that the persistent murmur would
have better been investigated earlier. Heart murmurs are not uncommon in
cats under 18 months old, but they typically disappear as growth and
development complete. Since the murmur was pre-existing, the defect was
probably congenital (present at birth). Whether the fluid, or a taurine
deficiency, were contributory, or to what degree, cannot be known. Nor can
it be known whether medication would have mitigated the normal progression
of the defect or disease. My sense is that if the IMV thought vasodialators,
beta blockers, angiostatins, or diuretics would have been helpful at that
point, he would have said so.

Congestive heart failure can be caused by many factors, including coronary
artery disease, heart attack, high blood pressure, heart valve disease,
heart muscle disease, infections of the heart valves or muscle, or
congenital defects of the cardiovascular sytem or the heart itself. Most of
the above have a remarkable onset, that is, suddenly appear. Obviously,
congenital issues are present from birth.

We've had 19 cats over the last 50 years (we will take in cats, usually
older, with diseases or conditions that require a 'nursing' level of
attention), and have had to make your decision a number of times. When that
desision must be made, it isn't about us, its about the cat. It isn't about
past events, its about future quality of life, or the lack thereof. I
commend you for trying to learn from the past, it is the only way the past
can positively contribute to the betterment of the future. But, IMO, your
decision was the correct one, and certainly the one I'd have made under
those circumstances.

Allan

[1} Relationshhipof hydration and heart physiology may be found at
http://www3.interscience.wiley.com/journal/119819256/abstract?CRETRY=1&SRETRY=0

--
One asks, many answer, all learn -- Plato, on the 'Forum
---
True civility is when every one gives to every other one every right
that they claim for themselves.

"MJ" > wrote in message
...
> This whole situation is in the past, but I'm still looking for
> answers.
>
> I'm interested in knowing why giving a 12 y/o, indoor only cat 100 mL
> of Sub-Q fluids twice a week would cause him to become sluggish and
> stop playing (his playing involved running around the house). About a
> month prior, all blood work and urinary results were normal. An x-ray

MJ
January 9th 10, 07:20 AM
Thanks for responding.

My cat was a 12 y/o (born in '97) Maine Coon mix and I believe he was
also part Himalayan. The heart murmur was diagnosed when he was 5. He
may have had one before then but I don't have the records from the
original vet and he never said anything about a murmur.

The internal medicine vet said the ultrasound showed mitral valve
regurgitation and right sided heart failure. There was also impending
left sided failure. There was a dilated left atrium and auricle. The
records from the primary vet show that during some exams there was a
murmur (usually grade 2) and other times there was no murmur.

At the time Sub-Q fluids were given, the right kidney was enlarged but
the ureter was not blocked, according to the x-ray. Sometime after
this, he developed two additional CaOx stones. I'm confused by their
location. The ultrasound findings show a bladder stone, a right kidney/
pelvis stone, and a gallbladder stone. I have no idea which one is
considered to be the pre-existing stone in the right ureter. I believe
the two additional stones were caused by a change in food. The vet
changed the food and even though it's formulated to prevent CaOx
stones, it also acidifies the urine. The label specifically says it
shouldn't be given to cats with renal failure, which my cat did not
have at the time he started this food.

The records from the primary vet show a differential diagnosis of
hydronephrosis and hydroureter. The internal medicine vet did not say
whether there was an obstruction. However, the "good" kidney (the left
one that was still working) was very small and shrunken to the point
of the vet having a hard time finding it during the ultrasound.

What I find confusing and interesting is that 2-3 days before he died,
the vet didn't hear a murmur. When I listened to his heart, there was
some "whooshing" sound present that was so loud I could barely hear
his heartbeat. Considering he was most likely in heart failure 2-3
days before he died, it seems like this would have been noticed by the
vet during the exam. And as I'm writing this I just remembered that I
had also noticed he looked bigger than normal (like he had put on
weight). I'm guessing that was from the abdominal fluid. I had
mentioned this "weight gain" to the vet who just ignored it.



On 8 Jan, 09:45, "Allan Smith" > wrote:
> MJ,
>
> A stable, low-grade heart murmur is not indicative of any particular
> cardiovascular condition, and, in and of itself, does not contrindicate
> sub-cu fluids, though increased caution and observation is indicated, along
> with close monitoring for any changes in the level or nature of the murmur.

Allan Smith
January 9th 10, 03:32 PM
NJ,

>My cat was a 12 y/o (born in '97) Maine Coon mix and I believe he was
>also part Himalayan. The heart murmur was diagnosed when he was 5. He
>may have had one before then but I don't have the records from the
>original vet and he never said anything about a murmur.

http://www.petmedsonline.org/heart-disease-and-blood-disease-in-cats.html
Note its prevalence in Maine Coons, and that it develops in young and
middle-aged cats, and is not always detectable early-on.

>The internal medicine vet said the ultrasound showed mitral valve
>regurgitation and right sided heart failure. There was also impending
>left sided failure. There was a dilated left atrium and auricle. The
>records from the primary vet show that during some exams there was a
>murmur (usually grade 2) and other times there was no murmur.

The dialated chamber is amost always present in cases of mitral valve
regurgitation. Some inflammatory causes of regurgitation result in
variabilily of murmur grade, depending on the current degree of
inflammation.

>At the time Sub-Q fluids were given, the right kidney was enlarged but

I'm snipping some of the reminder, for brevity. Basically, there were two
issues going on - kidney and heart, and treating one would probably worsen
the other. It is quite probable that the two were related, he heart issue
appearing first, and the kidney later. The heart issue could be congenital,
or could be the result of an infection, whether strep as in rheumatic fever,
or endocarditis. It is probable that only an autopsy might have been able to
discern which it was.

The same is true for the sudden development of kidney disease. There is a
part of me that thinks the two are related, possibly the result of the same
infection, or the kidney issues developing from an existing heart condition
and/or the tiny blood clots that infections (particularly strep) can
produce. But without a complete blood count including white-cell
differentials perhaps showing elevated monocytes and eosinophils, it is
impossible to conclude.

> I'm guessing that was from the abdominal fluid. I had
>mentioned this "weight gain" to the vet who just ignored it.

It is possible that serously reduced fluid-clearance capability could have
resulted in increased retention, and that in turn exacerbated the congestive
failure. I'm surprised your vet doesn't weigh every presenting patient,
every time. Sudden weight changes are important cues.

Reviewing all this, the IMV's opinion that the murmur would have been better
pursued earlier remains the most salient observation. In my
non-veterinarian and non-medical personal opinion, murmur suddenly
developing in a young cat, even one with a breed-predisposition, should be
evaluated by a CBC with Platelet Differentials to rule out detectable
infection, then by an ultrasound if no infection is indicated, to determine
appropriate ongoing treatment.

All that said, I don't think the eventual outcome would have been much
different, it is more a question of when than if. The only possibility I can
see is that if an infection were promptly detected and successfully treated
early, the heart and kidney damage done might have been minimized, and if no
infection, any congenital cardiac condition managed appropriately.

Allan

--
One asks, many answer, all learn -- Plato, on the 'Forum
---
True civility is when every one gives to every other one every right
that they claim for themselves.


"MJ" > wrote in message
...
Thanks for responding.


On 8 Jan, 09:45, "Allan Smith" > wrote:
> MJ,
>
> A stable, low-grade heart murmur is not indicative of any particular
> cardiovascular condition, and, in and of itself, does not contrindicate

The Nice Mean Man
January 11th 10, 02:10 AM
On Jan 8, 3:51*am, MJ > wrote:
> This whole situation is in the past, but I'm still looking for
> answers.
>
> I'm interested in knowing why giving a 12 y/o, indoor only cat 100 mL
> of Sub-Q fluids twice a week would cause him to become sluggish and
> stop playing (his playing involved running around the house). About a
> month prior, all blood work and urinary results were normal. An x-ray
> was done at my request just to confirm everything was ok since there
> was a history of stones, and the x-ray looked good. The vet did say my
> cat had a grade 2 (out of 6) heart murmur. In the past, the vets (two
> of them) had always diagnosed it as either a grade 2 or sometimes a
> grade 3. They both said further testing wasn't necessary at that time.
>
> The fluids were given maybe a total of six times to try to flush a
> stone out of the ureter (the tube that connects the kidney to the
> bladder). The sluggishness started after about the second or third
> time. I complained so much about the sluggishness that the vet
> relunctantly told me to stop giving the fluids. After my cat stopped
> getting fluids, his sluggishness improved only a little. He would
> play, but if his playing involved running, he would become tired very
> easily and stop. His appetite and thirst seemed normal. He also seemed
> to be using the litterbox normally, with no obvious increase or
> decrease in urine production.
>
> A little over three months later, my cat was taken to the vet for
> lethargy and loss of appetite. X-rays were taken that showed fluid
> around the heart. I was immediately sent to the internal medicine vet
> who did an ultrasound. A diagnosis of right-sided heart failure was
> made. Based on the poor to grave prognosis from the internal medicine
> vet and the regular vet, as well as my own gut instincts, I chose to
> euthanize my cat. After doing weeks of researching these medical
> problems, I still stand by my decision.
>
> Did the Sub-Q fluids cause the heart failure? I know it's possible my
> cat could have had some sort of undiagnosed heart problem (like
> cardiomyopathy), but he was acting perfectly normal until he started
> receiving the fluids. So, even if he did have an undiagnosed heart
> problem, it sounds like the fluids still caused the actual heart
> failure.
>
> Does anyone have any thoughts on this? I'm having a great deal of
> difficulty finding anything about Sub-Q fluids causing heart failure.
> The only website I can find that discusses this is one that is created
> by cat owners who don't seem to have any veterinary training. I tried
> to ask the internal medicine vet about what caused the heart failure,
> but was only given the runaround, which I'm sure they do for legal
> reasons. He did say the heart murmur should have had further testing
> years ago.

Man, you worry too ****ing much.