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CHF With Pulm Edema In A Cat

by equinesportsmed - November 19, 2019 View Case Report

Mouserou is a 13 year old MC DLH who has a long history of seizure disorder that is always barely under control in the winter (see below). Last night he did not eat well, and this morning would not eat at all. He was breathing rapidly-- 45 bpm from early this morning, and has seemed lethargic since cold weather set in a few weeks ago. I examined him briefly in passing, gums were pale-ish, but not sure if that is typical for him, cap refill was <1, increased inspiratory effort. I am hopeless at feeling pulses in cats, even though I practice on my own kitty nightly, so no info on pulse. I encouraged owner to take him to ER, where they found fluid on heart and lungs. He did better on O2 and Cornell plans to pull off some fluid, and send him home on diuretics and prepare them for the worst.

He is on phenobarbital, pregabalin and gabapentin BID, monitored by Curtis Dewey from Cornell Neurology. (I believe there is a psychomotor aspect of his seizure disorder, because it is triggered by his twisting to lick thoracic spine, and started after a 9 month episode of severe itching on topline maybe 8 years ago) In the winter, he wears a backwards cone to prevent him from triggering seizures but still has 1-2 a day. In the summer he is seizure free, and has not started seizing this fall. A few years ago, I tried him on CHJLGMLT, no response. He's also tried high dose CBD, no improvement. I was thinking about trying a KI yin tonic this winter as preventative, when this episode happened today.

Mous is a fairly cooperative guy and well loved. I will check again on tongue and pulse when he comes home tomorrow. Meanwhile, I was thinking about True Warrior (Zhen Wu Tang) vs XFZYT. His seizure pattern is so weird and seasonal, I have to think that KI is involved. He literally stops having any issues starting April, every year. He spends all day outdoors lying in the sun, then shifting to the shade briefly to cool off. Kim Henneman suggested lithium, another thing to try this winter, but I did not anticipate the complication of CHF. Any thoughts on where to start?

by naturevet

November 21, 2019

Hi there,

Zhen Wu Tang is a consideration. It most fits CHF in cold weak patients with rapid heart rates - in short, the kind of patient we used to use digitalis in. you don't mention how rapid his heart sounds are, but given the tachypnea, it seems a decent bet that he has tachycardia as well, and might thus benefit from Zhen Wu Tang.

Zhen Wu Tang can conceivably help deal with the seizures, too, if you add Gui Zhi (Cinnamon twigs), perhaps 15g per 100g. That change will enhance the formula's diuretic properties in pulling off fluid, and will help expel the seizure-causing Wind pathogen from the spinal column (that is apparently pushing deeper into the Tai Yang during the winter months)

Hopefully this helps. You may have to do more than this as the case unfolds, bringing in other formulas. But it should be a safe place to start

Steve

Zhen Wu Tang

by equinesportsmed

November 21, 2019

I added an update but hard to tell whether I was on the original case I entered or the new one that the Forum question had me make— (hmm... software should let us ask a question on existing case!)

Anyway, the sad story is that when Cornell did thoracocentesis to relieve fluid in his chest, they found he had restrictive, not congestive HF, AND that his right lung lobe had torsed while floating collapsed in fluid and was dead tissue. So we brought him home on diuretics and opioids and are trying to keep him alive at least until Saturday when Joanna gets back from her trip. He is quiet but seems to be comfortable, is drinking a little and eating chunks of raw beef liver— his favorite. The pros say it’s just a matter of time until that lung goes septic, and he’s too weak/compromised for surgical removal.

by naturevet

November 21, 2019

Then this is a case for Xue Fu Zhu Yu Tang. It may help restore normal pulmonary circulation. With such a grim outlook, best to load him up if you can! Double or triple doses perhaps

S

by equinesportsmed

November 21, 2019

Thanks, will try! The problem with treating cats is... treating cats. But these folks really want a miracle, so will try anything.

by equinesportsmed

November 25, 2019

Cat is stable, surprisingly, which makes me question the diagnosis. In human medicine, a torsed lung is usually diagnosed when it becomes septic, which tends to be fast and furious. He's been on a double dose (0.6 ml of Kan tincture) TID since evening of 11/21. Will update the case notes. Started miralax (gentle osmotic laxative) on 11/20 to combat opioid ileus. His appetite was diminished on 11/23, and he was straining to defecate. But still enjoyed going outside in the sun. This morning, he passed some diarrhea and chunks and seemed much more comfortable afterwards. Owner discontinued the butanorphone yesterday, and he does not seem painful. Low energy, but gets up every few hours to pee and drink.

by equinesportsmed

November 25, 2019

Cat is stable, surprisingly, which makes me question the diagnosis. In human medicine, a torsed lung is usually diagnosed when it becomes septic, which tends to be fast and furious. He's been on a double dose (0.6 ml of Kan tincture) TID since evening of 11/21. Will update the case notes. Started miralax (gentle osmotic laxative) on 11/20 to combat opioid ileus. His appetite was diminished on 11/23, and he was straining to defecate. But still enjoyed going outside in the sun. This morning, he passed some diarrhea and chunks and seemed much more comfortable afterwards. Owner discontinued the butanorphone yesterday, and he does not seem painful. Low energy, but gets up every few hours to pee and drink.

by naturevet

November 25, 2019

Consider also Minor Bupleurum, then (Harmonize the Qi) given the GI symptoms

S

Xiao Chai Hu Tang

by equinesportsmed

December 5, 2019

Now that the kitty is seeming to plan to stick around, we are wondering what to do next. Weighing the stress of taking him in for imaging compared to the possible benefit of what we could learn-- it hardly seems with it. Since the pulmonary torsion diagnosis is questionable, I am wondering whether the "constrictive" cardiomyopathy is also off base, in which case, perhaps inotropic medicines would be indicated? The only tincture I had on the shelf was Jia Wei Xue Fu Zhu Yu Tang, so that's what we gave, and hey, he's still alive!! He does hate it though. I got in some Zhen Wu Tang, but have been reluctant to make changes. No problem with the mail moving now that he is no longer on opioids. I never did add any XCHT, because of the difficulty of dosing him, and the direction it was already resolving. His appetite/willingness to eat has been slowly improving-- they hope he will eat from a bowl again soon, instead of being hand fed. Any thoughts on continuing care?

by equinesportsmed

December 10, 2019

Wondering whether to continue with XFZYT or shift to a different formula for maintenance. Maybe a Yin tonic, like Celestial Emporors Blend? He's still an ancient guy, but he seems 80-90% back to what he was before this episode.

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