Nobody's really sure just what is going on with him... His lungs are pretty clear, heart wasn't doing anything shocking, but moved from rapid breaths to abdominal (labored) ones while we were waiting to see the on-call vet.  They gave him a shot of Lasix, and his breathing started slowly improving again, enough that the vet felt it would be safe to send him home for the night.  I was iffy about it, though, so I proposed that we give him a couple of hours in the oxygen cage, to give him the best possible chance of staying home all night (rather than needing to be rushed back in). I came home for a rest & to get a few things done while they do that.  He'll also go right back onto antibiotics tonight, since it seems like dropping those might have made things even worse.

Generally, we're trying to stall until his cardiologist gets in tomorrow morning, as we're hoping she will know what to do, or what to give him.  I'll get a progress-report call in a little while, then this evening we'll go get him unless things get worse.  He refused to eat his meds while I was there, so he's going to be running late with those as well.

I think the subject line says how my talk with the cardiology nurse went.  The answer was essentially "I can't tell you to increase his medications, so you're supposed to just stay with 1.75 two doses and 2 for one dose, and if he starts getting worse then bring him back in."

On the other hand, it turned out that when they said "two days" they meant two full days, not the six doses that would occur in a 48-hour (two day) period.  That alone might have thrown things out of whack, since he wasn't due to reduce his dose until this afternoon.  Then again, maybe it didn't; it could be the inexplicably "wet" ear that doesn't even look like it's bothering him.

When I wrote this (forgot to hit "post") he was resting on my bed, flat on his side even though he's not supposed to have any inclination to do when having lung problem, and had quite happily eaten all of his medicated food again today.  (Usually during a decline, he starts avoiding food; heart problems tend to make cats nauseous, not sure about other species.) This morning, he was really energetic -- couldn't get at me at one point because something was in the way so he simply bounded over it, then later he was doing the feline game where they pretend a toy is alive and tag it with a forepaw before leaping to the other side & grabbing it again to fling it into the air, bouncing to go claw enthusiastically at his tall scratcher & rubbing against it. :)

I ran out for a few hours to get canned/dry cat food & human meds, and just got back a few little bit ago... He greeted me at the door, then we spent a while with him purring deeply while we played together & I petted him.  He just had a bit of fun stalking Chai and is still trill-talking from that, though she's grooming herself on the bed.  (I'm giving the blow-by-blow in part to illustrate how strange the gap between heart & behavior is right now...in part because him merely being up & around gives me a little hope.)

Oops, time for his early-evening Lasix/furosemide dose... I watched his breathing, wasn't satisfied (he was about the same as earlier) and decided that for now, I'm going to hold him on the 2 pills.  If he's already messed up, I fear that going down to 1.75 will cause a real crisis.  We'll see how he is tomorrow morning, since I won't reduce on the 1:30am dose either.

Let's keep our fingers crossed or whatever keep-the-good-thoughts-up things we can...

So, Bastian continued to make steady improvement today, so that I wasn't seeing any trouble even with exercise, so as the cardiologist instructed, I dropped back to 1.75 pills for his 7:45pm dose.  Checked on him at around 11:00pm while we were interacting, and noticed his breathing looked a little odd again; it was starting to become visible as he slept in my lap about 11:40pm.

That isn't what I wanted to see.  He shouldn't have sharp deterioration that quickly; while I can give him his full night meds right now (a little past four hours after his last Lasix dose), the schedule is for them to be given at 1:00am -- and I should be able to blow that one without seeing any change.  So something is going seriously wrong...

I took a look at everybody else's breathing, then his again, then the others, and tried to get a really good feel for where he's at.  I don't want to disobey orders and give him more medication than I've been told I can, so I want to be SURE I'm doing the right thing if I do that.  But it's the middle of the night, and the next scheduled dose won't be for 10-12 hours after this one...  Have to weigh my caution with "he seemed to get worse after only a few hours on the 1.75 dose" with "am I being paranoid and seeing more of a change than was really there" which might be a real issue, given the way every sneeze or odd look has sent me scrambling the last few weeks. I'm also paranoid about kidney damage from the Lasix, however.

I'll call ACC tomorrow morning, and ask to talk to either the cardiology nurse, or whatever internist is on-duty... His doctor's limited availability means she's not even on-site the second half of the week, so Monday's appointment is the first chance I'll have to actually talk to her about this.  I also am hoping that the on-duty emergency vet (if that's who I talk to) is Dr. S, who we saw last week; she used to be a bit of a pain two years ago, but she listened to me when we were there (despite the chest films only showing a "possible slight trace of fluid"), and tracked down the specialist without being asked. (It bugs me a lot that the only way to be listened to by vets in my area is to establish in advance that you know what you're doing.)

I'm hoping that it's possible that changing his other medications -- Enalapril & Atenolol, both which help his overall function -- could control whatever process is mucking everything up like this.  It's also possible that the two-pill dose simply wasn't carried out long enough, or that it wasn't a high enough dose; had he been hospitalized, he would have been put on a larger dose of IV-delivered Lasix for a few days, then come home after he was totally dried out.  We're essentially trying to make his normal regimen do the same work, and it isn't going over as planned.

We never got a callback about the bloodwork results... I am hoping that if something was seriously out of whack (like his kidney function) they would actually have contacted us.  Guess I'll have to ask about that, too, though I've never had to before.

What if this is all because I've had to put him on the Natto, instead of Lovenox, so many times because of the damn Canadian-pharmacy delivery issue?  Maybe it isn't good enough, and the thicker blood is wearing his heart out more?  Or that I didn't give him his Omega 3v supplement often enough?  A hundred what did I do wrong, please let there be a way to fix it thoughts are racing around in my head... I was feeling more up-and-productive earlier today, before his breathing changed again, but I'm really down now. 

About to go to bed once again, but wanted to give a little update on what's going on...

Tuesday morning, Bastian still wasn't "recovered" yet, despite two rounds of the higher dosage of Lasix... I called over to the vet to warn them that it didn't look like the two doses were enough, then got his normal dose into him while waiting for a reply.  As the hours went on, he worsened again (at first his breathing was quiet if he rested without purring, then even that was problematic) until I decided to call and demand a change in his medication, since clearly he wasn't getting what he needed.

After talking to our longtime cardiology nurse, who had already consulted with Dr. M, we decided on a more aggressive regimen.  Now we're going to be doing two full days of 2 pills 3x/day (i.e. six doses rather than two), then move up to 2 pills each morning, 1.75 for afternoon, 1.75 at night.  I hope, hope, HOPE this is enough, and that it works. I'm terrified that this is the end, and he'll fail to respond to diuretics or that the problem is full-out failure.

He spent most of the evening napping, as did his housemates, first on my bed and later on my lap... While Monday night & Tuesday morning his body had felt slightly chilly, by tonight it was really warm again, which is good.  He ate a little more eagerly/easily for his night dose than he has recently, including an extra dose of the immune-boosting supplement.  He has scratched on his scratcher a bit and jumped around on furniture... So anyone sending kind heart-strengthening thoughts his way, or just hoping beyond hope that he gets better, whatever you do that's positive, keep it up!

Another update later on, since I need to get to bed, and I've become a bit superstitious... Won't say how he is, for fear he'll be far worse in the morning! Hope life is treating the rest of you well...

I actually haven't gone to bed yet... I've been up keeping an eye on him (and kinda sick from stress).  We did end up taking him to ACC late in the afternoon, where he got chest x-rays that showed he has a possible slight trace of fluid in his lungs. (He does tend to react really severely to tiny bits of fluid!)  The ER vet consulted his cardiologist, who was luckily still there, and we're trying to handle his issues with 2 bursts of Lasix followed by a slight raise to his regular regimen.  He's to see his cardiologist in a week, when we luckily happen to have a checkup scheduled!

Those first two bursts have made a difference in how his breathing looks, but he's not out of the woods yet. With his cardio only here three days per week, we basically have two days to see whether it works... I don't know where we go next if it doesn't.

Oh, we also had a full blood panel run to see what his status is in that department... We'll get a call with the results sometime today, I am guessing.  I'm also upping his lysine (immune supplement) a bit, to help him get over the evil upper-respiratory ick he's been dealing with.

Off to bed, finally... I hope I can sleep without nightmares.  I had fixed my sleep schedule so it was almost "normal" again... Tonight clearly blew that out of the water!  Better than not having him, though, much much better.  I'd rather be exhausted with him in here with me being playful -- which he is, as well as hungry & affectionate (he seems very happy to be home) -- than feel totally up & alert but no longer have him at my side. Guess that goes without saying.  (*points to below* Sorry, I'm using Windows Live Writer with LJ without any real prior experience... Haven't figured out how to make tags work properly yet.)

I'm trying to remain calm... When I got up this morning, Bastian's breathing was a bit off/odd, mostly when he stood/sat certain ways.  Called hospital, they tried to get us in for an appointment but we were told the cardiologist is booked solid and since she had a baby, doesn't want to "stay late" to squeeze anyone in.  (Like the world will fucking END if she is away from the baby for 20 minutes...sure, my "baby" is in grave danger, but nooooo, guess he doesn't matter in the face of merely being with a human that's totally fucking safe!!  She should have quit if she was going to mangle the cardiology department, so they could hire someone that wasn't going to pull this crap!)

So we left a message asking whether I should up his furosemide...and that was about 1.5 hours ago.  Haven't heard anything, but his breathing is more obviously messed-up, and he's less interested in moving.  We've had an appointment for the 10th for weeks, but that won't do any good -- he won't last till then at this rate.

There isn't the money for full hospitalization this time.  Even if he was hospitalized, they said the vet probably wouldn't get a chance to look at him, so it wouldn't be terribly useful regardless. 

I'm going to look up other "good" vets in the area and hope I can find one with extensive cardiac experience. At this point, I don't know what else to do; the normal emergency vets won't have a clue (either they hospitalize, they treat if they know how, or they euthanize) and the cardiologist vet leaves for the day at 3:30pm.  Which, I guess, is how late she's going to wait to fucking tell me what to do for him...again, god fucking forbid she take the time to do her job. Sad to say, I now see why women have such a hard time getting hired, why employers worry about them getting pregnant: ones like Dr. M give them a really, really bad name.  Damn her!

Send whatever vibes or prayers or whatever you can come up with...