Telling the difference between CHF and COPD ( Heart verses lungs)

Hi -

Haven't posted in a while, which often means that everyone is doing fine.
After doing some research on Heart and Lung disease in rats , I have a few deaths that I now wonder if they weren't heart related , a few we actually started the heart meds but they passed w/in days as it was likely too late to make much of a difference.

I do have some questions as to how you tell the difference.

Looks like both start with what seems like an advanced myco flare that is now not controlled by meds. ( starting w/ Baytril /doxy combo ) then moving to Baytril / zithro ( Ive tried TMZ but never had any luck with resp conditions with that drug )

we currently have a Female Spayed rat ( est age 2 1/2 to 3 yrs old) she does have PT and has been treated successfully on cabergoline since Feb ?? She has been on preventative Baytril for 6 months - about a month ago we noticed noise - and added Doxy / Baytril at higher dose range. I was away for 2 weeks - hubby says he thought that the doxy/baytril had been working however when I returned her noisy was worst - and now she didn't want to eat , Her congestion gets way worst when she is picked up ( Ie to give meds) and her hind end has started to go noticeably getting worst ( did the elderly cage set up )

10 days ago Vet Rxed Zithro to add to our combo - we started neublizing sterile saline TID

by 7 days in we could tell it wasn't going to work and brought her in for xray . and hopefully Heart meds.

RX a steroid - dextrometh ( spelling ) all dose are correct.

Xray didn't show as much as the vet had hoped - It seems like she couldn't see alot of fluid - ?? but the side view xray heart looked within normal range - the view when she was on her back it looked like it could be quite enlarged . She was going to post them on an exotic forum and ask some opinions

On my own I added lasix first on Friday - which Helped ( Making us decide to stop the neublizing ) This helped alot , she started eating on her own again and was more herself - less paniced - pacing then hiding - IE more social.
Since her congestion/ noise could still be triggered by us touching her or activity - We started the Steroid on Sat and have continued lowest possible dose lasix- making sure she gets lots of watered down gruel . Ive also started to watch the salt and fat intake of her foods, considering the likelihood its heart related .

Since the combo helped - Both I am correct ?? would help for either lung or heart disease correct . I just had her out to give meds- which she hates - and had a good look at her hind end which is now stronger - feet and tail are normal temp to the touch . Not sure if they were cold before as hubby gives most of the meds- But he would have mentioned that -

So whats the next step for us and the vet to do . The steroids we had planned on doing the taper suggested in the rat guide under pneumonia .

1) Do we assume pneumonia or COPD
2) CHF ? Hypertopic Cardiomyopathy or is that the same thing ? Her symptoms really match both lung and heart and yes I know they can at the same time.
3) It is possible that her PT tumor has gotten larger and both lasix and the steroid would initailly help with that, That supports why her hind end seems stronger.
4) I think that the vet will be willing to do the ACE and Lasix not sure about the beta blocker .

OF NOTE
Her Sister passed last dec. after a very similar presentation - started with less activity - no appetite ect getting weaker ect- we did all the above with meds minus we never got to the heart meds part as she passed during the lets try the steroid phase- And was really in much worst shape than Dobby has gotten to. The Vet that saw her assumed it to be pneumonia . Xrays were done on showed alot of consolidation . She had side breathing and really suffered at the end despite O2 treatments and all the meds you can thing off.

As this one, is so much better at the moment - Meds- Baytril, doxy, Zithro - Cabergoline- Steroid and Lasix - I am assuming that her PT has not gotten worst so that dose doesn't need to be doubled yet .

How do we decide if its Heart or Lung or both - Which meds would you drop and which would you add- Those of you with this experience . which I know is many As the week of Trio AB didn't help which AB would you drop
Would you try dropping the steroid for a day ( since she just started a taper wouldn't be needed ? ) and what would that tell ? I know we can dose lasix higher and that sometimes it takes a few days to stabilize if thats being used for CHF

Ideas - suggestions- Successes and failures- what you learned that was important

Thanks

I'm no expert, that's for sure.
But I would say that if the Lasix helped, then it is most likely a heart issue. [which I say since Lasix is commonly used as a diagnostic tool for CHF]
As you said, it could of course be a combination of things.
The Lasix may also have helped if she did/does have fluid in her lungs (pneumonia) but honestly as of this point, the treatment is mostly the same regardless of what you are dealing with.
It's possible you and your vet could try an ACE inhibitor to see if it helps further.. If that did help then you would be able to pinpoint the heart as a problem.

The bit I would worry about is the Dextromethorphan... I am not sure why that is being given. That is a very unusual choice. Maybe someone else can chime in on it's use in rats.
DXM is a cough suppressant, popularly abused by kids around here.

I would ask about Theophylline in lieu of DXM, if you wanted something to replace it. We used it with Rocky's pulmonary abscesses and it helped him breathe better.
http://ratguide.com/meds/respiratory_drugs/theophylline.php

The 3 antibiotics combo should (hopefully) clear it up over time if it is a resp. infection
Lasix will help keep fluid out of her lungs (difficult balance so you need your vet to teach you to give sub-Q fluids and sell you what you need http://www.ratshackforum.com/forum/showthread.php?t=5076 )
if it is heart she will always need the Lasix, if it is related to resp. then it should only be short term

It could be related to her pt, it could be an infection or it could be her heart
She is on a lot of meds so adding any should be done in consulting with your vet
Nebulizing is a very bad idea for a rat with congestion so glad you stopped

To see if it is her heart, test dose with enalapril or benazepril (0.25 mg/Ib twice a day).
If it helps, then she has a heart problem and atenolol (1 mg/Ib twice a day) is added and she stays on these 2 meds and Lasix for life

and an xray is done to see if the heart is enlarged - There are heart problems that will not show up on an xray
If it is enlarged then digoxin (0.0025 mg/Ib twice a day) is added

But an xray is likely a good idea to see if there is something else in her chest, what her lungs look like etc too

Lilspaz68 might be able to give you some good info

Sorry - The spellcheck must have filled in the dextro- Plus I am very spelling challenged to begin with !!
yes the Dextrom...something is the last thing I'd give a heart patient- My heart is healthy but Ive never been able to take Dextrometha...whatever is in cold meds - it makes my heart race like crazy

I meant the D steroid - This is what we were given
Dexamethasone 1 mg/lb BID, then weaned down as follows:
1 mg/lb BID injectable or PO (oral) for 3 days
1 mg/lb SID for 3 days
0.5 mg/lb SID for 3 days
0.5 mg/lb orally every other day, three doses

Our vet is still waiting on reply on her uploaded xrays- She is leaning towards CHF as well- and suggested since we just started the steroid - to stop it for today - do the lasix for 3 doses IE every 8 hrs and assess how she sounds and acts in the morning - If she is still silent ( not bothered by resp issues ) and doing well - we will assume HD and add the ACE Inhibitor , continue lasix at lowest dose that dose the job - keep hydrated and continue on Baytril - Doxy for life

OH and drop the zithro But wondering on that until we know for sure its only Heart related and not lung as well -
Because of this post:

[FONT=Arial, Helvetica, sans-serif]
"In our past rats, a necro has shown long term zithro to actually shrink pulmonary adenomas , common . It can't cure it, but give longer quality time with you.
[/FONT]

RE : P { margin-bottom: 0.08in; }If the rat improves, a heart problem is assumed and atenolol (1 mg/Ib twice a day, to start) is added.
Then an xray is done and the rat's heart is enlarged, digoxin (0.0025 mg/Ib twice a day, to start) is added to the other medications."

I do have Atenolol pills I could compound - dose is 2.2mg/kg BID correct - I can add on myself if needed .
I am not sure if this vet is comfortable RXing /using digoxin, but if that's suggested by another vet she might .

She is a pretty good vet and really does care and super close to our house. My only issues with her is the limited hours -
she is usually only at the clinic once weekly - the other vet there sees our dogs will not see rats
SO though she doesn't see many rats, not that experienced, she is very willing to try to help and to learn. Which is huge !

The next closest rat vet that I trust is 50 miles away - and in our area traffic can mean thats a 2 plus hr trip one way - Which is very stressful for the rats and me.

Thanks for the advice: Hoping that we can give this one some good quality months . I'll post what happens

Best J & M
parents to Dobs, Wiggles and Teirra
3 cattle dogs and one Carolina dog

Passed over Sophie my Heart rat - Melba , Junebug , Banjo, Lola, Nika, Bear, Gigi. Molly, Harper and Leia. Heart dog Chelsea - cattle dog and Cherokee GS

Thanks VELO -
RE : I would ask about Theophylline
We used it with Rocky's pulmonary abscesses and it helped him breathe better.
http://ratguide.com/meds/respiratory...eophylline.php

The Dextro was a typo- She is / was on steroid - And will jump back if she doesn't hold on the lasix .

One Question is Theophylline the one you can't do w/ Baytril ? I know there is one thats contraindicated .

If it leans towards lung involvement I will ask for an RX

Another Q- Alot of these meds I do have in the fridge from past rats - On average - what is the shelf life on most of them ? I have not used them - since said RX rat passed away and mainly have kept some this long just to have the dose and concentrations as they were RXed By the few real rat experts w/in our state - for a couple rats that we drove along way to see. What I likely need to do is just scan and archive the labels for future use-

Esp as the compounded doses were made esp for those having to syringe meds- Thus 0.1 ml or less per dose which is SO MUCH easier and safer ) IE aspirating issues than the common doses that the compounding drugstores and vets around here make up IE doses that are like 0.3 ML BID - add that to 3-7 different meds and the poor rat is spending most there people time basically being tortured Trying hold them and slowing - carefully get what would be the volume of food per day - except all yucky meds - in their systems .

Thats a huge issue we have had- Concentrations too low that are way too much volume - I wish that I could get a vet or compounding drugist to have a pet rat so they hands on get how traumatic it is on the rat and owners to have to try and get all that down safely - in what is always at the point of having to use these drugs - In a rat that is already stressed to the limit . Off that soap box for the moment . But like Come on !!

We just dealt with that over a dose- which the vet called in and re wrote- and the druggust just made the same amount strengh again - Ignoring the vets request to step it up to make doses that equal 0.1 ml per drug dose .

Sigh

I guess at least in the US we have to be grateful that coumpounding pharmacy's still exist - as the FDA and the big drug company's are out to get them !! all out of business - My personal health insurance stopped covering so I have to pay out of pocket to get medications that I can safely take. Sadly - All about the mighty dollar in the US - and not about people and health at all

Just a few notes to add, I have had two rats so far that had heart issues with no resp issues, they were both treated for resp and it didn't help, so that is how it became clear that it was likely their heart
they were both started on benazepril (very similar to enalapril) and it helped so that was basically diagnostic

I believe lasix is used sometimes in resp issues, because fluid can build up not just in the lungs but outside them in the chest. under which circumstances it does this, I do not know. lasix needs to be used with great care and you really want the vets input on dosages and timing of doses etc

as far as digoxin goes, you need to know exactly what heart issue you're dealing with, which is difficult to diagnose in rats Digoxin is an extremely tricky drug to work with, there is a safer alternative for pets called pimoben I believe, not sure of the spelling
Digoxin can cause more heart issues then it can help, I know this as a human patient. at least in humans you can do an EKG and see what is happening, this is not available for rats, so personally I would never allow a vet to give a pet of mine digoxin.

looks like your vet is really doing all they can for your rats, you are lucky that they are willing to investigate all options.

Theophylline is fine with baytril. You should not use it with benadryl though.
We started with baytril doxy and theophylline and then switched to doxy zithro and theophylline.
I do believe zithro is a good drug... it really depends on what you're dealing with though... pneumonia would need stronger antibiotics than a heart problem. Part of the problem with zithro is it can be very pricey and the shelf life tends to be shorter.

As far as meds in the fridge, it can vary. According to the meds that I have mixed in my fridge currently:
Doxy - 4 months
Baytril - 9 months
Theophylline - 6 months
My zithro was 2-4 weeks depending on how it was mixed.
It does vary for all of those though.
I believe compounded doxy becomes toxic after it expires ?

Awesome input and alot is similar to what my vet looked up this weekend-
Thanks Ladies - Keep them coming - Excellent info on shelf lifes ( maybe that should be a sticky -

we do our own compounding of Baytil , amox and doxy on a regular basis -
and have done some pain meds-, valuim and now lasix and any OTC drugs ourselves -
But knowing approx shelf- life on Pharmacy compounds is very helpful -

For example Our compounded solution of Zithro RX from her sister Molly as made in DEC and had an expired by date ONE YEAR later - for sure thats going in the trash . and I won't use that druggist again- they were new to us and used because they were open on a Sunday .

Re the Lasix - Our vet explained it can be helpful alot of issues , and like " leaky gut " in dogs - leaky other things - like lung issues or if from her PT - the brain tissues , This vet seemed very comfortable w/ this drug and I must say did a lot of feeling around Dobbys entire body to assess edema and hydration levels - Might be the most complete exam any of our rats have had in along time. I will I felt comfortable doing Sub Q on a rat- Ive done on our dogs in dire cases but super freaked in a wiggling rat.

Velo and Petunia Thank you on your additions -
Others experience is so important for us rat owners -

The alternative drug for digoxin , was one that I'd never heard of I believe its called Pimobendan It was dosed once daily .
This was RXed 3 yrs ago, -for Gigi - my dancing queen - who a yr prior to having any health issues had electrocuted herself by chewing on a lamp chord - Which I assume caused her heart damage -

It was Rxed by a super expensive exotic vet that does house calls here in state But also is very experienced- and Sadly cost prohibitive . I think if I reached out I could ask the concentrations of the drugs she RXed as they were tiny doses - and very easy to give-
Sadly G passed away shortly after starting them - like within days - but I think if she had presented with symptoms earlier she might well have been saved and had a number of more comfortable months to a year .

Looking a Gigi's chart from 2013
Her drugs Rxed were the Pimobendan, Theophyline, Lasix, Enapril and Zithro & Doxy combo -
I archive all the records and drugs / supplements we do on a chart , so we know who gets what . I just pulled Gigis file to see what that drug was called- So thanks for the post I would not have thought to look in her file otherwise. And have something now to give my vet to think about what to RX .

Little Dobby was so awesome when I looked in our her a half hour ago - Bright eyed looking for a treat and pushing the youngsters around trying to get to the bars first just in case.

treasured moment .

Best J