Biomechanics in feline heart failure management
I first met Lulu over 10 years ago when I was called for a home visit vaccination (back when I still ran a full service home visit clinic). I was seeing Lulu at home as whilst she was a petite 3.5kg princess she had a major case of vet rage. She was more relaxed at home than at a clinic but still recognised me as a vet and managed to get a few swipes in and a little kitty swearing. Lulu has helped me hone my reflexes over the years as she has a lightning quick left punch once she decides she's had enough.
Almost 2 years ago Lulu developed heart failure and progressively worsening kidney symptoms. Lulu's owner has been doing an amazing job with three times daily diuretic medication to keep fluid from building up in Lulu's lungs. It is a balancing act managing Lulu's diuretic dose as we don't want to dehydrate Lulu too much and put more strain on her already stressed kidneys.
Last week Lulu's owner rang devastated as she had accidentally forgotten to replace Lulu's water following cleaning her bowl. Lulu was dehydrated and unwell. Ideally we would have sent Lulu to a vet clinic for IV fluids but the heart condition combined with her extreme vet rage would have meant that going to the vet was highly risky for Lulu. We reduced Lulu's diuretic dose and rehydrated her orally. Lulu seemed to pick up with this, however started breathing quicker and with more effort and wasn't responding to increasing the diuretic dose again. On examination Lulu seemed to have fluid in her thoracic cavity around her lungs and also in her peritoneal cavity around her intestines. For cats, diuretics work best to draw out the fluid inside the lung tissue and is less successful when fluid builds up in the body cavities.
For most cats with effusion I would have suggested a trip to the vet again to remove the fluid by using a needle or catheter into the chest. Then monitoring the hydration and the diuretic dose overnight at the clinic. Again this was much too risky for Lulu - we needed another plan. We needed to get the fluid that was sitting around Lulus organs back into the blood circulation.
It is the job of the lymphatic system to pick up the excess fluid and return it back to circulation. Lymphatics are thin vessel that don't have a pump. They are mostly reliant on muscular movement to pump lymph back to circulation. The major lymphatic vessel in the chest is called the lymphatic duct and it lies under the spine and empties lymph fluid into one of the large veins that returns blood to the heart. The major lymphatic vessel from the abdomen is the cisterna chyli which continues through the diaphragm into the thoracic duct.
To treat Lulu we started with osteopathic techniques to release the fascia around her ribs and also her diaphragm to allow lymph flow through the major lymphatic vessels to work better. I also used laser acupuncture on points that can assist with 'damp' and fluid dynamics. I then taught Lulu's owner to tap Lulu's chest and compress her abdomen to help to move the lymph fluid. Lulu immediately looked more relaxed and started breathing better. To be honest even I was shocked with how quickly she responded. (Lulu has also mellowed a little with me over the years and allows some treatment - she did get in a few swear words towards the end however!)
Lulu was left with a prescription of doing couch kiss walks (she will walk up and down the lounge to get kisses from her owner) in order to move her own body and get her lymph moving. Her owner was to continue to do the tapping and compressions. I'm happy to report that Lulu's breathing has stabilised again.