14 y/o cat with pleural effusion, advice?

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mentat

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Still, you could start a self-referral by initiating at a longer-distance hospital to differentiate heart disease, primary lung disease, mass effect, or infectious disease causing her pleural effusion. Especially now that she is stable and the longer car transport less likely to stress her respiration. Her current breathing rate and appetite are so improved, that is when we prefer to do an ultrasound, when our babies aren't as stressed or symptomatic. Chest and abdominal ultrasound, with them reviewing your primary care vet's radiographs and labwork, can get her on additional effective treatment for the primary disease causing the accumulation of fluid in her chest cavity. So very glad your reindeer huntress is better!
 
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Still, you could start a self-referral by initiating at a longer-distance hospital to differentiate heart disease, primary lung disease, mass effect, or infectious disease causing her pleural effusion. Especially now that she is stable and the longer car transport less likely to stress her respiration. Her current breathing rate and appetite are so improved, that is when we prefer to do an ultrasound, when our babies aren't as stressed or symptomatic. Chest and abdominal ultrasound, with them reviewing your primary care vet's radiographs and labwork, can get her on additional effective treatment for the primary disease causing the accumulation of fluid in her chest cavity. So very glad your reindeer huntress is better!
Hi, thank you for the reply! Unfortunately, I fear my car is not reliable enough for that long of a drive. Fortunately... This practice has ultrasound and ekg machines. I'm pretty confident with my decision to go with a different vet at this practice, he's gotten additional education to specialize in cats; or so that's what I've been told. Also, her lungs were clear in the xray and sounded normal but I guess that could change depending on the pictures they get.

I need to figure out what caused it since she got better so fast.. it would drive me crazy if I didn't figure it out!
 

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Congestive heart failure is the most common diagnosis in cats with pleural effusion; secondary lung disease to the heart disease. In mine it was HCM turned CHF, also common in feline medicine. Thoracentesis twice, cardiac meds incl off label use of pimobendan, ACE inhibitor, and diuretics bought us a few weeks to say goodbye. This varies, as I met folks in cardiologist waiting room whose cat/dog progressed slowly into worse CHF and some were critical again within days of initial thoracentesis. Less common is lung mass or heart based mass causing effusion; lymphoma; wet FIP; other, more rare diagnoses. Analysing the chest fluid via microscopy and their hematology diagnostic machine, my ER vet confirmed suspicion after hearing higher grade murmur than last vet exam ausculting his chest. If they saved fluid for potential culture, you can ask them to view some in hospital for evidence of exudate from heart disease vs lymphoma or virus.
Unfolding the Mysteries of Pleural Space Disease
 

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Also had a cat with pleural effusion. We were able to tap her, though.

I would work on a plan of action now in case she relapses - how will you go about the tap? Find out if Gabapentin is an option.

Does she respond to you when at the vet? Would your presence calm her during echo/X-ray/etc? I’ve had cats and dogs who were only cooperative during advanced diagnostics if I was there, so the vet allowed me to be there to distract them.

You need blood work and further screening to monitor the fluid, as well.

I agree with mentat’s assessments. Congestive Heart Failure is a primary cause of pleural effusions. In my kitty, the CHF was caused by the less common DCM, rather than HCM.

We were very fortunate in being able to reverse her CHF, which often isn’t possible. But when it is, it is critical to pursue diagnostics in a timely fashion, because - to be quite frank - CHF generally does not afford you a whole lot of time to act.

So be sure to stay on top of this, to the best of your ability. Furosemide is a bandaid, especially when you still don’t know the underlying cause. Don’t allow yourself to become complacent out of an illusion of comfort and being in the clear just because she’s no longer currently in crisis - she’s not out of the woods yet, and they can and do relapse sometimes even when on diuretics.
 
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Ravynn

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Also had a cat with pleural effusion. We were able to tap her, though.

I would work on a plan of action now in case she relapses - how will you go about the tap? Find out if Gabapentin is an option.

Does she respond to you when at the vet? Would your presence calm her during echo/X-ray/etc? I’ve had cats and dogs who were only cooperative during advanced diagnostics if I was there, so the vet allowed me to be there to distract them.

You need blood work and further screening to monitor the fluid, as well.

I agree with mentat’s assessments. Congestive Heart Failure is a primary cause of pleural effusions. In my kitty, the CHF was caused by the less common DCM, rather than HCM.

We were very fortunate in being able to reverse her CHF, which often isn’t possible. But when it is, it is critical to pursue diagnostics in a timely fashion, because - to be quite frank - CHF generally does not afford you a whole lot of time to act.

So be sure to stay on top of this, to the best of your ability. Furosemide is a bandaid, especially when you still don’t know the underlying cause. Don’t allow yourself to become complacent out of an illusion of comfort and being in the clear just because she’s no longer currently in crisis - she’s not out of the woods yet, and they can and do relapse sometimes even when on diuretics.
I'm not sure what the plan will be if she needs a tap. The vet (not one we chose) told me she wouldn't wake up from it and she would need to be put to sleep due to her "restlessness", so that's scary. She's been biting me and scratching me since she was 6 weeks old. If I try to clip her fluffy butt, she latches on like a lion. No joke. If she sees me standing still for too long with bare legs, she will sneak attack and bite my legs... But she's petrified of anyone other than my family and is timid.. but also a loving sweetheart when she wants to be! She has extreme boundaries. Hopefully this new vet understands these things.

When we went to the first vet that quickly listened to heart/lungs before sending her off for an xray, she started hissing and I scratched under her chin and she was distracted for a second and tried to claw me after. Not sure if she would care if I was there just because of how scared she would be. I'll see on Wednesday when a full, real exam will be done... Hopefully this time.

I completely understand that furosemide is just a bandaid. I'm just glad to see her not in breathing distress like she was. I'm making that very clear on Wednesday that it's important to me that more has to be done then keeping her on furosemide.

Do you think it would be a good idea to get another x-ray first to see what the fluid looks like and to see if they can visualize the heart or would something else be a better first option? Is there a significant price difference in xray vs ultrasound? Her xray was 200.

I wanted to update as well that her bpm has stabilized out to 25, she's eating wet food 3 times a day and eating Acana kibbles as treats instead of Temptations in between wet food feedings. She hasn't eaten that much in years.

To be frank, she really wasn't eating enough the end of 2019 for months. I was reading that cats can develop problems (ex. DCM) when they don't get even half of the food they need a day. Maybe just wishful thinking that it's because of that but it seems odd to me how she wasn't eating right for such a long time then developed this problem, like a taurine defienceny turned into heart failure.

Sorry for the word vomit. Thinking out loud here. It helps being able to post about her.
 

mentat

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When we went to the first vet that quickly listened to heart/lungs before sending her off for an xray, she started hissing and I scratched under her chin and she was distracted for a second and tried to claw me after. Not sure if she would care if I was there just because of how scared she would be. I'll see on Wednesday when a full, real exam will be done... Hopefully this time.
My internist, cardiologist, and some criticalists treating past lung/heart disease used cardiovascular sparing sedatives for stressful procedures, which to a cat having difficulty breathing is "any procedure or handling." The one they used the most was butorphanol injection for mild sedation, and etomidate for IV anesthesia (absolutely no anesthetic inhalent gas on these guys). If anything, they breathed better as they were flow by oxygenated or intubated, so the machine and trach tube was breathing "for" them. Just a thought for your next visit. We caught the 2nd episode of pleural effusion before 150mL was in chest, so much less stressed for the tap; still had butorphanol for it though. When a planned follow up appt, they prescribed gabapentin 100-150mg (5-8x the pain dose) 2 hrs before appt and night before; this eased the visit for the towel wrap restraint and butorphanol injection, so breathing rate and effort stayed normal.
 
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Ravynn

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Hi guys, update.

The new vet (which I was very happy with) said that he thinks she has right sided heart failure. He was very pleased that she responded so fast to the furosemide, as he even had a cat the same age come in last week with pleural effusion but much poorer prognosis (cancer). She is on benazepril/furosemide for the rest of her life, along with potassium supplement everyday. If anything changes, I take her in to reevaluate her meds/condition.

She missed her afternoon wet food yesterday, so she was starving when we got home and had a big serving of wet food with her potassium!
 

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So glad you're happy with good vet care team, on ACE inhibitor as well as diuretic, and she's happy eating potassium laced kitty snacks ;] Good news worthy of a victory dance, no doubt

If a congestive episodes recurs, rescue therapy with pimobendan is off-label use in cats and dogs. Cardiologists are employing it in daily management of some types of heart disease in cats, also extra-label use, like most feline medicine. Just something you can add to your bag of tricks if needed. Worth consideration by your cardio team.

"Off-label rescue indications: Pimobendan, commonly recommended in the emergency treatment of CHF caused by CVD and DCM, is rapidly absorbed with peak effects in 2 to 4 hours, making it valuable in initial stabilization and for chronic treatment. In addition, the drug can treat both right- and left-sided heart failure associated with various underlying causes."
"
Off-label indications: Feline heart disease leading to CHF is predominantly characterized by diastolic dysfunction. Chronic oral treatment emphasizes control of clinical signs associated with volume overload

Clinician's Brief


(eg, furosemide with/without an ACE-I), arterial thromboembolism prophylaxis (eg, clopidogrel with/without aspirin), and medications that may improve ventricular relaxation (eg, diltiazem or a b-blocker).

However, a number of feline heart diseases are characterized by echocardiographic evidence of systolic ventricular dysfunction. These include many forms of unclassified cardiomyopathy (UCM), DCM, and arrhythmogenic right ventricular cardiomyopathy (ARVC). Cats with CHF caused by systolic failure have poor long-term prognosis with a reported median survival of 13 days with conventional therapy.13"

Compounding pharmacies have made it for multiple friends/colleagues cats and dogs. Heartland Vet Supply has the lowest fee for compounded liquid, with quality formula that doesn't accumulate in the bottom of bottle; I used their compounding pharmacy for my mitral valve disease turned CHF dog until end of life. Great service, too.

Study using pimobendan in cats, just to demonstrate safety and common side effects, although your cat does't have HCM, it shows use in feline medicine at minimum: Cardiac Effects of a Single Dose of Pimobendan in Cats With Hypertrophic Cardiomyopathy; A Randomized, Placebo-Controlled, Crossover Study

If her right sided failure is due to arrythmogenic right ventricular cardiomyopathy, its use is "recommended" in this cardiology treatment guideline https://todaysveterinarypractice.com/wp-content/uploads/sites/4/2018/06/Pimobendan-Use-in-Cats.pdf
 

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If a congestive episodes recurs, rescue therapy with pimobendan is off-label use in cats and dogs
Am I wrong in thinking that another congestive episode would result in more fluid and reduced ability to breathe? I'm monitoring her bpm everyday and keeping a very very close eye on her. It is very reassuring to know that pimobendan is there as an option. I really appreciate all the info you've provided me as well. :) The vets without diagnostics fills out prescriptions and my vet works there a few days a week as well which is only a 5 min drive from my house so if I need anything in a hurry I can get there quick.
 

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Yes. Increased respiratory rate and effort are signs of pleural effusion or pulmonary edema secondary to CHF. CHF is "refactory" in nature, so congestion will occur again, unavoidably, but we can prolong the time between acute CHF episodes.
 
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I just wanted to come on here to give another update on Kitty. Overall she's still doing well, she's been eating a can and a half of fancy feast every day which is crazy for her as she's never been a big eater. Her breaths per minute have never gone above 26 and even though i'm still giving her furosemide 2x a day, she really doesn't pee as much as she used to which makes me believe there must not be much fluid, if any.

I've been noticing another issue though and that is that she seems to be losing muscle mass over time. You can't see them but I can feel her spine, ribs and her hip bones. I'm going to make another appointment for her with the same vet but i'm really anxious about it because they didn't want to touch her the last time because they were afraid of causing her too much stress on the heart from having to get her so worked up.

I really, really want to be able to get a senior blood panel and check her thyroid levels because I would really like to see whether she has hyperthyroidism or not... it seems all of these secondary symptoms can also be caused by that. The heart problems, fluid, losing muscle while eating good, and she really loves water but I can't tell if she's drinking a lot of it. She's a totally different cat with my family now. I mean... she meows at me in the morning to wake me up and give her wet food! She never ever did anything like that before.

I'm sure the vet has had to deal with other difficult cats to get blood work.... I wonder if we left her in her carrier and tried to get blood drawn from her leg while she's in there if that would work?

Any suggestions or tips on things I could bring up to the vet would be really helpful. I just really want to get her a blood test without causing her to go into cardiac arrest which i'm assuming is why they didn't want to do anything else to her last time. :(
 

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I don't have any help for questions, but assuming she's not very active can you have her walk with you around the house as a gentle start of getting more exercise to help out those muscles? Hold her just filled food plate in your hand and have her follow you.

Then maybe have food in different places in the house, if you can, so she has to walk around to get to them, and maybe if you have stairs, place a food bowl on one step up, then in a week or so two steps up...
 
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I don't have any help for questions, but assuming she's not very active can you have her walk with you around the house as a gentle start of getting more exercise to help out those muscles? Hold her just filled food plate in your hand and have her follow you.

Then maybe have food in different places in the house, if you can, so she has to walk around to get to them, and maybe if you have stairs, place a food bowl on one step up, then in a week or so two steps up...
I appreciate you replying regardless. Thank you. :hugs:

The heat has been really bad here and both her and my dog have been having a hard time. They both usually lay on the cold floor most of the day. She does get up quite a few times out of the day to go drink her water/eat but she goes back to her spot behind the fireplace where it's nice and cool. I've noticed the muscle loss more so the past 2 months that's it's been really hot but I don't know if it's from her not being as active or a part of her health issues.

She usually eats downstairs but maybe I can try feeding her upstairs so she has to travel up and down? She has no problem with that as her litter is also upstairs.
 

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You could ask your vet if they have any contacts that could come to your house and take blood. Kitty might need a follow up with the vet after the blood work results have been looked at by your vet, but at least the blood could be drawn without a visit.

Feeby (16+ yo) has been losing weight over the past 1-2 years, and with that she has lost some muscle mass, particularly in the past year. I think it is relatively common in older cats, but plan to bring it up when I get her into the vet for her geriatric appt (which is overdue).
 
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You could ask your vet if they have any contacts that could come to your house and take blood. Kitty might need a follow up with the vet after the blood work results have been looked at by your vet, but at least the blood could be drawn without a visit.

Feeby (16+ yo) has been losing weight over the past 1-2 years, and with that she has lost some muscle mass, particularly in the past year. I think it is relatively common in older cats, but plan to bring it up when I get her into the vet for her geriatric appt (which is overdue).
I meant to say in my other post take her to the same clinic but a different vet. It's another vet that is specializing in feline medicine but my sister has also taken her cat to her and said good things. I feel like I wasn't able to get a word in with the other vet even though he was knowledgeable (I took my dog to him a little while ago and felt the same way). I just feel like I couldn't explain how she was doing in detail which with little things could make a big difference.

My province is still being very strict with COVID and the vets just opened up to allow 1 person to take your pet in with no one else in reception so I don't think they are having people come to your house but I honestly haven't heard of someone coming to your house to do that. Who would come to do that? She didn't freak out the last time we took her so I think she will be okay to travel there.

Also wondering if it has to do with her completely being transitioned to wet food only even though she wasn't eating much before... she's always been a tiny cat and only ever was on dry food. It would be easier to get more food in her if she ate more each meal.. she eats multiple times throughout the day instead. Unless I can find a food with more calories

Sorry, just blabbing on. Forgive me! Lol
 

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I honestly haven't heard of someone coming to your house to do that. Who would come to do that?
A call to the clinic might shed some light on if there are in-home services in your area available for blood draws. That varies pretty much by area, region, state, country. I think it was mentioned before, but you could also ask the vet about a tiny dose of Gabapentin to help calm her before a vet visit - to see if that is possible for her with her condition.

Also wondering if it has to do with her completely being transitioned to wet food only even though she wasn't eating much before... she's always been a tiny cat and only ever was on dry food. It would be easier to get more food in her if she ate more each meal.. she eats multiple times throughout the day instead. Unless I can find a food with more calories
Canned food is usually lower in calories than dry, but typically higher in protein. 1.5 cans of FF is about 140 calories, just as a rough guesstimate (based on the pate style). Using the 'standard' as a gauge (20-25 calories per pound of body weight), that should sustain a cat that weighs 6-7 pounds. You can read about issues surrounding a cat that needs to gain weight, along with ideas of what you could try to feed her to add more calories, in this TCS article.
How To Get A Cat To Gain Weight – TheCatSite Articles

Feeby was a dry only food eater until about 3 years ago when I added canned food. She was also a grazer - and, actually still is, even with the canned food. Over that time, she pretty much fully transitioned herself from dry to canned - and, yes it has somewhat coincided with her weight loss. But, I am not sure it isn't coincidence, along with her aging and the associated muscle loss.
 

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Who would come to do that?
(There are some vets who will come to homes - we were able to find one here in Denver Colorado this year).

I can try feeding her upstairs so she has to travel up and down?
My boy is 15, and lost weight as well as some muscle mass when he was sick last year, however we've been able to get him back to his normal weight as well as strength and muscle mass. He does get his kibble in addition to canned, but his mobility, and ability to get into a backyard as well as use stairs regularly contributed a great deal to bringing him back to himself.

I realize you may not have a backyard, but can you take her for walks as she becomes stronger? Go gently at first though, as I think I may have mentioned, have her follow you around the house while you hold her food dish to entice her along for a little while, and place her food dish partway up the stairs for a few days, before you ask her to start going all the way up and down the stairs more frequently. It's not so different from us humans - it's not good to go from sedentary to doing 5 miles on the treadmill and lifting 10 pound weights all at once :)

These two articles have some good information that might help you ;
How To Get A Cat To Gain Weight – TheCatSite Articles
How To Get Your Cat To Start Eating Again – TheCatSite Articles
 
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