4.5 yo Male Cat CHF Survivor Now Has Ascites - Drain or Wait?

MyCatsCNJ

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Our 4.5 year male orange tabby cat has developed abdominal ascites after an emergency CHF episode 6 months ago, Mar 2019. He recovered after a short hospital stay, diagnostic tests, and medication/release. We have now requested the veterinarian perform an abdominal drain tomorrow, but we are not sure if this is the right thing to do yet. Looking for similar stories for insight.

For one he is a sweet, affectionate (but skittish) cat and he will be awake for this.

Here is his medical facts:
* Since about the age of 3 I noticed slight breathlessness after play.
* A few hairball-like coughs her and there. He then started developing more consistent weekly coughs.
* One day at about age 4 he started vomiting and became very short of breath.
* We rushed him to the vet. He was hospitalized, tested with Xray, CBC and US. Later was given EKG and Echocardiogram.
* Fluid found in or around lungs were resolved with Lasix intravenous and oxygen tank. Meds given, etc.
* He also lost about 10% to 12% of his body weight. From 14 lbs to 12 lbs.
* Diagnosis was CHF (i think right side?), echo showed very large heart. He stabilized and did well. Released in Mar, 2019.
* He was administered the following meds:
- Pimobendan/Vetmedin: Dose/Delivery: 1.25 mg | 1 tablet every 12 hrs.
- Benazepril: Dose/Delivery: 5mg | ¼ tablet every 24 hrs.
- Lasix: Dose/Delivery: 12.5mg | ½ tablet every 12 hrs.
* Mar to Sep went well, no real issues, playful etc.
* In mid Sept 2019 he seems to be more tired. Still eating, drinking, etc. Playing with his brother, they are inseparable so we adopted the 2.
* In mid-October 2019 I noticed his belly swelling. Not too bad. No other symptoms. Still eating, drinking, less active and less mobile.
* Vet says try conservative approach:
Lasix 3 x a day for 5 days last week to try and resolve the ascites, no luck.
* Past two weeks his stomach has grown sideways a bit.

Now the questions remain for us - and we can use some guidance from others experiences are...
> Is draining the right thing (too risky)? Are there other meds to try to reduce the ascites first, try and wait?
> Are the meds the right mix? Why is the condition seem to be advancing?
> If neither meds or draining work, then do we euthanize a cat swollen but not in pain? (he is not hiding or suffering)

The doc warned that the ascites could come right back, or we might need to drain every few weeks. He is an outstanding and caring vet but he doesn't know the future, nor do we. However, real life similar experiences from people like you (vet professional or not) would help steer our understanding and decisions. The only thing we are dealing now with is ascites. Otherwise the condition is under control, on the surface. Thank for your help!
 

FeebysOwner

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Hi. I really don't have any first hand experience to offer. But, I did want to know if the vet you are dealing with specializes in cardiology. If not, you might want to consider getting a second opinion about your cat's condition and validate the meds he is on are the appropriate ones and at the correct doses. Also, has he had a full blood panel (CBC, Chemistry Profile) done to see if any there any abnormal results that could indicate another possible health issue?

The belly fluid that is accumulating - does the vet think this is from his CHF? I noticed in your list of medical facts, he had fluid in or around his lungs - not his belly. There are other medical conditions that can cause fluid accumulation in the abdominal cavity.

Not knowing any more than I know, it would be hard for me, personally, not to try draining the fluid and see what happens. Tbh, I would want to have the fluid tested to see what it consists of. Perhaps, there is something else going on besides the CHF. You might want to ask your vet about this, and what all it can be tested for. Also, ask if he needs an IV to re-balance his electrolytes after the draining.

I wish I could offer more helpful information to you.
 
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MyCatsCNJ

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Hi. I really don't have any first hand experience to offer. But, I did want to know if the vet you are dealing with specializes in cardiology. If not, you might want to consider getting a second opinion about your cat's condition and validate the meds he is on are the appropriate ones and at the correct doses. Also, has he had a full blood panel (CBC, Chemistry Profile) done to see if any there any abnormal results that could indicate another possible health issue?

The belly fluid that is accumulating - does the vet think this is from his CHF? I noticed in your list of medical facts, he had fluid in or around his lungs - not his belly. There are other medical conditions that can cause fluid accumulation in the abdominal cavity.

Not knowing any more than I know, it would be hard for me, personally, not to try draining the fluid and see what happens. Tbh, I would want to have the fluid tested to see what it consists of. Perhaps, there is something else going on besides the CHF. You might want to ask your vet about this, and what all it can be tested for. Also, ask if he needs an IV to re-balance his electrolytes after the draining.

I wish I could offer more helpful information to you.
================
Awesome info and yes there is a cardiologist that the doc defers to who recommended the meds and dosages. So the generalist vet (and Ivy league grad) consulted with the cardiologist. We trust that he did the due diligence. CBC done multiple times just couple of weeks ago again and all tests normal. I guess something would have come up if it was FIP, for example. That could also accumulate fluid in abdomen as well. They also did a hyperthyroid, diabetic and taurine test in the past to rule that out for the cause of CHF - all normal. Assumption is that is is genetic.

I think the vet does assume the fluid is from CHF, but as you say I will ask for the fluid to be tested to further validate. I think the CHF incident accumulated fluid in the lungs on the ER visit in the past because maybe that's when the condition was unknown and it might have gotten to that point. Not sure on that one.

I agree with you we should try to drain because at this point there might not be another choice. I suspect the risk is low. I read about the IV rebalance possible need, and that's a good tip. The doc said that our cat will stay a bit after the procedure I would assume to do exactly that - monitor his vitals and blood.

If the fluid re accumulates quickly then we may defer to a cardio specialist first hand at a local well-known specialized hospital which I suspect our primary vet will also recommend. Anyway, thanks for your input, it was very valuable! I'd love to hear more opinions....
 

FeebysOwner

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CBC done multiple times just couple of weeks ago again and all tests normal. I guess something would have come up if it was FIP, for example.
Did they also do a Chemistry Profile? That would indicate issues with the liver which can cause abdominal swelling - don't think anything in a CBC would show liver issues. And, about the FIP - now that you mentioned it, I was hesitant to do so - there is a specific test to run on the fluid that is the most accurate there is (at least to my knowledge).
https://www.idexx.com/files/feline-infectious-peritonitis-virus.pdf

I certainly hope other members will come along soon and offer their input too!!
 
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MyCatsCNJ

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We had his fluid removed today. 400ml drained and sample is going to be reviewed with lab.
 
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MyCatsCNJ

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The drain really didn't do much. It seemed to have relived him a bit for a few days but he still seems distended and bloated. The doc really didn't drain a lot due to his fidgeting. The next step is to see the cardio that he works with again to review the stage and possible medication review.
 
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MyCatsCNJ

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yes, that came back consistent with heart issues, as suspected.
 
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