Chylothorax after surgery

QuaraLisa

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Hello everyone,

First of all, sorry for my english, but I'm French.

I'm trying to gather as many testimonies as I can about my cat's disease and in French forum, I did not get much of answers.
Let me try to sum up what is happening to us.

Tigrou is an european cat of 13 years old (13 years that he is my companion). Everything started 1 month ago.

1. Around one month ago, Tigrou started to breathe with difficulty. As I was homeworking, I went straight to the vet who told me that tigrou has a heart tumor and went through a "tamponnade" : meaning that the tumor was leaking blood into the pericard ("kind of bag" circling the heart) and compressed the heart. He was really closed to death but he was tapped by the vet team and released to us with a questionmark when it will start again (could be few days, months, never).

2. Unfortunately, 4 days after, "tamponnade" again and he was howling in pain. Straight to the vet again. And the vet tapped him again and explained us that we do not have lots of options as he is filling with blood too quickly and we cannot tap him every 4 days. So either we go to pericardectomy (cut parts of the "bag" (pericard) around the heart to let the blood leak from times to times into the thorax either we stop here and let him go. Vet seemed by that time pretty confident about the surgery if the tumor is benign. From his point of view & experience (mainly with dogs as unfortunately, this kind of tumor is more common with dogs), Tigrou can still have years ahead of him with that surgery.

3. We decided for the surgery as we were not prepared to let him go. Surgery went well. But unfortunately (again), complication arrived as 5 days after surgery, Tigrou experienced again issues with breathing and we brought him back in the middle of the night to the vet (clinic is open H24). He was diagnosed with chylothorax as consequences of surgery (they tapped him around 300 ml). Medications were changed and switched to prednisolon to support him. New protocols also applied with vet control visit every 48 h. The 2 first visits (Wednesday/Friday) we saw that they still were some liquid thanks to the echography but not too much and manageable by Tigrou without tapping. Diuretic was also added

4. Sunday (1 week after last tap & 2 days after last control), again, difficulty of breathing. Vet again in urgency. Chylothorax again. Tapped again with 300 ml. At that time, treatment with prednisolon & anti-biotics were over the day before.

5. 48h after for the tapping, we went to the control visit and again he had too many liquid and was tapped for the 3rd time (for Chylothorax) with 300 ml. Vet recommanded to start again prednisolon with higher dose (as the increase of liquid coincided with the end of the prednisolon treatment). As during those times, I read a lot of studies / researches in French / English, I proposed also to start also rutine 3 times a day 300 mg (our cat was 8 kilos, now 6). I also tried to reduce the fat in his diet (not entirely as he was very weak due to the fact that all "fat energy" were leaking in his thorax). Our vet expressed clearly that returning with this treatment is his last option without other surgery.

6. Unfortunately (again, I know), one week after he has started again to show signs of disconfort and I know that tomorrow during the control visit, he will have to be tapped.

And now, I'm lost. It seems that we are losing the battle. My little cat is fighting hard (still doing his walk in the garden, still playing if stimulated, still eating) and except from chylothorax, he has recovered well from the pericardiectomy. I know that in the long run, he is condemned by his heart tumor and we do not think that we will put him under surgery again. I love him too much to make him experience pain again, especially when the chance of success is very low.

I'm looking for ideas how to fight this disease. What could I have missed ? I read lots of articles, testimony about idiopathic chylothorax but did not find anything of chylothorax as result of pericardiectomy. Did it change something that it is after surgery ? Did you also experiment the same after surgery and manage to overcome this disease ?
This past few month has been hell for me : as we are alternating between hope & despair every 5 days. I'm crying every day to be so powerless. I'm waking up several times during night to check if he is breathing correctly. I really do not know how to help him, so any thought will be welcomed.

Thank you for those who would have read my long thread.
 

WMM201

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Q QuaraLisa I am afraid I don't have experience with this condition, but I wanted to offer you support during this difficult and emotionally painful crisis with your dear Tigrou. It is clear that you are trying every therapy available to help Tigrou have some quality of life. I hope that the diet change can help him. I am sending you and Tigrou hopeful wishes for recovery.
 
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QuaraLisa

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Q QuaraLisa I am afraid I don't have experience with this condition, but I wanted to offer you support during this difficult and emotionally painful crisis with your dear Tigrou. It is clear that you are trying every therapy available to help Tigrou have some quality of life. I hope that the diet change can help him. I am sending you and Tigrou hopeful wishes for recovery.
Thank you very much for your nice words. It is really an awful situation where I do not see a happy ending. I try to continue believing in him but I already had so much hope during this last month that were torn into pieces everytime he relapsed...
All I want is for him not to suffer. What is difficult is that he is not clearly dying so the decision is really heartbreaking but In case I have to do the unthinkable (letting him go),It is not a life for him getting tapped every few days. I already contacted a vet who is devoted to support end of life of cats & dogs. She comes to the house of the owners of dogs/cats to avoid additional stress and support end of life both for the animal & the owner. If we have to arrive to this point, I will do that to let him go the best way possible.

But first, I"m seeking some hope that I might not have tried everything for him.
 

fionasmom

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Search Results for Query: pericardectomy

I am also very sorry that you are facing this with your cat, and worse, you are facing it after having made the decision to try your hardest to treat him. There is not a lot on TCS about these conditions, but the link above will take you to those threads.

You appear to have good vets, so this is not a criticism of them. Can they contact any specialists, teaching hospitals, any place in the world, for a consultation?
 

FeebysOwner

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I have no valuable information to offer. The only one thing I remember reading about this is what was called 'epicardial stripping' sometimes done in conjunction with pericardiectomy for more severe cases, but it is considered a more complex procedure with a higher risk. Again, no real valuable information for you, as it would require another surgery, if it wasn't already done, to help your cat's current situation.

I did the reverse of the site search fionasmom fionasmom did above - to see if there are/were other cases, and did come up with some previous posts, but most are older, so I suspect the posters are no longer active. There is one more current one from D dbcatperson , but I don't know the differences/commonalities. See link below if you would like to look through them.
Search Results for Query: chylothorax | TheCatSite

I also echo fionasmom fionasmom 's suggestion about specialty vets or vet universities that your vet team could reach out to for additional guidance. These groups often have experience/education that extends well beyond what most vets in practice see in a lifetime.
 
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QuaraLisa

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Search Results for Query: pericardectomy

I am also very sorry that you are facing this with your cat, and worse, you are facing it after having made the decision to try your hardest to treat him. There is not a lot on TCS about these conditions, but the link above will take you to those threads.

You appear to have good vets, so this is not a criticism of them. Can they contact any specialists, teaching hospitals, any place in the world, for a consultation?
I already did some search on this forum (thanks to google) but I did use Chylothorax, not pericardiectomy. I will try that if some others encountered post-surgery issues.

The vet who is currently trying to treat Tigrou is not my regular one as mine does not have neither the knowledge or the right material to deal with the disease (we need a cardiac echography). So the current vet is specialized in cardiology but he is quite young as he has graduated from vet school only since 2016. But, the clinic where he worked employed more than a dozen vets and as we went lots of time there, most of them already know our Tigrou.
So, I already told the vet that I would like a 2nd opinion from some experts. We have near Paris a famous vet hospital (which is also a school for vet where our vet gratuated from). I have planned to ask him again today if he knows an expert we can go to.

(what does TCS mean ?)
 
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QuaraLisa

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I have no valuable information to offer. The only one thing I remember reading about this is what was called 'epicardial stripping' sometimes done in conjunction with pericardiectomy for more severe cases, but it is considered a more complex procedure with a higher risk. Again, no real valuable information for you, as it would require another surgery, if it wasn't already done, to help your cat's current situation.

I did the reverse of the site search fionasmom fionasmom did above - to see if there are/were other cases, and did come up with some previous posts, but most are older, so I suspect the posters are no longer active. There is one more current one from D dbcatperson , but I don't know the differences/commonalities. See link below if you would like to look through them.
Search Results for Query: chylothorax | TheCatSite

I also echo fionasmom fionasmom 's suggestion about specialty vets or vet universities that your vet team could reach out to for additional guidance. These groups often have experience/education that extends well beyond what most vets in practice see in a lifetime.
I also saw that combination of pericardiectomy + epicaridial stripping can help with chylothorax but my understanding was that last surgery is very invasive with low rate of success. So I do not think we will go this road.

Thank you also for the search. I will take a lot to both searches.
 

WMM201

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Q QuaraLisa i hope the second opinion visit will be helpful to Tigrou. It does sound like he getting good care already (especially from you) but a second opinion can't hurt. TCS is abbreviation for The Cat Site. Wishing Tigrou luck and some comfortable times with you.
 

fionasmom

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A young vet may be very informed on all new procedures and practices, so that may be a good aspect of this. Asking for a referral to a specialist is a certainly a respectable request for this specific kind of surgery and condition. Please let us know what happens.
 
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QuaraLisa

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We went today to his current vet for his control. Without any surprises, he still has lots of fluid in the chest but vet preferred not to tap as even if the breathing was not very good, he was coping with his condition.

He increased the dose of diuretic and added a treatment against heart issue (Vetmedin - pimobendane molecule) and asked us to continue with prednisolon & rutin.
We also discussed about having another opinion. From his point of view, he is not very convinced about it and as the current clinic we are in is specialized in this type of issue. (as he said, usually people are referred to them, not the other way around). We then have to think if it will be beneficial for Tigrou (who is very stressed by vet).

I'm really hoping that the addition of heart treatment will help and that it will decrease his fluid as it is heart breaking to see the effort he is spending to breathe.
 
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QuaraLisa

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Hello,

I come back to give you some (good) news.

End of July, we had the good surprise that the level of liquid inside the chest was lower than beginning of July (estimated around 100ml instead of 200ml).
As Tigrou was handling quite well this liquid, it was decided not to tap him and to start reducing cortisone
End of August, we did another control (in between we went to vacation with Tigrou + Vet in vacation also) and there was no liquid anymore. Still no liquid this Tuesday. So it seems that we have beaten the chylothorax this time.

For sure, he still has his heart tumor combined with hugh heart murmur. And vet already told us that the tumor enlargment might lead to additional chylothorax.

As of now, we are just enjoying to still have our cat and he is now feeling young again : trying to escape the garden, running after wedonotknowwhy during the night etc...
 

fionasmom

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Thank you for letting us know. I hope that this good period lasts for a long time.
 
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