Fluid In Cat's Chest - Advice Needed

[Antonio65]

At 4:30 pm I got the reports from the new vet.

Urine
Urine Proteins: 16 mg/dl
Urine Creatinine: 93.85 mg/dl
Pu/Cu Ratio: 0.17 [<0.2]
Color: pale yellow
Aspect: clear
Glucose: not present
Bilirubin: not present
Urobilinogen: normal
pH: 7.0
Specific weight: 1020
Blood: mot present
Ketones: not present
Nitrites: not present
WBC: 500 WBC/ul
Sediment: not active amorph material

Electrophoresis
Albumin: 61.6% 2.3 g/dl [2.5-4.3]
Alfa1: 1.6% 0.1 [0.3-0.5]
Alfa 2: 9.5% 0.4 [0.5-1.0]
Beta 1: 5.9% 0.2 [0.7-1.5]
Beta 2: 7.6% 0.3 [0.3-0.9]
Gamma: 13.8% 0.5 [0.8-2.9]

The vet told me everything is fine.
Since there are no high proteins in the urine, he said that it's safe to change the diuretic to Fortekor 5 mg, 1/2 pill daily.

His comment was that this case is extremely complicated and he needs some days to study it. He should call me on next Monday.
If he doesn't give me a good and final answer, I will look for someone else!

EDIT: forgot to say that I have already bought a 56-pill pack of Fortekor Flavor 5mg. The pharmacy where I usually go has always some packs available. They gave me a 10% instant discount on the price, 50 euro is what I have paid for it

 

[Antonio65]

Late last night the new vet sent an email and wrote that after reading all reports, old and new, he thinks a therapy with prednisolone would be useful and safe for Pallina.
The prescription is 5 mg a day, then a new chest scan is needed 10 days later.
If I had the email 3 hours earlier I could have bought the med at the pharmacy, now I have to wait until tomorrow (holiday today). He didn't give me any written prescription, that med requires a prescritpion. Usually my pharmacy does me a favor and does not ask for the prescription even for antibiotics and cortisone. I hope they do the same this time.

At the end of the email, though, he wrote what I wouldn't have liked to read!!!
The origin of the actelectasis (lung fibrosis) cannot be determined.
So, is this the result of years of college?
How can I prevent anything if the source of the problem is unknown?

I am going to look for a new opinion elsewhere...

 

[babiesmom5]

First of all, thank you for your kind words for all here. We are all, present or past, coping with serious illnesses in our feline family. Any help, support, encouragement is most welcome and I believe we learn from each other--probably we learn more from you than vice versa.

I know your journey to find a diagnosis for Pallina has been a long and arduous one. While I can well understand your frustration in determining the origin of the problem, I would not "jump ship" on this vet just yet.

From your description, this vet has been very thorough, competent and caring. He is willing to
listen, asks appropriate questions, considers all options, and in my opinion, he is willing to "go the extra mile" to find a solution to a complex problem. Although Pallina's case was extremely complicated, he studied the entire case carefully AND, got back to you before anticipated with answers and a therapy plan. I think this is a vet you can work with. Might I suggest you give him a chance to do more research on this complex case. Perhaps you could ask him if he would consult with his colleagues both there in Italy as well as in other countries, perhaps even the US. The internet is a wonderful tool! Also, as a vet he has access to scholarly literature, veterinary websites etc. which we do not have access to. Perhaps he could consult with other vets at veterinary school teaching hospitals. This is what my (very good) Internal Medicine Vet does and he learns a lot this way.

As far as determining the origin of the lung fibrosis, I believe you should focus more on treatment--how best to provide Pallina the best quality of life for as long as possible.
Pulmonary fibrosis, for both people and pets usually has no identifiable cause. We call that an "idiopathic" disease meaning no known cause. It is often a mystery.

My Mother suffered from Interstitial Lung Disease, which is the human form of lung fibrosis which Pallina has. This was only diagnosed late in her life despite many tests and doctor visits. Although anti-inflammatory corticosteroid therapy is the mainstay of treatment for this disease, it was unadvised in her case due to a weak heart. Fortunately Pallina has a good heart and your Vet has wisely prescribed Prednisolone.

There are anti-fibrotic agents you might ask your vet about which may be helpful. My mother was also prescribed bronchodilators (drugs which widen air passages to relax bronchial tissues making breathing easier), but Pallina may not need them.

No reason was ever determined for my Mother's Interstitial Lung disease. Some doctors theorized that it may have been an immune mediated response since she had Rheumatoid Arthritis for years. Other doctors thought perhaps it may have been as result of several bouts of pneumonia. No one was sure; it remained a mystery.

Although lung fibrosis has no identifiable cause, it CAN at least be successfully treated...and that is what I would focus on. Pallina is counting on you.

Your vet I believe is giving you good advice regarding treatment and follow-up. Hopefully, with the Prednisolone reducing inflammation, Pallina's chest x-ray in 10 days will show improvement. The steroid will no doubt help her appetite as well!

So I hope you will at least give this approach consideration before "jumping ship".

 

[Antonio65]

From your description, this vet has been very thorough, competent and caring. He is willing to
listen, asks appropriate questions, considers all options, and in my opinion, he is willing to "go the extra mile" to find a solution to a complex problem.
[...]
Perhaps you could ask him if he would consult with his colleagues both there in Italy as well as in other countries, perhaps even the US.

The vet told me he's available even during holidays, just for emergency, on his mobile phone.
He's been quicker than expected at giving me an answer, but I was probably expecting something more.

Pulmonary fibrosis, for both people and pets usually has no identifiable cause. We call that an "idiopathic" disease meaning no known cause. It is often a mystery.
My Mother suffered from Interstitial Lung Disease, which is the human form of lung fibrosis which Pallina has.
[...]
No reason was ever determined for my Mother's Interstitial Lung disease. Some doctors theorized that it may have been an immune mediated response since she had Rheumatoid Arthritis for years. Other doctors thought perhaps it may have been as result of several bouts of pneumonia. No one was sure; it remained a mystery.

Sorry to read about it...
What I know, though, is that Irish are the most exposed people on Earth to cystic fibrosis, due to genetic conditions.
I know this because I visit Ireland every year and got this info during one of our trips.

Your vet I believe is giving you good advice regarding treatment and follow-up. Hopefully, with the Prednisolone reducing inflammation, Pallina's chest x-ray in 10 days will show improvement. The steroid will no doubt help her appetite as well!

Yes, I know that the steroid could help her appetite as well, I do hope so!
Yesterday was a "no-day" for Pallina. She woke up vigil, alert, lively and playful. She asked to go out for a few minutes different times. We had snow and it's freezing outside, but yesterday it was windy. For too a long reason to explain, over here northerly winds often bring warm air, and yesterday we had nearly 8°C (46°F) rather than -2°C (28°F), so she felt it was time to take a short walk but she didn't want to eat... a can lasted all day!
I gave her a shot of ranitidine in the afternoon, she was rather sick. A couple of hours later I gave her 1/8 pill of cyproheptadine. None of them worked...

In late afternoon I got the prednisolone from the pharmacy along with the new liver supplement (very similar if not the same thing as Denamarin) and gave her the first pill of steroid.
Today she is rather hungry. She finished the morning can in about an hour

Some members of the HT Yahoo Group that I joined think that I should sent Pallina's blood to a different lab for thyroid tests. They think the lab my vets use is unreliable. In their opinion Pallina is now HYPO thyroid and we should assess this through a reliable lab.
I haven't heard from Ghent yet, I will call them tomorrow.

 

[artiemom]

Antonio65 , my dear friend, even though, I am taking a break from posting, I have to regarding Pallina. I have to agree with B babiesmom5 .

I honestly feel you should give this NVet a chance. He is well respected, has done research, is willing to work with you, and is available on week-ends and holidays!!!
This is important and so wonderful.

If it were me, I would trust his judgement and go along with what he is suggesting for therapy.

If you seriously feel Pallina is hypothyroid, then run it by him.. but I would rejoice in the fact that I finally found someone who was 'there' for you....
Give him a chance..rather than just one appointment.. look how much work/research he has done for you.. just a quick reminder, no one Vet is going to be 'perfect' .. it is humanely impossible. I say this will love....

(((((hugs))))) to you and Pallina..

 

[babiesmom5]

artiemom and I both subscribe to the theory "don't let good be the enemy of perfect".

As far as appetite, this is an ongoing struggle here. Have you tried Webbox lick-e-lix?
It is a tasty yoghurty treat that has Omega 3 & 6 in it. It comes in two flavors; chicken or salmon. Cats love both, although the salmon is favorite. It comes in a small box of 5 x15g sachets. You can use it as a topping on food to keep them eating, or use to camouflage medication. It is made in England, and I learned of it from a cat lover in London. I cannot purchase it in the US, so I order from Amazon. You might want to check it out. As you know you have to have a lot of tricks up your sleeve to outsmart a cat!

 

[Antonio65]

artiemom , I do appreciate you distracting from your important things with your very important Artie to read my updates and give me comfort and advice. I do appreciate it, a lot!!!
I will stick to this vet for a while and see how he will guide me through this adventure.

B babiesmom5 , thanks for the tip! Those treats are available on the Italian version of Amazon, 5x15g sachets for 13.20 euro.
Unfortunately fish and poultry are banned from Pallina's diet.
Today she ate enough. The first can went away in an hour this morning. She asked for another can around 4 pm and so far (8:15 pm here), she's has eaten 2/3 of it. Now she's sleeping. Rather normal for her at this time of the day.
She has already taken all her meds today, all but the cypro.

Thanks to the both of you!!!

 

[Antonio65]

I think it's time for a bit of an update.

Pallina had another visit with her regular vets on Dec 21st, when she had a check for her chest fluids. This time the vet drained 140 ml of fluid. It was clear that the prednisolone wasn't working at all. Her liver and kidneys levels were still high.
Of course, Pallina had no symptoms at all for this situation.
I forwarded all the reports to the new vet on the very day, and asked him whether it was the case to review the cortisone, given that we had no visible result.
Well... he disappeared for three weeks, I had no news from him... After 10 days (Christmas was in the middle) I sent him a new email, with no reply. Until three days ago, when he said he was sorry for late reply and asked me for news.

Meanwhile, on Jan 8th, Pallina had another visit. The aim of this visit was to understand if the lab that has been analyzing her thyroid was reliable. So I asked my vets for two tests at the same time, that is, sending the serum to two different labs and compare the numbers. The first lab was the one where we have been sending the samples so far, the other one is a new and reputable lab. While we were at it we had a blood panel done, and this showed that Pallina's kidney are slightly better than before Christmas, her liver is visibly improved, probably for the massive supplements I'm giving her.
Yesterday I got the report for her thyroid from the new lab and it says that she's euthyroid, her T4, fT4 and TSH (read on a canine range) are fine. We're waiting for the report from the regular lab.
I have promptly sent all these reports to the new vet. I think he will answer me in his own times.

What is totally new is that this morning I took Pallina to the Vet University (10 km from home) where she was visited by a IM professor. I don't know if abroad it is the same, but over here the visits at the University are with the professor and some vet students around. The professor visited Pallina, discussed with me about all we have done so far and asked me to send him the reports of all scans and tests done in the last year.
So I said to him "I'm warning you, they are dozens of reports. You need weeks to read them all!"
Given that the reports were so many, he said that he needs some time to read them all and tell me what it can be. He thinks that there must be something that we haven't done yet, but he needs to see what we have done.
He said he would like to do a new chest scan, a CT scan (which I wouldn't like to) and all the tests we haven't done yet.
In order to give Pallina as less stress as possible, he said he would like to see her when it's time to drain her again.
Unfortunately (or fortunately), so far I haven't seen her in trouble with her breathing, and all the drainings were done during a normal visit. So I cannot tell when it is time, and probably this time could never come.

However, he will tel me something when he reads all the reports. His words today were that it cold be an idiopathic form, so we will never know the origin. Same words I have heard from the other vets.
The good thing is that he didn't charge me for the visit (it would have been around 60 euro, anyway)

My regular vets and the new vet know nothing of the visit with the professor.

 

[di and bob]

How are Pallina's spirits? Is she interacting with you? I know there are good days and bad days, I pray you have many more good ones then bad...... That sweet little girl (and you) have been through so much, it breaks my heart. You are doing everything known to help, and then some, you exhaust me just reading of all you do. Please keep us updated, you are a huge inspiration to us all, may God bless you both and bring some happiness into your lives!

 

[Antonio65]

How are Pallina's spirits? Is she interacting with you? I know there are good days and bad days, I pray you have many more good ones then bad...... That sweet little girl (and you) have been through so much, it breaks my heart. You are doing everything known to help, and then some, you exhaust me just reading of all you do. Please keep us updated, you are a huge inspiration to us all, may God bless you both and bring some happiness into your lives!

di and bob ,
I feel a bit embarassed when someone says I'm an inspiration to others
Please, do take offence at my words, I thank you very much for your appreciation, but I think I've seen much more devoted people in here
Pallina is fine and her spirits are high, or pretty high. She isn't even complaining when it's time to go, she's got used to that
She eats her usual and drinks the average amount of water daily. She's regular in her litter tray. As the days are getting longer and milder she is showing more interest in getting outside, where I take her under control. She's not willing to run away, she just want to slowly patrol her courtyard and smell different "traces"
She vomits early in the morning every now and then. As soon as she gets up from her new bed she throws up some clear juices. Half an hour later she's ready to have her breakfast.

The professor was amazed to see how young-looking she is despite her age. And they were all happy to see how calm and relaxed she is at the vet's. They didn't know that she is just freezed for fear

Thanks for your huge support to me and others!

 

[di and bob]

Don't be embarrassed by heartfelt praise where it is due. You are a champion of cats and will be blessed for your care of them. Nothing but the truth.

 

[artiemom]

Antonio65 You are Legendary!! Do not ever think otherwise..

 

[di and bob]

I agree!

 

[Mia6]

Antonio,

It sounds like the new doc is a good one ad cares about dear Pallina.

Mia

 

[Antonio65]

Antonio,

It sounds like the new doc is a good one ad cares about dear Pallina.

Mia

He wrote me an email on Sunday afternoon to tell me he was reading the many reports and would have been back to me as soon as possible.
I hope it's true

However he dd something on Friday, he gave me a new plan for reducing the cortisone for Pallina, given that it didn't work at all. So for the next 15 days I will give her 1/2 pill a day (instead of one), then for the following 15 days I will give her 1/2 pill every other day.

 

[Mia6]

That sounds like a good plan. I like how he keeps you up to date.

Mia

 

[Antonio65]

New visit with the Veterinarian University professor this morning.

I had lost my hopes to hear back from him, it was two weeks ago when I saw him for the first time.
He called me on Wednesday for an appointment today.

This morning he had an x-ray and a chest scan done at the University labs and ended up that the exact origin of the issue cannot be known.
The two scans revealed a minor amount of fluid in Pallina's chest. He estimated around 40 ml, which is 3 times less than the average so far. What he also saw is that it seems that the atelectasy of Pallina's right lung has expanded to the caudal lobe. It was first seen in the right medial lobe, then in both cranial lobes and now the caudal one.
This is worrying, in my opinion.
He said that he wouldn't do anything more at the moment. He advised me to keep an eye on her breathing rate and pattern and as soon as I see that she breathes faster and/or with an irregular pattern, or I see her in discomfort because of her inability to breathe regularly then I should call him and have an emergency appointment. In that occasion he will have another chest scan done, will drain the fluid and have it tested, and will have a CT scan done to see if the situation has evolved.

Just like the other time, I didn't pay anything...!

Now we still do not have a diagnosis, or better, we have a diagnosis for something that can't be explained. It seems a unique case in the world. I wonder if fibrosis can affect cats, if this can be hereditary or if this disease shows in elder cats.

 

[artiemom]

Oh Antonio, I am so sorry..

But, at least it sounds as if you have found an excellent Vet.. to be so completly through, and not charge you!! that is amazing..

You now are aware that you have a Vet who will go the extra mile for you and Palina.
and have your best interests at heart.

I would really trust this Vet, finally....

The prognosis is horrible, but still, you have an idea of what is happening.. perhaps not a definitive diagnosis, but at least an understanding of what is happening. This is huge, compared with not knowing and just dealing with whatever came up.
I think sticking with one Vet who can orchestrate things, may take a ton of stress off of you..

You know this Vet is trying.. and trying really hard to help...and he seems so knowledgable...and wants, as much as you do, to find a diagnosis, a meaning for this to be happening to Palina..

Sometimes, in medicine, you cannot find a diagnosis..you just have to deal with the symptoms, effects of a disease, without knowing the exact cause.. that really stinks..

Sending tons of love and best wishes.....

 

[Antonio65]

This morning Pallina had a new visit for a complete blood test (including her thyroid) and an ultrasound scan of her abdomen.
The vet saw a slightly reactive duodenum and part of her pancreas, and this could justify her early morning vomit.
While the vet was prodding her tummy with the scan probe, Pallina gave out a loud and angry meow, and the vet said that her pancreas is giving her pain.
I had realized that in the last ten days or so, whenever I touched or gently squeezed her belly she would turn to me and try to bite. So he gave her a shot of a pain killer (I forgot the name, but I will retrieve it) and gave me four more pre-loaded syringes to repeat the shots every 12 hours for the next two days. If it works and her pain is relieved, then he'll send me the prescription to buy the med at the pharmacy.
He saw a slight amount of fluid between the two lobes of her liver, but he said it is so little that he wouldn't be concerned.

I didn't ask for it, but while we were at it, the vet wanted to scan her chest too and found a good amount of fluid, he estimated around 100 ml. This amount should give her trouble at breathing, but she's fine, her pattern and rate is good, the vet can't give an explanation to this.
I wasn't charged for the chest scan, though.

The blood test results should come to my phone in about 5 hours. The clinic is part of a group of clinics and they have an App that I install on my phone and register, then all reports are uploaded in this App and I am able to access them from any Android device where the App has been installed.
I asked them for the blood type test for Pallina too, I'm just curious

 

[artiemom]

Your New Vet sounds awesome.. so caring, and through.. I pray you can finally have a bit of peace, knowing that Pallina is in such great care.. finally...
Sounds like a great clinic, if they have an app for your phone.. that is great!!

It sounds as if your poor baby has pancreatitis.. that is painful.. and the pain meds sound like bupremorphine; I think..

Sending you all the best wishes, love, prayers...