GA Help with pleural effusion

This past Friday I took Nero in to the vet as he had a swollen nasal bridge and had been lethargic, eating less, and vomiting a lot / seemed like trying to get a hairball out. The vet said everything seemed ok but gave cerenia inj and topical steroid drop for nose. That night I noticed his breathing seemed more labored but I thought it might be reaction to the cerenia. It improved in the morning but then at night returned. On Monday I called the vet and he said he would note the reaction but it should get better soon because the med is almost out of his system. Well it seemed to get worse so I took in him Tuesday morning after watching him all night breathe 32-34 bpm but it just seemed labored. The vet did exam and said everything looks and sounds normal, to just watch him at home. I asked for chest X-ray because I was concerned. We transferred to vet with X-ray and on arrival she said I can feel fluid. The X-rays then showed he had fluid around his lungs and she told me to euthanize him that nothing can be done. I freaked out and said I want to take him home - she told me he wouldn’t make the drive. I felt so bad but I felt I had to try and get a hospice vet to come to our house. We made it home and Nero rested but then he got up to go to the bathroom and eat a bit. I called around to try to find a vet to come over to euthanize as they made it seem like his death is imminent. I finally found someone and then the vet with the X-ray called to say the report came back from radiology that it might be a heart issue, he could have a tap to drain fluid and ultrasound. I got some hope and took him to the ER.
they drained about 130 ml and took repeat X-rays which showed no signs of heart issues. I had the fluid analyzed and it came back lymphocyte rich but no diagnostic signs of cancer cells etc. they say with his age (13 almost 14) that their main concern is cancer like lymphoma. They say most likely cancer but can’t rule out heart issue, which would need an echo, they offer next step abdominal ultrasound to look for cancer there. his regular vet seems to be sold on euthanasia as it doesn’t look good and these visits are very stressful and scary for Nero. It’s a quality of life issue. Nero took about a day to recover from the ER trauma, last night he came to me for pets and he came onto my bed and cuddled my legs. He is still eating drinking etc. he seems tired and maybe uncomfortable. Tonight I think his breathing is getting bad again. I’m still unsure what to do. A vet I spoke to tonight offered that they could give dexamethasone steroid to try against the lymphoma even if we don’t know, and even with his diabetes. But he also probably needs another tap. I’m debating going in now or in the AM. He is resting on a bed. Sometimes I think I should just help him pass, although I hate being the one making that choice. And I want to do everything I can to help him. It was over $3k just for the things we did so far. I want to help him but if he has no chance of feeling good again I don’t want to put him through testing and procedures for my benefit.

 

Sorry for the long post but any advice ? We’re back at the ER vet now to be rechecked and possibly get an abdominal ultrasound or echo if they can today. I hate putting him through this. He obviously not feeling good but he still eating and trying. Just so hard to know what to do.

 

It looks like you saw the previous thread (from November). I don't think this is a common problem and that's why you're not getting many responses. In the length of time I've been here, I don't recall many times when the question has arisen.

 

My cat had a pleural effusion, but rather unique circumstances. It was caused by a chest tap by a vet when she had CHF, congestive heart failure, due to getting fluids - which her heart couldn't handle. She had to spend a couple days in the ER vet until the hole healed over. On oxygen. The ER vet at the time said most of the pleural effusions they saw were from blunt force trauma. Has your kitty had any injuries?

I think your cat needs an echocardiogram or at least be seen by a cardiology vet. X-rays will show the fluid, but aren't enough to diagnose why the fluids. Also, normal in and out breaths per minutes should be under 30. If it is a heart issue, a steroid is counter indicated.

 

Yes, I think their concern is cancer. They said unlikely heart issue but steroids would make it worse if so. Plus his diabetes. They’re going to do some expensive ultrasounds today and see if they can get samples of anything suspicious. I hate to put him through this but I’m trying to get answers. No he had no trauma, he was actually fine and normal until recently so this is all going very fast.

 

I wouldn't worry about the diabetes this point. You can always work his insulin dose around life saving medication if he needs steroids. Wishing you and Nero the best.

 

I'm very sorry that Nero is having difficulty, I can hear how hard it is on you -- it is so heartbreaking to try to decide based on things you don't yet know. The only personal experience that I have with pleural effusion was in a kitten diagnosed with wet FIP, but the fluid literally built up from nothing to eye-poppingly large in 24 hours. It can cause some of the symptoms that you are seeing, but FIP fluid is usually "straw" colored, and if I remember correctly, that fluid is low in lymphocytes but I would ask your vets to be sure.

At the same time that we were treating our foster kitten for FIP, our own 14 year old was being treated at a specialty vet hospital for 6 months with no answers only to find out on necropsy that it was also FIP (dry form, not wet, so no fluid). So if they say that "FIP just isn't common in older cats", they are probably right and it might not be common, but it does exist and I think that it is extremely underdiagnosed. Again, my recollection about the composition of the fluid is different, but if you don't get any answer about lymphocytes in FIP fluid from vets you can check with the Facebook Group "FIP Warriors 5.0". I do NOT want to give you false hope because FIP doesn't sound likely, but since I know personally how under-recognized it is especially in older cats, even with constant care from a very well respected veterinary specialty hospital, I wanted to bring up another option.

I'll be hoping that you get some answers to help you make an informed decision at a very difficult time. Hugs to you both.

 

Nero is gone, I'm devastated. After 5 years with diabetes, I thought he would live to be 18 or 20 years old. The biopsy showed he had high grade lymphoma in his right lung lobe. My poor baby. He was the nicest cat in the world.
I hope I made the right decision. Having that responsibility is so painful. It is so empty without him, and all of his stuff is everywhere. I know you all understand.

 

I am saddened by Nero's passing. It is always hard to say goodbye.

 

I'm so so sorry for your loss. We do all understand .What counts is quality of life. We all have had to make a difficult . Fly high sweet Nero, I'm sure you're chashing butterflies with all the other kitties that have passed.
Please take care of yourself. I know Nero knew how much you loved him
Sending you gentle hugs

 

I'm so sorry for your loss.

 

Oh no. This is terrible news. I am so very very sorry. I understand what you are going through. It makes me cry for you and for your beautiful Nero not being here anymore. I had something similar happen to my cat Julius in January 2020 when I joined this Board. It was very sudden. We were told he had pneumonia but three days later we had to let him go. My heart and hugs and sympathy go out to you.

 

I just thought about this thread and y'all yesterday, oh I cannot tell you how sorry I am... I am positive that you made the right decision -- not because I know when it was his time, but because I am sure that you knew in your heart that it was. Yes, the responsibility seriously sucks, but I completely understand how it feels. And over time, his belongings will bring you a smile rather than a tear.

My sincerest condolences,
Sandi.

 

I am so sorry for your loss. It is never easy to let our pets go but the greatest gift you could give him is to not let him suffer. Nero knows that you did everything you could for him.

Fly free sweet Nero and watch over everyone who loves you.

 

I am so sorry for your loss!!My sincerest condolences. Fly free sweet Nero.

 

I so understand, and my heart aches for you. My deepest condolences. I just lost my sweet boy on Feb 10, and am inconsolable. I hope Dyson has found Nero beyond the Rainbow Bridge, are playing and chasing butterflies together. I wish you strength and peace ️