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Ask Dr. Michael Salkin Your Own Question
Dr. Michael Salkin
Dr. Michael Salkin, Veterinarian
Category: Cat
Satisfied Customers: 28574
Experience:  University of California at Davis graduate veterinarian with 45 years of experience.
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During November 2015, my 14 yr old female cat coughed twice,

Customer Question

During November 2015, my 14 yr old female cat coughed twice, harsh sounding coughs which also had a snapping sound to them. Kept a close eye on her but as she seemed fine, displaying normal behaviour, I was not too alarmed. She had just very recently had her annual vaccination and check up, and all was well. Middle of December I noticed her breathing seemed laboured, and so I took her along to the vet. After physical exam, I was told to bring her in the following morning for xrays. Vet said lungs sounded very harsh, and warned me that depending on what they find with the xrays it may be kinder for my cat to be euthanised prior to coming round from the anaesthetic. The xrays showed she had fluid build up in the chest cavity - pleural effusion. Vet drained 180ml of fluid. He said the fluid seemed sterile, clear in colour with no blood or pus present. I was then informed that it was 'very likely' my cat has a tumour in her lung, and this caused the fluid build up. The vet said that fluid will continue to build up until the underlying problem is treated. He said they can do nothing more for her other than give her a long steroid shot (depo-medrone) which should last 4 weeks, and a repeat if necessary. He does not recommend doing the draining procedure again as ultimately it is not going to solve the underlying problem. So we are basically looking at quality of life now, and to have her put to sleep when the breathing becomes worse/she deteriorates. It'is been about 4 weeks since the draining procedure/xrays were done and I am due to take her to the vets in a couple of days time for another check up. I do struggle with the lung tumour 'diagnosis' as I believe the only way to know 100% certain that this is cancer, is to do a biopsy. This the vet is unable/unwilling to do however I do feel that if this was an option I don't think I would want to put my cat through such an invasive procedure anyway. If it were indeed a form of cancer then I also don't think it would be fair on her to put her through aggressive treatments that may only extend her life by a few months. I would prefer to concentrate on palliative care/quality of life. I realise she is old but again am somewhat troubled by the lung tumour diagnosis. I thought that lung tumours are more likely to stem from environmental issues rather than being genetic. Ofcourse there is also a chance that if she does indeed have a lung tumour then this could be secondary to cancer elsewhere in the body. I have two cats, both the same age, they have never been subject to second hand smoke, always been vaccinated annually and have led active/healthy lives. My cat continues to eat well, uses the litter box as normal, grooms herself and is her affectionate self - the only things different about her is the laboured breathing and lack of energy. She tends to sleep/rest all of the time. She is interested in going out and has attempted this a few times but the weather has been so wet/windy that she just sits on the door step for a few minutes. After the fluid was drained 4 weeks ago her breathing did seem to improve slightly but certainly not completely. It's steadily becoming worse and there are times when she has to work harder to breathe. She uses her abdominal muscles to breathe a lot however when she sleeps I have noticed that her breathing slows down and seems a relatively normal pace. I have heard her cough twice in the last week - both times through the night which was loud enough to wake me up. I live on a small island, north coast of Scotland which has just one veterinary surgery, they are limited to what they can do as its a small practice, and to go to another vet would be almost a whole day of travel by boat/car. It would be too stressful for her in her present condition and for that reason is not an option. I feel my hands are tied with this one and the only thing I can do is be guided by my cat, myself and the vet. I attach copies of the xrays - one before and one after fluid removal. Vet said xray after fluid removal did not look right and the grey area in front of the heart/under the windpipe was what he was referring to. In an ideal world I would wish that this was all a terrible mistake and my cat actually has a nasty chest infection that could easily be treated, but I realise that this is more than likely not the case. Ultimately I do not want her to suffer and therefore I am very much prepared to have her put to sleep, I just want to be as sure as I can given the circumstances that it is the right thing to do, and when actually to do it. She is a very much loved and cherished member of our family and has brought us 14 years of absolute pleasure and as heartbreaking as this all is, I am aware that euthanasia will ultimately be the best option for her given the vets grim prognosis. I would appreciate your professional thoughts on this situation and also your opinion on the xrays. Hopefully I can manage to attach the xrays. Thank you.
Submitted: 1 year ago.
Category: Cat
Expert:  Dr. Michael Salkin replied 1 year ago.
I would very much like to review the X-rays. If you need help uploading them, please contact***@******.***.
Customer: replied 1 year ago.
Many thanks for your quick response. I attach xrays.
Expert:  Dr. Michael Salkin replied 1 year ago.
Thank you! ***** see the mass effect cranial (toward her head) to the heart and obscuring the trachea and I also see a more subtle (due to fluid obscuring it) mass effect between ribs 2 and 3 abutting the sternum. These findings are consistent with neoplasia and any infection present would be secondary to the neoplasia. Good hospice care might include a diuretic such as furosemide (Lasix/Salix) which could help her rid herself of the thoracic effusion. Should her respriatory rate exceed 40 breaths/minute at rest, she''ll be in particular distress and will exhaust herself breathing. You'll have a difficult decision to make at that point, I fear.Please continue our conversation if you wish.
Customer: replied 1 year ago.
1.One vet suggested furosemide but the other said it would be no good for her as the fluid is around her lungs as opposed to fluid in her lungs. Does this make any sense to you? Surely if the furosemide would help, the vet would have prescribed this; 2. Although at times she works really hard at breathing she also displays very normal behaviour ie eating, affection. Do you think euthanising on the basis of her breathing alone, when this starts to exceed 40 bpm, even though her behaviour is normal otherwise; 3. What in your opinion do you think the depo-medrone shot does for her condition? Many thanks
Expert:  Dr. Michael Salkin replied 1 year ago.
The other vet isn't wrong but the potential efficacy of furosemide isn't so black and white. For example, if her heart is affected by the cancer or primary cardiomyopathy (heart muscle disease) exists, a thoracic effusion secondary to congestive heart failure should be considered and expected to respond to furosemide. Most important, there's little downside to seeing if it's of value and considerable upside. Euthanizing such a patient would be predicated upon her quality of life. If she reaches the point at which all her energy is being used to breathe, euthanasia is indicated. At that point, cats become anorexic and literally "shut down" while attempting to keep themselves oxygenated. Methylprednisolone (Depo-Medrone) is an antinflammatory glucocorticoid expected to reduce inflammation associated with neoplasia. Some cancers are more responsive to glucocorticoids than others. For example, lymphoma is quite responsive - at least for the initial 30 days of glucocorticoid therapy.You're quite welcome.
Dr. Michael Salkin and other Cat Specialists are ready to help you
Customer: replied 1 year ago.
Dr Salkin, many thanks for your insight. You have helped me to help my sweet girl.
With kind regards
Expert:  Dr. Michael Salkin replied 1 year ago.
Thank you for your kind accept. I appreciate it.
I can't set a follow-up in this venue so please return to our conversation - even after rating - with an update at your convenience.