there, vet Andrew here.
It seems that Simba is a complex case, and I understand your worry. However, there is a clear procedure that you can follow if not happy with your own vet. I will explain it to you.
First, you have no obligation to contact your own vet any further, although you are of course welcome to make a complaint to the senior partner of the practice. You should do it in writing and clearly set out what you feel is wrong and what you want done. If there is another vet in the practice, especially the senior partner, who you would like to take on the case then request that.
Alternatively, you may without notice take Simba to another practice.
It is then the duty of the new practice to request and read through Simba's notes before your initial consultation.
If Simba is insured, or your finances permit, I would recommend taking him to a feline specialist in a referral practice or a vet school.
I have dealt with many referrals from other practices, many of which were clients disgruntled with the treatment plan or the vet, and I assure you there is no bias towards following the original treatment plan. Often, you find that a fresh mind on the matter can throw up new plans or ideas.
I hope this explanation helps, but please ask away if you wish to know more. Also, you have given a detailed description of Simba's treatment to date. Do you have any questions that relate to his condition or treatment?
OK. Can you remember what type of fluid was found in Simba's chest?
Right, there are a few types of clear fluid, but the possible diagnoses are:
Low blood protein - this would have been picked up by blood tests already.Heart failure - as discussed, it's probably not thisPleural adhesions - scar tissue between the lungs, seen on CT scan and cured by surgery, which, of course, is highly invasiveTwisted lung lobe - should have been picked up on X-rayTumour or hernia - Again, picked up by X-rays.
The treatment pleural effusion, other than by drainage, is to tackle the underlying cause. In Simba's case, it looks like there is conflicting information about his heart, and your vet is covering it in case it is a factor. The only other item on the list is scar tissue, which requires CT and surgery, and I fully understand your reluctance to put him through that.
My feeling on the heart issue is that ultrasound is not everything, and if a blood test found evidence of heart muscle damage (I asssume this is the case), then I would treat as failure.
Simba's leg swelling was likely due to a blown vein, which can be quite severe in older animals. As long as it goes down over the following few days it is nothing to worry about.
To conclude, I feel that Simba's effusion is either heart-related or what we call idiopathic, i.e. no known cause, which can happen in Persians. The likelihood is that he will get one again, which will require drainage. The idea with therapy in these cases is to maximise the time between drainage sessions to improve Simba's quality of life.
The Fortekor is to reduce strain on the heart and improve pumping efficiency. The Prilactone is a diuretic to reduce fluid build-up, and the stomorgyl is to cover . These seem like reasonable drug choices, although the stomorgyl may not be needed long-term. If I were your vet, I would X-ray Simba regularly to monitor in his chest, too.
Simba's breathing rate will be a rough guide much fluid is currently in his chest.
How low was the protein?
Prilactone is actually , so the dose is slightly experimental. You may find a dose increase, or a switch to twice-daily dosing may help, but do this in communication with your vet.
The normal range is 16-40 breaths per minute, so I would put 40 as his upper limit.
As ultrasound, if he tolerates it well then I would try a monthly scan monitoring.
The scan will also help with adjusting his Prilactone rate.
I would say that the protein level may have contributed to the effusion once it started, but would not on its own have caused it. There are plenty of older cats with protein levels below normal who do not get effusions. The low protein, potassium and anaemia are likely related to the kidney disease. Sometimes a six-monthly injection of an anabolic steroid help here.
Yes, you have to be careful with diuretics, especially those used off-label, as they can cause dehydration.
The best cardiologists, depending on where you are, are found in veterinary schools, especially the RVC. You may request referral to there. Bear in mind, however, that you are close to exhausting the diagnostic options available. However, a fresh pair of eyes on the case may help.Pleural effusions all vary but typically need draining every 3 months or so.
The drinking is related to the diuretic and the kidney disease. You mustn't let his water bowl go dry or he'll dehydrate quickly.
All vets can drain a chest. I would take Simba to a good local practice, then request referral from there, as you are clearly not happy with your current vet. The new vet can do the chest draining and any other standard treatments while the cardiologist works on the case.
I think I've advised you as far as I can, because the next stage is to switch practice, get Simba re-assessed, and discuss referral. Please bear in mind the extent to which Simba has already been investigated, and use this to tailor your expectations of what the new vet and specialist are able to do. As long as he is improving, you may already be on the right track. I do appreciate your need fresh opinion, however.
there, sorry I was called away moment. There is medetomidine which can be reversed, but has to be used carefully in kidney patients.
Renal disease can cause protein loss to such an extent that a pleural effusion happens, but only in severe cases. The blood protein would have shown up as very low and Simba would have likely been emaciated as a result.
As back to me, I can schedule a further service with Just Answer once this session has been closed and rated. I have not used this feature before but it should provide further opportunity to ask me questions. I am glad to have been of some help.
I haven't used it either, but it is a new feature of JA which you can use to contact me. You'll be sent details of how to use it.
No problem. Just to be clear, you need to rate my answer so this session can close and give me the option to offer the extra service. Regards, ***** *****