Cat’s Chest Tap Proves Invaluable
Castiel’s Thoracocentesis Proves Therapeutic and Diagnostic
Cas, the one-year-old domestic short-haired black cat could not breathe. In order to diagnose the fluid seen on his chest x-rays he needed an urgent thoracocentesis.
Cas was shaved on both sides of his chest and a sterile surgical preparation was performed on his skin. The pleural space is an immunoprivileged area of the body. Immunoprivileged means once an infection gets into that area, it is difficult for the immune system to identify it and remove it.
Immunoprivileged body areas (all difficult to remove infections if they start):
- pleural space
- cornea and aqueous of the eye
- interstitium of the kidneys (where the tubes are that make urine)
- inside the prostate gland
Doc Truli inserted a special needle through the muscle in between Cas’s numbed ribs, and began removing the liquid. Physically, removing the liquid lets the lungs fully inflate so that oxygen can reach down into the deep alveolar air sacs of the lungs and dissolve into the bloodstream properly. Green-yellow chunky foul-smelling pus came out of the young cat’s pleural space. Oh no!
“Green-yellow chunky, foul-smelling liquid came out of the cat’s chest.”
Infection in the Pleural Space Is Complicated
Veterinarians know, no matter what the original cause of infection getting into the pleural space, once it’s in there, the best chance of getting it out is open-chest surgery. Because the pleural space is immunoprivileged, oral antibiotics rarely, if ever clear the infection.
Some causes of Pleural Space Infection
- Plant awns being breathed in and then working their way through the lining of the trachea into the pleural space
- Swallowing fish hooks, toothpicks, pins, needles, or other objects that puncture the esophagus
- Tracheal worms eating through the lining of the trachea and letting bacteria into the pleural space
- Foreign Body obstruction in the windpipe or the esophagus eroding through the wall and letting bacteria in (Doc Truli saw this with a dog treat: no coughing or vomiting, no kidding!)
Pleural Space Infection Can Become Permanent
The infection not only pockets not the connective tissue lining, not only infects the tissues themselves, but also coats the outside of the lungs and the lining of the chest wall. Also, possibly, whatever injected the infection into the pleural space could still be in the body causing a nidus (pronounced nigh-duss) of infection, or a constant source of new infection. Eve with open chest surgery, placement of a chest drain tube to take out ongoing pus accumulations, and infusion of antibiotics into the pleural space, some cats so not survive the surgery, and some cats do not clear the infection. Or they clear the infection, but there is significant scar tissue left in the pleural space that causes pulling and restriction on the movement and expansion of the lungs that compromises breathing anyway, even if the fluid is all gone.
Cas Cannot Have Surgery
Between the risk of dying during surgery, and frankly, let’s be blunt, the exorbitant cost required for open-chest surgery, with a ventilator to breath for Cas, and the intensive care costs of a kitty ICU after surgery, and the poor chances of surviving and thriving after the surgery, we seriously discussed what our next decision should be.
Should a Cat With Pleural Infection Be Put Down?
Many veterinarians would recommend humane euthanasia at this point in the care process. They would not be wrong. Massive infection, over 600 mL of pus, and a possibility of dying through not being able to breath are compelling reasons to try and prevent Cas from suffering in the future.
However, let me share my point of view. Me, Doc Truli. And tell you what we did for Cas.
Cas Can Have Compassionate Care
This is purely my personal point of view, and every cat is different, and every family is different. In Cas’s case, he was breathing easier from the chest tap procedure. he still had some fluid on the lungs, as you can see from the follow-up x-rays, but he felt better. He was a young, happy, strong cat with a sudden problem. A sudden change n his physical circumstance. Sudden changes can often suddenly get better; the vitality of the cat is string and vigorous. Sometimes, the illness seems very severe because f the body’s vigorous objection to the disease state even more than the virulence of the pathogen itself. Does that make sense?
“Sometimes the vigor of the body trying to return to a healthy state makes you think the disease is worse than the virulence of the disease would suggest,” says Doc Truli.
For example, a shiny, healthy cat eats a bad batch of cat food (I don’t know why, ask the cat), and the cat suffers violent sudden vomiting and diarrhea. This “disease” of vomiting and diarrhea is a sign of a healthy body purging an offending substance. If we help the cat through the episode, attend to fluid and electrolyte needs and prevent imbalance in the body, then this cat will be back to a healthy state soon.
Cas was so shiny and muscular and his eyes were so bright and clear, that he just seemed to have a chance in spite of the scientifically objective evidence of pus in his chest. Besides, textbooks ad case studies are guidelines, not prophecy.
“Textbooks, statistics, and case studies are guidelines, not prophecies,” says Doc Truli.
Cas’s Treatment and Future
Cas received intravenous antibiotics and antibiotics to go home, strict instructions to rest and tincture of time. He stopped panting after the chest tap. He was eating his food the next day. His mom worked hard to be sure he took his medicine. He’s not perfect. Every few months, he becomes slightly withdrawn, maybe has a different body posture and look on his face, and mom knows some of the infected scar tissue has flared up. His new chest x-rays look like a ten-year-old cat, not a two-year-old cat. You know what? I’m fine with that. He’s alive and happy and loved. Plus super handsome.
Castiel the black cat has a guardian angel looking out for him. She’s a human, not supernatural.