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Cat’s Chest Tap Proves Invaluable

November 20, 2011
Black Mowgie with round orange eyes lays in sink at animal hospital

Castiel After Treatment

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.

Tru Tip

 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

X-Ray of cat chest after chest tap shows cardiac silhouette and some white fluffy areas of infection lingering in the lungs

Castiel after chest tap, top to bottom X-Ray

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.

Black Mowgie with round orange eyes lays in sink at animal hospital

Castiel After Treatment

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.

11 Comments leave one →
  1. Amber Drury permalink
    October 23, 2015 4:09 pm

    Hello, I know this is an older post but Im hoping for some help. I was referred to a specialist by my vet to run some tests to try and figure out why my kitty is having fluid build up in his pleural cavity. Being that they are “specialists” costs are higher, but they insisted on anesthesia, overnite stay, oxygen, etc. My kitty is highly cooperative, (their own words).So I dont feel he needed to be anesthetized or overnite stay. That added a huge amount to my bill when they clearly knew money was an issue. Being that he was havin ng such a hard time breathing, I didnt have time to shop around! My questions are, is anesthesia and overnite observation a norm at vets for this procedure and is a new xray needed everytime he is tapped? They still dont know what is causing the fluid and I certainly cant keep paying over $1000 every couple of weeks when he needs a tap. He is happy and lively immediately after taps… is just killing me to think I may have to euthanize him when he is so happyand healthy otherwise.

    • November 22, 2015 1:11 pm

      Dear Amber,
      I’m so sorry to hear your kitty has this problem. Your question brings up a huge moral, ethical, and legal dilemma in veterinary medicine today as it is practiced at least as far as I know- in the United States. I believe and I have been told by lawyers in continuing education classes that we must offer the safest, best care we know. Which sounds like what your veterinary team is doing. On another hand, if a family cannot afford it, it does not seem moral or ethical to do nothing!

      You could try being very clear and forthright with your veterinary team. Offer to sign a statement that says you understand they are just trying to do the best for your cat without hurting the kitty, but you cannot afford it. You authorize a chest tap without the extra tests. Or you authorize with local anesthesia to the chest wall without general anesthesia. They may feel uncomfortable performing the procedure that way, in which case you will have to find another vet team to help you.

      I usually offer the full thing. Not chest x-rays before every tap- because the presumed fluid in the chest obscures the view of heart and lungs and what is the point? If ultrasound is available, then ultrasound-guided centesis is great! But again, adds to the cost.

      Many of my pet parents opt for the full safety, but they are concerned about risk vs benefit of sedation or anesthesia. It is not perfect to perform an anesthetic procedure on such a compromised cat. You have to understand that if your cat has fluid in their chest cavity, they would likely die without veterinary help and they may die during a tap procedure. Or need many taps to stay comfortable and then you start wondering about quality of life and the practical limitations of time and money. It’s just a tough road for anyone to help their cat with pleural effusion.

      Everyone faced with this situation feels they are killing their cat if they elect euthanasia. The fact of the matter is, it can be expensive, risky, and inconclusive to pursue a complete diagnosis. Almost all things that cause pleural effusion are terrible to treat and end badly. I feel for you with this awful situation.

      Have you spoken with your vet? They may be able to provide a basic tap procedure at a better price, if you are willing to accept the uncertainties and risks, and put it in writing to help your vet feel protected for the eventuality when your cat passes away.

      Yours, in sympathy,
      Doc Truli

  2. Jessica permalink
    July 19, 2014 12:42 pm

    H Doc –
    This story means a lot to us and has helped us as we face the same condition of pleural space fluid in our older CKD kitty. Can you tell me, have you ever done Tapping on a 17yo feline? His heart was not clearly visible on the xray due to the fluid so we have no way of knowing if cardiovascular disease issues are included. But he does have remnants of damage from asthma to his lungs.

    We made a choice for this weekend to stop Sub Q, allow him comfort at home and give 1/2 tab of Lasix 2x a day to try and alleviate “some” of the fluid. It’s actually brought back his appetite a bit and brought back his awareness and interaction. But we would be curious of your opinion about Tapping a 17yo. A sweet, beloved 17yo. Who manages, thru all this, to not pant and still sleep on his side, seemingly comfortably.

    Thanks for your time-

    • July 19, 2014 4:13 pm

      Hi Jessica,
      Yes, one kitty was 17 and one 18. It’s a little risky. I had one kitty go into arrest and pass away. He was super sick anyway and we were just trying to buy more time.

      I think it’s worth a try. But know you may lose him quickly if it destabilizes him. On the plus side, he could feel great for days, weeks, or months.

      Good luck! I would like to know it goes.
      -Doc Truli

  3. Chantal permalink
    April 23, 2012 6:50 pm

    We recently adopted a cat from a friend’s farm that was showing signs of distress (trouble breathing/weight loss). We took her in as we understood from the people there and from their veterinarian who checks the horses and cats that it was just allergies that she had developed over the course of the few months she was there, and that removing her from the environment was the best for her to help her improve. Well on day 6 at our house she was not improving and she was starting to pant, and I’ve never seen a cat pant-so I took her to the vet. She did one x-ray on her side and her lungs were completely filled with fluid, and no way of knowing what had caused it, we were very upset and sad. She said my options were limited, either euthanasia or emergency medical attention, which could have run in the $1000’s. We did chose euthanasia, it was not an easy decision as we wanted to have her as a companion for our other cat. But I feel confident that we made the right choice, she was struggling for every breath, and she had been in that condition and deteriorating for quite some time. Unfortunately no one had bothered to take her in and have her looked at sooner, and I’m glad she is no longer suffereing and she had someone love her until the end. I am happy to hear that you were able to save Cas, I wish you were here in our City!

    • April 29, 2012 4:19 pm

      I’m sorry your adopted kitty was so sick. Sometimes the body is just done. It is extra frustrating when there’s just basically one organ system going wrong. Like the lungs don’t work, or they can’t urinate, or they can’t hold down food–but their spirits and everything else are fine. Then you are faced with the uncertainty of expensive medical treatment with, of course, no guarantees of success. It is emotionally painful to be the human in these situations and to have to make difficult decisions for another living being. Th decision you made is better than drowning in her own fluid-filled lungs slowly and painfully. You did the right thing. Plus, we were really lucky with little Cass. He really is a miracle kitty.
      Doc Truli

  4. December 6, 2011 3:09 am

    You are such a good vet. I love your attitude,

  5. Ryan Williams permalink
    December 1, 2011 6:48 pm

    We had a chest tap done on our 10 year old female today. In our case it was a series of tumors that were causing a buildup of fluid and blood, but no noticeable infection.

    Ours is resting now, but already she’s breathing deeper and easier. We were presented with the tentative option of euthanasia also and we took your point of view. Compassionate care for animals is completely possible and well worth the few hundred dollars every half year you might spend to re-drain fluid or purchase medications.

    I can see putting her down if she was in terrible pain, couldn’t walk or eat, or breathe. I can’t see putting her down simply because things aren’t going to get better. She’s doing fine now and they don’t have to get better. They can just stay the same for a little while longer.

    • December 4, 2011 5:12 pm

      Dear Ryan,
      I’m so sorry to hear your kitty had a series of tumors. That’s tough news any day of the week. I’m so glad the chest tap went well and she’s feeling better.
      -Doc Truli

    • Emily Daigle permalink
      January 23, 2014 8:27 pm

      Hi if you don’t mind me asking, approximately how much did the pleural tap cost for your kitty? I have been looking all over the internet and can’t seem to find anything about it. We know my cat has fluid in her chest cavity, but a big factor on whether or not we can afford the procedure. All that I have found is that it is not an overnight procedure and anesthetics are not always needed which would essentially lower the costs. I know this post is old but I’m in need thank you!

      • January 23, 2014 9:16 pm

        No anesthesia, good cat, no extra oxygen, about $175. With extras (sometimes kitty is more stressed) can be $375. I had a client spend $625 at an er overnight for basically what i do.

        Good luck,
        Doc Truli

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