Ascites and bradycardia.

Re: Ascites and bradycardia.

Bob Russell — Wed, 23 Feb 2011 14:35:56 GMT

[quote user="Camilla Edwards"]

I did mention this, but as the cat is so well in itself, they'd rather take it home and enjoy the last few days with it, they were considering if respiratory problems started due to build up of ascites draining the abdomen, but weren't prepared to go as far as surgery.

[/quote]

Wise move I think!

Re: Ascites and bradycardia.

Camilla Edwards — Wed, 23 Feb 2011 09:51:11 GMT

Re: Ascites and bradycardia.

Bob Russell — Wed, 23 Feb 2011 09:34:55 GMT

[quote user="Michael Woodhouse"]

Camilla, if money is an issue you can do an ex lap for a lot less money that the radiographs, ultrasound etc? Might get you that crucial bit of info, without just putting cat to sleep.

[/quote]

At 16yrs old the news is very likely to be bad! I sometimes offer an ex lap linked to probable euthanasia. I have found the best way to phrase it is along the lines that I will PTS unless there is something constructive that can be done to return the cat to a reasonable state of health and welfare. Needless to say many owners decline this and the lap often shows some form of neoplasia.

Re: Ascites and bradycardia.

Camilla Edwards — Wed, 23 Feb 2011 09:22:04 GMT

Update:

The owners decided yesterday that they did not want any further investigations done on their cat, and have taken it home with a view to PTS in the very near future. So I guess it'll remain a mystery, unless I manage to get permission to PM it of course!

Re: Ascites and bradycardia.

Alex Gough — Tue, 22 Feb 2011 09:50:07 GMT

Generally I only tap enough to relieve respiratory embarrassment with ascites. I do recall one cat many years ago in general practice however, with ascites of unknown origin (never found a tumour or heart disease or hypoalbuminaemia), which I tapped roughly monthly, for about 18 months or so.

Alex

Re: Ascites and bradycardia.

Amanda Nicholls — Mon, 21 Feb 2011 22:34:58 GMT

[quote user="Michael Woodhouse"]

[quote user="amanda nicholls"]I would drain as much ascites as you can tomorrow, it will make him feel better and improve his appetite.[/quote]

I thought that we had moved away from draining ascites due to the massive protein depletion and because they just come back.

Have a yorkie in heart failure that I am filling up with two diuretics and steroids just to stop me putting a needle in the belly.

Unless we have removed the cause I thought contraindicated?

[/quote]

Normal albumin on bloods so no concerns about severe protein loss. I would be more concerned about electrolyte imbalance on diuretics. If the cat is eating well, he should be able to cope with the protein loss. Drain as much as you can and get the owner to report the response - even if it's due to neoplasia they do feel better. I cannot see any reason not to make the cat feel better by draining tomorrow, especially if you are waiting for test results.

Yes it will fill up again, when you have a diagnosis you can manage the ascites appropriately with medications or surgery and if you can't stop it reforming with meds, you can drain it again. I've treated a CKCS on triple diuretic therapy with periodic drainage when he filled up, he was very tolerant of it. Cats with abdominal tumours will also improve after draining their ascites.

You could do a Rivalta test very cheaply in house if you suspect FIP.

Re: Ascites and bradycardia.

Michael Woodhouse — Mon, 21 Feb 2011 22:25:54 GMT

Camilla, if money is an issue you can do an ex lap for a lot less money that the radiographs, ultrasound etc? Might get you that crucial bit of info, without just putting cat to sleep.

Re: Ascites and bradycardia.

Camilla Edwards — Mon, 21 Feb 2011 22:19:33 GMT

Thanks for all the input!

I also thought that drainning ascites was not great as a treatment or maintenance option, but could see how it might aid diagnosis, through palpation of abdomen, and x-rays.

I will discuss the options with the owner of ECG, BP measurement, ultrasound, x-ray. But no one here has given me much hope of finding something treatable, so I will be giving the option of waiting until PTS becomes necessary too. I will try and keep thread updated tomorrow, as long as not too manic at work tomorrow!

Re: Ascites and bradycardia.

Laurence Webb — Mon, 21 Feb 2011 21:55:05 GMT

[quote user="Michael Woodhouse"]

I thought that we had moved away from draining ascites due to the massive protein depletion and because they just come back.

[/quote]

I drain them if the ascites is causing them to feel unwell but otherwise just sample it.

Re: Ascites and bradycardia.

nikki — Mon, 21 Feb 2011 21:35:53 GMT

if it was my case scanning abdo and heart would be first on my list of things to do. i suspect fluid will come back as a modified transudate given the colour so be looking for neoplasia/heart diz/liver diz. is FIP a possibility? i wouldn't drain the fluid unless there's any signs of resp distress.

Re: Ascites and bradycardia.

Michael Woodhouse — Mon, 21 Feb 2011 21:28:47 GMT

[quote user="amanda nicholls"]I would drain as much ascites as you can tomorrow, it will make him feel better and improve his appetite.[/quote]

I thought that we had moved away from draining ascites due to the massive protein depletion and because they just come back.

Have a yorkie in heart failure that I am filling up with two diuretics and steroids just to stop me putting a needle in the belly.

Unless we have removed the cause I thought contraindicated?

Re: Ascites and bradycardia.

Amanda Nicholls — Mon, 21 Feb 2011 20:44:52 GMT

Interesting case. I would drain as much ascites as you can tomorrow, it will make him feel better and improve his appetite. I would be concerned about abdominal neoplasia and would want to do a scan - if you do the scan before the abdominocentesis you will have lovely contrast in the abdo. It would be a good idea to scan the heart at the same time. I would also do chest and abdo rads and an ecg - you may find a heart block with this degree of bradycardia. Has bradycardia been noted before on clinical exam? I sometimes come across cats with heart blocks - HR 80 in the surgery (!) as an incidental finding with no abnormalities detected at home - presumably the cats are sleeping all the time and never need to elevate their heart rates.

Have you checked his BP? I would want to know how good or poor his circulation is, especially prior to sedating if required for your investigations. If the bradycardia is related to heart failure I think the prognosis will be poor. I think unfortunately the prognosis is probably going to be poor whatever you find - please keep us posted.

Re: Ascites and bradycardia.

Mark Hedberg — Mon, 21 Feb 2011 20:24:20 GMT

That's weird. I'd be curious to see an ECG - not because I'm any good at interpreting them, but because I know a few people on here are and I'm very interested!