Chyloabdomen in geriatric CRF cat

Re: Chyloabdomen in geriatric CRF cat

Rob Loxley — Sun, 22 May 2011 22:34:17 GMT

[quote user="Mark Hedberg"]I've had good results with spironolactone - it's supposed to help with scarring in the heart chambers[/quote]

And with sodium retention by aldosterone antagonism and is a weak diuretic.

Re: Chyloabdomen in geriatric CRF cat

Andrew Kent — Sun, 22 May 2011 21:31:15 GMT

[quote user="Michael Woodhouse"]

[quote user="Alice Courtney"]is it worth trying steroids[/quote]

"don't let anything die without steroids"

A shot of depo-medrone will make the cat feel better. If it's not improving then PTS.

[/quote] Except if you have heart disease in which case you will make matters far worse!

Re: Chyloabdomen in geriatric CRF cat

Mark Hedberg — Sun, 22 May 2011 21:13:31 GMT

I've had good results with spironolactone - it's supposed to help with scarring in the heart chambers. At least so sayeth the rep...

Re: Chyloabdomen in geriatric CRF cat

sarah mason — Sun, 22 May 2011 14:07:36 GMT

[quote user="Bob Russell"]

The history screams hyperthyroid!

Hyperthyroid plus renal failure is very likely to end in tears!

Quality of life is about the only factor to consider.

[/quote]

My own cat has been quite happy with CKD and HT for 2 years now.....

Re: Chyloabdomen in geriatric CRF cat

Alice Courtney — Fri, 20 May 2011 23:17:01 GMT

Update: I did check T4 last week, is was 14

Did basic scan of heart today: assymetrical thickening of ventricles + enlarged LA. Also has small amount pleural effusion. Going with heart disease so despite the renal failure, I have put the cat on a tincture of frusemide, and am seeing it back on Monday... if she's still alive then

(I agree about heart failure + hyperthyroidism, I've treated it a few times and seen some surprisingly good responses, although some I lost to followup so not sure exactly HOW good!)

Thanks again.

Re: Chyloabdomen in geriatric CRF cat

Michael Woodhouse — Fri, 20 May 2011 22:54:50 GMT

[quote user="Alice Courtney"]is it worth trying steroids[/quote]

"don't let anything die without steroids"

A shot of depo-medrone will make the cat feel better. If it's not improving then PTS.

Re: Chyloabdomen in geriatric CRF cat

Kate Richardson — Fri, 20 May 2011 20:33:44 GMT

As a slight aside, I would like to add that people shouldn't necessarily condemn a cat in congestive heart failure if there is a suspicion of hyperthyroidism as the primary cause. I have seen several cats now in congestive heart failure (pleural effusions mainly) due to hyperthyroidism which have responded well to initial treatment (thoracocentesis, O2 and diuretics) which once stabilised and started treating and stabilising the hyperthyroid status, have gone on to do really well, to the point where an echo has shown the cardiac changes seen at initial presentation (including a dilated large atrium) to have resolved and diuretic therapy has been able to be withdrawn and as long as the hyperthyroidism is controlled, the heart remains stable.

Obviously different situation if other concurrent problems, but if due to uncomplicated hyperthyroidism, consider giving them a chance.

Re: Chyloabdomen in geriatric CRF cat

Richard Fox — Fri, 20 May 2011 16:45:10 GMT

Hmm yeh - difficult situation - need to look like you are trying but at the same time guide her into accepting the poor prognosis - Don't envy you :(

Re: Chyloabdomen in geriatric CRF cat

Alice Courtney — Fri, 20 May 2011 13:14:56 GMT

Thanks all for your thoughts. I am pretty sure I checked T4 last week & it was normal, will double check though that I did do it!

Cat already been diagnosed with CRF hence on renal diet + kaminox for hypoK. BP last week was 140-160mmHg so stable, although I wonder whether it might fluactuate quite a lot in this cat, the owner phoned today to says there's 'blood in the other eye'. The cat's a bit of a stress-head normally anyway, so I'm not sure how reliable the tachycardia is, but I'll suggest a cardiac scan.

Re QOL/PTS: This owner LIVES for her 2 cats, and finds it VERY hard to understand just how ill this cat is. I have had a number of consults with her over the last 10d or so, each time councilling her towards imminent PTS & encouraging her to make the most of the little time she has left (hint hint, etc).

Anyway I'll let you know how I get on in today's consult with the owner...Thanks once again!

Re: Chyloabdomen in geriatric CRF cat

Richard Fox — Fri, 20 May 2011 11:34:36 GMT

Sorry missed the 200bpm & hypertension! - T4 tick

Re: Chyloabdomen in geriatric CRF cat

Bob Russell — Fri, 20 May 2011 11:30:32 GMT

The history screams hyperthyroid!

Hyperthyroid plus renal failure is very likely to end in tears!

Quality of life is about the only factor to consider.

Re: Chyloabdomen in geriatric CRF cat

Kate Richardson — Fri, 20 May 2011 09:46:53 GMT

I echo the thoughts regarding hyperthyroidism/congestive heart failure secondary to this., esp given polyphagic/weight loss. An abdominal mass ie lymphosarcoma was my next thought, but you have a clear scan (although wouldn't take lympho off the list completely). The abnormal behaviour could well be due to hypertension, highly likely if she has CRF, and even more likely if she is hyperthyroid, plus hypertension could also contribute to cardiac changes and congestive heart failure.

So check a T4 and blood pressure first.

Sorry just seen that she is on amlodipine already so you have done her BP, but recheck if not done for a while!

[quote user="Martin Jones"]

At the risk of sounding like an obsolete old fart, could I suggest a compassionate guidance of the owners towards euthanasia? A blind cat with at least two incurable and debilitating problems is unlikely to be enjoying itself right now, and the light at the end of the tunnel is most likely an oncoming train.

[/quote]

You don't sound like an old fart at all, quality of life is the very most important thing and really needs to be given some serious thought by both the owner and the treating vet. However, if it is hyperthyroidism and the cat has been happy up till now, then there is at least a realistic chance that more quality life can be obtained for this cat by treating it. However, it can be tricky to balance hyperthyroidism and renal disease, so it depends a lot on how far advanced the renal disease is, and really how dedicated the owners are, as it may be that by treating one disease the other worsens. Their idea of happiness of their cat may be based on the fact that it is eating well and they don't really understand that this may be due to an illness.

Re: Chyloabdomen in geriatric CRF cat

Richard Fox — Fri, 20 May 2011 09:41:48 GMT

feline lymphangiectasia - never seen it in my carrier - I would go for cardiovascular disease and neoplasia myself - any evidence to suggest the cat has hypertension? And yes as above maybe were getting towards the end? :(

Re: Chyloabdomen in geriatric CRF cat

Rob Loxley — Fri, 20 May 2011 01:08:13 GMT

Few thoughts - what is the T4?; is there cardiomyopathy?; how common is feline lymphangiectasia?; might rutin be useful? what's the best ultralowfat diet for cats?

Re: Chyloabdomen in geriatric CRF cat

Martin Jones — Fri, 20 May 2011 00:17:51 GMT

On a technical note, why wasn't an echocardiograph performed by said specialist?

Re: Chyloabdomen in geriatric CRF cat

Mark Hedberg — Thu, 19 May 2011 18:23:14 GMT

May be secondary to congestive heart failure, esp with the higher heart rate. Any chance of a cardiac ultrasound? Also a t4 may be suggestive. You can get a hypertrophic cardiomyopathy secondary to hyperthyroidism, which can get you ascites or (once, for me) a chyloabdomen.