How JustAnswer Works:
  • Ask an Expert
    Experts are full of valuable knowledge and are ready to help with any question. Credentials confirmed by a Fortune 500 verification firm.
  • Get a Professional Answer
    Via email, text message, or notification as you wait on our site. Ask follow up questions if you need to.
  • 100% Satisfaction Guarantee
    Rate the answer you receive.
Ask Dr. Taus Your Own Question
Dr. Taus
Dr. Taus, Veterinarian
Category: Veterinary
Satisfied Customers: 505
Experience:  Veterinarian with experience in equine and small animal medicine.
Type Your Veterinary Question Here...
Dr. Taus is online now
A new question is answered every 9 seconds

14 YO neutered male, well controlled diabetic, DSH cat diagnosed

This answer was rated:

14 YO neutered male, well controlled diabetic, DSH cat diagnosed with chyloabdomen and chylothorax. Primary source is abdomen with back up into thorax. Chyle tested (no indication of cancer cells), x-rays taken, CBC (pancreas 7.6), ultrasound and echocardiogram performed between 9/3 and 9/5. Everything is clear so diagnosed as idiopathic. To date, have removed 1450 ml of chyle from abdomen (no labored breathing so none taken off of thorax). He lost almost 3 lbs with that removal (17.1# XXXXX 14.36). Met with surgeon on 9/10 and have surgery scheduled for 9/13 but we are second guessing our decision. Cat was showing signs of decreased appetite and now has gone off food completely even with a dose of mirtazapine. We are syringe feeding since 9/8. Has been on Denamarin since fall of 2012 for pancreas support. Started Rutin on 9/6. Tried to switch to a low fat diet but that was when appetite was waning. Held off on steroids in the event we want to pursue surgery. Will have a feeding tube put in on 9/13 at a minimum if we don't do surgery. Would then start steroids if we opt to cancel surgery. Are we being selfish by putting him through such an invasive surgery? He is super sweet and charms the entire vet clinic but we can see he is losing steam and have to decide on a course of action soon.
Hi there,

I'm so sorry to hear that your cat isn't doing well. How sad to see such a well-loved and sweet cat having problems!

If you're absolutely sure that there's no underlying cause (heart failure or cancer), then I think that surgery is a reasonable option because in truly idiopathic cases, it resolves the fluid buildup 80% of the time. You have a decent chance of getting him more time with a good quality of life. However, I'd want to be very sure that there is no reason for his chylothorax. Tumors don't always exfoliate well into the fluid, and if there is fluid buildup, they can be hard to see on imaging or feel by palpation. And idiopathic chylothorax is less likely to show up in both body cavities than it is to show up in the chest alone. One thing I would consider is a CT scan prior to surgery-- this is more sensitive for finding hard-to-spot tumors than other imaging, and you might be able to do the CT and decide whether it's worthwhile to proceed to surgery.

I've never had a client regret a feeding tube in a cat. I'd really encourage you to proceed with that, especially since he's a diabetic. The feeding tube can help get him on a better nutritional plane and make recovery from surgery easier, and it can improve his quality of life if you choose medical management.

I don't think you'd be wrong to proceed with surgery if you're confident that the chylous effusion is idiopathic. I do think getting a little more information might be helpful in terms of knowing what results to expect from the surgery, and in knowing that the recovery time from surgery is worth the results you expect. 14 is a senior citizen in the cat world, but I've seen cats as old as 24 (albeit rarely). You've been very thorough thus far and you clearly care deeply about your cat. Medical management may make him feel better, but I would not expect steroids to resolve the fluid buildup. I think that if you do not elect surgery, you should expect that the care you're providing is palliative and that you may not have him for much longer. This is not a wrong decision, either-- he is a senior cat with multiple medical problems, and his recovery from surgery will be longer because of that. In short, I'd encourage you to get a CT. If it's clean, or if your surgeon is totally confident that there is no tumor without a CT, I'd recommend surgery. If not, I'd recommend medical management, but I'd expect him to continue to deteriorate.

I hope this is helpful. If so, please rate me positively, and don't hesitate to let me know how I can help further.
Dr. Taus and other Veterinary Specialists are ready to help you
Customer: replied 4 years ago.
Thank you Dr.Taus. We are encouraged by your response. We heard the chylothorax surgery was about 80-100% effective when the pericardium is also removed. Our vet said the chyloabdomen is rare so they can't give specific odds. They estimated 50/50. They are planning to ablate the chylii cistern and then move to the thorax and ablate the duct and remove the pericardium sack. Their reports show the removal of that improves the odds. But adding in the abdomen is where the odds fall and that is what scares us. He is healthy in every other way. We have only had him 1 year and last fall I changed his diet to no dry food and only high protein, low carbs. It is through that regimen that we have gotten his diabetes well controlled. A fructoseimine test in early Aug was 295. Regardless of the big surgery we will be doing the feeding tube. We were seeking effectively a second opinion on the treatment path and you concurred with that so we appreciate your efforts. Thank you. Marc and Wendy Panaro (and Nelson)