Pleural Effusion- Any experiences?

[Bellasmom]

We are facing the exact issue right now. What has happened in Bella's care and treatment plan? It is such an expensive endeavor and as of yet, have had no answers. Normal on every test. We are just stumped as to how to help our Mandi.

I'm so sorry you're going thru this. She is on prednisone 5 mg every other day and her last fluid draw was 150 cc's. My advice is to do only ultrasounds and no X-rays because eventually they will want an ultrasound so save your money from doing x rays. We put in the pleural ports which are a godsend and a money saver. Each Thor accented is was costing us an average of $400 and it had to be done weekly yo every 10 days. Plus it made her comfortable sooner. She's doing good except we did have a surgical staple pop out. Half was under the healed skin and other half out, easy fix. Did you rule out congestive heart failure, Bartonella and cancer of the pericardium? We did the biopsies when the port was put in, saved us 2k by doing it together. You may want to try an initial dose of prednisone of 7.5 mags twice a day. It was a lot for Bella so we dropped her to 5mgs twice a day then to 5mgs daily. Note, you need to do biopsies before starting prednisone as it can affect the results.

How many ccs are they drawing? Has there been any trauma? Have they tested the fluid? Any infections? Any tumors/cancer? Are you close to Grafton,MA? Tufts has been awesome. What treatments have you tried so far?

I don't think we will ever find out what is causing the pleural effusion and my guess we will have to keep draining her. At least the fluid is down from 600ccs every 7 days so there has been an improvement. My thoughts are if this is what we have to do to keep her alive and happy, it's fine. It's not that bad to drain her and aside from the pleural effusion, she's just like a normal healthy dog in every respect. I'm just so happy we didn't put her down per one vets advice. He was so wrong. Good luck and if you have any questions or if you determine the cause please let me know.

 

[Mandi2016]

I'm so sorry you're going thru this. She is on prednisone 5 mg every other day and her last fluid draw was 150 cc's. My advice is to do only ultrasounds and no X-rays because eventually they will want an ultrasound so save your money from doing x rays. We put in the pleural ports which are a godsend and a money saver. Each Thor accented is was costing us an average of $400 and it had to be done weekly yo every 10 days. Plus it made her comfortable sooner. She's doing good except we did have a surgical staple pop out. Half was under the healed skin and other half out, easy fix. Did you rule out congestive heart failure, Bartonella and cancer of the pericardium? We did the biopsies when the port was put in, saved us 2k by doing it together. You may want to try an initial dose of prednisone of 7.5 mags twice a day. It was a lot for Bella so we dropped her to 5mgs twice a day then to 5mgs daily. Note, you need to do biopsies before starting prednisone as it can affect the results.

How many ccs are they drawing? Has there been any trauma? Have they tested the fluid? Any infections? Any tumors/cancer? Are you close to Grafton,MA? Tufts has been awesome. What treatments have you tried so far?

I don't think we will ever find out what is causing the pleural effusion and my guess we will have to keep draining her. At least the fluid is down from 600ccs every 7 days so there has been an improvement. My thoughts are if this is what we have to do to keep her alive and happy, it's fine. It's not that bad to drain her and aside from the pleural effusion, she's just like a normal healthy dog in every respect. I'm just so happy we didn't put her down per one vets advice. He was so wrong. Good luck and if you have any questions or if you determine the cause please let me know.

We have done all of the tests the specialist has suggested so far and nothing has come up that could cause the issue. We have two shelties and, last Monday, took them to get their teeth cleaned. Mandi's O2 levels dropped quickly when she was put under. They only had her under about 5 minutes and put her on oxygen afterwards. A CXR was done after notifying us and showed the fluid. Heart was normal sounding before surgery so there was really no clue of the crisis to come. We immediately went to the animal ER and admitted her for the night where a tap was done with 500 cc drained that night, another the next morning getting 200cc. Xray was done then and looked much better. Wh had an appointment this last Saturday with a specialist when another 600 cc was drained and abdomen US done with no real issues other than a thickened lining of her stomach. Blood work is normal too. Albumin level on the low side but not dangerous they said. We go again in the morning to have the heart US done. I am really not thinking anything will be found, just don't know how much more we put her through. I am taking your reply from today to ask about meds that might be beneficial for her. So far they haven't given anything medication wise. She is only 6 so we hate to give up yet, but this is pretty expensive and hate to spend the rest of her days at less than a good quality of life.
No trauma, we live in the Ft. Worth, Texas area. Thank you so much for responding to me, helps a lot knowing we aren't the only family affected by this, just wish there was a good solution and or cure!

 

[Bellasmom]

It might be coincidental but Bella had extensive dental work prior to her pleural effusion and my other sheltie didn't. Makes we wonder if there is any correlation??? Mandi is young and I was struggling with the same decision because of the expense and Bellas age. I have to admit, I'm glad we put the ports in. Check out www.norfolkvetproducts.com. We had 2 implanted so we could rotate sides and had a backup in case one got clogged. There was no extra charge other than for the kit itself which I think was $300. I think we paid $2,200 for the surgery which included the 2 ports, biopsies of the heart tissue, meds and hospital stay. It paid for itself within 4-5 weeks. We started in March and it's nearly November and she's doing good. Quality of life is good because we can drain her when she needs it and it's like instant relief. We drain her once a week and she doesn't mind it at all, she lays down and takes a snooze then she gets a treat afterwards. The other issue we had was pancreatitis and elevated liver enzymes but all that is fine. Early on she was on Cerenia, metrdiozole (may not be spelled right) and another med. PE is either inflammatory or immunosuppressive from what I understand. Testing the fluid to determine if it's an exudate or transudate may be helpful. It may be chylous effusion if it's milky, that outcome seems to be dim but I have read of success stories. We've spent about $13,000 so far and as hard as it was financially, I'm so glad we did. I couldn't put her down until we knew for sure that we've exhausted all options, we owed that to her. Once we ruled out cancer, it helped us to decide if we go further. She does have fibrins around her heart but the heart is normal. Like I previously posted, her fluid volume has decreased significantly. For awhile it averaged 250ccs then it went to 150ccs and sometimes 100ccs. We sometimes go 10-12 days between draining and we probably could go longer but I want a schedule to gauge the fluid production plus why wait until she's uncomfortable. The moment we see her breathing starting to get labored, we drain. If your vet wants to review her records, I have no problem sharing if he thinks it will help. We see Dr. Benedict at The Cummings School of Veterinary Medicine-Foster Hospital for Small Animals. She's excellent and I'm sure she would be happy to help in any way. The surgeon was Dr. Baron at the same hospital. It doesn't seem like many vets have a lot of experience implanting the ports so she might be helpful too. Also, the bartonella test is about $500 and that's a special test for specific tick diseases that aren't detected with a normal test. Bartonella can cause pleural effusion but if your area is not a high risk area then it may not be worth the expense. I take my girls traveling with me everywhere in the Northeast and I've found one tick on my other sheltie before somfor me it was worthwhile to do. My biggest joy was to be able to take her back to Maine to run on the beaches and go swimming again, she loves it! That in an of itself made it worth every penny! Again, anything I can do please just ask and good luck

 

[Bellasmom]

We have done all of the tests the specialist has suggested so far and nothing has come up that could cause the issue. We have two shelties and, last Monday, took them to get their teeth cleaned. Mandi's O2 levels dropped quickly when she was put under. They only had her under about 5 minutes and put her on oxygen afterwards. A CXR was done after notifying us and showed the fluid. Heart was normal sounding before surgery so there was really no clue of the crisis to come. We immediately went to the animal ER and admitted her for the night where a tap was done with 500 cc drained that night, another the next morning getting 200cc. Xray was done then and looked much better. Wh had an appointment this last Saturday with a specialist when another 600 cc was drained and abdomen US done with no real issues other than a thickened lining of her stomach. Blood work is normal too. Albumin level on the low side but not dangerous they said. We go again in the morning to have the heart US done. I am really not thinking anything will be found, just don't know how much more we put her through. I am taking your reply from today to ask about meds that might be beneficial for her. So far they haven't given anything medication wise. She is only 6 so we hate to give up yet, but this is pretty expensive and hate to spend the rest of her days at less than a good quality of life.
No trauma, we live in the Ft. Worth, Texas area. Thank you so much for responding to me, helps a lot knowing we aren't the only family affected by this, just wish there was a good solution and or cure!

Mandi, how is your girl doing? Mine is still getting the fluid but it seems like its slowing down. We are at 100-200 cc's every 10-14 days which is better than 600cc's every 7 days. Hope your girl is doing good!

 

[mrsquasar]

Mandi, how is your girl doing? Mine is still getting the fluid but it seems like its slowing down. We are at 100-200 cc's every 10-14 days which is better than 600cc's every 7 days. Hope your girl is doing good!

Hi all,

I hope Bella and Mandi are still doing well. My little Misty, a 14 lb, 11 year old blue merle, is now going through some of the same. She was at Tufts and had many tests. They put a pleural port in, and we're getting ~240 cc every 6 days. We just started her on antibiotics for possible Bartonella infection, although they haven't actually tested for it. I'd love to hear how other shelties have done in the long term with the pleural port and no clear diagnosis for the pleural effusion.

 

[Bellasmom]

Hi all,

I hope Bella and Mandi are still doing well. My little Misty, a 14 lb, 11 year old blue merle, is now going through some of the same. She was at Tufts and had many tests. They put a pleural port in, and we're getting ~240 cc every 6 days. We just started her on antibiotics for possible Bartonella infection, although they haven't actually tested for it. I'd love to hear how other shelties have done in the long term with the pleural port and no clear diagnosis for the pleural effusion.

Sorry to hear about Misty but don't lose hope. Bella is doing great and we are only getting about 35ccs every 2-3 weeks. She has improved so much! Tufts did replace both ports last month because one was lodged in her diaphragm, no clue how that happened. The other was allegedly blocked with fibrin. So now the new tubes ar shorter and they could not remove the tube in her diaphragm but that's ok, no harm will come. Be prepared to do a replacement surgery in about a year. After the fact, we learned that the ports allegedly don't last much longer than a year but I question that to be honest. We tested for Bartonella first and we did a biopsy to rule out mesothelioma. Did they biopsy the pleura? Is Misty on prednisone? Absent a firm diagnosis, which we don't have, it's either caused by inflammation or immune deficiciency. I would highly recommend Dr. Benedict, she has been superb in treating Bella and communicating options for treatments and its drawbacks. Bella is just like a normal dog except we have to drain her. Next step is to wean her off the prednisone and hope all remains stable. Did they show you how to drain Misty? If not let me know and I'll try to help, I was so nervous my first time. Then one of her ports went sideways. We didn't use it. Overall, it was the best choice and glad we did it despite previous vets recommending putting her down. Just couldn't do it. Good luck with Misty and hope all goes well. Any way I can help, just let me know

 

[mrsquasar]

Hi Bellasmom,

I completely forgot that I posted this. You were right to ask me at Tufts. Thanks again for the helpful info. Tufts gave me the wrong tubing, so I'd like to look into ordering everything myself. Can you send links?

We are starting prednisone today, keeping one antibiotic going and discontinuing another. I'm hoping she will want to eat more with the med changes.

Mrsquasar

 

[Bellasmom]

Hi Bellasmom,

I completely forgot that I posted this. You were right to ask me at Tufts. Thanks again for the helpful info. Tufts gave me the wrong tubing, so I'd like to look into ordering everything myself. Can you send links?

We are starting prednisone today, keeping one antibiotic going and discontinuing another. I'm hoping she will want to eat more with the med changes.

Mrsquasar

I order the tubing from my local vet and it's a little cheaper than Tufts. The irrigation saline I got from emedsupplies off of EBay, gauzes in a tray and sterile gloves from Vitality Medical. Needles I order direct from Norfolk Pet Products. Email Pam at
[email protected] to order. The chlorehexidine I got from Clorox for free but there places to order, just google it. The syringe tube I believe I ordered off of Amazon. Also check Vitality Medical for the sterile gauze in the tray.

Did you ask about diluting the chlorhexidine? What antibiotic is misty still on? I'm going to ask about the 10cc flush, I think Bella could benefit because of the fibrin build up. The prednisone will increase Mistys appetite so that should help. The recipe for the soft chew treats that I used to give Ned's is 1c coconut, pumpkin or almond flour, 1/2 cup unsweetened applesauce and 1 medium sweet potato or the equivalent of organic pumpkin. Mix and bake at 250 for an hour on a small pan. I use Saran wrap to cover it and pat it down, just like making brownies. Then I cut into squares and slip the pill inside, works like a gem. After your first try, double or quadruple the recipe since the amounts I gave you don't make a whole lot.

It was great meeting you and was interesting comparing the treatment each are getting. Any questions just ask and please keep us updated on her progress.

 

[mrsquasar]

Thanks!

I've been in touch with Norfolk. They say they are going to make kits in the very near future. I've already ordered the pre-filled saline syringes, plain syringes and chlorhexidine through amazon. Our local vet had some tubing that I could use, so I'm going to ask to buy more. We'll see if Norfolk comes through with kits.

Misty is still taking the Baytril. Thanks for the recipe!

 

[Bellasmom]

Thanks!

I've been in touch with Norfolk. They say they are going to make kits in the very near future. I've already ordered the pre-filled saline syringes, plain syringes and chlorhexidine through amazon. Our local vet had some tubing that I could use, so I'm going to ask to buy more. We'll see if Norfolk comes through with kits.

Misty is still taking the Baytril. Thanks for the recipe!

Just wondering how Misty is doing? Bella's doing great, still getting fluid but she's active, happy and has a great appetite. Getting between 50-100ccs every 2 weeks on average. Hope misty is doing good! Did you ever find out the cause yet?