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March 21st 08, 11:12 PM
Have about a 10 year old cat. Last vet found an aural polyp that he
thinks is mostly responsible for his chronic sneezing, and mucous. He
also has a swollen nare that is erythematous, firm, round. It's not a
nodule, is smooth and redness increases and decreases with small open
sore that occasionally bleeds or white cell discharge. Have tried some
natural anti-inflammatories, but no luck. Looked for allergies but
cannot find anything obvious. Vet thinks it is esophilic granuloma. I
suspect it could also be beginning SCC.

Many here advertise "full service vet", but really are not judging
from the equipment they have. They do not have x-ray capability, in
house labs, and other things.

Questions please:

How reliably can the average vet/lab determine definitive cause of the
nasal swelling? What is the least invasive method that is reliable?

What questions should I ask to determine if the vet is capable of
properly diagnosing this condition and doing nasal surgery in case the
nare is malignant? Sneezing could also be partly due to some viral
condition, but there is no eye involvment. He occasionally paws
forcefully at his nose as if to try to eliminate some obstruction-it
is swollen such that the breathing is effected, and he reopens the
sore, so it is obviously bothering him.

What is the estimated cost to determine the exact cause of the nostril
problem? If malignant what can I guess will be the cost of surgery.
What clinical tests would find the cause most efficiently?

Last vet wanted to put him on prednisone, and thought an allergic
response might be a factor. I have tried several different foods, some
seem to aggravate his condition, but have found no definite allergic
response to anything. If the nasal problem is malignant what effect
will the prednisone have on the problem-will it accelerate any
possible cancer? His breathing is sometimes worse than other times,
but not so bad that he is mouth breathing. Same for his sneezing-it
comes and goes.

Thanks for any educated answers from people who actually read the post
before replying ;-)

Sharon Too
March 21st 08, 11:23 PM
> What is the estimated cost to determine the exact cause of the nostril
> problem? If malignant what can I guess will be the cost of surgery.
> What clinical tests would find the cause most efficiently?

There is no standard estimate for any procedure, especially such as this. It
all depends on the cost to the doctor/hospital. Depends on how much
monitoring equipment they use, how many staff are used for surgeries, what
medications/anesthesia used, what their recovery facilities are, what
pathologies they opt for and where they send them out to, how many doctors
staff the hospital or if it's a specialty center. Overhead comes in many
different forms including medication, facilities, equipment, staff/payroll,
insurance etc. And estimates (also commonly called treatment plans) are
nothing more than guesses. They are not guarantees - just ball park figures.
Surgery could last longer, or shorter, than estimated. Depending on what the
doctor finds, there could be more expense in the medication department, etc.

In short, you get what you pay for. We tell people (and we are mid range
priced, not specialized, but AAHA accredited) that if they are looking for
the cheapest vet and cheapest care, they've come to the wrong place. If
they're looking for the hospital with the best care, educated staff and very
good facilities, then we are where they want to be. In the end, you make the
decision. Don't be afraid to ask to tour the facility. They should have
nothing to hide, unless they are taking care of another client in an area
and need to protect confidentiality.

Ask for an estimate with a low and high end, and don't expect it to be spot
on. For non-elective procedures, it's just not possible to have ESP and
predict everything that could come along.

-Sharon

beenthere
March 21st 08, 11:46 PM
"Sharon Too" > wrote in
:

>> What is the estimated cost to determine the exact cause of the
>> nostril problem? If malignant what can I guess will be the cost of
>> surgery. What clinical tests would find the cause most efficiently?
>
> There is no standard estimate for any procedure, especially such as
> this. It all depends on the cost to the doctor/hospital.

<edited>

Disagree completely. A good experienced clinician CAN tell you the most
cost efficient and best route to take. That is THEIR JOB. Should be easy
for anyone knowledgeable in the field especially given the O.P. has
given a quite specific clinical picture.

If they cannnot do that, look elsewhere. Some of these high price
clinics exist to make money and the often involves taking the scenic
route at patient's expense. They buy their state of the art facilities
and then expect you to pay for them whether you really need them or not.

Sharon Too
March 21st 08, 11:52 PM
> Disagree completely. A good experienced clinician CAN tell you the most
> cost efficient and best route to take. That is THEIR JOB. Should be easy
> for anyone knowledgeable in the field especially given the O.P. has
> given a quite specific clinical picture.

This wasn't a question about what would a 'cost efficient' be or what the
'best route' is to take. This person wanted to know an estimate for the
surgery. We can't do that from across the web. My point was that an estimate
is just that - and estimate. Any good clinician would NEVER give a set cost
for any non-elective procedure. A ball park figure with a high and low end,
yes. But no one can get it to the penny.

Dale Atkin
March 22nd 08, 12:00 AM
"beenthere" > wrote in message
...
> "Sharon Too" > wrote in
> :
>
>>> What is the estimated cost to determine the exact cause of the
>>> nostril problem? If malignant what can I guess will be the cost of
>>> surgery. What clinical tests would find the cause most efficiently?
>>
>> There is no standard estimate for any procedure, especially such as
>> this. It all depends on the cost to the doctor/hospital.
>
> <edited>
>
> Disagree completely. A good experienced clinician CAN tell you the most
> cost efficient and best route to take. That is THEIR JOB. Should be easy
> for anyone knowledgeable in the field especially given the O.P. has
> given a quite specific clinical picture.
>
> If they cannnot do that, look elsewhere. Some of these high price
> clinics exist to make money and the often involves taking the scenic
> route at patient's expense. They buy their state of the art facilities
> and then expect you to pay for them whether you really need them or not.
>

Often you don't know until you get in there. Vets aren't omnicient. If you
want a firm price, they can always quote high, and charge you that.

I know at the clinic I volunteer at, they won't quote firm prices on
dentals. Why? Because when you get the animal under, and really start poking
around their teeth, you find more have to come out that you would have
thought, or sometimes you find that none have to come out, or sometimes you
find that a massive tooth that looks healthy (but isn't once you get a
*really* close look) has to come out and its going to take a very long time.

So, they are faced with two options:

1. Be wishy washy about the price.
2. Be firm on the price, but quote so that all the 'maybes' are included.
(in which case on average the client would end up paying more).

Dale

March 22nd 08, 12:11 AM
It would be nice if someone actually READ my posts and saw that I
asked several important questions, and price was only one of them.
Maybe I need to bring down my language to a layman's level as
apparently there are no veterinarians reading or answering these
groups, nor even technicians, as they cannot answer the medical
questions I posed.


On Mar 21, 4:00 pm, "Dale Atkin" > wrote:
> "beenthere" > wrote in message
>
> ...
>
>
>
> > "Sharon Too" > wrote in
> :
>
> >>> What is the estimated cost to determine the exact cause of the
> >>> nostril problem? If malignant what can I guess will be the cost of
> >>> surgery. What clinical tests would find the cause most efficiently?
>
> >> There is no standard estimate for any procedure, especially such as
> >> this. It all depends on the cost to the doctor/hospital.
>
> > <edited>
>
> > Disagree completely. A good experienced clinician CAN tell you the most
> > cost efficient and best route to take. That is THEIR JOB. Should be easy
> > for anyone knowledgeable in the field especially given the O.P. has
> > given a quite specific clinical picture.
>
> > If they cannnot do that, look elsewhere. Some of these high price
> > clinics exist to make money and the often involves taking the scenic
> > route at patient's expense. They buy their state of the art facilities
> > and then expect you to pay for them whether you really need them or not.
>
> Often you don't know until you get in there. Vets aren't omnicient. If you
> want a firm price, they can always quote high, and charge you that.
>
> I know at the clinic I volunteer at, they won't quote firm prices on
> dentals. Why? Because when you get the animal under, and really start poking
> around their teeth, you find more have to come out that you would have
> thought, or sometimes you find that none have to come out, or sometimes you
> find that a massive tooth that looks healthy (but isn't once you get a
> *really* close look) has to come out and its going to take a very long time.
>
> So, they are faced with two options:
>
> 1. Be wishy washy about the price.
> 2. Be firm on the price, but quote so that all the 'maybes' are included.
> (in which case on average the client would end up paying more).
>
> Dale

Sharon Too
March 22nd 08, 12:54 AM
> It would be nice if someone actually READ my posts and saw that I
> asked several important questions, and price was only one of them.
> Maybe I need to bring down my language to a layman's level as
> apparently there are no veterinarians reading or answering these
> groups, nor even technicians, as they cannot answer the medical
> questions I posed.

I read everything but only answered where my expertise is as a practice
manager. I'm not qualified to get into the deeper medical issues. Hopefully
others will fill in the blanks.

-Sharon

mc
March 22nd 08, 04:22 AM
On Mar 21, 6:54 pm, "Sharon Too" >
wrote:
> > It would be nice if someone actually READ my posts and saw that I



:

I think it is completely unreasonable for someone to post and expect
answers to magically appear. Particularly within the time frame of
only several hours (in this case approximately six hours).

The folks on this board, unfortunately for you, are not here at the
mercy of your whims. We have lives too.

We are not veterinarians and can only answer questions within our own
ranges of "expertise".

Sorry for you if you feel "inconvenienced" to have to read through
several posts to get the answers you are seeking.

Perhaps your best bet would be to contact several veterinarians
offices with your "significant" knowledge of the condition and proceed
to get some opinions from some veterinarians directly. Certainly, that
will take some time and effort on your part, but most likely you will
get the answers you are specifically seeking.

Unfortunately, things are not always as easy as it seems like they
should be sometimes.

mc
March 22nd 08, 04:30 AM
There are actually QUITE A NUMBER OF VERY KNOWLEDGEABLE people on this
board who could probably help you... but with your pathetic attitude,
you may not get very far.

How sad for you. Pathetic.

blkcatgal
March 22nd 08, 04:47 AM
Maybe you should wait to see if you get some response from the
alt.med.veterinary group since you posted your message there too. Or call a
vet's office instead of posting a message on newsgroup if you want "medical"
advice.

S.
> wrote in message
...
> It would be nice if someone actually READ my posts and saw that I
> asked several important questions, and price was only one of them.
> Maybe I need to bring down my language to a layman's level as
> apparently there are no veterinarians reading or answering these
> groups, nor even technicians, as they cannot answer the medical
> questions I posed.
>
>
> On Mar 21, 4:00 pm, "Dale Atkin" > wrote:
>> "beenthere" > wrote in message
>>
>> ...
>>
>>
>>
>> > "Sharon Too" > wrote in
>> :
>>
>> >>> What is the estimated cost to determine the exact cause of the
>> >>> nostril problem? If malignant what can I guess will be the cost of
>> >>> surgery. What clinical tests would find the cause most efficiently?
>>
>> >> There is no standard estimate for any procedure, especially such as
>> >> this. It all depends on the cost to the doctor/hospital.
>>
>> > <edited>
>>
>> > Disagree completely. A good experienced clinician CAN tell you the most
>> > cost efficient and best route to take. That is THEIR JOB. Should be
>> > easy
>> > for anyone knowledgeable in the field especially given the O.P. has
>> > given a quite specific clinical picture.
>>
>> > If they cannnot do that, look elsewhere. Some of these high price
>> > clinics exist to make money and the often involves taking the scenic
>> > route at patient's expense. They buy their state of the art facilities
>> > and then expect you to pay for them whether you really need them or
>> > not.
>>
>> Often you don't know until you get in there. Vets aren't omnicient. If
>> you
>> want a firm price, they can always quote high, and charge you that.
>>
>> I know at the clinic I volunteer at, they won't quote firm prices on
>> dentals. Why? Because when you get the animal under, and really start
>> poking
>> around their teeth, you find more have to come out that you would have
>> thought, or sometimes you find that none have to come out, or sometimes
>> you
>> find that a massive tooth that looks healthy (but isn't once you get a
>> *really* close look) has to come out and its going to take a very long
>> time.
>>
>> So, they are faced with two options:
>>
>> 1. Be wishy washy about the price.
>> 2. Be firm on the price, but quote so that all the 'maybes' are included.
>> (in which case on average the client would end up paying more).
>>
>> Dale
>

Dale Atkin
March 22nd 08, 05:31 AM
Perhaps you should work on your patience. Within 45 minutes of posting your
question, you had 4 replies. While no, they didn't answer all of your
questions, they addressed one of your points.
There are in fact vets who read this group, as well as techs, and some very
knowledgable people. I have had lots of good advice from many of them for
everything I've ever come to this group for.

People will answer the points in your post they feel comfortable answering,
and to which they feel they can give a complete answer.

Perhaps part of your problem in dealing with your vet, is that you don't
want to accept that maybe they might be experts in the field of animal care,
nor do you seem to have any trust in them.

Vet wants to put him on prednisone: You go see another vet. Vet says they
can treat the animal, you consult strangers over the internet.

Given that you don't seem to care if people comment on only the parts of the
message that they feel they can provide a complete answer to, I'll do my
best to answer all of your questions.

Costs are going to be *HIGHLY* variable, which is the point Sharon
addressed.

The test that will most efficiently tell you what is wrong is going to be
the right test. What the right test is depends on what is in fact wrong.
This is what diagnostics is all about.

Ask if the vet has done this kind of surgery before, and how it came out. If
you don't trust them, go to another vet. You shouldn't be seeing a vet you
don't trust.

The 'least invasive method' is going to depend on what the problem is. If
you can get it right the first time, then obviously you'll be less
invasisive than if you have to test multiple times. (Prednisone seems like a
good idea to me as far as 'low invasiveness/low cost' goes, but I'm not a
vet so what the heck do I know.)

I've seen a number of vets reduce the swelling in tumors using prednisone.

As far as your language goes, I had very little trouble following it, with a
couple of exceptions.

When you say nare do you mean the singular form of nares? If so, all of my
tests refer to this as naris.

Also not sure what an esophilic granuloma is (consulted multiple medical
dictionaries with no luck). Do you mean eosinophilic granuloma?

Dale

> wrote in message
...
> It would be nice if someone actually READ my posts and saw that I
> asked several important questions, and price was only one of them.
> Maybe I need to bring down my language to a layman's level as
> apparently there are no veterinarians reading or answering these
> groups, nor even technicians, as they cannot answer the medical
> questions I posed.
>
>
> On Mar 21, 4:00 pm, "Dale Atkin" > wrote:
>> "beenthere" > wrote in message
>>
>> ...
>>
>>
>>
>> > "Sharon Too" > wrote in
>> :
>>
>> >>> What is the estimated cost to determine the exact cause of the
>> >>> nostril problem? If malignant what can I guess will be the cost of
>> >>> surgery. What clinical tests would find the cause most efficiently?
>>
>> >> There is no standard estimate for any procedure, especially such as
>> >> this. It all depends on the cost to the doctor/hospital.
>>
>> > <edited>
>>
>> > Disagree completely. A good experienced clinician CAN tell you the most
>> > cost efficient and best route to take. That is THEIR JOB. Should be
>> > easy
>> > for anyone knowledgeable in the field especially given the O.P. has
>> > given a quite specific clinical picture.
>>
>> > If they cannnot do that, look elsewhere. Some of these high price
>> > clinics exist to make money and the often involves taking the scenic
>> > route at patient's expense. They buy their state of the art facilities
>> > and then expect you to pay for them whether you really need them or
>> > not.
>>
>> Often you don't know until you get in there. Vets aren't omnicient. If
>> you
>> want a firm price, they can always quote high, and charge you that.
>>
>> I know at the clinic I volunteer at, they won't quote firm prices on
>> dentals. Why? Because when you get the animal under, and really start
>> poking
>> around their teeth, you find more have to come out that you would have
>> thought, or sometimes you find that none have to come out, or sometimes
>> you
>> find that a massive tooth that looks healthy (but isn't once you get a
>> *really* close look) has to come out and its going to take a very long
>> time.
>>
>> So, they are faced with two options:
>>
>> 1. Be wishy washy about the price.
>> 2. Be firm on the price, but quote so that all the 'maybes' are included.
>> (in which case on average the client would end up paying more).
>>
>> Dale
>

buglady
March 22nd 08, 08:02 PM
> wrote in message
...
> Have about a 10 year old cat. Last vet found an aural polyp that he
> thinks is mostly responsible for his chronic sneezing, and mucous.
..........well, I'm confused. He has a polyp in his ear the vet thinks is
causing sneezing and mucous? How far down his ear?

> also has a swollen nare that is erythematous, firm, round. It's not a
> nodule, is smooth and redness increases and decreases with small open
> sore that occasionally bleeds or white cell discharge.
........How do you know it's white cell discharge?

Vet thinks it is esophilic granuloma. I
.........not a bad guess. Good place to start.
http://www.vetinfo4cats.com/ceosinophilic.html
f http://www.vet.uga.edu/vpp/clerk/Starnes/index.php

General site for skin diseases:
http://www.infovets.com/healthycatsinfo/F770.htm

> suspect it could also be beginning SCC.
........why? Is this a white cat? How does his mouth look? Any
abnormalities?

> How reliably can the average vet/lab determine definitive cause of the
> nasal swelling? What is the least invasive method that is reliable?

...........The only way you're going to find out is to do a biopsy. That is
the most definitive method. I would first test this cat for FIV/FeLV if
that hasn't been done in the last yr.
>
> What questions should I ask to determine if the vet is capable of
> properly diagnosing this condition and doing nasal surgery in case the
> nare is malignant?
.......first you should educate yourself so you know what questions to ask.
Google eosinophilic granuloma complex and Squamous Cell Carcinoma feline.
Read all you can.

For example this site doesn't suggest surgery only:
http://www.manhattancats.com/Articles/Feline_Cancer.html
Best to get a consult with an oncologist if it is cancer.

http://www.vin.com/proceedings/Proceedings.plx?CID=WSAVA2002&PID=2636
http://www.lbah.com/feline/scc.html
http://vdt.ugent.be/code/showupload.php?id=175

> What is the estimated cost to determine the exact cause of the nostril
> problem?
........???????? Who knows! Depends on how many dead ends they have to go
down, whether or not you opt for biopsy or try to treat it first.

> Last vet wanted to put him on prednisone,
If the nasal problem is malignant what effect
> will the prednisone have on the problem-will it accelerate any
> possible cancer?
.........don't know. Pred is used in lymphoma in cats:
http://www.oncolink.com/experts/article.cfm?c=3&s=32&ss=86&id=1242
Feline Cancer resources: http://www.zzcat.com/resources/overview.htm

His breathing is sometimes worse than other times,
> but not so bad that he is mouth breathing. Same for his sneezing-it
> comes and goes.

........seems to me you also need to read about nasal polyps:
http://www.sniksnak.com/cathealth/nasal.html
http://www.vin.com/VINDBPub/SearchPB/Proceedings/PR05000/PR00197.htm
http://maxshouse.com/nasopharyngeal_polyps.htm

........If you haven't had any general BW done, I'd start there first, with a
FIV/FeLV test. Then X-ray the head. If those don't give the vet any
pointers to diagnosis, I'd get a punch biopsy done. Then you'll know. You
should be able to get prices for all of these things. Worrying about what
surgery for SCC costs is way down the line and might not even be the
diagnosis.

buglady
take out the dog before replying

March 23rd 08, 01:46 AM
First reply that actually made an attempt to answer my post. (more
below)

On Mar 22, 12:02 pm, "buglady" > wrote:
> > wrote in message
>
> ...> Have about a 10 year old cat. Last vet found an aural polyp that he
> > thinks is mostly responsible for his chronic sneezing, and mucous.
>
> .........well, I'm confused. He has a polyp in his ear the vet thinks is
> causing sneezing and mucous? How far down his ear?

this polyp may be partly obstructing the back of the throat, hence the
breathing problems. You might want
to educate yourself on aural polyps-they typical cause the same
sneezing/coughing symptoms found in URI.

>
> > also has a swollen nare that is erythematous, firm, round. It's not a
> > nodule, is smooth and redness increases and decreases with small open
> > sore that occasionally bleeds or white cell discharge.
>
> .......How do you know it's white cell discharge?

just guessing, it's clear and it comes from a small ulcer, so it's
probably white cells.

>
> Vet thinks it is esophilic granuloma. I
> ........not a bad guess. Good place to start.http://www.vetinfo4cats.com/ceosinophilic.html
> fhttp://www.vet.uga.edu/vpp/clerk/Starnes/index.php
>
> General site for skin diseases:http://www.infovets.com/healthycatsinfo/F770.htm

I've been all through the journals and mostly what I have learned is
that vet "science/research" is even much more primitive than medical
science for humans. LOTS of contradictory and "we don't know"
information. No wonder there are so many dissatisfied vet clients.

>
> > suspect it could also be beginning SCC.
>
> .......why? Is this a white cat? How does his mouth look? Any
> abnormalities?

area is white, so 13X the risk for skin cancer; in Arizona. Only
lesion now is on his nare.
(And to Dale, maybe you should get a job with an editorial board as
the journal articles refer to one nostril as a "nare"-possibly your
grammar skills are superior to your medical knowledge)

>
> > How reliably can the average vet/lab determine definitive cause of the
> > nasal swelling? What is the least invasive method that is reliable?
>
> ..........The only way you're going to find out is to do a biopsy. That is
> the most definitive method. I would first test this cat for FIV/FeLV if
> that hasn't been done in the last yr.

Already done the FIV/FeLV-negative. I am guessing biopsy requires
anesthesia, and guess what?- even the vets state that the pathology
labs are not even reliable. Maybe one reason I have not got more
definitive answers is that SOME readers of this group are hoping I
will go around getting more $50 consult GUESSES and spend several
hundred bucks on diagnostic procedures that aren't reliable?? Sounds
like auto mechanics that repair by successively replacing parts until
they stumble upon the right one-I'm sure most of
you have run into a few of those.

>
> > What questions should I ask to determine if the vet is capable of
> > properly diagnosing this condition and doing nasal surgery in case the
> > nare is malignant?
>
> ......first you should educate yourself so you know what questions to ask.
> Google eosinophilic granuloma complex and Squamous Cell Carcinoma feline.
> Read all you can.

Already have-see above re my comments about the backwardness of vet
science. Maybe if I fork over several thousand dollars I MIGHT get a
reliable diagnosis. Or then again, I might not. I have learned that
letters after a name do not necessarily translate to competence. Nor
does the term doctor necessarily mean
someone interested in helping animals.

>
> For example this site doesn't suggest surgery only:http://www.manhattancats.com/Articles/Feline_Cancer.html
> Best to get a consult with an oncologist if it is cancer.
>
> http://www.vin.com/proceedings/Proceedings.plx?CID=WSAVA2002&PID=2636http://www.lbah.com/feline/scc.htmlhttp://vdt.ugent.be/code/showupload.php?id=175
>
> > What is the estimated cost to determine the exact cause of the nostril
> > problem?
>
> .......???????? Who knows! Depends on how many dead ends they have to go
> down, whether or not you opt for biopsy or try to treat it first.
>
> > Last vet wanted to put him on prednisone,
>
> If the nasal problem is malignant what effect> will the prednisone have on the problem-will it accelerate any
> > possible cancer?
>
> ........don't know. Pred is used in lymphoma in cats:http://www.oncolink.com/experts/article.cfm?c=3&s=32&ss=86&id=1242
> Feline Cancer resources: http://www.zzcat.com/resources/overview.htm

you're right it is. But prednisone also suppresses the immune system,
so do they really know what they are doing? Prednisone also sets up an
animal for worsening of any exisiting infections, triggering herpes
outbreaks, etc. Question I posed is is prednisone carcinogenic or will
it trigger skin cancer?

>
> His breathing is sometimes worse than other times,
>
> > but not so bad that he is mouth breathing. Same for his sneezing-it
> > comes and goes.
>
> .......seems to me you also need to read about nasalpolyps:http://www.sniksnak.com/cathealth/nasal.htmlhttp://www.vin.com/VINDBPub/SearchPB/Proceedings/PR05000/PR00197.htmhttp://maxshouse.com/nasopharyngeal_polyps.htm
>
> .......If you haven't had any general BW done, I'd start there first, with a
> FIV/FeLV test. Then X-ray the head. If those don't give the vet any
> pointers to diagnosis, I'd get a punch biopsy done. Then you'll know. You
> should be able to get prices for all of these things. Worrying about what
> surgery for SCC costs is way down the line and might not even be the
> diagnosis.

Ok, best reply so far. X-ray is a good idea, but it may not pick up
nasal cancer, unless there is a large tumor. Punch biopsy sounds like
a plan. But if anesthesia is required for biopsy it would be more
efficient to just surgicially remove the entire lesion while the cat
is under-no sense making him go through two anesthesias. Thanks
buglady.

>
> buglady
> take out the dog before replying

March 23rd 08, 01:58 AM
On Mar 21, 9:31 pm, "Dale Atkin" > wrote:
> Perhaps you should work on your patience. Within 45 minutes of posting your
> question, you had 4 replies. While no, they didn't answer all of your
> questions, they addressed one of your points.
> There are in fact vets who read this group, as well as techs, and some very
> knowledgable people. I have had lots of good advice from many of them for
> everything I've ever come to this group for.

In several weeks of reading this group, I don't recall seeing one
reply from a veterinarian who identified him/herself as such. Oh wait,
there was one, but he did not really answer the question either. Guess
they don't want to give out free info. Had more luck with misc. legal
where lawyers frequently give good answers.
Funny, never thought of lawyers being more generous than vets.

>
> People will answer the points in your post they feel comfortable answering,
> and to which they feel they can give a complete answer.
>
> Perhaps part of your problem in dealing with your vet, is that you don't
> want to accept that maybe they might be experts in the field of animal care,
> nor do you seem to have any trust in them.

I don't accept them as experts because there are too many bad ones out
there. So you're right on that count; and I have very good reason. I
have never seen such a multitude of complaints against professionals,
even attorneys, as I have on the net against veterinarians. I don't
know how these vet schools screen their candidates, but it must be
based on some variables other than those that make good doctors. In
short, I think the problem is THEIRS, not mine.

>
> Vet wants to put him on prednisone: You go see another vet. Vet says they
> can treat the animal, you consult strangers over the internet.

And I don't accept what they say EITHER. I check, double check and
verify. You have to when a loved on is concerned. I would do not less
for a child, as I do for my pet.

>
> Given that you don't seem to care if people comment on only the parts of the
> message that they feel they can provide a complete answer to, I'll do my
> best to answer all of your questions.
>
> Costs are going to be *HIGHLY* variable, which is the point Sharon
> addressed.

They are mostly variable because the competence of the practitioners
is highly variable.
If you're going to charge high rates, then give high, precise returns,
or at least fully inform the customer of the options-which is often
not done.

>
> The test that will most efficiently tell you what is wrong is going to be
> the right test. What the right test is depends on what is in fact wrong.
> This is what diagnostics is all about.

Yeah, maybe they should require some kind of specialty in diagnostics,
since many of the vets just want to guess and treat based on guesses.

>
> Ask if the vet has done this kind of surgery before, and how it came out. If
> you don't trust them, go to another vet. You shouldn't be seeing a vet you
> don't trust.

Good point. I will.

>
> The 'least invasive method' is going to depend on what the problem is. If
> you can get it right the first time, then obviously you'll be less
> invasisive than if you have to test multiple times. (Prednisone seems like a
> good idea to me as far as 'low invasiveness/low cost' goes, but I'm not a
> vet so what the heck do I know.)

See my comments in the next post. If definitive diagnosis requires
biopsy, good reason to do the procedure in one anesthesia instead of
making the poor pet go through a second one. Prednisone is one
accepted treatment except he is basing it on clincal guesses and skin
cancer can often not be diagnosed except by biopsy. Prednisone is a
dangerous drug that can lead to all kinds of other deterimental
problems, diabetes for one.

>
> I've seen a number of vets reduce the swelling in tumors using prednisone.

And have you seen the animals who develop diabetes, or whose
infections go worse because pred. was given without definitive
diagnosis?

>
> As far as your language goes, I had very little trouble following it, with a
> couple of exceptions.
>
> When you say nare do you mean the singular form of nares? If so, all of my
> tests refer to this as naris.

Naris might be grammatically correct, in which case you should be
writing some of the journal editors and vets who frequently write
"nare" when they mean one nostril.

>
> Also not sure what an esophilic granuloma is (consulted multiple medical
> dictionaries with no luck). Do you mean eosinophilic granuloma?

Yeah I mispelled it. Forty lashes for me. :-)

>
> Dale
>
> > wrote in message
>
> ...
>
> > It would be nice if someone actually READ my posts and saw that I
> > asked several important questions, and price was only one of them.
> > Maybe I need to bring down my language to a layman's level as
> > apparently there are no veterinarians reading or answering these
> > groups, nor even technicians, as they cannot answer the medical
> > questions I posed.
>
> > On Mar 21, 4:00 pm, "Dale Atkin" > wrote:
> >> "beenthere" > wrote in message
>
> ...
>
> >> > "Sharon Too" > wrote in
> >> :
>
> >> >>> What is the estimated cost to determine the exact cause of the
> >> >>> nostril problem? If malignant what can I guess will be the cost of
> >> >>> surgery. What clinical tests would find the cause most efficiently?
>
> >> >> There is no standard estimate for any procedure, especially such as
> >> >> this. It all depends on the cost to the doctor/hospital.
>
> >> > <edited>
>
> >> > Disagree completely. A good experienced clinician CAN tell you the most
> >> > cost efficient and best route to take. That is THEIR JOB. Should be
> >> > easy
> >> > for anyone knowledgeable in the field especially given the O.P. has
> >> > given a quite specific clinical picture.
>
> >> > If they cannnot do that, look elsewhere. Some of these high price
> >> > clinics exist to make money and the often involves taking the scenic
> >> > route at patient's expense. They buy their state of the art facilities
> >> > and then expect you to pay for them whether you really need them or
> >> > not.
>
> >> Often you don't know until you get in there. Vets aren't omnicient. If
> >> you
> >> want a firm price, they can always quote high, and charge you that.
>
> >> I know at the clinic I volunteer at, they won't quote firm prices on
> >> dentals. Why? Because when you get the animal under, and really start
> >> poking
> >> around their teeth, you find more have to come out that you would have
> >> thought, or sometimes you find that none have to come out, or sometimes
> >> you
> >> find that a massive tooth that looks healthy (but isn't once you get a
> >> *really* close look) has to come out and its going to take a very long
> >> time.
>
> >> So, they are faced with two options:
>
> >> 1. Be wishy washy about the price.
> >> 2. Be firm on the price, but quote so that all the 'maybes' are included.
> >> (in which case on average the client would end up paying more).
>
> >> Dale

Dale Atkin
March 23rd 08, 06:32 AM
> wrote in message
...
> On Mar 21, 9:31 pm, "Dale Atkin" > wrote:
>> Perhaps you should work on your patience. Within 45 minutes of posting
>> your
>> question, you had 4 replies. While no, they didn't answer all of your
>> questions, they addressed one of your points.
>> There are in fact vets who read this group, as well as techs, and some
>> very
>> knowledgable people. I have had lots of good advice from many of them for
>> everything I've ever come to this group for.
>
> In several weeks of reading this group, I don't recall seeing one
> reply from a veterinarian who identified him/herself as such. Oh wait,
> there was one, but he did not really answer the question either.Guess
> they don't want to give out free info.

At least get genders right, so people think you actually spend time/thought
on your posts (unless you're thinking of another poster who I've not
noticed). Most vets and vet clinics I know are more than willing to give out
free advice. Just call up the clinic and ask, I've called/visited clinics I
don't even go to (various reasons, sometimes just exploring, getting the lay
of land, sometimes my clinic is closed, etc), and they are more than happy
to help. If they can give you information without seeing your animal they
(generally) will (unless you're an asshole about it, then they're generally
pretty unhelpful).

> Had more luck with misc. legal
> where lawyers frequently give good answers.

Law is much more concrete. The law is the law is the law. If I ask "Is is it
legal to do X in location Y", there is a concrete answer. One of the things
about biology, is there are very, very few absolutes.

>
>>
>> People will answer the points in your post they feel comfortable
>> answering,
>> and to which they feel they can give a complete answer.
>>
>> Perhaps part of your problem in dealing with your vet, is that you don't
>> want to accept that maybe they might be experts in the field of animal
>> care,
>> nor do you seem to have any trust in them.
>
> I don't accept them as experts because there are too many bad ones out
> there. So you're right on that count; and I have very good reason. I
> have never seen such a multitude of complaints against professionals,
> even attorneys, as I have on the net against veterinarians.

Vets deal with life and death decisions, often with much more limited
resources than human docotors. While I won't argue that there aren't bad
vets out there, I've yet to run in to one. (I've run it to more, and less
skilled vets, but that is a whole different ball of wax). Perhaps part of
the reason for complaints againsts vets (I haven't seen that many, but I
also don't go looking), is that people will need a place to vent much more
when things go wrong. If something does go wrong, its always seen as the
vet's fault. They should have known, they should have done test X, or
treated with drug Y. Its easy to make that call after the fact, and on top
of that, vets, being human make mistakes.

> I don't
> know how these vet schools screen their candidates, but it must be
> based on some variables other than those that make good doctors. In
> short, I think the problem is THEIRS, not mine.

Given the attitude you've shown here, I think the problem is probably yours.
Your vet very likely has more medical knowledge than you do (mind you, I'm
assuming this is the case. For all I know you could be a people doctor.

>
>>
>> Vet wants to put him on prednisone: You go see another vet. Vet says they
>> can treat the animal, you consult strangers over the internet.
>
> And I don't accept what they say EITHER. I check, double check and
> verify. You have to when a loved on is concerned. I would do not less
> for a child, as I do for my pet.
>

At some point, you have to take expert advice. You can't be an authority on
everything, and if you're trying to become an authority, newsgroups really
aren't the place to go. If you're not careful, you're going to spend all
your time/resources on second guessing, and no time actually working on the
problem, by which time, it may be too late.

>>
>> Given that you don't seem to care if people comment on only the parts of
>> the
>> message that they feel they can provide a complete answer to, I'll do my
>> best to answer all of your questions.
>>
>> Costs are going to be *HIGHLY* variable, which is the point Sharon
>> addressed.
>
> They are mostly variable because the competence of the practitioners
> is highly variable.
> If you're going to charge high rates, then give high, precise returns,
> or at least fully inform the customer of the options-which is often
> not done.

I don't follow your logic here. Could you please explain? I won't sit here
and tell you that vets are all poor and starving, but perhaps you didn't
really read Sharon's or my post (or decided to ignore them).

Costs vary because:

1) The services provided at the clinic are different. You're going to pay
more if 4 technicians are constantly monitoring your animal's every move,
and if they have to pay for super fancy, shmancy equipment, and specialists
in every particular area.
2) Overhead is also highly variable. You'll (typically) pay less for a vet
in a 'ritzy' high rent portion of a big city than you will in a country
practice.
3) The actual problems and proposed solutions are highly variable too. See
my example of a dental. A simple cleaning can turn out to involve some very
major extractions, taking up extra time and money. A very similar dog could
have no extractions. On top of that, there are different ways to deal with
the problems that are more, or less labour intensive. There are some 'dental
specialist' practices around that cost an arm and a leg, but the proceedures
they do are quite different than the ones done at a typical practice.
4) Some clinics insist on certain tests prior to anesthetic, some clinics
make this optional. They insist because the tests can be important, and
because they can be, they don't want to go without the information they
provide, but because they are expensive, and 999/1000 they show nothing (I'm
thinking blood tests on a young, healthy dog), other clinics won't insist on
them because a lot of people will think they are 'just in it for the money'
(and then may be blamed in the 1/1000 case where they might have shown
something).
5) Proceedures/techniques are also different: Does the animal get IV fluids
through the proceedure? Do they really need them? Some clinics insist on IVs
for all anesthetic proceedures, some only for riskier cases.
6) Last, but possibly not least, some clinics insist on higher profit
margins. Sometimes this is because they want higher profits, sometimes its
because they want to discourage price shoppers, sometimes its just 'charge
what the market will bear'.

NONE of the above has ANYTHING to do with the skill of the practitioner, and
will lead to very high variation in the amount charged by different clinics.

>>
>> The test that will most efficiently tell you what is wrong is going to be
>> the right test. What the right test is depends on what is in fact wrong.
>> This is what diagnostics is all about.
>
> Yeah, maybe they should require some kind of specialty in diagnostics,
> since many of the vets just want to guess and treat based on guesses.
>

Sometimes this is the most effective way to get at the problem. I recall a
case some time ago when a dog came in to the clinic, I forget exactly what
was wrong. Anyways, the vet who saw the animal was unable to make a
definitive diagnosis based on what they had available there. He communicated
this to the client, along with his 'best guess' as to what was wrong, and
course of treatment if this were the case. (I recall the treatment was daily
prednisone). Anyways, the owners decided they wanted a more definitive
answer. After months, and thousands of dollars of tests at the specialty
clinic, the specialists gave back a very generic answer (again I forget the
details, but I do recall that it wasn't something particularly specific),
and recommended a course of prednisone, which...wait for it... treated the
problem.

>>
>> Ask if the vet has done this kind of surgery before, and how it came out.
>> If
>> you don't trust them, go to another vet. You shouldn't be seeing a vet
>> you
>> don't trust.
>
> Good point. I will.
>
>>
>> The 'least invasive method' is going to depend on what the problem is. If
>> you can get it right the first time, then obviously you'll be less
>> invasisive than if you have to test multiple times. (Prednisone seems
>> like a
>> good idea to me as far as 'low invasiveness/low cost' goes, but I'm not a
>> vet so what the heck do I know.)
>
> See my comments in the next post. If definitive diagnosis requires
> biopsy, good reason to do the procedure in one anesthesia instead of
> making the poor pet go through a second one. Prednisone is one
> accepted treatment except he is basing it on clincal guesses and skin
> cancer can often not be diagnosed except by biopsy. Prednisone is a
> dangerous drug that can lead to all kinds of other deterimental
> problems, diabetes for one.
>

All drugs have the potential to be dangerous. Being aware of the dangers is
only the first step. Being aware of the dangers of doing nothing, and the
probabilities of various outcomes, and weighing the time/quality of life
issue is another one. An important rule is to treat the most threatening
condition first, rather than worry about conditions which may or may not
develop as a result of your treatment.

>>
>> I've seen a number of vets reduce the swelling in tumors using
>> prednisone.
>
> And have you seen the animals who develop diabetes, or whose
> infections go worse because pred. was given without definitive
> diagnosis?
>

I have seen animals on prednisone who later develop diabetes. Whether the
relation was causal or not is another matter (I'm not saying it wasn't, but
just because an animal on a medication gets a condition, does not mean that
said condition was caused by the medication).

>>
>> As far as your language goes, I had very little trouble following it,
>> with a
>> couple of exceptions.
>>
>> When you say nare do you mean the singular form of nares? If so, all of
>> my
>> tests refer to this as naris.
>
> Naris might be grammatically correct, in which case you should be
> writing some of the journal editors and vets who frequently write
> "nare" when they mean one nostril.
>
>>
>> Also not sure what an esophilic granuloma is (consulted multiple medical
>> dictionaries with no luck). Do you mean eosinophilic granuloma?
>
> Yeah I mispelled it. Forty lashes for me. :-)
>

My point is, before tooting your own wonderful use of language, and how it
must be beyond all us dumb folks here, you should make sure you've used that
language correctly.

Dale

Dale Atkin
March 23rd 08, 06:44 AM
>> .........well, I'm confused. He has a polyp in his ear the vet thinks is
>> causing sneezing and mucous? How far down his ear?
>
> this polyp may be partly obstructing the back of the throat, hence the
> breathing problems. You might want
> to educate yourself on aural polyps-they typical cause the same
> sneezing/coughing symptoms found in URI.
>

OK, colour me stupid, but I really don't understand how a polyp in the ear
is going to obstruct the back of the throat. An oral polyp, sure, no
problem, but an aural polyp? Given that you didn't correct yourself when
buglady brought it up, I have to assume that you mean what you said.

Could you please explain the mechanics of this? Please don't hesitate to use
small words, because I obviously don't understand the big ones.

Dale

buglady
March 23rd 08, 12:54 PM
> wrote in message
...
You might want
> to educate yourself on aural polyps-they typical cause the same
> sneezing/coughing symptoms found in URI.

.........not my cat that has the problem, no need to.

> I've been all through the journals and mostly what I have learned is
> that vet "science/research" is even much more primitive than medical
> science for humans. LOTS of contradictory and "we don't know"
> information. No wonder there are so many dissatisfied vet clients.

.........Are you a human Dr.? Actually I saw a survey a few days ago that
says vets are the least complained about.

> Already done the FIV/FeLV-negative. I am guessing biopsy requires
> anesthesia, and guess what?- even the vets state that the pathology
> labs are not even reliable.

.......I've never heard that. AFAIK the histopath reports I've gotten are
professional and complete.

Maybe one reason I have not got more
> definitive answers is that SOME readers of this group are hoping I
> will go around getting more $50 consult GUESSES >

.........Oh geez. Actually I think it's because no one can diagnose your pet
over the internet, no one knows if you're lying about symptoms (House would
say yes, I figure people leave out stuff due to ignorance), and you seem not
to have a grasp on what it takes to diagnose issues like this.

> Already have-see above re my comments about the backwardness of vet
> science. Maybe if I fork over several thousand dollars I MIGHT get a
> reliable diagnosis.
.............If you're a human with insurance they do every test in the book
to cover their butts. If you're a human without insurance they don't. Most
pets don't have insurance. Most people don't want to spend oodles of money
on pets. Ergo, sometimes they treat and monitor for response, rather than
go through hundreds of dollars of diagnostics. Your complaint seems to be
that they can't make a diagnosis without dipping into your pocket. That's
not logical. Nor does it happen in the human world. You just don't see the
true cost as insurance pays for it.

Question I posed is is prednisone carcinogenic or will
> it trigger skin cancer?

.........I haven't the foggiest. I'm not a vet and can't access most of the
full content of the journal articles on the web. Since you're so smart you
should already have the answer. Cats tolerate pred very well, much better
than dogs.

> Ok, best reply so far.
.......I didn't realize it was a contest. I regret spending my precious time
rehashing stuff you apparently already know.

X-ray is a good idea, but it may not pick up
> nasal cancer,
.........so what? It may pick up something, in which case you're further
down the road than you were before. A negative result is still a result.
Surely, as educated as you pose yourself to be, you should get that.

But if anesthesia is required for biopsy it would be more
> efficient to just surgicially remove the entire lesion while the cat
> is under-no sense making him go through two anesthesias.

........Seen a picture of a nosectomy? Want your cat to have one if it's
only got EGC? If it were a lump on the outside of the body, I'd agree with
you. Not in this case. And so far you don't know if you've got 2 or 3
things going on or just one.

buglady
take out the dog before replying

bruce
March 24th 08, 02:34 AM
On Mar 21, 5:12 pm, wrote:
> Have about a 10 year old cat. Last vet found an aural polyp that he
> thinks is mostly responsible for his chronic sneezing, and mucous. He
> also has a swollen nare that is erythematous, firm, round. It's not a
> nodule, is smooth and redness increases and decreases with small open
> sore that occasionally bleeds or white cell discharge. Have tried some
> natural anti-inflammatories, but no luck. Looked for allergies but
> cannot find anything obvious. Vet thinks it is esophilic granuloma. I
> suspect it could also be beginning SCC.
>
> Many here advertise "full service vet", but really are not judging
> from the equipment they have. They do not have x-ray capability, in
> house labs, and other things.
>
> Questions please:
>
> How reliably can the average vet/lab determine definitive cause of the
> nasal swelling? What is the least invasive method that is reliable?
>
> What questions should I ask to determine if the vet is capable of
> properly diagnosing this condition and doing nasal surgery in case the
> nare is malignant? Sneezing could also be partly due to some viral
> condition, but there is no eye involvment. He occasionally paws
> forcefully at his nose as if to try to eliminate some obstruction-it
> is swollen such that the breathing is effected, and he reopens the
> sore, so it is obviously bothering him.
>
> What is the estimated cost to determine the exact cause of the nostril
> problem? If malignant what can I guess will be the cost of surgery.
> What clinical tests would find the cause most efficiently?
>
> Last vet wanted to put him on prednisone, and thought an allergic
> response might be a factor. I have tried several different foods, some
> seem to aggravate his condition, but have found no definite allergic
> response to anything. If the nasal problem is malignant what effect
> will the prednisone have on the problem-will it accelerate any
> possible cancer? His breathing is sometimes worse than other times,
> but not so bad that he is mouth breathing. Same for his sneezing-it
> comes and goes.
>
> Thanks for any educated answers from people who actually read the post
> before replying ;-)



First off, most veterinarians would consider any cat over 5 years with
a reddish lump that waxes and wanes over and extended time (the
implication here from your history) as a potential cancer. In cats
the first ruleout would most likely be the sqaumous cell carcinomas,
especially if the cat has spent a preponderence of time outside (or
even inside but exposed to intense UV rays such as a tanning bed, or
an open window without UV glare shading). Second rule out would
likely be infectious due to foreign body or laceration. Third rule
out would go back to cancers, such as the eosinophilic. Fourth rule
out, and on, would be anything else (for instance virals if not up to
date on vaccinations, chronic granuloma/lacerations with outside
fighting cats, etc.).

As to how reliable a vet can be on diagnosis, most of this is
experience combined with training, so the most reliable would be a
specialist such as a veterinary oncologist.

Diagnosis will likely be less reliable as the invasiveness becomes
less. The most reliable requires cell identification under a
microscope, with special stains, and/or ELISA-like stains. Although
modalities such as Xrays and ultrasound are less invasive, they are
also less likely to define minute differences between neighboring
tissues, and thus less likely to give an idea of the complete area of
infection/CA. More highly refined noninvasives such as catscans and
MRIs are available but will require anesthesia, and are often seen as
an adjunct to pathology (allows guidance for biopsies in critical
areas), which is the "gold standard".

Although nasal surgery appears to be intuitive, the diagnosis would
predetermine the appropriate response. Infection would likely not
require surgery, but maybe multimodal pharmacology for infection and
immune control. Cancer may be local or metastatic, and thus surgery
or radiology or chemotherapeutics may be recommended. Biopsy most
likely would include complete removal of the lump as it is seen,
however may not be the end of surgery if additional sites are found
after proper pathological diagnosis.

Costs would range between $500 to $5000 depending on the area of the
world you are in, the specificity of the veterinarian you are using
(general practice versus surgical specialist), the definitive
diagnosis and recommended treatment protocols, and any complicating
conditions. In the USA and Europe there may be assistance provided by
pet insurance if you carry it. The most efficient test would be a
biopsy of the mass, with the followup clinical pathology.

Regarding prednisone, this is a general anti-inflammatory with
multiple side effects. If the cat is having breathing difficulties,
albeit not all caused by the nasal polyp, then feline asthma could
complicate breathing that would be somewhat responsive to the
prednisone, but not completely. Prednisone alone is an
immunosuppressive as you mentioned, however a cancer does not
generally act according to what the level of immune system reactivty
is at the moment. That being said, it is a modality of treatment in
human cancers to allow comfort from pain, and to relieve swelling in
an area around a cancer. Additionally, there is research and clinical
trials that shows using a more specific anti-inflammatory such as the
non-steroidals (ibuprofen, acetominophen, etc. on the human side,
metacam, rimadyl, previcox on the veterinary side) can SLOW down
growth, but not completely inhibit it. Back to the prednisone, some
veterinarians use the broadest forms such as prednisone, while some go
for more refined meds such as the methyl prednisolones, etc.

As far as your "full service vet", don't be deluded by advertising or
"toys". The best vets REQUIRE a very detailed history, a complete
hands-on physical examination, a definitive diagnosis from either
experience or samples, a confirming opinion (pathology lab or
associate that is often contrary to themselves), and a realistic
opinion of the success and failure of treatment modalities (which
often times is complicated by client compliance). Not only do you
have to trust the veterinarians' opinions and expertise, they have to
trust your willingness to "go the stretch" regardless of their
opinion. The pet is the unwilling accomplice, that actually has the
most important outcome influenced by both of the previous parties
preconceived ideas. A little preaching after an attempt to answer the
questions forthrightly, colored by my experiences.

freddy
March 24th 08, 10:30 PM
very good answer, my guess is from a vet, a physician or someone else in
the know. Thank you.


bruce > wrote in
:

> On Mar 21, 5:12 pm, wrote:
>> Have about a 10 year old cat. Last vet found an aural polyp that he
>> thinks is mostly responsible for his chronic sneezing, and mucous. He
>> also has a swollen nare that is erythematous, firm, round. It's not a
>> nodule, is smooth and redness increases and decreases with small open
>> sore that occasionally bleeds or white cell discharge. Have tried
>> some natural anti-inflammatories, but no luck. Looked for allergies
>> but cannot find anything obvious. Vet thinks it is esophilic
>> granuloma. I suspect it could also be beginning SCC.
>>
>> Many here advertise "full service vet", but really are not judging
>> from the equipment they have. They do not have x-ray capability, in
>> house labs, and other things.
>>
>> Questions please:
>>
>> How reliably can the average vet/lab determine definitive cause of
>> the nasal swelling? What is the least invasive method that is
>> reliable?
>>
>> What questions should I ask to determine if the vet is capable of
>> properly diagnosing this condition and doing nasal surgery in case
>> the nare is malignant? Sneezing could also be partly due to some
>> viral condition, but there is no eye involvment. He occasionally paws
>> forcefully at his nose as if to try to eliminate some obstruction-it
>> is swollen such that the breathing is effected, and he reopens the
>> sore, so it is obviously bothering him.
>>
>> What is the estimated cost to determine the exact cause of the
>> nostril problem? If malignant what can I guess will be the cost of
>> surgery. What clinical tests would find the cause most efficiently?
>>
>> Last vet wanted to put him on prednisone, and thought an allergic
>> response might be a factor. I have tried several different foods,
>> some seem to aggravate his condition, but have found no definite
>> allergic response to anything. If the nasal problem is malignant
>> what effect will the prednisone have on the problem-will it
>> accelerate any possible cancer? His breathing is sometimes worse
>> than other times, but not so bad that he is mouth breathing. Same for
>> his sneezing-it comes and goes.
>>
>> Thanks for any educated answers from people who actually read the
>> post before replying ;-)
>
>
>
> First off, most veterinarians would consider any cat over 5 years with
> a reddish lump that waxes and wanes over and extended time (the
> implication here from your history) as a potential cancer. In cats
> the first ruleout would most likely be the sqaumous cell carcinomas,
> especially if the cat has spent a preponderence of time outside (or
> even inside but exposed to intense UV rays such as a tanning bed, or
> an open window without UV glare shading). Second rule out would
> likely be infectious due to foreign body or laceration. Third rule
> out would go back to cancers, such as the eosinophilic. Fourth rule
> out, and on, would be anything else (for instance virals if not up to
> date on vaccinations, chronic granuloma/lacerations with outside
> fighting cats, etc.).
>
> As to how reliable a vet can be on diagnosis, most of this is
> experience combined with training, so the most reliable would be a
> specialist such as a veterinary oncologist.
>
> Diagnosis will likely be less reliable as the invasiveness becomes
> less. The most reliable requires cell identification under a
> microscope, with special stains, and/or ELISA-like stains. Although
> modalities such as Xrays and ultrasound are less invasive, they are
> also less likely to define minute differences between neighboring
> tissues, and thus less likely to give an idea of the complete area of
> infection/CA. More highly refined noninvasives such as catscans and
> MRIs are available but will require anesthesia, and are often seen as
> an adjunct to pathology (allows guidance for biopsies in critical
> areas), which is the "gold standard".
>
> Although nasal surgery appears to be intuitive, the diagnosis would
> predetermine the appropriate response. Infection would likely not
> require surgery, but maybe multimodal pharmacology for infection and
> immune control. Cancer may be local or metastatic, and thus surgery
> or radiology or chemotherapeutics may be recommended. Biopsy most
> likely would include complete removal of the lump as it is seen,
> however may not be the end of surgery if additional sites are found
> after proper pathological diagnosis.
>
> Costs would range between $500 to $5000 depending on the area of the
> world you are in, the specificity of the veterinarian you are using
> (general practice versus surgical specialist), the definitive
> diagnosis and recommended treatment protocols, and any complicating
> conditions. In the USA and Europe there may be assistance provided by
> pet insurance if you carry it. The most efficient test would be a
> biopsy of the mass, with the followup clinical pathology.
>
> Regarding prednisone, this is a general anti-inflammatory with
> multiple side effects. If the cat is having breathing difficulties,
> albeit not all caused by the nasal polyp, then feline asthma could
> complicate breathing that would be somewhat responsive to the
> prednisone, but not completely. Prednisone alone is an
> immunosuppressive as you mentioned, however a cancer does not
> generally act according to what the level of immune system reactivty
> is at the moment. That being said, it is a modality of treatment in
> human cancers to allow comfort from pain, and to relieve swelling in
> an area around a cancer. Additionally, there is research and clinical
> trials that shows using a more specific anti-inflammatory such as the
> non-steroidals (ibuprofen, acetominophen, etc. on the human side,
> metacam, rimadyl, previcox on the veterinary side) can SLOW down
> growth, but not completely inhibit it. Back to the prednisone, some
> veterinarians use the broadest forms such as prednisone, while some go
> for more refined meds such as the methyl prednisolones, etc.
>
> As far as your "full service vet", don't be deluded by advertising or
> "toys". The best vets REQUIRE a very detailed history, a complete
> hands-on physical examination, a definitive diagnosis from either
> experience or samples, a confirming opinion (pathology lab or
> associate that is often contrary to themselves), and a realistic
> opinion of the success and failure of treatment modalities (which
> often times is complicated by client compliance). Not only do you
> have to trust the veterinarians' opinions and expertise, they have to
> trust your willingness to "go the stretch" regardless of their
> opinion. The pet is the unwilling accomplice, that actually has the
> most important outcome influenced by both of the previous parties
> preconceived ideas. A little preaching after an attempt to answer the
> questions forthrightly, colored by my experiences.

March 25th 08, 09:03 PM
A very succinct, on-point and insightful reply( I knew there must be
someone out there that could read and answer my questions)

One thing I forgot to mention, should you find time to visit here
again, is that this cat only has a few teeth left in his mouth,
including a couple molars in the back with inflammed gums and one
broken tooth on the opposite side of his inflammed nare. When he eats
it he paws at his mouth as if it is causing pain. So, I was also
suspecting a stomatitis like condition. How likely is it that his
teeth can be causing the nare inflammation? 30 days on tetracycline
had little or no effect on the nare and 10 days on keflex improved it
only a small amount. Also he has none of the oral ulcers, tumors, nor
widespread mouth inflammation typical of stomatitis, only inflammed
gums around his few remaining teeth. This nare at times is cool to the
touch and other times is hot to the touch; as the inflammation betters
and worsens and he sometimes has sneezing attacks while eating. The
nare appears to be trying to heal, with a growing black pigment/crust
that he then rubs off to make it reveal the red underneath. In 2 of
the 3 months he has had the swollen, inflammed nare, it has not grown
nor has erosion seemed to progress much, if at all. One vet was ready
to do a dental and another said, he has so few teeth, probably not a
factor. The nare inflammation LOOKS like it could be in situ SCC, but
the last vet suggested eosophillic granuloma, which you implied is
cancer, but I thought that condition was benign? Thanks again for your
time.

On Mar 23, 6:34 pm, bruce > wrote:
> On Mar 21, 5:12 pm, wrote:
>
>
>
> > Have about a 10 year old cat. Last vet found an aural polyp that he
> > thinks is mostly responsible for his chronic sneezing, and mucous. He
> > also has a swollen nare that is erythematous, firm, round. It's not a
> > nodule, is smooth and redness increases and decreases with small open
> > sore that occasionally bleeds or white cell discharge. Have tried some
> > natural anti-inflammatories, but no luck. Looked for allergies but
> > cannot find anything obvious. Vet thinks it is esophilic granuloma. I
> > suspect it could also be beginning SCC.
>
> > Many here advertise "full service vet", but really are not judging
> > from the equipment they have. They do not have x-ray capability, in
> > house labs, and other things.
>
> > Questions please:
>
> > How reliably can the average vet/lab determine definitive cause of the
> > nasal swelling? What is the least invasive method that is reliable?
>
> > What questions should I ask to determine if the vet is capable of
> > properly diagnosing this condition and doing nasal surgery in case the
> > nare is malignant? Sneezing could also be partly due to some viral
> > condition, but there is no eye involvment. He occasionally paws
> > forcefully at his nose as if to try to eliminate some obstruction-it
> > is swollen such that the breathing is effected, and he reopens the
> > sore, so it is obviously bothering him.
>
> > What is the estimated cost to determine the exact cause of the nostril
> > problem? If malignant what can I guess will be the cost of surgery.
> > What clinical tests would find the cause most efficiently?
>
> > Last vet wanted to put him on prednisone, and thought an allergic
> > response might be a factor. I have tried several different foods, some
> > seem to aggravate his condition, but have found no definite allergic
> > response to anything. If the nasal problem is malignant what effect
> > will the prednisone have on the problem-will it accelerate any
> > possible cancer? His breathing is sometimes worse than other times,
> > but not so bad that he is mouth breathing. Same for his sneezing-it
> > comes and goes.
>
> > Thanks for any educated answers from people who actually read the post
> > before replying ;-)
>
> First off, most veterinarians would consider any cat over 5 years with
> a reddish lump that waxes and wanes over and extended time (the
> implication here from your history) as a potential cancer. In cats
> the first ruleout would most likely be the sqaumous cell carcinomas,
> especially if the cat has spent a preponderence of time outside (or
> even inside but exposed to intense UV rays such as a tanning bed, or
> an open window without UV glare shading). Second rule out would
> likely be infectious due to foreign body or laceration. Third rule
> out would go back to cancers, such as the eosinophilic. Fourth rule
> out, and on, would be anything else (for instance virals if not up to
> date on vaccinations, chronic granuloma/lacerations with outside
> fighting cats, etc.).
>
> As to how reliable a vet can be on diagnosis, most of this is
> experience combined with training, so the most reliable would be a
> specialist such as a veterinary oncologist.
>
> Diagnosis will likely be less reliable as the invasiveness becomes
> less. The most reliable requires cell identification under a
> microscope, with special stains, and/or ELISA-like stains. Although
> modalities such as Xrays and ultrasound are less invasive, they are
> also less likely to define minute differences between neighboring
> tissues, and thus less likely to give an idea of the complete area of
> infection/CA. More highly refined noninvasives such as catscans and
> MRIs are available but will require anesthesia, and are often seen as
> an adjunct to pathology (allows guidance for biopsies in critical
> areas), which is the "gold standard".
>
> Although nasal surgery appears to be intuitive, the diagnosis would
> predetermine the appropriate response. Infection would likely not
> require surgery, but maybe multimodal pharmacology for infection and
> immune control. Cancer may be local or metastatic, and thus surgery
> or radiology or chemotherapeutics may be recommended. Biopsy most
> likely would include complete removal of the lump as it is seen,
> however may not be the end of surgery if additional sites are found
> after proper pathological diagnosis.
>
> Costs would range between $500 to $5000 depending on the area of the
> world you are in, the specificity of the veterinarian you are using
> (general practice versus surgical specialist), the definitive
> diagnosis and recommended treatment protocols, and any complicating
> conditions. In the USA and Europe there may be assistance provided by
> pet insurance if you carry it. The most efficient test would be a
> biopsy of the mass, with the followup clinical pathology.
>
> Regarding prednisone, this is a general anti-inflammatory with
> multiple side effects. If the cat is having breathing difficulties,
> albeit not all caused by the nasal polyp, then feline asthma could
> complicate breathing that would be somewhat responsive to the
> prednisone, but not completely. Prednisone alone is an
> immunosuppressive as you mentioned, however a cancer does not
> generally act according to what the level of immune system reactivty
> is at the moment. That being said, it is a modality of treatment in
> human cancers to allow comfort from pain, and to relieve swelling in
> an area around a cancer. Additionally, there is research and clinical
> trials that shows using a more specific anti-inflammatory such as the
> non-steroidals (ibuprofen, acetominophen, etc. on the human side,
> metacam, rimadyl, previcox on the veterinary side) can SLOW down
> growth, but not completely inhibit it. Back to the prednisone, some
> veterinarians use the broadest forms such as prednisone, while some go
> for more refined meds such as the methyl prednisolones, etc.
>
> As far as your "full service vet", don't be deluded by advertising or
> "toys". The best vets REQUIRE a very detailed history, a complete
> hands-on physical examination, a definitive diagnosis from either
> experience or samples, a confirming opinion (pathology lab or
> associate that is often contrary to themselves), and a realistic
> opinion of the success and failure of treatment modalities (which
> often times is complicated by client compliance). Not only do you
> have to trust the veterinarians' opinions and expertise, they have to
> trust your willingness to "go the stretch" regardless of their
> opinion. The pet is the unwilling accomplice, that actually has the
> most important outcome influenced by both of the previous parties
> preconceived ideas. A little preaching after an attempt to answer the
> questions forthrightly, colored by my experiences.

March 25th 08, 09:28 PM
On Mar 23, 4:54 am, "buglady" > wrote:
> > wrote in message
>
> ...
> You might want
>
> > to educate yourself on auralpolyps-they typical cause the same
> > sneezing/coughing symptoms found in URI.
>
> ........not my cat that has the problem, no need to.
>
> > I've been all through the journals and mostly what I have learned is
> > that vet "science/research" is even much more primitive than medical
> > science for humans. LOTS of contradictory and "we don't know"
> > information. No wonder there are so many dissatisfied vet clients.
>
> ........Are you a human Dr.? Actually I saw a survey a few days ago that
> says vets are the least complained about.

Do a google search for complaints on vets, physicians and lawyers. I
was suprised to find how many people have serious complaints against
vets and how many have put up their own web pages specifically to
complain about bad veterinary mistakes; vets.

>
> > Already done the FIV/FeLV-negative. I am guessing biopsy requires
> > anesthesia, and guess what?- even the vets state that the pathology
> > labs are not even reliable.
>
> ......I've never heard that. AFAIK the histopath reports I've gotten are
> professional and complete.

"Biopsy samples seem to be pretty unreliable in feline nasal tumors,
based on a limited number of cases we have sent to oncologists. We
have had two patients whose biopsy results indicated non-specific
inflammatory changes who actually had cancer which was definitively
diagnosed later. I still think it is worth trying to get them and to
interpret them, but I think it is unwise to trust a negative result."

Dr. Mike Richards, DVM

>
> Maybe one reason I have not got more
>
> > definitive answers is that SOME readers of this group are hoping I
> > will go around getting more $50 consult GUESSES >
>
> ........Oh geez. Actually I think it's because no one can diagnose your pet
> over the internet, no one knows if you're lying about symptoms (House would
> say yes, I figure people leave out stuff due to ignorance), and you seem not
> to have a grasp on what it takes to diagnose issues like this.

I hope you're not a vet, as you're showing YOUR ignorance with that
statement.

>
> > Already have-see above re my comments about the backwardness of vet> science. Maybe if I fork over several thousand dollars I MIGHT get a
> > reliable diagnosis.
>
> ............If you're a human with insurance they do every test in the book
> to cover their butts. If you're a human without insurance they don't. Most
> pets don't have insurance. Most people don't want to spend oodles of money
> on pets. Ergo, sometimes they treat and monitor for response, rather than
> go through hundreds of dollars of diagnostics. Your complaint seems to be
> that they can't make a diagnosis without dipping into your pocket. That's
> not logical. Nor does it happen in the human world. You just don't see the
> true cost as insurance pays for it.

My complaint is that most people are led down a yellow brick road of
"trial and error" diagnoses and
"treatments". A really good veterinarian gets a proper diagnosis in
the most efficient way possible.
Often a vet with alot of experience KNOWS what is wrong and does not
need to do unnecessary tests.
Unfortunately a really good vet is hard to find, as is a really good
anything.
Just because someone has the grades and study habits to get into vet
school and make it out, does NOT necessarily mean they are good
clinicians.

>
> Question I posed is is prednisone carcinogenic or will
>
> > it trigger skin cancer?
>
> ........I haven't the foggiest. I'm not a vet and can't access most of the
> full content of the journal articles on the web. Since you're so smart you
> should already have the answer. Cats tolerate pred very well, much better
> than dogs.

If you're not a vet, on what basis are you offering your opinions? I
can access most all of the journals on the web, and even the so called
experts are in often contrasting disagreements. One reason I am
posting here is that there is so much contradictory information, even
in the journals.

>
> > Ok, best reply so far.
>
> ......I didn't realize it was a contest. I regret spending my precious time
> rehashing stuff you apparently already know.

It's ok, you've said about all you can. Take a look at a good answer
from Bruce below.

>
> X-ray is a good idea, but it may not pick up> nasal cancer,
>
> ........so what? It may pick up something, in which case you're further
> down the road than you were before. A negative result is still a result.
> Surely, as educated as you pose yourself to be, you should get that.

Also most vets do not have x-ray capability, nor radiologists. Also
MRI or CT scan is much
preferable, but who can afford that.

>
> But if anesthesia is required for biopsy it would be more
>
> > efficient to just surgicially remove the entire lesion while the cat
> > is under-no sense making him go through two anesthesias.
>
> .......Seen a picture of a nosectomy? Want your cat to have one if it's
> only got EGC? If it were a lump on the outside of the body, I'd agree with
> you. Not in this case. And so far you don't know if you've got 2 or 3
> things going on or just one.


Try to work on your reading comprehension. It is often SOP that most
of the lesion is removed when the biopsy comes back as malignant,
which I am guessing can be done immediately if the vet has in house
cytology.

This is not a "nosectomy" which is much more radical surgery. They did
the same thing with me when I had a basal cell cancer and they did not
even wait for the biopsy results.

>
> buglady
> take out the dog before replying

buglady
March 26th 08, 12:39 AM
> wrote in message
...
> One thing I forgot to mention, should you find time to visit here
> again, is that this cat only has a few teeth left in his mouth,
> including a couple molars in the back with inflammed gums and one
> broken tooth on the opposite side of his inflammed nare.

.........Yep, House was right. ;-) This is a glaring *omission*.

buglady
don't bother replying

buglady
March 26th 08, 12:51 AM
> wrote in message
...
>quote from Dr. Mike Richards, DVM

I like Dr. Mike, but this is just one person's opinion. Hardly something to
base a global statement on that vet pathologists are a bunch of stooooopid
people.

> My complaint is that most people are led down a yellow brick road of
> "trial and error" diagnoses and "treatments". A really good veterinarian
gets a proper diagnosis in the most efficient way possible.

..........That still doesn't mean you're not going to be paying out bucks to
find the proper diagnosis. The rule is to look for horses, not zebras.

> Often a vet with alot of experience KNOWS what is wrong and does not
> need to do unnecessary tests.

............Sometimes that's experience, sometimes they're just lucky.

> Also most vets do not have x-ray capability,

...........I don't know what planet you live on, but I've never gone to a vet
who didn't have one.

It is often SOP that most
> of the lesion is removed when the biopsy comes back as malignant,
> which I am guessing can be done immediately if the vet has in house
> cytology.
.........Dream on. Most vets I've been to do NOT do inhouse histopathology.
They simply do not have enough experience as it's a separate field. In a
perfect world the diagnosis would be made while the cat is still on the
table, but I do not know if that's even possible if you go to an oncologist
to have the biopsy taken.

buglady
don't bother replying

Sharon Too
March 26th 08, 03:27 AM
> ........Dream on. Most vets I've been to do NOT do inhouse
> histopathology.
> They simply do not have enough experience as it's a separate field. In a
> perfect world the diagnosis would be made while the cat is still on the
> table, but I do not know if that's even possible if you go to an
> oncologist
> to have the biopsy taken.

Yep. Unless they're boarded in Veterinary Pathology. That's why histopaths
are sent out. That's a HUGE field that is very specific. Needs a specialist
to interpret. I wouldn't want my doctor doing my histopaths.

bruce
March 27th 08, 12:14 AM
On Mar 25, 3:03 pm, wrote:
> A very succinct, on-point and insightful reply( I knew there must be
> someone out there that could read and answer my questions)
>
> One thing I forgot to mention, should you find time to visit here
> again, is that this cat only has a few teeth left in his mouth,
> including a couple molars in the back with inflammed gums and one
> broken tooth on the opposite side of his inflammed nare. When he eats
> it he paws at his mouth as if it is causing pain. So, I was also
> suspecting a stomatitis like condition. How likely is it that his
> teeth can be causing the nare inflammation? 30 days on tetracycline
> had little or no effect on the nare and 10 days on keflex improved it
> only a small amount. Also he has none of the oral ulcers, tumors, nor
> widespread mouth inflammation typical of stomatitis, only inflammed
> gums around his few remaining teeth. This nare at times is cool to the
> touch and other times is hot to the touch; as the inflammation betters
> and worsens and he sometimes has sneezing attacks while eating. The
> nare appears to be trying to heal, with a growing black pigment/crust
> that he then rubs off to make it reveal the red underneath. In 2 of
> the 3 months he has had the swollen, inflammed nare, it has not grown
> nor has erosion seemed to progress much, if at all. One vet was ready
> to do a dental and another said, he has so few teeth, probably not a
> factor. The nare inflammation LOOKS like it could be in situ SCC, but
> the last vet suggested eosophillic granuloma, which you implied is
> cancer, but I thought that condition was benign? Thanks again for your
> time.
>
> On Mar 23, 6:34 pm, bruce > wrote:
>
> > On Mar 21, 5:12 pm, wrote:
>
> > > Have about a 10 year old cat. Last vet found an aural polyp that he
> > > thinks is mostly responsible for his chronic sneezing, and mucous. He
> > > also has a swollen nare that is erythematous, firm, round. It's not a
> > > nodule, is smooth and redness increases and decreases with small open
> > > sore that occasionally bleeds or white cell discharge. Have tried some
> > > natural anti-inflammatories, but no luck. Looked for allergies but
> > > cannot find anything obvious. Vet thinks it is esophilic granuloma. I
> > > suspect it could also be beginning SCC.
>
> > > Many here advertise "full service vet", but really are not judging
> > > from the equipment they have. They do not have x-ray capability, in
> > > house labs, and other things.
>
> > > Questions please:
>
> > > How reliably can the average vet/lab determine definitive cause of the
> > > nasal swelling? What is the least invasive method that is reliable?
>
> > > What questions should I ask to determine if the vet is capable of
> > > properly diagnosing this condition and doing nasal surgery in case the
> > > nare is malignant? Sneezing could also be partly due to some viral
> > > condition, but there is no eye involvment. He occasionally paws
> > > forcefully at his nose as if to try to eliminate some obstruction-it
> > > is swollen such that the breathing is effected, and he reopens the
> > > sore, so it is obviously bothering him.
>
> > > What is the estimated cost to determine the exact cause of the nostril
> > > problem? If malignant what can I guess will be the cost of surgery.
> > > What clinical tests would find the cause most efficiently?
>
> > > Last vet wanted to put him on prednisone, and thought an allergic
> > > response might be a factor. I have tried several different foods, some
> > > seem to aggravate his condition, but have found no definite allergic
> > > response to anything. If the nasal problem is malignant what effect
> > > will the prednisone have on the problem-will it accelerate any
> > > possible cancer? His breathing is sometimes worse than other times,
> > > but not so bad that he is mouth breathing. Same for his sneezing-it
> > > comes and goes.
>
> > > Thanks for any educated answers from people who actually read the post
> > > before replying ;-)
>
> > First off, most veterinarians would consider any cat over 5 years with
> > a reddish lump that waxes and wanes over and extended time (the
> > implication here from your history) as a potential cancer. In cats
> > the first ruleout would most likely be the sqaumous cell carcinomas,
> > especially if the cat has spent a preponderence of time outside (or
> > even inside but exposed to intense UV rays such as a tanning bed, or
> > an open window without UV glare shading). Second rule out would
> > likely be infectious due to foreign body or laceration. Third rule
> > out would go back to cancers, such as the eosinophilic. Fourth rule
> > out, and on, would be anything else (for instance virals if not up to
> > date on vaccinations, chronic granuloma/lacerations with outside
> > fighting cats, etc.).
>
> > As to how reliable a vet can be on diagnosis, most of this is
> > experience combined with training, so the most reliable would be a
> > specialist such as a veterinary oncologist.
>
> > Diagnosis will likely be less reliable as the invasiveness becomes
> > less. The most reliable requires cell identification under a
> > microscope, with special stains, and/or ELISA-like stains. Although
> > modalities such as Xrays and ultrasound are less invasive, they are
> > also less likely to define minute differences between neighboring
> > tissues, and thus less likely to give an idea of the complete area of
> > infection/CA. More highly refined noninvasives such as catscans and
> > MRIs are available but will require anesthesia, and are often seen as
> > an adjunct to pathology (allows guidance for biopsies in critical
> > areas), which is the "gold standard".
>
> > Although nasal surgery appears to be intuitive, the diagnosis would
> > predetermine the appropriate response. Infection would likely not
> > require surgery, but maybe multimodal pharmacology for infection and
> > immune control. Cancer may be local or metastatic, and thus surgery
> > or radiology or chemotherapeutics may be recommended. Biopsy most
> > likely would include complete removal of the lump as it is seen,
> > however may not be the end of surgery if additional sites are found
> > after proper pathological diagnosis.
>
> > Costs would range between $500 to $5000 depending on the area of the
> > world you are in, the specificity of the veterinarian you are using
> > (general practice versus surgical specialist), the definitive
> > diagnosis and recommended treatment protocols, and any complicating
> > conditions. In the USA and Europe there may be assistance provided by
> > pet insurance if you carry it. The most efficient test would be a
> > biopsy of the mass, with the followup clinical pathology.
>
> > Regarding prednisone, this is a general anti-inflammatory with
> > multiple side effects. If the cat is having breathing difficulties,
> > albeit not all caused by the nasal polyp, then feline asthma could
> > complicate breathing that would be somewhat responsive to the
> > prednisone, but not completely. Prednisone alone is an
> > immunosuppressive as you mentioned, however a cancer does not
> > generally act according to what the level of immune system reactivty
> > is at the moment. That being said, it is a modality of treatment in
> > human cancers to allow comfort from pain, and to relieve swelling in
> > an area around a cancer. Additionally, there is research and clinical
> > trials that shows using a more specific anti-inflammatory such as the
> > non-steroidals (ibuprofen, acetominophen, etc. on the human side,
> > metacam, rimadyl, previcox on the veterinary side) can SLOW down
> > growth, but not completely inhibit it. Back to the prednisone, some
> > veterinarians use the broadest forms such as prednisone, while some go
> > for more refined meds such as the methyl prednisolones, etc.
>
> > As far as your "full service vet", don't be deluded by advertising or
> > "toys". The best vets REQUIRE a very detailed history, a complete
> > hands-on physical examination, a definitive diagnosis from either
> > experience or samples, a confirming opinion (pathology lab or
> > associate that is often contrary to themselves), and a realistic
> > opinion of the success and failure of treatment modalities (which
> > often times is complicated by client compliance). Not only do you
> > have to trust the veterinarians' opinions and expertise, they have to
> > trust your willingness to "go the stretch" regardless of their
> > opinion. The pet is the unwilling accomplice, that actually has the
> > most important outcome influenced by both of the previous parties
> > preconceived ideas. A little preaching after an attempt to answer the
> > questions forthrightly, colored by my experiences.





"A black pigment/crust over a red underlying area" to me indicates an
erosive lesion, with the black pigment/crust being dried blood
overlay. RED FLAGS for CA, IMHO.

Although eiosinophilic is immune medicated and not a CA by definition,
it is an out of control over population of "like" cells in an abnormal
area, thus to me has the prognosis of a CA, and thus my inclusion
there.