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polyps, steroids, average vet's capabilities



 
 
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  #21  
Old March 25th 08, 09:28 PM posted to rec.pets.cats.health+behav,alt.med.veterinary
[email protected]
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Posts: 6
Default polyps, steroids, average vet's capabilities

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


  #22  
Old March 26th 08, 12:39 AM posted to rec.pets.cats.health+behav,alt.med.veterinary
buglady
external usenet poster
 
Posts: 112
Default polyps, steroids, average vet's capabilities


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


  #23  
Old March 26th 08, 12:51 AM posted to rec.pets.cats.health+behav,alt.med.veterinary
buglady
external usenet poster
 
Posts: 112
Default polyps, steroids, average vet's capabilities


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



  #24  
Old March 26th 08, 03:27 AM posted to rec.pets.cats.health+behav,alt.med.veterinary
Sharon Too
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Posts: 26
Default polyps, steroids, average vet's capabilities

........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.


  #25  
Old March 27th 08, 12:14 AM posted to rec.pets.cats.health+behav,alt.med.veterinary
bruce
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Posts: 5
Default polyps, steroids, average vet's capabilities

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.
 




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