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#21
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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
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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
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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
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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
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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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