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#11
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polyps, steroids, average vet's capabilities
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 |
#12
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polyps, steroids, average vet's capabilities
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/Article...ne_Cancer.html Best to get a consult with an oncologist if it is cancer. http://www.vin.com/proceedings/Proce...A2002&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/arti...&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...00/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 |
#13
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polyps, steroids, average vet's capabilities
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/Article...ne_Cancer.html Best to get a consult with an oncologist if it is cancer. http://www.vin.com/proceedings/Proce...oad.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/arti...&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/na...eal_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 |
#14
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polyps, steroids, average vet's capabilities
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 |
#15
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polyps, steroids, average vet's capabilities
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 |
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polyps, steroids, average vet's capabilities
.........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 |
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polyps, steroids, average vet's capabilities
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 |
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polyps, steroids, average vet's capabilities
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. |
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polyps, steroids, average vet's capabilities
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. |
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polyps, steroids, average vet's capabilities
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. |
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