polyps, steroids, average vet's capabilities

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 ;-)

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

"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.

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.

"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

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

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

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

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

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