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Cat Forum / Health and Behavior / January 2008Opinions regarding Bullwinkle
I have spoken to the doctors at the emergency vet service several times since last night. Apparently, since Bullwinkle's chest was drained, he is doing much better, and he is ready to come home. Yay! Happy dance. They have put him on a diuretic (to prevent fluid buildup in his chest) and an Ace inhibitor (to open up his blood vessels so his heart doesn't have to work so hard). Nevertheless, his prognosis remains "guarded" and the doctor has estimated that he probably only has a few more months of time on this earth (in the best case scenario). I have been told that in the course of that time, I may need to have another thoracentesis (fluid drained from his chest) periodically to ease his respiration but between times, he should be eating, sleeping, using the litterbox normally and feeling comfortable. Okay. Last night's appointment involved: A full examination, bloodwork, thoracentesis, chest x-rays, echocardiogram, another set of chest x-rays, an overnight stay with monitoring, sedation, and medications. The bill for all of this is already well over $1000. As I said, the cat is currently stable on the medications, and his chest has not filled with fluid again. They want me to bring Bullwinkle back for a cardiology consult in a few days, which will cost an additional $500. I am thinking of skipping the consult because I don't see what it's going to yield. He's already had the x-rays and the echocardiogram. He's already on cardiac medications, which apparently are working. We already know that if his chest fills with fluid again, he will need another thoracentesis (which the regular vet can do). We already know his prognosis is guarded, and he will probably not last more than a few more months no matter what we do. I think the best bet is to keep him on the meds, keep him comfortable, and go for another thoracentesis if and when it becomes necessary (which is the same thing I would probably do if he had the cardiology consult). So, why am I feeling guilty about wanting to skip the cardiology consult (and not spend another $500)? Is there something I'm missing here? Is there anyone reading this who thinks I should go for the consult and why? Thanks in advance. Best regards, ---Cindy S. snip > I think the best bet is to keep him on the meds, keep him comfortable, and > go for another thoracentesis if and when it becomes necessary (which is > the same thing I would probably do if he had the cardiology consult). So, > why am I feeling guilty about wanting to skip the cardiology consult (and > not spend another $500)? Is there something I'm missing here? Is there > anyone reading this who thinks I should go for the consult and why? ----------- Bullwinkle is home. I spoke to another doctor at discharge and questioned her regarding what would be the yield from doing an echocardiogram (apparently, the "ultrasound" was not an echocardiogram) and having the cardiology consult. She said they may want to change the meds and would be able to render a definitive diagnosis and they might be able to pick up potential problems before they start. I don't know. To me this sounds like BS. If the echocardiogram and the consult could potentially improve the prognosis and extend Bullwinkle's life, I wouldn't hesitate for a moment, but it seems to me that the potential diagnoses are all grim, and just vary as to their degree of grimness. I can't imagine what condition the cardiologist is going to diagnose wherein they could preventatively initiate treatment and thereby avoid a negative course of events (as this other doctor was claiming). I tried to phone our regular veterinarian, but the office is closed until January 2. I would be interested in hearing the opinions of anyone who has gone through this. Phil, are you there? Thanks in advance. Best regards, ---Cindy S. > snip > [quoted text clipped - 23 lines] > Best regards, > ---Cindy S. Hi Cindy, I'm sorry to hear about Bullwinkle. I absolutely agree with getting an echocardiogram. Its imperative to find out what type of fluid it is and what is causing the fluid and most of all for you to reach a definitive diagnosis so you can devise an effective treatment plan. With the right treatment cats with heart disease can live for many years- that's if he actually has heart disease. There are several types of fluid and not all of them are caused by heart disease. The tentative diagnosis you were given was very vague- to say the least. If you are financially able, please go ahead with the echo and cardio consultation. Its noninvasive and may give Bullwinkle a few more years. Best wishes, Phil >> snip >> [quoted text clipped - 45 lines] > If you are financially able, please go ahead with the echo and cardio > consultation. Its noninvasive and may give Bullwinkle a few more years. -------- Hi, Phil! Thank you so much for your response. When Bullwinkle was at the emergency vet, they took two sets of plain x-rays plus an emergency ultrasound of his heart. He definitely has cardiac hypertrophy and not just a mild case either. Is it possible that his chest could have filled with fluid without a connection to the cardiac hypertrophy? Also, the doctor noted that he had a swollen parotid gland. No organisms were found in the fluid they extracted from his chest. Also, there was the mention of the taurine defiency (despite his eating commercial cat food which obviously contains taurine). When we went to pick him up from the emergency vet, it was a different shift, so we were unable to speak to the same doctor who had seen him the previous night. I mentioned the possibility of taurine deficiency to her, and she looked at us like we were crazy and said she never heard of such a thing in a cat who eats commercial cat food. At any rate, THANKYOU. We had pretty much decided against the echocardiogram, but now we are seriously reconsidering it. It's really a shame that all of these veterinary hospitals are owned by a single conglomerate, which is focused on making money. I feel confident that our veterinarians are excellent but they are not the owners of their practice. Same with the veterinary emergency hospital. Same corporation. I know of two veterinarians who left these practices because of the way they were run (businesswise). I suspect there was pressure on the veterinarians to push for expensive tests to make money. I thought that was why the emergency vet was pushing for the echocardiogram and consultation. I am currently waiting for a phone call from our regular veterinarian to discuss the situation further. I don't want to switch to a different veterinary office because we feel that the veterinarians themselves are excellent (and we just switched to this office within the last year). It's just such a shame that we need to be suspicious every time the veterinarian suggests a medical test or procedure. I will keep you posted. Best regards, ---Cindy S. > -------- > Hi, Phil! Hi Cindy, Thank you so much for your response. When Bullwinkle was at the > emergency vet, they took two sets of plain x-rays plus an emergency > ultrasound of his heart. He definitely has cardiac hypertrophy and not just > a mild case either. Did they tell you which type of cardiomyopathy they suspect? Is it possible that his chest could have filled with > fluid without a connection to the cardiac hypertrophy? Possible but not probable. Did the vet prescribe furosemide (Lasix) to control the fluid? and nitro ointment inside the pinna to reduce atrial filling pressure? That will also help reduce fluid. Also, the doctor > noted that he had a swollen parotid gland. No organisms were found in the > fluid they extracted from his chest. Also, there was the mention of the > taurine defiency (despite his eating commercial cat food which obviously > contains taurine). With what we've been reading about petfood manufacturing lately, I wouldn't take anything for granted. There is a form of cardiomyopathy that's caused by taruine deficiency. Its called Taurine Deficient Dilated Cardiomyopathy (TDDCM). Its quite rare since 1987 after feline diets were reformulated and fortified with taurine. But cases do appear here and there. TDDCM looks very different from HCM on x-rays. In DCM, the heart looks more round, whereas in HCM, the heart looks more like a valentine in severe cases. When we went to pick him up from the emergency vet, it > was a different shift, so we were unable to speak to the same doctor who had > seen him the previous night. I mentioned the possibility of taurine > deficiency to her, and she looked at us like we were crazy and said she > never heard of such a thing in a cat who eats commercial cat food. If she's "never heard of such a thing" I think you should find a new vet as soon as possible. An acidified diet that's low in potassium can reduce body stores of taurine. Primary dilated cardiomyopathy and taurine deficiency DCM have identical clinical presentations, so its wise to supplement taurine until the cat proves to be unresponsive to taurine. Its cheap and can't do any harm. > At any rate, THANKYOU. We had pretty much decided against the > echocardiogram, but now we are seriously reconsidering it. I really hope you do. I've seen many "no hope" cats live several to many years with heart disease with the right treatment. I have a particular interest in feline cardiology because I lost a dearly loved cat many years ago to heart disease that could have been cured because of my sad devotion to an incompetent vet. It's really a > shame that all of these veterinary hospitals are owned by a single > conglomerate, which is focused on making money. I know the type. Some vet hospitals will literally test a cat to death- even if the results would have no impact on treatment or outcome. I feel confident that our > veterinarians are excellent but they are not the owners of their practice. > Same with the veterinary emergency hospital. Same corporation. I know of two > veterinarians who left these practices because of the way they were run > (businesswise). I suspect there was pressure on the veterinarians to push > for expensive tests to make money. I thought that was why the emergency vet > was pushing for the echocardiogram and consultation. In this case, I think he gave you good advice. You can't possibly make the right decision without having all the information. I am currently waiting > for a phone call from our regular veterinarian to discuss the situation > further. I don't want to switch to a different veterinary office because we > feel that the veterinarians themselves are excellent (and we just switched > to this office within the last year). It's just such a shame that we need to > be suspicious every time the veterinarian suggests a medical test or > procedure. Cindy, you have be able to trust your vet and know his primary concern is your cat's health. If you can't trust him- for any reason- you need to find one you can trust. > I will keep you posted. Thank you. I'll be looking forward to your upades. Best of luck, Phil >> -------- >> Hi, Phil! [quoted text clipped - 8 lines] > > Did they tell you which type of cardiomyopathy they suspect? Yes. "Hypertrophic cardiomyopathy." I said to the vet "that's a description, not a diagnosis." She said she couldn't be more specific until after the echocardiogram next week. > Is it possible that his chest could have filled with >> fluid without a connection to the cardiac hypertrophy? > > Possible but not probable. Did the vet prescribe furosemide (Lasix) to > control the fluid? Yes. And Enalapril, which is an Ace inhibitor. >and nitro ointment inside the pinna > to reduce atrial filling pressure? That will also help reduce fluid. Nobody mentioned nitro ointment, not at the emergency clinic or our regular vet, but thank you for telling me. I will be going over to our vet in a little while to pick up new prescriptions, and I will ask about that. > Also, the doctor >> noted that he had a swollen parotid gland. No organisms were found in the >> fluid they extracted from his chest. Also, there was the mention of the >> taurine defiency (despite his eating commercial cat food which obviously >> contains taurine). Correction: According to my regular vet, the report from the emergency clinic stated that the lymph node was enlarged, not that the parotid gland was swollen. I was mistaken on that point. It was 2:00 a.m. I guess the emergency doctor said one thing, and I heard something else. > With what we've been reading about petfood manufacturing lately, I > wouldn't [quoted text clipped - 19 lines] > as > soon as possible. She's not our vet. She was just the doctor whose shift it was (at the emergency clinic) at the time Bullwinkle was being discharged. Her involvement was limited to verifying that he was stable and could be discharged from the emergency clinic. > An acidified diet that's low in potassium can reduce body > stores of taurine. Our cats had been eating Fancy Feast canned food and Purine OM dry cat food. Since Alex's phosphorus levels started to rise (in the last year), we've been trying out different low phosphorus (premium brand) canned foods like Wellness, Wysong, and NaturalLife. I've also tried Science Diet for senior cats. Unfortunately, the attempted transitions have been only modestly successful, and the only canned cat food they all continue to eat with gusto is Fancy Feast (Salmon Feast, Chicken Feast, or Whitefish and Tuna). They love the chicken and liver flavor too, but the phosphorus is very high. I'm giving Alex aluminum hydroxide capsules daily to try to bind the phosphorus. I recently switched the dry food to Royan Canin mature formula which is lower phosphorus than the Purina OM. I don't think any of my senior cats needs to be on a low calorie diet at this point. Since I can't seem to convince them to eat any of the low phosphorus canned foods I've tried (well, they eat them but don't really like them that much), at least their dry food is low phosphorus. >Primary dilated cardiomyopathy and taurine deficiency DCM > have identical clinical presentations, so its wise to supplement taurine > until the cat proves to be unresponsive to taurine. Its cheap and can't do > any harm. I'm going to ask about this too. Between Alex and Bullwinkle, I could start my own feline pharmacy :-( >> At any rate, THANKYOU. We had pretty much decided against the >> echocardiogram, but now we are seriously reconsidering it. > > I really hope you do. I've seen many "no hope" cats live several to many > years with heart disease with the right treatment. Yes. My regular vet has told me she has another cat in the clinic right now who has already survived over a year with this grim diagnosis. >I have a particular > interest in feline cardiology because I lost a dearly loved cat many years > ago to heart disease that could have been cured because of my sad devotion > to an incompetent vet. I'm sorry :-( > It's really a >> shame that all of these veterinary hospitals are owned by a single [quoted text clipped - 3 lines] > even > if the results would have no impact on treatment or outcome. Well, they suggest, but they're not overly pushy. I have every confidence that our regular vets are excellent. > I feel confident that our >> veterinarians are excellent but they are not the owners of their [quoted text clipped - 9 lines] > In this case, I think he gave you good advice. You can't possibly make the > right decision without having all the information. And thank you because I would not have gone ahead with the echo if you hadn't endorsed it. > I am currently waiting >> for a phone call from our regular veterinarian to discuss the situation [quoted text clipped - 11 lines] > find > one you can trust. I do trust the vets with our cats' health. Fortunately, our current office is one of the satellite clinics, so the two veterinarians at our office don't have the director breathing down their necks all day. We used to go to the main clinic where the director was there all the time. He once wanted to do a dental on our frail 15-year-old dog! I said absolutely not. The dog died a few months later, mostly due to old age. But our current vets are not like that at all. And the satellite practice is for cats and other small animals only (no dogs). >> I will keep you posted. > > Thank you. I'll be looking forward to your upades. And thank you Phil! That echocardiogram that you endorsed may very well give Bullwinkle a lot more time. Best regards, ---Cindy S. > >> snip > [quoted text clipped - 81 lines] > > - Show quoted text - First, A happy dance that Bullwinkle is home once more. I very much hope that he stablises for the forseeable future. Then, I agree. It really is a shame when your not sure if your veterinary center is being helpful, or whether the corporation running it, are waiting there ready to cash in on Bullwinkle's misfortune. It is a horrible predicament to be in. It feels like the days when you could go to your vet & know that you are getting the best of everything available for your money from your trusted veterinary surgeons, are gone. It is the same in the UK too. All of the smaller vets are selling out to chains of surgeries...?!! You, your family, son & cats are very much in our thoughts, Warmest Regards, Sheelagh >"o"< > "Phil P." <phil@maxshouse.com> wrote in message snip >> Hi Cindy, >> [quoted text clipped - 45 lines] > veterinarian suggests a medical test or procedure. I will keep you posted. > Best regards, ------- Bullwinkle is set up to have his echocardiogram a week from Thursday (with our former veterinarian who is now at a different practice but still performs echocardiograms for our current veterinary office). The cost of the echo will be only $155 (as opposed to $500 for the echo at the specialty office and the consultation with the veterinary cardiologist), and we will discuss the conclusions with our own veterinarian. After that, if she thinks there is still a need to see the cardiologist at the specialty practice, we will talk about it then. Thank you so much again, Phil. Best regards, ---Cindy S. |
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