Extortion by the vet. Come in for a wellness visit OR no more meds.

mommytobuck

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Last April I moved. Soon after my cat developed "ashtma" and was coughing. Finally we discovered that giving him a steroid would do fine to stop the coughing.  That has been working good. I went to pick up the medication today and was told this was my last prescription unless

(1) I took my cat in for a health visit and (it has been exactly one year since the last one)

(2) got him vaccinated for Rabies. (his last shot was one year ago)

I was confused and e-mailed my vet and asked if she was serious (but nicer than that)

Yes, unless I come in for a wellness visit and get the rabies vaccine she will cut my cat off from a needed medication faster than you can say poop.

Suffice to say I want to drop her like a hot potato. But, I fear any vet will be like this going forward. I think it is the new "normal". Money rules and no one cares about your cat, they just want their money. I see no reason whatsoever that he have a needless vet visit and I honestly resent like HELL the rabies vaccine issue. But  normally I can just blow them off and now I am tethered to comply or not get medication for my cat.

Couple of questions (1) is there anything natural I could use instead? I mean I suspect that the issue is inflammation. (2) I would like to try and see if they issue comes back after taking him off... do you have to taper the medication Predisone.

It isn't like I would never go but I just find it reasonable not to go unless there is some specific issue that needs to be addressed. My cat is fractious so usually it is pointless anyway even when there IS something wrong. It is just needless torture for him.
 

margd

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I don't know the answers to your questions but suspect you should taper the prednisone as you do in humans. I'm also not sure about the long term effects of steroid use - it certainly is not recommended for humans and I think I've read it can cause diabetes in cats.

My cat Milo suffered from asthma and he did okay without daily prednisone, although he had a mild case. He only suffered from a few episodes per year and it would quickly go away with treatment.

About your vet insisting on seeing you before prescribing any more meds - I know well how frustrating this is. However it might be a regulation; at least it is for human doctors in Maryland. It probably wouldn't be a bad idea for the wellness check anyway. I got in trouble with the rescue where I adopted my cat Polly because I waited 3 years to take her (she also freaked out at vet visits like your baby). It turned out Polly had dental issues that should have been caught earlier.

The rabies shot is an entirely different can of worms. There are many people on this site who don't vaccinate indoor cats and maybe one of them will come by and pitch in with advice for avoiding one.
 

jdollprincess

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In order to prescribe meds vets have to maintain a patient/doctor relationship which means they have to examine the patient at least once a year. An exams not too bad, my vet requires an exam every 6 months and bloodwork at least once a year for my cat that's on gabapentin. As for the rabies, vaccines should only be administered to healthy animals so you may be able to get out of doing that if your cat has a chronic condition.
 

denice

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My kitty is on steroids and he goes every 6 months.  He is on medication because of IBD.  He gets blood work done each time, one time is just a liver panel the next time is full blood work.  He did have fatty liver 4 1/2 years ago with his last bad flare before going on steroids.  I am sure the history of fatty liver is at least part of the reason for the liver panel done between complete blood work.

Steroids do raise blood glucose levels and can with long term use lead to diabetes.  They aren't necessarily a sole cause but can be a contributing factor to the development of diabetes.

My kitty that is on steroids doesn't get vaccinations because, even though his liver numbers have remained normal, he probably has some liver damage.

I really think wellness checks are important for all kitties and being on medication makes them even more important.  There are possible side effects with any medication.
 
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mommytobuck

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 There are possible side effects with any medication.
The problem is that my cat is fractious and they can almost never get blood work.  So that is pointless.   She knows that.    Still now after long discussions she hasn't yet informed me of the need for my cat to fast before the appointment because blood will be taken.

Most attempts to get blood end up in my cat getting hurt OR him having to be put out to get the blood tests.  But it does make me feel better that you all have to go in for exams.  I was never made aware of that or I would not have agreed to put him on the drug.  I suppose the good news is that we really didnt start the full long term dose until October so it has only been 8 months.

I suspect that my cat doesn't have asthma. He never responds to more asthma like medications. Such as a broncidilator.  It seems like he just gets mucus in his lungs and after about 3 months coughs it up.  It seems more like a COPD thing.  Though he has had x-rays and his lungs are healthy.
As for the rabies, vaccines should only be administered to healthy animals so you may be able to get out of doing that if your cat has a chronic condition.
My vet refused. She said she only would grant a waiver for like a cat who has cancer. I am very concerned about giving a vaccine to a cat that is on steroids.
 

4fabfelines

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Prednisone must be tapered after long-term use. You do not want to stop this medication cold turkey. When corticosteroids like prednisone are given for a prolonged period of time, the adrenal glands may begin to atrophy and produce less of their own corticosteroids (cortisol), since you are basically doing their job for them by providing regular prednisone. Slowly weaning off the medication will give the adrenal glands an opportunity to transition back to their normal function. If you just stop giving the pred, you run the risk of causing an adrenal crisis, which can be potentially life threatening.

Steroids should not impact her ability to respond appropriately to the rabies vaccine. Not vaccinating an indoor cat for rabies is risky. Even if the cat never sneaks outdoors, there is the possibility that a bat may end up indoors. If a cat who is unvaccinated (or has an expired rabies vaccine) is bitten by a rabid or potentially rabid animal, they must be either euthanized or subjected to a lengthy quarantine. I would personally be very hesitant not to vaccinate for rabies in the absence of a clear medical reason (such as a prior life threatening reaction to the vaccine).

What your vet is doing isn't extortion. A yearly visit is necessary to maintain a valid veterinarian/client/patient relationship and prescribe medications. (Honestly, a veterinarian who continues to prescribe medications for an animal they haven't seen in years probably isn't one that you want to be taking your cat to- this is potentially dangerous for your cat.) Some veterinarians refuse to work with unvaccinated pets (in the absence of extenuating circumstances), due to the additional risk handling these animals presents to the doctors and staff. If you absolutely do not want to vaccinate, and this is the primary reason that you are reluctant to bring her in, you will most likely be able to find a different veterinarian who is willing to work with you even if she is not up to date on her vaccines.

If you are worried about the risk of long term pred use, it may be worth talking to your vet about whether or not year round steroids are necessary. Depending on the severity/seasonality of your cat's asthma, it may be possible to manage her with intermittent steroids. Some cats require year round medication, others do not. My own asthmatic cat worsened after a move halfway across the country, and we did end up having to medicate him (prednisolone)- but his asthma (worse in spring and fall) has only ever warranted medication in the fall.
 

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As a general rule, the rabies vaccine is good for 3 years.  This does depend on state law, and I'm not sure where you are located.

If you had no proof the cat ever had a rabies vaccine when you went in last April, then the cat is treated as a first time recipient.  This means -- again, in most states -- that the first vaccine is only good for one year.  THEN the second one is good for 3 years.  If you wait one year and one day, you have to repeat the one year rule.  It can be frustrating especially if you adopt a cat with no prior paperwork.  That really is something you need to monitor, and be sure to get the pet in before the 1 (or 3) year time is up.

As for the prednisone, as everyone else has said you have to taper it to stop.  This is true for dogs as well.  I've never known a pet to be on it long term.  It has many side effects and monitoring is required.

Since your cat is so scared at the vet's, have you tried anything to calm him?  Bach's Rescue Remedy  may be one thing to try.  Do you take catnip or a cat toy with you to the vet?  Feliway spray will also work -- do not spray it directly on the cat.  You can spray it on a towel which you put in the carrier with the cat; and I know one person who made fabric "sleeves" to go over a cat collar, then she sprayed the sleeve.  Other items which may help calm your cat include:

Some other available stress-relieving herbal remedies are catnip, PetAlive PetCalm, Nutri-Vet Pet-Ease Paw Gel, and PetEssences line of flower essences (some of which are apparently specifically formulated for distressing cats).
 

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The issue about rabies seems a bit odd, however depending where you are and what the regulations are in that area it may be different. My cat has been on prednisone for almost 6 years, and like clock work every 30 days she coughs uncontrollably, and we give her a shot. She was in the fire when our business and home burnt down and was ok for the first while. The vet has never specifically diagnosed what she has but continues to give us the prednisone for her and requires a clinic visit to refill the prescription.

In regards to the side effects of diabetes with this medication, I was advised that wet cat food helps with this.
 

seaturtle

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My vet  requires a yearly visit, too. Rabies is a good idea for all cats - if as said, a bat or mouse comes into the house, or your cat escapes outside, rabies is a danger. Also, my vet cannot admit any animal without rabies vaccine into the hospital, so you might keep that in mind. Additionally, what if your cat bites someone?

I think the vet would be at risk if he/she didn't see the animal before giving an Rx.
 

denverwriter22

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It is standard practice for vets to require a once-a-year exam to keep prescribing medication.  Can I ask why you are against taking your cat in for a wellness check?  Even if he/she seems healthy, annual exams allow for problems to be caught early - sometimes before any symptoms are occurring.  A senior kitty should go to the vet twice a year.  

Yes, you do need to taper off Prednisone under the guidance of a veterinarian.  If the Prednisone is working for your cat, I would just go get the exam and vaccine and continue with it.  Rabies vaccines are required in most states by law, as well.

I wish you and your kitty all the best :)
 

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It's not extortion. Most reputable vets do require annual exams, esp when meds are involved. It's a way to check on the way the meds are acting on the cat, to see if the cat is doing well while taking the meds, etc. The vet can check on potential dental issues; some of our cats have dentals every other year. The three younger cats get a check-up every year; the geriatric bunch goes in twice a year, and BooBoo, our oldie-but-goodie, goes in every 3-4 months for a shot of steroids and an antibiotics shot for asthma and arthritis.

It's not pretty with our cats; although they don't flip-out too badly once at the vet, getting them in the their carriers can be a challenge. And we listen to the cat symphony the whole trip to the vet. They are not amused. But we deal. My GF had a cat who simply freaked out completely at the vet; she had to be muzzled in order to do anything to her because she was like a whirling dervish and it usually took the vet and the tech to contain her. But she got her there when she needed to go.

For the most part, I am anti-vaccine; our cats all got their kitten shots and then that is it. However, the rabies vaccine is the law in many states; we live in Pennsylvania and, as much as I hate making them get the rabies vaccine, we have to. In PA, the very first vaccine is for one year; the following year, they get the 3-year rabies vaccine and then they're good for the 3 years. Even for indoor cats. Seaturtle hit it correctly. Bats do get into homes. And if your cat were to bite somebody and you don't have proof of rabies??? Our vet will not accept any cat in the hospital without the rabies vaccine and they also will require a stool sample. It's to protect the other animal patients, too.

Steroids should be decreased under the management of your vet. It's best for the cat.

Good luck with your cat.
 
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mommytobuck

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. However, the rabies vaccine is the law in many states; we live in Pennsylvania and, as much as I hate making them get the rabies vaccine, we have to. In PA, the very first vaccine is for one year; the following year, they get the 3-year rabies vaccine and then they're good for the 3 years. Even for indoor cats. Seaturtle hit it correctly. Bats do get into homes. And if your cat were to bite somebody and you don't have proof of rabies??? Our vet will not accept any cat in the hospital without the rabies vaccine and they also will require a stool sample. It's to protect the other animal patients, too.
Ahh I actually dont' buy that excuse. First, there is a waiver that the vet can give for chronically ill cats. She refuses.  So clearly it is her choice to push the vaccine off on my cat.  Secondly, I looked it up in my state and the punishment for failure to vaccinate, $100 dollars. I volunteered to pay that fine. I hate when people use "the law" as an excuse for doing what they want to do. There is a test that will determine if your animal is still protected via a rabies shot.  Unfortunately she refuses to do that test as *she* doesn't feel it is necessary.  Sure fine, you want to do what YOU want to do... fine. Then make that clear when people come to your practice. Don't hide the ball until you have an animal on a drug and then black mail people into compliance or no further drug.

I guess I have to go ... but I do think it is extortion. She never mentioned this possibility when she put him on the drug. IN "the law" it is required that a vet or a doctor fully inform you of side effects of your medications. She never told me any of this and hasn't told me how to taper my cat off this medication safely -- of course, because she thinks I will comply.  I will speak to her about taking him off this drug.

My cat has had episodes of coughing with the drug.. but they have been few and far between.   Last year they were happening almost daily and he thew up a few times this massive amount of goo... which I think comes from his lungs and gets swallowed into his stomach.

.
 

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There is a test that will determine if your animal is still protected via a rabies shot.  Unfortunately she refuses to do that test as *she* doesn't feel it is necessary. 
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The test is a titer.  While it is used for other vaccines, it is very very rare to use it for rabies.    I really do not see this vet doing anything differently from any other vet. 
 

Three years ago, my 15 year old cat was clearly in a bad way, so I took him in to my vet.  (Cat could only walk 4 or 5 steps, then down on the floor to rest, panting, then up for a few more steps, obviously in trouble).  We agreed to do blood work.  During the blood draw, my cat scratched one of the vet techs, real deep long scratch.  As only cats can do, I'm sure you can imagine the scratch.  My cat was UP TO DATE on all shots, and had been his entire life (he came to me at age 4 months).  Still, when we decided he had to be PTS, the vet advised me that, due to that severe scratch, the cat would have to have a necropsy to verify no rabies.  LAW in Massachusetts.  Needless to say, I took him to another vet, did not mention the scratch, had him euthanized and brought him home.  Did I break the law?  ABSOLUTELY!  Was my vet out of line?  NO WAY, she was following the law which she is required to do to maintain her license.

You can pay the fine, sure, but then what?  You still have an unvaccinated cat.    Are you going to pay the fine every day?

The waiver is also used very rarely by vets, again because they are putting their license to practice on the line.  They write up the paperwork, but then the state has to approve it.  From your description of the cat's health, no way the state veterinarian would approve this waiver.
 

4fabfelines

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The rabies virus is, with one known exception, invariably lethal. It is also completely preventable. Unvaccinated animals potentially place the staff, clients, and patients of a practice at risk. 

You mentioned that your cat is fractious. Even if she were not rabid, if she were to bite a staff member (or anyone) during an appointment, she would need to be quarantined for ten days. If she happened to escape from the house during the quarantine period, the bitten individual would potentially have to undergo post-exposure prophylaxis (a series of rabies vaccinations +/- rabies immunoglobulin, depending on their prior vaccination status), since it would be impossible to prove whether or not she was rabid at the time of the bite.

I have had pre-exposure vaccines due to activities that place me at an increased risk of being exposed to the rabies virus. Though I'd never had any issues with other vaccines, I ended up having a reaction to the rabies vaccine. Even if someone has previously been vaccinated and has an acceptable titer, exposure to the virus means a set of booster vaccines (titers don't provide a complete picture of immunity). For some individuals, those booster vaccines may be dangerous. (And even if you haven't had a vaccine reaction, that doesn't change the fact that the rabies series is extremely expensive, and not particularly enjoyable.) 

It is the veterinarian's right to decide whether or not s/he is willing to accept the risk of working with unvaccinated animals, particularly when there is no compelling medical reason not to vaccinate. Waivers are reserved for very specific circumstances (see below).  While you may be unhappy with your veterinarian's decision, she is not extorting you. You may be able to find a veterinarian willing to treat an unvaccinated pet, but it is highly unlikely that you are going to find a veterinarian (or public health authority) that will approve a rabies vaccine waiver for an otherwise healthy asthmatic cat living in an area where rabies is endemic.

Per the American Veterinary Medical Association:

(https://www.avma.org/KB/Policies/Pages/Annual-Rabies-Vaccination-Waiver.aspx)

Because rabies continues to be a significant public health issue, waivers should not be issued arbitrarily upon client request and should be based upon clinical evidence that the animal would be at considerable risk of being harmed by the vaccine because of a diagnosed medical condition. Modern killed virus or recombinant rabies vaccines have no risk of inducing rabies in the vaccinated animal and are not contraindicated in most immunocompromised animals. Advanced age of the animal or a desire on the part of the client or veterinarian to minimize the use of vaccinations (in the absence of a specific contraindication to vaccination) should not be considered sufficient justification for issuing a rabies vaccination waiver.

To ensure that the risk to both the individual animal and to public health is considered, a waiver of rabies vaccination should only be issued when a licensed veterinarian with a valid veterinarian-client-patient relationship with the animal and the appropriate public health authorities concur that the waiver should be issued. The client must be informed that, even if a waiver is issued, the waiver only serves to allow the animal to be properly licensed in compliance with animal control regulations. In the event that the animal is involved in a potential rabies exposure incident, the animal should be considered unvaccinated against rabies for the purpose of appropriate public health regulations or when following the recommendations of the NASPHV Compendium of Animal Rabies Prevention and Control. All rabies vaccination waivers should be reconsidered at least yearly and, if appropriate, may be renewed on an annual basis following a reassessment of the animal's condition.
 

misty8723

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I think any responsible vet would want to check the cat before continuing to prescribe any medication.  My own doctor will not keep presribing my diabetes medicine or DH's blood pressure medication without periodic checkups and blood tests.

Not all rabies vaccines are good for 3 years.  We get the (cant' think of the name - the one that is supposed to be safest) and it is only for one year.  I am also anti-vaccine, but the main reason I cave and get this one is that if your cat does happen to bite someone, they can take the cat away to quarantine for a lone time and even sometimes put them to death.  I don't care about the fine, but I do care about that.

When my Cynthia had cancer, the vet stopped giving her the vaccine. I was worried sick about her having to have it, but the vet herself said she doesn't give it to cats with cancer. I'm not sure asthma would qualify as a reason not to get the vaccine, but that might be worth a little research.

If your vet can't get blood work because your cat is difficult, they can give a mild sedative .  That's what they have to do with my Swanie. He is NOT a good patient. I don't like having to sedate him, but I want him to have the blood tests, so I allow it.  I trust my vet.

If you are not sure about this vet or what her motives are, you might want to take your cat for a "second opinion" to another vet.  That will probably mean more tests though, and I don't know if a vet would refuse to see a cat who wasn't up to date on rabies shots.  If your cat is difficult and bites someone at the vet's office, they are legally bound to report it and I understand someone WILL show up at your door and force you to hand over your cat.
 
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mommytobuck

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 I trust my vet.
I guess I don't. 

My cat actually had an attack last night -- ironic after months of being ok. But today is extremely humid == one of the first days this year.. and I started wondering if the dose my cat is getting of the steroid is really doing anything at all.  My cat takes 1 mg every other day and he is actually quite big. 20 lbs.  I wonder if it really was the dry weather that was helping him out.
 

denverwriter22

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You can always choose to seek another veterinarian's services.  However, any ethical veterinarian isn't going to continue to prescribe medication without seeing your cat once a year.  Doing this ensures your cat is healthy and that the medication is working.  Vets can catch issues we sometimes don't, and that's why annual exams are essential.  

From your description, it does sound like your cat should stay on the medication.  You had said he was having a lot of episodes before the medication and not many now.  That would seem to indicate that it's helping.  If you think your kitty needs a higher dose, that would definitely be something to discuss with a vet. 

I do wish you the best of luck.  The owner-vet relationship is so important.  I hope you can find one that you're more satisfied with. 
 

jmarkitell

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Regarding Vets and trumped up charges and prices, I recommend that you avoid some of the newer franchise Vet services, such as Banfields at Pet Smart. When possible, I choose and use a vet that has been in practice for many years at a private clinic. They are typically much more experienced, much more compassionate, and don't typically run the bill up un-necessarily. My older female had a urinary issue that she has had on and off for the last 10 years. Typically a shot of a steroid and she is good for another few years. When I went to Banfield's, They wanted to do a urinalysis, which was $75. The collection fee was $10. The supplies were another $5, while the disposal fee was $7.50. Almost $100 for a urinalysis...but I agreed because they said they wouldn't treat her unless they had the test (my normal vet was closed on Sunday). The test came back good, but they thought she should have X-Rays to rule out kidney stones...that was only $200 plus $50 in added costs. I declined and then they recommended blood work...another $100 plus costs. When I declined this as well the Vet indicated that "she didn't feel comfortable treating the cat without the tests". The vet prescribed a diuretic that was OTC, and charged $20 per pill (I later found them online3e for $7/50 of them).

    The next day I took the kitty to my old Vet, who is close to 70. A shot of cortisone, $35, and my cat was good as new. Banfield wanted nearly $700 for their recommended diagnosis. I totally agree that medicine, both for people as well as for animals, is becoming a giant money grab with the dollar coming first and the patient coming last.
 

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We also go to a vet who is very old and charges little for medication and exams. He charges closer to what the cost is rather than adding extra fees. He is also so experienced that he doesn't usually try doing lab tests and xrays when he doesn't feel they are necessary. When we took our kitten in last week and she needed ear mite medication, deworming, and antibiotics for an URI. He gave us all of this medication and gave her two shots to help with coughing and the URI. The whole thing cost us $125 dollars. At most vets around here the exam fee would be higher than this and many of them would require lab tests, a chest xray, and more just to treat the URI. Trusting your vet is important! Try to find one you can trust.
 
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crazy4strays

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I have to agree with some of the others, that the potential consequences of not staying up to date on rabies shots are not worth it.

Having been through a cat bite situation recently where the cat was not vaccinated and the situation didn't go well, I feel that shot is essential. It's a safety net for the cat as well as for the human.

I'm not really a fan of shots in general but both of my cats are rabies vaccinated and will stay up to date on boosters even though we haven't opted for any of the other shots yet.

I would do the well check up as well. However, my vet only charges $25 for a check up. I realize that it may be more of a financial burden in other parts of the country....
 
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