Please help - limited time - multiple health concerns + medication

Hi... I'm worried with a time-limited decision to make with my sick cat, Sophie.  I know what my vet has advised me, but I would appreciate other opinions too, as this is weighing very heavily on me.

I'll outline the background info to explain how she got to today:

Dec 2014

- started pooping outside box, showing signs of bowel discomfort - poop looked okay

- vet dewormed her, vet grade food diet, gave her an antibiotic which caused diarrhea and no improvement

Jan 2015-May 2015

- continued pooping outside box, occasionally inside box, showed signs of discomfort

- I tried going natural route for diet and gave her Weruva Tuna + Pumpkin (I know tuna's not great for cats, but she wouldn't eat the chicken+pumpkin)

June 5 

- she had an incident with another cat and ended up with bite wounds

- she was put on clavaseptin for the wounds, which made her poop turn diarrhea again - still pooping outside the box

- she was also given a probiotic in a tube

June 20

- After her wounds were healed, her digestive symptoms seemed to get worse (stress-related is my guess?) and we did an x-ray of her intestines which showed colitis

- The vet gave her metronidazole 2x a day, cyproheptadine 2x a day (appetite stimulant), and continued the probiotic

- The vet also put her on Hills I/D gastro-high fibre chicken + veg

- I gave her 15 doses of metronidazole, 8 doses of the cypro (it was hard to give her 2 pills 2x a day, and I wasn't always successful being on my own)

- She POOPED in her box for the first time on June 28! It was big and healthy looking. YAY!

And then things took a turn for the worse...

June 29

- She started vomiting.  She vomited 3 times - mostly water.  She didn't eat much. (It was VERY hot that day too).

- From here on, I stopped giving her all her meds as she was throwing up.

- She ate a little.

June 30   (another hot day)

- Ate very little break and puked again

- She did do another healthy poop in her box! 

- She starts licking and scratching herself

- not drinking

July 1 (another hot day )

- The vet was closed for Canada Day, but a tech came in to give her 100 cc's of water intravenously 

- She has a slight fever

- She ate a little food, but vomited again, this time with a small amount of bile in it

- She didn't eat or drink. 

July 2 - Today - ANOTHER hot day

- The vet gave her 150 cc's of water intravenously and an injection of Cerenia to help with the vomit

- Her temp is at 39.7

- She's slept all day, and so has not eaten

The vet wants to give her an ultrasound tomorrow (which will cost $1100)...  

However, I'm realizing how serious the side effects of metronidazole - including irritated skin and vomiting.  My brother has been on metronidazole and it did really bad things to him, too.

I realize with the lack of drinking and eating this is a crucial decision... But $1100 is so much money after I've spent $1400 treating her in June alone.  And I can't help but wonder if all of this is a symptom of the metro?  If her body would recover after a little while of the drug.  After all, she was starting to poop back in her box right before this happened.

But the vet is pressuring me (though I don't fault her for her) saying that this ultrasound is urgent care, and that I can't leave her without care for the weekend. 

I agree that I can't do NOTHING if she doesn't start eating and drinking very soon.  

But I'm getting very anxious and stressed out having to make this expensive decision.  The vet is very unimpressed that I wouldn't do the ultrasound tomorrow.  The specialist comes in every couple of weeks to do it, so it's not like I can get it done anytime. I could go get a second opinion?

I don't know what to do.  I feel very lost.   I have to confirm tomorrow morning if I'm coming in for the ultrasound.

This might not be a practical solution since you have so little time to decide, but it might be worth calling around to see if you can get an ultrasound for less than $1100. Here in Maryland, I was quoted $400 for an ultrasound. Other than that I don't know what to suggest. Personally I would be unable to pay $1100 for an ultrasound these days but before I retired and had more money, I probably would have done it.

The ultrasound is actually only $400.  The rest of the quote is for the additional services:  daycare charge, blood collection + diagnostic (2nd in 2 weeks), Pancreatic test, sedation, fluids, and Ultrasound cystocentesis (not sure of that?) and urinalysis (not sure either.)

Total $1118.78

I've been on the phone talking to my parents about it.  

They feel that the best option is to hospitalize her and focus on getting her fluid intake up and reducing the fever, and seeing if she pulls out of it on her own.

That seems like a wise option to me.  The ultrasound wouldn't be treating her acute symptoms.. it's only a diagnostic, even if the vet feels that it would be better for her. 

But the vet seems very adamant, and is a little intimidating... She wasn't happy that I was reluctant to have the ultrasound.  She did say I would need to have her hospitalized if I didn't go through with the ultrasound, but I'm a little scared to tell her that in the morning, because it's clearly not her preferred treatment option.  

Yes, all those other tests do add up. Did the vet tell you exactly what she is looking for with the ultrasound? If she thinks it's so important and knows the cost is an issue, maybe she'll give you a break on the price or a payment plan. Otherwise she has no right to try pushing you into this.

It's really s tough choice. If you do hospitalize her and give her fluids and treat the fever and she doesn't get better, can you take her to another vet? Maybe have the ultrasound done then?

The vet is looking to see for signs of IBD.  And how her pancreas is.  She has a payment plan I could use, but honestly $1100 is so much, even spread out. 

When I called her up this afternoon, and told her I was hesitant and wary of the side effects of the metro, she became very tough sounding, and said that I cannot leave her to get better on her own - due to the lack of drinking and eating.  She says she MUST be hospitalized.  If I were to do that she would have to report me to APS.  I understand her concern, and I would never want to deprive Sophie of acute care.  But that really added a huge amount of stress that she would tell me that.  I know she cares about my kitty, but I am not withholding care to be cruel to my cat.  I'm just trying to make the smartest decision for both of us.  And it made me really upset.

I could take her to another vet if she doesn't get better with the hospitalization...

I don't know anything about IBD but there have been several recent threads about it filled with all kinds of information. I'm extremely surprised your vet threatened to report you when you are clearly doing your best for your cat. Frankly I think it's outrageous bullying and I'd get a new vet.

Is it possible to start treating for IBD without the ultrasound?

What a nightmare for you!

My dad thought so too.  I know she means well, and is trying to do the best for my kitty, but my dad says it must be what's best for both me AND my kitty. 

She needs to know the diagnostics because the treatment for IBD will be different based on what is going on with her internally.  I think, for example, if her pancreas is not doing well, a certain medicine cannot be used.  Or something to that effect. 

I still think that it would be better to stabilize her condition and reduce her fever, rather than give her an ultrasound at this moment?  She said I could take her for a second opinion somewhere, and that there are clinics in the area that are more "holistic" than they are, if that is more what I'm looking for.  But clearly she is pushing for the ultrasound.  I'm a little intimidated to tell her though because she knows exactly what to say in response.  And she is the expert and she sees these kinds of situations regularly. 

It's so hard when you're the one going through it though. 

Thank you for listening and your support. 

Hmmm. It really does sound like the ultrasound is needed before treatment can begin. I think I remember that the earlier it's caught, the better the prognosis but probably a few days won't make a difference. There are people on this site who swear by the holistic vets - again, it might be worth searching the site for more info on IBD and holistic vets.

I really wish one of the experts would pop by - I've never had to deal with this, Knock on wood!

It's great your vet has so much expertise but your Dad is right. It's about you as well as your kitty. This is heartbreaking enough without the vet giving you a hard time!

Tico said:

 
My dad thought so too.  I know she means well, and is trying to do the best for my kitty, but my dad says it must be what's best for both me AND my kitty. 

She needs to know the diagnostics because the treatment for IBD will be different based on what is going on with her internally.  I think, for example, if her pancreas is not doing well, a certain medicine cannot be used.  Or something to that effect. 

I still think that it would be better to stabilize her condition and reduce her fever, rather than give her an ultrasound at this moment?  She said I could take her for a second opinion somewhere, and that there are clinics in the area that are more "holistic" than they are, if that is more what I'm looking for.  But clearly she is pushing for the ultrasound.  I'm a little intimidated to tell her though because she knows exactly what to say in response.  And she is the expert and she sees these kinds of situations regularly. 

It's so hard when you're the one going through it though. 

Thank you for listening and your support. 

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I cannot really add any better support than @Margd....because I don't have any experience with IBD, either.

I really feel for you @Tico.  I totally agree with @Margd, and think that it's kind of outrageous that a vet can threaten to report you, especially when some clients cannot afford expensive tests and procedures. 

I understand that this vet is trying to reach a definitive and thorough diagnosis, so that it could help in the treatment plan of Sophie, but since she already mentioned 'colitis' and that is inflammation of the intestines, then would that not determine the treatment, or as Margd mentioned, can she not prescribe meds to take down the inflammation, and fever, and treat the immediate concerns?. 

But since this vet seems do adamant, then I would choose to go to another holistic vet, for a second opinion, if it didn't affect Sophie's condition. 

Could you perhaps phone a few vets up in the morning, and ask if they specifically have experience in dealing with IBD, or colitis.  You also have the right to get copies of all Sophie's records, so that the same tests are not repeated, unless necessary.

I know that some other members have had experience dealing with IBD, but they might not be online tonight, and then again, I would think they could not really advise, but just offer what their own cats went through with the condition. 

If your vet was not so pushy, then I would tell her, plain out, that you only have limited funds, and ask her how would she treat Sophie, if one of her clients could not afford expensive diagnostics.

  I do know that some vets will work with you, and develop a treatment plan, based on the client's situation, and ability to pay. It's so difficult, because I know we all want the best for our cats, but have to make tough choices, based on finances, as well. 

Thank you so much for your kind words too.

I'm really stuck, because I'm supposed to bring her in 8:30 for the ultrasound, if that is what I decide to do (although still leaning against it).

However most other clinics in my area don't seem to open until 8:30am or 9am. 

I feel cornered and put on the spot for a decision I'm not ready to make....  And yet, she's in crisis... She won't eat her dinner... Fever is clearly showing signs of being there. 

Tico said:

 
Thank you so much for your kind words too.

I'm really stuck, because I'm supposed to bring her in 8:30 for the ultrasound, if that is what I decide to do (although still leaning against it).

However most other clinics in my area don't seem to open until 8:30am or 9am. 

I feel cornered and put on the spot for a decision I'm not ready to make....  And yet, she's in crisis... She won't eat her dinner... Fever is clearly showing signs of being there. 

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@Tico   Sorry, I had to read back a bit, because I thought that Sophie was already at the vet clinic, and being hospitalized.  

Oh, gosh, yes, I forgot that most places do not open earlier, and that emergency vets are even worse at having high costs, so calling them would not be a good option, either.

Sophie probably does not feel like eating due to the fever, and not feeling well.  One of the threads I had read last year was from @catwoman707....but I don't recall how her cat was treated.  I do know that she had an ultrasound. 

I really agree with your parents, in that Sophie needs to have her symptoms reduced, and stabilized first....and then like you said....after the crisis is over....then get the diagnostic ultrasound done.

It really should be you, that tells your vet what you want done, but having the "expert help" of your vet to make those decisions.

I honestly would not know what to do, if I had to deal with a vet that did not give me options.

I have to wonder if your vet is trying to decide whether your cat has IBD, pancreatitis or cancer.

You CAN treat symptomatically for IBD. As for pancreatitis, there is a SNAP test (similar to combo testing or heartworm testing) that can be done, though I believe bloodwork or an ultrasound is the preferred diagnostic for cats. But, I have used the SNAP pancreatic test personally and it confirmed our suspicions.

But, an ultrasound would really be the way to decifer between the 3 mentioned illnesses. And, I could understand your vet's sense of urgency if this is the case.

Steroids can be used to treat IBD and is also palliative care for cancer. However, steroids are not used to treat pancreatitis.

Also, you could certainly opt for the ultrasound without a biopsy (cystocentesis) which would also negate the need for her to be sedated (unless she is really difficult to handle). I have had multiple (more than 2 dozen) ultrasounds/heart echoes done on cats without the need for sedation.

I know it is tough to make such decisions so quickly, especially when you feel the vet is urging you to do something you either are not completely comfortable with or cannot afford.

I think you need to have a heart to heart conversation with your vet and let her know your concerns and see what tests/treatment she feels are absolutely necessary. If you have a specific $ amount that you cannot go over, explain this.

My vets work with clients all the time that have "caps" on what they can afford. Luckily, this clinic is high volume and typically absorbs (meaning the climic loses $) costs that exceed the client's amount in order to give an animal the care they need.

I know this isn't the case with a lot of clinics, but your vet should be willing to work with you in a cost effective way.

cat nap said:

 
I really agree with your parents, in that Sophie needs to have her symptoms reduced, and stabilized first....and then like you said....after the crisis is over....then get the diagnostic ultrasound done.

It really should be you, that tells your vet what you want done, but having the "expert help" of your vet to make those decisions.

I honestly would not know what to do, if I had to deal with a vet that did not give me options.

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Yeah, I think she is worse tonight that she was this morning at the vet check-up.  Perhaps now the vet wouldn't even recommend the ultrasound due to her fragile state.  Perhaps.

But it makes me feel better to know that others would recommend the same thing as both my parents and I are thinking. Hospitalize her, try and get her past the crisis first. 

An ultrasound is a very good diagnostic tool for IBD, my IBD kitty has had two.  The results are very much dependent on the skills of the vet who is administering and reading the ultrasound.  I know it sounds as if you trust this vet even though she is definitely lacking in customer service skills.  I do not understand pushing a lot of other tests as well, she should give you an itemized cost estimate.  She should be willing to work with you as far as prioritizing the tests.. I really don't understand her assuming the need for anesthetic.  It is true that some kitties do need anesthetic for an ultrasound but not all.  My kitty does fine without an anesthetic

Your kitty does need care, possibly hospitalization with an IV, but I don't understand nor like your vet intimidating you to the point of backing you in the corner about a whole suite of  diagnostics. I know it is close to the weekend but is it possible for you to look into getting your kitty seen by another vet?

Denice said:

 
Your kitty does need care, possibly hospitalization with an IV, but I don't understand nor like your vet intimidating you to the point of backing you in the corner about a whole suite of  diagnostics. I know it is close to the weekend but is it possible for you to look into getting your kitty seen by another vet?

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I should specify that this clinic has two vets.  The vet she's been seeing has been away since the crisis started on Monday.  I quite like her.  The vet that saw her today has never seen her before, however, I would say she is the more senior of the two vets - in terms of running the place, not in terms of experience.  I don't know if the regular vet would disagree with her recommendation or not.  I also don't know when she returns from vacation either. 

I would seriously print out what @CatPack and @Denice mentioned, and ask this vet if she could work with you,....and also ask about steroids, and if they could be given without harming Sophie. 

What Cat Pack mentioned about the different situations, makes the most sense, and only if you could afford the care and treatment. 

I forgot to ask, how old is your Sophie? And is she able to take in some water from syringes.

I am just seeing that @Catnap  "paged" me, and quickly read through this thread to offer my advice, as I know it is 10:30 here now so it must be about 3 hours later there?

Hoping you are still up, and posting this as I write another detailed post to get your attention for now, that I am posting some advice.

Your kitties symptoms do sound a lot like IBD.  The symptoms sound very similar to my  kitties symptoms, constipation and bouts of anorexia and vomiting which is actually almost like dry heaves.  I don't think this is a reaction to the metro  The way I read it she started on the metro on June 20, there was improvement and dramatic worsening after the metro was stopped.  This actually points toward IBD.  Metro is an antibiotic with anti-inflammatory properties.  There was improvement while on it and then a rebound of the symptoms even worse after it was stopped.  This is very much what would happen if a steroid was suddenly stopped rather than tapered.

I would try again working with the vet as far as which diagnostics to do.  I have seen kitties where the vet has used a steroid like a diagnostic.  If there is improvement with a steroid then it is IBD, no improvement then it is something else.

catwoman707 said:

 
I am just seeing that @Catnap  "paged" me, and quickly read through this thread to offer my advice, as I know it is 10:30 here now so it must be about 3 hours later there?

Hoping you are still up, and posting this as I write another detailed post to get your attention for now, that I am posting some advice.

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Gosh, I am so sorry....I forgot that the @ is a paging device, and we are not really supposed to page advisors....what is worse is that I thought that Denice was west coast time, too.  Arhhh....I better stick to the rules.   But since you are here, catwoman707, I do appreciate it, too.     (Us canadians, have really high vet costs.)