Ultrasound Questions

Nutshell version follows.

Casper turns 15 this week.  He's been steadily losing weight due to poor eating and throwing up a lot.  We took him Saturday for his bi-annual senior check up, He's lost a total of nearly 2 pounds over this year. Not good. This, along with other issues he's having (cognitive problems) has pushed us to trying to find some better answers so that we can get him back on track.    

I just had a very long conversation with the vet.  All blood work and urinalysis was normal other than slightly elevator cholesterol levels.  He'd has x-rays of stomach and upper chest 6 months ago and those wer mostly normal, although a slight thickening was notated on the chest x-ray.  

They are now suggestion either:

More x-rays (probably not necessary since the others weren't showing much of anything)

Ultrasound (most likely next step)

Scoping his GI track, etc.  

Not going to jump into the GI series yet and x-rays we agreed probably won't give much further info.  Let alone he'd have to be sedated which we'd like to avoid.  So, leaning to going ahead with ultrasound.

It was suggested we take him to a specialist (luckily not too far from home) since they have someone on staff daily experienced in reading these types of tests.  I was quoted $450 for the ultrasound if done "in-house" by our vet (who we love).  I don't know cost yet for the specialist but assume it will be much higher.

Anyone have any input into this?  Do you think we should use a specialist or our regular vet?  

I do not know if this helps, but my Vet has an ultrasound machine in the office. It is a small one. She does have an ability to send the ultrasounds images and x-ray images to a Radiologist at one of the Vet hospitals, if she is stumped in reading the images. 

I do not think an ultrasound by her would be more than $100. 

I know if she sees something 'iffy' she will automatically insist on one to be done by a specialist; and deduct part of the U/S fee...

If there is something she feels should be looked at by a Radiologist, she will not do a scan and send the pet directly to the hospital to be looked at by a professional....

Personally, I prefer to use her advise as a guideline. I worked as a U/S tech for a hundred years. 

I prefer a trained Radiologist to do the scan once and for all, without having to go through it twice if something was 'iffy'..

I think the cost of the scan at the Vet hospital may have been about $400...

Why is your Vet charging so much if he is not a specialist? That price seems high to me.

Why take the chance to have to put your baby through this twice? I would rather go to the professional Radiologist and get an official reading without going through someone who is not specifically trained to perform scans. 

Artiemom said:

 
I do not know if this helps, but my Vet has an ultrasound machine in the office. It is a small one. She does have an ability to send the ultrasounds images and x-ray images to a Radiologist at one of the Vet hospitals, if she is stumped in reading the images. 

I do not think an ultrasound by her would be more than $100. 

I know if she sees something 'iffy' she will automatically insist on one to be done by a specialist; and deduct part of the U/S fee...

If there is something she feels should be looked at by a Radiologist, she will not do a scan and send the pet directly to the hospital to be looked at by a professional....

Personally, I prefer to use her advise as a guideline. I worked as a U/S tech for a hundred years. 

I prefer a trained Radiologist to do the scan once and for all, without having to go through it twice if something was 'iffy'..

I think the cost of the scan at the Vet hospital may have been about $400...

Why is your Vet charging so much if he is not a specialist? That price seems high to me.

Why take the chance to have to put your baby through this twice? I would rather go to the professional Radiologist and get an official reading without going through someone who is not specifically trained to perform scans. 

Click to expand...

Thanks very much for this.

First, price is typical around my area, unfortunately.  So far we've paid going rates similar to the 2 other vets we've used in the past.  We live close to NYC, and rates here tend to be some of the highest in the country.

I'm not so concerned about the cost as I am getting the results read correctly.  Your suggestion to just to straight to the specialist makes sense. I called their office and they were kind enough to quote me for the appointment with the vet and the testing.  Price was nearly exact as for my regular vet , was only about $50 more.  So for the difference, I think we'll just book with the specialist.

sivyaleah said:

 
Thanks very much for this.

First, price is typical around my area, unfortunately.  So far we've paid going rates similar to the 2 other vets we've used in the past.  We live close to NYC, and rates here tend to be some of the highest in the country.

I'm not so concerned about the cost as I am getting the results read correctly.  Your suggestion to just to straight to the specialist makes sense. I called their office and they were kind enough to quote me for the appointment with the vet and the testing.  Price was nearly exact as for my regular vet , was only about $50 more.  So for the difference, I think we'll just book with the specialist.

Click to expand...

Glad to hear it!! I think it is a wise decision. I live near Boston, so I can empathize about high rates....

Good Luck with the scan.  

Keep us informed.

Waiting to hear back from regular vet. They need to send over a referral to the specialist.  Thankfully, it isn't a critical situation so hopefully I can plan to bring him in when it's convenient for us.

Here it is a whole month later and then some. Finally got Casper in for the ultrasound.  We got sidetracked ourselves by bouts of bronchitis for both of us.  Pretty much all of May was a blur of our own illnesses.

Nothing completely conclusive was found, however, they saw thickening of his intestinal wall and, slightly enlarged lymph nodes.  This points towards some kind of lymphoma. Ot, possibly IBD. The only way to be sure is to do a biopsy.

I told him I was pretty sure that Tom wouldn't want to put Casper, at 15 years old already, through a biopsy, let alone if it is lymphoma, subsequent chemo.  I agree completely.  

The vet suggested administering a steroid to help with his lack of appetite and other related symptoms. We agreed this was an appropriate next step without resorting to invasive procedures.  

I actually broke down and bought some of the prescription diet food to see if it helps. At this point, he throws up so much all other foods that I figured I'll give it a try. He threw that up too, however, to be fair, he hasn't eaten since about 10:00 last night.as they needed his stomach to be completely empty for the ultrasound. 

That's the update. Tom is pretty upset about all of this while  I'm trying to see it realistically/rationally. No reason to get all emotional yet. We see the vet in a month for a follow up to see how well the steroid worked for him.  That's about it for now.  

The good thing is that there were no masses.  This type of ultrasound finding goes with both small cell lymphoma and IBD.  My kitty's symptoms were similar.  He had anorexia, vomiting when his stomach was empty to the point that the liquid that came up had blood in it from irritation.  He would also be constipated during a flare and was chronically underweight.  He has been on a daily dose of Prednisolone for 5 1/2 years now.  Since being on the steroid he has had one very mild flare about 4 years ago.  He will very occasionally eat a little less and be in the meatloaf position a lot for a day or two then come out of it.

My Krissy's ultrasound was done by a specialist, that is all she does full time now, goes to different clinics and vet hospitals to perform this, 

I remember hearing the cost was $450 also, initially, but afterwards, well worth having an expert doing it.

This test is only as good as the person who reads it.

Krissy has substantial thickened walls, inflammed pancreas, enlarged lymph nodes, yet this expert did not suspect small cell, she did mention it can only be confirmed with a biopsy, which I opted out of having, she didn't think needed anyway.

So if I were you I would forget about the possibility of it being small cell and assume it is IBD, that's how it sounds to me anyway.

Did you get a clear understanding of the complete diet change that's needed?

I got lucky and nearing our 2 year mark since diagnosis, have not had to go the med route, only changing her food to a single novel protein including canned mainly and limited ingredient dry, small amt daily.

So far so good

@catwoman707  sorry to hear Krissy also deals with IBD.  It really does require changes and it seems to be a one step forward, one step back kind of disease.  It seems a lot of people decide not to do the biopsy which makes us feel more comfortable with the decision we made.  

I had already tried a novel protein diet for him a while ago. Didn't find any change in the symptoms plus, he didn't like several of them and would totally turn up his nose and walk away.  I'm trying one of Hill's limited ingredient products now - much as I HATE doing so but I'm willing to give it a shot in order to find something he'll eat and not throw up.  So far, so good today plus he seems to like it.  Our other cat hates it though. I knew Casper wouldn't eat an entire can in one sitting (even though they are only 2.9 ounces) so I gave her some as a treat but she licked the gravy off it and left behind all the food    

I joined an IBD cat group on Facebook as the suggestions of a blogger friend of mine who heard very good things about them.  So far, they have been friendly and helpful and I'm sure I'll learn a lot from being able to "talk" to such a large community of people with the same problem.

And yes, it seems way more likely it is IBD than anything else.  Like I already mentioned this has been a slow, progressive situation which started about a year or so after he came to live with us.  He was 9-1/2 at that time so it started to be noticable when he was around 11-12 years old.  That's already 3 plus years.  Cancer surely would have taken him by now if it was that.

@Denice   Yes, no masses found. Just thickening and inflammation and not excessive yet either.  We were told the injection of the steroid would last about a month.  Today, he is behaving much improved and has kept his food down.