Is My Vet Being Honest With Me (Heart/Kidney Issues)

[ObeseChess]

Hello all!

Late night thinking about a recent trip to the vet. First off I will say that this vet has always been great to us, even gave me advice off the record before I rescued Sassy and the was still living outdoors. A number of friends also take their cats to the same vet and have nothing but positive experiences.

And yet.

I bring Sassy in for her first checkup because she’s acting funny about a year ago, right before I rescued her. They do a lot of blood work ($675) and everything is fine. I bring her in for her six month checkup sick months later - senior cat exam (Sassy is 12) is supposed to be a hundred bucks. They request a couple hundred dollars in blood work, which I agree to.

I bring her in for her six month checkup in March. Doctor wants more blood work and urinalysis, another six or so hundred dollars. Everything is great and normal, minus blood pressure and teeth (see below).

I bring her in for a follow up a few weeks ago as the doctor was concerned about high blood pressure at said checkup. Blood pressure is VERY high. Doctor requests blood work to rule out thyroid issues. Three hundred bucks. Thyroid is fine. We put her on blood pressure medication.

I bring her in for her follow up exam this past weekend. Blood pressure is normal with medication. Doctor says she has a heart murmur, which is new, and requests EKG and blood work. ($650). Doctor says it could be thyroid and wants to check this again, too. ($300). Doctor says one kidney is slightly smaller than the other, wants blood work and urinalysis ($300). All previous blood work and urinalysis have shown perfectly healthy kidneys as recently as April. Teeth do look bad, though, they will need to be pulled ($1200) with blood work to check heart function before anesthesia ($400). I decline the thyroid check and mention that they just checked her thyroid a few weeks ago. I agree to the dental work in the future, but I just…

This is my first cat, and she is a senior cat and a rescue, but it sure seems like a whole lot of very expensive problems keep showing up suddenly in my cat with no other symptoms, and that she needs a whole lot of blood work. Is it possible that a senior cat will suddenly develop a heart murmur like this? I think I read that 60% of healthy cats can have one when they are stressed, and she hates the vet. Is it possible that a cat with no other symptoms will suddenly have a kidney shrink? Is all this stuff really that expensive in Portland, Oregon? What is going on?

I have pet insurance and I love my cat, I’m more worried that I am being nickeled and dimed due to my inexperience as a cat owner. That said, I also want to make sure that if these are real issues I can get her the care she needs as soon as she needs it.

thank you!

 

[Sajast]

Ehhhhh. I’m not familiar with prices in your area. Are those numbers JUST for the panels or does that include office visit, blood draw fee, etc?

I’m also not sure what the original complaint was. Six month check ups on an asymptomatic cat with normal blood work seems excessive. The check up required following their blood pressure medication is normal. Also normal is the vet wanting to redo a panel prior to anesthesia.

I’m surprised the vet only recommended an EKG for the murmur. I would request an ultrasound of the heart if possible - congestive heart failure can be delayed with medication if the disease is caught early.They CAN have a benign murmur or even a transient murmur but at her age…They can also check out those kidneys.

Also - how did they diagnose that one kidney is smaller than the other? X-ray? Ultrasound? Palpating? If her kidney values are normal then I’d just continue monitoring annually with blood work unless new symptoms appear. And incorporate more wet food into her diet if she’s not eating wet food already. Basically just try and ease stress on her kidneys and keep them flushed out with water content. Maybe discuss a kidney friendly diet with your vet. Kidney failure is sadly a common problem with older cats so it’s likely raised a red flag even though it could just be a structural defect.

I would also have declined the thyroid panel and continue to do so unless new symptoms appear. Thyroid issues are common in older cats and can sometimes contribute to heart disease so if there’s a murmur it’d make sense they’d mention thyroid again. But after two normal thyroid tests I’d pass on that too (unless new symptoms).

It doesn’t necessarily sound like you’re being nickeled and dimed but you’re definitely at a point where you’re justified in pushing back a little for more context. Asking them what are they looking for in the next blood panel, what are they monitoring, is an annual panel sufficient (annual is the minimum preferred at her age), if the values were normal six momyths ago how likely is XYZ to change.

 

[FeebysOwner]

Hi. At the age of 12, I am pretty sure most vets would recommend semi-annual check ups, which usually include CBC & Super Chem blood work panels, along with a urinalysis. Feeby is ~17 yo and has been having semi-annual check ups since she turned 10 or 11. Sassy is a senior cat and health changes are much more prevalent when cats reach her age. The key is to find issues early on in order to more effectively monitor and/or treat them. There are some vets who recommend annual x-rays as well.

An EKG is the same thing as an ultrasound, and it is possible (although unusual) that it covered enough of Sassy's body to see her kidneys, so that might be how they determined one kidney is smaller than the other. All you have to do is ask to find out how they made that determination. The kidney size just needs to be re-checked a few times as it is very possible this is normal for her, and if no changes are seen, that is likely the conclusion the vet will come to.

A heart murmur can occur in an older cat, and it is very likely that they will want to monitor it to make sure it doesn't become a bigger issue as she ages. If she has been through previous check ups and the vet never heard a murmur before, that would be reason enough to believe it is probably a bit more than just stress of a vet visit.

Hyperthyroidism, which can cause high blood pressure, among other health problems, is pretty common in cats. So, it seems reasonable to think a vet might want to test for it, probably at least annually, with a cat Sassy's age - especially if there are any of the common symptoms. Not sure why the vet would have wanted to recheck it so soon after her last test, but that is another question to ask the vet - it is possible she tested slightly high and so the vet wanted to see if it was continuing to elevate.

Getting copies of her tests, and any written reports/notes, is your best bet so that you can become familiar with them and enable you to follow the numbers and see changes yourself. It will go a long way in helping you appreciate what repeat testing the vet might deem necessary. But, as always, it isn't unreasonable to ask the vet to go through test results with you and explain to you what they see and how it correlates with further testing.

I can't address the costs as they are going to vary by area, but regardless it can get very expensive to be sure. You could call around to various vets in your area and ask for a breakdown of costs to see how they compare with your vet. But, to do so, you need to be sure you know exactly what each test was, to avoid comparing 'apples to oranges'.

 

[Kflowers]

You could also ask if they recommend a six month check up for a senior cat and if so what is included in that check up.

Be aware that certain vets are owned by corporations and their prices reflect that. Mars corporation owns Banfield vets, VCA vets, and the Blue Pearl specialists. I only mention this so you won't waste time talking to more than one group they own as the prices will be the same for all of their properties.

 

[ObeseChess]

S Sajast FeebysOwner K Kflowers

Thank you all! I realize my message was a little bit muddled. Yes, I am doing semi-annual checkups every six months, which includes checks of eyes, ears, blood pressure, heart, lungs, teeth, skin, fur, and a physical check of everything inside (checking for distended/inflamed stomach, intestines, anal glands, etc) plus a haircut and toenail trim. This is completely fine with me as she is an old kitty I plucked off the street and I do not know her health history before I got her - my problem is how often the ~$85 checkup suddenly ratchets up to include hundreds of dollars in blood work despite them saying she is quite healthy for her age, which could be much older than 12 based on testimony from people in the neighborhood she was roaming around in. I totally agree about the necessity of the teeth cleaning/extraction and the need to do blood work to check everything before putting her under anesthesia.

Again, I will stress that nobody I know has anything bad to say about this vet (a private clinic here) and they've always been great to me, so it's possible I am overthinking things, I guess the part that started to set off the red flags was wanting to check for hyperthyroidism three weeks after checking for hyperthyroidism, which was itself a few months after checking for hyperthyroidism. The fact that a heart murmur or kidney problems could suddenly show up like that is encouraging that they are indeed being upfront with me!

Kidneys were checked by feel, Sassy drinks plenty of water and gets 50/50 wet and dry food - she may be drinking slightly more water since starting on amlodipine, but that's based only on observation when I am home, which is very non-scientific, and it has also been unseasonably dry recently. Sassy likes to use the litter box when I am in the bathroom as well, which makes observation easy - plenty of pee, no crystals or pain or straining or anything.

Thanks again everyone!

 

[fionasmom]

Your description of the suggestions and prices for Sassy, at her age, are completely consistent with vet care out here. TBH, in an older animal, and with a vet you trust, there are probably good reasons for doing some of these diagnostics. I do realize that it is shocking and concerning though, and I am glad that you have pet insurance.

There is a lot of good advice that I am not going to repeat. The only other option, and one which I have done now several times, is to ask for a referral to a veterinary internist or whichever specialist would be most helpful to Sassy. Sometimes these specialists can narrow things down, thereby saving you money and Sassy more vet visits.

After Jamie's echocardiogram, I asked for a referral to a veterinary cardiologist. His vet was more than happy to comply. She changed everything about his treatment, dialed back everything the regular vet had suggested, took him off of meds, and sent us home money ahead...we also have insurance.

You were very kind to give Sassy a good home after all her hard years and that is really the most important thing.

 

[ObeseChess]

Thanks for chiming in! I am more than happy to give her the care she needs, just wanted to make sure it was indeed care she needed. I have called a few well-regarded places that specialize in animal dental and think I can save some money on the extractions, but as I have no reason not to trust my vet and folks here are telling me everything is normal I will put the thought out of my head when it comes to any other care.

 

[flcat]

Well, depends where you live, but gut feeling is they are milking you for what they can, not uncommon with vets.

Years ago, for my first cat ever, had reaction to being vaccinated, the vet wanted $700 to do what they do, I looked around, found a great vet and they charged me a whopping $35 to fix her up. All she needed was hydration and a steroid shot.

 

[John Perram]

Get a second opinion, you should even do so for your own health care.

 

[ObeseChess]

Yes, I intend to do that as well but my mind has been put more at ease until I have the chance to do so - vets are understandably very backed up right now. I appreciate you all!

 

[Molly and Abby]

Hello all!

Late night thinking about a recent trip to the vet. First off I will say that this vet has always been great to us, even gave me advice off the record before I rescued Sassy and the was still living outdoors. A number of friends also take their cats to the same vet and have nothing but positive experiences.

And yet.

I bring Sassy in for her first checkup because she’s acting funny about a year ago, right before I rescued her. They do a lot of blood work ($675) and everything is fine. I bring her in for her six month checkup sick months later - senior cat exam (Sassy is 12) is supposed to be a hundred bucks. They request a couple hundred dollars in blood work, which I agree to.

I bring her in for her six month checkup in March. Doctor wants more blood work and urinalysis, another six or so hundred dollars. Everything is great and normal, minus blood pressure and teeth (see below).

I bring her in for a follow up a few weeks ago as the doctor was concerned about high blood pressure at said checkup. Blood pressure is VERY high. Doctor requests blood work to rule out thyroid issues. Three hundred bucks. Thyroid is fine. We put her on blood pressure medication.

I bring her in for her follow up exam this past weekend. Blood pressure is normal with medication. Doctor says she has a heart murmur, which is new, and requests EKG and blood work. ($650). Doctor says it could be thyroid and wants to check this again, too. ($300). Doctor says one kidney is slightly smaller than the other, wants blood work and urinalysis ($300). All previous blood work and urinalysis have shown perfectly healthy kidneys as recently as April. Teeth do look bad, though, they will need to be pulled ($1200) with blood work to check heart function before anesthesia ($400). I decline the thyroid check and mention that they just checked her thyroid a few weeks ago. I agree to the dental work in the future, but I just…

This is my first cat, and she is a senior cat and a rescue, but it sure seems like a whole lot of very expensive problems keep showing up suddenly in my cat with no other symptoms, and that she needs a whole lot of blood work. Is it possible that a senior cat will suddenly develop a heart murmur like this? I think I read that 60% of healthy cats can have one when they are stressed, and she hates the vet. Is it possible that a cat with no other symptoms will suddenly have a kidney shrink? Is all this stuff really that expensive in Portland, Oregon? What is going on?

I have pet insurance and I love my cat, I’m more worried that I am being nickeled and dimed due to my inexperience as a cat owner. That said, I also want to make sure that if these are real issues I can get her the care she needs as soon as she needs it.

thank you!

". . . . Doctor says one kidney is slightly smaller than the other, wants blood work and urinalysis . . ."

That is confusing to me. I don't see why the size of the kidneys would necessitate blood work & urinalysis.

Maybe the vet is being thorough b/c your kitty is 12 years old