Help me trust my vet and/or learn to ask better questions?

December 1, 2022 11:05 AM

Yesterday I took my cat Harley into the vet. There were a lot of recommendations and I don't know how well I did fielding them. This question is about (a) making better decisions under pressure at the vet's office and (b) generally does my vet seem to be acting more or less reasonably. Not asking for vetinary advice. Details inside.

Vet visit was for an episode of fecal incontinence (reservoir) in otherwise quite healthy cat. The new-to-me vet (they seem to cycle through at this office) examined her, and then recommended a whole bunch of tests, medications, and supplements, and (very) briefly explained each thing. I asked some questions along the lines of "What will this test show or rule out?" "How could this supplement help?" But found I didn't have any way to weigh the vet's answers, and didn't trust her enough to just blindly believe her. After the exam the vet recommended:

- Blood panel (Well Panel SrFe (CBC/Chem15/Lyte/TT4))
- urinalysis (Sedivue Ox w/ urinalysis Analyzer)
- fecal (IDEXX FECAL DX PROF w/ GIARD)
- 6 view xrays spine/abdomen
- Cerenia injection (reduces inflammation?)
- Cerenia tablets for takehome
- Probiotic paste
- Subcutaneious fluids

She said (and my pre-visit google consultation confirmed) that the incontinence could be due to any number of possible causes. Thus the reason to cast a wide diagnostic net.

I ended up authorizing almost everything they recommended because ... what do I know about this stuff ... but should I have? The one thing I declined was they wanted to have the xrays reviewed by a "board certified radiologist" for another $200. I figured the vet can recommend that after looking at the xray if she thinks it's necessary. Correct call?

Final result: The tests showed only a slightly elevated white blood cell count so the vet also added an antibiotic. The xrays showed an "area of denser tissue" near the colon/rectum border so now an ultrasound is scheduled for next Monday to drill down on that.

The tech said I shouldn't feel pressured to do everything on the list, but rather that it was a menu of all the things that *could* be done. But how am I supposed to know what things on the menu I should approve? And how do I trust that they aren't upselling or just throwing solutions at the wall to see what sticks? Or taking the position that "Well, we have the $ and capability to do it, so let's just test for everything just in case?" I'm all for being thorough and getting the best answer as quickly as possible, but ... why do I feel squicky here then? I should feel great about "love the cat, can afford the money, so hurry up and do all the tests".

$1200 later (before the ultrasound), and I'm second-guessing myself and the vet.

1. Did I do fine with my decisions?

2. Should I have asked to do right now only the test(s) most likely to show an actual problem (the xray I guess?)? Asked the vet to prioritize the things on the list?

3. Did the vet make generally appropriate recommendations? (not seeking veterinary advice per se, just reassurance that she isn't extremely over-recommending or upselling).

Any other advice for making decisions at the vet's office? It's been a long time since I've been in this position.

posted by bluesky78987 to Pets & Animals (10 answers total)

Best answer: If finances are a concern, I would in future specifically ask that the vet start with the tests that would confirm the most likely causes. A vet should be willing to do that unless they have a good, specific, explainable reason not to.

If excessive intervention leading to fear/discomfort for the pet is a concern, ask about the impact on the pet. Treatments/tests that are painful or scary should have a higher threshold for proceeding.

I've found that good vets are responsive when you raise either of these concerns and will adjust treatment plans (if feasible) to take them into account. Some of them do tend to put forth the full "menu" of options that they would undertake if neither were a concern to start with, though.
posted by praemunire at 11:13 AM on December 1, 2022

Best answer: (P.S. What a magnificent beast Harley is!)
posted by praemunire at 11:14 AM on December 1, 2022 [9 favorites]

Best answer: That list of recommendations seems like a lot to me. I've brought cats into the vet with issues both major and minor, and I've never gotten a list like this (even in situations where there was a life-threatening issue). Then again, part of why I really like my vet is that (1) she clearly explains the risks and rewards of each potential treatment or diagnostic test, (2) she keeps up with the research on treatment options and explains it clearly for each option, and (3) she's generally conservative in making recommendations for treatment.

I'd say you did well in the moment. You asked good questions and made the best choice you could. For future vet visits, the following have been helpful to me and may be helpful to you:
- Try different vets until you find one you like. My current awesome vet is the fourth one I tried.
- Ask, "If this was your cat, where would you start?" or "What's the most important thing to do first?"
- Let them know up front that you'd like to approach treatment conservatively. I've had luck with something like, "I don't want to put $bestcat through any extra stress with unnecessary treatments. Can you help me pick just the options that are most likely to make a difference in this situation?"

Harley is indeed magnificent. Good luck to both of you!
posted by ourobouros at 1:02 PM on December 1, 2022 [3 favorites]

Best answer: Cerenia is an anti-nausea treatment and subcutaneous fluids are similar to IV fluids for humans and will rehydrate your pet if they’re dehydrated due to vomiting or other reasons.
posted by A Blue Moon at 2:55 PM on December 1, 2022

Best answer: This is tricky with cats -- they don't give us a lot of clues when they're sick, so it's very hard to know what tests to run. And if your cat is not feeling good and basic tests might not show anything useful, the vets like to tell you everything that could be useful. The more you authorize, the higher the chance they find out what's wrong sooner. But that expensive last test might take them from 80% confidence to 95% confidence, and 80% might be enough. It's a hard call to make.

I want to take a moment to acknowledge that vets have a lot of customers who are unable or unwilling to pay for diagnostic work and/or treatment, so they spend a lot of time in situations where a sick pet goes without treatment and may continue to suffer, or a sick pet goes without treatment and is euthanized when their life could have been improved/extended. That's a massive bummer and vets have a lot of sad days because of this.

You are able to afford care for your cat. Wonderful! Asking questions so you understand the options and what that means for your cat is great. As your cat's caretaker, it's your responsibility to understand the care she's prescribed.

When my cat was sick (she is happy and healthy now!), the vet wanted to do multiple tests, including blood tests, X-rays and a biopsy. I asked the vet to explain what illnesses would be confirmed or eliminated by each test, and the relative likelihood that those illnesses were what my cat actually had. I was particularly reluctant about the biopsy because it was expensive and also painful and confusing for an animal to recover from. I asked what would happen if other tests were inconclusive but I still didn't want to do the biopsy. The vet explained that two diagnoses would be remain, and one (food sensitivity) was far more likely than the other (lymphoma) given the cat's symptoms and history. I asked about treatment and prognosis for both, and what would happen if we just assumed the more likely diagnosis was correct and treat the cat for that. She told me that was actually a good approach, because if we put my cat on hypoallergenic food for a few weeks and it works, that'd confirm that she just has a food sensitivity. If it doesn't help, we can talk about the biopsy again. The blood tests and X-rays did end up being inconclusive. We put the cat on hypoallergenic food. She got better! She's living her best life. And I didn't have to pay for a biopsy. (Although omg her food is so expensive.)

To answer your questions directly:

1. Yes
2. Yes, I think that's a great approach
3. Yes, it sounds reasonable. Getting blood, urine and fecal tests regularly is helpful both for finding something wrong now and to have as a baseline as she ages or if her stats are different next time. They're routine and relatively inexpensive. Vets seem to suggest subcutaneous fluids a lot because it can't hurt and it's relatively cheap (I had a cat who actually benefited from it a couple of times). X-rays are good for showing what's going on in their digestive tract, and your vet should be able to tell you what she could feel from the physical exam and what theories an x-ray would confirm/eliminate (I might say yes or no to the X-rays depending on whether it sounds like they'll help, but I'm inclined to say yes because they give answers quickly while other things will take longer). I'm unfamiliar with Cerenia but from a quick Google it sounds credible, and I'd consider it depending on the vet's specific advice and the cost.
posted by katieinshoes at 2:58 PM on December 1, 2022 [4 favorites]

Best answer: The medications all seem to be about providing comfort to your (very beautiful) cat, so that makes sense. But I agree that the number of procedures seems like a lot to do all at once. With diagnostics, you can ask a vet, "what are the most likely causes of this problem, and can we do tests that will eliminate those first before we do everything?" Which is to say, it's possible in this situation, your vet would first suggest bloodwork and the urine test - and then when those didn't prove anything, suggest an x-ray. So in this case you still would have done everything on that list.

It sounds like the main problem here is that the vet didn't really communicate well with you. Were you also surprised by the cost? I know it can feel awkward, but it's okay to ask for prices upfront.

I have moved around a lot and so had to find vets a number of times - I read reviews on Yelp + Google, and I look for people who say things like "I appreciate that the vet doesn't pressure you on tests you don't need" or "I appreciate the vet cares more about the animals than milking their owners" etc.
posted by coffeecat at 4:14 PM on December 1, 2022

Best answer: I had a cat that ate a piece of Magic Eraser, so he was barfing while it passed through his digestive tract. The vet gave him Cerenia to treat the vomiting, after an xray and inconclusive US. It's hard to image Magic Eraser so at the time no one really knew what it was, and I didn't figure it out until I found the culprit with a cat nibble out of it.

All this is to say that your choices make total sense. Saving the radiology review for a later time is probably fine, although I will say the specialist vet that did the XR and US review caught my cat's kidney disease about 9 mo before it became a problem.
posted by fiercekitten at 7:27 PM on December 1, 2022

Best answer: There's a good chance private equity backs your vet these days, just like there's a good chance you don't know it. The trick is to buy up a veterinarian-owned practice, and to stay quiet about the fact that it is no longer run by an independent veterinary group. The change in ownership has everything to do with both over- and up-selling. It's also responsible for the frequent turnover of vets, and the reason fewer people are entering the profession: "The market anticipates a 33% increase in pet health care spending over the next decade, but a shortage of nearly 15,000 veterinarians will likely still exist by 2030, according to a study published this week by MARS Veterinary Health." That, of course, will only make prices rise higher. One way around this would be to look for an independent vet. But not all communities have access to them anymore.
posted by Violet Blue at 11:28 AM on December 2, 2022 [1 favorite]

Best answer: Sorry, I realize I didn't directly answer your question. I'm extremely mad at how unaffordable petcare is these days. Like human healthcare, pet healthcare is not something anyone wants to be cheap about, and investor groups exploit that.

Your questions:
(1) Don't second-guess yourself, and don't regret. I think you did fine.
(2) Your instinct is right here. In future, only do tests will provide likely confirmations of your pet's diagnosis, rather than more speculative tests.

I hope your pet's problem is resolved soon.
posted by Violet Blue at 11:49 AM on December 2, 2022

Best answer: I recently had a stressful vet experience which may be relevant. For reference, cost of vet care in my country is more reasonable (to the best of my knowledge) than in the US, but I don't have pet insurance; in this case cost was not a factor, but concern over stressing out the animal unnecessarily was.

To cut a long story short, my old vet retired. My older cat, who has a chronic medical condition, had a health scare and was seen by three brand new vets within a short space of time, who recommended a series of tests to investigate why she was throwing up (first a blood test; later an ultrasound). This involved leaving the cat at the vet's office for the day twice, and I spent those days in a spiral of doom and anxiety, certain that the vets knew that something awful was up and This Was The End. The tests found nothing, the cat was eventually sent home with a course of antibiotics and anti-nausea meds, and now seems fine (touch wood!).

I was initially feeling resentful about the tests -- they seemed like a lot of fuss and anxiety (for me and for the cat!) over nothing. My old vet was very pragmatic, and would probably have tried the antibiotics first and ordered tests only if the cat didn't get better.

But after thinking over my reaction I came to the conclusion that if the tests hadn't been ordered, I would have been just as anxious waiting to see if the cat recovered, and I would not have those encouraging test results right now to reassure me about her overall health. I'd probably still be feeling paranoid today that she had temporarily recovered, but that the puking was a symptom of some horrible underlying condition that I wouldn't see coming (this is exactly what happened with a previous cat).

There was also at least one specific possible side effect of her chronic medication that a blood test was recommended for, and now I know that it hasn't happened and she appears to be tolerating the medication well.

So in the end I think the vets did the right thing, and I got something of great value out of the experience, even though the tests didn't directly help to fix the problem. Could they also have been upselling me, and suggesting things that weren't strictly necessary? Possibly. I don't know any of them well enough to have a rapport with them or establish a pattern of behaviour. But I am not displeased with the outcome.
posted by confluency at 2:10 PM on December 2, 2022