Avoiding unnecessary tests at the vet
January 9, 2018 10:32 AM   Subscribe

I strongly suspect my cat has asthma from watching videos and other research. (Not my cat, but same symptoms.) I am taking him to the vet today and it is crucial for me to keep costs low, but of course I still want to do right by my cat.

This has been going on for awhile and I thought it was hairballs so I switched him to hairball food and it made no difference. I finally started googling last night and realized the potential seriousness this morning.

I have been unemployed since last march and I'm pretty much living off of credit cards. I do have Care Credit but I am not sure that will work (not important why). Anyway I do not want the vet to run tests for anything and everything if it is not likely or necessary. This vet has seen my other cats but not this one. This cat's old vet is extremely expensive and was rude to me last time so this is why I am going to a different vet. I have had records sent over. What should I ask the vet to do or not do?

If it matters he is FIV+ and has not been sick otherwise. The other two cats don't show any symptoms.

Pictures of Spooky.
posted by AFABulous to Pets & Animals (25 answers total) 3 users marked this as a favorite
Response by poster: Also, all three are strictly indoor cats and there are no other pets.
posted by AFABulous at 10:36 AM on January 9, 2018

My cat has asthma, which was diagnosed by taking a chest x-ray, so that'll be one test where you want to decide if you go for the test or ask them to just listen to his lungs.

In my cat's case, he was given two kinds of meds to use with an inhaler, but we haven't been able to get him to tolerate the inhaler... and we've been unwilling to force the issue. One med is supposed to be an everyday thing, the other is a rescue inhaler for an acute attack that won't stop... it would buy time if we needed to rush him to the vet. The meds were very expensive.

His attacks are short (resolve within a couple minutes) and widely separated (days or weeks); this is why we haven't been using the inhaler with more urgency. So one thing to think about is how frequent and how long your cat's attacks are, and what kind of problem they represent for his quality of life. Another is whether there are obvious triggers for him (dust, type of litter, etc) that you could remove.

If your cat's attacks are short and widely separated, and money is critically tight, I would consider not even taking him in right now, unless you're the kind of cat owner who will realistically train the cat to tolerate an inhaler.
posted by LobsterMitten at 10:43 AM on January 9, 2018 [1 favorite]

Apologies if you only want specific information, but I just wanted to say that I have had really good responses when I've just been very upfront with the vet about my financial situation. I've even had vets give me a discount on the final bill - without my asking for it.

Good luck.
posted by FencingGal at 10:43 AM on January 9, 2018 [12 favorites]

Can you post to Facebook or within your social circles re: a compassionate, reasonably priced vet in your area? I was infuriated at my vet's prices (and the weird guilt tripping that went along with that) and ended up switching to a vet just a couple miles away, but whose entire practice has both more reasonable pricing + a lack of that snooty "if you loved your pet, you'd spend the money" attitude.
posted by BlahLaLa at 10:52 AM on January 9, 2018

Second to being very frank with the vet about your situation. A good vet tell you exactly what he/she expects to learn from any recommended tests, how it will affect treatment decisions, what risks you take if a "likely" treatment is started without this information. If they don't offer you this information freely and without judgment, you haven't found the right vet yet.
posted by peakcomm at 10:56 AM on January 9, 2018 [8 favorites]

The meds my cat was prescribed for his occasional asthma, so you can check prices:
AeroKat inhaler
albuterol/ProAir HFA for rescue/acute attacks
fluticasone/Flovent for everyday
posted by LobsterMitten at 11:04 AM on January 9, 2018

Oh my gosh, I just want to thank you for posting this because I just thought Chloe was coughing now and again! She probably has asthma!

I hope Spooky's okay.
posted by cooker girl at 11:08 AM on January 9, 2018 [2 favorites]

My cat deals way better with the Aerokat spacer plus inhaler than she ever does with pills or even liquid medications. If she had to take a pill every day to stay alive, she might choose not to. She is doing better since I tied her getting wet cat food, twice a day, to getting her inhaler treatment first. This also helps to clean off the steroid from her mouth so as to minimize the chance of getting a yeast infection or something. You're supposed to rinse your mouth with water after using it, which the cat is not going to do.

Unfortunately the cost is significant. She doesn't really need the albuterol inhaler, but she must have the steroid inhaler twice a day, and it is pricy. I have not managed to pay less than $174 per inhaler, using the pharmacy's "prescription club" to save a little bit, and the inhaler lasts only two months. She's using Flovent HFA 44 mcg. The cost of the vet visit dwindles into insignificance after paying for the inhaler six times a year. The Aerocat Spacer cost a little over sixty dollars. It is far better than a homemade spacer because it has a little flap that shows when the cat takes a breath. You have to keep the inhaler on her until she takes a certain number of breaths, and often she will hold her breath at first (especially if you inadvertently hug her too hard to keep her from getting away!). If you don't keep the inhaler on long enough, you're wasting the medication.

I have not tried ordering the inhaler online or from overseas in order to save money. If anyone has done so successfully I would like to know more.
posted by artistic verisimilitude at 11:16 AM on January 9, 2018

I should add that I started the inhaler use by showing my cat the spacer for the inhaler and giving her a treat. Then after a couple of days I touched her with it and gave her a treat. I didn't try to make it work right away, because I figured it was more important to establish that the inhaler wasn't too bad.

I put her on the edge of the bed, facing away from me, and stand next to the bed with one knee on the bed next to her, to help corral her. I hold the inhaler + spacer over her face with one hand, and if she doesn't struggle, I use the other hand to pet her. I have to readjust the angle of the inhaler if she moves her head. She objects less if I talk her through the whole thing, asking her for ten deep breaths and then counting her breaths. She is a very good cat. She never fights it physically the way she does liquid medication, though she complains and even growls a little bit sometimes to express her feelings.
posted by artistic verisimilitude at 11:22 AM on January 9, 2018

Response by poster: Thanks for the advice on medication. I do not yet know if he has asthma. I am asking about necessary tests to diagnose the cat, e.g. if the vet says "we need an MRI," is that really true?
posted by AFABulous at 11:23 AM on January 9, 2018

Our Liv has asthma, and responds well to the inhaler, in that she'll let us do it twice a day.

Prior to the asthma diagnosis, the vet wanted to keep her on oxygen, for which they charge by the hour. That was the bulk of our vet bill with her lung issues. So we had about 36 hours of her on oxygen, and then x-rays and the outset of the inhaler and medication. (Every time we get it filled the pharmacists are sad for us that we pay out of pocket at that expense.)

But I want to say at least this - let them do an x-ray. That's the way our girl was diagnosed, and it was a good baseline for us for when we went back in about six months later to discover that she has lung cancer. Our vet has been very good to us understanding our limits both emotionally and financially as to our treatment path (palliative, not chemo). So for as frustrated as I was about the hourly oxygen charge, I'm glad we had that baseline x-ray for the future issues that have cropped up.
posted by librarianamy at 11:34 AM on January 9, 2018

How badly is your cat doing? Does he seem perky in between coughing episodes, or does he lie around sadly? When my cat was diagnosed I had taken her to the vet because I thought she was likely to die soon and I just wanted to make sure whether there was anything I should be doing for her. I knew she had a heart murmur, and she was obviously ill. She had had canine heartworm some years before, which we knew had affected her heart, but we didn't realize that it had affected her lungs. The asthma diagnosis was a welcome surprise in comparison.

If your cat seems energetic and happy in between coughing sessions, then maybe it's not an emergency.

Wih my sick cats in the past, I have asked not to have all the tests done immediately, instead of running all the tests at once and having to pay for all of them. If one test is positive, maybe another test won't be necessary. One of the comments under that video said it turned out that their cat turned out to have borderella, rather than asthma. I guess the most important thing to start with might be a blood test to see if the cat's blood counts indicate an infection.
posted by artistic verisimilitude at 11:41 AM on January 9, 2018

Response by poster: Does he seem perky in between coughing episodes, or does he lie around sadly?

He looks pathetic for a bit after and then goes back to his typical asshole cat self. (Said with love.) If he runs around too much he'll start coughing again so for today I'm trying to keep him calm.
posted by AFABulous at 11:49 AM on January 9, 2018

I am asking about necessary tests to diagnose the cat, e.g. if the vet says "we need an MRI," is that really true?

Veterinarians have an ethical duty to offer you the highest and best quality of care that they can. More and more, that care includes advanced imaging and testing, and/or referral to a specialist. Your vet may say "we need an MRI," but what they should really say is "I recommend an MRI for these reasons..." You should absolutely feel comfortable asking them if there are less expensive diagnostic methods available, and what the cost/benefit analysis is for the various options.

You could also talk to them about a "stepwise" diagnostic approach, in which the least expensive tests are done first, then progressing to more expensive tests if the earlier tests are inconclusive. Keep in mind, this can result in spending more in the long run (for example, a stepwise approach might start with a $40 x-ray, and then progress to a $100 ultrasound if the x-ray is not sufficient to make a diagnosis. You've now spent $140 when you could have spent $100 by doing the ultrasound first).

You will also want to discuss with your vet what types of treatment you would be unable (or unwilling) to pay for. For example, a test might reveal what type of chemotherapy drug will be best for a particular cancer, but if chemotherapy is not an option, there is no reason to do that test.

Please be upfront with your vet about your financial situation from the start. Almost every vet I have ever worked with has lost sleep over trying to save their clients a few bucks, rather than the other way around. If they know cost is an issue, they can work with you to find the right balance of practicing good medicine and your financial situation.
posted by Rock Steady at 12:28 PM on January 9, 2018 [5 favorites]

If you want the vet to see the cat's symptoms, take a video and bring it in with you.
Cats often act as healthy as all get out when confronted with a vet who can help them!
posted by SLC Mom at 12:42 PM on January 9, 2018 [5 favorites]

My cat has asthma. We were not financially well off when he was being diagnosed. Things I would pay for:

vet visit

You do not need an mri or a ct or any advanced imaging. You're probably going to a "general practice" vet, but they should still be familiar with the signs of asthma. If they don't know what it is, and aren't confident that it's something else, I would ask for the script for the inhalers.

My cat has the same things as lobsterkitten's. I get it relatively cheaply from northwestpharmacy.com. I am on some feline asthma groups on facebook, and they linked to a different pharmacy where they can get generic fluticasone for $35 a puffer. I will be trying that place when it is time to reorder.

It is so scary and upsetting to hear your loved one struggling to breathe, especially when they don't know why. Asthma is manageable, but it will be a lifelong disease and cost. My cat's asthma flares depending on the season, right now he's having a worse flare and it is quite the struggle to get him to take his inhaler. Some cats don't mind at all and barely open an eye when you do it.

Check out Fritz the Brave.
posted by misanthropicsarah at 12:47 PM on January 9, 2018 [2 favorites]

So, our cat does the exact behavior in the video. Our vet initially suspected it was asthma, but our cat never shows blue gums or--indeed--any respiratory distress but did display unusual amounts of snot and a couple of dry scaly skin patches. A specialist vet diagnosed (through skin tests and a bunch of other things) a bunch of rather severe allergies for our guy. In fact, one of the things we discussed at length, displaying video of our cat doing it, was that exact behavior.

The specialist vet called it normal behavior to clear too much mucus. It can be a symptom of more severe things, but in our guy's case it was not.

His allergies are terrible and not responsive to allergy shots nor the immunosuppression drug they use for cat allergies. His weird wheezing happens sometimes. Not daily, not even weekly, and he drools a little, but shows no distress. So we do nothing at all about the wheezing. YMMV but it may not be asthma at all.
posted by crush at 12:53 PM on January 9, 2018

Oops, forgot the salient part, based on descriptions of our cat's behavior with the episodes, his known snotty nose, and the emerging skin issues, our vet ruled out asthma without any additional tests, Of course, the allergy rabbit hole was hideously expensive. But cross that bridge. We treat the snot with ordinary OTC Claritin, which does seem to cut back on the need to wheeze out the extra snot.
posted by crush at 12:58 PM on January 9, 2018

My asthmatic kitty was diagnosed with a chest x-ray. I also took a cell phone video of her rapid breathing, which helped the vet differentiate between rapid breathing at rest and the nerves of being at the vet's office. Combined with the exam and the pred prescription, I walked out the door for about $200.

She needs occasional maintenance when the asthma flares up, so I give her short prednisolone bursts. The pills are cheap, and I only need to refill the prescription about once a year. The pred has worked well for her and I haven't had to resort to inhalers or masks, which is good, because she's skittish enough as it is and wouldn't tolerate them, I don't think.
posted by mudpuppie at 1:12 PM on January 9, 2018 [1 favorite]

Response by poster: Managed to get a video of him doing it. There is ambient traffic noise, and the white thing in front of him is just a scrap of paper, nothing that came from him. This went on for a couple minutes after the video ended. Then he fell asleep on his favorite chair.

No snot, sneezing, runny eyes, dry patches or anything else that would indicate allergies but I'll see what the vet says. I'm leaving in about a half hour so I'll update later. Thanks all.
posted by AFABulous at 1:37 PM on January 9, 2018 [1 favorite]

I initially thought my cat had asthma, but an x-ray was negative, as was the physical exam. But Seconds the cat did have ear mites, which made her intermittently wheeze, cough and sneeze because she's allergic to them.

A few times a year, she wheezes and sneezes, and I give her the cat version of Revolution between the shoulder blades, and she's then fine.

Mad props to those who can actually get a cat to use an inhaler.
posted by answergrape at 1:39 PM on January 9, 2018 [1 favorite]

As a datapoint, my cat Zephyr has intermittent bouts of asthma. I showed the vet a video like this, which was all he needed for a diagnosis. The initial diagnosis, and Zeph's occasional need for prednisolone, has been remarkably inexpensive over the years. YMMV, of course.
posted by Lycaon_pictus at 7:02 PM on January 9, 2018

Managed to get a video of him doing it.

This same behavior is how I know a flare-up is coming on in my cat. When she starts doing the cough (which I also thought was hairballs at first), I start her on the pred -- twice a day for a two days, then once a day for a two days, then every other day for two days. The prescription label has her on it for longer, but there's a domino effect -- she has a very mild latent herpes virus that ramps up as the pred depresses the immune system. There's an annoying balance to achieve between the coughing and the herpes sneezing/sniffling, but I can keep her breathing well for most of the year.

Triggers that I've found in my cat are turning on the heat or AC for the first time after they've been off for a while, as well as the same high pollen count that gets me in the spring.

Yay cats. There must be a reason why we go through this with them.
posted by mudpuppie at 7:18 PM on January 9, 2018

Forgot to add: I also have to be really careful about cleaning products, especially those I use on the floor. It's vinegar and hot water all the way for me now. Anything else sets the cat off.
posted by mudpuppie at 7:25 PM on January 9, 2018

Response by poster: Well I ended up getting an X-ray but the doctor was not leaning towards asthma (I showed him the video). The chest radiographs were normal so he gave him an injection of an antibiotic (Cefovecin) to treat "suspect upper respiratory tract infection." I questioned how that could have been going on so long but he said it was probably because he's FIV+ and couldn't get over it on his own. So cross your fingers that's all it is. I wasn't clear what the next steps would be if it's not an infection or if the antibiotic does not work.
posted by AFABulous at 10:03 AM on January 10, 2018 [3 favorites]

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