# How to evaluate vet's advice? (Cat, a bit gross)
**URL:** https://boards.straightdope.com/t/how-to-evaluate-vets-advice-cat-a-bit-gross/413819
**Category:** Miscellaneous and Personal Stuff I Must Share
**Created:** [July 31, 2007, 3:51pm UTC](https://boards.straightdope.com/t/how-to-evaluate-vets-advice-cat-a-bit-gross/413819 "2007-07-31T15:51:31Z")
**Posts on this page:** 12
**Page:** 1
### Author:  [@Dr.Drake](https://boards.straightdope.com/u/Dr.Drake)
#### Post date: [July 31, 2007, 3:51pm UTC](https://boards.straightdope.com/t/how-to-evaluate-vets-advice-cat-a-bit-gross/413819/1 "2007-07-31T15:51:31Z")
I’m hoping the cat folks will be able to help me. My cat is 12. I don’t know how to post pictures. For the past couple of years she’s had irritable bowel syndrome.
I’ll post my questions first, and then the background.
1. Can feline IBS turn into lymphoma?
2. Should I follow my vet’s advice and get the super-expensive biopsy?
3. What if I just put my cat on prednisone for life? I know the risks, but I also know that people survive longterm on the same drug, so it can’t be THAT deadly.
4. What about ‘natural’ diets?
Her condition been controlled through Super-Expensive Cat Food (rabbit or venison flavor, the proteins she hadn’t been previously exposed to) and occasional courses of prednisone and flagyl. The basic symptom is extraordinarily smelly poo, light in color, and overly liquid, with occasional outside-the-box shenanigans (which she doesn’t do when healthy). Sorry for the grossness.
Lately it has been getting much worse. Prednisone still makes her fine, but no catfood works anymore, not even the magic Hill’s Science Diet Z/D. We have, of course, been in and out of the vet’s. The vet says that irritable bowel syndrome in cats can turn into lymphoma sometimes. I don’t know how to evaluate that; it seems fishy to me, but two different vets have said so. I know the two conditions are difficult to distinguish, but I don’t know that I really believe one turns into the other. I can see misdiagnoses being corrected later on with that as a cover story, but I am not in a position to know, really. Both vets (independently, at two different practices) also told me that it is important to get an extraordinarily expensive biopsy done in order to test this.
How should I evaluate this information? In both cases, the suggestion that I do the biopsy was more like a carefully rehearsed sales pitch than anything else. There are three versions of the test, and I was made to feel that if I cheaped out the results would be inconclusive and the cat would be needlessly stressed and we’d just have to go back and do the expensive one.
I should point out that she is indoor-only and has been vaccinated against FeLV and all the other bad things.
Where I need help: I just… don’t believe it’s lymphoma. I don’t think it’s denial on my part, though that’s always a possibility. Part of this is her general demeanor: she eats, she plays, she’s happy. Part of it is that the good ol’ internet says that cats with lymphoma tend to last up to two months if untreated, and she’s well over that. She’s also really gassy, a symptom the vet doesn’t seem to hear when I tell him.
Part of it is the sneaking suspicion that vets are taking advantage of my emotional distress to make money. They always want to do more blood tests in case anything has changed (last full test: late March. Results: negative). On the other hand, they are medical professionals and I am not; they must like animals in order to work with them all day long, and I can’t see anyone who likes animals being that mercenary. I want to do what’s best for her, and at this point nothing is working. This is horrible!
For question #4, a lot of people have recommended that I prepare regular food rather than canned / kibble catfood. I think most of them are caught by the fallacy that processed = unnatural = always worse; natural = always better. (Processed often is bad, of course, because those who process are in it for profit and will cut corners and add shelf-life extenders etc.)
Thanks to all who reply.
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### Author:  [@Contrapuntal](https://boards.straightdope.com/u/Contrapuntal)
#### Post date: [July 31, 2007, 3:58pm UTC](https://boards.straightdope.com/t/how-to-evaluate-vets-advice-cat-a-bit-gross/413819/2 "2007-07-31T15:58:12Z")
I can’t help for cats, but I have a 13 year old Jack Russell who will be on prednisone the rest of his life. It probably will shorten his life a bit, but it makes each day considerably more bearable.
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### Author:  [@Napier](https://boards.straightdope.com/u/Napier)
#### Post date: [July 31, 2007, 4:01pm UTC](https://boards.straightdope.com/t/how-to-evaluate-vets-advice-cat-a-bit-gross/413819/3 "2007-07-31T16:01:17Z")
Lotta cats here, but no experience directly on point.
Two concurring vets? That means they are almost certainly both telling you the accepted proper diagnosis and treatment.
Most vets I’ve worked with seem concerned for the animal, realistic about owner resources, and not interested in sales pitches. One, however, seemed outrageously aggressive about sales.
How much money are we talking here? And, how stressful is the test to the cat?
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### Author:  [@Dr.Drake](https://boards.straightdope.com/u/Dr.Drake)
#### Post date: [July 31, 2007, 4:10pm UTC](https://boards.straightdope.com/t/how-to-evaluate-vets-advice-cat-a-bit-gross/413819/4 "2007-07-31T16:10:21Z")
[QUOTE=Napier]
How much money are we talking here? And, how stressful is the test to the cat?
[/QUOTE]
The first procedure was a layered biopsy where (I gather) they just use a syringe to take out a cross-section of cat; a few hundred dollars. The “gold standard,” says the vet, is a full-scale surgery where they remove part of the intestine and examine it in the lab. It’s closer to $1K. And of course anything involving anaesthesia and surgery is stressful to elderly cats, but beyond that she should make a full recovery.
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### Author:  [@SnakesCatLady](https://boards.straightdope.com/u/SnakesCatLady)
#### Post date: [July 31, 2007, 4:11pm UTC](https://boards.straightdope.com/t/how-to-evaluate-vets-advice-cat-a-bit-gross/413819/5 "2007-07-31T16:11:30Z")
I hate to say it, but my first instinct is to tell you to try yet another vet. You don’t seem to trust either of the ones you have seen, and it is my opinion that trust is necessary. If you don’t trust them you are not going to be as diligent about following instructions as you might be if you had more confidence in them.
Are there vets that order tests just to make money? Sure there are. Are two vets who are not in the same practice likely to order the same expensive unnecessary test? I don’t think so. I don’t know anything about IBS turning into lymphoma; it’s not something I have to deal with. The steriod issue is a quality of life versus length of life issue to me; I know which one is more important to me. In evaluating the effect of medications you can’t compare cats to humans - cats have kidneys that are very sensitive to toxins. Prolonged steriod use will most likely shorten your cat’s life.
As for the “natural” diets - my vet is not a big fan of them, and I don’t have time to do it properly for 8 cats so I haven’t done that much research. Are you going to be able to find exotic meats for her? Cats _must_ have meat, it isn’t an option to put a cat on a vegitarian diet.
I am sorry you and your cat are having to deal with this, and I wish you the best of luck.
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### Author:  [@wonky](https://boards.straightdope.com/u/wonky)
#### Post date: [July 31, 2007, 4:27pm UTC](https://boards.straightdope.com/t/how-to-evaluate-vets-advice-cat-a-bit-gross/413819/6 "2007-07-31T16:27:00Z")
I think my first question about the biopsy would be, “What would it mean if it came back positive?”
Tests are fine and great, but some tests give you information that you can’t really use.
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### Author:  [@Harriet\_the\_Spry](https://boards.straightdope.com/u/Harriet_the_Spry)
#### Post date: [July 31, 2007, 4:47pm UTC](https://boards.straightdope.com/t/how-to-evaluate-vets-advice-cat-a-bit-gross/413819/7 "2007-07-31T16:47:26Z")
Speaking from a human perspective, IBS (irritable bowel syndrome) is a diagnosis based on eliminating more serious causes, IBS does not lead to other health conditions, and prednisone is not a typical treatment. However, there is also inflammatory bowel disorder, which is abbreviated IBD, and these two names can easily be confused. Are you sure they aren’t getting confused here? Or maybe there is different terminology for cats?
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### Author:  [@Dr.Drake](https://boards.straightdope.com/u/Dr.Drake)
#### Post date: [July 31, 2007, 5:08pm UTC](https://boards.straightdope.com/t/how-to-evaluate-vets-advice-cat-a-bit-gross/413819/8 "2007-07-31T17:08:20Z")
[QUOTE=Harriet the Spry]
Speaking from a human perspective, IBS (irritable bowel syndrome) is a diagnosis based on eliminating more serious causes, IBS does not lead to other health conditions, and prednisone is not a typical treatment. However, there is also inflammatory bowel disorder, which is abbreviated IBD, and these two names can easily be confused. Are you sure they aren’t getting confused here? Or maybe there is different terminology for cats?
[/QUOTE]
Thanks to all who reply. **Harriet** , I think this is what you’re calling IBD. Several websites use the terms as if they are interchangeable; I can’t remember which one the vets used.
**SnakesCatLady** , no worries — I’m not about to put my cat on a vegetarian diet! Although I love her as if she were a person, I do understand that she is a cat. It’s just that apparently her system develops negative reactions to proteins she has been exposed to in the past.
**jsgoddess** , I have asked that question, and the answer seems to be “chemotherapy,” but at the time I was overwhelmed and not able to go into the implications. I will ask that again today when I talk to the vet again.
Thanks to all who’ve replied so far. I want my cat to have the best quality of life, and if I have to choose quality over quantity I will, but it is a very. hard. choice. As for trusting the vet — my long-time vet abandoned his practice about a month before I moved to a new city, so it’s just a matter of developing a relationship with this guy. I have no reason to _distrust_ him, it’s just that I’m in uncharted territory and worried and scared and I want some more information before I make big decisions, and googling subjects I understand poorly isn’t really all that helpful. (Dr. Drake’s law of the internet: any medical symptoms you google mean death is imminent.)
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### Author:  [@wonky](https://boards.straightdope.com/u/wonky)
#### Post date: [July 31, 2007, 5:52pm UTC](https://boards.straightdope.com/t/how-to-evaluate-vets-advice-cat-a-bit-gross/413819/9 "2007-07-31T17:52:23Z")
[QUOTE=Dr. Drake]
**jsgoddess** , I have asked that question, and the answer seems to be “chemotherapy,” but at the time I was overwhelmed and not able to go into the implications. I will ask that again today when I talk to the vet again.
[/quote]
That’d be good for you to know. It could be the sort of thing where a little chemotherapy goes great and she has a good prognosis, or it could be the sort of thing where chemotherapy is going to make her miserable and barely extend her life.
> [@Dr. Drake](#):
>
> Thanks to all who’ve replied so far. I want my cat to have the best quality of life, and if I have to choose quality over quantity I will, but it is a very. hard. choice. As for trusting the vet — my long-time vet abandoned his practice about a month before I moved to a new city, so it’s just a matter of developing a relationship with this guy. I have no reason to _distrust_ him, it’s just that I’m in uncharted territory and worried and scared and I want some more information before I make big decisions, and googling subjects I understand poorly isn’t really all that helpful. (Dr. Drake’s law of the internet: any medical symptoms you google mean death is imminent.)
My law of veterinary medicine: The symptoms you ignore are the important ones. The ones that scare you end up being some stupid cat thing that they all do. Grr.
From [here](http://www.veterinarypartner.com/Content.plx?P=A&A=598&S=1&EVetID=0)
> [@](#):
>
> Is it at all Reasonable to just Try Treatment and Skip the Expensive Diagnostics?
>
> Possibly. The problem with the prednisone trial involves the possibility of intestinal lymphosarcoma (also called lymphoma). This is a type of cancer that produces chronic diarrhea or vomiting just as inflammatory bowel disease can. Lymphoma is temporarily responsive to prednisone but the response is short-lived. Exposure to prednisone will make the lymphoma much more difficult to diagnose should biopsies be obtained later. Plus exposure to prednisone can lead to resistance to other medications. (This is less of a problem for cats, but in dogs even a few days of prednisone can make a lasting remission impossible to achieve.)
>
> In short, if one tries prednisone without confirming a diagnose, harm can be caused should a lymphoma be present instead of inflammatory bowel disease.
Anyway, I found these stats [here](http://www.zzcat.com/resources/overview.htm#lymphoma)
> [@](#):
>
> - In one study 7 cats were treated with the COP protocol (cyclophosphamide, vincristine, and prednisone). Of these 7 cats, 6 achieved remission with a median duration of remission lasted 19 weeks. The grade of intestinal lymphoma was not considered.
> - In one study, 14 cats were treated with cyclophosphamide, vincristine, and methotrexate. Median survival time was 12 weeks. The grade of the intestinal lymphoma was not considered.
> - In another study, 132 cats with lymphoma were treated with COP plus doxorubicin, L-asparaginase, and methotrexate (the “CHOP-like” protocol). Of this group 125 cats had intestinal lymphoma. Out of the total 132 cats, 67% achieved remission with a 21-week disease-free interval. Another study using the same protocol on 21 cats with intestinal lymphoma, only 38% achieved remission but these cats had disease-free interval of 40 weeks.
> - In another study, 25 cats with intestinal lymphoma, 25 of which had high-grade lymphoma, were treated with COP. Those who achieved complete remission had a 30-week disease-free interval. The overall median survival when all 25 cats were considered was only 7 weeks.
> - Another study looked at 11 cats with high-grade intestinal lymphoma treated with COP plus doxorubicin and L-asparaginase. Only 18% achieved complete remission. Median survival was only 11 weeks.
> \*\*- As for low-grade intestinal lymphoma, a study of 50 cats included 36 treated with prednisone and chlorambucil. Here, 69% achieved complete remission for a median duration of 20.5 months."
> \*\*
And this is from [here](http://www.veterinarypartner.com/Content.plx?P=A&A=1446&S=1&SourceID=42)
> [@](#):
>
> The more infiltrative forms of intestinal lymphoma do not create actual growths; instead the intestine may only be abnormal under the microscope. It is very difficult to distinguish inflammatory bowel disease from lymphoma without a full-thickness biopsy (a full-thickness piece of intestine) obtained via exploratory surgery. A less invasive method of obtaining a sample is via endoscopy, usually adequate for diagnosis but full thickness biopsy samples cannot be obtained this way.
>
> ```
> * Cats with intestinal lymphoma treated with prednisone alone have a life expectancy of 45 to 60 days. Other protocols using multiple drugs yield much better results (see below for details).
>
> ```
So, it looks like survival from intestinal lymphoma isn’t great even after chemotherapy, though obviously the one I bolded has a decent remission rate and time.
I truly hope you’re just dealing with a sensitive digestive tract.
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### Author:  [@KarlGrenze](https://boards.straightdope.com/u/KarlGrenze)
#### Post date: [July 31, 2007, 11:33pm UTC](https://boards.straightdope.com/t/how-to-evaluate-vets-advice-cat-a-bit-gross/413819/10 "2007-07-31T23:33:02Z")
Vet student cap on
Check out if your cat has irritable bowel syndrome or inflammatory bowel disease. Two different diseases, two different treatments.
Inflammatory bowel disease is hard to diagnose, and can be confused with lymphoma. The best way to differentiate between the two is by full thickness biopsy (pathologists can apparently distinguish differences between the two diseases in different layers of the intestine). That is why the gold standard is so much more expensive.
Cats are more tolerant of prednisone than dogs and other animals. The major side effect is the possibility of diabetes. Still, like another poster cited, if it is lymphoma, it can still affect other chemotherapy protocols.
**jsgoddess** , the cites you offered mostly either didn’t take the grade of the disease into consideration (something a full thickness biopsy would give you, along with the patient’s history), or where high-grade diseases. In those cases, yes chemotherapy would be less effective.
Remission interval and survival time are not the same. Survival time is how long until they either die or were put to sleep. Remission interval is how long they were disease-free, for example, no tests found lymphoma in the body. Once the animal is out of remission, another protocol can be used to bring the animal into remission again. So the survival time may be longer than the remission time.
/Vet student cap off
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### Author:  [@Dr.Drake](https://boards.straightdope.com/u/Dr.Drake)
#### Post date: [August 1, 2007, 12:02am UTC](https://boards.straightdope.com/t/how-to-evaluate-vets-advice-cat-a-bit-gross/413819/11 "2007-08-01T00:02:33Z")
Thanks, **jsgoddess** and **KarlGrenze**. I will be much, much, much more informed when I talk to the vet again. **KarlGrenze** , can you recommend a source for me to read up on these? Either online or in print would be great.
ETA: Please.
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### Author:  [@KarlGrenze](https://boards.straightdope.com/u/KarlGrenze)
#### Post date: [August 1, 2007, 12:09am UTC](https://boards.straightdope.com/t/how-to-evaluate-vets-advice-cat-a-bit-gross/413819/12 "2007-08-01T00:09:25Z")
The Veterinary Partner website that **jsgoddess** provides a good online resource.