Should I get a new veterinarian? (some TMI)

In My Humble Opinion
1

OK, here’s the situation: my cat Harley is about 9 years old. He was a street rescue and was FIV+ when I got him. He was diagnosed with crystals in his urine and megacolon over the past 3 years or so, which I’ve treated with diet.

Well, over the last 2 weeks, he was not grooming and looked like crap to me. I noticed him straining, brought him in, and my vet did an exam and blood work. He said there was no blockage and his blood work was OK, charged me $100, and sent me home.

Monday, I came home really late and found that my house was covered in diarrhea and vomit, and Harley was dehydrated, filthy, with his rectum protruding and looking really bad. Took him back to the vet, who put him on IV fluids, gave him meds for the diarrhea, and sent him home. $100.

He not only didn’t get better, but refused to eat or drink anything. The vet said there was nothing more he could do, gave me a syringe to force fluids, and referred me to Cornell. Harley stayed there for 5 freakin’ days on IV fluids, antibiotics, and muscle relaxants. Turns out it wasn’t megacolon at all, but FUS, Feline Urologic Syndrome, and his bladder was full of silt and mucus that took days and drugs to pass it all. We narrowly averted surgery and the cost to me was $850. I am a teacher and my summer money is now officially spent.

The vet at Cornell was obviously loathe to badmouth my regular vet, though he did say that if we caught the FUS any later, surgery would have been required, as well as an ultrasound, and the cost would have been much higher. Also, the blood work my regular vet did was NOT normal; Harley’s white blood cell count was 5 times higher than normal, a clear sign of infection. Not to mention that they found a heart murmur that my vet, in 4 years, never detected.

Should my vet have caught all this? Was it wrong of him to charge me so much money for no results and a misdiagnosis? Would you switch vets if you were me? I know medicine is an inexact science, but the Cornell people figured out what was wrong with him with only observation and the same blood test, and cured him medically, without surgery. I have 5 cats, so I represent quite a bit of business for whatever vet I choose. I want to choose correctly. Any input much appreciated by me and the feline posse.

2

I should also mention that Cornell is not a practical option right now for all the cats, since I live an hour’s drive away from there. I’d have to find a new vet in my area.

3

I think you’re perfectly justified in switching vets. The original vet should have caught the infection.

4

Not only would I switch vets, but I would go back to the original vet and ask him why he didn’t catch the bloodwork. It sounds like carelessness to me. IMO, he should have caught the heart murmur, too. My vet caught very faint heart murmer in one of my cats 4 or 5 years ago - it’s so slight that medication isn’t necessary and it hasn’t gotten any worse even though my boy is 13 now. But she caught it.

The bottom line is that if you don’t trust the vet, you need to find a new one.

5

Are there more than one doctor at your current vet? Maybe demanding a different doctor would help (or maybe not…just a possibility).

At the very least I would have a strong talk with the vet. I have had similar trouble with my vet. I notice something wrong with my dog or cat and take them to the vet. The animal gets weighed, a thermometer shoved in its ass and listened to with a stethoscope. I gte to talk to the vet for five minutes and get a $75+ bill. In one case we had taken the cat to the vet and mostly got brushed off with generic advice twice. On a trip to the emergency vet (totally different problem and time) for her once she got x-rayed and they noticed spots on her lungs and asked what that was from. I can only assume it was the thing the original vet thought wasn’t a problem. Luckily kitty fought the infection herself but obviously it left some permanent damage behind.

I finally told my vet that I insist she take me seriously. I am not a hypochondriac on behalf of my pets. I am not thrilled at throwing money to the vet for no real benefit to the animal. I told her I understood I do not have a medical background but I am in touch with my pets. If I notice them acting abnormally you can take it to the bank something is wrong. Animals don’t play act and just because the animal is weirded out at the vet and not displaying a specific symptom doesn’t mean I need to be ignored. I told my vet that in the future I wanted ALL options laid before me and I’ll decide, in cooperation with the vet, if an x-ray or bloodtest or whatever is worth the effort. Bottom line is I don’t want the vet making assumptions on my or my pet’s behalf that some test or other isn’t worthwhile. The vet should be explaining to me what options exist and why she thinks they are or are not useful. I’ll listen to her expert advice but I want the decisions to be mine…not hers.

6

Whack-a-Mole, excellent point about animals not play-acting symtoms. They mask them as long as they can, and sometime the changes are very subtle. Only someone who lives with them every day would even notice sometimes.

7

My cat is also a very good patient. The vet does not have to wrestle him to the ground just to get a heart beat and temp. I hate to get all confrontational with him, but jeez louise, if he’d caught this problem earlier, he could have saved me $1000+ dollars. I do feel like he didn’t take Harley’s illness seriously enough and could have killed him.

Argh!

Thanks for the support and persuasion to do what I know I should, which is find a new vet.

8

I would find a new vet, but I would also write a letter to your current vet, outlining all of the above. I would specifically mention being very distressed that you were not told of the abnormal bood work and heart murmur. Any vet should be able to read a blood panel and note anything out of the ordinary.

Will you get your money back? Probably not. But perhaps your vet will be more careful with his future clients. And FWIW I ask for and keep copies of all tests and records with respect to my pets. I find it particlarly useful to have copies of blood panels for reference when taking them to an emergency vet.

9

Although you may be totally correct with your assessment of your vet’s competence, it also may not be so cut and dry. The Harley that Cornell saw was not the same cat your vet saw, and the problems may have significantly changed. Perhaps if your vet saw him at the same time the Cornell vets saw him, he would have prescribed the same thing.

Or maybe not. I’m not trying to defend your vet, just pointing out that it may not be so cut and dried.

For example, I’m led to believe that FLUTD (the more current name for FUS) is a very complicated syndrome (it is not technically a disease, just a set of symptoms that no one knows what the real cause for is), and is often triggered by srtess. It is possible that Harley’s original problem (whatever it was) caused much stress which triggered the FLUTD such that it was much more prominant by the time he got to Cornell. As an FIV+ cat with magacolon, Harley obviously has more than his fair share of medical problems.

BTW, if you you would like to read up a bit on FLUTD, check out:
http://www.marvistavet.com/html/feline_lower_urinary_tract_dis.html

Another possibility is that your vet was well aware of you spending limitations, and did not recommend a bunch of diagnostic tests that may each have had only a small chance of determining the real problem. I agree your vet should have given you all the possible options, but unfortunately when they do that many people accuse them of price-gouging and piling on unessecary tests just to make a profit.

I don’t know how things work in New York, but in California there is a State Veterinary Board which looks into complaints about veterinarians. There is no cost to the complaining client, and they have trained veterinarians that will look into cases to see if proper medical protocol was followed, etc. If they rule against the vet and for the consumer, you now have authoritative medical evidence against the vet you can use in small claims court (without which a small claims judge would hardly rule against the “medical expert” (the vet) as opposed to your uninformed opinion!)

Either way, if you are uncomfortable with your current vet by all means find one you can trust. I would suggest you find a vet who is a board-certified specialist either in Feline practice, or in whatever field (internal medicine? GI problems?) is appropriate for Harley’s conditions. I would also recommend finding a vet who accepts CareCredit, so if an expensive problem pops up in the future (and wuth Harley’s problems, this is probably likely) your treatment choices would not be restricted to your current cash flow situation.

10

Wow, a vet visit for my dog is a $30 base fee. When he had an infected anal gland, the entire bill, including injecting something into the gland ($30), and two prescriptions (a topical and an antibiotic), the entire bill was only about $102. They trimmed his claws for free and gave him a bath while he was there. (I left him for the day due to work conditions and they do not charge extra for boarding during the day.)

I’d say change vets on that reason alone. Unless cats just cost more?

11

richardb, your points are well taken, but… he did misread the blood work, if he thought it was normal. Those results were faxed to Cornell and they showed them to me. Even I could see that the values were much higher than the normal range. Stuff like that makes me wonder…

I am not excited about the idea of getting all my records and finding a new doctor. I may put it off for a little while, since I am good and tired of dealing with doctors for the time being.

12

If you’re uncomfortable with this vet, by all means find another. The symptoms you’re describing sure sound like megacolon, though. And it’s perfectly possible that he has both FUS and megacolon, but the FUS was the more prominent problem when he was at Cornell.

Unfortunately we have to deal with the “why didn’t my vet catch this?” thing at my clinic all the time, on the ER end and on the specialty end. It’s often a hard question to answer, because you don’t know what the animal looked like or was doing when the referring saw it. And in some cases, there are a lot of scenarios where the referring couldn’t have caught the problem. It’s hard to explain this adequately without sounding to the client like you’re just trying to to badmouth a colleague, though.

Oh, and Jean Grey, the bill depends entirely on what you’re having done. Ruby was getting an exam, bloodwork, and films done at most of these visits. Frankly, I’m surprised it wasn’t a lot more expensive than that. Back when I was working primary care, our exams were $27. A CBC was $30, and a two-view radiograph with interpretation was $85. If you did a full chemistry panel, that was another $65. By contrast, injections were only $27, and most prescriptions were in the $10 range.

We sometimes trimmed nails for free if the nails were really bugging us or if it was a long-term good client, but we never bathed a dog for less than $18 bucks unless it had gotten itself covered with feces or urine while on our premises. Then we’d give it a quick hose and lather for free so it wouldn’t go home reeking of its own waste.

13

Oh, for heaven’s sake…like you’re just trying NOT to badmouth a colleague.

14

CrazyCatLady, no films were taken. On the first visit to my vet, Harley was just checked out. He was not blocked but was straining, which was apparently a big hint that megacolon was not the culprit. My vet caught him up on his vaccinations while he was there. The next visit was after massive diarrhea and vomiting. He was also straining quite badly. Treated with IV fluids and anti-diarrheals and sent home, where his blockage continued to worsen.

Harley does have both FUS and megacolon. However, both times I brought him in, he was straining but had no fecal blockage. Cornell said that’s a big tip off that it was a urinary tract problem and not a colon problem.

Amazingly, Cornell was able to fix Harley without help of an X-ray, an ultrasound, or a catheter. The only diagnostic tools they used was a CBC and a thyroid test, plus observation. Impressive, ain’t it? Especially considering that my vet had access to those same tools and failed to diagnose.

My vet also could have treated Harley in the same way as he was treated at Cornell. What they did was push fluids and give muscle relaxants (to loosen the bladder sphincter and relax the spasms) and antibiotics; he passed the silt and mucus that was preventing him from peeing, so he was able to get better.

This whole episode cost me a mint but it bloody well worked, so they have my undying gratitude and admiration. Yes, I spend $850, but if I had to have other diagnostics and surgery it would have been twice as much. Yay Cornell! (my alma mater) Boo, my vet! (who sent me to Cornell as an emergency client, thus costing me $100 automatically, when he himself had the means to treat Harley in-house)

15

The New York State Board of Veterinary Medical Examiners is online here.

Also, there is a list of all the State Veterinary Boards in the USA, Puerto Rico, Virgin Islands, and Canada here.