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Coffee Talk
Hi, everybody. Welcome back. Guess what? This is our last coffee talk of the year because this is the last day Ellen and I are working together of this decade. You don’t care. I’m excited because I got to say decade.
I’m on vacation next week. Yes. You’re on vacation next week, and then I’m on vacation the following week. So we won’t see each other again. So we thought we would take a couple of minutes real fast– and just feel free to ask questions during this or whatnot. And we thought we would explain to you why a diagnosis is important when we’re trying to figure out what’s going on with your pet. So you mean versus a Google diagnosis, an actual diagnosis?
Diagnosis
I like real diagnoses. And I like it when I can get one in the clinic. And whether you sort out if it’s a Google diagnosis or come and you’re like, “Yeah. Let’s not do those tests because we don’t really need the tests. I’m just going to treat the symptoms,” that might not be the best case. So Ellen, real fast, why don’t you tell us what a diagnosis is? Oh, thanks. You were looking it up earlier I was looking it up earlier. It’s pretty complicated.
Essentially, a diagnosis is what your pet has. The doctor has to figure out this puzzle, put all the pieces together and go, “Aha. Your pet has this. Now we are going to treat it this way.” The problem is that so many diseases mimic each other so they have to put these little pieces together and fine-tune it and filter out all the information to kind of get the one answer we’re looking for. Now the problem with the diagnosis is it might be a broad diagnosis, it might be a very narrow diagnosis, it might be open diagnosis.
Getting to a diagnosis
So we have all these different types of diagnoses, that’s why it’s one of the things that we say, “Please do not use Google to google your pet’s symptoms because you will get everything from panleukopenia to IBD to rectal cancer, and some of these cats that have bloody diarrhea. And I’m sorry, man, it is scary out there. It’s true. And you can get– there’s so much misinformation out there, and that’s why it’s so important when you see your veterinarian, they actually start putting all the little pieces together by all the various diagnostics they’re going to do to create a true diagnosis. “This is what is wrong with your pet.”
Right. So to go further about what Ellen said, why don’t we– I was thinking the best way to do this would be to use an example. So let’s just say your cat has diarrhea. Say, it’s a newer kitten that you’ve recently adopted, and it has diarrhea. And you bring it in to the vet, and you’re like, “My cat has diarrhea.” Everyone says, “Okay, did you bring a fecal sample?” And you’re like, “Here’s the fecal sample. Do I actually need to run the tests?” Now here’s what I will say. Your cat has a sign, a clinical sign of having diarrhea.
Listing the differentials
We can treat the sign. The sign is a sign of the diagnosis. So I have diarrhea– or I don’t, the kitten has diarrhea. It could have multiple different diagnoses that cause diarrhea. It could have roundworms, hookworms, whipworms, coccidia, giardia, or a motility disorder. Some type of weird blockage, an anal gland issue, or have a liver issue. I can keep going, and going, and going. So that one sign could have lots of different diagnoses attached to it. So that’s why I would say, “Yes, we should do the diagnostic tests and the fecal.”
Treating symptomatically
So you prefer not to just treat symptomatically? I prefer not to treat symptomatically unless we can’t do diagnostics. Or under an assumption.
I feel like most doctors and most medical professionals prefer to have a diagnostic answer or diagnosis because then there’s lots– and then some of these diagnoses have lots of different treatment options. It depends. So say, for example– I’m trying to use something easy. Say this new kitten has roundworms. Okay, so let’s pick out a treatment for roundworms. Okay. So let’s go through– let’s say we’re just going to use our good pyrantel or Strongid. I used to work with this veterinary assistant who was from Romania, and she would say pyrantel instead of pyrantel.
Medications
It was so elegant. It’s this gross yellow stuff, so to make it sound elegant is pretty funny. So we would get– say we do a couple of treatments of pyrantel Strongid, and then a couple of weeks later, we retest to see if the roundworms are gone. Say, the diarrhea’s gone, the kitten’s doing great, there’s no more roundworms. Done. Great. There’s lots of different ways to kill roundworms though, so just because we have the diagnosis, then we could have lots of different treatments.
And again, this is an easy one. I’m not even talking about the cat that comes in and has lost weight, that’s not eating well, that’s vomiting intermittently, that doesn’t have a fever but she just doesn’t look right. There’s some playing, there’s hiding. That could be a whole host of things and we would need a whole host of medical tests to try to figure out what the diagnostics is.
Potential side effects and dangers
And I think that’s where a lot of people get frustrated because then it starts getting expensive. It’s expensive, believe me. We’re horrified by sometimes the diagnostic costs even on our end of certain tests, but sometimes it’s the only lab that offers that test, and they’re the only you have in the United States that does this specific test and we need it done. I think also, a lot of people don’t realize that sometimes there are certain drugs that you can only use with a certain– and it’s particularly Ronidazole for the treatment of Tritrichomonas in cats.
You cannot use that on kittens because it can be so neurotoxic. And then sometimes we got drugs that are dangerous. It’s neurotoxic anyways, and then you’re almost screwed because that’s the only treatment option right now. Rather than letting this poor cat’s GI tract try to figure it out itself, and therefore they’re a carrier for the rest of their life. And tritrich is one of the diarrhea problems that you’re left in a book wash to actually like do this test properly. So you just can’t bring in a sample. It has to be the freshest of the fresh samples to do it.
Repeating samples
And then hoping, maybe you have got some of that protozoa in that sample. So sometimes catching it during whatever phase of the life cycle they’re on can be tricky too. So even though we’re retreating for it, and then we come back and we do another fecal then, they’ll be like, “I thought you said this cat was negative.” Well, fun fact, sometimes you have to treat the problem more than once. There’s no once and you’re done with a lot of these medications.
Getting to an answer
Yes. And that’s why for some of the medications, that was a great example. That drug is a great drug in killing tritrich, it is not a good drug if you’re the one taking it. It can do a lot of negative things to your body. So that’s why we don’t just treat with it. There are some things where we’re just like, “You might have lymphoma, you might have IBD, you don’t want to do further testing because it’s not going to make a lot of changes on your end at the end of the day, and you want to treat with pride.”
That’s your prerogative, we understand. A lot of people do that, and that’s fine. But for some of these drugs where it might not be a good idea to just use a steroid, it depends. This is why you need to have a conversation with your veterinarian. And that’s why we really like to when we can, get a true diagnosis and not just treat the symptoms. Often we will just treat symptoms because that is what makes the most sense with the client and the patient at the time, right? But ideally, when you can get a diagnosis, then you can figure out the best medical treatment. And at the end of the day, we want to do what’s best for that pet on that day with that owner.
Coughing Cat
So there could be so many things wrong with a cat that coughs, and everyone’s like, “It’s just a hairball.” Well, fun fact, it’s usually just not a hairball. Okay? It could be asthma, it could be heartworm disease, it could be roundworms, it could be a whole host of other problems Lung cancer.
And so when the doctor actually physically does the physical exam and goes, “I think we need an X-ray. And I think we need to run this blood panels specifically to look for this, this, this, and this.” What that does is it creates a ruled out list and they check off the boxes. “Well, it’s not that, it’s not that, it’s not that.” And therefore, your little algorithm starts becoming a lot smaller.
And then it’s like, “Yes, it is feline asthma,” or, “no, it is this.” We’re running into these into these problems. Or you can take an X-ray and then walk around the room and be like, “How fun was that conversation?” Because sometimes when we take the X-rays and we look at them, we’re like, “Wow. This poor cat has a problem.” And so maybe that algorithm went that way because it was something that wasn’t even remotely on our list because that cat wasn’t following the trends of a coughing cat.
Heartworms
Right. And that’s a really good point because it is– this is a great example because it is exceedingly rare, especially our part of the country for an indoor cat to get heartworm disease. But I tell you what, if you don’t run that test on that coughing cat, it doesn’t matter what else you do, unless that, if that cat is positive for heartworm disease, nothing else matters because you need to take care of that disease because it’s still going to cough. It doesn’t matter what else you do, it’s going to cough.
Adverse Reactions
And if they don’t respond to the treatment that the feline client’s like, “No, I really want to try steroids and stuff,” and they don’t respond, well, you’re going to get stuck doing the diagnostics again, and then doing more on top of it. So it’s not like– there’s always the option of, well, we can try, and if there’s no response, this is the next step of the plan. SIt’s still quite complicated. I feel like when the problem’s like, “You’re just out for money?”
No, it’s actually because your patients can’t talk to you. And we actually need to do these diagnoses is to actually tick off the boxes to make sure that you’re treating appropriately because a lot of these cats are super sensitive to steroids or the steroid might be the completely wrong choice. And now the cat’s having an adverse reaction versus a reaction that’s appropriate or response that’s appropriate for it. So it’s not like we like to run tests because we like to run tests. It’s because the cat can’t tell us the symptoms of what’s going on. Sometimes the client isn’t very thorough in actually describing what’s happening,
Coughing or Vomiting?
Or the coughing is actually trying to vomit. It might be something completely different. So there’s a varying difference between a dry cough or white cough or trying-to-vomit-something-up cough. So when we’re in the room, and we’re actually physically going through the motions and describing it for you, when we actually will get, “Okay, look. I mean, it looks like the vomiting cat for a moment.” And we actually start saying that, “You can’t do this.” We’re trying to get more information from you on that because if the cat is treated inappropriately, well, we’re not even treating the disease that you’re looking for.
Asthma
Yes. And another thought is that I was thinking when you’re talking about the cat that might have asthma or the coughing cat. If it is asthma, and we start training with steroids, we can’t go back in time and get a blood sample and test for allergies. I mean, some people like us will freeze it. I always say, get lots of blood tubes, and then we’ll freeze them before we started the steroids. So we can see in the future, is this an environmental allergy?
If it is, that’ll change the course of the asthma and we can do things about that. But if we don’t do that and we just bypass this step, then that’s going to change the course for the cat. Yeah. Or now you’re using steroids, and then actually, the treatment, you need a non-steroid., and now we have to wait for this wild washout period to be able to use the appropriate medication. So there’s a lot of contraindications on top of it.
Eggbert and Paralysis
Progressive onset of paralysis. I took him to neurology, they’re like, “It’s not an injury. I don’t know what it is”. They disagreed that the cat wasn’t painful. We thought the cat was extraordinarily painful because he exceeded the Glasgow scale for pain.
Yes. For those of you who don’t know, the Glasgow pain scale and feline medicine is a really wonderful resource. If you want a link to that or anything like that, let us know. I’m pretty sure it’s on our website, which is novacatclinic.com. But it’s a great way to kind of go through this checklist to see and to quantify how much pain a pet is in, and it also has a facial recognition that Ellen was pretty big on helping them create the face.
Treating Eggbert
Right. It works in Unix too. So when I came back from neurology completely frustrated, believe me, I’m in veterinary medicine. I was generally frustrated when I came back from that visit, explained what was happening. I wasn’t happy with the open diagnosis, and I was given a poor prognosis with an open diagnosis. So that’s really confusing. So a poor prognosis means that it’s probably not going to do well, he doesn’t have a very good chance of doing well. And then an open diagnosis is just like, “I don’t know what it is right. I’m sorry. It’s open because we’re not sure.”
Euthanasia was the recommendation
So that was so frustrating for me because I got two ends of the spectrum. I basically was told, “Whatever, he’s not going to get better. You might as well euthanize him.” That’s how it felt. And so when I came back here, we all decided to say, these are the symptoms of meningitis. He’s actually showing the physical symptoms of it. But all of his tests and his blood work and stuff wasn’t really kind of correlating with it. So we had to make the decision to treat him anyway for it, and he responded. So that’s one of those cases that we’re going through this algorithm and nothing’s making sense. And then we’re like, “All right. Well, you know what?
Let’s start treating anyway, and see what we come up with.” And it’s been a long road of recovery, and it’s just not tons of steroids, and on CBT, and on phenoxybenzamine and [inaudible] to help them urinate and defecate properly, and rehab therapy. And it’s still kind of what we have to call “open” because none of the tests can say this is definitely this problem. They’re going by his symptoms of what he had, how he went ahead and responded to treatment, and where he is now.
CSF tap
Yes. And sometimes we have to do that because sometimes– he didn’t have a CSF tap, his lab works show meningitis, and it’s not an easy diagnosis. Regardless of what species you are, it’s not an easy diagnosis to make. So there are a lot of cases where we never get a true diagnosis. And sometimes after either pet or person passes away, there’s no diagnosis; it just happened. And even if you do an autopsy or a necropsy, you don’t have a true diagnosis. So that is frustrating. But I think in general, the medical community appreciates when we can get a diagnosis because then we know what we should do to treat it.
Insurance and diagnosis
Right. And then also, if you have pet insurance, they want a diagnosis. They do want a diagnosis. They want a diagnosis. So if you went up with these pets that have this chronic open folder of, what’s going on with you, that gets a little confusing too. So it’s just not a matter of the veterinary community just dumping every test possible. We really are truly trying to make your pets healthy and trying to extend their life. Veterinary medicine has come so far in just 20 years. I remember when I started over 25 years ago, the stuff that we had.
SNAP Test
When the first SNAP test first came out, I thought that was amazing. And now it’s like you take that kind of test for granted. There’s new, new stuff all the time, and it makes the diagnostic a lot easier to perform, and you guys get a quicker diagnosis on top of it.Or even pancreatitis or heart disease now. We could do those little SNAP tests to kind of give us an idea of, do we have something brewing, and can we start treatment earlier?
Right. For those of you who don’t know, a SNAP test is a in-hospital test we can run on some blood. Also, there’s some for giardia, which is on poop, and some other tests that we don’t use here because– we don’t have as much giardia here because we’re cat people here. You see it in kittens. It’s in kittens, but it’s not like they’re in the dog park sharing things.
Yeah, drinking the DC water fountains. There’s not as much giardia here, so we don’t have the in-house symptoms, but that’s off of poop. But there’s in-house snap tests, which basically you snap it like this, which is kind of fun. And we can do a lot of different diagnostics that way for certain things. So that’s what Ellen was talking about for SNAP test.
Happy New Year
I guess we were very thorough the first time. So that’s right. Sounds good. So I hope everybody has a happy holiday and a very happy and healthy new year. And if there’s any questions you have for us or if there’s any topics you’d like us to cover, let us know. Just so you know, sooner than later, hopefully, sooner, we’re working on it, we’re going to have a podcast coming up. So keep your eyes open for that. I’m sure we will plaster it everywhere. But thank you. Have a great one. Bye.