The vet says bloodwork, a stool sample, X-rays, ultrasound … and all I hear is money flying out of my bank account. Financial stress and the pressure to do what’s right for my cat are heavy burdens. But it doesn’t have to be this way when you work with your vet on incremental care.
In this post, I’ll tell you what conditions require emergency intervention (and likely expense), but also where you may have some wiggle room. We’ll take a look at how to have real conversations with your vet, as well as review case studies to show how incremental care can limit the stress on your cat and you. So what is incremental care? How do you talk to your vet about it? Here you go.
Disclaimer: I am a pet owner, not a vet, and this is from a pet owner’s point of view. The below suggestions are meant to give you an idea on what to discuss with your vet. This is not medical advice. Always run everything by your vet.
Intro to Incremental Care
Vets and most professionals in the health or science field tend to be analytical. They what to cover all their bases, be thorough, and provide a clear diagnosis along with a treatment plan. While I appreciate that, I am also realistic: Not everyone can afford a ton of diagnostics or procedures. Many of us live on budgets, and hundreds of dollars on tests for your cat isn’t something you often figure into it. That’s where incremental care comes in.
Incremental care is when you have different levels (aka increments) of care to treat your pet, from basic meds and a wait and see approach, all the way up to exploratory surgery and all the bells and whistles. Likely, many of us will prefer something in the middle, and incremental care affords you that benefit.
A Note on Senior Cats
Many seniors have chronic problems, mobility difficulty, and other issues. Incremental care is so important for this crew, especially if they’re a super senior (over 15 years). For example, back surgery on a 19-year-old cat with chronic kidney disease would likely not be the right move. Always ask the implications of diagnoses, and how you can put the least amount of stress on your senior, keep them comfortable, and be realistic with treatment. This doesn’t mean you don’t treat problems, but you want to be strategic about it. Work with your vet closely on a plan.
ER Situations Where Incremental Care May Not Be an Option
A few things before we continue. There are some conditions where incremental care isn’t an option. The most common instances for these include:
- Respiratory distress – Often requires X-ray to check condition of heart and lungs, along with swift decisive action to treat. A lack of oxygen doesn’t provide the luxury of slow moving treatment decisions.
- Toxin exposure – Immediate treatment could induced vomiting, bloodwork, and supportive care. Some toxins cause kidney failure, liver failure, heart problems, and seizures. These are literally matters of life and death.
- Urinary blockage – If a cat’s urethra is completely blocked, toxins build up and they’ll eventually die. Treatment includes catheterization, a hospital stay for a few days, medication after discharge, and often a prescription diet.
- Excessive bleeding – Obviously, if your cat’s injured or in labor and is losing a lot of blood, you MUST act quickly and get immediate care to stop the source of the bleeding.
- Extreme lethargy – Whether the cause is a virus, anemia, dehydration, or an injury, this can be a precursor to death, and requires immediate medical attention.
- Dehydration – Sick cats aren’t the best at taking care of themselves. Although not eating for a few days isn’t a huge deal, not drinking is. Common signs of dehydration include tacky gums or pinched skin on the back of the neck that doesn’t snap back. The quickest way to address dehydration is by administering fluids, which isn’t a huge expense, but discovering the main cause of the dehydration could cost more.
This doesn’t mean there aren’t other situations requiring action, but the above are probably the most common situations where waiting any amount off time could decrease the chance for survival.
Incremental Care: Diagnostics
Questions Before Agreeing to Diagnostics
Is this absolutely necessary or is there a treatment we can try first?
I’m someone who likes to operate with the most likely cause of something. If most likely it’s A, let’s treat that and if there’s no improvement, we can move to B ( or diagnostics). This may not be the right approach for you, but it certainly something you can try or discuss with your vet.
Must this test be performed here?
See if you can shop around to find the most affordable location to get the diagnostics done. If time is of the essence, this may not be an option.
How stressful is this procedure for my cat?
Many young, healthy cats handle diagnostics well. Older cats have a harder time. Consider the stress level before agreeing to anything.
What answers will be provided? Are additional diagnostics required?
Gain a clear understanding of expected results. If additional testing is needed after the first round, ask your vet if you can bypass the first test and go right to the one that will yield the most answers to benefit from a cost savings.
How long will it take to get the results and who will read them?
Obviously, we all want immediate results, but that isn’t always how it works. Make sure you understand how long the results will take and if you have to wait. Results read by someone outside of the clinic are typically a little more costly because those individuals are specialists in their field. That can sometimes explain the cost.
What is the best case scenario vs. the worst case scenario?
This is to help prepare you for the results. If the best case and worst case are too close together, you may decide not to do any diagnostics. For example, if you already know your cat has cancer and you don’t want to treat it, diagnostics may not be useful for your situation, and could end up stressing your cat without much benefit.
Ask for Bloodwork Options
Typically, you can order different levels of bloodwork. For instance, some vets provide basic electrolytes in-house or for a lower price than a full panel. It may or may not be the case. Ask your vet what options they offer.
Ask About Combo Diagnostics
Sometimes, it’s almost the same price to do bloodwork and a urinalysis, than it is to do just a urinalysis, for instance. Make sure you ask your vet if it makes sense to combine any diagnostics to get a clearer picture of what’s going on, for little increase in price. Most vets can enter multiple options into their computer systems and provide you with a range of pricing from different labs.
Ask About Urinalysis vs. Urine Culture
Just like in humans, a urinalysis will show if your cat has a urinary tract infection (UTI), but it will not show what type of bacteria is causing the problem. For that, you’ll need a urine culture, which is more expensive. Ask your vet if you can proceed with incremental care like this:
- Broad spectrum antibiotic for UTIs.
- If your cat isn’t improving within a day or two (or if they get worse) switch the antibiotic.
- Proceed with urine culture if absolutely needed.
Every situation is different. Your vet may not agree with this course of treatment, but it’s at least worth a discussion. If they disagree, ask them to explain why they are recommending a different course of action. For example, reoccurring UTIs warrant a urine culture, in my opinion.
Ask What Will Give You the Best Answers?
X-rays are a very popular diagnostic tool in all forms of medicine, providing quick results. They’re most useful for determining:
- Broken bones.
- Condition of the lungs – X-ray will show if they’re filled with fluid or if there is a growth. A growth doesn’t always mean cancer – sometimes it’s inflammation from pneumonia.
- Heart size – An enlarged heart is visible and could be the reason for respiratory distress.
- Foreign object presence – Although it may not always show what the object is, things like air pockets or a disruption in the intestines may be visible.
Ultrasound and/or Biopsy
An ultrasound is a great way to assess the health of the abdomen, including the liver, kidneys, pancreas, and GI tract. It’s helpful to:
- Examine masses for cancer.
- Locate fluid in the abdomen.
- Check for bladder stones.
- Look for obstructions.
- Identify signs of inflammatory bowel disease (IBD).
The results of an ultrasound will get you one step closer to a diagnosis, but you may still need a biopsy to 100% confirm a disease. This is where some decision making comes in.
For example, scar tissue in the colon along with symptoms like diarrhea, hard stools, or weight loss may come with a likely diagnosis of IBD. To 100% confirm the IBD, your cat would need a biopsy. Is the biopsy necessary? That is for you and your vet to decide, but you’d want to consider the age and health of your pet before going with biopsy route. The most common treatments for IBD include a diet change and steroids to decrease intestinal inflammation. A biopsy will often not change treatment.
Now, if a mass looks cancerous, even with a biopsy, you may not get answers with 100% certainty. If you want to remove a mass, your cat will need surgery, regardless of the biopsy results, and surgery includes biopsies anyway.
You can sometimes skip an ultrasound, have fluid from a mass withdrawn with a needle and analyzed. Again, you may not get definite answers, but it may help you decide how to proceed.
Ask your vet for all pricing options and outcomes so you can put your cat through the least amount of stress and get the best answers.
Incremental Care: Medications
Ask About the Form
Vets know you want meds that are easy to administer, and they frequently recommend liquid or transdermal (rubbed on the skin, usually inside of ear) meds. Transdermal medicines tend to be the most expensive. When it comes to liquid or pill forms, it actually varies. I think this is probably tied to the basic economic principle of supply and demand. High demand, low supply is more expensive. Low demand, high supply is cheaper. Ask your vet about pricing for liquid and pill forms to find out which will be the most cost effective. Even if your cat is hard to pill, you can hide it in a small piece of chicken (preferably boiled chicken) or lunch meat. Of course, always check with your vet before giving your cat any human food, and the pill form may not be cheaper every time.
Ask About Generic Versions
Generic versions may seem like a no brainer, but they aren’t. I’ve seen animals prescribed expensive prescription meds and their foster didn’t know there was a much less expensive generic form. Generic medicines contain the same active ingredients as their prescription counterparts. Ask your vet or do your own research to find out if there is a generic form of your cat’s meds. The savings can be substantial. Please keep in mind that newer meds will not have a generic.
Talk to Your Pharmacy
There are a lot of medications for cats that are also for humans. Talk to your pharmacy about the drug you’re giving your cat to see if they can fill a script for it, and how much it would cost. You may save filling it at a human pharmacy because of supply and demand. Because humans are bigger, we take larger doses and quantities, meaning the pharmacy should have a larger supply. If the medicine is a generic, chances are, you can get it at a cheaper price than from your vet. It also may be more convenient for you than running to the vet. Ask the pharmacist if you can use the app GoodRx, which will unlock more coupons and discounts with no insurance needed. You simply enter the drug, dose, and quantity, and you’ll see a list of pharmacies in your area along with prices.
Case Studies: Upper Respiratory Infections (URIs)
Upper respiratory infections or URIs can be tricky buggers! While they are mostly viral, they can create a secondary infection. Cats in shelters almost always received the antibiotic doxycycline. With high volume intake, it’s important to eliminate any infection and keep all the other cats as healthy as possible. For cats in foster care, you have a little more leeway to ride out the virus, as long as symptoms are mild. Below are four different scenarios you could encounter. We start with the easiest and least costly option first. You’ll see how different patients, situations, and histories led to different diagnostics and treatment plans.
Symptoms: Sneezing, nasal and ocular discharge
Diagnosis: Feline herpes (kitty cold) flare up. Likely only viral; no infection, no need for antibiotics.
Treatment: Famciclovir (anti-viral)
Plan: If no improvement, add antibiotic.
Result: Full recovery.
In Dolly’s case of a mild URI, it totally made sense to wait and see and not go crazy with meds and tests.
Symptoms: Loss of appetite, mild dehydration, fatigue
Diagnosis: After discovering nose was congested (no discharge or sneezing), vet diagnosed upper respiratory infection caused by feline herpes virus flare up.
Treatment 1: Clavamox (antibiotic)
Result: Improved over a few days, then regressed.
Diagnostics: Recommended bloodwork because of cat’s age. Chest X-rays option, but lungs sounded clear. Opted for bloodwork only to make sure nothing else was off.
Treatment 2: Doxycycline (antibiotic)
Plan: Since Lucy improved and then regressed, the vet felt it was likely the wrong antibiotic. If doxy didn’t work, we could go down the road of further diagnostics to check her chest or see if she had a nasal tumor or polyp.
Result: Full recovery.
Cost Savings: 1 Chest X-ray, est. $200
I decided to get bloodwork because her annual exam was in 2 months, so it made sense to do it when she was sick and make sure nothing else was contributing to the URI. Under normal circumstances, you could skip bloodwork and save about $200.
Symptoms: Sneezing, right eye closed
Diagnosis: Feline herpes (kitty cold) flare up.
Diagnostics: Culture taken of nasal discharge because flat-faced cats have more serious upper respiratory infections and wanted to make sure bacteria are being fought with appropriate antibiotic.
Treatment 1: Clavamox (antibiotic)
Plan: Adjust antibiotic based on culture results.
Result: Culture shiowed Bordetella and mycoplasma.
Treatment 2: Doxycycline (antibiotic)
Result: Full recovery.
In shelter medicine, the first go-to antibiotic is doxycycline because it’s inexpensive and treats a broad range of bacteria. Starting with doxy would have eliminated the need for a culture; however, given that Maple has a flat face and that won’t change, knowing the specific bacteria will also be helpful down the road. Again, you could remove the culture to save, but you would have to know to ask for doxy for a URI, and not every pet owner knows that.
Symptoms: Repeated congestion, sneezing, nasal discharge, loss of appetite
Treatment 1 & 2: Doxycycline, 2 weeks each time.
Treatment 3 & 4: Azithromycin for 2 weeks, then 30 days.
Diagnostics: Sedated exam to check for polyps and masses. Cavity flush. Culture.
Results: Culture showed Pasturella.
Treatment 5: AmoxiClav, 30 days + antivirals
Results: Still sick. Entire living space was scrubbed daily because it was caked with boogers and sneezed up food (ewww).
Plan: Appointment at University of Pennsylvania to look for underlying cause.
Updated Diagnosis: Extensive cleft palette. Food getting stuck in nasal cavity was making him sick.
Treatment 6: Surgery at Penn Dentistry & Oral Surgery to repair cleft palette.
Results: URIs resolved. Still some chronic rhinitis (nasal inflammation), but significant improvement.
In Rupert’s case, you can see that he went through a lot of steps until the cause of his problems was determined. I want to mention he was a foster through a big city shelter, which has limited resources, and that’s why he had multiple rounds of antibiotics. But I think this example shows you an extreme case of something that seems simple, actually requiring more diagnostics and even surgery to resolve.
Work with Your Vet
I know vet visits can be overwhelming. Make sure you can develop a relationship with your vet to talk opening about your options. It’s okay to say, “I can’t afford that,” and then see what recommendations your vet has. It doesn’t mean you don’t love your pet! Don’t allow anyone (including yourself0 to make you feel guilty.
If you don’t feel you can have these conversations with your vet, you may want to consider finding one who’s a better fit for you. It’s important you feel heard and can be honest regarding financial constraints.
In closing, remember, this is not medical advice, but a perspective on vet care from me, a cat owner and foster. I hope it helps you ask the right questions, or at the very least, have real conversations with your vet about what works for YOUR specific situation. The closer we work with vets and can incorporate incremental care, the better it is for everyone involved, especially our pets.