Test results Binie - what questions to ask to the vet?

Heike & BInie

Heike & BInie

Very Active Member
Last post: https://felinediabetes.com/FDMB/threads/10-15-binie-amps-403-3-301-6-278.294941/

Good evening,

fast than we thought, the testresults from the biopsy came. And as my vet warned me, they found nothing which can explain the lump and they recommend a surgery. I put the results under my text, it was translated with a translator.

I am very confused about my vets approach and I would love to hear, which questions you would ask and if you have any ideas on how to go on.

My vet suggests the following options:

1. option: Surgery, to get a proper sample.

My first thoughts: Everything inside me screams, that I don't want to hand her in for another surgery. She had a very rough year and I feel she can not take much more. The lump is close to her leg, so healing will be a problem. She would have to wear a cone again. With all her other things going on (multi resistant germs, kidney problems) I would hate to do that to her. And I also wonder which thread material the vet wants to use, as Binie reacted allergic to the threads the last time. At least that was what she thought, where the licking came from.

2. option: Leaving the cause of the lump open and treat Binie against an autoimmune diseasae. I forgot the name of the disease (one of the questions I have to ask) but as she recommends a treatment with either steroids or a med called Atopica, I think she meant that Binie might have an atopic dermatitis.

My first thoughts: I read a bit about atopic dermatitis but from what I learnt, it can explain the licking on her breast but I didn't read anything about swellings and lumps. And as both steroids or Atopica have an effect on her bg and side-effects, I really hate the idea to give it, if it is not necessary.

That's the options she is giving me. I was a bit surprised she didn't mention in her e-mail the infection with multi-resistant germs. I understood before, if the Chlorampenicol didn't work, we don't have treatment options anymore. So it makes no sense for me to schedule a surgery or give meds, if this isn't clear first. I will hand in urine next monday, so we will have the results probably at the end of next week.

I am so grateful for your ideas, questions and suggestions.

As I have a long business trip tomorrow, I will go to bed now and will read your answers or answer your questions tomorrow evening. Thank you so much already! :bighug::bighug::bighug:


###########

The translated test results:

Cytological examination report

Cytological examination findings:
On the smear preparations with a low cell count, small amounts of blood as well as several fat droplets
background containing small amounts of blood as well as several fat droplets, keratin scales and keratin lamellae.
keratin lamellae. In addition, individual capillary vascular structures can be visualized.
Cytologic diagnosis:
Detection of several fat droplets, keratin scales and keratin lamellae, individual capillary
capillary vascular structures and a small amount of blood and protein.
Comment:
During the cytologic examination, capillary vascular structures were detected which
possibly originating from granulation tissue. The blood detected as well as
the keratin scales and keratin lamellae could represent contamination due to removal.
contamination. For a final diagnostic and prognostic assessment of the case, we recommend
case, we recommend taking a tissue sample and sending it for histopathologic examination.

Translated with DeepL.com (free version)
 
Last edited:
Sorry but it looks like the sample was not a good one and therefore no diagnosis. Atopica is a medication for allergies. It has side effects such as diarrhea and vomiting at first. It dues not sound like allergies to me. While I hate to say it I think I would want the surgery.
My cat has dermatitis and no lumps. It appears on her ears. Zyrtec has taken care of it but not the EGC on her lips.
 
Oh (((Heike))) I’m sorry to hear they didn’t get a good result with the test. It’s so frustrating.

I think you are right to question about the multi resistant germs and try to get an answer on that first.
And yes, I think you are also right to ask what threads they would use since she seemed to react poorly to whatever was used in her last surgery.
I think that’s a good starting point of discussion so you can make informed decisions of how to proceed next.

I’m so sorry you and Binie are going through this. It’s so difficult to know what to do next until you get more information from the vet :(
I’m sending you many hugs and prayers for you and Binie. And hoping maybe you get more ideas on the forum.

Maybe post this question also on that main forum page to get more exposure, too.
:bighug::kiss::bighug::kiss::bighug::kiss::bighug::kiss:
 
I am sorry you did not get clear answers with the biopsy.
How long ago did the lump appear? If she does not have any symptoms linked with it, like pain, would it be crazy to wait a few days or weeks and see how it evolves? How does it feel? Is it regular and smooth, or hard and lumpy? Does the skin move around it, or does it feel "stuck" to the lump?
 
tiffmaxee said:
Sorry but it looks like the sample was not a good one and therefore no diagnosis. Atopica is a medication for allergies. It has side effects such as diarrhea and vomiting at first. It dues not sound like allergies to me. While I hate to say it I think I would want the surgery.
My cat has dermatitis and no lumps. It appears on her ears. Zyrtec has taken care of it but not the EGC on her lips.
Click to expand...

Thank you so much Elise! You confimed my doubt about the allergy hypothesis. When you said you would want the surgery, do you have anything in mind they could find? It might be cancer but do you have anything else in mind?
 
Staci & Ivy said:
Oh (((Heike))) I’m sorry to hear they didn’t get a good result with the test. It’s so frustrating.

I think you are right to question about the multi resistant germs and try to get an answer on that first.
And yes, I think you are also right to ask what threads they would use since she seemed to react poorly to whatever was used in her last surgery.
I think that’s a good starting point of discussion so you can make informed decisions of how to proceed next.

I’m so sorry you and Binie are going through this. It’s so difficult to know what to do next until you get more information from the vet :(
I’m sending you many hugs and prayers for you and Binie. And hoping maybe you get more ideas on the forum.

Maybe post this question also on that main forum page to get more exposure, too.
:bighug::kiss::bighug::kiss::bighug::kiss::bighug::kiss:
Click to expand...

Thank you so much Staci! :bighug::bighug::bighug: My head is really working overtime. I wish it would be easier to communicate with my vet, because there are so many things I don't understand but I need to know to make a decision.

And it is so difficult to make this decision for Binie because I can only guess, what her criterias and choices would be. As it seems, I need a few more days to see it clearly.

Thank you for mentioning the main forum. For that I have to prepare the information a bit better, which I will do with some time. I thought here it's family and you all know the background story. :)

Hope you have a good day and not too much stress. Curious to read your update! :bighug::bighug::bighug:
 
cecile & bella said:
I am sorry you did not get clear answers with the biopsy.
How long ago did the lump appear? If she does not have any symptoms linked with it, like pain, would it be crazy to wait a few days or weeks and see how it evolves? How does it feel? Is it regular and smooth, or hard and lumpy? Does the skin move around it, or does it feel "stuck" to the lump?
Click to expand...

Thank you so much Cecile! Good questions! It is difficult to answer all of them precisely because the lumps are in an area of Binies body which is extremely hard to examine. She will only let me touch her if she gets a churru or something to distract her and then she is wiggling and dancing to get away from my touch and eat the churru anyway. :) I can't force her, otherwise I would loose my hand. But I have a bit of an impression.

You asked, how long ago did the lump appear. At the 2th of September we have been at the vet and she examined the wounds and gave procaine. On this point in time, there was no lump. The vet said she can feel some hard tissue which might be scar tissue. She was not alarmed at all. After the procaine Binie stopped to lick the area and so I thought everything is o.k., until last weekend, when she started to lick again. Then I examined the area and found the lump. As far as I can feel it is not regular, hard and lumpy. The skin is not moving around but stuck. But this impression is only the result of my few seconds examination.

If I touch it, she doesn't express any pain. But the licking shows me, that something is bothering her and the licking itself makes problems, as the skin gets damaged. I don't know if it is medically o.k. to wait for a few days but I feel I have to because it is unclear to me if the surgery is really a benefit. We did a surgery before and sent everything to the patology and the result was equally unclear. And I think we have to take Binies other conditions into account too and so far we don't know if the treatment with the antibiotics was successful or not.

Quite complex, isn't it?

I hope Bella is all well and already enjoyed her daily piece of butter! :bighug::bighug::bighug:
 
Heike & BInie said:
Thank you so much Elise! You confimed my doubt about the allergy hypothesis. When you said you would want the surgery, do you have anything in mind they could find? It might be cancer but do you have anything else in mind?
Click to expand...

I was thinking it could be a benign fatty lump or it could be cancer. I don’t understand why the biopsy was in inclusive. How big is it?
 
tiffmaxee said:
I was thinking it could be a benign fatty lump or it could be cancer. I don’t understand why the biopsy was in inclusive. How big is it?
Click to expand...

Ah, o.k., thank you! I was curious what you have in mind. That makes sense to me. I can't tell you exactely how big it is because she doesn't let me examine it properly. But it is a long stretch, I would say like my index finger. But I can ask my vet about the measurements, as she was able to examine it closer.

What I wonder is, if this time the surgery will bring a result. Binie already had a surgery in this area and the vet removed "a lot of strange mass" but the pathology couldn't say what it is. They said it is not cancerous and guessed it might be something developed because of foreign object influence. That's why we thought Binie may got bitten there by another cat or animal. I am just very scared I torture her for nothing because I don't see why we would get a different result this time. Do you think that x-ray or ultra sound could also be a way to diagnose, what is going on?
 
So if I understand what you arev saying, there used to be some kind of similar mass in the same general area, and she had surgery to remove it, but they could not tell exactly what it was. If so, that might be the same thing, is that what you are saying?
If it's scar tissue, that could bother her somewhat. I know you said she does not like you touching her, but could you try and massage it, see if that helps?
Poor Binie, she seems to have a lot of issues. :bighug::bighug::bighug:
 
Heike & BInie said:
Thank you so much Staci! :bighug::bighug::bighug: My head is really working overtime. I wish it would be easier to communicate with my vet, because there are so many things I don't understand but I need to know to make a decision.

And it is so difficult to make this decision for Binie because I can only guess, what her criterias and choices would be. As it seems, I need a few more days to see it clearly.

Thank you for mentioning the main forum. For that I have to prepare the information a bit better, which I will do with some time. I thought here it's family and you all know the background story. :)

Hope you have a good day and not too much stress. Curious to read your update! :bighug::bighug::bighug:
Click to expand...
I know you are doing ok, Heike. I know your head must be exploding. I’m thinking about you and sending support.
Good suggestions here to think about, too.
:bighug::bighug::bighug::bighug::bighug::bighug:
 
Heike I’m so sorry to hear this :bighug::bighug::bighug: I still wonder about foxtails, especially if this is in an area adjacent to where she had that open wound. The mention of granulation tissue is usually the body repairing itself after a wound (but perhaps there’s an autoimmune disease in cats that does that—not the species I’m used to treating). I agree that keratin (skin) may have been introduced during the biopsy, but it could also have been dragged along with a foxtail. Could you at some point attach the pathology report from her last surgery?
One rule of thumb I use re testing on Methos is “will it change what we’re doing” and if the answer is no then I don’t see much to be gained vs the risk. So I’d ask your vet about how a more definitive answer would impact what you do. I know how hard it is to decide for Binie, but what you decide will be the best
 
@tiffmaxee @Diane Tyler's Mom GA @Staci & Ivy @SmallestSparrow @bluesunshine @cecile & bella

Thank you all for your valuable suggestions and good wishes! It took me a few days to digest but I finally wrote an e-mail to my vet today. I am a big fan of the series "The good doctor" and a yesterday my fried said to me, that she wish Binie had a team of doctors like in "The good doctor" who lock themselves in for a night and come out with a solution for a complicated case. For me you are kind of this team and I added ChatGPT which I can highly recommend. It also came up with helpful ideas. I translated my e-mail to the vet with all my ideas and questions and put it further down, in case you are interested.

Thank you so much all for your valuable support and ideas! You are really the best! :bighug::bighug::bighug:

######

Dear Mrs. xx,

It has taken me a few days to sort out my thoughts. As announced, I have a few questions and thoughts about the situation. Please tell me where I am wrong or misinterpreting things as a layman.

But first of all: Binie's general condition is better again. Her blood sugar level is dropping and last night she had a curve in the 100s again for the first time. She is currently receiving 2 IU. She is also eating much better again. I suspect the chloramphenicol had taken its toll on her. Unfortunately she is still licking her chest a lot, the procaine doesn't seem to have made any difference this time.

My thoughts:
1. surgery: I don't want surgery just yet because of several aspects. On the one hand, I am still unclear about Binie's overall condition. I would like to wait for the result of the urine sample, which I will give on Monday. If I understood you correctly beforehand, we have no more treatment options if the chloramphenicol has not eliminated the multi-resistant germ. In that case, I wouldn't want to put Binie through another operation. I would also like to have another blood test to see how her kidneys are doing.

On the other hand, we have already operated on the area, which made a lot of sense to me at the time. However, the operation did not result in a diagnosis or improve her symptoms in the long term. This gives me little hope for a new operation. Am I missing something? Could I please get the pathology report from April?

Then I wondered if there were things we hadn't considered. Could it also be an allergic event? Does it make sense to do an allergy test? What makes me think of this is that it is always ok in between and she doesn't lick and then starts again. Maybe there is an allergen that she is not always exposed to?

Would another imaging procedure such as ultrasound or x-ray help?

2. cortisone/Atopica: I have also looked into cortisone and Atopica again and I would like to put it on the back burner for the time being, as the benefits are not yet so clear to me. If Binie still has an inflammation in her bladder or kidneys, she needs the full function of her immune system.

I have read that Atopica also increases the blood sugar level. If in doubt, I would prefer to try an antihistamine first, if that makes any sense from your point of view?

I know that we are demanding customers. I am very grateful that you are with us! Thank you very, very much!

Best regards, Heike

Translated with DeepL.com (free version)
 
SmallestSparrow said:
Heike I’m so sorry to hear this :bighug::bighug::bighug: I still wonder about foxtails, especially if this is in an area adjacent to where she had that open wound. The mention of granulation tissue is usually the body repairing itself after a wound (but perhaps there’s an autoimmune disease in cats that does that—not the species I’m used to treating). I agree that keratin (skin) may have been introduced during the biopsy, but it could also have been dragged along with a foxtail. Could you at some point attach the pathology report from her last surgery?
One rule of thumb I use re testing on Methos is “will it change what we’re doing” and if the answer is no then I don’t see much to be gained vs the risk. So I’d ask your vet about how a more definitive answer would impact what you do. I know how hard it is to decide for Binie, but what you decide will be the best
Click to expand...

Thank you so much Colleen! Yes, I also mentioned the foxtail theory towards my vet and she said that it is a likely explanation. But she said she took out so much, that she doesn't think there is anything left. I don't have the pathology report from the surgery but I asked my vet for it and can post it next week. Hope you and Methos recovered from all the stress during the last days! :bighug::bighug::bighug:
 
cecile & bella said:
So if I understand what you arev saying, there used to be some kind of similar mass in the same general area, and she had surgery to remove it, but they could not tell exactly what it was. If so, that might be the same thing, is that what you are saying?
If it's scar tissue, that could bother her somewhat. I know you said she does not like you touching her, but could you try and massage it, see if that helps?
Poor Binie, she seems to have a lot of issues. :bighug::bighug::bighug:
Click to expand...

Hi Cecile, thank you so much! There was a mass which was removed but I think what we can feel now feels different to before. I think it is not scar tissue because it is also in areas where they didn't cut her. It is a long stretch. Yes, poor Binie. :( She has been really through a lot lately. Hope you and Bella are fine! :bighug::bighug::bighug:
 
bluesunshine said:
I don't have experience in this, but I am thinking of you, Heike. It is just one thing after another, and I really feel for you. You're very strong. Thoughts to you and Binie.
Click to expand...

Thank you so much Seth! :bighug::bighug::bighug: Having a sick kitty is really nerve wrecking, isn't it? Hope you and Bell are fine!
 
Heike that is a perfect letter—maybe I should have you write one for me for the next time I’m crying in the ER. I’m glad Binie’s numbers are better and I hope her urine test is perfect. My boys and I are crossing paws and fingers for you both.
 
SmallestSparrow said:
Heike that is a perfect letter—maybe I should have you write one for me for the next time I’m crying in the ER. I’m glad Binie’s numbers are better and I hope her urine test is perfect. My boys and I are crossing paws and fingers for you both.
Click to expand...

And thank you so much for your support Colleen, even though you have so much going on. I appreciate this so much! :bighug::bighug::bighug:
 
Heike & BInie said:
@tiffmaxee @Diane Tyler's Mom GA @Staci & Ivy @SmallestSparrow @bluesunshine @cecile & bella

Thank you all for your valuable suggestions and good wishes! It took me a few days to digest but I finally wrote an e-mail to my vet today. I am a big fan of the series "The good doctor" and a yesterday my fried said to me, that she wish Binie had a team of doctors like in "The good doctor" who lock themselves in for a night and come out with a solution for a complicated case. For me you are kind of this team and I added ChatGPT which I can highly recommend. It also came up with helpful ideas. I translated my e-mail to the vet with all my ideas and questions and put it further down, in case you are interested.

Thank you so much all for your valuable support and ideas! You are really the best! :bighug::bighug::bighug:

######

Dear Mrs. xx,

It has taken me a few days to sort out my thoughts. As announced, I have a few questions and thoughts about the situation. Please tell me where I am wrong or misinterpreting things as a layman.

But first of all: Binie's general condition is better again. Her blood sugar level is dropping and last night she had a curve in the 100s again for the first time. She is currently receiving 2 IU. She is also eating much better again. I suspect the chloramphenicol had taken its toll on her. Unfortunately she is still licking her chest a lot, the procaine doesn't seem to have made any difference this time.

My thoughts:
1. surgery: I don't want surgery just yet because of several aspects. On the one hand, I am still unclear about Binie's overall condition. I would like to wait for the result of the urine sample, which I will give on Monday. If I understood you correctly beforehand, we have no more treatment options if the chloramphenicol has not eliminated the multi-resistant germ. In that case, I wouldn't want to put Binie through another operation. I would also like to have another blood test to see how her kidneys are doing.

On the other hand, we have already operated on the area, which made a lot of sense to me at the time. However, the operation did not result in a diagnosis or improve her symptoms in the long term. This gives me little hope for a new operation. Am I missing something? Could I please get the pathology report from April?

Then I wondered if there were things we hadn't considered. Could it also be an allergic event? Does it make sense to do an allergy test? What makes me think of this is that it is always ok in between and she doesn't lick and then starts again. Maybe there is an allergen that she is not always exposed to?

Would another imaging procedure such as ultrasound or x-ray help?

2. cortisone/Atopica: I have also looked into cortisone and Atopica again and I would like to put it on the back burner for the time being, as the benefits are not yet so clear to me. If Binie still has an inflammation in her bladder or kidneys, she needs the full function of her immune system.

I have read that Atopica also increases the blood sugar level. If in doubt, I would prefer to try an antihistamine first, if that makes any sense from your point of view?

I know that we are demanding customers. I am very grateful that you are with us! Thank you very, very much!

Best regards, Heike

Translated with DeepL.com (free version)
Click to expand...
What a great and thorough letter, Heike.
I really hope your vet gives careful consideration and provides comprehensive answers to help you make some decisions.
And yes, we are all a team working together to help as best we can for the benefit of all of our cats. That’s such a great way of looking at it :bighug::bighug::bighug::bighug:
 
Heike & BInie said:
Oh Colleen, you are back to the ER? With Methos? How is he?
Click to expand...
No we’re not in the ER, I just want a letter for the next time I have to go :). He’s exhausted. So am I. He’s been drugged with gabapentin nearly every day this week. Today he got an enema at the clinic…after I tried suppositories unsuccessfully at home. I’m sure his BG will be sky high for the pmps.
If I put away my phone right now I can nap for twenty minutes. So more later.
 
SmallestSparrow said:
No we’re not in the ER, I just want a letter for the next time I have to go :). He’s exhausted. So am I. He’s been drugged with gabapentin nearly every day this week. Today he got an enema at the clinic…after I tried suppositories unsuccessfully at home. I’m sure his BG will be sky high for the pmps.
If I put away my phone right now I can nap for twenty minutes. So more later.
Click to expand...
(((Colleen))), sending you lots of love and warm hugs @SmallestSparrow
 
SmallestSparrow said:
No we’re not in the ER, I just want a letter for the next time I have to go :). He’s exhausted. So am I. He’s been drugged with gabapentin nearly every day this week. Today he got an enema at the clinic…after I tried suppositories unsuccessfully at home. I’m sure his BG will be sky high for the pmps.
If I put away my phone right now I can nap for twenty minutes. So more later.
Click to expand...

Oh Colleen, I am sorry this is so exhausting. :( I hope you managed to get some rest. :bighug::bighug::bighug: I try to take notes before I go to the vet, because otherwise I would forget half of what I like to ask. Maybe that would be a help for you too? I hope Methos feels better after the enema. Cats not pooping is so stressful. I send you a big, big hug and some good energy! :bighug::bighug::bighug:
 
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