Stertor and doubts about nasal surgery

Hello Could I ask for some advice about X-rays and nasal surgery for cats in the UK? My cat has recently been demonstrating a moderate amount of stertor, occurring only on an occasional basis, perhaps once or twice a day as far as I have noticed, but which so far steroid treatment (prednisone, from our visits to the vets over the past few weeks) have not yet quite been able to subdue, although there has definitely been an appreciable amount of improvement: her breathing is now too noisy only for a limited number of bouts each day, probably adding up to no more than a quarter of an hour altogether in total. From even before the steroid treatment began, as far as I have been able to tell, my cat has not been demonstrating any overt signs of distress, such as panting or gasping etc, and her behaviour, appetite etc. do not seem to be affected to any significant degree that I can see. My cat is approximately 10 years old and is usually always very healthy, so I don't begrudge some expenditure on her now if it really is necessary. She has had blood tests already from which we know she is otherwise healthy, the test results showing no reason for concern. Our current vet is new to me, and is suggesting that the best way forward is for an X-ray with a view to identifying a possible upper respiratory polyp, which in itself does seem like a reasonable diagnosis, but I am a little concerned that the guide prices I am being presented with for such surgical treatment seem to be progressively escalating with each conversation we have had about the subject. We're now at the stage where the full surgical treatment (if a polyp is found) is estimated to be around £2000 minimum, probably a good deal more, about which I am beginning to question the relative benefit, given the apparently minor, occasional basis of the symptoms. I have unfortunately previously lost another cat under anaesthetic and so am reluctant to subject my cat to only marginally beneficial procedures, given her age. However my main question is: does £2000+ (including apparently around £600 for an X-ray) sound like a reasonable cost for a surgical procedure of this nature? At one point the projected cost of the X-ray alone seemed to double for reasons I still remain uncertain about. I am definitely now in a quandary about what is the best decision to make and I feel that I need more information, so I really would like to get a second opinion over whether or not I am currently receiving the best advice, given the level of symptoms my cat is currently demonstrating: I feel hesitant about my cat remaining on steroids indefinitely, and in time I feel I would end up spending the sum mentioned on steroid prescriptions anyway, and would rather her be cured once and for all if there is any chance of her being subjected to considerable distress otherwise. So to summarize, (i) how much should this sort of procedure be expected to cost, (ii) how effective does it tend to be, and (iii) does it seem that my cat's symptoms warrant the risk and expense of surgery? Any advice you can offer would be very gratefully received. Regards  

Hello - I think that an x-ray is generally a good think to do;  airways show black on a radiograph and soft tissue obstructing them can be very clear.  If there is indeed a polyp, then surgery may help considerably, so the procedure should make a huge difference.  For more information about this, search the blog for an article about polyps in cats, written by Yvette Bell, dated 20th April 2021.  Of course, if the lump is not a polyp then the potential positives may not be so great, but your vet cannot know that until they can see more.   I agree that it is not ideal for a cat to remain on steroids indefinitely.  

To give an older cat a GA, it may make sense to do bloods etc to know as much about their body in advance of the surgery, and fluids in order to help their circulation to cope with the GA.   I'm afraid that I'm in no position to tell you whether the procedure will feel worth the money to you for your cat, as this is a value call and not an objective decision.  I know very little about your cat - whether they have underlying diseases, whether they will develop different signs, how long they are forecast to live if the operation is a success.  It is always painful to evaluate your own your cat in such terms - or indeed, a human's, when their human's health is at stake.  But vets help people to make these decisions every day and should not judge you, even if you ask very blunt questions such as, 'is it worth doing?' or 'would you do this for your own cat?'    Unless there is something that I am unaware of, and assuming that this does turn out to be a polyp, there sounds to be good potential to make a positive difference to your cats' breathing and comfort going forward.  From a vets' point of view, uncomplicated polyps can be very rewarding cases to treat.

Ps I just read that last line and felt that I should clarify something - it is actually against the law to pay vets bigger wages if they make higher profits at work.  When I say that vets find these cases rewarding to treat, I am not talking about money.  I like these cases because a cat arrives with an obvious difficulty and in a very short time, if the procedure goes well, there can be a significant improvement.

Hello and thanks for all the information which is very interesting. Can I just try to push a little more about whether you would judge the guide prices given to be typical? It's not that I wouldn't be prepared to pay for my cat's wellbeing: it would indeed be difficult for me to put a price on that - it's just that for such relatively minor symptoms, as I have so far judged them to be, the cost stated seems to be indicating a major operation. As I have limited experience of vets in recent years, I was hoping to get a second opinion about whether I ought to 'shop around', so to speak, with a different vet in my area. At the moment, my cat has just finished taking a steroid course that had been extended to last a month, and this week has scarcely been demonstrating  symptoms at all. We do have a follow-up appointment booked for the end of the month, but at the moment my instinct is to delay any decision to see to what extent the symptoms recur, as in my judgement she is not currently showing significant signs of any distress and is otherwise healthy. This would give me chance to save up for any surgery needed in the future, but in the meantime I was wanting to clarify if it was worth asking other vets in my area about the expected cost. For example, I was concerned about the stated cost of an X-ray apparently doubling to 600 pounds from one discussion to the next, between appointments, and thought perhaps I had somehow misunderstood the process required. To what extent would the cost of an X-ray vary according to specific circumstances? Thanks for any further advice you can offer. Regards  

Hi I do not do this kind of surgery so I'm afraid that I cannot give you a ball-park relevant to the modern era;  surgeons have been in short supply due to a perfect storm of various factors, including but not limited to Brexit, Covid and poor retention within the profession due to a profession-wide mental health crisis.  If you type keywords into the blog such as 'vets fees,' you can read about this.  I wonder whether its worth calling local specialist (certificate holding?) surgeons and asking them to offer a typical estimate for the same thing, as a guide.  Its also worth checking the qualifications of the vets involved, because specialist qualified surgeons ought charge more surgery time than normal vets.   First however, I think its worth explaining your concerns to your own vets because they ought to be upfront with you about pricing, and it would be helpful to them to know that that's not how they're coming across to you.  Perhaps they can explain any discrepancies.  I wonder whether someone initially told you the cost of the x-ray without considering the level of anaesthesia / supportive treatment for example, or without (this has tripped me up as a locum vet at some practises) realising that the GA fee needs to be repeated every quarter of an hour, or fluids / GA drugs have to be charged separately etc.  Sometimes vets who put an estimate up for surgery they do not reglularly do, might underestimate the time involved or the extra monitoring or drugs needed etc, but I would expect them to talk it through with you if the price shoots up dramatically from your previous expectations.   I'm sorry not to be more helpful here - please would you let us know how the story ends?