Ultrasound Needed - Should I Use Radiologist or Internal Medicine Vet?

[spac]

One of my cats needs an ultrasound of his abdomen. He may have a rare kidney disease or possibly cancer.

I can get this done locally (10 minute drive) using a radiologist or travel about 24 minutes and use the internal medicine vet. My cat gets stressed as soon as I walk out the door with him. He meows the entire car ride. I'm supposed to give him 50 mg of Gabapentin about 2 hrs before I leave to calm his nerves.

The radiologist travels to the vet clinic I use, so at least my cat will be in a familiar environment. The overall time he spends there should be much shorter than if I go to the internal medicine vet. In both options, I am not permitted to be present during the exam. I also plan to get an ultrasound of the heart, but it would be with these same doctors, not with a cardiologist.

I know the internal medicine vet actually specializes in kidney disease. But it looks like a radiologist can interpret the ultrasound better because they have more training in that area. So I don't know which option to go with. My vet has not been helpful in giving me information. I believe they prefer one over the other, but I believe that may be based on personality. I don't think they want to influence my decision.

I've been trying to look up the difference between a radiologist and internal medicine vet online, but can't find helpful info. Does anyone know anything about this?

From what I've been told, in this case, the radiologist does the ultrasound with the regular vet or a tech present. So if something questionable were found, they may be able to do an ultrasound on other areas of the body than what was originally agreed upon. Whereas the internal medicine vet only does the parts they agreed upon before the exam.

 

[Meowmee]

I would probably do the traveling radiologist because it is less stressful. When Sybil had chf/ hcm she had another us with a cardiologist who told us in detail what was going on. I think it was all included in the visit. I don’t remember if she had another one before that now. It really depends on how good the doc is at diagnosing conditions and their training etc.

 

[mrsgreenjeens]

I would also go with the radiologist vs the internal medicine vet.

 

[neely]

After needing an ultrasound for out cat twice over the past three years I completely agree with the above members. The radiologist is the most qualified to perform this test. The internal medical vet can then read the results and determine the best medical treatment for him especially since you mentioned your regular vet has not been very helpful.

 

[spac]

The radiologist is the most qualified to perform this test. The internal medical vet can then read the results and determine the best medical treatment for him especially since you mentioned your regular vet has not been very helpful.

I think there's been a misunderstanding. I'm sorry, completely my fault.

The radiologist would do the ultrasound AND make the diagnosis. The ultrasound would never be seen by an internal medicine vet or cardiologist. If I went to the internal medicine vet, they would be doing the ultrasound and making the diagnosis.

My issue is that I'm not sure how qualified a radiologist is to make an accurate diagnosis vs. an internal medicine vet. Since my cat may have a rare kidney disorder, I want the right doctor.

I get the feeling that the radiologist would do a more thorough exam of the internal organs, but I'm not sure. My vet has said that she does not know what's wrong with my cat, she's never seen anything like this in the 20+ years she's been practicing. She spoke to an internal medicine vet at the lab about the blood and urine tests and even he didn't know what could be wrong. From the research I did it looks like it could be Glomerulonephritis or Fanconi Syndrome, or cancer.

 

[Meowmee]

The radiologist is not going to treat the cat, only do the us & give a general diagnosis. They usually don’t do more than one area, you have to pay for each one ie: kidneys and heart. It really depends on the dvm, Merlin’s dvm traveling us did his whole abdomen / kidneys etc. A radiologist will not be able to give you details about a heart condition, a cardiologist will. So maybe go to the im if he/ she has a good reputation at diagnosis.

Another thing to keep in mind is that some things are not that easy to diagnose by us etc. I had 2-3 dvm say one of my kitty’s had x type of cancer based on us and bw / exam etc. but a necropsy proved them wrong.

 

[spac]

Thanks.

Just to be clear, no matter which option I go with, I'm just getting the ultrasound and a written report of the findings, diagnosis, and treatment plan. The total cost for both the abdomen and heart should be around $625 total no matter who I decide to go with. A cardiologist will not be reviewing anything.

Based on the blood work, it's probably not cancer though. Everything points to kidneys.

 

[Meowmee]

Thanks.

Just to be clear, no matter which option I go with, I'm just getting the ultrasound and a written report of the findings, diagnosis, and treatment plan. The total cost for both the abdomen and heart should be around $625 total no matter who I decide to go with. A cardiologist will not be reviewing anything.

Based on the blood work, it's probably not cancer though. Everything points to kidneys.

Yw. I am glad it is not cancer. Radiologists don’t usually recommend a treatment plan. If he has a heart condition he will need a cardiologist or im who specializes in that. Our im referred us to a cardiologist after diagnosing Syb. They did continue some of her treatment but did not have the specific experience/ equipment/ knowledge to manage all of it. The cardiologist after doing his own us gave us a very clear picture of what was going on and the prognosis etc. and he started a new treatment plan for all of her conditions.

 

[artiemom]

I ams o sorry you are going through this. It is so hard to deal with~~ decisions...

I will tell you my preferences and experiences. Actually, my guy issei's scheduled for an Internal Medicine appointment and an ultrasound, this morning at 9am..

I was also an ultrasound tech, before retirement.

A Radiologist will do the scan, and interpret the results. Your Vet will treat or refer you to an Internal Med Vet for treatment.

One thing you have not stated: Is the IM Vet at an animal hospital? If so, then a radiologist will do the scan with the IM Vet handling treatment.
This is the route I am going, with Geoffrey.

If the IM Vet is not at a hospital, then they can always send out the ultrasound images to a Radiologist for interpretation.

While we cannot tell you what to do, I would go with the IM Vet.

You also mentioned your Vet is puzzled by the lab results and is in contact with an IM Vet. This is an important point. Why not just go to the IM Vet?
It is not as if you are going to leave your own Vet. They are there for you..

My IM Vet always suggests to have a regular Vet along with him.

I know your kitty has anxiety issues with regards to traveling and at the Vets... It is frightening, but if you Go to the IM Vet, it may avoid a second trip...

You know your own kitty and how they handle stress..
Personally, I dread this ultrasound.. I really do. I went through all of this with Artie. I used an Internal Medicine Vet at a hospital, and my local Vet in conjunction.

I wish you ((((Hugs)))) and so much luck in whatever you decide to do.. It is so hard..

 

[fionasmom]

This is my recent experience with Jamie and an ultrasound/echocardiogram. All of my vets, dog and cat, use a traveling ultrasongrapher and have done for years. Nothing has ever gone wrong with that scenario.

First question, is the person who will do the ultrasound a radiologist or an ultrasonographer? What happened with Jamie is that once the ultrasongrapher read the report, he told the owner of the practice to put Jamie on two meds for HCM. When Jamie's vet returned the following Monday, she told me that I should really take him to a cardiologist. Even by LA standards, it was 4 freeways to get to a cardiologist who maintains her own practice and does only that. Most of them around here hit various clinics on certain days a week.

The cardiologist reviewed all of Jamie's reports and examined Jamie. She then called me and made a 180 correction to the meds, saying that the problem was that the ultrasonographer was not a radiologist or a cardiologist, so he basically did what everyone thinks you do for cats with HCM, despite the fact that one of the meds has been proven to have absolutely no effect on the condition. She was pretty dismissive about the fact that he was qualified to do a US, but that was about it.

So we are back to the fact that you are not sure if the radiologist is qualified to make the dx. Personally, I would see the kidney specialist/IM vet.

 

[spac]

Thanks to everyone for the help. I don't know if there is confusion here or not. It may be that my brain is fried and I'm just an idiot right now. I don't know, I'll let you decide. I'm not mad at anyone, just frustrated at the situation of not having enough info from the vet.


I'll try explaining this again. To be clear, my cat has some unknown, potentially uncommon/rare kidney issue. I just thought it would be a good idea to go ahead and do the heart as well since the added cost isn't that much.

Option 1: Radiologist travels to vet clinic to do ultrasound. Radiologist interprets ultrasound and makes a diagnosis. Radiologist and veterinarian decide on best treatment plan. Regular vet discusses treatment plan with pet owner. Pet owner has no communications at all with radiologist. Cost for ultrasound of abdomen and heart = around $625. The End.

Option 2: Internist does ultrasound (not a radiologist). Internist interprets ultrasound and makes a diagnosis. Internists decides on best treatment plan. Internist passes information along to regular vet to discuss with pet owner. Pet owner has no communications at all with internist. Cost for ultrasound of abdomen and heart = around $625. The End.

 

[Meowmee]

Thanks to everyone for the help. I don't know if there is confusion here or not. It may be that my brain is fried and I'm just an idiot right now. I don't know, I'll let you decide. I'm not mad at anyone, just frustrated at the situation of not having enough info from the vet.


I'll try explaining this again. To be clear, my cat has some unknown, potentially uncommon/rare kidney issue. I just thought it would be a good idea to go ahead and do the heart as well since the added cost isn't that much.

Option 1: Radiologist travels to vet clinic to do ultrasound. Radiologist interprets ultrasound and makes a diagnosis. Radiologist and veterinarian decide on best treatment plan. Regular vet discusses treatment plan with pet owner. Pet owner has no communications at all with radiologist. Cost for ultrasound of abdomen and heart = around $625. The End.

Option 2: Internist does ultrasound (not a radiologist). Internist interprets ultrasound and makes a diagnosis. Internists decides on best treatment plan. Internist passes information along to regular vet to discuss with pet owner. Pet owner has no communications at all with internist. Cost for ultrasound of abdomen and heart = around $625. The End.

We have mostly all done this and understand what you have explained. And given our thoughts about what to do. At this point you have to decide what you think is best. $625 is a lot of money to have no conversation with the im. If it were me I would take him directly to another im who will do a proper consult and us. No conversation with the radiologist seems to be standard for some crazy reason. I remember our former im who was an amazing doc, always on the phone with you etc., joking that he would like that job. Also keep in mind the test interpretations etc. and diagnoses are only as good as the people doing them.

 

[fionasmom]

Right....no conversation with the radiologist/sonographer is very standard for some reason. These guys are like ships in the night.

I would go with Option 2, but agree that if you could find an IM who would interface with you directly it would be better. What I don't like about Option 1 is that you have a radiologist and a vet, but no specialist which is where Jamie would have been had I not gone to the cardiologist. However, you know your cat, and have some familiarity with the doctors here, so it is ultimately your decision.

 

[daftcat75]

It would surprise me if the IM actually performs and interprets the ultrasound. Generally a radiologist would perform and interpret the ultrasound in both cases you describe. Radiologists have a specialized skillset and are in high demand. So they generally perform the procedure and send a write up to whoever ordered the ultrasound before moving on to the next cat or traveling to the next clinic. If you haven't decided yet, I would call the IM and clarify whether the IM him/herself will be performing and interpreting the U/S or whether it's being done by an in-house radiologist (vs. a traveling one like your local clinic.) In that case, it really doesn't matter. You can have the radiologist notes sent from the clinic to the specialist if s/he isn't the one doing the u/s anyway.

 

[daftcat75]

However, the advantage of going to a specialist hospital is that they will have doctors and equipment that your local clinic does not have. If the radiologist spots something concerning on the u/s, the specialty hospital will likely have whatever equipment or personnel needed for a next step without a return visit.

 

[spac]

Thanks again for the help. Sorry if I was (fill in the blank). I just want to make sure I get the correct tests, diagnosis, and treatment without wasting time and getting screwed over. It seems like doctors don't want to take the time to explain things anymore.

 

[Meowmee]

Thanks again for the help. Sorry if I was (fill in the blank). I just want to make sure I get the correct tests, diagnosis, and treatment without wasting time and getting screwed over. It seems like doctors don't want to take the time to explain things anymore.

No worries. I have actually never heard of an im who doesn’t talk to the patients people etc. So I think that is unusual.

 

[BlackCatOp]

I would do with option 1 of having the radiologist perform the ultrasound. Keep in mind, that a appointment could be scheduled for an internal medicine consult depending on the ultrasound results. Best of luck and hope your kitty is okay.

 

[aleeming]

Thanks to everyone for the help. I don't know if there is confusion here or not. It may be that my brain is fried and I'm just an idiot right now. I don't know, I'll let you decide. I'm not mad at anyone, just frustrated at the situation of not having enough info from the vet.


I'll try explaining this again. To be clear, my cat has some unknown, potentially uncommon/rare kidney issue. I just thought it would be a good idea to go ahead and do the heart as well since the added cost isn't that much.

Option 1: Radiologist travels to vet clinic to do ultrasound. Radiologist interprets ultrasound and makes a diagnosis. Radiologist and veterinarian decide on best treatment plan. Regular vet discusses treatment plan with pet owner. Pet owner has no communications at all with radiologist. Cost for ultrasound of abdomen and heart = around $625. The End.

Option 2: Internist does ultrasound (not a radiologist). Internist interprets ultrasound and makes a diagnosis. Internists decides on best treatment plan. Internist passes information along to regular vet to discuss with pet owner. Pet owner has no communications at all with internist. Cost for ultrasound of abdomen and heart = around $625. The End.

I don't understand why there is no conversation with anyone but the regular vet. I have had a cat go to an emergency clinic and seeing a radiologist who did the exam with me in the room and told me he only saw one slight thing which was likely nothing and that he did not know why the cat was sick but it was nothing he could see with the ultrasound (entire abdomen, heart etc done btw). He actually said "I'm a radiologist and if I can't see anything here I'm not the vet to try to diagnose for you." He sent his report to the internist who met with me and did diagnose the cat. It actually makes NO sense to not talk to the internist. It is ridiculous not to have an actual consult with them. Would you do that for a human being?

If the internist can do an ultrasound and you MEET them with the cat I'd go that route. But I would be raising hell and insisting on an appointment because how the hell can they have a good history and get any questions they have answered going through your vet? And what specialised tests might they need to get your permission to do which would then require another visit with a stressed cat? That's BS to do it the way they're planning.

If the radiologist sees nothing you'll have to go to the internist anyway. My internist is great at doing ultrasounds so its not an issue for me now. I only saw the radiologist because he was at the emergency clinic that day.