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seagrass_gw

Specialist vet visit cost more than my first car

8 years ago
last modified: 8 years ago

We spent the entire day yesterday off-Cape at a veterinary neurology clinic. Physical exam, consultation, bloodwork, anesthesia, CT scans, brain MRI,, spinal tap...no tumors found in our beloved 6-year-old Australian Shepherd who has been having seizures. Today got a call that the spinal tap showed inflammation so I got out my Visa card and authorized a complete analysis for sources of that.

She's also being tested for the genetic tendency for side effects from Heart Guard meds. We were advised to discontinue that med and switch to (a now available again) Interceptor. We were advised to up her dose of the 2nd anticonvulsant and the clinic (2 1/2 hours from us) called a new Rx to our pharmacy. We are going back in 2 weeks for f/u.

I can't thank all of you enough for your advice, opinions, experience and compassion.

seagrass

Comments (49)

  • 8 years ago

    I understand about the vet bill--last December, a one-day visit to a specialist for our Yorkie cost $900, and much more for tests, etc. after that. He has kidney issues, but blood pressure medicine is helping him tremendously. He is terrible about taking pills, so our vet found a place (Wedgewood Pharmacy in NJ) that formulates the medications into liquid form, and they provide the oral dispenser syringes. That solved a major problem for me. So, if you ever need meds formulated into liquid, keep them in mind. They are wonderful to deal with, and their prices are cheaper than the prescription pills I was getting.

    I hope she will be OK...having a sick furbaby is as bad as having a sick child. Hugs!

    seagrass_gw Cape Cod thanked wanda_va
  • 8 years ago
    last modified: 8 years ago

    Wanda - Thank you. Our girl is good with pills. We were using peanut butter but now because of the size, we buy "pill pockets" - they're rather stinky but hence the attraction, I guess.

    https://www.chewy.com/greenies-pill-pockets-canine-real/dp/37485?utm_source=google-product&utm_medium=cpc&utm_campaign=f&utm_content=Greenies&utm_term=&gclid=EAIaIQobChMI9KiAr6Xs1gIVhUGGCh0IhgBcEAQYASABEgLi2PD_BwE&gclsrc=aw.ds

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  • 8 years ago

    Poor puppy. I hope she's feeling better soon and that the seizures will stop. What a worry for you.

    seagrass_gw Cape Cod thanked blfenton
  • 8 years ago

    I had a dog with Cushings which was probably due to a brain tumor. He was 12 at the time and went into severe seizures despite my efforts when he was 13. My vet said she was surprised he lived that long. I gave him supplements and never got to all the expensive diagnostics.

    My 4 year old dog had 2 seizures in the last year, always at night, and after I observed him eating lush (chemicalized) grass and some unknown thing outside. I am assuming it was poisoning. I have been very careful when walking him now. There is a fine line between sniffing and eating. I actually slap him on the head and say spit it out now. And he obeys bc I never ever hit him. Hopefully a change in your dog's meds will solve the problem! You and your dog must be exhausted. Hope you can rest and solve this problem!

    seagrass_gw Cape Cod thanked andreap
  • 8 years ago

    So sorry for your scary time with your fur baby. I have no experience with seizures. Have dealt with Addison's disease (Standard Poodle) heart failure (senior rescues) and bone cancer (retired racing greyhounds) in our beloved critters. All scary and expensive! Hoping you find answers and good "fixes" to the problem.

    seagrass_gw Cape Cod thanked hounds_x_two
  • 8 years ago

    It's so expensive. I was billed over $10,000 for my Monkey a few years back when he had cancer. I had insurance but I would have paid anyway.

    I hope your baby is better soon. No tumors sounds promising!

    seagrass_gw Cape Cod thanked Chi
  • 8 years ago
    last modified: 8 years ago

    I’ve been watching for your post and it sounds like you all had a very long day. I know the expenses aren’t easy but she’s so young still. We went through so many expenses with our two elderly cats, that when we got Ellie, we opted to get pet insurance for her. I hope that the remedy is as simple as stopping the heartguard. There is another thread here in the forum that is a discussion about products that are counterfeit or manufactured with products that are counterfeit. It got me wondering if that may be a cause for a lot of these types of illnesses we’re seeing in our pets. I gave Ellie a dog medicine once that was tainted or not correctly dosed and she was up all night heaving. It scared the bejeepers out of me and now I only buy medicines from the vet or pharmacy and her food from Chewy or a small local shop I try to support.

    seagrass_gw Cape Cod thanked User
  • 8 years ago

    Lukkirish - she's our responsibility and we love her - we live with her but we have to live our own lives too. We're newly retired and hope to leave New England for 2-3 moths this winter and travel with her. So hopefully we can get this figured out. Thanks so much for your feedback and concern.

    seagrass

  • 8 years ago

    Glad you are able to do this for your girl. hope the answers come swiftly.

    It's tough and each family has to decide how much they can do. It is a conundrum when the bills quickly outrace the income. All the best.

    seagrass_gw Cape Cod thanked yeonassky
  • PRO
    8 years ago

    Please keep us updated. Sounds like a good work up. Surprised your vet gave HeartGuard/Invermectin without genetic testing.http://www.akc.org/content/health/articles/heartworm-medication-side-effects/

    seagrass_gw Cape Cod thanked mdln
  • 8 years ago

    Hope your baby is feeling better soon.

    seagrass_gw Cape Cod thanked ritamay91710
  • 8 years ago

    Hope your sweet dog will improve and the seizures will be under control. I am going to ask my daughter about her previous dog that had seizures. I can’t recall what the final diagnosis was with her retriever.

    seagrass_gw Cape Cod thanked OutsidePlaying
  • 8 years ago
    last modified: 8 years ago

    Sure hope it is resolved soon. Thanks for the info about heartworm medications.

    seagrass_gw Cape Cod thanked Pam
  • 8 years ago

    I've learned so much from people on this forum - it's unbelievable what our collective knowledge can do.

  • 8 years ago

    Know how scary this is. My granddog had two seizures while I was with her. My son has lost two dogs and we believe it is due to Roundup being used on the lawns. One of our neighbors also lost a dog the same way.

    seagrass_gw Cape Cod thanked User
  • 8 years ago

    I'm glad to hear that there is no tumor and I hope that the seizures stop for your sweet dog.

    seagrass_gw Cape Cod thanked PKponder TX Z7B
  • 8 years ago

    I'm glad they found no tumor. We lost our sweet girl at 9 y.o. from the effects of a brain tumor (and the steroid side-effects). We had 2 MRIs which cost about $3K each. Of course we'd do it again, if it could've saved her, but yeah, it's hard in every way imaginable. I hope your pup's going to be ok!

    seagrass_gw Cape Cod thanked Mrs. S
  • PRO
    8 years ago

    Elmer, I happened to be at the vet today with my dog - recurring eye problem. We were railing about a local specialist clinic - owned by a big national chain. I mentioned what you said about specialist residencies and he said that was true in his day (he's probably in his late 50's), but not today. He said when he graduated from vet school, one had to do clinical training at a vet school - very few available slots. But now, it's allowed to do a residency at a soecialty clinic and with the big corpoate ones springing up everywhere, it's not at all hard to find a slot. The need more specialists to fill the jobs at these clinics. Thought it was interesting info since we'd just been talking about this.

    seagrass_gw Cape Cod thanked Anglophilia
  • 8 years ago
    last modified: 8 years ago

    Anglo, your vet is very, very wrong. Here are residency match stats since 2010. The numbers have grown but they're still tiny. It's true, there are a few residencies offered by private practices. They remain a small percentage and are not well regarded because at many the training is poor and resources are limited compared to programs at vet schools. This translates into low board pass rates for those in these programs compared to ones at vet schools. The screening done by the program directors is of course to try to fill their positions with the best applicants, those with the best chances for success in the rigorous programs. Historical passing rates are available to applicants and is one measure by which the quality of the programs is judged. The better programs (by reputation and pass rates) get the better applicants.

    For comparison purposes, there are over 30,000 residency slots available each year for medical school graduates (MDs). Graduates of US medical schools have a higher than 90% success rate of obtaining a position.

    I think it's something less than 10% of vet school grads do residencies to become specialists. Depending on the specialty, the board failure rate can be 30 percent or higher. The low acceptance rate tells the story - it's not as brutal as how difficult it is to get into most vet schools, but still brutal.

    Year- # Applicants- #Matched to a residency position

    2010- 870- 239

    2011- 867- 252

    2012- 829- 241

    2013- 862- 268

    2014- 1008- 311

    2015- 1020- 314

    2016- 1005- 339

    2017- 1091- 342

    In the last 7 years, match rates have never been as high as 1/3, so over 2/3rds of the applicants are unsuccessful and turned away with nothing. The numbers are skewed upward a bit by Emergency slots that are rather more numerous than others and aren't in as much demand by applicants so they're easier to get with about a 50% match rate.

    Funny that your vet would say it isn't hard to get a position.

    These numbers come from the site that handles the match process for interns (one year of general training for experience purposes only) and residents (required for becoming a certified specialist). The link is below to stat page on the site that handles the matching, it's called VIRMP. You can look at the numbers and program match details within the stat PDFs for each year Also in those annual summaries are a breakdown by specialty.

    Yes, I know a lot about this. As I said, a member of my family went through it. Successfully but because of intense personal motivation and many years of very hard work and personal sacrifice. If you or anyone else is interested in more information, cruise around the VIRMP site. A list of available programs and slots can be seen by clicking Program Search.

    It's true that some of the specialty hospitals run by the large operators (like VCA) aren't always the best but for some areas, it's all that's available.

    Send your vet the link. He or she really ought to be better informed. If your dog has a recurring eye problem, maybe you should see a veterinary opthalmologist instead of your GP. Half said as a serious suggestion, half intentionally snarky. Good luck

    VIRMP match stats

    seagrass_gw Cape Cod thanked Elmer J Fudd
  • 8 years ago

    Our first Aussie went blind from cataracts. We spent about $5,000 with a veterinary ophthalmologist to have her eyesight restored. The veterinary neurologist who is evaluating our current Aussie is in private practice - she works with canines and felines - has a pain management therapy clinic as well as her diagnostics which are all on site. She's super great and we're fortunate to have access to her.

  • 8 years ago
    last modified: 8 years ago

    I hope that you get some answers! What is really frustrating is when you go and spend thousands only to get an "I don't know, try this and try that". Very very frustrating!

    I have a friend that talks about how frustrating it was when their last dog had been sick. It was having stomach issues. They kept taking her to the vet and they just kept giving her medicine but didn't have any answers to what was causing it. Finally they changed vets and this new vet right away suggested "is she eating a toxic plant in your yard?" SURE ENOUGH...their dog had been gnawing on their YEW plant in the back yard. But it took so long that the damage was already done and the dog never did really get over it and died at a young age.

    seagrass_gw Cape Cod thanked arkansas girl
  • PRO
    8 years ago

    Elmer, I've been to a specialist in the past - an ophthalmologist a the corporate Blue Pearl local practice. I know what's wrong - chronic condition - just needed meds.

    It doesn't make sense that with the proliferation of these huge corporate specialty clinics all over the country, that there wouldn't be more residency slots than when they were only at vet schools. These places are everywhere these day! Yes, it's great that they are places where attracting specialists in the past was difficult, but there is just an atmosphere in them that is unsettling.

    I adore my vet and have used him for years. He's a very bright man - graduated at the top of his class from Auburn. He's the vet in town that other vets used to send their difficult cases to prior to the specialty clinics arrival. He's a delight to work with as he is more than willing to consult with specialists at vet schools when necessary. This has served me well in the past with dogs with MVD. Of course, now that we have Pimobendan, this is not necessary as often anymore. As my vet says, there should be a picture of a Cavalier on the box for this drug!


    seagrass_gw Cape Cod thanked Anglophilia
  • 8 years ago

    Anglo - I lust for the company of a Cavalier! I've met several of them - they are so sweet and loving. I do love the Aussies but they're too much for me now. I'm not well or strong enough to handle them.


  • 8 years ago
    last modified: 8 years ago

    "It doesn't make sense that with the proliferation of these huge corporate specialty clinics all over the country, that there wouldn't be more residency slots than when they were only at vet schools. "

    The thing is, the two are completely unrelated and disconnected. Vet schools offer residencies based on their own staffing needs (patient load) and finances. Both are limited at most places. They don't care a wit about the job market demand for those who complete their programs and are unaffected by it.

    You're right, there has been a growth in specialty practices, driven by the need for more knowledgeable practitioners trained to handle the panoply of problems and the public's dissatisfaction with the limitations and frequent mistreatments by GPs, ACVIM, the governing body that oversees specialties including cardiology, oncology, neurology, and internal medicine, has an employment board on its website. This morning it lists 299 open jobs. The vast majority will go unfilled.

    Not all specialty practices, least of all the chains, are happy and well run. Not all the vets at them are as competent as they should be. And at many, a fair number haven't passed their boards. But there are also many, many very competent ones around, sometimes in less than desirable practice settings. Finding the right person is hard and is something we all struggle with. Going to a vet school is often a good option but not all are happy places where people spend their days humming and whistling their favorite tunes either.

    Your vet's lack of awareness and confidence about his misinformation of this important part of his profession is puzzling to me. That's fine, no need to continue to beat this dead horse (sorry for the slight pun). Good luck to you and to all as we try to do our best for our beloved pets.

    seagrass_gw Cape Cod thanked Elmer J Fudd
  • 8 years ago
    last modified: 8 years ago

    Our local vet and breeder are well informed and candid about their limitations. They helped us import our first two Aussies to Europe when we took a site assignment in the Netherlands. We were negligent in our resistance to take our Bella to the specialist when they first recommended we do that. They were right. Our reluctance wasn't about the money - it was about what decisions would follow. We could not come to an emotional decision about that but finally did. So far, with the change in her meds, she has't had a seizure since Monday and is quite herself.

  • 8 years ago
    last modified: 8 years ago

    I'm so glad your doggy is doing so much better, hopefully that will continue.

    "Our local vet ....... are well informed and candid about their limitations"

    That's awesome and, sadly, less common than it should be. For too many GPs, referring a patient to a specialist is postponed or avoided because of the financial consequences. It means losing out on being able to continue to charge to treat for that particular problem. Even when they're treating something beyond their ability or expertise, many continue anyway. The pet owner is sadly none the wiser about what's going on.

    A not-insignificant percentage of work that specialists have to face involves patients that GPs have misdiagnosed or mistreated and delayed referral. Often it happens that the GP hasn't done a referral at all, the action is taken by a dissatisfied owner. Sometimes it's heart-breaking because by the time the animal is seen and properly diagnosed, it's too late and earlier competent intervention could have led to a different outcome.

    seagrass_gw Cape Cod thanked Elmer J Fudd
  • 8 years ago
    last modified: 8 years ago

    Interesting perspective, Snidely - when we were presented with paperwork to sign before our consultation with the specialist vet the charge for a second opinion was twice that of an original diagnosis.

  • 8 years ago
    last modified: 8 years ago

    Can you explain it a different way, seagrass? I'm not sure I understand what you've said. Thx.

    seagrass_gw Cape Cod thanked Elmer J Fudd
  • 8 years ago

    Seagrass, that is awesome news about Bella and I hope it continues.

    seagrass_gw Cape Cod thanked User
  • 8 years ago

    Snidely - I don't have that paperwork but from what I understand from reading it I think that the vet we saw decided that if she was going to jump into a second opinion moray she was going to charge twice her normal fee - maybe to avoid the situation??? We weren't in that position so I didn't ask questions about it. Professional courtesy involved?? IDK.

  • PRO
    8 years ago
    last modified: 8 years ago

    You were charged double the normal fee because it was a "second" opinion??? If so, that is unprofessional.https://www.avma.org/public/YourVet/Pages/Complaints-against-Veterinarians.aspx

    So glad to have UI and UW specialists nearby, their fees are ~50-70% of what local vets charge.

  • 8 years ago

    No, madly, we were not. But the outline of charges we agreed to stated that if our visit was for a 2nd opinion it would be double the amount of the initial consult we paid. I'm not sure why that caveat was inserted - perhaps to cover herself from any kind of professional malpractice accusations? I worked with human surgeons for a long time and I know them to be a clique who cover their asses at every opportunity.

  • 8 years ago
    last modified: 8 years ago

    I can't offer a knowledgeable response and my family source isn't available to check with right now. If the idea was to avoid an overt assessment of the other vet's work, and maybe it was or it wasn't, I can tell you the motivation may have been more the desire to avoid a pissing contest and derogatory words than as a normal professional courtesy.

    Specialists are on a tightrope concerning GPs - they want to have good relationships (they rely on referrals) and be viewed as working in a collegial way, yet it's inevitable that they find themselves too often having to clean up a botched situation. And needing to do so without saying too much to the human client that that's what's involved. You can't live in the same community and offer yourself as a team member and resource if the outcome is that the work of others is bad-mouthed, even though that is often deserved.

    In the end, they try to do what's best for the patient as it comes in the door, without pointing fingers.

    Long answer. Short version - I don't know why.

    seagrass_gw Cape Cod thanked Elmer J Fudd
  • 8 years ago
    last modified: 8 years ago

    Snidely - you have a special brain. Wish I could download it.

  • 8 years ago
    last modified: 8 years ago

    Some here would burn it or serve it to their cat given half a chance, I need to keep it locked up.

    You're kind. I'm just a curious guy who likes to learn things. Many friends and also my family members have widely different experiences and occupations than I've had and that exposes me to stuff I wouldn't otherwise have a chance to know. Also my own experiences too, I like to be observant to understand what goes on around me. The downside is I come off to many as a pedantic know it all type and, unfortunately, that's sometimes a fair characterization.

    seagrass_gw Cape Cod thanked Elmer J Fudd
  • 8 years ago

    You're a treasure of knowledge even if you come on as stiff sometimes. I admire your perseverance and your voice on this forum.


  • 8 years ago
    last modified: 8 years ago

    Very nice of you to say. I sometimes get frustrated here and in real life with people who are obstinate and closed minded in their thinking.

    Much more importantly, I'm seriously hoping your doggy's situation will soon be resolved to everyone's great joy. It's deserved.

    seagrass_gw Cape Cod thanked Elmer J Fudd
  • PRO
    8 years ago

    Elmer, I'm NOT talking about job opportunities with the specialty practices, but about RESIDENCIES being done there. It used to be a requirement that ALL residencies had to be done at a vet school. Not any more. They can now be done at a specialty practice if the specialists there are boarded. So, there should be more opportunities for residencies since there are so many new practices.

    seagrass_gw Cape Cod thanked Anglophilia
  • 8 years ago
    last modified: 8 years ago

    Again, anglo, the number of specialty residencies in non-academic, private practice settings, subtracting Emegency/Crit Care, is small. About 10% of the total. It's inconsequential to the total and, based on the sub-par success records of many taking this path to train to become certified, is hardly a factor at all.

    The governing bodies assess all existing and new prospective residency programs and revisit them periodically. It's an accreditation matter. The same rules apply to academic and private practice programs alike - they need to show they have all the resources necessary to provide prospective participants with the right experiences for comprehensive training, including volume of cases, facilities, and access to appropriate mentors in supervision. Small vet schools have difficulty complying with some requirements and have fewer types and numbers of residency slots as a result. Most private practices lack the required resources to qualify and thus don't have any residents at all.

    My earlier link has all the actual information for the past several years. You can refer to the numbers and facts or ignore them for your comments, as you choose. If you're trying to defend your vet's ignorance, fine. You keep restating his misunderstandings, which the facts clearly contradict. I'm sorry, I've tried to help explain, have given real source information to help anyone understand the reality of it, and am now done. Why won't you let go of this and simply understand that his comments were wrong?

  • 8 years ago

    Sorry for the diversions, seagrass.

    seagrass_gw Cape Cod thanked Elmer J Fudd
  • 8 years ago

    Our sweet girl has been seizure free for almost a week. We are very suspicious it has to do with the heart worm med. We'll know soon. There are strong personalities on these forums but also opportunities for advice and knowledge. I try not to partake in the back and forth of any of it. To each his/her own.

  • PRO
    8 years ago

    Thank you for the update. If that is the case, perhaps the vet who prescribed the heartworm med should pay the bills for specialty consultation. :-)

    seagrass_gw Cape Cod thanked mdln
  • 8 years ago

    Seagrass, l am glad to hear there are no further seizures. Do you think that is due to the increased dose of the 2nd Med? If I'm not mistaken heartworm meds are once every month so her last dose would still be in her system. This is such scary stuff which is why I am asking so many questions. Hopefully this information will help someone from going through this.

    seagrass_gw Cape Cod thanked Pam
  • 8 years ago

    I thought the same thing about the heartworm medicine when you posted that she’s been well since Monday. As maddening as the idea of the medication making her ill is, it would still be so much better than her having a serious condition.

    We give our dog Sentinal for heartworm. It’s pricey, but we’ve had pretty good success with it.

    seagrass_gw Cape Cod thanked User
  • 8 years ago
    last modified: 8 years ago

    There have been quite a few studies done showing that certain breeds are sensitive to ivermectin which is used in heartworm meds. Ivermectin toxicity affect certain breeds that may carry a genetic mutation. They were starting to see this first in collies and later other herding breeds, the Aussie is included in those susceptible breeds. I remember discussing this with my vet when we had a Sheltie/Aussie mix. Apparently they have a test for the genetic mutation these days.

    I live in an area where heartworm is simply not a problem. My dog is not on heartworm meds at all. I have discussed this with my vet and he sees no reason for me to put her on it unless we plan to take her to areas where it is a greater risk. Then I would be happy to have her tested and put on medication for the time period necessary. I have no fleas either but if she is out in parks and places where she meets others dogs I do use a dose of Frontline at the start of flea season. No reason to do flea treat in the dead of winter.

    A lot of things are pushed on clients by vets for one simple reason. They know people get lax in the care of their animals. If they say recommend something for the season the client may forget next year so it's easier to put the dogs on heart worm year round. Of course this doesn't apply to people who travel a lot with their dogs or live in mosquito zones year round. By advocating for yearly vaccines they know they will at least see the dog once a year since people bring them in for annual health check ups or worse wait until they are extremely ill.

    Here is a link that may be informative:

    http://www.cliniciansbrief.com/sites/default/files/attachments/Ivermectin%20Toxicosis.pdf

    seagrass_gw Cape Cod thanked wildchild2x2
  • 8 years ago

    It’s very good information, Mdln posted about that up thread as well.

    seagrass_gw Cape Cod thanked User
  • 8 years ago

    Mention of ivermectin reminds me of when I insisted that our vet take a skin sample from our Westie's nose. He was constantly rubbing it. Concentrated doses of ivermectin helped tame his infestation of *mites*.

    Humans can develop the same problem with mites -- especially if they have diminished immune systems. No need to ask how I know, right? I never let our dogs lick my face, but I do think about the mites when I see that behavior on TV commercials!


    seagrass_gw Cape Cod thanked chisue
  • PRO
    8 years ago
    last modified: 8 years ago

    Previously posted the AKC site. The Aussie site has more detailed information.

    http://www.ashgi.org/home-page/genetics-info/faq/mdr1-faqs