When to do the expensive diagnostic tests?

[kassa]

I would like to raise a kind of delicate point, based on a discussion in another thread.

She wants to do a MRI and spinal tap tomorrow...to the tune of $3200. :O She's concerned about infectious disease and also other non-infectious problems in his cerebrum affecting his motor function, including genetic defects.

I can't comment specifically on this specific situation, not knowing the particulars, but I know from experience and the experience of my friends, that sometimes vets want to get to the bottom of things on an intellectual basis even if the knowledge won't necessarily lead to any kind of cure or longer life.

It seems to me that bloodwork and a spinal tap would help rule out certain infectious diseases, a course of antibiotics could be used, and if it's a brain tumor, then, sadly, time would tell.

More than once friends have been advised by their vets to do monumentally expensive scans, when the sad fact was, it was either a condition treatable (if not curable) by medication, or else a catastrophic condition that wouldn't be curable anyway. In that case, the sensible decision from a financial standpoint (assuming finances are a consideration, and they certainly are for most folks, including me!), would be to attempt the treatment for the less serious condition, in hopes that the dog responds, and there's your answer.

Making the decision to spend thousands of dollars to know that a) the dog is free of the catastrophic condition (but you still don't know what IS the problem) or b) HAS the catastrophic condition (and there's nothing you can do) is a situation that a caring vet can help guide you through.

I would certainly spend a couple of thousand dollars in straightforward care to restore a young healthy dog to health (trauma, etc.). But I do get concerned when I feel that people are being urged to do thousand dollar tests to answer questions that unfortunately could be answered within weeks on a $100 necropsy, since the outcome of the suspected condition is very poor.

Some questions to ask your vet:

If the expensive test shows the condition you're trying to rule out, what would be the treatment? Would there even BE a treatment? If so, is it a treatment we could attempt without absolute confirmation? (Sometimes the treatment IS medication or surgery, both of which would be cheaper than the test, or there's no treatment at all).

If the expensive test doesn't show anything, what's your next best guess? What would the treatment be for that? (Sometimes, amazingly, it's the SAME treatment as would have been the case if the first suspected condition was there -- in that case, how important is it to really know which it is?)

Ideally, we'd all have the $$ to spend whatever it took to know precisely what was wrong with our dogs and the tests could be used to fine tune treatment to make them better.

But sadly I've been finding more and more that the most expensive tests (brain scans and expensive contrast dye procedures, especially) are generally used when the most likely culprit is something imminently fatal. So it's always important to ask the vet before agreeing to a procedure a) what do you hope to find out; and b) once you have that information, what happens then?

You'd be amazed how often the answer is "nothing" or something that could be attempted without the test in the first place.

 

[jenn77]

I was in this situation over the winter.

My 6 year old, Griffin, had a cacophany of symptoms that could have been ascribed to anything - he had some seizure/fainting spells, was lethargic, was not eating, would not even get up off the couch without help, didn't want to get out of bed in the morning, etc etc.

The brough up all of the awful things - brain tumor, cardiomyopathy, Addison's disease, Cushing's, etc.

We went through an MRI, spinal tap, cardio workup, etc., to the tune of $4600 to rule all of these things out. On the day of the MRI, Griffin started to perk up a bit and ate the food I brought him (he spent 2 expensive nights in the Canine ICU).

Turns out he had a inner ear infection that went away in days with Baytril, an antibiotic.

The cruel irony is that he is now living with advanced Mast Cell cancer, which was diagnosed about 5 months after the above issues. Had we not spent so much on diagnosing the ear infection, we may have tried a chemo regimine for the cancer. As it is though, we have a baby on the way and can't justify another 5 grand for something that may make him sicker and may not even extend his life at all.

(re the cancer, he is almost 4 months past diagnosis, and while he is growing a golf ball sized tumor in his throat, so far he's still happy and acting quite healthy)

 

[FletchersMom]

Sadly I am facing this same situation myself. Fletcher had neuter surgery two days ago and our vet (now former vet) felt that based on vpc's that Fletcher had while under sedative that he may have BCM. There is a small chance that it was just a result of sedatives and anesthia he was given but a very small chance.

At any rate I spoke with a cardiologist yesterday and we are taking Fletcher in to see him to the tune of $105 - just to walk in the door. The tests I'm sure are going to be astronimical because they wouldn't even qoute me a starting price. I asked several questions about treatment for the disease and wsa told that we can put him on meds but we have to wait and see how severe the situation is.

I asked what the prognosis was with treatment and was told not great. That the meds don't stop the progresion of the disease and that they only help cut down the risk of accute death.

I don't know all the facts yet but I want to know if the benefits of the meds are going to outweigh having to have him on drugs for the rest of his life. Would it be better for him to let him live it to the fullest while he can?

My mother once told me that when you get a dog you are ultimately looking at a heartbreak and I never understood what that meant. Unfortunately I am beginning to get it.

 

[kassa]

Fletchersmom, I have a 7 year old dog with "boxer cardiomyopathy," and made the decision to not put him on meds. He's a neutered white pet, and had one fainting spell.

I then did a holter and it showed lots of double and triple beats. It also showed some periods where it paused entirely too long (but kicked back in).
And he has a slow heart rate to begin with.

He's very active and happy and healthy (appearing, anyway). He hasn't had a fainting episode since that time (witnessed, at any rate).

A side effect of the anti-arrhythmic medication is that it slows the heart. Well, his is already slightly slow, so I'm not eager to push that.

Also, sadly, as in humans, while you think that reducing the number of arrhythmias will lead to lower mortality rates and longer lives, it simply isn't true. The right medication will reduce the number of arrhythmias, absolutely, and in a dog (or person) that's fainting or in discomfort will reduce the number of those frightening episodes. However, it simply does not prolong life.

I made the decision not to medicate because of his secondary problem, and decided to revisit that decision should he start fainting or showing other lifestyle affecting problems. So far, so good.

 

[FletchersMom]

thanks Kassa for sharing those encouraging words. I'm going to wait and see what the cardiologist says but I'm inclined to agree with you. I just want Fletcher to be happy and live life to its fullest without having to take meds everyday if its not absolutely necessary.

 

[DannyB]

I would like to raise a kind of delicate point, based on a discussion in another thread.

"It seems to me that bloodwork and a spinal tap would help rule out certain infectious diseases, a course of antibiotics could be used, and if it's a brain tumor, then, sadly, time would tell."

Not all infectious diseases are caused by bacteria - what if the problem is viral or fungal? What if the condition is immune mediated? Antibiotics won't work for any of those and the spinal tap would be necessary to differentiate between all possibilities. And if it is a bacterial infection a culture of the sample is ideal to make sure the antibiotics prescribed are appropriate. It's a bit of a gamble to take an animal with neurologic disease and say, "let's try this antibiotic for a week and see if it works before we do anything else." (But if that's what the owner can afford or what they choose to do then it should be offered as an option).

"More than once friends have been advised by their vets to do monumentally expensive scans, when the sad fact was, it was either a condition treatable (if not curable) by medication, or else a catastrophic condition that wouldn't be curable anyway."

If it was clear ahead of time that the condition was treatable/curable with medication only or that the case was clearly in the realm of monitor quality of life only, then the scan should have been presented as an option but not pushed as necessary. If it was the scan that made it clear what was going on in the animal than it was necessary. I can't say, but in the case of the dog with the inner ear infection was it the MRI that made that diagnosis? Then the MRI was a necessary test.

"I would certainly spend a couple of thousand dollars in straightforward care to restore a young healthy dog to health (trauma, etc.). But I do get concerned when I feel that people are being urged to do thousand dollar tests to answer questions that unfortunately could be answered within weeks on a $100 necropsy, since the outcome of the suspected condition is very poor."

It all depends on the owner. Some people are not happy with "I have no idea what's wrong but I suspect Spot will die in a few weeks" and want to pursue every option. And again sometimes it takes the additional diagnostics to be able to say, "Spot has metastatic carcinoma that has invaded almost every organ and there is nothing we can do other than keep him comfortable."

Veterinary technology lags behind human technology by about ten to twenty years. CTs, MRIs, and other tests have only recently become possible to offer routinely to owners. Many owners are knowledgable about what's available in human medicine and expect their animals to have access to similar tests. A veterinarian should never push testing that someone can't afford but I think they are ethically required to make sure the owner knows the possibilities for advanced diagnostics are there as well as all the other options from less specific tests to treatment without testing to euthanasia.