Quote for testing alone is $630!

[scarlettjo'smom]

Just joined the group and have already learned so much about Cushings. I think my girl, Scarlett a 6 1/2 year old Goldendoodle may have Cushings. She is a big girl and weighs 108! I'm afraid I may need to find an extra job! She has been slowly gaining weight for about 2 years now despite cutting out her treats :( and adding green beans to her dog food to make her feel full. I had her thyroid tested last July and again this past June and her labs were normal. She didn't start really exhibiting other notable signs until this past 6 weeks. She has layed around alot, panted more than usual, been intolerant of her usual walks, had increased thirst but I thought it was perhaps the Texas heat. Then I noticed lameness in her hind quarters while walking and while squatting to do her backyard business. I also noticed she has a big apricot colored patch of hair on her normally light blonde coat. She also had a little injury on her front paw that took a consideable amount of time to heal. I guess the biggest things that have changed are the three P's, polyruia, polydypsia, and polyphagia, along with the listlessness and excessive panting. I called my vet to make an appointment and they called to tell me the price of just the testing alone will be $630.00. Does this seem average?

[Squirt's Mom]

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[Gwenny6]

Hi there! Is that a quote for the testing for cushings and/or diabetes? What specific tests is that for?

[labblab]

Hello and welcome to you and Scarlett, although I'm sorry for the problems that have brought you to us. As Gwen's mom has asked, you may want to ask for a breakdown of the various tests that your vet would plan to run. But unfortunately, $600+ dollars is not an unreasonably high cost for a battery of tests that could be associated with a Cushing's diagnosis. Typically, you would be expecting a regular blood panel that includes analysis of biochemical levels and also blood cell counts. Also, a urinalysis to see whether there are abnormalities in specific gravity, whether there is infection present, and whether any blood or protein is being lost in the urine. And finally, depending upon those results, there are two different blood tests that are specific to Cushing's: the ACTH stimulation test and the LDDS test. Either of those tests are usually more expensive than regular blood panels. So one option you might want to discuss with your vet would be to first proceed with the regular blood panels and the urinalysis, and hold off on the specialized Cushing's testing until you have the chance to see whether there are initial lab abnormalities that are even consistent with Cushing's.

Marianne

[scarlettjo'smom]

The quote was for the UC:CR and the ACTH stimulation test. Vet also wanted to re-run her thyroid panel, CBC, and Chemistry panel. She had her thyroid panel, CBC and Chemistry panel done 2 months ago by mobile vet and all her tests were WNL. Can you break done what the average costs each test is likely to run, as well as costs of ultrasound. I have seen on several posts that after the UC:CR comes back, to go straight to the ultrasound, (if of course UC:CR doesn't rule Cusings out). Of course, I will beg, borrow and steal if need be to provide her with the appropriate treatment, I just want to get an idea of what to expect. She is only the best dog on the entire Planet and it breaks my heart that she may have Cushings. Meanwhile, should I allow her to drink so much water? I worry it may cause her sodium levels to drop. Any recommendations to make babygirl comfortable until diagnostics are completed. Thanks!

[Renee]

First, DO NOT withhold water. A cushings dog has to drink because the kidneys are working so hard.

The testing you are describing sounds reasonable.

Here is a breakdown of what I paid in the way of diagnostics

$120 blood chemistry profile
$110 urine culture & sensitivity
$260 ACTH
$230 LDDS
$1300 CT scan (opted for this rather than ultrasound, which would have been approx $700)

A positive UC:CR does not automatically mean cushings, so you will likely still have to run an ACTH or LDDS, if your UC:CR comes back 'positive'.

The upfront costs can be quite daunting, but one thing at a time is the best way to proceed, and if it turns out your girl has cushings, the cost does drop once she is in the maintenance phase.

[scarlettjo'smom]

Thanks for the advice on the water. Should I keep her NPO for 12 prior to the UR:CR tests? Our appointment is tomorrow at 1:15. Please keep Scarlettjo in your thoughts, she really is the sweetest dog on the entire Planet! Any other advice is greatly appreciated. I have printed out information that I found from Mar Vista Animal Center (www.marvistavet.com) on Cushings, which explains the tests and purpose, so hopefully I will be prepared to ask the appropriate questions regarding further testing, prognosis and treatment. The only thing that gives me hope that this isn't Cushing's is that she does not have that Pot Belly that is so distinctive for this disease. Body wise she looks more like a dog with hypothyroidism, although I guess it is possible for her to have both diseases. The polydypsia, however leans me back toward a diagnosis of Cushings, however my research on the web says it could be due to hypokalemia. Hopefully I will know a little more tomorrow.

[labblab]

Will you only be consulting with the vet tomorrow about a general gameplan, or are you planning to actually move forward with testing? In reading your previous posts, I am confused about your vet's intentions re: the testing. It does not make sense to perform both a UC:CR and an ACTH stimulation test at the same time. The UC:CR is a urine test that is less expensive than an ACTH stimulation test, and is typically used as a first-line screening test to see whether more specific and expensive Cushing's testing is called for. The UC:CR can be used to rule out Cushing's if the result is in the normal range. However, elevation on the UC:CR can be caused by factors other than Cushing's. So if you get a "postive" on the UC:CR, that is the time that you'd move on to more specific Cushing's testing such as the ACTH or LDDS. If your vet is planning to perform an ACTH stimulation test, regardless, then there really is no point in performing a UC:CR in addition.

If your vet is indeed planning to first run a UC:CR as a preliminary screening test before moving on to an ACTH if needed, then the urine needs to be collected at home and definitely not in the vet's office. The stress of being examined/tested at the vet can increase the cortisol level enough to skew the results of the UC:CR. For a UC:CR, I am not aware of any food or water limitations beforehand. The protocol is simply to collect a free-catch urine sample from the very first urination in the morning. The sample should be kept refrigerated until it is delivered to the vet. We have been told by an endocrinological expert that for the most accurate testing, it is best to pool three samples, each one collected first thing in the morning on three subsequent days (and refrigerated). But regardless, the urine sample needs to be collected when the dog is as calm as possible and definitely not at the vet's office by any method (either by needle or free catch).


Although the UC:Cr is more frequently elevated than it is normal, when it is normal, you know that your patient does not have Cushing's disease and that you need to look for another possible cause for the patient's clinical signs.

It is preferable to perform a UC:Cr on a free-catch sample collected at home in the morning because a patient's stress from visiting the hospital or undergoing a cystocentesis can alter the UC:Cr.



As any form of stress can trigger a release of cortisol that could cause a false positive [on the UC:CR], samples must be collected at home.

If Scarlett is being seen solely to perform regular labwork and/or an ACTH stimulation test, then you need to check with your vet re: whether or not she should be fasted beforehand. I think that typically the answer is "yes" (when the ACTH and other labwork is being run for diagnostic purposes). But once again, if she is not being seen until mid-afternoon, it may be OK to give her an early breakfast since it will be several hours later before the blood sample is drawn. You would need to check with your vet to make sure how they want that handled.

Marianne

[scarlettjo'smom]

Originally I was taking her to a my vet that I have used for immunizations etc..., (hence the $630 quote), but after talking to my sister who had previously used this vet and her negative experience with them treating her dog for Addison's and another pet for CHF she convinced me to go to her current vet. Sis, actually called and arranged the appointment for me. Doc actually wants to see her first and examine her, get her history and present symptoms which makes more sense, (the other vet was going to perform the tests based on my suspicions...drop her off at 8 pick her up at 5 while they do testing).
So, in response to your question we will be discussing our game plan based on our visit tomorrow. I am to bring in her recent lab results which our being faxxed to me from the mobile vet clinic this afternoon. As mentioned before they were all completely WNL two months ago.
Scarlettjo had a really good evening yesterday. She chased a few frogs and didn't try to eat them, lol! She ate, but didn't seem as ravenous as usual. Of course most Golden's can eat you out of house and home. She didn't seem to overdrink, and didn't seem to pant much either. Temperatures dropped from triple digits to high 80's so perhaps that has helped her heat intolerance. She also needs her "last summer cut" of the season. She has not lost any hair, in fact she does not even shed so presently she is a full coat Goldendoodle which might be adding to her heat intolerance. Clippers are being repaired, so she is over due for her clipping.

[scarlettjo'smom]

BTW, how do I post a picture of my beautiful girl. I see everyone else's baby and want to share a pic of my sweet girl too.

[labblab]

Doc actually wants to see her first and examine her, get her history and present symptoms which makes more sense,

I am SOOOOOOO relieved to hear this, because absolutely it makes much more sense. Thank goodness! :)

As far as posting pictures of Scarlett (both in an album and also as your avatar), just click on this forum FAQs link and then select "User Profile Features." You'll find instructions about lots of helpful features, including handling photos. ;)

http://www.k9cushings.com/forum/faq.php

Marianne

[molly muffin]

Let us know if you have any trouble with the picture posting. We'd love to see her picture.

Also let us know what the vet thinks. It would be strange for her to have cushings and have all blood work within normal limits.

[scarlettjo'smom]

Scarlett had her appointment with her new vet yesterday. The vet spent two hours with her taking an extensive history and examining Scarlett from nose to tail tip. Doc thinks her discolored hair is due to licking as her skin pigment is universally pink and without discoloration. Doc said her fat is evenly distributed all the way to fat pads in her tail, and that she did not have a pot belly appearance, however Babygirl is overweight, (she had actually lost 5# and just 103). She ran some blood work up on Scar and compared it to her results from Mobile vet 2 months ago. Her WBC was quite elevated, and so doc ran a UA up also and Scarlett has a pretty nasty and quite severe UTI, which explains her excessive drinking and peeing. All other labs WNL with exception to her ALK Phos which was 202 (norm 2-150). I asked doc if that was a concern, and she said that it was not high enough to set off alarms. That with Cushings it would be much higher and most likely have elevated liver enzymes as well. Doc felt that her listlessness was due to her just having an infection, and that her exercise intolerance was due to her being overweight and maybe starting to show signs of arthritis. So we started some antibiotics for UTI, and a NSAID for arthritis. She goes back on 28th. Doc said that if she continues to show the increased thirst, peeing, listlessness, weight gain etc... we would do further testing, however she did not clinically see a Cushing dog. How high is an alarm bell for Alkaline Phosphate, and how often should it be checked? What other causes could make it go up, and is there any diet changes that could lower her alkaline phosphate? Presently she eats Victor dog food, Maintenance.

[Squirt's Mom]

MODERATOR NOTE: I have merged your post about the good news from the new vet into Scarlett’s original thread. We like to keep all posts about each pup in a single thread as it makes it easier for members, and parents, to refer back to the pup's history when needed. Thanks!

[molly muffin]

Oh gosh, my dog is over 1000 ALKP, so 202 is actually fine as your vet said. If you want to help her liver though, in general, a supplement that has milk thistle in it would probably work fine.

The UTI explains a lot and is one of the things that always has to be ruled out when it comes to the drinking and peeing before going into cushing testing.

I like the sound of this vet you saw and he seems to know more about cushings than the other vet did. So, good job mum.