A Bad Week

[Jim4157]

I found out this past week my best friend, Murphy (a 13 yr old Doodle), has Cushing's Disease. It started when I heard a strange scratching noise while sitting on my couch and when I looked around, he was sliding on the floor with only the use of his front legs and he had urinated all over himself. I thought he had injured his spine somehow. I rushed him to an emergency vet hospital (it was a Saturday around 5pm) and after agreeing to an MRI and spinal surgery (if necessary) I was informed his spine was OK. But, he was paralyzed. After an ultrasound they discovered he had a blood clot in the large artery that feeds blood to his hind legs and tail. They also found an adrenal tumor. It is a functional tumor that has not invaded other organs (yet). But, it is almost the size of his kidney. Plus, he had a severe urinary tract infection (UTI). After three days of treating him for the UTI and blood clot he has regained enough strength in his hind legs he can walk again for periods of about 75-80 seconds at a time before having to sit down. In hindsight this all makes sense. I had taken him to my vet a month ago b/c he had a bloated abdomen and I was scared he had an intestinal blockage after having given him a few small rawhide treats a few days before. But, that wasn't it. He peed and pooped fine. I had also noticed how much of an appetite he has had and his crazy thirst for lots of water. Then there were spells of heavy panting and the patches of hair dropping off his leg joints (elbows). The doc said blood clots and UTI's are also symptoms of Cushing's. All of the care he's received so far has cost me $7k. I was shocked when I got the final bill because I plunked down a $6400 deposit thinking that would cover the low end estimate for MRI+surgery+meds+hospitalization. And since the surgery was not necessary, I figured I'd be getting some money back. Nope. They found a way to spend it without telling me. Oh well. I had a feeling this would not turn out well. Anyway, I am treating Murph's blood clot with Clopidogrel (Plavix) hoping that he can regain his mobility someday. As for performing an adrenalectomy, I think that is not going to happen considering the additional cost and risk that he may not make it through the procedure/recovery given his age, plus I don't even know if he'll walk much anymore if the blood clot doesn't clear itself. Medicinal treatment of the tumor with Vetoryl (Trilostane) is an option I am seriously considering. I was quoted by the vet hospital it would cost $100 per two weeks (14 capsules) for the drug. That was a bit steep for me. Especially since he'd be on it for life. After looking online I found it priced at $53 for 30 capsules. That would save about $2k/year over the hospital's price. But, I would like to know how much all the testing will cost on top of the meds. I've seen the survey posted here. But, it doesn't really give me a good picture of what current day costs are since the survey has collected data over the years and doesn't really show the increase in pricing over the years, nor does it show the comparison of specialist cost vs GP cost. A couple graphs are in order. If anyone can shed some light on this I'd appreciate it. BTW, I live in the Denver area - not cheap. I would give a lot to extend the life of my best friend. I am divorced and live alone with him and he, like myself, is a survivor. I have beaten Leukemia and he has survived being hit by a car (broken leg) plus a botched surgery (non-related) where he almost bled to death. So, until next time, I'm not giving up on him.

[Joan2517]

Wow, he sure has been through a lot, the sweetheart...and you as well. Welcome....

I don't see anywhere in your post about blood work. Did they do any to test for Cushing's? If so please post those results so that members more knowledgeable than I can have a look. Just the highs and lows with the reference ranges.

[labblab]

Hello, and welcome from me, too. I'm certainly sorry, though, for all of Murphy's trials and tribulations right now. I certainly understand your reservations about proceeding with adrenal surgery, especially since he's already had this major clotting episode. I would think this vulnerability and his current Plavix regimen would make additional surgery really dicey. In fact, I don't see how it could even be considered unless the clot resolves and the Plavix was discontinued. Even then, this history of clotting would not be good, I wouldn't think, in terms of future surgical risks.

So, assuming surgery is "out," at least for now, Joan is right in that it will help us to know more about Murphy's labwork. Adrenal tumors can secrete a range of hormones -- do you know for certain that cortisol is one of them? In terms of trilostane treatment costs, probably the best thing you can do is to ask your vet what he/she will charge for the monitoring ACTHs. As you've already seen, the costs can be variable, depending on region and specialty. So for your own purposes, you need to find out what your own vet plans to charge. We can tell you that a monitoring ACTH should be performed no later than one month into treatment (and many vets prefer that it be done sooner, after 10-14 days). Once stabilized, the test should be performed every three months. However -- and this is a big however -- additional testing is required whenever problems occur or dosing changes are made.

I hope this gives you a little bit more to go on. Please continue to ask us questions and to tell us your thoughts. And big hugs to Murphy!

Marianne

[Squirt's Mom]

Hi Jim and welcome to you and Murphy! :)

Your sweet boy has certainly been thru the wringer already and I am sure the thought has occurred to you that this new discovery is completely unfair. We have all felt that way at least 100 times, so you are perfectly in line with the rest of us. You have been a great dad so far and I see no reason to think anything will change in the future. I am sure Murphy sees his hero when he looks at you. Whatever you ultimately decide, he trusts you completely to do the best you can for him...and so do we. One thing I have learned for sure during my years dealing with this disease and getting to know the parents who live with it - the decisions we make from a place of love are never, ever wrong.

I am glad you found us and want to be sure you see the top of the page here where it says, "Support, educate, encourage, remember". We live by those words every single day to the best of our ability. You need to know that you and Murphy are now part of our little family here at K9C - we will walk with you every step of the way. You are never alone.

Hugs,
Leslie and the gang

[Carole Alexander]

Hi Jim & Welcome,
Murphy's collapse and your experience with the emergency vet give new meaning to "a bad week". I hope that if you decide to treat Murphy that the Vetoryl gives you both relief. I know you will find supportive and helpful feedback here. Best to you both.

[Jim4157]

Thanks everyone for your kind words and support. I will be visiting the vet hospital today for Murphy's records and take them to my local vet. I will update on blood tests when I get them.

[judymaggie]

Hi, Jim -- I wanted to add my "welcome" to you and Murphy! It is obvious how much you and Murphy mean to each other. Others have already covered any questions I might have at this point in time so am looking forward to seeing Murphy's test numbers as well as the specific results of any Cushing's tests.

[molly muffin]

Hello, I too send you warm welcomes to the forum.

i agree, surgery is definitely dicey. Vetroyl is a possibility. There is also the generic brand of trilostane, which usually is cheaper. Most who use it get it from an online pharmacy, such as diamondback. I'm in Canada and found a pet pharmacy who compounded trilostane and that helped with the costs a lot.

ACTH can varify from vet to vet, and between specialist and gp vet. I got alll of mine done by the Internal med specialist and they actually had a reasonable cost for the ACTH because they do so many dogs, that they would divide and freeze the agent used for stimulation and it turned out to be cheaper than my gp vet who didn't use it as often and would have to charge more usually.
So that is something to keep in mind and a simple phone call to the various vets you use including the specialist and ask how much it is would be well worth your while.
I personally would probably want the specialist to be in charge of Murphys treatment just because things are dicey with that clot and I'd want the best to be dealing with everything. Well that is the road i chose to go down with my own molly when dealing with cushings, eye issues and kidney problems.

But the phone calls will be important to find out pricing. Even between states the prices can vary quite a bit.