Author Topic: Any veterinrians? Long term prednisone use for dog  (Read 12031 times)

frugalnacho

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Any veterinrians? Long term prednisone use for dog
« on: February 11, 2016, 04:00:30 PM »
TL;DR - The vet wants to run frequent expensive blood work tests on my dog that is on long term prednisone usage to control allergies.  I can't get a straight answer out of them as to why it's necessary.  I understand there are risks associated with long term steroid use, but we've gone over it a hundred times with the vet and it's absolutely required.

Some back story:

Have a 7 year old dog.  She has severe redness on her skin, to the point that her quality of life is so poor we would put her down if we couldn't treat it.  We had allergy testing done.  Dog is allergic to everything (all plants, dust, humans, etc, probably air too).  We gave her expensive allergy shots that were developed specifically for her from her allergy testing, in conjunction with prednisone.  She was on those shots for a year, and multiple times we tried to ween her off the prednisone and just give her the shots.  The combination worked pretty well, but every time she was off the prednisone her allergies and redness came back 100%.  The shots had literally no effect on her condition.  After a year of the shots we switched to a special oral immunotherapy that was squirted under her tongue twice a day.  Same deal as the shots, literally no effect, the only time the redness and uncomfortableness subsided was when she was receiving prednisone.  We did the oral thing for a year, and opted not to repurchase anymore since it was expensive and we saw no effect.  The vet kept telling us it takes time to get into their system, but i don't believe it should take over a year (two years total) with absolutely no effect - I think they just wanted to keep selling us very expensive snake oil. 

We made the decision to keep giving her a low dose of prednisone (which seems to take care of 90% of the redness/itchiness about 90% of the time) long term with the full understanding that it was almost certainly going to take a toll on her health, and significantly reduce her life span. We all (vet included) thought that was better than letting her suffer or putting her down.

Fast forward another year and the vet insists we take her in for a check up and blood testing, to the tune of almost $500*.  We do it and everything is fine.  Now they want to perform expensive blood work every 6 months before they give us another prescription of prednisone.  There is no going off the prednisone at this point, she is on it until she either dies or has to be put down; her quality of life will just be too low to justify keeping her around with such intense allergies (the vet knows this - they helped us come to this conclusion and agree with it).  I asked why it's necessary to keep checking her when we all came to the conlcusion that once a complication arises that necessitates stopping the steriods, we are putting her down.  Like what is the game plan with the expensive blood work? What exactly are we going to do regardless of the test? She is having no obvious signs of organ failure or discomfort (besides ongoing problems we are already aware of).  I was expecting the vet to be able to articulate some good, rational reason that we need to continue bringing her in, but they won't give me any type of straight answer, they just keep saying you are supposed to perform blood work every 6 months (maximum) because long term steroid use is bad (we know that, and have exhausted all other options already).  Really makes me think they are just trying to make some money by performing unnecessary tests.

Now I certainly don't want her to needlessly suffer, but I also don't want to cart her into the vet every 5-6 months for expensive unnecessary blood work and testing.

Unrelated she also has knee problems.  She tore her CCL on her back leg and had surgery done a few years ago.  She subsequently injured her other back leg as well (I think partly because she was prone to it, partly because she's on long term steroids, and partly because she was overcompensating because of her bunk surgery leg), but we didn't go through the surgery a second time.  It seems to have healed on it's own, although she still has some obvious difficulty using stairs.  Just one more reason we aren't eager to spend tons of money trying to extend her life once the quality declines.

Any vets on here that can weigh in?  Is it really necessary to perform $500 worth of tests every 5-6 months?  Is an organ failure problem going to manifest itself eventually anyway if we don't perform blood work? Is she going to suffer by going undiagnosed?  What should we do with this damn dog?

EDIT: *$500 was for the entire exam.  The cost of bloodwork alone is more likely in line with what others have posted ($160-200)
« Last Edit: February 20, 2016, 10:34:57 AM by frugalnacho »

Mtngrl

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Re: Any veterinrians? Long term prednisone use for dog
« Reply #1 on: February 11, 2016, 04:15:27 PM »
Not a vet, so I hope one will weigh in to give a more official answer. I can only share my experience with a dog with allergies. Forgive me if you have already tried this solution and it didn't help.

Have you tried switching to a different food? Preferably something grain-free and limited ingredient? This eliminated almost all the redness and itching for my dog. A benedryl every evening did the rest. Again, forgive me if you have already tried this and it didn't work. 

Elliot

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Re: Any veterinrians? Long term prednisone use for dog
« Reply #2 on: February 11, 2016, 04:21:47 PM »
Not a vet, but my dog has similar skin complaints. Limited ingredient diet helped a lot, but we also had to make the following changes:

Weekly wash with coal tar shampoo
Wash all dog bedding and blankets weekly
No "scratching" pets, as much as he enjoys them.

Also it might be worth getting the pet checked for yeast. Because of the frequent irritation, our dog is susceptible to skin yeast infections and a short course of a daily pill every so often is helpful to keep that at bay. We call the bet whenever his skin is red, flaky, and has that particular faint odor.

Gin1984

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Re: Any veterinrians? Long term prednisone use for dog
« Reply #3 on: February 11, 2016, 04:25:29 PM »
Not a vet, but my aunt is vet tech and my mom's dog is on the same drug.  The reason for the blood test is to catch if the pred is causes serious adverse effects.  It literally could cause your dog's organs to shut down and that is a painful way to die. 

cdttmm

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Re: Any veterinrians? Long term prednisone use for dog
« Reply #4 on: February 11, 2016, 04:32:12 PM »
Not a vet, but I've had several dogs and cats prescribed prednisone for various reasons. My understanding is this: if you're using pred at a level that it acts as an immunosuppressant (in your dog's case, to prevent a whole host of allergic reactions), then it can lead to a whole bunch of secondary infection possibilities and, potentially, the onset of drug-induced Cushing's disease. So basically, your vet wants to monitor the bloodwork to essentially know when (not if, but when) this stuff happens, which will allow your vet to respond with a different combo of drugs once your dog can no longer tolerate pred. But it seems like there's a fine line between when pred is doing more harm than good in these cases so regular bloodwork is pretty much the only way to know when you've crossed that line (or to try to guess that you're about to cross the line).

I feel for you. I have a cat with renal disease (mid stage), a dog with renal disease (early stage), and another cat with a currently undetermined medical issue. Regular bloodwork is just part of the routine for all of them. I try not to think about it in terms of dollars and cents instead preferring to think about the additional days/weeks/months/years of high-quality life they have gotten as a result. My cat was diagnosed with renal disease nearly 5 years ago. He'll turn 20 in April. Every vet visit, every round of bloodwork, every dollar spent has been totally worth it to have the extra 1,800+ days with him curled up on my lap while I surf the internet, sleeping in bed next to me every night, and bringing me a ridiculous amount of joy.

Now, if you don't trust your vet, then get a new vet. But, if you trust your vet, then follow their instructions. They spent a lot of years in school learning how to treat our furry, four-legged children.

And now, hopefully, some actual vets will weigh in on this.  :)

frugalnacho

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Re: Any veterinrians? Long term prednisone use for dog
« Reply #5 on: February 11, 2016, 04:33:06 PM »
Not a vet, so I hope one will weigh in to give a more official answer. I can only share my experience with a dog with allergies. Forgive me if you have already tried this solution and it didn't help.

Have you tried switching to a different food? Preferably something grain-free and limited ingredient? This eliminated almost all the redness and itching for my dog. A benedryl every evening did the rest. Again, forgive me if you have already tried this and it didn't work.

We've tried everything.  Benedryl, daily vacuuming, weekly washing of her bed and sheets with scent free soap, weekly baths with hypoallergenic dog soap, changing foods multiple times, etc.  We went through every possible option and came to the conclusion (with the vet) the only thing left to do is long term steroid use.

frugalnacho

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Re: Any veterinrians? Long term prednisone use for dog
« Reply #6 on: February 11, 2016, 04:41:20 PM »
Not a vet, but I've had several dogs and cats prescribed prednisone for various reasons. My understanding is this: if you're using pred at a level that it acts as an immunosuppressant (in your dog's case, to prevent a whole host of allergic reactions), then it can lead to a whole bunch of secondary infection possibilities and, potentially, the onset of drug-induced Cushing's disease. So basically, your vet wants to monitor the bloodwork to essentially know when (not if, but when) this stuff happens, which will allow your vet to respond with a different combo of drugs once your dog can no longer tolerate pred. But it seems like there's a fine line between when pred is doing more harm than good in these cases so regular bloodwork is pretty much the only way to know when you've crossed that line (or to try to guess that you're about to cross the line).

I feel for you. I have a cat with renal disease (mid stage), a dog with renal disease (early stage), and another cat with a currently undetermined medical issue. Regular bloodwork is just part of the routine for all of them. I try not to think about it in terms of dollars and cents instead preferring to think about the additional days/weeks/months/years of high-quality life they have gotten as a result. My cat was diagnosed with renal disease nearly 5 years ago. He'll turn 20 in April. Every vet visit, every round of bloodwork, every dollar spent has been totally worth it to have the extra 1,800+ days with him curled up on my lap while I surf the internet, sleeping in bed next to me every night, and bringing me a ridiculous amount of joy.

Now, if you don't trust your vet, then get a new vet. But, if you trust your vet, then follow their instructions. They spent a lot of years in school learning how to treat our furry, four-legged children.

And now, hopefully, some actual vets will weigh in on this.  :)

The vet has already said this is the end of the line.  We've tried everything, and they don't like the idea of giving her pred, but the alternative is putting her down (or just letting her suffer with her allergies - which is also not an option).  I've asked what happens when she gets organ failure and can no longer receive prednisone, and there is no next step.  Which is why i'm confused about why they need to test so much.

Like I said I don't want the dog to suffer, but are there any warning signs of impending organ failure?  Ones that don't require $500 worth of testing every 6 months?
« Last Edit: February 11, 2016, 04:44:02 PM by frugalnacho »

frugalnacho

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Re: Any veterinrians? Long term prednisone use for dog
« Reply #7 on: February 11, 2016, 04:44:38 PM »
Not a vet, but my aunt is vet tech and my mom's dog is on the same drug.  The reason for the blood test is to catch if the pred is causes serious adverse effects.  It literally could cause your dog's organs to shut down and that is a painful way to die.

That seems like a very good reason, so why couldn't the vet articulate that to me?

Elliot

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Re: Any veterinrians? Long term prednisone use for dog
« Reply #8 on: February 11, 2016, 04:48:01 PM »
I imagine the signs are the same as for humans. Blood tests ARE the easy, cheap way to know.

You can get health insurance for dogs, if that's something you want to look into.

frugalnacho

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Re: Any veterinrians? Long term prednisone use for dog
« Reply #9 on: February 11, 2016, 04:51:55 PM »
I imagine the signs are the same as for humans. Blood tests ARE the easy, cheap way to know.

You can get health insurance for dogs, if that's something you want to look into.

Well it's not cheap. 

How would insurance help with regularly scheduled blood work?  What kind of insurer would offer a policy they are for sure going to lose money on?  Due to the numerous problems this dog has, once she has organ failure it's the end of the line for her.

EDIT: Wtf is with the close quote not showing up? that's the second time in this thread it's done that to me, and i'm not editing the quotes or anything.
« Last Edit: February 11, 2016, 05:21:38 PM by frugalnacho »

Elliot

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Re: Any veterinrians? Long term prednisone use for dog
« Reply #10 on: February 11, 2016, 04:55:07 PM »
Those are questions for when you comparison shop plans.

frugalnacho

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Re: Any veterinrians? Long term prednisone use for dog
« Reply #11 on: February 11, 2016, 05:22:56 PM »
Those are questions for when you comparison shop plans.

They were rhetorical questions. 

lbmustache

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Re: Any veterinrians? Long term prednisone use for dog
« Reply #12 on: February 11, 2016, 05:30:43 PM »
Those are questions for when you comparison shop plans.

Most pet insurance will not cover pre-existing conditions.

startingsmall

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Re: Any veterinrians? Long term prednisone use for dog
« Reply #13 on: February 11, 2016, 06:48:22 PM »
If you're using pred at a level that it acts as an immunosuppressant (in your dog's case, to prevent a whole host of allergic reactions), then it can lead to a whole bunch of secondary infection possibilities and, potentially, the onset of drug-induced Cushing's disease. So basically, your vet wants to monitor the bloodwork to essentially know when (not if, but when) this stuff happens, which will allow your vet to respond with a different combo of drugs once your dog can no longer tolerate pred. But it seems like there's a fine line between when pred is doing more harm than good in these cases so regular bloodwork is pretty much the only way to know when you've crossed that line (or to try to guess that you're about to cross the line).

Vet here... and this description is pretty much exactly what I was going to type, so I'll just say ditto. (And add that I would love a client who pays this much attention and is this educated about their own pets!!)

Even if you won't stop the pred, monitoring the bloodwork will let you catch side effects early and some of those side effects could potentially be managed without having to discontinue the pred. It may all seem silly, but veterinarians get sued for drug side effects with increasing frequency and therefore we have no choice but to cover our butts in situations like this. You may be able to find a veterinarian who would let you go down to once yearly on the bloodwork (instead of every six months), if this is really a deal-breaker for you and you want to shop around. There are also some veterinarians that would let you continue long-term pred without any monitoring at all, but these are likely old-school vets that you wouldn't otherwise want to trust with your pet.

frugalnacho

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Re: Any veterinrians? Long term prednisone use for dog
« Reply #14 on: February 11, 2016, 07:38:40 PM »
If you're using pred at a level that it acts as an immunosuppressant (in your dog's case, to prevent a whole host of allergic reactions), then it can lead to a whole bunch of secondary infection possibilities and, potentially, the onset of drug-induced Cushing's disease. So basically, your vet wants to monitor the bloodwork to essentially know when (not if, but when) this stuff happens, which will allow your vet to respond with a different combo of drugs once your dog can no longer tolerate pred. But it seems like there's a fine line between when pred is doing more harm than good in these cases so regular bloodwork is pretty much the only way to know when you've crossed that line (or to try to guess that you're about to cross the line).

Vet here... and this description is pretty much exactly what I was going to type, so I'll just say ditto. (And add that I would love a client who pays this much attention and is this educated about their own pets!!)

Even if you won't stop the pred, monitoring the bloodwork will let you catch side effects early and some of those side effects could potentially be managed without having to discontinue the pred. It may all seem silly, but veterinarians get sued for drug side effects with increasing frequency and therefore we have no choice but to cover our butts in situations like this. You may be able to find a veterinarian who would let you go down to once yearly on the bloodwork (instead of every six months), if this is really a deal-breaker for you and you want to shop around. There are also some veterinarians that would let you continue long-term pred without any monitoring at all, but these are likely old-school vets that you wouldn't otherwise want to trust with your pet.

The dosage is pretty low according to the vet.  It's 10mg every other day, for a 60 lb dog.

startingsmall

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Re: Any veterinrians? Long term prednisone use for dog
« Reply #15 on: February 11, 2016, 08:30:02 PM »
That is pretty low. If it were my dog, I'd be checking bloodwork every 12 months. (Incidentally, the physical exam plus bloodwork would also cost around $200 in my area instead of $500... unless that number is also including additional services.)

frugalnacho

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Re: Any veterinrians? Long term prednisone use for dog
« Reply #16 on: February 11, 2016, 08:51:33 PM »
That is pretty low. If it were my dog, I'd be checking bloodwork every 12 months. (Incidentally, the physical exam plus bloodwork would also cost around $200 in my area instead of $500... unless that number is also including additional services.)

I don't remember exactly what the charges were last time.  It may have included other services.  I will definitely check into it.

Thanks for all the replies everyone.  I will come back eventually and update on the status.

Rural

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Re: Any veterinrians? Long term prednisone use for dog
« Reply #17 on: February 12, 2016, 03:15:21 AM »
I swear by those old school vets personally; one of them saved my dog from suffering needless hip surgery at age two because the fancy vet ran tests and insisted it was absolutely neccessary right away. The dog (giant breed) died a decade later of old age having never had any hip trouble at all.


Same old school vet had a different, very old dog on much higher doses of Prednisone than your dog to keep her comfortable. She made sure we understood that it wouldn't be appropriate in a younger dog, but she would not live long enough for the prednisone to do real damage. She had a much better last couple of years (longer than we expected) with no blood tests, but that may have been because she was terminal.

startingsmall

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Re: Any veterinrians? Long term prednisone use for dog
« Reply #18 on: February 12, 2016, 06:16:30 AM »
I swear by those old school vets personally; one of them saved my dog from suffering needless hip surgery at age two because the fancy vet ran tests and insisted it was absolutely neccessary right away. The dog (giant breed) died a decade later of old age having never had any hip trouble at all.


Same old school vet had a different, very old dog on much higher doses of Prednisone than your dog to keep her comfortable. She made sure we understood that it wouldn't be appropriate in a younger dog, but she would not live long enough for the prednisone to do real damage. She had a much better last couple of years (longer than we expected) with no blood tests, but that may have been because she was terminal.

I think we have different definitions of 'old school.' Giving an owner non-surgical options for hip replacement? Totally normal, not old-school at all. Using pred for a terminal disease (ie. lymphoma) without running routine monitoring bloodwork? Not old school and totally normal, because it's being used for palliative care and the lymphoma is worse than whatever pred side effects might develop. But chronic prednisone for allergies, with no monitoring bloodwork? That's something that, at least in my area, is typically done only by the docs who run the "get your cheap rabies here, no exam required!" super-cheap clinics. You know, the vets who are 70-80 years old and haven't updated their standards since graduation (cheap spays because they don't 'waste money' on pre-anesthetic bloodwork, IV catheter, intubation or inhalant anesthesia, surgical monitors, or trained/licensed technicians). I'm in a rural area, so my definition of 'old school vet' may be different from yours.... but around here, we have a lot of these old guys who still practice out of a tiny little falling-down clinic or even a room in their house, seeing clients for a few hours per day on a walk-in only basis. Clients love these guys because they're cheap, but then they come to us when 'old doc' closes at noon and their pet has complications from his treatment (or lack thereof).

Axecleaver

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Re: Any veterinrians? Long term prednisone use for dog
« Reply #19 on: February 12, 2016, 07:44:52 AM »
Quote
The dosage is pretty low according to the vet.  It's 10mg every other day, for a 60 lb dog.
The key with long term pred usage is giving it every other day. It's filtered by the liver, this gives your liver time to recover in between doses.

A lot of folks do whatever tests their doctor (or vet) recommends, without asking the question, "if it's a bad result, then what?" That's the question you need an answer to, and if the test result doesn't change your strategy, then why do it at all?

warmastoast

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Re: Any veterinrians? Long term prednisone use for dog
« Reply #20 on: February 12, 2016, 08:14:05 AM »
Not a vet but my dog has had severe skin problems as you describe since we moved to Austin - aka allergy capital of north america.  After constantly going back to the vet's for over 18 months, giving antibiotics, anti-fungals, steroids and anti-histamines we finally got to see a real dermatology vet.  The difference is amazing and here's what she did.

First off since my dog already had skin lesions, redness and a horrible yeasty smell with her hair falling out in handfuls.... anti-biotics, prednisone, an antibiotic/antifungal shampoo and most importantly,  a very restricted diet.  She was given a protein that we were sure she had never eaten before so the choice was Rabbit or Kangaroo.  Since rabbit is easier to digest we chose this.  Her anti-flea/tick medication was changed to a different one with no beef/chicken which lasts for 3 months (Bravecta) since the vet suspected that our dog is also allergic to flea bites and the previous flea/tick treatment seemed to wear off at about 3 weeks and not 4 weeks.  Ivermectin liquid was given in a small syringe so that there would be nothing in that which she might be allergic to.

This first round of treatment lasted about 5 weeks and cleared her up completely.

The medications were all stopped apart from the 2 x weekly anti-fungal, anti bacterial shampoo and we continued with the the very restricted diet of rabbbit only. 

She had no more problems for about 3 months then I noticed a little bit of redness and a small lesion.  This after I had given her one of her usual flea tick beef flavoured tablets.  Went back and derm vet said "cedar pollen" and she is allergic to beef and probably chicken since the two seem to go together. So she was given a stronger anti-fungal/anti-biotic mousse to use 2x daily for 2 weeks and we give her zyrtec morning and night.  Everything has cleared up and as soon as the cedar pollen dies down, I will stop the zyrtec.

It has been a horrible introduction to the US for our poor dog and I can't tell you how thankful I am that we now seem to have things somewhat under control

If you want to know exactly the medicines and products used. Let me know and I'll get a list together for you.
« Last Edit: February 12, 2016, 08:18:26 AM by warmastoast »

lthenderson

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Re: Any veterinrians? Long term prednisone use for dog
« Reply #21 on: February 12, 2016, 08:34:47 AM »
Years ago, I adopted a stray dog about one year old that had been shot in the rear hip at some point. At around age of 2 or 3, arthritis set in and we ended up giving him prednisone once a month. It was a miracle drug in my opinion. By the last week of the month, he would obviously be getting stiff and hurting in his rear hip area. The day after the shot, he would be out running around like a puppy again and that would last for three weeks or so. Eventually after about five years, it did destroy his liver and he died. We never did any blood tests and since this was 25 years ago, I'm not sure that was even an option back then. Would I do it again knowing the eventual outcome? Absolutely.

The_path_less_taken

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Re: Any veterinrians? Long term prednisone use for dog
« Reply #22 on: February 12, 2016, 08:49:19 AM »
NOT a vet, but have a dog (boxer/bulldog cross) who has allergies so severe she's damaged both of her corneas scratching, and has chewed/scratched hotspots deeper than skin level: just bloody meat showing.

The shots worked the first year. The second year we switched shots. Did everything you've done...every now and then it was just beyond insane allergy misery for this dog.

Tried brand new prescription Apoquel: dog was fine within 3 days. Skin/hair grew back, no scratching, everything normal.

Warning: Apoquel is hard to keep in stock and you might need to go to a couple of vets so you're always able to buy it....they limit how much they sell each vet. But it's also a drug that can be weaned off of and low dosed. Lulu hadn't been on it for moths, started scratching three days ago, one pill and nothing different and she's fine now. Will keep her on a half dose for a week and hopefully good to go until full summer allergy season hits (again: I'm not a vet, but I usually have 4-5 rescue dogs here).

Regarding the blood tests: I quit a vet I liked because they insisted on $350 blood tests every six months for a dog on phenobarb who had seizures. I had reduced the dosage to the point that a quarter pill less put her into grand mal seizures: the vet and I and the bloodwork all agreed she was on the correct dosage. No liver complications, and I had her on milk thistle anyway...

If, like you say, the option is 'stop the med/put the dog down'....the expensive tests pissed me off.

YES, maybe they can catch a complication. But if they're not offering an alternative then I don't see the point.


startingsmall

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Re: Any veterinrians? Long term prednisone use for dog
« Reply #23 on: February 13, 2016, 06:06:13 AM »

Regarding the blood tests: I quit a vet I liked because they insisted on $350 blood tests every six months for a dog on phenobarb who had seizures. I had reduced the dosage to the point that a quarter pill less put her into grand mal seizures: the vet and I and the bloodwork all agreed she was on the correct dosage. No liver complications, and I had her on milk thistle anyway...

If, like you say, the option is 'stop the med/put the dog down'....the expensive tests pissed me off.

YES, maybe they can catch a complication. But if they're not offering an alternative then I don't see the point.

There's often a difference of opinion between veterinarians (who have taken an oath to do what's best for the pet) and clients (who are often more focused on finances). Nothing I say is going to change that.... and the adversarial relationship that it creates is one of my primary reasons for wanting out of the profession. Still, there's a lot that could have been done if your dog's bloodwork was abnormal. If phenobarb levels were too high on monitoring bloodwork, or if your dog started showing signs of liver damage, your vet would have switched your dog to one of any number of other anti-seizure medications that are safer for the liver.

I always explain to clients not only the 'why' of testing, but how it might change our treatment plan. For example "we need to check Fifi's bloodwork every six months, to make sure that her phenobarb level is in the therapeutic range and that she is not having any adverse effects from the medication. If either of those things are happening, we'll need to discuss other treatment options." If your vet isn't doing that, or won't do that if asked, then I can definitely understand seeing a new vet. Just try to remember that your vet spent EIGHT YEARS in school (undergrad/prereqs + DVM) to learn all of this info, so we really aren't just pulling stuff out of our butts. Depending on the state, your veterinarian attends anywhere from 10-20 hours of continuing education per year in order to stay current. With a few exceptions (mostly the old-timers), we know our stuff.

bogart

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Re: Any veterinrians? Long term prednisone use for dog
« Reply #24 on: February 13, 2016, 09:39:23 PM »

There's often a difference of opinion between veterinarians (who have taken an oath to do what's best for the pet) and clients (who are often more focused on finances). Nothing I say is going to change that.... and the adversarial relationship that it creates is one of my primary reasons for wanting out of the profession.

I don't doubt that and am sorry it makes the profession difficult; I write this as an animal owner who's spent both comparatively vast and comparatively  tiny amount of money on animals and their medical problems over the years. 

I can't speak to the OP's situation and don't know what his finances involve, but I think it's worth remembering both that any given pet owner's finances may include other priorities (I am not, for the record, thinking here of RE, something that interests me personally very little -- though of course others might rank it higher) that are legitimately and appropriately higher ranked than expensive medical treatment for any given pet, even assuming a caring and concerned owner.  Indeed, in a context where healthy, adoptable animals are regularly euthanized, I find spending lots of money on any given animal's problems hard to justify, even just on the basis of "animal welfare," though as noted, I've done it and heck, likely will again sooner or later.

In terms of the given dog's best interest, it's not obvious to me that if the choice is
  • more-or-less-immediate euthanasia of an animal who can be kept comfortable using a very inexpensive, easy to administer medication, because the owner can't or wont' pay for the expensive blood tests that the vet recommends accompany the medication's use, or
  • an ongoing and comfortable life that ends at some unknown time down the road due to organ failure caused by the prednisone and absence of expensive blood tests -- and I have to assume that if the organ failure was detected based on symptoms, though I realize animals can be remarkably stoic, the owner would euthanize the dog

... that the first bullet is the kinder/better choice.

That seems to me a value judgment that is better made by the pet's owner in careful consultation with the vet than by the vet.

iris lily

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Re: Any veterinrians? Long term prednisone use for dog
« Reply #25 on: February 13, 2016, 10:34:21 PM »
Not a vet, but I've had several dogs and cats prescribed prednisone for various reasons. My understanding is this: if you're using pred at a level that it acts as an immunosuppressant (in your dog's case, to prevent a whole host of allergic reactions), then it can lead to a whole bunch of secondary infection possibilities and, potentially, the onset of drug-induced Cushing's disease. So basically, your vet wants to monitor the bloodwork to essentially know when (not if, but when) this stuff happens, which will allow your vet to respond with a different combo of drugs once your dog can no longer tolerate pred. But it seems like there's a fine line between when pred is doing more harm than good in these cases so regular bloodwork is pretty much the only way to know when you've crossed that line (or to try to guess that you're about to cross the line).

I feel for you. I have a cat with renal disease (mid stage), a dog with renal disease (early stage), and another cat with a currently undetermined medical issue. Regular bloodwork is just part of the routine for all of them. I try not to think about it in terms of dollars and cents instead preferring to think about the additional days/weeks/months/years of high-quality life they have gotten as a result. My cat was diagnosed with renal disease nearly 5 years ago. He'll turn 20 in April. Every vet visit, every round of bloodwork, every dollar spent has been totally worth it to have the extra 1,800+ days with him curled up on my lap while I surf the internet, sleeping in bed next to me every night, and bringing me a ridiculous amount of joy.

Now, if you don't trust your vet, then get a new vet. But, if you trust your vet, then follow their instructions. They spent a lot of years in school learning how to treat our furry, four-legged children.

And now, hopefully, some actual vets will weigh in on this.  :)

The vet has already said this is the end of the line.  We've tried everything, and they don't like the idea of giving her pred, but the alternative is putting her down (or just letting her suffer with her allergies - which is also not an option).  I've asked what happens when she gets organ failure and can no longer receive prednisone, and there is no next step.  Which is why i'm confused about why they need to test so much.

Like I said I don't want the dog to suffer, but are there any warning signs of impending organ failure?  Ones that don't require $500 worth of testing every 6 months?

Really? The end of the line? Not a vet. but--I've  got a rescue dog who came in to my house with the most horrific skin you can imagine, his former family treated it with pred and antibiotics. Then they would get tired of it. Then he would break out badly,and they would treat it. They Became tired of that and turned him into rescue..

I took one  look at him as foster mom and said "we are goong to the skin specialist,."  Lots and lots of dollars later after some analysis, he is on Apoquel which controls his skin beautifully. It costs about $500 -$600 annually. His medication routine is 2 pills daily, big dose in the am and small dose in the evening.
Apoquel has been out on the market for for about 2.5 years.

Sure, we also feed him grain free food but he is allergic to everything, the food isnt a cause.

Prior to Apoquel he was on an older and more expensive drug, Atopica, but he had side effects from that although it, too, controlled his skin nicely.

I wish I could post a photo to show you how bad he was. Honestly, I too would have euthanized him if we didnt get this miracle drug. It is truly a miracle.

Atopica took 6 weeks to kick in.  Apoquel  kicked in sooner.

If your vet isnt  talking about Either of these drugs, I would be interested to know why. It doesn't work for all dogs, of course.

Edited to add: i see that someone upthread talked about
Apoquel. Yes, it can be hard to get and some vets in gEneral practice may not be able to get it at all. Not too long ago  only the specialists were able to get the drug. Now, I know a vet in general practice who can het it.

But other than initial startup, our supply has been smooth. Besides, i woul ,break into the vets office with an Uzi to get Apoquel for me dog, its the difference between life and death for him.
« Last Edit: February 14, 2016, 07:26:32 AM by iris lily »

iris lily

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Re: Any veterinrians? Long term prednisone use for dog
« Reply #26 on: February 13, 2016, 10:41:06 PM »
I imagine the signs are the same as for humans. Blood tests ARE the easy, cheap way to know.

You can get health insurance for dogs, if that's something you want to look into.
Hes not going to get   health insurance for a dog with this pre existing condition.

startingsmall

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Re: Any veterinrians? Long term prednisone use for dog
« Reply #27 on: February 14, 2016, 06:04:37 AM »

There's often a difference of opinion between veterinarians (who have taken an oath to do what's best for the pet) and clients (who are often more focused on finances). Nothing I say is going to change that.... and the adversarial relationship that it creates is one of my primary reasons for wanting out of the profession.

I don't doubt that and am sorry it makes the profession difficult; I write this as an animal owner who's spent both comparatively vast and comparatively  tiny amount of money on animals and their medical problems over the years. 

I can't speak to the OP's situation and don't know what his finances involve, but I think it's worth remembering both that any given pet owner's finances may include other priorities (I am not, for the record, thinking here of RE, something that interests me personally very little -- though of course others might rank it higher) that are legitimately and appropriately higher ranked than expensive medical treatment for any given pet, even assuming a caring and concerned owner.  Indeed, in a context where healthy, adoptable animals are regularly euthanized, I find spending lots of money on any given animal's problems hard to justify, even just on the basis of "animal welfare," though as noted, I've done it and heck, likely will again sooner or later.

In terms of the given dog's best interest, it's not obvious to me that if the choice is
  • more-or-less-immediate euthanasia of an animal who can be kept comfortable using a very inexpensive, easy to administer medication, because the owner can't or wont' pay for the expensive blood tests that the vet recommends accompany the medication's use, or
  • an ongoing and comfortable life that ends at some unknown time down the road due to organ failure caused by the prednisone and absence of expensive blood tests -- and I have to assume that if the organ failure was detected based on symptoms, though I realize animals can be remarkably stoic, the owner would euthanize the dog

... that the first bullet is the kinder/better choice.

That seems to me a value judgment that is better made by the pet's owner in careful consultation with the vet than by the vet.

I absolutely understand that everyone has different financial/time/emotional budgets and I will never hesitate to euthanize a pet when the owner is not willing or able to afford appropriate care. I'm referring more to those conditions where owners make their own treatment decisions, ie. "I want to continue treating my pet with XYZ medication but I refuse to perform the necessary monitoring because my vet is a money-grubbing jerk" (not exactly what was said in this discussion, but something I hear on a regular basis).

A more productive way to approach that sort of conversation? "Hey Doc, I know you're saying that medication XYZ requires bloodwork monitoring every six months, but that's really not something I can do right now. Where does that leave us? What are our options?" Depending on the drug and your individual pet's condition, that may mean changing to an alternative drug with lower risk of side effects, may mean that the vet changes their monitoring requirements, or may mean that you're having a conversation about euthanasia... but either way, if money is tight then LET YOUR VET KNOW. I often have clients come in with a sick dog and a limited budget. What drives me nuts? When they pick and choose tests based on what their breeder said or what they read on the internet. What doesn't drive me nuts? When they tell me, honestly, "I only have $200 to work with here. I know that isn't enough to do everything that he needs, but what is your recommendation?" If funds are limited, most of us would be glad to help you choose the tests/treatments that will give you the most bang for your buck. Just last week, I had a vomiting puppy come in and the owner only had $90. She had scraped together $90 because that was just enough to cover our euthanasia fee :(   After looking at the puppy, I wasn't quite convinced that was necessary... and two of my techs offered to contribute their own money (I work in a corporate office, so I can't adjust off any charges or give anything away) so that we could perform some basic diagnostics and start symptomatic care. The client has failed to return our phone calls checking up on the puppy, so either the puppy didn't make it or she just feels weird about the situation, but we were able to at least give that dog a chance because she was honest with us instead of just coming in blustering about expensive vets.


startingsmall

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Re: Any veterinrians? Long term prednisone use for dog
« Reply #28 on: February 14, 2016, 06:09:55 AM »
And yes, Apoquel = amazing. My last job was at a clinic that was receiving a very small supply of Apoquel... and that stuff was like gold. Unfortunately, I now work for a large corporation that is slow to get new drugs and therefore never got on the list of Apoquel customers, so we're still having to wait for a more consistent supply. The dermatologists can usually get it, though.

Gin1984

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Re: Any veterinrians? Long term prednisone use for dog
« Reply #29 on: February 14, 2016, 12:48:46 PM »

There's often a difference of opinion between veterinarians (who have taken an oath to do what's best for the pet) and clients (who are often more focused on finances). Nothing I say is going to change that.... and the adversarial relationship that it creates is one of my primary reasons for wanting out of the profession.

I don't doubt that and am sorry it makes the profession difficult; I write this as an animal owner who's spent both comparatively vast and comparatively  tiny amount of money on animals and their medical problems over the years. 

I can't speak to the OP's situation and don't know what his finances involve, but I think it's worth remembering both that any given pet owner's finances may include other priorities (I am not, for the record, thinking here of RE, something that interests me personally very little -- though of course others might rank it higher) that are legitimately and appropriately higher ranked than expensive medical treatment for any given pet, even assuming a caring and concerned owner.  Indeed, in a context where healthy, adoptable animals are regularly euthanized, I find spending lots of money on any given animal's problems hard to justify, even just on the basis of "animal welfare," though as noted, I've done it and heck, likely will again sooner or later.

In terms of the given dog's best interest, it's not obvious to me that if the choice is
  • more-or-less-immediate euthanasia of an animal who can be kept comfortable using a very inexpensive, easy to administer medication, because the owner can't or wont' pay for the expensive blood tests that the vet recommends accompany the medication's use, or
  • an ongoing and comfortable life that ends at some unknown time down the road due to organ failure caused by the prednisone and absence of expensive blood tests -- and I have to assume that if the organ failure was detected based on symptoms, though I realize animals can be remarkably stoic, the owner would euthanize the dog

... that the first bullet is the kinder/better choice.

That seems to me a value judgment that is better made by the pet's owner in careful consultation with the vet than by the vet.
Actually organ failure can be painful and because it is a dog, many people don't recognize pain symptoms and the dog suffers when it should not have to.

Lanthiriel

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Re: Any veterinrians? Long term prednisone use for dog
« Reply #30 on: February 14, 2016, 02:16:10 PM »
You've received some very good advice, so I'll add in some plus 1s and a few other tips.

Apoquel. This stuff is amazing. My dog's skin was falling off in layers, and this was the only thing that helped. He also has environmental allergies that (thanks, Arctic climate!) only pop up in the spring/summer. Our vet just gives us 60 pills at a time (about $200 worth of meds), and that can get him through the worst of the season.
Douxo shampoo. Another expensive piece of our arsenal. He gets a bath once per week when he's showing symptoms (in our dog, it's his skin turning black when it's usually pink). It doesn't make the black go away, but it stops the irritation from turning into lesions. You can buy it on Amazon: http://www.amazon.com/Douxo-Chlorhexidine-Shampoo-16-9-oz/dp/B000O1HEJ0/ref=sr_1_1?ie=UTF8&qid=1455484183&sr=8-1&keywords=douxo
Natural Balance Limited Ingredient Diet. Someone else on here mentioned Rabbit and Kangaroo, so I have a feeling I'm not the only one feeding my dog this brand. The only one he likes and doesn't irritate his skin is the Rabbit and Potato formula. No chicken, no grains. Of the literal dozens of foods, we've tried, this one is the clear winner.

If you stick with the prednisone, I would recommend doing the blood tests at least annually, but I cannot imagine why they would cost $500. My dog was on Pentoxifylline for about 3 years, and we did annual tests to the tune of about $150/year. Luckily, using the three strategies above, we've been able to get our little guy off of the scary meds and more or less comfortable all year.

I hope you find the right combo of treatments that work for your dog. Good luck!

bogart

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Re: Any veterinrians? Long term prednisone use for dog
« Reply #31 on: February 14, 2016, 06:43:06 PM »

A more productive way to approach that sort of conversation? "Hey Doc, I know you're saying that medication XYZ requires bloodwork monitoring every six months, but that's really not something I can do right now. Where does that leave us? What are our options?"


Fair enough, makes sense.  And I'm not a vet (or anything similar, even if I do occasionally play one at home), but I have to say that choosing between keeping-a-pet-comfortable-and-happy-for-awhile versus avoiding a risk of
Actually organ failure can be painful and because it is a dog, many people don't recognize pain symptoms and the dog suffers when it should not have to.
-- well, it's genuinely not obvious to me which is the right choice (a longer and mostly happy life followed by a painful death, or at least a possibility it will end in a painful death, or, a comfortable death right now in lieu of treatment.  I'd probably base my decision on the likelihood of undetected organ failure and the likely length of the happy part of the extended life (relative to non-treatment).  Happily that's not a decision I have to make for any animals at this precise moment though it's the kind of thing I think most animal owners have struggled with in some form or another and yes, animals' stoicism (relative lack of pain symptoms) certainly makes it harder. 

frugalnacho

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Re: Any veterinrians? Long term prednisone use for dog
« Reply #32 on: February 18, 2016, 10:53:52 AM »
I absolutely understand that everyone has different financial/time/emotional budgets and I will never hesitate to euthanize a pet when the owner is not willing or able to afford appropriate care. I'm referring more to those conditions where owners make their own treatment decisions, ie. "I want to continue treating my pet with XYZ medication but I refuse to perform the necessary monitoring because my vet is a money-grubbing jerk" (not exactly what was said in this discussion, but something I hear on a regular basis).

I get the impression the vet is money-grubbing for a few other reasons. I'm extremely skeptical of all business.  I've never taken a car to a mechanic and had them say everything is just fine, it always requires hundreds or thousands of dollars worth of work.  Yet when I disagree with them and refuse the work the car miraculously runs just fine for years and years after the fact.  I get the same impression with almost every other business I deal with. We've taken the cat in and had extensive testing done when it was sick, and it was a constant barrage of expensive testing.  We need to perform another x-ray on this cat! More blood work! In the end we spent over $500 at two vets, and they didn't end up doing shit besides run up huge bills - the cat eventually got better on her own.  I know, this is just a single anecdote and I can't draw conclusions from that alone, but I think you get my point.  Also the vet (all vets i've found) are constantly moving up the time tables for procedures and tests that need to be done.  They started harping about the 6 month blood tests after only 4 months.  I had to go find the records and show them it's only been 4 months, not even the 6 they claim.  They always want to give her the required shots months ahead of time too, "she is due for her xyz shot in 2 months.  We should probably just give it to her now since it's more convenient".  "yeah but won't that move up the time table for that shot by 2 months permanently? And if you give it to her 2 months early every time, won't we eventually end up paying for several more "yearly" cycles during her life time?".  All of these reasons lead me to question the true motive of the vets (is it really in my dogs best interest, or your check books best interest?).  We've tried other vets, and this one is actually the best one.  I don't dislike the vet, I am just skeptical they are not trying to pad their bank accounts a bit while also trying to provide good care for my pet.

A lot of folks do whatever tests their doctor (or vet) recommends, without asking the question, "if it's a bad result, then what?" That's the question you need an answer to, and if the test result doesn't change your strategy, then why do it at all?

This is the question I asked and was not given a reasonable answer to.  If we aren't changing course, what's the point?

Just try to remember that your vet spent EIGHT YEARS in school (undergrad/prereqs + DVM) to learn all of this info, so we really aren't just pulling stuff out of our butts. Depending on the state, your veterinarian attends anywhere from 10-20 hours of continuing education per year in order to stay current. With a few exceptions (mostly the old-timers), we know our stuff.

Eh, I've met far too many vets, medical doctors, and lawyers that are insanely stupid to simply appeal to their authority without question.  I know you've spent far more time in school for this particular skill than I have, but if you can't break down your reasoning and explain it to me in a few minutes why you are making a particular recommendation, I don't feel comfortable blindly following your advice.  This isn't directed at you in particular, just authority figures in general.   


Really? The end of the line? Not a vet. but--I've  got a rescue dog who came in to my house with the most horrific skin you can imagine, his former family treated it with pred and antibiotics. Then they would get tired of it. Then he would break out badly,and they would treat it. They Became tired of that and turned him into rescue..

I took one  look at him as foster mom and said "we are goong to the skin specialist,."  Lots and lots of dollars later after some analysis, he is on Apoquel which controls his skin beautifully. It costs about $500 -$600 annually. His medication routine is 2 pills daily, big dose in the am and small dose in the evening.
Apoquel has been out on the market for for about 2.5 years.

Sure, we also feed him grain free food but he is allergic to everything, the food isnt a cause.

Prior to Apoquel he was on an older and more expensive drug, Atopica, but he had side effects from that although it, too, controlled his skin nicely.

I wish I could post a photo to show you how bad he was. Honestly, I too would have euthanized him if we didnt get this miracle drug. It is truly a miracle.

Atopica took 6 weeks to kick in.  Apoquel  kicked in sooner.

If your vet isnt  talking about Either of these drugs, I would be interested to know why. It doesn't work for all dogs, of course.

Edited to add: i see that someone upthread talked about
Apoquel. Yes, it can be hard to get and some vets in gEneral practice may not be able to get it at all. Not too long ago  only the specialists were able to get the drug. Now, I know a vet in general practice who can het it.

But other than initial startup, our supply has been smooth. Besides, i woul ,break into the vets office with an Uzi to get Apoquel for me dog, its the difference between life and death for him.

Yes the end of the line.  After years of suffering and thousands in medical bills we were ready to put her down.  Of course the vet always has one more special expensive trick up their sleeve, but we had a frank discussion about how far we were willing to go and how much we were willing to spend, and we reached that limit and then some.  Plus if the next suggestion the vet has is so great, why did we try the first 10 things?  The last thing the vet suggested was a super expensive prescription only dog food that was something insane like $300/mo.  We've already tried about 8 different foods trying to eliminate specific allergies (that I knew she wasn't allergic to according to her allergy testing) and none of them ended up working.  The only thing that had any effect on her at all was prednisone.  The vet didn't want to keep her on pred long term, but the alternative was putting her down. 

I've never heard of Atopica or Apoquel before, but I will ask the vet about them next time we take the dog in for an appointment.  Obviously though we've been to the vet numerous times in the past 2.5 years that the drugs been out though, so I'm curious why it was never mentioned.


frugalnacho

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Re: Any veterinrians? Long term prednisone use for dog
« Reply #33 on: February 18, 2016, 10:58:42 AM »
I also checked on her previous vet bills.  The blood testing wasn't $500 alone.  I don't know the exact price it was, but there were several other things being tested and shots being given and the total was close to $500.  At this point we are already past the 6 months (they made me sign a waiver to get pred), but she is coming up due for other annual tests, so we will be taking her in to get those done and will probably have her blood tested at the same time. 

The_path_less_taken

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Re: Any veterinrians? Long term prednisone use for dog
« Reply #34 on: February 18, 2016, 04:56:39 PM »
As far as expensive foods go:

I had a dog that for a while couldn't seem to digest anything.

Was scrambling eggs with brown rice, then slowly added tuna and mashed peas to the mix and a doggie vitamin....she lived off that for two years. Eventually they found an antibiotic that killed whatever bug was eating thru her gut and she's on the Nature's Domain from Costco, with is just rebranded Taste of the Wild (salmon/sweet potato).

Don't give up on the dog until you at least try Apoquel. Takes about 3 days to work.

frugalnacho

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Re: Any veterinrians? Long term prednisone use for dog
« Reply #35 on: February 18, 2016, 07:39:33 PM »
As far as expensive foods go:

I had a dog that for a while couldn't seem to digest anything.

Was scrambling eggs with brown rice, then slowly added tuna and mashed peas to the mix and a doggie vitamin....she lived off that for two years. Eventually they found an antibiotic that killed whatever bug was eating thru her gut and she's on the Nature's Domain from Costco, with is just rebranded Taste of the Wild (salmon/sweet potato).

Don't give up on the dog until you at least try Apoquel. Takes about 3 days to work.

She is on the nature's domain salmon food from costco.  She doesn't have any digestive issues.

I will be asking the vet about apoquel on the next visit.

startingsmall

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Re: Any veterinrians? Long term prednisone use for dog
« Reply #36 on: February 19, 2016, 08:59:19 PM »
They always want to give her the required shots months ahead of time too, "she is due for her xyz shot in 2 months.  We should probably just give it to her now since it's more convenient".  "yeah but won't that move up the time table for that shot by 2 months permanently? And if you give it to her 2 months early every time, won't we eventually end up paying for several more "yearly" cycles during her life time?".

I offer this all the time, so that I can help clients SAVE money. Yes, by doing the vaccine today, they're losing 2 months of 'life' on their vaccine. So, if said vaccine is one that costs $20 and is good for one year, they're losing out on $3.33 worth of vaccine value. But if they have to come back in two months, just for the vaccine, they're going to be spending $40.95 on a physical exam when I could just do the vaccine with today's exam. Totally up to the client, but I always give them the option because a lot of people get upset when they have to pay for another exam just a couple of months later.

Atopica is very expensive and also requires a lot of monitoring, so probably not a good option for you. (I rarely recommend it, except for in tiny dogs where the price isn't quite as insane.) Apoquel is a great option, if you can get it (many vets can't).
« Last Edit: February 19, 2016, 09:01:41 PM by startingsmall »

frugalnacho

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Re: Any veterinrians? Long term prednisone use for dog
« Reply #37 on: February 19, 2016, 09:02:34 PM »
They always want to give her the required shots months ahead of time too, "she is due for her xyz shot in 2 months.  We should probably just give it to her now since it's more convenient".  "yeah but won't that move up the time table for that shot by 2 months permanently? And if you give it to her 2 months early every time, won't we eventually end up paying for several more "yearly" cycles during her life time?".

I offer this all the time, so that I can help clients SAVE money. Yes, by doing the vaccine today, they're losing 2 months of 'life' on their vaccine. So, if said vaccine is one that costs $20 and is good for one year, they're losing out on $3.33 worth of vaccine value. But if they have to come back in two months, just for the vaccine, they're going to be spending $40.95 on a physical exam when I could just do the vaccine with today's exam. Totally up to the client, but I always give them the option because a lot of people get upset when they have to pay for another exam just a couple of months later.

Atopica is expensive, so probably not a good option for you. Apoquel is a great option, if you can get it (many vets can't).

Why would you need to perform another exam?  What purpose would another physical exam serve if you've checked the animal out within the last 2 months and all it needs is a vaccine? How does it take anymore time to simply administer the vaccines in two months?

startingsmall

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Re: Any veterinrians? Long term prednisone use for dog
« Reply #38 on: February 19, 2016, 09:13:38 PM »
Legally, we are required to perform a physical exam on every animal that we vaccinate. In my state, this involves a temperature, heart rate, respiratory rate and a full exam by a veterinarian. (Laws vary by state.) If I want to keep my license and protect myself from a lawsuit, I need to examine animals before I give vaccines.

From a more realistic standpoint, I frequently see animals presented for vaccines who are too ill to vaccinate. I've had dogs presented in IMHA (immune-mediated hemolytic anemia), whose owners didn't even realize their dogs were sick until I lifted the lips to show the owners their dogs' pale gums. Vaccines could have killed those dogs, by further triggering the immune system. I've had dogs presented in heart failure, with severe infections, etc etc. Vaccines in those dogs could have led to decompensation of their other condtions. It's not like humans, where we can just check off on the pharmacy's flu vaccine info sheet whether we've had a fever, felt ill, etc etc. As a veterinarian, I need to ensure that a patient is healthy enough to receive a vaccine and that requires an exam. And that takes time, which is why you pay for an exam.

I understand that it's probably hard for someone whose life revolves solely around money to understand (I find that people who think everyone is conning them are usually only thinking that way because they are always looking for similar opportunities themselves), but the overwhelming majority of veterinarians are NOT in it for the money. Yes, the treatments cost money, but that isn't why we recommend them. Anyone with the intelligence to get into veterinary school could make a lot more money in other fields, but veterinarians enter the field because they care about helping animals.

Side note: I've recently started doing some freelance writing work. It pays substantially more per hour than I make as a veterinarian. The schedule is flexible, unlike tonight when I missed dinner with my family so that I could reassure an elderly drunk woman that her dog was not dying. My clients don't yell at me or make snide comments when I provide them with estimates. And I don't stay up all night wondering about whether my patients will make it through the night. It's amazing. So maybe you're right about vets being stupid.... high grades and test scores be damned, anyone who stays in the profession pretty much HAS to be an idiot. After serving nine years, I'm getting out.
« Last Edit: February 19, 2016, 09:33:23 PM by startingsmall »

frugalnacho

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Re: Any veterinrians? Long term prednisone use for dog
« Reply #39 on: February 19, 2016, 09:35:59 PM »
Wow you seem a little defensive and insolent.  Sorry for daring to question the altruistic motives of the saints of the veterinary profession.

Rural

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Re: Any veterinrians? Long term prednisone use for dog
« Reply #40 on: February 20, 2016, 04:22:48 AM »
So, startingsmall, I guess low-cost annual rabies clinics are illegal in your state? Quite a public health problem you must have there. But I'm sure the mandated repeat exams for the ones who bother must outweigh the larger herd immunity...

FrugalFan

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Re: Any veterinrians? Long term prednisone use for dog
« Reply #41 on: February 20, 2016, 04:57:36 AM »
I'm not a vet. But we had similar issues with both of the dogs we've had. For the first one, he kept getting really bad skin problems and ear infections and the prednisone was the only thing that finally cleared it up for good and he was so much more comfortable the rest of his life (an extra 6 years after we started the prednisone). He lived a long time and died at 13, which is typical for a lab. For our current dog, she is crazy allergic to grass. She is fine in the winter if there is snow cover, or in places that don't have grass, but at home for most of the year she is miserable unless on prednisone. We give her a tiny amount every day and that's all that's needed to keep the itching at bay. Our vet is happy to support this and does not request any bloodwork at all. Our previous vet was fine with it as well. For us, it's an important quality of life issue. I would definitely look into another vet if they want to charge you 500 every six months for blood work.

Elliot

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Re: Any veterinrians? Long term prednisone use for dog
« Reply #42 on: February 20, 2016, 06:43:16 AM »
So, startingsmall, I guess low-cost annual rabies clinics are illegal in your state? Quite a public health problem you must have there. But I'm sure the mandated repeat exams for the ones who bother must outweigh the larger herd immunity...

Those low cost clinics include an exam, and the cost is typically subsidized.

startingsmall

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Re: Any veterinrians? Long term prednisone use for dog
« Reply #43 on: February 20, 2016, 06:45:33 AM »
So, startingsmall, I guess low-cost annual rabies clinics are illegal in your state? Quite a public health problem you must have there. But I'm sure the mandated repeat exams for the ones who bother must outweigh the larger herd immunity...

Rabies clinics are the exception, due to public health concerns. The benefit to the public health outweighs the risk to the dog. While vaccinating a dog without a physical exam could absolutely kill the dog or cause other harmful effects, the benefits to the public are considered to outweigh the risk to the dog (and owner). I have worked with veterinarians who have been disciplined for something as little as not documenting pet's temperatures at vaccine booster visits. (No, they didn't lose their license, but they were reprimanded by the state veterinary board.) Veterinarians have been successfully sued when clients have been bitten by their own pets IN THE LOBBY of the veterinary clinic; a lawsuit for a possibly-predictable adverse event related to vaccination is a no-brainer. So while I suppose I misspoke when I said illegal, because a vet wouldn't go to jail, it is absolutely against the practice act and the standard of care.
« Last Edit: February 20, 2016, 06:58:11 AM by startingsmall »

startingsmall

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Re: Any veterinrians? Long term prednisone use for dog
« Reply #44 on: February 20, 2016, 06:47:11 AM »
So, startingsmall, I guess low-cost annual rabies clinics are illegal in your state? Quite a public health problem you must have there. But I'm sure the mandated repeat exams for the ones who bother must outweigh the larger herd immunity...

Those low cost clinics include an exam, and the cost is typically subsidized.

This is true... I was thinking more of the drive-through rabies vaccine clinic that my county offers once per year. That rabies clinic really doesn't include an exam, but the benefits are thought to outweigh the risks.

frugalnacho

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Re: Any veterinrians? Long term prednisone use for dog
« Reply #45 on: February 20, 2016, 10:33:13 AM »
I'm not a vet. But we had similar issues with both of the dogs we've had. For the first one, he kept getting really bad skin problems and ear infections and the prednisone was the only thing that finally cleared it up for good and he was so much more comfortable the rest of his life (an extra 6 years after we started the prednisone). He lived a long time and died at 13, which is typical for a lab. For our current dog, she is crazy allergic to grass. She is fine in the winter if there is snow cover, or in places that don't have grass, but at home for most of the year she is miserable unless on prednisone. We give her a tiny amount every day and that's all that's needed to keep the itching at bay. Our vet is happy to support this and does not request any bloodwork at all. Our previous vet was fine with it as well. For us, it's an important quality of life issue. I would definitely look into another vet if they want to charge you 500 every six months for blood work.

I don't know the cost of the bloodwork, but the $500 was for the whole visit which included a fecal examination, frontline, and some vaccines also, so the actual bloodwork is likely more in line with what others have said in this thread.

Obviously I'm cynical and question the motive of nearly everyone (I'm not just singling out vets), but the vet is the one prompting my wife to schedule the appointments.  Everything is on annual, or triennial (rabies) basis - or apparently biannual for blood work.  All of these schedules stack up nicely and should never result in the animal being brought in 2 months prior to one of the scheduled vaccines being needed.  Unless of course the vet is intentionally trying to schedule appointments early to turn an annual cost into a 10 month cost, effectively increasing our annual vet budget by 20%.  When I tried to renew the prednisone they refused saying that she was due for her 6 month bloodwork check up, but our last visit was still fresh in my mind because it was slightly less than 4 months before that.  I had them bring up her last appointment and had to show them that 4 months is not 6 months, and they still didn't want to give me the prednisone (they eventually did after another phone call explaining the situation)! That and the fact they wouldn't/couldn't give me a straight answer on how the results of the bloodwork would change our treatment course (apparently there are some valid reasons given in this thread) left a bad taste in my mouth.

startingsmall

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Re: Any veterinrians? Long term prednisone use for dog
« Reply #46 on: February 20, 2016, 10:57:11 AM »
Once again, let me try to explain. Rabies vaccine is given every three years. DAPP is also typically given every three years. Vaccines such as Lepto, Lyme, and Bordetella are all given every 6-12 months, depending on risk. So let's imagine your dog goes into the vet every 6 months for exam/bloodwork because he's on chronic meds. Unless you always show up EXACTLY on the day that your six month visit is due (which almost never happens, due to the client's schedule or the vet's schedule), things get off-schedule over a 3 year period. Add in the fact that maybe your dog went in for a skin infection 3 weeks before a vaccine was due and you decided to do the vaccine early, and it doesn't take a high level of intelligence to understand why things don't stay on schedule.

This is something I deal with every single day. Multiple times. I couldn't care less whether the client comes back and pays another office visit or gets the stuff done while they're in that day, but I present them with the option. ("Hey, Fifi also has these things coming up - rabies is due in March, distemper in March, and HW test is due in April. Do you want us to take care of those things while you're here today or come back later?") It certainly makes more sense for them to save themselves the drive and the office visit fee so that we can try to take care of everything that is necessary to give them six vet-free months after their visit, but I don't care what they decide... it doesn't matter one way or the other to me, as long as the things get done on schedule and the pet is protected.

I may not always agree with my doctors (or my kid's daycare teachers, or the professors I had in college, or whatever) but I very rarely find myself assuming nefarious motives. That must be a very unpleasant way to live. Good luck with that.

startingsmall

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Re: Any veterinrians? Long term prednisone use for dog
« Reply #47 on: February 20, 2016, 11:09:07 AM »
That and the fact they wouldn't/couldn't give me a straight answer on how the results of the bloodwork would change our treatment course (apparently there are some valid reasons given in this thread) left a bad taste in my mouth.

Another thought.... did you ask this question of the veterinarian, while you were actually at the office during your appointment? The support staff doesn't typically understand the reasons for testing beyond a very superficial level, because the answer is different for each drug. I imagine the veterinarian could have articulated a better answer, if you actually asked in a non-confrontational way during an appointment. If they can't answer questions like that, then absolutely try another vet and see if they're a better fit. If you're having similar experiences at multiple vets, though, you may want to consider this.... many vet clinics have more business than they really 'need' and therefore focus on retaining good clients and don't work too hard at keeping hostile/abusive clients around. I've dealt with my fair share of hostile, cynical, confrontational clients who questioned my every motive... and while I'm not currently in a situation where I'm allowed to "fire" those clients, I absolutely go out of my way to provide less-than-stellar service in the hopes that they'll find another veterinarian to harass. Sure, I'd put up with the abuse if I was just in it for the money, but I'm not so I won't. (Obviously, that only applies for animals that aren't dealing with serious/life-threatening illness.)

If you keep having similar issues with multiple veterinarians, you may want to consider that it's more about you than them. I'm often shocked at the fact that I always seem to get great customer service almost everywhere I go.... then I go out with friends or family and see how their own hostility/mannerisms are reflected back to them and realize why they think every customer service person is terrible. It isn't that I always get lucky and get great servers at restaurants, etc.... it's just that I know how hard it is to work with the public, so I'm friendly and forgiving and therefore tend to get very friendly treatment in return.

frugalnacho

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Re: Any veterinrians? Long term prednisone use for dog
« Reply #48 on: February 20, 2016, 11:15:54 AM »
Once again, let me try to explain. Rabies vaccine is given every three years. DAPP is also typically given every three years. Vaccines such as Lepto, Lyme, and Bordetella are all given every 6-12 months, depending on risk. So let's imagine your dog goes into the vet every 6 months for exam/bloodwork because he's on chronic meds. Unless you always show up EXACTLY on the day that your six month visit is due (which almost never happens, due to the client's schedule or the vet's schedule), things get off-schedule over a 3 year period. Add in the fact that maybe your dog went in for a skin infection 3 weeks before a vaccine was due and you decided to do the vaccine early, and it doesn't take a high level of intelligence to understand why things don't stay on schedule.

This is something I deal with every single day. Multiple times. I couldn't care less whether the client comes back and pays another office visit or gets the stuff done while they're in that day, but I present them with the option. ("Hey, Fifi also has these things coming up - rabies is due in March, distemper in March, and HW test is due in April. Do you want us to take care of those things while you're here today or come back later?") It certainly makes more sense for them to save themselves the drive and the office visit fee so that we can try to take care of everything that is necessary to give them six vet-free months after their visit, but I don't care what they decide... it doesn't matter one way or the other to me, as long as the things get done on schedule and the pet is protected.

I may not always agree with my doctors (or my kid's daycare teachers, or the professors I had in college, or whatever) but I very rarely find myself assuming nefarious motives. That must be a very unpleasant way to live. Good luck with that.

The dog went in for her regularly scheduled check up and vaccines.  That's my entire point, the vet seems to be intentionally trying to schedule those appointments several months ahead of schedule, habitually.  I also don't understand why you think it's a binary situation where they either do what's in the best interest of the dog, or have some nefarious motives.  Couldn't they be doing what's in the best interest of the dog's health while simultaneously trying to earn more money for the practice, kind of like the situation of habitually scheduling appointments months in advice like I just described?  If you want to offer advice as a vet, that's great. However if you want to come in and keep insulting me i'd prefer you fuck off.

MOD EDIT: Forum rule #1.
« Last Edit: February 21, 2016, 03:50:15 AM by arebelspy »

warmastoast

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Re: Any veterinrians? Long term prednisone use for dog
« Reply #49 on: February 21, 2016, 02:53:40 PM »

Another thought.... did you ask this question of the veterinarian, while you were actually at the office during your appointment? The support staff doesn't typically understand the reasons for testing beyond a very superficial level, because the answer is different for each drug. I imagine the veterinarian could have articulated a better answer, if you actually asked in a non-confrontational way during an appointment. If they can't answer questions like that, then absolutely try another vet and see if they're a better fit. If you're having similar experiences at multiple vets, though, you may want to consider this.... many vet clinics have more business than they really 'need' and therefore focus on retaining good clients and don't work too hard at keeping hostile/abusive clients around. I've dealt with my fair share of hostile, cynical, confrontational clients who questioned my every motive... and while I'm not currently in a situation where I'm allowed to "fire" those clients, I absolutely go out of my way to provide less-than-stellar service in the hopes that they'll find another veterinarian to harass. Sure, I'd put up with the abuse if I was just in it for the money, but I'm not so I won't. (Obviously, that only applies for animals that aren't dealing with serious/life-threatening illness.)

If you keep having similar issues with multiple veterinarians, you may want to consider that it's more about you than them. I'm often shocked at the fact that I always seem to get great customer service almost everywhere I go.... then I go out with friends or family and see how their own hostility/mannerisms are reflected back to them and realize why they think every customer service person is terrible. It isn't that I always get lucky and get great servers at restaurants, etc.... it's just that I know how hard it is to work with the public, so I'm friendly and forgiving and therefore tend to get very friendly treatment in return.
[/quote]

This.   One thousand times......well said.