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Affordable pet MRI
August 5, 2012 4:09 PM   Subscribe

How to afford MRI/Spinal Tap procedure for a dog (in northeast US). Need to make decision in next 12 hours.

Our loved dog (4 yrs old, king charles spaniel) has had multiple seizures since this morning. We have her in a relatively stable condition at an animal hospital in NYC, however, tomorrow we will have to decide between two very difficult choices: either to go through with an MRI/Spinal Tap procedure which will require several days of hospitalization and will cost at least $5,000 to start - or to put her to sleep.

The emotional side of this decision notwithstanding, we are trying to get as much information as possible. While we do not want her to suffer more than she needs to, she is still relatively young for her breed, this is her first seizure, so we also want to make sure we have done everything we could before making this decision.

In an ideal world, we would at least have the possibility of running these tests, which according to our doctor will allow them to decide if this is caused by an infection that could be handled with antibiotics and other treatment - or if this is an inflammation affecting the brain, in which case the condition has much lower possibility of treatment or recovery.

So we approach the hive mind with the following question - are there places in NYC, Boston or the US Northeast that can possibly offer an MRI or Spinal Tap procedure for a dog at an affordable cost? So far, through the Humane Society in New York, we were referred to ASPCA, which we will call tomorrow morning. Some googling also came up with the possibility of doing the procedures at a medical school or lab, but so far we have been unable to get any specifics.

Will appreciate any response.
posted by lapidus to Pets & Animals (28 answers total)
 
Doctor here, not vet; applying human knowledge to dogs.

1) Could the dog just have epilepsy?
2) The spinal tap is a pretty straight forward procedure, and much less expensive than an MRI. Does the vet really think without any other symptoms besides seizures (fever, strange behavior, lethargy), the dog has meningitis (or encephalitis) that antibiotics could fix?
3) If you're worried about cost, if you're going to get an MRI, and it shows a structural abnormality (that's why you're getting the MRI), are you going to pay for the then-recommended surgery?
4) Can the dog not just take medicines for seizures? I of course understand needing to know why a human would have seizures (infection, structural abnormality, future learning, etc), but if it's your dog, can't it just have seizures -- is there a reason it must be investigated further?

Not trying to sound callous.
posted by gramcracker at 4:42 PM on August 5, 2012 [7 favorites]


I don't know a lot about dogs, but I do know that when faced with difficult medical decisions for my cats, a second or even third opinion has saved their lives. I'd start with that.
posted by cgg at 4:43 PM on August 5, 2012 [4 favorites]


What sort of seizure has your dog had? Grand Mal? (All over shaking/lock up/urinating, etc?) Are they ongoing? How many is "multiple"? If there were several in a very short period and then they ceased, that's one thing. If it's been one an hour for the entire day, that's closer to a "cluster" seizure and needs to be evaluated.

My yellow lab had a seizure about once every six weeks. They were scary, but he'd bound back from them, and that'd be that. We'd follow typical postictal (post-seizure) procedure: make sure lots of water was available, feed him a few spoons of vanilla Hagen Daaz (highly fat soluble sugars to get his energy level up, low likelihood of aspiration) and that'd be that. Now, he ended up having a very bad go of it one day about 8 months after the first one and we had to put him down: at that point, he had different pupil sizes that indicated encephalopathy of the brain and that's the decision we made.

But in the 8 months from the first seizure on, he was just fine. Because ours weren't clusters, we didn't even put him on anti-epileptics. If you do have to go that route, try for Potassium Bromide instead of the more commonly prescribed but more liver-damaging Phenobarbital.

Either way, I'm really not sure why they're presenting you with spinal tap or euthanasia as your only two options. You can also take the third option: second opinion. Or the fourth option: wait-and-see. If your dog is having them relatively infrequently, they're just fine. The seizures aren't painful (though they may hurt themselves if they're near hard/sharp things) and they usually bounce right out of them. There are different types of seizures, but the frequency, severity, and length of postichtal state should factor in to if you need a $5,000 procedure merely to DIAGNOSE the animal.

We were always told "it could be epilepsy, it could be a brain tumor or some other thing, if they're infrequent and he bounces back after, no big deal, if he has more than one in a 24 hour period, we may want to start the anti-epileptics." Not "we need $5k to tell you what's going on." That may be true, but the reality is that you don't necessarily NEED to know what's going on for your dog to continue to live for a few more years.

The Canine Epilepsy Network has a lot of really good information. Check them.

Also, just to confirm, you're POSITIVE this was a seizure? Did your dog bounce back and is now walking/moving around normally? If they're tilting, have a head-tilt, falling around, or look drunken, they very likely did NOT have a seizure but may be having a bout of vestibular disease, which is very different, but frankly presents more like a stroke than a seizure.

Either way, something rubs me the wrong way about you receiving ONLY THESE OPTIONS. They are NOT YOUR ONLY OPTIONS. The spinal tap, again depending on the severity, length, and frequency of these seizures is generally NOT required.

I am not a vet, just someone who dealt with a seizure-ing/vestibular (both) dog for the last year before we finally had to put him down. Obligatory photo of my beloved Hoover.

Best of luck.
posted by disillusioned at 4:54 PM on August 5, 2012 [6 favorites]


Is there a possibility for second opinion? Or can you ask the current vet to do some less spendy testing before escalating to MRI+spinal tap? Would the doctors consider treating for infection and see whether that resolves the issue?

This sounds like spare-no-expense treatment and it's hard to believe that the only 2 choices that you have are to either go this route or put the dog down. There have got to be other (less profitable) options that would still fall under medically acceptable diagnosis and treatment.

Also, I'm so sorry that you're going through this. I'm rooting for your furry baby!
posted by quince at 4:56 PM on August 5, 2012 [1 favorite]


Either way, something rubs me the wrong way about you receiving ONLY THESE OPTIONS. They are NOT YOUR ONLY OPTIONS.

^^this. My gut reaction is that you should seek a second opinion. I'm so sorry that you've been put in this position :(
posted by unknowncommand at 4:57 PM on August 5, 2012 [3 favorites]


I have to agree. Fast deadline, life and death and money usually mean you are being manipulated somehow.

Seek other options, and then decide.
posted by gjc at 4:58 PM on August 5, 2012 [1 favorite]


As an interesting point of reference, this scientific laboratory, the Small Animal Imaging Facility of the University of Pennsylvania, appears to charge researchers $70 per hour for access to MRI equipment and facilities, with the largest listed animal being a cat.
posted by XMLicious at 5:05 PM on August 5, 2012


Her first seizure presented itself in the morning, after two weeks of discomfort of what appeared to be her rear end (X-rays were normal). The seizure itself: she convulsed, appeared disoriented, her entire left side became rigid, had a bowel movement and peed herself. She was taken to her regular vet who put her on a drip for a muscle relaxant (she continued seizing without it). She later was transported to an animal clinic on Upper East Side, NY (we are told one of the best). There the vet couldn't say for sure what was wrong without the tests, however, based on the symptoms our dog has had for the past several weeks she supposed it could be a viral infection or something like meningitis. She is now sedated (benzodiazapine+phenobarbital drip because she continues to seize). Based on how fast her condition is progressing, the outcome is not looking good even WITH these tests/treatments according to the vets we've spoken to.

I don't mean to threadsit, but I am here to read your comments/suggestions. Thank you all.
posted by lapidus at 5:07 PM on August 5, 2012


Having had a dog with a seizure disorder, I strongly recommend getting another opinion. That said:

1) What is the harm in treating the dog as if the antibiotics might prove successful? At worse, they will not be effective. At best, you've solved the problem and not spent a huge sum of money.

2) Angell Memorial in Boston. Call them. Talk to them. Tell them everything. They were //wonderful// when I was dealing with tough financial situations combined with complicated medical issues for my dog.


Best of luck.
posted by driley at 5:20 PM on August 5, 2012 [1 favorite]


This is a hard decision, and I am very sorry that you are having to make it. I know though, that if I were in your position -- tests that I could not even come close to affording, ambiguity about whether they would do any good, possible significant ongoing expenses after the tests and drastically shortened lifespan or decreased quality of life for the dog -- I would put the dog to sleep. I would not feel good about it. I would feel very sad about it for quite a long time, I think, and it would be a heartwrenching experience that nobody should have to go through. That, though, is only what I would do and my decision would be colored by the fact that there is almost no way I could possibly come up with five grand on short notice and if I could then it would severely squeeze me financially for years to come. You should make your own decision; nobody else can do it for you.

I would ask if there is anything else that can be done though, first. If there's a strong possibility of bacterial meningitis, is it possible to simply treat the dog with antibiotics and such as if this were the case, and hope she recovers? That might be much cheaper than having an MRI and spinal tap done. Or likewise for whatever the vet thinks is most likely to be wrong. Obviously the outcome would not be as likely to be good as with comprehensive testing beforehand, but it sounds like the outcome is likely to be poor regardless.

If you can't afford the testing then you should simply tell the vet that you can't afford it and ask if there is anything less expensive that can be done regardless, either as a general treatment or as a shot in the dark. Perhaps there is, perhaps there isn't. I understand that you don't have unlimited time to make this choice.

Again, I am very sorry that you are in this position. It's a terrible thing to go through. My heart goes out to you and your dog.
posted by Scientist at 5:22 PM on August 5, 2012


Seizure-dog owner here, although our girl has epilepsy. This has been our experience:
1. Veterinarian Expertise: Not every provider is up to date on the latest research. The turning point for us came when by very good luck our ER Vet had recently attended a canine neurology conference. Vets don't always keep current on the most recent findings in the same way that a human doctor does. Seek out a doc with specific recent experience with seizures.
2. Old, ineffectual drugs: I'm very concerned that they are using phenobarbital on your dog. This is an old medication, and its use on our dog lead to terrible side effects. If Daisy had continued to be treated with phenobarbital, she would not have gotten better, and the literally constant anguished barking, continuous overpowering thirst and biting at the walls would have regretfully lead us to have had her put down. Fortunately this did not happen, and we found a more up-to-speed doctor who was able to prescribe a modern combination of drugs to help control her seizures. For us, replacing the phenobarbital with potassium bromide was key. Also, getting her on a human anti-seizure drug helped a great deal as well. I am not a vet, but in my considerable research on phenobarbital I can't think of any reason why your animal hospital should be using it now unless perhaps it is as a bolus (large front-loaded dose) to try and halt the seizures. Even so, potassium bromide coupled with a more modern anti-seizure drug should do the same thing.
3. New Meds Available: Speaking of those new anti-seizure drugs-- the vet very seriously told us "these medications have been used for several years on humans, and now are considered safe to try on dogs." I did a double-take at that. Shouldn't it have been the other way 'round? Two of the best new drugs are zonisamide (which is what we use) and keppra. Again if your doc is talking about phenobarbital, that is a danger sign! It's the equivalent of a human doctor suggesting bloodletting, or maybe a lobotomy-- techniques that have been superseded by more modern procedures.
4. Comparable Costs: We got Daisy through a rescue organization after her owners voluntarily surrendered her because they couldn't deal with the medical issues. She had never been on reliable medication, and had six grand mal seizures on the second and third day we had her. Six days of hospitalization in Washington DC cost $1400. Luckily the Rescue Foundation paid for it. This was before we met the good vet or had a solid treatment plan in place. At the time (May 2010) we were quoted $1500 as the beginning price for an MRI, but chose not to get one, because she did respond well to the drug cocktail. (And hasn't had a seizure in over a year!)
5. Sources for drugs: If your dog needs a human anti-seizure drug, your best bet is to get it from a human pharmacy. Any decent vet will call their prescription in to wherever you tell them. The cheapest we have found for zonisamide is Costco pharmacy-- literally 1/3 the price of anywhere else. We pay about $40 a month for her two medications. Potassium bromide is only used on animals, but even there, don't buy it directly from an animal hospital, who will pass along a hefty markup. Instead get it from a large reputable online pet pharmacy. We use Wedgewood, but there is another one I can't recall that is equally cheap. They are based in Arizona. Diamondback (?) or something like that.
Well, that's what comes to mind. I know your situation is not identical to ours, and there are many other factors, but knowing how we handled many similar decisions make help you with your own. Good luck, and send me a memail message if there is anything else you need to hear from us. It will be hard, but it sounds like you will make the best decision for your dog!
posted by seasparrow at 6:50 PM on August 5, 2012 [2 favorites]


If this is a King Charles has your vet considered Syringomyelia? It's a progressive neurologiacl disease caused by a physical malformation that is unfortunately relatively common in KCS. afaik, it doesn't have a sudden onset but check the page I linked to for symptoms and maybe you will recognize some in hindsight. The fact that she had some neuro signs before the seizure and that they cannot get her stabilized makes me wonder.
posted by fshgrl at 8:01 PM on August 5, 2012 [2 favorites]


Seconding syringomyelia. Upon the mention of King Charles and seizures this immediately came to mind. My friend has an adorable Cavalier with syringomyelia. He has been put on gabapentin and the last I heard, has been doing fine with it. You may want to find a vet who is familiar with the condition as well as with KCS's. Good luck; your little one is in my thoughts.
posted by choochoo at 10:37 PM on August 5, 2012


btw, if your vet does suspect Syringomyelia you might ask the breeder is other puppies from the litter have shown symptoms. It's apparently hereditary and the parents may not have shown signs (since the breeder bred them) but they can still pass it on.
posted by fshgrl at 10:49 PM on August 5, 2012


When you say she "continues to seize", do you mean nearly constantly?

Is there any chance at all you've traveled with her in a desert state in the past year? Down here in Arizona and the greater Southwest, we have Valley Fever, which can present in any number of ways that confound. It's not typically (if ever) found in the Northeast, though, so it's unlikely to be an issue if you haven't been traveling.

I agree with seasparrow, Phenobarb is unpleasant stuff. I don't think it's quite on the order of bloodletting, and it's still considered an option for some vets, but KBr is tolerated MUCH better and typically as effective. It's probably possible to transition to something like that and get her off benzos and see how things go. (The benzos are only being used for sedation, right?)

Having to put down Hoover was the hardest thing we've had to do. Even worse, as he was doing fairly well days before (having suffered his second vestibular bout about two weeks before), but his conditioned progressed rapidly in a single day, he already had a large tumor on his shoulder, and we realized that at that point it was most likely a brain issue which would be not-really-maintainable in any realistic form.

In the end, you'll make the decision you have to make. I hope they can find an alternative, and especially that you find a KBr-based therapy to be effective, and perhaps able to operate on the assumption that it's just epilepsy, which many dogs live with for years and years. But if it comes to it, know that it's okay, even if it feels like you could maybe do more. It's all about quality of life, as far as I'm concerned, with the financial considerations given appropriate weight.

Ask aggressively about options to stabilize her and take her home, or perhaps to another vet: talk to them (aggressively) about Potassium Bromide—immediate efficacy may require a loading dose; phenobarbital is natively effective immediately, KBr requires a loading dose typically. If the pheno is stopping the seizures right now, there's a good chance she'll respond well to that. Read up on canine epilepsy and canine seizures as much as possible to identify other potential causes and therapies.

There's lots on the web. This piece discusses KBr specifically and it's pros and cons.
posted by disillusioned at 2:11 AM on August 6, 2012


Having recently gone through a difficult medical decision for my dog, I have a few ideas for you:

1. Contact all breed rescues in the area. Email everyone and ask for ideas for more affordable MRIs. In DC, I was quoted $2,000 for an MRI and I was shocked at *that* price; the rescues identified some vet teaching hospitals (Virginia Tech was one, and I think there was a 2nd in DE). At any rate, they can probably provide some lower-cost resources.
2. Start calling all vets in the area and ask if they do MRIs and spinal taps. Both of these procedures are fairly common for dogs, so there are definitely options out there. If you have a car, consider going to NJ where, I'd imagine, the costs could be greatly reduced. If the vet says they don't do those procedures, ask if they can refer you to someone who does.
3. AFAIK, seizures are not life and death situations. Your dog is not necessarily in constant pain. Certainly, it's scary for both you and her, but you have time. There is no need to rush this decision. I'm sure your vet gave you tips for keeping her safe. If the incontinence is the most immediate issue, you can fashion appropriate diapers for her.

I'm sorry you're going through this.
posted by Flamingo at 6:39 AM on August 6, 2012


Update:

Unfortunately, our dog passed away on her own. Her condition appeared to progress and worsen throughout the evening and she started seizing even with the medication and eventually was unable to breathe without assistance.
posted by lapidus at 7:43 AM on August 6, 2012


I'm so so sorry to hear about your dog <3
Thoughts are with you, and feel free to email me if you need support.
posted by whalebreath at 8:26 AM on August 6, 2012


I'm so sorry.
posted by fshgrl at 9:55 AM on August 6, 2012


I'm so sorry to read this. Sending you and your family lots of hugs. These little furry beings have such a grip on our hearts and losing them is so very hard.
posted by quince at 11:02 AM on August 6, 2012


So sad. Sending good thoughts your way.
posted by unknowncommand at 12:44 PM on August 6, 2012


Awww. Hugs.

In a way, this was probably the best outcome. We had the same thing with Hoover: we could have tried for some methods to keep him alive through the night at great expense, but he surely would have passed within the next week, and so he basically made the decision for us once he started having real trouble.

It's still incredibly unfortunate.

So sorry for your loss. Three months on, I still miss my dog and think about him frequently.
posted by disillusioned at 1:34 PM on August 6, 2012


I'm sorry for your loss.
posted by 26.2 at 4:12 PM on August 6, 2012


Oh Lapidus, I am so very sorry to hear that. My thoughts are with you.
posted by msali at 9:31 PM on August 6, 2012


I'm so sorry you lost your sweet dog. You were obviously a great owner that wanted to do the very best you could for your animal. Pet ownership is a wonderful, wonderful, heartbreaking business.
posted by fyrebelley at 10:27 PM on August 6, 2012


I am very very sorry to hear the sad news about your dog.

I just wanted to add, I am hoping that this thread does not cause you undue concern about the care your dog was receiving. I am a human doctor and not a veterinarian, but I can tell you that my impression of a lot of the advice above is that it probably did not apply to your dog. This was not a simple case of epilepsy, this was status epilepticus, and that is managed quite differently, at least in humans. Any animal in status epilepticus has to be treated IV, and I don't even know if potassium bromide can be safely given IV, for one thing.

You did everything you could. My sympathies on your loss!!
posted by treehorn+bunny at 8:16 PM on August 7, 2012


I'm so sorry for your loss.
.
posted by brevator at 6:20 PM on August 8, 2012


I'm so so sorry. It's always so heartbreaking to lose our pets. I'm sure it was especially hard to see the little one go through so much. My heart goes out to you.
posted by choochoo at 9:23 PM on August 8, 2012


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