Practical and quality-of-life concerns with our dog's medical treatment
August 28, 2009 1:23 AM   Subscribe

My dog's been diagnosed with Cushing's Disease, and our vet (whom you are not) wants to do an MRI to determine the course of treatment. I have two questions about this.

To get it out of the way, here are the three pieces of info you're probably curious about:

First, he's a small dog, about fourteen years old, and every vet (including the current one) is always shocked by his good health, saying that if they didn't look at his teeth and see certain age-appropriate behaviors, they'd swear he was [half his current age].

Second, his symptoms are sudden, rapid weight loss, and some peeing in the house, but otherwise he seems in good spirits and does the things he normally does.

Third, we are indeed getting a second opinion from another trusted vet who has a history with our dog, before proceeding with treatment.

Now, then: the diagnosis of Cushing's Disease due to a pituitary gland tumor is a confident one, and the next step is an MRI to assess tumor size and whether it's operable.

My two questions:

1. Is $750 for such an MRI an unusually high fee? I just want to sanity-check the cost before we commit to having it done at this facility.

2. If you have been through this with your dog, what treatment did you pursue and what was the outcome, with specific interest in your dog's lifespan and quality of life moving forward from the treatment selection?

Ultimately we know he's an old dog, but that doesn't mean we're not going to aim for giving him the longest high-quality life possible. Thanks for any assistance you can provide.
posted by davejay to Pets & Animals (9 answers total)
Is $750 for such an MRI an unusually high fee?

I don't know anything about fees vets can demand, but half an hour ago I ran across this quote:
In the United States, an MRI scan of the neck region costs about $1,500. In Japan, the identical scan costs $98.

From this article on health care myths.
posted by ijsbrand at 2:57 AM on August 28, 2009

I am a vet, in the UK. Obviously IANYV.

In the UK MRIs can run upwards of £1000 ($1600+), so I dont think $750 is unusually high.

I can't comment on your dog specifically, but I will say that in general, Cushing's is often over- and mis-diagnosed. There are several diagnostic tests available and the results can be misinterpreted. If it is Cushing's, surgery (or even an MRI) is often not necessary or warranted (especially in an older dog), and the disease can be managed with oral medication.

Disclaimer - I am biased towards UK (not USA) treatment philosophy here. I'm not sure about which drugs are available in the US.

Definitely get that second opinion.
posted by peanut butter milkshake at 4:44 AM on August 28, 2009

Cushings seems to be the hot new pet diagnosis. It's suddenly blown-up everywhere.
Anyway, do some research. Many people seem to have successfully controlled Cushings in their dog by adjusting the diet. Not sure how effective diet might be as your dog seems to have a sudden and fairly severe attack.

Honestly...I can't see spending that kind of money on an MRI for my dog. Maybe that makes me cold and heartless. But, I can hardly swing that kind of out-of-pocket cash for my own kids. Of course, if you are more financially able, the decision becomes a bit less clear.

I would make sure that the $750 is all-inclusive. They will almost certainly have to sedate your dog for the MRI. Is that cost included in the $750.

I've also noticed that, as pet-health-insurance plans have moved into onto the scene, vets have started to employ more expensive testing and imaging procedures. And, yeah, it's probably confirmation bias. All I know is, even a couple of years ago, our vet would have never considered an MRI. Today, though, such procedures seem to have creeped into the most mundane conversation about your pet's health, and insurance brochures have begun to litter the check-out counter.
posted by Thorzdad at 5:02 AM on August 28, 2009 [2 favorites]

We had a small dog (dachshund) was diagnosed with Cushings back in 2000. We did do an MRI - although I remember it being a few hundred dollars, nothing close to $750 though. This is in VA. He was about 10 at the time and the Vet thought he had 4-6 weeks to live. We gave him prednisone. He lived a fairly normal life for another 18 months.

A 14 year old dog has had a long happy life. I'm not sure I'd invest a lot of money in diagnostic treatment at this point. Even if the tumor is operable, are you going to spend the money on surgery for a pet that is already approaching his natural end of life anyway? It's not a pleasant question but I'd think about it before investing in the MRI.
posted by COD at 6:42 AM on August 28, 2009

My dog was diagnosed with Cushing's at 14. Confirmed with bloodwork. She is now 16 and still happy, and comfortable. Our vet advised us to not spend any more money or try any expensive treatments because of her age and they didn't always help older dogs. She advised us to keep her well watered, fed and comfortable and treat any problems that arise as they come up. That is what we have done and she has had a good two years. She has some joint stiffness and some fatty tumors but still gets around the yard with our younger dog and happily plays with the kids. We will treat anything that may arise but I'm glad that our vet advised us and that we have been conservative so far.
posted by pearlybob at 7:27 AM on August 28, 2009 [3 favorites]

Exactly what pearlybob said. My old dog Toby lived about two more years after his Cushing's diagnosis with no special treatments; he never had an MRI or any expensive tests.
posted by mygothlaundry at 7:36 AM on August 28, 2009

Thanks for the feedback so far, everyone. We're making the decision now, and I appreciate the thoughtful responses.
posted by davejay at 8:59 AM on August 28, 2009

I'd strongly suggest doing some shopping around for the treatment. You can often get shockingly lower rates if you ask around carefully. There's often a provider in the area that will offer discounts if you pay them upfront. I've seen a HUMAN MRI go for $350, after it was initially quoted at $2,000. In that particular case, you prepaid, and then you got a bill for the full amount 30 days later. You called in, they adjusted it, and no more bills.
posted by Malor at 9:54 AM on August 28, 2009

Quick followup: we did the MRI, it came back inconclusive, we're now medicating as we would have if we didn't do the MRI, and the results from the meds so far are inconclusive. Which isn't much of a followup, really. But that's the fact of it, and he's still alive and seems reasonably happy, which is the main thing. In retrospect, I should have skipped the tests, but that's what hindsight is like.
posted by davejay at 1:18 PM on September 29, 2009

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