older dog decisions
April 9, 2016 1:23 PM   Subscribe

My 11 year old Westie has been drinking 2-3x more water than usual. My vet says the next step would either be an X-ray ($75) or an ultrasound ($500). I'm not sure what's the best next step? Cute pup photo here.

His main symptoms are drinking much more than usual and not wanting to eat his food. Otherwise he is his normal, bouncy self.

- The vet took a urine sample and found his urine to be diluted, some blood and crystals. She said he may have a bladder stone, which the X-ray will show. This doesn't explain his lack of appetite. She said the three most common things would be- kidney disease, diabetes, or Cushing's.
- She did blood-work and his readings for his kidney were at the higher bounds of normal (like if normal is .0-1.8, he was a 1.8). The blood-work ruled out diabetes and Cushing's (though he'd need a separate test for this, but a significant proxy for this did not show an issue).

She has no diagnosis for me and wants me to choose X-ray or ultrasound. She gave me antibiotics for the blood in the urine.

So, I could have her do an X-ray, which would show the bladder stone and if his kidney's were large/small as an indicator of kidney disease. OR I could do the ultrasound which would show all this and definitively show kidney disease or cancer, etc. OR is there something I am missing that my vet may also miss? Should I get a second opinion? I'm just nervous, and not sure, and already spend $300 on this past visit.
posted by inevitability to Pets & Animals (12 answers total)
Can't speak to the specific course of action to take here, but ask your vet if she takes CareCredit. You might be able to finance a large vet bill with no interest. That might ease some of the financial worries involved in your decision.

Good luck to you and Cute Pup.
posted by SuperSquirrel at 1:28 PM on April 9, 2016 [1 favorite]

One question Mr. Meat asks the vet all the time is "How will the result of this test dictate care?" In other words, you're ordering these tests to determine something, but are you actively going to change something with those results? Or, if your dog has a particular test result, are you going to choose to do nothing, or would you do a particular treatment with either test result?

My wording of that wasn't great, but I hope the point got across.
posted by Ms Vegetable at 2:33 PM on April 9, 2016 [21 favorites]

Get the X-Ray. You could progress to needing the ultrasound, but go with the X-Ray first. If the kidney values are not through the roof (they're up but not looking like kidney failure yet since they're still around upper end of normal) then the vet is trying to see if something jumps out at her from the X-Ray. The ultrasound would give a lot clearer picture on everything but that's a next step if they X-Ray doesn't make the diagnosis easy the first time.
posted by azpenguin at 3:24 PM on April 9, 2016

The only thing I can offer is that a vet used ultrasound to examine my last cat when he had abdominal cancer, and it didn't cost anywhere near $500. IANAVet and I don't really know what I'm talking about, so maybe you could get this service cheaper elsewhere, or maybe there are multiple types of ultrasound.
posted by jon1270 at 5:35 PM on April 9, 2016

I would strongly recommend the ultrasound. Yes, the x-ray is cheaper, but it won't show everything the ultrasound will. If you do the x-ray and it comes back clear, you might still need to do the ultrasound and end up spending more in the long run. Especially true if you would want to give therapy that is on the aggressive side.

If you live in a major city and are having a veterinary radiologist look at the images, $500 sounds perfectly reasonable. It's what I paid for an abdominal ultrasound for my dog, conducted by a radiologist in the DC area.
posted by schroedingersgirl at 5:42 PM on April 9, 2016 [1 favorite]

I would start with the X-ray for $75. You will only be out the $75 versus $500 if all you needed was the X-ray.

I am speaking from ultrasound experience. Spent almost $600 to find out my dog had gas. It was a painful trip for both of us.
posted by cairnoflore at 8:52 PM on April 9, 2016 [1 favorite]

Did the vet rule out diabetes insipidus or just diabetes mellitus?
posted by dweingart at 9:09 PM on April 9, 2016

Can't provide any help, unfortunately, but I merely wanted to say that you have a very cute companion, and terriers are the BEST (all dogs are great, though.).

I wish you both well. Good luck to you both.
posted by InsertNiftyNameHere at 9:15 PM on April 9, 2016

We've been on this ride with our dachshund and a mysterious liver/kidney issue. We went through both the x-rays and the ultrasound and still didn't get a conclusive diagnosis. The vet wanted to move onto a liver biopsy, but we figured that even if the diagnosis was cancer, there's really nothing we'd do for an elderly dog besides palliative care, so we stopped with the testing and just put him on a prescription diet.

So far so good. He's still drinking more than usual, but his mood has been great and he eventually started eating again.
posted by hwyengr at 9:40 PM on April 9, 2016

Can you wait until after the antibiotics are done and see if your dog is eating again? If the antibiotics do the trick then there is no need for ultrasound.
posted by crazycanuck at 11:18 PM on April 9, 2016 [1 favorite]

Recently my cat had a mystery disorder. The treatment history and the result are here. MsVegetable's comment is on the mark, my vet was stumped and shot-gunning for information by the fourth visit. What worked was supportive care and observation since X-rays and ultrasound alike showed healthy cat insides except for dehydration. The cause of her disorder was an environmental hazard, and it took time to put the pieces together.

It's a difficult ride when the situation is undefined. You're doing it right so far. The antibiotic was a good choice since it would take care of a number of common ailments. Rule out the majors next - stones and the like. That argues for doing the X-ray.

Ultrasound is better at showing differences in materials (fat, hairballs) than X-rays. An ultrasound by a radiologist with very good equipment costs about $500, use of small portable ultrasound equipment will cost a lot less.
posted by jet_silver at 5:01 AM on April 10, 2016 [1 favorite]

Thanks everyone for the advice. My pup hasn't gotten better, sadly, even with antibiotics so far. I'm going to call the vet tomorrow (with MsVegtables' q) and will go from there, though leaning towards the X-Ray.
posted by inevitability at 7:30 PM on April 10, 2016

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