There are many dogs on medication for SM that have not had an MRI, especially here in the States. I'm glad that Holly posted. If you don't have insurance and/or you are not affluent or if you don't live anywhere near a scanning facility, there is always the option of starting a gabapentin trial to watch for changes in symptoms. This is called "empirical" treatment. It's best to do after a neurologist physical exam and history but many don't even have access to a neurologist. I'd always opt to start with gabapentin for a trial rather than NSAIDs as gabapentin is generally safer than NSAIDS, especially for long term use.
Originally Posted by murphy's mum
Karlin has mentioned before, and I agree, that insurance companies are likely to eliminate MRI scan for SM for Cavaliers in the future when they figure out how this breed problem is affecting their bottom line. I fully expect that to happen. There will be much more empirical treatment at that point, particularly in this economy, as the average person just isn't going to be able to spend $2k on an MRI.
Thank you for posting that Holly and Pat - even a neurologist consult will really help if you can't manage an MRI scan. that is about £165 at Glasgow.
They quoted me £2000 for the scan, but it came in about £1800 - Also paid £100 for pre GA blood tests - essential in older dogs but advisable in younger ones - it also ruled out other issues. Kayleigh had a spinal tap [similar to a lumbar puncture in humans] - this examines the spinal fluid, checks for inflammation etc. They will have a shaved area on the top of the back in the area of the spine, usually towards the tail but sometimes towards the neck area. [not sure why they use different areas unless it's done after the MRI and they are trying to avoid syrinx areas? Pat might know?]
You can see a needle puncture wound but it heals up very quickly and hair re-qrowth is surprisingly fast.
Kayleigh had an ultrasound due to the weak pulse in her femoral artery - nothing was found and this seems to be another Cavalier thing although as long as they do not show symptoms, it's not clinically significant. This was actually much cheaper than expected, came in around £85.
If medication is needed, Glasgow will prescribe that and give you supplies for about a month, you can then obtain further prescriptions from your vet. It is probably cheaper to get them to issue a prescription and buy them elsewhere. Although vets do rely on income from drugs [this helps keep the consultations fees down...] sometimes they do charge what appears to be an excessive amount for drugs. I came to an arrangement with my vets that if they supply the drugs at a reasonable price [ not more than about 30% more] then I will purchase from them. That takes into account the cost of them writing a prescription - you need to factor that in.
Glasgow will discuss progress and future medication changes with your vet if required - they do ask for a follow up in 3-4 weeks by e-mail or 'phone - especially if you are too far away for further consults.
Thanks Nicki, I'm glad to hear that Glasgow is so nice. I am a little sad to be in the position to need to change vets, but I do feel it's very much in Misty's best interest. I know I am not an expert by any means, but it did feel as though I knew more about SM that either of the vets at my current practice. And like you say I should not have to be jumping up and down demanding a MRI scan and still getting told it's "pointless". I was hoping the consultation and the MRI would be done in the same day, but not to worry I suppose it's not too bad a journey. The new vets have already called for her history to be faxed over, so hopefully he should be up to speed by tomorrow.
Holly I do understand in those circumstances why and MRI can't always be down, but when I was so intent on getting one down, my vets really have no excuse not to refer Misty.
Pat, I did question the vet about why he wanted to start Misty on Metacam, but he said by starting her on anything else "would be jumping straight" in. She's been on it three days now, no obvious improvement, but I assume it's too soon anyway. Then again given the fact I have nagged, yes nagged, I'll admit it, the vets for months now about her symptoms, I shouldn't be surprised. Up until Friday, when I basically lost my temper, their attitude was very much wait and see.
Just to say that I am with AXA and before the scan I had no claims with Harley. They emailed me the Pre Authorisation Form, I printed it out filled it in the vet done the quote and faxed it with Harleys medical history direct to AXA and I had a decision 1 day later where AXA rang me and then my vet to say that itís ok to go ahead with the scan. I needed to take a normal form to the vets so they could claim it direct. But the scan was done at my vets so I didnít need a referral. I will need a referral when I see a neurologist so the consultation for that I will need to pay and claim back.
I'm feeling more nervous as the day goes on. I never thought I'd be looking to change vets after six years, it's worrying.
Plus i'll need to get them used to my singing Cavaliers. Murphy and Misty hate waiting at the vets so tend to be very noisy in reception.
I had to change Vets recently with Ruby as her vet left our surgery after 4 years of seeing her. I really panicked as I know that there wern't many vets around whom have knowledge of this disease!
Originally Posted by murphy's mum
I did alot of calling around and found a vet that was already treating 5 Cavaliers with SM so I took the plunge and got an appointment. I wasn't disatsisfied with him by any means - he knew what he was talking about, Ruby liked him- but then she isn't picky!
But the first time I asked for a Presciption for her meds which I get from Boots I was shocked that I had to pay over £15 and it was only for one dispense!
With my first Vet I only pay £9 for 3 repeats (it does 4 dispenses). To pay £15 every time I went to buy her tablets would mean I might as well buy it straight from the vets ( which I think was what they wanted).
But since then I have gone back to my old vets, for a few different reasons.. One of which being that Charlies Cardiologist is based there and secondly she knows the place and feels happy there if she has to stay over for anything. And it is closer to home (which was a god send when she was extremely sick last month)
And hey- If I can give a vet some experience of treating a dog with SM which can help another dog in the future then I'm happy to do that.
The difference is that I already have a Neurologist in Dr Rusbridge whom I trust deeply and that is another reason I feel comfortable enough to be under the care of a not so knowledgeable vet.
The lady I have now has taken so much time to read through the encyclopaedia that is Ruby's life so far and I really appreciate her for that. She trusts my instincts and will pretty much get on board with anything I need. I have told her about Clares website aswell and she is very interested to learn as much as she can!
For that I am very grateful and happy with the desision I have made.
I've started a new thread in the SM forum as it seems more appropriate. The newest of the bad news is listed there too :(