Embrace Pet Insurance Blog

To treat or not to treat Cushing's Disease

Over at Wellsphere, I had a heart-breaking question on one of my Cushing's Disease posts that I thought worth sharing here. The answer is from our esteemed veterinary consultant, Dr. Heather Carleton.

Question:

I have a minature schnauzer, Kizzie. She turned 11 in Feb. She was diagnosed with epilepsy at 3 and enlarged heart. She has been on 3 meds 2 times a day since. She has been to the vet hospital 3 times with pancreatitis and has cost me about $5,000 in medical bills. A couple of months ago she was diagnosed with Cushings.

I love her very much, but am at the breaking point financially with her. She is a member of the family, but for now I have chosen not to treat her with the additional expensive meds that the vet wants to put her on. Do you know the life expectancy of a dog with cushings...with no treatment?

She has just started loosing her fur in the past 2 weeks. She seems tired a lot and a bit weak, but other than that she is in good spirits and is not wimpering or anything like she is in any pain. From what I've read, the best to expect is 20-30 months...with meds...can't find anything out about without meds...If you know, I'd appreciate it!

Answer:

In general, a dog with untreated Cushing's can actually live as long as a treated dog, but will likely have more side effects (over time) from the disease if not treated. Usually treatment for Cushing's is not even recommended unless the dog has clinical signs because treatment does not necessarily change their overall life span - it just keeps them from being polyuric (urinating a lot), polydypsic (drinking a lot), losing their hair, etc.

However, in this case, if the dog is showing signs of weakness, the Cushing's may be having a negative impact on the dog's heart condition, which would be a reason to treat her if financially possible.

Regardless of whether or not this dog is treated, I would monitor her heart disease, especially if weakness persists or she starts coughing.

[from Laura: my heart goes out to you and your dog. Thank you for sharing your real life story]

Note:
As with any of your pet's health conditions, if you are worried about your pet, talk to your veterinarian - the internet is no substitution for an in-person visit.

Related Posts:
Cushing's Disease in Cats and Dogs

Photo courtesy of the Miniature Schnauzer Rescue of Houston - donations welcome

Where is Laura?

Don't worry, I'm still around but have not been able to find my blogging feet as of late. I have been tweeting once in a while on Twitter so you are more than welcome to follow me at http://twitter.com/laurabennett.

In the meantime, I'll resume normal programming as soon as I can.

One of our latest Embraced pets - I couldn't resist!

Ask Laura: dog weight bearing toe amputation appropriate or not?

I received this question as a comment on my post Toe Amputation for Cats and Dogs and thought I'd pull it out on its own as I get asked this question frequently enough.

Question from Jill Kane:

My dog's rear foot was run over by a car - tearing the pad through to the tendon and ultimately breaking her toe. One option I have is to patiently wait to see if the bones will heal over time (6-8 weeks). This option may not work due to the break. The other option is to amputate her toe. The concern is that it is a weight bearing toe - can this be done with favorable results?

Answer:

Jill, that is an excellent question that I'm definitely not qualified to answer. So, I popped the question off to one of our advisory veterinarians who specializes in orthopedic surgery and this was here answer:

One weight bearing toe can be amputated and the dog should do well, the veterinarian needs to be sure to reconstruct the skin in order to assist with weight distribution.

Also other things to take into consideration is how much of the toe needs to be removed. Are the metatarsals/metacarpals intact, certainly DO NOT remove those. Amputation of just p3 will do better than p2 and p3 as well as p1-p3.... Also, what is the size of the dog? Smaller dogs will do better than larger ones.

[Note that P1, P2, P3 are short for the different "phalanges" or toe bones, which you can see labeled in the illustration to the right]

Ask Laura: how does Embrace Pet Insurance treat a shelter cat without health history

Here's a question that came through my blog. It's a bit long but instead of me editing it and removing the personality of the question, I thought I'd leave it intact and let you scan accordingly.

Question:

My question has to do with health history and shelter pets. My beloved abyssinian died two weeks ago so I signed up with various breed rescue groups and began scouring petfinder for another one. The best way to grieve a pet is with a pet, right?

I located a great little guy (appears purebred abyssinian) who had just been brought to the shelter and drove 4 hrs round trip to adopt him the same day. He only spent about 6 hours in the shelter environment. He looks great, is playful and energetic, eating and pooping as expected and doesn't appear to have anything wrong with him. The shelter paperwork just records the shots he was given and is stamped that he might have been exposed to an upper respiratory infection which is standard for shelters - precisely why they have a stamp. Haven't noticed any symptoms but I'll give him a few weeks before introducing him to my other cat just to be sure.

So, having broken the bank trying to save my last cat, I would rather spend my 3-4 hundred dollars this year on insurance than on redundant wellcare. My preference would be to only bring this cat in to my vet if he needs it over the next 10-12 months until what would be his annual exam, shots, etc. By then I would have had about a year of insurance coverage.

However, what if something showed up during the vet visit? Worst possible outcome for me financially would be-

1) healthy cat from the shelter,
2) insurance payments for a year,
3) 300 or so spent on wellcare at the end of 10-12 months,
4) something discovered at the annual visit,
5) somehow whatever it is is considered preexisting even though it wasn't observable at the shelter or by me.

I'll never have a medical history for the previous 4 years (shelter estimated his age) and they gave him his shots before I took him home so I feel like I've got a "clean" cat. If I have to take him in for some kind of qualifying vet exam in order to obtain insurance I won't have enough cash left for the insurance.

I believe in wellcare for pets because they can't talk so you have to have an expert look them over on a regular basis. (As opposed to the annual exam for people which studies show is not necessary because humans can identify and explain their problems seeking care as they arise). However in this case I feel like the cat was evaluated at the shelter (albeit in a limited way), he has already had his vaccines etc. And I'm outa cash for a while. Smile.

If I buy a policy from Embrace (by far the best company around) I don't want to learn that he doesn't qualify for coverage in the future (whether 6 or 16 months from now) because I didn't take him in for a preliminary exam under the assumption that the shelter wouldn't have allowed me to adopt a sick animal.

Many thanks,

Answer:

First of all, thanks for reaching out. It’s great to see someone doing so much research. I'm sorry about your Abyssinian, my heart goes out to you.

But back to your questions. As you can imagine, this is not the first time we've come across this rescue shelter situation. We do assume that a shelter won't adopt out a sick cat or dog unless the adoption records say otherwise (some people specifically will take on a special needs pet). We also don't require you to go again to the vet. As long as you go once a year for a routine visit, that works for us.

On your first claim, just make sure to send in the rescue notes. I should remind you that the waiting period still applies - anything that happens in the first 2 weeks of the policy is not covered, including things that had symptoms in this period.

Does that help you folks with rescued cats and dogs?

As always, get a free quote for Embrace cat insurance over at our website www.embracepetinsurance.com. And while you are at it, you can learn about pet insurance there and compare pet insurance plans too.

Ask Laura: coverage for a Lyme Disease positive dog

Lyme Disease is quite contentious in the veterinary world because there are a lot of unknowns about the disease and how it affects dogs and cats.

For example, no-one really knows if Lyme Disease is "cured" when treated. It might just recede to come back at a later date - nobody really knows.

Here's a question from the comments in the Invisible Voices blog. It's a good one!

Question

One of my dogs tested low positive for Lyme disease, just curious if most anything that could happen to him now could be blamed on Lyme and therefore not covered?

Anne

[note that Anne is asking this question while researching pet insurance; she doesn't have a policy yet]

Answer

Anne, after much digging, I now know more than I ever wanted to about Lyme Disease. I'm sure I'm going to tell you some things you already know but here's some background on Lyme Disease for others reading this.

A positive test for Lyme Disease means that a cat or dog has antibodies to the bacteria and have these antibodies for one of three reasons:

1. he/she has an active infection;
2. he/she had an infection in the past and it's gone now; or
3. he/she has been vaccinated for Lyme Disease at some point in the past

The problem is that there is no test at present that can tell you which reason is causing the result.

Once a pet comes up Lyme-positive, some vets would opt to treat him/her with a month of Doxycycline (antibiotics) just to be sure of attacking the disease (reason 1), even if it's already cured or never existed in the first place (reason 2 or 3).

Others choose to wait and see if symptoms show up and then treat.

Another alternative is to do further titer tests to see check the antibodies levels. High levels of antibodies indicate an active infection; low levels indicate just antibodies, no infection.

So, with that in mind, I'm going to try to answer your question as our claims department would handle it Anne. You will have to ask the other insurers what they would do in the same situation.

Assuming the test occurs prior to you getting pet insurance (or in the waiting period):

• If you can prove the positive test is from a vaccination (from your vet records for example), then we'll treat your dog never having had Lyme Disease.
• If your dog has a positive Lyme Disease test and you decide to learn more by going for the titer test and find your dog has low levels of antibodies, we'll treat your dog as never having had Lyme Disease .
• Otherwise, we would exclude coverage for conditions that are known to be caused by Lyme Disease such as arthritis, limping, and just "not doing right". I know that's not a very satisfactory answer but Lyme Disease can manifest itself in all sorts of way. The good news is that things like cancer are not excluded as we do not believe they are more likely for a Lyme-positive dog.

If the positive test occured after the dog is covered by pet insurance (and the waiting period is up) and there were no signs that could indicate Lyme Disease, we'd cover whatever you and your veterinarian decide to do; the Lyme Disease would not a pre-existing condition.

As more comprehensive research becomes clear about Lyme Disease in pets and veterinarians come to a consensus on treatment approaches, we will update our approach accordingly.

NOTE: if you are planning on buying pet insurance and doing the test just to be sure about your dog or cat's lyme status, you should do that test after you have purchased your policy.

And that is the end of my tome on Lyme Disease for today!

Ask Laura: would a second ACL tear be covered?

Here's a question that was posted as a comment on one of my blog entries on pre-existing conditions in pet insurance. It's a regular question at Embrace so I thought it worth putting it in its own entry.

Question

My eskie just tore her ACL/PCL and is home from surgery today. we took out Care Credit to pay for the surgery (zero interest for 18 mo). It got me thinking about pet insurance.

Would this injury preclude her from coverage? What if the other knee became injured at a later date? Not likely, but would it be denied?

Linda

Answer

Linda, this is a question you should get answered right up front by any pet insurance company you are thinking of dealing with.

ACL (anterior cruciate ligament) tears are a bilateral condition - a condition that affects both sides of the body. Once you have had one leg tear, the second leg is more likely to tear, and that generally makes it a pre-existing condition in the second leg for most pet insurers. I'd confirm with any company to specifically tell you whether the second tear is covered assuming you've had no signs there's an issue already (and if they say yes, get it in writing!).

At Embrace, your Eskie's ACL would be considered a pre-existing condition and be excluded from future coverage; however, American Eskimo Dogs are also prone to other conditions such as hip dysplasia and progressive retinal atrophy (PRA) and assuming there have been no signs of these conditions before the end of the waiting period, they would be covered by Embrace going forward (not all pet insurers cover hereditary conditions such as these.)

How many times do you know of a dog getting just one condition over its life? It's worth getting coverage for whatever else might happen.

As an FYI, we've recently sharpened up the wording in our policy terms and conditions to clarify how bilateral conditions and other related conditions are treated and I'll blog in more detail about this shortly.

Stay tuned for that...

Ask Laura: sending veterinary records to Embrace

Question:

I was just wondering if my first claim would process faster if I faxed in the medical history records right away instead of with the first claim.

I was just wondering because with a previous pet insurance company , when I sent my first claim in, the vet's office faxed it for me along with the records and then it took almost 2 months before I got a letter saying the records were never received and then I had to have the vet send them again.[editors comment - she was referring to a company other than Embrace, thank goodness!]

Miranda

Answer:

Miranda, we welcome you to fax in your pet's medical history now that you've purchased your policy. If we have your pet's medical history up front, it should make your first claim go faster. And sometimes for you, it's much easier to hunt down records without the pressure of an unpaid credit card bill breathing down your neck.

What should you send us?

Fax us the medical records from all the vets your pet has been to in the last 2 years, including any visits in the first 14 days of the policy. If you are not familiar with veterinary medical records, these are the dated notes the veterinarian makes as she's examining your pet, the diagnostic results, and letters from referral vets - basically anything in your vet's files on your pet.

Embrace wants happy, healthy pets and one of our policy conditions is that your pet receive a checkup once a year. Although we don’t reimburse you for this, you can just fax in the dated invoice from your vet visit when you’re done and we’ll consider your pet checked. And if, heaven’s forbid, your vet should find something irregular during your pet's regular visit, remember that Embrace will be there to help you.

Our toll-free fax number for medical histories and claims docs is 1-800-238-1042.

Ask Laura: when to get continuing care?

Here's a question that was posted for me over at the Invisible Voices discussion about pet insurance.

Question:

Let’s say in the year 1 I don’t get “continuing care” coverage and my cat gets sick. Embrace covers the vet bills. In the year two when I’m renewing my policy, do I then have an option of still purchasing continuing care, or not? If I do, that means that in the first year of insuring you don’t need to purchase continuing care.  Jane

Answer:

Jane,

In the scenario you describe, you can pick up the continuing care option in year 2 but any illnesses in the first year would be considered pre-existing for the continuing care option going forward. In other words, you have to get continuing care now to have it apply to illnesses that occur in the first year.

Laura

Ask Laura: sending in my claim within 60 days if I haven't met my deductible

Question:

I chose a plan with a $500 deductible as I truly am most concerned with the major problems (and I couldn’t afford the premiums for a lower level). However, I notice your instructions indicate that claims over $50 must be submitted within 60 days of the vet visit. Do I still have to submit all claims before I reach the $500 deductible?

What would make the most sense to me is to save all bills, and then if, and only if, I get past the $500 would I submit for reimbursement. I would want to be able to include any lesser bills incurred during the year that would contribute towards the $500, but by that point they would be past 60 days old. If I have to keep submitting claims all year that I’m not going to get reimbursed for (because I have not yet met the $500 deductible) then this plan sounds like too much work.

Please advise.

Answer:

You are absolutely right - saving them until you meet your deductible total makes the most sense and that's what we've unofficially been allowing behind the scenes. But no point hiding the good news and I'm glad you asked this so I can say that we won't enforce the 60 days when you haven't met your deductible total.

Do make sure to send your invoices in in a timely manner when you finally go over the deductible and certainly be sure to send them in within 60 days of the end of your policy year so we can wrap up things up for our underwriters in a timely manner.

Thanks for that excellent point - I'll make sure to update the instructions on the claims as soon as I can.

Looking for a veterinary surgeon in the US or Canada?

We had a question in a comment that I thought was worth elevating to a full post since the answer we provided is useful to everyone looking for a surgeon. The original post was "Reparing a Tracheal Collapse in Dogs" and Bob's question is in a comment is attached

Question:

We have a toy Pom (7yr-old) who definitely has the symptoms of TC [tracheal collapse], and we've been trying to find info on the www about it, which is limited, as you mentioned. We love our dog as one of our children and want the best for her. Do you know of or have heard of any Vets close to northern New Jersey that have experience and familiarity with the diagnosis and treatment of this condition? Any help or leads would be greatly appreciated! Best regards - BobB

Answer:

Bob, we're so sorry about your Pomeranian :(

The American College of Veterinary Surgeons website is the place to search for board-certified specialists in New Jersey or anywhere in the US or Canada.

Go to http://www.acvs.org/AnimalOwners/FindaSurgeoninYourArea/ and select the state or province from the “State/Province” box (in Bob's case “NJ”. There are quite a few in NJ.)

Note that tracheal collapse can also be treated non-surgically but we understand that at some point it becomes necessary to go under the knife. There is also evidence that tracheal collapse contributes to liver disease due to low-level oxygen deprivation, best look at it asap.

Bob, good luck to you and your Pom.

Related Posts:
Treating tracheal collapse in dogs - Dr Chick Weisse
Repairing a tracheal collapse in dogs
Collapsing Trachea in a dog
New York Times - Cat and Dog Obesity
Dog choking on a ball
Big vet bills and no pet insurance?
Non-invasive veterinary surgery