This is part of my ongoing effort to track our pet finances here at the House of Two Bows. Previous posts in the series can be found under the category of finances.
The Cost of (Pet) Things for September 2012:
Food: $49
Treats: $30
Grooming: $7
Accessories and misc: $45
Vet & Medical: $20
TOTAL: $151 (running average for 2012 ~ $153 / month)
This is apparently the month of “green” food, including a variety of supplements. We got a lot of mileage out of our sample pouch of The Honest Kitchen’s Perfect Form, an herbal and plant-based digestive supplement, so I bought a full canister to keep on hand — not for everyday use. After last month’s half-successful trial with green tripe (Bowdu loved his share; Bowpi barfed up her entire portion), I went ahead and picked up two more chubs. While browsing at the local holistic pet store, this item called Green Mush™ caught my eye, so I grabbed a small sample bottle.
I liked it better when I hadn’t taken a look at the company website. I’m sufficiently scared by what I read from HealthForce™ that I’ll be giving them the rest of the bottle in ratios much lower than suggested, lest the Bows start beaming involuntary telepathic messages to Mayan DemonWarriorSpirits™ to come invade our home and do their Manna-thing all over us…
1 tsp Green Mush added to 1/4 cup of Honest Kitchen Preference… it’s practically glowing
Lesson learned: take heed of the CRAZY MYSTICAL SYMBOL™ on packaging before purchase. Luckily this stuff was not very expensive.
Moving along in this month’s showcase of The Overindulgent Pet Mommy to the treats and non-essential edibles category, the Bows got some more C.E.T. dental chews and a bag of really expensive dehydrated goat liver treats. I was enjoying a fleeting sense of optimism and in a mood to buy something shiny when I picked up that $15 pouch (about $13 after my store rewards discount). Though the Bows expressed their gratitude with appropriate enthusiasm, I felt like such a sucker by the following day that I bought a couple pig’s hearts to chop up and throw into the dehydrator. MY homemade treats will cost barely a fraction of what I paid for that pack of goat liver, dammit.
Grooming costs amounted to a single tube of pet toothpaste.
Accessories and miscellaneous costs included a Thundershirt, as mentioned (yet to be put to the test), and the toll across the Bay bridge to take the Bows to the beachside Shiba meetup. The parks themselves may be free, but travel still accounts for some expense — I’ve given up on counting gas money!
Finally, I had to reschedule Bowdu’s anticipated vet appointment for early October… so this month’s medical expense is merely for a refill of his Soloxine. That’s how much I paid 1-800-Petmeds for a 250-count refill of 0.4 mg pills (his entire daily dosage), minus a $5 loyalty credit. Thank goodness hypothyroidism is a relatively inexpensive and easily manageable condition… at least for Bowdu, for now!
TOTAL: $217 (running average for 2 months, $175.50 / month)
Aurgh. How did we end up spending so much this month, especially on edibles?
Well for starters, in the Food & Treats categories, I got a 180g container of PlaqueOff on Amazon for $43. Three times the amount of our usual 60g containers, which cost around $22 ~ $25 at local stores. Times like this, I feel no qualms about turning to online discounts.
We should have saved a bit this month, thanks to a sponsored review from Mr. Chewy. I guess we’ll feel the savings in subsequent months as we work through all our edibles. Also filed under treats are two packs of C.E.T. Dental Chews we got at a good price in celebration of National Pet Dental Month. These are the only beefhide products we feed here at the House of Two Bows.
As for Vet & medical costs, Bowpi went in for a checkup at a new vet for a mole/wart thing that’s been growing on her front leg. It didn’t seem to alarm the vet and he didn’t push any tests. He told us some of our options if we did want to get it more thoroughly checked out; in the meantime, we’re keeping an eye on it. So for the first time ever, we left our vet appointment with a double-digit vet bill, a “mere” $68 for the consultation.
Meanwhile, Bowdu needed a refill of Soloxine, and we’re doing something slightly different this time.
Instead of getting one 0.2mg pink tablet twice a day, he’s getting half a 0.4mg purple tablet twice a day. Based on the price list at Drs. Foster & Smith, our regular way would have been 12 cents a day for medication. This way, we’re paying 8 cents a day for medication.
Yes, it’s the difference of pennies. But considering that Bowdu will be on this thyroid medication for the rest of his life, every extra cent makes a different, doesn’t it?
Shortly after joining the Yahoo group for hypothyroid pets, another Shiba owner introduced herself to the list with the following anecdote (reposted with author’s permission with slight edits for clarity):
I have a five year old Shiba Inu who was just diagnosed as Hypothyroid. The reason we had her tested was due to “night terrors”. She has not slept through the night for 3 weeks. The first week she scratched at my face all night and panted so bad it was dripping all over my face. Nothing calmed her until dawn came. I used to crate her when she would get worked up over storms, but it wasn’t even storming. I tried to crate her but the anxiety increased. We tried to crate her in another room with a radio but she broke a tooth off at the gum line so crating is out. We do have a Kennel-aire now with the 1″ diameter wire so she can’t get her teeth on it. She goes in that during the day but I will still come home to a crate wet with drool. We tried Clomipramine at 25mg (she weighs 17lb) but that did nothing at night. While we were waiting for the thyroid results, which took 10 days, she has been on Reconcile [fluoxetine hydrochloride, aka Prozac] that helped a bit but seeing her on Prozac was SO SAD. She is now slowly being taken off that. It was horrible having her on it. She was on 8mg once a day which caused severe constipation.
NOW that we have her thyroid results she is on Pala-Tech 0.1mg twice a day. She still pants on and off through the night but she can’t make it through the night without going out to pee. I pull her water bowl up at 7pm and take her out at 9pm before bed. Is this due to the Pala-Tech? Will this go away? I need SLEEP. It’s been weeks. I also have to sleep downstairs with her because this night time fear all started when she heard bats in the attic and they were coming in the house. Bats are gone and we haven’t heard them for weeks now.
Of course, I jumped right on that one. I felt a particular sense of urgency to respond because Bowdu was going through a simultaneous bout of consecutive nights of “night terrors,” as she so aptly described it.
From April 21st to April 27th, Bowdu did not sleep through an entire night.
April 21, 7 AM (about half an hour before my alarm clock): Bowdu jumped up onto my side of the bed to hover over my head, back legs quaking.
April 22, 6 AM: Same thing. I groggily let him out in the backyard to relieve himself, thinking this might help. When he came back, he was still shaking so I held him and tried vainly to doze until my alarm went off.
April 23: An especially rough night. I was looking at a 14-hour day across the Bay, and already went to bed far too late. Bowdu jumped up into bed at 2:30 AM, shaking for no discernible reason. This time I desperately did not want to deal with it, so I flounced off to the front room with earplugs stuffed into my ears and closed the door, hoping the Doggy Daddy could be awakened from his winterbear-slumber. Instead, Bowdu pushed open my door and climbed onto the futon, trembling so hard that I could not fall asleep.
This lasted for three hours.
Finally at 5:30 AM, I reached over and dragged him from the edge of the futon over to the wall next to me, where I pressed my body against him and the pillow propped up against the wall. I basically sandwiched him between a bunch of soft things. And then miraculously, maybe because he was finally exhausted or because I had inadvertently unlocked the secret of the “squeeze machine”, he stopped shaking. Bodies aligned, we got about an hour’s worth of sleep.
That was the worst of it. Bowdu continued to jump up onto the bed trembling at 7 AM, 4 AM, and 7 AM again for the next few days, but the terrors eventually subsided. Unlike the other Shiba above, he did not drool, but the other behaviors sounded all too familiar — all that panting, pacing, trembling, which I’ve documented just recently.
I am not familiar with any of the drugs that the other Shiba owner gave her pet (except for Prozac, which is more extreme than what I think is necessary for Bowdu). We both got one “new” suggestion from the Hypothyroid pet list to check out our pets’ cortisol levels and to supplement with T3 drugs (Triiodothyronine) instead of just T4 (Levothyroxine), which is what we’ve been doing.
I am not ready to go this route, and need to look into it a little more, especially as I recall the peer-reviewed literature recommending against T3 therapy for a variety of reasons related mainly to sourcing (i.e., bovine vs. porcine hormones) that I have to fact check before I report back here. At any rate, I know there is some preference for this kind of dessicated thyroid therapy since it’s available from animal sources. Could the trade-off be standardization of production and quality control (including published research that does not make a distinction between bovine or porcine sources for natural thyroid extracts)? Though Soloxine is synthetic, honestly, it has worked very well for Bowdu for a good run so far, and I’m not willing to risk upsetting the balance until I know exactly what I’m doing or until I have veterinary approval.
At any rate, it’s a reminder to take online veterinary health advice with caution, and follow up with your own diligent research. Even if I don’t understand everything that I’m told/given, I will at least evaluate my sources. (The academic in me revolts against the very idea of citing Wikipedia as a source, but if you read between the lines of the entry on dessicated thyroid extracts, you get a hint of the contested nature of this terrain in both human and animal health.)
In other news, last week I ran into another Shiba owner whom I had never met before. She was with a handsome red male named Fuji. After brief introductions, one of her first questions was, “Does your Shiba have allergies?“
So I referred her to this blog…
I can’t remember how old Fuji is, but I seem to recall that he was quite young for a Shiba who’s already undergone the rigmarole of steroid pills, Atopica, allergy testing, and now allergy shots. I didn’t get a good look at his fur or his skin. It was rather hot that day, and Fuji was hanging out under the shade while the Two Bows were pushing ahead in the opposite direction. Fuji’s person commented that Bowdu appeared in good shape for a Shiba who was supposedly prone to allergies. All I can say to that is knock on wood. In the past couple of weeks, both Bows have been licking themselves and scratching their muzzles more often, though there is no visible change to their skin. We’re trying to get a jump on preventative therapy this year, so I’ve already been dosing Bowdu with OTC allergy pills about every other day or when plant activity seems especially profuse. I’m also busting out the baby wipes after every dog park run. I also need to pick up some more local honey from the community garden down the street (great for homemade facial masks, too!).
We’re also trying the above combination of Azmira Holistic herbal extracts. I dropped about $40 on two vials of Yucca Intensive and Aller’G Grass and Pollen mix (which contains a pungent mixture of eyebright herb, bayberry root bark, goldenseal root, calamus root, stinging nettle leaf, and grain alcohol). A couple other different kinds of Aller’G extracts are available through this company, and they recommend using them in combination with several other products, but given how expensive these remedies are, I’d rather try a bit at a time and see if I can notice any improvement over time.
The last 2 fl. oz vial of Yucca Intensive lasted nearly a year (only Bowdu was getting this natural anti-inflammatory supplement). So presumably the 1 oz. vial of Aller’G Grass and Pollen will last long enough for me to assess its efficacy. Both Bows are getting a few drops several times a day, mixed with a little bit of all natural apple juice. It’s a new treat they’re quite happy to lap up.
The Bows had an uncharacteristic day at the park today, where Bowdu was the one interested in playing with another dog while Bowpi sat out the fun and games.
This little, 6-month-old Yorkie-wire-haired-Dachshund-whatever mix, Maxine, was goading Bowdu into pursuit with her rapid movements and wriggly waddle.
And Bowdu accepted the invitation. The chase was on! Which actually made me a little nervous, as Bowdu was being very vocal (typical for him, though I’m never sure how other dogs are going to react) and he kept treading on the tiny little puppy.
Maxine kept tapping out, basically flopping over onto her side and exposing her tummy in an extremely obsequious gesture. She was behaving like this with the other large dogs in the area even before Bowdu started playing with her, so it just seemed like her natural defense mechanism. Basically, it was her way of reminding the other dog of how harmless she was, and that she was, after all, just playing.
During these pauses, Bowdu would hover over her, tail swaying in agitation like he was focused intently on her next move. He strikes the same posture when I’m trying to roll a tennis ball across the room, and he’s anticipating the direction of the launch so he can intercept before it rolls past his feet. The difference, of course, is that Maxine is not a tennis ball, but a live toy. She would call off her time outs by darting up to “tag” him with her muzzle before zipping off again, with Bowdu close behind.
I was monitoring Bowdu’s response to Maxine’s fish flops closely. It seemed to me that something about the way that Maxine moved, all quick and rabbitty, might have been stirring his prey drive and that’s why he felt compelled to play chase, though he’s seldom so conducive to this game. In fact, it’s Bowpi who’s usually more interested in chasing, though oddly enough, she sat this one out!
So I was worried that Bowdu might overstep his bounds and get too rough with little Maxine, especially if he was becoming too absorbed in the idea of this wee bite as “prey.” I guess this is what is known as predatory drift, and towards the end I think Bowdu was close to the edge. Maxine’s momma did in fact decide to call off the game when Bowdu chased her into a hedge, effectively trapping her. He stood over her going Aroooooo-rooorooo and barking sharply like he was eager to have her run some more, but she wanted to stay put. Since the game wasn’t going anywhere at that point, we called them both out and broke it up.
Maxine’s momma picked her up and walked away down a fork in the path. What surprised me is that Bowdu followed her, even jumping up against her thigh at several points — he hadn’t had enough! Bowpi and I continued walking further up another parallel path, since Bowdu is usually better about following when we wander out of sight. But as you can see from the distant shot below, he didn’t really seem to care where we were.
But at the next fork in the road, he came back.
Another notable thing about today’s dog park excursion was that Bowdu encountered a large, unaltered, heavily panting Olde English Bulldogge, but he was not at all reactive to her, even when she started to get scrappy with another Rhodesian Ridgeback in the vicinity.
Times like this when Bowdu is sociable, reasonable, and otherwise behaving as a normal dog are when I have to marvel at how far we’ve come since his earlier days. He’s not always a little devil. He’s actually quite good, more often than not, though we’ve had to work consistently to socialize him, and we’ve had to learn how to work through some of his specific quirks through calm, steady observation.
I can say with some certainty that Bowdu’s temperament has evened out a lot since we started him on thyroid pills, now going on our eighth month of this medication that he’ll be taking for life. It’s not all thanks to Soloxine, but I’m sure we’d be dealing with a lot more behavioral difficulties right now if we had never gotten him tested for hypothyroidism.
For a background explanation on why I’m charting our monthly pet expenses, please check my first post in this series.
This month kind of hurt.
THE COST OF (PET) THINGS: February 2011
FOOD: $81
TREATS: $32
ACCESSORIES & MISC: $42
VET/MEDICAL: $557
TOTAL: $712
(Running average for 2 months so far: $430)
Eee. Gads.
While this month is not representative of normal pet expenses here at the House of Two Bows, I also didn’t do a very good job meeting my prescribed goal of moderating purchases by keeping track of them. Food and treat expenses still exceeded the previous month, somehow. I had expected these costs to go down, since we have a freezer full of meats and raw meaty bones (which we’ve been diligently thawing and feeding). We’ve switched to Primal Raw patties instead of nuggets, which is more cost efficient though it takes some extra maneuvering to measure out the food in the right proportions. We also had to purchase two bags of kibble this month, a large and a smaller bag. All of this may get us through most of next month. And while I didn’t buy as many bags of treats this month, they were fancier — ostrich jerky, specially coated dental chews, and a large bag of training treats.
Under Accessories and miscellaneous, I’ve included some topical anti-fungal and OTC antihistamines in preparation for the possibility of another impending onslaught on Bowdu’s immune system in March. This is when things started to get bad for Bowdu’s skin last year, so I’m hoping to head some problems off at the pass.
And finally, about those vet fees… We refilled Bowdu’s Soloxine ($15 / 250 pills), reloaded both their supply of Comfortis ($78 / 7 doses), and then there was that big ol’ dental procedure that caused this month’s total to mushroom…
Bowpi - before and after dental work (layout provided by our vet)
The thing is, while that procedure itself is exceptional, I’m not about to brush aside the figure. That is, I would feel much more secure as a pet owner knowing that I could drop hundreds of dollars on vet fees, if emergency calls for it. So even if we didn’t have to bother with a full dental procedure for Bowpi this year, even if nothing out of the ordinary happened to either dog, this is an essential consideration for any pet budget, absolutely not to be dismissed.
Now is it always possible to have that kind of money on hand? Of course not, not for everyone. Again, I’m lucky to have someone to help me split the bills. Fate willing, I can at least fall back on good credit…
This post is about our experiences thus far with Soloxine, an inexpensive synthetic hormone currently manufactured and distributed by Virbac. Soloxine is one of the most popular name brands for Levothyroxine Sodium, designated specifically for veterinary (animal) use. Another brand for animals is Thyro-Tabs, which we have no experience with. Brand name L-thyroxine is apparently more effective than generics, and these two were the brands specifically recommended by Dr. Jean Dodds.
When Bowdu had his first thyroid panel done in August 2010, the results came back with his T4 levels below minimum, and his FT4 levels at 1 pmol/L within normal, at the bottom end of the reference range. My vet called it “borderline low,” but based on his concurrent clinical symptoms, I was ready to start him on thyroid supplementation immediately.
Once thyroid supplementation begins, it is usually expected that the dog is to remain on thyroid supplements for the rest of his life. Clinical signs of hypothyroidism, which clearly matched Bowdu’s physical condition, usually indicate that the thyroid has already been mostly destroyed by its own immune system. Long-term hormone replacement would result in the shutdown of any natural hormone production as well, which is why it is important to get an accurate diagnosis with both T4 and Free T4 panels, at the very least.
We began with one pill twice a day, at a dose of 0.2 mg based on his weight (at the time) of 33 pounds. Soloxine’s site recommends an initial dose of 0.1 mg per 10 pounds. Hemopet suggests 0.1 mg per 12 – 15 pounds, then adjusting the dosage as necessary according to follow-up bloodwork.
I had no hesitation about starting Bowdu on thyroid supplements, as I’d heard anecdotal accounts that they made a huge and immediate difference. I was also less concerned about this medication, given that thyroxine is supposed to be in his system anyway. However, as with all drugs, this one is not completely without side effects, though I think they were of minimal concern and far outweighed by benefits.
One of the more undesirable side effects that I would ascribe to the thyroid medication (though I don’t know for sure if this is the cause) is exhibited in this video:
Video taken 23 September 2010
About a week after Bowdu started thyroid supplementation and continuing for a couple months, he would exhibit bouts of confusion or just plain weird behavior. In this video, he’s still battling his raging allergies, as he had been all summer, which is why he’s in the cone. These episodes only happened at night, either right before or a few hours after his evening pill. He would get strangely clingy or antsy, and his tail would droop. He’d pant. He’d crawl into corners as if he was looking for something, or try to squeeze himself underneath endtables, or in this case, he’d poke at objects in corners of rooms, like this paper shredder that has always been there. Another time, he jumped up into bed, stepping all over my head in the process (he’s usually more conscious of personal space than that), moved from there to the nightstand, and pawed at the bedside lamp. When I pulled him towards me and held him, I could feel his body trembling.
The trembling was very similar to this video:
Video taken 29 August 2010
The above was taken when Bowdu appeared to be asleep. However, he was awake and very conscious in other episodes of shaking.
My only guess is that these were episodes of short-term thyrotoxicosis, or thyroid drug overdose. According to Soloxine’s drug information insert, the symptoms of thyrotoxicosis include: “polydipsia [increased thirst], polyuria [increased urination], polyphagia [increased appetite], reduced heat tolerance and hyperactivity or personality change.” The last bit seems overly generalized to me, and doesn’t adequately compare to even Wikipedia‘s description: “In excess, [thyroid hormone] both overstimulates metabolism and exacerbates the effect of the sympathetic nervous system, causing ‘speeding up’ of various body systems and symptoms resembling an overdose of epinephrine (adrenaline). These include fast heart beat and symptoms of palpitations, nervous system tremor such as of the hands and anxiety symptoms…”
As I understand it, thyroid hormones are normally secreted as necessary to keep overall levels stable. With synthetic supplementation, artificial “peaks and valleys” are created. While dosing twice a day (BID) as opposed to once every 24 hours (SID) creates more “stable” levels, no doubt the body still responds to the changing level of hormones. If Bowdu’s levels had been low for some time, it would stand to reason that these elevated thyroid levels would feel disorienting, even if they were being maintained at “normal” levels.
So for the sake of minimizing these shocks to his system, I thought it was important to keep Bowdu’s doses as close to 12 hours apart as possible. We’ve developed a pretty good system where he gets his medication first thing in the morning, about an hour before breakfast. Knowing that I have a hard time functioning before coffee, I’ve made things as easy as possible by preparing his marshmallow-wrapped morning dose in advance. A weekly round of morning pills rests conveniently on the nightstand; I don’t even have to be fully awake to pop one out of the case, lean over the edge of the bed to slip it to Bowdu, then hit the snooze bar.
The other half of the daily dose awaits in the kitchen, where it is offered in the evening, about 2-3 hours after dinner.
9 January 2011
Getting Bowdu used to his pills wasn’t hard, though it took a few tricks to turn it into routine. He has a bit of a sweet tooth, so we wrap his pill in a fat-free, but oh-so-sugary mini marshmallow. He also gets more interested if he sees me consuming something first, so at first I made a big show out of eating some marshmallows before offering him one. It also helped to lick the surface of the marshmallow I was offering him, so that it would become a little gooier, thus sticking more to his palate.
Marshmallows are also a great treat for catching in mid-air. Sometimes to liven up the routine of pilling, I’ll grab maybe three or four, one of them stuffed with Soloxine, and gently toss the treats for Bowdu to snap out of the air. When pilling becomes a game, the task is just easier.
About six weeks after he started taking Soloxine, we had a follow-up thyroid panel. Results were within normal range, as expected, so he remained on the same dosage. This will probably change over the years, but for now, we’ll maintain this regimen.
Also, the episodes of oddness depicted in these videos seem to have stopped for now. Something new may arise in the future. As for what came before, I can definitely say we’ve made progress when I compare the archives to his current state.
As much as I griped about my previous vet not being willing to work with online pharmacies, I know that Internet pharmacies are not above reproach, too. In the interest of equal opportunity bitching, today I will comment on my latest order from 1-800-PetMeds.
So my order, which included a prescription order of Soloxine, was placed last Tuesday. I received notification that it shipped Wednesday, after my vet faxed the prescription to their offices. I took one week, or five business days, to get from Pompano Beach, FL to California. No complaints about the efficiency of the process!
My order consisted of:
Soloxine 0.2 mg tablets (250 @ $0.09 = $22.50)
C.E.T. dental chews, size medium (30 count bag, $13.99)
Diphenhydramine 25 mg, 100 ct. bottle ($7.99)
The dental chews arrived fresh. The generic Diphenhydramine they sent along is called Banophen, distributed by Major Pharmaceuticals (31778 Enterprise Road, Livonia, MI). Good enough.
The main reason for my order, Bowdu’s Soloxine, turned out to be a little disappointing. I ordered 250 as I understood the pills come in either 250-count or 1000-count bottles from the manufacturer. We did not get a sealed bottle from Virbac with the original label and packaging information, as I had hoped would come. Instead, the pills were shipped in PetMed’s own labeled pharmacy bottle, which means I guess they collected the quantity I ordered from loose bottles.
Okay, fine, I can deal with that. But what irked me was that the expiration date was listed as 10/13/2011 — as in exactly one year from when the order was fulfilled. I highly doubt that’s what was written on the bottle(s) from whence these pills came, and so I have no idea how fresh these pills actually are. In that sense, they’re no better than my previous vet, who was giving me pills set to expire in a month.
To PetMed’s credit, they did stick a note onto the pharmacy bottle that indicates the medication is to be taken an hour before or 2 to 3 hours after a meal, which is the correct way to dose Levothyroxine. So they’re at least two steps ahead of my previous vet in terms of price and providing correct instructions.
I’ve e-mailed to ask how I (and other customers) can know for sure that we’re not getting expired drugs, so we’ll see how they respond.
Meanwhile, Bowdu’s skin and feet are no longer swollen and pink thanks to the antibiotic shot and the Ketoconazole, but now his paw pads seem to be cycling through another phase of grodiness. This yeasty overgrowth really is hard to control! We wipe his ears every day with Novalsan Otic, and while there’s considerably less gunk coming out of those orifices, his ears still exude unpleasant odors. We’ve tried shampooing his feet with two brands of pet shampoo so far, but his paw pads get crusty again within days.
I just bought a bottle of Selsun Blue and bathed his feet with it today. There was a noticeable slickness to the texture of his bald skin where the shampoo had soaked for 15 minutes, so I hope that means the selenium sulfide is working.
He has about five days of Ketoconazole left.
The weather is finally turning autumnal.
He’s cone-free at the park again. When he can remain cone-free at home for 24 hours without inflicting any major damage to himself, I’ll finally be able to stop stressing over this… until the next allergy season.
Photo taken 21 October 2010
Edit 24 October 2010: Also, as for this crap?
Screen capture from my e-mail inbox
That’s not my dog, but a generic Shiba Inu picture that’s designed to look like any amateur’s digital snapshot. And it’s creepy when an automated text generator asks me how my dog is doing, by name. It’s even weirder and borderline offensive when your customer service representative asks over the telephone, in her most blase, this-is-my-job-and-I-don’t-really-care tone of voice, So, how’s Bowdu doing? and ends the call with Give Bowdu a hug for us. You really don’t know my dog at all, do you, if you’re suggesting that I give him hugs and kisses on behalf of a total stranger. The very thought — HA! I doubt most shoppers turn to online pharmacies for a “personalized” experience, because any attempts to make it seem so just come across as disingenuous. Please, don’t bother.
You’d think I was trying to play Collect-’em-All! with thyroid panel numbers from as many national laboratories as I could access. This latest one comes from IDEXX Laboratories, now that we’ve switched vets and they use a different system. For the blood tests they ran last week, this is what we got:
Dogs with no clinical signs of hypothyroidism and results within the normal reference range are likely euthyroid. Dogs with low T4 concentrations may be hypothyroid or “euthyroid sick.” Occasionally, hypothyroid dogs can have T4 concentrations that are low normal. Dogs with clinical signs of hypothyroidism and low or low normal T4 concentrations may be evaluated further by sumission of free T4 and canine TSH. A high T4 concentration in a clinically normal dog is likely variation of normal; however elevations my occur secondary to thyroid autoantibodies or rarely thyroid neoplasia. For dogs on thyroid supplement, acceptable 4 – 6 hour post pill total T4 concentrations generally fall within the higher end or slightly above the reference range.
This blood was drawn about six hours after his morning pill, six weeks into his thyroid supplement treatment. As Dr. Dodds mentioned in her test results, “Optimal therapeutic response should be in the upper 1/3rd to 25% above the upper limits of the resting optimal ranges at 4 – 6 hours post-BID thyroid medication.” So it seems that his numbers fall within acceptable range, though I was expecting a dosage adjustment since he remains so itchy. Approximately 50% of all dogs require a dosage adjustment after the second blood draw, according to one study I read.
Nevertheless, it was good to confirm that the hormone supplementation was working as it should, and that we could go ahead and order an entire bottle of Soloxine now that we knew the appropriate dosage. Once again, I placed an order with 1-800-PetMeds; my order was filled and shipped within 24 hours, thanks to the fact that the new vet was willing to fax the prescription, just like that!
Hello, little yellow label! Are we going to become good friends over the next several years?
One thing disappoints me is that the product information posted on Soloxine‘s own website offers no warning of the chemical properties of Levothyroxine sodium. The package insert PDF file, accessible at the above link, states that “Soloxine tablets may be administered orally or placed in the food.” Since these instructions come from Virbac themselves, I can’t exactly fault my previous vet for giving me inaccurate instructions. Could it be that the manufacturers of this drug are not aware of how thyroxine binds to soy and calcium? Or do they know something about canine absorption that magically nullifies the chemical property of this drug? Regardless, to be on the safe side, we’ve been giving Bowdu his pills one hour before or three hours after meals, on an empty stomach. At any rate, I intend to contact Virbac and ask, but I will have to make a phone call to follow up on this, since they do not post an e-mail contact.
One more thing on the Soloxine website — there’s a cheesily produced episode of a “People and Pets” show where they briefly discuss [rather, advertise] the use of Soloxine in the treatment of canine hypothyroidism. The vet on the show recommends retesting blood to ensure correct dosage two to three times a year. Given how traumatic every blood draw has been for Bowdu, this seems completely excessive. I hope we can stick to a schedule of annual blood tests at the most, if we have any say in the matter!
Two pictures above of Bowdu’s front left paw, post Epsom salt foot soak, after he was caught having chewed vigorously on them in the absence of human company and despite the cone. I kept the pictures small so as not to totally gross anyone out. It’s pretty distressing to me. It’s also bad enough that he’s limping and raising his foot when standing.
Above is the back left foot, which was holding steady and even decreasing in swelling some days. I noticed a recent abrasion on the pad, as of yesterday. At some point he did manage to reach his back feet, so I guess he did that to himself?
“Pododermatitis due to hypothyroidism may take a minimum of 6 weeks to show clinical improvement,” writes Stephen D. White, in a graphically illustrated article, “Pododermatitis” (Veterinary Dermatology 1989; 1: 9). There are some other recommendations about controlling pododermatitis if the cause is due to allergies, but nothing sounds very new or very promising. Keep in mind, also, that this article was written two decades ago and some recommendations may have changed (I have omitted some information, for example drugs which are not currently pushed, but some has been kept intact to remind me of what may have changed):
While prednisone or prednisolone (1 mg/kg once daily, then tapered to the lowest every other day dosage needed) is usually effective, occasionally antihistamines will give relief from clinical signs. The author uses diphenhydramine [Benadryl] (2.2 mg/kg three times daily), hydroxyzine hydrochloride [Atarax] (2.2 mg/kg three times daily), chlorpheniramine [Chlor-Trimeton] (0.2 to 0.8 mg/kg twice to three times daily) [...]
Recently, products containing essential fatty acids (EFA) (DermCaps: DVM; EfaVet: Efamol Vet [available in the UK]) have been used as non-steroidal antipruritics. These drugs apparently interfere with the production and metabolisation of arachidonic acid (a precursor of prostagladin E2) and other “pro-inflammatory” substances.
In the author’s experience, approximately 20% of dogs with inhalant allergies show clinical improvement with antihistamine and/or EFA supplementation.
Cats and dogs with food allergies may be diagnosed by being placed on a “hypoallergenic” or limited allergen diet. [...] Alternately, the diet may be changed to some of the prescription diets available through veterinarians such as D/D or C/D (Hills Pet Products). However, the author has not found these prepared diets to be effective initial “hypoallergenic” diets. There are some pets which only tolerate a home-prepared protein and starch diet; in these cases a vitamin-mineral supplement should be added [...]
Contact allergy is probably uncommon as a cause of pedal dermatoses. [...] As a last resort, corticosteroids may be given to control pruritis if the allergen cannot be determined. (5-7)
As unwell as Bowdu’s feet appear, I take small comfort in the knowledge that it could be much, much worse, as documented in this source.
This is his sixth week on 0.2 mg of Soloxine, stuffed in a mini marshmallow and usually administered 1 hour before his breakfast and 3 hours after his dinner. Tomorrow, we get to find out how this little pink pill’s been doing its job. And we’ll see what the new vet can do for his feet…
So after all my running around trying to get thyroid meds for Bowdu, we finally got the prescription filled at…
Drumroll, please…
My original VCA.
Yeah, that’s how it worked out.
On Monday, I finally picked out a new vet. I went in and scheduled a follow-up blood draw for Bowdu’s thyroid panel, to be done in a couple weeks. Bowpi’s also going in for a tech appointment, during which they’ll evaluate her teeth and offer an estimate for dental work. Then I showed them the written prescription from my old vet, and asked if they said they would be able to fill it. The vet tech was sympathetic to my explanation, but after consulting with the doctors, had to tell me that legally, they could not fill my prescription because they had not yet seen Bowdu. I’m not sure if they were following AVMA guidelines, state law, or some other policies, but since I was already mentally prepared for rejection, it came as no shock.
They suggested I try a human pharmacy. So I went to Walgreen’s. Surprisingly, they presented the least resistance, and were all set to send me out the door with sixty pills of Levothyroxine until I realized they were going to sell me a generic brand for $32.99 (or, I could sign up for their pharmacy savers program for $20, then the price would be $10.99). I had been advised not to get the generic version, as dogs don’t seem to absorb it very well. As I soon realized, Soloxine is a brand name manufactured by Virbac that is specifically formulated for animal absorption. That is what is written on my prescription, and even though it wasn’t coming up in Walgreen’s database of drugs, the pharmacist just took my word that Levothyroxine was the same drug.
So even a human pharmacy was no use. Today, we trekked back up to the old VCA one last time. I had no intention of entering the clinic again after I “broke up” with them, but the Doggy Daddy was willing to oblige. Meanwhile, I took the dogs around the block for their daytime walk. Bowdu remembered the neighborhood, as he was moving cagily the entire time and pooped within a block, which he does when he’s anxious. He CHARGED the car when the Doggy Daddy came back and I gave the cue to pack up and go home.
The Doggy Daddy said that the VCA receptionist was surprised that the prescription was so hard to fill. Har, har, har. If they had just faxed the prescription to PetMeds in the first place (a Vet-VIPPS approved online pharmacy), NONE OF THIS WOULD’VE BEEN HARD AT ALL! PetMeds cannot legally accept faxed copies from private customers, only veterinary clinics, so I would have had to mail the paper prescription in. By the time I realized that every clinic in town was going to refuse to fill my prescription, we were down to four days worth of meds. Four days (including Sunday) to get a piece of paper across the country, an order processed, and shipped from whatever originating warehouse to my dog who needed his daily thyroid medication. The funny thing is that even if we had requested next day air shipping, the total cost would have been less than the $24.70 that the VCA charged us again.
And this time, they weren’t even good enough to put an expiration date on the bottle. It just says **/** where a date should be. I wonder if this batch is coming from the same bottle that is set to expire 10/10 like the batch they gave us last month, and so they just “conveniently” forgot to enter the expiration date on the label. I wouldn’t put it past them.
Moving along in this month’s showcase of The Overindulgent Pet Mommy to the treats and non-essential edibles category, the Bows got some more C.E.T. dental chews and a bag of really expensive dehydrated goat liver treats. I was enjoying a fleeting sense of optimism and in a mood to buy something shiny when I picked up that $15 pouch (about $13 after my store rewards discount). Though the Bows expressed their gratitude with appropriate enthusiasm, I felt like such a sucker by the following day that I bought a couple pig’s hearts to chop up and throw into the dehydrator. MY homemade treats will cost barely a fraction of what I paid for that pack of goat liver, dammit.
