I Could Really Use Your Advice, I Don't Know What To Do

[MerlinsMum]

I haven't been around much at all, and I'm sorry. Too much craziness in my life at the moment, it's been going on for a while and will continue at least until the end of summer. But I really need your advice, if you have any to give.

Sagan was supposed to get dental surgery today, and we rescheduled out of concern that he might otherwise be at risk for post-operative bleeding, due to his platelets being unusually low (yes, even for a greyhound). I am so glad I requested pre-dental labwork. Anyway, without getting into it all, which would lengthen this post considerably, the point is that my vet mentioned that there is medication (aminocaproic acid) that can be administered just before surgery - and then following surgery for a few days - that will prevent bleeding, so if his platelets were still low next week, the dental could still be carried out. The problem is that they don't have this drug in injectable form (apparently it's been off the shelf in that form for some time, and no one locally seems to have it in tablet form either, so it would have to be special ordered. It is a very expensive drug - $200 for five pills. I am now faced with a decision as to whether to spend an extra $200 on medication that I may not even need to use, because it is not refundable. $200 is a LOT of money for me. Merlin's chronic health issues, apart from putting years on us in terms of stress and anxiety, have depleted our savings and we literally can only just barely afford to pay our bills at the moment.

The vet tech I spoke to asked me if I wanted to look into possibly obtaining the meds from a Canadian online pharmacy to see if I could get them more cheaply that way. I wonder, has anyone done this before and can maybe recommend a good website that ships fast?

You might be asking, Why the rush? Why not wait to see if his platelet count improves before a dental? It's a good point. There are two problems:

1. If we don't do his dental now, we're going to have to wait for quite some time. My vet is not going to be around until possibly well into August. If things don't go as planned, it might be even later.
2. If we wait that long, I may end up spending even more money because he may well require extractions at that point. His teeth are horrible and his breath is awful.

The point here, though, is that we really can't afford to spend $200 for "just in case" medication. I also feel that this whole discussion overlooks the main issue, which is that his platelets are low and we need to find out why that is. And if we do, then the whole discussion about bleeding is redundant anyway. Although this all begs the question... what do vet offices do if a dog's labwork is fine and the surgery goes ahead and then all of a sudden the dog starts bleeding out? Do they seriously have to resign themselves to thinking "oh well, we're out of that particular medication that could stop the bleeding, tough luck"? I mean, I can't make sense of that at all.

Am I missing something?

 

What would you do?

Edited July 3, 2013 by MerlinsMum

[BauersMom]

Well, I don't know if I would recommend a dental - even with amicar - if there are low platelets. Seems like you'd want to get to the bottom of that, first.

 

Second, I don't remember amicar being that expensive when we gave it to Berkeley before his amp.

 

And lastly, I wouldn't rush into a dental just because of the vet's schedule - and if you are looking at extractions in August, you're likely looking at extractions in early July, too.

 

Good luck with whatever you decide!

[Guest Clawsandpaws]

Is this drug like Amicar? I believe that is what is best for Greyhounds with bleeding issues.

 

Would he be willing to write you an RX, and you could go to a Costco pharmacy or other human pharmacy? I heard that is a much cheaper way to go....

 

No real advice I guess, just hugs

[tbhounds]

Amicar is not expensive-you have been given some poor quotes. It most certainly is available in tablet form--you need to give 500mgs three times day for 5 days--start the evening of the procedure (it strengthens clots-doesn't help form them so no need to start the day before--per Dr Couto). I have some here--think it was $30ish dollars for 15 tablets-got mine from Walgreens. It took them a couple of days to order it for me but, it was no big deal.

As far as the platelet count-how low is low? Did you run tick borne panel? A clotting profile??

If your vet is comfortable with proceeding I would perform the dental prophy ASAP--his teeth are only going to get worse.

If you can not find the Amicar pm me.

[Batmom]

How low are his platelets?

 

Are you or is the vet expecting extractions? If it's just a teeth cleaning, you won't need the Amicar. If it's more than that, you might not need it either -- I'd see if your vet can talk with a canine dentistry specialist about some of the newer techniques and materials for minimizing bleeding after extractions.

[4My2Greys]

If you have trouble getting it try SBH Veterinary Compounding Pharmacy in Ohio. They show it as one of the drugs they carry. Their pricing also has consistently been the best for various drugs I've gotten through them.

Here's their number,: 866-724-6333

[greysmom]

I agree the low platelets are worrisome. Though they *can* vary from time to time. If a tick panel has come back negative, I might be talking to my vet about a week or so of doxycicline, just in case - TBD cans be notoriously tricky and sneaky. If other bloodwork is OK, there's not much else to go on without more expensive testing. You might need to make a choice of whether to go ahead or not, without knowing *why* his platelets are/were low.

 

I too would do some online checking/calling in your area before you give up on the amicar. Don't take your vet's word as final in this matter - they make money selling drugs to customers. Amicar is used for people and it isn't that expensive. The pharmacy may have to special order it, but should be able to get it, one way or another. Have your vet write you a scrip, or call one in to where you can find it. It is VERY new for use in greyhounds for bleeding, and most vets don't even know about it, or know how to administer it properly.

 

Places like Walgreen's, Walmart and Costco usually have pretty good prices and will even give a vet/pet discount. (You don't have to be a member to use the Costco pharmacy.)

[GreyPoopon]

FWIW, I just had a dental done on a dog with bleeding issues. (Her platelets are fine, but she does not clot well.) She did not have extractions. She did not bleed much and did not require amicar.

 

I think that if I were in your position, I would want to know that I could get amicar if needed. I certainly wouldn't want to have to place a special order if my dog were in trouble.

Edited July 3, 2013 by GreyPoopon

[LuvEarsies]

Our amicar prescription cost $30. After not being able to get it quickly for a bleeding issue with one of our hounds after extractions, we make sure we keep a 5 day supply on hand.

Edited July 3, 2013 by LuvEarsies

[mychip1]

Kerry...for what it is worth, medicine or not....cost of drugs not even considered, I would not take the chance. Bad teeth that have to wait until you can get funds for extractions will not kill him, but a platelet issue could. Worse case, if one of those teeth gets infected in the meantime, a round of clyndamiacin does wonders and it is not hugely expensive. EZs teeth need to all come out....half were removed five years ago...but he is too old and has a major heart murmur. We treat as needed. I realize he is older than Sagan so you may not want to ride those teeth out for a lifetime, but the risks seem too high.

 

Of course, you know my history....so my fears may be a bit extreme....but it just my perspective.

[macoduck]

I asked my vet to have Amicar on hand for Gracie's dental. She was glad to learn of the product. Fortunately it wasn't needed and we were not billed just for having the clinic have it in stock.

[MerlinsMum]

LuvEarsies, where did you get it so cheap? I have been looking online and even if you buy it more cheaply from a Canadian store, it seems you have to buy it in large quantities. I don't need 100 tablets.

 

The vet tech I spoke to this afternoon spent ages calling pharmacies around here and no one carried it. They could special order it but the cheapest price quoted to her for the amount I would need was $186 at Rite Aid.

[MerlinsMum]

Kerry...for what it is worth, medicine or not....cost of drugs not even considered, I would not take the chance. Bad teeth that have to wait until you can get funds for extractions will not kill him, but a platelet issue could. Worse case, if one of those teeth gets infected in the meantime, a round of clyndamiacin does wonders and it is not hugely expensive. EZs teeth need to all come out....half were removed five years ago...but he is too old and has a major heart murmur. We treat as needed. I realize he is older than Sagan so you may not want to ride those teeth out for a lifetime, but the risks seem too high.

 

Of course, you know my history....so my fears may be a bit extreme....but it just my perspective.

 

And it is a perfectly reasonable perspective, Robin In fact, I have felt more and more inclined to agree with those suggesting I wait. DH has made it clear that he thinks we should just wait and sort out the platelets and not buy these expensive meds that we may or may not need. Even if I could get them cheaply - in which case I wouldn't be averse to buying them just in case I might need them anyway - I am not sure I want him to go into surgery in a condition in which we have to give him certain meds to force his blood to clot because it's not doing it on its own. I mean, to me that's kind of scary. So many things can go wrong. And then there's the fact that, as greysmom said, it's only very recently been used for greys -- and like any meds there can be side effects. I don't know. I will discuss this a bit more with the vet tech tomorrow, and I don't deny that I'm very concerned about avoiding extractions, but tbh I'm more concerned about not having him bleed out on a table.

 

Please keep the advice coming, I so appreciate it and it's really helping me get a sense of the pros and cons. I am open to changing my mind 10 times over if necessary. It's easy to say that I want to go with my gut; but really, I don't. My gut has got things wrong before. There is no margin for error here, I have to get this right, yet there are so many question marks and IFs here, it's not easy.

[MaryJane]

Our amicar prescription cost $30. After not being able to get it quickly for a bleeding issue with one of our hounds after extractions, we make sure we keep a 5 day supply on hand.

 

 

Yup, mine cost about 50 for Lucy. I now keep a few days supply on hand because not all pharmacies carry it and it can take a few days to get it. I got mine at CVS.

 

I noticed that you are going to be discussing things with the vet tech -- maybe you want to talk to the vet instead. Also, find out who will be doing the dental, the tech or the vet.

 

If the platelets are low, I would not be contemplating any surgery - way too risky. As someone mentioned, you can take care of an infection with antibiotics until you get a better handle on this.

 

The vet also didn't seem to know that this is given afterwards and not before the surgery, I'm not so sure I would be comfortable with that.

[Walliered]

Just wanted to say that I have ordered from Canadianpharmacy.com and Alldaychemist.com. I get just about all my drugs from them. Alldaychemist.com is in India. Absolutely no problems at all. They give you a list of the American drug name and their corresponding drug name. The shipping is $25.00 no matter how many drugs you order and they do not want a prescription from your doctor. I have chronic health problems and buying them in the US puts me in the donut hole about June.

Oh, one more thing..the vet I have been using in Charleston said that Amicar had not been proven to be useful. I disagreed.

[MerlinsMum]

I asked my vet to have Amicar on hand for Gracie's dental. She was glad to learn of the product. Fortunately it wasn't needed and we were not billed just for having the clinic have it in stock.

 

That's nice to hear. I don't really understand why I would need to be charged for it if they ordered the injectable form. Surely they need to have some on hand at the clinic at all times, in case of a bleeding issue during surgery? So really I would assume that they would want to order some anyway, to have there, once it's available again... regardless of whether they know for a fact that they will need it for a patient. Sounds to me like one of those "just in case, better safe than sorry" type drugs you should have available at all times if you're a vet...

 

I agree the low platelets are worrisome. Though they *can* vary from time to time. If a tick panel has come back negative, I might be talking to my vet about a week or so of doxycicline, just in case - TBD cans be notoriously tricky and sneaky. If other bloodwork is OK, there's not much else to go on without more expensive testing. You might need to make a choice of whether to go ahead or not, without knowing *why* his platelets are/were low.

 

I too would do some online checking/calling in your area before you give up on the amicar. Don't take your vet's word as final in this matter - they make money selling drugs to customers. Amicar is used for people and it isn't that expensive. The pharmacy may have to special order it, but should be able to get it, one way or another. Have your vet write you a scrip, or call one in to where you can find it. It is VERY new for use in greyhounds for bleeding, and most vets don't even know about it, or know how to administer it properly.

 

Places like Walgreen's, Walmart and Costco usually have pretty good prices and will even give a vet/pet discount. (You don't have to be a member to use the Costco pharmacy.)

 

 

Amicar is not expensive-you have been given some poor quotes. It most certainly is available in tablet form--you need to give 500mgs three times day for 5 days--start the evening of the procedure (it strengthens clots-doesn't help form them so no need to start the day before--per Dr Couto). I have some here--think it was $30ish dollars for 15 tablets-got mine from Walgreens. It took them a couple of days to order it for me but, it was no big deal.

As far as the platelet count-how low is low? Did you run tick borne panel? A clotting profile??

If your vet is comfortable with proceeding I would perform the dental prophy ASAP--his teeth are only going to get worse.

If you can not find the Amicar pm me.

 

 

I have been looking online and everyone it's expensive or you have to buy it in large quantities, which ends up being expensive ....

If you have trouble getting it try SBH Veterinary Compounding Pharmacy in Ohio. They show it as one of the drugs they carry. Their pricing also has consistently been the best for various drugs I've gotten through them.

Here's their number,: 866-724-6333

 

Thank you very much.

 

How low are his platelets?

 

Are you or is the vet expecting extractions? If it's just a teeth cleaning, you won't need the Amicar. If it's more than that, you might not need it either -- I'd see if your vet can talk with a canine dentistry specialist about some of the newer techniques and materials for minimizing bleeding after extractions.

 

That's the problem... the vet says that she can't say for sure whether he needs extractions or not, although at this time they are not anticipating it. But his back teeth are very bad and his breath is nasty. She told me that if it's just a cleaning the Amicar won't be necessary. So I'm not sure why the vet tech mentioned that he would need to be given some before surgery too. What if there are no extractions after all? Is it given ahead of surgery "just in case" when it's available?

[4My2Greys]

I believe Amicar (aminocaproic acid) is standard protocol for all greyhounds having limb amputations at OSU, so certainly not a drug with little known effects on dogs.

 

Just wanted to add I understand the reluctance to proceed when you don't know what is causing the low platelets in the first place. I'm sorry things have been so tough for your family.

Edited July 3, 2013 by 4My2Greys

[MerlinsMum]

Yup, mine cost about 50 for Lucy. I now keep a few days supply on hand because not all pharmacies carry it and it can take a few days to get it. I got mine at CVS.

 

I noticed that you are going to be discussing things with the vet tech -- maybe you want to talk to the vet instead. Also, find out who will be doing the dental, the tech or the vet.

 

If the platelets are low, I would not be contemplating any surgery - way too risky. As someone mentioned, you can take care of an infection with antibiotics until you get a better handle on this.

 

The vet also didn't seem to know that this is given afterwards and not before the surgery, I'm not so sure I would be comfortable with that.

 

Of course the vet does the surgery. She has done dentals for Merlin and Sagan before and they have gone swimmingly. She is an extremely competent vet. I have no qualms about that. I think I have gaps in my understanding here though, for sure, and you're right, it's possibly from talking to the vet tech this afternoon rather than directly with the vet (who was in surgery). However, the vet tech in question specifically mentioned a few times that she did not have as much knowledge as she'd like about Amicar, and she checks in with the vet before and after every conversation and reports back. So maybe I'll talk with her again and ask if I can speak directly to my vet, if she is in tomorrow.

 

But at this moment in time, I think you and others are right, I think I am currently inclined to hold off on surgery for now, even if it's just to have a clearer and more comprehensive discussion with my vet over this matter. This whole drug drama and people in this country getting fleeced by greedy pharmaceutical companies makes my head spin. I don't get it, but that's a rant for another day

[mychip1]

Extractions or otherwise, depending on how low his platelets are there is a risk as they bleed a bit during dentals. JJ had a small lump removal cancelled for low platelets...which a hand count turned out to determine as normal....and that was nowhere near as bloody as a mouth.

[BauersMom]

Amicar needs to be given before and after surgery. We had about a week's worth of meds for the amp, and it was really not expensive. I got it at CVS, and it probably cost me a total of $50.

[IansMom]

I volunteer at an oncologist's office and help patients get access to treatment that they can't afford. There are a lot of discount programs out there. Www.medicationdiscountcard.com has amicar listed as a drug they provide discounts for. Just for future reference, rxreliefcard.com is another good one that I have personally used (amicar not on this one though). I hope this helps in some way.

[greysmom]

I'm just mentioning this because it's in my head - I have actually no empirical evidence - but I believe that amicar is used mostly for greyhounds and not for other breeds of dogs. This may be because it is Dr Couto who has championed it's use for amputations in osteo cases, and he works mainly with greyhounds (obviously). Other dog breeds may not have the unusual bleeding issues greyhounds have due to their more unique physiology and blood chemistry.

 

And even most greyhounds don't ever have a bleeding issue. (But when it happens, it can be devastating.) So unless a clinic specializes in treating greys, it might not be worth it for them to stock something they can't use except every once in a while.

 

For what it's worth, the surgeon/hospital who did Dude's amp had not heard of amicar before I requested it. They were very professional, up-to-date people, yet as close as two years ago they didn't know anything about it. Fortunately Dude's oncologist had trained with Dr Couto at OSU and had it under control. But they had to special order it, too, because they didn't keep it in stock.

 

As Robin mentioned, someone suggested she have JJ's blood sample sent to a lab to do a manual count of his platelets, instead of the automated one which is normally done (and which shows a low reading). Something about the blood of greyhounds clumping irregularly and not being counted correctly (I don't remember the exact reason). But it might be worth asking about when you talk with your vet. JJ's platelets turned out to be normal on a hand count.

[JJNg]

Lots of good, practical advice already. Just wanted to add that if platelets are low enough to cause a concern about clotting, Amicar may not even help. Greyhounds that have clotting issues that respond to Amicar usually have a normal platelet count (at least normal for greyhounds). The platelets need to be present for Amicar to work.

[Burpdog]

A tick panel at Protatek for greys costs around $65. I'd spend the money there first. The test would cover all the TBDs

[racindog]

Our vet gives it to all the greyhound spays etc and sends it home with the fosters to continue for a few days after surgery as well. It is pretty cheap here. No way would I allow any surgery on any of my hounds unless it was available. If they bleed out they die. That was the complication that killed Slim as a result of his GDV/bloat surgery. There were 4 vets attending him- they all said they couldn't stop his bleeding out- the head vet said it was DIC. Since it was emergency surgery he didn't have the opportunity to get any before it. Once they are bleeding out it is over IMO. I believe personally that Amicar can possibly prevent or keep it manageable but that's JMO. I am praying for the Wizard. I love him very much. Please give him a little hug for me.