Updated October 8, 2023
Did you see on TodayTonight where a dog went to two different vets and was told it would cost either $2000 or less than $100? The story focused on corporate vets but I don’t think that’s the real story. lf you want to get the vet care you want you need to understand what’s going on.
I’ve talked before about the reason why vets prices vary so much and again in 2021. That’s great in theory. Now I want to give you a practical example: my dog Tinker.
Tinker’s Liver Problem
A few months ago I noticed that Tinker was at the water bowl more than he used to be. There are a lot of reasons why a dog drinks more water and none of them should be ignored. Blood testing is a great place to start.
Every year since Tinker turned eight I’ve been doing blood tests with his annual checkup. Up to now, all normal, but this year all his liver enzymes were significantly elevated. Something was causing liver damage, and now we needed to find out what it was.
Diagnosing Liver Disease
I started with a liver ultrasound. It’s very good for detecting tumours, like Trixie’s example here, but will also give a good overview of the health of the organ and the rest of the abdomen.
Thankfully, his scan was all clear. You can see some of the pictures I took on our page about dog ultrasound exams.
The next step is a liver biopsy. Without an inspection of the liver cells, we can’t make a diagnosis. Without a diagnosis, we’re shooting in the dark. Or are we?
How Vets Make Decisions
There’s something you need to know. Animals get certain diseases commonly and others rarely. Which ones they get varies between species. The same symptoms in a human can give a very different list of likely problems than in a dog, cat or rabbit.
When vets make a decision, we’ve got in our mind something we call a differential diagnosis list. It’s, in my opinion, our most important skill. We think about all the things that could cause the symptoms, and then rank them in order of likelihood.
There isn’t the money in the world to test for everything that could be wrong so we have to prioritise. How many tests we will do depends on a few things:
- The odds of each problem occurring
- The urgency of treatment
- The vet’s own attitude to risk
- The owner’s preferences
The Tinker Protocol
There’s more than one way to, um, well you know what I mean. Each pet gets their own tailored protocol that will depend on each owner, vet, and disease.
In Tinker’s case, after the blood tests and ultrasound had been done, one canine liver disease stood out: chronic active hepatitis. It’s not the only possibility, but by far the most likely one. Additionally, it can be easily treated with anti-inflammatory doses of prednisolone.
Consequently, I decided to perform a careful treatment trial, something a lot of vets may criticise me for. I was happy to take the chance as I felt that further testing was not in Tinker’s interests.
I watched him closely and saw his drinking reduce and his health appear to improve. Then, last week I repeated the blood tests. As you can see, his results are good. Although I’m happier, it still doesn’t guarantee that my decision was the right one.
The Choices For Treatment
In Tinker’s case, I could have made five decisions. Each step increases the chance of success along with the price of treatment (costs below):
- Play the odds in the consultation and start prednisolone
- Decide from the blood test that CAH was likely
- Decide from bloods and ultrasound, as I did,
- Go for the liver biopsy for added security
- Refer to a canine medicine specialist
The hardest thing for a vet is communicating these choices in a way that gives an owner informed consent. If we just say it’s option 4 or nothing, some dogs will die for lack of treatment, and others will miss out on referral. These are the phone calls I take on my commute home only to find I’m still talking when I get there.
So, TodayTonight…
I was approached to be interviewed for the story, and here’s what I said: “if I was that vet who only charged $60, I’d be worried.” Can you see why?
It’s likely the first vet took a zero tolerance attitude to risk. Their only fault may have been in not tailoring the options for the client. True, his or her employer may not allow that sort of flexibility.
The second vet chose that testing wasn’t necessary, equivalent to option 1 above. You’d want to be sure you’d got informed consent for that one. If the first vet was right, disaster is just around the corner.
Vets, after all, are just people. They all care, but they also all think differently. That’s why I always say the best test a pet can have is a second opinion. Why use only one brain when you could use two?
And don’t forget that you are in control. If you want a test done, or want to know how important extra tests are, just ask. We’ll try to guide you but you are in the driving seat. Getting the most out of your vet means having conversations like these.
Costs of treatment
To finish, here’s roughly what each option would have cost in 2018. Visit our price list here.
| 1 | 2 | 3 | 4 | 5 | |
|---|---|---|---|---|---|
| Consult Fee | $62 | $62 | $62 | $62 | $62 |
| Blood Test | $120 | $120 | $120 | $120 | |
| Ultrasound | $430 | $430 | $430 | ||
| Biopsy | $700 | $700 | |||
| Referral | $1300 | ||||
| Total | $62 | $182 | $612 | $1312 | $3K+ |
Have something to add? Comments (if open) will appear within 24 hours.
By Andrew Spanner BVSc(Hons) MVetStud, a vet in Adelaide, Australia. Meet his team here.
Regarding liver biopsies for suspected CAH, do you recommend tru-cut biopsy (less invasive, less expensive, less conclusive, perhaps more dangerous for hemorrhaging? ) or laparoscopic liver biopsy (much more expensive, more invasive, more conclusive, etc)? My 11 year old labradoodle healthy and happy was found to have elevated ALT enzymes (311) and elevated bile acids. His abdominal ultrasound looked normal and he’s mostly asymptomatic (he may be slightly more thirsty). The internist is guessing copper storage disease. I feel really caught about how to proceed; spend thousands of dollars on the laparoscopic biopsy, or do the tru cut, which is also expensive and I worry about bleeding and worry that either test might be risky at his age, or do as you wrote about, which is treat with a steroid and hepatic diet and re-test. (I’m not sure if my original post went through so I am re-posting)
Roughly how much do you think a comprehensive blood test for a 14yo mini-schnauzer should cost? The pathology requested is:
“CBC, Core Chem, Urinalysis, TT4 And Spec CPL Vet Pathologist included”.
This is in Sydney.
Thank you.
Hi Felicity. That looks like the ‘Off Colour Profile’ from IDEXX. I can’t comment on individual prices but you could ask other local vets for their price for the same test. They would need to add a consultation fee, but it will serve as a useful second opinion if so. Good luck.
Hi Andrew,
Our Aussie Terrier boy Pedro aged 7 has been diagnosed with canine chronic hepatitis and a tumour on his liver. We’ve been told the tumour is small and not the thing that will eventually take him. He’s on Macrolone 20mg (1/2tab per day) and paw Blackmores denamarin. He has been on them for about 3 weeks, had bloods done yesterday and they’re slightly up. Meds not having desired effects. He’s also on Hills LiverCare. I’ve also started home cooking food – chicken, eggs, cottage cheese, sweet potatoes or similar. Wondering if you had any other suggestions. The vet has recommended we start a compound drug that’s $300 p month… What would be the best tic prevention to put him on considering the above? Also, should he be getting his regular vaccinations considering his liver is struggling? Love your articles, they’re super helpful. Wish you were in Sydney!
Hi Nicky. Canine chronic hepatitis can be very frustrating when it doesn’t respond to simple treatment, and no one has good answers for these dogs. Liver biopsy is always best in those cases (I would’ve done it if my own dog did not respond to prednisolone). Otherwise it’s hard to give specific guidance. As for tick control, I would suggest the Seresto collar but in a high risk area the tablets are often still needed. As for vaccinations, that’s best to discuss with your vet.
How much should female cat pedigree cat desexing cost. I have two female Russian blues first one just went in and was $300 and a $100 blood test total $400 sounds expensive and I still have another to do
Hi Steve. Fees will vary greatly, depending on the base cost plus optional extras, but you can get an idea of desexing prices here.
Salem, our boss (desexed male outdoor cat) is 18 years old and has just had dental surgery (3 teeth removed and major clean up). He had a test done (as recently, he pees occasionally inside) MCV 56, Urea 16.7, Toatal protein 85, Globulin 56, ALT 291, AST 149.
Salem absolutely hates going to the vet and I don’t want him to suffer any more upheaval. Since surgery 4 weeks ago, he’s confused, seems in pain (back hair and skin ripples when touched and he clearly doesn’t like it) and he’s so restless. He’s hunched and looks uncomfortable. He also started to excessively pull, scratch hair (he’s been on steroids in the past however, rarely for skin irritations). Now to my real question: I’m working a lot interstate and overseas and will be gone in 3 weeks for 6 weeks. My son who looked after him also left to live overseas and I’ll have a house sitter. I’m so worried about Salem’s well being and feel bad about feeling that perhaps it’s time for him to go? He’s had a great life, happy and he’s the main reason why I’m not moving as this is his home. My vet only sees more tests and (invasive) treatments which I simply do not want for Salem. Am I a terrible person for thinking this may be the time for Salem to end his life while not being utterly sick and still with me? I’m terrified of him dying while neither my son or I are there with him. Very grateful for your response and advice, kind regards
Hi Eva. It’s natural that your vet wants to do more tests as without them we are all having to make educated guesses at best. However, a few thoughts come to mind. Firstly, with those liver enzymes there’s something major going on. It could be as simple as a thyroid problem, but the blood profile that was done probably included a T4. It’s worth checking that this was done as hyperthyroidism is very common and easy to treat and control, and could explain his restlessness and skin reactivity. Otherwise, without investigation it’s hard to say. It is, however, fair to say that other problems are likely to have a poor prognosis and it’s reasonable to think of end of life decisions as one option if quality of life is being affected and there is no easy way out.
My Pom Cross weighing 5.4 kilos needs a CT Scan , what would I be looking at $ ?
He is 15 years old and urinates every 4-5 hours. He suffers with bad arthritis in his back and hind legs However today he was sitting peacefully then jumped up yelping in horrific pain and peed a little on me and ran away frantically ran and ran until I caught him. I took him immediately to the vet who gave me some anti inflammatory medication and pain relief muscular skeletal disorders . They said he has a possible tumour in one of his testicle and his bladder was empty at the time of his examination. His prostrate felt hard. Since the examination he has not been able to void and all the testing was done in Mount Gambier Blue Lake as I am visiting at the moment. I am unable to collect a urine specimen, it is almost 10 hours and has still not been able to pee. Also CT scan needed
Hi Elisa. It’s hard to make sense of it all without more testing. Before a CT I would be doing plain xrays of his spine and abdomen. CT usually costs over $1000, whereas a set of xrays might be $400. Whichever you choose, it needs to be done urgently. Good luck.
Hello my buster has been diagnosed with Cushing, he had a blood test which was in excess of 300. The advise it was Cushing, I asked if there were any tumours they stated no. Put him on a Trilostane liquid 1.5mg twice a day. Th liquid cost me 154.30. This cost an the blood cost will continue monthly. I have found after just two days, he has very loose bowel motions, very listless, still eats and drinks. He seems not to hear you and sits facing an object like a wall or door and seems to be oblivious and sad, no energy. I will contact vet tomorrow when they are open. I ask for a copy of the results which I got but it does not state much at all on it like we do as adults. I know I’m am not a vet or doctor but one can see and read if it states yes the person has or dog has such and such. The has nothing on it that states he has Cushings. What do I do. I have just spent over a thousand including vet appointments. I am on a pension and a person with a disability in a wheelchair and cannot see my way financially to get a second opinion. I was on vet insurance but I had been on it for five years and had not used I thought once, now I am out of it all things seem to be going wrong. I am at a loss and so worried it make me feel sick. What do I do. I can send you a copy of the blood results.
Hi Jenefer. I feel your pain. I suggest you read our guide to Cushings disease here which also shows likely costs, tests and treatments. I can’t comment on his tests or treatment but you can see if what we have available is also possible in your area.
Your post was very interesting.
We have a sick cat that has been diagnosed with suspected intestinal cancer and have been quoted $$$$$ to deliver any treatment or further investigation.
Hi Julie- intestinal neoplasia is very hard to diagnose in cats without biopsy, and even hard once you do if it’s small cell lymphoma. Sadly there isn’t an easy option for these cases. Some owners will elect to hope it’s not cancer and treat as if it’s IBD but as SCL is often treatable with chlorambucil and prednisolone it’s worth investigating.
Very interesting article.