Canine lymphoma

Re: Canine lymphoma

Braden Collins — Thu, 10 Jan 2013 13:36:20 GMT

You lost me a bit there Martin. Maybe I didn't explain things well. I (meaning the practice - I'm one of the owner) would charge me (as the "client") exactly the same as if I was not linked to the clinic. The claim would then be sent to the insurance company just the same as normal. There would be no inflation of costs, all payments would be processed through the clinic properly, and all chargesand treamtents would be consistent with normal. I don't see how that is in any way fraud.

Re: Canine lymphoma

Bob Russell — Wed, 09 Jan 2013 20:31:10 GMT

I don't charge anything, the practice does. The practice charges exactly the same for anything that is done in the normal way it would be charged for any other patient. I get another member of staff to book everything that is done. The claims form is filled in and signed by another practice member and a full itemised statement goes to the insurance company.

Payment comes directly to the practice. I have never had an insurance company question a claim and they know it is my own pet that is being treated.

I don't see where fraud comes into the equation, all open and above board!

Re: Canine lymphoma

Martin Atkinson — Wed, 09 Jan 2013 18:26:50 GMT

[quote user="Braden Collins"]I would still be inclined to charge myself properly then claim the insurance -[/quote] Are the rules on insurance fraud different in Australia? Unless this is very tongue in cheek, I really can't see how you can charge yourself (assuming by yourself you don't mean you have to pay the practice and proceeds are then given to your colleagues and not yourself), surely the best you can do is claim the net cost of the meds and materials back? Or am I missing a turn here?

Re: Canine lymphoma

Bob Russell — Wed, 09 Jan 2013 17:56:41 GMT

She did like the n/d (to my amazement) but she has developed AIHA and the vincristine has done little to help with remission. Had a blood transfusion this afternoon and L asparaginase but sods law says the vet will have one of the 20% that does not go into remission!

Re: Canine lymphoma

Cat Henstridge — Sat, 05 Jan 2013 19:01:16 GMT

Our last CPD day was about oncology and was given by Iain Grant who runs chemopet.co.uk. His service includes lots of advice and he will also remotely manage your cases for you if you want. He will also provide the chemo drugs you need, in the doses you need, on the day you need them in the Chemoclave system so you don't have any exposure at all.

I know this sounds like an advert but it isn't! (Well it is I suppose but it really is a good service which I don't think is available anywhere else and will probably save money as you don't need to order in whole bottles of meds when you only need small doses and there is no exposure risks!)

Re: Canine lymphoma

Bob Russell — Sat, 05 Jan 2013 15:47:32 GMT

[quote user="Braden Collins"]Cerenia is good stuff. Ondansteron also works very well. If they have nausea with any treatment I will use it for every treatment of that drug, given about 20 mins before treatment. If the nausea is after vincristine I will change to vinblastine. I definitely prefer chop over cop. Roughy 5 months longer median survival and treatment can stop after the 25 week course.

[/quote]

Vinblastine sounds like a good idea!

Re: Canine lymphoma

Braden Collins — Sat, 05 Jan 2013 11:52:31 GMT

Cerenia is good stuff. Ondansteron also works very well. If they have nausea with any treatment I will use it for every treatment of that drug, given about 20 mins before treatment. If the nausea is after vincristine I will change to vinblastine. I definitely prefer chop over cop. Roughy 5 months longer median survival and treatment can stop after the 25 week course.

Re: Canine lymphoma

Robin Grimmer — Sat, 05 Jan 2013 11:38:12 GMT

Sorry to hear about your dog Bob. I haven't done chemo in a while, I have tried various protocols, but I use COP (low dose). Simple, low toxicity to patient and staff.

Re: Canine lymphoma

Bob Russell — Sat, 05 Jan 2013 11:12:42 GMT

[quote user="Braden Collins"]

I use the PahSeal system for all my chemo cases and won't do chemo without it. Realistically I feel that these drugs should be handled with great care are a zero exposure level should be aimed for. For each dose of chemo administered it costs about 20 Aussie dollars in PhaSeal equipment, but that is such a small part of the cost of chemo that I don't think you can justify doing it without. To me doing chemo without the correct protective gear is a bit like hand holding animals for xrays when they should be chemically restrained - it's a small risk but a risk we shouldn't take.

The most important thing with doxorubicin is to get it in the vein. Extravascular injection will cause a severe tissue slough so always make sure it is administered through a well placed IV catheter (must get it in first attempt) over about 15-20 minutes. Remember it is potentially cardiotoxic so any breeds predisposed to DCM should have a cardiac ultrasound before treatment.

I'm not a fan of n/d personally as I find it not very palatable. Many dogs undergoing chemo will have altered taste/appetite so often won't be eaten. I'm also not convinced by the science behind it.

Also make sure you have a friendly oncologist you can talk to for advice. For any chemo protocol, weird things can happen so it's always worth having advice available.

At the risk of asking a silly question (asked as a business owner), why are you doing the treatment at cost for a pet that is insured?

Good luck with the treatment.

[/quote]

I can assure you I am not doing it at cost while the insurance lasts. perhaps I worded it badly. If the insurance runs out I will simply keep on for as long as it is appropriate and in her interest.

Not having a good day and she is very nauseous (thank goodness for Cerenia!!!). I still think the decision to treat is right for her but I am appreciating more and more how tough it is for a client. It is a real battle between the clinician in me and the owner!

The first round of chemo was done by an oncologist and she is at the end of the phone if necessary. I am quite happy to do the chemo here (the nurses are similarly keen to keep a close watch on her rather than delegate responsibility).

Re: Canine lymphoma

Braden Collins — Fri, 04 Jan 2013 23:43:00 GMT

I would still be inclined to charge myself properly then claim the insurance - otherwise why bother insuring the dog (other than for the small chance of needing referral). For me to do a full CHOP protocol it would cost the client around 2500-3000 aussie dollars by the time we do bloods before each treamtent, charge for drugs and the administration. I'd reckon that's worth a claim with the insurance company.

Re: Canine lymphoma

Claire McConnell — Fri, 04 Jan 2013 22:44:16 GMT

[quote user="Braden Collins"]At the risk of asking a silly question (asked as a business owner), why are you doing the treatment at cost for a pet that is insured?[/quote]

I believe it is the OP's own pet dog.

Re: Canine lymphoma

Braden Collins — Fri, 04 Jan 2013 22:41:12 GMT

I'm not a fan of n/d personally as I find it not very palatable. Many dogs undergoing chemo will have altered taste/appetite so often won't be eaten. I'm also not convinced by the science behind it.

Also make sure you have a friendly oncologist you can talk to for advice. For any chemo protocol, weird things can happen so it's always worth having advice available.

At the risk of asking a silly question (asked as a business owner), why are you doing the treatment at cost for a pet that is insured?

Good luck with the treatment.

Re: Canine lymphoma

Martin Atkinson — Fri, 04 Jan 2013 18:36:20 GMT

Don't have any experience with Hills n/d. Don't have too many issues with Doxorubicin either. I handle it over the tub table with gloves, goggles and mask, no-one else is allowed to handle it at any stage, administered through flushed I/V cannula or running drip, patient sedated if necessary, any helpers similarly attired. You will go mad if you worry too much about these things: health and safety meets common sense!

Re: Canine lymphoma

Bob Russell — Fri, 04 Jan 2013 15:57:56 GMT

Thanks for the links!

Re: Canine lymphoma

Rajat — Fri, 04 Jan 2013 15:32:03 GMT

I'm sure you'd have figured out the website but meant to put in as a link so here you are:

Re: Canine lymphoma

Rajat — Fri, 04 Jan 2013 15:31:07 GMT

Hi Bob

Sorry to hear re your dog.

Used n/d once or twice. Some oncologists don't like anti oxidants being used at the same time as chemo and I 'think' n/d does contain these.

If you get in touch with hospira they will send you doxo pre-diluted in saline bags or in syringes in a liquid prep so you don't have to mix up powder etc. I have been using hospira for 4-5 years now and they provide very good service including next day delivery and are familiar with vets using chemo drugs.

We do a fair amount of chemo but could not justify the cost of physeal systems...

Hope your dog does well!

Best

Raj

Re: Canine lymphoma

Rob Loxley — Fri, 04 Jan 2013 13:44:20 GMT

[quote user="Bob Russell"]Advice on up to date handling of Doxorubicin would be appreciated. I have mixed the stuff outside, dressed up like an astronaut in the past![/quote]

Cave Referrals sells the Physeal system (http://www.cave-vet-specialists.co.uk/phaseal/) which is recommended by many oncologists though others really do recommend using a laminar flow cupboard to draw it up.