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July 15, 2008

It’s not like clomipramine comes from Mars or is some new-fangled drug. It isn’t. It’s a pretty common medication for dogs with anxiety. Why, then, is it so @#$@# hard to get it where I live? And, why is the dog version SO MUCH MORE expensive than the human version? Talk about screwing the pooch, or at least  the girl who loves her!!!

I could SCREAM. Actually, I sat and cried for a bit yesterday, but I feel like punching something.

I’m still not convinced it’s going to work out since I just called and was told that my prescription is pending authorization, but here is the saga of me trying to get Lilly the medicine she needs.

Following our Thursday night appointment, the behaviorist faxed the prescription recommendation to our family veterinarian Friday afternoon. I called Saturday morning around 10 am to make sure it’d been called into the human pharmacy we use. It not only had NOT been called it, it would NOT be called in because there wasn’t a veterinarian at the hospital that day. Yes, a Saturday. There was supposed to be, but wasn’t … just like on June 17 when I drove Lilly down for her exam for naught.

So, on Monday, I waited until 11 am to call and see if the prescription had been called in. It hadn’t, but promises were made. Then, 2 hours later, I get a call, telling me that the Walgreens I use doesn’t have the drug in the right dosages (20, 40, & 60 mg) that I needed. They only come in 25, 50, and 75 mg capsules that cannot be divided. That means, I’d have to have them specially compounded at another pharmacy (much farther away), but no one seemed to know how that would be done, who’d have to OK it, etc.

I called our behaviorist and left a message asking for help. When she called back, she recommended trying to get my vet to script out the order to another local hospital that had the drug in-house. So, I called the 2 big referral practices in the Denver area that I know, and NEITHER of them had the drug in the building. One of them, however, recommended a practice (just a regular one) that might have it. I called them, and indeed they did have the drug in stock. BUT, they would not fill it, even if my veterinarian asked them to, without seeing Lilly for an exam.

Now, I totally get the whole doctor-patient relationship thing. I really do, but clearly Lilly has a VET, she’s seen a specialist at CSU for pete’s sake (all of which I explained). Thanks … for … NOTHING!

My other options were to drive 2-hours each way to pick up the medicine at CSU (if I could make it in time before the pharmacy closed … which is why I couldn’t get the first week’s worth of pills while I was there in the first place). OR, just order the darn medicine online … which is something I’ve never done.

Since staff at my regular vet essentially pushed the responsibility for figuring out the online thing myself, I made several more calls. Despite causing yet another delay in Lilly’s treatment, I ordered it online Monday afternoon. The behaviorist will have a veterinarian at CSU approve the order.

Shipping is free, but to get 6 weeks worth of Clomicalm is nearly $150. The nice thing about Clomicalm is that it’s in tablet form, so the pills can be split to make different dosages as needed. BUT, if Lilly could somehow use the dosages in the human or generic form (capsules), it would only be around $25 a month once we get up to the higher dose.

I’m not kidding … $25 for people, $150 for dogs.

In addition to pandering for sympathy or shared indignation, here’s why I’m telling you this … Living outside a city the size of Denver (despite perceptions elsewhere that it’s a hick town) it should NOT be this hard to get what Lilly needs. I think it means that veterinary medicine, as a whole, doesn’t take cases like ours seriously.

I might have been able to call around and find the med locally, if I had all the time in the world, but I feared being pushed to the brink by someone else telling me they won’t fill the prescription … as if I’m some kind of junkie looking for a fix. It’s not like I’m calling about ketamine for pity’s sake.

This whole medicine quest is exponentially exasperating in a way that even my best words cannot convey.

So, while I wean Lilly off the amitriptyline, with the knowledge of that many behaviors I thought meant something else really mean she’s out-of-her-mind anxious, I’m in for a tough few days until the meds arrive and begin to kick in.

I took detailed notes Monday so that we’d have something for comparison later, and Lilly interrupted me 16 times between 9 am and noon with anxiety-related behavior (mostly seeking my attention in a very determined manner). It makes an already stressful, deadline-soaked day even more so.

Behavior spikes like this are called Extinction Bursts, which is a scientific way of saying “It’s going to get worse before it gets better.”

Ho-ly crap!

About the Author Roxanne Hawn

Trained as a traditional journalist and based in the Rocky Mountains of Colorado, USA, I'm a full-time freelance writer for magazines, websites, and private clients. My areas of specialty include everything in the lifestyles arena, including health and home, personal finance and other consumer interests, relationships and trends, people and business profiles ... and, of course, all things pet related.

I don't just love dogs. I need them in my life. Seriously.

  1. Thanks, Mary for visiting. I actually linked to the article you mention in a post before this rant:  <https://championofmyheart.com/2008/07/14/the-new-training-plan-the-basics.aspx&gt;

    I can’t remember if we talked on the phone or via email about this time in 2007 about your article, when I finally decided to try meds for Lilly. I refer other people all the time to your article —  thanks for all the hard work you put into it. I know that the pay likely wasn’t very good.

    It took a week, but we did finally get the meds:
    <https://championofmyheart.com/2008/07/21/lillys-new-meds-clomipramine-arrive.aspx&gt;

    So, we’re on our way. It’ll take weeks to see any effect. I’m trying to be patient.

  2. Check out my article on anxiety medications at http://www.dogaware.com/anxiety.html — it may give you some ideas for what you can use to help your dog until the new medication arrives and takes effect, or some alternatives you might use that would work as well and cost less.
    I was lucky that my vet was more than willing to prescribe whatever my dog needed, but my local vet school (UC Davis) was no help whatsoever and the veterinary behaviorist couldn’t see me for a month, but was willing to talk to my vet to get my dog started on meds in the meantime. You may want to find a regular vet who is more willing to work with you.

  3. UPDATE at 5:15 pm …

    Last I heard last this morning, the behaviorist had chatted with my regular veterinary hospital about OKing the online prescription for me. All I had to do was call the online pharmacy and give them the right phone number for the hospital.Done!

    Fast forward to late afternoon, and the prescription STILL hadn’t been approved … so much for getting it shipped today.

    SO, I called my vet practice AGAIN. They apparently were waiting for the behaviorist to call them back because they wanted to talk to her about different dosages THAT THEY HAVE IN HO– USE.

    Yes, kids. All this time, they’ve had at least some clomipramine right there.

    Throw your heads back with me and say AUUGHHHHHHHH!!!!!!!

    Nonetheless, the dosages aren’t what I need, SO I asked as nicely as I could (considering the situation) to PLEASE OK the online prescription because frankly telling me 4-5 days into this drama that you’ve had the drug all along does NOTHING for my mood.

    They called back 30 minutes later saying it’d been approved.

    I just tried to check on that, but the automated phone system at the pharmacy is “unavailable at this time.”

    Of … course … it … is. Why would I expect anything else today?

  4. Wow, I wish I had some ideas for you on where to go but CSU would have been my first suggestion. I’m surprised they didn’t refer you to a vet behaviorist who would have prescription writing abilities given the nature of Lilly’s issues.

  5. WAIT! It gets worst … since the veterinary teaching hospital isn’t managing Lilly “medically,” they won’t OK (or I assume fill) the prescription. We’ll have to work through our regular vet hospital, which so far has proven ineffective.

    Our behaviorist is trying to help by making contact with my vet directly, rather than having me struggle to explain what’s going on to his staff.

    Current frustration aside, let’s take a minute to ponder the broader picture where even a veterinary hospital with a behaviorist on staff doesn’t consider anxiety meds a “medical” issue.

    Yikes! We’ve got a LONG way to go, Baby!

  6. See part of the challenge is that our behaviorist is a PhD not a DVM, so she has to ask a veterinarian (usually the client’s family vet) to order the meds. Since that avenue isn’t working for me, we’re trying to work through a doc at the teaching hospital, but clearly there’s a glitch because I just got an email from the online pharmacy telling me that the hospital has declined the drug order. The note said to call the hospital, but that was no help at all. SO … I have another message into our behaviorist.

    It’s a shame she doesn’t have prescription writing ability, like a human nurse practitioner or something. That would make all this a WHOLE lot easier.

    I don’t believe the vet school pharmacy will ship meds. At least, that wasn’t mentioned as an option … only that I could drive all the way up there and get the meds in person.

    So far, I’ve made more than a dozen phone calls trying to resolve this. Seriously, this should NOT be this hard.

    Who me? Have deadlines, work to do? Nah!

  7. It sucks that you’ have to go through so much just now when you’re already struggling with all the changes. Would the pharmacy at CSU send it to you?

  8. Shared indignation it is! I’m so sorry for your difficulties in getting Lily the treatment she needs. And the expense–holy moly! I wish I had some helpful suggestion for you, but I’ll keep you and Lily in my prayers as you go through this time.

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