Visiting Veterinarian: Balancing
priorities when Fido is sick
October 6, 2005
Michelle Gerhard Jasny, VMD
Late one night your old cat, Quandary, falls off your daughter's bed, convulsing. The seizure lasts only a minute but scares the pajamas off everyone. You immediately call the vet, who says that since Quandary seems fine now, you can wait to be seen in the morning. Maybe you believe her and make an appointment. Maybe you feel too panicked. Could she see you tonight? Yes, the emergency fee is $150. Do you go? You go.
When you see the vet, she suggests at least $100 worth of tests, which, she explains, are unlikely to determine the cause of the seizures but are the place to start. A fuller screen, testing for things like Feline Leukemia Virus, FIV, and Toxoplasmosis, would be more…and he has a heart murmur that should be worked up. Do you do it? You do it. All the tests come back negative. A few days later, Quandary seizures again. The vet says it could be a stroke or a brain tumor. The next step is to consult a veterinary neurologist for a CT-scan. That'll cost at least $500, not to mention time off work, and the ferry. Do you go?
This is just one example of the medical choices pet owners face these days. It's a relatively new dilemma. Veterinary medicine originated with an agricultural society's desire to maximize the productiveness of food and work animals. If your cow collapsed, it made sense to pay a vet to save her with a bottle on intravenous calcium. After all, she would put milk on the table for many years. If one of your 12 piglets broke a leg, however, then pork chops for dinner was the fiscally responsible choice. On the farm, economic realities rule.
Over the last century, as dogs, cats, and other pets have become more integral parts of our families, the value of an animal has become harder to define. How much is the love and loyalty of one dog or cat worth? It's priceless…or is it? Is Rover a used car that you are fond of and would like to keep running, if costs are reasonable? Or is he a child for whom no expense is spared?
What makes sense?
Compounding our dilemma is the ever-increasing access pet-owners have to human-level medical intervention. Twenty years ago, we would joke about sending a cat like Quandary for a CT scan, then prescribe a few dollars worth of palliative medication. Today, we routinely send pets off for MRIs, CT-scans, and other advanced diagnostics. If you have unlimited financial resources and you are clear that your pet is tantamount to a child, the early decisions are easy. You go to the specialists, pay the money, get the diagnosis. But what if you don't have the money? You need every penny for rent. What if you have some money but, in all honesty, your family really needs that long-awaited vacation? Much as you love your pet, you can't see spending so much. In the old days, it was more common for veterinarians to treat based on presumptive diagnosis and clinical impression. In other words, we made an educated guess. If we got to run some tests, great, the more the better, but we often had to make a treatment plan without a complete work-up. As a result, we were sometimes wrong or missed things, but many owners accepted this in exchange for lower expense. On the other hand, we couldn't offer many specific treatments, such as chemotherapy, without having an accurate diagnosis.
Nowadays, there has been a major shift in the overall tenor of the veterinary profession. We are expected to be more like human doctor, to practice defensively to avoid lawsuits, refer to specialists, do every indicated test, and encourage every possible treatment. We have access to an amazing array of medical advancements. These changes benefit many pets, but can also price some animals out of getting any care at all. Hopefully the veterinary profession will retain the skills and enough of the agricultural mind-set to assist owners and animals that cannot pursue definitive diagnosis.
Finding the answer
So Quandary does go for the CT-scan. It shows a brain tumor. There's a good chance it is benign but without surgery, symptoms may progress. You've already noticed that Quandary is a little disoriented and sometimes walks in circles. Surgery will cost $2,500. If Quandary is 10, he might live another four or five years. Do you do it? Yes? What if he's 12? Or 15? What if your young daughter herself has cancer, or has recently lost her father? Does that change your decision?
Quandary has the surgery. The tumor is benign but the surgeon was unable to remove it all. It will probably grow back. The oncologist offers chemotherapy. At first you say no, you don't want to put Quandary through that. You've had chemo yourself and were sick as a dog. The oncologist tells you side effects in cats are usually minimal. It will cost $3,000 and you will need to make several trips off-Island. Do you do it?
A veterinarian's personal philosophy may affect how options are presented to you. If you are not sure what to do, think about your own philosophy and collect information. Keep an open mind but don't believe everything you read on the Internet or that a friend tells you. I have seen a lot of misinformation and always wonder why someone would listen to their cousin's neighbor's babysitter rather than their veterinarian.
On the other hand, don't believe everything your vet says either. We are fallible. We have our blind spots. I remember the client 15 years ago who insisted the tumor on her cat's back was caused by a rabies vaccine. I dismissed her concerns, but a few years later, the problem of vaccine-related cancer in cats appeared in veterinary journals. Much of what you find on the net is urban legend, but not all. Most of what your vet tells you is accurate, but your own research and intuition may add a key piece.
If you know deep down it's time to say goodbye, be straight with yourself and with your vet. Vets try to read between the lines and recognize when people are looking for permission to call it a day, but we still need your explicit instructions if this is what you want to do. Otherwise, our job is to continue to offer every possible medical intervention. People sometimes ask me "What would you do if it was your pet?" We were trained that we shouldn't answer that question, but I have come to disagree. I think it can make sense for me to share my personal feelings as well as my professional training and experience with you. But you must temper your vet's advice with your own knowledge about your pet's temperament, your family dynamics, your ability to nurse an ailing pet, your emotional connection, and your own philosophy. Then you can make rational choices that balance heart, mind, and pocketbook.