At the North Carolina State University Veterinary Teaching Hospital in Raleigh, Blue, the homeless cat that Diane Harris adopted, is waiting for a kidney donation. After his kidneys started to fail, the 11-year-old spent a lot of time in a critical care unit. Blue is now up to 12 pounds and stable after dropping to five pounds. Blue will begin anti-rejection drugs if his kidney values start to climb, and two weeks later he will have kidney transplant surgery.
Harris, who carefully considered her cat’s alternatives, said that she decided on a transplant because she was determined to spend more time with her cat.
Like Harris, a lot of pet owners are utilizing cutting-edge veterinary medical procedures to give their pets a chance at living longer, higher-quality lives. These include hip replacements, dialysis, ventilators, pacemaker implants, chemotherapy, radiation therapy, laser surgery, kidney transplants, intensive care units, and gene therapy to develop “smart bomb” cancer treatments. Our pets now have access to treatments that were previously only available to humans.
Price Is No Object
Going to what some may deem excessive efforts to give our companion animals medical care underscores the importance that pets now have in our lives. The author of Pet Care in the New Century: Cutting-edge Medicine for Dogs and Cats, Amy Shojai, claims that more than 84 percent of contemporary pet owners view their animals as children (New American Library, 2001). The “pet generation” desires providing their cats and dogs with the same level of attention as their human family members.
In order to treat a malignant chest tumor in Brittany, an eight-year-old golden retriever, Mike and Dorothy Miller spent $15,000. The cost covered surgery, multiple stays in the intensive care unit, X-rays, blood transfusions, travels to the University of Pennsylvania Veterinary Hospital, chemo and radiation therapy, which would have given her an additional year or two of life. Mike Miller claims, “I have a son, and Brittany is like my daughter.”
Leigh and Tara Stivers paid $8,300 to have their cat Hobbes’ kidney replaced at the University of California/Davis’ Veterinary Medical Teaching Hospital. According to Leigh Stivers, “Our pets are actual members of our family.” Who among parents wouldn’t go to any lengths to protect their own children?
Dina is a maltreated kitten whom Barbara Nienaltowski rescued in Mexico in 1994; Dina’s shattered spine has left her with lifelong urinary incontinence. Barbara Nienaltowski has never kept track of the amount of time, money, or effort she has put into Dina. Nienaltowski has described expressing Dina’s bladder multiple times per day as “no big issue,” but this past year the cat required two hospitalizations for acute kidney infections. Dina’s doctor predicted that she only had a few months to live in May 2002. Nienaltowski observes that “her determination to life is so incredibly strong — it’s her defining quality.” How was I supposed to give her every opportunity? Dina now receives fluid treatment, antibiotics, anti-nausea medication, vitamins, potassium gel, a stool softener, and has her bladder drained as part of her daily care. She inquires, “You know that saying?” That you are responsible for that person’s continued existence if you rescue their life? Well, I do think that.
In order to treat her cat Henry Bergh’s hyperthyroidism and cardiomyopathy, Marian O’Connor, a former director of the Bergh Memorial Animal Hospital in New York City, shelled out $3,000 for the procedure. If I could have made him well, I would have spent $10,000, claims O’Connor. “For my pets, I would do anything.” O’Connor, it seems, speaks for a lot of people. The American Animal Hospital Association asked pet owners how much money they would spend to save their pet’s life in its 2002 Pet Owner Survey. Nearly half said, “Any amount.”
However, this approach could be foolish, particularly if the caregiver has never dealt with a pet who has a protracted, terminal disease. When a major illness strikes, today’s extraordinary medical advancements may offer the chance to prolong a pet’s life and quality of life, but they also present a quandary for most pet parents who are unsure of where to draw the line.
The causes of this are multifaceted and frequently have little to do with how much it costs to provide care. Stephanie LaFarge, Ph.D., an ASPCA psychologist, notes that many caregivers don’t want to have the impression that their charge’s life or death is in their control. It is difficult to decide how far to go with therapies when the animal’s future is uncertain.
However, some caregivers are completely unambivalent.
According to Lila Miller, DVM, the “A’s” veterinary advisor, “those who take extraordinary steps to save their dogs may share some psychological qualities, but no profile describes them entirely. She claims that she has witnessed “guys absolutely break apart” or “elderly people who identify their own mortality with their pet. It’s a highly personal matter.
Other traits could be a strong emotional bond with the animal, a strong dedication to it, or a dependence on it for the majority of one’s emotional needs. According to Carolyn Butler, MS, coordinator of Bond-Centered Education for the Argus Institute at the Colorado State College of Veterinary Medicine and Biomedical Science in Fort Collins, “A pet owner may have a symbolic connection to an animal.” “Perhaps the pet belonged to a deceased spouse, or your pet symbolizes a trying moment in the family’s life,” the counselor suggested.
However, a lot of pet owners are stumped when asked, “How much is too much?” More and more, family pet parents are turning to psychologists, counselors, and veterinarians for assistance with these challenging choices. They encourage anyone who will be providing prolonged care for a sick animal to start by learning as much as they can about the likely results. According to LaFarge, you should press the vet for information on the pet’s expected lifespan and quality of life following therapy.
The vet will run tests to determine how an animal responds to a certain course of treatment and ultimately what the chances are. The head of the Donaldson-Atwood Cancer Clinic at the Bobst Hospital of the Animal Medical Center in New York City, Philip Bergman, DVM, Ph.D., says, “We do a lot of studies to determine what the prognosis is so we can educate the client. “For instance, it might be simpler to treat a 12-year-old dog with a tumor than a 5-year-old dog with failing kidneys.
The leader of the kidney transplant program at the University of Pennsylvania Veterinary Hospital in Philadelphia, Lilian Aaronson, VMD, notes that before proposing particular treatments, the referring veterinarian does a number of pre-surgical workups and evaluations. By the time consumers come to us, they are quite serious and have learned about [kidney transplant].” Who is a candidate and who is not is something we strictly enforce. Later issues may result from underlying disease.
He has had to endure intravenous fluids, subcutaneous fluids, blood transfusions, blood draws, echocardiograms, Epogen® injections (a recombinant human protein used to treat chronic renal failure), a feeding tube to help him gain enough weight to undergo the transplant, and an orange Lycra® vest to hold his feeding tube in place.
Of course, there are no guarantees, not even with the most trustworthy diagnostic techniques. Five weeks after surgery, Hobbes’ body rejected the new kidney, and the Stivers lost him. According to Stivers, “the transplant was a gamble that provided Hobbes with his only chance of survival. Harris, on the other hand, has high hopes for Blue following surgery. Every day is a blessing for which I am eternally grateful, she says, whether it lasts for a year, five years, or a few months.
No Easy Answers
On how far to go when treating sick or injured animals, veterinarians disagree. Even if a vet may believe that euthanizing a pet is the most compassionate thing a client can do, he or she will be required to respect the owner’s desires. Pets are regarded as personal property in legal terms. According to Bernard E. Rollin, Ph.D., a prominent professor of philosophy, biomedical studies, and animal studies at Colorado State University and the author of Veterinary Medical Ethics: Theory and Cases, “it creates two issues for veterinarians” (Iowa State University Press, 1999). “One [issue] is when individuals wish to slaughter healthy animals. The third situation is when the client wants to pursue treatment even when the veterinarian thinks the animal is in pain.
On what is the right course of action, experts disagree. An ethics committee led by James Serpell, Ph.D., professor of Humane Ethics and Animal Welfare and director of the Center for the Interaction of Animals and Society, deals with patient care issues on a case-by-case basis because “people come with specific problems” at the University of Pennsylvania Veterinary Hospital.
Both pet owners and vets are primarily concerned with preventing suffering. But how is pain quantified? According to LaFarge, suffering can manifest itself in many different ways for animals. Other symptoms include losing the ability to groom or climb to favored perches, as well as disorientation, dementia, forgetfulness, breathing difficulties, and incontinence. “An animal may not seem upset, but I think these failures can be a big source of grief for him,” said the author.
Pet lovers, on the other hand, might imagine how they would feel if they had to go through what the animal is going through. Some people believe that a dog who loses a limb to osteosarcoma will be dreadfully unable to enjoy life, but that is untrue, according to Rollin. Chemotherapy is a treatment that frequently fills a person with terror. According to Bergman, “pets take chemotherapy better than humans do.” We may have strong recollections of a family who passed away from cancer after undergoing radiation and chemo.
The amount of time an operation buys an animal is secondary to other factors. LaFarge says, “I don’t think there’s any technique about which you can just declare the person has gone too far. “Perhaps it’s a good idea to give a cat a kidney transplant to keep it alive for a month. After surgery, quality of life is more crucial than quantity.
Most veterinary teaching institutions include staff members who assist patients in making these difficult choices. Butler says, “We advise clients to consider what the animal wants.” That varies for each person. Before a pet becomes sick and caretakers must make life-or-death decisions for it, LaFarge advises owners to determine what a quality life means for their animal companion.
Sometimes, especially if the beginning is unexpected, caregivers simply need some time to adjust to their animal’s condition. According to Lesley King, MVB, director of the University of Pennsylvania Veterinary Hospital’s acute care unit, “often it takes just 24 hours to get acclimated to the decision to euthanize.” “Our objective is to make the pet as comfortable as we can while assisting them in their decision.”
Euthanasia used to be the only option for easing suffering. Miller claims, “Now we have greater and better pain alleviation.” With the help of a veterinarian who prescribes medication and trains the owner in its use, pet hospice care now enables the caregiver to treat the animal at home. This enables the pet to pass away painlessly at home. It’s perfect for animals with serious conditions, like cancer. According to Serpell, “the veterinary community is catching on to home hospice care.” “Usually, an animal is happy at home.”
However, the reality is that many pet owners simply cannot afford the modern technologies. They are frequently expensive because many of them require a lot of effort and equipment. Miller points out that despite the fact that “we develop all these pricey new technology,” “there is no mechanism in place to make them affordable.”
Harris has taken out a home equity loan to cover the cost of Blue’s transplant, should it be necessary. Harris has other cats who need expensive medical care.
Since “people arrive with distinct concerns,” says, professor of Humane Ethics and Animal Welfare and director of the Center for the Interaction of Animals and Society, she approaches patient care issues on a case-by-case basis.
Veterinarians and counselors work to assist pet owners who are unable to afford more treatment to detach from their animals.
Veterinarians and counselors work to assist pet owners who are unable to pay for additional care to separate their affection of the animal from their financial situation. Butler asserts, “It’s not about love or compassion. “It’s about life’s reality,”
Currently, pet insurance in the US only offers a very small amount of assistance. Most insurance policies either exclude coverage for more sophisticated treatments or call for an additional rider on top of the standard coverage.
The Veterinarian’s Role
Despite the moral quandary a veterinarian occasionally faces, the practitioner nevertheless has a significant impact on the course the caregiver takes. According to Butler, “veterinarians need to be adept in guiding their patients toward a conclusion that is right for them.” “Everyone is in a unique position.”
How far to go may rely as much on the relationship you have with your pet as it does on its health or the associated costs. According to Alice Villalobos, DVM, consultant and veterinarian at the Veterinary Centers of America Coast Animal Hospital and Cancer Center in Hermosa Beach, California, “veterinarians need to be taught in the human/animal bond and address the subject with care.” “Our responsibility would be to examine each pet and person separately and treat the bond the same way we treat the animal.
The Argus Institute supports the broad adoption of veterinary practice models that prioritize people’s emotional support as equally as their pets’ medical care. This position involves preparing veterinary teams to fulfill the emotional requirements of families. Butler believes that when patients opt to stop receiving treatment, “all kinds of reasons are at play in people’s life. We have to assist vets understand this.”
Butler has made talks on the subject at conferences. The veterinary teaching college at Colorado State requires 100 hours of training in client/staff interactions to better prepare veterinarians to understand the emotional needs of the customer. According to Butler, in order to maintain the client’s self-esteem, you must increase awareness and have the ability to control your own emotions. “That’s not turning sentimental. It’s simply understanding how to interact with people under challenging emotional circumstances.
When the customer wishes to continue treatment, a veterinarian very rarely wants to stop. According to Serpell, “a veterinarian can always inform a client that he will not intend to continue treating an animal.” He can provide you the names of other vets, but not many do it out of concern that your customer will go to another one or that the owner will treat the animal at home.
A 26-year-old cat with cancer on his ear and forehead who had seen five other vets was operated on by Villalobos, one physician who has treated animals while other veterinarians had advised euthanasia. “We underwent major ear surgery and grafted neck skin to the forehead.” The cat survived for an additional year and a half before passing away from kidney failure.
When an animal is found to have an advanced illness, there are many options for treating the symptoms rather than immediately resorting to the most extreme measure—euthanasia. Villalobos asserts that “each problem must be resolved.” “The customer should be guided by the veterinarian, who should inform her of her options. We can insert a feeding tube or give the pet an apdogite stimulant if they have oral cancer and won’t eat. If the animal’s pain is a problem, we must apply a pain patch to it. Between an advanced sickness diagnosis and death, there is a long time. Louis Alvarez, DVM, a small-animal veterinarian in Queens, New York, states as follows: “First, you have to be an advocate for the animal’s standard of living. But after that, you make every suggestion you can. The pleasure of another guy cannot be valued.
The Heart of the Matter
Utilizing every veterinarian procedure available to save as many of our animal companions as possible is proof of how slowly human optimism wanes. In order to treat the numerous ailments that Rosie, Audrey Pavia’s appaloosa, had over their three years together, Audrey Pavia took out a loan for $15,000. Except for Rosie’s eye condition, every ailment was treated or cured. Pavia did not draw the line based on expense but rather on the mare’s future quality of life as a prey species without vision after Rosie lost both of her eyes to corneal ulcers. Pavia has no regrets, even though Rosie ultimately lost her battle. She says, “I would do it all again.” I required the assurance that I had taken all reasonable steps to ensure Rosie’s wellbeing.
Not all animal lovers believe that brave attempts to save a pet’s life are the best course of action. Dobbit, a retired nine-year-old greyhound, underwent initial treatment for osteosarcoma in his shoulder but did not respond favorably, so Pat Crumb decided to euthanize him. I was able to take him for walks by giving him a prescribed painkiller, but the walks got shorter and shorter. Then, at 2:30 in the morning one morning, Dobbit awoke weeping. Crumb spent the rest of the evening lying on the floor next to her dog, but the next morning she made arrangements for euthanasia by calling the doctor. Forgoing a few months with him and letting him pass peacefully is preferable, according to Crumb, than subjecting him to an amputation procedure and maybe losing him in the process.
Even though Bubba the shar pei of Ann and Greg Kulp was diagnosed with kidney failure, they decided to put him to sleep even though the dog had not yet manifested any overt symptoms of the condition. For a year, diet had managed to halt the progression of the sickness, but Kulp chose not to pursue fluid therapy to buy Bubba more time. According to Kulp, whose two prior shar peis also passed away from renal illness, “it appeared that giving him fluids would have been more for us than for him.” “We would have looked at our choices if he had cancer or something that could be operated on.”
Boots, one of Judy and Steve Ostraha’s three cats, got breast cancer despite having been spayed. The cancer came back following a second operation to remove the masses. They chose euthanasia despite their veterinarian’s recommendation of chemotherapy. According to Judy Ostraha, “The chemo might have helped for a while, but it wasn’t going to cure her.” “The only thing I regret is subjecting her to the second medical procedure.”
In regards to Blue’s condition, Harris has also adopted a positive outlook. “I’ll give up on the notion if at any point it doesn’t look promising for Blue to have a successful transplant,” she declares. “If the chances aren’t in his favor, I won’t put him through this.” In order to know when to stop battling, Nienaltow-ski believes she knows Dina well enough. She, too, keeps a close check on Dina’s quality of life.
Whatever the choice, the pet’s wellbeing and the owner’s contentment are at risk because a pet parent is the person who knows the animal the best. According to Shojai, people shouldn’t ever be made to feel bad about the decisions they make for their dogs. “There are no good or bad decisions.”
Stivers agrees. No material possession, in her opinion, could compare to the joy and satisfaction of having such a unique partner. “Hobbes’ total cost of care came to $8,329.00. Hobbes’ opportunity to regain his health is priceless.
Pets are Karen Commings’ area of expertise as a writer. She is based in Harrisburg, Pennsylvania. The Dog Lover’s and The Cat Lover’s Survival Guides are her works (Barron’s, 2001).
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