How Much Is Too Much?
September 23, 2010
One of the main reasons human health care costs continue to increase is that the sophistication of tests and treatments increases almost daily. The same thing is happening in veterinary medicine. Procedures that were unheard of when I got out of school in 1990 are now commonplace in general veterinary practices.
The advancement is so fast that many pet owners don’t even know what is available. The fact is that most tests or treatments that are available for people are theoretically useful for pets. Availability, necessary modifications and cost are the main factors that keep pets from being treated exactly as humans.
The trend to treat companion animals more like people began in the 1980s when people started asking about procedures that were becoming common for them. If cataracts could be removed from a person, why not a dog?
To make all of this high-tech medicine available for your pet, health insurance coverage may be necessary. Just as in human medicine, sophisticated care is expensive and may only be affordable for those who are insured. Therefore, pets should be insured when you first get them and before they develop any problems.
I am sure you have experienced blood testing with your pet, as it is a critical component of fully understanding your pet’s health and in catching early disease, but there are now blood tests for almost anything you can imagine. The tests might have to go to a specific lab or veterinary school, but, if you are prepared to spend enough, the possibilities are almost endless.
Blood pressure testing, something that is standard for people whenever they set foot in the doctor’s office, is now available for animals. However, the test is much more difficult to perform in animals and is less accurate. In my practice we reserve blood pressure testing for animals with diseases that predispose them to abnormal pressures like heart or kidney disease. Very accurate blood pressures can be achieved in veterinary schools and referral facilities by passing a probe into the jugular vein and toward the heart, but this is not how it is done in general practices.
Pulse oximetry is another thing that is routinely done when a human is admitted to an emergency room. That is the little probe that is placed on your finger that tells the nurse what percentage of your blood is saturated with oxygen. It does this by measuring the “pinkness” of your skin. This is also available for animals, but because of fur, we use the animal’s tongue to measure oxygen saturation. Thus, this test is only routinely feasible on anesthetized animals.
Veterinarians have always run ECGs, but now we have access to fancy equipment that helps us interpret those strips quickly and accurately. My favorite way to do this is by wiring the ECG to a veterinary cardiologist over the phone line. Other veterinarians have computer programs that help them with this interpretation.
Everyone is familiar with x-rays, and they have been part of veterinary medicine for decades, but limitations to this test have led to follow up tests including ultrasounds and CT scans. These are now routinely recommended to help us better understand the extent of heart disease or to determine how much a tumor has penetrated other organs. Even MRIs, which are the definitive test for almost anything in human medicine anymore, are slowly becoming available to referral veterinarians.
And then, once we have gotten all of the available testing and we understand the nature and extent of the problem, we have to talk about treatment options. Many pets undergo chemotherapy to lengthen and improve their lives with cancer. We can perform the same radioactive iodine treatments that are used for humans with hyperthyroidism; we can refer your pet for back surgery or cataract removals. Most of these things can be done locally. But, if you are willing to travel, treatment options become endless. Even kidney transplants are becoming routine at the University of Pennsylvania with a price tag of $10,000 – $25,000. Brain and heart surgery are no longer “out of the question” at major veterinary schools.
But, how much is too much? There is no one answer to this question. Each individual must know his or her physical and emotional restrictions as well as financial considerations. And, we must always consider the personality, pain tolerance and will of the pet in question. Some animals love the attention of weekly chemotherapy sessions. Others would quiver and shake at the thought of going to the veterinary hospital yet again. Some pets scream as they recover from surgeries; others act like nothing happened. These responses must be considered when making a decision about a pet’s treatment.
Unfortunately, it is difficult not to let our own guilt drive our treatment decisions. Once a pet’s owner learns that there are tests or treatments that can be attempted, even if the possibility of success is low, we feel guilty if we don’t at least try. One of the hardest things veterinarians do is to help people weed through all of the options available and make the right decision for that pet. It is never the same twice.