It's the question that all of us who have older pets ask ourselves every single day: How much is too much to spend on extending your pet's life? And through how much would you be willing to put a pet who doesn't understand why s/he is in a cage at a place that smells medicinal all the time?
Today's New York Times
has an article about new treatments that are available for formerly-terminal diseases, but at a cost:
Using equipment donated by the Mayo Clinic, Dr. Steven E. Suter, who established the college’s Canine Bone Marrow Transplant Unit in March 2009, harvested healthy stem cells from Tina’s blood and introduced them into her marrow, after radiating it to eliminate cancerous cells. After two weeks of painless treatment, and a $15,000 bill, Tina returned to Florida, unsteady on her feet but cancer-free.
Older pets like Tina are benefiting from advances in veterinary medicine that have accelerated in the past two to three years, raising not only the hopes of pet owners but also tough new questions about extending or saving an animal’s life, and how much to spend in doing so.
A long list of cancers, urinary-tract disorders, kidney ailments, joint failures and even canine dementia can now be diagnosed and treated, with the prospect of a cure or greatly improved health, thanks to imaging technology, better drugs, new surgical techniques and holistic approaches like acupuncture.
“What’s new is the sheer number of approaches to treat problems that, not too long ago, would have meant the end of the line,” said Dr. Julie Meadows, a specialist in feline geriatric medicine at the veterinary medical teaching hospital at the University of California, Davis.
The Animal Medical Center in Manhattan, which performed 34 stent procedures on dogs and cats in 2005, usually to open up clogged passages in the bladder or kidney, created a clinic about two years ago to accommodate rising demand for minimally invasive surgery. Last year, it performed 630 stent procedures.
Dr. Suter, at North Carolina State, has performed bone-marrow transplants on 65 dogs, with 10 more now on the waiting list. Many veterinarians offer hospice care, too, mapping out a treatment plan that lets a pet spend the remainder of its life at home, its pain eased through a program of palliative care.
Treatment like this comes at a price, both monetary and emotional. Improved veterinary care for all pets has increased consumer spending in this area to $13.4 billion last year from $9.2 billion in 2006, according to the American Pet Products Association.
Pet insurance rarely comes to the rescue, since less than 3 percent of Americans carry it, according to the American Animal Hospital Association. Those who do can expect reimbursement, according to their level of coverage, from a few hundred dollars to several thousand dollars, but bills for the most advanced forms of treatment far outpace even the most comprehensive plans.
Mr. Otworth paid about $25,000, all told, for Tina’s treatment at his local veterinary clinic and at North Carolina State. He also wrestled with the tough questions that pet owners face in deciding whether to go ahead with late-life treatment. Will the pet suffer unduly? Will treatment give it a good quality of life, or merely extend it?
All too often, this question is accompanied by "How much do I love my pet?" That's precisely the WRONG question to ask.
Over a decade ago, our cat Oliver was medicated for cardiomyopathy and congestive heart failure for a year. He did pretty well for most of that time, but towards the end, the furosemide we gave him for the CHF did his kidneys in, and we weren't about to start putting this kitty through daily injections of subcutaneous fluid and inedible Hill's K/D food just to buy him a little more time. These days, we are every day finding new ways to trick Maggie, who was a young cat seemingly five minutes ago and is now an 11-year-old cat, into taking her thyroid medicine. Sometimes she'll take a pill pocket, sometimes she'll lap it up in a teaspoon of half-and-half, sometimes we can disguise it in her food. For forty bucks a month and a blood draw every couple of months, it's worth it to treat her. If her kidneys go, I'm not going to put this little drama queen of a cat through daily needles.
Jenny is an even bigger issue, because she has never quite fully recovered from being a stray. She is very sweet, but we have never been able to pick her up, she hasn't been in a carrier since the day we brought her home on Christmas Eve 2000, and the two times she's been looked by a vet, I've had to call a house call vet to come out. I can't even clip her claws, let alone give her medicine. I tried to give her antibiotic ear drops once and was unable to do so. As much as we love her, Jenny has made her choice, and when she inevitably get ill with kidney failure or cancer, we will keep her as comfortable as we can and then ease her passing at home.
I love these cats dearly, but I will not put them or us through the trauma of aggressive treatment that we cannot afford, that they do not understand, and that often do not extend life significantly. The dog cited in the above article was lymphoma-free, but developed liver cancer and died nine months later. Is nine months of additional pet life worth $15,000?
Losing a pet is horrifically painful. I wailed like someone losing a child the morning we took Oliver for his last ride. I heard him howl in the house at night for months the way he used to when he'd wake up confused in the middle of the night because he was that dumb. Mr. Brilliant, who had just lost his job at the time, had to dig the car out of fourteen inches of snow three weeks later to take our other cat Wendy, whose kidneys had failed, to the vet for the last time. But soon Jenny and Maggie both had new homes and two more lives were saved.
Maggie is like an infant. She is so bonded with me that she just wants to be touching me all the time -- glued to my side on the couch, touching my face with her paw in the middle of the night. She's a vocal cat and her fussing and constant need for attention makes me nuts sometimes. But she's such an endearing soul, and so off-the-charts cute, and her neediness has made me make a huge amount of room in my life for her. When the time comes to make a decision about her, I'm going to be an absolute wreck. Now that there are vets who make house calls (and indeed, we've brought one in for Jenny whose entire office, including operating room, is mobile), it's possible to help our pets pass without that final trauma of a last visit to a scary veterinarian's office. But knowing we'll only have them for a short time is part of the bargain we make when we bring them home in the first place.
I've always thought that it was a kindness we can give to pets that we are unable to give to people -- a loving, painless way to ease their passing instead of spending endless days in pain and discomfort. In my experience, most pets tell us when they are ready to go, though sometimes their signals aren't entirely clear. But now that there is technology that can extend pets' lives by days, weeks, or months (but in most cases no longer), will part of the commitment of having a pet be to spare no expense to buy even a little more time, regardless of quality?
Labels: health care, pets