Veterinary Medicine: How much do you want to know?

A friend sent me a link to an article in Slate about how horrible veterinarians are for using expensive, high-tech, and aggressive testing and treatment methods on dogs and cats, with emphasis on the "expensive." The article leads off with the story of a vet clinic whose staff dropped everything they were doing to try and resuscitate a dog brought in by his owner, with the strong implication that they should have refused to even try. Given that the owner picked up his dead dog and brought him to the vet, it seems fairly obvious to me that this is exactly what the owner wanted. The bill over which so much horror is expressed was only $250; a pretty fair price for a shot at a miracle, and the tiniest fraction of the charge of what it would cost in human medicine for the exact same procedure:

Two trends are making a visit to your veterinarian an opportunity for endless guilt. One is the increasing acceptance of the notion that pets are family members (thus the movement to change the word owner to guardian). The other is the convergence of veterinary and human medicine—pets can get chemotherapy, dialysis, organ transplants, hip replacement, and braces for their teeth. In 2004, Americans spent $18 billion to treat the country's 164 million dogs and cats. Sure, you may have a health-care directive that begs your loved one to pull the plug. Grandpa's hospital bed may have a flashing "Do Not Resuscitate" order. But how can anyone be heartless enough to refuse to treat their dead dog?

She compares the human and veterinary systems of medicine, and finds vet med lacking:

In Sicko, Michael Moore indicts America's human health care, painting a portrait of a system so callous that the loss of life and limb is a matter of simple economic calculation. But in my experience, it's almost impossible to find a callous vet when you need one. Take what happened with my cat Sabra. At age 21—the equivalent of a 100-year-old human—Sabra was fading. She had stopped grooming and was barely eating. She spent her days curled in a chair, hissing occasionally like a deflating whoopee cushion. Instead of letting her go gently, of course I took her to the vet. The vet shook her head at Sabra's condition. She likely had cancer, kidney disease, multiple organ failure. All this would have to be sorted out through several days of rigorous testing. Instead of saying, "I'm going to take her home and let her deflate in peace," I handed her over.



As I left, I thought of my dear, departed grandmother. When she was 90, still lucid but in the hospital and facing the end, the doctors thought perhaps she had an undetected cancer. To confirm, the biopsy would have required anesthesia and a painful recovery. Everyone agreed to let it go. Sabra had no such luck. Two days and $800 worth of tests later, the vet couldn't find out what was wrong (besides the fact that she was 21) and said she was arranging a transport to a facility where Sabra could get an MRI. When I said I was coming to pick her up, the vet became hostile. "She might have a cancer we haven't found! She's not in good health!" said the vet. I returned Sabra to her chair, and she died a few months later.



I was left feeling the whole exercise was a way of shaming me into covering the overhead.

My issue here is not the owner's decisions, neither the one to have the testing done nor to take her cat home. I might have put a 21 year old cat through two days of testing and hospitalization if she was amazingly healthy up until then, but it's unlikely. No, my issue is the attitude that a veterinarian giving you medical advice and letting a pet owner know what options are available is an opportunist preying on our love of our animals.



My veterinarian is not in charge of my morals, my love for my pet, or my budget. I don't pay her for her opinion on how I spend my money nor on my value system. I pay her for medical information, period. And to any suggestion that vets should withhold information from us because we might experience it as a guilt trip, I say: Get a spine.



And I'll also tell you, while I have now and then seen vets forget the pet and his or her quality of life in the name of playing with some new toy or getting THE ANSWER to what's wrong with the animal even if it won't make a difference in treatment or outcome, most of the time I see the exact opposite: An almost total lack of interest in tracking down a diagnosis, and the routine administration of antibiotics and some kind of anti-inflammatory (either steroids or, more recently, NSAIDs like Rimadyl). It's the veterinary version of "take two aspirin and call me in the morning."



It's certainly true that some of us can't afford to get every high tech test and therapy for our companion animals, but that's genuinely a separate issue from whether or not a veterinarian should make us aware of the options that are available.



It's also true some of us won't spend the money even if we can afford it, but that, too, is a separate issue from whether or not our pets' veterinarians should inform us of what can be done.



I wrote about this a few months ago for my SFGate.com column, beginning with the story of my fight for the life of my dog, Bran, who was only four years old when I lost him:

I'd made the last 10 days of his life miserable with tests, tubes and hospitalization. I'd spent over $10,000, more than half of it borrowed. I'd let my professional and personal lives go completely to hell, while I sat next to my dog on the hospital floor, stroking his head and hoping for a miracle. If I'd known how it would end, I'd have put him to sleep the first day.



The problem is we never do know how it will end. From necessity, we do a kind of emotional and financial triage without the single most important piece of information: Will it be worth it?



For people with little or no money in the budget for veterinary care, that triage might be painful but simple. There's no point in debating the merits of a diagnostic procedure or treatment that you can't afford. But even if finances aren't tight, the incredible array of technologies available in veterinary practice today can burn through the most generous pet care budget in days, and can be bewildering to pet owners.



Surgeries that were once unheard-of in veterinary medicine -- such as organ transplants -- are now being done on pets. Chemotherapy, arthroscopic and laser surgeries, hip replacements, MRIs and nearly every form of sophisticated medical treatment or diagnostic procedure known to human medicine is available in animal practice, too.

I interviewed leading veterinary cardiologist Dr. Paul Pion, president and co-founder of the Veterinary Information Network, for the article, and who believes that veterinary medicine today offers choices that can overwhelm pet owners, particularly in the area of diagnostic testing:

"We can do a much better job of diagnosing things than we ever could," he said. "Today's veterinarian is a different vet from James Herriot, whose diagnostic methods were things like the laying on of hands, and smelling."



But Pion doesn't see technology as being the main source of veterinary medical miracles. "Things are being diagnosed earlier. Owners are watching them more. They're bringing them in when something can be done. And veterinarians are detecting more. It's not just the technology, it's having the relationship with the vet."



[....]



When faced with uncertainty, Pion recommends that pet owners "look the vet in the eye and ask, 'Do you believe this will make a difference? If this were your dog, what would you do?'"

My personal belief is that only we can make the decision of how far we are willing and able to go for answers about our pets' health, or to treat their illnesses and injuries. As I wrote in SFGate.com:

Some people go too far, putting their pets through needless stress to chase a cure that is, at best, unlikely. Others give up too soon, or resist digging a little deeper for money to pay for even routine care. Most people, though, just try to walk the difficult line between the extremes and make rational, caring decisions based on their animal's needs as well as their own.



Experienced professionals can help you evaluate the odds. Only you can decide how much you're going to bet, or how long you're going to play.

So my question to all of you is not, how far would you go? My question is this: How much information do you want about what can be done? Do you want your vet to make that decision for you, and be the gatekeeper of the information you're given? Do you feel guilt-tripped by your vets?

Comments

[catmom5]

This brought a lot of conflict and emotion to my mind. In November when CJ went into ARF (early catfood poisoning), I was lucky enough to have a prominent vet teaching hospital about 10 minutes away. I decided to let them treat her initially and than make decisions based on her response. The vets were incredibly up-front and honest about every test, every response and prognosis. Fortunately, she responded to the fluids, medications and wonderful care and made an amazing recovery. However, she required very close monitoring (not cheap) and developed complications requiring exploratory abdominal surgery. Not knowing what they would find, but knowing she would likely die without the surgery I decided to go ahead. I know that many people thought I was crazy. She had bacterial peritonitis (likely caused by perforating the intestine during a cysto), had a stomach feeding tube inserted and spent almost two weeks in critical care. Well, it's been almost a year and more than many thousands of dollars and she is still with me. She has had some liver involvement, which had required further testing and daily medication but I have a happy, relatively healthy 11 year old catgirl who I love very much. I don't have the new sofa I wanted, I didn't have a vacation this year or other stuff I thought I had to have. It's a matter of priorities for me and I decided early on that as long as CJ was fighting I would fight with her.

[straybaby]

i want all info. i do not want my vet to decide what info i should get (especially since i'll be looking it up anyway! lol!~) about treatments. My vet does not guilt trip me, but i did have to visit an alternative one on a Sunday once that did. That was 3 yrs ago and i STILL curse him. thankfully i trusted my gut and did NOT listen to him and was in my vet's office first thng in the AM. i love my vets (husband/wife team, holistic/traditional/plus) and fortunately had been going to them for awhile, so trusting my gut was easier when i was being basically bullied by the other vet. i went to the other on a sunday to make sure my 17+ yo male cat wasn't in the early stage of blocking. i've been through it before with another boy recently, so this was almost more precautionary as he seemed to be experiencing pain, but wasn't sure about blocking. i wanted to have him checked and be sure his bladder was indeed emptying. the vet listened to me while i explained the symptoms and my concerns nodding and agreeing. asked what i fed, told him raw and i was immediately told i was prob killing him. i bit my tongue and asked if he would please examine him re:bladder. he looks over the chart and sees my cats age and that he's never had a stone prob before and jumps to he most likely has a form of cancer and needs testing and something else that would require him to be knocked out, which of course because of his age, would require extra blood tests and he needed to stay there through all this. he went through and added it up quickly (out loud!) and said that would be what he needed to just get started on him. when i said i was uncomfortable with all of that and leaving him there since there was no overnight staff, he proceeded to explain that i would prob find myself at AMC sometime around midnight ("he could still block" he tells me like i don't know this!) spending much more and possibly losing him. i high tail it out of there, but not before my boy eliminates on his lobby floor while i was paying the bill (BIG puddle, good kitty!) i stopped by the health food store because i remembered the name of the herb on used on my other blocking kitty and started him on that until morning just in case. saw my vets the next morning. they gave him a full checkup while asking me questions (including recent diet with a smile as a response to my answer!) i let them know i had given him the herb and he seemed to be more comfortable, but still not right and he passed something that looked like a blood clot. also, in looking at him, i thought he looked a bit thinner in comparison to his brother. basic blood and urine work was suggested as a starter. turns out my boy had a nasty bladder infection. after a full round of antibiotics and retesting a couple weeks later, infection gone, weight back to normal and my boy looked like the 7yo cat everyone always mistaked him for.



can i say again i love my vets?! always discussion over exam. discussions of possibilities based on exam, more discussions after any testing etc. a year later when he and his brother both started going through health issues (both now 18+), discussions always included how invasive we wanted to go depending on what they would possibly find/treatment vs their age. and at times, that i needed to start thinking abut letting go if they didn't bounce back. and letting go included comfort and quality of life.



2 so different vet practices, both about the same walking distance from my home. and i have a third option in between. that vet is not a guilt tripper, but also not up on some of the more natural treatments and diets.



and as long as i'm typing. one other thing a vet should not do in my book, talk bad about a breed of dog you choose to love and live with. yes, that would be bully guilt trip vet! "my parents had Dalmatians when we were growing up. I would NEVER live with one of those again." gee mr vet, works for me as you'll never have the pleasure of meeting mine ;)

[Diane]

So veterinary medicine has made advances. How is that a bad thing? I lost cat to feline leukemia years ago, I think it's wonderful there's a vaccine for it now.



I doubt if Ms. Yoffe's veterinarian was holding a gun to her head. If you can afford what they recommend, great; if not, either accept a less expensive alternative or have the poor animal's suffering ended. But for heaven's sake, there's no need to whine about it.

[The OTHER Pat]

One of the distinguishing factors (human v.s. animal) that was left out of this discussion was the question of insurance (specifically "managed care" for human beings) and how this HEAVILY influences the economics of deciding what will or will not be done health-wise with human medicine. Many human doctors are pressured to minimize care in order ot maximize profits.



Not so in veterinary medicine, where insurance coverage is still relatively rare and so - also - the incentive to deny care. Now I'm not accusing vets of going to the other extreme (although I know there are those who make that accusation) - but simply pointing out that in the article that jumps from the indictments of Michael Moore's "Sicko" to the vet that spent two days (and asked for more) hunting down a diagnosis on a gravely ill geriatric cat, the discussion completely missed pointing out the essential defining distinction of how the bottom line demands of managed health care pretty much create this difference. That is, the money to pay for figuring out what was wrong with 21-year old Sabra was coming from the author's own pockets. And that - perhaps - is a distinction that some of the vets under discussion here seem to forget.



I want all the information so that I can make my own decisions. But - as sad a necessity as it is - that information should also include an up front discussion of how much my various choices are actually likely to COST.



My bird vet has an interesting approach to this. She spends the first part of the visit doing the exam, and going into detail with you about what she's seeing, what's likely to be going on, and what your choices are. Then she leaves the room, and the office manager comes in and goes over what the charges for today's exam and consultation was, and what the charges for the various choices under discussion are. You pay the bill (or make the arrangements) before things go any farther.



In a lot of ways, THAT approach might seem cold and callous. But I understand where she's coming from (vets have to deal with unpaid bills a LOT when an animal's owner decides the bill has exceeded the animal's "worth"). And seriously - separating the diagnostic discussion from the financial discussion actually seems to help think things through a little more clearly.



I remember when my 18 year old cat's kidneys finally gave out. I took her home with Sub-Q fluids for the weekend to see if she would rally, but by Sunday evening it was clear to me that she was saying "Just let me go".



We went in Monday morning, and when the vet came in and we began talking about what was to be done, he said "You know, they are doing kidney transplants on cats now."



I was a bit surprised, thought about it for a moment, and then said "No - she's 18 years old, shes tired and ready to go. I just can't see putting her through any more."



"I was pretty sure that would be your answer" he said, "but I would have been remiss if I hadn't at least mentioned it".



And isn't that - really - how it should go?

[Carol PW]

I would go as far as I could (money and effort) if the pet or a trusted vet told me it wasn’t yet their time to go, and if there was any hope at all. I want ALL the information and the vet’s advice, but I make the decisions. If I felt guilt-tripped by my vets they would no longer be my vets.



SCREW the money! I was happier when I was living poor and hungry with Ambrose (best beloved dog) than I was later, when I was pretty well off and lost him thirty years ago to something they would find today in routine tests. Pets are not with us long enough as it is, and I would forgo anything to extend their time with me unless their quality of life sucked.



And I had a cat (Tweezer) that was diabetic and on insulin at 10 years old, hypothyroid and on medication for it at 15, arthritic and in early stages of kidney failure at 18, congestive heart failure at 19, pretty much blind and deaf at 20, and loved life until congestive heart failure got to be too much for her at 22. Lots of $ along the way, but we were very happy in the meantime and that’s all that mattered to us.

[Sue Cosby]

Just another facet of the same question...



I've had the pleasure of working with a veterinary school emergency hospital as well as with the students (who volunteered at the shelter) overseeing and assisting in the treatment of animals at the hospital. The students consistently expressed their sadness at presenting a day's worth of clients options for diagnosis and treatment and finding very few who chose treatment. The pressure on the students - who knew they may be able to save the animals yet regularly encountered people who couldn't or wouldn't pay - was what I might even describe as traumatic. Sometimes I would see them at the end of the week, literally exhausted in emotional pain.



So, while the veterinarians may be seen as laying a guilt trip, and I believe the decision should be with the caretaker, I feel for vets who see (in some cases, but not all) easily treatable conditions go untreated. I suppose the individual veterinarian's experiences will form his or her "bedside manner" later on in a career. And to each veterinarian's credit, they should push for life whenever they feel it is reasonable. One veterinarian's threshold might be higher or lower than anothers.



For myself, with my own pets and with the animals at the shelter, I have two questions: what is the diagnosis and what is the prognosis. Those are the two questions I seek to answer and then evaluate whether we have the answers - or not - and where to go from there. I am constantly questioning myself, regardless of what the veterinarian says. If I don't feel right ... it's time for a second opinion!

[shadepuppy]

I want all the information that the vet can give me, but that information usually comes with pricey lab tests. My current regular vet is good about explaining what tests he would like to run and what they could rule in/rule out as far as diagnoses, and which ones would be most important if I can't pay for all of them. He's also good about not pulling any guilt trips to push me to spend more money for more procedures. He has told me several times that he agrees that it "is time" when I've taken one of babies in for euthanasia.



I have had surgery done on a cat with cancer of the intestine, and I don't intend to do it again because of the side effects. If something can be done to make my cat/dog well again, or "well with regular medication", I want to know about it and consider it. I have a budget and I have to consider money as well as Love.



The Emergency clinic is where I have my problems - they want to do everything they can for as long as they can and they WILL guilt me as much as possible to make this happen. Now that I've been through it a few times, I am better prepared to tell them what my limits are and that I am taking my baby home after what I decide is a reasonable amount of supportive care to see if they can survive on their own. I wish they would work with me like my vet does - what can we accomplish - what will it cost - which tests/procedures would give the best "bang for the buck", and what am I able/willing to approve. Instead, it's a struggle, and it comes at a time when I am least ready for a struggle. I wish dogs/cats/and people would only get sick during regular office hours, but there seems to be a rule against that... ;-)

[Gina Spadafori]

That writer has always annoyed the heck out of me, so I wasn't surprised.



Why ON EARTH would you not want to know everything that's available for your pet's care? And besides, why would you want a veterinarian who didn't respect you enough to NOT treat you like a child?



Get all the facts, and then make the decision. Walk away for a couple of hours if you have to to think about it. If you allow someone else to "make you feel guilty," well that seems to me to be your problem, isn't it?



Informed decision-making is a good and necessary thing, in all cases.

[Dorene]

I agree with Shadepuppy -- it's the Emergency Clinic that seems to want to guilt you into every possible test. And I say "guilt" because unlike my own vet, they try to pressure you into every possible test "because it will give us more information" but they don't want to tell you the worth (the prognosis) of that information -- even when you pressure them back.



I want to hear all the information that's inside a vet's head, but not all test information is equal -- some pieces will help you make a decision and some is just "nice to have."



If a test is really going to help us figure out the situation, I'm all for it -- if it's collaborative (and expensive), I'd rather put my pet through the least amount of testing (as none of them like it and they are stressed anyway) that will help us figure out the problem and what to do about it.



It also depends on what the problem is as to how far I'm willing to go. For instance, when one of my Persians had cancer, I did the MRI to find out how extensive it was. We found out her entire chest cavity was filled with cancer -- she would not have survived the surgery, so we kept her comfortable until she was ready to go. Six months ago, Pepper cut her leg on a wire coming out of a creek (after-hours, of course!). It appears if I was Terrierman, I could have handled this myself (;-)), but I immediately took her to the emergency vet to get stiched up. For a dog that was up on her shots and had been brought in within the hour of her accident, my husband and I thought that they wanted to do an excessive amount of testing (especially since she had cut herself worse as a puppy and our regular vet hadn't tested so much). As I was planning to follow-up with my regular vet, we compromised on the testing (all of which turned up negative) and Pepper is fine.



When Lindsey's life was on the line during the pet food recall, I thought the emergency vet clinic handled it fine. However, I do feel they overreacted and definately tried to make me feel guilty when Pepper cut her leg (which had to be handled, but was not life-threatening)-- and reading the comments here, I think I'm better prepared to deal with them in the future. Thanks, folks!

[Gina Spadafori]

Another thing that bugs the crap out of me: That Slate writer's whining about being shamed into "covering the overhead."



The "overhead" -- for sophisticated, high-tech diagnostic machines -- is there because many clients want and demand these options. It's market-driven, and if there wasn't a market the procedures wouldn't be available.



Still writing from rural Texas, where I saw two bulls turned into steers and a hamster cured and returned to a grateful 9-year-old -- by the same young vet, all in the course of 90 minutes.

[PBurns]

The article is making two simple points:



1. Some things are inevitable and pet owners need to deal with that, because the veterinarian is not likely to, as there is no financial incentive for him or her to give you the "hard news."



2. Veterinarians are in a business and it's not a little bit about money, it's a LOT about money, same as every other businsess.



As to the notion that all vets are saints or even neutral: Nonsense. Vets are people, and they are no different that the folks that fix cars and sell human medicine and health care, and YES these businesses ALSO rip people off.



Yes, ROUTINELY. Type in "Tenet" or "Columbia HCA" or "HealthSouth" and "fraud" and see what you get. Ditto for Pfizer, Briston-Myers, or any other major drug company you care to name. Go to Google and type in "atypical anti-psychotics" and "kickback" or "investigation" and see what you see about how doctors operate. You think it's different with veterinarians who have almost NO regulation at all and are not subject to either basic consumer law or federal regulation from laws like the False Claims Act? Nonsense.



Better yet, sit in an emergency veterinarians office and LISTEN to the nonsense you will hear. I heard a woman who was told simple kennel cough was going to require more than a week of hospitalization. And then there is the Lyme disease scam this article mentions -- it's amazing and true. False positives out the wazzo, and all kinds of tests are given, while the cure can be given by yourself and is available without prescription (see http://terriermandotcom.blogspot.com/2006/11/lyme-disease-hard-to-catch-and-easy-to.html ) and is damn near free. Not that anything at all needs to be done most of the time.



How about "heart worm" medicine given year-round North of the Mason-Dixon? Ridiculous, but as common as rain in the monsoon season.



Veterinarians (like all doctors) love nothing more than patients who are ignorant and have done no research and present with a vague collection of symptoms. Ka-ching -- it's TEST TIME. And believe me they will test, and test, and test. The folks who are advising vets how to "upcode" and gouge patients more are the "business consultants" at KPMG (see http://terriermandotcom.blogspot.com/2005/07/vet-care-reaches-human-care-costs.html ) and part of their pitch is to add more tests and to use more emotional leverage ot jack up the bill. And YES, vets are doing it. Now, to cushion the rapidly rising costs, many vets will show you a "prospective bill," but most patients do not know enough to see the double charges or cross out the nonsense that does not need to be there at all. I have cut bills in HALF with a pen in 10 seconds, and the dog is no worse the wear. And who are you talking to about this? Not the vet! Some high school kid; the vet KNOWS it's a rip off, but this is how "the practice" is structured and how "the girl" at counter was taught to bill, and so the vet ducks his or her head and hides in the back room. And YES, the same thing is going on in HUMAN health care too, only it matters less to you beause private insurance, Medicare and Medicaid pick up the costs. Hey, those are free, right??



Patrick

[ticocats]

I want to know all the options available, but only if combined with the vet's good faith estimation of how much benefit -- and how much suffering -- my pet is likely to get as a result.



Last week I lost a cat who, for 12 years, I loved more than I would have thought possible. I live in Costa Rica, but my wonderful vet knows what treatment options are available both here and in the US, and knows that I would have sold everything I owned if necessary to give this cat a longer, happy life. He had shown no signs of illness, only a rapidly growing suspicious lump. But for every option we discussed, after surgery revealed that cancer had destroyed one kidney and was spreading through the other, she advised that the most likely outcome would be a few months of illness and increasing pain, followed by a miserable death. So I agreed with her suggestion not to wake him from the surgery.



I am heartboken, but very grateful that my vet's clear focus was on what was best for my cat, rather than on her revenue or my own desperate wish to spend more time with him.

[Maria Shanley]

First post here, but have been reading this site for some time. I'm a retired AHT who used to work ER in Southern California, and have to say after working with about 50 different emergency vets, that I've seen the whole spectrum from those who would never recommend euthanasia and pushed clients to always pursue every diagnostic and treatment no matter how grim the prognosis, all the way to those who just went through the motions no matter how concerned the client or young/salvageable the patient.



It seems in retrospect that the difference in vets was partly due to ability and experience, partly due to where they were trained, and partly due to what I can only describe as "world view". Two of the most difficult to work with, were an internist who due perhaps to equal parts Buddhist religion and egotism refused ever to give up, even on animals which had multiple organ failure, were minimally responsive, had pressure sores despite hourly turning and meticulous skin care ( even demanding that we resuscitate them!); and a vet from Pakistan who clearly considered companion animals worth less than livestock and did not care if he caused unnecessary pain or even used accurate drug doses.



I must say one thing about ERs in general, however; the policy about what procedures and treatments are available or pushed is often not set by the veterinarian on duty, but rather by the board, owners or manager, some at least of whom are frequently MBAs, NOT vets or technicians. A business person was the one who hired and fired vets and nursing staff at two of the ERs I worked at.



I agree that the client should be offered as much info as possible to decide what they can or will do for their animal, and the better vets I worked with did so. But it was always dreadfully difficult when a client with a critically ill, suffering pet refused to either treat or euthanize, instead taking an animal with a severe trauma, poisoning, bloat etc home to die in pain. Those, and the ones where the human was clearly tired of the pet and euthanized over something very minor, were always the ones that haunted me. Most of us also had a hard time with clients who expected free care as a right, or who had caused their animal's condition (throwing their Labrador against a wall when they were drunk, giving their toy poodle enough alcohol to kill a dog three times its size, deep frying with a cockatiel perched on their shoulder and thus cooking the bird when it fell in the pan...) and then refused to deal with the result.



So an emphatic YES - tell the client all you can, but I think some clients could use a little guilt. Certainly anyone bothering to read these boards cares for their pets to their best ability, plus or minus finances; it's just too bad there are so many out there who regard their animal as furniture or maybe the kid's toy.

[Lynn]

I want to know ALL the options. Period. Sorry if it comes across as being pompous, but when it comes to pets, no one is capable of making me feel guilty.

[The OTHER Pat]

Wow, Maria.



What an eye-opening post. (I'm sitting here crying for the critters whose stories you've told.)

[Marilyn]

Maria, thank you for your post. You have pointed out the broad range of clients and situations that those of us in the field see on a regular basis.



I work as a vet tech in a full-service hospital and I would have to say that there is no one way to deal with all clients. Some clients love their pets dearly but their budgets are limited and they simply cannot do everything that could conceivably be done. Others have plenty of money but make comments like "He's just a cat. If he dies, he dies. I'll get another one."



The vast majority of clients that we see, when presented with a serious injury or illness, struggle with the issues of what procedures to put their pets through, how much to spend, when to stop treatment. I think our job is to give the clients as much information as they can handle (and that varies from client to client), tell them all the options, and then let them make their decision.



I agree with Christie... Clients should ask their vet "What difference will this test/treatment make?" That is the question I ask my vet when I take my own pets in.



So far, this discussion has centered primarily on whether tests or treatments will or won't benefit the pet. There is another aspect to be considered as well, which is that veterinarians and staff do not only deal with the pet/patient' needs. They also must deal with the personal needs of the client/owner. Some clients need more information about their pet's condition, not for the pet's benefit but because of their own "need to know." That may be because of innate curiosity, or to set their mind at rest, or to comfort their soul. An example is having a necropsy done after a pet dies. The necropsy will not help the pet at that point, but it may well help the owner.



It can get very complicated, and I can only say again that there can be no one right way to deal with the needs of both clients and their pets, except to be as sensitive as we know how to be and to communicate as well as we possibly can.

[Diane]

The last time I took my cat Smokey to the vet in February, it was because he had lost weight, didn't seem to be eating, and was drooling a lot. I thought it was an abcessed tooth or something. Unfortunately, the vet immediately diagnosed a malignant tumor on his jaw. The vet very gently but clearly told me we could do a biopsy to make sure it was cancer, although he was 99% sure already; remove most of the jaw and tube feed him for whatever time he had left; or keep him doped up with painkillers as long as they worked.



If there was any way of making him better, I would have found the money somewhere. But it seemed that all the alternatives were more for my sake than Smokey's, so I just told the vet to euthanize him.



I still feel guilty I didn't notice the weight loss sooner, but I don't feel guilty about the decision I made. That made the mourning a lot easier.

[Lynn]

Maria Shanley:



Thank you for writing your views and experiences, which I greatly respect. I admire you for having dealt with this - you have a big heart.



And absolutely - a lot of clients do deserve to be "guilted up"....and if they feel guilty that's THEIR problem, not the hospital's problem.

[Diana Guerrero]

I believe options should be given to the pet owner and that it is ultimately their decision.



My clients have complained about "guilting" but I haven't had a problem with that but I am a bit more savvy than the average pet owner.



That said, when my vet misdiagnosed a tumor and later when it was found to be cancerous--well, I am glad I had a sane friend with me to ask questions and that we took the time to go home to ponder what I would do. I believe I left my body when I heard the diagnosis...



As mentioned previously, there is a lot of variety and it depends on the veterinary clinic and the protocol of the facility as to how things seem to be handled.



The decision to attempt to remove the cancer was mine. I was devestated because the tumor had grown to a softball size internally. I was also freaked out because this was at a time when I was homeless and didn't have the money for the operation.



The surgeon was the best and so I thought I would give it a shot. It took a lot of work to find funds and a lot of effort to seek help from those closest to me--and who loved my dog.



My point here is that I understand those who go the extra mile for their animals but I also understand those who can't or don't.



Where I live I see the finest of the fine and then those who love their animals but just don't give them what I consider minimal standards of care.



At what point do you draw the line? I don't know the answer--and think we are all going to still ponder it for a while.



The world of animal care and handling has changed drastically and it is going to take a while for things to level out...will there ever be consistency between veterinary clinics? Probably not. Most are still independent businesses.



Ultimately, it is up to the pet owner to educate themselves and find a veterinarian they trust and feel comfortable with--which sounds easy but it isn't always so.



People don't always know what to look for in a pet professional and there are so many variables.



Opinions from friends and family still hold the weight even though they may be wrong. I see it on a daily basis.



Anyway, great topic and comments.

[perkysmom]

I have a 15 year old cat, Sonnyboy, who was diagnosed, May '07, with a large cancerous tumor in his abdominal area. My vet advised against surgery because of his age. When Sonny starts hiding and stops eating, I've been taking him in for a shot which perks him up. So far the shots have lasted about 6 weeks. He is sociable and eating well, but I know the time will come when he won't be able to eat. Watching an animal slowly die is almost as bad having one suddenly die. Some people give up too easily when the animal can still have quality of life.

[Randi]

I am so glad you wrote this. I saw that article on Slate and was mad.

Why would someone take a dead dog to a vet?

Because they wanted help.



I am an adult who can say no if I don't want to pay for something, but I will do what I can to help my dogs.

[Trudy Jackson]

I had a cat with cancer of the ear and it was taken off. It then spread down through His body, we didn't know it then, and when i talked to My vet He said something I will never forget. and i always think of it when making these discisions.He said=think of the pet- Does He have quantity or quality of life? If there is no qualiity of life for the pet, it's not fair to keep them alive just for us. I just had another cat that had cancer and a new [My vet was on vacation] vet said I could take Him home and He would probably die in a few weeks. I had Him put to sleep because He wasn't eating good, laying around, no quality of life left. Just a peaceful end.

But yes, I always ask all the questions.All of them.

[Katherine]

I had a horrible run of kitty cancer. The worst was squamous cell carcinoma, and because I didn't know whether it was cancer or an abscess I put her through horrible mouth surgery that I still regret. I was a lot more conservative with her daughter with lymphoma--perhaps too conservative, perhaps not, but this was a cat who would hide for two weeks if I gave her a pill, and I think that if the vet had kept her overnight without me she would have died of stress. Very highly strung cat. And right now I'm down on any treatment where I'd have to explain it to a person to get them through it. I can't explain to a cat that the feeling awful is going to make her live longer.



As for the people dissin' on emergency vets, mine is great. Then again, it seems like every time I'm there I'm sharing the waiting room with the worst pet owners ever. I was there once because I had a kitten with bloody diarrhea, and once because my cat with lymphoma was too miserable to wait until morning for euthanasia. I imagine dealing with people who don't seem to care much that their dog ate an entire cake of rat poison and leave the maid who doesn't speak English to deal with the non-Spanish-speaking vet while they go out to eat and refuse to share their cellphone number would make one a little jaded, but she's wonderful.

[Vets are people too...]

As a veterinarian I feel that people should remember that we vary in our backgrounds, education and general approach as much as any other diverse group of people. I feel for the people who go to a veterinarian that they do not have a working relationship with for a workup on a tough case. However I think that most of situations where the client is disgruntled can be avoided by having a good knowledge of how your vet works with you. To do this...bring your animals in regularly/yearly for rather low cost wellness exams (preferably not yearly over-vaccinations) That way you forge a good working relationship, know what your veterinarian has to offer, know whether they use pressure tactics etc. I work at an emergency clinic that has good vets with somewhat different approaches, but for the patients that need it, I am so glad to have a great range of pain meds, diagnostics capabilities and treatment options. If somebody cannot afford what is at first offered, I readily give them options as long as I do not think the patient is suffering. It is up to the client to stand up for themselves while listening to the vets concerns as well. I of course get frustrate when clients do not take me seriously when I know their animal is dying or suffering and they just want to take it home for their vet to see tomorrow without even some fluids under the skin or pain meds but I know that not all of us use pressure tactics. Be a responsible pet owner and get to know your vets and ask lots of questions. Ask what each test is for and what the treatment options are. But do not look down on those of us that do want to know all that is available to diagnose and treat our loved ones (my dogs are my children).

[Daniel Beatty, DVM]

Great article and I agree the decision is up to the pet owner. The information needs to be given by the vet and the decision made by the owner as to what they feel is in the best interest of their pet.



Making money by diagnosis is actually pretty foreign to vets and I agree with Christie's statement here - "most of the time I see the exact opposite: An almost total lack of interest in tracking down a diagnosis, and the routine administration of antibiotics and some kind of anti-inflammatory (either steroids or, more recently, NSAIDs like Rimadyl)"



My evidence for this? 33% of the majority of veterinary clinics income would not come from vaccinations if they actually did push diagnostics. I like most of my holistic vet counterparts have a service oriented fee structure not a product fee structure. Many of the traditional clinics that have gone to the new vaccine protocol or even further and have gone to titering are trying to make up for it by increasing services so I can see where some clients are starting to feel the impact of vets pushing services but in my experience many of the vets are still pushing the cover ups with anti-inflammatories rather than looking for a true diagnosis.



There is a fine line however in some cases and this just takes communication between vet and client. There again the vet provides the information and the client asks the questions and makes the decision they feel is right for their pet. So I agree with the comment above by 'Vets are people too' that "most of situations where the client is disgruntled can be avoided by having a good knowledge of how your vet works with you." What he is talking about is communication and with that it is a two way street. Many vets need to learn how to have a better bedside manner so that communicating with them is not so intimidating and/or difficult. Better communication would fix many of these issues that clients have with feeling pushed into services.



Just my 2 cents worth!

[Jim Kelly]

Avoid blind faith. I lost my beloved Callie to FELV because I did not require my vet to inform me of all the options available for my pets routine care, nor did I verify that they were in fact receiving that veterinary care. I always said do whatever they need as far as tests and vaccinations are needed and assumed that was what was being done. Most of my pets are from feral backgrounds, so I knew enough to ask that they be tested for FIV and FELV prior to any vaccinations being done. Callie was approximately 6 months old when I rescued her, tested negative for both diseases, was spayed and put on rabies, FIV, and FELV vaccination programs. At 20 months of age she went off feed, became somewhat lethargic, and began eating litter. I took her to her vet who did a wellness exam, declared her in excellent health and gave her an "A" on her health report card. He said her symptoms were probably due to a mental problem. I took her to another vet for a second opinion. She was euthanised at a university teaching hospital two weeks later after two blood transfusions failed to reverse her critical anemia that was caused by leukemia. The attending vet at the hospital said that since she came from a feral background, she should have had a second test for FELV six weeks after the first to verify the negative results.

My concern turned to my other cats who were also under the care of the same original vet for routine tests and vaccinations. I found that one, who had received Rabies, FIV, and FELV vaccinations for two years, had never been tested for either and was in fact now positive for FELV. A third cat tested negative for FIV, but I found that she had never been tested or vaccinated for FIV.

My blind faith that proper veterinary care was being given to my pets by this very pleasant husband and wife vet practice is partially responsible for the loss of Callie and soon to be loss of the other FELV+ cat. She's presently on Interferon and is isolated from the others.

With the information available today on the internet, books and publications I know now that proper home care, love, and nutrition is not enough to assure my pets of a long, healthy, and happy life. I must be better informed, and I pray that all pet owners will do the same.

[Dr. Patty Khuly]

Christie: Wow. You said it so much better than I did--or ever could. Love your style, girl.

[Barbara A. Albright]

The cost of miracles OR sometimes the cost of

F-R-A-U-D !! How does the average pet owner make informed decisions regarding treatment, diagnostics, and the like without honest, ethical, professional advice? The public is completely reliant upon the standards and ethics by the American Veterinary Medical Association, state licensure, and the "oath" taken upon granting of the DVM degree from a respected university/college.



Unfortunately, regulation and removal of the "bad apples" lies within the profession and is virtually non-existent. Until courage develops amongst colleages and/or legal recourse becomes obtainable with true penalty; all the average person can do is speak up, report abuse, and be left in the devastation of emotional and financial consequences. There are multitude of views to the advancement of medicine & ultimately trust and ethics are the needed guide

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