When Dr. Becker posted yesterday about kidney disease and a cat named Puff who beat the odds to live into his second decade, my first thoughts turned to Samson, a senior kitty I adopted when he was 15.
When I took him to the veterinarian for his first check-up, she was pessimistic. He had “ten years of deferred dental work,” needed all his teeth extracted, and was in renal failure. “He has maybe a year,” she said.
Samson lived to be 18 and a half, healthy, active and loved for all of it. Even three days before he finally breathed his last, he was still purring, playing and eating.
But then a second, darker memory came to mind.
My dog Bran was 4 years old, and had never been sick a day in his life, when he was diagnosed with kidney failure.
It didn’t seem too terrible at first. He got finicky about eating one day, but the next day he was fine. The day after that he was finicky again, and then he started to vomit, so we headed for the vet. She drew some blood, gave him some fluids and medication for his stomach and sent us home until the test results came back. He didn’t seem very sick.
The test results indicated kidney failure, so we took him to a specialist in another town. He still didn’t seem very sick, but his kidney values were so bad that the specialist was extremely concerned. We hospitalized him. We did more tests. We treated what we thought he had (letpospirosis), until that was ruled out by the tests.
We dug deeper. We did more tests. He was getting sicker. I took time off from work. I slept at the vet hospital, or in my car, or in a hotel room. I tried to hand-feed him, but he just vomited, so we gave him intravenous nutrition.
He got even sicker. His kidneys got worse. We still had no diagnosis. My vet bill at that moment was over $4,000. I cashed in my savings and paid it.
My vet suggested I take him to UC Davis. I hesitated. They wouldn’t let me stay with him at the hospital, and I was at a state-of-the-art specialty practice already. I asked her, “What can they do there that you can’t do here?”
“Dialysis,” she answered bluntly.
I went. And on the way, I called my credit card company and negotiated my credit limit upward, to cover the cost of dialysis. Fortunately, the person I spoke to was a dog lover, and he put the credit increase through on the spot.
At Davis, they were not optimistic, but did offer me a little hope. Some of the worst possibilities had been ruled out, and a few of his symptoms had actually improved, even though his kidneys were clearly worse. If this was a bacterial infection of some kind, the vets told me, dialysis might keep him alive while the antibiotics cured the infection, and he might recover. It wasn’t impossible.
He was only 4 years old. I’d held him in my hands when he was born. So I told them to go ahead. They put in the dialysis catheter and took a kidney tissue sample while he was anesthetized. I borrowed $2,000 from my mother.
The next day, he went into respiratory failure, and we put him to sleep.
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.
And while people with insurance find a big chunk of their own medical bills doesn’t come out of their own pocket, very few people have veterinary insurance for their pets. Those who do rarely find it covers intensive diagnostics or the most expensive therapies.
I wrote about this for my SFGate.com column a few years ago, and interviewed leading veterinary cardiologist Dr. Paul Pion, president and co-founder of the Veterinary Information Network.
He agreed 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.”
Unfortunately, as with my dog, no matter how many diagnostic tests you run, you don’t always get the answers you’re looking for. Not even on necropsy (the animal equivalent of a human autopsy) did the vets at UC Davis discover what destroyed my dog’s kidneys. 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?’”
Ultimately, the decision of how far to take the search for answers — and for miracles — is a personal one. 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.
Photos: Christie Keith