Money, money, money

I'm one day into my two week orthopedic surgery rotation.

My single appointment today reminded me just how much veterinary care can cost sometimes.

In a vet school/teaching hospital environment, it's often easy to forget that our clientele is not necessarily representative of the pet-owning population as a whole.

Our clients, as I'm sure I've mentioned in a previous post, come self-selected as a group of dedicated owners, most of whom have the time, energy, and especially money to "do whatever it takes" for their beloved pets.

On a rotation such as orthopedics, the vast majority of patients presenting to the service will head to surgery, for everything from limb amputations to fracture repairs to CCL repairs to corrections of congenital abnormalities to total hip replacements. The least inexpensive of the surgeries is, at the very minimum, over a thousand dollars.

So when you see these types of cases day in and day out (and it's not just orthopedics -- it's also the dermatology clients willing to commit $500 for skin testing for allergies, and $600/year for the rest of the animal's life for allergy shots -- and the neurology clients happy to drop $5000 to remove a ruptured disk from their Dachshund's back -- and the medicine clients who don't bat an eye at the $3000 bill for endoscopy and biopsies), it's easy to forget sometimes that in the eyes of a good percentage of the normal human population, spending thousands of dollars on a dog or cat's medical care just isn't something they can afford (or even want) to do.

Nonetheless, even seeing these clients every week who are unfazed by their enormous bills, I still run into the odd patient who makes me step back and re-amazes me with the staggering cost of vet care.

Case in point: Today's patient was a one-year-old exotic breed dog (one of those that you only ever see in the dog shows on TV, and have to struggle to pronounce) named Maggie. Maggie's owners bought her from a breeder as a young puppy.

Not too long after that, it became apparent that Maggie had some musculoskeletal issues. So when Maggie's rDVM spayed her at 5 months of age, he also took hip xrays while she was under anesthesia -- which revealed severe hip dysplasia on one side, already with evidence of arthritis, and moderate hip dysplasia on the other side.

Maggie and her owners made the 4 hour trip to the vet school about a month ago for an orthopedic consult. Given the severity of Maggie's disease (at merely a year old, she can barely walk because her hips are so painful, and has been on pain medication for most of her young life), the recommendation was to perform total hip replacements (THRs) on both of Maggie's hips, 8 weeks apart.

Maggie's owners said go for it.

Let's pause and consider that a single THR, without any significant complications, costs roughly $5500-6500.

Hope you didn't fall out of your chair. I almost did.

Now consider the fact that, in order to undergo a THR, a dog must be proven free of infection anywhere in its body that we can look -- so no fever, no elevated white blood cell count, negative urine culture, etc.

Maggie happens to have a not uncommon conformational abnormality of her vulva (external genitalia), wherein she has extra folds of skin leading to a "hooded" appearance to her vulva, and making her prone to skin infections in that region, which can (and have, in Maggie's case) ascend the urinary tract to cause bladder infections.

So before Maggie can have her first THR, she has to have her urinary tract infection resolved.

In order to keep her UTI from returning, she has to have her perivulvar dermatitis treated.

And her chronic, recurrent perivulvar dermatitis is almost certainly secondary to the abnormal shape of her vulva.

Which means that the news we delivered to Maggie's owners today was that, before we could even think about performing her THR, she'd have to have a vulvoplasty (classily described to the owners as a "facelift for the vulva" by the surgeon).

So we sent Maggie home today, following $400 of diagnostics for her recurrent UTIs, with a 2-week course of antibiotics (at a cost of $100 just for that single drug, due to Maggie's large size), with plans for her to return in a couple weeks for vulvoplasty. Then it'll be a couple weeks of recovery following that procedure, then we'll repeat many of the diagnostics we did today to ensure her infections have resolved, and then she'll be reconsidered for THRs.

As much as I love my pets, and as much as I admire the close relationships between Maggie and her owners, it still just kind of blows my mind that some people don't even bat an eye at the thought of spending what will probably be $12,000-14,000 by the end of it to get their dog in decent shape -- and all this before she's even a year and a half old.

The saving grace? Maggie's already spayed, so there's no chance she'll pass her crappy health genes (though wonderful temperament genes) on to another generation. :-)