When is more too much? – Dr. Carr’s Insight
I recently read an article written by a veterinary cardiology specialist that stated he was relieved when his regular veterinarian agreed to spay his dog without doing preoperative bloodwork. Really? His opinion was that you needed to be screening for SOMETHING.
Here at Arnold Pet Station, as in human medicine, we require pre-operative blood work for all our anesthetic procedures. We are screening for kidney disease, liver disease and anemia among other things. We look for anything that can complicate anesthesia. Yes, we do find abnormalities, thankfully not often. One of our patients, presenting to be spayed, had abnormal liver enzymes. She looked and acted completely normal. As it turns out, she had a shunt in her liver. Anesthesia could have killed her. Thankfully, she was able to have her defect repaired at the local surgical specialty practice.
What is standard of care?
The standard of care is what other professionals, similarly situated (geographically and within the same field of specialization), would do under the same circumstances.
There are many low cost spay and neuter clinics out there. They are low cost because they cut corners. It may be skipped preoperative blood work, no staff monitoring anesthesia, no IV catheters or fluids during surgery or even no pain medications. Is this what you want for your pet?
Back to my title, when is more too much?
I have a friend that practiced emergency and critical care medicine in New York City. She was telling me about a case of hers, a dog that had been hit by a car. The dog’s back had been broken and was presented in shock, unable to breath on its own. The owner wished to have anything and everything possible to be done to save this dog. The dog stayed on life support for NINE days until it was stable enough to have surgery to stabilize its spinal fractures. The dog did survive. The cost? Tens of thousands of dollars. Is that too much? Definitely for most people, but not at all to the person that loved that dog.
The point is that everyone each has their own unique point where either the cost, the medicine, the care or even the quality of life is too much to bear. I started my career in South Baltimore. Many families were struggling to put food on their table or shoes on their children. It was very difficult for me to suggest someone take their dog with hip dysplasia to a surgical specialist for a procedure that might cost more than $3000.
It is not my place as a veterinarian to judge, only to offer options and find solutions. Even though you may not have much money, maybe you have a rich aunt that loves you and your pet. There are now many companies that offer payment plans for veterinary clients. Maybe you are too squeamish to give your diabetic cat injections of insulin, but your roomie isn’t or your daughter lives next door and can do this for you.
I have an older client who owns a dog which needs to have an orthopedic surgery. The dog will need to be leashed walked and rested while in a cast for 4-6 weeks. She cannot fathom having to control and confine this active dog. It is not the cost of the surgery that bothers her, just the after care. She told me she would just have to keep this dog on pain control medicines for the rest of its life. (Which could possibly be more than five years). I offered a third option. If she wanted to have the dog operated on, I could do the after care. She could visit as often as she liked, but i would take care of the cast and any other post-operative requirements.
I care about our clients and their pets. It would devastate me to lose a young animal under anesthesia. A loss that could have been prevented by doing preoperative blood work. This is why I practice a high standard of care. I want what is best for your pet. I recognize and respect your right to say when it is too much, but please don’t ask me to do too little.
Dr. Carr has been the lead practitioner and owner of the Arnold Pet Station since1992.
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