Vail Pet Talk column: Knowledge comes at a price
“Knowledge is good.” It is ironic that this inscription on a statue in the movie “Animal House” inspired my veterinary career back in 1978 when I was a freshman at the University of Florida. And it is a truism in my profession and medicine in general.
But knowledge comes at a price and since veterinary bills are largely paid “out of pocket” rather than through third party insurance companies, we need to be careful and diligent in our quest for it.
Better Treatment Options
Let’s look closer at that inscription and ask “Why is knowledge so good?” in the medical fields? The answer is that all treatment decisions are based on our knowledge of the disease. The more we know about a disease and how involved it is, the better we are able to aim an effective treatment.
The problem in veterinary medicine is the price for that knowledge. So, we ask another important question in gathering such information. This question is rarely asked in the academic field and in veterinary teaching hospitals but is taught to veterinarians in vet school: Will the knowledge you gain by running additional tests change the way you treat your patient?
Here is a good example. Feline leukemia and feline AIDS viruses are a common cause of stomatitis, a painful, full-mouth inflammation and infection of the oral cavity in cats. However the occurrence of these two viruses is rather rare, affecting only 2-3 percent of cats nationwide. Is it worth running feline leukemia and AIDS tests when the patient needs to be treated regardless of whether they have feline leukemia or aids? Yes, because the preferred treatment is steroid injections and these shots will make a cat with leukemia or AIDS worse, if not outright kill them. In this disease we need this knowledge.
Another example is finding out, for a cost of $300 or more, whether your dog’s lymphoma is B or T cell. Both are treated the same way with chemotherapy but one has a much worse prognosis and does not respond as well to chemo. I have run the test and think it is a good idea but it really does not change the treatment, only our knowledge of the disease.
The same can be said of “staging” a cancer patient. Staging involves finding out how widespread the cancer is and involves blood tests, x-rays, ultrasound and bone marrow/lymph node biopsies. A referral to a specialty practice may be necessary to complete the staging. However, without referral, your local veterinarian can probably get a good idea how widespread the cancer is. Staging may change the protocol, or schedule, of chemo drugs used and it may lead a person to decide the cancer is so widespread that treatment is not advisable.
So how far do you go? If you are going to do surgery or chemo to treat cancer, then you need to have some funds available to treat the disease too. Accessing knowledge for prognostic reasons is great if you can afford it. At a minimum, I recommend running blood tests, urine tests and X-rays to see if the cancer has metastasized.
Giving Adequate Advice
I would love to be able to stage every cancer patient I see. Staging allows me to more adequately advise the owners of the prognosis and treatment options. Unfortunately, this is not a reality for so many of us veterinarians who practice in the real world. This is where field experience comes in handy.
I consult with many veterinarians who work at universities through a paid subscriber service. They have so much difficulty answering the question, “we have limited funds, what would you do next?” It is frustrating trying to get a straight answer from someone who has never practiced in private practice. These are our professions true nerds; they rarely think outside the box.
The good news is your veterinarian should be like a good family friend. You should feel comfortable asking and getting straight answers to your questions. “What do we do next? What can we expect of the treatment? How much is all of this going to cost?” are all legitimate questions.
This is one of the most enjoyable parts of practicing medicine to me. Being able to counsel and help people make difficult decisions regarding their pet’s health and treatments is something that provides great satisfaction to me!