Two years ago, Mike Otworth’s 10-year-old chow, Tina, was given a diagnosis of lymphoma. The prospects were grim. Lymphoma, a cancer of the lymph nodes that commonly develops in older dogs, can be put into remission through chemotherapy, but tumors almost inevitably reappear within a year, and death quickly follows.
Otworth seized on a new option. After a local veterinarian near his home in Indialantic, Florida, administered chemotherapy treatments to Tina, he drove her to North Carolina State University in Raleigh, North Carolina, where she became one of the first dogs to receive a bone-marrow transplant at its college of veterinary medicine.
Using equipment donated by the Mayo Clinic, the doctor who established the college’s Canine Bone Marrow Transplant Unit in March 2009, Steven Suter, harvested healthy stem cells from Tina’s blood and introduced them into her marrow, after radiating it to eliminate cancerous cells. After two weeks of painless treatment, and a US$15,000 bill, Tina returned to Florida, unsteady on her feet but cancer-free.
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Older pets like Tina are benefiting from advances in veterinary medicine that have accelerated in the last two to three years, raising not only the hopes of pet owners but also tough new questions about extending or saving an animal’s life, and how much to spend in doing so.
A long list of cancers, urinary-tract disorders, kidney ailments, joint failures and even canine dementia can now be diagnosed and treated, with the prospect of a cure or greatly improved health, thanks to the latest imaging technology, better drugs, new surgical techniques and holistic approaches like acupuncture and herbal medicine.
“What’s new is the sheer number of approaches to treat problems that, not too long ago, would have meant the end of the line,” said Julie Meadows, a specialist in feline geriatric medicine at the veterinary medical teaching hospital at the University of California.
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The Animal Medical Center in New York, which performed 34 stent procedures on dogs and cats in 2005, usually to open up clogged passages in the bladder or kidney, created a clinic about two years ago to accommodate rising demand for minimally invasive surgery. Last year, it performed 630 stent procedures.
Suter, at North Carolina State, has done bone-marrow transplants on 65 dogs, with 10 more currently on the waiting list. Many veterinarians now offer hospice care, too, mapping out a treatment plan that lets a pet spend the remainder of its life at home, its pain eased through palliative care.
Treatment like this comes at a price, both monetary and emotional. Improved veterinary care for all pets has boosted consumer spending in this area to US$13.4 billion last year from US$9.2 billion in 2006, according to the American Pet Products Association.
Pet insurance rarely comes to the rescue, since fewer than 3 percent of Americans carry it, according to the American Animal Hospital Association. Those who do can expect reimbursement, according to their level of coverage, from a few hundred US dollars to several thousand US dollars, but bills for the most advanced forms of treatment far outpace even the most comprehensive plans.
Otworth paid about US$25,000, all told, for Tina’s treatment at his local veterinary clinic and at North Carolina State. He also wrestled with the tough questions that pet owners face in deciding whether to go ahead with late-life treatment: Will the pet suffer unduly? Will treatment give it a good quality of life, or merely extend it?
“I wondered if I was doing this for selfish reasons,” he said. “As someone who underwent cancer treatment, I asked myself, ‘If I were a 10-year-old dog, would I want to go through this?”’
Some pet owners decide on treatment and then, after writing out the checks, have sobering second thoughts. The prospect of a US$6,000 bill for orthopedic surgery can force even the most ardent animal lover to ask, “Precisely how much do I love my dog?”
Patti and Dave Halberslaben of Madison, Wisconsin, recently spent US$10,000 to treat their 12-year Maltese-poodle mix, Chip, for an inoperable brain tumor. Much of that cost went toward three courses of radiation at the University of Wisconsin, where 118 dogs and cats have been treated in the last year using a highly accurate image-guided radiation machine called TomoTherapy.
“We did not hesitate to do it, but in the future, I’m not sure we can handle a bill like that,” Patti Halberslaben said. With a second child ready to begin college, she added, “I think we’ll just have to see how we deal with any medical emergencies.”
Even then, life extension for a cat or dog can be relatively short, and old age can bring a host of ills. Although Otworth’s dog, Tina, was cured of lymphoma, she developed liver cancer about nine months after returning home and soon died.
The most rapid advances in veterinary medicine have taken place in the treatment of cancer, propelled by the latest diagnostic technology like CT scanners and MRI machines. With precise imaging, veterinarians can deliver more concentrated doses of radiation to tumors whose location and dimensions were mostly guesswork just a few years ago.
The veterinary hospitals at the University of Wisconsin in Madison and Texas A&M now use TomoTherapy, a linear accelerator mounted on a helical device that circles the animal to deliver radiation from every angle. The radiation program, derived from a CT scan, divides each radiation beam into thousands of smaller, targeted beams that hit the tumor and avoid healthy tissue.
“We went from 1950s technology to state of the art in a very short time,” said Lisa Forrest, a professor of oncology at the University of Wisconsin’s School of Veterinary Medicine.
The cost depends on how aggressive the therapy is. A few sessions to relieve pain, rather than achieve a cure, cost about US$1,500. A full program of radiation costs about US$6,000.
Precise imaging has also made it possible to treat a variety of ills with minimally invasive surgery so owners can take their pets home within 24 hours. Allyson Berent, the director of interventional endoscopy at the Animal Medical Center in Manhattan, recently treated Simba, a 17-year-old cat who had developed a benign tumor in the urethra, making it impossible to urinate.
A mesh tube, or stent, inserted into the urethra opened up the blocked passageway. The cat, which had been in acute distress, went home in a matter of hours. “Traditionally, the animal would have been euthanized,” Berent said. “This used to be major, major surgery.”
Not all advances have been dependent on new machines. The drug company Merial, working with Memorial Sloan-Kettering Cancer Center in New York, recently developed Oncept, a DNA-based vaccine for oral melanoma, a common cancer in dogs. The drug, which received license approval from the Department of Agriculture in 2010, prevents the cancer from spreading to the lungs after being treated with radiation, previously a common outcome.
At the Animal Medical Center in Manhattan, Chick Weisse recently began administering chemotherapy directly into cancerous tumors through arteries, allowing him to deliver as much as 30 to 50 times the standard dosage, since the cancer-destroying chemicals do not affect the rest of an animal’s body. He is now experimenting with chemoembolization, injecting chemicals into arteries with tiny beads that prevent the chemicals from entering the venous system and spreading throughout the body.
“I think the biggest change has been in mindset,” said Marilyn Koski, a veterinarian at the University of California. “We now take an integrative approach. Rather than thinking in terms of a specific medication or procedure, we’re talking about following up with physical therapy, pain management, nutritional management — after all, many of our patients are obese. I’m excited to see all the disciplines working together.”
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