Owners Face Tough Choices: Concerning Their Pets

As more Americans share their beds with their dogs, they are becoming less willing to accept the verdict of the veterinarian who says, “I've done all I can” when pets become terminally ill. There are owners “so caught up in their animal's pain, suffering, and the potential loss of that animal that they're losing sight of what is a reasonable thing to do,” says doctor Nicholas Trout, a veterinarian surgeon at Boston's Angell Animal Medical Center. “They may be prepared to go to lengths that are not reasonable, that are verging on the inhumane, that would prolong the animal's suffering needlessly.” At this point, he says, the veterinarian must step in and render an opinion based on his or her knowledge and experience. “I try to do the right thing by the animal, and then try to share why I'm doing what I believe to be the right thing with the owner, and give the owner some comfort in what's happening and why we're doing these things,” Dr. Trout says.

Over the past 20 years, the veterinarian says, dogs have made their way from back yard kennels into the homes of American families as never before and “they are with the family (and) part of the family and to some owners their dogs are considered as important as a child in their lives.”Asked why this has happened, Dr. Trout says it's because animals form easy relationships and “don't ask questions” so it's “love without risk.” However, he adds, dog owners must recognize “that when we embrace these animals in our lives, we know we are doing it for a finite period of time; that the lifespan of a cat and dog is so short in relative terms that we are going to have to hold them in our hearts knowing we're going to lose them, and that's a tough part of this whole cycle.”

Sooner or later the tough questions will confront the owners of 77.5-million dogs and 93.6-million cats in the U.S. One in three U.S. households own at least one cat and 39 percent of U.S. households own at least one dog. In 2007, according to data from the American Pet Products Manufacturers Assn., pet owners spent $40-billion on their animals, including about $203 for routine vet visits for their cats each year and $225 for routine vet visits for their dogs each year. Owners who have invested their emotions and dollars in a sick pet have got to ask themselves, “Is the right thing to stop and just cut my losses?” Dr. Trout says. “I think with these animals in our lives for so long now, because we're (veterinarians) doing such a better job, we are going to face those tough questions of “How far do I go?” and “How much is my pet worth?” Thirty years ago if a dog had painful, horrible arthritis and a miserable quality of life, the veterinarian could say, “There's nothing I can do. I'm going to put your dog to sleep.” This would give owners the comfort of believing they did the right thing when the owner gave the vet the responsibility. “Those days are over,” Dr. Trout points out, because the vet can point to new medications and surgical options, and can throw the decision back into the pet owner's lap. An owner may have to wrestle with, “You're telling me it will cost me $5,000 to replace a hip, a surgery that works great, and that would really make a huge difference in the dog's quality of life, but it's $5,000 and the question is 'Can I do that? Is my dog worth this much to me?'” One of the things veterinarians are going to have to learn as a profession, the animal surgeon says, is how to help pet owners with these tough choices. Pet insurance, he adds, doesn't cover the entire cost of procedures “but it could make a difference to justify some of the more expensive things. My experience with people who've had pet insurance is, generally, they're quite satisfied that it's made enough of a difference. But not everyone's going to be able to afford pet insurance.”

Dr. Trout was interviewed by Diane Sullivan, a professor at the Massachusetts School of Law(MSLAW) at Andover and an authority on animal law. Professor Sullivan is the host of the MSLAW show “Educational Forum,” broadcast nationally via Comcast. Dr. Trout is author of the book “Tell Me Where It Hurts,”(Crown) about his life as an animal surgeon. Besides providing an affordable quality legal education to students from minority and low-income backgrounds, Massachusetts School of Law disseminates information on vital issues of our time.

With the “great care people are taking of their animals now,” Dr. Trout says, if you look over the last 20 years, “the quality of nutritional care, general health care, all the add-ons and the sort of high-tech surgery and medicine that we're now doing, animals are leading these longer and healthier lives.” He says there are animal hospitals that will do skin grafts, renal transplants, and open heart surgery on occasion and that minimally invasive laparoscopic surgery is becoming more common. “Less invasive means less discomfort and smaller incisions, and so things are changing and everything that we are looking for in ourselves (humans) is coming into veterinary medicine.”

Unfortunately, the surgeon says, our pets need exercise and if their owners are lazy they are not going to get it and become subject to the same panoply of diseases as their masters. “If they're sitting on the couch with us watching TV, whose fault is it that they're not exercising?” Dr. Trout asks. “Obesity has become a huge problem,” he adds, as 25- to 40 percent of all dogs and cats are overweight or obese, so, of course, “all those things that we were worried about in terms of type 2 diabetes, kidney disease, arthritis, heart disease are what's happening to dogs. Pets are a microcosm of our society.” Dr. Trout says he knows from personal experience with his own Labrador that “these guys are just so food-driven!” His dog gives him “a fatal combination of the doe eyes and the stares” and so “when we feed our dog they wag their tails, they're grateful and it's this positive experience” yet after you've given your dog something to eat “they look at you,” as if to say 'What was that?' it goes down so fast.” “What we've found in talking with dog owners is that it's difficult for them to see the reality that their own pet may be overweight or obese, instead of just chubby or fluffy,” Lisa Peterson of the American Kennel Club Human Fund told Reuters. “ The main cause of obesity in dogs, as in humans, is overeating and insufficient exercise. Neutering, hormonal disorders and slow metabolism can also cause dogs to pile on the pounds. Canine middle-age spread usually occurs by about the age of five or six years old,” the wire service reported. It should surprise no one that the primary reasons given for obesity in dogs is overeating and insufficient exercise. “Neutering, hormonal disorders and slow metabolism can also cause dogs to pile on the pounds. Canine middle-age spread usually occurs by about the age of five or six years old,” Reuters reported. Breeds considered liable to add unneeded pounds include Labradors, Golden Retrievers, Beagles, Collies, and Cocker Spaniels, among others.

Veterinarians, Dr. Trout says, are part of a complex, triangular relationship between owner and animal, between animal and vet, and between vet and owners. In this relationship the vet must “strike a balance” between objectivity and involvement because “if you become a bumbling wreck so caught up in the intensity of what is happening, the fear of losing this dog for this man, you're not going to be any use to anyone. And so you're trying to keep that knowledge there, but at the same time be surgically objective, to try to say, 'I've got to do my best for this animal, and I have to balance that between what I believe to be appropriate and what is maybe going too far.'” The question veterinarians must face are, “How far do we go?” and “When is that the right thing to do?”

One of the things Dr. Trout seeks to convey in his book is “this huge gray area” that exists throughout the medical profession in every specialty that “we're (doctors) human, and we're flawed, and we're fallible. And we make mistakes, but if our intent is still to do the right thing, then we can sleep well at night.” Because of this, “When I see a client, I want them to share the experience that I'm going through, the diagnostic dilemma, the uncertainty of what is the right thing to do. I want to say, come onto this side of the examination table for a while and see what it's like, and see that we're all trying to do the right thing, but it's not that clear cut. Sometimes it is and we get lucky, but a lot of the time we're going to have to try and discover that, and if we're going to do it, let's do it together.”

Dr. Trout Points To “Huge Transition” in Veterinarian Field

The animal surgeon says it's a “humbling experience” to see “the incredible dedication of people who want to become veterinarians.” Those considering entering the field likely need to have a 3.6 grade point average even to apply to veterinarian school. “We're looking for a bright, active mind, someone who is demonstrating a lot of interest in animals and in animal welfare as a veterinary technician or as an anesthesia technician,” he points out. They'll need dedication as there is a “ridiculous price tag on their education.” It's likely they will graduate with a debt of between $120,000 and $200,000. By then, they've proven “they were hungry enough to want this degree that they don't care about the debt,” Dr. Trout says. Increasingly, he adds, the veterinarian field is being dominated by female professionals, a change that comes about as vets are treating more small animals than large ones. “It used to be that 100 percent of the veterinarians' business was treating farm animals,” James Brandt, the president of the American Veterinary Medical Assn., told The New York Times in an article published June 9, 2002. “They treated the dogs and cats on the side. Now pets are treated as members of the families, and veterinary medicine is not the physical profession it once was.” Wendy Emerson, owner of Putnam Veterinary Clinic in Topsfield, Mass., told the paper money plays a role in the gender shift. “Men love animals, but they feel the obligation to support a family.” This may be one factor explaining why it is common to find 75 percent or more of a university's veterinarian class desks filled by women, up from fewer than 10 percent in the Sixties. Medical doctors, as a rule of thumb, enjoy an annual income twice that of veterinarians. The change has come about “not due to women physically being able or unable to work with some huge horse or cow,” Dr. Trout notes, but that a niche for women opened “in which they were perhaps more compassionate, more able to interact and relate to clients of companion smaller animals.” Charges that women drifted into veterinary careers because the salaries were lower than those earned by other doctors and that the shift had degraded pay scales have been proven false, the animal doctor says. “The gender switch occurred before there was any change in salary.” Right now, he adds, there are some universities that feel it won't be long before their veterinarian classes are composed 100 percent of women. “It's a great time to go into veterinary education if you're a single male.”

Public Now Expects Best Quality Surgical Care For Pets

Dr. Trout, who is a surgical specialist, says pet owners are no longer satisfied with allowing a general practice vet to operate on their pet. “There was a time when you'd go to your veterinarian in general practice and he'd say, 'Oh, well, I'll have a go. I've done one of these before.'” Today, the public demands a surgeon who's done thousands of such surgeries, the surgeon says. “Probably something like 80 percent of what I do is orthopedic surgery: hip replacements, cruciate ligament Tom Brady knee surgery, scoping joints, putting cameras inside joints, looking around, taking out chips and fragments and what have you. So there's a whole lot of orthopedic stuff and soft tissue stuff.”

To become a surgical specialist, the wannabe vets must go through a three-year residency and one year internship that requires them to see a variety of cases. They have to submit papers for publication in peer review journals and to sit for a rigorous examination to become a board-certified surgery specialist, the animal surgeon says. “So you have gone from being a general practice veterinarian, four years later, to have the potential to become a surgical specialist and this is different from human medicine, in which you are an MD, and then you go on,” Dr. Trout says. About 20 percent of veterinarians now choose to undertake this extra training and once they complete it “they are going to be the cream of the crop,” Dr. Trout says. They're “going to be filtered off, to be selected from all those people who want to become interns or residents....and there may only be three residency programs in the country in ophthalmology one year, so you can imagine these are fiercely competitive programs to get into.”At Angell, on average, he says, there's only one slot in surgery for 100 applicants!

Although they may be thoroughly prepared for their work, pet owners sometimes look at new veterinarians and think, “I'm not letting this kid touch my dog,” Dr. Trout says. However, he believes the young doctors on staff “will take care level to another degree” as they are “absolutely petrified of things going wrong.” In consequence, new vets spend long hours and make multiple phone calls to the owner to check in and the positive feedback they get from owners makes them realize “I'm actually making a difference” not only in the animal's life but also in the owner's life. He says that the intern who spends 13 months understudying at his hospital “is just a different bird” at the end of that time as they've made so much progress.

Dr. Trout says veterinarians may be compared to a detective like Sherlock Holmes. “We've got to be methodical, we've got to be deductive. The way I like to do it is to get the pet owner on the trail with me, so that they understand why we're doing this test, what's the yield, what's the upside, and what's the cost, why we should start here and go there,” he said. “From time to time owners will say, 'Well, why can't you just tell me what it is?' and I can't do that.” Understanding pet owners will acknowledge, 'Hey, this isn't an easy job.'” It's kind of obvious that it's becoming more complex for veterinarians to find what's wrong, he concludes, “because we don't get told where it hurts.” Dr. Trout is also the author of “ Love is The Best Medicine” and “ Ever By My Side,” both published by Crown.

The Massachusetts School of Law at Andover, founded in 1988, is purposefully dedicated to the education of students from minority, immigrant, and low-income households who otherwise would be denied the opportunity for a legal education. Sherwood Ross is a media consultant to MSLAW. For questions or comments about this article, contact him at sherwoodross10@gmail.com

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