Pet and/or Vet Questions...

We have a 14 year old cat.  She's been with us for the last 10 years and has become an important member of our family.  She is in reasonably good health for her age, but with the known exceptions being a heart murmur, early stage kidney disease, and some arthritis that has slowed her a bit during cold weather but doesn't seem to be causing pain.  Based on this I assume we probably have somewhere between 2-4 good years left before having to make that painful decision...

Today she went to the vet for what was assumed to be a urinary tract infection (has had several over the past 6-12 months) and turns out to be a sizable bladder stone (think kidney stone but in the bladder).  There may be 2 options on the removal.  Option A is to have a normal surgical procedure to cut her open and remove the stone with a cost of $700-$800.  Option B, if available (size of stone may prevent this), also requires anesthesia but instead of cutting they go through the urethra and break the stone into smaller pieces that can then be removed for an estimated cost of $1500-$2000 (better estimate to be had after specialty vet sees Xray and provides consult with main vet).

Questions:

1) How much increased risk is involved in anesthetizing a cat with a heart murmur?

2) What is the typical financial arrangement if a pet does not survive a procedure (assuming no malpractice)? I understand the vet has a financial investment in the procedure and yet the pet owner has an expectation of their pet surviving to be around for an additional time period. Concerns about Question 1 caused this question.

3) What is your opinion on the value of your pet's pain & suffering?  At what point would you choose Option B (if it was available) over Option A?

Thanks for your time and honesty in answering the questions.

Steve

Steve,

Sorry to hear about the situation you're in. Making financial decisions about pets can be difficult and emotional. We were just in a similar situation with our dog a couple months ago. He's 3 yrs old and suddenly fell ill with renal and hepatic failure. We had to make some tough decisions but luckily he pulled through. I'm not sure if it will help, but here are my answers:

1) Can't say much here but generally an older pet carries higher risk with anesthesia and surgery. 

2) As far as I could tell with our experience, you are responsible financially for all procedures you approve (whether or not the pet makes it). I would double check everything with your vet...sometimes they may work with you on billing.

3) Some people don't agree with me but I feel like as a pet owner we have the responsibility to limit pain and suffering as we are able. Sometimes this may mean incurring a significant vet bill. I'm ok with that as long as it doesn't put my family in a financial position where we wouldn't be able to cover a (human) medical emergency or meet basic needs. Unfortunately, this sometimes means letting them go if available procedures can only prolong the inevitable and extending life only extends their suffering. 

Ultimately, what you and your family decide is the right choice. You can't look back on things and wonder "what if?" Apologies for rambling a bit much; I hope things work out well.

In reply to enginenerd :

+1

I went through a similar issue with my cat a couple years ago although it was terminal cancer. It’s a difficult decision and my heart goes out to you and your family. 

1:  No specific experience with this, nor do I recall anything relating to it when I was in Vet. school.  As mentioned, there are general risks with older pets.

2:  We spent several thousand trying to save Clovis, our Siamese cat.  She had cancer and did not survive.  Other than the euthanasia, we were responsible for all costs associated with trying to save her.

3. I am a Christian.  The Bible teaches that God gave man dominion over the animal kingdom.  This is not a position of privilege, but one of responsibility and good stewardship.  Of course one need not have any particular religious affiliation to share this or any other view, but that is the basis of my own personal conviction.  With pets, increased love and compassion are an added part of the package.  So at a minimum I am charged with doing what is in the best interest of my pet to the best of my ability.  Love and compassion compel us to make the hard decisions.  For Clovis, it became clear when it was time to let her go - not when our ability to bear the cost was exhausted, but when her ability the bear the pain was exhausted.  The real burden of living is watching loved ones wither and die.

In reply to secretariata :

Hi Steve, I work at an emergency/general practice clinic, where we see cases like this regularly. You seem to truly have your pet's best interest in mind, and she thanks you for that!

1) How much increased risk is involved in anesthetizing a cat with a heart murmur?

A cystotomy (option A) is a common procedure, and if the surgeon is experienced, the cat has minimal time under anesthesia, which is ideal for cats with murmurs. There is a degree of increased risk with anesthetizing a cat with a murmur, but it happens (and is successful) generally speaking. I do understand it is always harder to look at the big picture when it is YOUR cat that has the issue that can increase risk, even if it happens all the time.

2) What is the typical financial arrangement if a pet does not survive a procedure (assuming no malpractice)? I understand the vet has a financial investment in the procedure and yet the pet owner has an expectation of their pet surviving to be around for an additional time period. Concerns about Question 1 caused this question.

At our clinic (and most), you are responsible for all costs of services that were performed and approved by you.

3) What is your opinion on the value of your pet's pain & suffering?  At what point would you choose Option B (if it was available) over Option A?

I am on the crazy person scale of doing anything and everything for my pets, as they are my "family." However, when going through any decisions like this, always try to be semi-logical . Having a bladder stone is an uncomfortable lifestyle, no doubt about that (not doing anything would result in chronic pain, possible kidney complications, and her kidneys are already at early stage CKD). So, option A, removes the stone. There is some recovery, and two incisions, one in the abdomen and one in the bladder itself. Ultimately that stone should be removed, despite the potential risks (which really are minimal). I would hesitate to go to Option B, it isn't something that isn't as commonly practiced (as it is a specialty procedure). I have noticed that with "minimally invasive techniques" the anesthesia time can be longer, and it is expensive. If the specialty vet assures you that the results are better in every way, including anesthetic risk, you might want to consider it. But, your cat is 14, and semi-arthritic, so it is different than asking a crazy 3 month old kitten to stay still and quiet for a week. Post procedure, they can live their long life out completely normally. Ask your vet, they may recommend a prescription diet that can hopefully prevent stone build up in the future.

Hope this helps, and I am sure you and your family will decide what is best for her. Don't hesitate to bug your veterinarian for answers and explanations, the best choices are made when there is a real discussion between client/veterinarian.

Cute kitty.  Spoke to my brother who is a well respected vet surgeon.  First and foremost he said by all means openly discuss your concerns with your vet, both financial and cats health.

He was curious about sex of cat and whether cat continued to urinate.  He felt cat could tolerate anesthesia even with age and murmur.  He recommend using ketomine (a halucinogenic) rather than general anesthesia.

Size of stone...xray or was stone so large vet was able to palate and feel stone?  If stone is large he feels option "a" would yield better results.

Also he asked if has doctor tried to insert a catheter to move stone from urethra first.  Good news is cat is a female because male cat's  have a tapered penis somewhat like a funnel that cause more issues. On a male a stone as small as a grain of salt can block urine flow...females pass stones easier due to flexible urinary tract.

If stone can be moved from urethra back into bladder with cath he would suggest doing that and putting cat on urine acidifier and anti biotics which can disolve stone in some cases.

he thinks prices quoted are a bit high but his clinic is in south georgia so that may be reason.

hope your cat gets better.